Baybrooke Village Care And Rehab Center

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

can treat any issues promptly and for general safety reasons. In interview with the DON on [DATE REDACTED] 11:02 AM, she stated that her expectations were not met with LVN A and LVN B's conduct. She was not notified of Resident #1's Lamotrigine issue until [DATE REDACTED] and immediately called the pharmacy to address the issue.

Additionally, she expected LVN A and LVN B to notify the provider if any resident medications were missed for any reason. She stated this was not done and it was not acceptable. She stated she was not sure why LVN A and LVN B did not escalate this concern up the chain of command, but she terminated both nurses as a result of their actions. She stated the issue with Resident #1's medication was related to an outstanding balance, and the pharmacy was withholding the medication until payment was received. She stated she received corporate approval to resolve the bill quickly so the resident would receive his medications as soon as possible. Additional intervention from the facility included extensive in-services and skills-checkoffs for staff that provide medications to the residents at the facility. She stated it was important for resident safety and to avoid a negative outcome for all residents to receive their prescribed medication

in a timely manner. In interview with the Administrator on [DATE REDACTED] at 3:48 PM, he stated his expectations were not met with LVN A and LVN B's conduct. He stated it was important for nurses to inform the provider if any resident medications were missed for any reason so the provider was aware and could consider appropriate actions and/or alternative options. He stated this was not done and resulted in LVN A and LVN B's termination. Record review of [Pharmacy] Request for Authorization to [NAME] House, dated [DATE REDACTED], revealed the facility's DON authorized the payment of Resident #1's outstanding balance to [Pharmacy].

Record review of Training In-Service Form, dated [DATE REDACTED] titled Resident Rights, Abuse + Neglect, and Medication Administration and Documentation, Notification to DON/Designee and MD When MD Not Available conducted by facility DON revealed multiple signatures including registered nurses, licensed vocational nurses, and certified medication aides. Education provided included:-Forgetting to administer medication on time is an example of neglect-Medication errors must be documented-What do to when a resident refuses medication-Informed consent of psychotropic medications -Resident rights related to medication administration-Responsibility of nurses to ensure residents remain free from any medication errors-When administering medications, the right route must be considered-It is necessary for all medications to have a clinical indication-Residents must have medication review within 24 hours of admission to the facility, including re-admissions-Injuries/Accidents/Falls are considered an adverse consequence to medication-Facility nurses are responsible for the clarification of a medication order they do not understand Record review of Competency Checklist, Skill/Procedure: Medication Administration, Feeding Tubes: Medication Administration Check-Off dated [DATE REDACTED] conducted by facility DON revealed multiple facility staff that provided medications to residents received a multi-step procedural review of their skills of medication administration. Record review of the facility's policy, Medication, rev. [DATE REDACTED] revealed Staff will assist the. authorized prescriber with medication orders in accordance with standard practice guidelines. 2. When medications are not available to staff to administer, medication aides will notify charge nurse. 3. Charge nurse will attempt to obtain medication from emergency kit. If not available, charge nurse will reach out to pharmacy for a STAT delivery. 4. Physician will be notified of missed doses due to medication availability. 7. Updates are communicated to provider as needed for additional information.

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

Baybrooke Village Care and Rehab Center

8300 Eldorado Parkway West McKinney, TX 75070

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

facility-wide elopement drill. Record review of facility Wander Drill, dated [DATE REDACTED] at 3:40 PM revealed documentation of a facility-wide elopement drill. Record review of facility Wander Drill, dated [DATE REDACTED] at 11:45 PM revealed documentation of a facility-wide elopement drill. Record review of facility's QAPI documentation, dated [DATE REDACTED], revealed Resident #1's elopement discussed with PHYSICIAN, Administrator, AND DON, Record review of Training In-Service Form, dated [DATE REDACTED] between 1:41 PM and 1:56 PM, titled Elopement Drill and Policy/Procedure Education, revealed multiple signatures including staff from administrative, therapy, dietary, housekeeping, and nursing departments. Education provided included:-Charge nurse role -Where to look for missing residents-Who to inform once a resident is missing-Once resident is located, nurse completes a head-to-toe assessment-To initiate incident report if not found after 30 minutes Record review of Training In-Service Form, dated [DATE REDACTED] titled Elopement Procedures, revealed multiple signatures including staff from administrative, therapy, dietary, housekeeping, and nursing departments. Education provided included facility's policy on elopement management. Record

review of Training In-Service Form, dated [DATE REDACTED] titled Protocol for Reporting Allegations of Abuse, revealed multiple signatures including staff from administrative, therapy, dietary, housekeeping, and nursing departments. Education provided included facility's policy on abuse, neglect, exploitation, and misappropriation of resident property. Record review of the facility's policy, Elopement Management, revised [DATE REDACTED] revealed An immediate investigation and search will be conducted if a resident is considered missing. The resident will be located and returned to a save environment within standard practice guidelines. Record review of the facility's policy, Abuse, Neglect and Exploitation and Misappropriation of Resident Property, revised [DATE REDACTED] revealed The purpose of this policy is to ensure that all healthcare facilities comply with federal and state regulations regarding protection of. residents from abuse, neglect, exploitation and misappropriation of resident property.

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

Baybrooke Village Care and Rehab Center

8300 Eldorado Parkway West McKinney, TX 75070

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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

facility. She stated it was important for resident safety and to avoid a negative outcome for all residents to receive their prescribed medication in a timely manner. In interview with Administrator on [DATE REDACTED] at 3:48 PM, he stated his expectations were not met with LVN A and LVN B's conduct. He stated it was important for nurses to inform the provider if any resident medications were missed for any reason so the provider was aware and could consider appropriate actions and/or alternative options. He stated his was not done and resulted in LVN A and LVN B's termination. Record review of [Pharmacy] Request for Authorization to [NAME] House, dated [DATE REDACTED], revealed the facility's DON authorized the payment of Resident #1's outstanding balance to [Pharmacy]. Record review of Training In-Service Form, dated [DATE REDACTED] titled Resident Rights, Abuse + Neglect, and Medication Administration and Documentation, Notification to DON/Designee and MD When MD Not Available conducted by facility DON revealed multiple signatures including registered nurses, licensed vocational nurses, and certified medication aides. Education provided included:-Forgetting to administer medication on time is an example of neglect-Medication errors must be documented-What do to when a resident refuses medication-Informed consent of psychotropic medications -Resident rights related to medication administration-Responsibility of nurses to ensure residents remain free from any medication errors-When administering medications, the right route must be considered-It is necessary for all medications to have a clinical indication-Residents must have medication review within 24 hours of admission to the facility, including re-admissions-Injuries/Accidents/Falls are considered an adverse consequence to medication-Facility nurses are responsible for the clarification of a medication order they do not understand Record review of Competency Checklist, Skill/Procedure: Medication Administration, Feeding Tubes: Medication Administration Check-Off dated [DATE REDACTED] conducted by facility DON revealed facility nursing staff received a multi-step procedural review of their skills of providing medications. Record review of facility policy, Medication, rev. [DATE REDACTED] revealed Staff will assist the. authorized prescriber with medication orders in accordance with standard practice guidelines. 2. When medications are not available to staff to administer, medication aides will notify charge nurse. 3. Charge nurse will attempt to obtain medication from emergency kit. If not available, charge nurse will reach out to pharmacy for a STAT delivery. 4. Physician will be notified of missed doses due to medication availability. 7.

Updates are communicated to provider as needed for additional information.

Event ID:

Facility ID:

If continuation sheet