Lakeside Health And Wellness

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

talking loudly and in a very demeaning manner to Resident #1 CNA F stated she removed Resident #1 and took him to his room and then informed the nurse. Record review of CNA F's written statement dated 03/01/2025 revealed she observed what she felt were patronizing and demeaning words from CNA D towards Resident #1.During an interview on 11/19/2025 at 11:30 a.m., LVN G confirmed her statement that

she overheard AP CNA D loudly talking to Resident #1 in a very condescending manner and when he was able to respond to her, AP CNA D told him he was tripping. LVN G stated that she intervened, asked AP CNA D to clock out and go home and then contacted the Abuse Coordinator. Record review of LVN G's statement dated 03/01/2025 revealed she overheard CNA D loudly speaking to Resident #1 and asked her to lower her voice and communicate more professionally with the resident. LVN G noted in her statement that CNA D was standing over Resident #1 who was in a wheelchair at the time, and she felt the tone of her voice was condescending. During an interview on 11/19/2025 at 5:01 p.m., the DON stated that she expects all staff to report any case of verbal abuse and intervene at the time of occurrence to keep the resident safe. The DON stated that all new hires receive on-boarding training for Abuse, Neglect & Exploitation and in-services are completed annually and as needed for any concern of abuse. She stated adverse effects of verbal abuse on the resident could be psychosocial wellbeing concerns, increased behaviors or alterations in mood state. The DON stated she was not employed at the facility at the time of

this reported incident and has no firsthand knowledge of the incident. During an interview on 11/19/2025 at 5:29 p.m., the Administrator stated that she was not working at the time of this incident and stated that she expects staff to notify her right away of any concern of abuse. The Administrator stated that she would lead

the investigation for any concerns of abuse and ensure the AP is suspended pending completion of the investigation. The Administrator stated she would ensure that a complete psychosocial assessment and follow-up are completed. The Administrator stated she is ultimately responsible for all aspects of the investigation. The Administrator stated she was not employed at the facility at the time of this reported incident and has no firsthand knowledge of the incident. Record review of the PIR dated 03/07/2025 revealed that CNA D was suspended pending investigation and CNA D verbally quit during the investigation period on 03/03/2025 and did not return to the facility or return calls from the Administrator. Record review of the facility policy titled Abuse, Neglect, and Exploitation revised on 01/08/2023 reflected, Each resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion and financial abuse.

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeside Health and Wellness

110 N State Hwy 274 Kemp, TX 75143

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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

misappropriation of monies from residents. The Administrator stated she was not employed at the facility at

the time of this incident and noted that misappropriation could affect the overall psychosocial wellbeing of residents and their safety within the facility. Review] of facility policy titled; Resident Abuse and Neglect Policy, dated 2021 revealed in part: 1. When an incident of theft and/or misappropriation of resident property is reported, the Administrator will investigate the incident. Misappropriation of resident property is defined as 2. use of a resident's belongings or money without the resident's consent and all residents will be free from deliberate misplacement, exploitation, temporary or permanent use of a resident's belongings or money without the resident's consent.

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeside Health and Wellness

110 N State Hwy 274 Kemp, TX 75143

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to review and revise Resident Care Plans after each assessment for 1 of 4 Residents (Resident #3) whose records were reviewed for care plan revision/timing, in that: The care plan of Residents #3 was not updated to reflect a pureed diet. This deficient practice could affect any resident and contribute to residents not receiving the care and services

they need.The findings included:Record review of Resident #3's admission Record, dated 11/18/2025, revealed a [AGE] year-old male admitted [DATE REDACTED] and readmitted [DATE REDACTED] with diagnoses to include dementia (a decline in mental ability that affects memory, thinking, and daily function), dysphagia (swallowing difficulty), Chronic Obstructive Pulmonary Disease (a progressive group of lung diseases that make it difficult to breathe), Peripheral Vascular disease (a circulation disorder affecting the arteries and veins outside of the heart caused by blockage from plaque buildup), Obstructive Uropathy (a condition where a blockage in the urinary tract causes urine to back up), osteoarthritis (inflammation of one or more joints causing pain, swelling, stiffness as the protective cartilage that cushions bones wears down over time) and depression (a serious mood disorder with symptoms including persistent sadness, loss of interest, fatigue and sleep or appetite changes). Record review of Resident #3's comprehensive MDS, dated [DATE REDACTED], revealed a BIMS score of 0, indicating severe cognitive impairment. Record review of Resident #3's comprehensive MDS, dated [DATE REDACTED], revealed that Resident #3 had upper and lower extremity impairments, required use of a wheelchair for mobility, supervision with eating, maximum assistance in toileting/peri-care, upper body dressing, bed mobility, was dependent in lower body dressing, bathing and transfers. Record

