Inspection·November 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation and interview in the hallway outside of Resident #180's room on 11/06/23 at 08:27 AM A/M Staff said, I don't know if they told you, but this one [gestured to Resident #180 lying in his bed on his back] is GIP. When A/M Staff was asked what GIP meant he stated, He is general admission. He is hospice. He is just here to pass. During an interview on 11/07/23 at 09:22 AM RN D said having Resident #180's catheter bag outside a privacy bag and in view from his open bedroom door created an issue with dignity for Resident #180. During an interview on 11/07/23 at 10:13 AM DON stated a possible negative outcome of having Resident #180's catheter bag outside a privacy bag and lying on the floor was, Bag should never be on the floor, tubing should never be on the floor, that is a risk of infection and back up urine into the patient's bladder. During an interview on 11/07/23 at 02:52 PM ADM stated a possible negative outcome of having Resident #180's catheter bag outside a privacy bag and lying on the floor was, Infection, damage. She said GIP hospice was the skilled version of hospice. ADM stated residents who were GIP hospice were actively dying or in a pain crisis and require RN care 24/7. During an interview on 11/08/23 at 01:24 PM HN stated GIP meant General Inpatient. Record review of an undated facility policy titled, Dignity revealed in part: As an extension of appropriate interactions between staff and residents, the following will be practices of the facility: . Staff will provide privacy for residents during any personal care and/or treatment. Staff will maintain resident privacy during all personal care. Urinary drainage bags will be covered unless residents are in their rooms, at which time the bag w [sic] be placed so as not to be visible from the hall if at all possible. The staff will not refer to the resident by . a term related to care (Ex: 'The total care in Rm. 100'). Note: Residents are to have all aspects of their dignity maintained by staff regardless of the resident's cognitive level or ability to realize or understand what is being said or done by others. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 2 of 28 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 11/20/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure all residents had the right to formulate an advanced directive for 1 (Resident #36) of 18 residents reviewed for advanced directives in that: Resident #36's DNR was signed on [DATE]. The chart header stated that resident was a Full Code. This failure could place residents at risk for not receiving healthcare as per their or their legal representatives wishes. Findings included: Record review of the face sheet of Resident #36 revealed a [AGE] year-old male, who was admitted to the facility on [DATE]. Resident #36 was admitted to facility with the diagnosis of Type 2 Diabetes mellitus with unspecified complication, heart failure, chronic pancreatitis, paranoid schizophrenia, Cachexia (wasting disease resulting in weight loss, muscle loss, lack of appetite, fatigue, and decreased strength), weakness, and chronic obstructive pulmonary disease. Under the section Misc. Resident #36 had a signed DNR dated [DATE]. Interview on [DATE] at 02:44 PM CNA E was asked how she would know if a resident was a full code vs. a DNR. CNA E stated that she would look in the Resident's binder to see what status the Resident was. CNA E stated that her first response was to notify the nurse and then either allow natural death or begin CPR, depending on Residents status. Observation on [DATE] at 02:46 PM revealed Resident #36's binder was opened and there was a large green paper stating, Full Code. Interview on [DATE] at 02:48 PM with Resident #36 was asked if he would want the nurse and CNA to perform CPR to save him, Resident #36 stated yeah. Interview on [DATE] at 03:02 PM LVN F was asked about DNR status and full code status for Resident #36. LVN F stated they (Residents) should have a red or green slip in the front of their (Resident's) chart. LVN F was asked if the resident had both a Full code and DNR status in their charts, how would she handle an emergency situation. LVN F stated that she would have to treat the resident as a full code due to not knowing what was in the computer during an emergency situation. Interview on [DATE] at 08:35 AM, the SW stated that Resident #36 had an issue with low blood sugar in the past. Resident's #36's family was notified, and family member of the resident was the DPOA stated that Resident #36 was a full code, and the family wanted the DNR revoked. Interview on [DATE] at 08:39 AM, the DON stated that Resident #36's chart should reflect what the resident and family want. The DON asked what a negative outcome would be of having a DNR and a full code status be. The DON stated that the resident would be coded, and CPR would be started. The conflicting information needed to be addressed. Record review of documentation stating that the family member of Resident #36 wanted the DNR would be pulled from the resident's chart, note dated [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 3 of 28 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 11/20/2023 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of a Care Conference notes dated [DATE], in the section named Social Services states the following: DNR, MINOR BEHAVIORS NOTED, TO REFUSE SHOWERS HOUSEKEEPING TO CLEAN ROOM, DOES NOT FOLLOW DIET DOES SEE PSYCH AND COUNSELING, NO FAMILY SUPPORT, LOVES SMOKING HAS BEEN MANIPULATED LATELY WITH OTHER REIDENTS TAKING HIS CIGS. Interview on [DATE] at 09:15 AM with Resident #36's family member stated that Resident #36's DNR or full code status was whatever he (Resident #36) has in his chart here. Family member could not recall if Resident #36 was a full code or not. Record review of a document titled Texas medical orders for scope of treatment (MOST) dated [DATE] revealed that resident is to receive CPR, Full interventions, Long-term medically assisted nutrition/hydration, including feeding tubes. Policy for Advance Directives was not obtained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 4 of 28 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 11/20/2023 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care for 1 (Resident #52) of 18 residents reviewed for baseline care plans in that: Resident #52 was admitted to the facility with a gastrostomy tube (a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation) and her baseline care plan did not mention the tube. This failure could place residents in danger of not receiving necessary care. Findings Included: Record review of Resident #52's face sheet dated 11/08/23 revealed a [AGE] year-old woman admitted to the facility on [DATE] with diagnoses that included but were not limited to acute respiratory failure with hypoxia (a condition resulting from not enough oxygen in the tissues of the body), chronic congestive heart failure (a progressive heart disease that affects the pumping action of the heart muscles resulting in shortness of breath and fatigue), bipolar disorder (serious mental illness characterized by extreme mood swings such as extreme excitement or extreme depressive feelings), and cognitive communication deficit (impaired ability to use language and speech to exchange information, thoughts, or feelings). Record review of Resident #52's Entry MDS revealed a completion date of 10/30/23. Record review of Resident #52's in progress admission MDS revealed a BIMS of 4 which indicated severely impaired cognition. Record review of Resident #52's baseline care plan completed on 10/31/23 by MDS LVN had no mention of a gastrostomy tube. There was an area on the baseline care plan under the Health Conditions section A where a box labeled Other could have been checked