Inspection·July 22, 2022

F 0695 Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 07/19/22 at 2:53 PM, Resident #118 was resting in bed awake and alert and visiting with his sister. A dirty towel was noted on top of his dresser with medication nebulizer and tail piece extending from the nebulizer cup was uncovered with a slight amount of medication remaining in the medication cup, loose oxygen tubing laying inside of the drawer and attached to the power unit that pumps air to the nebulizer creating a mist of medication. Residents Affected - Some During an interview on 07/19/22 at 3:15 PM, with an unidentified nurse identifying herself as the charge nurse for floor Resident #118 resided in, confirmed the nebulizer was not covered and not dated and should have been dated and, in a bag, to protect the device from being contaminated. Review of Resident #65's undated face sheet revealed she was a [AGE] year-old-female admitted on [DATE] with the diagnoses of sepsis, unspecified organism, pneumonia, chronic respiratory failure with hypoxia (inability to oxygenate tissues of the body) and pneumonitis due to inhalation of food and vomit. Resident #65 did not have a s care plan. This surveyor requested but was not provided prior to exit. Review of physician's orders dated 07/08/22 revealed: DuoNeb (ipratropium bromide and albuterol sulfate) every 6 hours as needed for shortness of breath. During an observation and interview on 07/19/22 at 3:15 PM, Resident #1 was resting in bed awake and alert. A nebulizer cup attached to a mask was noted on top of her dresser with medication nebulizer and mask was uncovered with a slight amount of medication remaining in the medication cup, loose oxygen tubing attached to the power unit that pumps air to the nebulizer creating a mist of medication During an interview on 07/19/22 at 3:15 PM, CNA A confirmed that the nebulizer was not covered and not dated and should have been dated and in a bag, to protect the device from being contaminated. Review of facility's policy and procedure title, Respiratory: Nebulizer Mist Therapy dated 4/16/2014 revealed the following [in part]: .20. Store nebulizer, t-piece, and mouthpiece in separate, labeled plastic bag (change all disposable parts once a week and label with date and initials). Review of website https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086084 on 07/22/22 revealed the following: Problem: Although many improvements in patient safety have been made in the nation's health care system, medication errors and health care-associated infections (HAIs) still top the list of problems . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 2 of 7 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 ensure on a daily basis to post the actual hours worked by the licensed and unlicensed nursing staff directly responsible for resident care for each shift was posted in a prominent place accessible to residents and visitors for 1 of 1 facility observed for staffing postings. Residents Affected - Many The facility did not include the total numbers of actual hours worked for RNs, LVNs, and CNAs on the daily staffing post. This failure could place residents and/or visitors at risk of not having access to information regarding staffing data and facility census. The findings included: Observation and record review on 7/19/2022 at 11:30 AM, revealed the daily nursing staffing hours form was posted by the employee time clock on a short side-hallway located in the front part of the building. Titled Facility Staffing Disclosure dated 7/19/2022, revealed the facility failed to document the actual hours worked for the day and night shifts, including RNs, LVNs, and CNAs. The form documented the staff numbers for two shifts, Day (6 AM - 6 PM) and Night (6 PM - 6 AM). But failed to include the number of actual staff hours worked each shift. Observation and record review on 7/20/2022 at 10:30 AM, revealed the daily nursing staffing hours form was posted by the employee time clock on a short side-hallway located in the front part of the building. Titled Facility Staffing Disclosure dated 7/20/2022, revealed the facility failed to document the actual hours worked for the day and night shifts, including RNs, LVNs, and CNAs. The form documented the staff numbers for two shifts, Day (6 AM - 6 PM) and Night (6 PM - 6 AM). But failed to include the number of actual staff hours worked each shift. Observation and record review on 7/21/2022 at 11:30 AM, revealed the daily nursing staffing hours form was posted by the employee time clock on a short side-hallway located in the front part of the building. Titled Facility Staffing Disclosure dated 7/21/2022, revealed the facility failed to document the actual hours worked for the day and night shifts, including RNs, LVNs, and CNAs. The form documented the staff numbers for two shifts, Day (6 AM - 6 PM) and Night (6 PM - 6 AM). But failed to include the number of actual staff hours worked each shift. Observation and record review on 7/22/2022 at 11:00 AM, revealed the daily nursing staffing hours form was posted by the employee time clock on a short side-hallway located in the front part of the building. Titled Facility Staffing Disclosure dated 7/22/2022, revealed the facility failed to document the actual hours worked for the day and night shifts, including RNs, LVNs, and CNAs. The form documented the staff numbers for two shifts, Day (6 AM - 6 PM) and Night (6 PM - 6 AM). But failed to include the number of actual staff hours worked each shift. In an interview on 7/22/2022 at 1:00 PM, the Administrator stated, the DON is responsible for ensuring the daily staffing was posted. She further stated, failure to post the actual hours worked would prevent residents