Flatonia Healthcare Center

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to provide a safe, clean, comfortable, and homelike environment for residents, staff and public for one (room # 411 vent) of seven vents observed and reviewed for environment. The facility failed to ensure the vent in room [ROOM NUMBER] was clean and free of dust particles. These deficient practices placed residents at risk for illness and decreased quality of life.Findings included:During an interview on 10/13/2025 at 2:03 pm the Maintenance Director stated the vent/AC register was responsible for directing the air. The Maintenance Director looked at the picture of the vent from room [ROOM NUMBER], and he stated that it was probably dust and needed to be cleaned. The Maintenance Director stated he would think it would have an impact on the residents, dust in their room, but was not sure of medical issues. The Maintenance Director said the dust in the vent of room [ROOM NUMBER] was not brought to his attention.During an interview on 10/13/2025 at 2:50 pm the DON looked at the picture of the vent in room [ROOM NUMBER] and stated that it was a vent with all dust and it could cause respiratory problems. She stated that meant the facility was not cleaning the vents. The DON stated Housekeeping and Maintenance were responsible for cleaning the vents in the building. The DON stated

the managers should be checking the vents during their morning rounds.During an interview on 10/13/2025 at 3:34 pm the housekeeping supervisor stated she gives her staff a daily schedule. Housekeeping supervisor stated cleaning the vent was part of their daily cleaning schedule, with the duster on the surface, but they couldn't get thorough cleaning. The Housekeeping supervisor stated they have to get maintenance to open the vent for thorough cleaning. The Housekeeping supervisor stated she has climbed on the ladder and taken the vent cover out to clean thoroughly but that was about a year ago. The Housekeeping supervisor stated she was not sure if cleaning the vent had an impact on the residents' health.During an

interview on 10/13/2025 at 4:03 pm the Administrator stated the facility had been working on the vents in

the facility but did not know the vent in room [ROOM NUMBER] was that dirty. The Administrator stated the dirty vent could potentially cause respiratory issues, but she had not had complaints regarding vents.Review of facility's policy revised June 2011 titled cleaning and disinfecting non-critical Resident -Care items reflected: Purpose--The purpose of this procedure is to provide guidelines for disinfection of non-critical resident-care items.Preparation--Assemble the equipment and supplies as needed.Review of facility's policy dated revised 06/30/2025 titled Cleaning and Disinfection of Resident-Care Items and Equipment reflected: Policy Statement --Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standard.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

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

Facility ID:

If continuation sheet

Event ID:

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Flatonia Healthcare Center

624 N Converse St Flatonia, TX 78941

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 - Few

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

pharmacy with a face sheet and cover sheet to clarify a resident's status.B. Nurses MUST COMMUNICATE to the pharmacy which medications need to be dispensed based on the readmission medication list.

Review current medication stock to avoid duplication and the patient's pay plan upon readmission.C. Use a fax cover sheet and indicate the time that the next doses are due, for the medications that are needed.Review of facility's policy dated 10/01/2025 titled Medication Monitoring-Medication Error and Incident Reporting reflected: PolicyTo define the process for reporting an actual or potential event that is inconsistent with usual operating procedures or pharmaceutical care, or an accident or incident that poses

a potential hazard. Injury does not necessarily occur. The perception of a client, visitor, or associate's potential for injury and/or property damage is sufficient to document on a medication error report. Examples of reportable incidents include but are not limited to:5. Non-Compliance6. Customer/Client Complaint7.

Transportation Issue (i.e., failure to deliver contracted services)8. OtherReview of facility's policy revised 10/01/2019 titled Medication Policies- Ordering and Receiving Medications from Pharmacy- Ordering Controlled Substances and CII Original Prescriptions reflected: PolicyBefore a controlled drug can be dispensed, the pharmacy must be in receipt of a clear, complete, and signed written or e-prescribed prescription from a person lawfully authorized to prescribe. A chart order is not equivalent to a prescription for controlled drugs. Therefore, the prescriber issuing the chart order must also provide the pharmacist with

a valid prescription. The written prescription may be faxed to the pharmacy for long-term care facility residents.To facilitate effective communication, documentation, and aid in prevention of medication errors, medication orders should be clear and concise and free of potentially dangerous abbreviations.ProcedureThe director of nursing and the consultant pharmacist maintain the facility's compliance with Federal and State Laws and Regulations in the handling of controlled medications. Only authorized licensed nursing, medical and pharmacy personnel have access to controlled medications.2.

Schedule II controlled medications prescribed for a specific resident are delivered to the facility only if a written or e-prescribed prescription has been received by the pharmacy prior to dispensing. When reordering Schedule II controlled substances, order at least 7 days in advance of need to allow for transmittal of the required written prescription to the pharmacist. Suggest reorder in 5 days for Schedule III -V. The prescriber is contacted for directions when delivery of a medication will be delayed, or the medication is not or will not be available.Review of facility's policy revised 10/01/2019 titled Medication Policies- Ordering and Receiving Medications from Pharmacy- Receiving Controlled Substances reflected: PolicyMedications included in the Drug Enforcement Administration (DEA) classification as controlled substances and medications classified as controlled substances by state law are subject to special ordering, receipt, and record keeping requirements by the facility in accordance with federal and state laws and regulations.The Director of Nursing, in collaboration with the consultant pharmacist, maintains the facility's compliance with federal and state laws and regulations in the handling of controlled substances.

Only authorized, licensed nursing and pharmacy personnel have access to controlled substances.Controlled substances are reordered when a 5-day supply remains to allow for transmittal of

the required written prescription to the pharmacist.

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

11/18/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Flatonia Healthcare Center

624 N Converse St Flatonia, TX 78941

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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

guarantees.9. Records shall be maintained in the maintenance director's office.10.Maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned. Review of facility's policy revised June 2011 titled cleaning and disinfecting non-critical Resident -Care items reflected: Purpose--The purpose of this procedure is to provide guidelines for disinfection of non-critical resident-care items. Preparation--Assemble the equipment and supplies as needed. Review of facility's policy dated revised 06/30/2025 titled Cleaning and Disinfection of Resident-Care Items and Equipment reflected: Policy Statement --Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standard.

Event ID:

Facility ID:

If continuation sheet