Inspection·July 28, 2025

F 0925 Level of Harm - Minimal harm or potential for actual harm were no clothes in the closet, the smell of bug spray was noted. Observation of the room did not show any signs of ants, the bed had been stripped of everything including the mattress. During an observation on 7/28/25 at 9:23 a.m. the three rooms that share the same outside wall and courtyard as Resident #1’s room, did not show any signs of ants. There were no signs of ants inside or outside. Observations showed snacks in two of the rooms without any ants being visible. Residents Affected - Few During an interview on 7/28/25 at 9:15 a.m. the Administrator said Resident #1 was sent to the hospital yesterday, 7/27/25 due to GI bleed. She said the staff reported they saw ants in Resident #1’s bed. The room was sprayed after she left. The Administrator said Resident #1 had a lot of snacks in her room, and the room was cleaned. During an observation and interview on 7/28/25 at 9:30 a.m., CNA A said she worked on 7/27/25 and was present when Resident #1 was sent out to the hospital. She said RN B called her to the room and Resident #1 was in bed. She said Resident #1 said she felt “tingly.” CNA A said Resident #1 could not get up unassisted and required a Hoyer for transfer. She said when RN B pulled the covers back, Resident #1 had ants on her. CNA A said it was not a lot of ants, just a few. She said she did not know if the resident had been bitten or not, she could not tell. She said the ants appeared to be coming from her back and coming from around her right thigh. She said she did not see any bites the resident said she felt “itchy,” but did not say she was bitten. CNA A said said Resident #1 used the A bed. She said the ants were mostly on Resident #1’s nightstand and on the handrail on the right side of the bed. Observation of Resident #1's room did not reveal any ants. CNA A said she pulled the sheets off the bed and the housekeeper cleaned and sprayed the room on 7/27/25. During an interview on 7/28/25 at 10:00 a.m. the Housekeeper stated she worked on 7/27/25. She said when she arrived in Resident #1’s room she saw one or two ants on the side rail. She said she disinfected the bed. She said a nurse brought in liquid to kill the ants. She said the family took the resident’s clothes. The Housekeeper said it was just a few ants. The Housekeeper said she did not see the resident; she only came in after she was gone and cleaned the room. During an observation and interview on 7/28/25 starting at 10:05 a.m., the Maintenance Director said someone told him on Friday, 7/25/25 Resident #1 had ants at the head of the bed. (He could not recall who, and interviews with staff did not reveal who.) He said he had gone into the room, looked, and did not see any ants. He had taken his flashlight and did a thorough search of Resident #1’s room. He said just to be on the safe side he went on the outside and around the perimeter of that hall and spayed. The Maintenance Director said he was not allowed to spray a room if a resident resided in it. He said he did not see any mounds or any live active ants on Friday, 7/25/25. He said he was told today there were ants in Resident #1’s room on 07/27/25. The Maintenance Director shined a flashlight on Resident #1's bed, wall, floor, nightstand and window seal and no ants were seen. Observation with the Maintenance Director of the outside perimeter of the E hall did not reveal any mounds, or live visible ant activity. He said when he sprayed, he usually spayed on the ground, and around the window unit. He used Ortho B-gone insect killer that was labeled for ants, roached, and spiders. He said he was told sometimes the ants made nests in the walls. He said they had a pest control company, and they came and treated the inside and the outside of the facility monthly. During a telephone interview on 7/28/25 at 10:46 a.m., RN B said she had gone into Resident #1’s room to administer medications. She said she had saw several ants and had pulled the covers back. She said there were several ants around Resident #1’s right thigh. She said there were more ants on the bed. RN B said it appeared the ants were coming from the night stand up the call light (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675666 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 675666 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Briarcliff Health Center of Greenville 4400 Walnut St Greenville, TX 75401 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few to the side rail of the bed. She said they took the snacks out of the way and cleaned the side rail. She said they were busy trying to get the ants off the resident, she was not sure if Resident #1 had any bites or not. RN B said she performed a skin assessment and there were some pinpoint red marks on the right thigh, but she was not sure if they were ant bites or not. She said Resident #1 said she felt “tingly” Resident #1 did not know if she was bitten or not. She said Resident #1 was sent to the hospital due to a possible GI bleed. RN B said Resident #1 had a pressure sore and the dressing was intact, and skin tears on her right arm with the dressing intact. She said there were no ants noted in those areas. RN B said CNA A and the weekend supervisor, RN C, were in the room to assist with getting Resident #1 ready to send to the hospital. During a telephone interview on 7/28/25 at 10:59 a.m., RN C said she was in the room with RN B to help Resident #1 and get her sent out to the hospital due to a possible GI bleed. She said she noticed ants on the bed on 7/27/25 and could see them moving around. She said she did notice ants were coming from the nightstand on the call light onto the bed. She said it appeared there were snacks on the nightstand. RN C said she saw ants on Resident #1’s feet and couple on her thigh. She said Resident #1 did not know the ants were there. She said Resident #1 said, “I feel prickly”. RN C said Resident #1 could not tell if she was being bitten or not. She said the ants were small and light brown. RN C said she would not have seen the ants if they were not moving. RN C said she could not see any bites and did not see any ants attached to Resident #1. She said housekeeping did most of the cleaning. RN C said she spayed, and CNA A packed up all the snacks and bagged the sheets. During an interview on 7/28/25 at 1:25 p.m., the hospital RN charge nurse said she was not aware Resident #1 had of any ant bites. She said Resident #1 had a lot of edema and it was hard to tell if she had any skin issues. She said the family was in the process of placing Resident #1 on hospice. She said she did not want to disturb the resident or family due to the resident’s current condition. During an observation and interview on 7/28/25 at 1:30 p.m. revealed Resident #1 was asleep in a hospital bed and did not awaken during the visit. There were several family members present. The family members said on 7/27/25 Resident #1 said she was bitten by ants. They said she mentioned the day before she thought there were ants in her bed. Observations were conducted during the interview of Resident #1’s left hand which had one small red area on her wrist and two small red areas on the top of her hand by her thumb that could have been ant bites. The family said they noted what they thought was a bite on her right inner arm. Observation of Resident #1’s right arm had an IV tapped and was not visible. Observation of Resident #1’s right thigh did not show any visible red marks. Resident #1 did not wake up during the visit. During an interview on 7/28/25 at 2:30 p.m., the Pest Control Technician said he was called out due to ants being found in Resident #1’s room on 7/27/25. He said he did a thorough inspection of the room and found one dead ant on the window seal of the room. He said he believed it was a sugar ant. He said they did not live in mounds but lived in a tree or were they had easy access to food. He said he put bait out and went to every room to include Resident #1’s room and put preventive measures in place. He said he came to the facility once a month and as needed for pest control issues. Record review of the facility’s Pest Control Policy, dated 9/22/23, indicated the facility shall maintain an effective pest control program. This facility maintains and on-going pest control program for insects and rodents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675666 If continuation sheet Page 3 of 3