Health inspection·December 15, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interviews, the facility failed to provide a safe, clean, comfortable, and homelike environment for residents in 2 (Shower room [ROOM NUMBER] and Shower room [ROOM NUMBER]) of 5 shower rooms reviewed for environment. 1. The facility failed to properly clean and sanitize the floor, toilet and sink of Shower room [ROOM NUMBER] and failed to empty the trash and soiled linen bins. 2. The facility failed to properly clean and sanitize the floor of one of the showers in Shower room [ROOM NUMBER]. This failure could affect all residents that were showered in the shower rooms by exposing them to bacteria and organisms that could impact their health and diminish their quality of life. The findings include: Record review of a grievances filed on 10/27/25 revealed a resident relative requested a cleaner environment for their relative at the facility. During an observation of Shower room [ROOM NUMBER] on 12/15/25 at 9:55am revealed a strong odor of urine as upon entrance to the shower room. Against the wall were two large see-through bins with plastic bags. The first bin was overflowing with linen, and the top would not close. The second bin was labeled trash; it was closed and trash was full to the top. The toilet bowl was observed to have what looked like feces and urine in it. The floor had two dried red circular spots. The sink counter had a beige dirty shoe insole on the corner of it. During an observation of Shower room [ROOM NUMBER] on 12/15/25 at 10:06am revealed, one shower (the one straight ahead upon entrance to the room), had 5 various sized brown smudges that ranged from quarter size to pencil eraser size on the tiled floor of the shower. During an interview and observation with the Director of Environmental Services on 12/15/25 at 10:17am revealed housekeeping staff was responsible for cleaning the shower rooms once or twice a day and upon request. The Director of Environmental Services and surveyor entered Shower room [ROOM NUMBER] and observed the same 5 brown smudges on the shower floor of the first shower, the Director of Environmental Services stated she could not confirm what the smudges were. She stated housekeeping had not cleaned Shower room [ROOM NUMBER] yet, however the CNAs were responsible for cleaning the shower room after each use. The Director of Environmental Services then observed Shower room [ROOM NUMBER] with the surveyor and stated she could not say what the red drops on the floor were and no one had informed her there were red spots on the floor that needed cleaning. The Director of Environmental Services referred to the bins against the wall in Shower room [ROOM NUMBER] as the bed rolls and explained one side was soiled linens and one was trash. She stated the bed rolls were at the point they needed to be emptied because they were full and stated the strong urine odor in Shower room [ROOM NUMBER] could have been due to the bed rolls not being emptied. She stated the CNAs typically emptied the bed rolls several times per day. She reported Shower room [ROOM NUMBER] was typically cleaned after lunch and after dinner due to its high usage. The Director of Environmental Services reiterated it was the CNAs responsibility to clean the shower rooms after each shower throughout the day as needed. She stated the insole of the shoe Page 1 of 3 675969 675969 12/15/2025 Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some observed in Shower room [ROOM NUMBER] should have been thrown away immediately and not left on the sink. The risk to the residents who were showered in a dirty shower was possible exposure to bacteria that could have made them sick. During an anonymous group interview with 8 Residents on 12/15/25 at 10:32am revealed the residents believed the shower rooms were messy and at times when they were taken to the shower rooms the shower rooms had dirty towels on the floor from the previous resident who showered. One of the anonymous residents stated they had observed feces on the floor in the shower on one occasion when staff took them to the shower room. During an interview with CNA A on 12/15/25 at 10:42 am revealed she was responsible for cleaning the showers after showering residents in the shower rooms. If a resident had an accident and there was urine or feces in the shower, she would have picked it up immediately and wiped the shower down. She would have then notified housekeeping about the need to sanitize the shower. CNA A stated the risk to the residents of not cleaning the showers after every use was the resident could have gotten sick, an infection or slipped if there was urine on the floor. During an interview with CNA B on 12/15/25 at 11:34 am revealed she had used the Shower room [ROOM NUMBER] about 8am and had not observed it to be dirty. CNA B stated it was the responsibility of the CNA to clean up any accidents that happened during or after a shower. She stated once they cleaned up any feces or urine, they would call housekeeping to sanitize the shower room. The risk of bringing a resident in the shower room while it was dirty with feces would have been the resident could have gotten contaminated or an infection. During an interview with CNA C on 12/15/25 at 11:44 am revealed she frequently used Shower room [ROOM NUMBER] to shower residents. She stated after every shower she would situate the resident in a safe place and would go back to the shower room and would pick up trash and dirty linens. If she saw poop on the floor, she would clean it up immediately. CNA C stated she also checked the showers before the end of her shift to make sure they were clean because her main goal was infection control. CNA C stated a dirty floor, with poop, in a shower room could have exposed a resident to bacteria. During an interview with CNA D on 12/15/25 12:15pm revealed he worked in the section assigned to Shower room [ROOM NUMBER]. CNA D stated he had not noticed the dirty conditions of Shower room [ROOM NUMBER] because he used another shower room in the area. He stated if he had observed blood on the floor he would have cleaned it up as best as he could and called housekeeping for more in-depth cleaning. If he was showering a resident and there were bodily fluids like urine, feces or blood he would have cleaned it and would have asked housekeeping to disinfect the room. CNA D reported the person who gave the shower to a resident was responsible for cleaning up the shower room after. He stated if he entered a shower room and it had feces or blood he would clean and disinfect it before he brought the new resident into the shower room. CNA D stated there was a high risk to residents if there was feces or blood in the shower room because they could catch something because you never know what is in the stool or blood. During an interview with the DON on 12/15/25 at 4:05pm revealed housekeeping staff had been cleaning the shower rooms daily, but CNAs were responsible for cleaning up after themselves between showering residents. The DON stated housekeeping staff should have been keeping up with the shower rooms and should have been checking them throughout the day. The risk to the residents of not having had clean showers was infection. During an interview with the Administrator on 12/15/25 at 4:51pm revealed the expectation of the CNAs after using the shower rooms would have been they no wait to clean up the shower but cleaned it immediately. The Administrator stated if a CNA saw BM on the floor he would have expected them to clean it up and not leave it there. The CNAs were required to keep the showers sanitary and clean. Housekeeping was expected to do their daily rounds to ensure the shower rooms remain clean, but it was not housekeeping staff's responsibility to keep the showers clean after every shower. The risk to 675969 Page 2 of 3 675969 12/15/2025 Settlers Ridge Care Center 1280 Settlers Ridge Rd Celina, TX 75009

F 0584 Level of Harm - Minimal harm or potential for actual harm the residents of not having clean showers was infections and negative effect on their sense of dignity. Requested the policy related to the cleanliness of the facility and/or the shower rooms on 12/15/25 at 5:00pm and was informed by the Administrator the facility did not have a policy related to cleanliness. The facility did not submit a policy on cleanliness of the facility or shower rooms by the date and time of exit. Residents Affected - Some 675969 Page 3 of 3