Health inspection·October 19, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 10/19/23 at 9:40 AM with the Assistant ADM, she stated dignity should be a high priority with staff. The Assistant ADM stated the curtain should be pulled and the door closed when staff enter a room to provide care. The Assistant ADM stated she did not know why the nurse did not provide dignity during the blood sugar check. The Assistant ADM stated herself and the DON were responsible for ensuring staff provide dignity during care. The Assistant ADM stated the potential negative outcome to the residents was they (the residents) could be affected emotionally due to being exposed physically. Record review of the facility's policy titled, Quality of Life - Dignity, dated February 2020, reflected the following: Policy Statement: Each Resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, feeling of self-worth and self-esteem. Policy Interpretation and Implementation: 1. Residents are treated with dignity and respect at all times . 10. Staff promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) Level I residents with mental illness were provided with an accurate PASRR Level I for 3 of 24 residents (Residents #8, #35, and #59) reviewed for PASRR screening, in that: Residents Affected - Some Residents #8, #35, and #59 did not have an accurate PASRR Level 1 assessments when they had a diagnosis of mental illness. These failures could place residents with an inaccurate PASRR Level 1 Evaluation and no PASRR Level 2 Evaluation at risk for not receiving care and services to meet their needs. The findings included: Resident #8: Record review of Resident #8's electronic face sheet dated 10/18/2023 revealed a [AGE] year-old female most recently admitted to the facility on [DATE]. The face sheet listed under Diagnosis Information a diagnosis of Schizoaffective Disorder/Depressive Type. Record review of Resident #8's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of Schizoaffective Disorder/Depressive Type. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 15 indicating the resident was cognitively intact. Record review of Resident #8's most recent care plan, undated, revealed a focus area and diagnosis of Schizoaffective Disorder/Depressive Type, this problem started 01/07/2022. Resident #8 was prescribed Cymbalta 30mg once a day and Risperdal 4mg once a day to assist with this area of need. Record review of Physician progress notes for Resident #8 dated 10/18/2023 revealed under current medications, Resident #8 was prescribed Cymbalta 30mg once a day and Risperdal 4mg once a day to assist with Schizoaffective Disorder/Depressive Type . Record review of Resident #8's Preadmission Screening and Resident Review Level One (PL1) form dated 03/08/2021 revealed under section C0100 Mental Illness an answer of NO, indicating the resident does not have a mental illness. Resident #35: Record review of Resident #35's electronic face sheet dated 10/18/2023 revealed a [AGE] year-old female most recently admitted to the facility on [DATE]. The face sheet listed under Diagnosis Information a diagnosis of PTSD, Chronic. Record review of Resident #35's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of PTSD. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 14 indicating the resident was moderately cognitively impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #35's most recent care plan, undated, revealed a focus area and diagnosis of PTSD, this problem started 03/24/2021. Resident #35 was prescribed Abilify 10mg twice a day, Paroxetine 20mg once a day, and Topiramate 50mg twice a day to address this diagnosis. Record review of Physician progress notes for Resident #35 dated 09/06/2023 revealed under current medications, Resident #35 was prescribed Abilify 10mg twice a day, Paroxetine 20mg once a day, and Topiramate 50mg twice a day to address her diagnosis of PTSD. Record review of Resident #35's Preadmission Screening and Resident Review Level One (PL1) form undated revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #59 Record review of Resident #59 electronic face dated 10/18/2023 revealed a [AGE] year-old male most recently admitted to the facility on [DATE]. The face sheet listed under Diagnoses Information, Major Depressive Disorder. Record review of Resident #59's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of Major Depressive Disorder. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 0 indicating the resident was severely cognitively impaired. Record review of Resident #59 most recent care plan, undated, revealed a focus area and diagnosis of Major Depressive Disorder, this problem started 01/30/2023. Resident #59 was prescribed Sertraline 100mg once a day to assist with this area of need. Record review of Physician progress notes for Resident #59 dated 10/18/2023 revealed under current medications, Resident #59 was prescribed Sertraline 100mg once a day for Major Depressive Disorder. Record review of Resident #59's Preadmission Screening and Resident Review Level One (PL1) form dated 1/12/2023 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. During an interview conducted on 10/19/23 at 11:00am with the ADM, she verified Residents #8, #35, and #59 had a diagnosis of mental illness. The ADM verified Residents #8, #35, and #59 did not have PASRR 2 Evaluations as all their PASRR 1 Evaluations were negative. The ADM stated the purpose of the PASRR 1 Evaluation was to identify if a Resident required additional services. She said if the PASRR 1 Evaluation was positive then it gets put into an online system and they reach out to the necessary people to ensure a PASRR 2 Evaluation was done. She said the MDS nurse was responsible for entering the PASRR 1 Evaluation into the system. The ADM stated the potential harm if a resident with a diagnosis of a mental illness who had a negative PASRR 1 Evaluation, and no subsequent level two evaluation was the residents could potentially go without services. During an interview with the MDS nurse on 10/19/23 at 11:25am, she stated Residents #8, #35, and #59 did not have PASRR 2 Evaluations as all of the Residents had negative PASRR I Evaluations. The MDS nurse stated Residents #8, #35, and #59 do not have accurate PASRR 1 Evaluations as the residents have a diagnosed mental illness. The MDS nurse stated it was her responsibility to ensure every resident entering the facility had a completed and accurate PASRR 1 Evaluation. The MDS nurse stated she did not know why #8, #35, and #59 did not have positive PASRR 1 Evaluations due to having had a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0645 Level of Harm - Minimal harm or potential for actual harm mental illness diagnosis. The MDS nurse stated the potential negative outcome for residents not having an accurate PASRR 1 Evaluation and subsequent PASRR 2 Evaluations would be the residents may not be offered the services they may need for their diagnosis. Preadmission Screening and Resident Review (PASRR) Policy Residents Affected - Some Revised 7/18/2018: The facility policy for PASARR states all applicants to a Medicaid-certified nursing facility must have a Level I PASRR completed to screen for possible mental illness. Residents with positive PASRR Level I cannot be admitted to a Medicaid-certified nursing facility unless approved through Level II PASRR determination. Those Residents covered by Level II PASRR process may require certain care and services provided by the nursing home, and/or specialized services provided by the State. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to develop a comprehensive care plan to meet the highest practicable physical, mental, psychosocial well-being for 2 of 26 residents (Residents #18 and #39) reviewed for care plans as follows: 1. Resident #18 did not have a care plan for indwelling catheter. 2. Resident #39 did not have a care plan for activities of daily living/rehabilitation potential, urinary incontinence, nutritional status, pressure ulcer risk or pain. These failures could place residents at risk of not receiving the care required to meet their individualized needs. Findings include: Resident #18 Record review of Resident #18's face sheet, dated 10/17/23, revealed an [AGE] year-old-female was admitted to the facility on [DATE] and readmitted [DATE] with diagnoses to include atrial fibrillation (irregular heartbeat, pneumonia (lung infection), diabetes (high blood sugar), pain, muscle weakness and hypertension (high blood pressure). Record review of Resident #18's Comprehensive Minimum Data Set, dated [DATE], revealed Resident #18 had a BIMS score of 11 which indicated Resident #18's cognition was moderately impaired. Resident #18's bladder and bowel assessment revealed Resident #18 had an indwelling catheter. The Care Area Assessment (problem areas) revealed indwelling catheter was a care area that would be addressed in the care plan and was marked on the care area assessment to be care planned. Record review of Resident #18's care plan, dated 09/19/23, revealed no care plan for indwelling catheter. During an interview on 10/18/23 03:20 PM with Resident #18, she stated she had foley catheter when she was admitted to the facility. She stated she was not sure if staff provide catheter care. She stated the staff might clean the catheter when they change her brief and she was not aware they were providing catheter care. Resident #39 Record review of Resident #39's face sheet, dated 10/17/23, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include hypertension (high blood pressure), atrial fibrillation (irregular heartbeat), heart failure, COPD (lung disease), major depression disorder (mental illness), and muscle weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of comprehensive MDS assessment dated [DATE] revealed Resident #39 had a BIMS of 15 which indicated the resident's cognition was not impaired. The functional status section revealed Resident #39 requires limited one person assistance with bed mobility, dressing, and personal hygiene. This section further revealed Resident #39 required extensive assistance with one person assistance