Health inspection·February 25, 2022

F 0636 he was severely impaired mentally. Level of Harm - Minimal harm or potential for actual harm Section A, condition related to ID\IDD, was left blank. Section H, Bladder and bowel was assessed as 0 meaning he was incontinent of bowel and bladder. Residents Affected - Few Record review Resident #41's physician's order dated 10/21/20 revealed he had a catheter related to sacral wound. Observation on 02/22/22 at 10:00AM, revealed Resident #41 was in bed, alert, and had a catheter to his bed side with about 300 cc of urine in the bag. During an interview with the facility DON on 02/24/22 at 2:00PM she said the MDS coordinators are responsible for ensuring the MDS accurately reflect Resident's condition . During an interview with MDS Nurse A on 02/24/22 at 3:30pm, he said the care plan for Resident #10 was not accurate. He said inaccurate assessment would affect residents by not getting the appropriate care needed to improve or maintain their health. He said Resident #10's MDS would be corrected to reflect their condition. He said he was responsible for ensuring that all MDS assessments reflect Resident's condition. Record review of the facility's policy on accuracy of assessment was requested from the DON on 02/25/22 at 11:00 PM. provided policy dated 2001 revised September 2013 did not address accuracy of MDS. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 2 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to refer all residents with newly evident or possible serious mental disorder condition for level II resident review upon a significant change in status assessment for 1 of 4 residents (Resident #14) reviewed for PASARR screening, in that: This facility failed to refer Resident #14 for PASARR level 2 assessment after being diagnosed with multiple mental disorder. This failure could place PASARR positive residents at risk of not having their medical and psychosocial needs met due to not receiving the appropriate services and medical equipment. Findings included: Review of face sheet revealed Resident #14 was a [AGE] year-old female who was initially admitted the facility on 10/06/2018, current admission date was 12/30/2018. Resident #14's diagnosis included Dementia, Anxiety disorder, Psychosis, Major Depressive disorder, schizophrenia (A disorder that affects a person's ability to think, feel, and behave clearly). Record review of Resident #14's PASARR level 1 dated 10/05/2018 was negative. However, facility failed to refer Resident #14 for PASARR level 2 assessment after Resident was diagnosed with the following: Anxiety disorder - diagnosed on [DATE] Psychosis diagnosed on [DATE] Schizophrenia diagnosed on [DATE] Major Depressive disorder diagnosed on [DATE] During interview on 2/24/2022 at 4:42 PM, MDS Nurse A said Resident #14 did not have the PASARR II done and the MDS nurse agreed that facility failed to perform PASARR II assessment on Resident #14. The MDS nurse agreed this failure could affect the resident by not getting the service suitable for them. The MDS nurse stated the facility did not have specific PASARR policy, he said they only follow the State requirement. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 3 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan that described the services to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 4 of (Residents #41, #26, #16, #46) of 14 residents reviewed for care plans. The facility failed to ensure Resident #41 was care planned for hospice care The facility failed to ensure Resident #16 and #46 were care planned for ADL's. The facility failed to ensure Resident #26 was care planned for behaviors. These failure could place residents at risk of not receiving care and services related to their identified needs. Findings included: Resident #41 1. Record review of Resident # 41's admission records face sheet dated 2/23/22 revealed he was [AGE] year-old male admitted to the facility 10/12/20 His diagnoses included Epilepsy, benign tumor (soft tissue tumors). Muscle wasting, urinary tract infection and age-related physical conditions. Review of Resident #41's Physician Orders dated 05/07/21 revealed -admission to local Hospice Record review of Resident #41's MDS assessment dated [DATE] revealed section O on specialized treatment, procedure and program was checked for hospice care. Record review of Resident #41's care plan dated 05/04/21 revealed no care plan for hospice care. During an interview with the facility DON on 02/24/22 at 2:00PM she said the MDS coordinators are responsible for ensuring that the MDS accurately reflect Resident's condition. During an interview with MDS Nurse A on 02/24/22 at 3:30pm, he acknowledged that the care plan for Resident # 41 was not accurate. He said Resident # 41's care plan would be corrected to reflect their condition. He said he was responsible for ensuring that all MDS assessments reflect Resident's condition. Resident #26 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 4 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2. Record review of Resident #26's face sheet revealed a [AGE] year-old female who was admitted into the facility on [DATE] and was diagnosed with