Inspection·January 22, 2026

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few periods of time). Record review of Resident #59's MDS assessment dated [DATE], reflected Resident #59 had a BIMS score of 6 which indicated his cognition was severely impaired. Resident #59 did not refuse care. Resident #59 required supervision or touching assistance with the following: eating, oral hygiene, personal hygiene, showers, upper and lower body dressing, toileting hygiene.Record review of Resident #59's Comprehensive Care Plan, dated 01/08/2026, reflected Resident #59 had an ADL self-care performance deficit. Intervention: Bathing: check nail length, trim, and clean on bath day and as necessary. Report any changes to the nurse. If diabetic, the nurse will provide toenail care.Observation and interview on 01/20/2026 at 9:10 AM revealed Resident #59 was sitting near the nurses' station in his wheelchair. Resident #59's fingernails on his right hand underneath his middle and ring fingernails had a blackish/brownish substance. Resident #59 had rough edges around his fingernails on his right hand and had blackish/brownish substance underneath his middle and fore fingernails on his left hand. Resident #59 stated he did not like his nails to be dirty. He stated he did not remember if he asked someone to help him with his nails. Resident #59 stated his nails had been dirty and rough for the past 4 or 5 days. In an interview on 01/21/2025 at 1:50 PM, LVN Charge Nurse A stated the nurses were responsible for residents with a diagnosis of diabetes with nail care such as trimming, cleaning, and filing. She stated the CNAs were responsible for all other residents' nail care. LVN Charge Nurse A stated if a resident had brownish/blackish substance underneath their nails and if a resident swallowed the substance there was a possibility a resident may become ill, such as stomach problems nausea and vomiting. She stated she would need to ask staff questions for the reason nail care was not completed on Resident #57 and Resident #59. LVN Charge Nurse A stated no one reported to her that Resident #57 or Resident #59 refused nail care. She stated anytime a resident refused care it was documented in the nurses' notes.In an interview on 01/21/2026 at 2:20 PM, Lead CNA B stated the CNAs were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes (a disease that occurs when blood sugar is too high). She stated the nurses were responsible for all the residents' nails with a diagnosis of diabetes. Lead CNA B stated the residents' nails were usually cleaned on Sundays, their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as vomiting and diarrhea. She stated if a resident had rough edges around the fingernails there was a potential a resident may scratch another resident or themselves and obtain a skin tear. She stated a resident could get their nail caught on something and pull their nail off their finger. Lead CNA B stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident #57 and Resident #59, and they did not refuse nail care. She stated the lead CNA assists with some training with new CNAs. In an interview on 01/21/2025 at 2:40 PM, CNA C stated the CNAs were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes. She stated the nurses were responsible for all the residents' nails with a diagnosis of diabetes. CNA C stated the residents' nails were usually cleaned on their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as nausea and diarrhea. CNA C stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident # 57 and Resident #59, and they did not refuse nail care. CNA C stated she did not know the last time these residents' nails were trimmed or cleaned she would need to check the medical records. She stated if a Resident's nails were rough around (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 2 of 3 Printed: 05/15/2026 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the edges there was a possibility the resident could scratch themselves and cause a skin tear. CNA C stated anytime a resident refused any type of care she reported it to the charge nurse. In an interview on 01/22/26 at 10:20 AM, the DON stated if a resident ingested the blackish substance on their fingers or underneath their fingernails, there was a possibility the substance may be some type of bacteria, however it would be difficult to determine if the blackish/ brownish substance was bacteria. She stated it was a possibility a resident may become ill with stomach issues such as vomiting and nausea if they ingested the blackish/ brownish substance. She stated the CNAs were responsible for all residents' nails such as cleaning, trimming, and filing except for the residents with diabetes. She stated for any resident with a diagnosis of diabetes the nurse was responsible for these residents' fingernails. The DON stated the nurse supervisor was responsible for monitoring CNAs giving ADL care which included nail care, and the ADON and DON were responsible for monitoring the nurse supervisors. Record review of the facilities policy on Nail Care, not dated, reflected Nail management is the regular care of the toenails and fingernails to promote cleanliness, and skin integrity of tissues, to prevent infection, and injury from scratching by fingernails or pressure of shoes on toenails. It includes cleansing, trimming, smoothing, and cuticle are and is usually done during the bath. Nails can become thinner and more brittle in the elderly and thicker if peripheral circulation isimpaired. Nails are also important in assessment, as changes occur with certain medical conditions,such as clubbing with chronic obstructive pulmonary disease or cardiac disease. Color changes withcirculatory or lymphatic impairment and certain drug therapy is common. Ingrown toenails are alsocommon in the elderly. Fungal infections of the toenails, dry, brittle ridges and thickening of the nailsall occur in the elderly with some frequency.Goals1. Nail care will be performed regularly and safely.2. The resident will free from abnormal nail conditions3. The resident will be free from infection. ProcedureShould be performed according to the resident centered plan of care.1. Explain the procedure to the resident.2. Wash hands.3. Immerse hands or feet in a basin of warm soapy water to cleanse and soften the nails for ease incleansing and trimming. Use a soft brush if necessary to cleanse under and around the nails.4. Remove debris from under the nails with an orange stick while soaking.5. Remove the hands or feet from the basin and pat dry.6. Apply lotion and massage into the cuticles and push back with a towel. Avoid cutting anycuticle.7. Trim the nails with a clipper, straight across for the toenails and rounded for the fingernails.8. Smooth the nails with an emery board.9. Apply hose and shoes or slippers as appropriate.10. Discard removed nails, cleanse basin and articles used and store for future use.11. Wash hands.12. Nails that are ingrown, thickened, or infected should be cared for by a podiatrist. Reportconditions immediately to the primary nurse. The nurse will ensure a referral to the podiatrist.13. Cutting should not be any shorter than at the line even with the nail folds on each side.14. When performed at bath time, the nail care can be done following the procedure or as a separateprocedure when needed at the convenience of the resident. Event ID: Facility ID: 455589 If continuation sheet Page 3 of 3