Health inspection·November 18, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some showers, lower body dressing and putting on or taking off footwear. In an observation and interview on 11/12/25 at 11:16 a.m. in Resident # 1's room, the floor had stains, food crumbs and plastic wrappers. Resident #1 was seated on her bed and when asked if staff cleaned her room, she said no. Resident #1 said the floors in her room were often dirty, and sticky and rarely swept or mopped. Resident #1 said she had bugs and the pest people would put out traps. Observed several round black disks in all four corners of her room, behind the toilet in the corners of her bathroom and around the entrance of her bifold closet door. During an observation and interview on 11/12/25 at 5:48 p.m. in Resident # 1's room, the floor remained stained with food crumbs and plastic wrappers. Resident #1 was seated to the side of her bed and was eating from a dinner tray. Resident#1's family member was seated in a chair at the bedside. Resident #1 said no one cleaned her room [ROOM NUMBER]/12/25. The family member said they visited Resident # 1 almost daily. The family member said they had not complained or said anything to management because they did not want to cause any trouble and usually when they point out the mess or lack of cleaning in the room to the resident's aide or nurse, someone comes to clean the room shortly thereafter. Resident #1 then said that if she asks someone to clean the room, they usually would l when they got around to it, but no one had on 11/12/25. Resident #1 shrugged her shoulders when asked how it made her feel when her room was not cleaned daily. Resident #1's family member said the facility should clean the residents' rooms daily. In an observation and interview on 11/18/25 at 1:17 p.m. in Resident #2's room, the floor was dirty with food crumbs, and stains that appeared to be dried coffee. The floor felt sticky with surveyor shoes sticking to the floor and the floor making squeaky noises when stepped on. Resident #2 was in bed and said his room was cleaned daily but had not been cleaned yet on 11/18/25. Resident #2 said normally the staff cleaned his room in the mornings, but it could be any time of day because there was no designated cleaner assigned to his hall. Observed the bifold closet door in Resident # 2's room off the top track and hanging forward out of the closet frame. Resident #2 said he complained that the closet doors did not open or close properly but could not remember who he told or when he reported it. Observed the footboard to Resident #2's bed splintered and broken. The resident said he had not noticed. Observed the light fixture above Resident #2's head of bed where he was laying was broken and cracked, with jagged pieces of plastic sticking out. Resident# 2 said a lot of things at the facility were broken or run down but it was home for now, and he was ok because the people treated him well and no place was perfect. Resident #2 said he would prefer if housekeeping cleaned in the morning and again in the evening but would be happy with once daily. Resident #2 said he there were ants crawling on him one time but could not recall when that happened. Resident #2 said it happened once and he had not seen any bugs, pests, insects, or rodents. Interview with DON and Administrator on 11/18/2025 at 1:24 p.m. in Resident # 2's room, the Administrator said he was unsure why Resident #2's room was not cleaned yet for the day. When shown the hanging, inoperable bifold closet doors, the Administrator said they should have reported that, and he would have maintenance fix it. When asked who he meant by the term they, he said the staff and or the resident. When shown the splintered footboard of Resident #2's bed the Administrator said they would have to fix that. When shown the dirty floor, the DON said Resident #2 sometimes threw trash on the floor. When asked when resident rooms should be cleaned both the Administrator and DON said daily. Both the Administrator and DON said Resident #2 notified them of any of the issues in his room. When asked if administrative staff conduct any kind of daily room rounds, the Administrator said yes and said the Central Supply/transport person was the assigned department head for Resident #2's daily room rounds, and he would have to locate her daily rounding sheets. Interview with Housekeeper A on 11/18/2025 at 3:44 p.m. said she worked at the facility for about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 If continuation sheet Page 2 of 7 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 11/18/2025 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some a month and had completed her assigned hallway for cleaning, which was 100 hallway. Housekeeper A said that 200 Hallway was a hallway they all split because there were only 3 housekeepers and 4 hallways. She said 200 hallway did not have a designated regular daily housekeeper. Housekeeper A said she cleaned the front of 200 hallway, but Housekeeper B signed the sheet that she did it instead. She said the Housekeeping Manager assigned the housekeeper to split 200 hall and each of them had a designated area of that hallway to clean but Resident #1's and Resident #2's rooms were not part of her assignment. Housekeeper A said they had not seen any live bugs or insects but saw bait traps in various resident rooms on all four hallways. Housekeeper A said all the residents' rooms should be cleaned daily because resident deserved a clean room. Interview with Housekeeper C on 11/18/2025 at 3:48 p.m., said she worked at the facility for five years and the housekeeping department was having trouble retaining staff. She said that 200 hallway was the only hallway that did not have a regularly assigned housekeeper and the three housekeepers working that day, including herself, were assigned to split 200 hallway but the back of 200 hall, which included rooms [ROOM NUMBERS] were not her assigned rooms. Housekeeper C said the assignment sheet was in the housekeeping office. Housekeeper C said she saw flies and roaches on 200 hall in the past but not recently. Housekeeper B said she reported any insects to administrator, her supervisor (when they had one) and maintenance so they could contact pest control. Housekeeper C said the rooms can get dirty and floors should be swept and mopped, bathrooms cleaned, and trash emptied at least daily. Interview with Housekeeper B on 11/18/2025 at 3:53pm who was actively cleaning Resident #2's room, Housekeeper A said she worked at the facility since June 2025 and had cleaned on the front of 200 hallway earlier in the day but had not made it to the back of 200 hallway yet. She said that the housekeepers usually split 200 hallway because there was no permanently assigned housekeeper for that hall. Housekeeper B said Resident #2's room was dirty on the floors, but she cleaned it daily whenever she worked. Housekeeper B said that she may not always clean her assigned area on 200 hall in the morning but completed it daily prior to the end of her shift. Housekeeper B said having food debris on the floor was not acceptable because it could attract pests or insects which she said she had seen before all around the facility. Housekeeper B said she saw flies, gnats, and roaches on 200 hall in the past. Housekeeper B said she reported any insects to the administrator, her supervisor and maintenance so they could contact pest control. In an interview with the Administrator on 11/18/25 at 4:03 p.m. the surveyor requested the 200-hallway assignment sheet for 11/18/2025. In an interview on 11/18/2025 at 4:50 p.m., the Maintenance Director said he started working at the facility on 10/31/25 and was not asked to assist with the building's pest control. He said he was asked to notify the pest control company, which he did. He said residents and staff complained about pests, including roaches and rodents, throughout the facility. He said the pest control program was ineffective because some of the pests could have nests in the walls. He said some areas of the building seemed to be worse than others. He said some of the residents' rooms on 200 hall were affected but could not recall which ones. He said since working at the facility, he had mainly been doing painting and touch-ups of rooms and only completed repairs when he had the time to, because the priority seemed to be getting the rooms painted and ready for new admissions. He said there was a repair log located at the central nursing station, and he was not notified about repairs needed in room [ROOM NUMBER]. The Maintenance Director said the facility and resident rooms should be cleaned daily. He said there were a lot of new staff in those departments and they were trying to get things corrected. Record review on 11/18/2025 at 4:52 p.m. of facility maintenance log from October of 2025 through 11/18/2025 revealed no entries for repairs to Resident #2's foot board, closet door, or overhead light. In an interview on 11/18/2025 at 4:53 p.m. the Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 If continuation sheet Page 3 of 7 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 11/18/2025 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete said he could not locate the daily room rounding sheets for Resident #2's room or the 200-hallway housekeeping assignment sheet. The Administrator said the housekeeping and laundry departments had a recent large turnover with several housekeepers and the former housekeeping supervisor all quitting at the same time. The Administrator said he t hired a new laundry and housekeeping supervisor and was trying to slowly get the department back on track. He said the new supervisor was not at the facility and he would be the person to answer any surveyor questions because the new manager had no information. The Administrator said staff should report any repairs to himself or the maintenance director. The Administrator said the Maintenance Director was also new. He said that all staff were trained and knew how to submit a repair request and where to locate the maintenance repair book for Resident #2's closet door, overhead light, and footboard. The Administrator said he did not know why staff had not reported the need for those repairs. The Administrator said the resident rooms should be cleaned daily to minimize bugs and pests. He said the facility had a pest control program that came in monthly and as needed. Interview with the DON on 11/18/25 at 4:55 p.m. said most of the residents on 200 hallway were more independent and had their own snacks and food items. The DON said she did not know why Resident #2's room was not cleaned for the first time all day until after 1:00 p.m. and was not familiar with the housekeeping schedules. The DON said that Resident #1 could be confused at times and may not have noticed if a housekeeper had cleaned the room. The DON said all of the resident rooms should be cleaned daily and that the Administrator and Housekeeper supervisors were responsible for ensuring the cleanliness of the facility and that the Administrator oversaw the pest control program at the facility. The DON said Resident #2 never told her about having an ant crawling on him and had no other reports about the alleged incident saying she learned about it at the same