Inspection·August 27, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility's front entrance area on 08/27/25 at 11:10 a.m. reflected Resident #1 was sitting in a wheelchair. An attempt to interview Resident #1 was made on 08/27/25 at 11:10 a.m., but Resident #1 was unable to maintain focus during the interview. During an interview on 08/27/25 at 11:19 a.m., the SW stated she was unsure who was responsible for identifying PASARR positive residents prior to and after admission to the facility, who was responsible for making the referral to the appropriate state-designated authority when a PASARR positive resident was identified, what the facility's process was for referring PASARR positive residents to the appropriate state-designated authority, and why a referral to the appropriate state-designated authority would not be made for a PASARR positive resident. The SW stated the MDS Coordinator oversaw the PASARR process. The SW stated facility had a resource who was responsible for the PASARR process because the former MDS Coordinator left the faciity on [DATE]. The SW stated she knew the importance of referring identified PASARR positive residents to the appropriate state-designated authority and said, Referrals should be made to the appropriate state-designated authority. Residents should be able to get specialized services in order to help their well-being. Residents would not get the services that they should have if they were not referred to the appropriate state-designated authority. During an interview on 08/27/25 at 11:30 a.m., LVN A stated nurses were responsible for identifying PASARR positive residents prior to and after admission to the facility. LVN A stated the SW was responsible for making the referral to the appropriate state-designated authority when a PASARR positive resident was identified. LVN A stated the nurses identified PASARR positive residents prior to and after admission to the facility, nurses notified the DON, SW and physician, and the SW made the referral to the appropriate state-designated authority. LVN A stated she did not know why a referral to the appropriate state-designated authority would not be made for a PASARR positive resident. LVN A stated the ADON oversaw the PASARR process. LVN A stated she knew the importance of referring identified PASARR positive residents to the appropriate state-designated authority and said, Residents must receive appropriate care for their needs. We must ensure residents were not dismissed for those services they require. Residents could decline or not receive appropriate care from the staff. During an interview on 08/27/25 at 11:40 a.m., LVN B stated the DON was responsible for identifying PASARR positive residents prior to admission to the facility. LVN B stated the nurses were responsible for identifying PASARR positive residents after admission to the facility. LVN B stated the Physician was responsible for making the referral to the appropriate state-designated authority when a PASARR positive resident was identified. LVN B stated the DON identified PASARR positive residents prior to admission to the facility, the nurses identified PASARR positive residents after admission to the facility, the nurses notified the DON, the DON or the nurses notified the physician, and the physician made the referral to the appropriate state-designated authority. LVN B stated a referral to the appropriate state-designated authority would not be made for a PASARR positive resident if the resident had a change in condition that resulted in them no longer meeting PASARR positive criteria. LVN B stated the ADON and DON oversaw the PASARR process. LVN B stated she knew the importance of referring identified PASARR positive residents to the appropriate state-designated authority and said, Residents could get treated according to their diagnoses and to ensure residents get the services they need. Resident could develop mental psychosis, become suicidal, and worsen psychosis condition if they did not receive the appropriate care.During an interview on 08/27/25 at 11:51 a.m., the ADON stated the BOM was responsible for identifying PASARR positive residents prior to admission to the facility. The ADON stated the nursing, therapy, and social services departments were responsible for identifying PASARR positive residents after admission to the facility. The ADON stated the SW was responsible for making the referral to the appropriate (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 2 of 4 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 08/27/2025 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few state-designated authority when a PASARR positive resident was identified . The ADON stated she did not know what the facility's process was for referring PASARR positive residents to the appropriate state-designated authority and why a referral to the appropriate state-designated authority would not be made for a PASARR positive resident. The ADON stated the SW and DOR oversaw the PASARR process. The ADON stated she knew the importance of referring identified PASARR positive residents to the appropriate state-designated authority and said, Residents need to receive the best care they could tolerate and get the best quality of life in which they are able to function. We