Health inspection·September 29, 2023

F 0677 Goal: Resident # 1 will achieve maximum functional mobility. Resident care as per facility protocol. Level of Harm - Minimal harm or potential for actual harm On 09/28/23 at 1:45PM, Observation of Resident #1 who was in bed and communicative. She has an air mattress and is in a one-person room. She was on her cell phone talking. She politely ended the telephone conversation after investigator walked in. Residents Affected - Some Interview with resident #1, revealed she had recently (yesterday) moved to her current room. This is a single room with a bathroom and shower. Resident #1 stated she was excited because she will finally be able to get a shower. The last time she was showered was about 3-6 weeks ago. She stated staff has always told her that she gets a shower because her wheelchair was extra wide and too big to fit in the shower area. Her last bed bath was 1 ½ weeks ago. She states she gets her bed baths by a CAN A name during the day and CAN B at night. She also stated staff will lie on residents and say they refused showers so that it appears the showers were offered. On 9/29/23 at 11:33AM, I went to Resident #1's room and observed what appeared to be a large shower chair. Resident #1 stated staff members were getting ready to get her into the shower today. She stated the doorway in her room to the shower is wider than most shower doors. Record review of Point of Care History, staff support provided for bathing was inconsistent. It appears some days Resident #1 was given showers/bathes every 12 hours. According to Resident #1 she has not received a shower or bed bath between the dates of 8/17/23 thru 9/13/23. This includes facial and oral care. Resident #2 Record review of Resident #2's undated face sheet revealed he was an [AGE] year-old male admitted on [DATE], with diagnoses of congestive heart failure(a long-term condition that happens when your heart can't pump blood well enough to give your body a normal supply), Type 2 diabetes mellitus with diabetic chronic kidney disease (Diabetic nephropathy is a common complication of type 1 and type 2 diabetes), hypertension heart and chronic kidney disease (When the kidneys don't work well, more stress is put on the heart), hypothyroidism (when the thyroid gland doesn't make enough thyroid hormones to meet your body's needs), Hyperlipidemia ( your blood has too many lipids (or fats), such as cholesterol and triglycerides), Benign prostatic hyperplasia (Factors linked to aging and changes in the cells of the testicles may have a role in the growth of the gland, as well as testosterone levels), dysphagia (swallowing difficulties) and cognitive communication deficit (difficulty with thinking and language). Record review of Resident #2's Comprehensive MDS dated [DATE], revealed a BIMS score of 11 which suggest moderate cognitive impaired. Resident #2 had the ability to express himself, is understood and understands others; required extensive assistance with personal hygiene, dressing, and bed mobility; he is total dependent and required physical help with bathing and two-person physical assistance. He used a wheelchair for mobility. On 9/28/23 at 11:45am, Observation and interview with Resident #2 revealed: resident was outside in the smoking area smoking a cigarette. He was seated in his wheelchair. He is a double amputee (Legs). I noticed resident had on a multiple color t-shirt that appeared to have food stains. Resident #2 fingernails were long (2-inches). He was wearing what appeared to be grey sweatpants. Resident was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675222 If continuation sheet Page 2 of 5 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 675222 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seabreeze Nursing and Rehabilitation 6602 Memorial Dr Texas City, TX 77590 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 Residents Affected - Some asked if anyone asked him to cut his fingernails and he stated that he likes long nails. I introduced myself and began to ask questions regarding ADL's. Resident #2 stated he generally must wait 2-3 weeks for a shower. He states the waiting period is a regular occurrence with staff at this facility. He stated when they get tired of him bugging them, then they will give him his shower. He stated yesterday, 09/27/2023, he had a bowel movement and told his CNA around 4pm. He stated no one came to change him until the night shift arrived at 6pm. He stated it doesn't feel good having to be treated like a second-class citizen. Record review of Resident #2's care plan, revised 09/27/23, revealed the resident will perform the following tasks at their highest practicable level: I prefer to take my Bath/Shower Once a Day on Mon, Wed, Fri: 6am-6pm. Nail Care Once a Day on Mon, Wed, Fri: 6am-6pm. Oral Care Twice a Day: 6am-6pm and 6pm-6am. Record review of Point of Care History, staff support provided for bathing was inconsistent. It appears some days Resident #2 was given showers/bathes every 12 hours and sporadic. There are days he is given a shower between 1:00am and 2:43am. While Resident #2 is a two person assist, he has been assisted with wheelchair transfer with one person. According to Resident #2 he has not received a shower or bed bath the dates of 9/3/23 and 9/4/23, 9/6/23 thru 9/8/23, 9/12/23, 9/16/23, 9/18/23 thru 9/19/23, 9/26/23 thru this date 9/28/23. This includes facial and oral care. Resident #3 Record review of Resident #3's undated face sheet revealed she was a [AGE] year-old female admitted on [DATE] and readmitted on [DATE], with diagnoses of cognitive communication deficit (difficulty with thinking and language), Type 2 diabetes (your body doesn't use insulin properly), peripheral artery disease (the narrowing or blockage of the vessels that carry blood from the heart to the legs), cerebral infarction due to thrombosis (A thrombotic stroke may also be called a cerebral thrombosis, a cerebral infarction or a cerebral infarct), cerebral palsy (a group of disorders that affect a person's ability to move and maintain balance and posture). Record review of Resident #3's Comprehensive MDS dated [DATE], revealed a BIMS score of 12, which indicated moderate cognitive impairment. Resident #3's MDS also revealed she does not suffer from any type of psychosis. The resident had unclear speech but could understand others and had adequate vision. Resident #3 required extensive assistance with personal hygiene, dressing, transfer, and bed mobility. She required physical help with bathing and two+ person's physical assist. She used a wheelchair for mobility. Resident #3 was always incontinent of urine and bowel. On 9/28/23 at 4:15pm, observations of resident #3, she was in her wheelchair, wearing a sweatshirt and jean pants. The clothing appeared to be