Health inspection·January 24, 2023

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and the MDS directed the care of the resident, so the resident might not receive the appropriate care. She said the assessment should be based on record review and interview with the resident. She said she had been trained by the corporate nurse. During an interview on 01/24/23 at 11:14 a.m., the DON said her expectations were for the resident's assessment to be completed correctly. She said if the assessment was not accurate, the resident may not receive the appropriate care. She said the MDS assessments were completed according to the RAI (Resident Assessment Instrument) guidance. Record review of the RAI version 3.0 section J1300 indicated . Steps for Assessment: 1. Ask the resident if he or she used tobacco in any form in the last 7 day look back period. 2. If the resident states that he or she used tobacco in some form in the last 7 day look back period, code 1, yes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 2 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain grooming and personal hygiene for 1 of 20 residents (Resident #40) reviewed for ADL care. Residents Affected - Few The facility failed to maintain Resident #40's fingernails, which extended approximately ¾ inch past the tips of her pointer and thumb fingers of the resident's right contracted hand. This failure could place the residents at risk of not receiving the appropriate care and services to maintain their highest level of well-being. Findings included: Record review of physician orders dated January 2023 indicated Resident #40, admitted [DATE] was [AGE] years old with diagnoses of cerebrovascular disease with muscle wasting and atrophy (stroke). Record review of the most recent MDS dated [DATE] indicated Resident #40 was alert, confused and required total assistance of 2 persons for personal hygiene and bathing. The resident's range of motion was impaired to both sides of the upper and lower extremities. Record review of the care plan revised 5/9/22 indicated Resident #40 was at risk for skin breakdown related to impaired mobility secondary to a stroke. The interventions were for all staff to be instructed on skin protection techniques, document incidents of bruising, skin tears or other skin problems and tailor interventions to prevent further occurrences. A care plan revised 12/23/22 indicated the resident had an ADL self-care performance deficit related to cerebral infarction (stroke). The interventions indicated the resident required total assistance of one to two persons for personal hygiene. Record Review of a treatment sheet dated January 2023 did not indicate Resident #40's fingernails were to be trimmed or had been trimmed. Record review of an ADL sheet dated January 2023 indicated Resident #40 was totally dependent for personal hygiene and bathing. There was no documentation to indicate the resident's nails had been trimmed. During observation and interview on 1/23/23 at 9:40 a.m., Resident #40 was lying in bed sleeping. CNA C entered the room and said the resident had paralysis on the right side. The CNA pulled the resident's right hand out from under the sheet to reveal the resident's fingers contracted inward towards the palm of the hand. The pointer fingernail and thumb nail were thick and approximately 3/4 inch in length from the tips of each finger. The pointer fingernail was pressing against the left side of the middle finger. When the surveyor asked the CNA to look at the middle finger, the CNA pulled the pointer finger away from the middle finger to reveal a dark red indention approximately 3/4 inch in length to the left side of the middle finger. The skin integrity was not altered. The CNA said she did cut some of the resident's fingernails, but she believed the nurse was responsible for cutting Resident #40's fingernails. She said the resident used to have a resting hand splint but no longer had it because she would not keep it on. When asked if she was supposed to report the resident's long fingernails to the nurse, she said she was, but did not notice the nails were long and did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 3 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0677 report it. Level of Harm - Minimal harm or potential for actual harm During observation and interview on 1/23/23 at 9:45 a.m., LVN D said Resident #40 was diabetic and she was responsible for cutting the resident's fingernails. The LVN pulled Resident #40's right pointer finger away from the middle finger and said the fingernail had made an indention in the resident's middle finger. She said her pointer and thumb fingernails on the right hand were too long and needed to be trimmed. She said she must have missed cutting them. She said the possible negative outcome of not keeping the fingernails