Health inspection·August 29, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Review of Resident #4's Order Summary Report, dated 8/28/23, revealed orders for Gabapentin 100 mg for pain beginning 5/10/23. Review of Resident #4's Care Plan, last updated 6/12/23, revealed no care plan addressing her cognitive needs or pain status. Residents Affected - Some Review of Resident #8's admission Record, dated 8/29/23, revealed She was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Acute Respiratory Failure with Hypoxia (condition in which there is not enough oxygen in the tissues of the body), dementia without behavior disturbance, heart attack, and depression. Review of Resident #8's Significant Change MDS Assessment, dated 8/16/23, revealed: Resident #8 had a mental status of 0 of 15 (indicating severe cognitive impairment) and signs and symptoms of delirium including inattention, disorganized thinking, and altered levels of consciousness. Resident #8 had a decline in behavior, but the behavior was not indicated. Review of Resident #8's care plan, last updated 8/27/23, revealed no care plan for delirium or the decline in behavioral symptoms. Review of Resident #11's admission Record, dated 08/29/23, revealed the resident was an [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses including dementia, moderate protein calorie malnutrition, Type 2 Diabetes, and Gastrostomy status. Review of Resident #11's admission MDS Assessment, dated 7/31/23, revealed: He had a cognitive score of 7 of 15 (indicating he was severely cognitively impaired) He needed extensive assistance of two staff for transfers, locomotion, dressing, toileting, and personal hygiene. Review of Resident #11's care plan revealed no care plan for his ADL status. Review of Resident #57's admission Record, dated 08/29/23, revealed he was a [AGE] year-old male, admitted to the facility 07/26/23, with diagnoses which included Type 2 Diabetes Mellitus, major depressive disorder with psychotic symptoms, hypertension (high blood pressure), benign prostatic hyperplasia (enlargement of the prostate that can cause difficulty with urination), and chronic obstructive pulmonary disease (lung disease that blocks airflow). Review of Resident #57's admission MDS Assessment, dated 08/07/23, revealed: He scored a 14 on his mental status exam (indicating no cognitive impairment). Section O indicated he received hospice services while he was a resident of the facility. Review of Resident #57's Comprehensive Care Plan, revised 08/28/23, revealed no care plan for hospice services. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 2 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 8/29/23 at 4:11 p.m. the MDS Coordinator, she stated she did the care plans for every resident. The MDS Coordinator said things that needed to be care plan was almost everything. The MDS Coordinator elaborated and stated resident allergies, communication, diagnoses, smoking. The MDS Coordinator stated she would expect to see a care plan on dialysis. The MDS Coordinator stated a care plan on delusions would depend on the resident's diagnosis and the issue might be under dementia care. She said a care plan on cognitive status would depend on the resident's mental status ability. The MDS Coordinator stated she care planed physical or verbal behaviors separately from dementia. The MDS Coordinator stated she should have done a care plan for pain if the resident took scheduled pain medication; she said she would do a care plan for Gabapentin. The MDS Coordinator stated she would do a care plan for hospice. She reviewed Resident #57's care plan and said she did not see a care plan for hospice. The MDS Coordinator stated she was informed of resident changes during morning meeting. She stated that when Resident #57 was admitted to the facility, he was already on hospice services and when she was made aware that he had no order for hospice, she stated it had been overlooked. The MDS Coordinator explained her process was on Mondays, she would pull the previous 72-hour reports and review them and on the weekdays, she would pull the 24-hour report. The MDS Coordinator said if the nurses were not documenting everything, she had no way to know if there were changes. Interview on 8/29/23 at 5:16 p.m. the DON, she stated her expectation on care plans was that everything be care planned to include falls, behaviors, if the resident took a psychoactive medication, code status, diet, if they were long or short-term residents. The DON stated everything should be care planned and it spelled out how to take care of the resident. The DON said she would expect a care plan on pain to include what medication, where the pain was, and interventions to relieve the pain. The DON stated she would expect a care plan on oxygen to include liters per minute, the range of oxygen to be used, what parameters the resident needed to stay in. the DON said her expectation for a hospice care plan would include which hospice agency the resident was with, why they were on hospice, division of labor and the resident's code status. Review of facility policy Comprehensive Care Plan, last revised 04/25/21, revealed, in part: The Interdisciplinary Team will review the healthcare practitioner's notes and orders (e.g., dietary needs, medications, routine treatments, etc.) and implement a Comprehensive Care Plan to meet the residents' immediate needs including but not limited to: a. Initial goals based on an admission include GG Section Discharge goals b. Physician orders c. Dietary orders d. Therapy services (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 3 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 0656 e. Level of Harm - Minimal harm or potential for actual harm Social services f. Residents Affected - Some PASRR recommendation, if applicable g. Skin prevention h. Fall prevention i. Pain management j. Advance Directives k. Immunizations (Flu/PA/COVID-19) l. Psychosocial Mood State/Adjustment to Placement/PASRR Needs as indicated m. Specific Care Plan on the main reason for admission to the community, i.e., dementia, ORIF, CHF, etcetera. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 4 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 (Resident #11) of 12 residents reviewed for quality of care. Residents Affected - Few The facility failed to document or communicate that the resident was removing his tube feedings during feeding times. This resulted in Resident #11 not receiving his full recommendation of prescribed formula. This failure placed residents at risk of decline and weight loss. Findings included: Review of Resident #11's admission Record, dated 08/29/23, revealed the resident was an [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses including dementia, moderate protein calorie malnutrition, Type 2 Diabetes, and Gastrostomy status (feeding tube). Review of Resident #11's admission MDS assessment, dated 07/22/23, revealed: He had a mental status of 7 of 15 (this indicated severe cognitive impairment) He received 51% or more of his nutrition and hydration through a feeding tube. Review of Resident #11's Care Plan, revised on 08/15/23, revealed: Problem: The resident requires tube feeding PEG TUBE related to Dysphagia, swallowing problem. Interventions included: the resident was dependent with tube feeding and water flushes. See doctor orders for current feeding orders; discuss with the resident/family/caregivers any concerns about tube feeding, advantages, disadvantages, potential complications to evaluate quarterly and as needed. Monitor caloric intake, estimate needs. Make recommendations for changes to tube feeding as needed. There was no care plan addressing Resident #11 disconnecting himself from the feeding pump. Review of Resident #11's Order Summary Report for 8/27/23 revealed orders for: Nothing by mouth diet beginning 8/2/23 related to Gastrostomy Status. Formula 1.5 at 50 ml/hr. over 22 hours and 50 ml/hr water flushes every shift for nutrition beginning 8/1/23. In an interview on 08/27/23 at 03:00 pm, Resident #11's family said the Resident #11 disconnected himself from the tube feedings to use the rest room and did not reconnect himself after. Observation on 08/27/23 at 03:30 pm revealed staff cleaning Resident #11's room due to tube feeding formula on the floor. In an interview on 08/28/23 at 04:40 PM. CNA F stated Resident #11 disconnected the feeding tube (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 5 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few all the time. CNA F stated Resident 311 constantly removed the feeding tube to go to the restroom or just to walk around. CNA E stated Resident #11 disconnected himself since he was admitted . RN G said Resident #11's family told her that Resident #11 used to disconnect himself at home a lot. RN G stated after Resident #11 disconnected himself from the feeding pump Resident #11 would normally leave the tube from the pump with the feeding formula on the bed. RN G stated she talked to the family about Resident #11 disconnecting from the pump but did not communicate the issue to anyone at the facility. In an interview on 08/29/23 at 10:35 AM, CNA F stated when she saw Resident #11 not connected to the feeding pump, she told the nurse so the nurse could hook Resident #11 back up to the pump. Review of the facility's job descriptions for Charge Nurse, undated, revealed: Essential Functions: Maintains acceptable standards of patient care. Identifies problems and guides personnel to their solution. Assess for and notifies physician and other appropriate parties of changes in condition. Uses assessment information to develop a care plan before the end of duty time that communicates enough information for incoming personnel to adequately care for the patient. Review of the in-service completed 3/10/23 by the DON revealed: all new orders, new admits, changes of conditions etc. must be documented on. Review of the facility's policy titled Quality of Life-Dignity, revised August 2009, revealed: Policy statement: Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 6 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to store all drugs and biologicals in locked compartments for 4 of 4 medication carts at the nurses station reviewed for medication storage in that: 1. The facility failed to ensure LVA A secured the medication carts when they were left unattended. 