Health inspection·July 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 interviews and record reviews, the facility failed to ensure the MDS assessment accurately reflected the resident's status for two residents (#8 and #94) of thirty-two residents reviewed for MDSs. 1. Facility failed to note on Resident #8's annual MDS, dated [DATE], the resident was taking CPAP (Continuous Positive Airway Pressure) at hours of sleep. 2. Facility failed to note on Resident #94's annual MDS, dated [DATE], she was taking a hypoglycemic medication. This deficient practice affects residents who receive care and could result in missed or inappropriate care. The findings included: Residents Affected - Few 1. Record review of Resident #8's face sheet, dated 07/31/2025, revealed the resident was a [AGE] year old male, originally admitted to the facility on [DATE], and re-admitted to the facility on [DATE] with the diagnoses of type 2 diabetes mellitus (a condition where the body has trouble regulating blood sugar levels, leading to persistently high blood glucose levels), cirrhosis of liver (chronic liver damage from a variety of causes leading to scarring and liver failure), hypertension (high blood pressures), atherosclerotic heart disease of native coronary artery (plaque and blood clots can reduce blood flow through an artery), muscle wasting and atrophy (loss of skeletal muscle mass), and sleep apnea (breathing repeatedly stops and starts at night's sleep). Record review of Resident #8's annual MDS assessment, dated 06/20/2025, revealed the resident's BIMS was 12 out of 15 indicated the resident had moderate cognitive impairment, and the resident required supervision or touching assistance (Helper provides verbal cues and/or touching assistance), such as sit to stand, chair to bed, and toilet transfer. Further record review of the MDS assessment revealed regarding the question of Non-invasive Mechanical Ventilator in Section O (Special care), the answered was coded No. Record cord review of Resident #8's comprehensive care plan, dated 05/19/2025, revealed the resident had the care plan of [Resident #8] has an order for CPAP (Continuous Positive Airway Pressure) for sleep apnea. For intervention – change CPAP (Continuous Positive Airway Pressure) tubing and setting it as ordered. Record review of Resident #8's physician order, dated 05/15/2025, revealed the resident had the order of CPAP (Continuous Positive Airway Pressure) settings: CPAP (Continuous Positive Airway Pressure) 11CMH2O (Centimeters of water) at HS (hours of sleep) and prn (as needed) at bedtime. During an interview on 07/31/2025 at 1:20 p.m. with MDS nurse stated Resident #8 was taking CPAP (Continuous Positive Airway Pressure) at night as ordered, and the MDS nurse thought CPAP (Continuous Positive Airway Pressure) was not Non-invasive Mechanical Ventilator. Further interview with the MDS nurse said she called the company's regional MDS coordinator, and the regional MDS coordinator said per RAI guidelines, if a resident had CPAP (Continuous Positive Airway Pressure), the answer of Page 1 of 11 675380 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Non-invasive Mechanical Ventilator in Section O (Special care) should be coded Yes. The MDS nurse said it was her mistake, and it should have been coded Yes because the resident was taking CPAP (Continuous Positive Airway Pressure). During an interview on 07/31/2025 at 3:00 p.m. with DON said Resident #8's annual MDS was inaccurate regarding the question of Non-invasive Mechanical Ventilator in Section O (Special care), and the answered should have been coded Yes because the resident was taking CPAP (Continuous Positive Airway Pressure) as ordered. The DON stated an inaccurate MDS assessment could result in a resident not being provided needed care which could result in poor health issues. 2. Record review of Resident #94's electronic face sheet dated 07/28/2025 reflected she was an [AGE] year-old-female admitted to the facility on [DATE]. Her diagnoses included: Alzheimer's disease (a progressive neurodegenerative disorder (a group of disorders characterized by the progressive degeneration and loss of nerve cells in the brain and central nervous system) that is the most common cause of dementia (a syndrome characterized by a progressive decline in cognitive abilities, such as memory, thinking, reasoning, and judgment, that interfere with daily functioning and social relationships)), type 2 diabetes mellitus (a chronic condition where the body either does not produce enough insulin or cannot properly use the insulin it produces, leading to elevated blood sugar