Inspection·March 26, 2024

F 0584 top sheet under her bedspread. Level of Harm - Minimal harm or potential for actual harm In an interview on 03/26/2024 at 9:20 AM the ADON stated the housekeeping department was operated by a third party and he was unaware the facility was low on top sheets. Residents Affected - Some Record review of the undated Face Sheet for Resident #3 reflected she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of Unspecified Dementia (condition characterized by progressive or persistent loss of intellectual functioning) without behavioral disturbance and Cognitive Communication Deficit (difficulty with thinking and how someone uses language). Record review of Resident #3's Comprehensive MDS dated [DATE] reflected she had a BIMS score of 14 indicating intact cognitive status. Observation on 03/26/2024 at 9:30 AM of Resident #3's bed revealed she had a bottom sheet and no top sheet under her bedspread. Record review of the undated Face Sheet for Resident #4 reflected he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Unspecified Dementia (condition characterized by progressive or persistent loss of intellectual functioning) Type 2 Diabetes (long term condition in which the body has trouble controlling blood sugar and using it for energy) and End Stage Renal Disease (condition in which the kidneys lose the ability to remove waste and balance fluids). Record review of Resident #4's Quarterly MDS dated [DATE] reflected he had a BIMS score of 14 indicating intact cognitive status. Observation on 03/26/2024 at 9:52 AM of Resident #4's bed revealed he had a bottom sheet and no top sheet under his bedspread. Record review of the undated Face Sheet for Resident #5 reflected she was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of Alzheimer's Disease late onset (common form of Dementia that begins after age [AGE]), Unspecified Dementia (condition characterized by progressive or persistent loss of intellectual functioning) and Epilepsy (neurobiological disorder marked by sudden episodes of sensory disturbance, loss of consciousness or convulsions, associate with abnormal electrical activity in the brain). Record review of Resident #5's Comprehensive MDS dated [DATE] reflected she had a BIMS score of 8 indicating moderate cognitive impairment. Observation on 03/26/2024 at 10:08 AM of Resident #5's bed revealed she had a bottom sheet and no top sheet under her bedspread. Observation on 03/29/2024 at 9:00 AM in the facility laundry room revealed there were no towels and no top sheets in the clean linen closet. In an interview on 03/26/2024 at 9:05 AM the Laundry Room Attendant stated there were five towels in the dirty laundry. Observation on 03/29/2024 at 9:58 AM in the rehabilitation unit revealed there were no top sheets or towels on the clean linen cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675837 If continuation sheet Page 2 of 4 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 675837 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kruse Village Senior Living Community 1700 E Stone St Brenham, TX 77833 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 - Some Observation on 03/29/2024 at 10:02 AM in the rehabilitation unit shower room revealed there were two bath towels, a purple one and a pink one. In an interview on 03/29/2024 at 10:05 AM CNA A stated she had worked at the facility for 10 years and they had recently had a shortage in the past month or two with a lack of top sheets and towels. She stated the pink and purple towel did not belong to the facility as the facility towels were all white. In a confidential interview on 03/29/2024 at 10:10 AM a staff member stated the facility had a shortage of bed sheets. In an interview on 03/26/2024 at 10:15 AM CNA B stated he made up the residents' beds without top sheets due to some family members coming to the facility early and he wanted the beds to look nice. In an interview on 03/26/2024 at 10:45 AM the ADON stated the housekeeping department was responsible for stocking the linen carts in the evening. In a confidential interview on 03/26/2024 at 11:00 AM a staff member stated it was amazing how things like linens showed up when surveyors arrived in the building. In an interview on 03/26/2024 at 11:53 AM the Housekeeping Supervisor stated she had been in that position for 8 months. She stated she did not know how many sheets or towels the facility needed, however, when she placed an order, it was for a dozen flat sheets and a dozen bath towels. She stated that's what her previous supervisor did. She stated she arrived at the facility at 7:00 AM and the laundry attendant arrived 6:30 AM. She stated the laundry attendant stocked the linen carts before she left the facility at 2:30 in the afternoon but there was no one to stock them in the evenings. She stated she thought some aides were throwing sheets and towels away, but she did not know that for a fact. She further stated that when she did the laundry, she never received enough flat sheets and towels back in the dirty laundry barrels. She stated she would put 15 towels out daily for the residents but agreed there were more than 15 residents in the facility. She stated they were going to put out more towels based on the census and not going to do what her previous supervisor did. In an interview on 03/26/2024 at 1:15 PM the Wound Care Nurse stated she had worked at the facility for 7 years. She said there had been shortages of mostly flat sheets and draw sheets on the 2-10 shifts and that problem had been worse in the past month. In an interview on 03/26/2024 at 2:29 PM the DON stated she had worked at the facility since October 2023. She stated the CNAs should be turning in their linen barrels before the laundry attendant leaves so the linens could be washed. She stated she, the ADON and the floor nurses were responsible for supervising the CNAs and ensuring they turned completed that task. In an interview on 03/26/2024 at 2;39 PM the laundry attendant stated she had worked at the facility for 9 years. She stated she arrived at the facility at 6:00 AM in the mornings and the washer took one hour and the dryer took 40 minutes to complete a load of laundry. She stated she had trouble getting the aides to bring her the dirty laundry. She stated they were not returning towels and flat sheets. She further stated she had only received one flat sheet back that morning. In an interview on 03/26/2024 at 2:55 Pm the Assistant Executive Director stated she had not received any complaints regarding laundry. She stated the Housekeeping Supervisor checked the laundry (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675837 If continuation sheet Page 3 of 4 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 675837 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kruse Village Senior Living Community 1700 E Stone St Brenham, TX 77833 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 - Some carts twice a day and the laundry lady stocked the carts. She stated the staff should know how to tell any supervisor if they were having issues with a shortage of linens. In an interview on 03/26/2024 at 3:40 PM the Executive Director stated his expectation was for residents to have top sheets, drawsheets and towels available. He stated the facility should have par levels of linens to meet the resident's needs. He stated he was the Interim Executive Director, and he was unaware there was an issue with the laundry, however, it would be addressed. Record review of a facility Policy and Procedure titled Resident Rights and dated 04/01/20208 and revised in January 2023 reflected Residents have the right to dignity, self-determined and person-centered care. The community must protect and promote the rights of all residents and ensure they are receiving the care and services they need. Safe Environment: A safe, clean, comfortable, and homelike environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675837 If continuation sheet Page 4 of 4