Merkel Nursing Center

F 0607

Develop and implement policies and procedures to prevent abuse, neglect, and theft.

Level of Harm - Minimal harm or potential for actual harm

Based on interviews and record reviews, the facility failed to implement written policies and procedures that prohibit and prevent abuse, neglect, exploitation of residents and misappropriation of resident property for 2 of 5 employees (Administrator Q and ADON E) reviewed for employability.The facility failed to follow written policy of completion of criminal history check and an initial EMR/NAR check for ADON E prior to offering employment.The facility failed to follow written policy of annual EMR verification was completed for Administrator Q. These findings placed residents at risk of receiving care by someone that was unemployable.The findings included:Record review of ADON E's employee file revealed a hire date of 06/08/2025 and no evidence of criminal history or an EMR/NAR check were completed prior to offering employment. Record review of Administrator Q's employee filed revealed a hire date of 09/17/2021 and no evidence of annual EMR check completed. During an interview on 08/20/2025 at 10:30 AM, Administrator Q stated his expectation was criminal history and EMR checks were to be completed upon hire and annually. Administrator Q stated the facility did not have a policy for annual EMR/NAR checks. Administrator Q stated the Business Office Manager was responsible to complete criminal and EMR checks.

Administrator Q stated he was ultimately responsible for ensuring checks were completed. Administrator Q stated what led to failure was improper training of the Business Office Manager. Administrator Q stated the negative effect to residents could have been at risk of receiving improper care. During an interview on 08/20/2025 at 1:15 PM the Business Office Manager H stated she had been working for the facility for a few months. Business Office Manager H stated she had been running the criminal history checks for new employees but had not been told to run EMR checks for new employees or annually for all employees.

Record review of facility policy titled, Background Screening investigations dated March 2019, revealed: Our facility conducts employment background screening checks, reference checks and criminal conviction investigation checks on all applicants for positions with direct access to residents.The Director of Personnel, or designee, conducts background checks, reference checks and criminal conviction checks on all potential direct access employees and contractors. Background and criminal checks are initiated within two days of

an offer or employee or contract agreement and completed prior to employment.

Residents Affected - Some

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

Resident #2 was missing. She did not contact the police. At 12:40 pm, she got into her car to go search for

the resident and as she was driving down the street, she saw the resident in a family friends car bringing him back to the facility. She said the resident was returned to the facility at 12:50 am. She said lunch was usually served starting at 11:30 am. In an observation on 8/13/25 at 12:30 pm of the area outside of the facility revealed the street in front of the facility had a speed limit of 45 miles per hour, no sidewalks, and an active railroad track adjacent to the road. In an interview on 08/13/25 at 3:00 pm with Administrator Q and Administrator-in-Training F, the Administrator-in-Training F said she was being supervised by Owner D of

the facility who also was a licensed Administrator. The Administrator-in-Training F said she was notified by

the facility charge nurse of Resident #2' missing from the facility after he had been already found and returned to the facility which was approximately around 12:45 pm. The Administrator-in-Training F then notified Owner D of the incident. Administrator-in-Training F said she did not know a missing resident was a reportable event to the State at that time. Administrator-in-Training F said the police were not notified.

Administrator Q was present during the conversation but did not add any additional information about the incident. In an interview on 08/21/25 at 10:50 am, Owner D said she was the supervisor of Administrator-in-Training F and was notified of the incident. She was not aware the State had not been notified of the incident. In an interview on 08/21/25 at 2:00 pm, Administrator-in-Training F said the importance of reporting the incident was accountability, resident safety, and in hindsight, the incidents should have been reported. Administrator-in-Training F said her expectation was to follow the facility's abuse and neglect policy to ensure the safety of all residents that resided in the facility.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

familiar or aware of the form that generated the Provider Investigation Report (3613-A). The Administrator-in-Training F said she had received training on the reporting procedures but did not reference

the actual training material when she reported an allegation to the State Survey agency. She said she had received her training from Owner D. The Administrator-in-Training F said she thought she had the process memorized and failed to bring a paper copy out each time she reported a self-reported incident. During an

interview on 08/21/2025 at 10:38 a.m., Owner D said she was not aware the Administrator-in-Training F did not know how to submit the Provider Investigation Report. Owner D said this did not meet her expectation and the negative outcome had the potential to not be reported correctly or accurately. Owner D said she trained the Administrator-in-Training F on the reporting procedures but apparently the training did not sink in. Record review of the facility's policy, Abuse Investigations, not dated, revealed the results of the investigation will be recorded on the Resident abuse Investigation Report Form and would be reported to

the state licensing agency within two (2) days of the results of the completion of the investigation.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some

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

Daily Process: 1. Each safety round documented by charge nurse on 24-hour report. 2. Any hazards noted must be corrected by DON within 2 hours (non-urgent) or immediate (urgent) 3. Charge nurse reports finding to DON within one (1) hour of discovery 4. DON/designee reviews all safety forms and trends issues weekly Monthly System Setup: 1. Administrator schedule monthly safety committee meeting with QAA/QAPI 2. IDT create safety suggestion system for staff and families 3. Maintenance supervisor set up quarterly comprehensive facility safety audit schedule 4. Each department supervisor conduct a safety walkthrough Ongoing Daily Process: * Daily: Charge nurse conduct a chart safety round findings * Weekly: DON analyzes trends and reports to Administrator, document corrective actions * Monthly: Safety Committee reviews all incidents and updates protocols; all incidents will be reported by the QAA/QAPI committee. Responsible party: Administrator Monitoring: Daily safety logs, weekly trend reports, monthly committee reviews Ensuring Safety of Other Residents ADON will complete a BIMS and Wandering Risk assessment on all residents to determine which residents need higher levels of supervisions, including 15-minute safety checks for residents with a high risk to wander and 1 hour safety checks for residents with cognitive impairment. Administrator will create a log for initials that checks were completed. QUALITY ASSURANCE MEASURES 1. MONITORING SYSTEM * Daily safety round with written documentation * Weekly QA meetings with IDT to review safety incidents * Administrator monthly trend analysis of safety-related occurrences * Administrator quarterly external safety audit 2. STAFF ACCOUNTABILITY * DON/designee mandatory safety competency testing every six (6) months * Administrator progressive discipline policy for safety violations * Administrator [TRUNCATED]

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.

Based on interview and record review, the facility failed to employ sufficient staff with the appropriate competencies, and skills set to carry out the functions of the food and nutrition service for 1 of 1 Dietary Manager (DM) reviewed for qualified dietary staff. The facility failed to ensure the facility had a certified DM from July 21, 2025, until August 20, 2025. This failure could place residents at risk of not having their nutritional needs met and placed them at risk for food born illnesses.Findings included: Record review of

the employee files revealed no evidence of a dietary manager. During an interview on 08/18/2025 at 11:30 AM DA R stated the facility currently did not have a DM. DA R stated that on July 21, 2025, the DM called in sick, and they had not heard anything else from the DM. DA R stated the facility had not hired another DM.

During an interview on 08/18/2025 at 12:00 PM the Administrator in Training F stated the previous DM had left without putting in notice. Administrator in Training F stated she had been trying to hire a new DM but had not been able to hire one at this time. During an interview on 08/19/2025 at 1:24 PM the Dietician stated she was notified on her last visit, 8/12/25, that the facility did not have a DM. The Dietician stated she visited the facility once per month. The Dietician stated she did not think there had been a negative effect to residents for not having a DM. The Dietician stated her expectation was for the facility to have a dietary manager. The Dietician stated what led to the failure of not having a DM was that it was difficult to find certified DM's.During an interview on 08/20/2025 at 10:30 AM Administrator Q stated his expectation was to have a full time DM. Administrator Q stated ultimately, he was responsible for ensuring there was a DM in place. Administrator Q stated negative affect on residents could have been lack of communication.

Administrator Q stated what led to the failure was possibly not having appropriate job postings posted.

Administrator Q stated they did not have a policy for having a DM.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0835 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

regulations. The LNHA ensures the delivery of high-quality resident care, compliance with applicable laws, financial integrity, and the effective supervision of staff. The description stated essential duties and responsibilities: Leadership & Oversight Provides executive leadership to ensure the Facility operates in compliance with all CMS, state, and local regulatory requirements. Implements policies and procedures approved by the Governing Body. Promotes a positive organizational culture, emphasizing resident-centered care. This description also revealed Regulatory Compliance.serves as the primary contact for state and federal surveyors.Coordinates survey preparation and directs corrective action plans.

