Health inspection·November 25, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few least every 2 hours when rounds were completed. She said Resident #3 asked her to empty his urinal around 6 AM, when she arrived on shift. CNA C stated the urinal was overflowing onto the ground beside his bed. She stated she tried to clean the urine up as best as she could. She stated Resident #3's room always smelt like urine because he used the urinal and was occasionally incontinent of urine. CNA C stated it was important to ensure strong urine odors were addressed by the facility staff. She stated she usually notified the housekeeping staff and then wiped his bed down with purple top wipes. She stated it was important to maintain a clean and homelike environment. During an interview on 11/25/25 at 11:27 AM, Housekeeper D stated she had worked at the facility for a couple of months. Housekeeper D stated she had problems with Resident #3's room smelling like urine. Housekeeper D stated Resident #3 used the urinal and could not physically get up to use the bathroom. She said Resident #3 was dependent on staff and when his urinal was full, he would empty it into the trashcan. Housekeeper D stated that sometimes Resident #3 missed the trashcan and the urine got on the ground. Housekeeper D stated the housekeeping staff cleaned his room daily, to include sweeping and mopping. She stated they did not have any special cleaners for urine odors. She stated it was important to ensure odors in the resident's rooms were pleasant for a more homelike environment. She stated family and visitors did not want to step on sticky floors or smell urine odors. During an observation on 11/25/25 at 1:09 PM, Resident #3 was sitting up in bed eating his lunch meal. There was a strong urine odor in the room. Resident #3 had two urinals that were hanging on the trashcan located beside his bed. There was a small amount of yellow urine noted in both urinals. The floor was sticky and there were four flies flying around the floor. During an interview on 11/25/25 at 1:31 PM, the Housekeeping Supervisor stated she had been promoted to manager, approximately 1 week ago. She stated there were several rooms at the facility that normally had a strong urine odor. The Housekeeping Supervisor stated Resident #3's room smelt like urine because he dumped his urinals into his trashcan. She stated the day after she was promoted, the housekeeping staff deep cleaned Resident #3's room but it did not seem to help the odor. She stated rooms were cleaned daily, which included around the bases of the toilets. She said she was working on getting some enzyme cleaner to help with the urine odors, but currently had no special cleaners to help with the urine odors. She stated it was important to ensure the odors at the facility were pleasant so there were no complaints and the general cleanliness of the building. During an interview on 11/25/25 at 2:03 PM, the Assistant Director of Clinical Operations stated the nursing staff should have been going into Resident #3's room every couple of hours to ensure his urinal was emptied. She stated Resident #3 did not like staff in his room during the night. The Assistant Director of Clinical Operations stated she had noticed Resident #3's room smelled like urine. She said his urinal getting knocked over and spilt probably had something to do with the urine odor in his room. She stated the facility staff cleaned up the urine and housekeeping cleaned his room daily, but the smell lingered. She stated it was important to ensure urinals were emptied and the urine odors were managed for the basic cleanliness of the facility and to maintain a homelike environment. During an interview on 11/25/25 at 2:26 PM, the Director of Clinical Operations stated the staff should have been checking Resident #3's urinal every time they passed his room. She stated Resident #3 did not seem bothered by the urine odor in his room, but the staff had noticed the smell. The Director of Clinical Operations stated the facility staff have tried to deep clean the room and Resident #3 refused to allow them. She stated the housekeeping staff and CNAs cleaned the best they could when the urine from his urinal was spilt. She stated it was important to ensure the urine odors were maintained for infection control issues and to maintain a homelike environment. During an interview on 11/25/25 at 3:01 PM, the Administrator stated he expected the facility staff to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675602 If continuation sheet Page 2 of 7 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 11/25/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete always deal with the urine odors in a timely manner. He stated he had never noticed Resident #3's call light going off to ask for staff assistance with emptying his urinal. The Administrator stated he was unsure what