Health inspection·May 7, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm During an interview on 05/07/2025 at 9:30 am the Administrator said that all staff should be maintaining resident dignity, and it was an ongoing effort for all staff to ensure each day resident rights were maintained. She said when a resident required assistance with meals, the staff assisting should be seated to not make the resident uncomfortable or intimidated. She said she expected each employee to treat all residents with respect and dignity. Residents Affected - Few Record review of a skills checklist dated 4/03/25 revealed the Activity Director had been trained on feeding residents. Record review of a facility policy titled Resident Rights dated December 2016 indicated, .Employees shall treat all residents with kindness, respect and dignity . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 2 of 14 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 05/07/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review the facility failed to provide a safe, sanitary, comfortable and homelike environment for residents for 1 of 8 resident rooms (Resident #45's room) observed for resident environment. The facility failed to ensure the personal fan in Resident #45's room was clean. There was a black substance on the fan blades and outer covering on 5/05/2025 and 05/06/2025. This failure could place residents at risk for an unsafe and unsanitary environment. The Findings included: Record review of a facility face sheet dated 05/06/2025 indicated Resident #45 was a [AGE] year-old male that admitted to the facility on [DATE] with diagnoses of heart failure (the heart muscle doesn't pump blood as well as it should) and end stage renal disease (a permanent condition where the kidneys can no longer filter waste from the blood and require a kidney transplant or dialysis to survive). Record review of a quarterly MDS assessment dated [DATE] indicated Resident #45 had a BIMS score of 14 indicating no impaired cognition. During an observation on 5/05/2025 at 1:12 PM and 05/06/2025 1:15 PM of Resident #45's room a box fan was sitting on a table in the resident's room. The box fan had a thick layer of black dust noted to the front and back of the outer covering and on fan blades. During an interview on 5/6/2025 at 1:15 PM, Resident #45 said the fan was brought to him by a family member. He stated he did not know who was responsible for cleaning the fan, but he would appreciate if it was cleaned. The resident said he was not able to clean the fan himself. He said he would not want to use the fan because it was so dusty. During an interview on 5/7/2025 at 8:34 AM Housekeeper D said she had been employed at the facility for 3 months and was responsible for cleaning resident rooms and common areas. She said she was not sure who was responsible for cleaning resident's personal fans. She stated she would dust any personal items that appeared dirty or dusty During an interview on 5/7/2025 at 8:40 AM with the Administrator, she said she was responsible for supervising the housekeeping staff. She said the family was responsible for cleaning personal fans. She stated she was not aware that Resident #45 had a personal fan in his room, and it was brought to him recently . She stated she removed the fan from the room on 5/6/2025 due to the amount of dust and dirt. She said the fan was to be cleaned or replaced. She said staff is responsible for recognizing if a resident's room or items in a resident's room need cleaning. She said all staff is responsible for a safe and clean environment . Record review of a policy titled Cleaning and Disinfecting Residents' Room effective 10/01/2024 stated Environmental surfaces will be disinfected (or cleaned) on a regular basis (e.g., daily, three times per week) and when surfaces are visibly soiled. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 3 of 14 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 05/07/2025 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 0584 . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 4 of 14 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 05/07/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 the necessary treatment and services, in accordance with comprehensive assessment and professional standards of practice, to prevent development of pressure injuries was provided for 1 of 6 residents (Resident #3) reviewed for pressure injuries. Residents Affected - Few The facility failed to ensure Resident #3's wheelchair had a pressure reduction cushion on 5/05/2025. This failure could place residents at risk for new development or worsening of existing pressure injuries, pain, and decreased quality of life. Findings included: Record review of Resident # 3's facility face sheet revealed Resident #3 was a [AGE] year-old male and admitted on [DATE] with diagnosis of heart failure. Record review of Resident #3's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 3 indicating severely impaired cognition, required maximal assistance with positioning and was at risk for developing pressure ulcers. Record review of Resident #3's comprehensive care plan dated 11/08/2024 revealed Resident #3 had a potential for pressure injury related to immobility and to follow facility policies and protocols for the prevention and treatment of skin breakdown. Record review of Resident #3's consolidated orders dated 5/06/2025 did not indicate an order for a wheelchair cushion. During three observations on 05/05/25 from 10:00 am to 2:28 pm Resident # 3 was sitting up in his wheelchair in his room. The wheelchair did not have a cushion for pressure reduction. Resident was unable to interview regarding a wheelchair