Health inspection·July 14, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 07/12/2023 at 7:44 AM, revealed Resident #45 was in her room lying in bed. Resident #45's call light was lying on the floor. The call button was partially under the bed. In an interview on 07/12/2023 at 7:45 AM, Resident #45 stated the call light was just laying on her bed last night and was not attached to anything on her bed. She stated she thought it fell off sometime during the night. She stated if she needed help with anything it would be difficult for her to yell for help because she cannot speak clearly or very loudly. Resident #45 also stated if she attempted to reach the call light from her bed she would probably fall. She is afraid of falling related to having fell in the past. 2. Record review of Resident #23's face sheet, dated 07/13/2023, reflected an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included unspecified lack of coordination ( uncoordinated movement), need for assistance with personal care (day- to- day activities people are unable to perform on their own), cognitive communication deficit (difficulty with thinking) abnormal posture (rigid body movements and chronic abnormal positions of the body) unsteadiness on feet (losing your balance while walking), and muscle weakness ( lack of strength in muscles). Record review of Resident #23's Significant Change MDS, dated [DATE], reflected Resident# 23 had a BIMS score of 1 which indicated residents' cognition was severely impaired. Resident #23 was assessed to require assistance with ADLs. She required to be stabilized with staff assistance during surface-to-surface transfer, and when she moved from seated to standing position. Resident #23 did not walk. She used a wheelchair for mobility. Record review of Resident #23's Comprehensive Care plan, dated 07/05/2023, reflected resident had impaired cognitive function or impaired thought processes. Resident had impaired visual function. Resident #23 was at risk for falls related to general body weakness, poor balance, and unsteady gait. Interventions: anticipate and meet the resident's needs. Be sure the resident's call light was within reach and encourage the resident to use it for assistance as needed. Observation on 07/12/2023 at 7:45 AM revealed Resident #23 was awake and lying-in bed. Her call light was on the floor beside her bed. In an observation and interview on 07/12/2023 at 7:46 AM Resident #23 stated that is a cord on the floor. She stated that does not need to be there. She pointed to the call light. Resident #23 closed her eyes and stated she was going to sleep, and for everyone to leave. In an interview on 07/14/2023 at 8:31 AM the Director of Nurses stated she expected the call lights be within reach of all residents. She stated if a call light was not in reach when a resident was in their room, the residents would not have any device to use if they needed any type of assistance. She stated some residents were able to yell, however, this was not the appropriate protocol for residents to yell for help. She also stated it was a greater risk for harm if the residents did not have the call light within reach. The Director of Nurses stated ensuring the call lights were within reach of a resident was all staffs' responsibility. She did not elaborate of what type of harm a resident may endure if the resident required assistance from staff and did not have their call light within reach. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 2 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 07/14/2023 at 8:52 AM CNA G stated all staff were responsible to check call lights when they entered a resident's room. She stated if the call light was not in reach the resident may fall attempting to reach the call light or try to find the call light. She also stated a resident may have any type of an emergency and would not have a device to call for assistance. CNA G stated some residents would be able to yell for help but there were some residents who would not be heard if they attempted to yell. She stated she had been in serviced on call lights within the past few months. In an interview on 07/14/2023 at 8:57 AM the Treatment Nurse stated if a resident's call light was not in reach a resident had potential to fall attempting to reach the call light or attempting to assist self out of their bed or wheelchair and fall trying to get help. She stated if the resident had an emergency, they may be able to yell for help but there were some residents would not be able to yell very loud and it would be difficult to hear those residents. She stated it was the responsibility of all staff in the facility to check call lights when they entered a resident room to ensure the call light was attached to something where the resident had easy access to the call light. She also stated staff had been in serviced on call lights within the past few months. In an interview on 07/14/2023 at 9:10 AM LVN A stated all residents' call lights were expected to be within reach. She stated a resident may need assistance with any type of physical problem and would not be able to call for assistance. She stated a resident may attempt to assist self out of bed or their wheelchair if they were needing something and fall. LVN A stated if the resident had their call light in reach the resident would use the call light for assistance instead of trying to transfer themselves to get help, go to the bathroom or try to get anything in their room. She stated there were some residents who would not be able to yell for help. LVN A also stated if staff was in another resident's room or was at the end of the hall from their room it would be difficult to hear a resident yell for assistance. She stated the staff had been in serviced on call lights within the past few months. In an interview on 7/14/2023 at 10:57 AM the Administrator stated all staff were responsible for checking call lights when they entered a resident's room. He stated he expected all call lights to be within reach of the residents. The Administrator if the resident was lying in bed and the call light was on the floor the resident had a potential of falling if attempted to reach for the call light. He also stated a resident may need immediate help from the staff and would not be able to call for help by using the call light. He stated not all residents could yell for assistance. Record review of the facility's in-service dated 03/01/2023 reflected anyone can answer a call light and reposition the call light to make sure it is in reach of the resident. This applies whether the resident is in a geri-chair (a large, padded chair that is designed to help elderly with limited mobility, wheelchair, or in bed. If staff is unable to assist resident due to need for direct care, notify charge nurse. Make sure all call lights are answered in a timely