Health inspection·March 19, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not reach her call light. Resident #1 stated if she needed assistance, she would have to wait on staff to come in her room. 2. Record review of Resident #2's admission record, dated 03/19/2025, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #2 had diagnoses which included: unspecified dementia (neurological condition affecting the brain that worsen over time), lower back pain, shortness of breath, and essential primary hypertension (high blood pressure without a known underlying cause.) Record review of Resident #2's Quarterly MDS assessment, dated 03/06/2025, reflected the resident had a BIMS score of 05, which indicated severe cognitive impairment. Resident #2 required substantial/maximal assistance in the area of shower/bathe self. Resident #2 was dependent in the area of putting on/taking off footwear. Record review of Resident #2's care plan, dated 03/19/2025, reflected Resident #2 was care planned for risk communication, high risk for falls, and had an intervention for Resident #2's call light to within reach and answered in a timely manner. During an observation on 03/19/2025 at 12:46 PM., Resident #2's call light was observed tied to the lower left part of her bed rail. Resident #2's call light was not within her reach. Resident #2 stated she could not reach her call light if she tried too. Resident #2 was not sure how long her call light had been out of reach. Resident #2 stated she would have to wait on staff to enter her room or call for assistance if she needed help. During an interview with the CNA A on 03/19/2025 at 2:05 PM, CNA A stated she and CNA B both were working the D hall where Residents #1 & #2 resided. CNA A stated CNAs made round's every two hours or as needed. CNA A stated it was everyone's responsibility for ensure resident's call lights were within reach. CNA A stated when making rounds CNAs checked to see if residents needed assistance and ensured the residents were safe. CNA A stated the purpose of a call light was a resident to call for assistance. CNA A stated she was not aware Resident #1 or Resident #2's call light was not within reach. CNA A stated if a resident could not reach the call light the resident would not be able to call for help if they need something. During an interview with CNA B on 03/19/2025 at 2:10 PM, CNA B stated she and CNA A both worked the D hall where Residents #1 & #2 resided. CNA B stated CNAs made rounds at least every two hours unless there was a resident who may require more frequent checks. CNA B stated that it's the CNAs and anyone who enter the resident's room to ensure the call lights was in reach. CNA B stated during rounds, CNAs were taught to ensure the resident call lights were in reach. CNA B stated she was not aware Resident #1 or Resident #2's call light was not within reach. CNA B stated if a residents call light was not in reach the resident would not be able to call for assistance. During an interview with the DON on 03/19/2025 at 3:05 PM, the DON stated all residents call lights should be always within reach. The DON stated it was everyone's responsibility to ensure residents call lights were always within reach. The DON stated if a resident's call light was not within reach the resident would not be able to receive assistance if they needed it. During an interview with the ADM on 03/19/2025 at 4:10 PM, the ADM stated call lights should always be within reach. The ADM stated it was everyone's responsibility to ensure the call light were within reach. The ADM stated if a resident call light was not within reach, then the resident may not be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676047 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 676047 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town Hall Estates Keene, Inc. 207 S Old Betsy Rd Keene, TX 76059 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 0558 Level of Harm - Minimal harm or potential for actual harm able to call for assistance. The ADM stated her expectation was for all resident's call lights to always be within reach. A record review of the facility's Answering the Call Light policy, revised September 2022, reflected The purpose of this procedure is to ensure timely response to the resident's requests and needs. Residents Affected - Few General Guidelines 5. Ensure that the call light is accessible to the resident when in bed, from the toilet, from the shower or bathing facility and from the floor FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676047 If continuation sheet Page 3 of 3