Fairview Healthcare Residence
Inspection Findings
F-Tag F600
F-F600-The center failed to prevent CNA A from physically abusing Resident #1 when she shoved resident #1
in the right arm and in the back.
CNA A was placed on suspension pending termination on 4/8/2025 by the Administrator.
Director of Operations conducted re-education on Abuse and Neglect including recognizing, responding, and reporting abuse and neglect with the Administrator and Director of Nursing on 4/8/2025. Administrator and Director of Nursing voiced understanding of the re-education to the Director of Operations and signed the re-education.
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 7 of 9 675311 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 675311 B. Wing 04/09/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Fairview Healthcare Residence 601 E Reunion St Fairfield, TX 75840
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 0600 Resident #1 was assessed for signs and symptoms of physical abuse by the Director of Nursing on 4/8/2025 with no negative findings. A progress note was charted on 4/8/2025. Level of Harm - Immediate jeopardy to resident health or All residents that are able to be interviewed for any abuse and/or neglect event (no cognitive impairment) safety were interviewed by the Director of Nursing/Designee on 4/8/2025 with no negative findings identified. A progress note was charted for each resident on 4/8/2025. Residents Affected - Few All residents with cognitive impairment/not inter-viewable were assessed by the Director of Nursing/Designee
on 4/8/2025 for signs/symptoms of physical abuse with no negative findings. A progress note was charted for each resident on 4/8/2025.
All staff were re-educated on abuse and neglect including recognizing, responding, and reporting abuse and neglect by the Administrator/Designee on 4/8/2025. Staff not present will be re-educated prior to the start of their next shift and this will be completed by 4/9/2025 (end of business day). Staff voiced understanding of
the re-education to the Administrator/Designee and signed the re-education.
The Medical Director of the center was notified of the immediate jeopardy event on 4/8/2025. The Medical Director had no recommendations.
The findings of this event will be presented to the center Quality Assurance Committee. An ad hoc Quality Assurance Committee meeting will be conducted on 4/9/2025.
The Administrator/Designee will monitor/review incident reports and do random resident interviews during
the work week (Monday through Friday) to validate no resident abuse and/or neglect events have occurred.
These audits will continue weekly for four weeks. Negative findings will be addressed at the time of discovery and presented to the center Quality Assurance Committee.
Monitoring of the facility's Plan of Removal included the following:
Record review of Resident #1's clinical records revealed the resident had been assessed by nursing after the incident on 01/21/25 and did not have any injuries.
Record review of QAPI meeting conducted by facility in regard to immediate jeopardy event held on 04/09/25 at 11:45 AM and consisted of ADM, DON, CRN, and RDO, MD participated via telephone.
Record review of in-servicing dated 04/08/25 conducted by RDO reflected ADM and DON were in-serviced
on abuse and neglect and abuse, neglect, exploitation, or misappropriation - reporting and investigating policy.
Record review on in-servicing dated 04/08/25 conducted by ADON reflected staff were in-serviced on attitude and attitude policy.
Record review on in-servicing dated 04/08/25 conducted by ADON reflected staff were in-serviced on conduct and behavior and conduct and behavior policy.
Record review on in-servicing dated 04/08/25 conducted by ADON reflected staff were in-serviced on reporting work burnout.
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 8 of 9 675311 Department of Health & Human Services Printed: 08/31/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391
STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 675311 B. Wing 04/09/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Fairview Healthcare Residence 601 E Reunion St Fairfield, TX 75840
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 0600 Record review on in-servicing dated 04/08/25 conducted by ADON reflected staff were in-serviced on courtesy and courtesy policy. Level of Harm - Immediate jeopardy to resident health or Record review on in-servicing dated 04/08/25 conducted by ADON reflected staff were in-serviced on safety resident rights and resident rights policy.
Residents Affected - Few Record review of staff interviews dated 04/08/25 reflected 3 resident interviews were conducted regarding abuse and neglect with no negative outcomes and residents all felt safe and comfortable with reporting harm if it had occurred.
Record review of employee interviews dated 04/09/25 reflected employee interviews were conducted regarding abuse and neglect with no negative outcomes and staff all knew that they were required to report abuse immediately to the abuse coordinator.
Record review of comparison of schedules worked and staff which were in-serviced signatures reflected all staff that have worked in the facility since immediate jeopardy was identified have been in-serviced appropriately according to facility plan of removal.
Interviews were conducted on 04/09/25 from 1:20 PM to 1:25 PM and 1:45 PM to 2:29 PM with staff from various shifts. The staff included LVN A, CNA F, HSK, CNA C, LVN B, CNA D, and CK.
All staff were able to identify:
What abuse was and the different types of abuse. The staff understood how to recognize, respond, and report abuse.
Observations and interviews with Resident's #2, #3, and #4 on 04/09/25 from 1:28 PM to 1:39 PM revealed
they felt safe and had no concerns for abuse or neglect.
In an interview on 04/09/25 at 4:38 PM, the ADM, DON, and ADON stated they had in-serviced all staff that have worked since the immediate jeopardy was called and staff would continue to be in-serviced and would be in-serviced prior to their shifts if they had not already been, on attitude, conduct and behavior, burnout, courtesy, resident rights, and abuse and neglect, which included recognizing, responding, and report abuse.
They stated they were in-serviced over these things as well. They stated CNA A has been suspended and will be terminated as soon as she returned their call or tried to show up at work. They stated they had been trying to call CNA A and had not been able to get ahold of her.
In an interview on 04/09/25 at 4:45 PM, the DON stated CNA A had returned her call and would be coming to
the facility the next day to be terminated.
The Administrator and DON were informed the Immediate Jeopardy was removed on 04/09/25 at 4:54 PM.
On 04/08/25 at 6:00 PM, an IJ was identified. While the IJ was removed on 04/09/25, the facility remained out of compliance at a scope of isolated and a severity level of potential for more than minimal harm due to
the facility continuing to monitor the implementation and effectiveness of their Plan of Removal.
FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 9 675311