manner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 3 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Level of Harm - Minimal harm or potential for actual harm Based on observation, interviews, and record review the facility failed to place most recent survey readily accessible to residents in a place most frequented by most residents have the most recent survey for 5 of 5 residents reviewed for resident group meeting. Residents Affected - Some The facility failed to have the survey manual readily accessible for the residents to view the survey manual. This failure could place residents at risk of not being able to fully exercise their rights to be informed of the facility's survey citation history. Findings included: Observation on 07/13/2023 at 9:30 AM revealed the state survey manual was located behind the nurse's desk on the medical chart rack. There were 28 manuals located on the chart rack and it was difficult to locate the survey manual. Where the medical chart rack was located the resident would need to go behind the nurse's station to view the survey manual. It was not readily accessible for residents to view the survey. The survey manual was not placed in an area where the resident had easy access to it. The area where the survey manual was located was not easily for a resident in a wheelchair to obtain the survey manual The sign on the wall stated a copy of the most recent survey conducted by the Texas Department of Aging and Disability Services can be reviewed at the nurse's station. This sign was in a picture frame with sixteen other signs in a picture frame. Record review on 07/13/2023 at 9:40 AM of the sign on the wall reflected a copy of the most recent survey conducted by the Texas Department of Aging and Disability Services can be reviewed at the nurse's station. The information is for reference only. The binder will contain survey information covering at least one year. Please do not remove the binder or any part of the binder. The sign was on a wall with approximately sixteen other picture frames with different information. In a confidential group interview on 07/13/2023 at 10:00 AM through 10:30 AM, five residents stated they did not know where or how to access the survey results in the facility. They did not understand or have knowledge this existed in the facility. The residents in the group stated they would like to have access to this information, because the staff did not tell them anything about visits from the state. Two of the residents stated they did not know the state sent a report to the facility of any type of visits. The other three residents agreed. Two residents stated if there was a sign about the survey book on the wall they did not know it was there due to there were a lot of signs on one wall and it was very confusing attempting to read and understand all the signs. There were two residents who stated there were approximately 25 or more signs on the wall. The residents stated most of the signs were confusing. The residents stated if there was a sign saying Texas Department of Aging and Disability survey can be reviewed at the nurse's station, they would believe it was how to apply for Medicaid or to receive forms about disability. The residents stated if the survey manual was behind the nurse's station they were not allowed to go behind the nurse's station. Two residents stated if they were allowed to go behind the nurse's desk to look at the survey manual their wheelchairs would not fit behind the nurse's station. The residents also stated they would not feel comfortable to ask the staff to get the survey for them because they would not want the staff to know they were looking at what the state survey said about the facility. The residents stated they would prefer to review the report from the state in an area where it was private, and they could take their time (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 4 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0577 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some reviewing the survey. The residents stated they never saw a sign about a survey book. The residents stated behind the nurse's station was not a good place for them to be able to look at the surveys anytime they wanted to without request to ask for the book. In an interview on 07/14/2023 at 10:57 AM the Administrator stated the resident's rights were reviewed with the residents upon admission. He stated the survey book was located behind the nurse's desk. He stated the resident did have a right to have access to the last survey. He also stated the resident would need to ask someone for the survey manual. The Administrator also stated behind the nurse's desk may not be the best place for the survey book due to not being accessible for the residents. He stated he thought it would be better to move the survey book to another area where the residents were able to look at it without having to ask someone for the manual. He stated the residents were not able to go behind the nurse's desk to obtain the survey book. He also stated having the survey manual behind the nurse's desk was not an ideal place . He also stated he did not know if it was a resident right for the residents to have access to surveys. He did not respond to the question of who was responsible to review resident rights and explain the survey book to the residents. He did not respond to the question about the sign posted about the survey book could be confusing to the residents such as: Texas Department of Aging and Disability survey. Record review of the Facility Policy on Resident Rights dated 11/28/2016 reflected the facility post in a place readily accessible to the residents, family members and legal representatives of residents, the results of the most recent survey of the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 5 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 ensure residents unable to conduct activities of daily living (ADLs) received the necessary services to maintain good grooming and personal hygiene for four of 15 residents (Resident #23, Resident #28, Resident #45, and Resident #48) reviewed for quality of life. Residents Affected - Some The facility failed to ensure Resident#23's, Resident #28's, Resident #45's, and Resident #48's fingernails were trimmed and cleaned. These failures could place residents at risk for poor hygiene, dignity issues and decreased quality of life. Findings included: 1. Record review of Resident #23's face sheet, dated 07/13/2023, reflected an 86 -year-old female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included type 2 diabetes mellitus without complications ( your body does not use insulin properly), unspecified lack of coordination ( uncoordinated movement), need for assistance with personal care (day- to- day activities people are unable to perform on