Health inspection·August 16, 2023

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with residents. She said she had not been in serviced on privacy and dignity since coming to work at the facility. She said she had not been in serviced on foley catheters since coming to work at the facility. In an interview on 8/16/2023 at 11:35am with CNA A she said she had worked at the facility since June 2023. She said the privacy bag for foley catheters was to prevent others from seeing urine in the bag. She said it was embarrassing to some residents when others could see urine in their foley bag. She said she had not been in serviced on foley care since working at the facility. In an interview on 8/16/2023 at 12:50pm with ADON A she said she had worked at the facility since April 24, 2023. She said she had been a nurse for almost 18 years. She said her duties were to check orders, check CNAs, help nurses, call doctors, help where needed, do in services, and training. She said the privacy bags on the foleys were for dignity issues for the residents, so they had privacy. She said the residents could get upset and embarrassed when others saw urine in the foley bag. In an interview with the DON, she said she had been working at the facility for seven days. She said the reason for privacy bags was to protect resident rights and dignity. She said when privacy bags are not used, residents were embarrassed. She said she did not know when the last in service on foley care was conducted. In an interview on 8/16/2023 at 1:36pm with ADON B she said she had been the ADON at the facility for almost three months. She said she had been a nurse for three years. She said her duties were to oversee nurses for halls three and four. She said they were last in serviced on Foleys yesterday, but she was not at work. She said the importance of having a privacy bag over a Foley was it gave resident dignity, she said staff should have had to cover the bag as it looked gross from the resident's perspective. She said the residents could have become insecure from having their urine exposed. Record review of facilities policy titled, Promoting/Maintaining Resident Dignity read in part . It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity .All staff members are involved in providing care to residents to promote and maintain resident dignity and respect resident rights .Maintain resident privacy . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675361 If continuation sheet Page 2 of 6 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 675361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wharton Nursing and Rehabilitation Center 1220 Sunny Lane Wharton, TX 77488 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an infection control program designed to ensure catheter changing procedures were followed by staff in the direct care for 2 (Resident #1 and Resident #2) of 5 residents reviewed for catheter care. The facility failed to change Resident #1 and Resident #2's foley catheters when ordered. These failures could place residents at risk for infection and blocked urinary catheters. Findings: Resident #1 Record review of Resident #1's Face Sheet revealed an [AGE] year-old male who was admitted on [DATE] with a diagnosis of Unspecified Dementia (Memory Loss), Heart Failure (Loss of heart Function), Pressure Ulcer Sacral Region (Wound to Buttock), Heart Disease (Blocked Arteries in the Heart), Muscle Wasting and Atrophy (Loss of Muscles). Record review of Resident #1's quarterly MDS dated [DATE] revealed a BIMS score of 7 out of 15 indicating the resident was severely cognitively impaired. Resident #1 required extensive assistance with bed mobility, transfers, dressing and toileting with 2 persons. Section H noted indwelling catheter. Record review of Resident #1's Care Plan dated 12/15/2022 revealed . a Foley Catheter related to BPH with retention, stage IV pressure ulcer to sacrum .Goal .The resident will show no s/sx of urinary infection through review date .Interventions . change catheter every Wednesday and PRN .Change Foley Cath each month on the 15th .Change foley cath bag the 1st and the 15th of each month . Record review of Resident #1's Physician Orders dated 4/26/2023 revealed . Change Foley Catheter once monthly one time a day starting on the 15th and ending on the 15th every month related to Pressure Ulcer of Sacral Region, Stage 4, Obstructive and Reflux Uropathy, Unspecified . Observation on 8/16/2023 at 10:10am Resident #1's Foley bag was dated 6/16/2023 written in black ink. Resident #2 Record review of Resident #2's Face Sheet revealed a [AGE] year-old male with a history of Unspecified Dementia, Moderate with Other Behavioral Disturbance (Memory Loss), Cerebral Infarction (Disrupted Blood Flow to the Brain), Muscle Wasting and Atrophy (Muscle Loss), Atherosclerotic Heart Disease of Native Coronary Artery (Heart Disease). Record