Inspection·June 3, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #2's MDS revealed Resident #2 BIMS score was not available as the resident was unable to complete the interview. The MDS reflected resident #2 has impairment on both sides of the lower body and she uses a wheelchair. Resident # 2 is dependent for: oral care, toileting, shower, putting on and taking off footwear. Resident # 2 needs partial to moderate assistance for personal hygiene such as combing hair, applying makeup, washing, or drying her face and hands. Resident # 2 needs substantial assistance regarding upper and lower body dressing. Record review of Resident #2's care plan revealed Resident #2 was at risk and or has potential for complications with deficits with ADL's. The care plan stated Resident #2 required dependent assistance with dressing. 3. Record review of Resident #3's Face sheet dated 06/03/2025 revealed Resident #1 admitted on [DATE] was a 92 -year-old female with diagnosis of Unspecified Dementia (a general name for a decline in cognitive abilities that impacts a person's ability to perform everyday activities), Obstructive and Reflux Uropathy (When urine can't flow through your ureter, bladder, or urethra due to some type of obstruction), Insomnia (having a hard time falling asleep at night). Record review of Resident #3's MDS revealed Resident #3 had a BIMS score of 07 which indicated severe cognitive impairment. Residents Functional Abilities indicate that Resident # 3 requires substantial/ maximal assistance for oral hygiene, toileting, and personal hygiene, as well as bathing, upper body, and lower body dressing. Record review of Resident #3's care plan revealed Resident #3 was at risk and/or has potential for complications with deficits with ADLs. Interventions: Resident # 3 required dependent assistance with dressing and other grooming. During an attempted interview on 6/3/25 at 9:05 AM with Resident#1 revealed she was not able to converse with the Investigator. She was wearing a top that was disheveled and had a dried brown substance stain on it. During an interview and observation on 06/03/2025 at 9:24 AM revealed Resident # 2 was located at the nursing station, she was sitting in her wheelchair holding a stuffed animal to her chest. Resident was not conversant. Resident # 2's hair was slightly disheveled. There were some unkept facial hairs and crumbs were on her slacks. During an interview and observation on 06/03/25 at 8:58 AM revealed Resident # 3 was not conversant. Resident # 3 was sitting in a wheelchair by the nursing station. There were crumbs on her blue top and on a blue blanket that was situated on her lap. Her fingernails were painted but a brown substance was visible under and around her fingernails. Resident # 3's face was soiled and appeared unclean. During an interview with CNA A on 06/03/2025 at 2:50pm revealed that she was trained on ADLS. She said the training covered proper training includes, transfers, greetings, body care, feeding, bathing, clothing. She said the last time she had the training was recently in a mandatory meeting. She said the ADL policy was to change the resident right away, she said to do a check and change which meant staff were to check the resident and if needed change the resident. She said the CNAs were responsible for ensuring that the residents were clean and well groomed. She said it was important to provide ADL care to the residents to ensure that they do not have skin breakdown and it makes the resident feel good when they are clean and groomed. She said the charge nurse monitors to ensure that ADL (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 06/03/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some care is being done. She said the nurse monitors it by doing a skin assessment, and checking the shower sheets, she said she did not know why Resident #1, Resident #2, and Resident #3 all had dirty clothing on. During an interview with CNA B on 06/03/2025 at 3:11pm revealed that she was trained on ADLS. She said the training covered, bathing, helping the resident with grooming cutting the resident's nails, clothing, and bathing the resident. She said the last time she had the training was in May. She said the ADL policy was to change the resident every two hours. She said they do a check and change which meant staff were to check the resident and if needed change the resident. She said the CNAs were responsible for ensuring that the residents were clean and well groomed. She also said that nail care was done on Sunday since there were no shower on Sundays. She said it was important to provide ADL care to the residents to prevent infection and skin She said the charge nurse monitors to ensure that ADL care is being done. She said the nurse monitored it by checking PCC charting. She said Resident #1, Resident #2 and Resident #3 may have gotten dirty at breakfast. During an interview with MA C on 06/03/2025 3:23pm revealed that she had been trained on ADLS. She said the training covered gate belt, transfers, changed every 2 hrs. She said she had the training during her 4 days of orientation. She said that the policy for ADLS was to do the check off list and greet the resident. She said staff should be providing care every two hours or PRN. She said that if a resident needed clothing changed or grooming that staff were supposed to get it done. She said everyone was responsible to ensure ADL care was done. She said it was important to do the ADL care because the residents could not do it themselves. She said by not doing ADL care for the resident could make them feel bad. She said that the Charge Nurse, and DON were responsible for monitoring that all staff did ADL care. She said that the nurse checks documentation in PCC. She said she did not know why Resident #1, Resident #2 and Resident #3 were in dirty clothing. During an interview with the DON on 06/03/2025 at 3:50 PM revealed that she had been trained on ADLS. She said the training covered grooming, teeth, nails, shampooing, bathing, dressing undressing, transfer lift. she said the facility had a 2-day ADL skills training March 2025 on Resident Rights. She said the policy for ADL care was provide whatever level of assistance they may need. Modified independence. She said ADL care should be provided when needed. She said grooming was an as needed thing, and it should be done on a regular basis. She said on Sundays the staff did extra care, like nail polish if it was wanted. she said the CNA, Charge nurse, ADON, DON were responsible for ensuring ADLS were done. She said it was important to make the resident feel better if they are clean and dry, they have a sense of well being and they have less skin breakdown. She said the resident would have dignity and feel good about themselves. she said if a resident was not groomed, or their clothing was dirty it might make the resident feel bad about themselves. She said the charge nurse was responsible for monitoring to ensure staff were doing ADL care. She said the charge nurse would look at POC every morning-to see docs, did they miss some documentation. She said she did not know why Resident #1, Resident #2 and Resident #3 were in dirty clothes. She said her expectation was that the residents would have been taken down to their rooms for cleanup. During an interview with the Admin on 06/03/2025 at 5:32 PM revealed that she and staff have been trained on ADL care. She said the training covered bathing, feeding, transferring, dressing. She said the last time she had the training was in February of 2025. She said the policy was to make sure residents received the amount. of ADL care they need. She said that staff should provide ADL care as needed daily. She said staff were to make sure all residents were looking presentable, looking nice. Oral care, hair is combed. She said that nursing assistants and charge nurse, and CNAs were responsible for providing ADL care. She said it was important for the residents overall grooming, everyone (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 06/03/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some deserves dignity. She said that she assumed the resident would not like being dirty and that the residents wanted to be well presented. She said the charge nurses were responsible for monitoring to ensure staff did ADL care. She said the charge nurse monitored the ADL documentation is on PCC. Check on morning rounds also called Ambassador rounds. She said if something was noticed the staff should say something to the Admin. She said she did not know why Resident #1, Resident #2 and Resident #3 were left in dirty clothing. Record review of the facility's policy dated November 2023, revealed: A resident who is unable to carry out the activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675837 If continuation sheet Page 4 of 4