The Woodlands Nursing And Rehabilitation Center

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

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

there was no evidence he hit his head on anything. In an interview on 09/04/25 at 01:22 PM, the Administrator said suspicious injuries were any injuries that could not be explained or something like fingerprint bruising. He said any suspicious injuries of unknown origin, neglect and abuse must be reported within 2 hours. The Administrator said no one saw how Resident #1 got the laceration to his head, there was no evidence he hit any furnishings, and there was nothing on the floor that could have contributed to

the floor like water etc. The Administrator said he used deductive reasoning to rule out a suspicious injury of unknown origin. He could not confirm that Resident #1's fall was not due to the injury, or that the fall occurred at the same time the injury occurred, but he said no one was in the hall around the time the resident was found on the floor. He said failure to timely report alleged injuries of unknown origin could place the facility at risk of receiving a citation.Record review of the facility policy titled Incident and Accidents revised 08/15/22 revealed, Policy: It is the policy of this facility for staff to report, investigate, and

review any accidents or incidents that occur or allegedly occur, on facility property and may involve or allegedly involve a resident. 3. Incidents that rise to the level of abuse, misappropriation, or neglect, will be managed and reported according to the facility's abuse prevention policy. 4. The following incidents/accidents require an incident/accident report but are not limited to: Unobserved injuries. 6. Any injuries will be assessed by the licensed nurse or practitioner and the affected individual will not be moved until safe to do so. First aid will be given for minor injuries such as cuts or abrasions.7. The supervisor or other designee will be notified of the incident/accident. If necessary, law enforcement may be contacted for specific events. 14. If an incident/accident was witnessed by other people, the supervisor or designee will obtain written documentation of the event by those that witnessed it and submit that documentation to the Director of Nursing and/or Administrator.Record revie of the HHSC provider letter titled Abuse, Neglect, Exploitation, Misappropriation of Resident Property and Other Incidents that a Nursing Facility (NF) Must Report to the Health and Human Services Commission (HHSC) revised 08/29/24 revealed, A NF must report to CII the following types of incidents, in accordance with applicable state and federal requirements: Suspicious injuries of unknown source. Reportable Incidents and Timeframes: Do Report: abuse (with or without serious bodily injury) an incident that results in serious bodily injury and that involves any of the following: neglect exploitation mistreatment injuries of unknown source misappropriation of resident property. When to Report: Immediately, but not later than two hours after the incident occurs or is suspected. Do Not Report: an injury that is not suspicious or of unknown source. Injuries of unknown source: Note: an injury should be classified as an injury of unknown source when ALL of the following conditions are met: The source of the injury was not observed by any person; and The source of the injury could not be explained by the resident; and The injury is suspicious because of: the extent of the injury; or

the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma); or the number of injuries observed at one point in time; or the incidence of injuries over time.

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