Health inspection·March 25, 2025

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few topically one time a day every Monday, Wednesday, and Friday for dry flaking skin. Order type: wound treatment (with med ). Route of Administration topically ( apply to the surface of the body particularly the skin). Record review on 03/25/2025 at 12:05 PM of the facility's shower schedule located at the nurse's desk reflected Resident #1 received a shower on Monday, Wednesday's and Fridays. Record review on 03/25/2025 at 2:45 PM of the facility's in-service on medication cart locks was conducted on 08/15/2025. There was not any information provided of what was reviewed during this in-service. Treatment Nurse B did attend the in-service. The Director of Nurses was the instructor of the in-service. Observation on 03/25/2025 at 8:35 AM revealed the 400-hall shower door was unlocked. There was a prescription of medicated shampoo located on a shelf in the shower room . Observation on 03/25/2025 from 8:35 AM to 3:00 PM there was not any residents wandering on the 400 hall. Interview on 03/25/2025 at 9:20 AM, CNA/Shower Aide A stated she did not lock the door when she left the shower room. She stated she was not aware there was prescription shampoo for Resident #1 in the shower room . CNA/Shower Aide A stated Resident #1 received a shower Monday, Wednesday, and Friday. She stated she was off on Monday and she was not going to give Resident #1 a shower today (03/25/2025). CNA/Shower Aide A stated the treatment nurse kept the prescription shampoo locked in the treatment nurse's cart. She stated when it was time for Resident #1's shower the shower aide would ask for the prescription shampoo from Treatment Nurse B and she would bring the prescribed shampoo to the shower room or the shower aide would go to the treatment nurse and she would give it to them at the treatment cart. She stated when the shower aide was finished with the prescribed shampoo it was expected for the shower aide to return the shampoo to the treatment nurse or the treatment nurse would come to the shower and get the prescribed shampoo. She stated CNA C gave showers in her place on 03/24/2025. CNA/Shower Aide A did not reveal how she knew CNA C gave showers on 03/24/2025 on Resident #1. She stated she was in serviced to keep the shower doors locked. CNA /Shower Aide A did not recall the date of the in-service. She stated she had not witnessed any residents on 400 hall wandering. CNA/Shower Aide A stated she worked on 400 hall several times a week. Interview via phone, attempted on 03/25/2025 at 10:30 AM with CNA C. A voice message was left for CNA C to return the phone call and a text message was also sent to CNA C asking for her to return the phone call. CNA C did not return phone call. Interview on 03/25/2025 at 9:45 AM, Treatment Nurse B stated Resident #1 was prescribed shampoo. She stated the shampoo was expected to be locked on the treatment nurse cart. She stated she delivered the prescribed shampoo to CNA C on 03/24/2025. She stated it was after 12:30 PM. Treatment Nurse B stated either the CNA/Shower Aide would return the prescription shampoo to her when they were finished or she would go to the shower room and get the prescribed shampoo and place it in the locked treatment cart. She stated she observed Resident #1 receiving a shower on 03/24/2025. She stated it was her responsibility to ensure the prescribe shampoo was returned to her and locked in the treatment nurses' cart. She stated she forgot to check on the prescribed shampoo and CNA C did not return it to her on 03/24/2025. Treatment Nurse B stated if a resident ingested the shampoo she would call the doctor and follow the doctors' orders. She stated she could not comment if there would be any adverse effect on a resident if the resident ingested the shampoo or if the shampoo was in the residents' (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm eyes. She stated she did not know if she was in serviced on locking medications. Treatment Nurse B stated there was not any residents who wandered on the 400 hall ( hall where the unlocked shower was located). She stated she would answer the question if she was in-serviced on storing medications after she reviewed the in-services. Treatment Nurse B did not report prior to exit if she received in-service on medication storage and locking medications. Residents Affected - Few Interview on 03/25/2025 at 10:33 AM, the Director of Nurses stated her expectations was all prescribed medications which included prescribed shampoo was to be locked in a medication cart or treatment nurses' cart when not in use. She stated leaving prescribed shampoo in the shower room was not acceptable. She also stated the shower room was to be locked at all times. The Director of Nurses stated the protocol for the shower aides to have the prescribed shampoo was the treatment nurse would give it to the shower aide and when the shower aide was finished with the prescribed shampoo, the shower aide would return it to the treatment nurse to be locked in the treatment cart. The Director of Nurses stated they did not have a shower schedule it would be under each resident's name in the electronic medical records beside the shower log. She stated if there was any suspicion of a resident ingested the prescribed shampoo, a nurse would contact the physician and the poison control. The Director of Nurses stated there was not any residents who wandered on the 400 hall (where the shower room was not locked). She stated she was not aware of any in-services in the past year of ensuring prescribed medications required to be locked. Interview on 03/25/2025 at 11:03 AM, the Medical Director stated the prescribed shampoo (ketoconazole external shampoo 2%) for Resident #1 would not cause harm to a resident. He stated it was a fungal type of shampoo. The Medical Director stated if there was any question if resident ingested the shampoo, the poison control could be called for guidance and he would suggest observing the resident. Interview on 03/25/2025 at 11:49 AM, CNA/Shower Aide D stated the shower doors was expected to be locked at all times. She stated she worked on 03/24/2025 but not as a shower aide. CNA/Shower Aide D stated she was assigned to work on the floor instead of giving showers. She stated CNA E gave showers on the residents she gave showers to and CNA C gave showers on the residents CNA A was assigned to give showers. CNA /Shower Aide D stated she did not give Resident #1 a shower. Resident #1 was not on her shower list. She stated when anyone had prescribed shampoo the protocol was to ask Treatment Nurse B for the prescribed shampoo and when finished with the prescribed shampoo the shower aide was expected to return the prescribed shampoo to the treatment nurse to lock it in the treatment nurse cart. She stated she was in-serviced on keeping the shower door locked but did not recall the date. She stated she was not aware of any residents who wandered on 400 hall where the unlocked shower was located. Interview via phone attempt, to call CNA E on 03/25/2025 at 1:20 PM. CNA E did not return phone call after a voice and text message was left for CNA E. Record review of the facility's Storage of Medications, dated 2003, reflected medications and biologicals are stored safely, securely, and properly following manufacturers recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. 1. Only licensed nurses, the consultant pharmacist, and those lawfully authorized to administer medications are allowed access to medications. Medication rooms, carts, and medication supplies are locked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675897 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 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 0761 and attended by persons with authorized access. Level of Harm - Minimal harm or potential for actual harm 2. Residents Affected - Few Except for those requiring refrigeration, medications intended for internal use are stored in a medication cart or other designated area. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675897 If continuation sheet Page 4 of 4