Inspection·September 17, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few incident report indicated Resident #1 was assessed for injuries and two new skin tears to her right arm were identified. Her level of pain on a PAINAD (observational pain scale) was assessed as 7/10 which indicated severe pain. Predisposing factors were identified as Resident #1 went into Resident #2's room.Review of a nurse's progress note dated 8/17/25 at 4:43 p.m. by RN A indicated .[Resident #1] received physical aggression from other patient.pt was assessed and Stat x-rays were ordered for R hip, pelvis, R femur (thigh bone), pain 10/10 after incident. Was witnessed by staff member, pt did not hit head, but hit right arm and caused two skin tears.Review of a provider progress note dated 8/18/25 indicated [Resident #1] has two skin tears on her RUE.X-rays were negative for fractures or dislocations. Neuro is intact.During an observation and interview on 9/16/25 at 10:30 a.m., Resident #2 was observed in a common sitting area, sitting on a couch. She appeared clean and well-groomed and she had no visible marks, bruises, or skin tears. Resident #2 was not able to recall the altercation with Resident #1 due to her diagnosis of dementia.During an interview on 9/16/25 at 10:33 a.m., LVN B said she did not witness the altercation between Residents #1 and #2 and only knew of the incident through report. LVN B said Resident #2 had a history of getting into verbal altercations with any resident who went into her room. LVN B said the CNA was responsible for monitoring the residents and redirecting them from entering other residents' rooms.During an interview on 9/16/25 at 10:43 a.m., CNA C said Resident #2 was known to be verbally aggressive toward residents who tried to enter her room. CNA C said she had not witnessed any physical aggression from Resident #2. CNA C said CNAs were responsible for monitoring the residents and redirecting them from entering other residents' rooms.During an observation and interview on 9/16/25 at 3:00 p.m., Resident #1 was observed in self-propelling herself in a wheelchair in the hallway on the secured memory care unit. She appeared clean and well-groomed and she had no visible marks, bruises, or skin tears. Resident #1 was not able to recall the altercation with Resident #2 due to her diagnosis of dementia.During a telephone interview on 9/16/25 at 3:45 p.m., CNA D said she was working on the memory care unit the day of the altercation between Residents #1 and #2. CNA D said she was in the hallway talking to CNA E when Resident #1 walked by her stating she was going to the restroom. CNA D said Resident #1 and Resident #2 had a shared bathroom. CNA D said Resident #2 went into her own room approximately 1 to 2 minutes later. CNA D said they heard Resident #1 yell out. CNA D said CNA E ran down to Resident #2's room and opened the door. CNA D said she saw Resident #2 stepping toward the door to leave the room as CNA E was going in. CNA D said she heard CNA E tell the residents to stop fighting so she went and alerted RN A for assistance.During an interview on 9/17/25 at 9:00 a.m., LVN F said Resident #2 had exhibited verbal aggression towards residents who wandered into her room in the past. LVN F said Resident #2 had not exhibited any physical aggression towards residents. LVN F said CNAs were responsible for monitoring the residents and redirecting them from entering other residents' rooms.During an interview on 9/17/25 at 10:45 a.m., the DON said Resident #2 had no previous aggressive behavior noted. The DON said she believed the incident occurred because Resident #2 valued her personal space and considered the shared bathroom to be her personal space. The DON said Resident #2 was put on 1-to-1 observation immediately and referrals were sent to two inpatient behavioral health facilities. The DON said Resident #2 was also moved to a room with a private bathroom. The DON said staff were expected to intervene and redirect any resident wandering into other resident rooms.During an interview on 9/17/25 at 11:00 a.m., CNA E said she was assigned to work on the hall next to the secured unit on 8/17/25 and witnessed the resident-to-resident altercation between Residents #1 and #2. CNA E said she was on the secured unit talking to CNA D when Resident #1 passed by them and went into her room. CNA E said approximately 1 to 2 minutes later Resident #2 went into her own room, which shared a bathroom (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455986 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 455986 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Henderson Health & Rehabilitation Center 1010 W Main St Henderson, TX 75652 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 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete with Resident #1's room. CNA E said she heard Resident #1 hollering and ran down to Resident #2's room. CNA E said she saw Resident #2 push Resident #1 down on the floor by the bed, with both hands and kick her in the side. CNA E said Resident #2 was jumping back as she was coming into the room. CNA E said she told the residents to stop fighting and told Resident #2 to leave the room. CNA E said CNA D ran and alerted the charge nurse, RN A, who conducted the post incident assessments.During an interview on 9/17/25 at 11:10 a.m., the ADM said Resident #2 had displayed verbal aggression with other residents, but there had been no previous physically aggressive behavior. The ADM said following the altercation between Residents #1 and #2 the residents were immediately separated; Resident #2 was placed on 1-to-1 supervision and referred to behavioral health inpatient facility. The ADM said Resident #2's medications were adjusted, and she was moved to a room with a private bathroom and there had been no more incidents of physical aggression. Attempted interviews with RN A by telephone and text message on 9/17/25 at 11:34 a.m. Review of progress note dated 8/17/25 at 4:30 p.m. by the DON indicated Resident #2 was placed on 1-to-1 supervision immediately following altercation with Resident #1.Review of a progress note dated 8/17/25 at 5:24 p.m. by RN A indicated Resident #2 was tolerating 1-to-1 supervision well.Review of a nursing follow-up dated 8/18/25 at 5:46 a.m. by FNP indicated Resident #2's Olanzapine dose was increased from 2.5mg to 5mg nightly and she was put on one-to-one observation.Review of a psychiatric hospital Discharge summary dated [DATE] at 2:40 p.m. indicated Resident #2 was admitted to the facility on [DATE] at 4:32 p.m. and discharged on 8/27/25 with medication changes including discontinuing Olanzapine and starting Uzedy.Review of an admission record dated 9/16/25 indicated Resident #2 was admitted to the facility from a psychiatric hospital and assigned to room [ROOM NUMBER]-B.During an observation on 9/17/2025 at 11:30 am, Resident #2's room [ROOM NUMBER]-B revealed the room to have a private bathroom. Review of facility policy titled Policy and Procedures: Abuse, Neglect, and Exploitation revised on 9/6/24 indicated .Identifying, correcting, and intervening in situations in which abuse.is suspected or identified.by taking immediate action to correct any issues that can reduce the risk of further harm continuing or occurring. Event ID: Facility ID: 455986 If continuation sheet Page 3 of 3