time the surveyor did. In an interview with LVN A on 11/18/25 at 6:33 p.m. said she worked the 6pm-6am shift fulltime for about one year. LVN A said her regularly assigned hallway was 200 and there were housekeeping issues since she started. LVN A said she was unsure if the housekeeper had adequate supplies or training and the dirty rooms were repeatedly reported to administration, and it would get better for a little while and revert to being dirty. LVN A said none of the residents ever complained to her about dirty rooms, but she would prefer not to work in a dirty environment and usually brought her own cleaning supplies to work including wipes, hand sanitizer and garbage bags. LVN A said she felt sorry for the residents sometimes because they lived there and deserved a clean and healthy environment. LVN A said if the environment was dirty, it could spread bugs and infection. LVN A said she noticed the broken closet in Resident #2's room and reported it in the maintenance log but the facility did not have a maintenance director. LVN A said she had not noticed Resident #2's splintered foot board on his bed or the cracked overhead light. LVN A said the pest control program at the facility was ineffective because she and other staff saw roaches and bugs regularly throughout the facility. Record Review of the facility's policy titled Cleaning and Disinfection of Environmental Services, dated August 2019, revealed in part: 10. Environmental services will be disinfected or cleaned on a regular basis (e.g., daily, three times per week) and when surfaces are visibly soiled. Requested a policy and procedure on Maintenance Services from the Administrator on 11/18/25 at 5:15 p.m. and did not receive one prior to facility exit. Event ID: Facility ID: 675848 If continuation sheet Page 4 of 7 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 11/18/2025 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to maintain an effective pest control program so that the facility was free of pests for 1 of 4 hallways, (Hall 100) and Resident #4's room. The facility had a live roach and live flies in Resident #4's room. This failure could place residents at risk for decreased residents' health, safety, and quality of life. Findings included: Record review of Resident #4's admission Record dated 11/18/2025 revealed a [AGE] year-old female, admitted [DATE] and readmitted [DATE] with diagnoses of encephalopathy (disease or damage that affects the brains function or structure causing a change in mental status), dysphagia (difficulty swallowing with an inability to move food or liquids easily from the mouth to the stomach), history of falls, ataxic gait (an abnormal clumsy and staggering walk characterized by a lack of balance), atrial fibrillation (a common type of arrythmia[an abnormal heart rate]where the heart's upper chamber beat chaotically and irregularly, often too fast), and intellectual disability. Record review of Resident 4's admission MDS, dated [DATE], revealed a BIMS score of 9 out of 15, which indicated moderate cognitive impairment. The resident's functional abilities in section GG revealed she required maximal assistance with toileting, and personal hygiene, and moderate assistance with showers, lower body dressing and putting on or taking off footwear. Observation and interview with Administrator on 11/18/25 at 1:35 p.m. of an empty resident room # 209 with a live pile of ants or some type of crawling insects in a mound in the corner just inside the door of the room. The Administrator said the room was empty and he would call the pest control company to come out and do an off-schedule treatment. The Administrator said he was doing his best to stay on top of things after returning to the facility and he was just getting up to speed on a lot of things that had fallen through the cracks in his absence. During an observation and interview with the facility Ombudsman on 11/18/2025 at 3:18 p.m., in Resident #4's room with the Ombudsman to show a live roach on the floor in front of her recliner chair and 2 flies flying around in the room. Resident #4 was at an activity and the Ombudsman stepped on the roach killing it. The Ombudsman said the facility had an issue with roaches and other pests and would say they were addressing it but did not feel it was effective because there were pests all over the facility and this was not the first time she had seen or killed a live insect or bug, while visiting with residents at the facility. Observation and interview with Resident #4 on 11/18/25 at 3:27 p.m. in main dining room area. Resident #4 was appropriately dressed and groomed and seated in a chair. When asked if she had ever had any issues with bugs, roaches, flies or pests in her room she said from time to time. When asked what happened when she saw pests in her room, she said she would tell the nurse or aide and someone would kill it. When asked if her room was cleaned daily, she said yes. When asked if she felt like the facility did enough to make sure there were no bugs or pests in her room, she said yes. Resident #4 said she saw the pest control people regularly at the facility at least every few weeks. Interview with Housekeeper B on 11/18/2025 at 3:53 p.m. who was actively cleaning Resident #2's room Housekeeper A said she worked at the facility since June 2025 and had cleaned on the front of 200 hallway earlier in the day but had not made it to the back of 200 hallway yet. She said that the housekeepers usually split 200 hallway because there was no permanently assigned housekeeper for that hall. Housekeeper B said Resident #2's room was dirty on the floors, but she cleaned it daily whenever