2. The facility failed to ensure LVN B secured the treatment cart when it was left unattended. These failures could place residents at risk for drug diversion or accidental ingestion. Findings included: During an observation on [DATE] at 11:00 AM 4 medication carts and a treatment cart were all seen unlocked and unattended at the nurses station. Inside the cart were several medication packets and pill bottles, wound care supplies and scissors. During an observation on [DATE] at 11:50 AM, the treatment cart was seen unlocked and unattended for approximately 7 minutes. The DON walked by twice and failed to notice the unlocked unattended cart. Inside the cart were several medications, ointments, and scissors During an interview on [DATE] at 11:05 AM, LVN A said that she was monitoring them from the nurses desk and had just walked away for a short time. LVN A stated that she worked at facility for 10 years and was aware that the med carts and treatment carts should be locked at all times. During an interview on [DATE] at 12:00 PM, the DON stated that staff probably left the carts open for convenience. DON stated that staff knew better and took advantage of the fact that it was a Sunday and she was not in the facility. During an interview on [DATE] at 03:00 PM, LVN B stated that he pushed the lock button but didn't notice that it did not lock. LVN B statedthat he was nervous because he was being observed for wound care. During an interview on [DATE] at 3:30 PM, the ADON, stated that all department heads round the halls daily and they are aware that medication/treatment carts should always be locked. If they find an unlocked medication/treatment cart, they lock it and notify us. The ADON stated full time staff is usually good about it, but our PRN staff are not. ADOn stated that she has constantly reminded staff and provided training and in-services. During an interview on [DATE] at 5:16 PM the DON stated she monitored carts. The DON said she monitored the contents of the carts to make sure they were dated as necessary and not expired. The DON said she did check carts to see if they were locked. The DON said she checked them as she walked by. When informed of the [DATE] observation of her walking by the unlocked, unattended treatment cart, the DON covered her face with her hands and stated I did. The DON said the carts were easier to check when they were at the nurse's station. The DON was told all the medication carts were unlocked and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 7 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 0761 unattended on [DATE] at entrance. The DON stated I thought it was just one cart, not all of them. Level of Harm - Minimal harm or potential for actual harm Record review of the facility policy titled storage of medications revised 08/2020 indicated in part: medications and biologicals are store safely, securely, and properly. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Residents Affected - Some Only licensed nurses, pharmacy personnel, and those lawfully authorized to administer medications (such as medication aids) are permitted to access medications. Medication rooms, carts, and medication supplies are locked when they are not attended by persons with authorized access. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 8 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain an infection control program designed to prevent the development and transmission of infections for 2 of 4 residents (Resident #16 and #61) reviewed for infection control. Residents Affected - Few 1.CNA C failed to perform hand hygiene appropriately while providing incontinent care for Resident #16. 2.CNA D failed to perform hand hygiene appropriately while providing incontinent care for Resident #61. These failures could place residents at risk for transmission of diseases and organisms. The findings included: Review of Resident #16's Resident Face Sheet dated 08/29/23 revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Type 2 diabetes mellitus, hypertension (high blood pressure), peripheral vascular disease (circulatory condition where narrowed blood vessels reduce blood flow to the limbs), chronic atrial fibrillation (irregular heart rate caused by poor blood flow), stage 3 kidney disease (mild to moderate). Review of Resident #16's Quarterly MDS, dated [DATE], revealed: Resident had BIMS score of 15, which suggested resident was cognitively intact. He required extensive to total assistance of two or more staff for all ADLs. He was occasionally incontinent of bowel and bladder. He had an amputation of right leg below the knee and uses a wheelchair. Review of Resident #16s Care Plan, dated 06/08/23, revealed: Problem: resident is incontinent and at risk for skin breakdown related to Diabetes Mellitus, Fragile Skin, Immobility, Incontinence, Physical Impairment Goal: will remain clean, dry, and odor free with no occurrence of skin breakdown throughout the review date. Interventions: Monitor for incontinence every 2 hours or as needed, change promptly and apply protective skin barrier; monitor for s/s of skin break down and report abnormal findings to physician, assess for causes of incontinence, labs as ordered by MD, encourage fluid intake within dietary limits, monitor for s/s of infection and notify physician. Review of Resident #61's Resident Face Sheet dated 08/29/23 revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Type 2 diabetes mellitus, hypertension (high blood pressure), chronic atrial fibrillation (irregular heart rate caused by poor blood flow), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 9 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 ischemic cardiomyopathy (hearts decreased ability to pump blood properly), dementia (progressive loss of intellectual functioning) Level of Harm - Minimal harm or potential for actual harm Review of Resident #61's admission MDS, dated [DATE], revealed: Residents Affected - Few Resident had BIMS score of 11, which suggested resident was moderately cognitively intact. He required assistance of one staff for all ADLs. He was frequently incontinent of bowel and bladder. He uses a wheelchair. Review of Resident #16s Care Plan, dated 06/08/23, revealed: Problem: I am at risk for Skin Breakdown related to: Diabetes Mellitus, Incontinence Goal: will remain clean, dry, and odor free with no occurrence of skin breakdown throughout the review date. Interventions: Monitor for incontinence every 2 hours or as needed, change promptly and apply protective skin barrier; monitor for s/s of skin break down and report abnormal findings to physician, assess for causes of incontinence, labs as ordered by MD, encourage fluid intake within dietary limits, monitor for s/s of infection and notify physician. Observation on 08/27/23 at 11:24 AM of Resident #16's incontinent care, CNA C pulled curtain for privacy, donned gloves. Residents soiled brief was pulled down in front, and front perineal area was wiped clean with wet wipes. CNA C disposed of wet wipes in trash can. Resident turned to right side, with assistance of CNA C. Residents buttocks were wiped with wet wipes until free of bowel movement. CNA C disposed of wet wipes in trash can. Soiled brief and sheet were removed and placed in bag. CNA C placed a clean brief placed under resident, resident rolled to back, brief was secured. CNA C placed a pillow under residents leg and pulled blanket up to cover legs. CNA C doffed gloves but did not use hand sanitizer or wash hands after doffing gloves. Observation 08/28/23 at 11:45 AM of Resident #61's incontinent care, CNA C and CNA D donned gloves. CNA C wiped patients groin area with three wet wipes and placed the soiled wipe directly onto the resident's bed. CNA D assisted resident to his right side. CNA D wiped residents buttocks clean with wet wipes which she disposed of in the trash can, CNA D removed soiled brief and disposed of it in the trash can. CNA D placed clean brief under the resident, secured the brief and helped pull residents pants back up. CNA C then picked up the case of wipes and moved them to foot of bed. Both CNA's then doffed soiled gloves and assisted resident into the wheelchair. CNA C and CNA D did not use hand sanitizer or wash hands after doffing gloves. During an interview on 08/29/23 at 3:10PM with ADON/ Infection Preventionist, stated that her expectations for staff is to wash hands before all resident care. Staff should knock on door, introduce themselves, wash hands, don gloves. Staff should then provide incontinent care, then doff gloves. Staff should wash hands, don new gloves prior to applying new brief. All staff should be washing hands before they leave the room. The ADON was informed of the observation and stated the facility did proficiency checks on hire and quarterly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 10 of 11 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 675751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Odessa 2443 W 16th St Odessa, TX 79763 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 Review of the facility's staff skills competencies on incontinent care, dated 06/13, revealed: Level of Harm - Minimal harm or potential for actual harm 1. Prepare for process, obtain supplies, and wash hands. 2. Prepare work area Residents Affected - Few 3. Wash hands 4. Remove soiled brief and place in bag. 5. Doff gloves, wash hands, don new gloves. 6. Clean the resident, doff gloves and place soiled items in bag. 7. Wash hands and don new gloves. 8. Position clean brief under resident, apply barrier cream. 9. Doff gloves, wash hands, position resident for comfort 10. lower bed and place call light in reach, wash hands. Review of the facility's policy titled; Hand Hygiene revised on 10/24/2022. Policy statement reads: Hand hygiene is used to prevent the spread of pathogens in healthcare settings. Hand hygiene is a general term that describes hand washing using soap and water or the use of an alcohol-based hand rub to destroy harmful pathogens, such as bacteria and viruses, on the hands. 1. You should always perform hand hygiene before providing any type of care. 2.You must perform hand hygiene after contact with bodily fluids, such as urine. The following procedures are the recommendations from CDC's new hand hygiene guidelines. Indications for hand hygiene include: -Anytime you remove protective gloves or PPE. -Before or after treating a cut or a wound. -Between performing different procedures on the same resident. Note: wearing gloves does not replace the need for hand hygiene FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675751 If continuation sheet Page 11 of 11