Inspection·January 15, 2026

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 observation, interview and record review, the facility failed to 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 out of 2 staff (LVN A) and 2 of 3 residents (Resident#1 and Resident #2) reviewed for infection control. LVN A failed to ensure hand hygiene was performed prior to handling Resident #1's medication(s) and after administering Resident #1's medication(s). LVN A failed to ensure hand hygiene was performed prior to handling Resident #2's medication(s) and after administering Resident #2's medication(s). These failures could place residents at risk for cross contamination, infection and decline in health. Findings include: Resident #1 Record Review of Resident #1's admission record dated 01/13/2026, revealed the resident was an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including peripheral vascular disease (circulatory condition where narrowed blood vessels reduce blood flow to different parts of the body), Secondary drug induced Parkinsonism (a movement disorder where medications block hormone effects on the brain causing slow movements, tremors and stiffness), and emphysema (a chronic lung disease where damage to the lung's air sacs causes reduced oxygen intake and results in difficulty breathing). Record review of Resident's #1's Annual MDS dated [DATE] revealed a BIMS score of 9 that suggested moderate cognitive impairment. Record review of Resident #1's Order Summary Report dated 01/13/2026 revealed an order for Atorvastatin 20 mg one tab by mouth every day at bedtime (7pm) and Gabapentin 100 mg Give 2 tablets by mouth every night to equal 200 mg (7pm). Record review of Resident #1's MAR printed 01/13/2026 revealed Atorvastatin 20 mg one tab by mouth every day at bedtime (7pm) and Gabapentin 100 mg Give 2 tablets by mouth every night to equal 200 mg (7pm), were documented as administered by LVN A on 12/25/2025 at 7pm. Resident #2 Record Review of Resident #2's admission record dated 01/15/2026, revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including pneumonia (a lung infection that inflames the air sacs causing them to fill with fluid or pus), dementia (a decline in mental ability severe enough to interfere with daily life affecting memory, thinking, reasoning and language), and epilepsy (a chronic brain disorder defined by a tendency to have recurrent, unprovoked seizure). Record review of Resident's #2's quarterly MDS dated [DATE] revealed a BIMS score of 4 that suggested severe cognitive impairment. Record review of Resident #2's Order Summary Report dated 01/15/2026 revealed an order for Atorvastatin 10 mg give one tablet by mouth at bedtime (8pm) Record review of Resident #2's MAR printed 01/15/2026 revealed Atorvastatin 10 mg one tablet by mouth at bedtime (8pm) and was documented by LVN A as administered on 12/25/2025 at 8pm. Record review of facility staffing sheet dated 12/25/2025 on 01/13/2026 at 6:23pm revealed LVN A worked on 12/15/2026 on the 7pm to 7 am shift. Observation on 1/13/2026 at 11:15 am of video evidence dated 12/25/2025at 7:46pm revealed LVN A entered the room of Resident #1 and Resident #2 holding 2 small clear medication administration cups in her ungloved, bare hands. LVN A walked to Resident #1's bedside table and placed both cups down on Resident #1's bedside table and without washing her hands or sanitizing them with ABHS or donning gloves, proceeded to administer Resident #1 her medications. Handling and maneuvering Resident #1's beverage straw with her bare hands and handing her the cup of medications. LVN A was observed in the video then picking up the second cup of medications off of Resident #1's bedside table and walking to the bedside of Resident #2 and without washing her hands or sanitizing then with ABHS or donning gloves, proceeded to administer Resident #2's medications from the clear plastic administration cup. LVN A was then observed leaving the room without washing her hands or using ABHS. Interview and observation of video evidence Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676223 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 676223 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/15/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bayou Pines Care Center 4905 Fleming Street LA Marque, TX 77568 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 01/13/2026 at 11:36 am with the DON who said LVN A should have washed her hands before she administered Resident #1's medications and then washed her hands again before administering Resident #2's medications. The DON said they did not know why LVN A had not washed her hands or used ABHS or donned or doffed gloves. The DON said that was not what they trained staff to do during medication administration. The DON said they would need to conduct a 1:1 in-service training with LVN A. The DON said LVN A should have washed her hands and because she did not, it was an infection control issue because she could pass germs from one resident to another. Interview and observation of video evidence 01/13/2026 at 11:36 am with Administrator who said LVN A should have washed her hands before she administered Resident #1's medications and then washed her hands again before administering Resident #2's medications. The Administrator said that the DON and nursing staff were responsible for ensuring staff were trained properly on medication administration. Unable to interview LVN A prior to facility exit. Attempted telephone interview with LVN A on 01/13/2026 at 6:15pm. Attempted telephone interview with LVN A on 01/15/2026 at 9:43pm. Record review of policy Infection Control Guidelines for all Nursing Procedures dated revised October 2010 revealed: a. Before and after direct contact with residents. Event ID: Facility ID: 676223 If continuation sheet Page 3 of 3