Deerbrook Skilled Nursing And Rehab Center

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

them and needed to be sent out for his safety and the safety of others. She stated she was unaware Resident #1 was transferred without prior acceptance. She stated the expectation regarding transfer involved the acceptance of the receiving facility prior to transfer of the resident. The Administrator stated without prior acceptance, the receiving facility was unaware of the residents' needs, and residents could be traumatized due to the transfer back to the facility. The Administrator stated prior acceptance minimized the resident's anxiety. Record review of the facility's policy, Transfer or Discharge, Emergency revised date December 2016 read in part . Should it become necessary to make an emergency transfer or discharge to

a hospital or other related institution, our facility will implement the following procedures: Notify the receiving facility that the transfer is being made.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerbrook Skilled Nursing and Rehab Center

9250 Humble-Westfield Rd Humble, TX 77338

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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

and DON. Record review of the facility's Policy titled Care Plans, Comprehensive-Person Centered dated December 2016 revealed, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.14 The Interdisciplinary Team must review and update the care plan:a.When there has been a significant change in the resident's condition; b. When the desired outcome is not met; c. When the resident has been readmitted to the facility from a hospital stay; and d. At least quarterly, in conjunction with the required quarterly MDS assessment.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerbrook Skilled Nursing and Rehab Center

9250 Humble-Westfield Rd Humble, TX 77338

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

Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living (ADLs) received the necessary services to maintain nutrition, grooming and personal and oral hygiene for 1 of 7 residents (Resident#3) reviewed for ADLs. The facility failed to ensure Resident #3 was provided fingernail care. This failure could place residents at risk for infections and a decreased quality of life. Record review of Resident #3's quarterly MDS assessment, dated 10/10/25, revealed an [AGE] year-old male admitted on [DATE REDACTED], and readmitted on [DATE REDACTED]. His diagnoses included Non-Alzheimer's Dementia (Vascular Dementia, Lewy Body Dementia [including Parkinson's dementia], and Frontotemporal Dementia), Cerebrovascular Accident (a stroke that occurs when blood flow to the brain is interrupted, either by a blockage or a ruptured blood vessel, causing brain cells to die), hypertension (Elevated blood pressure), and muscle weakness. Resident#3 had a BIMS score of 03 out of 15 which indicated severe cognitive impairment. She required assistance from staff with ADL care.Record

review of Resident #3's care plan, dated 10/14/25, revealed, Focus: [Resident#3] has an ADL self-care performance deficit r/t muscle weakness. Will be cleaned, well-groomed, appropriately dressed.through next review date. Intervention/Tasks: [Resident#3] requires setup or clean-up assistance with oral hygiene and partial/moderate assistance with personal hygiene.Observation on 11/19/25 at 07:53 a.m. Resident #3 was lying in bed. His fingernails on both hands were about 0.3 cm long and appeared dirty with a brown substance underneath the nails. He stated he liked long nails but he would like his nails cleaned.Interview

on 11/19/25 at 07:58 a.m. CSD looked at Resident #3's fingernails and said they were not clean and needed care. She stated it was the responsibility of all residents' care staff to make sure residents' fingernails were cleaned and trimmed to residents' liking. She stated the risk to residents was development of infection. In an interview on 11/20/25 at 10:59 a.m. the CSD said the CNAs were responsible for monitoring and cleaning nails during showers. He said the nurses should cut the nails if the resident was diabetic. He said if nails were not clipped and cleaned it could cause injury and have an effect on infection control and hygiene. He said residents could get sick or injure themselves. In an interview on 11/20/25 at 12:24 p.m. the Administrator stated nail care should be completed as needed and every time CNAs washed

the residents' hands. The Administrator stated nails should be observed daily. The Administrator stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. The Administrator stated she expected CNAs to offer to cut and clean nails if they were long and dirty. The Administrator stated residents having long and dirty nails could be an infection control issue. Record review of the facility's Care of Fingernails/Toenails policy revised April 2007 revealed in part, .the purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections .

1. 1. Nail care includes daily cleaning and regular trimming. 2. Proper nail care can aid in the prevention of

skin problems around the nail bed. 3. Unless otherwise permitted, do not trim the nails of diabetic residents or residents with circulatory impairments. 4. Trimmed and smooth nails prevent the resident from accidentally scratching and injuring his or her skin .

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerbrook Skilled Nursing and Rehab Center

9250 Humble-Westfield Rd Humble, TX 77338

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 0810

enlarged/padded handles, plate guards, and or special cups.

Level of Harm - Minimal harm or potential for actual harm 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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerbrook Skilled Nursing and Rehab Center

9250 Humble-Westfield Rd Humble, TX 77338

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

infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown and glove use during high contact resident care activities . EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDRO's to staff hands and clothing. EBP are indicated for residents with any of the following: .Wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO. For residents for whom EBP are indicated, EBP is employed when performing the following high-contact resident care activities: .incontinent care .Record review of the facility's policy Infection Control Guidelines for All Nursing Procedures (revised 2012) revealed in part: .3. Employees must wash their hands.under the following conditions .f. Before moving from a contaminated body site to a clean body site during resident care.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerbrook Skilled Nursing and Rehab Center

9250 Humble-Westfield Rd Humble, TX 77338

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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

worked or entered the resident's room to report when there were problems with equipment so he could fix them.In an interview and observation on 11/20/25 at 10:59 a.m., the CSD stated it was the responsibility of

the CNAs and nurses working with the resident to report the problem of the bed remote not functioning to

the Maintenance Director. He stated the night shift staff should move the resident with his permission to another room with a functioning bed until his bed was fixed. He stated the risk to the resident was infringing

on the Resident rights, because he did not have the control over his bed functioning and being able to be in

the position he liked to sleep on.In an interview and observation on 11/20/25 at 12:24 p.m., the Administrator stated, she expected the nurse to call for the bed to be fixed, or get the resident out of that bed, and put the Resident in bed that work, they should not leave the resident in a flat bed. She stated the risk the Resident was lying flat he could be unable to breathe, safety issue serious hazard to him.Record

review of the facility policy titled Bed Safety dated December 2007 revealed, Our facility shall strive to provide a safe sleeping environment for the resident.The resident's sleeping environment shall be assessed by the interdisciplinary team, considering the resident's safety, medical condition, comfort, and freedom of movement as well as input from the resident.

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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Deerbrook Skilled Nursing and Rehab Center

9250 Humble-Westfield Rd Humble, TX 77338

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

light button was on the floor under the head of the bed. During an observation and interview on 11/19/25 at 07:53 a.m., revealed CNA C entered Resident #4's room and located the call light cord and button on the floor. CNA C picked up the call light button and put it within Resident #4's reach. She stated the call light was on the floor, and not next to Resident #4. She stated the problem was Resident #4 was not be able to call for help and anything could happen to her. CNA C stated if she was incontinent, she could not call for assistance and if there was an emergency she could not call for help.Interview with the CSD on 11/20/25 at 10:59 AM revealed the expectation for call light placement was residents should always have the call light within reach, and the call light should be placed on the resident's dominant side. He stated the risk to residents of not having had their call lights within reach was delayed care, and possible fall and injury.

Interview on 11/20/25 at 12:24 PM the Administrator stated her expectation was the call light button should always be within residents' reach clipped to residents' clothes or linen where they could reach it. She stated

the risk was the resident could not call for help if they sustained a fall, and not having their needs met.

Review of the facility policy titled Resident Call light System, dated June 2020, revealed, Purpose: The purpose of this procedure is to respond to the resident's requests and needs. Policy Implementation: A call light system (audible and visual) is in place and operative in the facility. This system allows individual residents to access a system that notifies nursing that the resident has a need. Residents can communicate with the Nurse's Station from their room and/or bathing and toileting facilities. General Guidelines: .4. Ensure that the call light is easily reachable by the resident.

Event ID:

Facility ID:

If continuation sheet