Mesquite Village Wellness & Rehabilitation

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

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

stated she forgot because it had been so long ago last year 2024. She stated she was not aware he had a wound care consult. Interview on 08/20/25 at 3:21 pm, CNA R stated she remembered Resident #1, he had

a sore on his butt more like circular and sometime would see just a little blood coming from it last year

1. 2024. Interview on 08/22/25 at 4:16 pm, former CNA U stated Resident #1 had a wound and noticed it

when she started working at that facility last September 2024 up until he discharged this facility. Interview

on 08/20/25 at 12:46 pm, MDS P stated the timeframe for completing care plan she was not sure. She stated for new diagnosis she would create a care plan and discuss in the IDT meeting. She stated she was not sure why Resident #1's pressure injury diagnosis was not care planned because she was not the MDS Coordinator at that time. She stated she went over the resident's documentation weekly by using a calendar to check five residents per day their nurses notes, doctor's notes and hospital records and psychiatric records for any new additions to the resident's EMR profile. She stated if the diagnosis were not added the resident could have a change of condition and need to go to the hospital or get infections. She stated the resident might receive improper care, not get the right treatment for skin issue. She stated they had 14 days to revise care plan as soon as she was aware of the new diagnosis. Interview on 08/21/25 at 4:57 pm, the Administrator stated the MDS Coordinator was responsible for ensuring medical records were accurate and care plans are updated. She stated the timeframe for inputting new diagnosis into care plans was 14 days.

Record review of the Facility's Care Plan Policy Revised March 2022 revealed, Policy Statement: The Interdisciplinary team is responsible for the development of the care plan. Policy Interpretation and Implementation: 1. Resident care plans are developed according to the timeframes and criteria established by 483.21 and 2. Comprehensive person centered care plans are based on resident assessments and developed by an interdisciplinary team (IDT).

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mesquite Village Wellness & Rehabilitation

825 W. Kearney Street Mesquite, TX 75149

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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

shower sheets and thought the nurses documented in the nurses notes. She stated Resident #1 had dry skin on the bottom of legs and his butt wound bled a little bit at times. She stated the last time Resident #1's butt wound bled was a couple of times before he discharged this facility. She stated the time his butt wound bled, she completed the shower sheet, then the nurse put the cream on it. She stated sometimes Resident #1 did not have a dressing on it and if it drained, a dressing was put on it. She stated she was not sure if

the nurse managers were aware of his butt wound but the shower sheets were completed and the nurse put them in the drawer at the nurses station. Interview on 08/20/25 at 12:01 pm, LVN N stated Resident #1 had

a sore with a dressing on his coccyx and was kind of not sure of the size. She stated she forgot because it had been so long ago last year 2024. She stated she was not aware he had a wound care consult.

Interview on 08/22/25 at 4:16 pm, former CNA U stated Resident #1 had a wound and noticed it when she started working at that facility last September 2024 up until he discharged this facility. She stated when she would give him a shower, she would pat the area of his butt really softly. She stated she did not see Resident #1's butt sore healed. She stated at times his butt wound bled a little bit and was about the size of

a quarter. She stated she spoke to the nurses and they put dressing and cream on it and added LVN C was good about putting the dressing on his wound. She stated she did not see other nurses doing the skin treatments after he showered but LVN C. She stated sometimes Resident #1 was in pain because of the butt wound. She stated DON O started working there and he was not too talkative and did not say hello to

the CNA's and would just walk by them, so she never talked to him about anything. She stated she did not see ADON G to talk about Resident #1's wound but did talk to the nurses about it. Interviews on 08/21/25 b[TRUNC

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mesquite Village Wellness & Rehabilitation

825 W. Kearney Street Mesquite, TX 75149

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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

it last year 2024. Interview on 08/22/25 at 4:16 pm, former CNA U stated Resident #1 had a wound and noticed it when she started working at that facility last September 2024. Interview on 08/20/25 at 4:21 pm, DON O stated the physician orders were supposed to be followed and the nursing staff worked under the Doctors. He stated they could not do anything arbitrarily and do something different than what the Doctor ordered. Interview on 08/21/25 at 4:57 pm, the Administrator stated ADON G and DON O could not override what the Doctor's orders were. She stated the Doctors orders superseded what ADON G and DON O thought and they should also follow the Doctor's orders to ensure the residents received proper treatment. Interview on 08/21/25 at 5:42 pm, ADON G stated she had a training about wound care from DON O yesterday (08/19/25) and another wound care training by text from the RN Consultant today (08/20/25). She stated if it is a wound and the resident had a wound care consult order, she was going to make sure the referral was sent to the Wound Care Doctor. She stated she was going to send it to the Wound care Doctor regardless of what she thought because it was a Doctor's order. Record review of the Facility's QAPI policy dated February 2020 revealed, Policy Statement: This facility shall develop, implement, and maintain an ongoing, facility wide, data-driven QAPI Program that is focused on indicator of

the outcomes of care and quality of life for our residents. Policy Interpretation and implementation: 1.