their own), cognitive communication deficit (difficulty with thinking), and muscle weakness ( lack of strength in muscles). Record review of Resident #23's Significant Change MDS assessment, dated 06/05/2023, reflected Resident# 23 had a BIMS score of 1 which indicated residents' cognition was severely impaired. Resident #23 was assessed to require assistance with ADLs. Resident #23 did not reject care. Record review of Resident #23's Comprehensive Care plan, dated 07/05/2023, reflected resident had impaired cognitive function or impaired thought processes. Resident had impaired visual function. Observation on 07/12/2023 at 7:30 AM revealed Resident #23 was awake and lying-in bed. Resident #23 had a blackish/brownish substance underneath the nails on her ring finger, middle finger, and fore finger on the right hand. In an observation and interview on 07/12/2023 at 7:33 AM Resident #23 stated that looks awful (when she was looking at the blackish/brownish substance underneath her nail). She stated she did not know anything about cleaning her nails. She stated she was not able to clean her nails or do anything, she was sick and could not do anything for herself. 2. Record review of Resident #28's face sheet, dated 07/13/2023, reflected a 75 -year-old male admitted to the facility on [DATE] with diagnoses which included need assistance for personal care (day- to- day activities people are unable to perform on their own), cognitive communication deficit (difficulty with thinking), hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side ( paralysis on the right side of the body due to tissue damage to the brain or spinal cord). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 6 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 Record review of Resident #28's Quarterly MDS assessment, dated 06/28/2023, reflected Resident # 28 had a BIMS score of 14 which indicated resident's cognition was intact. Resident required assistance with ADLs. Resident #28 did not refuse care. Resident was frequently incontinent of bowel. Record review of Resident #28's Comprehensive Care plan, dated 05/31/2023, reflected Resident #28 had hemiplegia, and hemiparesis related to CVA. Resident had poor vison. Resident had hearing deficit. Resident had a communication problem related to stroke. Resident had impaired cognitive function/dementia and impaired thought processes. Resident required assistance with personal hygiene. Intervention: resident required one person staff assistance with personal hygiene and oral care. Observation on 07/12/2023 at 7:24 AM, revealed Resident #28 was in his room sitting in a wheelchair waiting on breakfast. Resident #28 had a blackish/brownish substance underneath the fingernails on the following fingers on both hands: middle finger, ring finger and fore finger. His middle fingernail on his right and the ring fingernail on his left hand were long and jagged. In an interview on 07/12/2023 at 7:24 AM, Resident #28 stated he had asked someone three days ago to clean and trim his nails. He stated the person he asked stated they would come back and clean and trim his nails and they never came back to his room. He stated he did not remember the staff's name. He stated sometimes he gets bowel stuff on his nails almost every night. Resident #28 stated he did not want to discuss this any further. 3. Record review of Resident #45's face sheet, dated 07/13/2023, reflected a 56 -year-old female admitted to the facility on [DATE] with diagnoses which included hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (paralysis on the right side of the body due to tissue damage to the brain or spinal cord), muscle weakness generalized (decreased strength of the muscles), and cerebral infarction (occurs because of disrupted blood flow to the brain due to problems with the blood vessels that supply it). Record review of Resident #45's Quarterly MDS Assessment, dated 05/04/2023, reflected Resident #45 had a BIMS score of a 9 which indicated resident's cognition was moderately impaired. Resident #45 was assessed she did not exhibit behavior problems such as rejecting care. Resident #45 required supervision with one person assist with ADLs except for personal hygiene and bathing. Resident #45 required extensive assistance with personal hygiene and required physical assistance with part of her bathing. Resident was occasionally incontinent of bowel. Record review of Resident #45's Comprehensive Care Plan, dated 05/10/2023, reflected Resident #45 had hemiplegia/ hemiparesis related to CVA. Intervention: assist with ADLs. Resident #45 had ADL self-care performance deficit. Intervention: check nail length, trim, clean on bath day and as necessary. Observation on 07/12/2023 at 7:40 AM, revealed Resident #45 was in her room lying in bed. Resident #45's nails were long, and the nail polish was peeling from her fingernails. She had a blackish /brownish substance underneath the fingernails of the fore finger, the ring finger, the little finger, and the middle finger on her left hand. In an interview on 07/12/2023 at 7:40 AM, Resident #45 stated she asked the same staff two times to clean her fingernails. Resident #45 stated she accidentally touched some bowel stuff on her hand. She stated she removed the bowel stuff from her hand; however, she could not clean the bowel stuff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 7 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 underneath her fingernails. Resident #45 stated she did not remember the staff's name. Level of Harm - Minimal harm or potential for actual harm 4. Record review of Resident #48's face sheet, dated 07/13/2023, reflected an 82 -year-old female admitted to the facility on [DATE] with diagnoses which included Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks), unspecified lack of communication (persistent problems in language and speech), unspecified lack of coordination (uncoordinated movement) and, muscle weakness (decreased strength of the muscles). Residents Affected - Some Record review of Resident #48's Quarterly MDS Assessment, dated 05/01/2023, reflected Resident #48 had a BIMS score of a 3 which indicated resident's cognition was severely impaired. Resident #48 did not reject care. She required assistance with ADLs. Resident #48 required supervision with eating. Resident #48 was frequently incontinent of bowels. Record review of Resident #48's Comprehensive Care Plan, dated 05/10/2023, reflected Resident #48 had a communication problem related to Alzheimer's disease. Intervention: anticipate and meet needs. Resident #48 had an ADL self-care performance deficit. Intervention: check nail length, trim, and clean on bath day and as necessary. Observation on 07/12/2023 at 8:14 AM, revealed Resident #48 was in the dining room eating breakfast. Resident #48 was feeding herself, and she placed the ring finger