Jourdanton Nursing And Rehabilitation

F 0583

Keep residents' personal and medical records private and confidential.

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 residents had the right to personal privacy and confidentiality of their personal and medical records for 1 of 1 resident (Resident #11) reviewed for resident rights. The facility failed to ensure CNAs H and I completely closed Resident #11's privacy curtain while providing perineal care for the resident. This deficient practice could place residents at risk of loss of dignity.The findings were: Record review of Resident #11's face sheet, dated 11/21/2025, revealed

an admission date of 12/03/2014, and a readmission date of 10/19/2020. Resident #11 had diagnoses which included: Vascular dementia (decline in cognitive abilities), Schizoaffective disorder (mental disorder characterized by abnormal thought processes and an unstable mood), Hypertension (High blood pressure), Type 2 diabetes mellitus (high level of sugar in the blood), and Irritable bowel syndrome (chronic disorder affecting the large intestine, causing symptoms like abdominal pain, bloating, gas, constipation, or diarrhea)

Record review of Resident 11's Quarterly MDS, dated [DATE REDACTED], revealed the resident had a BIMS score of 09, which indicated moderate cognitive impairment, and was indicated to always be incontinent of bowel and bladder. Record review of Resident 11's care plan, dated 09/26/2025, revealed a problem of Impaired Skin Integrity related to history of excoriation on the scrotum due to moisture, friction, or incontinence and

an intervention of Maintain proper incontinence care. Observation on 11/20/2025 at 6:33 a.m. revealed CNAs H and I provided incontinent care for Resident #11. During care CNAs H and I did not pull the curtain to offer privacy to the resident. Resident #11 could be seen by his roommate and could have been seen by someone opening the room's door. During an interview with CNAs H and I on 11/20/2025 at 6:35 a.m., CNAs H and I stated the privacy curtain was not closed while they provided care for Resident #11 but should have been. They stated they were nervous and had forgotten. CNAs H and I stated they received resident rights training from the DON within a year. During an interview with the DON on 11/20/2025 at 7:11 a.m., the DON stated privacy must be provided during nursing care and Resident #11's privacy curtain should have been closed completely to prevent loss of dignity for the resident. She stated the staff received resident rights training within the year and skills were checked annually and as needed. Record review of

the facility's policy titled, Resident rights dated 2025, revealed, The resident had a right to personal privacy and confidentiality [ .] Personal privacy includes accommodations, medical treatment [ .].

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jourdanton Nursing and Rehabilitation

1504 Highway 97e Jourdanton, TX 78026

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 0641 Level of Harm - Minimal harm or potential for actual harm

resident. She stated the nurses and CNAs did not look at the MDS Assessments. Record review of the facility's policy, Documentation in Medical Record, dated as Copyright 2024, reflected: Policy: Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation.

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jourdanton Nursing and Rehabilitation

1504 Highway 97e Jourdanton, TX 78026

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

assessment would have been detrimental for him because his incontinence brief was changed as needed, so if he had any skin impairments, there would be someone whose eyes would have been on the skin to notify the appropriate people. During an interview on 11/20/2025 at 01:47 p.m., the ADMIN stated the impact of a resident having missed a skin assessment would depend on the resident, their dietary needs, and their functional needs. She stated for a resident that who had his incontinent brief changed frequently and had received shower assistance, the aides would have seen his skin multiple times per day. The ADMIN stated she did not believe Resident #2 would have been impacted by a missed skin assessment because he was constantly monitored by therapy staff, received incontinent care and shower assistance, and his meal intake was pretty good. Record review of the facility's policy, Skin Assessment, dated as Copyright 2025, reflected: Policy: It is our policy to perform a full body skin assessment as part of our systematic approach to pressure injury prevention and management. This policy includes the following procedural guidelines in performing the full body skin assessment.Policy Explanation and Compliance Guidelines:1. A full body, or head to toe, skin assessment will be conducted by a licensed or registered nurse upon admission/re-admission, daily for three days, and weekly thereafter.7. Documentation of skin

assessment

a. Include date and time of the assessment, your name, and position title. b. Document

observations (e.g. skin conditions, how the resident tolerated the procedure, etc.). c. Document type of wound. d. Describe wound (measurements, color, type of tissue in wound bed, drainage, odor, pain). e.

Document if resident refused assessment and why. f. Document other information as indicated or appropriate.

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jourdanton Nursing and Rehabilitation

1504 Highway 97e Jourdanton, TX 78026

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 Residents Affected - Few

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

Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **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 incontinent of bladder received appropriate treatment and service to prevent urinary tract infections and to restore continence to the extent possible for 1 of 1 resident (Resident #11) resident reviewed for incontinent care and catheter care. The facility failed to ensure CNA H retract Resident #11's foreskin (the retractable roll of skin covering the end of the penis) while providing incontinent care . This deficient practice could place residents at-risk for infection and skin break down The findings were: Record review of Resident #11's face sheet, dated 11/21/2025, revealed an admission date of 12/03/2014, and a readmission date of 10/19/2020. Resident #11 had diagnoses which included: Vascular dementia (decline in cognitive abilities), Schizoaffective disorder (mental disorder characterized by abnormal thought processes and an unstable mood), Hypertension (High blood pressure), Type 2 diabetes mellitus (high level of sugar in the blood), and Irritable bowel syndrome (chronic disorder affecting the large intestine, causing symptoms like abdominal pain, bloating, gas, constipation, or diarrhea) Record review of Resident 11's Quarterly MDS, dated [DATE REDACTED], revealed the resident had a BIMS score of 09, which indicated moderate cognitive impairment. Resident #11 was indicated to always be incontinent of bowel and bladder. Record review of Resident 11's care plan, dated 09/26/2025, revealed a problem of Impaired Skin Integrity related to history of excoriation on the scrotum due to moisture, friction, or incontinence and an intervention of Maintain proper incontinence care.

