Health inspection·August 24, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete containing soiled linens and barrels containing trash were in the communal shower room on the resident hallway near the conference room and stated it was the usual practice for the barrels with soiled linen and trash to be stored in communal shower rooms. During an interview with the DON on 08/24/2023 at 4:02 p.m., the DON stated there was no facility policy regarding resident dignity. Event ID: Facility ID: 455278 If continuation sheet Page 2 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure the care plan was reviewed and revised by the interdisciplinary team after each assessment, including both the comprehensive and quarterly review assessments for 2 of 8 residents (Resident #188 and #33), reviewed for comprehensive care plans in that: 1. The advance directive code status was not updated for (Resident #188's care plan; and 2. The diet order was not updated for Resident #33's care plan. These deficient practices could affect residents with comprehensive care plans and could result in missed or delayed continuity of care. The findings included: 1. Record review of the admission record dated 8/24/2023 revealed Resident #188 was an [AGE] year-old female admitted on [DATE]. Diagnosis information included: heart failure; hypertension [high blood pressure]; mixed hyperlipidemia [combined high cholesterol, triglycerides and other lipids in the blood] and history of malignant neoplasm [cancerous tumor] of the breast. Advance Directive section indicated DNR [do not resuscitate]. Record review of the admission MDS assessment, dated 8/21/2023, revealed a BIMS Summary Score of 10 for Resident #188, indicative of moderate cognitive impairment. Record review of the order summary report for Resident #188 dated 8/24/2023 revealed a physicians' order for DNR with an order date of 8/16/2023. Record review of progress note dated 8/14/2023 at 3:11 PM, authored by LVN F, revealed, Resident #188, is DNR per report from [redacted]. No physical copy available. Record review of miscellaneous forms revealed signed, Out of Hospital Do Not Resuscitate form for Resident #188 dated 8/16/2023. Record review of the care plan for Resident #188, initiated 8/14/2023, with the most recent revision date on 8/24/2023, revealed no advance directive status listed for either previous full code status or current DNR status. 2. Record review of the admission record dated 8/24/2023 revealed Resident #33 was an [AGE] year-old (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 3 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0657 female originally admitted on [DATE]. Level of Harm - Minimal harm or potential for actual harm Record review of the comprehensive MDS assessment, dated 8/06/2023, revealed Resident #33 had a summary BIMS score of 05, indicative of severe cognitive impairment. Under Section G, Functional Status, eating was coded as supervision of the activity with set up assistance. Under Section GG, Functional Abilities and Goals, eating was coded as set up or clean up assistance for eating. Under Section I, the resident's primary medical condition category for primary reason of admission was non-traumatic brain dysfunction related to unspecified dementia. Under Section K, Swallowing/Nutritional Status, 'none of the above' was selected for swallowing disorder [a. loss of liquids/solids; b. holding food in mouth/cheeks; c. coughing or choking during meals or when swallowing medications; d. complaints of difficulty or pain with swallowing]. 'None of the above' was selected, under the subheading for Nutritional Approaches that included, mechanically altered diet. Under Section L, Oral/Dental Status, 'none of the above' was selected, indicative of no dental issues. Residents Affected - Few Record review of the order summary report dated 8/24/2023 revealed Resident #33 had active physician orders, if resident eats less than 50% of meal then offer nutritional substitute and may alter medication by crushing, opening caps, or administering in food or fluids; dated 7/26/2023. No active dietary order listed. Record review of progress notes dated 7/29/2023 at 8:02 AM, authored by LVN E, revealed under Nutrition subheading, diet Regular, see chart for full diet order. Progress note dated 7/29/2023 at 4:25 PM authored by FSS, revealed, Resident #33 admitted on a regular diet, regular texture, thin liquid diet. [Resident #33] Tells me she has no issues with chewing or swallowing; Record review of the care plan for Resident #33 revealed a focus area of malnourished as evidenced by nutritional screening tool, initiated 7/26/2023. Care plan did not address liquid consistency or food texture in a focus area and no associated interventions were listed. In an observation on 8/21/2023 between 11:45 AM and 12:32 PM, Resident #33 was observed to be seated in a high backed, wheelchair at a round table with her peers in the common dining area, receiving staff assistance from the AD to eat. Resident #33 was served a regular diet texture with thin liquids. In an interview on 8/24/2023 at 12:21 PM, the DON stated she was responsible for updating care plans as situations change. The DON stated she expects care plans to be updated within 72 hrs. The DON stated she was not aware diet plan changes were not on care plans for Resident #33; and was not aware code status was not updated on care plan for Resident #188. The DON stated going from a full code status to a DNR status would be considered a significant change. In an interview on 8/24/2023 at 2:14 PM, the DON stated recommendations and changes were submitted by the RD in writing in triplicate, entitled Status Report. The DON stated each Status Report is routed to the appropriate discipline for action. The DON stated she did not keep copies of the status report half sheet. The DON stated she had the sheets shredded upon immediately acting upon the status report. In an interview on 8/24/23 at 2:33 PM, the Med Rec clerk stated she had contacted the FSS for instructions on where to find the Status Report sheets. The Med Rec clerk stated, after searching for the Status Reports, the facility had no other documentation regarding notification that diet orders were missing from electronic health record from the RD. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 4 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of Care Plan/Comprehensive Interdisciplinary policy, dated 2005, revealed, periodically be reviewed and revised by the interdisciplinary team; otherwise updated as warranted by changes in medication treatment or other changes in condition. Record review of Nutrition and Mealtime policy, undated, revealed, 2. When a change in nutritional status is noted, nursing personnel will consult with the dietitian and or physician to determine the causes and response to the change; 3. Documentation of changes in nutritional status will be made in the residents' medical record. Event ID: Facility ID: 455278 If continuation sheet Page 5 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 - Some 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 resident environment remained as free of accident hazards as possible for 2 halls (disused hall near therapy gym and hall near conference room), and 1 shower room (Shower Room C) reviewed for environment, in that: Hazardous materials, sharp tools, and equipment in disrepair were found in areas accessible by facility residents. This deficient practice could place all residents at risk of injury due to exposure to hazardous materials, sharp tools, and equipment in disrepair. The findings were: Observation on 8/21/2023 at 11:41 a.m., on the 200-wing shower room (Shower Room C) on the right side of the hallway from the nurses' station, the wall next to the toilet was observed to have a missing toilet paper holder exposing the drywall behind the tiled wall. Additionally, the toilet seat had multiple gouges in the finish, mostly centered around the front of the toilet seat, which exposed the rough wood like material underneath. The toilet seat lid had deterioration in the finish, in the area where it attached to the toilet seat and toilet, which exposed the rough wood like material underneath. The screws embedded in the toilet seat appeared to have a reddish-brown material seeping on to the bracket. Observation on 08/21/2023 at 12:02 p.m. of the Maintenance Closet located on the hall near the conference room, revealed it was unlocked and contained: four containers of cleaning materials, each with a label which stated the material was harmful if it came into contact with eyes and/or harmful if swallowed. During an interview with RA A and CNA B on 08/21/2023 at 12:05 p.m., RA A and CNA B confirmed the Maintenance Closet was unlocked and contained bottles labeled as hazardous. Observation on 08/24/2023 at 2:14 p.m. revealed the shower room next to the therapy gym was used for therapy sessions and contained a sink which was loosely affixed to the wall and a toilet which was loosely affixed to the floor. During an interview with the Office Manager on 08/24/2023, at the same time as the observation, the Office Manager confirmed the presence of a sink which was loosely affixed to the wall and a toilet which was loosely affixed to the floor in the therapy shower room. Observation on 08/24/2023 at 2:17 p.m., in the disused hallway near the therapy gym, revealed the bathroom of room [ROOM NUMBER] had a toilet which was loosely affixed to the floor and contained a bottle of cleaning material with a label which stated the material was harmful if swallowed. Further observation revealed a room labeled Hopper Room, in which was a toilet with no seat which contained brown liquid