and/or visitors to the facility who may desire to know how many nursing staff were present and on duty and the actual hours worked per each shift daily. In an interview on 7/22/2022 at 1:30 PM, the DON stated she was responsible for posting the daily (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 3 of 7 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 Residents Affected - Many staffing sheets but was not sure what the facility policy and procedure was for daily nursing staff posting. She stated she just knew they were supposed to post it daily. She further stated, the actual hours worked are documented on the daily staffing form the following day for the prior day and filed in the office. However, the DON did reveal, she could see that not posting the actual staff hours worked would prevent the residents and/or visitors to the facility who may desire to know how many nursing staff were present and on duty and the actual hours worked per each shift daily. Review of the facility's policy for Nurse Staffing Posting Information, dated 1/16/2020, revealed the following [in part]: Policy It is the policy of this facility to make staffing information readily available in a readable format to residents and visitors at any given time. Policy Explanation and Compliance Guidelines: 1. The nurse staffing information will be posted on a daily basis and will contain the following information: a. Facility name b. The current date c. Facility's current resident census d. The total number and the actual hours worked by the following categories of licensed and unlicensed staff directly responsible for resident care per shift: I. Registered Nurses II. Licensed Practical Nurses/Licensed Vocational Nurses III. Certified Nurse Aides 2. The facility will post the nurse staffing data at the beginning of each shift. 3. The information posted will be: a. Presented in a clear and readable format. b. In a prominent place readily accessible to residents and visitors. 4. A copy of the schedule will be available to all supervisors to ensure the information posted is up-to-date and current. a. The information shall reflect staff absences on that shift due to call-outs and illness. After the start of each shift, actual hours will be updated to reflect such (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 4 of 7 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 5. Nursing schedules and posting information will be maintained in the Human Resources Department for review for at least 18 months or according to state law, whichever is greater Level of Harm - Potential for minimal harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 5 of 7 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to maintain an effective pest control program so that the facility was free of pests in one of one kitchen observed for pests. Residents Affected - Some The facility failed to ensure an effective pest control program was implemented to prevent the presence of roaches in the kitchen. The facility's failure placed the residents at risk for foodborne illness and/or disease spread by pests. The findings include: During an observation and interview on 7/22/22 at 10:17 AM, live roaches were observed in the dishwashing machine area and in the food preparation/cooking areas on the floor and wall behind the storage and cooking equipment. Further observation showed utensils and trash were found under equipment and in corners. The Dietary Manager said she was aware of the problem and had been working with the Pest Control Vendor. Review of the dietary department cleaning records, provided by the Dietary Manager on 7/22/22, revealed staff had not been cleaning behind and under the kitchen equipment. The Daily Cleaning Schedule was last initialed and dated on 7/03/22 by the 1 PM to 8:30 PM shift staff. Review of the facility's contract with the pest control company, undated, revealed the contracted pest control company would provide bi-monthly service. Review of the facility's pest control service manual, used to organize the service invoices, revealed there was nothing mentioned or documented regarding any problems in the kitchen. Review of the contracted pest control service invoices revealed the following: - 7/12/22 - Treatment for General Pest, Scorpions and Mice/Rat bait stations. Treatment area- Common Areas, Entry Ways, Hallways. The Technician Comments did not mention pests/roaches in the kitchen. - 6/27/22 - General pest. Treatment area- Common Areas, Entry Ways, Hallways. The Technician comments documented met with DM (Director of Maintenance), he had no issues, spoke with kitchen staff, had no issues. - 6/13/22 - Treatment for General Pests, target areas - Bathrooms, Breakroom, Common Areas, Entry Ways, Hallways. Technician comments: DM had no issues, Kitchen no issues. In a telephone interview on 7/22/22 at 11:13 AM, the pest control service personnel stated she was unaware of any problems in the facility's kitchen and the service technician's records showed he had not been treating areas in the kitchen. In an interview on 7/22/22 at 2:01 PM, the Maintenance Director stated the pest control service technician told him what was done and/or found during the service visit. He stated he was unaware of any problems in the dietary department until today. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 6 of 7 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0925 Review of the facility's Pest Control Policy, undated, revealed the following [in part]: Level of Harm - Minimal harm or potential for actual harm .this facility will maintain an on-going Pest Control program to ensure that the building is kept free of insects and rodents . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 7 of 7