Review of Resident #2's quarterly MDS dated [DATE] revealed a BIMS score of 8 out of 15 indicating the resident was moderately cognitively impaired. Resident #2 required limited assistance with bed mobility, dressing and toileting. Resident #2 required extensive assistance with transfers and required the assistance of one person. Section H noted indwelling catheter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675361 If continuation sheet Page 3 of 6 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 675361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wharton Nursing and Rehabilitation Center 1220 Sunny Lane Wharton, TX 77488 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 0690 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #2's Physician Orders dated 6/27/2023 revealed . Foley Catheter: Change 16F with 10ml bulb every night shift starting on the 27th and ending on the 28th every month . Neuromuscular Dysfunction of Bladder. Observation on 8/16/2023 at 10:30am Resident #2's Foley bag was dated 6/27/23 written in black ink. Residents Affected - Some In an interview on 8/16/2023 at 11:05am with the Wound Care Nurse she said she had worked at the facility for 2 weeks. She said the importance of changing the foley catheter bag out every 30 days was to prevent bacteria from growing in the catheter and to prevent infections. She said she had not been in serviced on foley catheter care since working at the facility. In an interview on 8/16/2023 at 11:35am with CNA A she said she had worked at the facility since June of 2023. She said she had been a CNAs for 5 years. She said her duties were to clean, feed, change and reposition residents. She said she transferred residents, showered, and groomed them. She said the reason for changing the foley out was to prevent infection. She said she had last been in serviced on foley care 1 or 2 weeks ago. In an interview on 8/16/2023 at 12:50pm ADON A said she had worked at the facility since April 24,2023 and had been a nurse for almost 18 years. She said her duties were to check orders, check CNAs, help nurses, call physicians, and help where needed. She said she conducted in services and trainings. She said the last in service on foley care was not long ago and was not sure when. She said it was important to change a foley catheter out every 30 days because residents developed residue inside of the foleys and to prevent infection. She said foley catheters can get clogged and urine may not drain from the bladder due to not being changed out. In an interview on 8/16/2023 at 1:25pm with the DON who said she had worked at the facility for 7 days. She said she oversaw nursing care at the facility. She said she transferred from another facility to improve care. She said changing a foley catheter as ordered was for infection prevention. She said if foleys were not changed as ordered there was potential for backflow of urine. She said she did not know when the last in service on foley care was conducted. In an interview on 8/16/2023 at 1:36pm ADON B said she had been ADON at the facility for almost 3 months. She said she had been a nurse for almost 3 years. She said her duties were to oversee halls three and four. She said the importance of changing a foley bag out once a month was to prevent an infection of the urinary tract. On 8/16/2023 at 1:40pm surveyor requested policy on catheter care from the DON and did not receive one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675361 If continuation sheet Page 4 of 6 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 675361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wharton Nursing and Rehabilitation Center 1220 Sunny Lane Wharton, TX 77488 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an infection control program designed to ensure a safe, sanitary environment and to help prevent the development and transmission of communicable diseases and infection for 1 of 5 staff (CNA B) observed for hand hygiene. Residents Affected - Few The facility staff failed to use proper handwashing technique when assisting Resident #3. This failure could place Resident #3, other residents and staff at risk for infection. Findings: Record review of Resident #3 s Face Sheet revealed a [AGE] year-old male who was admitted on [DATE] with diagnoses of Unspecified Dementia, Unspecified Severity, Without Behavioral Disturbance, Psychotic Disturbance, Mood Disturbance, And Anxiety (Memory Loss), Unspecified Protein Calorie Malnutrition (Lack of Nutrition), Type 2 Diabetes (High Blood Sugars), Dysphagia (Difficulty Swallowing). Record Review of residents quarterly MDS dated [DATE] revealed a BIMS score of 0 out of 15 indicating severely cognitively impaired. Resident #3 required total dependence on bed mobility, transfers, dressing and toileting with one person assistance. Section K noted a feeding tube. Record Review of residents