but was not. There was an area on the baseline care plan under Health Conditions section I where comments could have been entered but this area was blank. Record review on 11/08/23 at 08:59 AM of Resident #52's active orders revealed an order to Flush G/T with water once a shift and an order to Cleanse G/T site with Normal Saline daily. Both of these orders had a start date of 11/02/23. Record review of Resident #52's progress notes revealed a note from 10/30/23 at 15:58 (3:58 PM) that stated, Admit to [facility name] skilled rehab . Peg tube (gastrostomy tube) to LUQ. During an observation on 11/06/23 at 08:32 AM Resident #52 was lying in bed on her right side with no shirt on and a sheet covering her from the waist down. She had a gastrostomy tube sticking out of the left side of her abdomen. During an observation and interview on 11/06/23 at 01:26 PM Resident #52 was sitting in her w/c watching TV in her room. She stated she did not know what her gastrostomy tube was for. When asked if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 5 of 28 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 11/20/2023 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she had trouble eating or drinking, she replied, Look at me, do I look like I have trouble eating or drinking? There were stitches around the opening for the gastrostomy tube in Resident #52's abdomen. The opening appeared to be clean, dry, intact, and free from infection. During an interview on 11/06/23 at 02:25 PM DON stated she would have to look up why Resident #52 had a gastrostomy tube. During an interview on 11/06/23 at 02:48 PM DON stated Resident #52's gastronomy tube was put in by the acute care hospital she was transferred from due to her being intubated for acute respiratory failure. During an interview on 11/07/23 at 02:52 PM ADM was asked for a baseline care plan policy. During an interview on 11/07/23 at 03:07 PM DON was asked for a baseline care plan policy. During an interview on 11/08/23 at 10:15 AM DON stated a possible negative outcome of Resident #52's gastrostomy tube not being on her baseline care plan was, It has to be flushed. Anything like that, added to the body, that is not naturally occurring can be a high risk of infection. It needs to be kept clean. During an interview on 11/08/23 at 10:24 AM MDS LVN stated she was responsible for entering baseline care plans into the EHR. She stated a gastrostomy tube should be on a baseline care plan if they use it for feeding, definitely, and even if they are eating by mouth, it should be on there. She said a possible negative outcome of Resident #52's gastrostomy tube not being on her baseline care plan was potential for infection. During an interview on 11/08/23 at 10:27 AM ADM stated there could be a negative outcome if a gastrostomy tube was not on a baseline care plan. She said, I am not clinical at all, but I believe it has to be checked and flushed and look at the site. Cleanliness. During an interview on 11/08/23 at 11:05 AM ADM and DON were asked for a baseline care plan policy. They stated they thought they had already provided said policy. Surveyor explained they had provided a comprehensive care plan policy but not a baseline care plan policy. Facility did not provide a baseline care plan policy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 6 of 28 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 11/20/2023 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - 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 with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection, and prevent new ulcers from developing for 1 of 18 residents (Resident # 4) reviewed for pressure ulcers. Residents Affected - Some The facility failed to prevent the development of one facility-acquired Stage III pressure injury for Resident #4. This failure could place residents at risk for worsening of an ulcer, infection, and a decreased quality of life. Findings included: Record review of Resident #4's face sheet reflected a [AGE] year-old female who was re-admitted to the facility on [DATE]. Resident #4 was admitted with diagnoses which included: Other Cerebral Palsy Other Acute Kidney Failure Type 2 Diabetes Mellitus Without Complications Other Seizures Mild Intellectual Disabilities Mild Protein-Calorie Malnutrition Morbid (Severe) Obesity Due to Excess Calories Schizoaffective Disorder, Depressive Type (a mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania). Other Neuromuscular Dysfunction of Bladder (The name given to several urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problems). Other Recurrent Depressive Disorders Diabetes Insipidus (a rare disorder that causes the body to make too much urine-up to 20 quarts per day). Other Specified Anxiety Disorders Colostomy Status (an operation that creates an opening for the colon, or large intestine, through the abdomen). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 7 of 28 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 11/20/2023 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 0686 Gastro-Esophageal Reflux Disease Without Esophagitis Level of Harm - Actual harm Intermittent Explosive Disorder Residents Affected - Some Essential (Primary) Hypertension Malignant Neoplasm Of Colon, Unspecified Cyst Of Bartholin's Gland (The Bartholin's glands are located on each side of the vaginal opening. They secrete fluid that helps lubricate the vagina. Sometimes the ducts of these glands become obstructed and fluid backs up, forming a cyst. Personal History Of Urinary (Tract) Infections Record review of Resident #4's Quarterly Care Plan, dated 9/30/23, indicated Resident #4 had potential for pressure ulcer development related to self-care deficit. Resident #4 did at times refuse to be repositioned while in her bed and was prone to redness in her skin folds. The goal for Resident #4 was to be free of preventable skin breakdown through the next review date of 12/24/23. The intervention for Resident #4 was to be monitored and reported to physician, any changes in skin condition, status, appearance, color, and impairment. Pressure relieving devices were to be used as ordered, repositioning as allowed and weekly skin checks for redness, circulatory problems, pressure sores, open areas, and other changes to skin integrity were to be reported to the physician. Record Review of Resident #4's skin assessment, dated 7/20/23, reflected a sacral pressure ulcer (the bottom of the spine that lies between the fifth segment of the lumbar spine (L5) and the coccyx (tailbone)) had been discovered and was categorized as an in-house acquired with no staging, undermining, tunneling or Sinus Tract (abscess) identified. There was no exudate (fluid that leaks out of blood vessels into surrounding tissues) and the skin was red, but cool to the touch. Record review of Resident #4's physician order, dated 7/20/23, was daily cleansing with Dakins Solution (sodium hypochlorite (0.4% to 0.5%) and boric acid (4%) diluted in water) and packing with alginate (a naturally occurring anionic polymer obtained from brown seaweed). The preventative intervention was pressure redistribution mattress, specific turning/repositioning program, positioning devices and heel boots. Resident #4 would be turned every 2 hours for repositioning; position would be documented every 2 hours and resident would be up in her Geri Chair 3 times per day to assist with wound healing and offload of pressure. Record review of Resident #4's clinical record reflected there was no additional documentation of Resident #4's sacral ulcer until 8/18/23. Record review of Resident #4's progress notes, dated 08/18/2023 at 5:39 PM, reflected Resident #4 received a bed bath but refused repositioning afterward. Wound care was provided, and education was given on the importance of repositioning. There was no documentation that Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 08/19/2023 at 2:52 PM, reflected Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 8 of 28 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 11/20/2023 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 0686 refused repositioning and wound care was completed. There was no documentation that Resident #4 refused to get out of bed. Level of Harm - Actual harm Record review of Resident #4's progress notes, dated 08/20/2023 at 6:22 PM, reflected Residents Affected - Some Resident #4's wound care was completed, and the facility wound care nurse was notified of copious amounts of drainage. Resident #4 refused to be repositioned. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 08/23/2023 at 3:55 PM, reflected Resident #4's wound care was completed. Resident #4's mattress was exchanged for a new air mattress. Resident #4 was given education on the importance of repositioning. Resident #4 refused to reposition. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 08/24/2023 at 12:51 PM, reflected Resident #4 received a bed bath and wound care was completed. Resident #4 continued to refuse repositioning. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 08/28/2023 at 1:58 PM reflected Resident #4 was seen by the Wound Care Nurse Practitioner. No new wound care order was completed. Resident #4 refused to reposition. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress note, dated 09/03/2023 at 5:06 PM, reflected Resident #4 received a bed bath PRN related to colostomy bag mess. Dressing was changed to buttocks. Resident #4 continued to decline to turn and reposition. Education was provided. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 09/07/2023 at 10:43 AM, reflected Resident #4 had a dressing change to the coccyx due to the dressing being soiled with drainage. Resident #4 continued to decline to participate in turning and repositioning. Education was provided on the importance of turning and repositioning and the resident continued to decline. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 09/13/2023 at 03:10 AM, reflected the wound care services' Nurse Practitioner performed rounds on Resident #4 to assess a PU to the sacrum which measured 5.5 centimeters by 2.3 centimeters by 1.3 centimeters. The ulcer was cleansed with wound cleanser and patted dry with 4X4 gauze pad. Alginate with silver was applied to the wound bed and covered with foam dressing. Continued heavy drainage. The NP obtained a wound culture. Education was provided to the resident regarding turning and repositioning. Resident #4 voiced understanding but continued with non-compliance. No other concern; continue to monitor. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 09/25/2023, reflected Resident #4 continued antibiotic for wound infection. The resident's central dressing was CDI. Resident continued to refuse to turn and reposition. Education was provided, but the resident continued to decline. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's wound report, dated 9/28/23, reflected a facility acquired sacral ulcer with a length of 5.5 centimeters, width of 4 centimeters and depth of 2 centimeters. There was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 9 of 28 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 11/20/2023 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 0686 moderate drainage which was purulent (discharging pus) with a foul smell. The treatment was cleansing with Dakins solution and treating with alginate. Level of Harm - Actual harm Residents Affected - Some Record review of Resident #4's skin assessment, dated 10/9/23, categorized the sacral ulcer for Resident #4 as in-house acquired, Stage III, (full thickness tissue loss) with a length of 5.5 centimeters, width of 4 centimeters and depth of 2 centimeters. There was no tunneling, undermining or Sinus Tract identified. The exudate was moderate and purulent with a thick, tenacious (clinging) consistency and foul odor. The wound color was red with defined margins and weeping surrounding skin. Record review of Resident #4's progress notes, dated 10/09/2023 reflected Resident #4's IV to right side of neck Central line was intact with no signs or symptoms of infection noted, no redness, no swelling, and no pain. Wound care was performed with a dressing change. The NP rounded and no new orders were received. Resident #4 continued to refuse to turn or reposition. Resident #4 received education on the importance of turning and repositioning, but the resident continued to decline. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's physician order, dated 10/9/23, reflected cleansing with Dakins Solution 25% strength, patting dry with 4x4 gauze, packing with alginate, and covering with dry dressing. The preventative intervention was pressure redistribution mattress, specific turning/repositioning program, positioning devices and heel boots. The wound was determined to be infected, and Resident #4 was placed on contact precautions with antibiotic therapy. Record review of Resident #4's progress notes, dated 10/14/2023 at 09:32AM, reflected Resident #4 was tolerating antibiotics, central line was clean/dry/intact. No signs or symptoms of infection, swelling, redness, no complaints of pain or discomfort. Central line was patent. Resident #4 continued to refuse turning and repositioning. Education was provided and the resident continued to decline. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 10/15/2023 at 09:34 AM, reflected Resident #4 was not having any adverse reactions to the antibiotics. Central line to right side of the neck was clean/dry/intact. No signs or symptoms of infection, redness, swelling, no complaints of pain or discomfort. Central line was patent. Resident #4 continued to refuse to turn or reposition. Education was provided, but resident declined. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's skin assessment, dated 10/16/23, categorized the sacral ulcer as in-house acquired, Stage III, with a length of 5.5 centimeters, width of 4.0 centimeters and depth of 1.5 centimeters. There was no tunneling, undermining or Sinus Tract identified. The exudate was moderate and serosanguineous (producing serum with small amounts of blood present) with a thin, watery consistency and no odor present. The wound color was pink and red and was erythematic (abnormal redness of the skin due to the accumulation of blood in dilated capillaries). The wound margins were undefined. Record review of Resident #4's physician order, dated 10/16/23, reflected cleansing with Dakins Solution, packing with collagen particles and alginate with silver rope and covering with a silicone foam dressing. The preventative intervention was pressure redistribution mattress, nutritional supplements, vitamin supplements, positioning devices and protein supplements. Record review of Resident #4's progress notes, dated 10/16/2023 at 10:36AM, reflected Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 10 of 28 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 11/20/2023 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 0686 Level of Harm - Actual harm Residents Affected - Some was receiving Cefepime HCL intravenous solution 2gm/100ml. No adverse reactions noted, wound care completed by wound nurse. Continued to encourage resident to turn. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's skin assessment, dated 10/23/23, categorized the sacral ulcer as in-house acquired, Stage III, with a length of 5.0 centimeters, width of 3.0 centimeters and depth of 2.0 centimeters. There was no tunneling, undermining or Sinus Tract identified. The exudate was moderate and serosanguineous with a thin, watery consistency and no odor present. The wound color was pink and black and was erythematic. The wound margins were undefined. Record review of Resident #4's physician order, dated 10/23/23, reflected cleansing with Dakins Solution, packing with collagen particles and alginate with silver rope and covering with a silicone foam dressing. The preventative intervention was pressure redistribution mattress, vitamin supplements and protein supplements. Record review of Resident #4's progress notes, dated 10/23/23 at 3:35 PM, indicated reflected Resident #4 did not want to be repositioned at that time. Resident #4 also declined being turned at 5:14 PM and 8:50 PM. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 10/24/23 at 12:27 AM, indicated Resident #4 did not want to be turned at that time. Resident #4 cooperated with repositioning at 3:00 AM and 12:50 PM. At 3:17 PM, Resident #4 was given a bed bath and did not want to be repositioned afterward. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 10/25/23 at 5:45AM, indicated Resident #4 did not want to be turned at that time. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 10/26/23 at 10:25PM, indicated Resident #4 was comfortable and lying on her left side. Record review of Resident #4's progress notes, dated 10/27/23, indicated Resident #4 did not want to be repositioned at 8:50 AM, 12:57 PM, 5:35 PM, 9:17 PM and 11:03 PM. There was no documentation Resident #4 refused to get out of bed. Record review of Resident #4's progress notes, dated 10/28/23, indicated Resident #4 did not want to be repositioned at 5:02 AM and 1:16 PM. There was no documentation Resident #4 refused to get out of bed. Record review of skin assessment for Resident #4, dated 11/1/23, categorized the sacral ulcer as in-house acquired, Stage III, with a length of 5.5 centimeters, width of 5.0 centimeters and depth of 2.0 centimeters. There was no tunneling, undermining or Sinus Tract identified. The exudate was moderate and serosanguineous with a thin, watery consistency and foul odor present. The wound color was red and black and was erythematic. The wound margins were undefined. Record review of Resident #4's physician order, dated 11/1/23, reflected cleansing with Dakins Solution, packing with collagen particles and alginate with silver rope, covering with silicone foam dressing. The preventative intervention was pressure redistribution mattress, nutritional supplements, and vitamin supplements. The dietician was notified of the need for additional nutritional (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 11 of 28 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 11/20/2023 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 0686 assessment. Level of Harm - Actual harm Record review of Resident #4's skin assessment, dated 11/8/23, categorized the sacral ulcer as in-house acquired, Stage III, with a length of 5.5 centimeters, width of 3.0 centimeters and depth of 2.0 centimeters. There was no tunneling, undermining or Sinus Tract identified. The exudate was moderate and serosanguineous with a thin, watery consistency and foul odor present. The wound color was red and black and was erythematic. Residents Affected - Some Record review of Resident #4's physician order, dated 11/8/23, reflected cleansing with Dakins Solution, packing with collagen particles and alginate with silver rope, covering with a silicone foam dressing. An interview with CNA I on 11/7/23 at 1:14 PM revealed there was no Geri Chair big enough for Resident #4 on Unit C-1S, nor was there a Hoyer Lift. Equipment was shared by Unit C-1S and Unit C-1N. CNA stated that Resident #4 is very large and cannot transfer herself, so she cannot get out of bed on her own. CNA I stated there was not enough room on Unit C-1S to store a Hoyer Lift or Geri Chair. She stated she would ask the therapy department for help in finding equipment. An observation and interview on 11/7/23 at 1:18 PM of Resident #4's room revealed a manual bariatric wheelchair pushed against the wall of her room. Resident #4 stated the staff didn't like to get her out of bed and into her chair, because she was too hard to lift. Resident #4 stated staff were supposed to get her out of bed three times a day and were to reposition her every 2 hours, bet this was not being done. An observation and interview on 11/7/23 at 1:42 PM revealed Resident #4 in the same position in bed, as earlier today. She stated she had not gotten out of bed because staff had not come to reposition her or get her out of bed. An interview with LVN H on 11/7/23 at 2:07 PM revealed equipment was shared by Unit C-1S and Unit C-1N and the Hoyer Lift stayed on the North Unit because they had more space. LVN H stated she did not know of a Geri Chair large enough for Resident #4, that was not already being used by another resident. CNA I stated she told me yesterday she would ask the therapy department if they had equipment that was not being used. LVN H stated Resident #4 didn't like to get up from her bed. CNA I stated she had not gotten Resident #4 out of bed today, due to lack of equipment. An interview with Resident #4 on 11/7/23 at 2:29 PM revealed she wanted to get out of bed every day and would go to an activity if she could get up. An interview with the DON on 11/8/23 at 2:35 PM revealed the negative outcome of not following a doctor's order to get a resident up with the Hoyer lift and into a Geri Chair x 3/day, would result in the resident getting stiff joints, which reduces ADLs. The resident would develop a pressure ulcer in the places that touched the bed all day. The DON stated Resident #4 frequently refused to get out of bed and when this happened, the staff did not make her reposition or get out of bed, due to her size. DON was asked for documentation of the resident's refusal to get out of bed, but no documentation was produced. An interview with CNA J on 11/16/23 at 3:24 PM revealed Resident #4 refused to get out of bed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 12 of 28 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 11/20/2023 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 0686 Level of Harm - Actual harm frequently. She thought documentation was done on the resident's screen (on computer) under locomotion but was not positive. She would have to ask a nurse where the documentation was supposed to be done. CNA J stated she did not always document. CNA J stated Resident #4 liked her bed baths on Tuesday, Thursday and Saturday and was cooperative. Residents Affected - Some An interview with LVN L on 11/16/23 at 3:28 PM revealed nursing documented any refusal of a resident refusing to get out of bed. She stated she should have documented on Resident #4 since she got up so infrequently, but she was used to this behavior, so it was not documented. LVN L stated Resident #4 was comfortable in a chair for about 30 minutes. Resident #4 wanted to be in bed all the time. Resident #4 was cooperative with bathing. An interview with CNA K on 11/16/23 at 3:35 PM revealed Resident #4 frequently refused to be repositioned. It was hard to get Resident #4 up due to the fact she was a 2-person assist and had to use a Hoyer lift. When they were busy, it was hard to get 2 people to help with a Hoyer lift, because some were helping other residents or taking residents outside to smoke. CNA K stated there was a place to document refusal by Resident #4 in the resident's chart, but she didn't document due to Resident #4 getting up so infrequently. An observation and interview on 11/16/23 at 3:45 PM revealed Resident #4 was sitting in a Geri chair watching television by the nurse's station. She stated her bottom hurt if she sat in the chair for too long. Resident #4 stated it was nice to be in up out of bed and in the chair, today. She had participated in an activity, which she had enjoyed. This occurred after surveyor intervention on behalf of Resident #1. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 13 of 28 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 11/20/2023 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review the facility failed to post the following information on a daily basis: facility name, the current date, the total number and the actual hours worked by the following categories of licensed and unlicensed nursing staff directly responsible for resident care per shift--registered nurses, licensed practical nurses, or licensed vocational nurses (as defined under state law), certified nurse aides-and resident census for one of one facility reviewed for posted nurse staffing information. Residents Affected - Many The facility failed to post nurse staffing data as required in that it did not include the current date on posting, posting was dated 11/06/2023. This failure could place residents and visitors at risk of not being informed regarding the current day's nurse staffing levels. Findings included: During an observation on 11/08/23 at 10:24 AM the nurse staffing posting hanging on the wall behind the front desk in the entry way of the facility was not dated 11/08/2023, it was dated 11/06/2023. During an interview on 11/08/2023 at 10:27 AM the front desk receptionist stated that the staffing posting was always a day behind. Observation on 11/08/2023 at 10:25 AM revealed staffing posting, dated 11/06/2023. Interview on 11/08/23 at 10:47 AM with DON, stated that the schedule should be updated on a daily basis. There was also a schedule next to the time clock so that staff can see the schedule when they clock in. Observation of 11/08/23 at 10:50 AM revealed an updated schedule with a date of 11/07/2023. Interview on 11/08/23 at 10:59 AM with Front desk receptionist, stated what a negative outcome would be, They wouldn't know how many people were here in the facility. Interview on 11/08/23 at 11:01 AM with ADM stated that there was no negative outcome for the posting not being updated daily. The actual schedule that the staff use was posted at the time clock. Interview on 11/08/23 at 11:03 AM with DON stated that the document that was being used to post the staffing was new for the staff responsible for updating it. The posting has the previous day due to the last 24hrs staffing and census being the information that was posted. Record review of the facility policy titled, BIPA Staffing Posting Requirement, not dated, states the following: Policy: It is policy of the facility, in cooperation with Medicare/Medicaid Services, (CMS), to comply with the requirement of daily posting of nursing staff in the facility. Procedure: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 14 of 28 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 11/20/2023 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 0732 1.) Level of Harm - Potential for minimal harm SNFs and NFs must post daily, at the beginning of each shift, the facility specific shift schedule for the 24 hour period, the number and category of nursing staff employed or contracted by the facility for each 24 hour period, as well as the total number of hours worked by licensed and licensed nursing staff who are directly responsible for resident care. Residents Affected - Many 2.) Direct Care Staff is interpreted as: a) Registered Nurses-RNs b) Licensed Practical Nurses-LPNs c) Licensed Vocational Nurses-LVNs d) Qualified Medication Aides-QMAs-may be counted and CNAs e) Certified Nursing Assistants-CNAs 3.) Other required posted data includes: a) Facility Name b) Current Date c) Current Census 4.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 15 of 28 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 11/20/2023 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 0732 Posting Requirements: Level of Harm - Potential for minimal harm a) Data must be posted in a clear, readable format with a font of 14 or above Residents Affected - Many b) Data must be in a conspicuous prominent location; accessible to resident/visitors c) Data must be updated as changes arise-Example-a call in that changes the staffing number reported on the BIPA form 5.) Public Access: a) Data must be available for public access for review in certain situations NOTE: CMS does not require that the daily census (calculated at midnight the previous night), be posted as part of this BIPA rule. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 16 of 28 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 11/20/2023 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 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 drugs and biologicals were stored and labeled in accordance with currently accepted professional principles to include the appropriate accessory and cautionary instructions, and the expiration date when applicable on 2 of 3 medication carts (1BEast and 1BWest medication carts) and 1 of 3 (1BEast/1BWest Medication room) medication rooms in that: 1. 3 loose pills were found in the 1BEast medication cart. 2. 16 loose pills were found in the 1BWest medication cart. 3. Refrigerator in medication room, shared by 1BWest and 1Beast, had a temperature at 29 degrees. 4. 5 Medications discovered in E-kit for 1BEast and 1BWest were expired. These failures could result in residents not receiving an accurate dose of medication as well as not being maintained at their best therapeutic level. Findings include: Observation on 11/06/23 at 10:55 AM of 1BEast Med cart with LVN F, revealed there were 3 loose medications in this cart. LVN F was only able to identify 1 pill, LVN F stated that it was Zoloft. Other 2 pills were discarded in sharps container before identified. Observation on 11/06/23 at 11:06 AM of 1BWest med cart with LVN G, revealed there were 16 loose medications in this cart. LVN G poured water onto medications to dissolve them. Pills were not identified before destroyed by LVN G. Observation and interview on 11/07/23 at 09:03 AM of medication room for 1BEast and 1BWest. There was no sink readily available for hand washing in this medication room. LVN F was asked where the closest handwashing sink would be, she stated Way over there!. Refrigerator was at a temp of 29 degrees. Medications that were in the fridge were Humira, Novolin, Novolog, Ozempic, for different residents on both units. LVN F was asked how often the medications were destroyed and she stated that would be up to ADON. Interview on 11/07/23 at 09:16 AM with LVN F to see who she reports the fridge being out of temp range, LVN F stated that it would be reported to ADON DON, and maintenance. LVN F stated that it would be checked on the night shift and I wouldn't know anything about it, but I would let the ADON, DON, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 17 of 28 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 11/20/2023 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 0761 and maintenance know that the fridge is not at the correct temperature. Level of Harm - Minimal harm or potential for actual harm Interview on 11/07/23 at 09:18 AM with ADON stated that If the fridge is out of range for 1 day that is ok, we would just need to adjust the temperature. But the meds would be ok. ADON stated that one of the fridges upstairs was replaced before due to it running to cold, and we had to throw out a lot of vancomycin. Residents Affected - Some Observation on 11/07/23 at 09:25 AM of the E-kit revealed it was opened by ADON and DON. Observation revealed that the following medications were expired: Amlodipine tab 2.5mg expired on 09/12/2023 Amiodarone tab 200mg expired 09/12/2023 Acetaminophen w/Cod tab #3 Expired 09/05/2023 Alprazolam tab 0.25mg expired 09/13/2023 Clonazepam tab 0.5mg expired on 09/19/2023 Interview on 11/07/2023 at 10:10 AM with DON, DON was asked when medication was destroyed, DON stated once a month. Interview on 11/07/23 at 10:13 AM with DON, DON stated that a negative outcome of a fridge being out of a safe temperature would be that the medication would be damaged, and no damaged medication should ever be given to a resident. DON stated that a new temp and fridge will be obtained to prevent this again. Interview on 11/07/23 at 01:18 PM with DON, she stated that a negative outcome for giving an expired medication would be that the potency would not be what it should and depending on the medication the resident would not receive the accurate dose. Record review of facility policy titled, Medication Storage, dated 07/23/2019, states the following, but not limited to: Policy 4.1 General Guidelines for medication Storage Procedure . .9. medication requiring refrigeration or temperatures between 2 degrees C (36 degrees F) and 8degrees C (46 degrees F) are kept in a secured refrigerator with a thermometer to allow temperature monitoring. .11. Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled or without secure closures are immediately removed from stock, disposed of according to procedures for medication destruction, and reordered from the Pharmacy, if replacements are needed. Record review of facility policy titled, Medication Monitoring, dated 06/21/2023, states the following, but not limited to: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 18 of 28 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 11/20/2023 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 0761 Policy 8.4 Medication Station Inspection Level of Harm - Minimal harm or potential for actual harm Policy Residents Affected - Some The consultant Pharmacy or pharmacy representative performs periodic nursing station inspections to evaluate appropriate storage of medication per facility agreement. Procedure 1. The Consultant Pharmacist/pharmacy representative is responsible for the following: a. Checking the emergency medication supply at least quarterly or more frequently as required by State regulations to ascertain that is properly sealed and stored and that the contents are not outdated. 2. The facility is responsible for: a. Removing discontinued and expired drugs and maintaining the medication care and medication room in a clean and sanitary fashion on a daily basis FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 19 of 28 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 11/20/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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, distribute, and serve food in accordance with the professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure foods were properly stored, labeled, and dated. 2. The facility failed to ensure general cleanliness was maintained in the kitchen. 3. The facility failed to ensure beard covers were worn. These failures could place residents who ate food served by the kitchen at risk of food-borne illness. Findings include: Observation of the freezer on 11/6/23 @ 8:40 AM revealed the following: 1. (1) box of pancakes, open to air. 2. (1) box of frozen sugar cookie dough, open to air. 3. (1) baggie of biscuits, not in original package, no label or date. 4. (1) box of dinner rolls, open to air. 5. Several baggies of meat, no label or date, not in original box. 6. (1) bag of biscuits, no label or date, not in original box. Observation of the kitchen food prep area and the Traulsen Cooler in the kitchen prep area on 11/6/23 at 8:45 am revealed the following: 1. 1 baggie of burritos open to air, no label, not in original package. 2. 1 baggie of corn dogs open to air, no label, not in original package. 3. 4 boxes of pork egg roles in cooler. Label stated, Keep Frozen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 20 of 28 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 11/20/2023 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 0812 4. 1 ziplock baggie of pastry, no label or date, open to air, not in original package. Level of Harm - Minimal harm or potential for actual harm Observation of the pantry area on 11/6/23 at 8:47 am, revealed food debris and dirt on 4 plastic trays holding packages of gravy mix. Residents Affected - Many Observation of the kitchen food prep area on 11/6/23 at 8:50 am revealed plastic containers of flour, sugar and rice were sticky and grimy to the touch. The container lids had food crumbs on the top and were sticky to the touch. The lids were not secured. Observation on 11/6/23 at 8:55 am revealed [NAME] A was in the kitchen prep area with no beard cover. Observation of the kitchen on 11/6/23 at 9:00 am revealed there was no cleaning schedule posted. In an Observation and an interview on 11/6/23 at 9:30 am, [NAME] A was observed in the kitchen prep area with no beard cover. [NAME] A stated he had just come back to the kitchen from delivering snacks. There was no move to get a beard cover. Observation on 11/6/23 at 11:30 am revealed [NAME] A was in the kitchen prep area preparing food for the noon meal. [NAME] A had no beard cover on. Observation of the pantry area on 11/7/23 at 8:45 AM revealed food debris and dirt on 4 plastic trays holding packages of gravy mix. Observation of the freezer on 11/7/23 at 8:50 AM revealed the following: 1. (1) box of pancakes, open to air. 2. (1) box of frozen sugar cookie dough, open to air. 3. (1) baggie of biscuits, not in original package, no label or date. 4. (1) box of dinner rolls, open to air. 5. Several baggies of meat, no label or date. 6. (1) bag of biscuits, no label or date, not in original box. Observation of the kitchen food prep area and the refrigerator on 11/7/23 at 8:55 am revealed the following: 1. 1 baggie of burritos open to air, no label, not in original package. 2. 1 baggie of corn dogs open to air, no label, not in original package. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 21 of 28 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 11/20/2023 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 0812 3. 4 boxes of pork egg rolls in cooler. Label stated, Keep Frozen. Level of Harm - Minimal harm or potential for actual harm 4. 1 ziplock baggie of pastry, no label or date, open to air, not in original package. Residents Affected - Many Observation of the kitchen food prep area on 11/7/23 at 9:00 am revealed plastic containers of flour, sugar and rice were sticky and grimy to the touch. The container lids had food crumbs on the top and were sticky to the touch. The lids were not secured. Observation on 11/7/23 at 9:05 am revealed [NAME] A was washing dishes in the kitchen dishwashing area with no beard cover. Observation and interview on 11/7/23 at 9:45 am revealed [NAME] B was washing dishes in the kitchen dishwashing area with no beard cover. [NAME] B stated he did not know he was supposed to wear a beard cover. Observation on 11/7/23 at 9:50 am revealed there was no cleaning schedule posted. Observation on 11/7/23 at 9:55 am revealed [NAME] A was preparing food in the kitchen with no beard cover. Observation and interview of the kitchen on 11/7/23 at 2:25 pm revealed [NAME] C was in the kitchen putting foods in the cooler and did not have a beard cover. [NAME] C stated he did not know he was supposed to wear a beard cover. In an interview and a walk through with the DM on 11/7/23 at 2:30 pm, the DM stated of the issues with the food grime and crumbs on the containers of sugar rice and flour and the food particles on the trays in the pantry that she is sorry they have missed it and she will get it cleaned. The DM stated she expects all staff to be cleaning daily. The DM stated she has been out of the facility, and it was just missed. The Dietary Manager stated she does not have cleaning schedule sheets and did not know she was to keep them for at least one year. The DM stated she trains the staff on cleaning practices and the labeling and dating of foods. The DM stated she expects all staff to close all packages of food after they use the package. The DM stated the consequences of not labeling and