Health inspection·March 14, 2025

F 0880 Record review of Resident #1's Nursing Progress Note dated 3/7/2025 revealed the following: Level of Harm - Minimal harm or potential for actual harm . [Resident #1] is positive for COVID .Patient has new COVID . Residents Affected - Some In an observation on 3/14/2025 at 8:57 a.m. of Resident #1's closed door revealed signage that reflected, STOP - DROPLET PRECAUTIONS - EVERYONE MUST: Clean their hands, including before entering and when leaving the room. Make sure their eyes, nose and mouth are fully covered before room entry. Remove face protection before room exit. There was a three-draw container with hazard bags in the bottom drawer, gowns in the middle drawer, and the top drawer was empty. There was a package of personal cleansing wipes on top. In an observation on 3/14/2025 at 8:58 a.m., the Administrator entered Resident #1's closed room with a surgical mask on (Surveyor stood outside of the room). He did not sanitize his hands, put on gloves, a gown or eye protection before he entered the room. After he entered the room, he left the door open. Resident #1 was sitting with a meal tray in front of her. The Administrator assisted Resident #1 with pouring a liquid into a bowl. Resident #1 asked for more milk. The Administrator left the room and went to the next hall toward the kitchen. He did not sanitize or wash his hands before leaving Resident #1's room. The Administrator walked up to an open window with a counter. The Administrator placed his hands on the countertop. He asked a dietary aide for a cup of milk. He left the counter and entered back into Resident #1's room (left the door open). He did not sanitize or, wash his hands, or put on additional PPE. The Administrator assisted Resident #1 with the milk, walked out of the room and closed the door. In an interview on 3/14/2025 at 9:06 a.m. the Administrator said Resident #1 was on droplet precautions and initially said he did not need to gown up because Resident #1 had not touched her plate wear or food. He said he could not say without certainty if Resident #1 touched her dishes or food. He said he forgot to sanitize his hands when he entered the room, he was focused that the call light was on and went to answer it. He said he did not think his action was a risk for other residents or staff. He said he was trained on PPE and universal infection control protocols. In an interview on 3/14/2025 at 3:16 p.m. the DON said when a resident was on droplet precaution, staff should put on a N95 mask, eye protection, gown and wash or sanitize their hands when they entered the room. She said staff or visitors should take off all the PPE, throw it away before they left the room and wash or sanitize their hands after they have left the room. She said when the Administrator entered Resident #1's room without the required PPE and left the room and did the wash or sanitize his hands, he placed residents and staff at risk of spreading infection. She said Resident #1 was on droplet precaution because she tested positive for COVID on 3/9/2025. In a phone interview on 3/14/2025 at 3:33 p.m. the ADON (Infection Control Preventionist) said all staff, including the administrator, was required to wear N95 mask, eye protection, a gown, gloves, and shoe protection. She said the shoe protection was optional. She said staff should wash their hands before entering and exiting the room. She said universal infection control included sanitizing their hands before resident contact. She said there was a risk of spreading germs to residents and staff. Record review of facility's In-service Training and Education - Infection Control - Hand Hygiene Efforts (dated February 2025) revealed the following in part: Hand-Hygiene Practices: You must use hand sanitizer on your hands appropriately before entering (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 2 of 3 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 675961 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency Village 409 W Green Webster, TX 77598 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm patient rooms & exiting the room despite proper handwashing efforts in efforts completed, you must use hand sanitizer again once you exited the room. Should you touch surfaces such as doorknobs, carts, etc. it is always better air on the side of caution and just use hand sanitizer, its easy, its available and its best practice! You must wash hands OR use hand sanitizer before donning PPE. This is to prevent to prevent the potential of cross contamination - spreading infections. This is the proactive of IFC: Infection Control. Residents Affected - Some Record review of the facility's Infection Prevention and Control Program policy (revised October 2018) reflected in part, . An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections . (7) implementing appropriate isolation precautions when necessary; and (8) following established general and disease-specific guidelines such as those of the Centers for Disease Control (CDC).] Record review of CDC guidance Droplet Precaution (dated 3/2024) reflected Use Droplet Precautions for patients known or suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking. Source control: put a mask on the patient. Ensure appropriate patient placement in a single room if possible. In acute care hospitals, if single rooms are not available, utilize the recommendations for alternative patient placement considerations in the Guideline for Isolation Precautions. In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis considering infection risks to other patients in the room and available alternatives. In ambulatory settings, place patients who require Droplet Precautions in an exam room or cubicle as soon as possible and instruct patients to follow Respiratory Hygiene/Cough Etiquette recommendations. Use personal protective equipment (PPE) appropriately. [NAME] mask upon entry into the patient room or patient space. Limit transport and movement of patients outside of the room to medically-necessary purposes. If transport or movement outside of the room is necessary, instruct patient to wear a mask and follow Respiratory Hygiene/Cough Etiquette. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675961 If continuation sheet Page 3 of 3