Mustang Park Therapy And Living Center

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observations, interviews, and record review, the facility failed to treat each resident with respect and dignity and care for each resident in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life for one of six residents (Resident #5) reviewed for dignity. The facility failed to conceal Resident #5's catheter bag lying in public view. This failure placed residents at risk of not having their right to a dignified existence and self-determination maintained.Findings included: Record review of Resident #5's Face Sheet, dated 10/08/25, reflected he was a [AGE] year-old male admitted to the facility

on [DATE REDACTED]. Relevant diagnosis included urinary tract infection. Record review of Resident #5's Quarterly MDS assessment, dated 7/18/25, reflected a BIMS score of 00 (severe cognitive impairment). For ADL care, it reflected the resident required full assistance. Active diagnosis included renal failure (kidney failure).

Record review of Resident #5's Comprehensive Care Plan, dated 8/01/25, reflected the resident was care planned for bladder incontinence, but the intervention did not include an intervention for the use of a catheter bag. Record Review of Resident #5's physician orders, dated 10/08/25, reflected Catheter Suprapubic catheter (16)fr 10 (cc) to close drainage system. In an observation on 10/08/25 at 8:40 AM, Resident #5 was observed with a catheter bag hanging from his bed. The catheter bag was visible from the door entrance, and it did not have a privacy bag. In an interview and observation on 10/08/25 at 8:43 AM, LVN R was shown a picture by the Surveyor of Resident #5 not having his catheter bag covered with a privacy bag. He stated the resident should have a privacy bag covering the catheter bag to protect the resident's dignity. In an interview on 10/08/25 at 10:00 AM, the DON was told and shown a picture of Resident #5 with a catheter bag and no privacy bag over it. She stated a CNA had brought this to her attention this morning and she had given him a privacy bag to cover it. She stated it was a dignity concern for the resident and the catheter bag should always have privacy bag. Record review of the facility's policy

on Dignity, dated February 2021, revealed Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mustang Park Therapy and Living Center

4501 Plano Parkway Carrollton, TX 75010

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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

required full assistance. Active diagnosis included muscle weakness. Record review of Resident #5's Comprehensive Care Plan, dated 8/01/25, reflected the resident was a fall risk and an intervention included ensuring call light was within reach of the resident and to encourage the resident to use it. In an

observation on 10/08/25 at 8:50 AM, Resident #5 was observed lying in bed and his call light was observed

on the floor behind the head of the bed, out of reach of the resident. 6. Record review of Resident #6's Face Sheet, dated 10/08/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE REDACTED].

Relevant diagnoses included lack of coordination and a history of falls. Record review of Resident #6's Quarterly MDS assessment, dated 8/02/25, reflected a BIMS score of 15 (intact cognitive response). For ADL care, it reflected the resident required some assistance. Active diagnosis included muscle weakness.

Record review of Resident #6's Comprehensive Care Plan, dated 10/02/25, reflected the resident had muscle weakness and an intervention included ensuring call light was within reach of the resident and to encourage the resident to use it. In an observation and interview on 10/08/25 at 8:43 AM, Resident #6 was lying in bed, and her call light was observed on the floor. She was asked if she knew where her call light was located and she stated she did and reached down from the bed, nearly falling over to grab the call light. In an interview and observation on 10/08/25 at 8:43 AM, LVN R was shown by the Surveyor of Resident #1, #2, #3, #4, #5 and #6 call light being out of reach of the residents. He stated the call lights should be in reach of the resident so they could contact staff. He stated staff should be checking to ensure call lights were in reach of the residents when they made their rounds. In an interview and observation on 10/08/25 at 8:50 AM, CNA O was shown by the Surveyor Resident #1, #2, #3, #4, #5 and #6 call light not being in their reach. She stated the call lights needed to be within reach of the resident so they could contact staff if they needed help. She stated it was just her second day at the facility and was learning the process of what to look for when checking on residents. In an interview and observation on 10/08/25 at 8:50 AM, CNA C was shown by the Surveyor Resident #1, #2, #3, #4, #5 and #6 call light not being in their reach. She stated the call lights needed to be within reach of the resident so they could contact staff if they needed help. In an interview on 10/08/25 at 2:40 PM, ADON J was told by the Surveyor of Resident #1, #2, #3, #4, #5 and #6 call light not within their reach. He stated call lights needed to be within reach of the residents so they could be able to contact staff if they needed assistance or had an emergency. He stated staff should be checking and ensuring call lights were within reach of the residents every time they entered

the residents' room. In an interview on 10/08/25 at 2:44 PM, the DON stated when she started on September 1, 2025. She was shown pictures by the Surveyor of Resident #1, #2, #3, #4, #5 and #6 call light not within their reach. She stated she was in the process of training staff to ensure call lights were within the residents' reach whenever they did their rounds and to also clip them to the bed to ensure they did not fall off. She stated the residents needed their call light within their reach to contact staff for assistance. Record review of the facility's policy on Call System, Resident, undated, 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.

