Health inspection·November 26, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some person physical assistIndicating 1 out of 2 days bath/shower received Record review of the facility's Comprehensive CNA Shower Review sheets provided by the facility on 11/25/25 indicated:11/07/25 -no documentation of Resident #1's hair wash11/10/25 - no documentation of Resident #1's hair wash11/11/25 - no documentation of Resident #1's hair wash11/12/25 - Resident #1's hair was washedThere were no additional Comprehensive CNA Shower Review sheets provided for review. Record review of nurse progress notes from 11/01/25 through 11/25/25 indicated no documentation of bath/shower refusals or hair care refusals. Record review of a grievance submitted by Family Member A dated 11/11/25 indicated Resident #1's hair was not being brushed, and she was not notified of Resident #1's refusals for showers. Resident #1 was assessed with no visible signs of neglect. The facility reported the allegation of Neglect to HHSC on 11/11/25. The facility implemented notification of Family Member A when Resident #1 refused care, medications, and showers. The grievance was noted as resolved on 11/18/25. Record review of facility investigation dated 11/18/25 indicated Family Member A came to the facility to visit Resident #1. She was upset when she saw the hair was matted on the back of Resident #1's head. She alleged the facility neglected Resident #1 and Resident #1 was not getting showers. CNA C and CNA S confirmed Resident #1 was getting bed baths. They said she did not refuse bed baths. They stated that she would not let them wash or brush her hair and she barely let them wash the important parts before saying okay okay okay, son of a bitch. Staff were educated between 11/11/25 and 11/18/25 to let Family Member A know when Resident #1 did not want to go to the shower so she could assist with encouraging Resident #1 to go to the shower and to document refusals and notifications in PCC. Resident #1 did not feel neglected. The allegation of neglect was unconfirmed. Observation of a picture provided to the surveyor on 11/24/25 from (family member) showed a hair mat/ball approximately 4 inches tall and 2 inches wide (compared to a dinner fork) that had been cut from the back of Resident #1's head on 11/11/25 (per the family member). During an interview on 11/24/25 at 4:35 p.m., a family member said she visited Resident #1 on 11/11/25 in the facility. She said she found a large hair mat on the back of Resident #1's head. She said the hair mat could not be combed out. She said the hair mat was almost 4 inches tall and 2 inches wide. During an observation and interview on 11/25/25 at 12:30 p.m., Resident #1 was lying flat in bed. She appeared clean and had no odors. Her hair was combed. She said she preferred to lay flat because if she sat up it caused her pain. She said she preferred bed baths over showers because she did not like to be taken out of bed. She said she did not have her hair washed when she was in bed or had a bed bath. She said she sometimes does not like staff to wash or comb her hair because it takes too much time from start to finish. She said she understood that not combing her hair left her hair messy and it could develop knots that were difficult to comb out. She could not remember which days where her shower/bath days. During an interview on 11/25/25 at 2:09 p.m., MDS LVN N said she was responsible for developing the resident care plans. She said Resident #1's refusals for medication and blood sugar checks were added on 01/31/24. She said Resident #1 prefers bed baths, but the family member wanted her to have showers. She said the intervention to call the family member for all refusals was added on 11/18/25. She said hair care refusals were not addressed specifically. She said staff were to document all refusals and notify the charge nurse and the charge nurse was to notify the family member. During an interview on 11/25/25 at 2:30 p.m., CNA C said Resident #1's scheduled bath/shower days were Monday, Wednesday, and Friday. She said sometimes there was not enough time or she refused and it was done on the next day. She said Resident #1 refused to sit up and yells and cusses. She said Resident #1 refuses showers but tolerated bed baths. She said when Resident #1 received a bed bath she did not have her hair washed or combed. She said Resident #1 barely let staff wash the important areas. She said if a resident refused (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 2 of 6 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Some care she was supposed to document the refusals and tell the charge nurse. She said it was possible she missed documenting the refusals in Resident #1's chart. She said residents were at risk of skin break down and other skin issues and infections when they did not receive shower/bath, as necessary. During an interview on 11/25/25 at 2:40 p.m., CNA S said Resident #1's scheduled bath/shower days were Monday, Wednesday, and Friday. She said Resident #1 often refused hair care. She said she could not recall if it was documented or if she informed the nurse. She said sometimes, she did not complete the required documenting. She said residents were at risk of skin break down and other skin issues and infections when they did not receive shower/bath, as necessary. During an interview on 11/25/25 at 3:48 p.m., RN W said she was aware Resident #1 often refused ADL care. She said the family member was not notified until recently when notification was requested by the family member. She said she did not document Resident #1's ADL refusals in the progress notes. She said residents were at risk of skin break down and other skin issues and infections when they did not receive shower/bath, as necessary. During an interview on 11/26/25 at 7:50 a.m., the DON