Provide a means to measure current and potential indicators for outcomes of care and quality of life. 2.

Provide a means to establish and implement performance improvement projects to correct identified negative or problematic indicators. Authority 1. The owner and/or governing board (body) of our facility is ultimately responsible for the QAPI program. Implementation:1. The QAPI Committee oversees implementation of our QAPI Plan, which is the written component describing the specifics of the QAPI program, how the facility will conduct its QAPI functions, and the activities of the QAPI Committee.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mesquite Village Wellness & Rehabilitation

825 W. Kearney Street Mesquite, TX 75149

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

arbitrarily and do something different than what the Doctor ordered. Interview on [DATE REDACTED] at 4:57 pm, the Administrator stated she was not sure why Resident #1 did not get the ammonium lactate ointment for his legs. She stated some nurses gave Resident #1 the ointment and others did not.[ She stated for Medication administering the ADON and DON were responsible for ensuring the services were being done. Record

review of LVN H's Record of in-service dated [DATE REDACTED] by DON O revealed, If medications aren't available, it is the charge nurses responsibility to call pharmacy. Meds (Medications) can be pulled from E-kit if not available. MD notification must be made so med (medication) can be placed on hold and/or change to an alternative. and this document was signed by LVN H. Record review of the facility's Medication and Administration Policy Revised [DATE REDACTED] revealed, Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Policy Interpretation and Implementation: 2. The Director of Nursing Services supervises and directs all personnel who administer medications and/or have related function. 4.

Medications are administered in accordance with prescriber orders, including any required timeframe.

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

08/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mesquite Village Wellness & Rehabilitation

825 W. Kearney Street Mesquite, TX 75149

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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

was not added to Resident #1's EMR profile. Interview on 08/19/25 at 1:16 pm, Doctor J stated Resident #1 had some skin issues on his legs and a wound on his bottom January 2024 and sometime in May 2024. He stated Resident #1 was diagnosed with a pressure wound of his sacral area and that the Wound Care Doctor had treated it. He stated he did not know that Resident #1 had not been assessed by the Wound Care Doctor. Interview on 08/19/25 3:47 pm, DON O stated he was not sure why his pressure injury was not added to his medical records because he was not working here at the time. Interview on 08/19/25 at 4:38 pm, MDS P stated she was the person who updated the resident's diagnosis in the EMR. She stated when the Facility Doctors diagnosed a resident they should be added to the resident's medical record. She stated she looked at the residents progress notes from the facility doctors and outside doctors to add diagnoses. She stated she was responsible for ensuring the diagnoses were added to the EMR. She stated if the diagnoses were not added to the EMR the staff wound not know what was going on with the resident.

She stated not adding the diagnoses could cause anything to happen like infections and hospitalizations.

Interview on 08/20/25 at 12:46 pm, MDS P stated she went over the resident's documentation weekly by using a calendar to check five residents per day to review their nurses notes, doctor's notes and hospital records and psychiatric records for any new additions to the resident's EMR profile. She stated if the diagnosis were not added, the resident could have a change of condition and need to go to the hospital or get infections. She stated the resident might receive improper care or not get the right treatment for a skin issue. Interview on 08/20/25 at 4:21 pm, DON O stated not being sure why Resident #1's pressure Ulcer of buttock diagnosis was not added to his medical record and if the doctor put it on a progress note, it should have been added. He stated Resident #1's pressure ulcer diagnosis should have been added to his diagnosis profile and been care planned. He stated not having a diagnosis added to a resident records runs

the risk of the diagnosed condition not being treated. Interview on 08/21/25 at 4:57 pm, the Administrator stated the MDS Coordinator was responsible for ensuring medical records were accurate. Interview on 08/21/25 at 5:42 pm ADON G stated she was not sure why Resident #1's pressure ulcer of buttock diagnoses was not added to his EMR profile. She stated she was not sure of the timeframe diagnosis should be add and would assume within a couple of days depending on what it is. Record review of the Facility's Medical records policy was requested 08/19/25 at 5:14 pm and 08/21/25 at 5:24 pm and the Administrator stated the facility did not have one.

Event ID:

Facility ID:

If continuation sheet