Health inspection·March 8, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation on 03//07/2023 at 7:54 am Resident # 42 was observed sitting in her wheelchair in the dining room in the secured unit with 7 other residents present and urinary drainage catheter bag attached to wheelchair without a privacy covering with yellow urine present in approxiamtely 1/4 of bag. During an interview on 03/07/2023 at 9:52 am CNA A stated Resident # 42 has had a catheter since coming to the facility. She stated all catheter bags should be covered for privacy and dignity and she just overlooked that Resident # 42's was not covered. She stated that a catheter bag exposed to others could cause resident to be upset. During an interview on 03/07/2023 at 9:15 am LVN B stated that all indwelling catheter bags should be covered for privacy and dignity. He stated the night nurses are responsible for changing out the catheters, but it was everyone's responsibility to see that they are covered for privacy. LVN B stated the risk of catheter not being covered would be not honoring resident privacy and dignity. During an interview on 03/07/2023 at 9:35 am the ADON stated that the facility's policy was that all indwelling catheter bags had a privacy covering for privacy and dignity. She stated the nurses and management staff were responsible for overseeing the privacy covering was present on all urinary catheter bags and that privacy bags were kept in the nurse closet. She stated the risk could be not honoring resident's privacy related to their need for a device. She stated she would in-service all staff on facility policy and procedure and put in place a monitoring system for ensuring all catheter bags are covered. During an interview on 03/08/2023 at 9:20 am the administrator stated that it was the facility's policy for all urinary catheter drainage bags were covered for privacy and dignity. She stated the nursing staff were responsible for ensuring the catheter drainage bags had a privacy cover. Administrator stated the risk could be not honoring resident's privacy and dignity. She stated the plan going forward would be to put in a monitoring system for checking all catheter drainage bags daily for privacy covers and provide in-services on the reason and need for privacy covers. Record review of facility policy and procedure titled admission Policy and Procedures undated indicated, .Section L. Privacy and Confidentiality,1. resident has the right to personal privacy and confidentiality of his/her personal and clinical records, a. personal privacy includes accommodations, medical treatments Record review of facility policy and procedure titled Catheter Insertion and Care, dated 04/2021 indicated, .catheter insertion procedure, 8. place catheter drainage bag in a cover to preserve dignity of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 2 of 7 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 675433 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Huntsville 1302 Nottingham St Huntsville, TX 77340 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights that include measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 24 residents (Resident #26) reviewed for accuracy of care plan. The facility failed to ensure the care plan accurately reflected Resident #26's status for oxygen use, goals, and interventions. This failure could place residents at risk for not receiving the appropriate care and services to maintain the highest level of well-being. Findings include: Record review of an admission record for Resident #26 dated 3/7/2023 indicated she admitted to the facility on [DATE] and was [AGE] years old with diagnoses of pneumonia, (lung infection), Alzheimer's disease, COPD, (Chronic Obstructive Pulmonary Disease), (lung disease), and chronic diastolic heart failure. Record review of the baseline care plan for Resident #26 dated 1/20/2023 indicated a health condition of oxygen therapy, the resident had been using oxygen at home. Record review of the comprehensive care plan dated 01/23/23 for resident # 26 there was no oxygen listed on the care plan. An observation on 03/07/23 at 10:45 AM revealed there was an oxygen concentrator at Resident #26's bedside with undated tubing, and an undated water bottle attached to the machine. A Nebulizer machine with undated tubing and a face mask, was on the bedside table. An observation on 03/08/23 at 09:41 AM revealed Resident # 26 was observed lying in bed with O2 at 5 liters per nasal canula. During an interview on 03/08/23 at 09:57 AM Resident #26 said there was nothing coming out of the oxygen (O2) tubing, so she kept turning the oxygen up. She said she had been on O2 for over twenty years, the oxygen was supposed to be on about 3 liters. Record review of an admission MDS assessment dated [DATE] for Resident #26 indicated she had moderate impairment in thinking with a BIMS score of 10. She had special treatments of oxygen therapy while a resident within the last 14 days. Record review of a Significant change MDS assessment dated [DATE] for Resident #26 indicated she had moderate impairment in thinking with a BIMS score of 10. She had special treatments of oxygen therapy while a resident within the last 14 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 3 of 7 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 675433 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Huntsville 1302 Nottingham St Huntsville, TX 77340 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 3/8/2023 at 10:15 AM, the Administrator said she was not aware that Resident #26 did not have oxygen listed in the care plan. She said the DON was responsible for overseeing that the care plans were correct. During an interview on 3/8/2023 at 11:35 AM, MDS said she had been employed at the facility since November 2021 and in the MDS position for 6 months. She said she was responsible for completing the care plans and updating them. She said it was a lot to keep up with completing them. During an interview on 3/8/2023 at 11:43 AM, the Regional MDS nurse said all the IDT team members were responsible for completing and updating care plans. He said the DON was the nurse who signed the MDS assessments. He said the MDS nurse was responsible for ensuring the CAAs that were triggered were care planned. He said a resident could have a possible change in condition if no orders or care plans were implemented for the residents. Record review of a facility policy titled Care Plans, Comprehensive Person-Centered with a revised dated of December 2016 indicated, .8. The comprehensive, person-centered care plan will: b. Describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 