River Bend Healthcare

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

DON, and the ADON stated, on 9/15/2025 during their IDT morning meeting, they reviewed all the previous admissions which included a review for care-plan development and implementation to which Resident #2's care plan was not accurately reviewed to reveal the lack of nursing focuses, goals and interventions for Resident #2's intravenous access for his antibiotic medications. The Administrator stated the lack of review could have potential negative outcomes for residents who had needs for support with their healthcare needs. A record review of the facility's Baseline Care Plan / Summary undated policy revealed, Purpose: Promote continuity of care and communication among staff, increase resident safety and safeguard against adverse events that are most likely to occur right after admission. Also, to ensure the resident and representative, if applicable, are informed of the initial plan for delivery of care and services by receiving a written summary of the baseline care plan. Procedure: A baseline care plan for each resident will be developed within 48 hours of the resident's admission to this facility. The baseline care plan will be based

on information available from the transferring provider as well as discussions with the Resident / representative. It will include interim approaches for meeting the residents' immediate needs and reflect changes to approaches, as necessary, that occurred before the development of the comprehensive care plan. The baseline care plan will include but not limited to this information needed to care for the Resident: initial goals based on admission orders, instruction needed to provide effective and person-centered care that meets professional standards of quality care; .

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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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Remarkable Healthcare of Seguin

1339 Eastwood Dr Seguin, TX 78155

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

supports for a urinary tract infection supported by intravenous antibiotics. The DON and the ADON stated a

record review of Resident #2's medical records revealed LVN A failed to develop and implement a baseline care plan within 48 hours to support Resident #2 intravenous access which LVN A identified on the admission nursing progress note dated 9/13/2025. The DON and the ADON stated the MDS nurse did assess Resident #2 with having a intravenous access while a Resident but did not document the intravenous access in Resident #2's care plan template. The Administrator, the DON, and the ADON stated,

on 9/15/2025 during their IDT morning meeting they reviewed all the previous admissions which included a

review for orders and intravenous access however, Resident #2's intravenous access was not reviewed and

the order for the intravenous access was not reviewed. The DON stated on 9/16/2025 Resident #2 was prescribed by the physician to receive intravenous antibiotics, and he had not recognized Resident #2 had no order for the intravenous access. The DON stated the admission nurse LVN A was responsible for securing that order since Resident #2 was admitted with the intravenous access. The DON stated the lack of the order should have been reviewed by himself when the antibiotic order was received, and LVN B should have reviewed the order for the intravenous access prior to establishing the new access. The DON stated LVN B was trained and expected to call the physician with the change of condition when he had to discontinue the intravenous access and established a new intravenous access. The Administrator, the DON, and the ADON concurred the failure could have a potential negative outcome for residents receiving care without physician orders. A record review of the facility's undated admission of a Resident policy revealed, Purpose: . Assess residence overall status upon admission . Obtain timely position admission orders including, medications, . Procedure: . Review accompanying documentation from hospital / physician's office for information orders etcetera contact the transferring facility to resolve any questions or to obtain clarification. Contact the attending physician's office as needed for orders, clarification, etcetera . Licensed nurse will contact admitting physician regarding any orders that need clarification and transcribe orders according to facility policy .

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If continuation sheet