cushion. During an observation and interview on 05/05/25 at 3:15 pm while Resident #3 received incontinent care and said his butt was sore. During an interview on 05/06/2025 at 10:32 AM CNA A said that residents that were at risk for skin breakdown should have a wheelchair cushion. She said she was not sure why Resident #3 did not have one yesterday (05/05/25) and did not notice there wasn't one in his wheelchair until she placed him in the bed. She said by not having a cushion in his wheelchair it could increase his risk of pressure ulcers. During an interview on 05/06/2025 at 10:37 am RN C said that the CNA was responsible for making sure the residents had a pressure reduction cushion in their wheelchair if they were at risk for skin breakdown. He said Resident #3 was at risk for skin breakdown and should have a cushion in his wheelchair. He said by not having a pressure reduction cushion the resident could develop skin breakdown. During an interview on 05/07/2025 at 9:00 am the DON said the CNAs assisting the residents should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 5 of 14 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 05/07/2025 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 0686 Level of Harm - Minimal harm or potential for actual harm be ensuring pressure reduction cushions were present in the resident's wheelchair when they were up. She said all direct care staff were trained on hire and annually and she would ensure each resident at risk had a cushion in place. She said that the resident's risk for pressure ulcers was determined through assessments and if the resident was at risk, then there should be a pressure reduction cushion present to prevent skin breakdown. Residents Affected - Few During an interview on 05/07/2025 at 9:30 am the Administrator said the nursing staff were responsible for ensuring residents that were at risk for skin breakdown had the appropriate pressure reduction cushion in their wheelchair. She said staff were trained on the use of pressure reduction techniques and devices and expected the procedure was followed to prevent pressure injuries. Record review of a facility policy titled Skin Management: Prevention and Treatment of Wounds dated 11/01/2019 indicated, .the purpose of this procedure is to prevent skin breakdown. 2. Prevention: residents at risk for developing pressure injuries will have pressure reduction cushion devices in their wheelchair . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 6 of 14 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 05/07/2025 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents, for 3 of 8 residents (Resident #3, #10, and #40) reviewed for accidents and supervision. 1. The facility failed to ensure CNA A and CNA B used a gait belt to transfer Resident #3 from the wheelchair to bed on 05/05/2025. 2. The facility failed to develop and implement a policy and procedure to properly handle the care of mechanical lift slings including interventions to inspect the mechanical lift sling for signs of damage before each use and remove damaged slings from service for Residents #10 and #40. These deficient practices could place residents at risk of falls and injuries during transfers. Findings included: 1.Record review of Resident # 3's facility face sheet revealed Resident #3 was a [AGE] year-old male and admitted on [DATE] with diagnosis of heart failure. Record review of Resident #3's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 3 indicating severely impaired cognition and required maximal assistance with transfers. Record review of Resident #3's comprehensive care plan dated 7/17/2024 revealed Resident #3 had limited physical mobility related to unsteady gait, generalized weakness and the resident required extensive assistance by staff for locomotion using gait belt. During an observation on 05/05/2025 at 3:23 PM CNA A and CNA B were observed transferring Resident #3 from his wheelchair to bed. The staff did not apply a gait belt and placed their arms under the resident's arms and manually lifted him and placed him in the bed. During an interview on 05/06/2025 at 10:36 AM CNA A said that for residents that need help transferring the staff should use a gait belt or mechanical lift. She said when she and CNA B transferred Resident #3 on 5/05/2025 they should have placed a gait belt and not manually lifted him under his arms. She said by transferring manually accidents could happen. During an interview on 05/06/2025 at 10:39 am CNA B said that he had been trained on using a gait belt for transfers and should have used a gait belt to transfer Resident #3 on 5/05/2025. He said by not transferring properly a resident could get injured. During an interview on 05/07/2025 at 8:30 am the Therapy Director said that residents were screened and evaluated to determine safest transfer ability and for residents that require assistance a gait belt should be used to prevent falls and injuries. She said she assisted with the staff training and would retrain direct care staff on appropriate transfer techniques. During an interview on 05/07/2025 at 9:00 am the DON said she was responsible for ensuring the direct care staff were properly transferring residents. She said the direct care staff must complete a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 7 of 14 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 05/07/2025 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some competency training on hire and annually and that training included use of gait belts for manual transfers. She said the residents were evaluated by therapy to determine the transfer status and therapy had also provided training to staff on the use of gait belts. She said that residents that were transferred improperly could sustain injuries. During an interview on 05/07/2025 at 9:30 am the Administrator said the DON and ADON were responsible for the oversight of direct care staff and ensuring the residents were transferred properly. She said the therapy department along with the DON complete trainings on hire, annually and throughout the year to ensure the staff knew proper technique and use of gait belts. She said if residents were not transferred properly injuries could occur and she expected all direct care staff to follow the facility's policy for transfers. Record review of nurse aide competency training for gait belt revealed CNA A was trained on 4/16/25. Record review of nurse aide competency training for gait belt revealed CNA B was trained on 02/18/25. 