the process was for emptying urinals but expected alert residents to be more involved with their care. The Administrator stated it was important to ensure urine odors were managed because he would not have wanted to live or work in a facility that smelt bad. Record review of the Quality of Life - Homelike Environment policy, revised May 2017, reflected The facility staff and management shall maximize, to the extent possible, the characteristics of the facility that reflected a personalized, homelike setting. These characteristics include: .clean, sanitary and orderly environment. pleasant, neutral scents. Event ID: Facility ID: 675602 If continuation sheet Page 3 of 7 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 11/25/2025 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who is incontinent of bladder receives appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 2 of 2 residents (Resident #1 and Resident #2) reviewed for incontinent care. 1.The facility failed to ensure CNA A changed gloves and performed proper hand hygiene before going from dirty to clean during Resident #1's catheter and incontinent care on 11/25/25. 2. The facility failed to ensure CNA B performed hand hygiene before applying new gloves and changed gloves before going from dirty to clean during Resident #2's incontinent care on 11/25/25. These deficient practices could place residents at risk for decreased quality of life, infection, and skin breakdown due to improper care practices. The findings included: 1.Record review of Resident #1's face sheet, indicated she was a [AGE] year-old female admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included frontotemporal neurocognitive disorder (dementia involving the progressive degeneration of the brain's frontal and temporal lobes), down syndrome (a genetic condition caused by an extra copy of chromosome 21, resulting in intellectual disability), paraplegia (a condition characterized by the loss of motor and sensory function in the lower half of the body), neuromuscular dysfunction of bladder (a condition where nerve damage disrupts the communication between the brain and bladder leading to issues with controlling urination), need for assistance with personal hygiene and osteomyelitis (a bone infection caused by bacteria or fungi that can enter the bone through the bloodstream, an open wound, or recent surgery). Record review of Resident 1's quarterly MDS assessment, dated 11/12/25, indicated Resident #1 was sometimes understood by others and usually understood others. The MDS assessment indicated he had a BIMS score of 10 indicating moderate cognitive impairment. The MDS did not indicate Resident #1 refused care. The MDS indicated she was always incontinent of bowel and bladder. Record review of Resident #1's comprehensive care plan, dated 8/07/25, indicated Resident #1 was incontinent of bowel and had a foley catheter. Resident #1 was at risk for skin breakdown. The interventions were to monitor for incontinence every 2 hours/ PRN, change promptly and apply protective skin barrier and assess for causes of incontinence. Record review of Resident #1's comprehensive care plan, dated 8/07/25, indicated Resident #1 had a self-care deficit: Resident #1 needed assistance with ADL's related to down syndrome (a genetic condition caused by an extra copy of chromosome 21, resulting in intellectual disability). The interventions for personal hygiene were; the resident requires assistance by staff with personal hygiene and oral care. Record review of Resident #1's order summary report dated 08/07/25 indicated D-Mannose oral capsule (D-Mannose), Give 1300 mg by mouth one time a day for frequent UTI. Record review of Resident #1's order summary report dated 10/07/25 reflected Gentamicin 80 mg/50 mL normal saline Injectable - Give 30mL intravesical (into the bladder) two times a day for frequent UTI. Hold in bladder 30 minutes by clamping foley catheter then let drain. During an observation on 11/25/25 at 9:10 AM, CNA A provided catheter and incontinent care to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675602 If continuation sheet Page 4 of 7 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 11/25/2025 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #1. CNA A placed a trash bag for dirty items and wipes on Resident #1's bedside table. He did not clean the bedside table or place a barrier on the bedside table before placing items. CNA A removed Resident #1's covers and stuffed animals and placed catheter bag to the bottom of the resident's bed. CNA A explained what he was going to do to Resident #1. He wiped Resident #1's genital area starting with the outer folds of the pubis using a downward motion, then he cleaned labia minora. Lastly, he cleaned Resident #1's catheter. He then turned Resident #1 on her side while touching her buttocks and hips with the same dirty gloves