clean; however, her hair did not look like it had been combed. On 9/28/23 at 4:30pm Interview with Resident #3 regarding showers, she stated she last showered last Friday. She stated her shower days are Monday, Wednesday and Friday. She stated prior to last Friday, staff has not given her a shower on Monday or Wednesday. Resident #3 states she receives her shower in the evenings when she has specifically requested her showers be given in the mornings. She stated she tried not to complain much because if she does then staff scorns her, and she feels they may retaliate against her. She stated in the past staff would not change her linen, they would just (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675222 If continuation sheet Page 3 of 5 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 675222 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seabreeze Nursing and Rehabilitation 6602 Memorial Dr Texas City, TX 77590 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 make up her bed and tell her, You got me in trouble. Level of Harm - Minimal harm or potential for actual harm On 9/29/23 at 2:00pm, Interview with Resident #3. Resident #3 called me over to where she was sitting in the hallway. She stated she feels she is inept. I asked her what does that mean? She began to cry and stated staff does not treat her right. She stated she doesn't get regular showers and sometimes she can smell herself. She stated she has asked if someone could braid her hair and she does not get a response. She stated she is sick and tired of begging for a shower or wash up. She states when staff gets mad they will document in the shower log that either you refused or they gave you a shower which is not true. Residents Affected - Some Record review of Resident #3's care plan, revised 09/18/23, revealed the resident will perform the following tasks at their highest practicable level: I prefer to take my Bath/Shower Once a Day on Mon, Wed, Fri: 6am-6pm. Nail Care Once a Day on Mon, Wed, Fri: 6am-6pm. Oral Care Twice a Day: 6am-6pm and 6pm-6am; keep linens clean, dry and wrinkle free; and provide incontinence care after each incontinence episode. Record review of Point of Care History, staff support provided for bathing was inconsistent. It appears some days Resident #3 was given showers/bathes every 12 hours. According to the resident #3, she has not received a shower or bed bath since 9/22/23. This includes facial and oral care. On 9/29/2023 at 4:12PM - Interview CNA A: Have worked at this facility for about 9 months. Has been a CNA for 10 years. She works 6am -6pm on the 100 hallways. The CNAs are all on 12-hour shifts. Typically give residents their showers in the mornings between 8:15am - 8:30am. Gives showers to residents who sleep in the A-beds, which is on the right side of hall. They are showered on Monday, Wednesday and Fridays. B-beds are completed same day but at night between 6pm - 6am. States she gives showers to every resident on her side of the hall. Stated sometimes when she leaves for her two-day break, she stated resident R #5 is in the same clothes and sometimes his adult diaper is soiled. Regarding R #2's showers, she states, I'm not gonna lie, R #2 was last showered about 2 weeks. 9/29/2023 at 12:11PM - Interview with CNA B/AD. States she has been in this facility almost a year. Was working as a PRN (CNA) prior to being offered a full-time position. She states she work as an AD (8am-5pm) but will take the position of CNA if there is a call-in or shortage. The AD states she controls the meetings and sometimes will assist the PRC with meeting minutes and writing the grievances. States currently the PRC. of is in the hospital and the SRC, Resident #4 has just returned from the hospital. States the issues with the showers are always surfacing during the meetings and she wrote the concerns in a grievance and gave it to the DON on 9/6/2023. I asked if the residents still complain about not getting showers and the AD stated they are always complaining. She states she doesn't put the information in the minutes or file a grievance because the grievances are considered old news and she has already dealt with those issues by writing a grievance. She states the minutes should represent new issues even though there continues to be complaints from residents not getting their showers. She then stated she has seen some CNAs give showers. Record review of the Resident Council Minutes revealed several months with no complaints. According to AD, the residents did complain about lack of showers, but since it was the same issues she just put Nothing to report. She again stated she verbally informed the DON and the current Admin about the continued concerns. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675222 If continuation sheet Page 4 of 5 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 675222 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seabreeze Nursing and Rehabilitation 6602 Memorial Dr Texas City, TX 77590 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 She stated the DON continued to tell her she would talk with the nurse about it. Level of Harm - Minimal harm or potential for actual harm Record review of facility policy on Dignity, revised February 2021, revealed, in part: Residents are treated with dignity and respect at all times; When assisting with care, residents are supported in exercising their rights .For example, residents are groomed as they wish to be groomed (hair styles, nails, facial hair, etc.; Residents Affected - Some 9/29/2023 at 1:30PM - Interview RN/DON. Is currently clinical support who works for the corporate office and is currently in the facility to conduct training and train the new DON. States she makes rounds daily and asked residents if they have had their showers daily. The DON stated she has seen staff trying to care for residents timely. She stated, Residents have the right to be treated with respect and dignity and should have showers daily. 9/29/2023 at 1:50PM -Interview Administrator. He stated he has been at this facility since the end of April of this year. He stated regarding residents not getting their showers, I would not feel good as a human being not having a shower or bed bath daily. We are still going through the process of cleaning up and eliminating bad staff and hiring new staff. Hiring and finding good staff has been a process and a very long and slow process. I know there are some staff that are not truthful. Resident should get at least a shower or bed bath three showers a week. When investigator presented the administrator with the Point of Care History and the inconsistencies of the time, he stated, this is a lie! There is no way these times are accurate. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675222 If continuation sheet Page 5 of 5