Carrollton Health And Rehabilitation Center

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

curtain. Review of facility's policy Resident Rights dignity and respect revised dated 2015, reflected: It is the policy of this facility that all residents be treated with kindness, dignity, and respect.4. residents shall be examined and treated in a manner that maintains the privacy of their bodies. A closed door or drawn curtain shields the residents from passer-by. 5. Privacy of a Resident's body shall be maintained during toileting, bathing and other activities of personal hygiene. 6. Violation of the Residents' Rights to dignity and respect should be promptly reported to the Director of Nursing Services and/or Administrator.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carrollton Health and Rehabilitation Center

1618 Kirby Rd Carrollton, TX 75006

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

the resident. Record review of the in-service logs dated 08/2025-10/2025 reflected on 8/10/2025 and on 10/31/2025 an all-staff in-service titled Falls and Fall Management system was conducted. CNA D attended both in-services. Further review reflected the DON followed-up with the staff once a week for two weeks on reporting and following the policy and procedure for falls and reporting. [NAME] review of the employee file for CNA D reflected the only write-up in the CNA D's file was dated 10/31/2025, concerning, resident was

on the floor and did not follow the facility policy and procedure. Record review of the facility's policy titled Fall Management System revised December 2023, read in part . Policy: It is the policy of this to provide an environment that remains as free of accident hazards as possible. It is also the policy of this facility to provide each resident with appropriate assessment and interventions to prevent falls and to minimize complications if a fall occurs. procedure: 3.When a resident sustains a fall, a physical assessment will be completed by a licensed nurse.a.The attending physician and Resident Representative shall be notified of

the fall and the resident status.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carrollton Health and Rehabilitation Center

1618 Kirby Rd Carrollton, TX 75006

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview and record review, the facility failed to ensure all drugs and biologicals were stored in accordance with currently accepted professional principles in locked compartments and permit only authorized personnel to have access to the keys for 1 (Resident #2) of 4 reviewed for storage of drugs, in that: The facility failed to ensure Resident #2's calmoseptine ointment (ointment applied to the bottom to treat and prevent redness) was secured. This failure could place residents at risk of medication misuse and diversion.The findings were: Record review of Resident #2's quarterly MDS assessment, dated 06/06/2025, revealed a [AGE] year-old male who was admitted to the facility on [DATE REDACTED]. Resident #1 had diagnoses which included: Cerebral Vascular Disease (stroke), aphasia (unable to speak), dysphagia (unable to swallow), and hypertension (high blood pressure). Resident #2's cognition was severely impaired, he was unable to make decisions and required assistance from one staff for activities of daily living. Record review of Resident #2's physician orders dated 11/2025 reflected no orders to self-administer medications. During

an observation and interview on 11/20/2025 at 5:00 a.m., a medication cup with a pink substance on the top of the dresser in Resident #2's room wasd unsecured and unattended. RN B stated, Oh that is probably

the cream the staff uses on his bottom, when they change him. The RN did not attempt to remove the cream and left the room. An observation on 11/20/2025 at 5:15 a.m. revealed the pink ointment in the medication cup was still on the dresser in Resident #2's room. An interview on 11/20/2025 at 5:15 a.m. with CNA C revealed she did not use the pink ointment in the medication cup on Resident #2 when she changed him. She stated she used incontinent wipes and placed on no cream. CNA C stated she did not know what the ointment was. An interview on 11/20/2025 at 6:15 with CNA D revealed the CNA did not know what the pink stuff was, CNA D stated she had never seen it before. An interview on 11/20/2025 at 12:06 p.m., with LVN E revealed all the treatments for the residents, to include ointments, other medications, and supplies were all in the treatment cart and locked. LVN E stated that the nurses were required to perform the treatments or if the treatment was more than one time a day. LVN E stated the treatment for skin conditions should never be left outside of the locked cart only when being used by the nurse, or if this was an order to leave it in the residents' room. During an interview on 11/20/2025 at 12:17 p.m., the DON stated she expected the nurses to know better than to leave medications in any resident's rooms. The DON stated negative effects could occur to the residents if medications were left in their rooms.

During the interview the DON did not confirm what the cream was. The DON stated, anybody can get them and have access to them. The DON stated this could cause harm to another resident or even staff. Record

review of the Facility's Policy titled Pharmacy Services revised dated May 2007 reflected: It is the policy of

this facility that drugs and treatments shall be administered/carried out upon the order of a person duly licensed and authorized to prescribe such drugs and treatments.2. All drugs and biologicals orders shall be dated.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Carrollton Health and Rehabilitation Center

1618 Kirby Rd Carrollton, TX 75006

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

equipment) Record review of Resident #2's physician orders dated 09/30/2025 reflected, change all enteral feeding tubing and water bags every night shift on Wednesday. An observation on 11/20/2025 at 5:00 a.m., revealed RN B performing the replacement of the gastroenterology tube (feeding tube) supplies for Resident #2. During which time the RN placed on gloves and the PPE, personal protective equipment (gloves, gown and mask) and began to remove the used tubing and the used water bag. The RN placed the used supplies in the trash. RN B opened the door to the bathroom, took the cap off the new water bag, and filled it with water. RN B returned to the bedside of Resident #2, replacing the tubing RN B connected the new tubing to the gastronomy tube and hanging the new water bag and a new bottle of formula. The RN took her gloves off and left the room. The RN never replaced the gloves or sanitized her hands from the dirty supplies used to the new supplies. An interview with the DON, who was the infection control preventionist on 11/20/2025 at 2:39 p.m., revealed the DON stated that all direct care staff must keep their supplies available for usage, but in a clean supply area. The DON stated the staff, when performing incontinent care, should be changing gloves from dirty to clean, and washing their hands or using the available hand sanitizer. The DON stated she had just had an in-service in the past 3 weeks presenting the importance of changing gloves and washing hands during care and incontinent care. The DON stated that some of the CNAs had spent extra time with them, to make sure they understood. The DON stated during

the in-service, the staff did not ask any questions and appeared to understand and indicated they knew everything. The DON stated if the staff did not change gloves and clean their hands when they should, they could spread germs to themselves and the residents. Record review of the Facility's Policy titled Infection Control Guidelines for All Nursing Procedures dated December 2024, reflected: Purpose: to provide guidelines for general infection control while caring for residents . for residents when performing high-contact resident care activities: dressing, grooming, transferring, providing hygiene, changing linens, changing briefs ., 4. Employees must wash hands for twenty (20) seconds or longer using antimicrobial or non-antimicrobial soap and water under the following conditions: .a. after direct contact with resident, d.

after removing gloves, after handling items potentially contaminated with blood, body fluids, or secretions,

Event ID:

Facility ID:

If continuation sheet