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F0638
D

Failure to Complete Timely Quarterly Assessment

Irving, Texas Survey Completed on 07-31-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to complete a quarterly assessment for one resident at least once every three months, as required by federal and state guidelines. Record review showed that the resident's last quarterly assessment was completed on a specific date, with no subsequent reassessment documented within the required timeframe. The resident's medical history included cerebral palsy, generalized anxiety disorder, and major depressive disorder. The MDS tab in the electronic health record confirmed the absence of a timely reassessment. During interviews, the DON stated that the MDS nurse was responsible for completing assessments and was unaware of the exact due dates, but expected them to be completed on time. The MDS coordinator confirmed that the last assessment was completed on the previously mentioned date and believed the assessment was still valid because the RUG had not expired, and the resident was scheduled for reassessment in August. The facility's policy requires assessments to be conducted and submitted according to current federal and state timeframes, but this was not followed in this instance.

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