Care Plan dated 8/4/2023 revealed . requires tube feeding r/t swallowing problem .The resident will remain free of side effect or complications . On 8/16/2023 at 9:50am surveyor observed CNA B manipulating Resident #3's g tube and gown. CNA B walked to doorway, took off gloves and did not use hand sanitizer or wash hands. CNA B walked out into hallway, touched door handle of linen room, entered linen room, gathered clean linens, and entered resident #3's room. CNA B did not wash her hands or use hand sanitizer, she did not don gloves. CNA B began touching Resident #3's G tube. Surveyor observed leakage coming from G tube and onto Resident #3's gown. Surveyor observed CNA B place a towel under leaking G tube, wipe her hands on the towel and then place gloves on. After care was provided surveyor observed CNA B walk to trash can, take gloves off, gather trash bag, leave room without washing hands or using hand sanitizer, walk over to dirty utility room, punch in door code, enter dirty utility room, leave utility room, come back out and reenter Resident #3's room without washing hands or using hand sanitizer. CNA B then donned gloves and assisted resident. CNA B completed care, discarded gloves, and came out of room without washing hands or using hand sanitizer. In an interview on 8/17/2023 at 09:58am with CNA B she said she had been a CNAs since 2019. She said she knew the process for coming in and out of a resident's room was to wash hands. She said she knew she did not wash her hands both times she came out of Resident #3's room and she did not use hand sanitizer. She said Germs could have spread when hands were not sanitized, and they could carry bacteria and infection. CNA B said she would wash her hands and use hand sanitizer in the future. CNA B said her last in service on handwashing was in nursing school in April 2023. In an interview on 8/17/2023 at 10:00am with ADON B she said she had worked at the facility for 3 months. She said she had been a nurse for 3 years. She said the last time she was in serviced on handwashing was 2 weeks ago. She said she was supposed to use hand sanitizer prior to going into and leaving a resident's room. She said she could wash her hands as well. She said if hands were not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675361 If continuation sheet Page 5 of 6 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 675361 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wharton Nursing and Rehabilitation Center 1220 Sunny Lane Wharton, TX 77488 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sanitized, they could carry different diseases to residents, staff to staff and to visitors. She said the environment could be contaminated. In an interview on 8/16/2023 12:50pm with ADON A she said the importance of hand sanitizer or hand washing prior to going in a resident's room was to prevent carrying germs in. She said cleansing hands between glove changes was important because there may have been a tear or hole in the glove allowing bacteria to pass through. She said hand hygiene was important after caring for a resident, so germs were not carried out of the room to the next resident. She said hand hygiene was to prevent infection. In an interview on 8/16/2023 at 1:18pm with CNA C she said washing hands and gloving were important prior to resident care for infection control so the resident was not given disease. She said after providing care she took her gloves off and used hand sanitizer as it was important to prevent the spread of infection. She said the last in service on handwashing was today. In an interview on 8/16/2023 at 1:25pm with the DON she said infection control was the basis of everything they did to prevent cross contamination. She said handwashing and sanitization was the number one prevention and she was not aware staff did not sanitize their hands. In an interview on 8/16/2023 at 1:36pm with ADON B she said the last in service on handwashing was 2 weeks ago when they had a couple of residents with Covid. She said the Covid in service included hand washing. She said the process for going into a resident's room was to use hand sanitizer going in and out. She said after 3 hand sanitizers then they washed hands. She said between glove changes they would have washed hands or used hand sanitizer. She said cross contamination with germs can happen if these processes were not followed and residents and staff could have acquired an infection. Record review of facilities policy titled, Hand Hygiene dated 10/24/2022 read in part . All staff will perform hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working within the facility .Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice . The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, and immediately after removing gloves . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675361 If continuation sheet Page 6 of 6