Health inspection·June 15, 2023

F 0602 going to pay the money back, that Resident #1 was her friend. Level of Harm - Minimal harm or potential for actual harm Interview with the BOM on 6/14/2023 at 12:14 pm revealed Resident #1 came to her on 6/6/2023 and stated there was something wrong with his bank account that he was getting insufficient fund fees. The BOM stated she took Resident #1 to his bank the next day, 6/7/2023, and the bank showed them where withdrawals had been made from his account to a cash app account with CNA A's name on it. She stated the resident told the bank he had not authorized those withdrawals, so the bank cancelled his debit card. They came back to the facility, and she reported this to the AD and the AD started an investigation. Residents Affected - Few Interview with Resident #1 on 6/15/23 at 2:55 PM revealed he had been on the skilled nursing side of the facility until 10/20/22 .He stated he had made friends with CNA A while on the SNF side. He stated he asked CNA A to purchase him a TV after he moved to the ALF side from the SNF side of the facility somewhere around the end of October 2022. He stated he put his debit card on the counter at the nurse's station and CNA A went online to Walmart and ordered him a TV. Then she went and picked it up a few days later and gave it to him and he had the maintenance man install it. Resident #1 stated last week he started having problems with his bank account, so he went to the BOM, and she took him to the bank the next day. He stated he noticed his account was overdrawn. Resident #1 stated when he got to the bank he found out about all the missing money and the cash app transfers that CNA A had taken. He stated he wasn't going to press charges because he thought she was his friend, but after seeing how much money she had taken he decided to press charges. He stated he was very upset that it happened and felt very embarrassed that he was taken advantage of like that by someone he thought was a friend. He stated he started to wonder if she might have done it to someone else, that's why he decided to report it to the police. He stated the police came out the next day and talked to him and he told them what happened with the TV. He also stated the bank had told him his last payment to the facility had not cleared. He stated the bank had refunded about $814 of his money and everything is alright now. He stated he didn't even know what a cash app account was until he went to the bank with the BOM and had never authorized CNA A to take his money. During an interview with the AD on 6/15/2023 at 4:56 PM she stated the in-services she provided for review had a pink highlighted dot on them where CNA A's signature and name were to confirm she had received the in-services on Resident Rights and Abuse and Neglect. AD went through 3 different in-service topics and pointed out the highlighted dots by CNA A's signature/name. Record review of in-service dated 4/11/2022 on Resident Rights policy revealed CNA A signature on the in-service. Record review of in-service dated 4/11/2022 on Abuse and Neglect policy revealed CNA A signature on the in-service. Record review of in-service dated 5/31/2022 on Resident Rights policy revealed CNA A signature on the in-service. Record review of facility policy Resident Rights dated December 2006 revealed: Employees shall treat all residents with kindness, respect and dignity. Further, Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: c.) be free from abuse, neglect, misappropriation of property and exploitation. Record review of facility policy Abuse dated 1/27/2020 revealed: The purpose of this policy is to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675140 If continuation sheet Page 2 of 7 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 675140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Hamilton 1315 East State Hwy 22 Hamilton, TX 76531 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 0602 Level of Harm - Minimal harm or potential for actual harm ensure that each resident has the right to be free from any type of Abuse, Neglect, Intimidation, Involuntary Seclusion/Confinement, and or Misappropriation of property. Further, The facility staff will adhere to the policies and procedures and will follow the guidelines in the written policy and procedure. Also, The facility has in place policies and procedures to aid in the prevention of abuse, neglect, mistreatment, involuntarily seclusion and misappropriation of resident property. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675140 If continuation sheet Page 3 of 7 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 675140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Hamilton 1315 East State Hwy 22 Hamilton, TX 76531 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 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure the resident environment remains free of Residents Affected - Few accidents and hazards for one (1) resident (Resident #2) reviewed for accidents and hazards. The facility failed to ensure a warm compress was safely prepared and it burned Resident #2. This failure could place residents at risk of pain, injuries, and hospitalization. Findings include: Review of Resident #2's face sheet dated 6/14/2023 reflected a [AGE] year-old female resident admitted on [DATE] with diagnoses that included: Chronic Kidney Disease - Stage 3, Congestive Heart Failure (chronic condition in which the heart doesn't pump blood correctly), Parkinson's Disease (brain disorder causing uncontrolled movements, balance and coordination issues), Atrial Fibrillation (heart rhythm disorder), Intervertebral Disc Disorder (a breakdown of discs in the bones of the spine causing pain) , Spinal Stenosis (narrowing of the spinal canal), and Osteoarthritis (degeneration of joint cartilage and the underlying bone). Review of Resident #2's MDS dated [DATE] revealed a BIMS of 15 indicating Resident #2 