Health inspection·August 11, 2023

F 0755 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #1's quarterly MDS, dated [DATE], revealed a BIMS of 13, which indicated he was cognitively intact and required supervision and set-up help only with all activities except bathing which revealed he was independent with and required no setup or physical help from staff. Record review of Resident #1's physician orders dated 08/09/23 revealed order for Revlimid Oral Capsule 25 MG (Lenalidomide) Give 1 capsule by mouth at bedtime for RECEIVED FROM OUTSIDE PHARMACY related to MULTIPLE MYELOMA NOT HAVING ACHIEVED REMISSION (C90.00) until 08/14/2023 23:59 wear gloves with med administration/ do not given if broken--- NOTIFY ADON/DON WHEN 7 PILLS REMAIN-- SO ORDER CAN BE DONE******** Record review of Resident #1's Nursing Progress Note, dated 7/23/2023 21:56 (9:56 PM) revealed the following: Residents son asked this nurse how many capsules does resident have left Revlimid 25mg. This nurse noted bottle sealed and has not been opened. RP upset d/t resident has not been getting his Revlimid medication and next dosage of 21 days is soon to come up again. This nurse noted residents last dose of Revlimid was around 6/30/23. NP notified of missed medication video call this nurse via spruce new order to restart Revlimid 25mg as ordered and notify VA DR. ADON, RP, VA notified. Revlimid ID'd at 2000 (8:00 PM) with narn. vs: 117/75, 74, 18, 97.5, SPO2 96% RA. Record review of Resident #1's MAR for June 2023 revealed Revlimid Oral Capsule 25 MG was administered on June 1st and 2nd and then June 9th through 29th at 6:00 PM. Record review of Resident #1's MAR for July 2023 revealed Revlimid Oral Capsule 25 MG was administered on July 24th at 6:00 PM. Record review of Resident #1's TAR for July 2023 revealed Revlimid Oral Capsule 25 MG was administered on July 25th through 31st at 6:00 PM. Record review of Resident #1's TAR for August 2023 revealed Revlimid Oral Capsule 25 MG was administered on August 1st through 8th at 6:00 PM. Revlimid Oral Capsule 25 MG (Lenalidomide) 1 capsule by mouth at bedtime. This medication is a chemotherapy and is used to treat multiple myeloma not having achieved remission, which is a cancer of plasma cells, a type of white blood cell, that normally produces antibodies per Google. Record review of Resident #1's care plan dated 07/25/2023 revealed resident takes cancer medication Revlimid. Cycles on medication for 21 days and off for 7 days- (Medication supplied by the VA Pharmacy/ resident's FAM brings medication to facility) Goals: Staff to assure medication is administered per orders through review period. Interventions: Monitor for adverse reactions- which include- hypersensitivity, angioedema (an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes), [NAME]-[NAME] syndrome (a rare, serious disorder of the skin and mucous membranes that is often a reaction to medication or an infection), toxic epidermal necrolysis (a life threatening skin disorder characterized by a blistering or peeling of the skin), Tumor Lysis Syndrome (a group of metabolic abnormalities that can (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 2 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 - Immediate jeopardy to resident health or safety occur as a complication from the treatment of cancer), hepatotoxicity (injury or impairment of the liver function caused by exposure to xenobiotics such as drugs, food additives, alcohol, chlorinated solvents, peroxidized fatty acids, fungal toxins, radioactive isotopes, environmental toxicants, and even some medicinal plants), thrombocytopenia (a low number of platelets in the blood), neutropenia, pruritis (itching), rash, fatigue, constipation, nausea. Residents Affected - Some Staff to assure that medication is swallowed whole and not chewed. Staff to wear gloves with administration of this medication. Record review of facility policy titled Medications brought to the facility by the resident/family dated 2001 (revised April 2007) revealed Policy Statement: The facility shall ordinarily not permit residents and families to bring medication into the facility. Policy Interpretation and Implementation: 3. If a medication is not otherwise available and/or it is determined to be essential to the resident's life, health, safety, or well-being to be able to take a medication brought in from outside, the Director of Nursing Services and nursing staff, with support of the Attending Physician, and Consultant Pharmacist, shall check to ensure that: b. The medications have been ordered by the resident's Attending Physician and documented on the physician's order sheet. During an interview on 08/09/2023 11:16 AM with MA E, she stated medications should be given to residents as ordered by the physician. She stated if a resident was not given medications correctly, it could potentially cause major side effects. She stated a blood pressure medication could cause a blood pressure to rise or fall, aspirin could cause heart problems, and Depakote could cause agitation, and missing a medication could even cause death depending on the medication. She stated she was in-serviced regularly on abuse/neglect and medication administration. During an interview on 08/09/2023 11:44 AM with LVN A, he stated medications should be given to residents as ordered by the physician. He stated if a resident was not given medications correctly, it could potentially cause adverse reactions. He stated he was in-serviced regularly on abuse/neglect and medication administration. During an interview on 08/09/2023 11:55 AM with LVN B, she stated she was in-serviced regularly on abuse/neglect and medication administration. She stated medications should be given to residents as ordered by the physician. She stated if a resident was not given medications correctly, it could potentially cause adverse side effects, delayed action of medication for whatever it was supposed to cure, or if it's for a preventative measure, whatever it was supposed to prevent could occur. She stated Resident # 1's medication came from the VA. She stated the son picked the medication up and dropped it off at the facility. She stated the medication did not come from their pharmacy, and they did not order it. She stated Resident #1 took the medication for 21 days and was off of the medication for 7 days and it continuously cycled that way. She stated she was not sure where the disconnect was, where the medication was brought in and the order was not put in the system to be administered, or if the nurse that the FAM gave it to just forgot or what, but the resident did not get his medication started back up this last time on time. She stated she did not know exactly how many days the medication had been missed. During an interview on 08/09/2023 12:13 PM with MA F, she stated she was in-serviced regularly on abuse/neglect and medication administration. She stated medications should be given to residents as ordered by the physician. She stated if a resident was not given medications correctly, it