Woodway Rehabilitation And Healthcare Center

F 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

was care planned for the potential to be physically aggressive when he pushed another resident on 1/25/25. His interventions included monitoring for agitation, redirection, give the resident choices, and to intervene before agitation escalates. Review of the facility's incident/accident reports from the last three months revealed an incident occurred on 10/10/25 where physical aggression was received by Resident #2, and physical aggression was initiated by Resident #1.Review of a nursing incident/accident investigation worksheet, dated 10/10/25 by agency LVN A, revealed that on 10/10/25 at 2:15PM Physical Aggression was received by Resident #2 and there was resident to resident contact. Under the investigation summary section, it was indicated that the resident said, I don't know why he just walked up and hit me., and the staff did not know what caused the incident, and there were no witnesses. It indicated the resident was not injured. It also revealed a staff statement, Staff heard residents calling for HELP When staff arrived at D/R resident was on the floor-and the other resident was noted holding him down. Resident was noted lying on

the floor with his shoulders up-trying to release himself from the residentReview of a typed document on a piece of paper provided to the surveyor by the DON and VPHR revealed: [Resident #2] and [Resident #1]Completed by [previous ADM], 10.10.25Staff heard a cry for help and went to dining room. Found [Resident #2] on the floor with [Resident #1] holding his shoulders. No staff on duty witnessed the incident.

Staff escorted [Resident #2] back to room. Nursing staff immediately notified DON and ADONof incident.

DON, came to notify me of incident. [Resident 1] unable to retell events of what occurred. He was witnessed walkingdown hall and appears to be calm at this time. [Resident 2] stated I don't know why he just walked up and hit me.Psych NP notified 10.10.25 of incident, came to facility, spoke with [Resident 1] and wrote new orders. Staff will continue to monitor for any adverse affects.An interview was attempted with

the previous ADM on 11/20/2025 at 10:55 a.m. but the surveyor did not receive a return call after leaving a voicemail. In an interview on 11/20/2025 at 11:10 a.m. with the DON she stated that it was not Resident #1's normal behavior to act in the way he did with Resident #2. She stated that she did not consider the incident to be abuse because no one saw the incident happen and neither resident could tell them what happened, and that neither resident received injuries. She stated that resident to resident abuse would be if one resident was seeking out another resident, like intentionally following them around, trying to push the other resident, and that Resident #1 had not been exhibiting those behaviors. An observation and interview was attempted on 11/20/2025 at 12:20 p.m. of Resident #1 and Resident #2 but both were pleasantly confused and unable to participate in interviews due to severe cognitive impairments. They both appeared well groomed and dressed appropriately. In an interview on 11/20/2025 at 1:03 p.m. with the VPHR who was serving the facility as the interim ADM, she stated that resident to resident abuse would be any unprovoked physical contact between residents. She stated that the incident on 10/10 was an instance that would warrant an investigation by the AC. She stated the DON investigated the incident from 10/10/25, which resulted in the facility unable to determine if resident abuse occurred due to no witnesses of the incident and no new injuries, but the only investigation she could locate that the AC conducted was what

she provided the surveyor typed on a blank sheet of paper. She stated the AC was responsible for investigating abuse allegations. She stated that on 10/10 the previous ADM was the AC.Review of the facility's Abuse, Neglect and Exploitation policy dated last reviewed 05/2025 reflected: 6. Upon receiving any allegations of abuse, neglect, exploitation, misappropriation of resident property orinjury of unknown source, the administrator is responsible for determining what actions (if any) are needed for the protection of residents.A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur.

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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

11/20/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Woodway Rehabilitation and Healthcare Center

7801 Woodway Dr Waco, TX 76712

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

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

p.m. by the DON and VPHR revealed: [Resident #2] and [Resident #1]Completed by [previous ADM], 10.10.25Staff heard a cry for help and went to dining room. Found [Resident #2] on the floor with [Resident #1] holding his shoulders. No staff on duty witnessed the incident. Staff escorted [Resident #2] back to room. Nursing staff immediately notified DON and ADONof incident. DON, came to notify me of incident. [Resident 1] unable to retell events of what occurred. He was witnessed walkingdown hall and appears to be calm at this time. [Resident 2] stated I don't know why he just walked up and hit me. Psych NP notified 10.10.25 of incident, came to facility, spoke with [Resident 1] and wrote new orders. Staff will continue to monitor for any adverse affects.An interview was attempted with the previous ADM on 11/20/2025 at 10:55 a.m. but the surveyor did not receive a return call after leaving a voicemail. In an interview on 11/20/2025 at 11:10 a.m. with the DON she stated it was not Resident #1's normal behavior to act in the way he did with Resident #2. She stated that she did not consider the incident to be abuse because no one saw the incident happen and neither resident could tell them what happened, nor did either resident receive injuries. She stated that a resident-to-resident altercation would be if one resident was seeking out another resident, intentionally following them around, trying to push the other resident, and that Resident #1 had not been exhibiting those behaviors. In an interview on 11/20/2025 at 1:03 p.m. with the VPHR who was serving the facility as the interim ADM, stated that resident to resident abuse would be unprovoked physical contact between residents. She stated that the incident on 10/10/25 was an instance that would warrant an investigation by the AC. When asked if it warranted a report to the state agency, she stated that would be determined after the investigation by the AC. She stated the DON investigated the incident from 10/10/25, which resulted in the facility unable to determine if resident abuse occurred due to no witnesses of the incident and no new injuries, but the only investigation she could locate that the AC conducted was what

she provided the surveyor typed on a blank sheet of paper. She stated the AC was responsible for investigating abuse allegations and reporting it to the necessary entities. She stated that on 10/10/25 the previous ADM was the AC.Review of the facility's Abuse, Neglect and Exploitation policy, dated 05/2025, reflected: It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property.1. If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law.2. The administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies:a. The state licensing/certification agency responsible for surveying/licensing the facility.

Event ID:

Facility ID:

If continuation sheet