Lakeside Rehabilitation And Care Center

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

just looked at the Administrator and did not respond. Resident #1 stated he was fine, and the incident did not affect him negatively. He stated he did not feel intimidated and had not changed his usual patterns in

the facility. He stated he likes to stay up late and sleep late and staff accommodate him and let him do the things he wants to do. In a telephone interview on 08/27/25 at 4:05 PM, the RNC stated Housekeeper B told her about the incident with Resident #1 and the Administrator's hand gesture. She stated she did not speak to Resident #1, but he did not report any issues in the Safe Survey. She stated she did not feel it was

a reportable incident of abuse because a lot of time had passed (from 04/29/25 - 05/08/25 ten days). She stated the Administrator was verbally counseled regarding the incident, but it was not a written counseling.

She stated in response to the incident and residents' responses on the Safe Surveys dated 05/08/25 an in-service on abuse was conducted, but no further investigations were conducted into any of the allegations

on the surveys. In a telephone interview on 08/27/25 at 4:09 PM, the RDO stated he over saw 20 facility's and it had been sometime since the incidents so he might not remember all the details or the timeline. He stated the former DON and ADON's complaints about theAdministrator were emailed to him. He stated the RNC was tasked with investigating the DON's complaint. He stated he could not remember the details of

the complaint or the timeline to say if the allegation was reportable. He stated he believed the RNC shared

the results of her investigation with him. He stated the finger gesture was bordering on reportable but sounded like it was reportable. He stated he was not aware Resident #1 was not interviewed by the RNC.

He stated he was not sure what action was taken regarding the incident, but he thinks the Administrator was counseled. In a confidential telephone interview it was stated they heard about the Administrator flipping Resident #1 off. They stated they heard Resident #1 tell the former ADON, I don't know why he would feel comfortable doing that with me because we don't have a relationship like that. During the exit conference on 08/28/25 at 1:04 PM the Administrator stated he disagrees with findings. He adamantly denied the allegation he flipped Resident #1 off. He stated he was not counseled by the RNC and all she said was, if you did it don't do it again. Record review of the facility's Resident Rights policy dated December 2016 reflected employees shall treat all residents with kindness respect and dignity.

Event ID:

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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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeside Rehabilitation and Care Center

4306 24th St Lubbock, TX 79410

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

lot of time had passed (from 04/29/25 - 05/08/25 ten days). She stated the Administrator was verbally counseled regarding the incident, but it was not a written counseling. She stated in response to the incident and residents' responses on the Safe Surveys dated 05/08/25 an in-service on abuse was conducted, but no further investigations were conducted into any of the allegations on the surveys. In a telephone interview

on 08/27/25 at 4:09 PM, the RDO stated he over saw 20 facility's and it had been sometime since the incidents so he might not remember all the details or the timeline. He stated the former DON and ADON's complaints about theAdministrator were emailed to him. He stated the RNC was tasked with investigating

the DON's complaint. He stated he could not remember the details of the complaint or the timeline to say if

the allegation was reportable. He stated he believed the RNC shared the results of her investigation with him. He stated the finger gesture was bordering on reportable but sounded like it was reportable. He stated

he was not aware Resident #1 was not interviewed by the RNC. He stated he was not sure what action was taken regarding the incident, but he thinks the Administrator was counseled. In a confidential interview on 08/28/25 at 7:22 AM, it was said they heard about the Administrator flipping Resident #1 off. They stated

they heard Resident #1 tell the former ADON, I don't know why he would feel comfortable doing that with me because we don't have a relationship like that. They stated they followed up with the resident about a week later and the resident said no one had come to talk with him about it but he was told it's been taken care of. They stated they were not interviewed by the RNC regarding the allegation. They stated all the staffing changes made them not feel comfortable to report anything to the Administrator or Corporate.

During the exit conference on 08/28/25 at 1:04 PM, the Administrator stated he disagrees with findings. He adamantly denied the allegation he flipped Resident #1 off. He stated he was not counseled by the RNC and all she said was, if you did it don't do it again.

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

08/28/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Lakeside Rehabilitation and Care Center

4306 24th St Lubbock, TX 79410

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

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

interview on 08/28/25 at 7:22 AM, staff stated they heard about the Administrator flipping Resident #1 off.

The staff stated they heard Resident #1 tell the former ADON, I don't know why he would feel comfortable doing that with me because we don't have a relationship like that. The staff stated they followed up with the resident about a week later and the resident said no one had come to talk with him about it but he was told it's been taken care of. The staff stated they were not interviewed by the RNC regarding the allegation. The staff stated all the staffing changes made them not feel comfortable to report anything to the Administrator or Corporate. In an interview on 08/28/25 at 9:30 AM, Resident #4 stated staff were not rude or abusive to her. She stated sometimes staff tell her they are going to do something and then they don't. In an interview

on 08/28/25 at 10:08 AM, the Administrator stated, regarding the residents' responses to the Safe Surveys and the lack of Grievances, the first week in April 2025 the facility had a re-certification survey, and grievances was cited, so he completed his plan of correction for the process. He stated the responses were from 05/08/25 and he could narrow down who the staff in question was. He stated he has done customer service and resident rights in-services but a lot of the staff working during this time, May 2025, were no longer working because the facility had an 80% turnover in aides. In an interview on 08/28/25 at 10:15 AM, Resident #3 stated she liked the facility and did not report any abuse or rudeness from the staff. In an

interview on 08/28/25 at 10:52 AM, Resident #8 reported no issues with his care and treatment in the facility. In an interview on 08/28/25 at 10:56 AM, Resident #6 reported no issues or concerns regarding her care or treatment in the facility. In an interview on 08/28/25 at 10:58 AM, Resident #9 had no complaints about her care or treatment in the facility. In interview on 08/28/25 at 11:05 AM Resident #12 reported no issues with his care or treatment in the facility. In an interview on 08/28/25 at 11:38 AM, the SW stated she did the Safe Surveys and gave them to the RNC on 05/08/25, but the RNC did not give her any further instructions. She stated when the Administrator returned from his suspension she gave him a copy of the Safe Surveys. She said she could not remember if she gave him a physical copy or emailed a copy to him

In an interview on 08/28/25 at 11:43 AM, the SW said she had no record of emailing the Safe Surveys to

the Administrator so she must have handed a copy to him. During the exit conference on 08/28/25 at 1:04 PM, the Administrator stated he disagrees with findings. He adamantly denied the allegation he flipped Resident #1 off. He stated he was not counseled by the RNC and all she said was, if you did it don't do it again.

Event ID:

Facility ID:

If continuation sheet