Inspection·April 16, 2023

F 0656 MUSCLE WEAKNESS (GENERALIZED) Level of Harm - Minimal harm or potential for actual harm OTHER ABNORMALITIES OF GAIT AND MOBILITY OTHER SYMPTOMS AND SIGNS INVOLVING THE MUSCULOSKELETAL SYSTEM Residents Affected - Few COGNITIVE COMMUNICATION DEFICIT UNSPECIFIED VIRAL HEPATITIS C WITHOUT HEPATIC COMA COCAINE ABUSE, UNCOMPLICATED ADVANCE DIRECTIVE Record review of Resident #1's physician orders indicated that Dulaglutide Subcutaneous Solution is to be administered by injection, 3mg subcutaneously, one time a day every 7 days(s) for Diabetes Mellitus. Record review of Resident #1's Medication Administration Record (MAR) dated 4/2/23 and 4/9/23 indicate that no Dulaglutide Subcutaneous Solution had been administered, since Resident #1's admission on [DATE] until today, which indicates that he has missed two (2) required doses. Both entries to the MAR read as follows: No Order data found for INSULIN ADMINISTRATION RECORD In an interview conducted on 4/16/23 at 11:01AM Resident #1 stated that today (4/16/23) was the first time that he had received his insulin injection, since he arrived at the facility on 4/2/23. In an interview with the DON and ADON on 4/16/23 at 12:02PM regarding administration orders for Resident #1's insulin, they were informed that Resident #1 had stated to this Surveyor that he had not received his insulin since he had been admitted to the facility on [DATE]. DON and ADON were observed looking at the Medication Administration Record (MAR) where they were unable to see an entry for the dispensing of his prescription of Dulaglutide Subcutaneous Solution (Pen-Injector 3mg/0.5ml). DON and ADON looked at Resident #1's orders from the rounding physician where they realized that he was to be given an injection, once every 7 days as related to his Diabetes Mellitus. I then observed them checking the refrigerator on his unit where they found a box with 2 injection pens that he had brought from home, upon his admission to the facility and another bag with a prescription label attached from their pharmacy provider with the dispensing information that stated to Inject 3mg subcutaneously one time a day every 7 day(s) for Diabetes Mellitus. I then observed them looking at the Medication Administration Record (MAR) to see who should have been dispensing the medication as ordered and found that two (2) RNs should have been dispensing the medication, but had failed to document the missed doses. The DON called each RN on the phone to inquire as to why the doses had been omitted and both said that they did not know that the medication was in the unit's refrigerator and had not followed up on the order. Both RNs immediately received a written disciplinary action, which they will sign when they arrive for their next shift. Record review of resident #1's Care Plan reflect the following interventions with regard to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 2 of 5 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 455675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Amarillo Rehabilitation and Nursing Ce 5601 Plum Creek Dr Amarillo, TX 79124 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 resident's Diabetes Mellitus: Level of Harm - Minimal harm or potential for actual harm · Diabetes medication as ordered by doctor. Monitor/document for side effects and Residents Affected - Few effectiveness. Date Initiated: 04/14/2023 · Fasting Serum Blood Sugar as ordered by doctor. Date Initiated: 04/14/2023 · Monitor/document/report to MD PRN s/sx of hypoglycemia: Sweating, Tremor, Increased heart rate (Tachycardia), Pallor, Nervousness, Confusion, slurred speech, lack of coordination, Staggering gait. Date Initiated: 04/14/2023 · Monitor/document/report to MD PRN for s/sx of hyperglycemia: increased thirst and appetite, frequent urination, weight loss, fatigue, dry skin, poor wound healing, muscle cramps, abd pain, Kussmaul breathing, acetone breath (smells fruity), stupor, coma. Date Initiated: 04/14/2023 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 3 of 5 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 455675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Amarillo Rehabilitation and Nursing Ce 5601 Plum Creek