trimmed could be altered skin integrity and infection. She said the resident used to have a resting hand splint but would not keep it in her hand and would take it out. Residents Affected - Few During an interview and record review on 1/23/23 at 10:38 a.m., OT E said Resident #40 did have a resting hand splint issued to her, but she would not keep it in her hand. The contracture book indicated on 2/14/22 the resident was non-compliant with the resting hand splint. During an interview on 1/23/23 at 2:38 p.m., the DON said there was not a policy for ADL care or fingernail care. She said the facility followed best practice for ADL care. She said her expectations were for the CNAs and the nurses to assess the residents for nail care daily and keep them trimmed. She said the possible negative outcome could be altered skin integrity and infection. During an interview on 1/24/23 at 9:21 a.m., the administrator said his expectations were for the staff to check the resident's nails and keep them trimmed. He said staff should be checking them daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 4 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure respiratory care was provided according to professional standards of practice for 2 of 20 residents reviewed for respiratory care and services. (Resident #'s 32 and 299) Residents Affected - Few *Resident #32's oxygen concentrator filter was soiled with a layer of thick gray substance. *Resident #299's oxygen concentrator filter was soiled with a layer of thick gray substance. This failure could place residents who required respiratory care at risk of not receiving proper care and treatment and a decreased quality of life. Findings included: 1. Record review of a face sheet dated January 2023, indicated Resident #32 admitted [DATE], was a [AGE] year-old female with a diagnosis of chronic obstructive pulmonary disease (COPD) (a condition involving constriction of the airways and difficulty or discomfort breathing). Record review of the admission MDS dated [DATE] indicated Resident #32 was severely impaired of cognition with a diagnosis of COPD and received oxygen therapy within the last 14 days. Record review of a care plan initiated on 12/05/22 indicated indicated Resident #32 had a potential for ineffective airway clearance related to COPD with interventions that included oxygen via nasal cannula (a device used to deliver supplemental oxygen or increased air flow to a patient in need of respiratory help) at 2L(liters) per minute with humidified air as needed. Record review of Physician orders dated January 24, 2023, indicated Resident #32 was prescribed Oxygen at 2L per minute via nasal canula for COPD as needed and check filter for placement and cleanliness every week on Sunday night and as needed with a start date of 11/30/22. Record review of the MAR indicated Resident #32 oxygen concentrator filter was checked for placement and cleanliness every week on Sunday including 1/15/23 and 1/22/23 by LVN E. During an observation on 01/22/23 at 11:06 a.m., Resident #32 was observed in bed wearing oxygen at 2L per nasal canula and the oxygen concentrator filter was covered with a thick gray substance. During an observation and interview on 01/24/23 at 08:50 a.m., Resident #32 was observed in bed wearing oxygen at 2L per nasal canula. The concentrator filter was covered with a thick gray substance. Resident #32 said she did not know if the staff cleaned the filter or changed the tubing. 2. Record review of a face sheet dated January 2023, indicated Resident #299 admitted [DATE], was a [AGE] year-old female with a diagnosis of COPD and respiratory failure (a serious condition that makes it difficult to breath on your own). Record review of a baseline care plan initiated on 01/19/23 indicated Resident #299 received oxygen therapy while a resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 5 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Physician orders dated January 24, 2023, indicated Resident #299 was prescribed Oxygen at 3L per minute via nasal canula continuously and needed the oxygen concentrator filter checked for placement and cleanliness every week on Sunday night and as needed every night shift every Sunday with a start date of 01/29/23. Record review of the MAR indicated Resident #299 received oxygen continuously and the oxygen concentrator filter was due to be checked for placement and cleanliness every week on Sunday with a start date of 01/29/23. During an observation on 01/22/23 at 11:05 a.m., Resident #299 was observed in a wheelchair, wore oxygen at 3L per nasal canula, and the oxygen concentrator filter was covered with a thick gray substance. During an observation and interview on 01/24/23 at 08:50 a.m., Resident #299 was observed in bed, wore oxygen at 3L per nasal canula. The concentrator filter was