Health inspection·August 6, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #2] has an ADL Self Care, Performance Deficit related to deconditioning activity intolerance, fatigue, Impaired balance. Goal: [Resident #2] will improve current level of function in all ADLs through the review date. Intervention: PERSONAL HYGIENE/ORAL CARE: [Resident #2] is dependent with personal hygiene.In an observation and interview on 08/06/25 at 11:05 AM Resident #2 was up lying in bed. The resident's nails on both hands were approximately 0.6 cm in length extending from the tip of her fingers. The nails were discolored tan and had brown colored residue underneath. Resident #2 stated she wanted her fingernails cleaned and trimmed. In an interview and observation on 08/06/25 at 11:21 AM CNA B looked at Resident #2's fingernails and stated she would clean and trim them today. She stated that fingernails should be trimmed and cleaned on shower days and as needed. She stated that Resident #2 had dirty, untrimmed fingernails. She stated that dirty nails could lead to infections. In an interview on 08/06/25 at 2:45 PM, the DON stated nail care should be completed as needed and every time aides washed the residents' hands. The DON stated nails should be observed daily. The DON stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. The DON stated she expected CNAs to offer to cut and clean nails if they were long and dirty. The DON stated the ADON, and the DON would do the routine rounds to monitor. The DON stated residents having long and dirty fingernails could be an infection control issue. In an Interview on 08/06/25 at 3:39 PM, the Administrator stated nail care should be completed during the shower days. He stated the activities staff participated in nails care for the residents. He stated nail care was the responsibility of the clinical care staffs, CNAs and nurses. He stated the risk to residents was infection. Record review of the facility policy titled, Grooming Care of the Fingernails and Toenails undated reflected, Nail care is given to clean and keep the nails trimmed . Fingernail are trimmed by Certified Nursing Assistants except for residents with the following condition A. Diabetes or circulatory impairment of the hands, B. Ingrown, infected, or painful nails . Event ID: Facility ID: 455653 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 455653 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Skyline Nursing Center 3326 Burgoyne Dallas, TX 75233 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to 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 1 of 6 residents (Resident #3) reviewed for infection control. The facility failed to ensure CNA A performed hand hygiene while providing incontinence care to Resident #3 on 08/06/25. These failures could place residents at risk of cross-contamination and development of infections. Record review of Resident #3's annual MDS assessment dated [DATE] reflected Resident #3 was an [AGE] year-old male initially admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included hypertension (elevated blood pressure), neurogenic bladder (a problem in the brain, spinal cord, or central nervous system that make a person lose control of the bladder) muscle weakness, dementia (diseases that affect memory, thinking, and the ability to perform daily activities), and lack of coordination. Resident #3 had a BIMS score of 5, which indicated severe cognitive impairment. The MDS assessment indicated Resident #3 required substantial/maximal assistance with personal hygiene. Record review of Resident #3's Care Plan dated 06/02/25, reflected the following: Focus: [Resident#3] has an ADL selfcare performance deficit related to dementia. Goal: [Resident#3] maintain current level of function in . personal hygiene through the review date. Interventions: Personal hygiene. [Resident#3] requires extensive assistance with personal hygiene .Observation on 08/06/25 at 10:27 AM revealed CNA A entered Resident #3's room to help him change his clothes. Resident #3's pants were wet with urine. CNA A put on gloves without performing any form of hand hygiene. CNA A got a pull up brief, and Resident #3's clean short pants ready at the foot of the bed. CNA A helped Resident #3 to standing position. CNA A removed Resident #3's wet pants and pulled up the brief. CNA A changed gloves without performing any form of hand hygiene. CNA A put a clean pull up brief, and clean short pants on Resident #3, and pulled them up to Resident #3's knees. CNA A cleaned Resident #3's private area front to back with wipes and pulled the brief and shirt up without changing gloves and performing hand hygiene. CNA A helped Resident #3 to sit in his wheelchair and put on his shoes. CNA A changed gloves without any form of hand hygiene and proceeded to help Resident #3's roommate. In an interview on 08/06/25 at 10:38 AM, CNA A stated he should perform hand hygiene before putting on clean gloves, and anytime he changed gloves. CNA A stated he should change gloves with hand hygiene when he went from dirty to clean. CNA A stated failing to follow proper hand hygiene, and gloves use could expose the resident to infections. In an interview on 08/06/25 at 2:46 PM, the DON stated they trained at length on when staff were to change their gloves and sanitize their hands. She stated staff needed to perform hand hygiene upon entering the resident's room, and each time they changed gloves. She stated staff needed to change their gloves with hand hygiene when they went from dirty to clean. She stated the risk was increased risk of infections. She stated she and the ADON would be doing a one-to-one re-training and observing care to ensure staff compliance. Record review of the facility's policy, Perineal Care, dated June 2020, reflected Wash hands .Put on gloves .Wash the penis .Wash the scrotum .Turn the resident on side .wash, rinse and dry buttocks and peri-anal area without contaminating perineal area .Remove gloves. Wash hands or use alcohol-based sanitizer .Note: Do not touch anything with soiled gloves after procedure (example: curtain, side rails, clean linens , call bell, ) .put on clean gloves .Clean and return all equipment to its proper place .Place soiled linen in proper container .Removed gloves. Wash hands.Record review of the facility's policy titled, Hand Hygiene, dated June 2020, reflected The facility considers hand hygiene the primary means to prevent the spread of infections .Facility Staff .must perform hand hygiene Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455653 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 455653 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Skyline Nursing Center 3326 Burgoyne Dallas, TX 75233 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 procedures in the following circumstances .Wash hands with soap and water .when soiled with visible dirt or debris .Hand hygiene is always the final step after removing and disposing of personal protective equipment Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455653 If continuation sheet Page 4 of 4