and middle finger on her right hand in her mouth. Resident had a blackish/brownish substance underneath the nails of her forefinger and middle finger on her right hand. In an interview on 07/12/2023 at 8:17 AM, it was determined Resident #48 was not interviewable. She smiled and would mumble. In an interview on 07/14/2023 at 8:31 AM the Director of Nurses stated the CNAs were responsible of cleaning and trimming/cutting residents' nails except the residents with a diagnosis of diabetes. She stated for any resident with or without a diagnosis of diabetes the treatment nurse was responsible for all nail care including trimming and cleaning when she completed the weekly skin assessments. She stated if a resident had dirty nails there was a possibility bacteria could be on their fingers and/or underneath the resident's nails. She stated there was a potential a resident could ingest bacteria from their fingernails into their mouth. She stated it depended on the type of bacteria of what type an illness a resident could receive from the bacteria. The Director of Nurses also stated a resident potentially could become ill with stomach issues or any type of infection. She stated it depended on what was underneath the residents' nails. She also stated a resident had a potential to scratch themselves and may develop a skin concern such as a skin tear and may develop an infection if the residents' nails were not trimmed properly. She stated it was the nursing administration responsibility to monitor nursing staff to ensure residents were receiving proper nail care. In an interview on 07/14/2023 at 8:48 AM RA C stated the residents were expected to have their nails trimmed and cleaned on their shower days. She stated if a resident was a diabetic it was the Nurses' responsibility. She also stated nail care was expected to be taken care of when nails were visibly dirty or needed to be trimmed. RA C also stated if it was a certain type of bacteria a resident may become physically ill. She stated if a resident had dirty nails there was a possibility bacteria could be on their fingers and/or underneath the resident's nails. RA C stated if the resident was eating food with their hands there was a potential a resident could ingest bacteria transferred from their hands and/or fingernails onto their food. She stated it depended on the type of bacteria of what (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 8 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 type an illness a resident could receive from the bacteria. She also stated a resident could become ill with stomach issues and develop diarrhea or vomiting. She also stated a resident had a potential to scratch themselves and may develop a skin concern such as a skin tear and may develop an infection. She stated she had never heard that it was treatment nurses' responsibility to trim and clean residents' nails. In an interview on 07/14/2023 at 8:52 AM CNA G stated the CNAs were responsible to clean and trim the residents' nails except for the residents with diagnosis of diabetes. She stated the charge nurse was responsible to clean and trim diabetic residents' nails. She also stated any staff was expected to clean and trim non-diabetic residents' nails if they observed the residents' nails needed to be trimmed or cleaned. She also stated she never was in serviced or informed it was the treatment nurses' responsibility to complete nail care weekly on the residents. CNA G stated several of the residents had feces underneath their nails. She also stated if a resident swallowed bacteria from their fingernails there was a possibility a resident develops some type of stomach infection and need to be hospitalized for further medical treatment. In an interview on 07/14/2023 at 8:57 AM the Treatment Nurse stated she trimmed and cleaned certain residents' nails. She stated there were certain residents who preferred her to trim and clean their nails. She stated any nurse can trim and clean diabetic resident's nails and the CNAs were responsible for trimming /cleaning non-diabetic residents' nails. She stated she had not been instructed by anyone that it was her responsibility to trim and clean nails during skin assessments. She stated if she sees a residents' nails dirty or needed to be trimmed she would clean /trim residents nails. She stated it was an effort on all the nursing staff to ensure the residents' nails were clean and trimmed. She also stated if any non-nursing staff viewed residents' nails dirty or needed to be trimmed the staff was expected to report it to the nurse. She also stated if residents' nails are jagged there was a potential a resident may scratch themselves and receive a skin tear. The Treatment Nurse stated a resident may become physically ill if ingested any type of bacteria. She stated it was difficult to know exactly the symptoms until the bacteria was identified. She stated it was a possibility a resident may need medical care from the hospital depending on what type of symptoms the resident may develop after ingesting bacteria. She stated it was the Nurse supervisor's responsibility to monitor the CNAs on completing nail care. In an interview on 07/14/2023 at 9:10 AM LVN A stated CNAs and shower aide had responsibility of cleaning and trimming resident's nails of non-diabetic residents. She stated all diabetics nail care was the duty of an LVN or RN. She stated she had not been in serviced or informed by anyone it was the treatment nurses' responsibility to complete nail care. For a resident with a diagnosis of diabetes with long/dirty nails, they were expected to notify any nurse. LVN A stated a resident had potential of ingesting bacteria and according to what type of bacteria the resident ingested may cause severe GI problems such as vomiting, diarrhea and possibly a resident may become dehydrated and need to be evaluated at the hospital. She stated it was the nursing supervisor's responsibility to monitor the job tasks assigned to the CNAs. In an interview on 7/14/2023 at 10:57 AM the Administrator stated residents' nail care was the CNAs' responsibility. He stated if a resident was a diabetic it was the Nurses' responsibility. He stated nail care was expected to be taken care of when nails were visibly dirty or needed to be trimmed. He also stated if it was a certain type of bacteria a resident may become physically ill. He also stated there was a possibility a resident may require medical care from the hospital and that depended on what type of bacteria a resident may ingest. The Administrator stated it was the nurse supervisor's responsibility to monitor residents' nail care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 9 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 Record review of the facility's Policy on Nail Care, dated, 2003 reflected the policy was used during an in-service on nail care on 07/11/2023 and reflected nail management is the regular care of the fingernails to promote cleanliness, and skin integrity of tissues, to prevent infection, and injury from scratching by fingernails. It includes cleansing, trimming, and smoothing. Nail care usually done during the bath. Nail care will be performed regularly and safely. The resident will be free from abnormal nail conditions. The resident will be free from infection. Procedure as follows: 1. Immerse hands in a basin of warm soapy water to cleanse and soften the nails for ease in cleansing and trimming. 