levels) with diabetic neuropathy (kidney disease that develops a complication of diabetes), hypokalemia (condition characterized by low levels of potassium in the blood) and major depressive disorder (a serious mental illness characterized by persistent sadness, loss of interest, and other symptoms that significantly interfere with daily life). Record review of Resident #94's annual MDS assessment dated [DATE] reflected she was usually understood and usually was able to understand. She scored a ninety-nine on her BIMS which indicated she was unable to complete the interview. Diabetes mellitus was noted under active diagnoses. Under Section N - Medications, reflected Resident #94 received insulin injections daily. Under section N0415. High-Risk Drug Classes: Use and Indication, J. Hypoglycemic (including insulin) was not noted on either 1. Is taking, or 2. Indication noted. Record review of Resident #94's comprehensive care plan revised date of 07/06/23 reflected Problem, has diabetes, Interventions, administer medications as ordered. Record review of Resident #94's Active Orders as of: 07/28/2025 reflected Toujeo Solostar's subcutaneous (under the skin) solution pen-injector 300 units/ml (insulin Glargine) inject 5 units subcutaneously one time a day related to type 2 diabetes mellitus with a start date of 07/12/25. She had insulin ordered as needed which started on 01/29/2025. During an interview on 07/31/2025 at 1:36 pm with the MDS nurse, she stated she missed noting Resident #94's high risk hypoglycemic area on her annual MDS assessment dated [DATE]. She stated she did not know how it was missed, and that the MDS needed to be accurate to reflect the type of care a resident had and needed or the care might be missed or the wrong care provided which could result in health issues. During an interview on 07/31/2025 at 1:45 pm with the DON, she stated she was not aware Resident #94's annual MDS was inaccurate, and she would have to audit from then on to ensure MDS accuracy. She stated an inaccurate MDS assessment could result in a resident not being provided needed care which could result in poor health issues. 675380 Page 2 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0641 Level of Harm - Minimal harm or potential for actual harm Record review of CMS's RAI version 3.0 Manual, dated 10/2024, revealed For Non-invasive Mechanical Ventilator, code any type of CPAP (Continuous Positive Airway Pressure) and BiPAP (bi-level positive airway pressure) respiratory support devices that prevent airway from closing by delivering slightly pressurized air through a mask or other device continuously or via electronic cycling throughout the breathing cycle. Residents Affected - Few Record review of the CMS RAI Version MDS 3.0 Manual dated October 2024 revealed in part, .The OBRA regulations require nursing homes that are Medicare certified, Medicaid certified or both, to conduct initial and periodic assessments for all their residents. The Resident Assessment Instrument (RAI) process is the basis for the accurate assessment of each resident. 675380 Page 3 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to identify a diagnosis of mental illness on the preadmission screening and resident review (PASRR) assessment for 1 of 8 residents (Resident #55) whose records were reviewed for PASRR services. The facility failed to recognize on the Level I PASRR screening that Resident #55 had the mental illness diagnoses of depression, delusional disorder and bipolar disorder which would qualify Resident #55 for a PASRR evaluation. This deficient practice could place residents with mental illness at risk for not obtaining the services needed to treat their mental health diagnoses. The findings included: Record review of Resident #55's face sheet, dated 07/30/2025, revealed she was admitted on [DATE] with diagnoses which included: depression, delusional disorders and bipolar disorder, unspecified. Record review of resident #55's Quarterly MDS assessment, dated 05/30/2025, revealed the resident's BIMS score 99 noting resident was unable to complete the interview. Quarterly MDS assessment revealed with diagnoses of bipolar disorder and psychotic disorder (other than schizophrenia). Record review of Resident #55's care plan, initiated date 03/10/2025, revealed Resident #55 had a problem of [resident name] has a mood problem r/t depression, bipolar disease, delusional disorders. Record review of Resident #55's PASRR screening dated 02/20/2025, noted an answer of 0 (No) in section C0100 Mental Illness in response to the question, Is there evidence or an indicator this is an individual with a