Advanced Health & Rehab Center Of Garland

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

she refused to disclose it due to concerns of how Resident #1 was transferred to the ER on [DATE REDACTED]. An

interview with the BOM on 08/26/25 at 1:33 PM, revealed she was responsible for completing the admission documentation for new admissions. The BOM stated when a resident admitted to the facility, We start admission documentation that day. I have to be here. Most important docs are consent to treat and social security. The BOM stated the next step was to ensure there was a POA on file, especially if the resident was not cognitively intact, as well as advanced directives which were included in the admission packet. The BOM stated she was not present the evening Resident #1 admitted to the facility, but had been working earlier that day. When she came to work the following day 08/21/25, she saw that Resident #1 had been sent out to the hospital, so she called his RP to get his social security number and needed the RP to sign his Consent to Treat form. The BOM stated, We still needed it because we still cared for him briefly while he was here, so it is a CYA [cover your ass]. [RP] finally answered me this morning and said no to giving his social until [RP] got what she needed on why he was discharged . The BOM stated Resident #1's RP had come in a week prior to admission to tour the facility but claimed the RP did not come the night he admitted . The BOM said a lot of the required forms at the time of admission could be done electronically, so the person did not have to be at the facility face to face to complete them. The BOM stated by the end of

the first week she liked to have all her required admission documentation in place. She stated, I have nothing on him [Resident #1]. I know that is bad, but I did try to get it in my defense. She [Resident #1's RP] could have signed them electronically the day he came in, but I feel like I didn't know he was coming, it was not set in stone. The BOM stated she could not provide any evidence that the facility notified the resident and his RP of the required admission documentation and disclosures. Review of the facility's Introduction statement in their admission Packet undated reflected, State and federal regulations require nursing homes to have written policies covering the rights of residents.The nursing home's staff must implement these policies and explain them to you.This booklet describes your rights and the responsibilities nursing homes have for ensuring those rights. The admission Packet also included 10 forms that were listed as requiring receipt and acknowledgement by the resident or the RP/POA to include:1. Consent to Treat2. Assignment of Benefits3. Schedule of Charges for Ancillary Services4. Information about Medicare and Medicaid Eligibility5. Medicaid Estate Recovery Program6. Resident Rights Under Federal Law7. Ombudsman Services and Contact Information8. Family Council Information9. Policy for Criminal History Check for Employees10. Drug Testing Policy11. Advanced Directive Education and Advanced Care Planning Information12. Privacy Act.

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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

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Advanced Health & Rehab Center of Garland

1201 Colonel Drive Garland, TX 75043

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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

appointments, but for any destinations, including the ER.4. A trained CNA, or Licensed nurse will be assigned to supervise transportation if supervision is deemed necessary from the checklist. The DON or Designee will arrange supervision if needed.5. The supervising staff member will stay with the resident at

the ER and check them in with ER personnel.6. If there is a behavioral emergency during transport staff are instructed to pull over to a safe place, stay with the resident and call 911.Education & Training1. Regional Nurse DON/designee will educate DON on emergency transport vs non-emergency transport with posttest.

Completion by [DATE REDACTED]. DON/designee will educate all licensed nurses on emergency transport vs non-emergency transport with posttest. Completion by [DATE REDACTED]. DON/designee will educate license nurses

on the Return to Acute Checklist before calling non-emergency transport. Completion by [DATE REDACTED].

DON/designee will educate CNAs on recognizing and reporting line-pulling, fidgeting, and self-harm risks immediately to the charge nurse. Completion by [DATE REDACTED]. Staff unavailable to attend in service on [DATE REDACTED] will receive personalized education and posttest prior to assuming their duties. Monitoring:1. DON/Designee will audit 100% of all hospital/ER transfers for 30 days to verify:a. Completion of Return to Acute Checklist for non-emergency transport.2. Findings will be reviewed in QA/QI Committee meetings monthly for 3 months, then quarterly thereafterDate Facility Asserts Likelihood for Serious Harm No Longer Exists: [DATE REDACTED].Monitoring interviews for the Immediate Jeopardy were started on [DATE REDACTED] at 2:45 PM with nine nursing staff and management across multiple shifts to include: DON, ADM, RN B, ADON I, ADON J, RN K, LVN L, LVN M and LVN N. All staff were able to provide competency of education on the new Resident Transfer Checklis

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