Inspection·January 9, 2024

F 0584 There were no other invoices from the plumbing company that pertained to the hot water delivery system. Level of Harm - Minimal harm or potential for actual harm During an interview on 01/09/24 at 10:05 AM, Resident #1 stated the water in his bathroom was not heating up, and he could not wash his hands and face, shave, or rinse out his coffee cup. Resident #1 stated he had talked to the ADM about the problem and had met with the MAINT about it, as well. Resident #1 stated the MAINT did not have any idea how to fix the problem. Resident #1 stated it had been going on for more than one month. Resident #1 stated no one had offered him a room change, but he preferred not to move rooms, as he had a lot of belongings and had his room set up the way he wanted it. Resident #1 stated not having hot water in his room was a big deal to him. He stated if the facility were fixing it, that would be one thing, but they had done nothing to try to figure out the problem. He stated they had a meeting in the ADM's office, and she showed him an invoice for an inline water pump they had ordered, but the water pump was not what they needed. Resident #1 stated he had been educated in homebuilding, and he knew hot water did not move by a pump. He stated he was not sure exactly what the pump was for, but it would not have been to restore hot water to his room. Resident #41 stated there were other sinks in the building that had hot water, but he chose not to seek those out and use them. Residents Affected - Few Observation on 01/09/24 from 10:20 AM to 10:30 AM revealed the sink faucet in Resident #1's room ran cold water for ten minutes without the water ever warming up at all. There was a bottle of alcohol-based hand rub on the television console just outside of his bathroom. During an interview on 01/09/24 at 02:58 PM, the MAINT stated he was not sure why the hot water was not going to Resident #1's room. He stated he had replaced the pumps on the water heaters and followed the pipe up into the roof. He stated nothing was broken or missing along the pipes, but the water was just not getting to certain spots. The MAINT stated there were issues on the 400 hall, especially in Resident #1's room. The MAINT stated he was trying to figure out how the water would travel, but he was by no means a plumber. He stated the plumbing company had been to the building many times recently and had not offered a solution. The MAINT stated they told him once when they came out that it was possible Resident #1's room was not even plumbed for hot water, but the MAINT had not made time to open up the wall and check. The MAINT stated the plumber had been there, and all the water pumps were working, and he did not know what was wrong. The MAINT stated he had been in the ceilings trying to get the hot water to move. During an interview on 01/09/24 at 03:10 PM, the office manager for the plumbing company stated the company had been to the building many times in recent months, but most of the visits were for drains not draining. She stated the pump mentioned in the 11/08/23 invoice was for pumping sewage out of the building and clearing pipes that drain out. She stated this pump was also known as an inline water pump, and it had nothing to do with the hot water delivery system in the facility. She stated the only work that had been done on the hot water delivery system was a replacement water heater for 100 and 200 halls. She stated nothing had been done for the hot water delivery on 400 hall, and there was nothing in any of the notes about a specific residents room. She stated if the facility had requested, they work on the resident room, that would have been in the plumber's documentation system. During an interview on 01/09/24 at 03:41 PM, the ADM stated she had been aware of the lack of hot water in Resident #1's room, but that had been fixed. She stated she believed it had been fixed, because the MAINT had told her he fixed it. She stated there was a pump ordered, and she thought the MAINT had everything he needed. She stated the plumbers had been to the facility several times. She stated she was shocked to learn the plumbers had not worked on the hot water in Resident #1's room and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675445 If continuation sheet Page 2 of 3 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 675445 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Flatonia Healthcare Center 624 N Converse St Flatonia, TX 78941 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 that the pump they had ordered was not related in any way. The ADM stated she monitored that maintenance requests were fulfilled by speaking with the MAINT during morning meeting and trusting that he completed the tasks when he said he did. She stated the potential negative impact of not having hot water in a resident's room was the resident might not be hygienic. Policy on hot water, maintenance requests, and safe/clean/comfortable/homelike environment was requested from the ADM on 01/09/24 at 04:05 PM and not provided by the time of exit. Event ID: Facility ID: 675445 If continuation sheet Page 3 of 3