could potentially cause a change in residents body or it could potentially cause harm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 3 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 08/09/2023 at 1:16 PM with ADM and DON, they stated they were in-servicing staff regularly on medication administration. They stated medications should be given to residents as ordered by the physician. They stated if a resident was not given medications correctly, it would depend on the medication being given as to what reactions could occur. They stated if it was discovered that a medication was not given properly, the nurse should do an assessment on the resident and follow up with notifying the family and doctor. They stated Resident #1 received the chemotherapy medication from the FAM picking it up from the VA and bringing it to the facility. They stated the FAM called facility on 07/23/23 at 21:56 (9:56 PM) and spoke to a nurse and asked how many pills were left to see if he needed to re-order the medication, and that was how it was discovered Resident #1 was not currently receiving the medication. They stated that was when staff realized there was a full bottle of the medication on the medication cart. They stated Resident #1 took the medication for 21 days and off for 7 days, then it started back up and cycled routinely with that order. They stated when the FAM brought the most recent bottle of medication, resident had still not completed previous cycle of medication so nurse could not put the new cycle into the administration record. They stated they could not put the medication into the system to stop and restart the way the medication was ordered. They stated if a resident did not receive this type of medication, it could cause their blood count to be off. They stated they had in-serviced their staff on medication administration and receiving and accepting medications. They stated they had put the medication on a management board, and they discussed this medication every morning now to ensure that the dates were aligned, and the medication was available and being administered as ordered. They stated they had their clinical resource person to look into the system to see if there was any way to put it in the system with no resolution, and they had the pharmacy consultant to check for this as well. They stated if a resident did not receive this medication, it could cause his blood count to be off. They stated the VA informed them that they ran all of residents labs to check for any off blood counts and to make sure that everything looked ok or there was no changes from previous status. They stated resident went to the ONC at the VA every week and has done this throughout the time he was not receiving the medication and there were no adverse reactions. During an interview on 08/09/2023 1:47 PM with PA, she stated there was always a potential for harm or adverse reaction with any medication that is missed or not taken. She stated any medication being missed could certainly cause side effects. 08/09/2023 1:56 PM Call placed to ONC, doctor was not available to speak to surveyor. During an interview on 08/09/2023 at 1:58 PM with PHARM, he stated the only potential thing that could have occurred would have been the progression of cancer. During an interview on 08/09/2023 at 2:14 PM with Resident #1, he stated he just got back from the VA, and he goes to the VA every week because he has cancer. He stated liked it here and the staff all treated him well. He stated he was told about missing his cancer medication and his son talked to him about it also. He stated he has not had any problems or issues due to the medication being missed. He stated he did not realize he was missing any medication and he would not have known it if they didn't tell him. He stated he feels safe here in the facility and he has no complaints about nothing. He stated he uses a cane or walker for mobility, and he always gets to his appointments. During an interview on 08/09/2023 3:09 PM with LVN C, she stated they only received the chemotherapy medication orders from the new bottles of medication when the residents family brought it to them. She stated the only order they had for the medication is what the medication bottle says and from the original paperwork when resident first started the medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 4 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 - Immediate jeopardy to resident health or safety Residents Affected - Some 08/09/2023 Record reviewed of physician orders dated 04/07/23 and 07/26/23 and signed by ONC, received by LVN C which revealed Lenalidomide 25 mg po daily x 21 days then, 1 week off (next cycle to start once completed prior 21 day supply and 1 week off). During an interview on 08/09/2023 5:30 PM with ADM, he stated there was only one resident in the facility which receives Chemotherapy. He stated there may have been others before and there were residents with a diagnosis of cancer, but none received chemotherapy now except the one in incident. 08/09/23 Record review of facility policy titled Administering Medications dated 2001 (Revised December 2012) revealed in policy statement: Medications should be given in a safe and timely manner, and as prescribed. Record review of staff in-service training report dated 07/25/2023 revealed nurses and medication aides were in-serviced on medication administration and medication orders. 08/09/23 4:31 PM Record review of facility policy titled Accepting Delivery of Medications which is not dated revealed Policy heading: 1. All staff follow a consistent procedure in accepting medications. Policy Interpretation and Implementation 4. A nurse signs the delivery ticket, indicating review and acceptance of the delivery, and keeps a copy of the delivery ticket. Both the nurse and the delivery agent must sign any notations about errors. 5. The delivery ticket is archived in a designated location. An immediate Jeopardy (IJ) was identified on 08/10/2023 at 10:15 AM, due to the above failures. The Administrator was notified of the IJ and the IJ template was provided. The Administrator verbalized understanding of the IJ and a Plan of Removal was requested. The Survey team monitored the plan of removal as follows: The Plan of Removal was accepted on 08/11/2023 at 1:50 PM and is as follows: DON assessed resident #1 on 8/9/2023 for new or worsening symptoms associated with his multiple myeloma or adverse side effects of the missed medication including increased pain or neurological symptoms. The attending physician and ONC were notified of medication error and no new orders were given with the exception of restarting medication immediately. The assessment did not reveal any obvious adverse effects related to the deficient practice. The Corporate Clinical Consultant provided education to the DON on 8/10/2023 regarding the administration of medication in a safe manner according to physician orders and per policy. DON/Designee completed education with all licensed nursing staff on 8/10/2023 regarding the administration of medication in a safe manner according to physician orders and per policy. All licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required staff were educated. New staff, will be in-serviced during orientation period prior to working a shift. The DON/Designee completed an audit of all residents to establish which residents receive medications from outside pharmacies on 8/10/2023. 