Inspection·January 30, 2026

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility for 3 months. She stated that she recalled an appointment with Resident #1 at a Urologist's office on 01/20/2026, and that they were gone much longer than normal on that day due to him having multiple appointments She stated that when they arrived at that appointment, she could see that Resident #1's clothes were wet. She stated she had no idea Resident #1 was double briefed until the urologist appointment, which was the 2nd appointment of the day. She stated she did not know who tended to Resident #1 that morning. She stated that residents did not bring change of clothes with them, and that was the 1st time something like that had happened since she had started transporting. She stated there was almost a 3-hour time frame between the appointments, and that no other staff went with her that day. She stated that at the time she thought Resident #1 had a catheter in place. She stated that she did not have a CNA license. She stated she felt responsible to a degree for the incident due to her driving the van that was not equipped with toiletries. She stated the resident's she transported most recently were completely self-sufficient due to the van's wheelchair lift being broken. She stated she did not alert management to the incident. She stated that the doctor's office put a new brief and pair of pants on Resident #1. She stated that a negative outcome was that Resident #1 had to sit in his urine, in public, and was embarrassed. An interview was attempted on 01/30/2026 at 12:31 PM with CNA B, but the voicemail was not returned. In an interview on 01/30/2026 at 12:44 PM with LVN A, she stated that she remembered pushing Resident #1 in his wheelchair to the side door where the transportation van would have been parked. She stated the CNAs would have been responsible for getting him dressed. She stated that CNAs absolutely did not double brief residents because it was against the rules and Resident #1 had a wound on his lower back. She stated that if someone double briefed a resident, they would be doing it for reasons that were not good, such as knowing that a resident would be sitting in a brief for a long period, without being changed. She stated she was not responsible for ensuring residents had extra sets of clothes or briefs for appointments. She stated that she thought that transportation would have scheduled a CNA to go with them. She stated that Resident #1 had not been catheterized for a few months, and that it took one person to change him. She stated that Resident #1 always told staff when he needed a brief change.In an interview on 01/30/2026 at 12:58 PM with the DON, she stated that the TD was responsible for keeping the vans stocked with briefs, linens, and changes of clothes. She stated it was not practice for residents to carry a bag with personal items and changes of clothes when leaving the facility for appointments. She stated she had not done a recent in-service on resident rights or not double briefing residents. She stated it was never okay to double brief, and that double briefing would not prevent urine from leaking out. She stated that the only reason she could think someone would be double briefed was because someone thought that a person would be going for a long period of time without being changed, which was also not okay because that could cause skin breakdown. She stated Resident #1 had all-day appointments on 01/20/2026.In an interview on 01/30/2026 at 1:10 PM with the ADM, he stated that they tried to send residents out of the building in a presentable way, and if a resident was incontinent, they would try to send a CNA with them. He stated he did not recall specifically talking about Resident #1's appointment in the morning meeting to send a CNA with them. He stated that Resident #1's RP usually transported Resident #1 to appointments, but that was not the case on 01/20/2026. He stated that it would be embarrassing for a resident to sit in their own urine.An interview was attempted on 01/30/2026 at 1:19 PM with CNA D, but the voicemail was not returned. In an interview on 01/30/2026 at 4:36 PM with CNA C, she stated that she was working with CNA B on 01/20/2026. She stated she did not recall getting Resident #1 ready for his appointments that day. She stated she was working the 200 hall but that most of the time night shift staff got the residents ready for appointments, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676074 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 676074 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitney Nursing and Rehabilitation Center 101 San Marcus Whitney, TX 76692 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete especially if the residents' appointments were out of town, and that night shift staff would get residents ready and then sit them by the front door to wait for transport. She stated that day shift tried to check and change the residents before they left for appointments, but she did not check Resident #1 before he left. She stated she had never double briefed residents and that they were not allowed to double brief residents because it caused skin breakdown. She stated that the transportation driver was new, and since the transportation driver was not a CNA, she believed a CNA should have attended the appointments. She stated she should have caught that Resident #1 was double briefed before he left, but she did not because she was not the one to get him ready for his appointment.In an interview on 01/30/2026 at 4:47 PM with CNA E, she stated that she worked on 01/20/2026, but that she did not get Resident #1 up that morning or ready for his appointments. She stated that she did not really get residents up and ready for appointments. She stated that she does not double brief residents and that she would never do that because if they double briefed residents it could contribute to skin breakdown.Review of the facility's undated Quality of Life policy reflected, The facility will care for residents in a manner and environment that promotes maintenance or enhancement of each resident's quality of life, including dignity and respect with full recognition of his/her individuality. Facility Mission Statement:Treat each resident with dignity and respect and to make a difference in the lives of the elderly that have been entrusted to our care. Event ID: Facility ID: 676074 If continuation sheet Page 3 of 3