Paradigm At Katy

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Administrator on 11/20/ 2025 at 1:44pm, he said he was not the Administrator at the time and was not notified or aware about the fall on 07/28/2025. He found the initial report and facility investigation but could not find the 5-day investigation. The Administrator said if the investigation report was not sent in, there was

a possibility that the investigation would not be completed. If the investigation was not done, then an issue related to CR #1's fall could have remained unaddressed. The Administrator said the goal was to focus on taking care of residents.Record review of facility's Abuse/ Neglect & Exploitation Policy dated 04/2024 reflected the facility will report all alleged violations, involving abuse, neglect, exploitation or mistreatment including injuries of unknown source to the administrator or a designee and reports any alleged abuse, neglect, exploitation or mistreatment including injuries of unknown source should also be reported to other officials including to the state agency in accordance with applicable state law.

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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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Paradigm at Katy

1480 Katy Flewellen Katy, TX 77494

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

Based observation, interview, and record review, the facility failed to 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 diseases and infections for one (Hallway A) of four hallways observed for infection control. -CNA K left her hooded jacket and eyeglass case of the clean linen cart in Hallway A.This failure could place the residents at risk of cross-contamination and development of infection. During an observation and interview with RN C of a clean linen cart on Hallway A on 11/19/2025 at 12;19pm, there was an eyeglass case laying directly on top of a black zip-up jacket which was laying on top of the green mesh covering of the clean linen cart. The wheeled cart contained folded linen sheets and briefs inside the mesh cover. RN C said those items should not have been there and that it was an infection control issue. Interview with CNA B on 11/19/2025 at 1:55pm, she said she was one of the CNAs working

on Hallway A but was not the person who put the jacket on the cart. CNA B said the jacket and eyeglass case should not have been there and that could be an infection control issue. Personal items could be placed in a locker or purse. Interview with CNA K on 11/19/2025 at 2:00pm, she said she was giving a resident a bed bath and then her sleeves of her jacket got wet, so she took it off and placed it along with her eyeglass case on the clean linen cart because she had to get back to the resident. CNA K apologized and said she shouldn't have done that and that it was an infection control issue. CNA K said she should have put it up somewhere else. Interview with the ADON on 11/20/2025 at 1:39pm, he said he was also the Infection Preventionist at the facility. The ADON said everything in the cart was for residents and that staff items like the jacket and eyeglass case should not have been on the cart. The facility had halls with major infections and if those items came into contact with staff, infections could spread to residents and vice versa. Interview with the Administrator on 11/20/2025 at 1:44pm, he said that the staff personal items should not have been on the cart. He said it would have been hard to say if the jacket would have caused

an infection control issue. If the jacket was wet, then it might be an infection control issue, but he did not know the state of the jacket on the linen cart.Interview with the DON on 11/20/2025 at 3:01pm, she said the clothing items should not have been on the cart. She was going to do another audit on CNA K and do some re-training. The DON said a negative outcome of the clothing item on the clean linen cart could be infection control and that the facility needed to maintain their isolation protocol.Record review of the facility's policy

on Infection Control last revised on 6/2024 read in part, The Facility is dedicated to maintaining a safe and healthy environment by implementing an effective infection control program that adheres to state and federal regulations . Environmental Safety .The cleanliness and hygiene standards within The Facility are paramount for effective infection control practices .Includes: regular disinfection of high-touch surfaces, proper handling and disposal of contaminated materials, and maintenance of optimal ventilation and air quality.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet