Health inspection·November 25, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not like it and told him to take a shower tomorrow 10/22/2025.3. Record review of an admission Record dated 10/21/2025 for Resident #8 indicated he was admitted to the facility on [DATE] and was [AGE] years old with diagnoses of schizoaffective disorder, bipolar type (combines symptoms like hallucinations and delusions), type 2 diabetes, and generalized anxiety disorder (excessive and persistent worry and anxiety that is difficult to control).Record review of a Quarterly MDS assessment dated [DATE] for Resident #8 indicated he rarely/never understood and did not have a BIMS score. He required setup or clean up assistance with showering/bathing.Record review of a care plan revised on 7/7/2025 for Resident #8 indicated he had an ADL self-care performance deficit. Interventions for bathing indicated he required assistance x1 with bathing/showering three times weekly and as necessary.During an observation and interview on 10/21/2025 at 2:09 PM, Resident #8 was sitting in a chair in the dining room. He said he had been at the facility for a while. He said he was not sure of his scheduled shower days, and he did not get a shower yesterday on 10/20/2025. He said the facility always had issues with the water where it barely ran or did not have any hot water. He said not having hot water made it hard for him to shave. He said it aggravated him sometimes when the facility did not have hot water or not enough pressure.Record review of the facility's Resident Council Meeting notes dated 8/19/2025, 9/2/2025, and 9/16/2025 indicated residents who were in attendance voiced complaints of having problems with the hot water and pressure in the facility with no changes or resolutions.Record review of a shower schedule for Halls C and D undated indicated Resident #8 and #9 were scheduled for showers on Monday, Wednesday, and Friday on the 6 am-6 pm shift. Both were to get a shower.During an interview on 10/20/2025 at 1:04 PM, the AD said during the resident council meetings the past few months, the residents had been complaining about the water saying it did not get hot, and it had low pressure. She said the [plumbing company] came out and did something but was not sure what it was. She said the residents had been able to get bed baths/sponge baths when the water pressure was too low or the water was not getting hot. She said the staff would have to get the hot water from wherever they could at the facility. She said most staff would get hot water from the kitchen and carried it in basins to where they needed it. She said she would not like it if she wanted a shower and could not get one because of low water pressure or if the water was not hot enough.During an interview on 10/20/2025 at 2:28 PM, the Maintenance Supervisor said he had been employed at the facility for 3 years. He said the facility had some pipes repaired before he started as they had lime buildup and sometimes would not have good water flow in the facility. He said he changed out the water filters about twice or more a month. He said after he changed the filters, the water pressure would work for a while and then slow down again. He said the facility was working on getting a new water filtration system and [plumbing company] came out and gave them a quote for the repairs. He said he kept a log of water temperatures in the facility weekly as the water temperatures fluctuated. He said sometimes the facility would have hot water on some halls but low water pressure on others. He said sometimes the residents would have to get a bed bath instead of a shower because of the water issues and the staff would have to get water from the laundry room or kitchen. He said the staff would carry the water in a basin to where they needed it. He said it had been an issue for 3 years, but he tried to keep the filter changed to help.During an observation on 10/20/2025 at 3:24 PM, CNA B was observed exiting the shower room on Hall C with a basin of water in her hand.During an observation and interview on 10/20/2025 at 3:29 PM, CNA B was in room [ROOM NUMBER] on C Hall said she had to get water from the shower room because there was not any hot water in the bathroom to give the resident a bed bath. The hot water was turned on at the sink in the bathroom and the temperature was checked by the Surveyor and it was 72 degrees.During an interview on 10/20/2025 at 3:36 PM, the Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676103 If continuation sheet Page 2 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some said she was aware the facility had water issues, and they had a plumber that came out and informed her they would need to replace the system. She said she followed up a week later via email to ask about a quote so she could submit it to corporate but had not heard anything back. She said she knew if the kitchen was using water to wash dishes, then the staff would have to wait an hour or so for the water temperature or pressure to come back up for the halls and shower rooms. She said she was not aware staff carried hot water from the kitchen or laundry to the rooms to give baths.During a phone interview on 10/20/2025 at 3:57 PM, the Plumber said the last time (6/19/2025) he visited the facility he checked the back flow valve and took it apart because it failed. He said it had a white, heavy film from the city water supply. He said another plumber from [Plumbing company] was working on getting a water filtration system for the facility and had requested the facility send him their monthly water usage as he would have to custom built it. He said he was going back to the facility that day to get a water sample to test the system to ensure the correct size system would work for the facility. He said the facility was not given a quote yet because they were not sure what size system and how many tanks it would require. He said it would take about 2-3 days to build and then would have to install it. He said there had been buildup in the lines from years ago on two halls in the facility and at that time they replaced the copper pipes and put in pex piping for the two halls. He said the copper pipes had so much buildup that a pencil could not fit inside the pipes. He said the buildup in the lines would not allow water to flow properly and it could cause fluctuations in the water temperatures. He said they tested the back blow valves yearly and the last time he checked it; he could not get it to work properly and had to take it apart.Record review of a back flow valve test dated 6/19/2025 at the facility by the [Plumbing company] indicated the back flow valve failed on initial test, repaired and was tested again without any leaks. They installed a complete repair kit and cleaned out trash.During a phone interview on 10/21/2025 at 8:50 AM, LVN D said the residents have not been getting showers like they needed to because the water pressure was low or there was not any hot water. She said if they needed hot water they would get warm water from the kitchen in a basin. She said it had been going on for several months. She said residents should never go without a bath or shower and they could give a bed bath and get hot water from the kitchen. She said the kitchen always had hot water. She said she would be upset if she had to wait on hot water to take a bath/shower. She said she always told the staff to offer the residents a bed bath.During an interview on 10/21/2025 at 9:36 AM, CNA C said she had been working at the facility for a while in the kitchen but had been a CNA for about 6 months. She said she was always assigned to work halls C and D. She said the water issue had been low since she started on the floor, if water was not hot enough or the pressure was low, they would get water from the kitchen and put the water in a basin and take it to the resident room to give a bed bath or in the shower room. She said she would not like it and would complain if she would get a proper shower with hot water and water pressure. She said she was never informed to wait until later in the day to give a shower due to the water pressure.During an interview on 10/21/2025 at 10:17 AM, [NAME] F said he had been employed at the facility for 2 months and worked split shifts. He said he had observed staff asking for hot water from the kitchen about 1-2 times since he had been employed. He said the staff told him they needed hot water to give a resident a bath. He said they told him the water was not getting hot in the resident rooms.During an interview on 10/21/2025 at 2:43 PM, the DON said she started at the facility on 9/29/2025. She said the week she started the water pressure was low and was told if they gave showers before 9 am-10 am before the kitchen started washing dishes and then after lunch the water pressure would be better. She said she would be upset and would feel like she should have services available to her for which she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676103 If continuation sheet Page 3 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete paying. She said she was not aware of resident's not getting their showers as scheduled.During an interview on 10/21/2025 at 3:13 PM, the Administrator said the plumbing company had finally given them a quote that day (10/21/2025) and planned to install a mixer valve and it would be a separate line that would go to the water heater from the kitchen to the halls. She said she started 8/18/2025, and was not aware at that time the facility had an issue with the water. She said she had been emailing back and forth with the plumbing company for the past month to see about how much it was going to cost. She said the Maintenance Supervisor was responsible for checking the water and temperatures in the facility at least daily. The facility had a system in place where they could report maintenance issues. She said she did not know staff carried water from the kitchen or laundry room and would not want that to happen as there could be a risk of injury.Record review of a maintenance log dated 9/24/2025 indicated the shower on A-hall did not have any water pressure. The issue was completed on 10/14/2025. Comments indicated, fixed.During an interview on 10/21/2025 at 3:30 PM, the Regional Director of Operations said he was aware Halls C and D did not have hot water in the rooms. He said they would first repair the mixing valve for the facility and then would get to the issue with the halls. He said all residents in rooms on those halls had hand sanitizer in the bathrooms and if a shower was needed, those residents could go to one of the other halls that usually had hot water. He said the plumber was at the facility and had given them a quote and repairs would be made. He said in the meantime, there would be 2 staff members in the shower rooms when residents were given showers. One staff would monitor the temperature of the water to ensure it did not drop and get cold while the other gave the shower. He said all staff would be inserviced on the changes until the repairs had been made.Record review of a facility policy titled Homelike Environment revised February 2021 indicated, .Resident are provided with a safe, clean, comfortable, and homelike environment. 