Inspection·November 18, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring and administering of all drugs to meet the needs of each resident for one resident (Resident #1) of four residents reviewed for medication administration in that: Resident #1 was not administered her Clonazepam 0.5 MG (anti-anxiety medication-- is a benzodiazepine medication used to treat panic disorders, certain seizure disorders, and movement disorders) for 3 days from 09/23/2025 to 09/25/2025 due to the facility not obtaining medication from the pharmacy. This failure could place residents on anti-anxiety medication at risk for increased anxiety and depression and change in ADLs.Findings included:Review of Resident #1's undated face sheet reflected a [AGE] year-old female who was admitted on [DATE] with the following dx. Major Depressive Disorder, recurrent, moderate (a mood disorder that causes a persistent feeling of sadness and loss on interest), Panic Disorder [episodic paroxysmal anxiety] (a panic disorder is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause), Generalized Anxiety Disorder (a condition characterized by excessive or unrealistic anxiety about two or more aspect of life), Bipolar Disorder, recurrent episode mixed (a condition where a person experiences episodes that contain both manic and depressive symptoms at the same time and that these episodes happen repeatedly).Review of Resident #1's quarterly minimum data set (MDS) assessment dated [DATE] reflected a brief interview for mental status (BIMS) score of 15, indicating no cognitive impairment. Section I, Active Diagnoses reflected: Anxiety Disorder, Depression, Bipolar Disorder. Section N, Medications reflected antidepressant and Anticonvulsant medications were given in the last 7 days. Antianxiety and antipsychotic were not checked.Review of Resident #1's care plan initiated 12/24/2024 reflected Resident #1 required staff assistance for meeting emotional, intellectual, physical and social needs related to physical limitations. Care plan initiated 09/25/2024 reflected, resident uses anti-anxiety medications Clonazepam and Hydroxyzine related to Anxiety with intervention to administer ANTI-ANXIETY medications as ordered by physician. Monitor for side effects and effectiveness Q-SHIFT.Review of complaint file with HHSC dated 10/02/2025 reflected: From 09/19/2025 to 09/24/2025, The Resident [Resident #1] was without her CLONAZEPAM, for anxiety, because the facility was unable to get her medication from the pharmacy.Review of Resident #1's physician orders reflected an order dated 09/22/2025 for Clonazepam Tablet 0.5 MG Give 1 tablet by mouth at bedtime related to BIPOLAR DISORDER, CURRENT EPISODE MIXED, MILD, to start 09/23/2025.Review of Resident #1's Narcotic count sheet reflected 30 pills of Clonazepam Tablet 0.5 MG was delivered for Resident #1 on 08/18/2025, started taking on 8/19/2025 and was completed on 09/22/2025, zeroing out. It was also revealed that Resident #1's next Clonazepam Tablet 0.5 MG pills were delivered on 09/26/2025.Review of Resident #1's MAR for the month of September reflected:Clonazepam Tablet 0.5 MG Give 1 tablet by mouth at bedtime related to BIPOLAR DISORDER, CURRENT EPISODE MIXED, MILD and for the dates of 09/23/205, 09/24/2025 and 09/25/2025 signed by RN A, it indicated the number 6. The meaning for the number #6 on the MAR reflected: other/see progress notes.Review of Resident #1's progress notes dated 09/23/2025 at 10:54 pm, 09/24/2025 at 10:46 pm and 09/26/2025 at 00:02 am written by RN A reflected: Clonazepam Tablet 0.5 MG Give 1 tablet by mouth at bedtime related to BIPOLAR DISORDER, CURRENT EPISODE MIXED,on order.Review of Resident #1's progress notes dated 09/25/2025 at 3:19 pm written by LVN B reflected: Spoke with [XXX] at Pharmacy, to send Clonazepam today.Review of Resident MAR indicated behavior monitoring dated 09/24/2025 which reflected : Behavior monitoring Anti- Psychotic Q Shift: 0.None 1.Afraid 2.Agitated 3.Angry 4.Anxious 5.Mood change 6.Noisy 7.Restless 8. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675445 If continuation sheet Page 2 of 8 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 11/18/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Withdrawn/crying 9.Crying 10.Combative 11. every shift related to BIPOLAR DISORDER, CURRENT EPISODE MIXED, MILD. There were no monitoring done on 09/24/2025 and the nurses indicated 0 on 09/25/2025 meaning no behavior noted. Review of Resident #1's progress notes from 09/22/2025 through 09/26/2025 did not reflect staff notifying Resident ‘s NP/MD for Clonazepam Tablet 0.5 MG.During an interview on 10/13/2025 at 10:31 am Resident #1 stated the staff usually do not give her medication and would say she refused her medication.Observation on 10/13/2025 at 1:55 pm reflected there were 13 pills of Clonazepam Tablet 0.5 MG left on the blister packet of pills for Resident #1 which was delivered on 09/26/2025.During an interview on 10/13/2025 at 2:25 pm, LVN B stated she called the local pharmacy on 09/25/2025 regarding Resident #1's Clonazepam Tablet 0.5 MG to be delivered. LVN B stated she was not sure if Resident #1 was out of Clonazepam Tablet 0.5 MG or if she was low on her Clonazepam Tablet 0.5 MG. LVN B stated the medication aides would know if Resident #1 was out of Clonazepam Tablet 0.5 MG. LVN B