Inspection·December 5, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2:00PM-10:00PM shift had ignored aiding. Resident #1 stated his roommate had to use his call light to assist him. He stated he witnessed evening staff sitting in the halls talking on the phone instead of assisting with his needs. In an interview on 10/18/25 at 2:28 PM, Resident #1's roommate revealed he did not need much assistance but Resident #1 did. He revealed staff did not round Resident #1 every two hours. He also stated at times the CNAs did rounds and did not return to their room. He stated staff did not always ensure Resident #1 call light was within his reach. Resident #1's roommate also revealed staff did not always answer his roommate's call light. He stated he used his call light to get Resident #1 assistance. Resident #1's roommate revealed staff would leave Resident #1 in his brief for hours after the call light had been pressed. He also stated when staff took long to answer the call light, he would go into the hall to get staff. Observation on 10/18/2025 at 2:48 PM, two CNAs seated in the hall on their cell phones. At the time, Resident #1 stated he needed assistance due to dry throat but was unable to reach his call light from the floor. In an interview on 10/18/25 at 2:50 PM, CNA A stated she had finished her first rounds for rooms 21, 22, 23, 24. 25, and 26. CNA A also stated she was sitting while she waited for ice to be passed to residents on the opposite end of the hall. CNA A stated Resident #1's room was worked by CNA B, so CNA B would assist. She stated there was only one ice chest for the entire hall. She also stated while she waited, she was on her phone taking care of her kids. In an interview 10/18/25 at 3:01 PM, the DON stated expectations once staff arrived for shift was to complete their rounds. She stated when staff came in for their shift, she expected them to check on residents, check to ensure call lights were within reach, provide showers, and get residents' water. She stated staff were to assist residents with whatever was needed at that time. In an interview on 10/18/25 at 5:39 PM, CNA A stated she did not work with Resident #1. She stated she worked in the same hall where Resident #1 was located but different rooms. CNA A stated she when she completed her rounds, she would check to ensure call lights were within reach. She stated she did rounds at 2:00 PM, 4:00 PM, 6 PM, 8:00 PM, and 9:00 PM. She also stated she gave her residents 30 minutes after finishing dinner to do repositioning and turning. CNA A stated not answering call lights could be a life-or-death situation with the resident. She stated if a call light was not in reach, the resident would not be able to ask for help. In an interview on 10/18/25 at 6:06 PM, CNA B stated she worked 2:00PM-10:00PM. CNA B stated she had worked with Resident #1. CNA B also stated on 10/18/25 she worked with residents in Rooms 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, and 26. CNA B revealed she had completed her first rounds approximately 20 minutes after she arrived. She stated her first rounds consisted of checking bed linens, ensuring call lights were pinned on sheets or within reach, ensure residents had water, and anything else resident may need. CNA B stated her second rounds were done shortly after which consisted of giving residents ice water. CNA B stated she was not aware of Resident #1 call light on the floor. She stated after she was told to give Investigator a moment to leave, she went and sat down in the hall. She stated she had not had a chance to pick Resident #1's call light off the floor. CNA B stated the expectations were for staff to answer call lights timely and ensure they were in reach. Record review of the facility's in service, dated 9/24/25, on the topic Rounding, linen, attendance, POC charting, revealed in part the following: Rounds: Every resident is to be rounded on every 2 hours Even your continent residents BSC must be checked hourly for continent residents-residents should not be emptying their own BSC. Record review of the facility's in service, dated 01/14/25, on the topic In-Service, revealed in part the following: 1. First and foremost, every resident is your resident the minute you clock in. Whether or not you are assigned to them. Please when you are asked by someone to help or answer questions about a resident whether you are assigned to them that shift or not, you need to help them or find someone (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455475 If continuation sheet Page 2 of 6 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 455475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Settlement Nursing Center 7820 Skyline Park Dr White Settlement, TX 76108 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 0677 Level of Harm - Minimal harm or potential for actual harm who can help them and don't just walk away, stay there until they get the help they need.2. Incontinent care is to be performed every 2 hours.3. Residents must be repositioned every 2 hours in the bed or in their chair.4. Residents should not be left up all day without getting incontinent care.5. Call lights are to always be within reach of the residents. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455475 If continuation sheet Page 3 of 6 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 455475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Settlement Nursing Center 7820 Skyline Park Dr White Settlement, TX 76108 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the facility was adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or a centralized staff work area for 1 of 5 resident rooms (Resident #1) reviewed for call lights. The facility failed to ensure a call light in Resident #1 room was accessible. Resident #1's call light was observed on the floor out of his reach while he was in bed on 10/18/25. This failure could place residents who rely on the call light system to have delayed response or no way to contact staff to meet their needs. Findings included: Record review of Resident #1's admission Record, dated 10/18/25, reflected the resident was a [AGE] year-old male initially admitted [DATE] with diagnoses to include Cerebral Infarction (disruption of blood supply that could result to tissue death), Epilepsy (seizures), Cognitive Communication Deficit (trouble participating in conversations), Dysphagia Oropharyngeal Phase (difficulty swallowing in mouth and throat), Dysarthria and Anarthria (complete loss of speech), Amyotrophic Lateral Sclerosis (loss of muscle control), Muscle Weakness, Unsteadiness on Feet, Lack of Coordination, and Repeated Falls. Record review of Resident #1's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 6 out of 15, which indicated severe cognitive impairment. In MDS Assessment Section GG-Functional Abilities revealed resident was dependent or required substantial assistance for ADL care. Record review of Resident #1's care plan, revised date 10/21/24, revealed Focus: Visual Function (Impaired): [Resident #1] has impaired visual function and is at risk for falls, injury. Goal: [Resident #1] will maintain optimal quality of life and not experience a decline in ADL functional abilities, or an injury related to vision loss in the next 90 days. Interventions: Anticipate needs and meet them as able. Keep call light in reach when in room or bathroom. Focus: Communication (Impaired): [Resident #1] has a communication problem related to Alz and he may miss part of simple directions given. History of CVA, causing speech to be slurred/muffled at times. Goal: [Resident #1] will have needs met in a timely manner, dignity will be maintained, and current level of functioning will be maintained over the next 90 days. Interventions: Ensure/provide a safe environment: Call light in reach, Adequate low glare light, Bed in lowest position and wheels locked, Avoid isolation. Focus: ADL's: [Resident #1] an ADL Self Care Performance Deficit related to: Limited ROM, Limited Mobility, Confusion. Requires 2 staff members to assist [Resident #1] due to size, extensive assistance, and high fall risk. Goal: [Resident #1 will participate to the best of their ability and maintain current level of functioning with activities of daily living (ADLs) through the next review date. Interventions: Resident educated to use call light prior to attempting activities and wait for assistance. Remind/educated on physical limitations and inability to walk without assistance. Staff will frequently round to anticipate needs. Resident is Max assist. Focus: Falls: [Resident #1] the potential for further falls related to cognitive impairment, incontinence, Gait/balance problems. [Resident #1] has an actual hx of falls related to confusion with no injuries and unable to balance my own body weight for positioning. Goal: [Resident #1] will be free of falls through the next review date. Interventions: anticipate and meet need of resident. Place frequently used items within reach. CALL LIGHT WITH IN REACH, CALL [DON'T] FALL SIGNAGE. Observation on 10/18/25 at 2:23 PM, Resident #1 was lying in bed watching television. Resident #1's call light was observed on the floor approximately 2 feet away. In an interview on 10/18/25 at 2:24 PM, Resident #1 stated staff did not round every 2 hours. Resident #1 also stated staff did not ensure his call light was always within his reach. Resident #1 revealed there were times that staff did not respond when he pressed his call light. Resident #1 also revealed at times, staff had come into his Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455475 If continuation sheet Page 4 of 6 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 455475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Settlement Nursing Center 7820 Skyline Park Dr White Settlement, TX 76108 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few room, turned off his call light, and left without addressing his needs. Resident #1 stated numerous times staff on the 2:00PM-10:00PM shift had ignored aiding. Resident #1 stated his roommate had to use his call light to request assistance for him. He stated he witnessed evening staff sitting in the halls talking on the phone instead of assisting with his needs. In an interview on 10/18/25 at 2:28 PM, Resident #1's roommate revealed he did not need much assistance but Resident #1 did. He revealed staff did not round Resident #1 every two hours. He also stated at times the CNAs did rounds and did not return to their room. He stated staff did not always ensure Resident #1 call light was within his reach. Resident #1's roommate also revealed staff did not always answer his roommate's call light. He stated he used his call light to get Resident #1 assistance. Resident #1's roommate revealed staff would leave Resident #1 in his brief for hours after the call light had been pressed. He also stated when staff took long to answer the call light, he would go into the hall to get staff. Observation on 10/18/2025 at 2:48 PM, two CNAs seated in the hall on their cell phones. At the time, Resident #1 stated he needed assistance due to dry throat but was unable to reach his call light from the floor. In an interview on 10/18/25 at 2:50 PM, CNA A stated she had finished her first rounds for rooms 21, 22, 23, 24. 