Health inspection·October 16, 2023

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were frequently repositioned with pillows. LVN B stated all interventions should be on the care plan, and she was not sure who was responsible for updating care plans. During an interview on 10/11/23 at 11:15 a.m. LVN C stated interventions used for residents with elevated risk for pressure ulcers included turning every 2 hours, pillows between legs, or behind back, and making sure residents were kept clean and dry. LVN C stated there was a how to book about wound care kept at the nurses station they could use if needed for reference on wound care. During an interview on 10/11/23 at 2:10 p.m. LVN D stated she updated care plans when she received new orders. LVN F stated the DON and ADON reviewed care plans. During an interview on 10/12/23 at 3:00 p.m. the Administrator stated the DON reviewed care plans, and any staff member could put interventions in. During an interview on 10/16/23 at 9:29 a.m. the ADON stated the DON reviewed the care plans. The ADON stated interventions such as pillows for offloading and turning every 2 hours should be in the care plan. During an interview on 10/16/23 at 10:20 a.m. LVN E stated the DON had showed the staff how to put information into the care plan, before she left on leave about a month ago, but she had forgotten how to do it. LVN E stated that interventions used for residents with or at risk for pressure ulcers included repositioning every 2 hours and offloading heels. LVN E stated all specific interventions should be on the care plan. Stated the DON had told the staff to put interventions into the computer the time the incident occurred. During an interview on 10/16/23 at 11:26 a.m. the Interim DON stated ideally, specific interventions should be on the care plan. Interim DON stated the wound care company the facility was contracted with provided a manual to assist staff in identifying and staging wounds as well as providing treatment guidelines and protocols. Interim DON stated staff were expected to follow these guidelines. Stated any staff member could update care plans and was not sure if there was one person who was responsible for them. Record Review of policy titled Skin Management: Prevention and Treatment of Wounds with a revision date of 10/6/2022 indicated the following: Residents at risk for developing pressure ulcers based on the Braden Score will have care plan developed to include interventions to prevent skin breakdown . Record review of a policy titled Comprehensive Care Plan with a revision date of 4/25/21 indicated the following: the care plan is revised every quarter, significant change of condition, annual or as the resident condition changes . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 2 of 4 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 10/16/2023 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 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure services provided or arranged by thge facility as outlined by the comprehensive care plan meets professional standards of quality for 1 of 8 residents (Resident #1) reviewed for skin assessments. Residents Affected - Few The facility failed to ensure Resident #1 received a weekly skin assessment. This failure could place the resident at increased risk of not having their individual needs met. Findings included: Record review of Resident #1's face sheet dated 10/10/23 indicated Resident #1 was an [AGE] year-old female admitted to the facility 10/11/22 with diagnoses of Alzheimer's disease (a type of brain disorder that causes problems with memory, thinking and behavior), muscle wasting, osteoporosis (a disease that weakens your bones), dementia (a term used to describe a group of symptoms affecting memory, thinking and social abilities), and dysphagia ( difficulty in swallowing) following cerebral infarction (the most common form of stroke). Record review of Resident #1s quarterly MDS dated [DATE] indicated Resident #1 had a BIMS score of 7, indicating she had severely impaired cognition. The MDS indicated Resident #1 required extensive assistance with personal hygiene and dressing. The MDS indicated Resident #1 was always incontinent of bowel and bladder. The MDS indicated Resident #1 was at risk for developing pressure ulcers/injuries and had no unhealed ulcers/injuries at this time. Record review of Resident #1's physician orders dated 10/1/23-10/31/23 indicated the following: nursing to perform weekly skin assessment. Every night shift, every Monday. During an interview on 10/11/23 at 9:56 a.m. LVN A said skin assessments were done weekly. LVN A stated there was a schedule at the desk and the dates they need to be completed. LVN A stated there was also an alert that popped up on the computer screen when assessments were due. LVN A stated night shift and day shift were responsible to see that all skin assessments were done. LVN A stated if a skin assessment was not completed, the alert turned red and stayed on the computer until it has been done. LVN A stated if she found any new skin concern on a resident, she would do a full skin assessment from head to toe, and she would report it to the DON, ADON, MD, and family. LVN A stated that all clothing needed to be removed for proper skin assessment to be done. During an interview on 10/11/23 at 10:45 a.m. LVN B stated skin assessments were done weekly. LVN B stated the computer alerted staff to residents who were due for an assessment, and when they needed to be done. LVN B stated a full skin assessment included removing clothing from head to toe. LVN B stated on 10/1/23 she was notified by another staff that Resident #1 had 2 open areas. LVN B stated she assessed Resident #1 and it looked like 2 scratches on the top and bottom of Resident #1's right hip. LVN B stated she did not complete a full head to toe assessment. LVN B stated she just assessed Resident #1's bottom. LVN B stated that if any new wound/skin condition were found, staff were to do a full skin assessment. During an interview on 10/11/23 at 11:15 a.m. LVN C said skin assessments were to be done weekly. LVN C stated residents skin was to be looked at from head to toe. LVN C stated clothing would be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 3 of 4 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 10/16/2023 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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few removed to get a good look at all the skin. LVN C stated if a new skin condition were observed, she would do a complete head to toe skin observation. During an interview on 10/11/23 at 12:30 p.m. Interim DON said the LVN charge nurses did head to toe skin assessments weekly. Interim DON stated LVNs could measure wounds but not stage them. Interim DON stated her expectation, and what she would like the staff to do is a new full skin assessment when any new skin issue was identified. During an interview on 10/12/23 at 10:15 a.m. the ADON stated staff were to do complete head to toe skin assessments weekly, and if they were notified of any skin issue, they should also do a full assessment. During an interview on 10/12/23 at 10:28 a.m. LVN F stated head to toe skin assessments were done every week. LVN F stated there was a pop up on the computer to let staff know when the assessments were due. LVN F stated when she did her assessments, she would make the resident stand up, lie down, and remove all clothes including any socks. LVN F stated if she found any skin issues, or any were reported to her she would do a complete skin assessment. LVN F stated staff were also supposed to do a complete head to toe skin assessment whenever there was a fall. LVN F stated she always had another staff member look at any wounds she found as she did not feel comfortable measuring them. During an interview on 10/12/23 at 3:00 p.m. the Administrator stated skin assessments are done weekly, and all clothing should be removed. Administrator stated when staff identified a new skin condition, they were to do a skin assessment, and typically would do a full assessment. During an interview on 10/16/23 at 10:20 a.m. LVN E stated she did 5-6 skin assessments per week. LVN E stated there were alerts on the computer to alert staff when skin assessments were due. LVN E stated she tried to do her assessments when the residents were in the shower so she could get a good look at their skin. LVN E stated if she found, or was notified of any new skin condition, she would do a complete head to toe assessment removing clothing including socks. LVN E stated she received training when she was hired which consisted of doing overall skin assessments/wound reports. Record review of a policy titled Skin Management: Prevention and Treatment of Wounds with a revision date of 10/6/2022 indicated the following: .skin assessments will be conducted at a minimum of every 7 days on a week on a Weekly Skin Assessment . Residents at risk for developing pressure ulcers based on the Braden Score will have care plan developed to include interventions to prevent skin breakdown. Dependent residents will have heels floated while in bed and be turned and repositioned at a minimum of every 2 hours .Wound Protocols will be used for wound care guidelines and reference for staging wounds .care plan will be developed by the IDT to include risk factors, interventions to promote skin wellness and healing pressure ulcers . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675398 If continuation sheet Page 4 of 4