on. He proceeded to wipe his buttocks using the front-to-back motion. After he performed incontinent care to Resident #1's backside he removed her dirty draw sheet and dirty brief then placed the items in bag on bedside table. CNA A applied Resident #1 with a clean brief and clean draw sheet. He repositioned Resident #1 in bed, replaced her covers over her, replaced her stuffed animals close to her head, replaced foley catheter bag to frame of bed and adjusted bed in lowest position with hand handle controller. CNA A gathered his trash and removed his dirty gloves. CNA A performed hand hygiene, by washing hands in the bathroom, for the first time since the catheter and incontinent care started and left the room. During an interview on 11/25/25 at 9:22 AM, CNA A said he should have changed his gloves before he started cleaning the resident's genital area, because he had touched her covers and foley catheter bag. He said he felt like he should have changed his gloves after cleaning the front side of the resident. CNA A said all the germs from the front side could have been transferred to the backside of the resident because he did not change his gloves. He said he should have changed his gloves and performed hand hygiene after he removed Resident #1's dirty brief and dirty draw sheet. He said he should have changed his gloves and performed hand hygiene prior to applying Resident#1's clean brief and clean draw sheet. CNA A agreed he did not have the appropriate barrier and did not sanitize Resident #1's bedside table prior to starting the care. CNA A said he should have changed his gloves and performed hand hygiene prior to replacing Resident #1's covers over her and replacing her foley catheter to bedrail. CNA A said he was sorry he did not change his gloves while providing care to Resident #1. He said he had been trained at the facility on incontinent care or handwashing. He said the negative effect of improper foley catheter and incontinent care, and improper hand hygiene was an infection issue. 2. Record review of the face sheet, dated 11/25/25, reflected Resident #2 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of multiple sclerosis (chronic autoimmune disorder that affects the central nervous system, including the brain, spinal cord, and optic nerves; the immune system attacks the protective covering of the nerve cells), urinary tract infection (bladder infection), and sepsis (blood infection). Record review of the quarterly MDS assessment, dated 11/17/25, reflected Resident #2 had clear speech, was understood by others, and was able to understand others. Resident #2 had a BIMS score of 15, which indicated no cognitive impairment. Resident #2 had no behaviors or refusal of care. The MDS reflected Resident #2 normally required substantial/maximum staff assistance with toileting hygiene. Resident #2 had an indwelling catheter and was always incontinent of bowel. Resident #2 had an active diagnosis of neurogenic bladder (bladder dysfunction caused by nerve damage) and urinary tract infection within the last 30 days. The MDS reflected Resident #2 took antibiotics within the look-back period. Record review of the comprehensive care plan, undated, reflected Resident #2 had an indwelling catheter and was at increased risk for urinary tract infections. Resident #2 took an antibiotic prophylactically for frequent UTIs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675602 If continuation sheet Page 5 of 7 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 11/25/2025 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 0690 Level of Harm - Minimal harm or potential for actual harm Record review of the comprehensive care plan, undated, reflected Resident #2 had an ADL self-care performance deficit. The interventions included: extensive staff assistance with toilet use. Record review of the comprehensive care plan, undated, reflected Resident #2 had bowel incontinence related to Multiple Sclerosis. The interventions included: provide peri care after each incontinent episode. Residents Affected - Few Record review of the comprehensive care plan, undated, reflected Resident #2 had an actual UTI. Record review of Resident #2's order summary report, reflected the following orders: 1. On 11/13/25, Admit to skilled services for diagnosis of UTI. 2. On 09/06/24, Enhanced barrier precautions during high contact and direct care activities every shift for catheter. 