Mental Illness? During an interview and observation on 07/30/2025 at 12:57 p.m. the CMC stated Resident #55 came in from the community based off what they were provided from the community she did not trigger positive but triggered negative for mental illness on the 1 PASRR. The CMC reviewed Resident #55's PASRR dated 02/20/2025 along with her EMR then stated at the time she did not have any positive mental illness listed on her history paperwork at all. The CMC further stated Resident #55 should have been reassessed and a new 1 PASRR completed when the mental illness diagnoses were noted. The CMC stated she did not know why Resident #55 wasn't reassessed. The CMC stated a new 1 PASRR should have been completed. The CMC further stated it was her responsibility to ensure a new 1 PASRR assessment was completed. The CMC stated with the quarterly assessment they should have been reviewing the diagnoses codes and updating the diagnoses in case it was missed. During an interview on 07/30/2025 at 2:29 p.m. the RCS stated the facility did not have a policy but follows the THHSC Guidelines and provided a copy of the guidelines. During an interview on 07/31/2025 at 12:34 p.m. the DON stated the 1 PASRR was usually received once they got a referral for admission, and it was normally received from whatever entity they were receiving the resident from. The DON stated a new 1 PASRR should have been completed for Resident #55 so they could have initiated services for her, and so the local authority would have come out and assessed her. The DON stated the purpose of an accurate 1 PASRR was to ensure the resident had the opportunity for services. During an interview on 07/31/2025 at 12:43 p.m. the Administrator stated the admission team would ensure they received the 1 PASRRs and then admissions would input it into the EMR and then the MDS nurses (CMC) review them to make sure they were accurate.Record and Nursing Facilities to Complete the PASRR Level 1 Screening Form guidelines, dated June 2023, read, Section C.1: PASRR Screening: Steps for Assessment: 1. Identify diagnoses: Review the medical record, if available, for an MI, ID, and/or DD/RC diagnoses. Medical record sources can include but are not limited to: verbal interview with the individual, family members or LAR, observation, progress notes, annual physical exam, the most recent History and Physical, hospital discharge summaries or diagnosis list. 2. If you cannot locate a diagnosis, but suspect that an individual does have an MI, ID, and/or DD/RC, then document that information in this section of the Residents Affected - Few 675380 Page 4 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0645 Level of Harm - Minimal harm or potential for actual harm form. C0100 Mental Illness-Is there evidence or an indicator this is an individual that has Mental Illness? 0. No 1. Yes. Examples of MI diagnoses are: Schizophrenia, Mood Disorder (Bipolar Disorder, Major Depressive Disorder or other mood disorder) . Residents Affected - Few 675380 Page 5 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to review and revise resident care plans after each assessment for 1 of 26 residents (Resident #8) reviewed for care plan revision/timing. The facility failed to ensure Resident #8's care plan addressed changes in his smoking status regarding the resident did not need a smoking apron while smoking because he was very safe smoker after smoking assessment, dated 06/20/2025. This deficient practice could affect residents' care and services and may cause a delay in treatment and/or decline in health. Findings included: Record review of Resident #8's face sheet, dated 07/31/2025, revealed the resident was a [AGE] year old male, originally admitted to the facility on [DATE], and re-admitted to the facility on [DATE] with the diagnoses of type 2 diabetes mellitus (a condition where the body has trouble regulating blood sugar levels, leading to persistently high blood glucose levels), cirrhosis of liver (chronic liver damage from a variety of causes leading to scarring and liver failure), hypertension (high blood pressures), atherosclerotic heart disease of native coronary artery (plaque and blood clots can reduce blood flow through an artery), muscle wasting and atrophy (loss of skeletal muscle mass), and sleep apnea (breathing repeatedly stops and starts at night's sleep). Record review of Resident #8's annual MDS assessment, dated 06/20/2025, revealed the resident's BIMS was 12 out of 15 indicated the resident had moderate cognitive impairment, and the resident required supervision or touching assistance (Helper provides verbal cues and/or