Parkview Nursing And Rehabilitation Center

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

Resident #1 if he came back into the room. LVN A stated she did not know the name of the CNA but stated

they worked on the 400 hallway. LVN A explained to Resident #2 that Resident #1 had dementia and did not know any better. LVN A stated she notified the ADM and DON. LVN A stated that staff tried to keep an eye

on Resident #1, but after she went to lunch, she heard yelling, cursing, and Resident #2 was standing out

in the hallway. Resident #2 stated he pushed/hit Resident #1 and she observed Resident #1 lying on the floor by the door in Resident #2's room. LVN A stated she did an assessment and Resident #1 had pooled blood underneath him, redness on his face, wound on the head and she put a bandage on it because it was bleeding. LVN A called the DON, the ADM, 9-1-1 and EMS. LVN A had not known or seen Resident #1 to be aggressive with any other residents prior to the incident; only staff. LVN A had been trained in abuse policy, identification and de-escalation of behaviors, and preventing resident-to-resident altercations.During

an interview with the DON on 11/19/2025 at 4:55 PM the DON stated she did know who the C.N.A was who had reported to LVN A before the incident when Resident #1 had wandered into Resident #2's room and Resident #2 had threatened to harm Resident #1 if he returned, she said she would need to investigate that. During an interview with the ADM on 11/20/2025 at 9:23 AM, the State Surveyor asked for all documentation related to the incident on 11/08/2025 as there were no statements or interviews in the provider investigation. Review of the police report reflected Resident #3 was listed as a witness. Review of

the facility provider investigation reflected an undated witness statement by Resident #3. Resident #3 had reported Resident #1 came in and Resident #2 punched him.hit him. During an interview with Resident #3

on 11/20/2025 at 2:02 PM, Resident #3 stated he used to be Resident #2's roommate and was lying in bed when the incident occurred on 11/08/2025. Resident #1 came into their room and Resident #2 punched him (Resident #1) in the face as hard as he could. Resident #1 fell backwards and might have hit something.

Staff immediately responded and took Resident #2 out of the room and a nurse helped Resident #1. The DON was presented with the IJ template at 11/20/2025 at 6:19 PM and it was explained that the IJ was PNC and there was no current immediacy. During an interview with the DON on 11/20/2025 at 6:45 PM,

she stated she did not find out the identity of the CNA that talked to LVN A and warned LVN A that Resident #2 had threatened to hit Resident #1. The DON stated she was not aware of the progress note until the State Surveyor pointed it out in Resident #2's chart. The ADM was unable to interview prior to exit as he had left the facility. Review of in-service dated 11/08/2025 reflected abuse policy, identification and de-escalation of behaviors, and preventing resident-to-resident altercations were reviewed with most staff.

Review of facility policy titled Abuse, Neglect, Exploitation, and Misappropriation Prevention Program dated April 2021 reflected, Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation.1. Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: b. other residents. Review of facility policy titled Identifying Types of Abuse dated September 2022 reflected, 1. Abuse of any kind against residents is strictly prohibited. 4. Abuse is defined as the willful infliction of injury.with resulting physical harm, pain or mental anguish. Physical Abuse: 1. Physical abuse includes, but is not limited to hitting, slapping, biting, punching, or kicking. Review of facility policy titled Resident Rights dated February 2021 reflected:1.

Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: c. be free from abuse, neglect, misappropriation of property, and exploitation.

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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

Parkview Nursing and Rehabilitation Center

1501 S Main St Lockhart, TX 78644

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 0689 Level of Harm - Immediate jeopardy to resident health or safety

Each resident will receive adequate supervision and assistive devices to prevent accidents. This includes:

1. 1. Identifying hazard(s) and risk(s).2. Evaluating and analyzing hazard(s) and risk(s). 3. Implementing

interventions to reduce hazard(s) or risk(s). 4. Monitoring for effectiveness and modifying interventions as necessary. Definitions: Risk refers to any external factor, facility characteristic (e.g. staffing or physical environment) or characteristic of an individual resident that influences the likelihood of an accident.

Supervision/Adequate Supervision refers to intervention and means of mitigating risk of an accident.

Residents Affected - Few

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

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