Inspection·August 1, 2024

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. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for foods safety for two of two staff reviewed for food safety and sanitation. The facility failed to ensure two staff, [NAME] B and [NAME] C wore beard restraints . This failure placed residents at risk of foodborne illness. Findings included: Observation on 07/30/2024 at 9:20 AM during the initial kitchen tour, [NAME] B had a beard and was not wearing a beard restraint. Observation and interview on 07/30/2024 at 12:05 PM during meal service in the kitchen, [NAME] B and [NAME] C had beards and were not wearing beard restraints. [NAME] B stated the Dietary Manager was on sick leave and was not available for an interview. He stated he was not aware of any beard restraints in the kitchen for staff to wear. In an interview on 07/31/2024 at 10:00 AM the ADM stated the men in the kitchen did not have beards until this month. She stated the kitchen did not have beard covers until it was brought to her attention. She stated the staff had been in-serviced on wearing beard restraints, and the staff were wearing beard restraints. She stated the facility had ordered beard restraints. She further stated she did not think their policy said anything about covering beards. In an interview on 07/31/2024 at 2:08 PM [NAME] B stated hair could fall in food if he was not wearing a beard restraint. He stated hair could contaminate the food and it could make the residents angry to see hair in their food. He further stated he had been told about the beard restraint policy, but they didn't have them available to wear. In an interview on 07/31/2024 at 2:12 PM [NAME] C stated he had never been told about a beard restraint policy and there had not been any beard restraints available. He further stated the potential risk to the resident was hair in their food and it could contaminate the food. In an interview on 07/31/2024 at 2:22 PM the interim DM stated she had worked at a sister facility for nine years and would assist at the facility when requested. She stated she had conducted an in-service on hair and beard restraints that morning. She stated staff were required to wear hair and beard restraints. She further stated hair could fall in the food and cause a food borne illness. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 675445 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 08/01/2024 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)