Health inspection·January 22, 2026

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to maintain an effective pest control program so that the facility is free of pests and rodents for 2 (Resident #1's room and Resident #3's room) of 5 residents room reviewed for pestThe facility did not ensure Resident #3's room was free of roaches and Resident #1's room was free of gnats. This failure could place residents at risk for uncomfortable environment.Findings included: Record review of Resident #1's face sheet dated 01/21/26 reflected, Resident#1 was admitted to the facility on [DATE]. Resident #1 was diagnosed with but not limited to, Cerebral palsy (a group on conditions that affect movement and posture), unspecified, major depressive disorder (Mod disorder that significantly impacts daily life) recurrent, unspecified and anxiety disorder (mental health conditions that cause fear, dread and other symptoms that are out of proportion to the situation).Record review of Resident #1 MDS, dated [DATE] reflected Resident #1 had a BIMS score of 11 which showed moderate cognitive impairment.Record review of Resident #3's face sheet dated 01/21/26 reflected, Resident #3 was admitted to the facility on [DATE]. Resident#3 was diagnosed with but not limited to, Parkinson's disease without dyskinesia, without mention of fluctuations (disease of the nervous system) mild neurocognitive disorder (early-stage condition featuring slight but noticeable declines in memory, language, or thinking skills that exceed normal aging) due to known physiological condition without behavioral disturbance.Record review of Resident #3's MDS, dated [DATE] reflected Resident #3 had a BIMS score of 9 which showed moderate cognitive impairment.Requested policy on physical environment and pest control on 01/21/26 at 10:29 am to the Admin and DON by email.During an interview and observation on 01/21/26 at 10:40 a.m., Resident #3 and Resident #4 were roommates and were interviewed together. Resident #3 said she had roaches and they kept coming back. Resident #3 said she had talked with the Admin about the roaches. Resident #3 said the roaches were everywhere in her remote and refrigerator. Resident #3 said she went to another room and came back to this one. The Surveyor did not see roaches in Resident #3's bedroom and bathroom at this time. Resident #4 yelled no when surveyor asked if she had seen roaches in the room recently.During an interview and observation on 01/21/26 at 11:05 a.m., Resident #1 and Resident #2 were roommates and were interviewed together. Resident #1 said, see those little black flies. The surveyor saw gnats around Resident #1's bed. Resident #1 said, it was hard to sleep at night because of the flies around his head all the time. Resident #1 said, he told them [nursing staff] about the[ gnats]and they [Maintenance Director] would come and fix it, The surveyor observed that Resident #1 yelled when he talked and could be heard in the hallway. The Surveyor asked Resident #2 if the flies bother him, and Resident #2 said no.During an interview on 01/21/26 at 11:15 a.m., Resident #5 said that she saw the little black flies in her room, but they do not bother her because they do not bite.During an interview on 01/21/26 at 11:27 a.m., the Dietary Manager said that she had not seen gnats and roaches in the kitchen. The Dietary Manager said she was told by other staff that Resident #3 had a problem with Residents Affected - Few (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 675906 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 675906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Benbrook Nursing & Rehabilitation Center 1000 McKinley St Benbrook, TX 76126 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)