Health inspection·August 27, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some air into his room for several days. Resident #2 stated the facility could not give him a time or date as to when the air conditioning was going to be fixed. The resident stated it was summer and hot. Resident #2 stated the facility did not offer him air conditioning window unit. Resident #2 stated he told the facility that if he had money in his account to go get a window unit for him. The resident stated he bought the air conditioning unit using his own money because the facility did not know how long it was going to take to fix the air conditioning. He stated the current maintenance guy installed the window AC unit. Resident #2 stated he was comfortable since the window AC unit was installed. Record review of the window AC unit receipt dated 06/10/2024 reflected the facility purchased a window AC unit worth $155.88 from Walmart for Resident #2. The facility used Resident #2's funds to purchase the AC unit. Record review of Resident #3's quarterly MDS dated [DATE] reflected Resident #3 was a [AGE] year-old female with an original admission date of 03/08/2023, current admission date of 07/10/2024. Resident # 3's diagnoses included: Parkinson's disease (a chronic, progressive brain disorder that affects the nervous system and causes movement and non-motor symptoms), muscle wasting and atrophy (the thinning or loss of muscle tissue that can cause a decrease in muscle size and strength). Record review of quarterly MDS dated [DATE] reflected resident had a BIMS score of 15, which indicated intact cognitive abilities. Observation and interview with Resident #3 on 08/26/24 at 12:20 PM revealed Resident #3 had a window AC unit in his room. Resident #3 stated she was not satisfied with the central air condition in her room which blew air to the wall. Resident #3 stated she could not remember if the facility offered an air conditioning unit. The resident stated her family bought a window air condition unit, and the facility staff installed it. Resident stated she now had a comfortable room temperature, and the window unit blew the air towards her. Record review of Resident #4's MDS assessment dated [DATE] indicated resident was a [AGE] year-old female with an admission date of 06/08/2024. Resident # 4's diagnoses included: acute respiratory failure with hypoxia (a condition in which the lungs have difficulty exchanging oxygen and carbon dioxide with the blood, resulting in low oxygen levels in the body's tissues), type 2 diabetes (a chronic condition that causes high blood sugar levels). Record review of the MDS assessment dated [DATE] reflected resident had a BIMS score of 13, which indicated intact cognitive abilities. Observation and interview with resident#4 on 08/27/2024 at 11:48 AM revealed she had a window AC unit in her room. Resident stated her family member #6 bought it for her to make her comfortable. An interview with the facility Maintenance Director on 08/26/2024 at 12:48 PM who stated the facility had air condition issues in some parts of the building and he had installed several window AC units in resident rooms. He stated the facility was responsible to make sure the residents had a comfortable room temperature. Maintenance director stated the facility was responsible to purchase and install the window air condition unit without delay. He stated the residents will not have a comfortable stay if the room temperature was not right. An interview with DON on 08/26/2024 who stated the facility was having trouble with the AC since the they had an old air condition system. DON stated some rooms get cold and some do not. DON stated some residents preferred to have an extra window AC unit and a fan because they were hot. She stated she did not know who was responsible to purchase the window unit if a resident was not comfortable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675067 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 675067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Convalescent Center 1900 O'Neal St Gainesville, TX 76240 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 0585 with the room temperature. DON stated the Administrator was handling AC related things. Level of Harm - Minimal harm or potential for actual harm Interview with the Administrator on 08/26/2024 at 1:24 PM who stated some of the resident complained they did not cool enough room and the facility offered window AC units to those residents. She stated some residents preferred to use their own window units. She stated a Resident #2 had to spent down money from his trust fund account to pay for an AC window unit. The facility used that money to purchase a window unit. Administrator stated the facility purchased several window units and installed it to the residents whoever wanted one. She stated none of the residents had to purchase a window AC unit because the facility did not offer to buy one. Residents Affected - Some An interview with the DON and the Regional Nurse on 08/27/2024 at 1:32 PM The Regional Nurse stated if a resident complained that their room was not cooling, the maintenance director would check the AC and repair it as soon as possible. If the AC was not able to fix immediately then the facility purchased window AC units and installed it. DON stated the facility would offer to move that resident to a cool room, offer fans/alternatives to address the concern. Interview with the Grievance officer/Administrator on 08/27/24 at 2:00 PM who stated she and the maintenance director were responsible to address any air condition related grievances expressed by the residents. She stated if a resident had expressed concerns about the room temperature, with the help of the maintenance director, she tried to find out the reason and get it fixed. She stated residents were offered alternate rooms or window AC units. Administrator stated she had not run into any delays in addressing resident grievances. Administrator stated if there was an issue the maintenance director could not resolve, she contacted the company which had contract with the facility to repair the AC. Administrator stated the facility offered window AC units to all who asked for it and some residents preferred to buy their own units. The interview with the Administrator on 08/27/2024 at 2:00 PM revealed she did not remember which resident was complaining about the air conditioning issue. The interview revealed she did not receive any grievances during the summer. The administrator stated that she did not know what the situation was and what lead to the purchase of the air conditioning unit for Resident #2. Interview of the maintenance director on 08/27/2024 at 2:40 PM who stated he did not know what a work order was, he stated if a resident had an issue with the AC, then that was communicated to him verbally or the nurse would write it on the maintenance log located in the nurse's station. He then communicated with the business office manager or the administrator to get money to purchase parts to complete the repairs. Review of the facility policy on Grievances dated April 2017 reflected Residents and their representatives have the right to file grievances, either orally or in writing, to the facility staff or to the agency designated to hear grievances (e.g., the State Ombudsman). The administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative. All grievances, complaints or recommendations stemming from resident or family groups concerning issues of resident care in the facility will be considered. Actions on such issues will be responded to in writing, including a rationale for the response. Upon receipt of a grievance and/or complaint, the grievance officer will review and investigate the allegations and submit a written report of such findings to the administrator within five (5) working days of receiving the grievance and/or complaint. The grievance officer, administrator and staff will take immediate action to prevent further potential violations of resident rights while the alleged violation is being investigated. The administrator will review the findings with grievance officer to determine what corrective actions, if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675067 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 675067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gainesville Convalescent Center 1900 O'Neal St Gainesville, TX 76240 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 0585 any, need to be taken. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675067 If continuation sheet Page 4 of 4