covered with a thick gray substance. Resident #299 said the nurse put new tubing on her concentrator, but she did not know if the filter was cleaned. She said she did not know that it had a filter. During an observation and interview on 01/24/23 at 08:55 a.m., LVN, F said she was Resident #32's and #299's nurse today. She said the oxygen concentrator filters were dirty and should have been changed Sunday night for Residents #32 and #299. She removed the filters and cleaned them. She said it was just overlooked. LVN F said the 10- 6 nurse on Sunday night was responsible and checked the oxygen concentrator filters, cleaned them, and changed the oxygen tubing. LVN F said the DON made rounds every week and checked the concentrators. She said she was in-serviced a few months ago on oxygen concentrators care and infection control. She said the risk of an oxygen concentrator's filter not cleaned was a resident could have affected respirations and breathing. During an interview on 01/24/23 at 12:20 p.m., the DON said her expectation was for all residents on oxygen therapy to have their tubing changed and filters cleaned every Sunday by the night shift nurse. She said LVN E worked Sunday night and was responsible for changing the oxygen tubing and cleaning the concentrator filter for Residents #32 and #299. The DON said the partner rounds staff member responsible for Residents #32 and #299 was responsible to double check the concentrator filters were cleaned and the tubing was changed. She said she was Resident #32 and #299's partner staff member. The DON said she saw the tubing was changed and did not double check the filter, she said she just overlooked the filters. The DON said the staff were educated a few months back on oxygen concentrators and infection control. She said the risk to the resident was possible respiratory issues. During an interview on 01/23/23 at 2:16 p.m., LVN E said she was the nurse for Resident #32 and #299 on Sunday night, 1/19/23. She said she was responsible to ensure oxygen tubings were changed and concentrator filters cleaned. LVN E said she must have overlooked the filters. LVN E said she knew she was responsible but did not remember if she was in-serviced on it. She said she is unsure who double checks and makes sure the filters are cleaned. She said the risk with dirty filters was the resident may not get the appropriate oxygenation. During an interview on 01/23/23 at 2:40 p.m., the administrator said his expectation was for all oxygen concentrator filters to be cleaned and changed according to policy. He said it was just missed. The administrator said the risk was a potential effect to a resident's oxygen status. Record review of an in-service dated 09/08/22, titled Infection Control indicated, . 10p - 6a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 6 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete charge nurses are responsible for changing O2 tubings , filters cleanliness, and neb (a nebulizer is a small machine that turns liquid medication into a mist that can be easily inhaled) mask Q(every) Sunday during scheduled shift. Inservice was signed by LVN E. Record review of a policy dated 04/2021, titled Respiratory indicated, .It is the policy of this community to ensure all oxygen administration is conducted in a safe manner. 11. Wash filters from oxygen concentrators every 7 days in warm soapy water. Rinse and squeeze dry. Event ID: Facility ID: 676094 If continuation sheet Page 7 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food under sanitary conditions in the kitchen reviewed for dietary services. Residents Affected - Some The facility failed to prevent the following: 1. Food items were not properly labeled with product and expiration date in the refrigerator. 2. Container of black eye peas was labeled 1/1 and was in the refrigerator for 21 days. 2. Health shakes were not labeled with a date when thawed. These failures could place residents, who ate meals prepared in the kitchen, at risk for food borne illness. Findings included: During an observation and interview with [NAME] A and Dietary B on 01/22/2023 at 8:30 a.m. the walk-in refrigerator contained: large bowl of green salad with whitish liquid and was not labeled or dated; 2 sandwiches in a fold over plastic bags and were not labeled or dated; a piece of ham (approximately 4 inches by 3-inches) covered with foil wrap and was not labeled or dated; 30 health shakes individual cartons in a box with no date on box or cartons of the thaw date; and a large container labeled black eye 1/1 . Cook A said the large container was black-eyed peas and may be from New Year's Day. [NAME] A said the sandwiches, large bowl of salad, and the ham should have been labeled and dated. [NAME] A said all dietary staff are to date items, so old food is not served to residents. She