Inspection·April 25, 2024

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Hemiparesis following Cerebral Infarction (a condition where one side of the body is paralyzed and the other side is weak, but not completely paralyzed). In an observation/interview on 04/23/2024 at 10:22 AM revealed Resident #14 was lying in his bed and the call light was within reach. Resident #14 stated, Sometimes I wait 2-3 hours to be changed. It happens mostly during the day shift. I don't need to be changed much as night. Sometimes I slip through the cracks. 3. Record review reflected an [AGE] year-old male who was admitted to the facility on [DATE]. The resident had a diagnosis which included Unspecified Sequelae of Cerebral Infarction (a condition referred to as a stroke) and has a BIMS of 15. In an observation/interview on 04/23/2024 at 12:24 PM revealed Resident #34 call-push pad was not within reach or visible. The resident had limited range of motion and was unable to turn his head. The resident stated he did not know where the call-push pad was located or how long he was unable to reach it. A CNA was summoned from the hallway to locate the call light for Resident #34. The CNA found the residents call-push pad located on top of the roommates over-the-bed light. In an interview on 04/25/24 at 12:54 PM with LVN A, she stated call lights should always be available and within reach of the residents. LVN A stated everyone was responsible for making sure residents had their call lights within reach. She stated the resident could fall and that may cause an injury. In an interview on 04/25/24 at 01:10 PM with the DON, she stated residents needed to be able to always push the call button. Everyone was responsible for making sure all residents had their call lights. The negative effects to the residents for not having their call light within their reach was the resident may not be able to communicate their needs; it could lead to falls. A record review of the facility's policy titled Call Light/Bell, dated 4/2024, reflected Procedure #5 was to Leave the resident comfortable. Place the call device within the resident's reach before leaving room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 2 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed ensure residents had the right to a safe, clean, comfortable, and homelike environment, in that: 1. The facility failed to ensure resident room floors in halls 200 and 300 didn't have a buildup of stains and physical dirt, scratches, peeling and chipping paint on the walls. 2. The facility failed to ensure the furniture wood was not chipping. 3. The facility failed to ensure there was not a strong urine odor in the facility upon entrance to the building. 4. The facility failed to ensure there were no dirty clothes on the floors of residents closets. 5. The facility failed to ensure the community showers on the halls didn't have soap scum. 6. The facility failed to ensure the toilets were not leaking in the residents rooms. These failures could place residents at risk of a diminished quality of life. Findings included: During an observation on 04/23/2024 at 8:30 AM revealed upon entrance in the door, there was a strong urine odor in the entrance way. The admission Coordinator stated it was an old building and residents sat in the front of the building and the urine smell had just been there. She had housekeeping mop the area, but the urine smell was still there . An Observation of rooms 221A, 219, 214, 307, 309 and 311B on 4/23/24 at 10:10 AM revealed chipped, peeling, two-toned paint coming off the walls. An Observation of rooms 221, and 219 on 4/23/24 at 10:16 AM revealed floor trim and baseboards were hanging off the wall. An Observation of rooms [ROOM NUMBERS] on 4/23/24 at 10:16 AM revealed there were clothes on the floor in the closets. The closets doors would not close. The door was dragging against the floor which caused scratches on the floor. Observation of room [ROOM NUMBER] on 4/23/24 at 10:51 AM revealed the toilet was leaking and it had a tile lifted from the floor. Observation of the community shower rooms of halls 200 and 300 on 4/23/24 at 10:59 AM revealed white soap scum on the walls. In an interview on 04/25/24 at 10:23 AM, with the Housekeeper she stated the CNAs were usually responsible for cleaning the closets . She is not sure how often the task is completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 3 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0584 Level of Harm - Minimal harm or potential for actual harm In an interview on 04/25/24 at 10:30 AM with Maintenance he stated the evening housekeepers were responsible for cleaning the shower rooms . He stated if he didn't clean the walls then it didn't get done. The Maintenance man stated he was not aware of any leaking toilets or rooms that needed immediate attention. He stated there were notifications for maintenance for immediate needs to be filled out by the staff kept at the nurse's station. Residents Affected - Some In an Interview on 04/25/24 at 12:49 PM with LVN A revealed anyone was responsible for straightening the closets and rooms. She stated the facility had a program within the PCC system that allows staff to place a maintenance request , if the problem continues, we notify the admin. In an interview on 04/25/24 at 12:54 PM with LVN B revealed maintenance was notified for any environmental concerns. There was a chart in the PCC system that communicated with maintenance for issues such as leaking toilets, wet floors, mold, or water damage. The expectation was dirty clothing be bagged and placed in barrel outside the residents' room , and clean clothing be hung up correctly in the closet. CNA's, nurses, and laundry would all be responsible for cleaning up a room. The risk for residents having an unkept room would be not having a homelike environment leading to depression . In an Interview on 04/25/24 at 01:22 PM, Admin stated every employee was responsible for straightening and cleaning rooms. The Administrator stated department heads have daily room rounds to check all resident rooms for deep scratches in paint, chipping wood on doors, and leaking water pipes. The administrator currently stated the facility only has a maintenance assistant. The Administrator stated have The Facility had a system called TELS, this is a system to report work orders for completion. She stated The Facility was in between maintenance supervisors and were in the process of renewing and renovating the rooms. The Facility had someone assigned to paint the rooms when needed. She stated she was not sure how the building aesthetics would negatively affect a resident. The ADM stated there was always a risk for slipping on wet tile. Record review of the facility's, undated, policy on Residents Rights reflected You have a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 4 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation , interview and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming and personal and oral hygiene for 3 of 3 residents (Residents #7, #40 and #104) reviewed for ADL care. Residents Affected - Some The facility failed to ensure Residents #7, #40 and #104 received their bath/showers three times a week as per their shower schedule. This failure could place residents at risk of skin breakdown, infection, and loss of self-esteem. Findings include: 1. Record review of Resident #7's face sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #7 had diagnoses which included Type 2 Diabetes Mellitus with Unspecified Complications (a problem in the way the body regulates and uses sugar as a fuel), Stage 3 Pressure Ulcer Of Sacral Region (involves the full thickness of the skin and may extend into the subcutaneous tissue layer; granulation tissue and epiboly rolled wound edges are often present), Stage 3 Pressure Ulcer of Right and Left Buttock (The skin now develops an open, sunken hole called a crater or ulcer. The tissue below the skin is damaged), Neuromuscular Dysfunction of Bladder, Unspecified (the nerves and muscles don't work together very well), Colostomy Status (A colostomy is an operation that creates an opening for the colon, or large intestine, through the abdomen). Also, the resident needed Assistance with Personal Care. Record review of Resident #7's Comprehensive MDS, dated [DATE], reflected he had a BIMS score of 14, which indicated intact cognitive status. His functional abilities reflected he required substantial/maximal assistance for tub/shower transfer. Record review of Resident #7's facility shower schedule reflected Resident #7 was scheduled to receive a shower three times a week on Tuesdays, Thursdays and Saturdays on the 6AM-2 PM shift . 2. Record review of Resident #40's face sheet reflected she was a [AGE] year-old female who was admitted to the facility 03/13/2023. Resident #40 had diagnoses which included Dysarthria and Anarthria (is a motor speech disorder resulting from impaired neuromuscular control over speech production), Post-Traumatic Stress Disorder, Unspecified (a mental health condition that's triggered by a terrifying event - either experiencing it or witnessing it), Lymphedema, not Elsewhere Classified (swelling caused by a buildup of lymph fluid in the body between the skin and muscle), Parkinson's Disease without Dyskinesia, without mention of fluctuations (A disorder of the central nervous system that affects movement, often including tremors). Record review of Resident #40's Comprehensive MDS, dated [DATE], reflected she had a BIMS score of 15, which indicated intact cognitive status. Her functional abilities reflected she required substantial/maximal assistance for tub/shower transfer. Record review of Resident #40's facility shower schedule reflected Resident #40 was scheduled to receive showers on Mondays, Wednesdays, and Fridays on the 2PM -10PM 3. Record review of Resident #104's face sheet reflected 04/23/2024 at [AGE] year-old male who was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 5 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some admitted to the facility on [DATE]. Resident #104 had diagnoses which included Anemia, Unspecified (a problem of not having enough healthy red blood cells or hemoglobin to carry oxygen to the body's tissues), Muscle Weakness (Generalized) (Generalized weakness or decreased strength of the muscles, affecting both distal and proximal musculature), Unsteadiness on Feet (a pattern of walking that's unstable. This can increase your risk of injury if left unmanaged), Unspecified Abnormalities of Gait and Mobility (an injury, sore, an inner ear balance issue or nerve damage), Need for Assistance with Personal Care (helps clients with everyday tasks. These tasks are called activities of daily living). Record review of Resident #104's Comprehensive MDS, dated [DATE], reflected she had a BIMS score of 15, which indicated intact cognitive status. Her functional abilities reflected she required substantial/maximal assistance for tub/shower transfer. Record review of Resident #104's facility shower schedule reflected Resident #104 was scheduled to receive showers on Tuesdays, Thursdays, and Saturdays on the 2PM-10PM shift . In an interview on 04/24/2024 at 4:35 PM, Resident #7 stated he was not getting his showers on the days he was supposed to receive showers. He stated the staff did not want to give him a shower and he would ask them for a shower. He stated he felt neglected, and it caused stress and depression . In an interview on 04/24/2024 at 4:55 PM, Resident # 40 advised a VA representative she was not getting her showers. She stated she was supposed to get a shower on 4/20/2024 and 4/23/2024 and she did not get one . In an interview on 04/23/2024 at 11:40 AM, Resident #104 stated he was not getting his showers. He stated he had one on 04/23/2024 and the last time he had it was on 4/11/2024. He stated he was supposed to get one every other day. He spoke with the DON, and she advised him they were getting new staff and they would have the shower dates set up. He stated he asked to have one every day, and he wasn't getting one. He was scheduled for morning shower's and did not get one and the evening staff would tell him they did not have enough staff, or they did not have time. A CNA, unknown, advised him to let her know he wanted a shower, and she would give him one. During an interview with the DON on 4/25/2024 at 4:00 PM, she stated the CNA's were to give showers to the residents. She stated she was made aware and told the staff they were to accommodate the resident needs. She would go watch the floor or assist with the showers if needed . During an interview with the ADM on 4/25/2024 at 4:25 PM, she stated the CNA's and then the nurse reviewed the shower sheets. She stated they reviewed the situation and made sure the residents did not refuse a shower, we educate and in-service our staff and the residents were showered immediately. During an interview with the VA representative on 4/25/2024 at 9:22AM, she stated the reason why she was in the building was due to concerns of VA residents. She stated she spoke with Residents #40 and #14 and one of their concerns was they were not receiving showers as they should. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 6 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 5 residents (Resident #8) reviewed for physician orders. Residents Affected - Few The facility failed to obtain a physician's order prior to providing treatment for an open wound to the right lower forearm for Resident #8. This deficient practice could place residents at-risk of inadequate monitoring and treatment of medical conditions and an infection of the skin wound. The findings were: Record review of Resident #8's, undated, face sheet reflected [AGE] year-old female who readmitted to the facility from the hospital 04/14/24. Resident #8 had diagnoses which included Chronic Obstructive Pulmonary Disease (a group of lung diseases that block airflow and make it difficult to breathe), Diabetes Type 2 (elevated blood sugar), Intermittent Asthma (bronchial spasms), Heart Failure (a condition where the heart doesn't pump blood as well as it should), shortness of breath, and weakness. Record review of Resident #8's quarterly MDS, dated [DATE], reflected a BIMS score of 15, which indicated the resident was cognitively intact. Resident #8 was Dependent for ADL care such as showers grooming and toileting. Record review of Resident #8's care plan, dated 3/19/24, reflected Resident #8 had an actual skin tear to her right extremity related to trauma. Resident #8's goal was the skin injury would be healed by the review date. Interventions included to monitor and document location, size and treatment of the skin injury. Report abnormalities, failure to heal, signs and symptoms of infection or maceration to the medical doctor. Record review of Resident #8's medication administration record for April 2024 reflected Resident #8 had an order to clean skin tear to right lower arm with normal saline, pat it dry, and cover with a dry bordered dressing daily and as needed for loose or soiled dressing. The order was dated 3/29/24 and discontinued 4/11/24. In an interview and observation on 04/23/24 at 10:19 AM with Resident #8 revealed the resident had a brown colored dressing in place with hard deep brown dried fluid around the boarders of the dressing. Resident #8 stated she received a skin tear 3 weeks ago. She stated the dressing was changed three (3) times by the nurse. The Resident stated she did not know when the dressing had last been changed. The dressing had no date or initials on it . In an interview on 04/25/24 at 12:54 PM with LVN A, she stated she was not aware of any skin tear on Resident #8's right lower arm. She stated nurses were responsible for obtaining orders from the physician to treat any skin issues as they were needed. LVN A stated skin assessments were completed weekly. LVN A stated the negative effects for not addressing an open wound or skin tear would be infection . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 7 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 04/25/24 at 01:10 PM with the DON, she stated she would expect the nurse to investigate assess and clean wounds and provide treatment as they happen. This would have included obtaining a physician's order for treatment. She stated the dressing should have been dated and initialed. The DON stated the nurses were responsible for obtaining a physician's order to treat any skin issues. The DON stated the risk to the resident for not obtaining an order would be lack of communication, treatment of the injury or wound leading to infection. A record review of the facility policy titled Quality of Care, dated 03/2015 reflected that residents who enter the facility with a wound would not develop signs and symptoms of infection, unless the residents clinical condition makes the development unavoidable. The policy also reflected Procedure #1 a treatment order will be obtained from the attending physicians for areas requiring treatment including open skin tears. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 8 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 observation, interview and record review the facility failed to ensure that a resident who needed respiratory care was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents goals and preferences for 1 of 5 residents (Residents #8) reviewed for respiratory care. Residents Affected - Few The facility failed to ensure Resident #8's oxygen concentrator had a clean filter in place, humidifier was filled and dated, and tubing was changed as ordered by physician. This failure could place residents at risk for respiratory infections . Findings include: Record review of Resident #8's, undated, face sheet reflected [AGE] year-old female who was admitted to the facility on [DATE]. Resident #8 had diagnoses which included Chronic Obstructive Pulmonary Disease (a group of lung diseases that block airflow and make it difficult to breathe), Diabetes Type 2 (elevated blood sugar), Intermittent Asthma (bronchial spasms), Heart Failure (a condition where the heart doesn't pump blood as well as it should), shortness of breath and weakness. Record review of Resident #8's care plan, dated 2/21/24, reflected Resident #8 had shortness of breath. Interventions on the care plan included to apply oxygen via nasal cannula. Resident #8's goals included not to have a rehospitalization within the next 30 days and no complications related to shortness of breath through the review date. Record review of Resident #8's quarterly MDS, dated [DATE], reflected a BIMS score of 15, which indicated the resident was cognitively intact. The MDS also reflected that The Resident was dependent for ADL care such as showers grooming and toileting. Section O (special treatments) of the MDS indicated Resident #8 used oxygen therapy continuously. Record review of Resident #8's Physicians order summary report, dated 4/23/24, reflected Resident #8 had an order for Oxygen at 2 -3 liters per minute continuously for treatment of COPD. The orders also reflected an order to change oxygen tubing and humidifier bottle every night shift every Sunday. Record review of Resident #8's Medication Administration Record for April 2024 reflected a task to change oxygen tubing and humidifier bottle every Sunday and was signed off as completed on 4/21/24. In an observation and interview on 04/23/24 at 10:19 AM revealed Resident #8 was lying in bed with her oxygen on her nose. The oxygen tubing was dated for 4/16/24. The oxygen concentrator had no filter in place. The humidifier was dated 4/16/23 and was empty of water. Resident #8 stated she used her oxygen continuously because she was short of breath without it . In an interview with LVN A on 04/25/24 at 12:54 PM, she stated she was not sure why Resident #8's oxygen was not changed. She stated the oxygen policy was for the night shift nurse to change all oxygen tubing, humidifiers, and filters weekly every Sunday. LVN A said the risk to Resident #8 for not having her oxygen filter in place and tubing unchanged was respiratory infection . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 9 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 Residents Affected - Few In an interview with the DON on 04/25/24 at 01:10 PM, she stated it's her expectation that the oxygen tubing, filter, and humidifiers be changed weekly on Sundays. The oxygen tubing and humidifiers should be dated, and initialed when changed. She stated the task was delegated to the night shift nurse and they were responsible for ensuring it was completed. The DON monitors the Medication Administration Record to ensure the oxygen task had been completed. The DON stated not having clean tubing, filters in place on the oxygen concentrator, and humidification could place Resident #8 at risk for infection and feeling uncomfortable. A record review of the facility policy titled Disposition of Respiratory equipment Disposables, dated 04/2024, reflected It is the policy of this facility that certain disposable respiratory equipment will allow utilization of resources at responsible levels and with the highest quality care and treatment of our patients. Each facility will stock disposable supplies adequate to provide safe respiratory care to respiratory patients. Supplies will be clearly dated when initially setup or changed. All disposable change outs are performed per facility requirements. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 10 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a drug regimen review for each resident was reviewed at least once a month by a licensed pharmacist for five of five reviewed for drug regimen review. The facility failed to document an MRR for Residents# 1, 15, 8, 34 and 22 for the months of January, February and March 2024. This failure could place residents at risk of adverse drug consequences and a decline in their physical and mental health status. Findings include: 1. Record review of the facility's pharmacy monthly review reports for Resident #15, reflected Resident is given Buspirone HCl for anxiety. There is no MRR documentation the doctor has conducted a monthly or frequent review of the residents medical record January, February and March 2024. Record review for Resident #15 medical diagnosis sheet reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #15 had diagnoses which included Chronic Obstructive Pulmonary Disease, Unspecified (refers to a group of diseases that cause airflow blockage and breathing-related problems), Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified (is a type of nerve damage that can occur if you have diabetes. High blood sugar glucose can injure nerves throughout the body), Generalized Anxiety Disorder (Persistent worrying or anxiety about several areas that are out of proportion to the impact of the events), Chronic Kidney Disease, Stage 3 Unspecified (you have an eGFR between 30 and 59 and mild to moderate damage to your kidneys), Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris (is the buildup of fats, cholesterol and other substances in and on the artery walls. This buildup is called plaque) and had a BIMS of 08. 2. Record review of the facility's pharmacy monthly review reports dated January-March 2024 for Resident #1, reflected there is no MRR documentation the doctor has conducted a monthly or frequent review of the residents medical record. He is prescribed Benztropine Mesylate for Tremors, Depakote Seizures, Duloxetine Mood Disorder, HCl Risperidone for Schizophrenia. Record review of Resident #1 medical diagnosis sheet reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included Schizophrenia, Unspecified (A disorder that affects a person's ability to think, feel, and behave clearly), Cognitive Communication Deficit (Acquired cognitive-communication deficits may occur after a stroke, tumor, brain injury, progressive degenerative brain disorder, or other neurological damage), Spinal Stenosis, Thoracolumbar Region (he spinal canal, located in the mid-region or thoracic spine, can narrow with age), Parkinsonism, Unspecified (a term used to describe the collection of signs and movement symptoms associated with several conditions - which included Parkinson's disease PD and had a BIMS of 10. 3. Record review of the facility's pharmacy monthly review reports dated January - March of 2024 for Resident #8, reflected no documentation of monthly MMRs were conducted in January, February and March 2024. Record review of Resident #8's, undated, face sheet reflected a [AGE] year-old female who was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 11 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some admitted to the facility on [DATE]. Resident #8 had diagnoses which included Chronic Obstructive Pulmonary Disease (a group of lung diseases that block airflow and make it difficult to breathe), Diabetes Type 2 (elevated blood sugar), Intermittent Asthma (bronchial spasms), Heart Failure (a condition where the heart doesn't pump blood as well as it should), shortness of breath and weakness. Record review of Resident #8's care plan, dated 8/01/21, reflected Resident #8 was receiving anticoagulant therapy. Interventions on the care plan included to monitor and report to the medical doctor immediately any signs or symptoms of unusual bleeding, pale skin, weakness, black tarry stool and head injury related to falls or trauma. Record review of Resident #8's quarterly MDS, dated [DATE], reflected a BIMS score of 15, which indicated the resident was cognitively intact. Resident #8 was Dependent for ADL care such as showers grooming and toileting. Section N (Medications) was coded that the resident was receiving an anticoagulant daily. Record review of Resident #8's Physicians order summary report, dated 4/23/24, reflected Resident #8 had an order for Apixaban (a blood thinner used to reduce the chances of stroke) by mouth two (2) times daily for clot prevention. 4. Record review of the facility's pharmacy monthly review reports dated January - March 2024 for Resident #34, reflected no documentation of monthly MMRs were conducted in January, February and March 2024. Record review of Resident #34's, undated, face sheet reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #34 had diagnosis which included Unspecified Sequelae of Cerebral Infarction (a condition referred to as a stroke) and has a BIMS score of 15. 5. Record review of the facility's pharmacy monthly review reports dated January - March 2024 for Resident #22, reflected no documentation of monthly MMRs were conducted in January, February, and March 2024. Record review of Resident #22's, undated, face sheet reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #22's had a diagnosis which included Neurocognitive Disorder with Lewy Bodies (a progressive dementia affecting movement, thinking skills, mood, memory and behavior). There were no BIMS score available. Interview on 4/25/2024 at 4:00 PM, the DON stated a representative from the pharmacy conducted monthly reviews for a sample of residents and the facility physician conducted a medication review in PCC quarterly or as needed, if there is an adverse reaction. Interview on 4/25/2024 at 4:25 PM, the ADM stated, The facility conducts MRRs quarterly and as needed, and the ADM stated the have the physician look at meds monthly. She also stated, We hold GDR meetings monthly with the psychiatrist, psychologist and our physician. Record review of the Medication Administration Record for April 2024 reflected Resident #8 received Apixaban two times daily for clot prevention. There was no monitoring in place for unusual bleeding. Record review of the facility's policy, titled medical diagnosis sheet Unnecessary Drugs, revised (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 12 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 0756 April 2014, reflected: Level of Harm - Minimal harm or potential for actual harm Purpose: Residents Affected - Some The purpose of this requirement is that each resident's entire drug/medication regimen be managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial well-being. 4. Record review of the facility's pharmacy monthly review reports for Resident #34, reflected no documentation of monthly MMRs were conducted in January, February and March 2024. Record review of Resident #34's, undated, face sheet reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #34 had diagnosis which included Unspecified Sequelae of Cerebral Infarction (a condition referred to as a stroke) and has a BIMS score of 15. 5. Record review of the facility's pharmacy monthly review reports for Resident #22, reflected no documentation of monthly MMRs were conducted in January, February, and March 2024. Record review of Resident #22's, undated, face sheet reflected an [AGE] year-old male who was admitted to the facility on [DATE]. Resident #22's had a diagnosis which included Neurocognitive Disorder with Lewy Bodies (a progressive dementia affecting movement, thinking skills, mood, memory and behavior). There was no BIMS score available. Interview on 4/25/2024 at 4:00 PM, the DON stated a representative from the pharmacy conducted monthly reviews for a sample of residents and the facility physician conducted a medication review in PCC quarterly or as needed, if there is an adverse reaction. Interview on 4/25/2024 at 4:25 PM, the ADM stated, The facility conducts MRRs quarterly and as needed, and we have the physician look at meds monthly. She also stated, We hold GDR meetings monthly with the psychiatrist, psychologist and our physician. Record review of the Medication Administration Record for April 2024 reflected Resident #8 received Apixaban two times daily for clot prevention. There was no monitoring in place for unusual bleeding. Record review of the facility's policy, titled Unnecessary Drugs, revised April 2014, reflected: Purpose: The purpose of this requirement is that each resident's entire drug/medication regimen be managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial well-being FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 13 of 14 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 455637 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Rehabilitation and Healthcare 1802 S 31st Temple, TX 76504 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 observation, interview and record review the facility failed to ensure, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 1 of 2 medication carts (Medication Cart #1) reviewed for medication storage . The facility failed to ensure Medication Cart # 1 was not left unattended and unlocked. This failure could place residents at risk of obtaining access to prescription and over-the-counter medication, that could cause overdose, allergic reactions, poisoning or exacerbation of illness and symptoms. Findings include: Observation on 04/24/2024 at 4:32 PM revealed Medication Cart #1 was against a wall in a resident hallway. Three residents walked by the unattended and unlocked medication cart. There were no visible facility staff on the hallway at that time. Observation on 04/24/2024 at 4:34 PM revealed Medication Cart #1 remained unattended and unlocked. There were no visible facility staff on the hallway at that time . Residents were in the hallway. Observation on 04/24/2024 at 4:37 PM revealed Medication Cart #1 remained unattended and unlocked. There were no visible facility staff on the hallway at that time . Residents were in the hallway. Interview on 04/25/2024 at 4:00 PM, the DON stated the expectation was for medication and treatment carts to be locked anytime someone was not physically with the cart. When asked about potential negative outcomes for residents, she said, Residents may not realize what is in there. They might hold onto the cart to scoot themselves. The heavy drawers could come open and they could pinch a finger or hurt themselves. Interview on 04/25/2024 at 4:25 PM, the ADM stated her expectation was for the medication carts to be locked when not in use. She said leaving it unlocked placed the residents at risk of taking unprescribed medications. Record review of the facility's policy titled Medication Storage in the Facility, revised November 13, 2018, reflected the following: 1. Storage of Medications Policy Medication and biologicals are stored safely, securely, and properly, following manufacturer's recommendations or those of the supplier. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel or staff members lawfully authorized to administer medications. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 14 of 14