North Star Ranch Rehabilitation And Health Care Ce

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

interview on 10/22/2025 at 1:51 PM, LVN D did not answer the phone. During an interview on 10/23/2025 at 10:38 AM, MA H said she worked Saturday, 10/18/2025. MA H said they were short and she worked all over the building, and she did not know if the residents' received showers. MA H said they were short staffed frequently, and sometimes they missed the showers. MA H said Saturdays were awful. MA H said

she did not give any showers on 10/18/2025. MA H said the residents not receiving their showers as scheduled could affect their skin and them being clean. During an interview on 10/23/2025 at 11:39 AM, the ADON said she was aware showers were not given as scheduled. The ADON said Saturday, 10/18/2025,

she worked and gave medications to the residents for 12 hours and then worked as a CNA the last 4 hours of her shift. The ADON said she did not give any showers on 10/18/2025. The ADON said she completed

the charting for MA H on, 10/18/2025, and she was under the impression MA H had given Resident #4 her shower, so she signed it off as being completed. The ADON said the nurses were responsible for ensuring

the residents received their showers. The ADON said if the residents did not receive their showers, it could cause skin breakdown and odors. During an interview on 10/23/2025 at 1:17 PM, the DON said the only person that had complained to her about not receiving showers was Resident #4. The DON said a couple weekends ago Resident #4 informed her she had not received a shower, and she gave her one herself. The DON said she monitored if the residents were getting their showers by checking the task records, and she had not noticed any issues. The DON said if the residents did not receive their showers it could result in low self-esteem, and they would not feel clean. During an attempted phone interview on 10/23/2025 at 1:50 PM, LVN D did not answer the phone. During an interview on 10/23/2025 at 2:21 PM, the Interim Administrator said Resident #4 reported to her several weekends ago she had not received a shower, but

the DON had given her one. The Interim Administrator said she was not aware of Resident #4 not receiving

a shower on 10/18/2025. The Interim Administrator said she expected the residents to get showers, and the nursing staff and everybody were responsible for ensuring this happened. The Interim Administrator said

the residents not receiving their showers would mean they were dirty. Record review of the facility's policy titled, Activities of Daily Living (ADL), Supporting, revised March 2018, indicated, Residents will be provided with care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (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.Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. hygiene (bathing .).

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

North Star Ranch Rehabilitation and Health Care Ce

709 W Fifth St Bonham, TX 75418

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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

FORM CMS-2567 (02/99) Previous Versions Obsolete

care, treatment, and services as appropriate to maintain or improve their ability to carry out activities of daily living (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.Appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a. hygiene (bathing .). Record review of the facility's policy titled, Medication Administration, revised June 2025 reflected, . Medications are administered in a safe and timely manner, and as prescribed.3. Staffing schedules are arranged to ensure that medications are administered without unnecessary interruptions. 4. Medications are administered in accordance with prescriber orders, including any required time frame.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

North Star Ranch Rehabilitation and Health Care Ce

709 W Fifth St Bonham, TX 75418

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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

affect their blood pressure. During an interview on 10/23/25 at 12:54 p.m., the DON stated medications can be given one hour before or one hour after. The DON stated the facility did have a culture time which means

a window for medication administration. The DON stated if the first dose was given close to when the second dose should be given, the second dose should be held and the MD notified. The DON stated she was responsible for monitoring and overseeing by pulling the medication administration audit report in PCC randomly. The DON stated there have been issues in the past and when she investigated it the staff stated

it was given on time just documented late. The DON stated it was important medications were given on time to ensure the residents received the accurate dose and decrease their risk of complications. During an

interview on 10/23/25 at 2:08 p.m., the Administrator stated she expected the medications to be administered according to the schedule to ensure effectiveness. The Administrator stated the DON and the ADON were responsible for monitoring and overseeing medication administration. The Administrator stated

it was important to ensure medications were given on time to prevent an adverse reaction. Record review of

the facility's policy titled, Medication Administration, revised June 2025 reflected, . Medications are administered in a safe and timely manner, and as prescribed.3. Staffing schedules are arranged to ensure that medications are administered without unnecessary interruptions. 4. Medications are administered in accordance with prescriber orders, including any required time frame.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

North Star Ranch Rehabilitation and Health Care Ce

709 W Fifth St Bonham, TX 75418

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 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.

Based on interview and record review the facility failed to provide sufficient support personnel to carry out

the functions of the food and nutrition service for 1 of 4 dietary staff (Dietary Aide G). The facility failed to ensure that dietary staff (Dietary Aide G) serving in the kitchen maintained a current Food Handler Certificate. This failure could place residents at risk of the facility not having staff to provide dietary services requirements. Findings included: During an interview on 10/21/2025 at 2:28 PM, the Dietary Manager said Dietary Aide G's food handler certificate was expired. Record review of Dietary Aide G's employee file indicated her date of hire was 07/17/2025, and her Texas Food Handler Certificate was issued 10/06/2022 and expired 10/05/2024. During an interview on 10/21/2025 at 4:21 PM, the Dietary Manager said the food handler certificate should be obtained within 30 days of hire. The Dietary Manager said she did not pay attention to when Dietary Aide G's food handler certificate expired. The Dietary Manager said she and the human resources department were responsible for ensuring the dietary staff had their food handler certificates. The Dietary Manager said it was important for the kitchen staff to have food handler certificates, so they knew the importance of food temperatures and cleaning. During an interview on 10/21/2025 at 4:29 PM, Dietary Aide G said she realized her food handler certificate expired 3-4 days ago. Dietary Aide G said

she did not renew it because she did not have the money to pay for the renewal. Dietary Aide G said it was important to have a food handler certificate to know how to handle food and prevent cross contamination.

During an interview on 10/23/2025 at 2:30 PM, the Interim Administrator said she was not aware Dietary Aide G's food handler certificate had expired. The Interim Administrator said the Dietary Manager was responsible for ensuring the food handler certificates were maintained up to date. The Interim Administrator said she did not know the risks associated with dietary staff having an expired food handler certificate.

During an interview on 10/23/2025 at 2:33 PM, the Interim Administrator said the facility did not have a policy regarding food handler certificates.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

12/01/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

North Star Ranch Rehabilitation and Health Care Ce

709 W Fifth St Bonham, TX 75418

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 0825 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

from the insurance company. She said if the resident did not win the appeal, then the resident/family was aware that they might incur charges. She said they had some confusion with Resident #5 and her appeal process. She said they had problems reaching the RP, and they only became aware that Resident #5 had won the appeal through the RP in June 2025. She said once she was aware Resident #5 had won her appeal, during the period of June, when she missed therapy, she forgot to add her to the therapy schedule.

She said it was an oversight. She said she was responsible for ensuring residents received their ordered therapy. She said failure to receive therapy could cause a decline in a resident's function. During an

interview on 10/23/25 at 11:55 a.m., the ADON said she knew Resident #5 had mentioned she was not getting up, but she had asked the aides, and they said they were getting her up. She said the aides should never tell a resident that they were shorthanded, but they might have. She said she agreed they were short-handed during the period Resident #5 said she was not getting up, according to the facility assessment. She said she was not aware of the requirements of how many staff they should have. She said

she would like them to have 4 aides on days (6 am -2 pm) and evenings (2 pm-10 pm), and 2 aides on nights (10 pm- 6 am), but they mostly had 3 aides on the day and evening shifts. She said she was not aware of any missed therapy visits for Resident #5 in June 2025. She said if a resident missed therapy, it could cause a setback or stall in their progress. During an interview on 10/23/25 at 1:35 p.m., the DON said

she expected therapy to follow the order for any resident who had orders for therapy. She said she was not aware Resident #5 did not receive some of her therapy in June 2025. She said the DOR and the Administrator were responsible for ensuring therapy was received as ordered. She said if a resident was not receiving therapy as ordered, then they could have a functional decline. The DON said she did not have a policy on therapy. During an interview on 10/23/25 at 2:30 p.m., the interim Administrator said she expected residents to receive therapy if it was ordered. She said the DOR was responsible for ensuring the resident received therapy. She said if a resident did not receive therapy, it could be a potential decline in function.

Event ID:

Facility ID:

If continuation sheet