Inspection·July 26, 2023

F 0550 entered without asking resident permission to enter. Level of Harm - Potential for minimal harm During an interview on 07/26/2023 at 8:02 am, Resident #51 stated that nurses knocked on the door and say hello but never ask permission prior to entering the room. Residents Affected - Many Resident #103 Review of Resident #103 ' s patient profile revealed Resident #103 was [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis of fracture of left ulna (fracture of left upper arm). Review of Resident #103 ' s admission assessment dated [DATE] revealed BIMS of 14, indicating resident was cognitively intact. During an observation on 07/26/2023 at 8:58 am, LVN-B entered Resident #103 ' s room without asking permission prior to entering to administer medications. During an interview on 07/26/2023 at 3:40 pm, DON stated that facility staff were trained in the acronym of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You). Staff are not trained to ask permission prior to entering resident ' s room. The DON also stated the facility did not have a policy or procedure regarding asking permission prior to entering a resident ' s room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 2 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 0577 Allow residents to easily view the nursing home's survey results and communicate with advocate agencies. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to post in a place readily accessible to residents, and family members and legal representative of residents, the results of the most recent survey of the facility reviewed for resident rights. Residents Affected - Many The facility failed to ensure the most recent survey results was posted for residents, family members, and visitors to review. The failure placed residents and their family members and representatives at risk for violation of the right to review the findings from State surveys and investigations conducted in the facility without asking to review the reports. Findings included: During an initial observation on 07/25/2023 at 7:45 am, the last survey results could not be located. Review of facility's survey history revealed last re-certification survey occurred on 09/18/2019. During an interview on 07/26/2023 at 3:45 pm, the DON stated she was not aware survey results had to be posted. DON stated that the facility followed required postings from https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/regulatory-services-facility Review of facility provided document titled Required Postings | Texas Health and Human Services dated 06/15/23 revealed F577 - Most Recent Survey/Inspection Results and Notice of Availability of Survey/Inspection Results 42 CFR Section 483.10(g)(11) - An NF must: Post in a place readily accessible to residents, family members, and legal representatives of residents, the results of the most recent survey of the facility. Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the three preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request. Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. Review of https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/regulatory-services-facility accessed on 07/26/2023 revealed: F577 - Most Recent Survey/Inspection Results and Notice of Availability of Survey/Inspection Results 42 CFR Section 483.10(g)(11) - An NF must: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 3 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 0577 Level of Harm - Potential for minimal harm Residents Affected - Many Post in a place readily accessible to residents, family members, and legal representatives of residents, the results of the most recent survey of the facility. Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the three preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request. Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. Review of website https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/regulatory-services-facility accessed on 07/26/2023 revealed: F577 - Most Recent Survey/Inspection Results and Notice of Availability of Survey/Inspection Results 42 CFR Section 483.10(g)(11) - An NF must: Post in a place readily accessible to residents, family members, and legal representatives of residents, the results of the most recent survey of the facility. Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the three preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request. Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. Review of https://www.hhs.texas.gov/providers/long-term-care-providers/long-term-care-provider-resources/regulatory-services-facility accessed on 07/26/2023 revealed: F577 - Most Recent Survey/Inspection Results and Notice of Availability of Survey/Inspection Results 42 CFR Section 483.10(g)(11) - An NF must: Post in a place readily accessible to residents, family members, and legal representatives of residents, the results of the most recent survey of the facility. Have reports with respect to any surveys, certifications, and complaint investigations made respecting the facility during the three preceding years, and any plan of correction in effect with respect to the facility, available for any individual to review upon request. Post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 4 