Health inspection·March 22, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few happened before but he had not told anyone. He stated there had not been a curtain around his bed since arriving at the facility, he preferred the bed closest to the door, and would like a curtain for privacy. During an interview on 03/21/2023 at 08:32 am CNA C stated she should have pulled the bed linen over Resident # 52 when the therapist opened the door. She stated by not doing so it exposed Resident # 52 to the hallway and could have caused him embarrassment. CNA C stated she did not know why there was no curtain to provide full privacy for Resident # 52. She stated she had been trained on dignity and privacy and would never want any of her residents to feel bad. During an interview on 03/21/2023 at 08:39 am the COTA stated she knocked, heard someone inside the room and thought it was ok to enter. She stated when she saw Resident # 52 exposed, she should have closed the door and come back at another time. She also stated she should have not entered the room until the resident said for her to come in. She stated the risk to the resident would be not protecting their privacy and dignity. During an interview on 03/21/2023 at 08:42 am the DON stated that a closed door was the resident's privacy and if a CNA voiced patient care in progress no one should enter that room. She stated the room in which Resident # 52 resides was set up to be a private room and only had the privacy curtain in the middle. She stated Resident # 52 does prefer the bed next to the door and should have a curtain on that side to provide full privacy. She stated she would see that a privacy curtain was installed and that all staff are retrained on maintaining privacy and dignity for all residents. She stated the risk could be embarrassment. During an interview on 03/21/2023 at 08:45 am the administrator stated Resident # 52's room was set up as a private room a few years back and she had not realized Resident # 52 was residing in the bed closest to the door. She stated that all residents should be able to have full visible privacy and would see that a curtain was put in place today. She stated that by not having a curtain in place could allow exposure of resident during care causing embarrassment or humiliation. Record review of facility policy and procedure titled, Quality of Life - Dignity dated August 2009 indicated, .#6. Resident's private space and property shall be always respected. a. Staff will knock and request permission before entering resident's room, 10. Staff shall promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 2 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0583 Keep residents' personal and medical records private and confidential. 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 ensure that each resident had a right to privacy during medical care for 1 of 24 residents (Residents # 52) observed for privacy. Residents Affected - Few The facility failed to ensure full visual privacy during incontinent care for Resident # 52. This deficient practice placed residents at risk of loss of privacy and dignity. Findings: Record review of facility face sheet dated 03/21/2023 indicated Resident # 52 admitted to the facility originally on 12/05/2022 and was readmitted [DATE], and 03/13/2023 with diagnoses of pneumonia (lung infection), hypoglycemia (low blood sugar), and major depressive disorder. Record review of admission MDS dated [DATE] indicated Resident # 52 had a BIMS score of 11 indicating moderate cognitive impairment and required extensive assistance times one person for toilet use. Record review of comprehensive care plan dated 03/13/2023 indicated Resident # 52 had ADL (activities of daily living) self-care performance deficits with intervention for toilet use for extensive assistance times one person and alteration in bowel elimination with intervention of providing adequate time and privacy for elimination. During an observation on 03/21/23 at 08:52 am Resident # 52 resided on the side of room next to the door with only a curtain suspended from the middle of the room. During an observation on 03/20/2023 at 11:39 am Resident # 52 was lying in bed located closest to the door and room only had 1 curtain suspended in the middle of the room. No curtain present on Resident # 52's side of the room to allow for full privacy. During an observation on 03/21/2023 at 08:22 am Resident # 52 was receiving incontinent care from CNA C with the door closed to the room but no curtain available to pull for full privacy. While performing incontinent care the COTA knocked on Resident # 52's door and opened the door after CNA C voiced 2 times patient care was in progress exposing Resident # 52 to the hallway. Resident # 52 was in the bed on his left side without any clothing from waist down. The COTA stood at the doorway talking to CNA C and Resident # 52 for approximately 45 seconds. During an interview on 03/21/2023 at 08:29 am Resident # 52 stated he was embarrassed by the therapist coming in his room during incontinent care and his private area being exposed. He stated it has happened before but had not told anyone. He stated there had not been a curtain around his bed since arriving at the facility, he preferred the bed closest to the door, and would like a curtain for privacy. During an interview on 03/21/2023 at 08:32 am CNA C stated she should have pulled the bed linen over Resident # 52 when the therapist opened the door. She stated by not doing so it exposed Resident # 52 to the hallway and could have caused him embarrassment. CNA C stated she did not know why there was no curtain to provide full privacy for Resident # 52. She stated she had been trained on dignity and privacy and would never want any of her residents to feel bad. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 3 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0583 Level of Harm - Minimal harm or potential for actual harm During an interview on 03/21/2023 at 08:39 am the COTA stated she knocked, heard someone inside the room and thought it was ok to enter. She stated when she saw Resident # 52 exposed, she should have closed the door and come back at another time. She also stated she should have not entered the room until the resident said for her to come in. She stated the risk to the resident would be not protecting their privacy and dignity. Residents Affected - Few During an interview on 03/21/2023 at 08:42 am the DON stated that a closed door was the resident's privacy and if a CNA voiced patient care in progress no one should enter that room. She stated the room in which Resident # 52 resides was set up to be a private room and only had the privacy curtain in the middle. She stated Resident # 52 does prefer the bed next to the door and should have a curtain on that side to provide full privacy. She stated she would see that a privacy curtain was installed and that all staff are retrained on maintaining privacy and dignity for all residents. She stated the risk could be embarrassment. During an interview on 03/21/2023 at 08:45 am the administrator stated Resident # 52's room was setup as a private room a few years back and had not realized Resident # 52 was residing in the bed closest to the door. She stated that all residents should be able to have full visible privacy and would see that a curtain was put in place today. She stated that by not having a curtain in place could allow exposure of resident during care causing embarrassment or humiliation. Record review of facility policy and procedure titled, Quality of Life - Dignity dated August 2009 indicated, .#6. Resident's private space and property shall be always respected. a. Staff will knock and request permission before entering resident's room, #10. Staff shall promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 4 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain personal hygiene for 1 of 4 residents reviewed for ADL care. (Resident #38) Residents Affected - Few The facility failed to ensure Resident #38 received timely incontinent care. This failure could place residents at risk of embarrassment, discomfort, and skin breakdown. Findings included: Record review of an admission Record dated 3/21/2023 for Resident #38 indicated he admitted to the facility on [DATE] and was [AGE] years old with diagnoses of schizoaffective disorder (a mental illness that can affect thoughts, mood and behavior), bipolar type (extreme mood swings), unspecified dementia (impaired ability to remember, think or make decisions), type 2 Diabetes and venous insufficiency (veins unable to send blood back from the legs to the heart). Record review of a care plan for Resident #38 dated 1/20/2022 with a revision on 11/14/2022 indicated, I am incontinent of bowel and bladder. I have no control of bladder or bowel. Interventions included to monitor for incontinence every 2 hours and prn (as needed), change promptly and apply protective skin barrier. Record review of a Quarterly MDS assessment for Resident #38 indicated he had severe impairment in thinking with a BIMS score of 5. He required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene with one to two persons assist. He was totally dependent in bathing with one person assist. During an observation and interview on 3/20/2023 at 3:16 PM in Resident #38's room, Resident #38 was lying in bed with a wet gown and sheet on bed. The room had a strong urine odor smell that filled the room. CNA E entered the room looking for CNA F and CNA E observed resident lying in bed. and this surveyor had CNA E to verbalize what condition she observed Resident #38 in at that time. CNA E said there was a ring of urine on the bed that Resident #38 was lying in that had extended past his shoulders and his gown was wet. CNA E said she was not assigned to the hall for Resident #38 and would find CNA F and bring her back to the room. During an observation and interview on 3/20/2023 at 3:33 PM CNA F entered the room of Resident #38 and said it was about 1:40 PM today when she last checked on Resident #38 and she changed his brief and rotated him in bed and then went on her break. CNA F was assisted by CNA E, both washed their hands in the bathroom in the room and applied gloves. Both removed the wet hospital gown from Resident #38, brief pulled down and thick, yellow-green discharge was present coming out of his penis. CNA F said she didn't notice any drainage earlier during her shift from his penis. CNA F used wipes to clean Resident #38's penis. There was a small open wound noted to his sacrum that was bleeding, no dressing was noted. Resident #38's back had wrinkles on his skin, the draw sheet was saturated in urine, his sacral area was red and macerated (skin wrinkly from being in moisture too long), excoriation (red and raw) on both inner thighs. Both CNA E and F provided incontinent care to Resident #38 and applied barrier cream to his sacrum. Resident #38's linens were changed, and the mattress was wiped down because of urine saturation on the mattress , there was no water proof cover on the mattress. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 5 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 - Few CNA E exited the room to notify the charge nurse of the drainage from Resident #38's penis and bleeding noted from his sacrum. During an interview on 3/20/2023 at 4:08 PM, CNA F said she had been employed at the facility for a year. She said she normally worked hall 100 where Resident #38 was. She said she checked on the dependent residents about 5 times during her 12-hour shift. She said Resident #38 was wet the last time she checked on him about 1:40 PM, and she changed him. She said she checked on the residents every 2 hours. She said he had been saturating the bed but did not tell the nurse that he was very wet. She said that was the first time to see the drainage around his penis. She said he has had the redness on his bottom for a couple of weeks and staff was applying barrier cream to the area. She said the open area on his bottom was noted earlier and Resident #38 has had it for a while, but it was not bleeding earlier. She said the ADON conducted skills check off on incontinent care at the beginning of last month with her. She said the resident could be at risk of skin break down if the resident was left in urine for extended periods. She said she could have done more and checked him again before she went on her break and to her it looked like he had not been changed at all that day. During an interview on 3/21/2023 at 12:35 PM, with the DON and ADON. The DON said she was aware of the condition that Resident #38 was found in yesterday afternoon. The DON said she talked with CNA F who told her the last time she changed Resident #38 was before lunch (noon). She said they conducted check offs with the CNA's annually and periodically if they see there had been a problem. The ADON said CNA F completed a check off on incontinent care in November 2022 with her. The DON said Resident #38 was a dependent resident and the CNAs should be checking and changing the resident at least 3 times during their 12-hour shift. The DON said a resident that was left in urine for extended periods of time could develop wounds, excoriation, and discomfort. The DON said she met with her staff on 3/20/2023 and had an in-service on turning and repositioning of dependent residents. The DON said going forward she would make the nurses more responsible and have the staff make more rounds. She said CNA F should have checked on Resident #38 more often. The DON said the facility did not have a policy specific on ADLs, but they did expect the staff to follow the resident's care plan. During an interview on 3/22/2023 at 1:43 PM, the Administrator said she was made aware of the condition that Resident #38 was in on 3/20/2023 by the DON. She said all residents would receive their care timely based on individual needs. She said the risk for residents not receiving care timely would be skin break down. She said going forward she would make sure all the residents who were dependent would be assessed for their needs on an individual basis, and their care plans would be up to date along with their tasks if they needed more frequent attention. Record review of a Competency Evaluation dated 11/26/2022 for CNA F indicated she was checked off on incontinent care of a male resident without a catheter by the ADON. Record review of a facility policy titled Comprehensive Care Plan with a revised date of 4/25/2021 indicated, .Every resident will have an individualized interdisciplinary plan of care in place. The interdisciplinary team will continue to develop the plan in conjunction with the RAI (resident assessment instrument) MDS and CAAS (care area assessment). 2. To assure that the resident's immediate care needs are met and maintained . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 6 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 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 observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assures the accurate acquiring, receiving, dispensing, and administering of medications for 1 of 4 residents (Resident #51) reviewed for pharmacy services. The facility did not ensure medications were administered by licensed staff for Resident #51. This failure could place residents at risk for the unsafe administration of medications, not receiving prescribed doses of ordered medications and infection. Findings included: During a record review physician order summary dated 3/21/23 for Resident #51 indicated he was [AGE] years old with diagnosis of diabetes (high glucose in the blood), blindness and chronic pain with an admission date of 10/01/22. Resident #51 Physician orders indicated an order for Latanoprost Solution 0.005% instill 1 drop in both eyes at bedtime and Lubricating Plus Eye Drops Solution 0.5% (carboxymethylcellulose Sodium) instill one drop in both eyes four time a day for dry eye, blindness. During a record review of Resident #51's MDS dated [DATE] indicated he was legally blind, cognitively intact with a BIMS score of 15 and required supervision with setup help only for ADLs except bathing in which he required assistance of one person for showering. During an interview and observation on 03/20/23 at 2:12 PM with Resident #51 revealed a white plastic medication bottle was on the bedside table with a handwritten label indicating eye drops were inside. After asking permission from resident this surveyor opened the bottle and found a vial of Latanoprost Solution 0.005% with prescription label for resident #51. Resident #51 said he puts his own drops in nightly and his own lubricating eye drops in four times a day. Resident #51 showed this surveyor his vial of lubricating drops. During an interview and observation on 03/21/23 at 08:05 AM of medication administration with LVN A and Resident # 51, LVN A said that the eye drops were kept at bedside for resident use. She said she was not aware the resident needed an assessment to self-administer his eye drops. Resident #51 agreed that he kept and administered his own eye drops at night and lubricating eye drops during the day. He said I put them in, so I don't have to bother anyone for help. Resident #51 said I can do that myself. LVN A said that applying his eye drops without washing his hands could cause infection. Resident #51 said he could not see well but he touched the vial to his eye to make sure the drop went in. During an interview