Inspection·November 26, 2024

F 0880 Level of Harm - Minimal harm or potential for actual harm incontinent of bowel and bladder and as dependent for toileting and toileting hygiene indication the helper or CNA does all the effort to complete the activity. In a peri care observation on 11/25/24 at 2:30 PM CNA C and CNA D did not change their gloves or wash their hands when removing a dirty brief and applying a clean brief. Residents Affected - Some In an interview on 11/25/24 at 2:58 PM CNA C and CNA D stated they had been trained on infection control and peri care. They stated the nurses visually check CNA's off on peri care annually with skills training. They just stated they forgot to wash their hands. They stated not changing gloves or washing hands when working from a dirty to clean surface or area could spread germs and bacteria. Resident #86 Record review of Resident #86's undated face sheet reflected she was a [AGE] year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included Pneumonia, Respiratory Failure, Acute Kidney Failure, and Gastro-esophageal reflux (indigestion). Record review of Resident #86's care plan dated 10/19/2023 and revised on 03/07/24 reflected she had a history of urinary tract infections. Interventions included Resident/family/caregiver teaching should include good hygiene practices: Females to wipe and cleanse from front to back, clean peri area well after bowel movement in order to help prevent bacteria in urinary tract. Record review of Resident #86's admission MDS assessment, dated 11/17/2024, reflected staff assessment of her mental status indicated short term and long-term memory problems. The MDS indicated Resident #86 was able to recall her own room and names of staff. Resident #86 was Substantial/maximal assistance staff assistance with eating, personal hygiene, toileting, and showering. Section H of the MDS Bowel and Bladder indicated resident #86 was always incontinent of bowel and bladder. Record review of Resident #86's Physician Orders Summary Report dated 11/26/24 reflected an order for care to surgical incision to left gluteal fold (left buttocks) that read cleans with wound cleanser and gauze, pat dry with gauze, pack wound with iodoform packing strip (a gauze strip soaked in iodine) and apply dry dressing to wound daily. In a wound care and peri care observation on 11/25/24 at 11:38 AM for Resident #86 LVN A and CNA B removed the soiled brief and linens and place them unbagged on the floor in the room. CNA B cleansed Resident #86 from front to back and placed a new clean brief under resident without washing her hands or changing her gloves. LVN A then removed a soiled dressing from Resident #86's left buttocks and placed the soiled dressing in the pile with the soiled linens and soiled brief on the resident's floor. LVN A then changed her gloves and applied a clean pair. LVN A did not wash her hands or use alcohol-based hand sanitizer between glove changes. LVN A packed wound to left buttocks and applied a clean dressing. In an interview on 11/25/24 at 12:00 PM CNA B stated staff do normally use alcohol-based hand sanitizer in between glove changes. She stated they were trained on infection control often. CNA B stated the risk for the resident for not cleansing hands and using clean gloves would be passing germs from one to the other. She stated normally staff keep trash bags available at bedside and put soiled linens in the trash bag. Soiled briefs were placed in the trash can and staff change the liner out (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675884 If continuation sheet Page 2 of 5 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 675884 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Teague Nursing and Rehabilitation 884 Hwy 84 W Teague, TX 75860 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 when removed. CNA B stated it was not practice putting soiled linens or briefs on the floor. She stated the risk for residents for not cleansing hands and placing soiled linens on the floor wound be spreading germs. In an interview on 11/25/24 at 12:10 PM LVN A stated she does not normally perform peri care on residents. Residents Affected - Some I'm not aware of what the policy says about glove changes between dirty and clean surfaces. LVN A stated yes she normally throws soiled linens on the floor if the dirty has been folded up inside. She stated the housekeepers come in and mops the floor. LVN A stated she had thrown soiled wound dressings on the floor if the dirt is on the inside. She stated risk to the residents for not cleaning hands and placing soiled linens on the floor would be spreading germs. Resident #24 Record review of Resident #24's face sheet dated 11/26/24 revealed an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses were, Type 2 diabetes, Edema (swelling), Adjustment disorder with mixed anxiety and depressed, Pain in right hip, Chronic obstructive pulmonary disease ( difficulty to breath) , Muscle weakness and Lack of coordination, Record review of Resident #24's care plan dated 10/11/24 reflected Resident #24 had hypertension and relevant intervention was giving anti-hypertensive medications as ordered and monitoring side effects such as orthostatic hypotension and increased heart rate. Record review of Resident #24's quarterly MDS assessment, dated 09/17/24 revealed a BIMS score of 14 indicating her cognition was intact. Resident #14 Record review of Resident #14's face sheet