Valley Grande Manor

F 0641

Ensure each resident receives an accurate assessment.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observations, interviews and record reviews, the facility failed to ensure the assessment accurately reflected the resident's status for 3 (Resident #4, Resident #11, and Resident #13) of 10 residents reviewed for MDS assessment.Resident #4's quarterly MDS assessment dated [DATE REDACTED] failed to indicate Resident #4 had falls on 07/28/25 that resulted in major injury, on 09/09/25 that resulted in minor injury, and on 10/02/25 that resulted with no injury.Resident #11's quarterly MDS assessment dated [DATE REDACTED] failed to indicate Resident #11's behavior of physical aggression that occurred on 09/23/25.Resident #13's quarterly MDS assessment dated [DATE REDACTED] failed to indicate Resident #13's behaviors of delusions and refusal of care that occurred on 09/16/25.Resident #13's quarterly MDS assessment dated [DATE REDACTED] failed to indicate Resident #13 had a fall that resulted in minor injury that occurred on 10/13/25.This deficient practice could place residents at risk for inadequate care and services to meet their needs based on inaccurate assessments.

Residents Affected - Few

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Valley Grande Manor

1212 S Bridge Weslaco, TX 78596

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 0656 Level of Harm - Minimal harm or potential for actual harm

developed and implemented for each resident. 8. The comprehensive, person-centered care plan will:g. incorporate identified problem areas.13. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change.

Residents Affected - Few

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

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

11/21/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Valley Grande Manor

1212 S Bridge Weslaco, TX 78596

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 - Few

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

notify the RP, and complete all risk management forms. The ADON said if LVN E was notified by another resident of what happened, LVN E should have still considered the incident a fall since she did not see or know for sure how Resident #4 ended up on the floor. The ADON said another resident may or may not have had the cognitive ability to say what happened. The ADON said LVN E did not document that the doctor was notified or if the doctor gave any orders, nor did she document the assessments for the incident.

In reference to Resident # 13, the ADON stated anytime there was a change in condition, the nurse was supposed to document what happened in the progress notes and fill out the change of condition form. She stated LVN F should have done a progress note and a change in condition form done for Resident #13 on 10/10/25 about her incident of aggressive behavior. The ADON stated LVN D should have documented the most recent blood pressure, pulse, respiratory rate, oxygen saturation, and temperature for the change of condition form for Resident #13's fall on 10/13/25 and documenting a blood sugar from 2 years prior was not appropriate for a change of condition assessment.On 10/23/25 at 1:05 PM, in an interview with the DON, she said she reviewed Resident #4's progress notes and read the progress note by LVN E on 09/05/25. The DON said LVN E did not document that the doctor was notified, only the RP. The DON said if LVN E was told Resident #4 was crawling on the floor by another resident, the DON could not say if LVN E should have treated this incident as a fall. The DON said she was not aware of the entire situation. The DON said LVN D, LVN E, and LVN F were trained and in-serviced on falls, what to do for incidents, to identify changes of condition, and initiate the risk management forms which included the pain assessment, fall risk assessment, skin assessment, neuro checks, and change in condition form. The DON stated she was not at the facility at the time of Resident #13's incident of aggressive behavior on 10/10/25, but she got

a phone call about it. She stated LVN F was the primary nurse for both residents and she told him when to do the change of condition form for Resident #13 and the other resident when he called, but he did not do them. The DON stated the risk assessments were done on both residents so it triggered for her to look at them and ensure the associated assessments and notes were done. She stated when she saw that the change of condition was not done for Resident #13, she called LVN F, and they did it over the phone. She stated she did the skin assessment on Monday morning 10/13/25 because it had not been done by LVN F

on 10/10/25. The DON stated LVN F had not worked in the facility since 10/10/25. The DON said her expectation for nursing staff was to document everything accurately and timely. The DON said if staff failed to document, residents could go without the care needed.Record review of Charting and Documentation Policy dated April 2008, reflected:Policy statement: All services provided to the resident, or any changes in

the resident's medical or mental condition, shall be documented in the resident's medical record.3. All incidents, accidents, or changes in the resident's condition must be recorded.6. Documentation of procedures and treatments shall include care-specific details and shall include at a minimum:f. Notification of family, physician or other staff, if indicated.

Event ID:

Facility ID:

If continuation sheet