on 03/21/23 at 09:41 AM the DON said that the resident could not keep his eye drops at bedside without an MD order and an assessment for safe medication administration. She said she would remove the eye drops, complete an assessment today and contact the Physician if it was appropriate. She said if the resident was unable to safely administer his eye drops it could cause an eye infection or under dosing and overdosing. During an interview on 3/22/23 at 11:30 the Administrator said that resident #51 could not self-medicate without an assessment and an order from his medical doctor. The administrator said the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 7 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete medication had been removed. She said that the DON and ADON were responsible for ensuring medications were administered according to regulation. The administrator said there was a risk to the resident for infection or incorrect dosages. The administrator said that the staff had already received an Inservice for safe administration of medication to ensure this problem is corrected. Review of a Pharmscript Policy revision date 08-2020, General Guidelines for Medication Administration reflected: Medications are administered as prescribed in accordance with good nursing principles and practices and only by person legally authorized to administer .13. Residents are permitted to self-administer medications when specifically authorized by the attending physician and in accordance with the procedures for self-administration of medications. Event ID: Facility ID: 675398 If continuation sheet Page 8 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure drugs and biologicals used in the facility were stored in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 3 medication carts (nurse cart 600 hall) reviewed for labeling and storage. The facility failed to remove expired insulin from the nurse medication cart on hall 600. This deficient practice could place residents at risk for improper glucose monitoring and could result in residents not receiving the intended therapeutic effects of their medications causing a health decline. Findings include: Record Review of physician order summary dated 3/21/23 reflected Resident #36 was a [AGE] year old admitted [DATE] with a diagnosis of diabetes (high blood sugar), alcoholic cirrhosis of liver and alcohol dependence with dementia. Review of physician orders reflected Insulin Detemir solution 100 unit per milliliter 20 units subcutaneously at bedtime for diabetes dated 6/12/22. During observation and interview on 03/21/23 at 8:45 AM of the nurse cart on 600 hall revealed a vial of Levemir Insulin was dated as opened on 10/22/2022 and the package insert indicated to discard 42 days after opening, (discard date 12/03/22). LVN A said she had been employed at the facility for 6 years. LVN A said the nurses were responsible for checking that insulin was within administration dates before administration. LVN A said she was not aware how long the insulin was good for, maybe six months from the date opened. LVN A said she had not received any education recently on when the multi dose vials expire. She said the risk could be ineffective medication action, injection site infections and elevated blood sugar readings. During an interview on 03/21/23 at 12:30 PM, the DON said she and the ADON were responsible for ensuring the carts are checked for expired medications and supplies. The DON stated she had just performed a total audit last week on all carts and the medication room was surprised that expired insulin was found on the cart. The DON said that the consultant pharmacist also checks carts and medication rooms for expired medications monthly during the medication review. During an interview and record review of Resident #36's medication administration record on 03/21/23 at 1:00 PM, the DON said that the resident had a history of refusing his insulin and the last day of documented insulin administration was 2/23/23. The DON said Resident #36's Glycosylated Hemoglobin on 3/21/23 was 5.5. The DON said Resident #36's physician was contacted, and the insulin was then discontinued on 3/21/23 due to resident refusals. The DON said that insulins were good for so many days depending on manufacturer and should be removed from the cart when expired. During an interview on 03/21/2023 at 5:00 PM, the Administrator stated the DON and ADON were responsible for oversight in the nursing department. She stated she would assist with overseeing the DON and ADON retrained nursing staff on policy and procedures and those policies were followed. She said that the negative outcome of not removing expired medications could be that residents are given (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 9 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0761 medications that have lost their effectiveness. Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy and procedure titled Vials and Ampules of Injectable Medications, revision date 09/2020, indicated, Quality of Control solutions and test strips, Policy: Vials and ampules of injectable medications are used in accordance with the manufacturer's recommendations of the provider pharmacy's directions for storage, use and disposal. 1 Vials and ampules dispensed by the pharmacy are maintained in the box or container with the pharmacy label in which they are dispensed .4. The solution in multi-dose vials (MDV) is inspected prior to each use for unusual cloudiness, precipitation, or foreign bodies If the Multi dose vial is opened and does not indicate an opened date the open date reverts to the dispensing date .6. Medication in multi-use vials may be used until the manufacture's recommended expiration date . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 10 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 provide food that was palatable and at an appetizing temperature for 1 of 1 resident (#52) and 10 confidential residents reviewed for food palatability and temperature. Residents Affected - Some The facility failed to serve food that had a palatable flavor and temperature. This failure could affect residents who ate their meals from 1 of 1 kitchen by placing them at risk for weight loss, altered nutrition status and a diminished quality of life. Findings Include: During a confidential group interview on 03/21/23 at 9:47AM with ten residents, identified as being alert, oriented and cognitively intact. All ten residents said the food was cold all the time. During an observation on 03/21/23 at 1:29 PM the test tray- pureed was cold when served to the surveyors. The tray included that turnip greens, baked beans, and pork roast. During an observation and interview on 03/22/23 at 7:25 AM Resident #52 was observed up in bed with his breakfast tray on the over bed table. He said, it is what it is. He said he eats in his room daily and his food is cold when he gets it every time. He said he has not complained or told anyone because he did not want to be a bother. He said he would let the staff know he wanted a new tray that was hot. During an interview on 03/22/23 at 1:04 PM CNA D said she had been a CNA for 11 years and employed at the facility for 2. She said the dietary staff prepared the hall trays and put them on the cart to go down each hall, while the nursing staff are assisting in the dining room. She said she had to finish assisting residents in the dining room before taking trays down the hall and sometimes trays sit for longer times. She said that residents may not eat well if their food is cold. Record Review of facility face sheet dated 03/21/23 indicated resident #52 admitted to the facility on [DATE] and was readmitted [DATE], and 03/13/2023 with diagnosis of pneumonia (lung infection), hypoglycemia (low blood sugar), and major depressive disorder. Record review of admission MDS dated [DATE] indicated resident #52 had a BIMS score of 11 indicating moderate cognitive impairment and required setup assist for eating. Record Review of comprehensive care plan dated 03/13/2023 indicated resident #52 may have an altered nutritional status, weight loss, dehydration, and skin breakdown with an intervention to serve diet as ordered and monitor intake every meal. During a phone interview on 03/22/23 at 12:57 PM the RD said she was last in the building on 03/16/23, and the food was hot on the sample food tray on that day. She said she did not provide any in-service training during the visit on 03/16/23. She said she would send any in-services needed to the dietary manager for her to perform. She said, I would not be happy if I received a food tray that was cold. She said the Administrator was responsible for training the dietary manager and the dietary manager would be responsible for training her staff in the kitchen. She said the facility served the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 11 of 12 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 675398 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Center 501 Timpson Center, TX 75935 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 0804 dining room first, secured unit second and then the trays go down the hall. Level of Harm - Minimal harm or potential for actual harm During a phone interview on 03/22/23 at 1:00PM with the Regional Dietician Consultant, she said the RD had on going in service training with the DM which started during orientation and continued during every visit to the facility. The RD would identify issues during her visit to the facility and have on going-trainings with the DM. The DM is responsible for in servicing her staff in the kitchen. The Administrator and the RD are responsible for providing oversight to the DM. The RD will get with the Administrator about concerns to monitor in the kitchen, what observations were noted during the visit. The Regional Dietary Consultant said it was not the first time to hear anything about cold food items and they have had issues in the past. She said the facility does not have plate warmers or insulated carts. Residents Affected - Some During an interview on 03/22/23 at 1:33PM with the DM and the Administrator, the DM said she had been employed at the facility for a year and had been the DM since July 2022. She said she was responsible for training the staff in the kitchen. She said she was aware of the test tray served to the RD being cold on the last visit. She said the RD said she was not aware if it just took too long for the test tray to get to her, was the reason the food was cold. The RD said the facility does not have the plug ins for plate warmers. She said the facility also only has one insulated cart and it goes to the unit. The DM said they would keep the food in the oven longer, wrapped in foil before plating it to go down the halls and that would help keep it warm. The Administrator said they would look at the timing of how long it takes for the trays to be passed on the hall. The Administrator said the secured unit is the only hall that has an insulated cart. Record Review of the Registered Dietician Consultant Report dated 02/28/23 by the RD indicated meal/rounds/dining service observation tasks: hot food items not hot. Meatloaf and pureed item's not on steam table. Salad not cold; should have been on ice during meal service. Additional recommendations: Will provide in-service for kitchen staff next visit. Next RD visit scheduled March 15, 2023. Record Review of facility policy titled Food Production Meal Service dated 04/2022 indicated, .Residents will be provided with nourishing, palatable, and attractive meals . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 12 of 12