review of Resident #3's comprehensive MDS, dated [DATE REDACTED] revealed resident receives a mechanically altered diet.Record review of Resident #3's care plan, undated, viewed 11/18/2025 revealed a focus problem dated 05/07/2024 and revised 08/04/2025 indicating Resident's diet is: Regular mechanical soft diet with thin liquids. Record review of November 2025 physician's orders for Resident #3 revealed an order for Regular diet, pureed texture dated 10/01/2025. During an interview and observation on 11/19/25 at 12:45 p.m. with Resident #3, observed pureed textured tray served to resident. Resident stated he has been receiving baby food for a while now. During an interview on 11/19/2025 at 3:32 p.m., the MDS Nurse LVN B stated she reviews new orders daily in the morning meeting and updates the care plans accordingly.

The MDS Nurse LVN B stated she has been working here since June 2025 and is still updating individual care plans. The MDS Nurse LVN B stated that it is her responsibility to update the care plans to reflect each residents' needs. During an interview on 11/19/2025 at 5:01 p.m., the DON stated that she expects nursing staff and primarily the MDS Nurse to review and update the care plans as orders are received with quarterly reviews. The DON stated that care plans not matching physician's orders could result in harm or injury to a resident. The DON stated that a resident who received the wrong diet could experience aspiration or even death. The DON stated she is ultimately responsible for the accuracy and completeness of the care plans.During an interview on 11/19/2025 at 5:29 p.m., the Administrator stated that she expects

the nursing staff to monitor and update the care plans as needed and that not adhering to the physician's orders and the physician's orders not matching the care plan could result in harm, injury or even death to

the resident. Record review of the facility policy, titled Care Plan Process, undated, revealed .the resident's care plan must be .revised based on changing goals, preferences and needs of the resident and in response to current interventions. and the facility interdisciplinary team utilizes the CMS requirements of

the Resident Assessment Instrument as policy for reviewing and revising care plans.

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeside Health and Wellness

110 N State Hwy 274 Kemp, TX 75143

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

are responsible for ensuring orders are carried out. The DON stated that orders are reviewed in the stand-up meeting in the mornings and noted that the order to remove the staples for Resident #4 was inaccurately coded in the EMR program which meant the orders for removal were not placed correctly on

the TAR for the Treatment Nurse to complete. The DON stated she would complete an Inservice to ensure

the floor nurses know how to properly input orders in the EMR system. The DON stated the staples not being removed could result in further injury if the staples become embedded in the skin or infection. During

an interview on 11/19/2025 at 5:29 p.m., the Administrator stated that all residents would be at risk for not having orders followed if nursing staff did not accurately in-put orders into the EMR system. The Administrator stated that failure to follow physician's orders could result in residents not receiving the appropriate care as directed by the physician. Requested policy for Skin and Wound Management on 11/19/2025 at 4:50 p.m. from the DON, did not receive prior to survey exit.

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

11/19/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeside Health and Wellness

110 N State Hwy 274 Kemp, TX 75143

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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

dated. The Administrator said the failure placed a risk is for infection control and no water in the bottle could have caused dryness for Resident #6. The Administrator said Resident #6 should have had an order for oxygen use. The Administrator said the failure of not having an order for oxygen placed a risk for error and for nurses not knowing the parameters and liters Resident #6 should have received. Record review of the facility policy Oxygen Administration revised October 2010 indicated: Purpose The purpose of the procedure is to provide guidelines for safe oxygen administration. Preparation 1. Verify that there is a physician's order.14. Periodically re-check the water level in the humidifying jar. The policy did not indicate how often to clean and change the tubing.

Event ID:

Facility ID:

If continuation sheet