Health inspection·November 21, 2025

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 provide necessary care and services to ensure a resident who was unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming and personal and oral hygiene for 4 of 5 residents (Resident #1, Resident #2, Resident #3, Resident #4) reviewed for quality of life.The facility failed to provide Resident #1's, Resident #2's, Resident #3's and Resident #4's assigned showers for the month of November 2025.This failure could place residents at risk of not receiving the services and care needed, decreased self-esteem, and a decreased quality of life. The findings were:Record review of Resident #1's face sheet, dated 11/10/25 revealed a [AGE] year-old female admitted [DATE] and readmitted [DATE] with diagnoses including (but not limited to) dementia (a general term for a group of conditions that cause a decline in cognitive function), bipolar disorder (a mental health condition that causes extreme mood swings), major depressive disorder (a mental health condition characterized by persistent feelings of sadness), Diabetes Mellitus Type II (a chronic condition where the body does not use insulin effectively or produce enough insulin), Hyperlipidemia (a condition characterized by high levels of lipids/fats in the blood stream), peripheral vascular disease (a group of disorders that can cause narrowing or blockage in the arteries and veins), dysphagia (difficulty swallowing), polyosteoarthritis (inflammation of multiple joints at once), hypertension (high blood pressure) and overactive bladder (a frequent need to urinate, incontinence). Record review of Resident #1's BIMS assessment, dated 9/3/2025, reflected Resident #1 had a BIMS score of 15 indicating intact cognition. Record review of Resident #1's MDS assessment, dated 9/3/2025, reflected Resident #1 had no impairment to upper or lower extremity, utilized a walker for mobility and required supervision with tub/shower transfers and bathing hygiene.Record review of Resident #1's care plan viewed 11/10/25 revealed resident had an ADL (activities of daily living) self-care deficit and required supervision or touching assistance with bathing and that a shower should be provided per scheduled and when needed.During an observation and interview on 11/10/25 at 2:39 p.m., Resident #1 stated that she did not receive a shower on Monday 11/3/25 or Wednesday, 11/5/25; did receive a shower on Friday 11/7/25, but not on Monday, 11/10/25Resident stated, they did not even ask her or tell her anything about it. Presented odor free, hair disheveled, appropriately dressed.Record review of shower sheets for the month of November 2025 indicated Resident #1 received a shower on 11/3/25, refused a shower on 11/5/25 and received a shower on 11/10/25. No shower sheet provided for 11/7/25. Record review of Resident #2's face sheet, dated 11/10/25 revealed a [AGE] year-old female admitted [DATE] and readmitted [DATE] with diagnoses including (but not limited to) Congestive Heart Failure (a chronic condition where the heart cannot pump enough oxygen-rich blood to meet the body's needs, causing fluid to back up in the lungs, liver and other body parts), Diabetes Type II (a chronic condition where the body does not use insulin effectively or produce enough insulin), Parkinson's Disease (a progressive neurological disorder Residents Affected - Some Page 1 of 4 675020 675020 11/21/2025 Greenville Health & Rehabilitation Center 4910 Wellington St Greenville, TX 75402

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that affects movement due to the death of brain cells causing tremors, stiffness and slowness of movement), Dysphagia (difficulty swallowing), dementia (a general term for a group of conditions that cause a decline in cognitive function), and Osteoporosis (a disease that weakens bones, making them more fragile and prone to fractures).Record review of Resident #2's BIMS assessment, dated 9/18/25, reflected Resident #2 had a BIMS score of 9 indicating moderate cognition.Record review of Resident #2's MDS assessment, dated 9/18/25, reflected that Resident #2 had impairment to lower extremity, utilized a wheelchair for mobility and required total care for tub/shower transfers and bathing hygiene. Record review of Resident #2's care plan viewed 11/10/25 revealed Resident #2 had an ADL (activities of daily living) deficit and required total assistance in bathing and shower should be provided per schedule and when needed. During an observation and interview on 11/10/25 at 2:36 p.m., Resident #2 stated she did not receive a shower today because, they do not have a shower aide, so we don't get one. Resident #2 stated she did not remember if she received a shower last Friday, 11/7/25. Resident presented alert, odor free, appropriately dressed.Record review of shower sheets for the month of November 2025 indicated no shower sheets were completed and did not reflect that Resident # 2 received a shower or bed bath on 11/3/25, 11/5/25, 11/7/25 or 11/10/25. Record review of Resident #3's face sheet, dated 11/10/25 revealed a [AGE] year-old female admitted [DATE] and readmitted [DATE] with diagnoses including (but not limited to) Osteoarthritis (inflammation of the joints), Osteoporosis (a disease that weakens bones, making them more fragile and prone to fractures), Schizoaffective disorder Bipolar type (a mental health condition characterized by a combination of hallucinations and delusions and mood disorder symptoms of both mania and depression), Seizures (convulsions caused by abnormal electrical activity in the brain), and Chronic Obstructive Pulmonary Disease (a group of chronic lung diseases that block airflow and make breathing difficult).Record review of Resident #3's BIMS dated 9/29/25 reflected Resident #3 had a BIMS score of 15 indicating intact cognition.Record review of Resident #3's MDS dated [DATE] reflected resident has no impairment to upper or lower extremity, utilized a wheelchair for mobility and required total dependence in tub/shower transfers and maximum assistance in bathing hygiene,Record review of Resident #3's care plan viewed 11/10/25 revealed Resident #3 had an ADL (activities of daily living) self-care deficit and required total assistance for bathing and shower should be provided per schedule and when needed. During an observation and interview on 11/10/25 at 12:26 p.m., Resident #3 stated that she has received bed baths because they do not want to get her to the shower with use of the Hoyer lift. Resident stated she prefers a shower. Resident #3 presented clean, odor free and wearing a hospital gown in bed.Record review of shower sheets for the month of November 2025 indicated Resident #3 was offered a shower on 11/5/25 but was asleep and informed the aide after waking that she would accept a bed bath. No shower sheet for 11/3/25, 11/7/25 or 11/10/25 was provided. Record review of Resident #4's face sheet, dated 11/10/25 revealed a [AGE] year-old female admitted [DATE] and readmitted [DATE] with diagnoses including (but not limited to) polyarthritis (inflammation of the joints), neurosyphilis (infection of the central nervous system), Parkinson's disease (a progressive neurological disorder that affects movement due to the death of brain cells causing tremors, stiffness and slowness of movement), COPD (Chronic Obstructive Pulmonary Disease, a group of lung diseases that cause airflow to the lungs to be blocked leading to breathing problems) , (Diabetes Type II (a chronic condition where the body does not use insulin effectively or produce enough insulin), Sciatica (pain that radiates from the lower back down one leg).Record review of Resident #4's BIMS assessment, dated 10/9/25, reflected Resident # 4 had a BIMS score of 14 indicating intact cognition.Record review of Resident #4's MDS assessment, dated 9/3/25, reflected Resident #4 had no impairment to upper or lower extremity, utilized a walker 675020 Page 2 of 4 675020 11/21/2025 Greenville Health & Rehabilitation Center 4910 Wellington St Greenville, TX 75402

