Health inspection·November 19, 2025

F 0776 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Left femur (upper leg), 2 views2. Right knee, 2 views3. Right Tibia and fibula (lower leg), 2 viewsThe order details reflected it was sent to the radiology provider. Record review of Resident #1's radiology report reflected the right knee x-ray was completed on 10/16/25 at 12:24 PM and was read by the radiologist and reported to the facility on [DATE] at 5:25 PM. The impression was findings concerning for a nondisplaced lateral plateau fracture [break or crack in the shin bone or tibia] Record review of Resident #1's radiology report reflected the right tibia and fibula x-ray was completed on 10/16/25 at 12:22 PM and was read by the radiologist and reported to the facility on [DATE] at 5:26 PM. The impression was findings of an age-indeterminate distal fibular fracture [fracture of the fibula bone near the ankle, unable to determine the age of the injury] . Record review of Resident #1's radiology report reflected the right femur x-ray was completed on 10/16/25 at 12:26 PM and was read by the radiologist and reported to the facility on [DATE] at 5:27 PM. The impression was no acute osseous abnormality [bone structure changes]. Record review of the follow-up note, dated 10/19/25, reflected Resident #1 had pain in her right knee with swelling and pain during movement. The follow-up note did not reflect any information on the x-ray results. Record review of Resident #1's radiology report reflected a right ankle x-ray was completed on 10/20/25 at 1:09 PM and was read by the radiologist and reported to the facility on [DATE] at 2:18 AM. The impression was osteopenia (bones are weaker than normal) and no fracture noted. Record review of the in-service education record, dated 10/20/25, reflected education was provided on osteopenia for nurses only. There were 4 nurse signatures. Record review of the in-service education record, dated 10/20/25, reflected education was provided on the pain management policy and procedures for nurses only. There were 3 nurse signatures. Record review of the witness statement, signed and dated 10/20/25 at 2:00 PM by CNA B, reflected the following: [Resident #1] was transferred to shower chair by 2 staff, given a shower then transferred back to bed in 116. I never heard anything pop and she never said anything hurt. Record review of the witness statement, signed and dated 10/21/25 at 12:00 PM by RN A, reflected the following: On 10/15/25 [Resident #1] was being transferred to shower chair prior to room change. [Resident #1] informed staff her right knee was swollen. Upon assessment right knee was swollen but no redness, warmth, or pain noted. [Resident #1] was transferred without incident to shower chair then after shower transferred to bed in 116. [NP] notified of swelling and pain management regimen continued per [Resident #1's] baseline. I never heard anything pop and she never complained of increased pain. Record review of Resident #1's progress notes, dated 10/21/25 at 1:14 PM, the DON documented Spoke with [Resident #1's family member] regarding fracture of right leg in 2 places, [new order] for straight leg brace, [non-weight bearing] to right leg and [orthopedic] referral. Record review of the 24-hour report sheets, dated 10/15/25 to 10/25/25, reflected the following:1. On 10/15/25, Resident #1 moved to 304. The 24 report sheet did not address Resident #1's right knee.2. On 10/16/25, Resident #1 moved to 116 and STAT [right lower extremity] x-ray for swelling/pain/warmth.3. On 10/17/25, Resident #1 pending x-ray results.4. On 10/18/25, Resident #1 was not listed.5. On 10/19/25, Resident #1 was not listed.6. On 10/20/25, the 24 hour report sheet did not address Resident #1's right knee or x-ray. During an observation and interview on 10/30/25 at 9:33 AM, Resident #1 was lying in the bed with the head of her bed elevated slightly. Resident #1's hair was pulled back, and she appeared neat and clean. Resident #1 was pleasant and calm during the interview. Resident #1 stated she was having some pain this morning, but the nurse had just given her some pain medication. Resident #1 stated she took pain medication regularly and her pain was well-controlled. Resident #1 stated her pain was from her right knee and leg. Resident #1 said she recently found out she had a fracture. Resident #1 stated it was an accident and happened during a transfer. Resident #1 stated she did not remember (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675293 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 675293 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Linden 1201 W Houston St Linden, TX 75563 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 0776 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few everything about the incident because her memory was not that good. Resident #1 stated she had no complications or increased