Fallbrook Rehabiliation And Care Center

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

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

were supposed to make rounds every two hours and as needed for incontinent care. LVN P said Resident #2 could develop UTI and skin breakdown if she was left on incontinent brief for extend time. During an

interview on 09/04/25 at 4:49 p.m., CNA L said the aides were supposed to make rounds every two hours to check and change the resident. CNA L stated when she unfastened Resident #1's incontinent brief, it revealed the incontinent brief was very soaked, and when she turned the resident to her left, it revealed the two draw sheets and the air mattress were also soaked with urine. CNA L said Resident #1 could have skin breakdown or an infection because she had not been changed for hours. During an interview on 09/04/25 at 5:21 p.m., CNA T said Resident #1 was her resident. CNA T said Resident #1 was not her original resident. CNA T said when she became aware Resident #1 was assigned to her, she came to provide incontinent care. CNA T said aides were supposed to make rounds for incontinent care every two hours.

CNA T said Resident #1's incontinent brief was very wet and soaked with urine, as well as the two draw sheets, and the air mattress. CNA T said Resident #1's skin could break down. During an interview on 09/05/25 at 9:17 a.m., the DON said aides should make rounds for incontinent care at least every two hours. The DON said the residents were not supposed to ask the aide to provide incontinent care because that was part of ADL care. The DON said the aides should make rounds every two hours. The DON said Resident #1 was a heavy wetter, and when she voided, she voided a lot because she drank a lot of water.

The DON said if the continent brief was brown, it could mean the urine had been on the incontinent brief for

an extended time. The DON said Resident #1 could develop moist-associated skin damage, and the resident would not feel good being left on a wet incontinent brief. During an interview on 09/05/25 at 1:07 p.m., the Administrator said the aides should make rounds for incontinent care every two hours according to the facility's policy. The Administrator said the staff should also make PRN rounds for incontinent care.

He said if Resident #1 was left in a wet incontinent brief, it could cause skin breakdown and infection. He said Resident #1 would feel uncomfortable and dirty. Record review of the facility's policy on activities of daily living, dated revised 04/23/25, and implemented 09/01/25, read in part .care and services will be provided for the flowing activities of daily living: 3. Toileting.policy explanation and compliance guideline #2.

A resident who is unable to carry out activity of daily living will receive the necessary services to maintain . grooming .

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fallbrook Rehabiliation and Care Center

10851 Crescent Moon Dr Houston, TX 77064

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

her original resident. CNA T said when she became aware Resident #1 was assigned to her, she came to provide incontinent care. CNA T said aides were supposed to make rounds for incontinent care every two hours. CNA T said Resident #1's incontinent brief was very wet and soaked with urine, as well as the two draw sheets, and the air mattress. CNA T said Resident #1's skin could break down. During an interview on 09/05/25 at 9:17 a.m., the DON said aides should make rounds for incontinent care at least every two hours. The DON said the residents were not supposed to ask the aide to provide incontinent care because that was part of ADL care. The DON said the aides should make rounds every two hours. The DON said Resident #1 was a heavy wetter, and when she voided, she voided a lot because she drank a lot of water.

The DON said if the continent brief was brown, it could mean the urine had been on the incontinent brief for

an extended time. The DON said Resident #1 could develop moist-associated skin damage, and the resident would not feel good being left on a wet incontinent brief. During an interview on 09/05/25 at 1:07 p.m., the Administrator said the aides should make rounds for incontinent care every two hours according to the facility's policy. The Administrator said the staff should also make PRN rounds for incontinent care.

He said if Resident #1 was left in a wet incontinent brief, it could cause skin breakdown and infection. He said Resident #1 would feel uncomfortable and dirty. Record review of the facility's policy on activities of daily living, dated revised 04/23/25, and implemented 09/01/25, read in part .care and services will be provided for the flowing activities of daily living: 3. Toileting.policy explanation and compliance guideline #2.

A resident who is unable to carry out activity of daily living will receive the necessary services to maintain . grooming .