stated the process for reordering a narcotic medication was to call the pharmacy to see if a new prescription was needed or whatever, if new prescription was needed, contact the physician. LVN B stated all narcs needed a new prescription from the MD. LVN B stated an authorized agent could call the pharmacy for resident's narcotics and the DON was the only authorized agent in the facility. LVN B stated she did not notify the DON of Resident #1 needing Clonazepam Tablet 0.5 MG.During an interview on 10/13/2025 at 2:50 pm the DON stated Resident #1 did not get the Clonazepam Tablet 0.5 MG on 09/23, 09/24 and 09/25/2025, because the pharmacy did not send the medication. The DON stated Resident #1's Clonazepam Tablet 0.5 MG decreased from BID to once a day at night on 09/22/2025. The DON stated she was not made aware that Resident #1's Clonazepam Tablet 0.5 MG was not available or not delivered by the pharmacy. The DON stated she should have been made aware because she was the only agent in the facility to call the pharmacy for narcotic medication reordering. The DON stated Resident #1 not taking her Clonazepam Tablet 0.5 MG could make her more depressed, mood will be different and will have increased anxiety. The DON stated if she had known, she would have done a medication error report and trained her nurses. The DON stated nighttime medications were given by the night shift nurses.During an interview on 10/14/2025 at 08:29 am, RN A stated she worked with Resident #1 on 09/23/2025 through 09/25/2025. RN A stated Resident #1 had ordered Clonazepam Tablet 0.5 MG to be given at bedtime, but the medication was not available for those 3 days. RN A stated she documented in Resident 1's progress notes that Clonazepam Tablet 0.5 MG was on order. RN A stated, that was her mistake; she should have called the pharmacy to find out and then call the DON to call the medication in to the pharmacy. RN A stated she did not notify the DON that the medication was not available, and she did not notify the NP/MD. RN A stated Resident #1 had other medications for sleep and anxiety, so she was not anxious during those 3 days. Review of facility's policy dated 10/01/2025 titled Ordering and Receiving Medications from PharmacyOrdering and Receiving Non-Controlled Medications reflected: PolicyAll medication orders will be faxed to the pharmacy or submitted via EHR using the ‘MOST ORIGINAL order. The most original order may be a telephone order, new admission physician order sheet or an interim physician order sheet. All medications are ordered and dispensed in the most efficient and cost-effective manner. The supply quantity and packaging will be in accordance with pharmacy policy unless otherwise specified by physician order. The facility maintains accurate records of medication order and receipt. It will be the responsibility of the facility to re-order the medication to avoid any lapse in therapy. Direction Change order for existing residentsA. The Most Original order must be faxed to the pharmacy along with any relevant discontinuation order.B. Indicate the time that the doses are due on the Physician's Order Sheet. Medications will be sent to meet the next dose time requirements.3. ReadmissionA. The Most Original order must be faxed to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675445 If continuation sheet Page 3 of 8 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 11/18/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete pharmacy with a face sheet and cover sheet to clarify a resident's status.B. Nurses MUST COMMUNICATE to the pharmacy which medications need to be dispensed based on the readmission medication list. Review current medication stock to avoid duplication and the patient's pay plan upon readmission.C. Use a fax cover sheet and indicate the time that the next doses are due, for the medications that are needed.Review of facility's policy dated 10/01/2025 titled Medication Monitoring-Medication Error and Incident Reporting reflected: PolicyTo define the process for reporting an actual or potential event that is inconsistent with usual operating procedures or pharmaceutical care, or an accident or incident that poses a potential hazard. Injury does not necessarily occur. The perception of a client, visitor, or associate's potential for injury and/or property damage is sufficient to document on a medication error report. Examples of reportable incidents include but are not limited to:5. Non-Compliance6. Customer/Client Complaint7. Transportation Issue (i.e., failure to deliver contracted services)8. OtherReview of facility's policy revised 10/01/2019 titled Medication Policies- Ordering and Receiving Medications from Pharmacy- Ordering Controlled Substances and CII Original Prescriptions reflected: PolicyBefore a controlled drug can be dispensed, the pharmacy must be in receipt of a clear, complete, and signed written or e-prescribed prescription from a person lawfully authorized to prescribe. A chart order is not equivalent to a prescription for controlled drugs. Therefore, the prescriber issuing the chart order must also provide the pharmacist with a valid prescription. The written prescription may be faxed to the pharmacy for long-term care facility residents.To facilitate effective communication, documentation, and aid in prevention of medication errors, medication orders should be clear and concise and free of potentially dangerous abbreviations.ProcedureThe director of nursing and the consultant pharmacist maintain the facility's compliance with Federal and State Laws and Regulations in the handling of controlled medications. Only authorized licensed nursing, medical and pharmacy personnel have access to controlled medications.2. Schedule II controlled medications prescribed for a specific resident are delivered to the facility only if a written or e-prescribed prescription has been received by the pharmacy prior to dispensing. When reordering Schedule II controlled substances, order at least 7 days in advance of need to allow for transmittal of the required written prescription to the pharmacist. Suggest reorder in 5 days for Schedule III -V. The prescriber is contacted for directions when delivery of a medication will be delayed, or the medication is not or will not be available.Review of facility's policy revised 10/01/2019 titled Medication Policies- Ordering and Receiving Medications from Pharmacy- Receiving Controlled Substances reflected: PolicyMedications included in the Drug Enforcement Administration (DEA) classification as controlled substances and medications classified as controlled substances by state law are subject to special ordering, receipt, and record keeping requirements by the facility in accordance with federal and state laws and regulations.The Director of Nursing, in collaboration with the consultant pharmacist, maintains the facility's compliance with federal and state laws and regulations in the handling of controlled substances. Only authorized, licensed nursing and pharmacy personnel have access to controlled substances.Controlled substances are reordered when a 5-day supply remains to allow for transmittal of the required written prescription to the pharmacist. Event ID: Facility ID: 675445 If continuation sheet Page 4 of 8 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 11/18/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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. for 1 of 1 kitchen observed in that:The facility failed to ensure the water dispenser in the main dining hall was clean.The facility failed to ensure the sinks in the kitchen were clean.The facility failed to ensure the Resident's drink area in the kitchen was clean.The facility failed to ensure the vent in the kitchen was closed and clean.The facility failed to ensure there were no broken tiles in the kitchen.These deficient practices placed residents at risk for illness and decreased quality of life.Findings included:Observation on 10/13/2025 at 10:02 am reflected the water dispenser/drinking fountain in the main dining area had brown-colored liquid in the drip tray that looked slimy with tiny particles. Observation on 10/13/2025 at 10:05 am the kitchen sink was brown-colored and there were two small brown pellets on the drain strainer. The sink had black area at the back directly under the faucet.Observation on 10/13/2025 at 10:07 am kitchen vent without cover and the other vent was cover with dust.Observation on 10/13/2025 at 10:08 am the countertop of the drinks area had brown stains.Observation on 10/13/2025 at 10:09 am revealed there were cracked tiles in the kitchen under the sinks which created tripping hazard for staff. During an interview on 10/13/2025 at 12:34 pm, the Administrator stated the water dispensers were checked at least daily and she checked it daily on her daily morning rounds. The Administrator stated she expected the water dispenser to be clear, clean, no residual. The Administrator stated housekeeping staff was supposed to make sure the water dispenser was clean. The Administrator stated most of the Residents drink from the water dispenser due to the hard water system in the city. During an interview on 10/13/2025 at 12:55 pm the Dietary aide said everybody in the kitchen was responsible for the cleaning. The Dietary aide looked at the picture of the kitchen sink and counter area and stated she had never seen an area like that. She also stated she did not know who was responsible for cleaning the water dispenser in the dining area. The Dietary aide stated one of the vents in the kitchen had been open for a while, but she couldn't recall how long. During an interview on 10/13/2025 at 1:05 pm the [NAME] stated everyone was responsible for cleaning certain things in the kitchen. The [NAME] stated the Dietary aide was responsible for cleaning the drinks area. The aide was responsible for cleaning that sink because that was her area. The [NAME] said the Dietary manager was responsible for ensuring tasks were completed in the kitchen based on the cleaning list. The [NAME] stated dietary staff had to initial once their cleaning task was completed. The [NAME] stated the vent in the kitchen had been opened since she started working at the facility about 3 months ago. The [NAME] stated she spoke with the Dietary Manager about the vent being opened. The [NAME] stated the vent was supposed to have a filter to prevent dust or anything else from coming in. The [NAME] also stated the cracked tiles had been like that since she started working at the facility and the Administration was aware. During an interview on 10/13/2025 at 1:22 pm the Dietary Manager stated she started a cleaning log