Wells Ltc Nursing & Rehabilitation

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

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

paying. She said she was not aware of resident's not getting their showers as scheduled.During an

interview on 10/21/2025 at 3:13 PM, the Administrator said the plumbing company had finally given them a quote that day (10/21/2025) and planned to install a mixer valve and it would be a separate line that would go to the water heater from the kitchen to the halls. She said she started 8/18/2025, and was not aware at that time the facility had an issue with the water. She said she had been emailing back and forth with the plumbing company for the past month to see about how much it was going to cost. She said the Maintenance Supervisor was responsible for checking the water and temperatures in the facility at least daily. The facility had a system in place where they could report maintenance issues. She said she did not know staff carried water from the kitchen or laundry room and would not want that to happen as there could be a risk of injury.Record review of a maintenance log dated 9/24/2025 indicated the shower on A-hall did not have any water pressure. The issue was completed on 10/14/2025. Comments indicated, fixed.During

an interview on 10/21/2025 at 3:30 PM, the Regional Director of Operations said he was aware Halls C and D did not have hot water in the rooms. He said they would first repair the mixing valve for the facility and then would get to the issue with the halls. He said all residents in rooms on those halls had hand sanitizer in

the bathrooms and if a shower was needed, those residents could go to one of the other halls that usually had hot water. He said the plumber was at the facility and had given them a quote and repairs would be made. He said in the meantime, there would be 2 staff members in the shower rooms when residents were given showers. One staff would monitor the temperature of the water to ensure it did not drop and get cold while the other gave the shower. He said all staff would be inserviced on the changes until the repairs had been made.Record review of a facility policy titled Homelike Environment revised February 2021 indicated, .Resident are provided with a safe, clean, comfortable, and homelike environment. 2. The facility staff and management maximize to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting.

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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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wells Ltc Nursing & Rehabilitation

46 May Street Wells, TX 75976

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 - Minimal harm or potential for actual harm Residents Affected - Few

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

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to ensure the residents' environment remains as free of accident hazards as possible for 1 of 9 residents (Resident #3) reviewed for accident hazards.The facility failed to ensure two cans of air freshener were not left in Resident #3's room on 10/20/2025 and 10/21/2025.This failure could place residents at risk of injuries due to environmental hazards. Findings included:Record review of an admission Record dated 10/21/2025 for Resident #3 indicated he was admitted to the facility on [DATE REDACTED] and was [AGE] years old with diagnoses of type 2 diabetes, morbid obesity (overweight), hypertension, and cerebral infarction (stroke).Record review of a Quarterly MDS assessment dated [DATE REDACTED] for Resident #3 indicated he did not have any impairment in thinking with a BIMS score of 15. He was dependent on staff for showering/bathing.Record review of a care plan dated 11/27/2023 for Resident #3 indicated he had an ADL self-care performance deficit. Interventions for bathing indicated he was dependent on staff to provide a bath how often (3 times weekly) and as necessary.During

an observation and interview on 10/20/2025 at 9:55 AM, Resident #3 was in his room and in bed awake. He said he had been a resident at the facility for 2 years. There were two aerosol cans of air freshener on his nightstand. He said the staff had left them in his room. One can read to keep out of reach of children on the label. He asked if he needed to remove the cans as one of the cans he had purchased, and the other can was one that staff had left in the room. He said there have not been any residents who wander into his room.During an observation on 10/21/2025 at 2:01 PM, Resident #3 was not in his room. The two cans of air freshener were still in his room on the nightstand.During an interview on 10/21/2025 at 2:43 PM, the DON said she started at the facility on 9/29/2025. She said there should not be any residents in the facility to have access to air fresheners in their possession. She said the air fresheners should be locked in a cart or room and not stored in the resident rooms. She said she was not aware Resident #3 had air freshener in his room and would talk to him. She said there could be a risk for fires or cause other people to get sick from the inhalants.During an interview on 10/21/2025 at 3:13 PM, the Administrator said residents should not have aerosols in their rooms. She said the air fresheners should be stored in a locked closet or in housekeeping. She said residents could be at risk for respiratory issues. She expected staff to keep aerosols on their carts or lock them in a closet after use.Record review of a facility policy titled Hazardous Areas, Devices and Equipment revised July 2017 indicated, .All hazardous area, devices and equipment in