8 residents were identified through this audit. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 5 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 - Immediate jeopardy to resident health or safety Residents Affected - Some DON/designee then conducted an audit of medication storage areas to validate that none of these residents' medications were missing and the administration record was reviewed for each resident to validate that there were no missed doses within the last 90 days on 8/10/2023. Care plans updated with directions of receiving from outside pharmacy, also initiated instructions RECEIVED FROM OUTSIDE PHARMACY No issues were identified related to missed doses or missing medication. DON/Designee completed education with all licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required licensed staff were educated on 8/10/2023 on entering orders correctly in Point Click Care for proper and error-free medication administration, and to include instructions 'RECEIVED FROM OUTSIDE PHARMACY as identification when medication is brought in from outside pharmacy, this education will be ongoing for all newly hired nurses. Sr [NAME] President of Clinical Services revised policy titled Medications Brought to the Facility by Resident/Family to having a signed receipt of accepting of the medication by licensed staff only, on 8/10/23. Director of Clinical Operations educated DON in regard to policy change. DON/Designee completed education with all licensed nursing staff informing this of this policy change. All licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required staff were educated. New nursing staff and agency staff will be educated upon or upon initial shift at facility, ongoing. Education completed on 8/10/23. DON/designee completed a review of all residents to validate the availability of all medications on 8/9/2023. There were no concerns identified related to the availability of medications through this review. Director of Nursing/designee completed review of all residents to identify which medication are provided by outside pharmacy. 8 residents were identified. This review was completed on 8/9/2023. No concerns were identified related to missing medications or missed doses in the last 90 days for any of the 8 residents. The orders for the 8 residents identified were updated to reflect that meds are received from an outside Pharmacy to alert nursing staff that refills should not be requested from the house pharmacy on 8/9/2023. Corporate Clinical Consultant completed a review of the following policies on 8/10/2023: Pharmacy Services Overview, Administering Medications, Medications Brought into the Facility by Resident/Family, Accepting Delivery of Medications. Medications Brought into the Facility by Resident/Family policy was revised by Sr [NAME] President of Clinical Services to include signed acceptance receipt of medication, no other policy changes were made. Licensed nurses will communicate via 24 hour report and shift hand off of medications that were ordered and not received during shift. The Corporate Clinical Consultant completed education with the DON on 8/10/2023 on these policies and the procedure for receiving, ordering, and administering medications brought in by family or received from an outside pharmacy. The procedure is to include receipt of medication by a licensed nurse, notification of DON/designee, verification of order from the attending physician, verification of proper order entry in PCC to include notation that medication is received from and outside pharmacy, verification of proper labeling of medication container with medication and resident information, verification of quantity and type medication being delivered from outside pharmacy. The receiving nurse will be responsible for conducting the first check verification as medications are received and orders are entered and the DON/designee, will conduct the second check verification Monday-Friday in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 6 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 - Immediate jeopardy to resident health or safety Residents Affected - Some the morning clinical meeting to include needed medications for upcoming weekend, and any changes/needs from prior weekend. For after hours or weekends, the receiving nurse will contact on-call nurse manager and physician for any concerns related to supply of medications. The DON/designee completed education with licensed nurses on 8/10/2023 regarding the procedure to ensure that medications are received and administered according to ordered date, time, and frequency for residents whose medications are dispensed from an outside pharmacy. All licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all licensed nursing staff were educated. Medications that are received from outside pharmacies will be entered with an additional note in the instruction section indicating that meds are 'RECEIVED FROM OUTSIDE PHARMACY with any additional information on the pharmacy name and/or who delivers the medication and how to obtain a refill. Communication will be shift to shift via 24 hour report, when medications are ordered or needed for licensed nurses to assure timely delivery. Education will be provided to all newly hired nurses prior to their first shift and all current staff have been educated as of 8/10/2023. DON/designee added orders with skipped days through end of calendar year, also added onto daily monitoring for review of ongoing order, on 8/10/2023. The DON/designee will conduct monitoring of new medication orders and medications stocked in medication carts/rooms/refrigerators to validate that medications received from outside pharmacies have orders entered appropriately in Point Click Care, that they are received and administered according to ordered date, time and frequency and that there is adequate stock remaining or that refill request has been initiated. Any concerns identified will be reported to the physician immediately upon identification with corrections made according to physician orders. Monitoring will occur, starting on 8/10/23, 3 times per week for 4 weeks then weekly for 2 months. Any trends identified will be reported to the QAPI Committee monthly and as needed until a lessor frequency until substantial compliance is achieved. QAPI meeting was held on 8/10/23 with the Medical Director, ADM, DON, and Nurse Management to review newly revised policy on medication brought in by family, and review and validate the plan of removal. The Administrator will be responsible for the implementation of ensuring the adequate process regarding Safe