pain from the fracture in her leg. During an interview on 10/30/25 at 10:56 AM, LVN C stated Resident #1 had first complained about pain in her right knee during the night of 10/15/25 when they were moving her room. LVN C stated RN A had contacted her when she was driving to work and informed her the NP had ordered an x-ray for Resident #1's right leg. LVN C stated when she arrived at work, she placed the x-ray order into the computer system as STAT and it was automatically sent over to the radiology company. LVN C stated she was unable to remember when the x-ray was performed or if she received the results. LVN C stated she was unsure what the time frames were for STAT orders on radiology. LVN C stated when STAT orders were ordered by the doctor, she normally received the results the same day. LVN C stated Resident #1 had pain medications scheduled, which were effective at controlling her pain. LVN C stated she did not work at the facility again until 10/20/25 but had to leave early for a family emergency. LVN C stated 10/20/25 was her last day working at the facility. During an interview on 10/30/25 at 11:24 AM, the DON stated Resident #1 had diagnoses of multiple sclerosis and osteopenia. She stated on 10/15/25 prior to the transfer and room change, Resident #1 had reported to the staff her right knee was swollen but denied any pain. She stated the staff transferred Resident #1 to the shower chair, provided a shower, then transferred her back to bed. The DON stated Resident #1 was a stand and pivot transfer with a gait belt and 2 staff assistance. She stated Resident #1 was usually weak but was able to bear some weight. She said the next morning, on 10/16/25, LVN C noticed Resident #1 had new onset of pain, swelling, and warmth to her right knee. The DON stated LVN C completed the change of condition assessment and notified the NP. She stated the x-rays were ordered and completed the same day. She stated on 10/17/25 she received a text message from the radiology representative that the order was missing diagnosis codes. The DON stated she was out of town and was not going to be able to provide the diagnosis codes until she returned. The DON stated she did not hear back from the radiology representative, so she assumed he got in touch with the staff at the facility. She stated the facility did not obtain the radiology results until 10/20/25 when she checked the portal. The DON stated she notified the doctor, family, and obtained new orders for a brace and orthopedic consult. The DON said she initiated inservice education on osteopenia and pain management. She stated she expected the facility staff to ensure STAT orders were followed up on. She stated all the nurses had access to the radiology results portal. The DON stated the radiology company did not call the facility to notify them that Resident #1 had a fracture. She said the radiology representative only mentioned the diagnosis code when he called on 10/17/25 but did not mention Resident #1 had a fracture. During an interview on 10/30/25 at 11:58 AM the ADON stated he has been the ADON for the last week and prior to that he worked the floor. The ADON stated he was working the floor on 10/17/25 and 10/18/25. The ADON stated he got a stomach bug the evening of 10/18/25, went home early, and called in 10/19/25. He said normally when STAT x-rays were ordered, the order was placed in the computer and submitted to the radiology company. He stated the company would have come out, completed the x-ray, and posted the imaging results under diagnostic results. He stated the company would have posted the results online and did not usually fax them. He said he was not made aware the x-rays were ordered and obtained on Resident #1 on the 17th or 18th when he worked. He said Resident #1 had no complaints of pain or discomfort during that weekend and was always in a good mood. He stated he was in Resident #1's room daily because he had to perform wound care. He stated if he was aware Resident #1 had x-rays completed, he would have looked for the results or followed up with x-ray company for the results. He stated he had no issues with the radiology company prior to the incident. He stated he was under the impression a STAT radiology or lab order (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675293 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 675293 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Linden 1201 W Houston St Linden, TX 75563 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 0776 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few could be completed within 24 hours. He stated it was important to ensure x-ray results were obtained timely to prevent further injuries to the resident. He stated it was important to ensure issues or concerns or pending results were passed on in report so follow up could happen timely with no delays in treatment. During an interview on 