dementia, hypertension, and multiple sclerosis. Record review of Resident #26's MDS, dated [DATE] revealed the resident's BIMS assessment was unable to be completed due to resident being never or rarely understood. The resident was not assessed to have any psychiatric disorders. Record review of Resident #26's physician's orders, dated as of 02/22/2022 revealed the resident was taking clonazepam and buspirone for anxiety starting 12/17/2021, trazadone for sleep/depression starting 12/17/2021, Seroquel for bipolar disorder starting 02/17/2021. Record review of Resident #26's care plan, as of 02/22/2022, revealed the only note made about resident's behavior was, . The resident has a behavior problem in which she sits on the floors and other objects despite encouragement not to do so. There were no other notes regarding resident behavior or psychiatric-related diagnoses. Record review of Resident #95's face sheet revealed an [AGE] year-old male who was admitted on [DATE] and was diagnosed with cognitive communication deficit, psychosis and dementia. Observations of Resident #26 and #95 on 02/22/22 at 10:30AM revealed Resident #26 sitting in a wheelchair while yelling at and cursing out surveyor after surveyor asked for CMA J and LVN R for location of a room number. Resident #26 was then observed passing nearby Resident #95 as he slept in the hallway on a Geri-chair. Resident #26 yelled wake-up while swiftly brushing Resident #95's cheek with her hand. CMA J was observed to quickly remove Resident #26 from Resident #95. Resident #26 was later observed to cry out loud while asking for her son. In an interview with CMA J on 02/24/22 at 1:05 PM, she stated Resident #26 was aggressive, gets upset and calls her sons' name. She said the resident gets up to fight with staff as if she is preparing to defend her son. She went up towards Resident #95 on 02/22/22 and brushed his face she believed with the intention to get his attention so he could move out of the way. She usually does not fight other residents. In an interview with LVN R on 02/24/22 at 1:50PM, she stated Resident #26's behaviors included shouting and looking for her children and when hearing a random person's voice, she thinks its her son talking. She does not harm residents but she touches residents sometimes with the intention of going where she wants to go or probably due to vision problems. She stated this type of behavior should be documented and care planned. In an interview with the Administrator on 02/25/22 at 10:31AM he stated has never seen Resident #26 hit a resident before but he knows the resident has her outbursts due to her behaviors. He stated he expects behavior monitoring to be care planned for her psychiatric diagnoses as well as psychotropic medication usage. In an interview with the DON on 02/25/22 PM, she stated Resident #26's only behavior that she had noticed was screaming and yelling. She stated she is on medications that have been adjusted by her psych provider. She said this type of behavior should be care planned. She stated they usually have care meetings on Friday with nurse department team and they make updates to resident care plans then. She said her care plan was likely missed because they did not talk about her behaviors during a meeting yet. She stated the implication of not care planning behaviors is not having care and needs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 5 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0656 followed up on with interventions and goals to manage behaviors in place Level of Harm - Minimal harm or potential for actual harm In an interview with MDS Nurse A and MDS Nurse B on 02/25/22 at 11:44AM, MDS Nurse A stated Resident #26 was initially in the secured unit and shows aggressive behavior and curses people out and therefore had to leave the secured unit. He said she admitted back into the facility's general community after getting her medications adjusted during her discharge. He stated behaviors settled down but slowly came back. MDS Nurse B said these behaviors should have been care planned and if the resident is on psych meds it should have been triggered in the care plan as well. Residents Affected - Some Resident #16 3. Record review of the face sheet for Resident # 16 revealed a [AGE] year-old female with initial admission date of 6/7/21, and re-admission date 2/15/22. Diagnoses included Schizophrenia, Bipolar disorder, anxiety disorder, dementia without behavioral disturbance, Epileptic seizures, hypertension, and Multiple Sclerosis. Record review of the quarterly MDS dated [DATE] revealed Resident # 16 had unclear speech and sometimes understood and sometimes understands others. Resident # 16's BIMS score was 3 indicating severely impaired cognitive skills for daily decision making and required total staff assistance for bed mobility, transfer, dressing, hygiene, toileting, and bathing. Record review of Resident# 16's care plan, undated, revealed there was no care plan developed for ADL's, including interventions for ADL assistance. Observation and attempted interview with Resident # 16 on 2/22/22 at 9:40 am revealed she was in bed, awake and alert. Resident had clean linens, catheter bag at bedside draining