dated 11/26/24 revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses were Cognitive communication deficit, Anemia, Unsteadiness on feet, Difficulty in walking, Lack of coordination, Type 2 diabetes, Hypertension and Muscle weakness. Record review of Resident #14's care plan dated 09/11/24 reflected, she had hypertension and relevant intervention was giving anti-hypertensive medications as ordered and monitoring side effects such as orthostatic hypotension and increased heart rate and effectiveness. Record review of Resident #14's quarterly MDS assessment, dated 09/06/24 revealed a BIMS score of 01 indicating her cognition was severely impaired. An observation on 11/26/24 at 8:25AM , revealed MA E failed to sanitize the blood pressure monitor before using it on Resident #24, in between Resident #24 and Resident #14 and after Resident #14. MA E took the blood pressure monitor from the top of the med cart and without sanitizing it she took the blood pressure of Resident #24. MA E then moved on to Resident #14 and took her blood pressure with the same blood pressure monitor without sanitizing it. After completing the measurement on Resident #14, without cleaning the blood pressure monitor ,she kept it on the top of the med cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675884 If continuation sheet Page 3 of 5 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 675884 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Teague Nursing and Rehabilitation 884 Hwy 84 W Teague, TX 75860 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 During an interview on 11/26/24 at 9:05AM , MA E stated she was working at the facility for about 10 years. MA E said she was concentrating on administering medications for the residents and forgot to sanitize blood pressure cuff before and after using it on Resident #24 and Resident #14. She stated it was important to follow infection control protocol and sanitize the blood pressure cuffs before using it on the residents. She added, this was essential to minimize the risk of spreading contagious diseases. MA E stated she was aware of the importance of sanitizing medical equipment and received training in the past however did not remember exactly when it was. In an interview on 11/26/24 at 11:48 AM the DON stated it was her expectation that all staff followed the policy for infection control. She stated when staff cross from a dirty to a clean area, they should disinfect their equipment, change their gloves and use alcohol-based hand sanitizer gel in between dirty and clean surfaces. She stated linens were to be bagged and disposed of properly. She stated she was responsible for training the staff on infection control. She stated the risk for residents for not cleaning hands, equipment items like blood pressure monitor , and maintaining a clean environment would be cross contamination and spreading of infections. In an interview on 11/26/24 at 12:00 PM the ADM stated it was his expectation staff to follow policy and procedures for infection control. He stated that the DON had in serviced the staff on peri care, handwashing we and infection control practices. The ADM stated The DON was responsible for providing education on infection control. He stated she completed the Inservice quarterly and as needed. The ADM stated the risk to the resident for not following infection control practices would be the spread of infections. Record review of the facility's policy titled Dressings, Soiled/Contaminated dated 2001 Revised 2009 reflected: Disposable items such as bandages, applicators, gauze pads, that are soiled or contaminated with infective material, blood, or body fluids must be place in a plastic bag and removed from the residents' room upon completion of any procedure. Record review of the facility policy titled Laundry and Bedding, Soiled dated 2001 Revised 2018 reflected: Soiled laundry/bedding shall be handled, transported and processed according to best practices for infection prevention and control. Record review of the facility policy titled Handwashing / Hand Hygiene dated 2001 Revised 2023 reflected: Hand Hygiene is indicated: after contact with blood, body fluids or contaminated surfaces, after touching a resident, after touching a resident's environment, before moving from work on a soiled body site to a clean body site on the same resident and immediately after glove removal. Review of the facility's policy titled Cleaning and disinfection of Resident care Items and Equipment revised in October 2018 reflected: Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standard. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675884 If continuation sheet Page 4 of 5 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 675884 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Teague Nursing and Rehabilitation 884 Hwy 84 W Teague, TX 75860 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 The purpose of this procedure is to provide guidelines for disinfection of non-critical resident care items. Level of Harm - Minimal harm or potential for actual harm . 1.The following categories are used to distinguish the levels of sterilization/ disinfection necessary for items used in resident care Residents Affected - Some d. Reusable items are cleaned and disinfected or sterilized between residents (e.g., stethoscopes, durable medical equipment) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675884 If continuation sheet Page 5 of 5