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mustang Park Therapy and Living Center

4501 Plano Parkway Carrollton, TX 75010

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

muscle weakness and unsteadiness on feet. Record review of Resident #12's Comprehensive MDS Assessment, dated 10/07/25, reflected her BIMS score of 15 (intact cognitive response). The Comprehensive MDS Assessment reflected the resident required total assistance with bathing. Record

review of Resident #12's Comprehensive Care Plan, dated 10/07/25, reflected the resident was required total assistance for showers and required three showers a week. An attempted record review of Resident #12's Bath/Shower Sheets for the month of September 2025, was not made because the DON and ADON J could not provide any documents or records of the resident receiving showers. In an interview on 10/08/25 at 2:00 PM, the DON was told by the surveyor of Resident #10, #11, and #12 complaint of not receiving their scheduled showers. She stated that when she first started with the facility on 9/01/25, she received complaints from residents of not receiving their showers and she confirmed residents were either not receiving their showers or the CNAs were not updating the system of records of the shower occurring.

She stated the CNAs work on an honor system, and they should document when showers had been given, and she spot checked with residents to confirm they were given. She stated she placed many CNAs on a performance improvement plan and many of them had resigned because of it. She stated she completed

an in-service on showers with the Nursing staff recently. She stated if the residents did not receive their showers, they could have skin breakdown. She stated since the new company took over, they did not have

a consistent way of tracking when residents received their showers. She stated they currently had no proof

the residents were receiving their scheduled showers. She was asked for shower records for Resident #12, and she stated she did not have any records for this resident either. In an interview on 10/08/25 at 2:40 PM, ADON J was told by the Surveyor of Resident #10, #11, and #12 complaint of not receiving their scheduled showers. He stated they had a lot of CNA turnover and a change in the system of records because of the change in ownership. He stated he had mentioned to leadership the concern of recording resident showers.

He stated he thought residents were receiving their scheduled showers but could not confirm it. He stated if residents were not receiving their scheduled showers, it could impact their skin integrity. Record review of

the facility's policy on Activities of Daily Living (ADL), Supporting, dated 2001, (ADLs) do not diminish unless the circumstances of their clinical condition(s) demonstrate that diminishing ADLs are unavoidable. a. The existence of a clinical diagnosis or condition does not alone justify a decline in a resident's ability to perform ADLs. b. Unavoidable decline may occur if he or she: (1) has a debilitating disease with known functional decline; (2) has suffered the onset of an acute episode that caused physical or mental disability and is receiving care to restore or maintain functional abilities; and/or (3) refuses care and treatment to restore or maintain functional abilities and: a) the resident and or representative has been informed of the risk and benefits of the proposed care or treatment; and b) he or she has been offered alternative interventions to minimize further decline; and c) the refusal and information are documented in the resident's clinical record. 2. Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. hygiene (bathing, dressing, grooming, and oral care)

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mustang Park Therapy and Living Center

4501 Plano Parkway Carrollton, TX 75010

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

nasal cannulas should not be on the floor to avoid the residents from getting an infection. In an interview on 10/08/25 at 10:00 AM, the DON was told and shown pictures of Resident #1, #7, and #8 not having their nasal canula bagged and Resident #6's Trach hose on the floor. She stated the expectation was for the nursing staff to ensure all mask and nasal cannulas are bagged when not in use to avoid the resident getting an infection. She stated Resident #6's Trach hose should not have been on the floor and should be replaced to avoid contamination. In an interview on 10/08/25 at 2:40 PM, ADON J was shown pictures by

the Surveyor of Resident #1, #7, and #8 not having their nasal canula bagged and Resident #6's Trach hose on the floor. He stated the hose and nasal cannulas should not be on the floor to avoid the residents from getting an infection. He stated it was the nurses' responsibility to ensure nasal cannulas were bagged and the trach hose not on the floor when they make their rounds, which occurred at least every two hours.

Review of the facility's policy Respiratory Care Policy, undated, reflected Purpose - To ensure that all residents requiring respiratory care in the long-term care facility receive safe, evidence-based, and individualized respiratory services that optimize respiratory function, prevent complications, and improve quality of life.

Event ID:

Facility ID:

If continuation sheet