2. Use a soft brush if necessary to cleanse under and around the nails. 3. Remove debris from under the nails with an orange stick while soaking. 4. When performed at bath time, the nail care can be done following the procedure or as a separate procedure when needed at the convenience of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 10 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 ensure all residents with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for one (Resident #37) of eight residents reviewed for pressure ulcers. Residents Affected - Few The facility failed to promptly assess the size of Resident t#37's pressure ulcers. The facility failed to promptly input orders for would care for Resident #37's pressure ulcers. These failures could place residents at risk of worsened pressure ulcers. Findings included: A record review of Resident #37's face sheet dated 7/13/2023 reflected an [AGE] year-old female readmitted on [DATE] with diagnoses of chronic kidney disease (loss of kidney function), anemia (unhealthy red blood cells), atrial fibrillation (irregular heartbeat), cognitive communication deficit (problems with communication), dementia (symptoms affecting memory and thinking), heart failure, and major depressive disorder (depression). A record review of Resident #37's MDS assessment dated [DATE] reflected she did not have any unhealed pressure ulcers. A record review of Resident #37's care plan last revised on 7/10/2023 reflected she had stage III pressure ulcers to the left inner buttock and right lower buttock. A record review of Resident #37's BIMS assessment dated [DATE] reflected a BIMS score of 0, which indicated severe cognitive impairment. A record review of Resident #37's progress note dated 6/30/2023 authored by LVN I at 5:23 p.m. reflected Resident #37 arrived at the facility via ambulance transport. A record review of Resident #37's Initial Skin assessment dated [DATE] authored by LVN I reflected yes Resident #37 had a pressure, venous (affecting the veins), arterial (affecting the arteries), or diabetic ulcer. This assessment did not include measurements or staging of pressure ulcer(s) and it reflected If yes, complete the Ulcer Assessment. A record review of Resident #37's Ulcer assessment dated [DATE] authored by the Treatment Nurse reflected Resident #37 was admitted with an unstageable pressure ulcer on the right lower buttock measuring 2x7 cm and a stage III pressure ulcer on the left inner buttock measuring 6x4x0.2 cm. A record review of Resident #37's physician orders reflected orders dated 7/04/2023 for wound care for the pressure ulcers on Resident #37's left inner buttock and right lower buttock. The wound care orders reflected staff were to cleanse, pat dry and apply dressing to wounds. A record review of Resident #37's WAR for June 2023 reflected no orders or treatments documented for wound care to Resident #37's pressure ulcers on the right lower buttock and left inner buttock. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 11 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A record review of Resident #37's WAR for July 2023 reflected wound care to Resident #37's pressure ulcers on the right lower buttock and left inner buttock were not signed off as having been completed on 7/04/2023. A record review of Resident #37's progress notes from June and July 2023 reflected no documentation indicating wound care was completed for her left inner buttock and right lower buttock pressure ulcers from 6/30/2023-7/04/2023. During an observation on 7/12/2023 at 8:33 a.m., Resident #37 was observed lying in bed with oxygen on and a catheter hanging below her bed. Resident #37 was non-interviewable. During an interview on 7/13/2023 at 10:08 a.m., the Treatment Nurse stated Resident #37 came to the facility on Friday 6/30/2023 and she did her ulcer assessment on Monday 7/03/2023. During an interview on 7/13/2023 at 11:39 a.m., LVN I stated she worked on 6/30/2023 when Resident #37 was readmitted to the facility. LVN I stated I would have to backtrack to tell you the policy on admitting residents with pressure ulcers. LVN I stated, I know that we have a treatment nurse and wound care coordinator but as far as the absolute policy goes, I would have to look that up. LVN I stated if a resident came in with a new pressure ulcer, she would have to let an RN or wound care doctor stage it. LVN I stated yes that measuring the ulcer was expected of nurses but at the same time, in the back of my head, I'm thinking we are being told the way one person measures is different than the way the other person measures. LVN I stated that over the years she had heard that it was better to have one person measuring wounds but she had not heard that from that facility. LVN I stated she did not complete weekly ulcer assessments and that those were completed by the Treatment Nurse. When asked why she had not completed an Ulcer Assessment on 6/30/2023 as prompted by indicating yes on the Initial Skin Assessment, LVN I stated she would have to look back at her notes to see what else was going on. LVN I then stated she remembered feeding Resident #37 dinner on 6/30/2023 while completing her admission assessment when she was summoned to the dining room because another resident had fallen and needed immediate medical attention. LVN I stated she had to triage and prioritize what was going on for the remainder of the shift. When asked if the weekly ulcer assessment should begin when the ulcer is first identified, LVN I stated, that's a good question. LVN I stated Resident #37 was on hospice and she expected the hospice RN to stage the ulcers and measure them. LVN I stated yes ma'am that hospice typically measured ulcers. During an interview on 7/13/2023 at 1:12 p.m., the Treatment Nurse stated she had worked in the facility for ten years and had been in her current position for seven years. The Treatment Nurse stated she believed the skin assessment policy was the same as the ulcer assessment policy but she would have to look at the policies and procedures. The Treatment Nurse stated normally the admitting nurse would do the initial skin assessment and then Monday when I come in I relook at the residents' skin to know what they look like with my own eyes. The