4 of 7 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 675433 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Huntsville 1302 Nottingham St Huntsville, TX 77340 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 residents received respiratory care consistent with professional standards of practice, the comprehensive person-centered care plan, the residents' goals, and preferences for 2 of 6 Residents (Resident #26 and #33) reviewed for respiratory care. Residents Affected - Few The facility failed to ensure Resident #26 and #33 had physician's order for the oxygen therapy. These deficient practices could place residents at risk of respiratory failure, respiratory infections, and complications. Findings include: 1. Record review of a face sheet, dated 01/20/23, indicated Resident #26 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included pneumonia (lung infection), chronic obstructive pulmonary disease, (lung disease), chronic atrial fib, (heart irregularity), shortness of breath, and CHF, (congested heart failure). Record review of the physician's order dated 03/07/23 indicated Resident #26 did not have an order to receive oxygen therapy. Record review of an admission MDS assessment dated [DATE] indicated Resident #26 had moderate impairment in thinking with a BIMS score of 10. She had special treatments of oxygen therapy while a resident within the last 14 days. Record review of the comprehensive care plan dated 01/23/23 for Resident # 26 there was no oxygen listed on the care plans. An observation on 03/07/23 at 10:45 AM revealed there was an oxygen concentrator at Resident #26's bedside with undated tubing, and an undated water bottle attached to the machine. A Nebulizer machine with undated tubing and a face mask, was on the bedside table. An observation on 03/08/23 at 09:41 AM revealed Resident # 26 was observed lying in bed with O2 at 5 liters per nasal canula. During an interview on 03/08/23 at 09:57 AM Resident #26 said there was nothing coming out of the oxygen (O2) tubing, so she kept turning the oxygen up. She said she had been on O2 for over twenty years, the oxygen was supposed to be on about 3 liters. During an interview on 03/08/23 at 10:13 AM LVN C said when she received an order for oxygen for a resident, she would immediately type the order in the electronic health record. She said when she received an admission from the hospital, she would send the admission orders from the hospital to the Doctor to see if he wanted to proceed with the orders or make any changes. If the physician wanted to proceed with the orders, she would put them into the charting system. She said she did not know how the order for oxygen was missed for Resident #26. During an interview on 3/8/2023 at 10:15 AM, the Administrator said she was not aware that Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 5 of 7 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 675433 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Huntsville 1302 Nottingham St Huntsville, TX 77340 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #26 did not have an order for oxygen on the MAR or in the care plan. She said the nurses were responsible for putting in orders and the DON was responsible for overseeing that the orders and care plans were correct. During an interview on 3/8/2023 at 11:35 AM, the MDS Nurse said she had been employed at the facility since November 2021 and in the MDS position for 6 months. She said she should have caught that there was no order for oxygen for Resident #26. She said she was responsible for completing the care plans and updating them. She said it was a lot to keep up with updating and completing them. During an interview on 3/8/2023 at 11:43 AM, the Regional MDS Nurse said all the IDT team members were responsible for completing and updating care plans. He said the DON was the nurse who signed the MDS assessments. He said the MDS nurse was responsible for ensuring the CAAs that were triggered were care planned. He said a resident could have a possible change in condition if no orders or care plans were implemented for the residents. He said he provided training to the MDS nurse for the appropriate assessments. 2. Record review of a face sheet dated 3/8/23, Resident 33 was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses of cerebral infarction (stroke), anemia (low iron levels in blood), vitamin d deficiency, chronic obstructive pulmonary disease (trouble breathing), and dysphagia (trouble swallowing). Record review of an admission MDS dated [DATE], revealed Resident #33 had a BIMS score of 12, indicating a mild cognitive impairment. MDS section O also indicated that Resident # 33 had received oxygen therapy in the previous 14 days. Record review of an order summary report dated 3/8/23 revealed that Resident #33 did not have a physician's order in his record to receive oxygen therapy. Record review of a care plan dated 3/6/23, revealed Resident #33 received oxygen therapy related to Ineffective gas exchange. An observation on 3/8/23 at 7:30am revealed Resident #33 lying in bed with oxygen on at 2 Liters per minute by nasal cannula. During an interview on 3/8/23 at 7:35am LVN C said that Resident #33 only uses oxygen as needed and last night's nurse must have gotten a low oxygen saturation and put it on him. She said that he only uses it as needed if he gets short of breath or has a low oxygen saturation. Record review of a facility policy titled Oxygen Therapy with an effective dated of 4/2021 indicated, .It is the policy of this community to ensure all oxygen administration is conducted in a safe manner. 1. Verify there is an order for Oxygen administration to include: a. Method of delivery, b. flow rate, c. oxygen saturation parameters if indicated .9. Change the reservoir, Oxygen Cannula and tubing every 7 days. Record review of a facility policy titled Physician Services with a revised dated of April 2013 indicated, .4. Physician orders and progress notes shall be maintained in accordance with current OBRA regulation and facility . Record review of a facility policy titled Care Plans, Comprehensive Person-Centered with a revised (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 6 of 7 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 675433 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Huntsville 1302 Nottingham St Huntsville, TX 77340 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 0695 Level of Harm - Minimal harm or potential for actual harm dated of December 2016 indicated, .8. The comprehensive, person-centered care plan will: b. Describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 7 of 7