Health inspection·December 1, 2025

F 0774 Help the resident with transportation to and from laboratory services outside of the facility. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide normal transportation for residents to medical services outside of the facility for 1 of 6 residents (Resident #1) reviewed for transportation. The facility failed to provide transportation for Resident #1 to a doctor's appointment on 10/14/25. This failure could place residents at risk of possible adequate evaluation, hospitalization and unmet needs.Findings include: Record review of Resident #1's face sheet, dated 10/28/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included: paraplegia (a condition characterized by the loss or impairment of motor sensory functions in both lower limbs), gastro-esophageal reflux disease (a condition where stomach contents flow back up into the esophagus, causing irritation and various symptoms) and flatulence (the release of gas from the digestive tract through the anus). Record review of Resident #1's quarterly MDS, dated [DATE], reflected Resident #1 was usually understood and usually understood by others. Resident #1's BIMs score was a 15, which indicated cognition was intact. Resident #1 required dependent assistance with all ADLs. Record review of Resident #1's care plan, dated 8/4/25, reflected Resident #1 had alteration in bowel elimination related to the history of constipation. The interventions included administer medications as ordered by the MD and monitor effectiveness, notify MD if not effective, encourage fluid intake if not contraindicated by diet or fluid restriction, encourage participation in activities, monitor bowel movements every shift and record and check for impaction as needed, monitor for abdominal distention, bowel sounds, or complaint of abdominal pain or pressure as needed resident complaint and provide adequate time and privacy for elimination. Record review of Resident #1's nurses' notes reflected LVN B documented on 10/02/25 at 11:41 A.M. Resident #1 had an Appointment with on October 14th at 10:00 A.M. Record review of Resident #1's nurses' notes reflected LVN C documented on 10/28/23 at 12:52 P.M. Nurse Practitioner here and talked with resident about consult on 14th with the doctor for colostomy bag for diagnosis of sweal bowel ischemia (a condition where the bile ducts do not get enough blood flow). During an interview on 10/28/25 at 9:32 A.M., a Family Friend said the facility knew about the doctor's appointment for Resident #1 on 10/14/25, at 10:00 A.M. two weeks prior to the day. She said there was no reason why the facility should have let Resident #1 miss her appointment, because the van was at the facility. She said Resident #1 needed to go to her appointment because her physicians' office referred her to the colon surgeon for a colonoscopy (a medical procedure to examine the inside of the large intestine [colon] and rectum using a flexible tube with a camera called a colonoscope.) due to a swollen colon. She said on 10/14/25 during the morning hours, she spoke with the office staff and reminded them about the appointment for Resident #1, then the staff told her they did not have a van driver to take Resident #1 to her appointment. During an interview on 10/28/25 at 11:57 A.M., with Family Member #1, he said Resident #1 had an issue last week when the facility did not take her to her doctor's appointment. He said Resident #1 was very upset she missed Residents Affected - Few Page 1 of 3 675602 675602 12/01/2025 Focused Care of Gilmer 623 Hwy 155n Gilmer, TX 75644

F 0774 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few her doctor's appointment on 10/14/25. He said he did not know the reason why the facility did not take her to her appointment, but it was concerning, because Resident #1 was so upset. During an interview on 10/28/25 at 1:51 P.M., with Resident #1, she said on 10/14/25, she had an appointment at 10:00 A.M. to go see a surgeon about getting a colostomy. She said the facility knew about her appointment two weeks before the date and that morning they told her they did not have a driver to take her to her appointment. She said that made her so angry, because they knew she needed to go to that appointment and they waited to the last minute to tell her they did not have a driver to take her. During an interview on 10/28/25 at 3:18 P.M., with EDOO, she said the incident happened on 10/14/25 with Resident #1, she wanted to say she had an appointment, and it was an issue with a transportation service, and they canceled . During an interview on 10/28/25 at 3:54 P.M., with EDOO, she said Maintenance Man A was going to drive the facility van the day of Resident #1's appointment, but he called in sick; then the backup driver came in a little later and took another resident to their doctor's appointment. At that point MRC had already rescheduled Resident#1's appointment, because her MD charged a $50.00 fee if appointments were not canceled. She said the backup transportation driver came in after Resident #1's appointment. She said Maintenance Man A notified MRC early that morning he was not going to be able to come in to take Resident #1 to her appointment, but they could not get the backup driver to come in soon enough to get Resident #1 to her appointment. During an interview on 10/28/25 at 4:05 P.M. with MRC, she said she was not sure what happened when Resident #1 missed her appointment on 10/14/25. She said she thought maybe the transportation service was cancelled, due to their van not working. During an interview on 10/28/25 at 5:00 P.M., with MRC she said the facility did have a transportation aide who took the residents to their appointments, but she quit without notice. She said on 10/14/25 they had one person available to drive and he called in. She said Maintenance Man A was the van driver currently. He was currently the only driver they had. She said he contacted her at 7:08 A.M. that morning on 10/14/25 to let her know he was not coming to work, and he was not going to be able to do the transport. She said Resident #1's appointment was scheduled for 10:00 A.M. that morning, so they should have left the facility about 9:15 A.M., but she canceled the appointment. She said prior to canceling Resident #1's appointment, she called a local emergency medical service and local transportation service to see if she could get them to take Resident #1 to her appointment. She said the facility currently did not have a backup driver; they were talking about cross training her to be the backup driver. She said the appointment Resident #1 missed was a consultation for a colostomy (a surgical procedure creating an opening [stoma] in the abdomen to divert waste out of the body and into a collection pouch.) She said she was not sure what Resident #1's previous health was or the reason for getting the colostomy (a surgical procedure creating an opening [stoma] in the abdomen to divert waste out of the body and into a collection pouch. During an interview on 10/28/25 at 5:23 P.M., with RDOCS she said the facility would do whatever was needed to meet the residents' needs. She said she understood things that came up. She said she did not know when the resident was going to the doctor, and she did not know Resident #1's medical history to know what the appointment was for exactly. She said she agreed to a colostomy (a surgical procedure creating an opening (stoma) in the abdomen to divert waste out of the body and into a collection pouch.) consultation was probably a very important appointment. She said she was not sure where LVN C got that diagnosis from in Resident #1's progress notes of sweal bowel ischemia. She said the risk of Resident #1 missing her appointment was if a resident had bile ischemia (damage to the bile ducts caused by insufficient blood supply) it could lead to bile blockage. During an interview on 10/28/25 at 5:33 P.M. with the EDOO she said her expectations were the facility would schedule the appointments and got 675602 Page 2 of 3 675602 12/01/2025 Focused Care of Gilmer 623 Hwy 155n Gilmer, TX 75644

F 0774 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few our residents to their appointments. She said Maintenance Man A was the driver, and he was the only driver they had right now. She said she had an aide who was a PRN driver, and she resigned last week. She said they did not currently have a backup driver. She said the MRC would be trained this week to be the backup driver. She said the risk of Resident #1 missing her appointment was a delay in care. She said the facility was currently running an ad for transportation aid. Record review of the facility's Transportation, Diagnostic Services Policy, revised December 2008, reflected Our facility will assist residents in arranging transportation to/from diagnostic appointments when necessary.Should it become necessary for the facility to provide transportation, the Social Service Designee will be responsible for arranging the transportation through the business office. Record review of the facility's Resident Rights Policy, revised December 2016, Resident Rights reflected Employees shall treat all residents with kindness, respect, and dignity. Federal and state laws guarantee certain basic rights to all residents of this facility. f. communication with and access to people and services, both inside and outside the facility. 675602 Page 3 of 3