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fallbrook Rehabiliation and Care Center

10851 Crescent Moon Dr Houston, TX 77064

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 0690 Level of Harm - Minimal harm or potential for actual harm

on [DATE REDACTED]. Record review of the facility's, undated, policy on perineal care read in part . it is the practice of

this facility to provide perineal care to all incontinent residents.and needed in order to promote cleanliness and comfort, prevent infection.facility explanation and compliance guideline. Female. 11.c.separate the resident's labia with one hand and cleanse perineum with the other hand by wiping in direction from front to back.

Residents Affected - Few

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

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fallbrook Rehabiliation and Care Center

10851 Crescent Moon Dr Houston, TX 77064

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

stated CNA L and CNA T should not have used gloves from their uniform pockets because it would lead to cross-contamination and the spread of germs. The DON stated CNA L and CNA T should have removed

the dirty gloves used to clean Resident #1, washed or sanitized their hands, and then donned clean gloves

before applying a clean incontinent brief to decrease the spread of germs. The DON stated CNA L should have disinfected the low-loss air mattress instead of wiping it with a peri wipe, which was an infection control issue because the germs were still present on the mattress. During an interview on 09/05/25 at 1:12 p.m., the Administrator said CNA L and CNA T should have washed their hands before they donned clean gloves and provided care for Resident #1. He said CNA L and CNA T should have taken gloves from the glove box on their incontinent care setup, not from their uniform pockets, because of infection control, and

they could spread germs from one resident to another. The Administrator said CNA L and CNA T should have taken off the gloves they cleaned Resident #1 with, washed or sanitized their hands, and donned clean gloves, then applied a clean incontinent brief on Resident #1. He said it was an infection control issue when CNA L used peri wipes and cleaned the urine on Resident #1's air mattress instead of disinfecting wipes, which would kill the germs. Record review of the facility's policy on hand hygiene, dated 09/01/21, read in part . All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility.

Policy Explanation and Compliance Guidelines: Additional considerations. 6a. The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, and immediately after removing gloves. Record review of the facility's policy on infection control, dated 03/2023, read in part . This facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help prevent and manage transmission of diseases and infections.

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

09/08/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fallbrook Rehabiliation and Care Center

10851 Crescent Moon Dr Houston, TX 77064

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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

staff handed the call light to Resident #1. The DON said Resident #1 would not get the assistance she needed until the staff made the next round. The DON said there would be a variable negative outcome for Resident #1 and did not respond to what types of variables. During an interview on [DATE REDACTED] at 12:58 p.m.,

the Administrator said the maintenance director was responsible for making sure all the call lights were working. He said he did the audit of all the call lights last night when he became aware Resident #1's was not working. The Administrator said the call light was what Resident #1 used to communicate her needs to

the staff. The Administrator said Resident #1 could have delayed care because the resident's call light was not functioning correctly. The Administrator said the staff should have checked and made sure the call light was working before she gave the call light to Resident #1. The Administrator stated he performed a call light audit on [DATE REDACTED], and the maintenance director should have documented it. During a telephone interview on [DATE REDACTED] at 3:13 p.m., the Maintenance Director stated the entire maintenance team conducted monthly rounds to ensure the call lights were functioning. However, he was not required to document these monthly checks; instead, he documented the yearly call light checks. He said he did not work yesterday ([DATE REDACTED]), and he was not aware Resident #1's call light was not working. The Maintenance Director said the staff should have checked if the call light was working before the staff gave the call light to Resident #1. He said

it would not be safe for Resident #1 because if she fell, she would not be able to get assistance promptly, because the call light was not working. The Maintenance Director said the nursing staff should document any call light repair in the maintenance log or tell one of the maintenance staff, and one of the maintenance staff would fix the call light. Record review of the facility's maintenance log for hall 100 did not reveal there was any call light order repair for Resident #1 room call light from [DATE REDACTED] to [DATE REDACTED]. Record review of the facility's, undated, policy on call lights read in part .The purpose of this policy is to assure the facility is adequately equipped with a call light at each residents' bedside .2. Staff will report problems with a call light or the call system immediately to the supervisor and/or maintenance director and will provide immediate or alternative solutions until the problem can be remedied. (Examples include replace ‘call light', provide a bell or whistle, increase frequency of rounding, etc.) .

Event ID:

Facility ID:

If continuation sheet