2. The facility staff and management maximize to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. Event ID: Facility ID: 676103 If continuation sheet Page 4 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the residents' environment remains as free of accident hazards as possible for 1 of 9 residents (Resident #3) reviewed for accident hazards.The facility failed to ensure two cans of air freshener were not left in Resident #3's room on 10/20/2025 and 10/21/2025.This failure could place residents at risk of injuries due to environmental hazards. Findings included:Record review of an admission Record dated 10/21/2025 for Resident #3 indicated he was admitted to the facility on [DATE] and was [AGE] years old with diagnoses of type 2 diabetes, morbid obesity (overweight), hypertension, and cerebral infarction (stroke).Record review of a Quarterly MDS assessment dated [DATE] for Resident #3 indicated he did not have any impairment in thinking with a BIMS score of 15. He was dependent on staff for showering/bathing.Record review of a care plan dated 11/27/2023 for Resident #3 indicated he had an ADL self-care performance deficit. Interventions for bathing indicated he was dependent on staff to provide a bath how often (3 times weekly) and as necessary.During an observation and interview on 10/20/2025 at 9:55 AM, Resident #3 was in his room and in bed awake. He said he had been a resident at the facility for 2 years. There were two aerosol cans of air freshener on his nightstand. He said the staff had left them in his room. One can read to keep out of reach of children on the label. He asked if he needed to remove the cans as one of the cans he had purchased, and the other can was one that staff had left in the room. He said there have not been any residents who wander into his room.During an observation on 10/21/2025 at 2:01 PM, Resident #3 was not in his room. The two cans of air freshener were still in his room on the nightstand.During an interview on 10/21/2025 at 2:43 PM, the DON said she started at the facility on 9/29/2025. She said there should not be any residents in the facility to have access to air fresheners in their possession. She said the air fresheners should be locked in a cart or room and not stored in the resident rooms. She said she was not aware Resident #3 had air freshener in his room and would talk to him. She said there could be a risk for fires or cause other people to get sick from the inhalants.During an interview on 10/21/2025 at 3:13 PM, the Administrator said residents should not have aerosols in their rooms. She said the air fresheners should be stored in a locked closet or in housekeeping. She said residents could be at risk for respiratory issues. She expected staff to keep aerosols on their carts or lock them in a closet after use.Record review of a facility policy titled Hazardous Areas, Devices and Equipment revised July 2017 indicated, .All hazardous area, devices and equipment in the facility will be identified and addressed appropriately to ensure resident safety and mitigate accident hazards to the extent possible. Identification of Hazards: 1. A hazard is defined as anything in the environment that has the potential to cause injury or illness. Examples of environment hazards include, but are not limited to: g. Access to toxic chemicals. Event ID: Facility ID: 676103 If continuation sheet Page 5 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to, in accordance with accepted professional standards and practices, maintain medical records on each resident that were complete and accurately documented for 2 of 9 residents (Residents #8 and #9) reviewed for medical records.The facility failed to ensure Resident #8 and Resident #9's medical records were accurate when CNA C documented both residents received a bath on 10/20/2025 when they did not.This deficient practice could place residents at risk of improper care due to inaccurate medical records.The findings include:1.Record review of an admission Record dated 10/21/2025 for Resident #9 dated 10/21/2025 indicated he was admitted to the facility on [DATE] and was [AGE] years old with diagnoses of nonrheumatic mitral valve insufficiency (mitral valve in the heart does not close properly), cardiomegaly (enlarged heart), bradycardia (slow heart beat), and hypertension.Record review of an Annual MDS assessment dated [DATE] for Resident #9 indicated he did not have any impairment in thinking with a BIMS score of 15. He required setup or clean up assistance with showering/bathing.Record review of a care plan dated 5/15/2024 indicated he had an ADL self-care performance deficit. Interventions for bathing indicated he required staff assistance x1 with bathing.Record review of the nurse aide tasks for Resident #9 for October 2025 indicated his baths were scheduled for Monday, Wednesday, and Friday. Further review revealed on 10/20/2025 CNA C documented the resident received his bath.During an observation and interview on 10/21/2025 at 1:17 PM, Resident #9 was in his room on D hall sitting in a chair. Resident #9 said he had been at the facility for 1.5 years and things were going ok. He said his shower days were scheduled for Monday, Wednesday, and Friday and sometimes he missed getting them because of the water issues. He said the water in the facility was not working properly with low pressure or no hot water. He said he was supposed to get a shower on yesterday 10/20/2025 but did not because the facility had water issues. He said his bathroom has never had hot water. He said if he did not get a shower, he did not care, but his family did not like it and told him to take a shower tomorrow 10/22/2025.2. Record review of an admission Record dated 10/21/2025 for Resident #8 indicated he was admitted to the facility on [DATE] and was [AGE] years old with diagnoses of schizoaffective disorder, bipolar type, type 2 diabetes, and generalized anxiety disorder.Record review of a Quarterly MDS assessment dated [DATE] for Resident #8 indicated he rarely/never understood and did not have a BIMS score. He required setup or clean up assistance with showering/bathing.Record review of a care plan revised on 7/7/2025 for Resident #8 indicated he had an ADL self-care performance deficit. Interventions for bathing indicated he required assistance x1 with bathing/showering three times weekly and as necessary.Record review of the nurse aide tasks for Resident #8 for October 2025 indicated his baths were scheduled for Monday, Wednesday, and Friday. Further review revealed on 10/20/2025 CNA C documented the resident received his bath.During an observation and interview on 10/21/2025 at 2:09 PM, Resident #8 was sitting in a chair in the dining room. He said he had been at the facility for a while. He said he was not sure of his scheduled shower days, and he did not get a shower on yesterday 10/20/2025. He said the facility always had issues with the water where it barely ran or did not have any hot water. He said not having hot water made it hard for him to shave. He said it aggravated him sometimes when the facility did not have hot water or not enough pressure.Record review of a shower schedule for Halls C and D undated indicated Resident #8 and #9 were scheduled for showers on Monday, Wednesday, and Friday on the 6 am-6 pm shift. Both were to get a shower.During an interview on 10/21/2025 at 9:36 AM, CNA F said she had worked at the facility for a while but had been a CNA for about 6 months. She said on 10/20/2025 there were five residents who were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676103 If continuation sheet Page 6 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete scheduled to get a bath/shower on halls C and D. She said Resident #9 did not get a shower because he wanted to wait until after breakfast and whenever she let him know that they were going to do it after lunch, when she went to tell him he was lying down in the room. She said Resident #8 did not get a shower on yesterday 10/20/2025. She said she accidentally documented that both received their showers in the charting system, but they did not. She said only three of the five residents received a bath on 10/20/2025 that were scheduled.During an interview on 10/21/2025 at 2:43 PM, the DON said she started at the facility on 9/29/2025. She said when a resident refused a shower, the nurse aides should notify the nurse and the nurse should try to persuade the resident to take a shower; if they still refuse, they should document the refusal in a progress note. She said the nurse aide should document a refusal in the charting system under the task for bathing. She said it was false documentation if they documented a shower was received when it was not given. The charge nurse should supervise the nurse aides to ensure the residents are getting their showers.During an interview on 10/21/2025 at 3:13 PM, the Administrator said if a resident refuses a shower, they should tell the nurse, and the nurse should talk to the resident and document that they all documented and refused and have told them to make a 3rd attempt. She said the DON and ADON were responsible for conducting audits to ensure residents are not refusing and review the 24-hour report. She said if a resident did not receive a shower, they need to document that they did not receive the care. She said documenting care received when it was not was falsifying a document. She stated it was her expectation for staff to strike out and make a correction if there was a documentation error.Record review of a facility policy titled Charting and Documentation revised July 2017 indicated, .3. Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate. Event ID: Facility ID: 676103 If continuation sheet Page 7 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 9 residents (Resident #4) and 1 of 4 staff (CNA A) reviewed for infection control.The facility failed to ensure CNA A changed gloves and washed or sanitized her hands when providing care to Resident #4 on 10/20/2025.This failure could place residents at risk of exposure to infectious diseases due to improper infection control practices. Findings include:Record review of an admission Record for Resident #4 dated 10/21/2025 indicated he admitted to the facility on [DATE] and was [AGE] years old with diagnoses of hemiplegia and hemiparesis (paralyzed on one side of the body), malignant neoplasm of prostate (cancer in the prostate gland), cerebral infarction (stroke), and dysphagia (difficulty eating or swallowing).Record review of a Quarterly MDS Assessment for Resident #4 dated 9/14/2025 indicated he had moderate impairment in thinking with a BIMS score of 9. He was dependent on staff for personal hygiene. He was always incontinent of urine and bowel.Record review of a care plan for Resident #4 dated 9/9/2025 indicated he had bladder incontinence. Interventions included checking the resident every 2 hours and as required for incontinence.During an observation on 10/20/2025 at 1:47 PM, in the room of Resident #4. CNA A and CNA C were present to perform incontinent care. CNA A and CNA C both washed their hands and applied gloves. Both staff removed the resident's pants and the lift sling and placed them in a plastic bag. CNA C opened the resident brief and pulled it down between his thighs. CNA A removed wipes from the package and wiped the residents' inner thighs and placed the wipes in the trash. CNA A removed more wipes and then wiped the shaft of his penis and pulled the foreskin back and cleaned in a circular motion and then pulled foreskin back over and placed the gloves in the trash. CNA A removed her gloves and placed them in the trash and put on clean gloves without washing or sanitizing her hands. CNA A removed wipes and CNA C rolled the resident onto his left side and CNA A wiped his rectal area using multiple wipes and placed them in the trash. CNA A rolled the brief underneath the resident's buttocks and removed the brief and placed it in the trash along with her gloves. CNA A placed clean gloves on her hands without washing or sanitizing them and applied skin protectant to his buttocks and removed her gloves and placed them in the trash. CNA A applied clean gloves without washing or sanitizing her hands. A clean brief was placed underneath the resident's buttocks and secured, and the resident was repositioned in the bed. CNA A removed her gloves and placed them in the trash and washed her hands in the bathroom. CNA C removed her gloves and washed her hands.During an interview on 10/20/2025 at 2:06 PM, CNA A said she had been employed at the facility for over a year. She said she worked all over the facility. She said the last time she had a skills check off with staff was with the ADON about 2 weeks ago. She said during the care provided to Resident #4; she did not wash or sanitize her hands between glove changes. She said she had sanitizer in her pocket and did not know why she did not use it. She said there was a risk for infections and UTI's if staff did not wash or sanitize their hands between glove changes.Record review of a Nurse Aide Proficiency for CNA A dated 8/1/2025 by the ADON indicated she had training on perineal care with a male resident and was satisfactory with hand hygiene.During an interview on 10/20/2025 at 2:11 PM, the ADON said she was responsible for training staff and conducting skills check offs with the staff in the facility. She said she did it yearly. She said she observed the staff provide incontinent care and perform handwashing. She said staff should wash or sanitize their hands before care was started, anything they were visibly soiled, between glove changes and after care was completed. She said there was a risk of infections Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676103 If continuation sheet Page 8 of 9 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 676103 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wells Ltc Nursing & Rehabilitation 46 May Street Wells, TX 75976 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete if staff did not wash or sanitize their hands between glove changes.During an interview on 10/21/2025 at 2:43 PM, the DON said she and the ADON were responsible for training staff on their competency for skills check off once a year that included hand hygiene and infection control. She said hand hygiene before, in between when changing, when gloves are changed, and after care completed and can use sanitizer between. Risk for cross contamination and carrying germs to another resident.During an interview on 10/21/2025 at 3:13 PM, the Administrator said the DON and ADON were responsible for training staff on infection control. She said she was aware of the observation of staff not washing their hands with glove changes on yesterday 10/20/2025. She said staff should perform hand hygiene before care was started, between residents, when going from dirty to clean, after care, and can use hand sanitizer if hands were not visibly soiled. She said residents could be at risk for cross contamination.Record review of a facility policy titled Handwashing/Hand Hygiene revised October 2023 indicated, .This facility considers hand hygiene the primary means to prevent the spread of healthcare-associated infections. 2. All personnel are expected to adhere to hand hygiene policies and practices to help prevent the spread of infections to other personnel, residents, and visitors. Indications for hand hygiene: 1. Hand hygiene is indicated: c. after contact with blood, bloody fluids, or contaminated surfaces; f. before moving from work on a soiled body site to a clean body site on the same resident; and g. immediately after glove removal. 2. Use an alcohol-based hand rub containing at least 60% alcohol for most clinical situations. 5. The use of gloves does not replace hand washing/hand hygiene. Event ID: Facility ID: 676103 If continuation sheet Page 9 of 9