Inspection·February 10, 2025

F 0580 after 8am. [the exact time on the UA report is not legible.] Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's progress notes dated 1/17/2025 by LVN #1 at 12:37 pm, revealed Resident #1's UA results had been received and NP #2 had been notified. Progress note further indicated they were still waiting on C&S results. Residents Affected - Few Review of Resident #1's progress notes dated 1/17/2025 by LVN #1 at 3:54 pm, revealed temperature reading of T-100.4 [degrees F]. Further review of Resident #1's progress notes from 1/16/2025 to 1/18/2025 reflected no entries from LVN #1 indicating she had notified NP #2 of Resident # 1's elevated temperature readings at two different times on 1/17/2025. During an interview on 2/10/2025 at 11:02 am with LVN #1, she stated she had assessed Resident #1's vital signs on 1/17/2025 at 8:14 am and he had a temperature of 101.7F. She stated she had also taken his vital signs on 1/17/2025 at 3:54 pm and he had a temperature of 100.4F. She stated both of those readings indicated Resident #1 had a fever and indicated a change in condition and NP #2 should have been notified. She stated she thought she had contacted NP #2 with that information but to my 100% knowledge, I don't know if I did. She stated if she had contacted NP #2, I would have documented this in a progress note. LVN #1 was informed there was no progress note in the EMR about her contacting and notifying [NP #2] of Resident #1's fever. She stated, This means [NP# 2 ] was not notified. She stated with Resident #1 running a fever she would have concerns about infection, or a UTI. Resident #1 could have developed a serious infection, possibly sepsis (systemic infection of the entire body), which could lead to death . During an interview with NP #2 on 2/10/2025 at 11:16 am, she stated she had ordered a UA for Resident #1 on 2/16/2025 because nursing staff had noticed he had dark colored urine draining into his indwelling catheter bag. She stated she was never contacted about Resident #1 having a fever on 1/17/2025. She stated if she had known that, per the facility policy she would have started a broad-spectrum antibiotic to start treating Resident #1's suspected UTI. She stated the antibiotic could have started to work on the infection while they were waiting for the lab results to come back and reduced Resident #1's discomfort. NP #2 stated Resident #1's UA came back positive on 2/17/2025 for bacteria present. A positive UA indicated he had an infection, so a Culture & Sensitivity (C&S) test was initiated. She stated a C&S is done to ensure the infection is treated with the appropriate antibiotic. She stated the facility received the results of the C&S back on 9/19/2025, and she gave orders to start antibiotics, but before they could initiate antibiotic therapy, Resident #'1's RP requested he be sent to the emergency room (ER), so the facility sent him out to the ER. During an interview with the MD on 2/10/2025 at 3:19 pm, he stated he was not aware that Resident #1 was febrile (had a fever) and met the criteria for initiation of antibiotic therapy per the facility antimicrobial stewardship policy . He stated if a resident showed clinical signs of a fever where a UTI was suspected, they would start a broad-spectrum antibiotic while they waited for additional testing results to come back from the lab. He stated, It would have been nice if they notified us. We could have started him on an antibiotic. The MD stated his expectations were that the nursing staff would notify either him or NP #2 when a resident had a fever with a suspected UTI so they could give orders to start antibiotics. During an interview on 2/10/2025 at 4:05 pm, the DON stated she was not aware Resident #1 had run a fever on 1/17/2025 and that NP #2 had not been contacted by LVN #1. She stated her expectation was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676014 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 676014 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twilight Home 3001 W Fourth Ave Corsicana, TX 75110 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that LVN #1 should have called the practitioner and made them aware of Resident #1 running a fever. She stated Resident #1's infection could have gotten worse, or the resident could have even developed sepsis. During an interview on 2/10/2025 at 4:15 pm, the ADM stated she was not aware that Resident #1 had developed a fever and her expectation was that the nurse would call the provider. She stated when Resident #1 ran a fever that indicated a change in condition and could have indicated his infection had been getting worse. She stated Resident #1 could have become septic. Review of undated facility policy Antimicrobial Stewardship reflected the following: Policy - Treatment with antibiotics is only appropriate when the practitioner determines, on the basis of an assessment, that the most likely cause of the patient's symptoms is a bacterial infection. Procedures - 1. When the facility staff suspects a resident has an infection, the nurse should perform and document a complete assessment of the resident using established and accepted assessment protocols to determine if the resident's status meets minimum criteria for initiating antibiotics. A. Suspected Urinary Tract Infection, with indwelling catheter; at least one of the following: Fever (>100 degrees F), New costovertebral tenderness [tenderness where the ribs meet the spine], Rigors [shivering with a rise in temperature] or New onset of delirium [altered mental status]. Review of facility policy Notifying the Physician of Change in Status dated Rev March 11, 2013, reflected the following: 1. The nurse will notify the physician immediately with significant change in status. The nurse will document signs and symptoms of significant change, time/date of call to physician, and interventions that were implemented in the resident's clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676014 If continuation sheet Page 3 of 3