Health inspection·December 9, 2023

F 0644 know what medications he had been taking. Level of Harm - Minimal harm or potential for actual harm 12/06/23 11:56 AM Interview with MDS Coordinator who said she had worked at the facility for about 3 years but was new to her MDS Role and had only been working as an MDS Coordinator for 8 months. She said the RN at this facility could not sign the MDS' right now because she had to take a class. She said that she had been trained by corporate staff who had retired and then by Regional MDS staff. She said that the social worker was responsible for setting meetings with MHMRA or LIDAA. She said that she did not keep PASRR evaluation or Level II denial letters, and that perhaps the social worker had them. Residents Affected - Few 12/07/23 10:00 PM Interview and record review with MDS Coordinator who revealed that she was not aware the PASRR evaluation Level II had not been completed for Resident #53's after Resident # 53 was diagnosed with an intellectual disability of 03/01/2023. 12/07/23 2:00 PM Interview and record review with MDS Coordinator who revealed that she was responsible for completing the PASRR. She stated that completed PASSR Level 1 referral update on 12/07/2023 after surveyors kept asking for the PASARR positive list of the residents with a denial of services letter. She said Resident #53's PASRR on admission was negative and he was diagnosed with an intellectual disability of 03/01/2023. She said she did not know that all residents with negative level 1 PASRR were supposed to be reassessed after a diagnosis of an intellectual disability. She stated that the PASSR should have been completed within 24 hours of Resident #53's updated diagnosis. The MDS Coordinator did not say whether or not she had received any training regarding PASARR. MDS Coordinator did not reveal how monitoring to ensure it was done timely and accurately. She said she would wait to see what the recommendations were after the referral was processed. She did not know why the referral had not been completed on 3/01/23 and she said that it would be important for a resident to receive PASARR services if they qualified. The MDS Coordinator said that the potential risk to a resident for not having the corrected referral submitted to identify intellectual disability, would be that resident would not receive the necessary services qualified for. Record review of the facility's Resident Assessment-Coordination with PASARR Program policy dated implemented 6/2023 and Date Revised: 06/2023 revealed 9. Any resident who exhibits a newly evident or possible serious mental disorder, intellectual disability, or a related condition will be referred promptly to the state mental health or intellectual disability authority for a level II resident review .b. A resident whose intellectual disability or related was not previously identified and evaluated through PASARR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure the comprehensive resident-centered care plan was reviewed and revised by the Interdisciplinary team after each assessment for 1 of 18 residents reviewed for care plan accuracy (Resident # 80) in that: ---Resident # 80 was care planned for Restorative Care Program, but facility does not have a Restorative program This failure could place residents at risk of receiving inaccurate care and services. Findings include: Record review of Resident # 80's face sheet revealed a [AGE] year old male with admission date of 3/3/23 and diagnoses including traumatic brain injury (brain dysfunction caused by an outside force, usually a violent blow to the head), cerebral infarction (stroke), hemiplegia and hemiparesis (weakness and paralysis on one side of the body), following cerebral infarction, speech and language deficits following cerebral infarction, Diabetes (chronic disease causing elevated levels of blood glucose that cause damage to major organs) , depressive disorder (loss of interest), hypertension (high blood pressure), heart disease (damage of the major blood vessels of the heart), atrial fibrillation (irregular heart rate that causes poor blood flow). Record review of Resident # 80 care plan for limited physical mobility, undated, revealed intervention for Nursing Rehabilitation/Restorative: Bed Mobility Program, with restorative aide to perform Range of motion exercises in all planes 3 to 5 times a week. Record review of Resident # 80 MDS dated [DATE] revealed a BIMS score of 14, indicating no impairment of cognitive skills, limitation in range of motion with mobility impairments in upper and lower extremities and substantial/maximal assistance required for mobility. Resident # 80 was not coded as having therapy. Observation of Resident #80 on 12/05/23 at 04:00 PM revealed resident in bed, covered with sheet, awake, alert, but unable to talk (stroke), gave thumbs up sign when asked how he was doing. He was asked about assistance from staff with moving his limbs while providing care, and he gave a thumbs up sign. Observation of Resident #80 on 12/6/23 at 12:20pm revealed resident in bed, lunch tray on bedside table, resident picking at food, fork on table. CNA S came in room, asked if he wanted PBJ, unwrapped