Medication Administration. The new processes/system was initiated, and all licensed nursing staff had completed education by 8/10/2023. This new process will be ongoing for new hires and agency staff prior to working a shift at the facility. All licensed nurses and medication aides were in-serviced. DON/designee used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required staff were educated, completed on 8/10/23. Monitoring was conducted from 08/10/2023 through 08/11/2023. During an interview on 08/10/2023 at 12:47 PM with the ADM and DON, they stated the facility had a QAPI meeting the morning of 08/10/2023 with the medical director included addressing the medication error in incident but they had not had a meeting regarding medication errors in the past 3 months prior to surveyor entrance. During an interview on 08/10/2023 at 12:58 PM with LVN A, he stated he had recently been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 7 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 - Immediate jeopardy to resident health or safety Residents Affected - Some in-serviced by management regarding medication administration, receiving medications, how to put the medication in the system, and when medications come in from an outside pharmacy or family. He stated the in-service taught him if the medicine comes in from an outside pharmacy or the family delivered it, to specifically make a progress note to say that the medication came in. He stated he would write that additional note in the system and label the bottle or card that comes from the pharmacy. He stated he was informed on and had reviewed the policies for medication administration, receiving medications, and receiving medications from an outside pharmacy. He stated he had never been given medication from hospice from an outside pharmacy but that always had an order prior to medication being delivered and he had to sign a receipt of delivery. During an interview on 08/10/2023 at 1:15 PM with LVN D, she stated she had recently been in-serviced by management that morning regarding medication administration, pharmacy protocols, medication coming in from the pharmacy and outside pharmacy or families protocol, and basically everything that had to do with medications coming into the facility. She stated there was a sheet that they will be signing and documenting on when receiving a medication from an outside pharmacy or family member. She stated the in-service taught her to document and double check everything and leave it in the book to refer to. She stated she would sign in any medications received from an outside pharmacy or family member and document that she received it. She stated would also check to make sure there are orders for the medications and verify that the orders have been transcribed into the MAR's or TAR's. She stated she was informed on and had reviewed the policies for incoming medications, medication administration, and signing in medications and checking orders. She stated she had not been given medication that was brought in from an outside pharmacy or family member that she can recall. During an interview on 08/10/23 at 1:31 PM with MA F, she stated she had recently been in-serviced by management regarding medications that are coming in from outside of the facility pharmacy or family members. She stated the in-service taught her that any medication given to her will go directly to the nurse and that it should be noted on the MAR's if the medication came from their pharmacy, an outside pharmacy, or family. She stated she would re-direct whoever is bringing the medication to the nurse so the nurse could sign the medications in. She stated she was informed on and had reviewed the policies for medications coming from family or other pharmacies and to check and make sure everything was correct on their MAR's. She stated she had not been given medication that was brought in from an outside pharmacy or family before. During an interview on 08/10/2023 at 1:36 PM with MA E, she stated she had recently been in-serviced by management this morning regarding family bringing in medication and pharmacy bringing in medication. She stated the in-service taught her that if a family member brings in medication that she was to re-direct them to take the medication from the nurse and if the medication comes from an outside pharmacy there was to be a note put in the system to show the medication was received. She stated she would direct family to give any medication to the nurses if they try to bring it to her. She stated she was informed on and had reviewed the policies for receiving medication from families or outside pharmacies. She stated there were 3 in-services, but she could not remember all of the exact names of the policies. She stated she had not been given medication that was brought in from an outside pharmacy or family before. She stated she had family and pharmacies try to give her medications, but she had been taught from the beginning to not accept or sign for any medications and to re-direct them to the nurse. Record review of Resident #1's TAR for August 2023 revealed Revlimid Oral Capsule 25 MG was administered on August 9th at 6:00 PM. Medication was administered correctly during this time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 8 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 On 08/11/23 at 9:30am - Monitoring visit conducted in facility. Level of Harm - Immediate jeopardy to resident health or safety 08/11/23 Reviewed facility in-servicing for staff that covered Medications Brought to the Facility by the Residents/Family, Receiving Medication from Outside Pharmacy and Pharmacy Services Overview dated 08/10/2023. Residents Affected - Some Reviewed MAR's for the sampled residents: All reviewed residents have a note added with the medication order stating the order comes from an outside pharmacy. Interview on 08/11/23 at 10:30am - DON stated that nurses and MA's are being in-serviced on the Medications Brought to the Facility by the Residents/Family policy, the procedure for Receiving Medication from Outside Pharmacy and Pharmacy Services Overview. DON stated that the facility's nurses and MA's are receiving the services prior to working their shift. DON stated some staff are receiving the training verbally and some in person to ensure all staff were trained immediately. DON stated that she asked all staff if they understood the training, and all replied yes. DON stated the facility implemented a receipt of medication brought in by the resident/family. Nurse reviewing and family member bringing medication in had to be signed and dated. DON stated there is a sticker placed on the medication that states it is from another pharmacy and a note entered with the order from other pharmacy or provided by family. DON stated that there was an alert added the facility's clinical white board for Resident #1 chemotherapy medication to be re-added to PCC. DON stated that PCC will not allow medication to be added more than 3 months at a time. DON stated that the white board is reviewed daily by the facility's clinical team Administrator, ADONs, DON, Therapy, Social Worker. Record review of Resident #1's TAR for August 2023 revealed Revlimid Oral Capsule 25 MG was administered on August 10th at 6:00 PM. Medication was administered as ordered. Reviewed change to Medications Brought to the Facility by the Residents/Family policy. The facility added Signed receipt of medication, listing medication brought in to acknowledge delivery from family or RP, and receiving staff member is completed. Reviewed care plans for Resident #'s 1-9, care plans were updated to reveal medications were brought in from outside sources such as family or other pharmacies. On 08/11/23 at 11:45am - MA E stated she has been trained on Medications Brought to the Facility by the Residents/Family policy. The facility added Signed receipt of medication, listing medication brought in to acknowledge delivery from family or RP, and receiving staff member is completed. MA E stated she understood the training and has no issues or concerns. On 08/11/23 at 12:15pm - MA F stated she has been trained on Medications Brought to the Facility by the Residents/Family policy. The facility added Signed receipt of medication, listing medication brought in to acknowledge delivery from family or RP, and receiving staff member is completed. MA F stated she understood the training and has no issues or concerns. On 08/11/23 at 12:30pm - LVN G stated she has been trained on Medications Brought to the Facility by the Residents/Family policy. The facility added Signed receipt of medication, listing medication brought in to acknowledge delivery from family or RP, and receiving staff member is completed. LVN G stated she understood the training and has no issues or concer[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 9 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure residents were free of any significant medication errors for 1 of 8 residents (Resident #1) reviewed for significant medication errors. Residents Affected - Some The facility failed to ensure Resident #1 received his chemotherapy medication for 17 days (07/07/23 to 07/23/23) after medication was delivered to the facility (between 06/29/23 and 07/07/23) for 1 of 9 residents reviewed for medication administration. Resident #1 should have restarted medication on 07/07/23. Medication error was discovered when FAM called to see if medication needed to be replenished and medication was started again on 07/24/23, which Resident #1 to not receive medication as ordered for 17 days. An IJ was identified on 08/09/23 at 3:30 PM. The IJ template was provided to the facility on [DATE] at 5:36 PM. While the IJ was removed on 08/11/23, the facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not IJ scoped at a pattern, due to staff needing more time to monitor the plan of removal for effectiveness. This failure could place residents at risk of complications from deterioration in health, worsening of cancer, extended recoveries, and hospitalizations. Findings included: Record review of Resident #1's admission record dated 08/09/23 revealed a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included, multiple myeloma not having achieved remission (a cancer of plasma cells, a type of white blood cell, that normally produces antibodies), dysphagia (difficulty in swallowing food or liquid), anxiety disorder (feeling nervous, restless or tense or having a sense of impending danger, panic or doom), cognitive communication deficit (difficulty with thinking or how someone uses language), diabetes (a group of diseases that result in too much sugar in the blood), and PTSD (post-traumatic stress disorder)(a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being). Record review of Resident #1's quarterly MDS assessment, dated 06/06/23, revealed a BIMS of 13, which indicated he was cognitively intact and required supervision and set-up help only with all activities except bathing which revealed he was independent with and required no setup or physical help from staff. Record review of Resident #1's physician orders dated 04/07/23 and signed by ONC, received by LVN C which revealed Lenalidomide 25 mg po daily x 21 days, then 1 week off (next cycle to start once completed prior 21 day supply and 1 week off). Record review of Resident #1's Nursing Progress Note, dated 7/23/2023 at 21:56 (9:56 PM) revealed the following: Resident's family member asked this nurse how many capsules does resident have left Revlimid 25mg. This nurse noted bottle sealed and has not been opened. RP upset d/t resident has not been getting his Revlimid medication and next dosage of 21 days is soon to come up again. This nurse noted resident's last dose of Revlimid was around 6/30/23. NP notified of missed medication video call this nurse via spruce (communication platform) new order to restart Revlimid 25mg as ordered and notify VA DR. ADON, RP, VA notified. Revlimid ID'd at 2000 (8:00 PM) with narn. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 10 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #1's physician orders dated 07/26/23 and signed by ONC, received by LVN C which revealed Lenalidomide 25 mg po daily x 21 days, then 1 week off (next cycle to start once completed prior 21 day supply and 1 week off). Record review of Resident #1's physician orders dated 08/09/23 revealed order for Revlimid Oral Capsule 25 MG (Lenalidomide) Give 1 capsule by mouth at bedtime for RECEIVED FROM OUTSIDE PHARMACY related to MULTIPLE MYELOMA NOT HAVING ACHIEVED REMISSION until 08/14/2023 at 23:59 (11:59 PM) wear gloves with medication administration/ do not give if broken--- NOTIFY ADON/DON WHEN 7 PILLS REMAIN-- SO ORDER CAN BE DONE******** Record review of Resident #1's MAR for June 2023 revealed Revlimid Oral Capsule 25 MG was administered on June 1st and 2nd and then June 9th through 29th at 6:00 PM. Medication was administered correctly for the month of June. Record review of Resident #1's MAR for July 2023 revealed Revlimid Oral Capsule 25 MG was administered on July 24th at 6:00 PM. Medication should have restarted on 07/07/23 through 07/27/23. Medication was missed on the days from 07/07/23 to 07/23/23 when medication error was discovered. Medication was restarted on 07/24/23 after physician was notified of error and the order was given to restart medication immediately. Record review of Resident #1's TAR for July 2023 revealed Revlimid Oral Capsule 25 MG was administered on July 25th through 31st at 6:00 PM. Medication was continued correctly. Record review of Resident #1's TAR for August 2023 revealed Revlimid Oral Capsule 25 MG was administered on August 1st through 8th at 6:00 PM. Medication was administered during this time. Revlimid Oral Capsule 25 MG (Lenalidomide) 1 capsule by mouth at bedtime. This medication is a chemotherapy and is used to treat multiple myeloma not having achieved remission, which is a cancer of plasma cells, a type of white blood cell, that normally produces antibodies per Google. Record review of Resident #1's care plan dated 07/25/2023 revealed resident takes cancer medication Revlimid. Cycles on medication for 21 days and off for 7 days- (Medication supplied by the VA Pharmacy/ resident's FAM brings medication to facility) Goals: Staff to assure medication is administered per orders through review period. Interventions: Monitor for adverse reactions- which include- hypersensitivity, angioedema (an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes), [NAME]-[NAME] syndrome (a rare, serious disorder of the skin and mucous membranes that is often a reaction to medication or an infection), toxic epidermal necrolysis (a life threatening skin disorder characterized by a blistering or peeling of the skin), Tumor Lysis Syndrome (a group of metabolic abnormalities that can occur as a complication from the treatment of cancer), hepatotoxicity (injury or impairment of the liver function caused by exposure to xenobiotics such as drugs, food additives, alcohol, chlorinated solvents, peroxidized fatty acids, fungal toxins, radioactive isotopes, environmental toxicants, and even some medicinal plants), thrombocytopenia (a low number of platelets in the blood), neutropenia, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 11 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 pruritis (itching), rash, fatigue, constipation, nausea. Level of Harm - Immediate jeopardy to resident health or safety Staff to assure that medication is swallowed whole and not chewed. Residents Affected - Some During an interview on 08/09/2023 at 11:16 AM with MA E, she stated medications should be given to residents as ordered by the physician. She stated if a resident was not given medications correctly, it could potentially cause major side effects. She stated a blood pressure medication could cause a blood pressure to rise or fall, aspirin could cause heart problems, and Depakote could cause agitation, and missing a medication could even cause death depending on the medication. She stated she was in-serviced 07/25/23 on medication administration. Staff to wear gloves with administration of this medication. During an interview on 08/09/2023 at 11:44 AM with LVN A, he stated medications should be given to residents as ordered by the physician. He stated if a resident was not given medications correctly, it could potentially cause adverse reactions. He stated he was in-serviced 07/25/23 on medication administration. During an interview on 08/09/2023 at 11:55 AM with LVN B, she stated she was in-serviced 07/25/23 on medication administration. She stated medications should be given to residents as ordered by the physician. She stated if a resident was not given medications correctly, it could potentially cause adverse side effects, delayed action of medication for whatever it was supposed to cure, or if it was for a preventative measure, whatever it was supposed to prevent could occur. She stated Resident # 1's medication came from the VA. She stated the FAM picked the medication up and dropped it off at the facility. She stated the medication did not come from their pharmacy, and they did not order it. She stated Resident #1 took the medication for 21 days and was off of the medication for 7 days and it continuously cycled that way. She stated she was not sure where the disconnect was or if the nurse that the FAM gave it to just forgot or what, but the resident did not get his medication started back up this last time on time. She stated she did not know exactly how many days the medication had been missed. During an interview on 08/09/2023 at 12:13 PM with MA F, she stated she was in-serviced 07/25/23 on medication administration. She stated medications should be given to residents as ordered by the physician. She stated if a resident was not given medications correctly, it could potentially cause a change in resident's body or it could potentially cause harm. During an interview on 08/09/2023 at 1:16 PM with ADM and DON, they stated they had in-serviced staff 07/25/23 on medication administration. They stated medications should be given to residents as ordered by the physician. They stated if a resident was not given medications correctly, it would depend on the medication being given as to what reactions could occur. They stated if it was discovered that a medication was not given properly, the nurse should do an assessment on the resident and follow up with notifying the family and doctor. They stated Resident #1 received the chemotherapy medication from the FAM picking it up from the VA and bringing it to the facility. They stated the FAM called facility on 07/23/23 at 21:56 (9:56 PM) and spoke to a nurse and asked how many pills were left to see if he needed to re-order the medication, and that was how it was discovered Resident #1 was not currently receiving the medication. They stated that was when staff realized there was a full bottle of the medication on the medication cart. They stated Resident #1 took the medication for 21 days and off for 7 days, then it started back up and cycled routinely with that order. They stated when the FAM brought the most recent bottle of medication, resident had still not completed previous (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 12 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some cycle of medication so nurse could not put the new cycle into the administration record. They stated they could not put the medication into the system to stop and restart the way the medication was ordered. They stated if a resident did not receive this type of medication, it could cause their blood count to be off. They stated they had in-serviced their staff on medication administration and receiving and accepting medications. They stated they had put the medication on a management board, and they discussed this medication every morning now to ensure that the dates were aligned, and the medication was available and being administered as ordered. They stated they had their clinical resource person to look into the system to see if there was any way to put it in the system with no resolution, and they had the pharmacy consultant to check for this as well. They stated if a resident did not receive this medication, it could cause his blood count to be off. They stated the VA informed them that they ran all of residents labs to check for any off blood counts and to make sure that everything looked ok or there was no changes from previous status. They stated resident went to the ONC at the VA every week and has done this throughout the time he was not receiving the medication and there were no adverse reactions. 08/09/2023 at 1:44 PM Attempted to reach the FAM, no answer, left message for return call. During an interview on 08/09/2023 at 1:47 PM with the PA, she stated there was always a potential for harm or adverse reaction with any medication that is missed or not taken. She stated any medication being missed could certainly cause side effects. 08/09/2023 at 1:56 PM Call placed to the ONC, doctor was not available to speak to surveyor. During an interview on 08/09/2023 at 1:58 PM with the PHARM, she stated the only potential thing that could have occurred would have been the progression of cancer. During an interview on 08/09/2023 at 2:14 PM with Resident #1, he stated he just got back from the VA, and he goes to the VA every week because he has cancer. He stated he liked it here and the staff all treated him well. He stated he was told about missing his cancer medication and his FAM talked to him about it also. He stated he has not had any problems or issues due to the medication being missed. He stated he did not realize he was missing any medication and he would not have known it if they did not tell him. He stated he feels safe here in the facility and he has no complaints about anything. He stated he uses a cane or walker for mobility, and he always gets to his appointments. During an interview on 08/09/2023 at 3:09 PM with LVN C, she stated they only received the chemotherapy medication orders from the new bottles of medication when Resident #'s family brought it to them. She stated the only order they had for the medication is what the medication bottle says and from the original paperwork when the resident first started the medication. An immediate Jeopardy (IJ) was identified on 08/09/2023 at 3:30 PM, due to the above failures. The Administrator was notified of the IJ and the IJ template was provided. The Administrator verbalized understanding of the IJ and a Plan of Removal was requested. The Survey team monitored the plan of removal as follows: The Plan of Removal was accepted on 08/11/2023 at 1:50 PM and is as follows: DON assessed resident #1 on 8/9/2023 for new or worsening symptoms associated with his multiple myeloma or adverse side effects of the missed medication including increased pain or neurological (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 13 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Level of Harm - Immediate jeopardy to resident health or safety symptoms. The attending physician and ONC were notified of medication error and no new orders were given with the exception of restarting medication immediately. The assessment did not reveal any obvious adverse effects related to the deficient practice. The Corporate Clinical Consultant provided education to the DON on 8/10/2023 regarding the administration of medication in a safe manner according to physician orders and per policy. Residents Affected - Some DON/Designee completed education with all licensed nursing staff on 8/10/2023 regarding the administration of medication in a safe manner according to physician orders and per policy. All licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required staff were educated. New staff, will be in-serviced during orientation period prior to working a shift. The DON/Designee completed an audit of all residents to establish which residents receive medications from outside pharmacies on 8/10/2023. 8 residents were identified through this audit. The DON/designee then conducted an audit of medication storage areas to validate that none of these residents' medications were missing and the administration record was reviewed for each resident to validate that there were no missed doses within the last 90 days on 8/10/2023. Care plans updated with directions of receiving from outside pharmacy, also initiated instructions RECEIVED FROM OUTSIDE PHARMACY No issues were identified related to missed doses or missing medication. DON/Designee completed education with all licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required licensed staff were educated on 8/10/2023 on entering orders correctly in Point Click Care for proper and error-free medication administration, and to include instructions 'RECEIVED FROM OUTSIDE PHARMACY as identification when medication is brought in from outside pharmacy, this education will be ongoing for all newly hired nurses. Sr [NAME] President of Clinical Services revised policy titled Medications Brought to the Facility by Resident/Family to having a signed receipt of accepting of the medication by licensed staff only, on 8/10/23. Director of Clinical Operations educated DON in regard to policy change. DON/Designee completed education with all licensed nursing staff informing this of this policy change. All licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required staff were educated. New nursing staff and agency staff will be educated upon or upon initial shift at facility, ongoing. Education completed on 8/10/23. DON/designee completed a review of all residents to validate the availability of all medications on 8/9/2023. There were no concerns identified related to the availability of medications through this review. Director of Nursing/designee completed review of all residents to identify which medication are provided by outside pharmacy. 8 residents were identified. This review was completed on 8/9/2023. No concerns were identified related to missing medications or missed doses in the last 90 days for any of the 8 residents. The orders for the 8 residents identified were updated to reflect that meds are received from an outside Pharmacy to alert nursing staff that refills should not be requested from the house pharmacy on 8/9/2023. Corporate Clinical Consultant completed a review of the following policies on 8/10/2023: Pharmacy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 14 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Services Overview, Administering Medications, Medications Brought into the Facility by Resident/Family, Accepting Delivery of Medications. Medications Brought into the Facility by Resident/Family policy was revised by Sr [NAME] President of Clinical Services to include signed acceptance receipt of medication, no other policy changes were made. Licensed nurses will communicate via 24 hour report and shift hand off of medications that were ordered and not received during shift. The Corporate Clinical Consultant completed education with the DON on 8/10/2023 on these policies and the procedure for receiving, ordering, and administering medications brought in by family or received from an outside pharmacy. The procedure is to include receipt of medication by a licensed nurse, notification of DON/designee, verification of order from the attending physician, verification of proper order entry in PCC to include notation that medication is received from and outside pharmacy, verification of proper labeling of medication container with medication and resident information, verification of quantity and type medication being delivered from outside pharmacy. The receiving nurse will be responsible for conducting the first check verification as medications are received and orders are entered and the DON/designee, will conduct the second check verification Monday-Friday in the morning clinical meeting to include needed medications for upcoming weekend, and any changes/needs from prior weekend. For after hours or weekends, the receiving nurse will contact on-call nurse manager and physician for any concerns related to supply of medications. The DON/designee completed education with licensed nurses on 8/10/2023 regarding the procedure to ensure that medications are received and administered according to ordered date, time, and frequency for residents whose medications are dispensed from an outside pharmacy. All licensed nurses and medication aides were in-serviced. Facility used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all licensed nursing staff were educated. Medications that are received from outside pharmacies will be entered with an additional note in the instruction section indicating that meds are 'RECEIVED FROM OUTSIDE PHARMACY with any additional information on the pharmacy name and/or who delivers the medication and how to obtain a refill. Communication will be shift to shift via 24 hour report, when medications are ordered or needed for licensed nurses to assure timely delivery. Education will be provided to all newly hired nurses prior to their first shift and all current staff have been educated as of 8/10/2023. DON/designee added orders with skipped days through end of calendar year, also added onto daily monitoring for review of ongoing order, on 8/10/2023. The DON/designee will conduct monitoring of new medication orders and medications stocked in medication carts/rooms/refrigerators to validate that medications received from outside pharmacies have orders entered appropriately in Point Click Care, that they are received and administered according to ordered date, time and frequency and that there is adequate stock remaining or that refill request has been initiated. Any concerns identified will be reported to the physician immediately upon identification with corrections made according to physician orders. Monitoring will occur, starting on 8/10/23, 3 times per week for 4 weeks then weekly for 2 months. Any trends identified will be reported to the QAPI Committee monthly and as needed until a lessor frequency until substantial compliance is achieved. QAPI meeting was held on 8/10/23 with the Medical Director, ADM, DON, and Nurse Management to review newly revised policy on medication brought in by family, and review and validate the plan of removal. The Administrator will be responsible for the implementation of ensuring the adequate process (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 15 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Level of Harm - Immediate jeopardy to resident health or safety regarding Safe Medication Administration. The new processes/system was initiated, and all licensed nursing staff had completed education by 8/10/2023. This new process will be ongoing for new hires and agency staff prior to working a shift at the facility. All licensed nurses and medication aides were in-serviced. DON/designee used a staff roster meeting with all available staff in person and contacting each PRN and Agency staff member via phone to ensure all required staff were educated, completed on 8/10/23. Residents Affected - Some During an interview on 08/09/2023 at 5:30 PM with the ADM, he stated there was only one resident in the facility who receives Chemotherapy. He stated there may have been others before and there were residents with a diagnosis of cancer, but none received chemotherapy now except Resident #1. On 08/09/23 at 5:36 PM Notified ADM of past non-compliance immediate jeopardy and provided ADM with immediate jeopardy template. During an interview on 08/10/2023 12:47 PM with ADM and DON, they stated the facility had a QAPI meeting the morning of 08/10/2023 with the medical director that addressed the medication error in incident but they had not had a meeting regarding medication errors in the past 3 months prior to surveyor entrance. Record review of staff in-service training report dated 07/25/2023 revealed nurses and medication aides were in-serviced on medication administration and medication orders. Record review of facility policy titled Administering Medications dated 2001 (Revised December 2012) revealed in policy statement: Medications should be given in a safe and timely manner, and as prescribed. Record review of facility policy titled Medications brought to the facility by the resident/family dated 2001 (revised April 2007) revealed Policy Statement: The facility shall ordinarily permit residents and families to bring medication into the facility. Policy Interpretation and Implementation: 3. If a medication is not otherwise available and/or it is determined to be essential to the resident's life, health, safety, or well-being to be able to take a medication brought in from outside, the Director of Nursing Services and nursing staff, with support of the Attending Physician, and Consultant Pharmacist, shall check to ensure that: b. The medications have been ordered by the resident's Attending Physician and documented on the physician's order sheet. Record review of facility policy titled Pharmacy Services Overview dated 2001 (revised April 2019) revealed Policy Statement: The facility shall accurately and safely provide or obtain pharmaceutical services, including the provision of routine and emergency medication and biologicals and the services of a licensed pharmacy consultant pharmacist. Policy Interpretation and Implementation: 4. Residents have sufficient supply of their prescribed medication and receive medications (routine, emergency or as needed) in a timely manner. 7. Medications are received, labeled, stored, administered and disposed of according to applicable state and federal laws and consistent with standards of practice. 9. The consultant pharmacist , in collaboration with the dispensing pharmacy and the facility, oversees the development of procedures related to pharmacy services, including, (but not limited to): a. Acquisition and availability of medications: (4) Facility staff roles and responsibilities during the receipt and storage of medications; b. Medication packaging and dispensing systems; c. Administration of medication; d. Disposition of medications; e. Authorization, training, and competency of personnel; and f. Documentation of processes, as applicable. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 16 of 17 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 08/11/23 10:30am DON stated that on 07/25/23, that there was an alert added to the facility's clinical white board for Resident #1's chemotherapy medication to be re-added to the facility electronic recording system. DON stated that the white board was reviewed daily by the facility's clinical team Administrator, ADON's, DON, Therapy, Social Worker). On 08/11/2023 at 1:50 PM at exit, the facility was notified that the IJ was lowered. However, the facility remained out of compliance at a severity level no actual harm with the potential for more than minimal harm that is not immediate jeopardy with a scope of pattern due to the facility requiring time to train all staff and monitor their plan of removal. Event ID: Facility ID: 455486 If continuation sheet Page 17 of 17