Health inspection·May 2, 2025

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #43 required total assistance with putting on/taking off footwear, maximal assistance was required for lower and upper body dressing, showering/bathing, and toileting hygiene. Moderate assistance was required for Resident #43 with oral and personal hygiene, and setup assistance was required for eating. During an observation on 04/30/25 at 11:38 AM Resident #43 had a NC on and oxygen concentrator was delivering oxygen on 4L/min. to Resident #43. During an observation on 05/01/25 at 01:32 PM revealed Resident #43's oxygen concentrator set at 4L/min and Resident #43 had a NC on and receiving oxygen at the time of the observation. During an observation and interview on 05/02/25 at 09:56 AM revealed Resident #43's oxygen concentrator set at 4L/min and running, but Resident #43 couldn't find her NC to put it on. Resident #43 stated she wore her oxygen all of the time, and the machine was so loud. During a record review of Resident #43's oxygen saturation log, saturation level's had not been checked since 02/11/2025. During an interview on 05/01/25 at 10:50 AM MDS nurse stated she did not put the resident would need oxygen therapy due to the resident does not need oxygen from the documentation that she needed to perform the assessment. During an interview on 05/02/25 at 01:28 PM MDS nurse stated she did not assess the resident directly she looked at the documentation she received from the floor nurses. MDS nurse stated the accuracy of her assessment was only done by reviewing the documentation she was provided. MDS nurse stated the floor nurses were supposed document accurately, and the MDS nurse stated she was unaware if the documentation was accurate or not. MDS nurse stated the DON and the Regional MDS Coordinator were responsible for checking her work. MDS Nurse stated to check the accuracy of the information she was provided she just checked orders. MDS nurse stated the negative outcome for not having an accurate assessment would be We won't get reimbursement. During an interview on 05/02/2025 at 1:32 PM DON stated the negative outcome for not performing an accurate assessment would be you don't really know what the care the resident will need, and I do sign off on them, but I should be looking at them more closely because I don't really read them. the Regional MDS should be looking at them too. Record review of the facility provided policy titled, Electronic Transmission of the MDS, revised November 2019, revealed the following: 1. All staff members responsible for completion of the MDS receive training on the assessment, data entry, and transmission processes, in accordance with the MDS RAI Instruction Manual, before being permitted to use the MDS information system. A copy of the MDS Rai Instruction Manual is maintained by resident assessment coordinator. Record review of the Long Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.18.11, dated October 2023 revealed the following: Section O - Special Treatments, Procedures, and Programs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 2 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 0641 Respiratory Treatments: Level of Harm - Minimal harm or potential for actual harm C1. Oxygen Therapy a. Residents Affected - Few On Admission b. While a Resident c. At Discharge Coding Instructions for Column b. While a Resident Check all treatments, procedures, and programs that the resident received or performed after admission/entry or reentry to the facility and within the last 14 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 3 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 observations, interviews, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment and described the services that were to be furnished to attain or maintain the resident's highest t practicable physical, mental, and psychosocial well-being for 1 (Resident #37) of 16 residents reviewed for care plans. The facility failed to develop a comprehensive person-centered care plan that accurately addressed Resident #37's oxygen therapy. This failure could place residents at risk of not receiving desired and necessary care and treatment. Findings included: Record review of Resident #37's admission record dated 05/02/2025 revealed an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included unspecified diastolic congestive heart failure, acute respiratory failure with hypoxia, and hypokalemia (low potassium). Record review of Resident #37's quarterly MDS completed on 04/03/2025 revealed a BIMS score of 12 out of 15 indicating moderate cognition impairment. Section J Shortness of Breath (dyspnea) revealed no shortness of breath during exertion, sitting at rest, or lying flat. Record review of Resident #37's care plan latest revision on 04/22/2025 had a focus for Resident #37's congestive heart failure with interventions for oxygen settings: oxygen via NC/ 2-3 L continuous. Record review of Resident #37's active physician orders dated 02/22/2024 revealed the following: May use oxygen at 2 L per NC to maintain sats at or above 90 and/or SOB as needed. During an observation on 04/30/2025 at 10:08 AM, Resident #37 was in his room sitting in his recliner, the oxygen tank was located near his bed. Resident #37 was not utilizing oxygen therapy. During an observation on 04/30/2025 at 12:00 PM Resident #37 was in the dining room for lunch, he was sitting at a table alone, he was not utilizing oxygen therapy. During an observation on 05/02/2025 at 8:02 AM, Resident #37 was in the dining room for breakfast, he was sitting at a table alone, he was not utilizing oxygen therapy. During an observation and interview on 05/02/2025 at 10:23 AM, Resident #37 was in his room sitting in his recliner, he was utilizing oxygen therapy at 2LPM Resident #37 stated he did not utilize oxygen all the time, he mostly used it in his room., He stated he never used it out in the dining room. Resident #37 stated he was unsure what his orders were related to his oxygen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 4 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 During an interview on 05/02/2025 at 10:38 AM, the DON stated she was responsible for ensuring care plans were done correctly and updating them as needed. The DON stated oxygen therapy should be in the care plan and it's interventions . During an interview on 05/02/2025 at 10:50 AM, the BD stated every morning during staff meetings, the staff discuss resident care and care plans. The BD stated the DON was responsible for ensuring care plans were accurate and reflected doctor orders. The BD stated if the care plan did not reflect the doctor's orders, then the resident would not get the care he or she needed. During an interview on 05/02/2025at 11:00 AM, LVN K stated the DON was responsible to ensure the care plans were accurate and that the care plan should match what the doctor ordered. LVN K stated if a doctor ordered prn oxygen, then it should reflect prn in the care plan. The negative outcome for not having an accurate care plan would be a resident would not get the services they needed. During an interview on 05/02/2025 at 11:11 AM, the MDS Coordinator stated Resident #37 did not utilize oxygen continuously and said if the care plan stated his oxygen therapy was continuous then the care plan was inaccurate. The MDS Coordinator stated she and the DON were responsible for updating residents care plans and the care plan should reflect what the physician ordered. The MDS Coordinator stated there would be no negative outcome for having an inaccurate care plan. Record review of the facility policy titled 'Care Plan, Comprehensive Person-Centered ' no date: The comprehensive, person-centered care plan: Describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial wellbeing. Reflects currently recognized standards of practice for problem areas and conditions. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes and relevant clinical decision making. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 5 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that residents who need respiratory care were provided such care consistent with professional standards of practice for 1 (Resident #43) of 12 residents reviewed for respiratory care. Residents Affected - Few The facility failed to administer oxygen at the correct dose for Resident #43. This failure could affect all residents on oxygen therapy by placing them at risk for respiratory compromise and associated complications such as shortness of breath, confusion, respiratory failure, and exacerbation of their condition. Findings included: Record review of Resident #43's face sheet, dated 05/02/2025, revealed Resident #43 was a [AGE] year-old female resident admitted to the facility on [DATE] with diagnoses to include type 2 diabetes mellitus without complications (a condition where blood sugar levels are persistently high due to either the body's inability to use insulin effectively (insulin resistance) or the pancreas doesn't produce enough insulin, or both), pulmonary hypertension (a condition characterized by high blood pressure in the arteries of the lungs), dorsopathy (any disease or condition of the spine and related structures, often causing back pain), and essential hypertension (a condition in which the force of blood against the walls of the arteries is consistently elevated above normal levels). Photo of Resident #43 on face sheet revealed the resident with NC on in the photo. Record review of Resident #43's last quarterly MDS, dated [DATE], revealed that Resident #43 was not receiving oxygen therapy. The ARD date for MDS was 02/17/2025. The MDS did reveal that Resident #43 had a BIMS score of 09, which indicated Resident #43 did have moderate cognitive impairment. Resident #43 required total assistance with putting on/taking off footwear, maximal assistance was required for lower and upper body dressing, showering/bathing, and toileting hygiene. Moderate assistance was required for Resident #43 with oral and personal hygiene, and setup assistance was required for eating. Record review of Resident #43's active medication orders, dated 05/02/202, revealed Resident #43 had an oxygen order that stated: May use oxygen @ 2 L per NC to maintain sats @ =/> 90% and/or SOB. every shift for SOB Verbal Active 09/17/2024 09/17/2024 Record review of Resident #43's care plan, dated 03/26/2025, revealed the following: Focus o [Resident #43 name] has a terminal prognosis r/t respiratory failure -[Hospice name] hospice -continuous O2 via NC (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 6 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 0695 Date Initiated: 10/09/2024 Level of Harm - Minimal harm or potential for actual harm Revision on: 04/10/2025 Goals Residents Affected - Few o [Resident #43 name]'s comfort will be maintained through the review date. Date Initiated: 10/09/2024 Revision on: 03/26/2025 Target Date: 03/30/2025 o [Resident #43 name]'s dignity and autonomy will be maintained at highest level through the review date. Date Initiated: 10/09/2024 Revision on: 03/26/2025 Target Date: 03/30/2025 During an observation on 04/30/25 at 11:38 AM Resident #43 had a NC on and oxygen concentrator was delivering oxygen on 4L/min. to Resident #43. During an observation on 05/01/25 at 01:32 PM revealed Resident #43's oxygen concentrator set at 4L/min and Resident #43 had NC on and receiving oxygen at time of observation. During an observation and interview on 05/02/25 at 09:56 AM revealed Resident #43's oxygen concentrator set at 4L/min and running, but Resident #43 couldn't find her NC to put it on. Resident #43 stated she wore her oxygen all of the time, and that the machine was so loud. During a record review of Resident #43's oxygen saturation log, saturation level's had not been checked since 02/11/2025. During an interview on 05/02/25 at 10:04 AM LVN K stated a negative outcome for not following physician orders, the resident wouldn't get the medication that they need. During an interview on 05/02/25 at 01:32 PM DON stated a negative outcome for not following (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 7 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 0695 Level of Harm - Minimal harm or potential for actual harm physician orders would be that the resident would not get the correct dose of medication and it could have a negative outcome for the resident. Record review of the facility provided policy titled, Oxygen Administration, revised October 2010, revealed the following: Residents Affected - Few Purpose The purpose of this procedure is to provide guidelines for safe oxygen administration. Preparation 1. Verify that there is a physician's order for this procedure. Review the physician's orders for facility protocol for oxygen administration. Record review of facility provided policy titled, Administrating Medications, revised April 2019, revealed the following: .4. Medications are administered in accordance with prescriber orders, including any required time frame. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 8 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observations, interviews, and record review, the facility failed to ensure drugs and biologicals were stored in locked compartments and labeled in accordance with currently accepted professional principles and include the appropriate accessory and cautionary instructions, and the expiration date when applicable on 3 of 3 medication carts (NE Hall, NW Hall, and South side Hall) and 1 of 12 residents (Resident #15) reviewed for medication storage. -Medication cart for NW Hall revealed Fluticasone Propionate nasal spray 50mcg with no open date on the bottle or resident identifying information. -Breo Ellipta had a date of 06/11/2025, with no resident identifying information. -Medication cart for NE Hall had a pill in a medication cup in the top draw of the medication cart. -Medication cart for NE hall had 1 unidentified pill loose in the bottom of the medication cart drawers. -Medication cart for NE hall had 1 loose Protonix pill in the bottom of the medication cart drawers. -Medication cart for NE hall had Fluticasone Propionate nasal spray 50mcg, for Resident # 15, bottle did not have an open date on it. -Medication cart for South side had Fluticasone Nasal spray 50mcg with no name and no open date on the bottle. -Medication cart for South side had 2 loose pills in the bottom of the medication cart drawers. The facility's failures could place residents receiving medication at risk for drug diversion, lack of drug efficacy, and adverse reactions. Findings included: During an observation and interview on 04/30/25 at 10:15 AM the medication cart for NW hall revealed Fluticasone propionate 50mcg nasal spray for Resident #8 had a date on the box of 04/23. LVN A was unsure if that was the open date or date of expiration. Fluticasone Propionate nasal spray 50mcg had no open date on the bottle or any resident information. Breo Ellipta had a date of 06/11/2025, no resident information on the medication. LVN A was unsure if this was an open date or an expiration date. LVN A stated a negative outcome for having expired medications was that the meds would be effective due to not knowing if the medication was still good or not. During an observation and interview on 04/30/25 at 10:37 AM the medication cart for NE Hall revealed a loose pill in a medication cup in the top drawer of the medication cart. LVN B stated it was a probiotic for Resident # 1. LVN B stated she pulled the probiotic out early and the medication was to be given to Resident #1 at 8am, but the resident refused it. 2 unidentified pills were found loose (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 9 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm in in the bottom of the medication cart drawers. One pill was an Oval yellowish/cream in color pill that was identified as a Protonix. Fluticasone Propionate nasal spray 50mcg, for Resident # 15 nasal spray bottle did not have an open date on it. LVN B stated a negative outcome for having medications without expiration dates could lead to a medication not being effective. LVN B stated the negative outcome for having loose pills was staff would not know what they (the pills) would be. Residents Affected - Some During an observation on 04/30/25 at 01:50 PM the medication cart for the South side revealed Fluticasone Nasal spray 50mcg with no name and no open date on the bottle of nasal spray. 2 loose pills were found in the bottom of the medication cart drawers 1 was identified as Lisinopril and the 2nd pill was identified as omeprazole by LVN E. During an interview on 04/30/25 at 02:01 PM LVN E stated the negative outcome for having loose pills in the medication cart was it could lead to the resident being short on medication at the end of the month. LVN E stated the negative outcome for not having the open date on medications that required them, would be the medication could be expired and not as effective for the resident. During an interview on 05/02/2025 at 01:32 PM DON stated the negative outcome for having loose pills in the medication carts would be that the staff don't know what the medications are. DON stated having expired medications in the cart would be the medication was not as effective as it should be. DON stated the negative outcome for not writing the open date on a medication that needs one was that the medication could be expired and then not effective and not having the name on the medication we don't know who the medication belongs to. Record review of the facility provided policy titled, Administering Medications, Revised April 2019, revealed the following: .12. The expiration/beyond use date on the medication label is checked prior to administering. When opening a multi-dose container, the date opened is recorded on the container. No other policy provided by the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 10 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 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, and serve food under sanitary conditions in 1 of 1 kitchens when they failed to: Residents Affected - Many A. Ensure kitchen staff used proper hand washing and sanitation procedures when handling food. This failure could cause decreased meal satisfaction and decreased meal consumption due to using unsanitary practices in the facility's only kitchen and could affect all residents in the facility that receive meals from the facility kitchen. Findings included: Observation of the kitchen food prep activities on 4/30/25 from 11:15 a.m. to 12:35 p.m. revealed the following: In an observation and interview on 4/30/25 at 11:40 a.m., [NAME] I was observed in the kitchen with gloved hands, chopping meat for lunch using a spoon to chop the meat. [NAME] I pushed meat off the bowl of the spoon with her gloved hands. [NAME] I did not wash her hands. [NAME] I took off her gloves and applied new gloves from her pocket. [NAME] I began touching the meat with her gloved hand, picked up the meat and put the chopped meat in the metal container. [NAME] I was asked if she realized she had not washed her hands and had touched other surfaces then touched the meat with her gloved hands. [NAME] I just smiled and said she did not speak English. The DM was present and stated to [NAME] I in Spanish, she needed to wash hands and change gloves between tasks. The DM stated she expected [NAME] I to wash her hands, and change her gloves between tasks before putting on new gloves. In an observation and interview on 4/30/25 at 11:50 am [NAME] J was observed carrying a tray of glasses to the serving counter with gloved hands. [NAME] J set the tray on the counter and began turning the glasses right side up. [NAME] J picked up a glass with one gloved hand and grabbed a handful of ice with his other gloved hand. [NAME] J filled the glass with ice. [NAME] J then put the glass down and picked up another glass. [NAME] J then filled another glass of ice using his gloved hand and set the glass down. [NAME] J touched other kitchen surfaces in the kitchen then filled another glass with ice using his gloved hand. [NAME] J did not wash his hands or change his gloves. [NAME] J was asked if he realized he had touched the ice after touching other kitchen surfaces. [NAME] J stated No, I did not. [NAME] J refused to speak to this writer the rest of the observation. In an observation and interview on 4/30/25 at 11: 55 am, [NAME] I was observed with gloved hands to touch food trays, picked up the serving utensils, put the serving utensils down on the counter, removed the lids off the food on the tray line, picked up the serving utensils and placed them into the food items, picked up tray tickets and put them down, picked up a plate, put the plate down, picked up tray tickets again and then picked up a plate. [NAME] I began plating the food. [NAME] I picked up a roll with her gloved hands and placed it on the plate. [NAME] I picked up another plate, plated the food and picked up another roll with her gloved hand and placed the roll on the plate. [NAME] I was asked if she realized she had touched various surfaces in the kitchen and then used her hand to pick up the roll. [NAME] I smiled and said No English and continued to plate the food. [NAME] I did not change her gloves. The DM was present and spoke to [NAME] I. [NAME] I used tongs to place the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 11 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 roll on the plates for the next few plated meals. Level of Harm - Minimal harm or potential for actual harm In an observation and interview on 4/30/25 at 12:20 pm, [NAME] I was observed from the kitchen/ dining room window picking up utensils, plates, touching the serving cart and then plating food. [NAME] I was seen picking up a roll with her gloved hands and placing the roll on the plate. [NAME] I then picked up another plate, plated the food and placed a roll on the next plate. [NAME] I did not change her gloves or wash her hands. Residents Affected - Many In an interview on 5/1/25 at 10:00 am, the DM was asked about handwashing. The DM stated They shouldn't be touching the food. FSS further stated, Tongs should be used to serve rolls. The DM stated the staff were just nervous. She stated both [NAME] I and [NAME] J came to her and stated they were nervous and just forgot to wash and change gloves. The DM stated she was trained by the Dietician for her job duties. The DM stated she trained the staff on handwashing and glove use and had just in serviced the staff that week. The DM stated the consequences of not washing hands and changing gloves was cross contamination. Record Review of the facility's policies titled Indications for Glove Use with a date of 2009, documented: ' Food service employees may not contact exposed ready to eat food or food that will be cooked with their bare hands and shall use suitable utensils . Change gloves when an unsensitized surface is touched. Change gloves when beginning a different task . Record Review of the facility's policies titled Safe Food Preparation with a date of 2009, documented: ' Prepare foods in a sanitary manner with minimal handling Hands do not touch areas of utensils, dishware or silverware where the food or mouth is placed. Avoid touching foods with bare hands. Use tongs instead. Record Review of the facility's policies titled Safe Food Handling with a date of 2009, documented: ' Follow all local, State and Federal regulations when handling food. Food is served with clean sanitized utensils. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 12 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 Based on observations, interviews, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 6 of 12 residents (Resident #15, #24, #26, #27, #31, and Resident #36) reviewed for infection control. Residents Affected - Some The facility failed to ensure that facility staff performed hand hygiene appropriately during medication preparation, medication administration and incontinent care. This failure could place the residents at an increased risk for potentially exposing them to viral infections, secondary infections, tissue breakdown, communicable diseases and feelings of isolation related to poor hygiene. Findings included: During an observation on 04/30/25 at 11:00 AM Resident #27 was being assisted to the restroom by CNA F who did not don any PPE. Resident #27 was on EBP due to having a wound. During an interview on 04/30/25 at 11:08 AM CNA F, stated he didn't know if Resident # 27 was on EBP precautions. CNA F went to the door of the residents room and turned to the state investigator and stated yep, he sure is. CNA F stated a negative outcome was the possibility of spreading infection to other residents. During an observation on 04/30/25 at 12:23 PM CNA C was assisting 2 unidentified residents with eating and used her right hand for both residents without performing hand hygiene in between residents. During an observation on 04/30/25 at 02:14 PM CNA C stated a negative outcome for not washing hands when assisting residents to eat was that it could lead to cross contamination. During an observation on 05/01/25 at 06:31 AM LVN B administered medication to Resident #15 who was on EBP and did not don PPE to perform a glucose check or to administer insulin to Resident #15. LVN B did not perform hand hygiene before administering insulin and did not perform a glove change after preparing medication and then entering the resident's room. During an observation on 05/01/25 at 06:34 AM LVN B administered insulin to Resident #24, LVN B did not clean glucometer before performing the glucose check and did not perform hand hygiene before donning gloves to perform the glucose check. LVN B used the same gloves she prepared medications with and administered insulin to Resident #24 without performing HH or a glove change. During an interview on 05/01/25 at 06:45 AM LVN B stated the negative outcome for not performing HH and not donning PPE for a resident on EBP was it could lead to the passing of bacteria on to another resident. During an observation on 05/01/25 at 06:48 AM LVN A who was preparing medicated eye gtts for Resident #31, did not perform HH before donning gloves to administer eye gtts. LVN A did not perform HH after removing gloves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 13 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 During an observation on 05/01/25 at 06:56 AM LVN A donned gloves at her medication cart which was located midway down the NE hall and walked to the end of the hallway were Resident #36's room was, Resident #36's roommate was on contact precautions for ending stages of shingles. LVN A left room with the gloves on that she checked Resident #36's blood sugar with and walked down the hall with dirty gloves on and touched her medication cart. LVN A removed gloves and did not perform HH. Residents Affected - Some During an observation on 05/01/25 at 07:07 AM LVN A did not perform HH and did not don gloves to administer insulin to Resident #23 and did not perform HH after the administration of medication. During an observation on 05/01/25 at 07:18 AM LVN A did not perform HH before donning gloves for insulin injection of Resident #35. During an interview on 05/01/25 at 07:28 AM LVN A stated by not performing HH or donning/doffing gloves at the appropriate times could lead to cross contamination and the spread of germs. During an observation on 05/01/25 at 12:27 PM CNA D was assisting the wound doctor and LVN M with incontinent care and wound care for Resident #26. CNA D walked into the room and did not don PPE since Resident #26 was on EBP for a wound and Foley catheter. CNA D did not wash hands before donning gloves and took over the incontinent care for LVN M who was washing hands and donning new gloves so she could start wound care for Resident #26. CNA D did not perform HH after performing care and doffed and donned new gloves with no HH performed in between glove change. Before wound care was started she donned a gown. At the end of assisting LVN M with wound care CNA D did not perform HH. During an interview on 05/01/25 at 12:51 PM CNA D stated the negative outcome would be that other residents could get an infection. During an interview on 05/02/25 at 01:32 PM DON stated a negative outcome for not performing HH could lead to the transmission of microbes to everywhere and everyone. DON stated the negative outcome for not donning gloves to perform an injection could lead to a potential a stick and it isn't safe. DON stated a negative outcome for not donning PPE for residents on EBP was the potential to transmit bacteria via clothing. Record review of facility provided policy titled, Administering Medications, revised April 2019, revealed the following: .25. Staff follows established facility infection control procedures (e.g., handwashing, antiseptic technique, gloves, isolation precautions, etc.) for the administration of medications, as applicable. Record review of the facility provided policy titled, Insulin Administration, revised September 2014, revealed the following: .Steps in the procedure (Insulin Injections via Syringe) 1. Wash Hands . 21. Wash hands. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 14 of 15 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 455551 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Plainview Healthcare Center 2510 W 24th St Plainview, TX 79072 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 Record review of facility provided policy titled, Handwashing/Hand Hygiene, revised August 2019, revealed the following: Level of Harm - Minimal harm or potential for actual harm Policy Statement Residents Affected - Some This facility considers hand hygiene the primary means to prevent the spread of infections. Policy Interpretation and Implementation 1. All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, resident, and visitors. .7. .c. Before preparing or handling medications. .e. Before and after handling an invasive device (e.g., urinary catheters, .) . .H. before moving from a contaminated body site to a clean body site during resident care; . .m. after removing gloves; n. Before and after entering isolation precautions settings; o. Before and after eating or handling food; p. Before and after assisting a resident with meals; . .8. Hand hygiene is the final step after removing and disposing of person protective equipment. 9. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455551 If continuation sheet Page 15 of 15