clear urine, and an IV pole with medications being infused for UTI. Resident # 16 stated I'm tired and closed her eyes when an interview was attempted. Observation and attempted interview with Resident # 16 on 2/23/22 at 9:15 am revealed she was in bed, awake and alert. Resident # 16 stated Who are you? Bye and closed her eyes when an interview was attempted. Resident #46 4. Record review of the face sheet for Resident #46 revealed a [AGE] year-old male with admission date of 1/06/21. Diagnoses included Parkinson's disease, need for assistance with personal care, dementia without behavioral disturbance, Diabetes, hypertension, Schizophrenia, Benign Prostatic Hyperplasia (enlarged prostate), and paralysis following cerebral infarction (stroke). Record review of the Annual MDS dated [DATE] revealed Resident # 46's cognitive skills for daily decision making were moderately impaired, and he required extensive assistance from staff for bed mobility, transfer, dressing, hygiene, toileting, and bathing. Record review of the Care Area Assessment (CAA) Summary revealed ADL/Functional/Rehabilitation Potential was not triggered. Record review of Resident #46's care plan, undated, revealed there was no care plan developed for ADL assistance, including appropriate interventions for ADL care. In an interview with MDS Nurse A on 2/24/22 at 10:10 am revealed ADLs were not triggered in the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 6 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Care Area Assessment for Resident's # 16 and #46, so the care plan for ADL's was not developed. MDS Nurse A stated the care plans were developed from the comprehensive assessment for each resident, and if the CAA's are triggered for a particular area, a care plan would be done for that care area. Record review of the facility policy Care Planning - Interdisciplinary Team, dated September 2013, revealed, in part: .the care plan is based on the resident's comprehensive assessment and is developed by the Care Planning/Interdisciplinary Team . Record review of facility's provided care plans policy dated 2001 revised September 2013 read in part . our facility 's care planning/interdisciplinary team is the responsibility for the development of an individualized comprehensive care plan for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 7 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure 1 of 3 residents (Resident #3) reviewed for pressure ulcers received care to prevent pressure ulcers and necessary treatment and services, consistent with professional standards of practice, to promote healing, in that: Residents Affected - Few Resident #3 was noted to have a wound on her sacrum by CNA R on 01/22/22, but no wound assessment, wound care or treatment was provided to the resident until 01/26/22. The facility nursing staff assessed Resident #3 to have no skin abnormalities on 01/21/22 but on 01/26/22 was later assessed to have two stage 3 pressure ulcers - full thickness skin loss potentially extending into subcutaneous tissue layers. This failure caused a resident to develop pressure ulcers and could place other residents at risk of development or worsening of pressure ulcers. Findings included: Record review of Resident #3's undated face sheet revealed a [AGE] year-old female who was admitted into the facility initially on 10/29/2014, and was diagnosed with protein-calorie malnutrition, abnormal weight loss and dysphagia. Record review of Resident #3's Braden scale for predicting pressure ulcer risk, dated 02/08/2022, revealed resident was categorized to have a moderate risk for developing pressure ulcers with a score of 14, with 18 being the highest risk score. Record review of Resident #3's care plan, dated 02/24/2022, revealed the resident was at risk for skin breakdown/pressure ulcers due to incontinence and immobility. The goal was for the resident to maintain or develop intact skin with the invention of inspecting skin morning and evenings and during showers or ADL care, also, to document each incident of skin problems to prevent further occurrences. Record review of Resident #3's MDS, dated [DATE], revealed the resident had an incomplete BIMS score, indicating assessment of cognition level was unable to be done or the resident was rarely/never understood, and was a two+ person assist for bed mobility and transfers. Record review of Resident #3's weekly skin assessments revealed the resident was noted to not have any skin issues on 01/07/22, 01/14/22, and 01/21/22. Record review of Resident #3's skin monitoring/shower review sheets revealed on 01/22/22, the resident was noted to have a wound on sacrum by CNA R. This review was signed off by an unidentified nurse. Record review of Resident #3's nurses notes revealed no notes were written concerning resident skin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 8 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0686 condition from 01/21/22 to 01/25/22. Level of Harm - Actual harm Record review of Resident #3's weekly wound assessment, dated 01/26/22, revealed a new stage 3 pressure wound on her coccyx measuring 0.4cm by 0.5cm by 0.1cm with an open wound bed with moderate, clear exudate. Treatments