Resident & Family Relations.Investigates and resolves complaints or grievances promptly. Working Conditions: Full-Time, exempt position. Regular business hours with availability for emergencies, evenings, weekends, and holidays, as needed.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

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

Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies for 1 of 1 facility. The facility failed in conducting the facility assessment to ensure involvement from nursing home leadership and management, including but not limited to, a member of the governing body, the medical director, an administrator, and the director of nursing. This failure could place residents at risk of their needs going unmet and result in a lack of services provided by the facility to competently care for all residents.Findings included: In an interview on 8/15/25 at 1:29 pm, Administrator-in-Training F did not know what a facility assessment was, and Owner D stated she could not locate it. The Administrator-in-Training F stated she began working for the facility in January 2025. In an

interview on 8/15/25 at 6:50 pm, Administrator-in-Training F stated what she provided at that time was the Facility assessment dated [DATE REDACTED], reviewed by QAPI on 8/15/25, and created after being requested the facility assessment. Prior to this date, there was no facility assessment. Record review of the Facility assessment dated [DATE REDACTED] revealed the date assessment reviewed with QAPI is 8/15/25. Facility Assessment revealed the Person involved in completing the assessment were the Administrator-in-Training F and DON C. The facility Assessment for medical supplies read DON reviews census and acuity to ensure appropriate equipment is ordered and available. Record review of the Facility Assessment Policy dated October 2018, revealed 1. Once a year, and as needed, a designated team conducts a facility-wide assessment to ensure that the resources are available to meet the specific needs of our residents. 2. The team responsible for conducting, reviewing and updating the facility assessment includes the following: a.

The Administrator; b. A representative of the governing body; c. the medical director; d. the director of nursing; e. the infection preventionist; f. the director (or designee) from the following departments: 1.

Environmental services; 2. Physical operations; 3. Dietary services; 4. Social services; 5. Activity services; and 6. Rehabilitative services. The Facility Assessment Policy further revealed 4. The Facility Assessment also includes a detailed review of the resources available to meet the needs of the resident population. This part of the assessment includes.b. Equipment and Supplies (medical and non-medical);.

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

08/22/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Merkel Nursing Center

1704 N 1st Merkel, TX 79536

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 0844 Level of Harm - Potential for minimal harm Residents Affected - Many

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

Follow rules about disclosure of ownership requirements and tell the state agency about changes in ownership and/or administrative personnel.

Based on interview, and record review the facility failed to provide written notice to the State Agency responsible for licensing the facility at the time of change, for a change in the facility's administrator for 1 of 1 facility.The facility failed to notify the State Agency of a change in AdministrationThis failure could result in

the lack of knowledge and inability to connect with the appropriate leadership of the facility.Findings included:Review of the Texas Unified Licensure Information Portal (TULIP) accessed on 08/15/2025 at TULIP HOME | Salesforce revealed the administrator of the facility was Owner D.In an interview on 8/15/25 at 1:24pm Administrator Q introduced himself as the administrator to the facility.In an interview on 8/15/25 at 3:33pm, Owner D stated she was the owner, and her family member was the Administrator, and family member B was the Administrator-in-Training. The owner stated she had not yet changed the Administrators name yet from herself to family member in TULIP and was not sure if she should do that yet.In an interview

on 8/17/25 at 5:23 pm Administrator-in-Training F stated she was the Administrator-in-Training, and Owner D was training her. The Administrator-in-Training F named Administrator Q as a family member and stated

he was the day-to-day Administrator.In an interview on 8/18/25 at 9:34 am Administrator Q stated he had been the Administrator for one year and one month. He stated Owner D as the owner and not the Administrator.Record review of the facility posting at the nurse's station revealed Administrator Q as the Abuse Coordinator. The facility had no evidence of a policy on notifying State Agency with changes in Administrator/

Event ID:

Facility ID:

If continuation sheet