the facility will be identified and addressed appropriately to ensure resident safety and mitigate accident hazards to the extent possible. Identification of Hazards: 1. A hazard is defined as anything in the environment that has the potential to cause injury or illness. Examples of environment hazards include, but are not limited to: g. Access to toxic chemicals.

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wells Ltc Nursing & Rehabilitation

46 May Street Wells, TX 75976

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 - Few

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

scheduled to get a bath/shower on halls C and D. She said Resident #9 did not get a shower because he wanted to wait until after breakfast and whenever she let him know that they were going to do it after lunch, when she went to tell him he was lying down in the room. She said Resident #8 did not get a shower on yesterday 10/20/2025. She said she accidentally documented that both received their showers in the charting system, but they did not. She said only three of the five residents received a bath on 10/20/2025 that were scheduled.During an interview on 10/21/2025 at 2:43 PM, the DON said she started at the facility

on 9/29/2025. She said when a resident refused a shower, the nurse aides should notify the nurse and the nurse should try to persuade the resident to take a shower; if they still refuse, they should document the refusal in a progress note. She said the nurse aide should document a refusal in the charting system under

the task for bathing. She said it was false documentation if they documented a shower was received when it was not given. The charge nurse should supervise the nurse aides to ensure the residents are getting their showers.During an interview on 10/21/2025 at 3:13 PM, the Administrator said if a resident refuses a shower, they should tell the nurse, and the nurse should talk to the resident and document that they all documented and refused and have told them to make a 3rd attempt. She said the DON and ADON were responsible for conducting audits to ensure residents are not refusing and review the 24-hour report. She said if a resident did not receive a shower, they need to document that they did not receive the care. She said documenting care received when it was not was falsifying a document. She stated it was her expectation for staff to strike out and make a correction if there was a documentation error.Record review of

a facility policy titled Charting and Documentation revised July 2017 indicated, .3. Documentation in the medical record will be objective (not opinionated or speculative), complete, and accurate.

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

11/25/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Wells Ltc Nursing & Rehabilitation

46 May Street Wells, TX 75976

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

if staff did not wash or sanitize their hands between glove changes.During an interview on 10/21/2025 at 2:43 PM, the DON said she and the ADON were responsible for training staff on their competency for skills check off once a year that included hand hygiene and infection control. She said hand hygiene before, in between when changing, when gloves are changed, and after care completed and can use sanitizer between. Risk for cross contamination and carrying germs to another resident.During an interview on 10/21/2025 at 3:13 PM, the Administrator said the DON and ADON were responsible for training staff on infection control. She said she was aware of the observation of staff not washing their hands with glove changes on yesterday 10/20/2025. She said staff should perform hand hygiene before care was started, between residents, when going from dirty to clean, after care, and can use hand sanitizer if hands were not visibly soiled. She said residents could be at risk for cross contamination.Record review of a facility policy titled Handwashing/Hand Hygiene revised October 2023 indicated, .This facility considers hand hygiene the primary means to prevent the spread of healthcare-associated infections. 2. All personnel are expected to adhere to hand hygiene policies and practices to help prevent the spread of infections to other personnel, residents, and visitors. Indications for hand hygiene: 1. Hand hygiene is indicated: c. after contact with blood, bloody fluids, or contaminated surfaces; f. before moving from work on a soiled body site to a clean body site on the same resident; and g. immediately after glove removal. 2. Use an alcohol-based hand rub containing at least 60% alcohol for most clinical situations. 5. The use of gloves does not replace hand washing/hand hygiene.

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Facility ID:

If continuation sheet