Health inspection·December 10, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews and record review, the facility failed to store, prepare, and distribute food in accordance with professional standards for food service safety for one of two kitchens reviewed for kitchen sanitation. 1. The facility failed to ensure Dietary Assistant [NAME] A used proper hand hygiene during food preparation.2. The facility failed to ensure Dietary Assistant [NAME] A used appropriate oven mitt to remove food from the oven and prevent cross-contamination of the food. These failures could place residents who ate food from the kitchen at risk for foodborne illness.Findings included: 1. Observation on 11/01/2025 at 7:20 AM, reflected Dietary Assistant [NAME] A touched her shirt, the right side of her hair, and touched her face with her right hand. She did not wash or sanitize her hands prior to touching the cereal in bowls on a meal tray. She placed the meal tray full of bowls of cereal in the meal cart to be delivered to the 600-hall kitchenette. Interview on 11/01/2025 at 7:30 AM, Dietary Assistant [NAME] A stated she did not wash her hands, and she did touch her clothes and hair. She stated she did not recall if she touched her face. She stated her clothes, and hair was considered to be contaminated. Dietary Assistant [NAME] A stated she was required to wash her hands anytime she touched anything that was considered to have germs. She stated there was a possibility germs or bacteria may transfer from her hands onto the raisin bran cereal. Dietary Assistant [NAME] A stated if a resident ate the cereal the resident may have stomach issues such as being too sick to eat and have diarrhea. She stated she had been in-service on hand hygiene but did not recall the date of the in-service. 2. Observation on 11/01/2025 at 7:35 AM, Dietary Assistant [NAME] A obtained a dish rag with holes in the rag and brownish color stains laying on top of mop heads in a medium size white container. She held the dish rag and entered the kitchen area and used the dish rag to remove hot pan of bacon from the oven. When she removed the silver pan of bacon the dish rag touched over half of the bacon. The Dietary Assistant [NAME] A placed a lid on the bacon and placed it on the meal cart to be delivered to the kitchenette on 600 hall. She placed the dish rag on the food prep table and had very light scent of disinfectant. Interview on 11/01/2025 at 7:38 AM, the Dietary Assistant [NAME] A stated the dish rag was on the mop heads, and she did not know if the dish rag had been used to clean anything in the kitchen. She stated she was expected to use an oven mitt or potholder to remove food from the oven. She stated the dish rag did have holes in it and was stained. Dietary [NAME] Assistant A stated she did not smell anything on the dish rag when she first picked it up but she did smell something when she placed it on the food prep table. She stated the dish rag did touch the bacon, but it would be ok to serve the bacon. She stated she thought it would be ok to serve the bacon. Interview on 11/01/2025 at 7:42 AM Dietary [NAME] B stated the bacon, and cereal was considered contaminated and was expected to be thrown away and prepare more food for the residents. She stated anytime you touch clothes staff was expected to wash their hands. She stated only an oven mitt, or potholder was to be used to remove anything from the oven. Dietary [NAME] B stated all dietary staff had been in (continued on next page) 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 Page 1 of 2 Event ID: 455908 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 455908 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Schulenburg Regency Nursing Center 111 College St Schulenburg, TX 78956 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)