Park Manor Of Conroe

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

and stated the goal was to deliver warm food with a great presentation. Record review of an in-service titled Food temperatures dated on 09/26/25 with the dietary staff highlighted the purpose of the in-service was to ensure all dietary staff understood proper food temperature control and how it directly impacted resident satisfaction, safety, and compliance. This in-service documented that it was used as a learning opportunity to reinforce the standards and prevent recurrence of the recent incident in which grilled cheese sandwiches and tomato soups were served cold. Best practices indicated to take and document food temps before service begins, after transport, and on the line. Always use a calibrated food thermometer. Label and cover trays to retain heat and coordinate closely with nursing or dining teams to time delivery properly. Lastly, never guess temperatures based on feel or appearance. Record review of an in-service dated 09/29/25 revealed that the ADM educated all nursing staff on resident rights, abuse and neglect, and the policy on meal pass times and temperatures. Record review of DM B's employee file reflected that on 10/6/25, DM B received a 90-day performance review that stated that while coaching and feedback were consistently provided, the outcomes have not met the expectations for a food service manager at [name] company. Her areas of concern included the resident dissatisfaction regarding meal services, defensiveness or blame shifting when receiving feedback, raised tones and dismissive behavior towards staff that resulted in low morale and workplace tensions, and low progress to coaching sessions. She was effectively demoted on 10/6/25 to the position as a cook. DM B refused to sign this document and her employment with the facility and the contracted dietary company was terminated. Record review of a letter written by the ADM to whom

it may concern from the contracted dietary company on 10/6/25 read that: Despite repeated attempts to address these issues through one-on-one discussions, progress has been limited. A primary barrier to resolution appears to be [DM B's] overall attitude and approach. She frequently became defensive or agitated when concerns were raised, often providing excuses or shifting blame rather than working towards solutions. Additionally, she had been observed raising her voice at her staff and had demonstrated dismissive or uncooperative behavior when approached by her nursing or administrative team members in collaboration. Given the continued complaints, the influence of grievances, and the lack of meaningful improvement, it appears to be the best interest of the facility to move forward and parting ways with [DM B] at this time.

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Park Manor of Conroe

1600 Grand Lake Dr Conroe, TX 77301

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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

interview with the ADM on 10/10/25 at 2:16 p.m., she stated that she sat in on the Resident Council Meeting in August and she was concerned about all of the complaints she received regarding the dietary department. This prompted her to begin a QAPI and start in-services to her staff. The facility tried to coach with DM B but her attitude made her difficult to work with and receive feedback, ultimately leading to her termination. Record review of the facility's grievance and complaint log for August showed that on 8/20/25, there were 13 grievances directed towards the dietary department. Record review of the grievances for September 2025 documented 15 complaints directed towards the dietary department. Record review of the Resident Council Meeting minutes conducted on 9/16/25 at 2:00 p.m. revealed that complaints were made regarding food being served cold, overcooked, and failure by kitchen staff to follow meal preferences.

Resident #1 stated that her breakfast was served cold that morning and her waffles were still frozen.

Resident #1 stated that she did not want any sausage on her breakfast tray but she still received sausage

on her tray every time it was served. She also stated that she received two bowls of oatmeal that morning for breakfast instead of the bowl of dry cereal with milk and cranberry juice she requested. Record review of

an in-service dated on 09/15/25 revealed that the ADM educated all nursing staff on mealtimes and stated

the goal was to deliver warm food with a great presentation. Record review of an in-service dated 09/29/25 revealed that the ADM educated all nursing staff on resident rights, abuse and neglect, and the policy on meal pass times and temperatures. Record review of DM B's employee file reflected that on 10/06/25, DM B received a 90-day performance review that stated that while coaching and feedback were consistently provided, the outcomes have not met the expectations for a food service manager at [name] company. Her areas of concern included the resident dissatisfaction regarding meal services, defensiveness or blame shifting when receiving feedback, raised tones and dismissive behavior towards staff that resulted in low morale and workplace tensions, and low progress to coaching sessions. She was effectively demoted on 10/06/25 to the position as a cook. DM B refused to sign this document and her employment with the facility and the contracted dietary company was terminated. Record review of a letter written by the ADM to whom

it may concern from the contracted dietary company on 10/06/25 read that: Despite repeated attempts to address these issues through one-on-one discussions, progress has been limited. A primary barrier to resolution appears to be [DM B's] overall attitude and approach. She frequently became defensive or agitated when concerns were raised, often providing excuses or shifting blame rather than working towards solutions. Additionally, she had been observed raising her voice at her staff and had demonstrated dismissive or uncooperative behavior when approached by her nursing or administrative team members in collaboration. Given the continued complaints, the influence of grievances, and the lack of meaningful improvement, it appears to be the best interest of the facility to move forward and parting ways with [DM B] at this time.

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Park Manor of Conroe

1600 Grand Lake Dr Conroe, TX 77301

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

that: We prioritize the cleanliness and sanitation of all dishware, service ware, and utensils to uphold the highest health and safety standards.Procedures1. Training and Handling: Our Dietary Services staff undergo comprehensive training to proficiently operate dishwashing machinery and handle clean dishware, ensuring strict adherence to sanitary protocols.2. Machine Temperature Management: We regulate the temperature of dishwashing machine water according to the specifications provided by the manufacturer, whether utilizing high-temperature or low-temperature cleaning systems.3. Record Keeping: Meticulous logs are maintained to track either temperature or sanitizer concentration, depending on the type of machine, always guaranteeing compliance with sanitation standards.4. Drying and Storage: Cleaned dishware is air dried and stored appropriately to prevent any potential contamination prior to use, maintaining the integrity of our sanitary practices.Required Documentation: Dish Machine Log. Record review of the contracted dietary company's policy titled Dry Goods Storage Policy and Procedure (not dated, received 10/10/25) displayed that:5. Condition of Stored Items: All packaged and canned foods must be maintained in a clean, dry state and properly sealed to preserve their integrity.6. Organization: Storage areas shall be organized and maintained in a manner that allows for easy identification and access to items, with all goods appropriately dated.

Event ID:

Facility ID:

If continuation sheet