Capstone Healthcare Estates At Veterans Memorial

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

right to feel like they are humans, and it was the responsibility of all staff to make sure that resident rights were protected. He said he would report to the Administrator if a resident's rights were not respected. He said a negative effect of not respecting resident rights might be that residents were affected emotionally. He said residents have the same rights as any other person.Interview on 10/31/25 at 11:02 am with LVN F reflected he worked with CNA G, and he felt like she was respectful to residents and no residents complained about the way she treated them. He said he was trained in resident rights when he was hired at

the facility, and it was the responsibility of everyone to protect resident rights. He said examples of resident rights were the right to privacy, to be treated fairly and respectfully and to make decisions of their own choices. If a staff member did not allow a resident to ask questions that would be inconsiderate and disrespectful and was a violation of resident rights and borderline abusive. LVN F said if he felt a resident's rights were being disrespected, he would talk to the staff member who was not respecting the resident's rights then speak to the resident then let the ADON or DON know. Allegations of abuse and neglect were reported to the Administrator first and foremost and he would also report resident rights issues to the Administrator.Interview on 10/31/25 at 11:13 am with the DON reflected resident rights involved honoring residents' likes and dislikes and respecting and honoring residents' wishes. The DON said this included making sure Residents' feelings were not hurt and they were respected. She said residents have the right to know they have a say and for their voice to be heard. She said that after the SSA brought the Life Satisfaction results involving CNA G to her attention and the Administrator, they talked with the residents and let them know CNA G would not be back. She said it was the responsibility of everyone to protect the residents' rights, from the nurses to the CNAs to the dietary staff, everyone. Interview on 10/31/25 at 11:11 am with the Administrator reflected after the life satisfaction surveys were reported to her, she would have terminated CNA G's employment, but CNA G already resigned. She said, after hearing what Residents #4, #5, #6, and #7 felt about how CNA G made them feel, it was possible she violated their rights. She said the staff were trained in resident rights when they were hired and it was the responsibility of everyone to make sure residents had their rights protected. It was her expectation that staff reported to her any knowledge of resident rights violation. She said the possible negative effect of resident's having their resident rights violated would be residents could regress and not feel they have rights in their living space. Review of facility Resident Right's Policy dated February 2021 reflected employees shall treat all residents with kindness, respect, and dignity.Policy Interpretation and Implementation1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents' right to: 1. a dignified existence;2. be treated with respect, kindness, and dignity;3. be free from abuse, neglect, misappropriation of property 4. communication with and access to people and services, both inside and outside the facility;exercise his or her rights as a resident

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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

10/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Capstone Healthcare Estates at Veterans Memorial

1424 Fallbrook Drive Houston, TX 77038

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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

CNA staff for technique and safety beginning 10/07/25. Competency documentation showed that over 80% of the staff completed the training by 10/08/25. During interviews on 10/29/25 from 2:27 pm - 10/31/25 at 10:25 am, four LVNs, 1 LPN, and 10 CNAs from different shifts all stated they were in-serviced by the ADON and DON on 1. facility Abuse and Neglect Policy and Procedures2. always operate mechanical lift with 2 (two) staff members and staff should verify mechanical lift is fully functional and operating properly. If

the mechanical lift is not functioning properly staff are to pull it off the floor, notify management/maintenance director and put a work order in TELS (a service request platform used by facilities for maintenance and operations).3. to check gait belts and slings daily every shift for any tears, holes, or thread unraveling. If any defects are noted to equipment staff are to pull it from the floor and notify DON/ADON immediately. Shower (mesh) slings are only to be used for residents when giving showers.

They are not to be used for everyday get up to participate in daily activities. Staff to ensure batteries sufficiently charged before each use of mechanical lift/sit to stand before use to ensure they are functioning properly.

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

10/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Capstone Healthcare Estates at Veterans Memorial

1424 Fallbrook Drive Houston, TX 77038

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 0694 Level of Harm - Actual harm Residents Affected - Few

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

that the staff initiated and followed the PICC line dressing changes after his return from the hospital with another PICC line, on 07/21/25.Record review of the in-service file revealed on 07/16/25 the facility conducted an in service on IV care and Monitoring. The staff were educated on the following1. IVs are to be flushed Q shift as well as before and after med administration2. IV site to be cleaned and dressing changed Q Sunday and PRN3. IV site to be monitored Q shift and PRN for patency , infiltration, phlebitis [bleeding] and infection.4. Any and all change in condition to be reported to nurse management immediately and documentation completed . Record review of facility policy Midline Dressing Changes revised in April 2016 reflected: The purpose of this procedure is to prevent catheter related infections associated with contaminated , loosened or soiled catheter site dressings.1. Change midline catheter dressing 24hours

after catheter insertion and every 5-7days , or if it is wet, dirty, not intact or compromised in any way .

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