for transfers, locomotion on and off unit, toilet use and bathing. Bladder and bowel revealed Resident #39 was always incontinent of urine and bowel. Swallowing and nutritional status revealed Resident #39 had a swallowing disorder (coughing and choking during meals or when swallowing medications). It further revealed resident had a mechanically altered - therapeutic diet. Skin condition section revealed Resident #39 was at risk for pressure ulcers. Section - Health conditions revealed Resident #39 received as needed pain medication and had pain almost constantly. The Care Area Assessment (problem areas) revealed ADL (activity of daily living) functional/rehabilitation potential, urinary incontinence, nutritional status, pressure ulcer and pain were care areas that should be addressed in the care plan and was marked on the care area assessment to be care planned. Record review of a care plan dated 09/20/23 for Resident #39 did not reveal a care plan for ADL functional/rehabilitation potential, urinary incontinence, nutritional status, pressure ulcer or pain. During an interview on 10/18/23 at 02:00 PM Resident #39 stated she eats in the assisted dining room because she was a choking risk. She stated her food was chopped up in small pieces and she needs gravy with every meal. She stated there has been several times she did not receive the gravy with her meal. She stated she would have to request it after receiving her meal. She stated she was incontinent of bowel and bladder and requires assistance from staff. She stated her pain was controlled with pain medications. She stated she was receiving physical therapy. During an interview on 10/18/23 03:07 PM the DON stated Resident #39 triggered care areas was not care planned. She stated all that was care planned was code status, medication allergies, actual fall, and psychotropic medications. During an interview on 10/19/23 at 09:05 AM the DON stated there was no care plan for indwelling catheter for Resident #18. She stated the MDS nurse had been doing care plans, but she had recently took then back and she was responsible care plans. She stated all CAA (care area assessment) areas should be care planned unless it was determined it's not an issue for the resident. She stated all missing CAA for Resident #18 and #39 should have been care planned. She stated that Resident #39 had a basic care plan, but no comprehensive care plan has been completed yet. She stated that she has done an audit of all care plans in the facility and has not had time to complete the missing care plans. She stated that the care plan was information used to take care of residents. She stated everyone uses the care plans. She stated the potential negative outcome was not knowing how to care for resident. She stated you could transfer someone wrong or not provide the right ADL's if the information was not there. She stated everything should be care plan related to resident care, behaviors, and special conditions. She stated her expectations were for all CAAs to be care planned along with ADL information. She stated that she has been trained on care plans. During an interview on 10/19/23 09:15 AM the ADM stated the DON was responsible for care plans. She stated that all CAA areas should be care planned. She stated the potential negative outcome could be residence not receiving care they needed and could cause harm by not receiving the proper care. She stated the care plan was used for individualized care for each resident so everyone's on the same page and knows how to care for that resident. She stated her expectations were for the care plans to be accurate and applicable for that resident so we can provide the highest quality of care possible. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the provided facility's policy titled Care Plans, Comprehensive Person-Centered, revised [DATE], revealed: Policy Statement - a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the residents physical psychosocial and functional needs is developed and implemented for each resident . Policy Interpretation and Implementation . 2. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment . 8. The comprehensive, person-centered care plan will: . b. Describe the services that are to be furnished to attain or maintain the resident's highest practical physical mental and psychosocial well-being. c. Describe services that would otherwise be provided for the above, but are not provided due to the resident exercising his or her rights including the right to refuse treatment . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0805 Level of Harm - Minimal harm or potential for actual harm Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview and record review, the facility failed to provide food that was palatable, and at a safe and appetizing temperature for 2 of 2 meal reviewed for palatability. Residents Affected - Few 1) The facility failed to provide food that was palatable for 1 of 3 food forms served (Regular, Mechanical soft and pureed) at 2 of 2 meal observed (10/17/23 and 10/18/23 lunch). These failures could place residents at risk of decreased food intake, hunger, and unwanted weight loss. The findings included: During an observation on 10/17/23 at 11:00 AM [NAME] A prepared puree fried chicken, corn, and green beans. Surveyor tasted fried chicken had a powder texture on tongue with large chunks that had to be chewed. The corn had large pieces of corn skin and greens with strings. During an observation on 10/18/23 at 12:45 AM surveyor tested a puree test tray with the following items: pork riblets, okra, roll and watermelon. It was found pork riblets not smooth had large chunks that had to be chewed. Okra had large okra seeds that had to be chewed and watermelon with large chunks and thickener flavor. During an interview on 10/19/23 at 08:30 AM [NAME] A stated puree should not have chunks in it. She stated it should be smooth as baby food. She stated they did not have any cream style corn was the reason she used whole kernel corn. She stated the potential negative outcome could be chocking because resident cannot swallow. She stated she has been trained on how to prepare puree foods. During an interview on 10/19/23 at 11:30 AM DM stated puree food should be smooth with no lumpy texture. She stated all staff have been trained on how to prepare puree foods. She stated they currently only have 2 residents who requires a puree diet, but one was in the hospital. She stated the potential negative outcome could be a choking hazard and hard for resident to swallow. During an interview on 10/19/23 09:15 AM the ADM she stated puree food should be smooth. She stated all staff have safe server certificates. She stated her expectations are for puree to be smooth. She stated the potential negative outcome was chocking or difficulty swallowing food. Record review of the facility policy titled Diets and Texture: Pureed Texture, dated 2019, revealed the following documentation, Description The Pureed texture is a mechanical modification of the Regular Diet or any therapeutic diet, designed for people with moderate to severe swallowing difficulty and a poor ability to protect their air way. This texture allows pureed food (pudding like consistency) that is smooth and easily stays together. Food should be avoided if they require chewing. Coarse and dry textures, raw fruits and vegetables, breads and nuts should also be avoided . It is critical that standardized recipes be followed when preparing pureed foods to ensure nutritional quality is maintained . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0805 Vegetables should be soft, well cooked and pureed without lumps, husk, or seeds . All fruit that can pureed to a smooth consistency without pulp, seeds, skin, or chunks . 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: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for dietary services, in that: 1)The facility failed to ensure foods were processed and pureed under sanitary conditions. 2) The facility failed to ensure foods were stored in a manner to prevent contamination. 3) The facility failed to ensure foods were served at temperature above 135 degrees Fahrenheit. These failures could place residents at risk for food contamination and foodborne illness. The findings included: The following observations were made during a kitchen tour on 10/17/23 that began at 9:00 AM and concluded at 10:10 AM: Dessert plates and dessert bowls stored right side up in tub on shelf. Raw chicken stored in tub on shelf in fridge above sack of raw onions. Bowl of fruit with marshmallow covered with plastic wrap stored above box of raw bacon dripping clear liquid onto open box. Cups of milk and juice stored on tray in fridge not covered and no date. The following observations were made on 10/17/23 at 11:00 AM during observation of puree meal preparation: After pureeing fried chicken, [NAME] A took processor bowl, lid, and blade to 3 compartments sink and cleaned all 3 parts. [NAME] A took all there parts back to processor base and assembled. Bowl had water in bottom and lid was dripping water. [NAME] A prepared puree corn then took processor bowl, lid and blade to dishwasher and ran through dishwasher. She then took bowl, lid and blade to processor base and assembled. The bowl, lid and blade had water on all of them. The following observation was made on 10/17/23 at 11:50 AM while observing [NAME] A take temperatures of puree foods. Puree chicken temp was 124 degrees Fahrenheit. [NAME] A placed puree fried chicken back in steam oven and closed the door. [NAME] A prepared resident tray by taking all 3 bowls out of steam oven and placed on plate. [NAME] A did not re-temp puree fried chicken. Record review temperature log dated October 17, 2023, revealed menu item: puree meat, acceptable temperature (degree F) 140-155-degree F, Tuesday 124-degree F. During an interview on 10/17/23 at 01:46 PM [NAME] A stated the temp for puree chicken was 124 degrees Fahrenheit. [NAME] A stated she forgot to recheck the temp of the puree chicken before serving it and stated she did not turn the steam oven back on