half sandwich, he took the sandwich and took one bite but put it down. CNA S went to get him more water and said he can feed himself. In further interview, she said the aides move his arms and legs while providing care throughout the day. Record review of Resident #80's clinical physician order dated 3/3/23 revealed ST and OT to evaluate and treat as needed. Physician order dated 12/5/23 revealed ST to evaluate and treat as needed. In an interview on 12/8/23 at 11:00 am, the Rehab Director said Resident # 80 had Physical Therapy for 8 weeks in April after he was admitted to the facility, and he was evaluated for therapy every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 quarter, and he was just evaluated by ST on 12/5/23. She said Resident # 80 was on Hospice services. Level of Harm - Minimal harm or potential for actual harm In an interview on 12/8/23 at 12:20 pm, the DON said there is no Restorative Program in the facility. She said the program ended, and CNA's work with the residents while they provide care. She said they did an audit of the care plans a few months ago to make sure the Restorative Program was removed, but they must have missed this one. She said the risk of having inaccurate care plans would be the resident would not receive proper care. Residents Affected - Some In an interview on 12/8/23 at 12:40 pm, the Administrator said they do not have a Restorative Program anymore because they did not have the necessary components. She said the Restorative program needed to be removed from the care plan since it was not accurate, and care plan should be correct for the care the resident receives. In an interview on 12/8/23 at 1:40 pm, the MDS coordinator said the Restorative program has been discontinued, and an audit was done of all the care plans to remove it, but Resident # 80's care plan was missed, but it would be removed, since care plans needed to be accurate. She said the risk of not having accurate care plans would be the resident would not receive proper care. In an interview on 12/8/23 at 2:40 pm, CNA S said Resident # 80 was on Hospice, and the Hospice aide comes twice a week to bathe him, and the aides in the facility check and change his brief as needed and perform some range of motion if he allows it. Record review of the facility policy on Care Plans, dated 9/3/20XX, read, in part, .care plan is revised every quarter, significant change of condition, annual or a resident condition change on an individualized basis . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interviews, the facility failed to provide pharmaceutical services, including procedures that ensure the accurate acquisition and administration of all drugs to meet the needs of 1 of 8 residents (Resident #67) reviewed for pharmaceutical services. - The facility failed to acquire and dispense Clonazepam 1 MG, an anticonvulsant (antiseizure) used to treat anxiety to Resident #67 as ordered from 11/5/23 through 11/9/23 and again on 11/24/23 and 11/25/23. This failure could place residents receiving medication at risk of inadequate therapeutic outcomes, increased negative side effects, and a decline in health. Findings included: Record review of Resident #67's admission Record dated 12/06/23 revealed, a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included: Wernicke's Encephalopathy (a life-threatening illness caused by thiamine deficiency, which primarily affects the peripheral and central nervous symptoms), anxiety disorder, and post-traumatic stress disorder. Record review of Resident #67's undated care plan revealed, Focus -The resident uses anti-anxiety medications r/t anxiety disorder. Goal- The resident will be free from discomfort or adverse reactions related to anti-anxiety therapy through the review date. Interventions- Administer ANTI-ANXIETY medications as ordered by physician. Monitor for side effects and effectiveness Q-SHIFT. Record review of Resident #67's Order Summary Report dated 11/01/2023 -11/30/2023 and printed on 12/8/23 at 1:34pm revealed only 1 medication listed Abilify Oral Tablet 10 MG (Aripiprazole) Give 1 tablet by mouth one time a day for Bipolar D/O. Prescriber Entered 11/10/2023 Discontinued 11/11/2023. Interview with Administrator and DON on 12/7/23 at 10:30am updated order summary report was requested to include all medications in November. Was not received prior to exit. Record review of Resident #67's November MAR revealed, Resident #67 did not receive Clonazepam 1 mg every 12 hours on the following days because the medication was not available: 11/05/23 scheduled for 08:00 PM 11/0623 scheduled for 08:00 AM and 08:00 PM 11/07/23 scheduled for 08:00 PM 11/08/23 scheduled for 08:00 AM 11/09/23 scheduled for 08:00 PM 11/24/23 scheduled for 08:00 AM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 0755 11/25/23 scheduled for 08:00 AM Level of Harm - Minimal harm or potential for actual harm Record review of Resident #67's nursing progress notes dated 11/6/23 by MA A revealed Note Text: (sic)Clonazepam Tablet 1 MG Give 1 tablet by mouth every 12 hours for (sic)ANXIETY Nurse reordered. Residents Affected - Some Record review of Resident #67's nursing progress notes dated 11/7/23 