dating foods could cause residents to have food borne illnesses. The DM stated the consequences of not storing food properly would possibly make the residents sick if consumed. She further stated residents could get sick from the food not being covered or refrigerated after being opened. The DM stated she did not have cleaning sheets for review. The DM stated she was not aware male staff with beards were to wear beard covers. The DM stated she did not have any beard covers and will order the beard covers. The DM stated a consequence of not having beards would be hair in the food and on kitchen surfaces. Record Review of the policy dated 3/27/12, titled Dress Code documented: [NAME] guards must be used for employees with facial hair. Record Review of the policy dated 11/2/17, titled Infection Control Guidelines documented: open foods are labeled and dated with content, opened on date and use by date according to guidelines. Opened refrigerated foods will be covered, labeled and dated. Equipment and counters will be cleaned and sanitized after each use. Record Review of the policy dated 3/26/12, titled Dry Food Storage documented: Foods will be stored in a clean, cool, dry area. Opened food items will be stored in clean, dry, sealed containers with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 22 of 28 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 11/20/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm content noted and opened on dates. Foods stored in bins will be clean with tight fitting lids to prevent contamination. Record Review of the policy dated 3/26/12, titled Cold Storage Areas documented: Date label and properly secure all food products. Residents Affected - Many Record Review of the policy dated 3/25/12, titled Cleaning and Sanitation documented: The Food and Nutrition Director will develop, implement and monitor schedules for cleaning, sanitizing and maintenance and keep record for 1year. Cleaning schedules designate cleaning for each position and are posted in an accessible area. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 23 of 28 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 11/20/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain complete, accurate, readily accessible, and systemically organized medical records for 2 (Resident #36 and Resident #180) of 18 residents reviewed for medical records. 1. Resident #180 was admitted to the facility with a catheter and no physician's orders for catheter care. 2. Resident #36 was receiving antipsychotic injections bi-weekly outside of the facility and there was no documentation of said in his EHR. These failures could place residents at risk of not receiving appropriate care through inadequate documentation possibly resulting in deterioration in condition, exacerbation of disease process, overmedication, and increased risk of harm or injury. Findings included: 1. Record review of Resident #180's face sheet dated 11/08/23 revealed a [AGE] year-old male admitted to the facility on [DATE] for hospice respite. He had diagnoses that included, but were not limited to, malignant neoplasm of bladder (bladder cancer), malignant neoplasm of left lung (lung cancer), and cachexia (wasting disease resulting in weight loss, muscle loss, lack of appetite, fatigue, and decreased strength). Record review of Resident #180's MDS tab in his EHR revealed an Entry MDS dated [DATE]. Record review of Resident #180's baseline care plan dated 11/02/23 and completed by SW revealed an initial admission goal of Hospice care will keep comfortable. The baseline care plan also noted Resident #180 had an indwelling catheter. In the section labeled Physician Orders the care plan read, See current MAR and TAR orders .See current Therapy Orders .See current Dietary Orders. Record review on 11/08/23 at 09:41 AM of Resident #180's active orders revealed no order for catheter care. Record review of Resident #180's MAR and TAR report dated 11/08/23 at 10:03:08 AM revealed no mention of catheter care. Record review of Resident #180's progress notes revealed the following nursing note dated 11/01/23 at 10:42 PM: . Patient arrived via EMS on stretcher at 2040 [10:40 PM]. Foley catheter draining blood-tinged urine to gravity. 2. Record review of Resident #36's face sheet dated 11/06/23 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, mild cognitive impairment, paranoid schizophrenia (a mental illness characterized by episodes of psychosis including hallucinations, delusions, and disorganized thinking), and cachexia (wasting disease resulting in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 24 of 28 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 11/20/2023 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 0842 weight loss, muscle loss, lack of appetite, fatigue, and decreased strength). Level of Harm - Minimal harm or potential for actual harm Record review of Resident #36's Quarterly MDS completed on 10/05/23 revealed a BIMS of 11 which indicated moderately impaired cognition. Section N of the MDS revealed no record of Resident #36 receiving antipsychotic medication during the look back period. Section E of the MDS indicated no behaviors were noted for Resident #36 during the look back period. Residents Affected - Few Record review of Resident #36's care plan, completed on 10/27/23 revealed no mention of Resident #36 receiving antipsychotic injections. The care plan contained no mention of Resident #36 having paranoid schizophrenia except for list of diagnoses at the end of the care plan. Record review of Resident #36's Order Summary report revealed no orders for antipsychotic medications. Record review of Resident #36's EHR miscellaneous tab revealed one letter dated 09/29/22 from an outside agency regarding a follow up appointment on 10/07/22 for Resident #36 with a doctor. The letter stated, It is important that you keep this appointment in order to continue your care with TPC. The letter did not specify what the appointment was intended to address. Record review of a fax from the outside agency administering Resident #36's antipsychotic injections provided to surveyor on 11/08/23 revealed Resident #36 received an antipsychotic injection on 10/06/23. The fax further revealed Resident #36 received these injections intramuscularly on a bi-weekly basis. During an observation on 11/06/23 at 08:24 AM Resident #180 was lying in bed. His catheter bag and tubing were on the floor near the foot of his bed. The bag was half full of red tinged liquid and the tubing contained red tinged liquid for the 7-10 inches before the tube entered the bag. During an observation on 11/06/23 at 11:29 AM Resident #180 was lying on his back in bed asleep and his catheter bag was in a privacy sleeve with tubing lying on the floor. During an observation on 11/07/23 at 09:52 AM Resident #180 was lying in bed on his back asleep and his catheter bag was clipped to the end of his bed and in a privacy sleeve. The bottom of the catheter bag and tubing full of red tinged liquid were touching the floor. Interview on 11/07/23 10:47 AM with MDS LVN stated that Resident #36 received an antipsychotic injection every 2 weeks administered by an outside agency. During an observation on 11/07/23 at 10:51 AM Resident #180 was lying in bed on his back asleep and his catheter bag was clipped to the end of his bed and in a privacy sleeve. The bottom of the catheter bag and tubing were touching the floor. Interview on 11/07/23 01:43 PM with MDS LVN stated that outside agency administering Resident #36's antipsychotic injections was having issues with their system. During an observation on 11/08/23 at 10:04 AM Resident #180 was lying in bed asleep on his back with the head and knee portion of the bed slightly raised. His catheter bag and was clipped to the foot of his bed and was not touching the