do not want anyone to be able to do something and not have special service, equipment or assistance for the condition. Residents could potentially decline if they do not get what they need.During an interview on 08/27/25 at 12:11 p.m., the DON stated the MDS Coordinator was responsible for identifying PASARR positive residents prior to and after admission to the facility and making the referral to the appropriate state-designated authority when a PASARR positive resident was identified. The DON stated she did not know why a referral to the appropriate state-designated authority would not be made for a PASARR positive resident and said, There shouldn't be a reason a referral is not sent out. The DON stated the MDS Coordinator oversaw the PASARR process. The DON stated the MDS Coordinator sent Resident #1's PASARR referral to the wheelchair vender and did not follow-up on the status. The DON stated the SA notified the facility that Resident #1 did not receive her CMWC for her PASARR positive condition. The DON stated Resident #1's CMWC was ordered and the facility was waiting for it to arrive at the time of the interview. The DON stated the MDS Coordinator left the facility at unknown date. The DON stated she knew the importance of referring identified PASARR positive residents to the appropriate state-designated authority and said, Residents quality of life is better when they receive specialized services. Resident could develop a decrease in quality of care and not have needs met if they did not receive specialized services. During an interview on 08/27/25 12:28 p.m., Resident #1's POA stated Resident #1 had PASARR positive conditions before her admission to the facility. Resident #1's POA stated Resident #1 requested specialized equipment for her PASARR positive condition. Resident #1's POA stated Resident #1 told her that the facility told her that they were getting her CMWC. Resident #1's POA stated the nursing department helped transfer Resident #1 using a mechanical lift and therapy department helped Resident #1 strengthen her ADLs to address her PASARR positive condition as the CMWC order was pending. Resident #1's POA stated she was concerned with Resident #1 having not received the CMWC. During an interview on 08/27/25 at 12:50 p.m., the ADM stated the facility's resource was responsible for identifying PASARR positive residents prior to and after admission to the facility. The ADM stated the DOR was responsible for making the referral to the appropriate state-designated authority when a PASARR positive resident was identified. The ADM stated he did not know why a referral to the appropriate state-designated authority would not be made for a PASARR positive resident and said, I can't imagine that there would be any reason for a referral not being sent out. The ADM stated the MDS Coordinator oversaw the PASARR process. The ADM stated the MDS Coordinator left the faciity on [DATE]. The ADM stated the DOR left the faciity on [DATE]. The ADM stated Resident #1's IDT care plan review meeting was on 04/23/25, the DOR sent Resident #1's PASARR referral to the wheelchair vender on 05/02/25, the wheelchair vender told him on 05/14/25 that the IDT care plan review meeting was too far from when the DOR sent Resident #1's PASARR referral and requested a new IDT care plan review meeting, Resident #1's new IDT care plan review meeting was on 07/23/25, he did not know when Resident #1's PASARR referral was sent out again, he followed up with the wheelchair vender on 08/05/25 and the vender confirmed the request Resident #1's referral request was completed on 08/15/25. The ADM stated the DOR did not meet the timeframe for submitting and following up on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455637 If continuation sheet Page 3 of 4 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 08/27/2025 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #1's PASARR referral for a CMWC. The ADM stated he was told the timeframe to submit the referral was within 30 business days. The ADM stated he knew the importance of referring identified PASARR positive residents to the appropriate state-designated authority and said, Residents have a right to receive specialized services. The ADM said, It depends on the resident and their condition for what could happen to a resident if they did not receive specialized services. During an interview on 08/27/25 at 1:42 p.m., the surveyor requested the ADM and DON provide the facility's PASSAR policy. During an interview on 08/27/25 at 1:43 p.m., the ADM stated the facility's PASARR Resident Assessment policy was the facility's PASARR policy. During an interview on 08/27/25 at 2:43 p.m., the DON stated the facility's PASARR Resident Assessment policy was the facility's PASARR policy. Review of the facility's In-Services, April-August 2025, reflected staff were not given any reeducation related to PASSAR. Review of the facility's PASARR Resident Assessment policy, reviewed 05/2021, reflected, Policy: It is the policy of this facility to ensure that each resident is properly screened using the PASARR specified by the State. Procedures: The facility will refer to the state's Pre-admission Screening and Resident Review policy. Event ID: Facility ID: 455637 If continuation sheet Page 4 of 4