Los Arcos Del Norte Care Center

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

The Administrator clarified that he has never told staff that this was a regulation or requirement, nor has he heard the Director of Nursing communicate such a rule. Record review of the facility's Patient/Residents Rights dated 2023 read in part Policy: The Facility employs measures to ensure patient and resident personal dignity, well-being, and self-determination are maintained and will educate patients and residents regarding their rights and responsibilities. Resident rights: The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section; A resident must receive and consent with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality; The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States.

Record review of the facility's Infection Prevention and Control Program and Plan policy dated May 15, 2023, revealed there was nothing that indicated staff could not provide soiled brief changes minutes prior and during meals due to cross contamination concerns.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Los Arcos Del Norte Care Center

11169 Sean Haggerty El Paso, TX 79934

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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

before lunch. [Administrator] said that he would talk to DON to see if they can come up with a solution. 06/09/2025 At 11:17 AM, [Resident #2] tells me she needs to be changed because she pooped, I press the call switch the light goes on. Shortly afterwards [SW] walks in and asked who needed assistance, I responded that [Resident #2] needed to be changed. She said she would get someone and left the room, shortly she returns saying in an apologetic manner that [Resident #2] could not be changed at the moment cause the food trays were going to be distributed to the residents. I feel that the patients are being neglected and the progress of the staff was making has faltered. I have reached out to [Ombudsman] about what the Administrator and DON said about the regulations or law about changing patients at lunch or

before lunch. His response was I have sought out law or regulation about patients being changed during lunch, before or after and have reached out to an Investigator of Health and Human Services, and found

this information is baseless and suggested I file a grievance report. During an interview on 8/20/25 at 9:12 am, Resident #2 stated she needed assistance with toileting and wore briefs. She stated that if she was soiled, she had to ask in advance because if it was close to mealtime, she had to wait until after she finished eating. She stated she was not given a reason for this but was told it was just how the facility operated. She stated there were times she sat in soiled briefs during meals and that it was uncomfortable, embarrassing, and irritating. She stated she had not told anyone because she was informed by staff that

she had to wait and assumed it was the norm at the facility. During an interview on 8/20/25 at 1:33 pm, the DON stated the Social Worker and Administrator conducted the investigation. The DON stated that for a typical grievance, the process would be completed online; however, since this was reportable, the investigation continued and was resolved. The DON stated they completed the investigation but did not document it. She explained the risk of not completing the documentation was that if it was not documented,

it did not happen, and without follow-up it could not be supported.During an interview on 8/20/25 at 3:39 pm, the SW stated she had received the grievance from Resident #2's RP. The SW stated she had reviewed the notes and the additional page where the RP mentioned [Resident #2] being neglected, which led her to determine it was reportable. The SW stated that whenever a grievance mentioned neglect or resident rights not being met, it was considered reportable, and a self-report required to the state office.

The SW stated the Administrator then took over and conducted the report but emphasized that the complaint itself was still her responsibility. She stated it was not completed because it was reportable. The SW stated she had reviewed the policy with the surveyor on 8/20/25 and identified that nothing in the policy reflected that the grievance form should not be completed due to a self-reportable. The SW stated that although she had access to the policy, she had not reviewed it prior to that day. The SW stated that if it had not been reported to the state, the grievance could have fallen through the cracks. The SW stated that even with the self-report, there could be a negative outcome because without proper documentation, there was no way to confirm if it was resolved or who had investigated it.Record review of the facility's Complaint/ Grievances Process policy dated 10/23/19 read in part Procedures: 2- Upon receipt of the grievance/ complaint the receiver completes and signs all appropriate sections of the current complaint/grievance form; 4- The SW/ designee ensures all sections of the Complaint/grievance report are completed appropriately and signed by the staff completing the investigation and developing the resolution. Ensure any supportive documentation related to the grievance is attached.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Los Arcos Del Norte Care Center

11169 Sean Haggerty El Paso, TX 79934

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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

impaired. Toileting was dependent, upper body dressing was Max assistance, lower body dressing was total dependence. Clinical Impressions: upon evaluation Resident #3 demonstrates significant deficits affecting selfcare tasks and functional mobility. During an interview on 08/20/25 at 2:02 PM, with the DON, she stated Resident #3 was a high fall risk. The DON stated Resident #3 had a scoop/booster mattress to help repositioning, to help find the borders for him, and to prevent him from rolling off the bed. The DON stated Resident #3 was able to get in and off the bed by himself. The DON stated Resident #3 was evaluated for

the scoop/booster mattress but did not know if he was evaluated to see if he was able to in and out of bed.