25, and 26. CNA A also stated she was sitting while she waited for ice to be passed to residents on the opposite end of the hall. CNA A stated Resident #1's room was worked by CNA B, so CNA B would assist. She stated there was only one ice chest for the entire hall. She also stated while she waited, she was on her phone taking care of her kids. In an interview 10/18/25 at 3:01 PM, the DON stated expectations once staff arrived for shift was to complete their rounds. She stated when staff came in for their shift, she expected them to check on residents, check to ensure call lights were within reach, provide showers, and get residents' water. She stated staff were to assist residents with whatever was needed at that time. In an interview on 10/18/25 at 5:39 PM, CNA A stated she did not work with Resident #1. She stated she worked in the same hall where Resident #1 was located but different rooms. CNA A stated the expectations when a resident pressed the call light was to answer within a timely manner. She stated when she responded to call lights, she knocked, introduced herself, and found out what was needed. CNA A stated she when she completed her rounds, she would check to ensure call lights were within reach. She stated she did rounds at 2:00 PM, 4:00 PM, 6 PM, 8:00 PM, and 9:00 PM. She also stated she gave her residents 30 minutes after finishing dinner to do repositioning and turning. CNA A stated not answering call lights could be a life-or-death situation with the resident. She stated if a call light was not in reach, the resident would not be able to ask for help. In an interview on 10/18/25 at 6:06 PM, CNA B stated she worked 2:00PM-10:00PM. CNA B stated she had worked with Resident #1. CNA B also stated on 10/18/25 she worked with residents in rooms 16, 17, 18,19, 20, 21, 22, 23, 24, 25, and 26. CNA B revealed she had completed her first rounds approximately 20 minutes after she arrived. She stated her first rounds consisted of checking bed linens, ensuring call lights were pinned on sheets or within reach, ensure residents had water, and anything else resident may need. CNA B stated her second rounds were done shortly after which consisted of giving residents ice water. CNA B stated she was not aware of Resident #1 call light on the floor. She stated when she went to check on Resident #1, the Investigator informed her she was in the room and to hold on. She stated after she was told to give Investigator a moment to leave, she went and sat down in the hall. She stated she had not had a chance to pick Resident #1's call light off the floor. CNA B stated the expectations were for staff to answer call lights timely and ensure they were in reach. In an interview on 10/18/25 at 6:50 PM, ADON revealed her expectations were that all residents have a call light within reach. She stated her expectation was for staff to answer call lights within 10 minutes. She also stated her expectations when staff arrived for their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455475 If continuation sheet Page 5 of 6 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 455475 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Settlement Nursing Center 7820 Skyline Park Dr White Settlement, TX 76108 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete shift was to complete rounds. She stated when staff did rounds, they should ensure residents were in the facility, residents were clean and dry, call lights within reach, and provide residents with ice water. She also revealed she received a complaint last week from a resident stating the call light was not being answered. She stated no in-service was completed for the one staff on the day she received the complaint, but she did more of a talk directive to the one specific staff member. She revealed she stayed on top of staff. The ADON stated the risk of not having a call light or an unanswered call light would be residents not receiving help. The ADON stated the resident may risk injuries such as falls or choking hazard. Interview on 10/18/25 at 7:51 PM, DON stated she expected CNAs to ensure call lights were within reach whenever rounds were done. The DON stated her expectations were that staff answered call lights as quickly as possible. She stated rounds were expected to be done every two hours. In an interview on 10/18/25 at 7:52 PM, the Administrator revealed her expectations were for each resident's call light to be within reach and answered as soon as possible. She stated she was not aware Resident #1 call light was on the floor but when the staff went to check on Resident #1, Investigator was in the room and told staff to hold on. Record review of the facility's policy and procedure, revised on 01/01/24, subject Call Light-Use of, reflected in part the following: Policy:It is the policy of this home to ensure residents have a call light within reach that they are physically able to access and that they have been instructed to use. Equipment:1. Beside call light in functioning order.2. Emergency call light in functioning order Procedure:1. All nursing personnel must be aware of call lights at all times.8. When providing care to residents, be sure to position the call light conveniently for the resident to use. Tell the resident where the call light is and show him/her how to use the call light.12. Be sure call lights are placed near the resident, never on the floor or bedside stand. Event ID: Facility ID: 455475 If continuation sheet Page 6 of 6