Health inspection·January 8, 2026

F 0728 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to not use any individual working in the facility as a nurse aide for more than four months unless that individual had completed a training and competency evaluation program for 3 (SNA A, SNA B, and SNA C) of 6 student nurse aides reviewed for nursing services.The facility failed to ensure SNA A, SNA B, and SNA C were certified within four months of hire.This failure could place residents at risk for receiving inappropriate care from individuals whose skill level was not known. Findings included:Record review of SNA A's employee files revealed SNA A had a hire date of [DATE] and no evidence SNA A was certified as a nurse aide at that time. An employability status check dated [DATE] indicated SNA A had a CNA certification that expired [DATE]. Record review of SNA B's employee file revealed SNA B had a hire date of [DATE] and no evidence SNA B was certified as a nurse aide at that time. An employability status check dated [DATE] indicated SNA B had no CNA certification. Record review of SNA C's employee file revealed SNA C had a hire date of [DATE] and no evidence SNA C was certified as a nurse aide at that time. An employability status check dated [DATE] indicated SNA C had no CNA certification. During an interview on [DATE] at 11:00 AM, the RNC stated her expectation was when NAs were hired, they were enrolled in classes within 30 days and were certifiable at 60 days. She stated the facility had no policy on NAs, and there was no time limit other than what the NATCEP requirements were. The RCN stated SNAs should have been certified as a CNA no more than 4 months after hire. The RCN stated she felt the failure was due to the previous DON from a sister facility who monitored the SNAs education and time frames of becoming certified. She stated as of that day had changed the three SNAs to Hospitality Aides because they had worked for four months or more. During an interview on [DATE] at 5:29 PM, the ADMN stated SNAs should have been certified within 4 months of hire. She stated the sister facility's DONad not kept up with monitoring and tracking of the certification. She stated they had been performing direct care with residents even after the 4-month allotted time frame. The ADMN stated the DON had been responsible for monitoring the nurse aides, but she was no longer at that facility. The ADMN stated she felt the failure occurred with the previous DON not following up and completing the task she was given. She stated there was potential harm for residents if staff were not trained properly in not knowing what out of the range signs and/or symptoms to look for. Record review of the facility's email dated [DATE] from the NATCEP Program Specialist II, LTC Regulatory, Credentialing Unit, to the RCN read in part.3. A facility must not use any individual working in the facility as a nurse aide for more than four months. 4. If they fail the test they can continue to work as a student nurse aid for 4 months. A student nurse aide only has 4 months to test, so they will need to re-test before their 4-month timeframe is up. If the test is failed 3 times, they must complete the course again and will not be able to work as a student nurse aide and will have to complete the training again. Record review of the facility's policy, titled Job Page 1 of 2 676046 676046 01/08/2026 Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802

F 0728 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Description for a SNA dated 2014 revealed: Knowledge Base -Must provide written proof of the completion of 16-hour ADL training by authorized school instructor. Only perform patient care areas that they have been trained for, accountable for personal care (grooming, dressing, personal care, catheter care, peri care, and dressing), basic computer knowledge, identifies and reports any condition requiring management attention, ambulate and transfer residents utilizing appropriate assistive devices and body mechanics .Applicant declaration: I have read the qualifications and requirements of the position of student nurses' aide; I understand this position is not permanent but limited to 120 days in which I am required to test and obtain certification. I understand and certify that the foregoing is a non-exhaustive criterion that is consistent with the needs of this facility and is a legitimate measure of the qualifications for a Certified Nursing assistant and relates to the functions essential to a certified nursing assistant. 676046 Page 2 of 2