by CNA/MA C revealed Note Text: (sic)Clonazepam Tablet 1 MG Give 1 tablet by mouth every 12 hours for (sic)ANXIETY (sic) i talked to the nurse this med has been reordered waiting on arrival. Record review of Resident #67's nursing progress notes dated 11/8/23 by CNA/MA B revealed Created Date: 11/8/23 11:08 Note Text: (sic) clonazepam Tablet 1 MG Give 1 tablet by mouth every 12 hours for (sic)ANXIETY On order. Record review of Resident #67's nursing progress notes dated 11/8/23 by LVN C revealed Note Text: Nurse called the pharmacy around 7:30am, 11/7/23 to order clonazepam 1 mg. (a person) answered the call and she said his medicine is coming next delivery, but it didn't (sic) came so nurse called again pharmacy 11/8/23, 8:40 am they said they need new prescription, so nurse notified Dr. B he need new prescription. Record review of Resident #67's nursing progress notes dated 11/24/23 by CNA/MA A revealed Note Text: (sic)Clonazepam Tablet 1 MG Give 1 tablet by mouth every 12 hours for (sic)ANXIETY nurse to call Dr. Record review of Resident #67's nursing progress notes dated 11/25/23 by CNA/MA C revealed Note Text: (sic)Clonazepam Tablet 1 MG Give 1 tablet by mouth every 12 hours for (sic)ANXIETY med has been reordered waiting on (sic)arrival. Observation and interview of Resident #67 on 12/4/23 at 9:18am revealed he was lying in bed and appeared well fed and groomed and in no immediate distress, Resident #67 said they would rate facility a 6 out of 10 with only care concern related to not receiving Klonopin/Clonazepam on a couple of occasions because the medication had run out per staff. Resident #67 said they were ok on those occasions without the medication and had other as needed medications but Resident #67 said they did not want it to happen again because it was supposed to be a scheduled medication and did not know if a new prescription was needed. Resident #67 said they had not reported the issue to the physician or the facility administration through an official grievance. Resident #67 said it had not happened for the month of December so far. Telephone interview with CNA/MA B on 12/923 at 2:09 pm who said they did not remember the documentation on Resident #67 on 11/8/23. CNA/MA B said they did not normally work on Resident #67's unit and was not familiar with the resident or the Clonazepam order. CNA/MA B said that whatever was written on 11/8/23 must have been what happened and said that MA's do not have access to any emergency kits or the facility electronic emergency medication disbursement system (Nexsys). CNA/MA B said that they had been trained by facility to obtain and submit refill requests when a resident had at least 3 days of medication left and sometimes sooner if over a holiday or weekend. CNA/MA B said that they would have reported the medication being unavailable to the charge nurse because that was what they had been trained to do, per facility policy and procedure. Attempted interview/telephone interview with CNA/MA A on 12/8/23 at 10:33am and again on 12/9/23 at 2:06 pm. There was no answer and no return call prior to exit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Attempted interview/telephone interview with LVN B on 12/9/23 at 2:12pm. There was no answer and no return call prior to exit. Interview with LVN C on 12/9/23 at 2:14pm who said they did not recall Resident #67 ever being out of medication and then said it had been a long time since Resident #67 had been out of any medication. LVN C said they attempted to remove Resident #67's Clonazepam medication on 11/8/23 but the removal failed because the medication needed a new prescription and had no refills. They said that Clonazepam was a controlled substance and required a specific prescription and refill. LVN C said they did not know why or how Resident #67 ended up running out of Clonazepam at that time. LVN C said they did not want to speculate on why or how the medication did not get a refill prescription in time. LVN C said that the MA's give the scheduled medications for the facility's residents and the nurses give the as needed medications because anything as needed requires an assessment. LVN C said it would have been the MA's assigned to Resident #67 to report any refill issues to the charge nurse and that the MA's can even go higher and speak with ADON or DON if needed and if issue was not resolved or addressed. LVN C said they were only aware of Resident #67 being out of Clonazepam on 11/8/23 per their note. Interview with the DON on 12/9/23 at 2:30 pm who said that Resident #67 did not get Clonazepam 1 mg as scheduled in November 2023. The DON said they did not know why Resident #67 did not receive Clonazepam 1 mg as prescribed and did not know why Resident #67 did not have any refills or a new prescription per the nursing documentation. The DON said Resident #67 should have gotten the clonazepam without any gaps or delays due to ordering and that the nurses should have been able to get the medication from the facility emergency kit/Nexsys. The DON said they had conducted some updated in-service training with staff over the last couple of days and that they had reconfirmed all of the licensed nurses had access to