Dr Amarillo, TX 79124 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation and record review the facility failed to ensure that drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable, for 1 of 9 residents (Resident #1) reviewed for medications in that: Resident #1's scheduled doses of Dulaglutide Subcutaneous Solution Pen Injector 3milligrams/0.5millileter for Diabetes Mellitus were not administered according to doctor's orders or the resident's comprehensive care plan. This deficient practice could affect the resident by not receiving the prescribed and therapeutic dose. Findings include: In an interview conducted on 4/16/23 at 11:01AM Resident #1 stated that today (4/16/23) was the first time that he had received his insulin injection, since he arrived at the facility on 4/2/23. Review of Resident #1's face sheet on 4/16/23 at 11:38AM indicated that he was admitted to the facility on [DATE] after an above knee amputation (AKA) to the left leg. The resident's diagnoses are as follows: GANGRENE, NOT ELSEWHERE CLASSIFIED ACQUIRED ABSENCE OF LEFT LEG ABOVE KNEE METABOLIC ENCEPHALOPATHY TYPE 2 DIABETES MELLITUS WITHOUT COMPLICATIONS PERIPHERAL VASCULAR DISEASE, UNSPECIFIED ESSENTIAL (PRIMARY) HYPERTENSION CARDIAC MURMUR, UNSPECIFIED WEAKNESS OTHER LACK OF COORDINATION MUSCLE WEAKNESS (GENERALIZED) OTHER ABNORMALITIES OF GAIT AND MOBILITY OTHER SYMPTOMS AND SIGNS INVOLVING THE MUSCULOSKELETAL SYSTEM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 4 of 5 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 455675 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Amarillo Rehabilitation and Nursing Ce 5601 Plum Creek Dr Amarillo, TX 79124 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 0755 COGNITIVE COMMUNICATION DEFICIT Level of Harm - Minimal harm or potential for actual harm UNSPECIFIED VIRAL HEPATITIS C WITHOUT HEPATIC COMA COCAINE ABUSE, UNCOMPLICATED Residents Affected - Few ADVANCE DIRECTIVE Record review of Resident #1's physician orders 4/16/23 at 11:42AM indicate that Dulaglutide Subcutaneous Solution is to be administered by injection, 3mg. subcutaneously, one time a day every 7 days(s) for Diabetes Mellitus. Record review of Resident #1's Medication Administration Record (MAR) dated 4/2/23 and 4/9/23 indicate that no Dulaglutide Subcutaneous Solution had been administered, since Resident #1's admission on [DATE] until today, which indicates that he has missed two (2) required doses. Both entries to the MAR read as follows: No Order data found for INSULIN ADMINISTRATION RECORD In an interview with the DON and ADON on 4/16/23 at 12:02PM regarding administration orders for Resident #1's insulin, they were informed that Resident #1 had stated to this Surveyor that he had not received his insulin since he had been admitted to the facility on [DATE]. I then observed them looking at the Medication Administration Record (MAR) where they were unable to see an entry for the dispensing of his prescription of Dulaglutide Subcutaneous Solution (Pen-Injector 3mg/0.5ml). I then observed them looking at his orders from the rounding physician where they realized that he was to be given an injection, once every 7 days as related to his Diabetes Mellitus. I then observed them checking the refrigerator on his unit where they found a box with 2 injection pens that he had brought from home, upon his admission to the facility and another bag with a prescription label attached from their pharmacy provider with the dispensing information that stated to Inject 3mg subcutaneously one time a day every 7 day(s) for Diabetes Mellitus. I then observed them looking at the Medication Administration Record (MAR) to see who should have been dispensing the medication as ordered and found that two (2) RNs should have been dispensing the medication, but had failed to document the missed doses. The DON called each RN on the phone to inquire as to why the doses had been omitted and both said that they did not know that the medication was in the unit's refrigerator and had not followed up on the order. Both RNs immediately received a written disciplinary action, which they will sign when they arrive for their next shift. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 5 of 5