Health inspection·November 20, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Precautions dated 8/26/2025 indicated CNA A completed her training. Record review of a certificate titled Enhanced Barrier Precautions dated 8/4/2025 indicated CNA B completed her training. During a phone interview on 11/8/2025 at 9:36 AM, CNA A said she assisted on the floor and had come to the facility for a few hours. She said she was at the facility from approximately 9 am- 12:30 pm. CNA A said she recalled she assisted CNA B with changing Resident #7. She said she could not recall if she wore PPE while providing incontinent care to Resident #7. CNA A said she has not always worn PPE while providing care. She said she believed she wore PPE on 11/1/2025. CNA A said a resident on EBP precautions would have a plan of care in the computer and the supplies would be in the room with an orange sticker on the door. CNA A said if proper PPE were not worn, it could cause infection if my clothes were contaminated. She said it would be an infection control issue. CNA A said the facility had plenty of PPE. CNA A said the nurses, charge nurses, ADON and DON were responsible for ensuring the staff was wearing proper PPE and the aides were following proper precautions. CNA A said she had been in-serviced on PPE and EBP through townhalls and through the facility's online in-services. During a phone interview on 11/8/2025 at 9:47 AM, CNA B said she worked at the facility PRN, and she did not think she worked that day. CNA B said she did recall providing care to Resident #7. CNA B said she was not familiar with EBP. She said she wore a gown if a resident had an open wound. She said you never wear gowns while performing incontinent care with residents with a catheter and she said she was not required to wear a gown with a resident with a feeding tube. CNA B said she felt the facility had plenty of PPE. She said she had been in-serviced on EBP through clinics, and she said she still had training to complete. CNA B said no one was responsible for ensuring staff wore proper PPE. She said it was chaotic sometimes and it would be an infection control issue for both staff and residents. During an interview on 11/8/2025 at 10:00 AM, LVN D said she had been at the facility for approximately 3 years. She said residents who have a wound, tube feeding, catheter or immune-compromised would be on EBP. LVN D said there would be a hanging organizer on the door with PPE. She said that was how the staff know to use PPE. LVN D said there was not a sign on the outside of the door but thought there was a sign on the inside of the resident room on the organizer. LVN D said EBP was important to prevent germs from getting to the residents and was an extra precaution. She said the Infection Control nurse was ADON and she was responsible for ensuring staff were wearing PPE. LVN D said it was everyone's job to ensure they were wearing it properly. LVN D said it could cause cross-contamination and make residents sick if not worn. LVN D said she had been in-serviced on EBP. During an interview on 11/8/2025 at 10:07 AM, the ADON said residents who had catheter, gastrostomy tube, wounds, and PICC (peripherally inserted central catheter) lines were required to be on EBP. The ADON said the residents on EBP have little orange stickers on the outside of their door and then have a sign on the inside of the door with an organizer with PPE. The ADON said she had in-serviced the staff repeatedly and said they were having a hard time getting it and using EBP. The ADON said the staff continue to not follow despite her education. The ADON said EBP prevents the spread of MDRO's (Multidrug-resistant organisms). She said the staff could be spreading infection from one resident to another. She said the facility had plenty of PPE. The ADON said a resident could be affected if EBP was not followed causing a resident could develop a MDRO, an infection or make them sick with something else. The ADON said she was ultimately responsible, but the nurses were responsible in her absence. During an interview on 11/8/2025 at 10:15 AM, CNA C said he has changed Resident #7 in the past. He said EBP was to prevent infections with residents with catheters, wounds, or tube feedings. CNA C said he always wore PPE. CNA C said there were signs on the wall in the room and the organizer with PPE. He said the facility had plenty of PPE available to staff. He said a resident could get an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675602 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 675602 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care of Gilmer 623 Hwy 155n Gilmer, TX 75644 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete infection and were at high risk if PPE was not worn. CNA C said he had not observed any staff members not wearing proper PPE. He said he would tell the staff member if he noticed they were not wearing proper PPE. CNA C said the charge nurse or DON were responsible for ensuring the staff were wearing proper PPE. During an interview on 11/8/2025 at 10:42 AM, the DON said she had been at the facility for 2 years and in her role as DON for 11 months. The DON said EBP were used when a resident had an insertion device such as a catheter, feeding tube, or a wound. The DON said she expected the staff to wear proper PPE when providing care to residents who were on EBP. The DON said the facility had in-services with staff on which residents were on EBP. She said the facility had a Kardex and it was also on the care plan. The DON said the facility had signage on the door with what the precautions were. She said there was an organizer on the door with PPE available to staff. The DON said the facility had plenty of PPE. During an interview on 11/8/2025 at 10:50 AM, the ADM said EBP was used when a resident had an open wound, feeding tube or a catheter. She said she expected the staff to be following proper precautions. The ADM said a resident would have an orange sticker on the door and an organizer in the room with supplies available to them. The ADM said the Infection Preventionist was primarily responsible, but all staff should make sure they were following the precautions. She said a resident could be at risk for infection if proper PPE was not followed. The ADM had identified the 2 CNA's as CNA A and CNA B.Record review of a facility's Standard and Enhanced Precautions policy dated 4/1/2024 indicated.Enhanced Barrier Precautions (EBP) are a CDC guidance to reduce the transmission of multi-drug-resistant organisms (MDRO) in healthcare settings, including nursing homes.Procedure.1. Determine residents MDRO status on admission to community.2. Determine if a resident has wounds.3. Place signage on residents' closet door, maintain PPE in residents' room, and assure all team members are aware of resident status. 4. High contact resident care activities.Dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs, or assisting with toileting, device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator, wound care: any skin opening requiring a dressing. Event ID: Facility ID: 675602 If continuation sheet Page 3 of 3