Treatment Nurse stated she completed all of the weekly ulcer assessments and other nursing staff did not complete ulcer assessments unless she was out. The Treatment Nurse stated no that staff were not required to notify her of newly identified pressure ulcers when she was off work. The Treatment Nurse stated residents' pressure ulcers should be assessed for size the day they came in. The Treatment Nurse stated in the skin assessment, there was a box where staff should document the size of pressure ulcers. When asked what a potential negative outcome was of not measuring Resident #37's ulcers on the day she was readmitted with them, the Treatment Nurse stated it could get worse and if I didn't see it I wouldn't be able to know whether it got better or worse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 12 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 7/13/2023 at 1:49 p.m., the DON stated ulcer assessments were done weekly and skin assessments were completed upon admission and readmission. The DON stated new wounds should be assessed whenever they were identified. The DON stated typically the Treatment Nurse was responsible for completing ulcer assessments but if she was not there, it was the charge nurse's responsibility. When asked how staff were trained on assessing wounds and measuring wounds, the DON stated, they're aware of the admission process. The DON stated the size of wounds should be documented in the skin assessment and the nurse completing the initial skin assessment should measure the wound. The DON stated she monitored the Treatment Nurse and the Treatment Nurse monitored nurses to ensure staff were completing skin and ulcer assessments accurately and in a timely manner. When asked how not immediately measuring Resident #37's wounds had the potential to negatively affect her, the DON stated, you don't have a baseline and you don't know if it got better or worse. An observation on 7/14/2023 at 11:00 a.m. revealed Resident #37 was in bed. The Treatment Nurse removed dressing from Resident #37's right buttock to reveal a stage III pressure ulcer approximately 2 cm long and 7 cm wide. The wound bed consisted of granulation (formation of new connective tissue and blood vessels on the surface of a wound during the healing process) tissue and the wound was without drainage or signs of infection. The Treatment Nurse then removed a dressing from her left buttock to reveal a stage III pressure ulcer that was 4 cm by 5 cm with granulation (formation of new connective tissue and blood vessels on the surface of a wound during the healing process) tissue and no signs of infection were noted. During an interview with the DON on 7/14/2023 at 11:41 a.m., when asked how she should know whether wound care was completed if it were not documented, the DON stated she would expect there to be an order and for staff to document on the WAR. The DON stated she spoke to the RN supervisor (RN J) who worked the weekend after Resident #37 was admitted and RN J said she did wound care that weekend (7/01/2023-7/02/2023). The DON stated the nurse who admitted a resident was responsible for putting in orders for wound care. The DON stated LVN I was the one who admitted Resident #37 and she was not sure why LVN I did not put in orders or measure the wounds. During an interview on 7/14/2023 at 11:50 a.m., the Treatment Nurse stated she entered Resident #37's wound care orders on 7/03/2023 and the system automatically set the start date to be 7/04/2023. The Treatment Nurse stated she had completed Resident #37's wound care on Monday 7/03/2023 and on Tuesday 7/04/2023, and she was not sure why she had not documented it. A record review of the facility's policy dated 8/12/2016 titled Pressure Injury: Prevention, Assessment and Treatment reflected the following: Procedure: 2. Early prevention and/or treatment is essential upon initial nursing assessment of the condition of the skin on admission and whenever a change in skin status occurs. The nurse will determine if prevention and/or treatment of pressure sore(s) is indicated and notify the Treatment Nurse/designee of any potential problems. 3. Upon assessment and identification of a pressure sore the staff nurse will notify the treatment nurse/designee. 6. Nursing Action/Rationale: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 13 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 1. Prevention: The nurse can assist in the prevention of pressure injuries by performing the following nursing interventions: Note: Add any interventions to care plan. 10. Treatment Nurse/designee or Director of Nursing will assess site and evaluate for appropriate stage as listed in this procedure. Notify physician; obtain an order and monitor site daily. Sign off on treatment sheet any treatment completed (i.e., Stage I through State IV). Staging of pressure injuries is an important part of wound documentation, but it is only one part of the wound and resident assessment. Assessment of the pressure injury should also include the site, size, and W x L x D, of the injury. A record review of the facility's policy dated 8/15/2016 titled Skin Assessment reflected the following: It is the policy of this facility to establish a method whereby nursing can assess a resident's skin integrity to allow of appropriate intervention be initiated in a timely manner. Procedure: 1. All new admits and residents returning from a hospital stay will have a head-to-toe skin assessment completed. If the facility Treatment Nurse/designee is available he/she should complete the assessment within four (4) hours of the resident's arrival at the facility. If the Treatment Nurse/designee isn't available then the charge nurse should complete the assessment within four (4) hours of the resident's arrival at the facility. The charge nurse will then notify the Treatment Nurse/designee of any skin problems noted. Complete the appropriate attachments/assessments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 14 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for one of one kitchens reviewed for sanitation. The Director of Food and Nutrition failed to ensure all food items were labeled, dated, and properly stored. CK H failed to wash her hands after handling dirty dishes. These failures could place residents at risk of foodborne illness. Findings included: An observation of the reach-in refrigerator in the kitchen on 7/12/2023 at 7:08 a.m. revealed an opened container of mayonnaise dated 12/02/2022, a container of opened pickles dated 4/12/2023, and a plastic storage container filled with an unknown substance that was not labeled or dated. During an interview on 7/12/2023 at 7:10 a.m., CK H stated the dates on the mayonnaise and pickles were received dates and not opened dates. CK H stated food items needed to be labeled with an opened date when they were opened. CK