in August 2025 to make sure the staff were cleaning their work areas. The Dietary Manager stated she checked the cleaning log daily. The Dietary Manager looked at the picture from the kitchen sink and the drinks area and stated the drinks area was [NAME], and the sink had mold, and it was like that when she started her position and had gotten better. The Dietary Manager stated the mold was not supposed to be in the sink, it was gross, it could cause sickness to the residents. The Dietary Manager stated the Dietary aide was responsible for cleaning the sink and the drinks area and she was responsible for ensuring the cleaning was completed. The Dietary Manager stated the vent in the kitchen had been open for a while (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675445 If continuation sheet Page 5 of 8 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 11/18/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and it was not ok to remain open because anything like debris could come in. The Dietary Manager stated the Maintenance Director was aware of the open vent. The Dietary Manager stated she was told the Maintenance Director and the Housekeeping Supervisor were responsible for cleaning the water dispenser. The Dietary Manager stated she checked the water dispenser in the dining area at about lunchtime, and it had coffee in the drip tray. When the Dietary Manager looked at the pictures and stated, no, this is not what I saw, this is not coffee, this was dirt. The Dietary Manager stated the water dispenser was clean now, she had cleaned it. During an interview on 10/13/2025 at 2:03 pm the Maintenance Director stated there were 2 water dispensers in the facility, 1 in the dining area and 1 in the lobby. The Maintenance Director stated he checked the water dispensers every morning and when they were dirty and he let the housekeeper know to clean it. The Maintenance Director stated he checked the water dispenser in the lobby and the Dietary Manager checked this morning and it didn't seem dirty. The Maintenance Director looked at the picture of the water dispenser and stated it did not look like that yesterday; it looked clean. The Maintenance Director stated the water dispenser did not look good, it was dirty, it was going to have an impact on the residents; it needed to be clean. The Maintenance Director stated he had not checked the rooms' vents since he had been in the facility for about 2 months and it was not on his to-do list. He stated he was not sure if it was supposed to be checked. The Maintenance Director stated the vent/AC register was responsible for directing the air. The Maintenance Director stated the vent in the kitchen was brought to his attention about a week or 2 weeks ago and he was working on it. The Maintenance Director stated the vent/AC register in the kitchen needed to be replaced. The Maintenance Director stated the air will not be directed properly due to the vent being opened. During an interview on 10/13/2025 at 2:50 pm the DON stated she sometimes looked at the water dispenser and refills them. The DON looked at the water dispenser pictures and stated it was gross. The DON stated she wouldn't get water from the water dispenser like that because it might have bacteria or mold. The DON stated about 1/2 of the residents in the facility get their own water from the water dispenser. The DON stated she hasn't gone into the kitchen since the new manager started. The DON looked at the photos of the kitchen and stated 1 was the sink next to coffee pot and the black substance was a mildew not from the hard water, and the sink looked like it had not been cleaned. The DON looked at the other picture and stated that was the countertop by the juices. The DON stated it looked greasy. The DON stated Housekeeping and Maintenance were responsible for cleaning the vents in the building. The DON stated the managers should be checking the vents during their morning rounds. The DON stated the vent in the kitchen was from the roofers and they were supposed to come back and fix it. The DON stated there was food in the kitchen, and there shouldn't be an open hole. During an interview on 10/13/2025 at 3:34 pm the housekeeping supervisor stated she gives her staff a schedule daily. Housekeeping supervisor stated cleaning the vent was part of their daily cleaning schedule, with the duster on the surface, but they couldn't get thorough cleaning. The Housekeeping supervisor stated they have to get maintenance to open the vent for thorough cleaning. The Housekeeping supervisor stated she has climbed on the ladder and taken the vent cover out to clean thoroughly but that was about a year ago. The Housekeeping supervisor stated she was not sure if not cleaning the vent had an impact on the residents' health. The Housekeeping supervisor stated she did not know who was responsible for cleaning the water dispensers in the dining area. She stated the water dispenser in the lobby was cleaned by the housekeeper, the one in the kitchen she didn't know. The Housekeeping supervisor stated she did not know if housekeepers or maintenance were supposed to be cleaning the water dispensers. During an interview on 10/13/2025 at 4:03 pm the Administrator stated the vent in the kitchen had addressed numerous times with corporate, she had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675445 