said it was her expectation residents received their shower/bath as scheduled. She said if staff were not able to complete the shower/bath then they were supposed to notify the charge nurse or herself. She said Resident #1's scheduled bath/shower days were Monday, Wednesday, and Friday. She said she was not notified Resident #1 did not get her shower/bath or hair care as required. She said Resident #1 should have received her shower/bath and hair care as scheduled. She said if she had been notified she would have talked to Resident #1. She said the nurse was supposed to call the family member when Resident #1 refused. She said as soon as she found out about the shower refusals it was addressed. She was not aware the hair care was not completed. She said residents were at risk of skin break down and other skin issues and infections when they did not receive shower/bath, as necessary. During an interview on 11/26/25 at 8:28 a.m., LVN N said she was not aware Resident #1 was not receiving baths, showers, or hair care. She said she did not notice Resident #1's hair was matted into a large knot at the back of her head. She said if she was made aware of the refusals she would have talked to the resident and tried other approaches to complete the ADLS. She said if the alternate approaches were not successful she would have called the RP and the physician if necessary. She said residents were at risk of skin break down and other skin issues and infections when they did not receive shower/bath, as necessary. The surveyor attempted to contact LVN T on 11/26/25 at 8:47 a.m. via phone regarding Resident #1's ADL refusals. There was no answer, and a message was left with the surveyor's contact information. LVN T did not respond as of the investigation exit. During an interview on 11/26/25 at 10:26 a.m., the ADON said if Resident #1 refuses care the staff are supposed to document the refusal and then the nurse would make the necessary notifications. She said if the nurses were not made aware of refusal for care, then there could be skin break down and it could also affect the resident's mental health. During an interview on 11/26/25 at 10:37 a.m., the Administrator said if Resident #1 refused care, the staff are supposed to document and notify the family member effective 11/11/25. She said it was her expectation the staff were supposed to document the refusals and notify the charge nurse of refusals. She said the nurses were supposed to document in the progress notes. She said the nurse would make the required notifications to family and physician if necessary. She said residents were at risk of skin break down and other skin issues and infections when they did not receive shower/bath, as necessary. Record review of the facility's Bath, Shower/Tub policy dated 2001 (revised 02/2018) indicated The purposes of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. Documentation 1. The date and time the shower/tub bath was performed. 2. The name and title of the individual(s) who assisted the resident with the shower/tub (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 3 of 6 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 bath. 3. All assessment data (e.g., any reddened areas, sores, etc., on the resident's skin) obtained during the shower/tub bath. 4. How the resident tolerated the shower/tub bath. 5. If the resident refused the shower/tub bath, the reason(s) why and the intervention taken. 6. The signature and title of the person recording the data. Reporting 1. Notify the supervisor if the resident refuses the shower/tub bath. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 4 of 6 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Some 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 observation, interview and record review, the facility failed to maintain clinical records on each resident in accordance with accepted professional standards and practices that were complete and accurately documented for 1 of 5 residents (Resident #1) reviewed for accuracy of clinical records. Facility staff failed to document Resident #1's ADL for baths or showers and hair care or refusals. This failure could place residents at risk of not receiving care and services to meet their needs. Record review of Resident #1's face sheet dated 11/25/25 indicated she was an [AGE] year old female, admitted on [DATE], and her diagnoses included cognitive communication deficit (difficulties in communication that arise from underlying cognitive impairments), muscle wasting and atrophy (thinning or loss of muscle mass), Parkinson's (movement disorder), diabetes (condition that affects blood sugar levels), dementia (decline in cognitive function), major depressive disorder (mood disorder that causes a persistent feeling of sadness and a loss of interest), and need for assistance with personal care. Record review of Resident #1's quarterly MDS assessment dated [DATE] indicated she was able to make herself understood and understood others, and was cognitively intact (BIMS-13). No rejection of care was noted in the 7 day look back period. She was dependent for showers/baths. She required partial/moderate assistance with personal hygiene (combing hair). Record review of Resident #1's care plan dated 06/29/23 indicated she had an ADL self-care performance deficit and limitations in physical mobility related to fatigue/malaise/weakness, and limited mobility/ROM/musculoskeletal impairment. Interventions included extensive assistance by 2 staff with bathing/showering at least 3 times weekly and as necessary. There was no intervention specific to hair care. Record review of Resident #1's care plan dated 11/18/25 indicated she refused showers and preferred bed baths. Family Member A wanted Resident #1 to have a shower. Interventions included notify Family Member A for refusals to assist with