H stated the unknown substance was chili and said, it needs a date. During an interview on 7/12/2023 at 7:12 a.m., the Director of Food and Nutrition stated she had a lot of new staff in the kitchen and everyone was in training. During an interview on 7/12/2023 at 7:14 a.m., the Director of Food and Nutrition stated food items should be dated when they were opened. An observation of the reach-in freezer on 7/12/2023 at 7:16 a.m. revealed a bag of frozen white rectangular items dated 7/07/2023 but not labeled. The plastic bag was ripped and open to air. There was also a blue bag of unknown substance tied shut with no label or date. During an interview on 7/12/2023 at 7:18 a.m., the Director of Food and Nutrition stated the blue bag contained hamburger patties and stated yes that everything should be covered. The Director of Food and Nutrition stated, it's a battle but did not clarify what this meant. An observation on 7/12/2023 at 11:36 a.m. revealed CK H pureed pork chops, washed the food processor in the three compartment sink, and did not wash her hands. CK H then proceeded to puree broccoli. During an interview on 7/12/2023 at 11:49 a.m., CK H stated she had not washed her hands after cleaning the food processor because she had rinsed her hands off in dishwasher and sanitizer water. During an interview on 7/12/2023 at 1:49 p.m., the Director of Food and Nutrition stated she had not had any problems in the kitchen and the RD had told her she did not need to look because she knows it's good. The Director of Food and Nutrition stated the RD had not completed any kitchen sanitation audits. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 15 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview on 7/13/2023 at 7:57 a.m., the Administrator stated kitchen sanitation audits were not something the RD did at that facility. The Administrator stated the RD monitored the kitchen via walk throughs with the Director of Food and Nutrition when she came in and stated the RD discussed any issues with the Director of Food and Nutrition. The Administrator stated the RD did that once a month. The Administrator stated the facility also had unannounced white glove audits which were completed yearly by members of the facility's corporate office. The Administrator stated the facility recently had a white glove audit of the kitchen. During an interview on 7/13/2023 at 2:25 p.m., the Director of Food and Nutrition stated yes all foods should be covered, labeled and dated. The Director of Food and Nutrition stated yes she expected staff to wash their hands after handling dirty dishes and before preparing a food item but stated she felt washing, rinsing and sanitizing them in the three compartment sink while washing a dish was good enough. The Director of Food and Nutrition stated staff could hardly stand her because she was consistently in the kitchen and was always monitoring them. The Director of Food and Nutrition stated she monitored for food storage by looking in the refrigerators and freezers every morning around 7:30 a.m.-8:00 a.m. The Director of Food and Nutrition stated she trained staff on food storage verbally and visually by showing them. The Director of Food and Nutrition stated the RD came in once a month to look around but had not written anything down because she hasn't found any issues. The Director of Food and Nutrition stated if the RD did find issues, she would tell her and it would be corrected right then. When asked what a potential negative outcome was if food were not stored or handled properly, the Director of Food and Nutrition stated she did not give residents bad food and what I don't eat, I'm not going to let them eat. During an interview on 7/13/2023 at 3:06 p.m., the RD stated yes all foods should be covered, labeled and dated with an opened date. The RD stated she expected staff to wash hands with every change in task and although no she did not believe washing hands in the three compartment sink was a substitute, she could see why dietary staff might be confused and said she could do an in-service. The RD stated she had not done any formal in-services with dietary staff yet and stated the Director of Food and Nutrition trained dietary staff. The RD stated she completed walk throughs every month but these were not documented. When asked what a potential negative outcome was if food that was improperly handled or stored were served to residents, the RD stated it would be a food safety concern. During an interview on 7/14/2023 at 10:15 a.m., the Administrator stated foods needed to be labeled if they were opened and stored items needed to be labeled and dated. The Administrator stated hands needed to be washed when contaminated and based on their policy, the three compartment sink was not a substitute for handwashing. The Administrator stated dietary staff were trained by shadowing the Director of Food and Nutrition. The Administrator stated the Director of Food and Nutrition was responsible for ensuring compliance of dietary polices. The Administrator stated if hands were not washed when soiled and food was not handled properly, it could result in food contamination and they could get sick. A record review of the facility's [NAME] Glove Dietary assessment dated [DATE] reflected NO next to Food Rotation Dates and a note reflected Multiple open bags. A record review of the facility's policy dated 2012 titled Hand Washing reflected the following: We will ensure proper hand washing procedures are utilized. Employees are to frequently perform hand washing as outlined below. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 16 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 0812 Procedure: Level of Harm - Minimal harm or potential for actual harm 1. Hand washing occurs in sinks provided for that purpose; sink areas provide hot/cold running water, soap in dispensers, and paper towels, and should have a sign posted conspicuously near or above wash basin. Residents Affected - Many 5. Food preparation sinks are not to be used for hand washing. A record review of the facility's policy dated 2012 titled Storage Refrigerators reflected the following: Procedure: 5. Food must be covered when stored, with a date label identifying what is in the container. A record review of the 2017 FDA Food Code reflected the following: (B) Except as specified in [paragraph] (E) -(G) of this section, refrigerated, READY-TO-EAT TIME/TEMPERATURE CONTROL FOR SAFETY FOOD prepared and PACKAGED by a FOOD PROCESSING PLANT shall be clearly marked, at the time the original container is opened in a FOOD ESTABLISHMENT and if the FOOD is held for more than 24 hours, to indicate the date or day by which the FOOD shall be consumed on the PREMISES, sold, or discarded, based on the temperature and time combinations specified in [paragraph] (A) of this section and: (1) The day the original container is opened in the FOOD ESTABLISHMENT shall be counted as Day 1; and (2) The day or date marked by the FOOD ESTABLISHMENT may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on FOOD safety. 