she worked. Housekeeper B said that she may not always clean her assigned area on 200 hall in the morning but completed it daily prior to the end of her shift. Housekeeper B said having food debris on the floor was not acceptable because it could attract pests or insects which she said she had seen before all around the facility. Housekeeper B said she saw flies, gnats, and roaches on 200 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 If continuation sheet Page 5 of 7 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 11/18/2025 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some hall in the past. Housekeeper B said she reported any insects to the administrator, her supervisor and maintenance so they could contact pest control. Interview on 11/18/2025 at 4:50 p.m., the Maintenance Director said he started working at the facility on 10/31/25 and was not asked to assist with the building's pest control. He said he was asked to notify the pest control company, which he did. He said residents and staff complained about pests, including roaches and rodents, throughout the facility. He said the pest control program was ineffective because some of the pests could have nests in the walls. He said some areas of the building seemed to be worse than others. He said some of the residents' rooms on 200 hall were affected but could not recall which ones. In an interview on 11/18/2025 at 4:53 p.m. the Administrator said he could not locate the daily room rounding sheets for Resident #2's room or the 200-hallway housekeeping assignment sheet. The Administrator said the housekeeping and laundry departments had a recent large turnover with several housekeepers and the former housekeeping supervisor all quitting at the same time. The Administrator said he t hired a new laundry and housekeeping supervisor and was trying to slowly get the department back on track. He said the new supervisor was not at the facility and he would be the person to answer any surveyor questions because the new manager had no information. The Administrator said the resident rooms should be cleaned daily to minimize bugs and pests. He said the facility had a pest control program that came in monthly and as needed. The Administrator said he felt like they were doing all they could do to minimize and control pests at the facility. Interview with the DON on 11/18/25 at 4:55 p.m. said all of the resident rooms should be cleaned daily and the Administrator and Housekeeper supervisors were responsible for ensuring the cleanliness of the facility and that the Administrator oversaw the pest control program at the facility. The DON said Resident #2 never told her an ant was crawling on him and had no other reports about the ant crawling on Resident #2 and said she learned about the ant crawling on Resident #2 at the same time the surveyor did. In an interview with LVN A on 11/18/25 at 6:33 p.m. said she worked the 6pm-6am shift fulltime for about one year. LVN A said her regularly assigned hallway was 200 and there were housekeeping issues since she started. LVN A said she was unsure if the housekeeper had adequate supplies or training and the dirty rooms were repeatedly reported to administration, and it would get better for a little while and revert to being dirty. LVN A said none of the residents ever complained to her about dirty rooms, but she would prefer not to work in a dirty environment and usually brought her own cleaning supplies to work including wipes, hand sanitizer and garbage bags. LVN A said she felt sorry for the residents sometimes because they lived there and deserved a clean and healthy environment. LVN A said if the environment was dirty, it could spread bugs and infection. LVN A said she noticed the broken closet in Resident #2's room and reported it in the maintenance log but the facility did not have a maintenance director. LVN A said she had not noticed Resident #2's splintered foot board on his bed or the cracked overhead light. LVN A said the pest control program at the facility was ineffective because she and other staff saw roaches and bugs regularly throughout the facility. Record review on 11/18/25 at 6:37 p.m. of facility pest controls logs with an 11/06/2025 entry that read in part: room [ROOM NUMBER]: Resident present during service. Found live German roaches behind the nightstand. Applied roach gel bait and placed Lo-liner monitors, room [ROOM NUMBER]. Significant roach activity observed on glue boards and the floor. Applied roach gel bait and placed Lo-liner monitors. room [ROOM NUMBER]: Live German roach activity found; unit is infested. German roaches clean out service needed for 105/106 and 208. Record Review of the facility's policy titled Cleaning and Disinfection of Environmental Services, dated August 2019, revealed in part: 10. Environmental services will be disinfected or cleaned on a regular basis (e.g., daily, three times per week) and when surfaces are visibly soiled. Record review of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 If continuation sheet Page 6 of 7 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 11/18/2025 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 0925 Level of Harm - Minimal harm or potential for actual harm facility's undated pest control policy reflected in part: Our Facility shall maintain an effective pest control program. 1. This facility maintains an on-going pest control program to ensure that the building is kept free of insects. 6. Maintenance services assists, when appropriate and necessary, in providing pest control services. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675848 If continuation sheet Page 7 of 7