Health inspection·November 18, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some a fall. She stated with any fall; she expected the event to be reported. That report triggered the required assessments. She expected the DON to complete an assessment and to reassess the resident before closing out the event at 72 hours as some bruises took time to develop. She stated if the documentation was missing or not accurate, there was no way to assess the outcome, and the facility may have missed something. During an interview on 10/15/25 at 11:42 AM, the DON stated she expected documentation to be accurate and timely. She expected after a fall the nurse completed a fall assessment, a progress note, an incident report, notification of the NP/MD, RP, and DON. She stated she and the ADON were responsible for monitoring the documentation and train/in-service staff, but since the ADON was out, she was responsible. The DON stated the ADON was also the MDS nurse who was responsible for care plans. She stated while the ADON was out, she was responsible for ensuring care plans were updated. During an interview on 10/15/25 at 12:18 PM, the ADM stated it was important that documentation was thorough and timely. She expected staff to take care of the resident first then complete the documentation. She stated it was her expectation that the documentation painted a picture of the resident's status so anyone would know what happened. She expected all documentation was completed before the staff left at the end of their shift. The ADM stated the new ADON was responsible for monitoring documentation, but she was out on leave, so the monitoring was done by the DON. During an observation and attempted interview on 10/15/25 at 1:28 PM, Resident #1 was sitting in a wheelchair in the dayroom. His posture was relaxed, no indicators of pain or distress observed. He made eye contact and smiled. He responded to questions with a giggle but did not respond verbally. A telephone interview with LVN A was attempted on 10/15/25 at 10:43 AM. A telephone interview with LVN A was attempted on 10/15/25 at 2:03 PM. No return call was received prior to the exit. 2.Review of Resident #2's admission record, printed 10/15/25, reflected an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included hypertension (high blood pressure), abnormalities of gait and mobility, muscle weakness, and repeated falls. Review of Resident #2's quarterly admission assessment, dated 09/08/25, reflected a BIMS score of 12 which indicated moderately impaired cognition. The assessment reflected Resident #2 needed set up assistance for transfers and ambulation. The assessment reflected no falls since the prior assessment. Review of Resident #2's comprehensive care plan, initiated 08/11/25, reflected in part, Focus: I am at risk for falls related to unsteady gait, history of falls, muscle weakness. Goal: I will remain free from injury. Interventions/Tasks: I will be reminded to use my call light. Staff will ensure my bed is in the lowest position, wheels are locked, and the call light is always within reach. My care plan will be updated after any fall or change in condition. Further review revealed the fall care plan did not reflect any revisions after the 09/15/25 fall. Review of Resident #2's progress note dated 09/15/25 at 5:05 AM, and written by LVN C, reflected in part, Resident reported that she fell. she stated she hit her left arm. Upon assessment, a laceration was noted. When asked if she would like to be sent out for further evaluation, resident declined. Wound cleansed. Review of the incident log from 09/01/25 through 10/14/25, reflected Resident #2 had an unwitnessed fall on 09/14/25 at 8:46 PM. Review of Resident #2's Fall Risk Evaluation, dated 09/15/25, reflected that she was at high risk of falls. During an interview on 10/15/25 at 1:20 PM, Resident #2 stated she had a fall at the facility but did not remember when it happened. She stated nothing was hurt besides her pride and she declined to be sent out to the hospital. She stated staff were attentive and checked on her frequently. 3.Review of Resident #3's admission record, printed 10/15/25, reflected a [AGE] year-old female admitted to the facility on [DATE]. Her diagnosis list reflected schizoaffective disorder, bipolar type. Review of Resident #3's medical record reflected her MDS assessment was not yet due nor completed. Review of Resident #3's baseline care plan, initiated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 10/13/25, reflected in part, Focus: I am at risk for falls related to unsteady gait, history of falls, muscle weakness, cognitive impairment. Goal: I will remain free from injury. Interventions/Tasks: I will be given non-skid socks or footwear to help me move safely. I will be reminded to use my call light. Staff will ensure my bed is in the lowest position. Review of the incident log from 09/01/25 through 10/14/25, reflected Resident #3 had an unwitnessed fall on 10/13/25 at 7:30 PM. Review of Resident #3's progress notes from 10/13/25 through 10/15/25 at 1:03 PM, reflected no progress note regarding a fall. Review of Resident #3's Fall Risk Evaluation dated 10/13/25 at 11:28 PM, reflected a score of 14 which indicated she was at risk for falls. During an interview on 10/15/25 at 11:42 AM, the DON stated she witnessed Resident #3 on the floor on the evening of 10/13/25. She stated she treated it as an unwitnessed fall and initiated the incident report and assessments. She stated she did not document a progress note but should have. During an observation and interview on 10/25/25 at 1:45 PM, Resident #3 was observed sitting up in a wheelchair in her room dressed in clean clothes. No bruises or injuries were observed on her exposed skin. Resident #3 stated she felt good because she just had a shower. When asked if she had a fall at the facility, she stated, About 25 times. She repeated that she had about 25 falls. She denied pain, and she denied any injuries. She stated she felt safe at the facility and wanted to stay there forever. Review of the facility's Incidents and Accidents policy, reviewed/revised 04/11/25, reflected in part, It is the policy of this facility for staff to utilize (Title) to report, investigate, and review any accidents or incidents that occur or allegedly occur, on facility property and may involve a resident. Compliance Guidelines: 12. The nurse will enter the incident/accident information into the appropriate form/system within 24 hours of occurrence and will document all pertinent information. 13. Documentation should include the date, time, nature of the incident, location, initial findings, immediate interventions, notifications and orders obtained for follow-up interventions. Review of the facility's Fall Prevention Program policy, Reviewed/Revised 10/14/25, reflected in part, Policy: Each resident will be assessed for fall risk and will receive care and services in accordance with their individualized level of risk to minimize the likelihood of falls. Compliance Guidelines: When any resident experiences a fall, the facility will: a. Assess the resident. b. Complete a post-fall assessment. c. Complete an incident report. d. Notify physician and family. e. Review the resident's care plan and update as indicated. f. Document all assessments and actions. g. Obtain witness statements in the case of injury. Event ID: Facility ID: 675132 If continuation sheet Page 3 of 3