Health inspection·September 8, 2025

F 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some on [DATE] with diagnoses including COPD and type II diabetes. Record review of the MDS dated [DATE] indicated Resident #2 had short term memory problems and some difficulty with cognitive skills for daily decision making. The MDS indicated Resident #2 required supervision or touch assistance for most ADLs (oral hygiene; toileting; shower/bathing; dressing of the upper/lower body; putting on/off footwear). The MDS Resident #2 needed set up or clean-up assistance only for eating. Record review of the care plan dated 8/28/25 indicated Resident #2 had COPD. The care plan interventions included; monitor for signs and symptoms of respiratory infection. During an interview and observation on 8/21/25 at 1:40 p.m., Resident#2 was sitting in his wheelchair in his room. Resident #2 indicated Resident #1 was his roommate. Resident #2 said he saw roaches in his room all the time. There were multiple covered containers containing food on Resident #1's side of the bed. Resident #2 pointed to the space between the two nightstands and said look there is one right now. A small cockroach was noted crawling on the floor in between the space between the two night stands. Resident #2 declined to talk further with the surveyor and left the room in his wheelchair. 3.Record review of the face sheet for Resident #3 indicated she was readmitted to the facility on 11/30 24 with diagnoses including heart failure, and type II diabetes. Record review of the MDS dated [DATE] indicated Resident #3. The MDS indicated she had clear speech. The MDS indicated she usually understood and usually made herself understood. The MDS indicated she was cognitively intact (BIMS of 14). Record review of the care plan revised on 8/11/25 indicated Resident #3 was at risk for frequent infections related to her diabetes. During an interview and observation on 8/21/25 at 2:00 p.m., Resident #3 was sitting in her bed. Resident #3 said she saw large water bugs and small cockroaches just about every day in her room. Resident #3 said she did see facility staff spray the bugs. During an interview on 8/21/25 at 12:45 p.m. the maintenance director said staff were to report any bug sightings (including roaches) in the maintenance repair book located at the nurses station . The maintenance director said usually staff just came to him and told them if they saw bugs and he would he spray for them. The maintenance director said he was not always at the facility and usually worked 8am -5 pm Monday through Friday. He explained that is why they have the maintenance book for staff to write in. Record review of the facility maintenance log from April 2025 to August 2025 had revealed no loggings of bug sightings. During an observation and interview with CNA D on 8/22/25 at 3:00 p.m., CNA D picked up a large dead bug (commonly described as a water bug) from the hallway to the left of the nurses station with a paper towel and threw it in the trash. CNA D wiped the area with a Cavi wipe. CNA D said she saw large water bugs 2-3 times a week. CNA D said she would usually just squish them and clean the area. CNA D said she was not aware of a book she was suppose to record bug sightings in. During an interview on 8/22/25 at 3:30 p.m., CNA E said she saw water bugs and roaches maybe twice weekly. CNA E said she would report the sightings to the maintenance man if he was still in the building. CNA E said if the maintenance man was not in the building she would squish the bug and throw it away. CNA E said ashe was not aware of any book staff were to write bug sightings in. During a phone interview interview on 9/8/25 at 9:49 a.m., the contracted exterminator reported he sprayed the facility monthly. He said he had sprayed for both American cockroaches and stated theses bugs are what people often refer to as water bugs as well as German roaches, which people generally identify as roaches. He said he always talked to the maintenance director, if he is available, in attempt to identify any problem areas. The contracted exterminator said he also had a book for facility staff to log bug sightings in. He said he checks the book before he sprays monthly but has never saw it utilized for bug sightings. The contracted exterminator said he could spray more frequently and target the areas/bugs the facility continues to have issues with in-between the monthly treatments if it was communicated. During an (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 09/08/2025 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete interview with the ADON on 9/8/25 at 9:50 am the ADON said he had seen large water bugs but could not say he had seen small roaches. The ADON said staff are to write in the maintenance book any bug sightings so they can be targeted if needed. The ADON said it was important to maintain an effective pest control program to prevent infection. During an interview on 9/8/25 at 10:20 a.m., the Administrator said the facility conducts administrative rounds in which Monday through Friday an administrative personnel rounds on no more than 6 residents. Any issues reported by the resident and anything they see in the environment (such as bugs) are placed on a sheet to discuss solutions in morning meetings but any bug sightings are also to be written in the maintenance book. The Administrator during the weekends, the weekend administrator performs the rounds for all residents. The Administrator said all staff identifying bugs, such as roaches, should be writing that in the maintenance book so it can be addressed. Record review of the facility policy and procedure dated 2/1/17, titled Pest Control, stated Policy Our facility shall maintain and effective pest control program. Procedure The facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. Event ID: Facility ID: 455900 If continuation sheet Page 3 of 3