for this wound included calcium alginate, daily wound treatment and low air loss mattress. The resident's physician and family member were notified on this date. Residents Affected - Few Record review of Resident #3's weekly wound assessment, dated 01/26/22, revealed a new stage 3 pressure wound on her sacrum measuring 3.1cm by 4.2cm by 0.1cm with an open wound bed with moderate, clear exudate. Treatment for this wound included calcium alginate daily, daily wound treatment, vitamin therapy, protein supplement and low air loss mattress. The resident's physician and family member were notified on this date. In an interview with the Wound Care Nurse on 02/24/2022 at 10:54AM, she stated she was the main wound care and treatment nurse that stages the wounds during assessments. Other nurses' duties for wound care are to document on resident skin discoloration, open skin, redness and any change of conditions should be notified to her. She stated the date 01/26/2022 was when she was made aware of Resident #3's wounds. She stated wounds can happen overnight, especially with the resident not getting adequate nutrition or is experiencing a decline. She stated she does not go through the shower sheets but they usually verbally report to her if there are resident skin concerns. She stated she could not remember if she was notified about Resident #3's wound by another nursing staff or if she caught it during routine weekly assessments. She stated she was unaware of the note on the wound on sacrum made on Resident #3's skin shower sheet, dated 01/22/22 but based on the timing of the documentation, there was a delay in treatment if no assessment was done on that day. She stated the consequences of not documenting and communicating skin concerns could lead to possible neglect of the health of the resident. A phone interview was attempted with CNA R on 02/24/22 at 12:16PM. Both attempts failed. In an interview with the CNA M on 02/24/22 at 11:34AM, she stated she had given Resident #3 a shower and if she were to see any skin issues such as redness, or marks, she would notify her charge nurse because she knew it could have the potential of developing into a wound. She stated sometime in January, date unknown, she remembered notifying a charge nurse, likely LVN R but she was not sure, about seeing a red mark on her butt and got the nurse to assess it. She stated there was no open skin at that time but the charge nurse applied A&D ointment and said it was okay. She said the charge nurse thanked her for letting her see it and walk out of the room, she did not know if anything was done afterwards about it. In an interview with CNA D on 02/24/22 at 11:45AM, she stated, she had worked with Resident #3 and gave the resident a bed bath, date unknown. She stated remember while doing her bed bath at one point, the resident's back looked red on the middle part of her back and on the side of her cheek, but there was no sore on it. She stated she notified her charge nurse, unsure which nurse, and put A&D ointment on the resident. She stated she forgot to note anything on her shower sheet indicating the redness and where it was located. She said it slipped her mind to do it but generally it was supposed to be done. In an interview with LVN R on 02/24/22 at 1:50PM, she said she did not sign off on any of the shower sheets from 01/18 /22 - 01/25/22. When asked if she was expected to sign it, she said sometimes the sheets can go unsigned for up to two days because they rushed and dropped it in the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 9 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0686 Level of Harm - Actual harm Residents Affected - Few room, so she and nurses will sign it later based on seeing if it appears as if the resident had a bath. She said around the time the resident was assessed with the wound, she stated she was notified by a CNA of the redness that was seen near the resident's sacrum. She said she went to look at the patient and saw no broken skin but it just looked like she was laying on her side too long. At the moment she remembers applying A&D ointment and as she came out of the room, she saw the Wound Care Nurse and notified her at that time about the redness. She stated she did not document her findings because the Wound Care Nurse is usually good about following up on the resident's skin conditions. She said she was unaware of the shower sheet written on 1/22/22 that noted the wound on Resident #3's sacrum. She said based on the time the note was made and the assessment was documented 1/26/22, she recognized there was a delay in communication. She said she remembered on a Monday, 01/24/22 she had said to herself how come no one said that this woman's butt is red . Oh, so nobody said anything throughout the weekend? She stated the expectation of CNAs were to report skin abnormalities to her. She stated that she, as the charge nurse, she was supposed to notify the physician and family and the wound nurse all verbally or over the phone, but she did not document it because she would only take full responsibility of assessing and documenting skin concerns unless the Wound Care Nurse was not in the building at the time. She said in