Health inspection·July 2, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview the facility failed to ensure residents had the right to a safe, clean, comfortable and homelike environment for Residents #6, #7, and #8 (Resident room # 302 and #306) reviewed for environment. The facility failed to ensure resident rooms #302 and #306 were thoroughly cleaned and sanitized. This deficient practice could place residents at risk of living in an unclean and unsanitary environment which could lead to a decreased quality of life. Findings include: An observation on 7/1/25 at 9:45am of room [ROOM NUMBER], revealed the floor was sticky and stained, trash/candy wrappers, and food particles under beds A and B. There was also dirt, candy wrappers, and food particles behind dressers and nightstand., The room had a foul odor. Interview on 7/1/25 at 9:46am, in Resident room [ROOM NUMBER] bed A, Resident #6 stated she was well, staff were respectful., Resident #6 stated that housekeeping cleans the room., When asked when the last time it was swept and mopped, Resident #6 stated maybe last week, she did not recall. Resident stated that she would like her room to be cleaned, it makes her feel better. Resident #6 stated she did not complain to any staff about her room being upswept and needed mopping. Interview on 7/1/25 at 9:50am, Resident's room [ROOM NUMBER] bed B, Resident #8 stated that rooms are kept cleaned by housekeeping, they generally clean several times a week, resident stated he does not recall when the last time it was swept and mopped. Resident stated the floors do need to be swept and mopped and the floors are sticky. Resident stated he spilled tea a day ago and floor are sticky. Resident stated he did not say anything to anyone, stated they will get around to it. Resident stated he does like a clean environment, make him feel good. An observation on 7/1/25 at 9:59am, Resident's room [ROOM NUMBER] bed B, trash and food particles found on floor and under bed, behind dresser, nightstand and floors are sticky. Interview on 7/1/25 at 9:59am, Resident's room [ROOM NUMBER], Resident #7 stated he did not say anything to anyone about room needing to be cleaned, resident stated they (housekeeping) does a good job, but not under bed. Resident stated he likes his room clean. Interview on 7/1/25 at 2:07pm, CNA C stated housekeeping cleans rooms daily or as needed. CNA C stated that if she sees a room that needs to be cleaned, she will notify housekeeping or clean room herself. CNA C stated that residents deserve to live in a clean environment, it is their right. CNA C did not know why rooms #302 and #306 have not been cleaned. Interview on 7/1/25 at 2:37pm, LVN D stated that rooms should be swept and mopped if needed daily. Housekeeping cleans rooms several times per week, sweeping and mopping, daily if needed. LVN D stated she did not notice rooms #302 and #306 being unclean, LVN D stated she reports to housekeeping when rooms need attention. Interview on 7/2/25 at 9:00am, HK Director stated that housekeeping staff were responsible to sweep under beds and behind furniture each time rooms are cleaned. HK Director stated she has in-serviced HK staff on cleaning under beds and furniture and will do so again. HK Director stated that residents having clean rooms was a dignity and rights issues, clean rooms are a big part of Infection Control. HK Page 1 of 2 675009 675009 07/02/2025 Coleman Healthcare Center 2713 S Commercial Ave Coleman, TX 76834

F 0584 Level of Harm - Minimal harm or potential for actual harm Director's expectation was for the residents to have a clean and sanitary environment to live in. Interview on 7/2/25 at 9:45am, Administrator stated it was his expectation that the facility was clean 24/7, this falls on all staff not just HK to be observant and help keep the facility clean. The residents have a right to a clean, sanitary, and comfortable environment to live in. Residents Affected - Few 675009 Page 2 of 2