If continuation sheet Page 6 of 8 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 11/18/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few been going back and forth with the corporate office and it had been like that since she had been in the facility for about a month. The Administrator stated there was a hole in the kitchen from the vent covering not being present, dust and debris could come in and that was not safe, it was a huge concern. The Administrator stated she took pictures of the flooring in the kitchen, the cracked tiles and sent them to the Maintenance Director. The Administrator stated the tile was loose in the kitchen and that was a slip hazard for staff which was unsafe. The Administrator stated the sink in the kitchen looked like it had rust, could potentially grow mold due to being moist. The Administrator stated she saw stains by the juice machine; they look rusty, it should be clean. The Administrator stated the Dietary Manager did not use the sink with the rust and the mold. Review of facility's policy dated revised August 2025 titled Sanitization reflected: Policy Statement --The food service area shall be maintained in a clean and sanitary manner.Policy Interpretation and Implementation-- All kitchens, kitchen areas and dining areas shall be kept clean, free from litter and rubbish and protected. All utensils, counters, shelves and equipment shall be kept clean, maintained in good repair and shall be free from breaks, corrosion, open seams, cracks and chipped areas that may affect their use or proper cleaning. Seals, hinges and fasteners will be kept in good repair. FIXED EQUIPMENT-1. Fixed equipment will be routinely cleaned and maintained in accordance with the manufacturer's directions.2. Staff members will be trained in the cleaning and maintenance of all equipment.3. Food contact equipment will be cleaned and sanitized after every use.4. Non-food contact equipment will be clean and free of debris15. Kitchen and dining room surfaces not in contact with food shall be cleaned on a regular schedule and frequently enough to prevent accumulation of grime.16. The Food Services Manager will be responsible for scheduling staff for regular cleaning of kitchen and dining areas. Food service staff will be trained to maintain cleanliness throughout their work areas during all tasks, and to clean after each task before proceeding to the next assignment. Review of facility's policy dated December 2009 titled Maintenance Service reflected: Policy Statement--Maintenance service shall be provided to all areas of the building, grounds, and equipment.Policy Interpretation and Implementation1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times.2. Functions of maintenance personnel include, but are not limited to:1. maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines.2. maintaining the building in good repair and free from hazards.3. maintaining the fire alarm system and emergency generator system in good working order.4. maintaining the heat/cooling system, plumbing fixtures, wiring, etc., in good working order.5. maintaining lighting levels that are comfortable and assuring that exit lights are in good working order.6. establishing priorities in providing repair service.7. maintaining the paging system in good working order.8. maintaining the grounds, sidewalks, parking lots, etc., in good order.9. providing routinely scheduled maintenance service to all areas.10. others that may become necessary or appropriate.3. The maintenance director is responsible for developing and maintaining a schedule of maintenance service to assure that the buildings, grounds, and equipment are maintained in a safe and operable manner.4. A copy of the maintenance schedule shall be provided to each department director so that appropriate scheduling can be made without interruption of services to residents.5. Maintenance personnel shall follow the manufacturer's recommended maintenance schedule.6. Changes in maintenance schedules must be approved by the maintenance director.7. Maintenance personnel shall follow established infection control precautions in the performance of their daily work assignments.8. The maintenance director is responsible for maintaining the following records/ reports.1. Inspection of building.2. Work order requests.3. Maintenance schedules.4. Authorized vendor listing; and5. Warranties and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675445 If continuation sheet Page 7 of 8 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 11/18/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete guarantees.9. Records shall be maintained in the maintenance director's office.10.Maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned. Review of facility's policy revised June 2011 titled cleaning and disinfecting non-critical Resident -Care items reflected: Purpose--The purpose of this procedure is to provide guidelines for disinfection of non-critical resident-care items. Preparation--Assemble the equipment and supplies as needed. Review of facility's policy dated revised 06/30/2025 titled Cleaning and Disinfection of Resident-Care Items and Equipment reflected: Policy Statement --Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standard. Event ID: Facility ID: 675445 If continuation sheet Page 8 of 8