Carrollton Health And Rehabilitation Center

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

turned on. In an interview and observation on 01/30/26 at 2:06 PM, RN A and CNA L were shown Resident #7's phone charger cord that she stuck directly into an electrical outlet. They stated staff should have connected the resident's phone to the charger after placing the resident into her bed, because the resident wanted her phone near her so she could contact the Responsible Party. RN A stated the resident could injure herself if she attempted to charge the phone herself.In an interview on 01/30/26 at 2:06 PM, The Administrator and DON were informed of Resident #7 having the phone charger cord stuck directly into an electrical outlet and staff not following the Resident's Responsible Party request to have the phone charger connected by staff for the resident. The DON stated staff should have plugged in the charger for the resident once they placed her back in bed. The DON stated the resident could have harmed herself by plugging the charging cord directly into the outlet. The facility's policy Resident Rights (undated) reflected

The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. The facility must provide--1. A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.a. This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk.

Event ID:

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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

01/30/2026

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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

of Resident #1, #2, #3 and #4 not having not having their breathing mask or canula bagged. She stated the items needed to be bagged to avoid the resident getting an infection. She stated a nurse had already brought this to her attention and she was going to -In-service them on the expectation.In an interview on 01/30/26 at 2:14 PM, LVN U stated she works at a different facility but was helping today. She stated she covered the hall of Resident #1 and #2. She was informed of Resident #1 and #2 not having their breathing mask bagged. She stated nasal canula's and breathing mask should be in a plastic bag when not in use to keep them from getting contaminated. She stated nurses should be checking for this when they make their rounds.Review of the facility's policy Oxygen Administration, 10/2010, reflected The purpose of this procedure is to provide guidelines for safe oxygen administration. 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration.2. Review the resident's care plan to assess any special needs of the resident.The policy had no reference to bagging the breathing devices when not in use.

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

01/30/2026

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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

help. She stated all staff were responsible for ensuring the call lights were within reach of the residents.In

an interview on 01/30/26 at 02:14 PM, LVN U stated she works at a different facility but was helping today.

She stated she covered the hall of Resident #8 and #9. She was informed the residents were lying in bed and their call lights were not within their reach. She stated call lights should be within the resident's reach so they could call for help.Record review of the facility's policy on Call System, Residents, January 2025, revealed Residents are provided with a means to call staff for assistance through a communication system that directly calls a staff member or a centralized workstation. Each resident is provided with a means to call staff directly for assistance from his/her bed, from toileting/bathing facilities and from the floor.

Event ID:

Facility ID:

If continuation sheet