Inspection·December 31, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure assessments accurately reflected the residents' status for 2 of 7 residents reviewed for assessments. (Resident #2 and Resident #55)The facility failed to ensure Resident #2's MDS, dated [DATE], was coded for receiving IV medications.The facility failed to ensure Resident #55's MDS, dated [DATE], was coded for the resident having a diabetic foot ulcer.These failures could place residents at risk of not having individual needs met.Findings included:1. Record review of a facility face sheet, dated 12/30/25, for Resident #2 indicated he was a [AGE] year-old male, admitted on [DATE], with diagnosis including congestive heart failure and bipolar disorder.Record review of a quarterly MDS assessment, dated 11/24/25, for Resident #2 indicated a BIMS score of 14, which indicated he had intact cognition. Assessment Reference Date was 11/24/25. He was not coded for receiving IV medications during the 14-day lookback period (11/11/25 through 11/24/25). Record review of a comprehensive care plan, dated 11/11/25, for Resident #2 indicated he had a pressure ulcer and an intervention to administer medications as ordered. Record review of a Treatment Administration Record, dated 11/1/25 through 11/30/25 for Resident #2 indicated he received an IV infusion for wound and skin healing support on 11/18/25 consisting of 250ml of Normal Saline with Vitamin C 5g, B Complex 1ml, Zinc 10mg, Biotin 5mg, Magesium Chloride 1g, and Amino Blend 5ml.During an observation and interview on 12/30/2025 at 9:43 AM Resident #2 was observed sitting up in a geri-chair in his room. He had heel protectors on both feet. He had a dressing in place to right lower extremity. He said they took good care of his foot with the wound and had no complaints.2. Record review of a facility face sheet, dated 12/30/25, for Resident #55 indicated she was a [AGE] year-old female, admitted on [DATE], with diagnoses including Alzheimer's disease and type 2 diabetes mellitus. Record review of a Quarterly MDS assessment, dated 12/1/25, for Resident #55 indicated a BIMS score of 00, which indicated severe cognitive impairment. Assessment Reference Date was 12/1/25. She was not coded for diabetic foot ulcer or having application of dressings to feet (with or without topical medications). Record review of a comprehensive care plan, dated 10/12/25, for Resident #55 indicated she had a diabetic foot ulcer related to diabetes. Record review of a Treatment Administration Record, dated 11/1/25 through 11/30/25, for Resident #55 indicated she received daily treatments for diabetic ulcer to left foot during lookback period. Treatment consisted of cleaning, application of a topical medication, and covering with a dressing (a cover for the wound).During an interview on 12/31/25 at 9:30 a.m., the MDS Coordinator said she had been doing MDSs for about seven years and realized yesterday (12/30/25) that Resident #55's MDS was inaccurately coded for her diabetic foot ulcer. She said she was in the process of getting that corrected. She said she must have missed coding the IV medications on Resident #2's MDS. She said diabetic foot ulcers and IV medications should be correctly coded on MDS assessments. She said if MDS assessments were not accurate, it could affect the plan of care for residents. She said, going forward, she would double and triple check her work to ensure accurate coding.During an interview on Residents Affected - Few (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 6 Event ID: 675183 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 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)