3. On 09/12/24, cranberry tablet 300 mg – give 1 tablet by mouth two times a day for prevention of UTIs. 4. On 5/20/25, D-mannose oral capsule 500 mg – give 2 capsules by mouth one time a day for recurrent UTI's. 5. On 05/20/25, Macrodantin (antibiotic) oral capsule 50 mg – give 1 capsule by mouth at bedtime for recurrent UTI's. During an observation and interview on 11/24/25 at 9:41 AM, Resident #2 was lying in the bed with the head of her bed slightly elevated. Resident #2 she had a Foley catheter since being admitted to the facility. She stated she was constantly getting UTIs and recently had a suprapubic catheter placed. Resident #2 had a catheter drainage bag hanging on the side of the bed with a small amount of clear yellow urine. There was no privacy cover, but Resident #2 stated it did not bother her. She stated she blamed her UTIs on the facility staff because they were not competent at following infection control practices during incontinent or catheter care. She said that she had to sit for 3 hours in her poop, and she had to use numerous wash rags in the shower to get herself clean. Resident #2 stated she was a germaphobe and it drove her crazy. During an observation on 11/25/25 at 10:28 AM, CNA B gathered her supplies for incontinent care on Resident #2. CNA B applied an isolation gown, washed her hands, then applied gloves. She performed incontinent care on Resident #2's front side, changed her gloves but did not perform hand hygiene. CNA B performed incontinent care on Resident #2's back side, then changed her gloves but did not perform hand hygiene. CNA B then wiped Resident #2 several more times, then took the clean linens and placed them under Resident #2 without changing her gloves. During an interview on 11/25/25 at 10:39 AM, CNA B stated she had no sanitizer in her pocket like she normally had, but she should have applied hand sanitizer each time she replaced her gloves. She said that she became busy when she started work and forgot to get a pocket sanitizer from the nurse's station. CNA B stated she should have changed her gloves after cleaning a dirty area and before she touched the clean linen. She stated she was nervous with the state watching. She stated it was important to ensure infection control practices were followed during incontinent care to prevent the spread of infection and prevent urinary tract infections. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675602 If continuation sheet Page 6 of 7 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 11/25/2025 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 11/25/25 at 2:03 PM, the Assistant Director of Clinical Operations stated she expected the CNAs to ensure infection control practices were at the forefront of their mind while performing incontinent or catheter care. She stated the nursing management provided in-service education and check offs for incontinent and catheter care all the time. The Assistant Director of Clinical Operations stated she understood the staff became nervous when state surveyors were watching, but she still expected them to follow the infection control practices during incontinent or catheter care. She stated it was important to ensure infection control practices were followed during incontinent or catheter care to prevent the risk of urinary tract infections. The clinical checkoffs for incontinent care were requested for CNA A and CNA B. During an interview on 11/25/25 at 2:26 PM, the Director of Clinical Operations stated she expected the staff to ensure they were sanitizing their hands and changing gloves at the appropriate times during incontinent or catheter care. She stated the staff completed checkoffs and online training and in-service education. She stated next month several of the facilities were providing a skills fair that would have included incontinent care. The Director of Clinical Operations stated it was important to ensure infection control practices were followed during incontinent or catheter care, so the staff did not contaminate other body openings and decreased the risk of UTIs. She stated poor incontinent care could have contributed to Resident #1 and Resident #2's recurrent UTIs. During an interview on 11/25/25 at 3:01 PM, the Administrator stated he expected the nursing staff to ensure the best practices were utilized when performing incontinent or catheter care. The Administrator stated he did not have a clinical background and the administrative nursing staff were responsible for monitoring to ensure infection control practices were utilized during incontinent and catheter care. He stated it was important for infection control issues. Record review of the Nursing Services - Competency Evaluation, dated 11/03/25, reflected CNA A met the performance criteria for incontinent care, with no comments noted. Record review of the Nursing Services – Competency Evaluation, dated 11/03/25, reflected CNA B met the performance criteria for incontinent care, with no comments noted. Record review of the Elimination, Perineal Care policy, effective 10/01/21, reflected To provide cleanliness and comfort to the resident, to prevent infections and skin irritation. The policy did not address infection control practices related to incontinent or catheter care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675602 If continuation sheet Page 7 of 7