with a foul odor. Further observation revealed a communal shower room which contained three gallon sized containers (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 6 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 of cleaning material with labels which stated the material was harmful if swallowed. Level of Harm - Minimal harm or potential for actual harm During an interview with the Office Manager on 08/24/2023, at the same time as the observation, the Office Manager confirmed the presence of hazardous materials and equipment in disrepair on the disused hallway near the therapy gym. The Office Manager further confirmed that residents could access the disused hallway from resident halls which were in use, and that residents could also access the disused hallway from the therapy gym. Residents Affected - Some Observation of the Maintenance Room, located next to snack and drink dispensers in the disused resident hall, revealed it contained numerous tools with sharp edges. Further observation revealed the presence of containers of cleaning and maintenance materials each with a label which stated the material was harmful if it came into contact with eyes and/or harmful if swallowed. During an interview with the Office Manager on 08/24/2023, at the same time as the observation, the Office Manager confirmed the presence of sharp tools and hazardous materials in the Maintenance Room located next to snack and drink dispensers, and confirmed the room was accessible by residents. During an interview with the Administrator on 08/24/2023 at 4:00 p.m., the Administrator stated all staff were responsible for storing hazardous materials behind locked doors. The Maintenance Director was not available for interview. During an interview with the DON on 08/24/2023 at 4:02 p.m., the DON stated there was no facility policy regarding accident hazards. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 7 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to utilize the services of a registered nurse for at least eight consecutive hours per day, seven days per week and the facility failed to designate a registered nurse to serve as the director of nursing on a full-time basis for 3 of the 13 months reviewed, in that: The facility did not employ a Director of Nursing and did not employ sufficient full-time registered nurses to utilize their services for at least eight consecutive hours per day, seven days per week from July 2022 to October 2022. This deficient practice could place all residents in danger of not receiving adequate care. The findings were: During an interview with the Administrator on 08/23/2023 at 3:36 p.m., the Administrator stated the DON began working in October 2022 and prior to that, the facility had not employed a Director of Nursing since before the time of the previous re-certification survey in July 2022. The Administrator further stated the facility had not employed sufficient full-time registered nurses to utilize their services for at least eight consecutive hours per day, seven days per week from July 2022 to October 2022. Record review of the facility document, Staff List, undated, revealed the DON was hired in October 2022. During an interview with the DON on 08/24/2023 at 3:18 p.m., the DON confirmed she began her tenure as Director of Nursing in October 2022 and worked full-time. During an interview with the DON on 08/24/2023 at 4:02 p.m., the DON stated there was no facility policy regarding the employment of a registered nurse for at least eight consecutive hours per day, seven days per week and the designation of a registered nurse to serve as the director of nursing on a full-time basis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 8 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administration of all drugs and biologicals, to meet the needs of two of 6 residents reviewed for pharmacy services (Residents #12 and #1), in that: 1. The facility failed to ensure vital signs were obtained immediately prior to the administration of medication, metoprolol [a medication for high blood pressure], for Resident #12. 2. The facility failed to ensure that liquid medications were dispensed into a graduated receptacle for accuracy of dosing for Resident #1. These deficient practices could place residents at risk of not receiving the intended therapeutic benefit of the medications, could result in a worsening or exacerbation of chronic medical conditions, hospitalization and or a diminished quality of life. The findings included: 1. Record review of the admission record dated 8/24/2023, revealed Resident #12 was a [AGE] year-old female with an original admission date of 01/20/2015. Active diagnoses included essential (primary) hypertension [high blood pressure without an identifiable secondary cause]. Record review of the care plan for Resident #12 revealed a focus area of hypertension, takes lisinopril and metoprolol for medication management; with the following associated interventions and tasks: give antihypertensive medications as ordered; monitor for side effects such as orthostatic hypotension [a significant drop in blood pressure when changing position from supine to sitting or standing], increased heart rate and effectiveness with a date initiated of 8/01/2022. Record review of order summary report dated 8/24/2023, revealed Resident #12 had an active order for metoprolol 50 milligrams: give one tablet by mouth two times a day related to essential (primary) hypertension with a start date of 11/16/2021. In an observation on 8/23/2023 at 7:11 AM, LVN F administered metoprolol, a medication for hypertension that required vital signs to assess if parameters are met for safe administration, to Resident #12. In an interview on 8/23/2023 at 7:15 AM, LVN F stated Resident #12's vital signs were measured at approximately 6:15 AM, at the start of her shift. LVN F stated Resident #12's blood pressure was 147/76 and heart rate was 62; LVN F stated those numbers were within the parameters, so it was safe to administer the medications as ordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 9 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 In an interview on 8/24/2023 at 12:51 PM, the DON stated she expected vital signs to be taken just prior to medication administration for any medication that requires parameters such as blood sugar, heart rate, or blood pressure. The DON stated staff were trained upon orientation, annually, and as needed, thereafter, that vital signs should be measured immediately prior to preparing the medications for administration. Record review of metoprolol contraindications, accessed 9/12/2023 from https://www.drugs.com/monograph/metoprolol.html, revealed: metoprolol is contraindicated in patients with a heart rate less than 45-60 beats per minute, systolic blood pressure less than 100 mm Hg [millimeter of mercury, measurement used to record blood pressure]. Record review of an undated Medication Administration, Oral policy revealed, under the heading, Remember: .Note any medications that need vital signs taken before being given and take them and hold the medication if necessary. 2. Record review of the admission record dated 8/24/2023, revealed Resident #1 was a [AGE] year-old female with an original admission date of 9/23/2017. Active diagnoses included anemia [deficiency of healthy red blood cells in blood]. Record review of the care plan for Resident #1 revealed a focus area of, resident has anemia; with the following associated interventions: give medications as ordered; monitor, document, report PRN [as needed] signs and symptoms of anemia, with a date initiated of 11/20/2022, and revision on 8/13/2023. Additional focus area of Regular, mechanical soft, thin liquids diet; with the following associated interventions: give supplements as ordered - med pass and mighty shakes; alert nurse and dietitian if not consuming on a routine basis with a date initiated of 4/06/2022, revision on 5/10/2023. Record review of order summary report dated 8/24/2023 revealed Resident #1 had an order for Med Pass 2.0 [a liquid supplement] 60 milliliters: three times a day for prophylaxis [prevention and treatment for malnutrition and anemia] with a start date of 11/21/2021. In an observation on 8/23/2023 at 7:28 AM, LVN F poured Med Pass 2.0 [a liquid medication] directly into an opaque, white Styrofoam cup that was not graduated for measurements for Resident #1. LVN F administered the liquid without assessing the accuracy of the dose. In an interview on 8/24/2023 at 12:51 PM, the DON stated the opaque, white Styrofoam cups are used to administer liquids during medication administration. The DON stated she expected liquid medications to be measured into the clear plastic graduated medicine cup on a flat stable surface and the nurse should move down so that she is at eye level to assess at the meniscus (the lowest point of the curve of liquids) to determine accurate dosing. The DON stated the nurse may need to pour 2 or three medicine cups of liquid in to the larger opaque, white Styrofoam cup, if the volume is larger than a single clear plastic graduated medicine cup. The DON staff were trained upon orientation, annually thereafter, and as needed on preparing medications for administration. Record review of an undated Medication Administration, Oral policy revealed necessary equipment as, 6. Medicine cups to put medicine into (supply and disposable plastic 30CC [milliliter] cups); 7. drinking cups. under the title Preparing Liquid Medications: .5. Pour liquid medication for non-unit dose medication as follows: shake bottle, if directed to do so; medication cup at eye level; pour (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 10 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 away from the label; pour until meniscus of liquid is level with dosage mark on cup. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 11 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, and interview, the facility failed to store all drugs and biologicals in locked compartments for one of four medication carts (200-wing treatment cart) reviewed for medication storage, in that: The facility failed to ensure the 200-wing treatment cart was unlocked and unattended at the nurses' station. This deficient practice could affect residents who have medications in the medication cart and could result in lost medications, drug diversion, or harm due to accidental ingestion or misuse of unprescribed treatments. The findings included: In an observation on 8/24/2023 at 2:00 PM, the 200-wing treatment cart was observed unlocked and unattended at the nurses' station. Staff, visitors, and ambulatory residents were in the immediate vicinity. The cart included both over the counter and prescription medications along with diabetic testing supplies, specifically lancets, and glucometer control testing solutions. The cart was next to the open door of the unoccupied nurses' station. In a group interview on 8/24/2023 at 2:11 PM with the DON, LVN D and LVN E, LVN E stated the 200-wing treatment cart was her responsibility. LVN E stated she did not know that the treatment cart needed to be locked since it was not a medication cart. LVN D stated she locked the cart within the previous 5 minutes when she noticed it was unlocked and unattended. LVN E stated she had just unlocked the cart within the last two to three minutes to obtain supplies. LVN E then proceeded to the resident's room, leaving the cart unlocked, and unattended at the nurses' station. LVN E stated she had left it unlocked and unattended for less than 2 minutes before realizing she had the wrong size dressing then and came back to the location of the treatment cart to obtain the correct sized dressing that she needed. The DON stated carts were to be locked when not in active use. In an interview on 8/24/2023 at 4:02 PM, the DON stated she did not have a policy on medication storage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 12 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 interviews, and record reviews, the facility failed to maintain medical records on each resident that are complete, accurately documented, readily accessible, and systematically organized for 3 of 8 residents (Resident #188, #28, and #33), reviewed for resident records, in that: 1. The facility failed to ensure the Advance Directive code status was updated for Resident #188's care plan; 2. The facility failed to ensure the diet order was updated for Resident #28's care plan and physician orders; and 3. The facility failed to ensure the care plan was updated for Resident #33 to include diet orders. This deficient practice could affect all residents whose records are maintained by the facility and could place them at risk for errors in care and treatment. The findings included: 1. Record review of the admission record dated 8/24/2023 revealed Resident #188 was an [AGE] year-old female admitted on [DATE]. Diagnosis information included: heart failure; hypertension; mixed hyperlipidemia [familial combined high cholesterol, triglycerides and other lipids in the blood] and history of malignant neoplasm [cancerous tumor] of the breast. Advance Directive indicated DNR [do not resuscitate]. Record review of the admission MDS assessment, dated 8/21/2023, revealed a BIMS Summary Score of 10 for Resident #188, indicative of moderate cognitive impairment. Record review of progress note dated 8/14/2023 at 3:11 PM, authored by LVN F, revealed, Resident #188, is DNR per report from [redacted]. No physical copy available. Record review of the order summary report for Resident #188 dated 8/24/2023 revealed a physicians' order for DNR with an order date of 8/16/2023. Record review of miscellaneous forms revealed signed, Out of Hospital Do Not Resuscitate form dated 8/16/2023. Record review of the care plan for Resident #188, initiated 8/14/2023, with the most recent revision date on 8/24/2023, revealed no advance directive status listed for either previous full code status or current DNR status. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 13 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 2. Record review of the admission record dated 8/24/2023 revealed Resident #28 was a [AGE] year-old female originally admitted on [DATE]. Record review of the quarterly MDS assessment dated [DATE] revealed Resident #28 was rarely/never understood with short-term and long-term memory problems and severely impaired cognitive skills for daily decision making. Under Section G, functional status, Resident #28 was coded as total dependence with one-person physical assist in the ADL [Activity of daily living] category of eating. Under Section I, Active Diagnosis, Resident #28 was admitted with the primary medical category of other neurological conditions, and aphasia [speech and language disorder caused by damage to the brain]. Under section K, swallowing/nutritional status, Resident #28 if you don't utilize a mechanically altered diet as a nutritional approach for swallowing difficulties. Record review of the care plan revealed Resident #28 had a focus area of, swallowing problem related to dysphagia; with the following interventions: all staff to be informed of the residents' special dietary and safety needs; diet to be followed as prescribed. Record review of the order summary report dated 8/24/2023 revealed Resident #28 had active physician orders, if resident eats less than 50% of meal then offer nutritional substitute and may alter medication by crushing, opening caps, or administering in food or fluids; dated 2/04/2023. No active dietary order listed. Record review of progress notes: dated 2/28/2023 at 12:52 PM authored by the RD, revealed under the Note Text, Diet - no diet ordered in PCC; with recommendations to, 1. Add diet order to [electronic health record]; dated 4/02/2023 at 6:32 PM authored by the RD, revealed under the Note Text, Diet - Not in [electronic health record]; with interventions: , 1. Add diet order to [electronic health record]; dated 7/11/2023 at 3:40 PM authored by FSS, revealed under the Note Text, [Resident #28] is currently on a regular, mech[anical] soft, thin liquid diet. Record review of Dietary Profile dated 8/6/2023 at 5:49 PM, authored by unidentified staff, revealed Resident #28's current diet order and current texture of food as Reg[ular]. In an observation on 8/21/2023 between 11:45 AM and 12:32 PM, Resident #28 was observed in the communal dining area, being assisted by various staff with eating. 3. Record review of the admission record dated 8/24/2023 revealed Resident #33 was an [AGE] year-old female originally admitted on [DATE]. Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #33had a summary BIMS score of 05; indicative of severe cognitive impairment. Under Section G, Functional Status, eating was coded as supervision of the activity with set up assistance. Under Section GG, Functional Abilities and Goals, eating was coded as set up or clean up assistance for eating. Under Section I, the residents primary medical condition category for primary reason of admission was non-traumatic brain dysfunction related to unspecified dementia. Under Section K, Swallowing/Nutritional Status, none of the above is selected for swallowing disorder [a. loss of liquids/solids; b. holding food in mouth/cheeks; c. coughing or choking during meals or when swallowing medications; d. complaints of difficulty or pain with swallowing]. None of the above is selected, under the subheading for Nutritional Approaches that included, mechanically altered diet. Under Section L, Oral/Dental Status, none of the above is selected, indicative of no dental issues. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 14 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 Record review of progress notes dated 7/29/2023 at 8:02 AM authored by LVN E, revealed under Nutrition subheading, diet Regular, see chart for full diet order; dated 7/29/2023 at 4:25 PM authored by FSS, revealed, Resident #33 admitted on a regular diet, regular texture, think liquid diet. [Resident #33] Tells me she has no issues with chewing or swallowing; Record review of the order summary report dated 8/24/2023 revealed Resident #33 had active physician orders, if resident eats less than 50% of meal then offer nutritional substitute and may alter medication by crushing, opening caps, or administering in food or fluids; dated 7/26/2023. No active dietary order listed. Record review of the care plan for Resident #33 revealed a focus area of malnourished as evidenced by nutritional screening tool, initiated 7/26/2023. Care plan did not address liquid consistency or food texture in a focus area and no interventions were listed. In an observation on 8/21/2023 between 11:45 AM and 12:32 PM, Resident #33 was observed to be seated in a high backed, wheelchair at a round table with her peers in the common dining area, receiving staff assistance from the AD to eat. Resident #33 was served a regular diet texture with thin liquids. In an interview on 8/24/2023 at 12:21 PM, the DON stated she is responsible for updating care plans as situations change. The DON stated she expects care plans to be updated within 72 hrs. The DON stated she was not aware diet plan changes were not on care plans for Resident #33; and was not aware code status was not updated on care plan for Resident #188. In an interview on 8/24/2023 at 2:14 PM, the DON stated recommendations and changes are submitted by the RD in writing in triplicate, entitled Status Report. The DON stated each Status Report is routed to the appropriate discipline for action. The DON stated she did not keep copies of the status report half sheet. The DON stated she had the sheets shredded upon immediately acting upon the status report. In an interview on 8/24/23 at 2:33 PM, the Med Rec clerk stated she had contacted the FSS for instructions on where to find the Status Report sheets. The Med Rec clerk stated, after searching for the Status Reports, the facility had no other documentation regarding notification that diet orders were missing from electronic health record from the RD. Record review of Care Plan/Comprehensive Interdisciplinary policy, dated 2005, revealed, periodically be reviewed and revised by the interdisciplinary team; otherwise updated as warranted by changes in medication treatment or other changes in condition. Record review of Nutrition and Mealtime policy, undated, revealed, 2. When a change in nutritional status is noted, nursing personnel will consult with the dietitian and or physician to determine the causes and response to the change; 3. Documentation of changes in nutritional status will be made in the residents' medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 15 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to designate a member of the facility's interdisciplinary team who was responsible for working with hospice representatives to coordinate care and failed to obtain documentation and information from the hospice company for 2 of 4 residents (Resident #7 and Resident #26) who received hospice services reviewed, in that: 1. There was not a designated member of the facility's interdisciplinary team who was responsible for working with hospice representatives to coordinate care. 2. The facility did not obtain documentation and information from the hospice company for Resident #7 and Resident #26 regarding their hospice services. This deficient practice could place residents who receive hospice services at risk of not having their needs met due to lack of communication and coordination between the facility and the provider of hospice services. The findings were: 1. During an interview with the Social Worker on 08/22/2023 at 10:15 a.m. the Social Worker stated she worked part-time at the facility and was not the designated hospice liaison. The Social Worker further stated the liaison was the Medical Records Director. During an interview with the Medical Records Director, on 08/22/2023 at 1:12 p.m., the Medical Records Director stated she was not the hospice liaison and stated the liaison was probably the Administrator. During an interview with the Administrator on 08/23/2023 at 3:36 p.m., the Administrator stated the DON was the hospice liaison. During an interview with the DON on 08/24/2023 at 3:18 p.m., the DON stated the facility liaisons were hospice staff members. The DON further stated all document and information regarding Resident #7 and Resident #26 were either located in their paper medical charts or electronic medical charts. 2. Record review of Resident #7's face sheet, dated 08/24/2023, revealed the resident was admitted to the facility on [DATE] with diagnoses including: Unspecified Right Bundle Branch Block, Bilateral Primary Osteoarthritis of Knee, and Age-Related Physical Debility. Record review of Resident #7's Quarterly MDS, dated [DATE], revealed a BIMS score of 14 which indicated intact cognition. Record review of Resident #7's care plan, revised 04/16/2023, revealed, [Resident #7] has a terminal prognosis [related to] Right Sided Heart Failure on [hospice company] services. Record review of Resident #7's order summary report, dated 08/24/2023, revealed a physician order to admit to hospice care dated 03/22/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 16 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #7's paper and electronic medical charts revealed the most recent hospice plan of care, the hospice election form, and the current physician re-certification of terminal illness were not present. Record review of Resident #26's face sheet, dated 08/24/2023, revealed the resident was admitted to the facility on [DATE] with diagnoses including: Chronic Obstructive Pulmonary Disease, Anemia in Neoplastic Disease, and Other Chronic Pain. Record review of Resident #26's Quarterly MDS, dated [DATE], revealed a BIMS score of 14 which indicated intact cognition. Record review of Resident #26's care plan, revised 03/01/2023, revealed, [Resident #26 has] a terminal prognosis [related to] Malignant Neoplasm of Parotid Gland. [Resident #26] is on [hospice company] services. Record review of Resident #26's paper and electronic medical charts revealed the most recent hospice plan of care, the hospice election form, and the current physician re-certification