Health inspection·December 19, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Record review of an incident report dated 9/26/24 indicated, Upon arrival of this nurse to male secured unit it was reported to this nurse that resident had sustained a witnessed fall observed by CNA reported to administrator. This nurse immediately assessed resident for any post injuries and only noted old yellow bruises on skin check. The incident report indicated Resident #1 did not have any new injuries and no signs or symptoms of pain. Residents Affected - Few Record review of the Morse Fall Scale dated 9/26/24 indicated Resident #1 was at high risk for falling, The Morse Fall Scale indicated Resident #1 had previous falls. The Morse Fall Scale indicated Resident #1 did not use any ambulatory aids. The Morse Fall Scale indicated Resident #1 had a weak gait. Record review of the PIR dated 9/26/24 indicated CNA B reported witnessing LVN A push Resident #1 resulting in Resident #1 falling without injury. The PIR indicated Resident #1 was assessed by the ADON. The PIR indicated the assessment revealed Resident #1 with bruising to his right upper thigh, left lower leg, and reddened area to his right back. The PIR indicated LVN A was suspended on 9/26/24 and terminated on 9/30/24. The PIR indicated wellness checks were performed in the unit, notifications were made, safe surveys were complete, and staff were in-serviced regarding abuse and neglect. During an interview on 12/18/24 at 12:24 p.m. CNA B said she was still employed at the facility. CNA B said she did recall the incident with LVN A pushing Resident #1 resulting in a fall. CNA A said LVN A was heading to the restroom and Resident #1 was standing close to the restroom. CNA B said she heard LVN A tell Resident #1 to move, get out of the way. CNA B said Resident #1 responded saying F*** it, f*** it. CNA B said then she heard LVN A say don't pull out your dick it is non-existent. CNA B said Resident #1 got more upset and then she witnessed LVN A push Resident #1 to the ground. CNA B said when she tried to assist Resident #1 up LVN A told her not to help him up to let him get up on his own. CNA B said she immediately went to the Administrator at the time to report the incident and the Administrator at the time walked LVN A out of the building immediately. During an interview on 12/19/24 at 1:01 p.m. the Administrator said if staff witnessed abuse, she expected them to establish resident safety first and then report the abuse to her or the DON. The Administrator said being the Abuse Coordinator she would expect them to report the abuse to her as soon as possible. The Administrator said if a staff member was accused of abuse, they would be removed from providing care and suspended pending investigation of the allegation. The Administrator said if a resident became aggressive with staff, she expected staff to honor resident safety, re-direct the resident, if possible, step away and reapproach later if needed. Record review of the facility's Abuse policy last revised 1/1/23 indicated The purpose of this policy is to ensure that each resident had the right to be free from any type of Abuse, Neglect, Intimidation, Involuntary Seclusion/Confinement, and or Misappropriation of property .Residents will not be subjected to abuse by anyone, including, but not limited to community staff, other residents, consultants, volunteers, staff of other agencies serving the residents, family members or legal guardians, care taker, friends, or other individuals .All employees are required to be trained in issues related to abuse prohibition practices . The facility had corrected the noncompliance prior to surveyor entrance by the following: Suspending and Terminating LVN A In-servicing staff regarding abuse and neglect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455900 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 455900 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Mount Pleasant 1606 Memorial Ave Mount Pleasant, TX 75455 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 0600 The surveyor confirmed the facility had corrected the non-compliance prior to survey starting by: Level of Harm - Minimal harm or potential for actual harm Record review of the Disciplinary Action Record dated 9/26/24 indicated LVN A was suspended due to failure to refrain from abuse of a resident. Residents Affected - Few Record review of the Disciplinary Action Record dated 9/30/24 indicated LVN was terminated due to failure to refrain from abuse of a resident. Record review of an in-service dated 9/27/24 indicated staff were in-serviced regarding abuse and neglect. Staff interviewed (CNA B, LVN C, CNA D, RN E, LVN F, LVN G, LVN H) on 12/18/24 and 12/19/24 between 9:47 a.m. and 12:29 p.m. were able to name all types of abuse including physical, verbal, sexual, emotional, and misappropriation of property. Staff interviewed said if they witnessed abuse they would intervene and then report it immediately. Staff interviewed said the Administrator was the Abuse Coordinator of the facility. Staff interviewed said if a resident became aggressive towards them, they would stay calm, attempt to redirect the resident, step-away from the resident and reapproach the resident at a later time, attempt to find the resident's trigger, document the behavior, and notify the physician. The noncompliance was identified as PNC. The noncompliance began on 9/26/24 and ended on 9/27/24. The facility had corrected the noncompliance before the survey began. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455900 If continuation sheet Page 3 of 3