said food that was old could make residents sick and these items should have been marked and thrown out after 3 days. Dietary Aide B said we date all our leftovers and the items placed in the refrigerators. During an interview and observation on 01/24/2023 at 9:18 a.m. the DM said she would look for a policy on food storage. The DM said the health shakes were good 7 to 14 days after thawed. The carton of the health shake indicated use by 14 days after thawed. She said the box of health shakes should be dated when placed in the refrigerator. She said the cooks are supposed to label and date left-over food items when placed in the refrigerator and left-over food should be disposed of after 3 days. During an interview on 1/24/23 at 11:00 a.m., the Administrator said they did not have a policy for food storage. Reference obtained on internet on 1/26/23 at 8:30 a.m., https://www.fda.gov/media/110822/download (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 8 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some . (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers. (B) Label information shall include: (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement; . Reference obtained on internet on 1/26/23 at 8:33 a.m., https://www.fsis.usda.gov/food-safety/safe-food-handling-and-preparation/food-safety-basics/leftovers-and-food-safety . Store Leftovers Safely .Safe handling of leftovers is very important to reducing foodborne illness. Follow the USDA Food Safety and Inspection Service's recommendations for handling leftovers safely. .Leftovers can be kept in the refrigerator for 3 to 4 days or frozen for 3 to 4 months . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 9 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain mechanical and electrical equipment in safe operating condition for 1 of 1 kitchen. Residents Affected - Some The facility did not ensure the stove and oven were in working order: Two of the six burners on the stove did not light when the knobs were turned on. One of the 2 ovens did not cook the food. This failure could place residents and staff at risk of breathing in gas fumes and food borne illness. Findings included: During an observation and interviews on 01/22/23 at 8:40 a.m., there were 6 pies with very dark crust on the preparation table and the Dietary Aide said the oven was too hot and burnt the pies. [NAME] A said the oven sometimes gets too hot or cooks unevenly. [NAME] A said the repair man came out last week, but the oven worked fine for him. During an observation and interview on 01/22/2023 at 8:50 a.m., [NAME] A turned the stove burners on, and the first two burners did not light, and she said they used a piece of paper or a match when this happens. [NAME] A said she would report this to the Maintenance Supervisor . During an observation and interview on 01/23/2023 at 11:30 a.m., [NAME] A opened the door to the oven and said the meatloaf is not cooking and the oven is not hot. The DM obtained the temperature in several areas of the meatloaf which indicated 119 to 120 degrees Fahrenheit. The meatloaf was still pink, no brown edges were noted. There was no grease or meat drippings in the bottom of the pan around the meatloaf. The DM said the pan felt warm like it had been cooking. During an interview on 01/23/2023 at 11:35 a.m., the DM said she put the meat loaf in the oven at 10:00 a.m. She said it took about 15 minutes to prepare the meatloaf prior to placing them in the oven. The DM said I think the meat is still ok to cook. During an interview on 01/23/2023 at 11:45 a.m., the DM said the meatloaf would be disposed of and not served. She said the burners on the stove were working the maintenance supervisor got them working again. During an interview on 01/23/2023 at 11:47 a.m., [NAME] A said if the oven did not work properly residents could get sick from spoiled food. She said the cooks would use the oven that was working properly. During an interview on 01/24/2023 at 9:18 a.m. the DM said she would look for a policy on maintaining essential equipment. During an interview on 1/24/23 at 11:00 a.m., the Administrator said they did not have a policy for maintaining equipment. He said they had the repair man out last week for the oven and the repair man would be coming back out today. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 10 of 11 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 676094 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Orange 4201 Fm 105 Orange, TX 77630 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 0908 Record review of an invoice dated 1/17/23 indicated the repair service Arrived to inspect the oven. Checked thermostat operation. Watched 1 hour cycle at 350 degrees. Checked okay . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676094 If continuation sheet Page 11 of 11