Health inspection·November 24, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #1. CNA B wiped Resident #1's right buttock, which contained bowel, and then assisted to turn her on her left side without hand hygiene or changing her gloves. CNA C wiped Resident #1's left side buttock, which contained bowel, and assisted in turning Resident #1 to her back without hand hygiene or changing her gloves. CNA B wiped her front area using the same wipe and wiping side to side, then used the same wipe and wiped her indwelling catheter without changing her gloves or performing hand hygiene. CNA B then grabbed a clean brief, applied barrier cream, and changed her linen, all while using the same dirty gloves. During an interview on 11/24/25 at 4:22 p.m., CNA B and CNA C said Resident #1 did not have an EBP sign on her door or a cart outside her door. They said they had not been using gowns while providing care for Resident #1. They said LVN A gave them the gowns today (11/24/25) when they told her the surveyor wanted to watch incontinent care. CNA B and CNA C said they did not perform hand hygiene or change their gloves after wiping Resident #1, then touching the clean brief and linen with dirty gloves. They said they knew that without hand hygiene or removing dirty gloves, they could cause cross-contamination and infection.During an interview on 11/24/25 at 5:00 p.m., LVN A said she was Resident #1's nurse. She said she expected staff to provide incontinent care to keep the residents clean. She said she expected the CNAs to practice hand hygiene and change gloves when soiled. She said Resident #1 was on EBP. She said Resident #1 did not have signage or a cart placed on her door or outside her room, and said it was an oversight. She said if staff were not wearing proper PPE (gown and gloves), it could cause infection and or bacteria. She said when the CNAs told her they were going to provide incontinent care, she saw that Resident #1 did not have a cart or a sign on her door, so she gave them gowns to use. She said afterwards she told management about the signage and cart for Resident #1. 2. Record review of Resident #2's face sheet, dated 11/24/25, indicated she was a [AGE] year-old female admitted on [DATE] with diagnoses which included compression fracture of thoracic (back) at #7 and #8 vertebrae, chronic obstructive pulmonary disease, also called COPD ( a progressive lung disease that causes restricted airflow and breathing problems), and diabetes (a chronic disease where the body doesn't produce enough insulin or cannot effectively use the insulin it produces, leading to high blood sugar levels).Record review of Resident #2's admission MDS assessment, dated 10/15/25, indicated Resident #2 usually understood and was usually understood by others. Resident #2 had moderately impaired daily decision-making. The MDS indicated Resident #2 required maximum assistance with her ADLs. The MDS indicated Resident #2 was always incontinent of bowel and had an indwelling catheter. Record review of Resident #2's physician order, dated 10/03/25, indicated a urinary catheter 18Fr/30cc to gravity drainage every shift for pain. Record review of Resident #2's comprehensive care plan, dated 10/03/25, indicated Resident #1 had enhanced barrier precautions and an indwelling catheter. The interventions required staff to wear gloves and a gown when the following activities occurred: linen change, resident hygiene, transfer, dressing, toileting/incontinent care, bed mobility, wound care, enteral feeding care, catheter care, trach care, bathing, or other high-contact activities. Also, there should be a posting at the residents' room entrance indicating that the residents were on EBP.During an observation and interview on 11/24/25 at 11:35 a.m., Resident #2 was lying in her bed. Resident #2 had an indwelling catheter but did not have an EBP posting or a cart outside her door or on the hallway. Resident #2 was unable to answer whether the staff were wearing PPE while providing care. During an interview on 11/24/25 at 4:00 p.m., CNA E said she was Resident #2's aide. She said she was not aware that Resident #2 required PPE when providing care. She said they usually placed a sign on the door and a cart outside her room, but because they had not, she did not wear PPE (gown). She said it placed her and the resident at risk of infection.During an interview on 11/24/25 at 4:15 p.m., LVN D said she was Resident #2's charge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676235 If continuation sheet Page 2 of 4 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 676235 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rock Creek Health and Rehabilitation 1414 College Street Sulphur Springs, TX 75482 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 nurse. She said she was aware Resident #2 was on EBP but said she did not have signage or a cart outside her room, which could cause staff not to wear PPE (gown and gloves) when providing care. She said that without the proper PPE, it could cause an infection for the residents. She said Resident #2 should have had signage on her door and a cart by her door when she was admitted , but for unknown reasons, she did not. She said she did not think about the signage or cart not being there until questioned by the state surveyor. She said someone from management placed the signage on the door and a cart outside Resident #2's room about thirty minutes ago. During an interview on 11/24/25 at 5:55 p.m., the DON said she had worked at the facility for about three weeks. She said she expected the CNAs to perform incontinent care correctly. She said she expected staff to change their gloves between dirty to clean and use hand hygiene between glove changes. She said the IP nurse oversaw the infection control process. She said she was not aware that Resident #1 or Resident #2 did not have a sign on their door or a cart outside of their room. She said staff should change gloves, practice hand hygiene and wear proper PPE (gown and gloves) when caring for residents on EBP to prevent infection and cross-contamination.During an interview on 11/24/25 at 6:00 p.m., the IP nurse said she was responsible for the infection process. She said when a resident was admitted or received a new order for EBP, she was responsible for making sure the resident had a sign on their door and a cart outside their door. She also said anyone who saw that they did not have the signage or cart could have placed it on or by the residents' room. She said she reviewed orders and did random audits and rounds to ensure signage and carts were in place. She said she was not aware that Resident #1 and Resident #2 did not have signs or carts outside their rooms, but knew they were both on EBP. She said sometimes the signs fall. She said if staff were unaware of EBP, then they could spread infection.During an interview on 11/24/25 at 6:09 p.m., the interim Administrator said she expected all staff to use proper hand hygiene techniques between dirty and clean areas with all care. The Administrator said the DON and IP nurse were responsible for ensuring staff were trained on incontinent care, hand washing, EPB, and infection control. She said improper hand hygiene and not wearing the proper PPE (gown and gloves) could place residents at risk for cross-contamination or infection.Record review of the facility's policy titled Fundamentals of Infection Control Precautions, undated, indicated, A variety of infection control measures are used to decrease the risk of transmission of microorganisms in the facility. These measures make up the fundamentals of infection control precautions. 1. Hand Hygiene: Hand hygiene continues to be the primary means of preventing the transmission of infection. Record review of the facility's policy titled Infection Control Plan, dated 03/24, indicated, Infection Control: The facility will establish and maintain an Infection Control Program designed to provide a safe, sanitary, andcomfortable environment and to help prevent the development and transmission of disease and infection. Intent: The intent of this policy is to ensure that the facility develops, implements, and maintains an Infection Prevention and Control Program in order to prevent, recognize, and control, to the extent possible, the onset and spread of infection within the facility. The program will: Perform surveillance and investigation to prevent, to the extent possible, the onset and the spread of infection; Prevent and control outbreaks and cross-contamination using transmission-based precautions in addition to standard precautions.Record review of the facility's policy titled Nursing: Personal Care, dated 05/11/22, indicated, Purpose: This procedure aims to maintain the resident's dignity and self-worth and reduce embarrassment by providing cleanliness and comfort to the resident, preventing infections and skin irritation, and observing the resident's skin condition. #17) Gently perform perineal care, wiping from clean, urethral area, to dirty/' rectal area, to avoid contaminating the urethral area -CLEAN to DIRTY! Female resident: Working from front to back, wipe one side (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676235 If continuation sheet Page 3 of 4 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 676235 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rock Creek Health and Rehabilitation 1414 College Street Sulphur Springs, TX 75482 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 of the labia majora1 the outside folds of the perineum (skin that protects the urinary meatus and the vaginal opening). Continue perineum care to the inner thigh. If applicable, gently wash the juncture of the Foley catheter tubing from the urethra down the catheter about three inches. Then wipe the other side. Use a clean area of the washcloth or pre-moistened cleansing wipes for each stroke.Record review of the facility's policy titled Enhanced Barrier Precautions, undated, indicated, Multidrug-resistant organism ([NAME]) transmission is common in long-term care (LTC) facilities. Enhanced Barrier Precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employ targeted gown and glove use during high contact resident care activities. EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing.EBP are indicated for residents with any of the following: Wounds and/or indwelling medical devices (Indwelling medical device examples include central lines, urinary catheters, feeding tubes, and tracheostomies) even if the resident is not known to be infected or colonized with a [NAME]. The facility will ensure PPE and alcohol-based hand rub are readily accessible to staff prior to entry to their room. Communication to Staff: The facility will utilize posting outside the room to communicate to staff if a resident requires EBP. Event ID: Facility ID: 676235 If continuation sheet Page 4 of 4