had no cognitive impairments. Review of Resident #2's orders dated 6/15/2023, revealed no orders for warm compress therapy. Review of Resident #2's Care Plan dated 4/14/2023 revealed resident was at risk for skin breakdown due to fragile skin and stated SKIN 5/27/23 burn incident. Where resident noted to have small white discoloration area to her left outer thumb index finger on her left hand is stinging .large, discolored area to left buttock. Review of Resident #2's progress note dated 5/27/23 at 21:30 (9:30 PM) by LVN B: Late Entry: Called to room by CNA to assess resident d/t warm compress overheating. Resident states It just felt really warm, and I knew I needed to get it off of me. I knew I couldn't get out of bed fast enough, so I grabbed it and tried to throw it off the bed. Assessment completed and resident noted to have small white discolored area to her left outer thumb. She states her index finger on [NAME] is stinging, no visual skin issues noted. Resident has a large, discolored area to left buttock, denies symptoms of burn. Review of Progress note dated 5/28/2023 at 1:35 AM revealed: No redness or sign of irritation or burn noted to hip or back. No assessment of thumb or fingers noted. Progress note dated 5/28/2023 at 4:13 PM revealed: No redness noted on buttocks. Resident states that area does not hurt. No assessment to thumb or fingers noted. Review of Hospice RN G's visit notes dated 5/27/2023, revealed Resident #2 reported a pain score of 5, on a 0-10 score and indicated she was uncomfortable because of pain. The visit notes indicated the location of Resident #2's pain was Right thumb, right pointer finger, coccyx (bony area at the base of the lower back) and lower back and was described as burning. On the visit notes under the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675140 If continuation sheet Page 4 of 7 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 675140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Hamilton 1315 East State Hwy 22 Hamilton, TX 76531 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Integumentary section (skin) the notes indicated a skin assessment was done and PT has burned area to right thumb, right pointer finger, coccyx areas. Further in the visit notes RN G's notes indicated LVN B assisted this nurse of pulling back dressings to assess areas. Patient has 2 small dressings to left buttocks and these areas were assessed. Skin appears slightly red but intact. Facility had applied Medi honey ointment when treating burned skin so these area do have some brownish discoloration due to the ointment. Patients Left thumb and pointer finger has band aids in place which were pulled back for assessment. Left thumb has a pea sized blister and pointer finger has slight red area. All skin areas that were burned appear to have mild burns with skin intact. During an interview on 6/14/2023 at 1:40 PM, the DON stated she doesn't know if the facility has a process or procedure for using warm compresses, but she will get with ADON and find out . During an interview on 6/14/2023 at 1:54 PM the MD stated when asked about using a microwave to heat warm compresses, No, that is contrary to their policy to warm things in the microwave and use it. He stated, there may not be a specific policy on it, but it is not best practice. He further stated the compress could be too hot or not hot enough. If it was not hot enough it could not be therapeutic and if it was too hot it could burn the patient - they could get a thermal burn or thermal injury. The MD stated no one from the facility had reached out to him for an order for Resident #2 to have warm compress therapy. He stated the hospice agency Resident #2 has services with has a standing order for premade heating pads, similar to the type you can buy over the counter like Salon Pas. He stated he was aware that Resident #2 had some redness to her finger/thumb but not aware of any blisters. During an interview on 6/14/2023 at 2:09 PM, LVN B stated Resident #2 had been complaining of back pain and did not want any pain medications so Resident #2 asked for a heating pad. LVN B stated the facility did not carry heating pads, so she heated up a towel in the microwave and had done it 3-4 times throughout the day on 5/27/2023. She stated she had not received any training on hearting up compresses and was not sure if there was a facility policy on it but it was acceptable practice as far as I know. She stated she had not reached out to the doctor for an order or guidance. She stated her understanding was that later that evening , CMA E heated the compress up in the microwave and it later caught fire . She stated she was called to the room by CNA H and assessed Resident #2 for burns, did not find any skin breakdown or blisters on her back, so she cleaned the area on her back off an applied Medi honey. She stated Resident #2 did complain of burning her pointer finger and thumb, and later that evening she saw a white area on Resident #2's thumb and she treated it with cool compresses and Medi honey. She stated she had not delegated the task of heating of the compress and did not give directions to CMA E. She stated Resident #2 asked CMA E to warm it up and CMA E went and did it. She stated CMA E may have seen her warming up the compress in the microwave earlier in the day, but she had not given CMA E any instructions. During an interview on 6/14/2023 at 2:45 PM, ADON C stated LVN B called her in the evening on 5/27/2023 and told the events of Resident # 2 requesting a warm compress and it caught on fire. ADON C stated LVN B told her that she had instructed CMA E to warm up the compress in the microwave and take it to Resident #2. ADON C stated she also spoke with the hospice nurse a little while later, and she said there were no physical injuries at that point. ADON C stated she didn't know if the facility had a policy for heat therapy but that they normally request that the Therapy