Inspection·May 16, 2025

F 0677 Interventions: toileting - extensive assistance of one. Dated Initiated 5/3/25 and revised 5/16/25 Level of Harm - Minimal harm or potential for actual harm In an interview on 5.15.25 at 1:30 PM, CNA B said she had concerns about the night shift aide that she relieved this morning. She stated Resident #6 was pulling her call light when she came on shift and that she was upset because she was soaked through to the mattress and was very wet. She stated she had told the nurse on duty about it, and she stated she said she would ask LVN A about it. She stated it has happened before and usually happens with this rotation of aides that she relieves (which was CNA D and CNA E). Stated she believes they neglect their duties because they are friends with the charge nurse, who was LVN A, and she would take up for them. Residents Affected - Few In an interview on 5/15/25 at 1:45 PM CNA C stated she had concerns about the night shift aides that she relieved morning. She stated Resident #6 was pulling her call light when she came on shift on 5.15.25 and Resident #6 was upset because, she was soaked through to the mattress and was very wet when she went in to answer the light. She stated she believed this occurred because CNA E didn't like to do their job. She stated she had told the DON of her concerns. In an interview on 5/15/25 4:30 PM, the DON said it was her expectation for resident's to be changed when needed. She stated she was going to speak with the aides regarding the residents' concerns and. She stated she did not know why it happened. She stated she would look into it. In an interview with CNA D at 6:30 PM on 5.15.25 she said she did not check on Resident #6 that morning. She stated CNA E was supposed to check on her. She stated she and CNA E divided the incontinent residents up for last bed check on the morning of 5.15.25 that they make at about 5 am and CNA E did Resident #6. She stated she had never had concerns regarding her coworkers being neglectful. She stated not changing a resident could cause skin breakdown or infection. In an interview with CNA E at 6:45 PM on 5.15.25 she stated she did not check on Resident #6 that morning before she got off. She stated CNA D was supposed to check on her. She stated they divided the incontinent residents up and she checked on 11 residents but didn't check on Resident #6 . She stated she had never had concerns regarding her coworkers being neglectful. She stated they usually didn't check on Resident #6 unless she called, because Resident #6 had asked them not to wake her at night. In an interview with Resident #6 on 5.16.25 at 9:00 AM she stated that she called for assistance twice on 5.15.25 due to urinary incontinence and no one came until after 7: 00 AM. She stated she asked the nurse LVN A for someone to change her while LVN A was performing colostomy care. She stated LVN A told her she would get the Nurse. She stated nobody ever came and it was the day shift CNA's that changed her. She stated that she did not think that the girls did it on purpose to be neglectful. She stated she thinks they just overlooked her. Stated it has never happened before. She stated it made her feel uncomfortable physically, but it didn't hurt her emotionally. She stated she had been a nurse's aide herself and she knew how it was when you got busy. Sometimes people just forget what they are doing. She stated she did fall back asleep while she waited. She also stated she had never asked the aides not to check on her at night, which was when she needed them. During an interview on 5.16.25 at 9:30 AM the Administrator stated she would expect the nurse to change the resident if she had time or to ensure that an aide cared for the resident. She stated she believed the failure occurred because of the lack of monitoring on the nurses' part and the aides' lack of communication. She stated she had reported the alleged neglect to the state and had suspended the CNA's effective yesterday evening (5.15.25) until the completion of her investigation. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675042 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 675042 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seymour Rehabilitation and Healthcare 1110 Westview Dr Seymour, TX 76380 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 0677 Level of Harm - Minimal harm or potential for actual harm stated she had done an Inservice on abuse and neglect, and reporting and a one-on-one counseling with CNA B for not reporting to her immediately. Record Review of the facility policy Activities of Daily Living (ADLs) Guidelines revised 2.10.2020, revealed the following [in part] . Residents Affected - Few Policy Statement Anticipated Outcome Residents will receive essential services for activities of daily living to maintain good nutrition, grooming, and personal and oral hygiene.' Residents participate in and receive the following person-centered care: Toileting/Continence: toileting or receiving assistance with toileting or receiving incontinence care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675042 If continuation sheet Page 3 of 3