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 - Many 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 interview and record review, the facility failed to develop a baseline care plan with necessary information within 48 hours of the resident ' s admission for 3 of 3 residents (Resident #101, Resident #51, Resident #103) reviewed for baseline care plans. The facility failed to include physician orders for medications and diets in Resident #101, Resident #51, and Resident #103 ' s baseline care plan. This failure placed residents at risk of not receiving continuity of care and communication among nursing staff and residents as well as increased risk of resident safety and safeguard against adverse events that are most likely to occur after admission. Findings included: Resident #101 Review of Resident #101 ' s patient profile revealed Resident #101 was [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis of right hip fracture. Review of Resident #101 ' s admission assessment dated [DATE] revealed BIMS of 15, indicating resident was cognitively intact. Review of Resident #101 ' s physician orders dated 07/19/2023 revealed resident was prescribed Aspirin 325mg two times per day with breakfast and supper, atorvastatin 40mg at bedtime, levothyroxine 137mg before breakfast, multivitamin 1 tablet daily, Prednisolone ophthalmic drops four times per day to right eye, paroxetine 20mg daily, MiraLAX 1 packet daily, as needed sliding scale insulin for blood glucose above 200, 1800 ADA Carbohydrate Control diet, and Glucerna Vanilla shakes twice a day. Review of Resident #101 ' s baseline care plan dated 07/20/2023 revealed no evidence of focus, objectives or interventions for Aspirin 325mg two times per day with breakfast and supper, atorvastatin 40mg at bedtime, levothyroxine 137mg before breakfast, multivitamin 1 tablet daily, Prednisolone ophthalmic drops four times per day to right eye, paroxetine 20mg daily, MiraLAX 1 packet daily, as needed sliding scale insulin for blood glucose above 200, 1800 ADA Carbohydrate Control diet, and Glucerna Vanilla shakes twice a day. During an interview on 07/25/2023 at 10:05 am, Resident #101 stated she did not remember participating in care plan meetings. Resident #51 Review of Resident #51 ' s patient profile revealed Resident #51 was [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis of [NAME] fracture of proximal end of left tibia (fracture left lower leg). Review of Resident #51 ' s admission assessment dated [DATE] revealed BIMS of 13, indicating resident was cognitively intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 5 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 - Many Review of Resident #51 ' s physician orders dated 07/18/2023 revealed resident was prescribed ascorbic acid 200mg daily, Aspirin 81mg 2 times per day with meals, furosemide 40mg daily, losartan 25mg daily, Multivitamin Vitamin B Complex with C and Folic Acid daily, MiraLAX 1 packet daily, heel protectors, and Ensure Enlive Shakes two times per day. Review of Resident #51 ' s baseline care plan dated 07/19/2023 revealed no evidence of focus, objectives or interventions for ascorbic acid 200mg daily, Aspirin 81mg 2 times per day with meals, furosemide 40mg daily, losartan 25mg daily, Multivitamin Vitamin B Complex with C and Folic Acid daily, MiraLAX 1 packet daily, heel protectors, and Ensure Enlive Shakes two times per day. During an interview on 07/25/2023 at 10:14 am, Resident #51 stated not knowing anything about care plans. Resident #103 Review of Resident #103 ' s patient profile revealed Resident #103 was [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis of fracture of left ulna (fracture of left upper arm). Review of Resident #103 ' s admission assessment dated [DATE] revealed BIMS of 14, indicating resident was cognitively intact. Review of Resident #103 ' s physician orders dated 07/21/2023 revealed resident was prescribed amiodarone 100mg daily, apixaban 2.5mg two times per day, celecoxib 200mg two times per day, losartan 100mg daily, metoprolol succinate XL 50mg daily, probenecid 500mg two times per day, rosuvastatin 20mg at bedtime, regular diet, and Ensure Enlive shakes two times a day. Review of Resident #103 ' s baseline care plan dated 07/22/2023 revealed no evidence of focus, objectives or interventions for amiodarone 100mg daily, apixaban 2.5mg two times per day, celecoxib 200mg two times per day, losartan 100mg daily, metoprolol succinate XL 50mg daily, probenecid 500mg two times per day, rosuvastatin 20mg at bedtime, regular diet, and Ensure Enlive shakes two times a day. During an interview on 07/25/2023 at 1:29 pm, Resident #103 stated she had not been informed of care plans. During an interview on 07/26/2023 3:44 pm, the DON stated the facility had no policy or procedures on baseline care plans. She stated that the facility follows Texas Administrative Code for baseline care plans. DON stated that each discipline creates their portion of the baseline care plan upon the resident ' s admission. Review of Texas Administrative Code 554.802(a) https://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&t accessed 07/28/2023 revealed: (a) Baseline care plans. (1) The facility must 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 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 6 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 professional standards of quality care. The baseline care plan must: Level of Harm - Minimal harm or potential for actual harm (A) be developed within 48 hours of a resident's admission; (B) include the minimum healthcare information necessary to properly care for a resident, including: Residents Affected - Many (i) initial goals based on admission orders; (ii) physician orders; (iii) dietary orders; (iv) therapy services; (v) social services; and (vi) PASRR recommendation, if applicable. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 7 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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, interviews, and record reviews, the facility failed to ensure staffing information was posted in a prominent place readily accessible to residents and visitors that included: The facility name, the current census, 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 or Certified nurse aides) for 1 of 1 Staffing Log reviewed for nursing services. Residents Affected - Many The facility failed to ensure the Direct Care Nursing/Staff Daily Log dated July 25, 2023, was completed with the facility name, current census, and the total number of hours worked and the actual hours worked by the RN and the LVN. This failure could place residents, their families, and visitors at risk of not having the staffing information readily accessible for review, residents and visitors are not able to know how many staff are currently working to provide care on all shifts. Findings Included: Observation on 07/25/2023 at 10:58 AM on the wall across from the nurse's station revealed a dry erase board with the date and names of charge nurse and nurse. There was no evidence of the facility's name, resident census or the number of hours or the actual hours worked by licensed staff providing direct care. During an interview on 07/25/2023 at 11:05 AM the DON stated the nurses staffing was posted on the dry erase board on the wall across from the nurses' station. The DON stated she followed what the TAC required for posting. The DON stated she did not know why she did not have the facility's name, resident census or the number of hours or the actual hours worked by licensed staff providing direct care written on on the board. The DON stated she must have overlooked the part about the facility name, the census and the nursing hours. Review of facility provided document titled Required Postings | Texas Health and Human Services dated 06/15/23 revealed F732/N1518-1520 and N1932 - Nursing Staffing Information 42 CFR Section 483.35(g) and 26 TAC Section 554.1001(b)(1)-(2) and Section 554.1921(e)(13) - An NF must conspicuously and prominently post the following information, in a clear and readable format and a prominent place readily accessible and available to residents, employees, and visitors, in accordance with Section 554.1921(e): On a daily basis: Facility name Current date Resident census Specific shifts for the day (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 8 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 Level of Harm - Potential for minimal harm At the beginning of each shift, the total number of hours and actual time of day to be worked by the following licensed and unlicensed nursing staff, including relief personnel directly responsible for resident care: Registered nurses (RNs) Residents Affected - Many Licensed vocational nurses (LVNs) Certified nurse aides (CNAs) In addition, the licensed NF must make the information required to be posted available to the public upon request. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 9 of 10 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 455683 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hendrick Skilled Nursing Facility 1900 Pine Abilene, TX 79601 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 0851 Level of Harm - Potential for minimal harm Residents Affected - Many Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Based on interview and record review, the facility failed to follow guidelines for mandatory submission of staffing information based on payroll data in a uniform format. Long-term care facilities must electronically submit to CMS complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format according to specifications established by CMS . The facility failed to submit staffing information to CMS for FY Quarter 2 2023 (January 1- March 31). The facility's failure could place residents at risk for personal needs not being identified and met, decreased quality of care, decline in health status, and decreased feelings of well-being within their living environment. The findings included: Record review of the facility's Staffing Data Report for FY Quarter 2 2023 (January 1- March 31) revealed the facility triggered for Failed to Submit Data for the Quarter and One Star Staffing Rating. During an interview on 07/26/2023at 12:20 PM, the DON stated her expectation was that the facility followed CMS guidelines . The DON stated during the 2nd Quarter, they did not have residents and was not aware of who would have been responsible for reporting the staffing information. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455683 If continuation sheet Page 10 of 10