Department do heat therapy. She stated their practice was to use a damp towel, warm it up and wrap in another towel. She stated they don't do it very often, but when therapy is not here, sometimes they do. She stated there had been no training on warm compresses, it was just nursing knowledge and it used to be common (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675140 If continuation sheet Page 5 of 7 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 675140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Hamilton 1315 East State Hwy 22 Hamilton, TX 76531 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 0689 practice. Level of Harm - Minimal harm or potential for actual harm During an interview on 6/14/2023 at 3:02 PM, LVN D stated she was working a double shift on 5/27/023 and was at the nurse's station when she overheard CMA E talking to LVN B about a resident wanting a compress heated up. She stated she heard LVN B tell CMA E to heat it up for a minute to a minute and a half in the microwave. She stated CMA E heated it up in the microwave and took it down the hall to Resident #2. She stated she did not recall every getting nay any training on warm compresses at the facility but has done it throughout her career, but never at this facility. Residents Affected - Few During an interview on 6/15/2023 at 12:52 PM, CMA E stated Resident #2 had her light on and when she went in the room, Resident #2 asked her to heat up the compress. The compress was in the chair, and it was a towel in a plastic bag. She stated she took it back to the nurse's station and told LVN B that resident needed a warm compress. She stated LVN B instructed her to warm it up in the microwave for a minute to a minute and a half and take it back down to Resident #2. CMA E stated she had never done any compresses before which is why she asked LVN B for directions. She stated she had never received training on warm compresses. During an interview on 6/15/2023 at 1:23 PM, RHD F stated the Therapy Department uses heat therapy with residents and they use a heat pack hydrocollator. It warms to a set temperature of 152 degrees. It is moist heat, and the packs sit inside a pool of warm water and then they pull them out, put them in a special wrap and place them on the resident. He stated only Therapy uses them and they are kept in the therapy room so that their use can be supervised. He stated the therapy team has received training on the proper use of the hydrocollator and they can use heat therapy Monday thru Friday when therapy is available. RHD F said he spoke to the resident the next morning on 5/28/2023 when she came for therapy and Resident #2 denied pain or tenderness at that point and there were no signs/symptoms of pain or injury during her therapy session. He stated he had taken a look at Resident #2's back but denied looking at Resident #2's fingers. During an interview on 6/15/2023 at 1:55 PM, Hospice RN G stated she was notified of the incident with Resident #2 about 8:52 PM on 5/27/2023. She stated she came out to the facility about 9:15 PM to assess Resident #2. She stated Resident #2 was alert and oriented and recounted the details of the event to her. She stated Resident #2's finger and thumb were red; the left thumb had a pea sized blister, and the pointer was just slightly red. She stated the area on Resident #2's back where the compress had been sitting was just barely red and not hardly noticeable. She stated Resident #2 complained of pain of a 5 on a 1-10 scale at that time to her left thumb and left pointer finger. She states Resident #2 had band aids on her finger when she arrived, and she removed them to assess resident and then reapplied fresh band aids. She gave no further orders or treatment interventions - she instructed nursing staff to leave the band aids in place until the following morning and then leave the areas open to air. During an interview on 6/15/2023 at 2:18 PM, CNA H stated she was working the evening of 5/27/2023 and answered Resident #2's call light when it came on. She stated she wasn't sure of the time but it was sometime around 9-9:15 PM. She stated she went to Resident #2's room and the resident told her the compress was burning her . She pulled the compress out from behind Resident #'2s back and it was smoking. She stated she threw the compress on the floor, and then she saw flames. She stated she stomped it out on the floor and them then picked up the compress and put it in the sink and ran water on it. She made sure Resident #2 was okay and then she went and got LVN B. CNA H stated she has provided warm compresses to resident before but has not received any training on how to do it. She stated she has done it for a long time, and she will either run the towel under warm water or put a wet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675140 If continuation sheet Page 6 of 7 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 675140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Hamilton 1315 East State Hwy 22 Hamilton, TX 76531 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few towel in the microwave for about 30 seconds. She stated she then takes it to the room and has the resident touch it to be sure it is not too warm and then she will monitor it for a little while after she puts it on to make sure it doesn't get too hot. She stated earlier that day she had seen LVN B prepare a warm compress for another resident and LVN B did it the same way she had told CMA E to do it. During an interview on 6/15/2023 at 4:56 PM the AD stated she had checked with corporate, and the facility did not have a policy or procedure for warm compresses. She stated they have discontinued use of warm compresses and have begun in-servicing all staff. A facility policy on Accidents and Supervision was verbally requested but not provide by the time of exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675140 If continuation sheet Page 7 of 7