touching assistance), such as sit to stand, chair to bed, and toilet transfer. Further record review of the MDS assessment revealed regarding the question of tobacco use, the answered was coded Yes. Record review of Resident #8's comprehensive care plan, dated 06/17/2025, revealed the resident had the care plan of [Resident #8] is a smoker. The resident requires a smoking apron while smoking. Record review of Resident #8's smoking assessment, dated 07/17/2024, revealed the resident needed a smoking apron while smoking. Further record review of the resident's smoking assessment, dated 06/20/2025, revealed the resident did not need a smoking apron while smoking because the resident was a safe smoker. Interview on 07/31/2025 at 12:00 p.m. with Resident #8 said the resident did not wear a smoking apron while smoking anymore because he was a very safe smoker. Interview on 07/30/2025 at 4:00 p.m. with care management coordinator stated Resident #8 was a safe smoker, so the resident did not need a smoking apron anymore. The current care plan was inaccurate, and it should have been revised after smoking assessment dated [DATE] to reflect current resident status. During an interview on 07/31/2025 at 3:00 p.m. with DON said Resident #8's current care plan was inaccurate regarding a smoking apron, and the care plan should have been revised after smoking assessment dated [DATE], and not updating care plan could result in a resident not being provided needed care which could result in safety issues. Record review of the facility policy, titled Care Plan Revisions Upon Status Change, dated 10/24/2022, revealed The comprehensive care plan will be revised, and revised as necessary, when a resident experiences a status change. 675380 Page 6 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 observations, interviews, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 (Resident #7) of 4 residents reviewed for incontinence care. CNA A after he retracted Resident #7's foreskin of his penis did not pull it forward after incontinent care and CNA B did not clean the left buttock and scrotal area of Resident #7 when they turned him over to complete his incontinent care. This failure could place residents who required incontinence care at risk for cross contamination and the development of urinary tract infections. The findings included: Record review of Resident #7's electronic face sheet dated 07/30/2025 reflected he was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included: Alzheimer's disease (progressive brain disorder that gradually impairs memory, thinking, and the ability to carry out simple tasks), senile degeneration of brain (age-related cognitive decline, particularly memory loss), atrial fibrillation (a heart condition characterized by an irregular and often rapid heartbeat) and dementia (loss of cognitive functioning-thinking, remembering and reasoning-to such an extent it interferes with a person's daily life and activities). Record review of Resident #7's quarterly MDS assessment dated [DATE] reflected he rarely understands others and was rarely understood. He was not a candidate for a BIMS which indicated he was severely cognitively impaired. He was dependent for care with his ADLs. He was always incontinent of bowel and bladder. Record review of Resident #7's comprehensive care plan revised date 10/19/24 reflected Problem, has bladder and bowel incontinence r/t dementia, Interventions, clean peri-area with each incontinent episode. Observation on 07/30/2025 at 11:22 am of CNA A and CNA B perform incontinent care for Resident #7 revealed CNA A retracted Resident #7's foreskin to clean the resident's penis, and did not pull the foreskin back upon completion of peri care. CNA A cleaned the right buttock of Resident #7, and then Resident #7 was turned over to his left side, and instead of cleaning Resident #7's left buttock area, CNA B proceeded to pull the clean linen and brief through Resident #7's crotch area to initiate the completion of peri care. The surveyor prompted CNA A to pull Resident #7's foreskin back to the original position. During an interview on 07/30/25 at 11:40 CNA A and CNA B, they both stated they were trained to clean both sides of the buttocks and to pull the foreskin back in place after retracting it to clean the penis. They both stated it could cause pain and could result in infection or swelling.During an interview on 07/31/2025 at 1:45 pm with the DON, she stated CNA A and CNA B were trained to provide proper incontinent care and not putting the male foreskin back could result in pain and swelling. She stated not cleaning Resident #7's buttocks and scrotal area completely could result in cross contamination and infection. Record review of facility Incontinent Care Skills Checklist for CNA B dated 01/02/2025 reflect she met 5. Gently grasp shaft of penis and if uncircumcised retract foreskin, 6., Unretract foreskin of uncircumcised male, 10. With new wipe or cloth, cleanse the entire buttock area and surrounding hip area. Turn over surface of wipe to cleanse other side of buttock. Record review of the facility policy and procedure titled: Perineal Care dated 10/24/2022 reflected It is the practice of this facility to provide perineal care to all incontinent residents during routine bath and as needed in order to promote cleanliness and comfort, prevent infection to the extent possible, and to prevent and assess for skin breakdown, 12. Males, j. Turn the resident on his side, k. Clean and dry the bottom the scrotum and anal area. 675380 Page 7 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) for 2 (north nursing cart and south nursing cart) of 3 med carts and 1 (Resident #11) of 26 residents reviewed for pharmacy services. 1. There was one individual pack of Remedy - Intensive skin therapy Hydragurd-D dimethicone cream to protect skin from the drying effects that expired 05/2025 found in north nursing cart and seven individual packs found in south nursing cart on 07/30/2025. 2. Resident #11's insulin Flasp (Insulin aspart) for diabetes had open date of 06/26/2025, found inside the south nursing cart on 07/30/2025. Per the label of the insulin said, Discard 28 days after date opened, which was on 07/24/2025. This failure could place residents at risk of not receiving appropriate therapeutic effects of medication. The findings included: 1. Observation on 07/30/2025 at 11:38 a.m. revealed one individual pack of Remedy - Intensive skin therapy Hydragurd-D dimethicone cream to protect skin from the drying effects that expired 05/2025 (0.14 ounce) found in north nursing cart. Further observation on 07/30/2025 at 11:52 p.m. revealed seven individual packs of Remedy - Intensive skin therapy Hydragurd-D dimethicone cream to protect skin from the drying effects that expired 05/2025 (0.14 ounce) found in south nursing cart. During an interview on 07/30/2025 at 12:06 p.m. with ADON-C she acknowledged one individual pack of Remedy Intensive skin therapy Hydragurd-D dimethicone cream to protect skin from the drying effects that expired 05/2025 found in north nursing cart and seven individual packs in south nursing cart. ADON-C said she did not know what reason these skin barrier creams were stored in north and south nursing carts. All expired medications and biologicals should have been removed from med carts. Expired medications and biologicals might not reach therapeutic effects. 2. Record review of Resident #11's face sheet, dated 07/31/2025, revealed Resident #11 was a [AGE] year-old female and admitted to the facility on [DATE] with diagnoses of type 2 diabetes mellitus (body does not insulin properly, resulting in high blood sugar levels), spinal stenosis (the spaces inside the bones of the spine get too small), paraplegia (the inability to voluntarily move the lower parts of the body), muscle weakness, and anemia (the blood does not have enough healthy red blood cells and hemoglobin, a protein found in red blood cells, to carry oxygen all through the body). Record review of Resident #11's annual MDS, dated [DATE], revealed the resident's BIMS score was 15 out of 15, which indicated the resident's cognition was intact, and the resident was receiving insulin injections every day as ordered. Record review of Resident #11's physician's order, dated 05/29/2025, revealed the resident had the order of Flasp Injection Solution 100 UNIT/ML (Insulin Aspart) Inject as per sliding scale: if 0 - 200 = 0 units; 201 - 250 = 2 units; 251 - 300 = 4 units; 301 - 350 = 6 units; 351 - 400 = 8 units Administer 10 units and Notify Medical Doctor if Blood Sugars >400, subcutaneously before meals related to TYPE 2 DIABETES MELLITUS. Record review of Resident #11's medication administration record, dated from 07/01/2025 to 07/31/2025, revealed the resident was receiving Insulin Flasp (Aspart) subcutaneous solution 100 unit/ml - inject subcutaneously for type 2 diabetes mellitus at 7:30 am 11:00 am, and 4:00 pm. Observation on 07/30/2025 at 11:52 a.m. revealed Resident #11's insulin Flasp (Aspart) for diabetes with open dated 06/26/2025 inside the south nursing cart. Further observation revealed the resident's insulin had the box, and the box had label indicated Discard 28 days after date opened. During an interview on 07/30/2025 at 12:06 p.m. ADON-C stated Resident #11's insulin Flasp (Aspart) for diabetes with open date on 06/26/2025 was inside the south nursing cart, and the label on the insulin box indicated Discard 28 days after date opened. Further interview, ADON-C said Resident #11's insulin 675380 Page 8 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Flasp (Aspart) for diabetes should have been discarded 28 days after opening on 06/26/2025 per the label, which should have been discarded on 07/24/2025. However, ADON-C did not know what reason nurses did not discard the insulin and still used it on 07/30/2025. Resident #11 did not have any negative outcome related to blood sugars, but it might affect not reaching therapeutic effects. During an interview on 07/31/2025 at 4:00 p.m. DON said the facility nurses should have discarded Resident #11's Flasp (insulin Aspart) on 07/24/2025 because it was opened on 06/26/2025 and got 28 days after opened per the label of the insulin box. DON said Resident #11's insulin might not have therapeutic effects, and it was nurses' responsibility, and DON and ADON sometimes reviewed nursing carts, but they did not know what reason nurses did not discard the insulin. Further interview with the DON said the facility did not have specific policy regarding insulin but followed general guidelines and labels on medications. Record review of facility policy, titled medication Storage and disposal, revised 10/01/2019, revealed Drugs, which have been dispensed for individual residents, are not to be used beyond the expiration date indicated by the manufacturer, by the pharmacy, or based on the following criteria. The facility is to be strictly adhere to the expiration dating. 675380 Page 9 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen. The facility failed to ensure the Robot Coupe that was being used to prepare altered texture diets was clean and free from contaminates prior to using. These failures could place residents who received meals and/or snacks from the kitchen at risk for food borne illness. The findings included: Observation of the facility kitchen on 07/30/2025 at 10:06 AM revealed the cook was in the process of preparing pureed rice. The cook was observed setting up the robot coupe by placing the bowl and blade on the base with the lid sitting on the prep table. Small bits of debris, yellow in color, were observed on the lid, on the inside of the bowl and on the blade. The cook then pureed rice in the robot coupe. Interview with The [NAME] on 07/30/2025 at 10:50 AM revealed she had worked at the facility in the kitchen for 34 years. The [NAME] stated that the robot coupe needed to be cleaned prior to preparing altered textured foods for the residents. The [NAME] stated the process was to ensure all equipment was clean before using and then cleaned in between each food item that was prepared. The [NAME] stated she had prepared mechanical soft corn, cleaned the robot coupe and then set the robot coupe up to puree the rice. The cook stated it was the responsibility of all staff in the kitchen to ensure equipment was clean and free from debris prior to use. The [NAME] stated she did not see the debris prior to preparing the puree rice. The [NAME] stated by not ensuring equipment was free from debris it could cause food born illness in those that receive food from the kitchen. Interview with the Dietary Manager on 07/31/2025 at 1:13 PM revealed equipment should be clean prior to use. The Dietary Manager stated it was the responsibility of all staff to ensure equipment should be clean prior it being used. The Dietary Manager stated if staff use dirty equipment, it could cause food born illness. Interview with DON on 07/31/2025 at 2:05 PM revealed the kitchen staff should ensure equipment was cleaned prior to it being used. DON stated if dirty equipment was used in the kitchen, it placed the residents at risk for food born illness. DON stated no residents had recent signs or symptoms of food born illness. Interview with Administrator on 07/31/2025 at 2:11 PM revealed equipment should be clean prior to it being used to prepare food. The Administrator stated all kitchen staff were responsible to ensure equipment was clean before using it. The Administrator stated if equipment is not properly cleaned prior to use it could place the resident's at risk for food born illness. Record review of the facility policy named Mechanical Cleaning and Sanitizing of Utensils and Portable Equipment, dated October 1, 2018, revealed 3. Rinse or scrape equipment and utensils and, when necessary, soak to remove gross food particles and soil prior to being washed. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils. (A) Equipment food contact surfaces and utensils shall be clean to sight and touch. (B) The food-contact surfaces of cooking equipment and pans shall be kept free of encrusted grease deposits and other soil accumulations. (C) Nonfood-contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris. 675380 Page 10 of 11 675380 07/31/2025 Windsor Nursing and Rehabilitation Center of Segui 1219 Eastwood Dr Seguin, TX 78155

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 observations, interviews, and record review, the facility failed to establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development of communicable diseases and infections for 1 (Resident #90) of 7 residents reviewed for infection control practices during medication administrations. MA-D did not sanitize or wash her hands and did not clean a blood pressure cuff when administering medications and measuring blood pressure to Resident #90. This deficient practice could place residents at risk for cross contamination and infections. The findings included: Record review of Resident #90's face sheet, dated 07/31/2025, revealed the resident was a [AGE] year old male and admitted to the facility on [DATE] with the diagnoses of vascular dementia (memory loss due to stoke), atherosclerotic heart disease of native coronary artery (plaque and blood clots can reduce blood flow through an artery), muscle wasting and atrophy (loss of skeletal muscle mass), difficulty in walking, and saddle embolus of pulmonary artery (a large blood clot that gets stuck where the main artery in the lungs, called the pulmonary artery, branches left and right to bring blood to each lung). Record review of Resident #90's quarterly MDS, dated [DATE], revealed the resident's BIMS was 13 out of 15 indicated the resident's cognitive was intact, and the resident required setup or clean-up assistance (Helper sets up or cleans up) to sit to stand, chair to bed, and toilet transfer. Record review of Resident #90's comprehensive care plan, dated 04/05/2024, revealed [Resident #90] is at risk for deterioration of medical condition related to possible exposure to other covid-19 individuals. For intervention - Assist resident in practicing hand hygiene and educate staff on use of personal protective equipment and provide instruction on proper donning, doffing, and disposal of items used. Observation on 07/29/2025 at 5:02 p.m. revealed MA-D prepared Resident #90's evening medications at the 500-hallway to administer evening medication to the resident. MA-D did not sanitize or wash her hands when preparing the resident's medications. Further observation revealed the MA-D took a blood pressure cuff, entered Resident #90's room, and measured the resident's blood pressure before giving the evening medications without cleaning the blood pressure cuff, then came out from the room and gave all evening medication to Resident #90 without sanitizing or washing MA-D's hands and cleaning the blood pressure cuff. During an interview on 07/29/2025 at 5:23 p.m. with MA-D stated she did not sanitize or wash her hands during medication administration to Resident #90 and did not clean a blood pressure cuff when measuring blood pressure to the resident. Further interview with MA-D said she should have sanitized or washed her hands and cleaned the blood pressure cuff to prevent possible infection during medication administration. MA-D said she was very nervous so forgot cleaning her hands and blood pressure cuff. During an interview on 07/31/2025 at 4:00 p.m. with DON said MA-D should have cleaned her hands and blood pressure cuff during medication administration to prevent possible infection. Record review of the facility policy, titled Medication Administration, revised on 10/01/2019, revealed . B. Handwashing and hand sanitization: the person administering medications adheres to good had hygiene, which includes washing hands thoroughly before beginning a mediation pass, prior to handling any mediation, after coming into direct contact with a resident and before and after administration of ophthalmic, topical, vaginal, rectal, and parenteral preparation and medication s given via enteral tube. Record review of the facility policy, titled Infection Prevention and Control Program, dated 05/13/2023, revealed . 10. Equipment Protocol: a. All reusable items and equipment requiring special cleaning, disinfection, or sterilization shall be cleaned in accordance with our current procedure governing the cleaning d sterilization of soiled or contaminated equipment. Residents Affected - Few 675380 Page 11 of 11