the emergency medication kit/Nexsys. The DON said they had hired an ADON, and she will follow up on these things. Record review of facility policy and procedure titled Administration Procedures for All Medications and dated with a revision date(s) 08-2020 contained no information regarding refilling medications or controlled substance prescriptions. Record review of facility policy and procedure titled Controlled Substance Prescriptions dated Revision Date(s) 08-2020 revealed: Note: If an electronic health record (EHR) system is used, specific procedures should be. followed, and may differ slightly from the procedures for using paper physician order sheets, verbal telephone order sheets and MARs/TARs. Electronic systems also describe procedures for electronic signatures. Maintenance and support procedures for these systems are described in. the system user manuals. Procedures will vary between the various electronic systems available. The policy and procedure provided contained not information on timeframes for reordering scheduled controlled substance medications. Additional policies and procedures regarding reordering medications and timeframes for reordering medication and or emergency kit/Nexsys access were requested and not received prior to facility exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 infection for 6 of 15 residents (Resident #31, #47, 44, #54, #66, #67, #77) reviewed for transmission base precautions and infection control. Residents Affected - Some The facility failed to ensure LVN A implemented appropriate use of PPE and transmission-based precautions prior to enter and exiting residents' rooms (room [ROOM NUMBER] and room [ROOM NUMBER]) The facility failed to ensure LVN A washed or sanitized their hands after providing care to Resident # 44 who was on contact isolation. Corporate Nurse A failed to implement appropriate use of PPE and transmission-based precautions prior to entering and exiting Resident #42's room (room [ROOM NUMBER]) who was on contact isolation. The facility failed to notify family members, residents, or physicians about the possible RSV (Respiratory Syncytial Virus - contagious virus that causes infections of the respiratory tract) outbreak and was unable to articulate or show evidence of resident or staff testing for RSV or criteria for testing residents. These failures have the potential to affect residents by placing them at an increased and unnecessary risk of exposure to communicable diseases and infections. Findings included: Record review of Resident #54's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis of URI dated 12/1/23; a physician order and medication record revealed that Resident was stated on Amoxicillin for Upper Respiratory tract infection for 7 days, with a start date and time of 12/01/2023 at 9:00pm. Record review of Resident #67's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis of URI dated 12/4/2023; a physician order and medication record revealed that Resident was stated on Amoxicillin for Upper Respiratory tract infection for 1 day, with a start date and time of 12/04/2023 at 8:00pm and an additional order of Amoxicillin for Upper Respiratory tract infection for 4 days. Record review of Resident #77's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis of COPD dated 10/26/23; a physician order and medication record revealed that Resident was stated on Amoxicillin for Upper Respiratory tract infection for 4 days, with a start date and time of 12/02/2023 at 5:00pm Record review of Resident #31's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis of RSV dated 12/02/23. Record review of Resident #47's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis of RSV dated 12/02/2023. Resident #47 had no RSV test or test results. Resident #47 nurse progress notes revealed that Resident had a CXR for productive cough, fever of 100.5, and bilateral lung sounds on 11/30/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #66's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis of RSV dated 12/02/2023. The lab results provided for #31, #47 and #66 revealed positive RSV nasal swab results dated 12/1/23 indicating the residents were all positive for RSV. The provided facility roster revealed that these identified residents resided on the 100 hall of the facility. Record review of facility infection control tracking and trending log dated November 2023 revealed Residents #42, #27, #70, and CR #136 were being treated for URI. Residents #42, #27, #70, and CR #136 was not part of the sampled resident. Record review of Resident #44's face sheet dated 12/08/2023 revealed resident was admitted to the facility on [DATE], age [AGE] years old; resident had a diagnosis had no order for contact isolation and had a history of MRSA (methicillin-resistant Staphylococcus aureus. MRSA is a staph germ (bacteria) that does not get better with the type of antibiotics that usually cure staph infections. When this occurs, the germ is said to be resistant to certain antibiotics), E. Coli (Escherichia coli is a bacterium that is found in the lower intestine), ESBL (ESBL production is associated with a bacteria usually found in the bowel and can be resistant to some antibiotics) and Proteus Mirabilis (occur usually in patients under long-term catheterization. The bacteria have been found to move and create encrustations on the urinary catheters. Proteus mirabilis can enter the bloodstream through wounds. This happens with contact between the wound and an infected surface). Observation on 12/04/23 and 12/05/2023 revealed that both Resident #54 and Resident #67 resided on the 400 hall of the facility and there was no TBP postings or PPE observed in or around Resident #54 and Resident #67 room. Both was symptomatic for RSV and were being treated for Upper Respiratory tract infection. Observation, interview, and record review with Resident #77 on 12/4/23 at 09:30am revealed resident lying in bed awake wearing NC with 3L oxygen supply. Resident #77 stated she was being treated for RSV. There were no TBP postings or PPE observed in or around Resident #77's room and the door. Record review revealed resident had a diagnosis of URI and was being treated with antibiotics dated 12/1/23. Residen#77 resided on 100 hall of the facility, directly across from Residents #31 and #47 who was also being treated for RSV. Observation of Resident #44 at the main nursing station located in the middle of the facility, at 2:30 pm revealed the resident was seated amongst other residents gathered for a musical guest activity. Resident #44's dressing to her head and face was loose enough to visualize extensive wound to face that was exposed to air. Resident #44 was identified by the facility as a contact isolation resident as evidenced by posting on the resident's room door. Resident #44 resided on 300 hall of the facility. Observation, interview, and record review on 12/04/2023 at 2:45pm revealed that Corporate Nurse A walked into Resident #42's room without donning PPE. Resident #42's room was identified as Contact Isolation with signs posted on door and PPE set-up directly outside of the room. Observation of Corporate Nurse A walking in and out of Resident #42's room without donning/doffing PPE or washing his hands. Interview with Corporate Nurse A who said that he did not need to don any PPE to enter Resident #42's room because he did not touch anything. Corporate Nurse A stated that after leaving the room, Corporate Nurse A said that he was going to touch Resident #42's Foley catheter bag to lift it up off of the floor. When asked why the Resident was on Contact Isolation, Corporate Nurse A stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 Level of Harm - Minimal harm or potential for actual harm he did not know why the Resident #42 was on Contact Isolation. Corporate Nurse A donned PPE to re-enter Resident #42's room. Corporate Nurse A also said he had been fully vaccinated. Resident #42's room door remained open. Record review of Resident #42 physician order report dated 12/08/2023 revealed resident was place on contact isolation due to candida auris (is a type of yeast that can cause severe illness and spreads easily among patients in healthcare facilities). Residents Affected - Some Observation on 12/04/2023 at 2:47pm, LVN A was observed assisting Resident #44 back to her room on 300 hall, which was identified with posting on door Contact Isolation with signs posted on door and PPE set-up directly outside of the room. The door was open. LVN A observed entering the room with resident without donning any PPE. LVN A was not wearing a face mask or gloves and did not wash or sanitize her hands before or after entering the room. Observation on 12/04/2023 at 2:50pm who then walked across the facility to the100 hall and entered room [ROOM NUMBER] which was identified as Droplet Precaution for RSV and had with signs posted on door and PPE set-up directly outside of the room. The door was open. LVN A did not donn any PPE; was not wearing a face mask or gloves; and did not wash or sanitize her hands before or after entering the room. Both Resident #31 and Resident #47 were inside the room [ROOM NUMBER] at that time. The care provided to the residents at the time of the observation was not revealed by LVN A. Observation and Interview on 12/4/23 at 10:00am revealed Resident #31, Resident #47, and Resident #66 was placed Droplet Precaution for RSV and had PPE set-up outside the door. Interview with LVN A revealed that Resident #77 was being treated for an URI infection but had no PPE set-up outside or around Resident #77 's room. LVN A stated that she did not know why Resident #77 who was being treated for URI did not have signs posted on door and PPE set-up outside of the room. LVN A stated that no facility training had been provided on RSV. 12/04/23 09:19 AM Interview with Housekeeper J, revealed that he had worked for about 6-7 months. Peroxide based disinfectant used and appropriately labeled on cart. No facility training had been provided on RSV. Interview on 12/4/23 at 10:10am with CNA S stated that she did not know why Resident #77 who was being treated for URI did not have signs posted on door and PPE set-up outside of the room. CNA S stated that no facility training had been provided on RSV. Interview with Corporate Nurse A on 12/4/23 at 2:55pm who said that he did not know why LVN A entered the