encouraging resident to take showers. There was no focus for hair care refusals or interventions. Record review of Resident #1's ADL personal hygiene record dated 10/28/25 through 11/25/25 indicated she required 1 to 2 person physical assist for ADL-Personal Hygiene. There was no documentation for 10/31/25, 11/01/25, 11/06/25, and 11/14/25. There were no refusals noted. There was no documentation specific to hair care. Record review of Resident #1's bath/shower record from 11/01/25 through 11/25/25 indicated:Monday 11/03/25 - no documentationWednesday 11/05/25 - no documentationFriday 11/14/25 - no documentationMonday 11/17/25 - no documentationWednesday 11/19/25 - no documentationFriday 11/21/25 - no documentationMonday 11/24/25 - no documentation Record review of the facility Comprehensive CNA Shower Review sheets provided by the facility on 11/25/25 indicated:11/07/25 -no documentation of Resident #1's hair wash11/10/25 - no documentation of Resident #1's hair wash11/11/25 - no documentation of Resident #1's hair washThere were no additional Comprehensive CNA Shower Review sheets provided for review. Record review of nurse progress notes from 11/01/25 through 11/25/25 indicated no documentation of bath/shower refusals or hair care refusals. During[KS1] an observation and interview on 11/25/25 at 12:30 p.m., Resident #1 was lying flat in bed. She appeared clean and had no odors. Her hair was combed[KS2] . She said she preferred to lay flat because if she sat up it caused her pain. She said she preferred bed baths over showers because she did not like to be taken out of bed. She said she did not have her hair washed when she was in bed or had a bed bath. She said she sometimes does not like staff to wash or comb her hair because it takes too much time[KS3] from start to finish. She said she understood that not combing her hair left her hair messy and it could develop knots that were difficult to comb out. She could not remember which days where her shower/bath days. During an interview on 11/25/25 at 2:09 p.m., MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676439 If continuation sheet Page 5 of 6 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 676439 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trinity Rehabilitation & Healthcare Center 314 E Caroline St Trinity, TX 75862 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete LVN N said staff were to document all refusals and notify the charge nurse and the charge nurse was to notify the family member. During an interview on 11/25/25 at 2:30 p.m., CNA C said Resident #1's scheduled bath/shower days were Monday, Wednesday, and Friday. She said Resident #1 refuses showers but tolerated bed baths. She said when Resident #1 received a bed bath she did not have her hair washed or combed. She said if a resident refused care, she was supposed to document the refusals and tell the charge nurse. She said it was possible she missed documenting the refusals in Resident #1's chart. During an interview on 11/25/25 at 2:40 p.m., CNA S said Resident #1's scheduled bath/shower days were Monday, Wednesday, and Friday. She said Resident #1 often refused hair care. She said she could not recall if it was documented or if she informed the nurse. She said sometimes, she did not complete the required documenting. During an interview on 11/25/25 at 3:48 p.m., RN W said she was aware Resident #1 often refused ADL care. She said she did not document Resident #1's ADL refusals in the progress notes. During an interview on 11/26/25 at 7:50 a.m., the DON said it was her expectation residents received their shower/bath as scheduled. She said if staff were not able to complete the shower/bath then they were supposed to notify the charge nurse or herself. She said staff were supposed to document if baths/showers or hair care was not completed or refused. During an interview on 11/26/25 at 8:28 a.m., LVN N said she was not aware Resident #1 was not receiving baths, showers, or hair care. The surveyor attempted to contact LVN T on 11/26/25 at 8:47 a.m. via phone regarding Resident #1's ADL refusals. There was no answer, and a message was left with the surveyor's contact information. LVN T did not respond as of the investigation exit. During an interview on 11/26/25 at 10:26 a.m., the ADON said if Resident #1 refused care the staff are supposed to document the refusal and then the nurse would make the necessary notifications. She said if the nurses were not made aware of refusal for care, then there could be skin break down and it could also affect the resident's mental health. During an interview on 11/26/25 at 10:37 a.m., the Administrator said if Resident #1 refused care, the staff are supposed to document. She said it was her expectation the staff were supposed to document the refusals and notify the charge nurse of refusals. She said the nurses were supposed to document in the progress notes. She said the nurse would make the required notifications to family and physician if necessary. Record review of the facility policy Charting and Documentation dated 2001 (revised 07/2017) indicated All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional or psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. 7. Documentation of procedures and treatments will include care-specific details, including: a. the date and time the procedure/treatment was provided; b. the name and title of the individual(s) who provided the care; c. the assessment data and/or any unusual findings obtained during the procedure/treatment; d. how the resident tolerated the procedure/treatment; e. whether the resident refused the procedure/treatment; f. notification of family, physician or other staff, if indicated; and g. the signature and title of the individual documenting. Event ID: Facility ID: 676439 If continuation sheet Page 6 of 6