floor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 25 of 28 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 11/20/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 11/08/23 at 10:06 AM RN D stated she knows how often to provide catheter care to Resident #180 because there should be an order in there [gestured to nurse's laptop]. During an interview on 11/08/23 at 10:10 AM RN D stated she does not have orders for catheter care for Resident #180. She further stated that as a nurse it was common sense to her that any resident with a catheter received catheter care once a shift. During an interview on 11/08/23 at 10:14 AM DON stated Resident #180 should have orders for foley cath [catheter] care. She said a possible negative outcome of not having orders in his chart was, He would have an infection. During an interview on 11/08/23 at 10:27 AM ADM was asked for a possible negative outcome of not having orders for catheter care for Resident #180. She stated, If they [nurses] weren't caring for it [catheter] it would be a negative outcome. During an interview on 11/08/23 at 01:24 PM HN was asked why Resident #180 did not have orders for catheter care. She stated, that is on me actually, when he was on hospice at home, he did not have a catheter and during the transfer from emergency room to here, I overlooked that. Interview on 11/08/23 at 02:23 PM the MDS LVN was asked if any information had been received from the outside agency administering Resident #36's antipsychotic injections. MDS LVN stated that the computer system over at the outside agency was hacked and she had not received any further information. During an interview on 11/08/23 at 03:45 PM MDS LVN stated Resident #36 had been receiving bi-weekly antipsychotic injections prior to his admission to the facility and the treatment was a continuation of care. Record review of a facility policy titled, Medical Records and dated 08/10/2016 revealed no information regarding accuracy and completeness of medical records. The policy did reveal the following: .The 'clinical record' will be defined as the collection of documentation created or data captured in the process of providing care and health services to residents. The whole or any part of the clinical record is maintained within the facility . Record review of a facility policy titled Physician Orders-(Following Physician Orders) revealed in part: . It is the policy of the facility to follow the orders of the physician. At the time of admission the facility must have physician orders for the resident's immediate care. The facility will have orders to provide essential care to the resident, consistent with the resident's mental and physical status upon admission. The facility must have orders from the physician upon admission for: . Routine care to maintain or improve the resident's functional abilities until staff can conduct a comprehensive assessment . Orders that accompany the resident on admission will be clarified by the physician through action of the nurse who will contact the physician for clarification upon the resident's admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 26 of 28 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 11/20/2023 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 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 programs designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #180) of 18 residents reviewed for infection control in that: Residents Affected - Few Resident #180's catheter bag and tubing were allowed to rest on the floor of his room. This failure could place residents at risk of infection. Findings included: Record review of Resident #180's face sheet dated 11/08/23 revealed a [AGE] year-old male admitted to the facility on [DATE] for hospice respite. He had diagnoses that included, but were not limited to, malignant neoplasm of bladder (bladder cancer), malignant neoplasm of left lung (lung cancer), and cachexia (wasting disease resulting in weight loss, muscle loss, lack of appetite, fatigue, and decreased strength). Record review of Resident #180's MDS tab in his EHR revealed an Entry MDS dated [DATE]. Record review of Resident #180's baseline care plan dated 11/02/23 and completed by SW revealed an initial admission goal of Hospice care will keep comfortable. The baseline care plan also noted Resident #180 had an indwelling catheter. Record review of Resident #180's progress notes revealed the following nursing note dated 11/01/23 at 10:42 PM: Note Text: Patient arrived via EMS on stretcher at 2040 [10:40 PM]. Foley catheter draining blood tinged urine to gravity. During an observation and interview on 11/06/23 at 08:24 AM Resident #180 was lying in bed with the head and knee section of the bed slightly raised. His catheter bag and tubing were lying on the floor near the foot of his bed. The catheter bag and tubing were on the door side of Resident #180's bed and in full view from the hall outside his open door. The bag was half full of red tinged liquid and the tubing contained red tinged liquid for the 7-10 inches before the tube entered the bag. Resident #180 attempted to turn his head toward surveyor but did not seem able to respond to interview questions. During an observation on 11/06/23 at 11:29 AM Resident #180 was lying on his back in bed asleep. His catheter bag was in a privacy sleeve and the bottom of the catheter bag and tubing for the catheter were lying on the floor. During an interview on 11/07/23 at 09:22 AM RN D stated a possible negative outcome of having Resident#180's catheter bag and tubing touching the floor was an infection control issue. During an observation on 11/07/23 at 09:52 AM Resident was lying in bed on his back asleep and his catheter bag was clipped to the end of his bed and in a privacy sleeve. The bottom of the catheter (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 27 of 28 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 11/20/2023 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 0880 bag and tubing full of red tinged liquid were touching the floor. Level of Harm - Minimal harm or potential for actual harm During an interview on 11/07/23 at 10:13 AM DON stated a possible negative outcome of Resident #180's catheter bag and tubing touching the floor was, bag should never be on the floor. Tubing should never be on the floor. That is a risk of infection and back up urine into the patient's bladder. Residents Affected - Few During an observation on 11/07/23 at 10:51 AM Resident #180 was lying in bed on his back asleep and his catheter bag was clipped to the end of his bed and in a privacy sleeve. The bottom of the catheter bag and tubing were touching the floor. During an interview on 11/07/23 at 02:52 AM ADM stated a possible negative outcome of Resident #180's catheter bag and tubing touching the floor was, Infection, damage. Record review of an undated facility policy titled Cleaning and Disinfection of Environmental Surfaces revealed in part: . The following categories are used to distinguish the levels of sterilization/disinfection necessary for items used in resident care and those in the resident's environment: a. Critical items consist of items that carry a high risk of infection if contaminated with any microorganism. Objects that enter sterile tissue (e.g., urinary catheters) . are considered critical items and must be sterile. c. Non-critical items are those that come in contact with intact skin but not mucous membranes. Non-critical environmental surfaces include . floors. Record review of facility policy titled, Catheter (Indwelling), Insertion and Removal of (Female and Male) and dated 2006 revealed in part: . 14. Secure urinary drainage bag below level of the bladder AND KEEP OFF THE FLOOR AT ALL TIMES. Coil extra tubing and secure. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455675 If continuation sheet Page 28 of 28