the nursing field if she did not write it down it meant she did not do it. In an interview with the DON on 02/24/22 at 4:00PM, she stated nursing care to prevent skin breakdown includes turning, more frequent changes, use of cream A&D and zinc ointment. She said Resident #3 used to get up but resident stopped eating because she was grinding her teeth and could no longer open her mouth, and as a result, she had peg tube placed in February 2022. She stated due to Resident #3's decline with weight loss, the bony areas become more prominent placing her at risk for skin breakdown. She said redness of the skin is usually the first sign for skin breakdown and if CNAs saw it, they are expected to document on the shower sheet and notify the nurse, the nurse is expected to notify the doctor and who would place a standing order for wound care. She stated the nurses are responsible for noting skin concerns and if the skin is open, the nurse should notify the doctor, and put in an order for wound care that would have started no later than the next day. She said she was not notified of resident having red skin before the Resident #3's was diagnosed with stage 3 wounds. She said the nurse on duty at the time the wound was first noted should have had the order placed that day and dress the wound herself. She stated the Wound Care Nurse wound be responsible for re-assessing the wounds with measurements and provided additional treatments if necessary. She stated based on the timing from which the wound was first noted on the shower sheet to when the wounds were assessed, there was a delay in the provision of care or care the was not being documented at all. She said the implication of not documenting the development of a wound and relying on wound care to make all assessments is a delay in treatment. Observation of Resident #3's wound care on 02/25/22 at 11:09AM, one sacral wound 8 by 5 cm with eschar tissue in the center and white skin on the edges of the wound. Record review of the facility's policy on Skin Management System, undated, stated, . Routine weekly checks will be completed on the Skin observation Tool on every resident; if skin is intact it will be noted as such. If a new pressure sore is noted, a Weekly Wound Observation Form will be started CNA's will note any alteration in skin integrity during care in [EHR] and reported to the Charge Nurse . Keep open lines of communication with physicians, families, and residents regarding status of wounds. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 10 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 Based on observation, interview, and record review, the facility failed to maintain infection prevention and control process designed to provide safe and sanitary environment and to help prevent the development and transmission of diseases and infections for four (Residents #33, #37, #40 and #106) out of five Residents observed for infection control during medication administration: in handling of laundry and in wearing of face mask, in that: Residents Affected - Some LVN D and CMA E failed to sanitize blood pressure machine used for multiple residents during medication administration for residents #33, #37, #40 and #106. The facility failed to ensure Laundry Provider D was transporting clean resident clothes down the 200 Hall with laundry cart covered. The facility failed to ensure CNA A, and CNA B wore N95 masks properly. These failures could place residents at risk of cross contamination and contracting of infectious diseases. Findings included: Transmission-Based Precautions Observation on 02/22/22 at 12:04 PM revealed CNA A, and CNA B were not wearing N95 masks properly. The backstrap of the N95 was hanging underneath their chins. During an interview on 02/22/22 at 12:09 PM, CNA A said he was not wearing his mask properly because he could hardly breath. During a follow-up interview on 02/23/22 12:28 PM with CNA A, he said he was trained on infection control a couple of weeks ago. He said the training covered wearing masks appropriately, proper hand hygiene, donning and doffing PPE. During an interview on 02/22/22 at 12:12 PM, CNA B said she was not wearing her mask properly because she could hardly breath and she forgot to put it on properly. Observation on 02/22/22 at 12:15 PM revealed the Speech Therapist making contact with residents. She did not wash her hands or use hand sanitizer while cutting food for a resident during lunch service. During an interview on 02/22/22 at 1:34 PM with the Speech Therapist, she said she was supposed to wash her hands in between residents during dining. She said there was not that many sanitizing stations in the area, so it was just easier to help the resident in need rather than to walk over to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 11 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some sanitizing station. She said she normally used hand sanitizer at her building because there were sanitation stations on every wall which was not the case in this facility. Observation and interview on 02/22/22 at 1:50 PM revealed the Activity Director passing out snacks. She said her role was to clean up her cart and pass out coffee, snacks, and other