Cascades At Galveston

F 0656 Level of Harm - Minimal harm or potential for actual harm

initiate small amounts of pureed textured snacks (not to exceed >1/2 a meal tray for pleasure with SLP supervision or trained caregiver.G-tube placement on 07/28/25. During an interview on 09/03/25 at 1:00 p.m., the DON said the MDS nurse, or she was responsible for updating care plans. During an interview at 2:30 p.m., the Regional Nurse Consultant said they do not have a care plan policy, and that they follow the RAI manual.

Residents Affected - Few

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

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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

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Cascades at Galveston

3702 Cove View Blvd Galveston, TX 77554

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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

they both texted her back and said they would take care of it in the morning. She said the DON said she would order a new wheelchair. She said the following night, she went back to the room, and it appeared to have been clean and treated. She said weeks prior to this incident (could not recall date), she saw 4 to 6 roaches in the resident's room. She said she reported it to the DON around her first week of employment, June 18th, and she said the DON said they would have maintenance take care of it. She said the resident would refuse to let staff take her dinner tray out of her room. During an interview on 09/05/25 at 12:48 p.m.,

the DON said a nurse notified her that there were roaches in Resident #2's room. She said the roaches were reportedly on her wheelchair. She said she asked staff to clean her up and to give her a bed bath. She said they moved the resident to the room next door. She said there were a lot of issues with Resident #2, and she had spoken to the Doctor and NP of psychiatry, because they were having issues with the resident getting very upset and yelling if they took her food items out of her room, specifically her meal tray. She said

she notified the Administrator and Director of Maintenance and told them pest control needed to come out.

She said she believed pest control came out the following day. She said the NP with psychiatry visited Resident #2 and adjusted her medications and also talked to her guardian. She said Nurse B may have told her that there had been a few roaches in the resident's room prior to this incident, but not to the extent that was reported that evening. She said she did not know what date the roaches were found on the resident's wheelchair. She said the wheelchair was power washed, her old cushion was thrown away, a new cushion was bought, and she believed maintenance tossed the bed mattress. She said Resident #2 was in a new room. During an interview on 09/05/25 at 3:02 p.m., the Director of Maintenance stated he treated Resident #2's room on several occasions. He said her mattress was also replaced about a month ago. He said he did not recall the dates, but just about every time he treated her room, he saw German roaches. He said he would pull out the end table, pull out the outlet, and would see between 10 to 20 roaches each time. He said he would treat the room with roach spray because it killed on contact. He said he did not personally treat the room last week, 08/24/25-08/30/25. He said last week, 08/24/25-08/30/25 (did not know the exact date), they moved the resident to a different room and let the exterminator treat the room. He said pest control had not been effective in Resident #2's originally assigned room. He said every time he went in her room, he found food. He said pest control came out 08/29/25 and treated the room. He said he would see food crumbs on the floor and on her bed. He said pest control came out monthly, and when they called them to come out to do other stuff. He said he also requested the exterminator to exterminate Resident #2's room on 08/20/25. He said having roaches in a bedroom could affect a resident's ability to sleep, their health, and cause discomfort. Record review of pest control invoice, dated 04/16/25, revealed location in/out was treated for roach prevention. Record review of pest control invoice, dated 05/21/25, revealed Residents #2's room was one of several other locations treated for roach prevention. Record review of pest control invoice, dated 06/18/25, revealed interior/exterior was treated for prevention of roaches, ants, and spiders. Record review of email from pest control, dated 07/16/25, revealed treatment was performed on 07/16/25. Record review of store invoice, dated 07/25/25, revealed one-9 oz can of roach spray was purchased on 07/25/25. Record review of pest control invoice, dated 08/20/25, revealed in/out location was treated for roach prevention. Record review of pest control invoice, dated 08/29/25, revealed Resident #2's room was one of several other locations treated for roach prevention.

Event ID:

Facility ID:

If continuation sheet