The DON stated she could not recall if there was a physician order for the scoop/booster mattress. The DON stated there was no physician order seen for the scoop/booster mattress. The DON stated Resident #3 was care planned for the scoop/booster mattress. The DON stated the care plan mentioned to place resident on scoop mattress as ordered. The DON stated there would have to be an order for use of the scoop/booster mattress. The DON stated there was no consent form seen for use of the scoop/booster mattress. The DON stated the nurses were responsible for getting the orders and the consent for use.

During an interview on 08/21/25 at 10:25 AM, with the DOR, he stated the therapy had done their own evaluation of Resident #3 but do not do evaluation on residents to see if they are able to use bed rails or scoop/booster mattress to see if they can use them as enablers. The DOR stated Resident #3's PT evaluation for bed mobility stated he was a max assistance and also with transfers. The DOR stated Resident #3 was unable to walk. The DOR stated Resident #3 would not be able to use the scoop/booster mattress to get out of bed or help him use it as an enabler. The DOR stated he did not see the negative outcome of Resident #3 using the scoop/booster mattress. The DOR stated if there were an emergency Resident # would not be able to get out of bed on his own. During an interview on 08/22/25 at 11:24 AM, with the Administrator, he stated a scoop/booster mattress was ordered for Resident #3. The Administrator stated Resident #3 did not have a physician order, nor consent form for use of the scoop/booster mattress, and no therapy or nursing assessment conducted to see if Resident #3 was able to use the scoop/booster mattress. The Administrator stated the purpose of the therapy/nursing assessment was to make sure the scoop/booster mattress fit Resident #3 and was an enabler as not doing so could be a risk of entrapment.

During an interview on 08/22/25 at 1:32 PM, NP B stated he was not too familiar with the scoop/booster mattress. NP B stated there were no orders for the scoop/booster mattress as he did not give any nor were any asked by the facility to him. NP B stated as per policy the negative outcome would be that the scoop/booster mattress would be not appropriate for Resident #3's use. Record review of the facility Bed Rails and Side Rails, installation and use Policy, dated 05/05/25, revealed, Policy - The facility will attempt to use appropriate alternatives prior to installing a side or bed rail. The facility will ensure the correct installation, use and maintenance of bed rails/side rails when their use was determined to be appropriate for the patient/resident. Procedures: Acceptable alternatives will be considered prior to the installation of bed rails. Alternatives include but are not limited to roll guards, foam bumpers, lowering the bed and using concave mattresses that can help reduce rolling off the bed. -The resident will be evaluated for the risk of entrapment prior to installation.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Los Arcos Del Norte Care Center

11169 Sean Haggerty El Paso, TX 79934

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

for Resident #2. The DON stated the form should have been adjusted to say something different other then, Suggest Questions for Accused. The DON stated it was a documentation error and all staff have been trained on how to documents properly. The DON stated the negative outcome of improper documentation would be failure in documenting of the care and what was done for the resident. During an interview on 08/21/25 at 9:21 AM, CNA C stated family member #1 had voiced that Resident #2 was not being changed.

CNA C stated they were changing Resident #2 and were marking the changes down on a log every time

they changed her. CNA C stated she was called into the office and was asked to fill out a document. CNA C stated she does not read English and was not told that the documents title was Suggested Questions for Accused was accusing her of the allegation. CNA C stated if she would have known she would have not filled out and signed the document.During an interview on 08/21/25 at 9:52 AM, with CNA D, she stated family member #1 was complaining that staff were not changing Resident #2. CNA D stated CNA C and her were told to go to the DON's office to fill out the Suggest Questions for Accused documentation. CNA D stated she was informed that the Suggest Questions for Accused was an attention to a concern with a resident and not a write up. CNA D stated she did not read English and did not know what she was filling out other then what she was being told. During an interview on 08/21/25 at 3:33 PM, with LVN F, she stated Resident #2's family member #1 had made a complaint that staff was not changing Resident #2. LVN F stated she filled out the Suggest Questions for Accused but did not realize what she was signing. LVN F stated the staff were not suspended as it was not a write up but only information that the facility was requesting for the investigation. LVN F stated if she would have paid better attention to the document that

she would have questioned it. LVN F stated the nursing staff was providing perineal care all the time. During

an interview on 08/22/25 at 11:05 AM, with the Administrator, he stated the title Suggested Questions for Accused documents where the nursing staff had filled out, was a template that was given to them by corporate and should have had the part of accused being changed to something else as the nursing staff was not being accused of anything. The Administrator stated that staff are trained on documenting. The Administrator stated the nursing staff should have known how to document, clearly, and to be able to capture what was being done. The Administrator stated the negative impact would affect reimbursement and not knowing what the residents' needs are if not documented accurately and correctly.

Event ID:

Facility ID:

If continuation sheet