The Brazos Of Waco

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

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

Inservice with LVN D regarding reporting incident/change of condition to the DON/Designee.

Documentation of the Personnel action was present and reflected the signature of LVN D. Record Review of in-service dated 08/11/2025 reflected 20 staff had been in-serviced on notification of resident change. Our ability to ensure trust is paramount in what we do daily, and by keeping lines of communication open and involving the resident and their responsible party/emergency contact in the care we are providing; we build that foundation. It is REQUIRED to notify residents, responsible parties, or an emergency contact of any changes that occur with our residents. Responsible Party (RP) or an emergency contact if resident is their own RP will be notified of any changes at the time of occurrence and be DOCUMENTED in the progress notes.Record Review of in-service dated 08/11/2025 reflected 14 staff had been in-serviced on notification to the director of nursing but there was no mention of notification of the physician. Communication is crucial for proper management of nursing facilities and notification of the Director of nursing is imperative. You are required to notify the Director of Nursing and or designee for the following immediately: Incidents and Accidents with C/O Pain or Observed Injury BurnsSafety Hazards / Equipment Malfunction Record Review of in-service dated 08/12/2025 reflected 22 staff had been in-serviced on burns. Burns are a major incident

in nursing homes and can cause serious negative out comes. Any burn injuries are required to have the provider assigned, DON, RP, and administrator notified immediately no matter the severity of the burn.

Record Review of facility wound care policies and procedures revision date 06/01/2015 reflected all burns and scalds will be seen by a physician or a nurse as soon as possible for appropriate treatment. The purpose is to provide immediate first aid when injury occurs in the facility. Record review of the policy entitled: Care of a Burn Injury dated 06/01/2025 states Notify the physician and supervisor as soon as possible.

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

The Brazos of Waco

2430 Market Place Drive Waco, TX 76711

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 - Immediate jeopardy to resident health or safety Residents Affected - Few

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

in the dining room. He stated coffee is not to be left unattended in the dining room. He stated after meals

the coffee is brought to the nutrition room which is kept locked. He stated the temperature should be between 155 degrees -175 degrees. He stated the coffee is served in an urn which had a sticker that shows

the item, temperature, and staff initial. He stated staff pour and served the coffee for residents. He stated if

a resident asked for coffee, he would go get the coffee and bring it to the resident. He stated most of the coffee drinkers are independent. He stated coffee is served in a Styrofoam cup with lid. He stated some of

the residents had a specialized cup with lid. He stated if a resident sustained an injury he would immediately report to the nurse in charge. Record Review of in-service dated 08/10/2025 reflected 13 staff from different shifts had been in-serviced on abuse, neglect, and resident rights. Record Review of in-service dated 08/10/2025 reflected 18 staff had been in-serviced on the hot beverage policy. Record

Review of evaluations completed for all residents. Their criteria were all the same for the evaluations.

Residents were screened for cognition, mobility, dexterity, and behaviors to see if they were safe with hot beverages. Record Review of facility daily monitor log for appropriate hot beverage cup/lids reflected 08/11/25 through 08/15/25 no concerns. On 08/28/25 at 3:00 PM conducted Interview the DON stated she had worked at the facility for four months.She stated she had been trained on abuse, neglect, resident rights, and hot beverages. She stated the electric urn was discontinued immediately. She stated coffee is being served from an urn. She stated the dietary manager, DON, and Administrator were reeducated on coffee service for the r[TRUNCATED]

Event ID:

Facility ID:

If continuation sheet