Observation on 11/20/2025 at 6:33 a.m. revealed while providing incontinent care for Resident #11, CNA H did not retract the foreskin of the resident, therefore not properly cleaning the head of Resident #11's penis.

During an interview on 11/20/2025 at 6:35 p.m. with CNA H, he stated he did not retract the foreskin of Resident #11's penis. CNA H was unclear why he did not retract the foreskin but knew he had to clean underneath it. He stated he received incontinent care training from the DON. During an interview with the DON on 11/20/2025 at 7:11 a.m., she stated that in the case of an uncircumcised male resident, the foreskin should be retracted to provide proper hygiene and prevent infection and skin breakdown. She stated providing incontinent care training for the staff within the year. Skills were checked annually and as needed. Record review of the facility's policy titled Perineal care, dated 2024, revealed, gently retract the foreskin if applicable .

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jourdanton Nursing and Rehabilitation

1504 Highway 97e Jourdanton, TX 78026

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

01:47 p.m., the ADMIN stated if she saw a blank in a resident's MAR/TAR, she would not know what happened, if the medication was given or no She stated it would be the same issue if see progress note was documented and there was not a progress note, she would have to bring that staff member back and make sure that they documented what happened. Record review of the facility's policy, Medication Administration, dated as Copyright 2025, reflected: .Policy Explanation and Compliance Guidelines:.20.

Sign MAR after administered.23. Correct any discrepancies and report to nurse manager. Record review of

the facility's policy, Documentation in Medical Record, dated as Copyright 2024, reflected: Policy: Each resident's medical record shall contain an accurate representation of the actual experiences of the resident and include enough information to provide a picture of the resident's progress through complete, accurate, and timely documentation.

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Jourdanton Nursing and Rehabilitation

1504 Highway 97e Jourdanton, TX 78026

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

Provide and implement an infection prevention and control program.

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 establish and maintain an Infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent

the development and transmission of communicable disease and infection for 1 of 1 resident (Resident #11) reviewed for infection control, in that: 1. The facility failed to ensure CNAs H and I washed their hands

before starting to provide incontinent care for Resident #11. 2. The facility failed to ensure CNA H sanitized his hands between change of gloves during incontinent care for Resident #11 . These deficient practices could place residents at-risk for infection due to improper care practices.The findings were: Record review of Resident #11's face sheet, dated 11/21/2025, revealed an admission date of 12/03/2014, and a readmission date of 10/19/2020. Resident #11 had diagnoses which included: Vascular dementia (decline

in cognitive abilities), Schizoaffective disorder (mental disorder characterized by abnormal thought processes and an unstable mood), Hypertension (High blood pressure), Type 2 diabetes mellitus (high level of sugar in the blood), and Irritable bowel syndrome (chronic disorder affecting the large intestine, causing symptoms like abdominal pain, bloating, gas, constipation, or diarrhea). Record review of Resident #11's Quarterly MDS, dated [DATE REDACTED], revealed the resident had a BIMS score of 09, which indicated moderate cognitive impairment. Resident #11 was indicated to always be incontinent of bowel and bladder. Record

review of Resident #11's care plan, dated 09/26/2025 , revealed a problem of Impaired Skin Integrity related to history of excoriation on the scrotum due to moisture, friction, or incontinence and an intervention of Maintain proper incontinence care. Observation on 11/20/25 at 6:33 AM revealed CNAs H and I did not wash their hands after entering Resident #11's room and before providing incontinent care for Resident #11. CNA H did not sanitize his hands between change of gloves, after cleaning the resident's buttocks and

before touching the clean briefs. During an interview with CNAs H and I, on 11/20/2025 at 6:35 a.m., they stated they had not washed their hands before starting the care. CNA H stated he changed his gloves

before touching the clean briefs but did not use sanitizer between change of gloves. They stated they forgot but knew hand hygiene was important to prevent infection for the residents. They stated they received infection control training at least once a year . During an interview with the DON on 11/20/2035 at 7:11 a.m., she stated staff had to wash their hands before starting to provide care for a resident and had to use sanitizer or wash their hands between change of gloves to prevent the spread of infection. She stated she provided infection control training at least annually and the staff's skills were checked annually and as needed. Record review of the facility's policy, titled Infection control guidelines for all nursing procedures, dated quarter 3 of 2018, revealed Employees must wash their hands for ten to fifteen seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: a. Before and after direct contact with residents [ .] In most situations, the preferred methos of hand hygiene is with alcohol-based hand rub [ .] use an alcohol-based rub [ .] before moving from contaminated body site to clean body site

during resident care [ .] after removing gloves.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet