Health inspection·August 30, 2022

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Many Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure 34 (Room number's 2, 3, 4, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 and 39) out of 34 multiple-resident bedrooms, measured at least 80 square feet per resident. The facility failed to ensure multiple resident Room number's 2, 3, 4, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 and 39 met the required minimum of 80 square feet per resident. This failure could place residents at risk of not having sufficient space. Findings included: In an interview on 08/29/2022 at 10:00 AM, the Administrator revealed the facility had a room size waiver in place for the bedrooms measuring less than the required square footage. The Administrator also stated nothing has changed in the past years regarding resident's room square footage. She stated that the risk of residents not having the appropriate space could result in residents possibly having accidents because of the lack of space or they may not have the privacy they want. Review of Form DADS 3740 (Bed Classifications Form), completed by the Administrator on 08/28/2022, revealed all 34 bedrooms in the facility had two beds and were classified as Medicare and Medicaid. Review of the facility's license on 08/28/2022 at 2:30 PM revealed the facility was licensed for 74 beds. Review of the resident bedroom measurements listing, undated provided by the Administrator on 08/29/2022 revealed the following: 1) Resident Rooms 2, 3 and 4 measured 127 square feet; 2) Resident Rooms 6, 8 and 10 measured 132 square feet 3) Resident room [ROOM NUMBER] measured 146 square feet 4) Resident rooms [ROOM NUMBERS] measured 147 square feet 5) Resident Rooms 12, 14, 15, 16, 17 and 19 measured 156 square feet Page 1 of 2 676424 676424 08/30/2022 Farmersville Health and Rehabilitation 205 Beech St Farmersville, TX 75442

F 0912 6) Resident room [ROOM NUMBER] measured 159 square feet Level of Harm - Potential for minimal harm 7) Resident Rooms 20, 22, 24, 26 and 28 measured 151 square feet 8) Resident Rooms 23, 25, 27, 29, 30, 31, 32, 33, 34, 35, 36, 37 and 39 measured 153 square feet. Residents Affected - Many Review of the waiver issued to the facility on [DATE] indicated that the following waiver was approved and would remain in effect unless conditions are found to exist that would cause reconsideration or rescission:

F912, 483.90(e)(1)(ii), Measure at least 80 square feet per resident in multiple resident bedrooms, and at least 80 square feet in single resident rooms. 676424 Page 2 of 2