2. Record review of a facility face sheet dated 5/6/25 for Resident #10 indicated she was a [AGE] year-old female admitted to the facility on [DATE] and most recently readmitted [DATE] with diagnosis of unspecified sequalae of cerebral infarction (complications of a stroke). Record review of a Comprehensive MDS assessment dated [DATE] for Resident #10 indicated a BIMS score of 6, which indicated she had severe cognitive impairment. She was dependent for transfers. Record review of a comprehensive care plan dated 2/3/21 for Resident #10 indicated she had a self-care performance deficit related to CVA with hemiplegia (stroke with paralysis on one side of the body). She had an intervention which read: .the resident requires assist of [mechanical] lift for transfers with assist of 2 to assist . Record review of a facility face sheet dated 5/6/25 for Resident #40 indicated he was a [AGE] year-old male admitted to the facility on [DATE] with diagnosis of cerebral infarction (stroke). Record review of a Comprehensive MDS assessment dated [DATE] for Resident #40 indicated he had a BIMS score of 7, which indicated he had severe cognitive impairment. He was dependent with transfers. Record review of a comprehensive care plan revised on 5/2/25 for Resident #40 indicated he had an ADL self-care performance deficit related to disease processes and right sided hemiplegia. He had an intervention that read: .TRANSFER: The resident requires total assist assistance 2 staff with [mechanical] lift to move between surfaces and as necessary . During an observation on 5/5/25 at 12:00 pm Resident #10 was observed in the dining room in a wheelchair with a mechanical sling underneath her with sling loops that were faded in color. Resident #40 was also observed in the dining room in a wheelchair with a mechanical lift sling underneath him with sling loops that were observed to be faded in color. During an interview on 5/6/25 at 1:51 pm Laundry staff said he does not use bleach on the mechanical lift slings. He said he dried them in the dryer on about 36 (which he said was high heat so they would dry faster). He said they used to hang to dry, but Administrator had told him to stop doing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 8 of 14 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 05/07/2025 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that and dry them in the dryer because they were not fully drying before they needed to use them again. He was unable to answer questions regarding inspection of lift slings. During an interview on 5/7/25 at 8:30 am LVN E said faded colors on sling loops indicated signs of wear and tear. She said if slings were worn and still used to transfer residents, they could break causing a fall and possible injury. She said they (CNAs and Nurses) usually check for signs of wear and tear before using them to transfer a resident. During an interview on 5/7/25 at 8:40 am DON said laundry staff check for signs of wear and tear before sending them out for use and floor staff should also be checking them before using them for transfers. She said residents could be injured if a sling broke. She said she expected laundry staff to air dry the lift slings. She said she would be providing education to ensure that happens going forward. During an interview on 5/7/25 at 9:22 am Administrator said CNAs were to check the slings before use. She said she would randomly check the slings as well. She said slings are supposed to be air dried and laundry staff were told to hang them to air dry. She said Laundry did not understand her when she had told him to stop putting them in the closet before they were completely dry. She said he took it to mean that he should dry them in the dryer. She said she would be providing further education. She said residents could be at risk for injury if slings with wear and tear were used to transfer residents. Record review of guidance titled Full Body Slings: Instructions for Use retrieved from www.medline.com on 5/7/25 read .Always inspect slings prior to each use. Signs of rips, tears, or frays indicate sling wear which is unsafe and could result in injury. Signs of color fading, bleached areas, or permanent wrinkles on the straps indicate improper laundering which is unsafe and could result in injury. Any slings with signs of wear or improper laundering should be immediately removed from use . Record review of a facility policy titled Safe Lifting and Movement of Residents dated July 2017 indicated, .this facility uses appropriate techniques and devices to lift and move residents. 4. Staff responsible for direct resident care will be trained in the use of manual (gait/transfer belts) and manual lifting devices . Record review of a facility policy titled Safe Lifting and Movement of Resident dated July 2017 read: .1. Resident safety, dignity, comfort and medical condition will be incorporated into goals and decisions regarding the safe lifting and moving of residents . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 9 of 14 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 05/07/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 in 1 of 1 kitchen reviewed for kitchen sanitation. 1. The facility failed to store and label foods in accordance with professional standards. 2. The facility failed to ensure staff wore hair coverings appropriately while preparing and serving food. These failures could place residents who ate the food from the kitchen at risk for food-borne illness and/or transmission-based infections. Findings include: During an observation on 5/5/25 between 10:00 am and 10:30 am a ziplock bag was observed in the kitchen refrigerator with 4 boiled eggs that was not labeled or dated. During an observation on 5/5/25 at 12:00 pm Tray Aide was observed placing food onto plates to be served with hair net not covering all hair, it only covered the bun of her hair. During an observation and interview on 5/6/25 at 10:50 am Tray Aide was observed near staff that was pureeing foods in the kitchen with a hair net only covering the bun of her hair. She said, I guess I didn't realize it had moved around. She said, I normally wear 2 to make sure all my hair is covered. She then went and got another hair net to cover all hair appropriately. During an interview on 5/7/25 at 8:40 am DON said if kitchen staff do not wear hair nets appropriately it could allow hair to get into food and it could also be an infection control issue. She said if foods were not properly dated and labeled, that residents could be potentially at risk of food related illnesses if they were to eat foods past expiration dates. She said she expected kitchen staff to wear hair nets appropriately and properly label and date foods. She said she would provide in-services to kitchen staff. During an interview on 5/7/25 at 10:24 am DM said she expected her staff to appropriately label and date foods once they were opened and the boiled eggs should not have been left in the refrigerator unlabeled and undated as it could cause residents to be at risk for food-borne illnesses. She said she expects her staff to appropriately wear hair nets to prevent hair from getting into foods. She said that could cause a reaction to residents if staff wear certain chemicals in their hair and the hair gets in the food. She said going forward she will be doing in-services with the staff and checking to ensure compliance. Record review of a facility policy titled Sanitation - Personal Hygiene dated 10/2023 read: .Nutrition Services personnel must meet acceptable standards of personal hygiene, appearance and behavior: .c. Hair clean and worn in a manner that it can be completely covered by hair restraint. Hair nets or other hair restraint to be worn by employees at all times in the kitchen . and .Hair nets or caps and/or beard restraints must be worn to keep hair from contacting exposed food, clean equipment, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 10 of 14 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 05/07/2025 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 0812 utensils and linens . Level of Harm - Minimal harm or potential for actual harm Record review of https://www.fda.gov/media/164194/download, accessed 05/07/2025 indicated .Labeling 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers. (B) Label information shall include: (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement; (2) If made from two or more ingredients, a list of ingredients and sub ingredients in descending order of predominance by weight, including a declaration of artificial colors, artificial flavors and chemical preservatives, if contained in the FOOD; (3) An accurate declaration of the net quantity of contents; (4) The name and place of business of the manufacturer, [NAME], or distributor; and (5) The name of the FOOD source for each MAJOR FOOD ALLERGEN contained in the FOOD unless the FOOD source is already part of the common or usual name of the respective ingredient. Residents Affected - Some Policy for food storage and labeling in kitchen was requested on 5/7/25 at 10:20 am, none was provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 11 of 14 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 05/07/2025 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 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 reviews, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 8 residents (Residents #3 and #21) and 2 of 8 staff (CNA A and CNA B) reviewed for infection control. Residents Affected - Few 1. The facility failed to ensure CNA A followed infection control measures when providing incontinent care to Resident #3 on 05/05/2025. 2. The facility failed to ensure CNA A and CNA B followed enhanced barrier precautions when providing care to Resident #21 on 5/05/2025. These failures could place residents at risk for cross contamination and infection. Findings included: 1. Record review of Resident # 3's facility face sheet revealed Resident #3 was a [AGE] year-old male and admitted on [DATE] with diagnosis of heart failure. Record review of Resident #3's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 3 indicating severely impaired cognition, required maximal assistance with toileting and was incontinent of bowel and bladder. Record review of Resident #3's comprehensive care plan dated 11/08/2024 revealed Resident #3 was incontinent of bowel and bladder and dependent on staff for care and monitor for signs and symptoms of infection and had an ADL self-care performance deficit and required extensive assistance from staff for hygiene. During an observation