10/30/25 at 12:25 PM, CNA B stated nothing significant happened during the transfer with Resident #1 on 10/15/25. She said Resident #1 was complaining of pain to her right knee before they moved or transferred her. She stated when she placed Resident #1 back in bed she was still complaining of pain, so she notified the nurse. CNA B stated her knees were always big and nothing looked abnormal. She said she heard no popping noises or anything that would have indicated Resident #1 had an injury. She stated she transferred Resident #1 using a gait belt. She stated Resident #1 was able to bear weight. During an interview on 10/30/25 at 2:50 PM, The Administrator stated she was first notified of Resident #1's fracture on 10/20/25 during the stand-up clinical meeting. She said that was when the facility obtained the results for her x-rays. The Administrator stated the IDT met to try and determine the cause of the injury, but she had no falls or injuries reported. The Administrator stated she submitted the report to HHSC and completed her investigation. She stated she had no reason to believe her injuries were intentionally caused by the facility staff. The Administrator stated during her investigation it was determined that Resident #1 had been complaining of pain during the evening of 10/15/25 prior to any transfers. She said Resident #1 reported she heard a popping noise during the transfer, but the staff denied any popping noises. The Administrator stated it was discovered she had osteopenia and was at risk for fractures. She said she was unsure if there had been any issues or concerns with the radiology company. The Administrator stated she expected the nursing staff to follow up with STAT orders. She stated they should have been looking for the results and noting them on the 24 hour report sheet. She stated it was important to ensure radiology results were received timely to prevent a delay in treatment or decreased quality of care. She stated Resident #1 was well-managed while the results were pending and developed no complications. During an interview on 10/30/25 at 2:38 PM, the NP stated she expected the facility to ensure results were obtained from STAT x-ray orders. The NP stated if the facility did not have the results from a STAT order, they should have followed up with the radiology company for the results. She said at the minimum it should have been passed on during report for continued follow up. The NP stated it was important to ensure that radiology results were received timely to ensure treatment and services were implemented to prevent further injuries. The NP stated Resident #1 was stable and developed no complications. She stated Resident #1 was bed bound and her pain was managed with her current pain regimen. During an interview on 10/30/25 at 2:57 PM, the Director of Radiology stated the technicians tried to perform STAT orders within 4 hours of receiving the orders. He stated the time in which the STAT order was completed, depended on the territory and where the technicians were in relation to where the test was ordered. He stated the average time it took for the radiologist to read the x-rays was 1 hour, but it depended on the day and what was going on. He stated the x-ray results were submitted to the facilities in real time, as the results were sent straight into the portal and into their electronic charting system. He stated the facility should have access to the results as soon as it was read by the radiologist. During an interview on 10/31/25 at 2:01 PM, the Radiology Compliance Officer stated Resident #1's x-ray orders were completed on 10/16/25 at 12:06 PM, which was the same day they were ordered. He stated the radiologist read them on 10/17/25. He stated the orders were not put into the system as a STAT order. Record review of the imaging services agreement, dated 01/06/25, reflected .Company will use reasonable efforts to dispatch STAT x-ray services as soon as possible after receipt of the STAT order. STAT (emergency) service is provided for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675293 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 675293 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Linden 1201 W Houston St Linden, TX 75563 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 0776 Level of Harm - Minimal harm or potential for actual harm life-threatening and/or critical situations requiring rapid images. Record review of the Lab/Radiology Management policy, revised 04/21/21, reflected .provide or obtain laboratory services to meet the needs of its residents.the community is responsible for the timeliness of the services.the community must notify the attending physician of the lab results.ensure all labs ordered have been collected with results communicated to doctor and family in a timely manner. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675293 If continuation sheet Page 5 of 5