of terminal illness were not present. During an interview with the DON on 08/24/2023 at 4:02 p.m., the DON stated there was no facility policy regarding coordination of hospice services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 17 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0944 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program. Based on interview and record review, the facility failed to include as part of its QAPI program, mandatory training that outlined and informed staff of the elements and goals of the facility's QAPI program, for 20 of the 25 staff members reviewed for mandatory training, in that: Twenty of the twenty-five staff members reviewed for mandatory training had not received training regarding the facility's QAPI program. This deficient practice could place residents at risk of receiving inadequate care from staff who are unfamiliar with the facility's QAPI program. The findings were: Record review of LVN E's employee file revealed LVN E was hired on 07/27/2023 and had not received training regarding the facility's QAPI program. Record review of RN H's employee file revealed RN H was hired on 08/10/2023 and had not received training regarding the facility's QAPI program. Record review of RN I's employee file revealed RN I was hired on 06/13/2023 and had not received training regarding the facility's QAPI program. Record review of LVN J's employee file revealed LVN J was hired on 05/22/2023 and had not received training regarding the facility's QAPI program. Record review of 's Dietary Aide K's employee file revealed Dietary Aide K was hired on 05/18/2023 and had not received training regarding the facility's QAPI program. Record review of Restorative Aide L's employee file revealed Restorative Aide L was hired on 02/09/1994 and had not received training regarding the facility's QAPI program. Record review of CNA M's employee file revealed CNA M was hired on 02/06/1996 and had not received training regarding the facility's QAPI program. Record review of CNA N's employee file revealed CNA N was hired on 11/20/2022 and had not received training regarding the facility's QAPI program. Record review of CNA B's employee file revealed CNA B was hired on 12/07/2009 and had not received training regarding the facility's QAPI program. Record review of CNA O's employee file revealed CNA O was hired on 09/20/2017 and had not received training regarding the facility's QAPI program. Record review of PTA P's employee file revealed PTA P was hired on 03/28/2019 and had not received training regarding the facility's QAPI program. Record review of RA A's employee file revealed RA A was hired on 07/06/2009 and had not received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 18 of 19 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 455278 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Knopp Healthcare and Rehab Center Inc 1208 N Llano Fredericksburg, TX 78624 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 0944 training regarding the facility's QAPI program. Level of Harm - Minimal harm or potential for actual harm Record review of OTA Q's employee file revealed OTA Q was hired on 03/30/2020 and had not received training regarding the facility's QAPI program. Residents Affected - Many Record review of LVN R's employee file revealed LVN R was hired on 04/26/2021 and had not received training regarding the facility's QAPI program. Record review of LVN G's employee file revealed LVN G was hired on 11/23/2022 and had not received training regarding the facility's QAPI program. Record review of MDS/LVN S's employee file revealed MDS/LVN S was hired on 02/13/2023 and had not received training regarding the facility's QAPI program. Record review of LVN D's employee file revealed LVN D was hired on 10/24/1994 and had not received training regarding the facility's QAPI program. Record review of PT T's employee file revealed PT T was hired on 02/22/2019 and had not received training regarding the facility's QAPI program. Record review of OT U 's employee file revealed OY U was hired on 02/22/2019 and had not received training regarding the facility's QAPI program. Record review of ST V's employee file revealed ST V was hired on 07/18/2023 and had not received training regarding the facility's QAPI program. During an interview with the Office Manager and the Administrator on 08/24/2023 at 3:42 p.m., the Office Manager and Administrator stated they were jointly responsible for ensuring staff members completed mandatory training. The Administrator stated she was unaware of the requirement that all staff receive training regarding the facility's QAPI program. The Administrator further stated there was no facility policy regarding staff training and the QAPI program. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455278 If continuation sheet Page 19 of 19