because she did not want the puree to get to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many hot. She stated the steam oven will keep the puree food at the correct temperature. She stated she did not know what the temperature was when she served the puree chicken. She stated she cleaned the processor bowl, lid and blade in the 3 compartment sink the first time and the dishwasher the second time. She stated she did not allow the processor bowl, lid, or blade to air dry. She stated she was in a hurry and forgot to allow it to air dry. She stated they only have one processor bowl, lid, and blade. She stated she had been trained and the proper way was to allow it to air dry. She stated the potential negative outcome could be water or chemical on the bowl, lid, or blade. She stated raw chicken should have been stored on the bottom shelf. She stated she stored the chicken above the raw onions. She stated she did not realize the onions were on the bottom shelf. She stated the potential negative outcome could be cross contamination. She stated all food and drinks should be covered and dated. She stated staff who put the food/drinks in the refrigerator were responsible to making sure it was covered and dated. She stated the potential negative outcome of not dating the items or covering them was cross contamination and serving out of date food. During an interview on 10/19/23 08:47 AM DM she stated that chicken should be stored on the bottom shelf of the refrigerator. She stated that bowls and plates should be stored upside down never right side up. She stated that chicken should be served at 165°F. She stated all food items including drinks should be covered and dated. She stated the potential negative outcome could be contaminated food. She stated all staff have been trained and have safe serve certificates. She stated that all staff were responsible for making sure items were dated and covered when they put the items in the refrigerator. She stated that the food processor should be air dried before using again. She stated the potential negative outcome could be standing water with chemicals. During an interview on 10/19/23 09:15 AM the ADM stated that raw chicken should not be stored above raw onions. She stated that all dishes should be stored upside down. She stated all food items in the refrigerator should be covered and dated. She stated all staff were responsible to cover and dated food items placed in the refrigerator but that the DM was responsible for overseeing the dietary staff. She stated the potential negative outcome could be residents end up sick or the food becomes contaminated. She said all staff have their safe serve certificates. Record review of the facility policy, titled Cleaning Food Mixers, revised April 2004, revealed the following: Immediately after use: . 5. Air dry. Record review of the facility policy, titled Food Preparation and Service, dated October 2022, revealed the following: Policy Statement: Food and nutrition services employees prepare and serve food in a manner that complies with safe food handling practices. Policy Interpretation and Implementation Food Preparation Area . 4. Appropriate measures are used to prevent cross contamination. These include: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 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 0812 a. Storing raw meat separately and in drip-proof containers, and in a manner that prevents cross-contamination from other foods in the refrigerator; . Level of Harm - Minimal harm or potential for actual harm Thawing Frozen Food Residents Affected - Many 1. Foods will not be thawed at room temperature. Thawing procedures include: a. Thawing in the refrigerator in a drip-proof container; . Food Preparation, Cooking and Holding Time/Temperatures 1. The danger zone for food temperatures is between 41 °F and 135°F. This temperature range promotes the rapid growth of pathogenic microorganisms that cause food borne illness. 2. Potentially hazardous foods include meats, poultry, seafood, cut melon, eggs, milk, yogurt and cottage cheese. 3. The longer foods remain in the danger zone the greater the risk for growth of harmful pathogens. therefore, PHF must be maintained below 41°F or above 135°F . 11. Mechanically altered hot foods prepared for a modified consistency diet remain above 135°F during preparation or they are reheated to 165°F for at least 15 seconds . Record review of the facility policy, titled Dietary/Food Handling, dated April 2001, revealed the following: Purpose: the purpose of this procedure is to provide guidelines for the safe preparation handling and storage of perishable food and proper environmental cleaning . 2. Temperatures must be maintained at the following (Fahrenheit) settings for the items indicated below: . e. Stuffing, poultry, stuffed meats, wild game - 165 degrees Fahrenheit or above; . 25. d. Open containers must be dated and sealed or covered during storage . Record review of the facility policy, titled Food Receiving and Storage, dated October 2022, revealed the following: Policy Statement: Foods shall be received and stored in a manner that complies with safe food handling practices . 8. All foods stored in the refrigerator or freezer will be covered, labeled, and dated (use by date) . 13. Uncooked and raw animal products and fish will be stored separately in drip-proof containers and below fruits, vegetables, and other ready-to-eat foods . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. 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 maintain an infection control program designed to provide a safe, comfortable and sanitary environment to help prevent the development and transmission of diseases for 4 of 4 (Residents #19, #26, #59, and #171) and 5 of 7 (LVN A, CNA A, CNA C, CNA E, and CNA F) staff reviewed for infection control. Residents Affected - Some 1. LVN A failed to wear gloves while checking the blood sugar for Resident #26 or perform hand hygiene after the procedure. 2. CNA A failed to perform hand hygiene between glove changes when providing incontinent care for Resident #19. 3. CNA C failed to perform hand hygiene between glove changes when providing incontinent care for Resident #171. 4. CNA E and CNA F failed to perform hand hygiene between glove changes when providing incontinent care for Resident #59. These failures could place residents at risk for spread of infection and cross contamination. Findings include: Resident #26 A record review of Resident #26's face sheet, dated 10/18/23, revealed a [AGE] year-old female was admitted to the facility on [DATE] with diagnoses to include generalized osteoarthritis (bone disease), depression (mental illness), and type 2 diabetes mellitus (high blood sugar). Record review of Resident #26's comprehensive Minimum Data Set (MDS) assessment, dated 08/21/23, revealed Resident #26 had a BIMS of 03 which indicated the resident's cognition was severely impaired. During an observation on 10/17/23 at 11:52 AM, LVN A checked the blood sugar for Resident #26 and did not wear gloves. LVN A did not perform hand hygiene after checking Resident #26's blood sugar and before going back into the medication cart. During an interview on 10/17/23 at 2:20 PM with LVN A, she stated had been trained to wear gloves when doing blood sugar checks and to wash hands after providing care to the resident. LVN A stated she forgot to wear gloves and wash her hands after providing care because she was nervous. LVN A stated the potential negative outcome to the resident was possible infection. Resident #19 Record review of face sheet for Resident #19, dated 10/18/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: covid-19 (respiratory infection), unspecified dementia (cognitive loss), and type 2 diabetes (high blood sugar). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #19's comprehensive MDS, dated [DATE] revealed Resident #19 had a mental assessment by staff which indicated the resident's cognition was moderately impaired. The MDS revealed Resident #19 required total dependence with one person assist for toilet use and total dependence with one person assist for personal hygiene. The MDS further revealed Resident #19 was always incontinent of bladder and bowel. Residents Affected - Some During an observation on 10/18/23 at 6:25 AM, CNA A was providing incontinent care for Resident #19 with the help of CNA B. CNA A washed her hands with soap and water and donned clean gloves. CNA A wiped Resident #19's groin area, removed her gloves and donned a pair of clean gloves. Resident #19 was turned and CNA A wiped her buttocks, removed her gloves and donned a pair of clean gloves. CNA A applied barrier cream to Resident #19's buttocks, removed her gloves and donned a pair of clean gloves. CNA A then placed a clean brief on Resident #19. CNA A did not perform hand hygiene between any of the glove changes. During an interview on 10/18/23 at 7:08 AM with CNA A, she stated she has been trained to perform hand hygiene between glove changes. CNA A stated they do skills check off's but cannot remember the last time it was done. CNA A stated she should have done performed hand hygiene between glove changes but forgot to take ABHR in the room with her. CNA A stated the potential negative outcome to the residents was a risk of infection. Resident #171 Record review of face sheet for Resident #171, dated 10/18/23, revealed a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: chronic obstructive pulmonary disease (lung disease), dementia (cognitive loss), muscle weakness, and essential hypertension (high blood pressure). Record review of Resident #171's comprehensive MDS, dated [DATE] revealed Resident #171 had a BIMS of 01 which indicated the resident's cognition was severely impaired. Resident #171 required extensive assistance with one person assist with toilet use and personal hygiene. Resident #171 was always incontinent of bladder and bowel. During an observation on 10/18/23 at 6:40 AM, CNA C was providing incontinent care for Resident #171 with the help of CNA D. CNA C washed her hands with soap and water and donned clean gloves. CNA C wiped Resident #171's groin area, removed her gloves and donned a pair of clean gloves. Resident #171 was turned on her side and CNA C wiped her buttocks, removed her gloves and donned a pair of clean gloves. CNA C then placed a clean brief on Resident #171. CNA C did not perform hand hygiene between any of the glove changes. During an interview on 10/18/23 at 8:20 AM with CNA C, she stated she has been trained to perform hand hygiene between glove changes. CNA C stated she does not remember the last time she was trained. CNA C stated she just forgot to perform hand hygiene between the glove changes. CNA C stated the potential negative outcome to the residents is contamination between clean and dirty and bad germs. Resident #59 Record review of face sheet for Resident #59, dated 10/18/23, revealed a [AGE] year-old male admitted to the facility on [DATE] with the following diagnoses: acute embolism and thrombosis of deep veins of right lower extremity (blood clot in leg), gastro-esophageal reflux disease (acid reflux), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 urinary tract infection, and hyperlipidemia (high cholesterol). Level of Harm - Minimal harm or potential for actual harm Record review of Resident #59's MDS, dated [DATE] revealed Resident #59 had a mental status assessment performed by staff and which indicated the resident had modified independence with cognitive skills for daily decision making. Resident #59 required total dependence with two-person assist for toilet use and extensive assist with two-person assist for personal hygiene. Resident #59 had a catheter and was always incontinent of bowel. Residents Affected - Some During an observation on 10/18/23 at 6:46 AM, CNA E and CNA F provided catheter care and incontinent care for Resident #59. CNA E and CNA F washed their hands with soap and water and donned clean gloves. CNA E wiped Resident #59's groin area and provided catheter care to his indwelling catheter. CNA E removed her gloves and donned a pair of clean gloves. Resident #59 was turned, and CNA E wiped a bowel movement from his buttocks, removed gloves, and donned a pair of clean gloves. Resident #59 was turned to the other side and CNA F then wiped the excess bowel movement from his buttocks. CNA F removed gloves and donned a pair of clean gloves. A clean brief was then placed under Resident #59. CNA E and CNA F did not perform hand hygiene between any of the glove changes. During an interview on 10/18/23 at 7:02 AM, CNA E and CNA F stated they have been trained to perform hand hygiene between glove changes. CNA E and CNA F stated they didn't think about hand hygiene between glove changes because they were nervous. CNA E and CNA F stated the potential negative outcome to the resident is it could cause infection. During an interview on 10/18/23 at 3:05 PM, the ADON stated herself and the DON were both responsible for monitoring staff for infection control concerns. The ADON stated she expects the nurses to wear gloves and perform hand hygiene when doing blood sugar checks on residents. The ADON stated she was really big on handwashing and expected the CNAs to perform hand hygiene between glove changes. The ADON stated LVN A and the CNAs were probably nervous and that is why they messed up. The ADON stated the nurses and CNA's do handwashing competencies yearly but was unsure the last time it was done and stated she would have to pull those records. The ADON stated the risk to the residents with not wearing gloves during blood sugar checks and not performing hand hygiene after providing resident care or between glove changes was the staff could be spreading infection and bacteria everywhere. During an interview on 10/19/23 at 8:47 AM, the DON stated she expects the nurses to wear gloves anytime they are dealing with resident's blood or bodily fluids. The DON stated she expects staff to perform hand hygiene after resident procedures and between glove changes, no exception. The DON stated she did not know why the nurse did not perform hand hygiene after the blood sugar check or wear gloves to check the resident's blood sugar as blood was involved. The DON stated she thought the CNAs were nervous and that is why they failed to perform hand hygiene between glove changes, but that was still no excuse. The DON stated the ADON and she are responsible for monitoring staff for infection control. The DON stated the staff has completed competencies and she would have to pull them to be reviewed. The DON stated the potential negative outcome to the residents is possible infection or urinary tract infections. During an interview on 10/19/23 at 9:40 AM, The Assistant ADM stated she expected staff to wash hands before and after providing patient care. The Assistant ADM stated she expected staff to wear gloves when dealing with blood or body fluids. The Assistant ADM stated she did not know why LVN A did not wear gloves or perform hand hygiene after the blood sugar check. The Assistant ADM stated she expected the CNAs to wash their hands or use hand sanitizer between glove changes. The Assistant ADM stated she did not know why the CNAs did not perform hand hygiene between glove changes and stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some they were probably nervous. The Assistant ADM stated the DON and the ADON were responsible for monitoring staff for infection control. She stated the risk to the residents with the lack of gloves and lack of hand hygiene was they could spread infection. Record review of competency assessment: Obtaining a fingerstick glucose level for LVN A revealed satisfactory completion was demonstrated on 09/27/22 and included wearing gloves and performing hand hygiene after care. Record review of initial/annual nurse aide competency review for LVN A, dated 06/24/23, revealed satisfactory completion of handwashing, perineal care, and when handwashing should be performed checklist. Record review of initial/annual nurse aide competency review for LVN C, dated 07/15/23, revealed satisfactory completion of handwashing, perineal care, and when handwashing should be performed checklist. Record review of initial/annual nurse aide competency review for LVN E, dated 07/15/23, revealed satisfactory completion of handwashing, perineal care, and when handwashing should be performed checklist. Record review of initial/annual nurse aide competency review for LVN F, dated 06/24/23, revealed satisfactory completion of handwashing, perineal care, and when handwashing should be performed checklist. Record review of the facility's policy titled, Infection Prevention and Control Program, with a revised date of 12/21, reflected the following: Policy Statement: An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections Record review of the facility's policy titled, Obtaining a Fingerstick Glucose Level, with a revised date of 12/11, reflected the following: Purpose: The purpose of this procedure is to obtain a blood sample to determine the resident's blood glucose level . Steps in Procedure 5. Wear clean gloves . 19. Remove gloves and discard into designated container 20. Wash hands Record review of the facility's policy titled, Personal Protective Equipment - Using Gloves, with a revised date of 06/05, reflected the following: Purpose: To guide the use of gloves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Objectives: Level of Harm - Minimal harm or potential for actual harm 1. To prevent the spread of infection; 3. To protect hands from potentially infectious material; and Residents Affected - Some 4. To prevent exposure to the HIV (AIDS) and hepatitis B (HBV) viruses from blood or body fluids. Miscellaneous: 4. Use non-sterile gloves primarily to prevent the contamination of the employee's hands when providing treatment or services to the patient and when cleaning contaminated surfaces. 5. Wash hands after removing gloves. (Note: Gloves do not replace handwashing.) When to use gloves: 1. When touching excretions, secretions, blood, body fluids, mucous membranes or non-intact skin Record review of the facility's policy titled, Handwashing-Hand Hygiene Policy and Procedures, with a revised date of 10/20, reflected the following: Policy Statement: This facility considers hand hygiene the primary means to prevent the spread of infections. Policy Interpretation and Implementation: 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 3. Hand hygiene products and supplies (sinks, soap, towels, alcohol-based hand rub, etc.) shall be readily accessible and convenient for staff use to encourage compliance with hand hygiene policies . 6. Wash hands with soap (antimicrobial or non-antimicrobial) and water for the following situations: a. when hands are visibly soiled; and b. after contact with a resident with infectious diarrhea including, but not limited to infections caused by norovirus, salmonella, shigella and C. difficile. 7. Use an alcohol-based hand rub containing at least 62% alcohol; or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: b. before and after direct contact with residents; j. after contact with blood or bodily fluids; m. after removing gloves; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 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 455509 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sterling Hills Rehabilitation and Healthcare Cente 705 NE Georgia Avenue Sweetwater, TX 79556 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 8. Hand hygiene is the final step after removing and disposing of personal protective equipment. Level of Harm - Minimal harm or potential for actual harm 9. The use of gloves does not replace hand washing/hand hygiene. Integration of gloves use along with routine. Residents Affected - Some 10. hand hygiene is recognized as the best practice for preventing healthcare-associated infections. 11. single-use disposable gloves should be used: b. when anticipating contact with blood or body fluids . Applying and Removing Gloves: 1. Perform hand hygiene before and after applying non-sterile gloves FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455509 If continuation sheet Page 19 of 19