Droplet precaution rooms on 100 hall of the facility without proper PPE. Corporate Nurse A said that Residents #31 and #47 were on droplet precautions for RSV and that LVN A should have donned and doffed PPE properly. Interview with the ADON on 12/4/23 at 2:58 pm who said that LVN A walking in and out of Resident #44's room and in and out of Resident's #31 and #47's rooms without proper PPE was cross contamination. The ADON said that LVN A should not have done that. The ADON said that Residents #31 and #47 were on Droplet Precautions due to testing positive for RSV. The ADON said that they were testing residents for RSV based on resident symptoms but could not articulate which residents were symptomatic or how they were checking ADON stated that all positive resident resided on the 100 hall of the facility. The ADON was not aware Interview on 12/4/23 at 3:00 pm with the Administrator, ADON and Corporate Nurse A who said facility IP was out sick. The Administrator stated that IP A is responsible for the tracking and monitoring (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 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 675848 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Webster 17231 Mill Forest Webster, TX 77598 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some of communicable infectious disease within the facility. The Administrator stated that in IP A absences, the DON is responsible and is the designated IP back-up, but that DON was also absent on 12/04/2023 due to [NAME] Duty. The Administrator said that facility cases of RSV were first identified over the weekend (12/02/2023) and the Interdisciplinary Team had not had time to review what the next steps would be. The ADON, Administrator and Corporate Nurse A were unsure how many residents had tested positive for RSV and were unsure of how many residents were tested for RSV. The Administrator stated that she was unaware of how RSV was being tracked by IP A who was on sick leave as of 12/04/2023. The Administrator stated that education related to RSV had not been provided to staff as of 12/04/2023. The medical director had not been notified of the outbreak as of 12/04/2023. The Administrator revealed that the facility did not have an implemented system in place to ensure the prevention of further resident infections. The Administrator revealed that nothing had been done to mitigate the risk of others (residents/staff) being infected. Interview on 12/5/23 at 1:30pm, the ADON revealed that IP A had not completed the required training (CDC Nursing Home Infection Preventionist Training Course) and the DON was the backup IP. The Administrator fail to provide documentation of training/competency for IP A as of 12/05/2023. Interview on 12/05/2023 at 4:09pm, [NAME] County Public Health Infectious Disease Epidemiologist stated that the facility had not reported the RSV outbreak. Per the information provided, definition for respiratory outbreaks outbreak in a long-term care facility is three or more cases occurring within 72 hours in residents who are in proximity to each other (e.g., in the same area of the facility), OR a sudden increase of cases. Per the Epidemiologist the facility was required to report the RSV outbreak. As of 12/05/2023 at 11:00am the facility had not provided any lists of residents who had been tested for RSV or any additional RSV results since 12/1/23 as requested by the surveyor from the Administrator and ADON at 8:30am, 11:30, and 4:30pm on 12/04/203. Record review of the facility's policy titled, Infection Control - Transmission - Based Precautions For Infection, with and effective date of 11/10/2019 and last revised on 10/24/22 revealed Droplet-In addition to Standard Precautions, use droplet precautions (gown, gloves, mask) for a resident known or suspected to be infected with microorganisms transmitted by droplets that can be generated by the resident sneezing, coughing, talking, etc. and drop from the air. These incudes bacterial infections and some viral infections Spatial separation >6 feet and only co-horting residents with same virial infection in the same room with droplet route. If resident must leave room the resident should wear a surgical facemask. Record review of the facility's policy titled, Infection Control - Transmission - Based Precautions For Infection, with and effective date of 11/10/2019 and last revised on 10/24/22 revealed Contact-In addition to standard precautions, use Contact precautions (gown, gloves, mask or face shield if splashing could occur) for residents known or suspected to be infected with microorganisms that can be easily transmitted by direct or indirect contact includes epidemiologically important organisms (Multidrug-resistant organisms) such as methlcillin-resistant Staphylococcus aureus (MRSA} and vancomyclnresistant Enterococcus (VRE), other highly transmissible infections such as C/ostridium difficile and herpes (simplex or zoster), other transmissible conditions such as impetigo, pediculosis, scabies, and conditions such as a rash of unknown origin, conjunctivitis, draining wounds, etc FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 If continuation sheet Page 11 of 11