on 5/05/25 at 2:33 pm CNA A provided Resident # 3 incontinent care. She opened the soiled brief and cleaned the front with wipes in a forward to backwards motion. Resident #3 turned to his left side and CNA A removed stool from his peri area. Then using soiled gloves, CNA A entered Resident #3's side table for skin barrier cream. Using the same soiled gloves, CNA A applied barrier cream to Resident #3's buttocks. She then applied a clean brief with the same soiled gloves. Gloves were removed and no hand hygiene was performed before leaving the room. During an interview on 5/05/25 at 2:40 pm CNA A said that she had been trained on incontinent care and should have had all her supplies prepared before beginning incontinent care. She said she should have removed her soiled gloves and performed hand hygiene before touching items in the drawer and any time she went from dirty to clean. She said she should have washed her hands before leaving the room and by not following infection control measures she could cause cross contamination. 2. Record review of Resident #21's facility face sheet revealed Resident #21 was a [AGE] year-old male and admitted on [DATE] with diagnosis of cerebral infarction (stroke). Record review of Resident #21's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 99 indicating assessment could not be completed and a SAMS was completed and indicated moderately impaired cognition for daily decision making. Resident #21 required an indwelling catheter, was dependent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 12 of 14 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 05/07/2025 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 0880 on staff for all ADLs, required a feeding tube and had a pressure ulcer. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #21's comprehensive care plan dated 9/12/2024 revealed Resident #21 was on EBP, and staff would maintain EBP when performing care. Residents Affected - Few During an observation on 5/05/2025 at 2:46 pm CNA A and CNA B were present in Resident #21's room to reposition and check and change brief if needed. There was a EBP sign above Resident #21's bed and there were gowns present on the back of the closet door. CNA A and CNA B repositioned Resident #21 on his left side and propped him with pillows. CNA A opened Resident #21's brief to check if he was soiled and CNA B adjusted Resident #21's catheter bag. CNA A and CNA B only wore gloves and no gown per the EBP. During an interview on 5/05/2025 at 2:57 pm CNA A said that she saw the EBP sign, and that Resident #21 required a gown and gloves for care because of his catheter, wound and feeding tube. She said she blanked out and was nervous and forgot. She said by not following EBP cross contamination could occur. During an interview on 5/05/2025 at 3:00 pm CNA B said he had been trained on EBP and saw the sign, but it did not register, and he should have put on a gown and gloves before providing Resident #21 care. He said by not following the precautions infections could spread. During an interview on 5/06/2025 at 1:45 pm the ADON said she was the infection prevention nurse and all staff had been trained on infection control regarding incontinent care and EBP. She said she expected all staff to follow the facility's infection control policies and procedures and by not doing so could cause the spread of infections. During an interview on 05/07/2025 at 9:00 am the DON said that herself and the ADON were responsible for the infection control program in the facility. She said that all staff were trained on hire, annually and throughout the year on infection control measures with hand hygiene, incontinent care and EBP. She said she and the ADON did random check offs as well to ensure the staff were following the policy. She said for residents that require EBP there was a sign above the bed along with PPE on the back of the door for staff to know when precautions were needed. She said that staff not following infection control measures could cause the spread of infections. During an interview on 05/07/2025 at 9:30 am the Administrator said that the infection control program was overseen by the DON and ADON. She said they complete the trainings and competencies on hire, annually and as needed throughout the year. She said training consisted of proper hand hygiene, incontinent care measures and following EBP. She said when staff don't follow the infection control program the risk of infections increases. She said she expected all staff to follow the infection control policies and procedures for incontinent care and EBP. Record review of Competency Training dated 02/14/2025 revealed CNA A was trained on infection control measures. Record review of Competency Training dated 01/23/2025 revealed CNA B was trained on infection control measures. Record review of a facility policy titled Perineal Care dated 10/01/21 indicated, .to provide cleanliness and comfort to the resident, 11. remove gloves and wash and dry hands, 12. reposition, 13. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 13 of 14 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 05/07/2025 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 0880 place the call light, 15. wash and dry hands . Level of Harm - Minimal harm or potential for actual harm Record review of a facility policy titled Enhanced Barrier Precautions dated 04/01/2024 indicated, .enhanced barrier precautions are a CDC guidance to reduce the transmission of multi-drug resistant organisms. EBP require team members to wear a gown and gloves while performing high contact care activities . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675433 If continuation sheet Page 14 of 14