3-302.12 Food Storage Containers, Identified with Common Name of Food. Except for containers holding FOOD that can be readily and unmistakably recognized such as dry pasta, working containers holding FOOD or FOOD ingredients that are removed from their original packages for use in the FOOD ESTABLISHMENT, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the FOOD. 2-301.12 Cleaning Procedure. (A) Except as specified in (D) of this section, FOOD EMPLOYEES shall clean their hands and exposed portions of their arms, including surrogate prosthetic devices for hands or arms for at least 20 seconds, using a cleaning compound in a HANDWASHING SINK that is equipped as specified under § 5-202.12 and Subpart 6-301. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 17 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 5 residents (Residents #7 and #9) reviewed for infection control. Residents Affected - Few A) CNA E and F failed to practice appropriate hand hygiene and infection control techniques during incontinent care for Resident #7 B) CNA G and D failed to practice appropriate hand hygiene and infection control techniques during incontinent care for Resident #9 These failure could place residents at risk for developing infections. Findings included: A) Review of Resident #7's Face sheet dated 07/13/2023 reflected an [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: chronic kidney disease (A condition characterized by a gradual loss of kidney function. Early stages can be asymptomatic. Disease progression occurs slowly over time.), overactive bladder (a frequent and sudden urge to urinate that may be difficult to control.) and vascular disorder of intestine (is a condition that happens when narrowed or blocked arteries restrict blood flow to your small intestine). Review of Resident #7's Quarterly MDS assessment dated [DATE] reflected Resident #7 was assessed to have a BIMS score of 7 indicating moderate cognitive impairment. Resident #7 was assessed to require extensive assist with toilet use. Resident #7 was further assessed to be always incontinent of bowel and bladder. Review of Resident #7's Comprehensive Care Plan reflected a focus area dated 11/23/2021 The resident has bladder incontinence. Interventions included incontinent care at least every 2 hours .monitor/ document for signs and symptoms of UTI . Observation on 07/13/2023 at 9:49 AM revealed CNA E and CNA F in Resident #7's room to perform incontinent care. Both CNAs washed hands prior to the procedure and donned gloves. CNA E was holding Resident #7 over and CNA F cleaned Resident #7's perineal area (private areas below the waist) in the front and changed gloves (no hand hygiene). CNA F then cleaned Resident #7's buttock and changed gloves with no hand hygiene to apply a new brief. In an interview on 07/13/2023 at 11:14 AM CNA E stated she did not use hand sanitizer or hand hygiene between glove changes when doing perineal area care with Resident #7. She stated CNA F did not perform hand hygiene between glove changes. In an interview on 07/13/2023 at 12:20 PM CNA F stated I changed my gloves, but I did not sanitize my hands when I changed my gloves. She further stated Looking back yes i should have sanitized by my, and I did not while doing perineal care for Resident #7. B) Review of Resident #9's Face Sheet dated 07/13/2023 reflected she was admitted on [DATE] with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 18 of 19 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 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Franklin Nursing Home 700 Hearne St Franklin, TX 77856 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 - Few the following diagnoses Chronic Obstructive Pulmonary Disease (persistent respiratory symptoms like progressive breathlessness and cough.) and Dementia (A group of symptoms that affects memory, thinking and interferes with daily life.) Review of Resident #9's Annual MDS assessment dated [DATE] reflected Resident #9 was assessed to have a BIMS score of 6 indicating moderate cognitive impairment. Resident #9 was further assessed to require extensive assist with ADLs and to be always incontinent of bowel and bladder. Review of Resident #9's Comprehensive care plan reflected a focus area dated 05/15/2022 The resident has bladder incontinence. Interventions included .incontinent care at least every 2 hours and apply moisture barrier after each episode .Monitor/ document for signs and symptoms of UTI: pain, burning . Observation on 07/13/2023 at 9:27 AM revealed CNA G and CNA D in Resident #9's room to perform incontinent care. CNA G and CNA D both washed hands and donned gloves. CNA G was performing incontinent care and CNA D assisted. CNA G cleaned Resident #9's front perineal area performing the procedure correctly. CNA G then removed her gloves and without hand hygiene she donned new gloves and cleaned the back perineal area. CNA G removed her gloves again and without hand hygiene donned new gloves and applied barrier cream to Resident #9. CNA G then changed gloves and without hand hygiene donned new gloves and applied Resident #9's clean brief. In an interview on 07/13/2023 at 12:17 PM CNA D stated she was trained to sanitize hands between gloves changes. She stated she did not when doing care for Resident #9. In an interview on 07/13/2023 at 12:21 PM CNA G stated she did not recall in training if she should sanitize her hands between glove changes and stated she did not when doing care for Resident #9. In an interview on 7/13/2023 at 12:23 PM the Nurse Consultant stated it was the facility's policy that staff should sanitize their hands after glove changes because hands can become contaminated even with gloves on. In an interview on 07/13/2023 at 1:52 PM the DON stated staff should sanitize their hands after glove changes, because it could lead to infections. She stated she was in-servicing the staff regarding this failure. Review of the facility's policy Fundamentals of Infection Control Precautions dated 04/25/2022 reflected A variety of infection control measures are used for decreasing the risk of transmission of microorganisms in the facility. These measures make up the fundamentals of infection control precautions. Hand Hygiene continues to be the primary means of preventing the transmission of infection. The following is a list of some situations that require hand hygiene .After removing gloves Wearing gloves does not replace the need for hand washing because gloves may have small inapparent defects or be torn during use, and hands can become contaminated during removal of gloves . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 19 of 19