items. She said she also passed out juice, yogurt, and water. She said staff was supposed wash their hands and wear gloves and wash again between residents. She said she did not wear gloves today because it was a bad habit. She said she would do better. She said the facility could benefit from adding more sanitizing stations. Universal Precautions During observation on 2/23/2022 at 7:53 AM LVN D on the 200 Hall was using a blood pressure machine to check Resident #106 blood pressure but failed to sanitize the blood pressure machine after using it. During observation on 2/23/2022 at 8:31AM LVN D went to Resident #40 to check his blood pressure using the same blood pressure machine she used on Resident #106 - again, LVN D failed to sanitize blood pressure machine before using it on Resident #40 and failed to sanitize the blood pressure machine after using it on the Resident #40. During interview on 2/23/2022 at 9:49 AM LVN D agreed that failure to sanitize the equipment used for multiple residents was a compromise of infection control which could affect the residents. During an observation on 2/23/2022 at 8:53 AM CMA E was took the blood pressure of Resident #37 but failed to sanitize the blood pressure machine after using it for the resident. During an observation on 2/23/2022 at 9:15 AM, CMA E checked Resident #33's blood pressure using the same blood pressure machine she used on Resident #37 - again, CMA E failed to sanitize blood pressure machine before using it on Resident #33 she also failed to sanitize the blood pressure machine after using it on Resident #33. During an interview on 2/23/2022 at 9:42 AM CMA E stated that she forgot. She stated that she had proper infection control training and was aware this could place residents at risk for infection. Laundry During an observation and interview on 2/23/22 at 9:00 am revealed Laundry Provider D was transporting clean resident clothes down the 200 Hall in an uncovered laundry cart. Laundry Provider D did not know if the clothing should have been covered while transporting it down the hallway. Interview on 2/24/22 at 2:30 pm, the Director of Laundry Services revealed the laundry cart was always covered with a plastic tarp unless it was being loaded with clean clothing and should always be covered when it was transported down the hallways for infection control purposes. She stated it was important to make sure the clean clothing was not contaminated by anything it might contact while it was being moved down the hallways. During an interview on 2/24/22 at 8:57 AM with the DON and the ADON, the DON stated they always trained their staff during hiring process and they provided ongoing training for them. The ADON stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 12 of 13 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/25/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some they also had an online training portal where all employees were being assigned training on a regular basis. Both the DON and the ADON agreed staff were required to sanitize equipment used for multiple residents, as failure to sanitize equipment posed infection risk to residents, because they could pass any disease or virus from one patient to another. During an interview on 2/24/22 at 8:57 AM with the DON, she said staff were supposed to wash or sanitize their hands when feeding the residents. She said after feeding one resident, staff should wash or sanitize before feeding another resident. She said all staff members were required to wear face mask to always cover mouth and nose. She said alteration of facemasks was not acceptable. She said staff were not required to wear gloves when passing out food, but they were required to wash or sanitize their hands. During an interview on 2/24/22 at 10:00 AM surveyor requested a facility policy on infection control regarding equipment used for multiple residents, the DON stated they did not have any specific policy regarding equipment such as blood pressure machine used for multiple residents. However, DON stated it was required of employees to sanitize equipment such as stethoscope, blood pressure machine, Oxygen saturation machine, thermometer, etc. used for multiple residents. Interview with the DON on 2/24/22 at 3:40 pm revealed the clean laundry cart should be covered with a plastic tarp or similar cover while it was being used to transport clean laundry down the hallways, to make sure it did not become contaminated with dust or anything it might touch. Record review of facility's policy Departmental (Environmental Services) - Laundry and Linen, revised January 2014, revealed, in part: clean linen will remain hygienically clean (free of pathogens in sufficient numbers to cause human illness) through measures designed to protect it from environmental contamination, such as covering clean carts . Record review of the website https://www.cdc.gov/infectioncontrol/guidelines/environmental/index.html#g revealed, in part: .transport and store clean textiles and fabrics by methods that will ensure their cleanliness and protect them from dust and soil during interfacility loading, transport, and unloading . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 13 of 13