Signature Pointe

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 #4) reviewed for dignity. The facility failed to conceal Resident #4's gall bladder 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 #4's Face Sheet, dated 10/02/25, reflected an [AGE] year-old female who was admitted to the facility on [DATE REDACTED]. Resident #4 had diagnosis of Gastro-Esophageal Reflux disease (digestive disease).

Record review of Resident #4's Quarterly MDS Assessment, dated 8/11/25, reflected Resident #4 had a BIMS score of 99 (unable to complete the interview). The Quarterly MDS Assessment reflected an active diagnosis of Acute Cholecystitis (inflammation of gall bladder). Record review of Resident #4's Physician Order, dated 10/02/25, reflected RESIDENT HAS ORDER FOR C-TUBE (GALLBLADDER TUBE) PLEASE ENSURE BAG IS COVERED WITH PILLOWCASE FOR PRIVACY/DIGNITY. In an observation and

interview on 10/02/25 at 10:18 AM, ADON M and the Surveyor observed Resident #4's gall bladder bag on

the bed near her and she did not have a privacy bag. ADON M stated the resident needed a privacy bag because it was a dignity issue. He stated he did not know why she did not have one. In an interview on 10/02/25 at 10:22 AM, LVN O was told by the Surveyor that Resident #4 was observed to have a gall bladder bag sitting on top of the bed, uncovered. She stated the resident needed the bag covered for privacy. She stated she made rounds this morning but did not check to ensure the bag was covered. In an

interview on 10/02/25 at 10:39 AM, ADON Y was told by the Surveyor that Resident #4 was observed to have a gall bladder bag sitting on top of the bed, uncovered. She stated she went to the resident's room and confirmed she did have a gall bladder bag exposed. She stated the nursing staff normally used a pillowcase to cover it. She stated it should be covered for infection control, privacy, and for the resident's dignity. In an interview on 10/02/25 at 12:07 PM the DON stated ADON Y told her about Resident #4 not having a privacy bag for her gall bladder bag. She stated the resident should have been provided with a privacy bag or a pillowcase to cover the bag. She stated the bag was needed to protect the resident's dignity. Record review of the facility's policy on Dignity, dated September 2022, 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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Signature Pointe

14655 Preston Rd Dallas, TX 75254

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

the bed, and she also in-serviced staff on ensuring call lights were within reach and ensuring the call lights were clipped. She stated if the call light was not within reach of the resident they would not be able to contact anyone for help. Record review of the facility's policy on Answering Call Lights, dated September 2022, revealed The purpose of this policy is to assure timely responses to the resident's requests and needs. Ensure the call light is accessible to the resident when in bed.

Residents Affected - Few

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

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

Signature Pointe

14655 Preston Rd Dallas, TX 75254

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 0604 Level of Harm - Minimal harm or potential for actual harm

bed accessories), the facility shall promote the following approaches: Identify additional safety measures for residents who have been identified as having a higher than usual risk for injury including entrapment (e.g., altered mental status, restlessness, etc.).

Residents Affected - Few

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

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

Signature Pointe

14655 Preston Rd Dallas, TX 75254

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

Provide safe and appropriate respiratory care for a resident when needed.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observations, interviews, and record review the facility failed to ensure that residents, who needed respiratory care, were provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one of three residents (Resident #6) reviewed for respiratory care. The facility failed to ensure Resident #6's nebulizer mask was properly stored in a bag when not in use on 10/02/25. This failure could place the resident at risk for respiratory infection and not having his respiratory needs met.Findings included: Record review of Resident #6's Face Sheet, dated 10/02/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE REDACTED]. Relevant diagnosis included acute respiratory failure (shortness of breath). Record review of Resident #6's Quarterly MDS assessment, dated 6/30/25, reflected he had a BIMS score of 99 (unable to complete the interview). For ADL care, it reflected the resident required extensive assistance and had an active diagnosis of acute respiratory failure. Record Review of Resident #6's physician orders, dated 10/02/25, reflected IPRATROP-ALBUT 0.5MG-2.5MG/3ML 1 vial inhale orally every morning and at bedtime related to ACUTE AND CHRONIC RESPIRATORY FAILURE VIA NEBULIZER. In an interview and

observation on 10/02/25 at 10:52 AM, LVN O and the Surveyor observed Resident #6 with her Nebulizer mask unbagged in her nightstand. She stated the mask should be bagged to avoid the resident getting an infection. She stated she normally checked to ensure her mask was bagged but somehow overlooked it this morning. In an interview on 10/02/25 at 12:07 PM, the DON stated LVN O and ADON Y told her about Resident #6 not having her nebulizer mask bagged when not in use. She stated LVN O stated she had forgotten to bag the mask after the resident had used it this morning. She stated the resident was provided with a new mask. She stated bagging the mask was necessary to avoid an infection. Review of the facility's policy Oxygen Administration, dated 09/2024, 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. 3. Assemble the equipment and supplies as needed.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet