Health inspection·December 29, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few aid with ADLs as needed.Record review of Resident #2' s Progress Notes dated 12/28/2025 at 7:43 PM revealed, LVN A notified FNP about Resident #2 rash on 12/28/2025. Resident #2 was seen by FNP 12/28/2025 on telehealth virtual visit for a rash that was on the left side of the front of his torso area and under both breast areas. Resident stated it itches during the day and night as well. The nurse ordered to continue topical Nystatin (is an antifungal, antibiotic treatment for fungal infections of the skin) and Ketoconazole (used to treat various fungal skin conditions) cream BID along with oral doxycycline for 7 days and fluconazole PO for 14 days. Resident #1 was educated on hygiene of hands and refused an PO PRN for s/s of pain and reaction.During an interview and observation with Resident #2 on 12/28/2025 at 10:20 AM, revealed he does not have any sores from lying in bed, but he has a sore under his left breast that he had for a couple of days. Resident #2 stated the redness under his breast along with creamy white gooey substance. He stated they had put some cream on it. Resident #2 stated he cannot make it to the bathroom sometimes and he wet his bed and that was why he has the rash under his breast. During the interview and observation, there was no odor from Resident #2, but he appeared to be unkept lying in bed halfway.During an interview with CNA B on 12/28/2025 at 11:40 AM, revealed Resident #2 has a rash and cannot diagnosis it. She stated he had complained he needed it washed, and he was showered. He also revealed the rash hurt, and she reported it to the nurse. CNA B stated he was given a shower and placed the medicated powder the charge nurse gave her.During an interview with LVN A on 12/29/2025 at 11:58 AM, it was revealed that Resident #2 has an order for cream, and it has gotten better. He advised her he had it for a few days. She took a picture of the rash, and the NP gave her 4 different orders along with the Nystatin steroid cream, doxycycline, and another antibiotic by mouth. LVN A stated he will lay in bed and do not go to the restroom. She stated at night they try to get him to use the briefs. He was previously moved from another room due to him urinating on the floor or wherever and had the room smelling like urine. He will not go to the bathroom and will lie in the urine. LVN A stated they provided him with a female urinal because the hole was bigger. She stated she was not sure if he was ashamed of the briefs, but he can go to the restroom by himself. If the Care Plan is not accurate the residents will not be able to get the proper care they need.In an interview with Med Aide A on 12/29/2025 at 1:58 PM, it was revealed that she has been employed here for four years, and Resident #2 has had a rash. She stated they do not know what was causing the rash. He refuses to take a shower, but he is getting better. The nurse gives them cream to apply to him. He sits in urine all day. He does not have a brief. He can go to the bathroom. They will ask him to get change, and he denies needing to be changed. He was embarrassed to wear them. He stated he was a grown man, and he should not have to wear them. She stated if the resident care plans are not correct, it can be something that can cause potential harm they will not get the proper care they need.In an interview with CNA A on 12/29/2025 at 3:00 PM, it was revealed that she noticed the rash on Resident #2 on Saturday and she reported it to the nurse and the orders were put in and she gave the cream to the CNAs. She stated he does not complain about it hurting, he just states its itching. When they change him, they put the cream on him. During the daytime he goes to the bathroom by himself but at nighttime he puts the brief on. She stated if care plans are not updated, the residents will not get the care they are supposed to have.In interview with DON on 12/29/2025 at 3:10 PM, revealed that Resident #2 has had the rash underneath the folds under his breast and it is moist along with redness and they had been using nystatin cream. Over the weekend, they started seeing it more, and it got worse, and the nystatin was not doing anything about it, so they got orders for the antibiotics by mouth. She stated he stays non-compliant with not wearing the brief and she thinks he is embarrassed. DON stated they sent a man to talk to him regarding his private (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 2 of 5 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete area. They also sent the male nurse to speak to him to use the woman urinal since it is bigger at the mouth part. She stated he stays moist due to his size. DON stated he takes his scheduled showers and now they give it to him daily to help with the odor and his hygiene. They noticed the rash this weekend. The DON stated if the care plan is not updated, the staff cannot take care of the residents properly. The direct care cannot be given. Their care plans give you a window about that resident. Everything catered to each residents' needs. Residents may have aggressive behaviors so you know who can go in the room with them or someone cannot have a roommate with them. Some must be carefully planned because they are not compliant with smoking break, and it can lead to them hurting themselves or burning the building.In an interview with MDS Coordinator on 12/29/2025 at 12:45 PM, revealed that Resident #2 has had a rash. She stated as the MDS Coordinator documents the chronic care plan once the resident gets admitted into the facility, the falls/accidents, antibiotics therapy, skin tears, and pressures ulcers. The MDS Coordinator or ADON depends who catches the changes will speak on in the morning meeting. If the care plan or the MDS is not current or updated nothing will happen because the staff go by the orders and their ADLs to care for the residents. The long-term residents care plans are updated quarterly to match their quarterly assessments.Record review of the facility's Care Plans, Comprehensive Person-Centered, policy revised December 2016, revealed in part A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.11. Assessments of residents are ongoing, and care plans are revised as information about the residents and the residents' conditions changes. Event ID: Facility ID: 676438 If continuation sheet Page 3 of 5 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 observations, 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 good nutrition, grooming, and personal and oral hygiene for one of four residents (Resident# 1) reviewed for ADL care.The facility failed to provide Resident #1 showers consistent on her shower days who were physically impaired.This failure could place ADL dependent residents at risk of experiencing embarrassment from odors, infection, and skin breakdown.Findings included:Record review of shower schedule from electronic records revealed the following:Resident #1- was scheduled for Tuesdays, Thursdays, and Saturdays on the 2pm-10pm shift for December 2025. The following dates revealed the resident received showers:12/2/2025 at 17:31 pm12/4/2025 at 23:22 pm12/6/2025 at 22:39 pm12:8/2025 at 4:08 am12/9/2025 at 23:46 am12/11/2025 at 22:43 pm12/13/2025 at 15:20 pm and 22:19 pm12/17/2025 at 00:01 am and 17:59 pm12/18/2025 at 4:07 am12/19/2025 00:41 am12/20/2025 at 00:56 am12/21/2025 at 2:52 am12/24/2025 at 14:52 pm12/26/2025 at 5:59 amRecord review of Resident #1's face sheet dated 12/29/2025 reflected she was a [AGE] year-old female who was admitted to the facility on [DATE] and readmission 6/17/2025 with diagnoses of major depressive disorder, recurrent, mild (someone who experiences distinct, repeated episodes of depression, but with fewer and less severe symptoms than moderate or severe cases, significantly impacting life but without full incapacitation, and with no history of manic or hypomanic episodes), mixed hyperlipidemia (high levels of both cholesterol (especially LDL) and triglycerides in your blood), polyneuropathy, unspecified (damage affecting multiple peripheral nerves (outside the brain and spinal cord) where the specific underlying cause isn't identified or documented), gout, unspecified (the specific type or location isn't documented, but it's a painful inflammatory arthritis from uric acid crystal buildup in joints, causing sudden swelling, redness, and intense pain), disorder or muscle, unspecified (a medical classification for a muscle condition when the specific type isn't known, but it generally involves symptoms like weakness, pain, cramps, or stiffness, affecting the muscles' ability to function properly due to underlying issues with muscle fibers, nerves, or their connection). Review of Resident #1's Quarterly MDS, dated [DATE], reflected the resident had a BIMS score of 14, which indicated she cognitively intact. Resident #1 required partial/moderate assistance (helper does less than half the effort) with personal hygiene, lower body dressing, transfers, bed mobility, and toileting hygiene. She was dependent on staff for showers.Review of Resident #1's Comprehensive Care Plan, with revision date of 12/29/2025 reflected Resident # 1 required one staff assistance with bathing, dressing, grooming and hygiene.Observation and interview on 12/29/2025 at 10:45 AM, revealed Resident #1 was in her room lying in bed. There were no foul odors in the room, Resident #1 looked clean, she stated no one had been in her room yet to take her clothing out for her to put on for the day. Resident #1 stated it depends on who was giving the showers that day and she gets them at night. She stated she received her shower on 12/27/2025 and the previous Saturday on 12/20/2025. Record review revealed the resident received a shower on 12/21/2025, 12/24/2025, and 12/26/2025. Resident #1 stated she was told the water was cold and they had to fix it, and she could not give her a shower. She stated she could give her a bed bath, but Resident #1 refused wanting to take a bed bath with cold water. Resident #1 stated if she had any concerns she will tell the SW, nurse on duty, or the DON regarding the CNA and she will escalate it up by contacting the Ombudsman. Resident #1 could not provide which staff member advised her the water was cold so that staff member was not interviewed.In an interview with DON on 12/29/2025 at 3:10 PM, revealed that certain residents do not like to get out of bed until after breakfast and before lunch. DON stated Resident #1 does not refuse Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676438 If continuation sheet Page 4 of 5 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 676438 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Killeen Nursing & Rehabilitation 5000 Thayer Dr Killeen, TX 76549 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete showers and makes her own decisions. She stated she is very pleasant and outspoken. She stated sometimes she wants a bed bath. DON stated if the residents refused their showers, the nurse would find out why, and she would contact the family and write a progress note. They will try to get their shower done the next day. They will ask them. If they do not get it, they will end up on their rotation day. She stated if they do not receive their showers, they can smell, skin breakdown, all kind of health issues, UTI, yeast infections, even with the men. They will also feel bad about themselves, and it can cause them to have mental health. In an interview with CNA A on 12/29/2025 at 3:00 PM, revealed that if residents do not receive their showers, they will have skin issues and that is not good for them. Living in an environment that will not smell good and the breakdown of the residents with sensitive skin. CNA A stated Resident #1 receive showers and she is vocal.In an interview with Med Aide A on 12/29/2025 at 1:58 PM, revealed that Resident #1 refused showers and request a bed bath instead. She will take a shower once a week and the rest of the week she will request a bed bath. She stated she was outspoken, and she will not allow you to leave her dirty. She stated if the residents do not take a shower, it can lead to skin issues (breakdown of the skin) and dignity issues.In an interview with LVN A on 12/29/2025 at 11:58 AM, revealed that Resident #1 was one of the five residents that like to get up late. She stated she Resident #1 gets her showers and she did not hear of any complaints about her not getting her shower. She is very outspoken and energetic and always out in the community. She stated if the residents do not get their showers, it can cause skin breakdown, and they can start feeling some kind of way.In an interview with ADM on 12/29/2025 at 3:55 PM, it revealed that if the residents do not receive their showers, they can have skin breakdown and hygiene concerns from their neighbors if they are in the common area or their roommates. But the most concern is the skin breakdown. She stated Resident # 1 is vocal in everything she does and has not complained or stated she was not receiving her showers.Review of the Facility's Policy on Activities of Daily Living, dated 03/2018, reflected Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to conduct ADLs. Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal and oral hygiene. Event ID: Facility ID: 676438 If continuation sheet Page 5 of 5