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some or wheelchair for mobility and required maximum assistance for tub/shower transfers and bathing hygiene.Record review of Resident #4's care plan viewed 11/10/25 revealed Resident #4 had an ADL (activities of daily living) self-care deficit and required assistance of 1 person for bathing and shower should be provided per schedule and when needed.During an interview and observation on 11/10/25 at 3:15 p.m., Resident #4 stated she gets a shower about once a week here. She stated there was not consistent staff for showers. Resident presented odor free, and her hair was combed. Her hair appeared to be greasy. Resident was unable to recall her last shower day.The DON was requested to provide the shower sheets for Resident #4 on 11/10/25. Facility was unable to locate shower sheets for Resident #4 for month of November 2025. During an interview on 11/10/25 at 12:48 p.m., NA A stated that she had completed her scheduled showers for today. She stated she was aware of the shower schedule that has been updated and that sometimes (about twice a week) she does not have enough time to complete the showers, and she will let the nurse know. NA A stated she had completed her showers for 11/10/25 and was not assigned to shower any of the residents identified in this investigation.During an interview on 11/10/25 at 12:48 p.m., NA B stated that she has only worked here a few weeks and has observed showers being completed by her co-worker. She stated she has been told that shower sheets should be completed after each shower and turned in to the charge nurse. Stated she did not provide the showers and did not exactly know which residents were scheduled for showers.During an interview on 11/10/25 at 1:00 p.m., NA C stated the facility has a shower schedule by room numbers for the day of the week and what shift. She stated she was advised to turn in the shower sheet reflecting the skin issues after each shower. She stated she has completed her showers this shift and was not assigned to complete showers for any of the residents identified in this investigation.During an interview on 11/10/25 at 1:12 p.m. NA D stated that the facility has a shower schedule and it was just updated. She stated she has not been able to complete all of her showers per schedule today. NA D stated she will pass this information on to the next shift and she does not know if they will have time to finish them. NA D stated she was not assigned to shower any of the residents identified in this investigation. During an interview on 11/10/25 at 2:45 p.m., LVN A stated no shower sheets for the 6-2 shift have been turned into her and she was unable to verify if the residents had received their scheduled showers. She stated she should let the DON know if a shower was not completed per schedule.During an interview on 11/10/25 at 3:17 p.m., LVN B stated she advises her nurse aides to complete the shower sheet after each shower and turn them in to her as they happen, even if the resident refuses a shower. She stated the schedule was made by the nursing administration team, but if there was a reason to alter the schedule for appointments or resident preference, she will let the DON know. She stated she has received some shower sheets today but has not verified them yet. During an interview on 11/10/25 at 4:11 p.m. with the DON, the DON stated he expects the nurse aides to notify their charge nurse right away if a resident refuses to shower or if they are unable to complete their scheduled showers to allow nursing administration staff to adjust shower assignments. He stated he expects nursing staff including nursing administrative staff to assist with shower needs if the floor staff report they are unable to complete the assigned showers before the end of their shift. The DON stated that his new ADON (former Treatment Nurse) had just recently updated the shower schedule and created a more equal schedule with breakdown by room number, shift and day of the week. He stated missed showers could result in residents not being clean, and although 3'xs per week was scheduled, he expects as least 2 showers per week to ensure resident cleanliness. The DON stated additional showers could be received on Sundays.During an interview on 11/10/25 at 4:20 p.m., with the Administrator, the Administrator stated that her expectation for showers was that the staff complete the showers according 675020 Page 3 of 4 675020 11/21/2025 Greenville Health & Rehabilitation Center 4910 Wellington St Greenville, TX 75402

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to the assigned schedule and if they were unable to do so regardless of the reason, staff should notify the Charge Nurse right away. The Administrator stated she expects nursing staff to ensure residents' hygiene needs were being met. Record review of the shower schedule (undated) revealed Nurse for hall must initial and sign completion of shower and turn into ADON/Treatment Nurse along with skin sheet for each shower.Record review of Clinical Practice Guidelines (reviewed 2/11/21), titled Activities of Daily Living Care Guidelines revealed Residents will receive essential services for activities of daily living to maintain.grooming, and personal and oral hygiene, and Process: Residents will participate in and receive the following person-centered care. Bathing: includes grooming activities such as shaving and brushing teeth and hair. 675020 Page 4 of 4