Health inspection·November 24, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete privacy curtains fully drawn, and the window blinds were shut properly. Review of the facility's policy Resident Rights undated, reflected: The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside our facility, including those specified in the policy. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of lord.We protect and promote the following rights of each resident. Privacy and Confidentiality-The resident has a right to personal privacy and confidentiality. 1. Privacy includes accommodations, medical treatment, personal care. Event ID: Facility ID: 455994 If continuation sheet Page 2 of 4 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (CNA A) of two staff observed for infection control. CNA A failed to change their soiled gloves and wash hands during incontinent care to Resident #1. This failure could place residents at risk of the spread of infection through cross-contamination. Findings included: Record review of Resident #1's quarterly MDS dated [DATE] revealed a [AGE] year-old male who was initially admitted to the facility on [DATE]. Diagnoses included: Post traumatic stress disorder (mood disorder), hypertension (high blood pressure), Diabetes Mellitus (high blood sugar), and renal insufficiency (kidneys are slow to work). Resident #1 was alert and oriented and able to make decisions. Record review of Resident #1's care plan dated 09/03/2025 reflected the resident had incontinence of bowel and bladder. Required the assistance of one staff for incontinence care and two staff for transfer using a mechanical lift. Observation of incontinence care on 10/07/2025 at 09:30 a.m. revealed CNA A used hand gel in the hallway and donned (placed gloves on hands) clean gloves. CNA A entered the room; Resident #1 was lying on his back. CNA A unfastened the resident's brief tabs and wiped the pubic area with a disposable wipe, discarding the wipe in the trash bag. CNA A wiped the genitals, discarding the wipe in the trash bag. CNA A wiped the shaft of the penis and discarding the wipe in the trash bag and then cleaned the head of the penis and discarding the wipe in the trash bag. CNA A positioned Resident #1 on his left side with the help of Resident #1. CNA A wiped the rectal area that was soiled with bowel movement and discarded the wipe, using another wipe CNA A completed cleaning the rectal area of bowel movement, discarding the wipe. CNA A wiped the left buttocks, which were soiled with urine, discarding the wipe. Repositioning Resident #1 with her soiled gloves to his right side, CNA A cleaned the right buttocks, which was soiled with urine, discarding the wipe. CNA A assisted, with her soiled gloves, the other staff member to reposition Resident #1 on his back. CNA A pulled the clean brief up underneath him with the soiled gloves and fastened the brief, removing the soiled brief placing it in the trash. CNA A then left Resident #1 with his clean gown in the bed, to be transferred to the shower bed. CNA A removed her dirty gloves and used hand sanitizer when she came outside in the hallway. CNA A obtained the mechanical lift and assisting staff brought the shower bed into the room, preparing for transfer of Resident #1. In an interview on 10/07/2025 at 11:35 a.m., CNA A said she was to perform hand hygiene before and after the procedure and between changes of gloves. The glove changes should occur at the beginning and at the end of the incontinent care. She said she did not do it this time because she was nervous and talking. She stated the risk would be spread of infection. In an interview on 10/07/2025 at 1:00 p.m., the DON stated the expectation was to perform hand hygiene and glove changes before and after any care, and any time after removing dirty gloves. If your hands are visibly soiled clean with soap and water, otherwise can use hand sanitizer. The DON stated the risk is not performing hand hygiene, would be cross contamination. The DON stated she would be doing in-servicing concerning handwashing and the changing of gloves starting today. Review of in-services reflected an in-service performed by the DON on 07/2025 covering hand hygiene and incontinent care. CNA A was reflected as having attended the in-service. Review of the facility's policy Perineal Care dated May 2022, revealed, Policy Statement This procedure aims to maintain the resident's dignity and self-worth and reduce embarrassment by providing cleanliness and comfort to the resident, preventing infections and skin irritation, and observing the resident's skin condition. procedure content: 10) perform hand hygiene 11) don gloves.24) doff gloves 25) Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 If continuation sheet Page 3 of 4 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete perform hand hygiene.26) provide resident comfort and safety by re-clothing (if applicable-incontinence pads(s) and briefs, . 31) perform hand hygiene . Review of the facility' policy Infection Control Guidelines for all Nursing Procedures undated reflected, A variety of infection control measures are used for decreasing the risk of transmission of microorganisms in the facility. The measures make up the fundamental for infection control precautions.1. Hand hygiene: hand hygiene continues to be the primary means of preventing the transmission of infection. Wearing gloves does not replace the need for hand washing because gloves may have small inapparent defects or be torn during use, and hands can become contaminated during removal of gloves. failure to change gloves, and wash hands between resident contacts is an infection control hazard. Event ID: Facility ID: 455994 If continuation sheet Page 4 of 4