Health inspection·April 29, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2.Record review of Resident #2's admission record, dated 04/29/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #2 had diagnoses which included: paranoid schizophrenia (when someone experiences strong paranoia/they are intensely suspicious and fearful of others), type 2 diabetes mellitus without complications (condition were your body doesn't use insulin properly causing high blood sugar levels), muscle weakness (reduce ability of the body to contract muscle properly, resulting in a lower strength in one or more muscle), and anxiety disorder (mental health condition characterized by excessive and persistent worry and fear). Record review of Resident #2's Annual MDS assessment, dated 02/14/2025, reflected the resident had a BIMS score of 15, which indicated cognitively intact. Resident #2 required supervision or touching assistance in the area of shower/bathe self. Record review of Resident #2's care plan, dated 04/29/2025, reflected Resident #2 was care planned for risk of falls r/t psychotropic med use, and had an intervention for Resident #2's be sure Resident #2 call light is within reach us for assistance as needed. During an observation and interview on 04/29/2025 at 9:24 am., Resident #2's call light was observed hanging between the wall and his bed. Resident #2 stated that he could not reach his call light if he tried to. Resident #2 stated he would have to move his bed to get to his call light. Resident #2 stated he did not know how long his call light was behind his bed. During an observation on 04/29/2025 at 1:40 pm., Resident #2's call light was observed hanging between the wall and his bed. Resident #2 was sleep at the time of this observation. 3.Record review of Resident #3's admission record, dated 04/29/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #3 had diagnoses which included: systolic heart failure (happens when the heart's main pumping chamber, the left ventricle, doesn't pump blood effectively), cognitive communication deficit (someone had trouble communicating because they're struggling with thinking and problem-solving skills), lack of coordination (having difficulty controlling your movements and making them work together smoothly), and anxiety disorder (mental health condition characterized by excessive and persistent worry and fear). Record review of Resident #3's Quarterly MDS assessment, dated 03/03/2025, reflected the resident had a BIMS score of 12, which indicated moderate cognitive impairment. Resident #3 required partial/moderate assistance in the area of shower/bathe self, lower body dressing, and putting on/taking footwear. Record review of Resident #3's care plan, dated 04/29/2025, reflected Resident #2 was care planned for risk of falls r/t gait/balance problems, psychoactive drug use, and had an intervention of be sure Resident #3's call light is within reach and encourage her to use it for assistance as needed. During an observation and interview on 04/29/2025 at 10:15 am., Resident #3's call light was observed hanging towards the ground on the left side of her bed. Resident #3 stated that she could not reach her call light if she tried to. Resident #3 was not aware of how long her call light had been out of reach. During an interview with the CNA A on 04/29/2025 at 1:30 pm., CNA A stated she and CNA B both were working the 100 hall where Residents #1, #2, and #3 resided. CNA A stated CNAs made rounds every two hours or as needed. CNA A stated it was everyone's responsibility for ensure residents' call lights (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676071 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 676071 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Groesbeck Ltc Nursing and Rehabilitation 607 Parkside Dr Groesbeck, TX 76642 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 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 Residents #1, #2 or #3's call lights were 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. Residents Affected - Few During an interview with CNA B on 04/29/2025 at 1:50 pm., CNA B stated she and CNA A both worked the 100 hall where Residents #1, #2, and #3 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 was the CNAs and anyone who entered 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, #2, or #3's call light was not within reach. CNA B stated if a resident's call light was not in reach the resident would not be able to call for assistance. During an interview with the DON on 04/29/2025 at 2:55 pm., the DON stated all residents' call lights should be always within reach. The DON confirmed that CNA A and CNA B were working the 100 halls where Residents #1, #2, and #3 resided. 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 04/29/2025 at 3:55pm., 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 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, undated, reflected The purpose of this procedure is to ensure timely response to the resident's requests and needs. General Guidelines .5. When the resident is in bed or confined to a chair be sure the call light is within easy reach of the resident FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676071 If continuation sheet Page 3 of 3