Inspection·May 1, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of Resident #1 Care Plan dated 03/28/2018 revealed that Resident #1 has a visual function impairment, blind in left eye and tunnel vision in right eye with interventions of assure that the lenses of the glasses are clean and in good repair, keep call light in reach at all times Record Review of Resident #1 Care Plan dated 03/28/2018 revealed that Resident #1 has urinary incontinence requiring assist with transfers to toilet with interventions of apply moisture barrier to skin as needed and as ordered, keep call light in reach, provide assistance for toileting transfer with staff x2, provide incontinence care after each incontinent episode, report any signs of skin breakdown such as soreness, tenderness, redness, and/or broken areas. Interview with Resident #1 on 05/01/2023 at 4:00 pm. Resident #1 stated that she was given small bells and a plastic whistle to use to call staff when she needs help. Resident #1 stated that she has tried to use both, and the staff do not come because they do not hear the bells or whistles. Resident #1 stated that she has to go to the restroom to use the call light in there to get help. Resident #1 stated that it is hard for her to get to the restroom to do that every time so sometimes she just has to wait until a staff member just comes in the room. Resident #1 stated that it makes her frustrated because when she needs something, and she cannot get help then she feels helpless. Resident #2: Record review of Resident #2s face-sheet revealed a [AGE] year-old female, admitted to the facility on [DATE] with a diagnosis of: congestive heart failure, pressure ulcer on the left buttock, iron deficiency anemia, depression, insomnia, high blood pressure, type 2 diabetes, hyperlipidemia, anxiety, muscle weakness, acute kidney failure, stroke. Record Review of Resident #2s admission MDS dated [DATE] revealed that Resident #2 has a BIMS (Brief Interview Mental Status) of 7 meaning severe impairment. Under Section G for Functional Status indicated that Resident #2 was listed at extensive assistance with one-person physical assist for bed mobility, transfers, dressing, and toilet use. Resident #2 was listed as supervision with set up only for walk in room and corridor, Resident #2 was listed as limited assistance with one person physical assist for locomotion on and off unit. Record Review of Resident #2 Care Plan dated 04/30/2023 revealed that Resident #2 had an actual fall with interventions of bed in low position, orthostatic hypotension precautions, encourage use of call light, instruct resident on safety measures, keep call light within reach. Record Review of Resident #2 Care Plan dated 03/07/2022 revealed that Resident #2 has a cardiac problem with interventions of access heart rate, blood pressure, respiratory, diet restrictions. Interview with Resident #2 on 05/01/2023 at 2:41. Resident #2 stated that she does not get the help she needs from staff since the call lights have been out. Resident #2 stated that she is mostly independent but does still need help because she gets weak often. Resident #2 stated that she has used her whistle and bells and none of the staff come help and then she will have to just walk to the nurse's station to get someone to come help her. Resident #2 stated that it was not like this when the call lights worked. Resident #2 stated that she has even had a hard time getting water. Resident #2 stated that the call lights have been broken for a while. Resident #2 was not sure how long it had been broken. Resident #2 stated that she [NAME] like she is not going to get help when she needs it. Resident #2 stated, Like I said, I get weak a lot. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 2 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Resident #3: Level of Harm - Minimal harm or potential for actual harm Record review of Resident #3s face-sheet revealed a [AGE] year-old male, admitted to the facility on [DATE] with a diagnosis of: hemiplegia and hemiparesis (muscle weakness or partial paralysis on one side of the body) following a stroke, hypokalemia (low potassium), anxiety, inflammation, dysphagia (difficulty swallowing), aphasia (loss of ability to understand or express speech), acid reflux disease, muscle wasting and atrophy (is the thinning of muscle mass), muscle weakness, insomnia, high blood pressure, stroke, depressive episodes, hypercalcemia (too much calcium in the blood), vitamin deficiency. Residents Affected - Some Record Review of Resident #4s admission MDS dated [DATE] revealed that Resident #4 has a BIMS (Brief Interview Mental Status) of 7 meaning severe impairment. Under section G for Functional Status indicated that Resident #3 is listed as total dependent with one-person physical assist for bed mobility, transfers, dressing, and toilet use. For bathing is listed as physical help in part of bathing activity with two-person physical assist. Record Review of Resident #3 Care Plan dated 03/26/2021 revealed that Resident #3 is at risk for falls with the interventions of Resident #3 will use call light and wait for staff to assist resident with all transfers. Record Review of Resident #3 Care Plan dated 01/11/2021 revealed that Resident #3 is needs assistance with ADLS, Resident #3 has hemiplegia related to cerebrovascular accident (stroke) with interventions of approach resident from affected side t promote attention to the affected side, give resident verbal reminders not to ambulate/transfer without assistance, keep call light in reach at all times, observe frequently and place in supervised area when out of bed. Observation in Resident#3's room on 05/01/2023 at 2:15 pm of open area on the wall with wires hanging out. Observed no face plate on the wall where call light system is supposed to go. Surveyor went to go get DON to show her the open area on the wall with the wires hanging out. DON observed the open area on the wall. DON stated that she would get the maintenance man to cover the open area. Interview with Resident #3 on 05/01/2023 at 2:22 pm. Resident #3 is not able to talk but has a card with letters on it and was able to spell out or use hand gestures to communicate with Surveyor. When Resident #3 was asked if he was able to use the bells or whistle to call for help, Resident #3 shook his head no. Observed the string of bells and a whistle on the bedside table across the room from Resident #3. Resident #3 appeared frustrated by putting his hands up and waving away at the bells and whistles and shaking his head no. When Resident #3 was asked if this is frustrating him, he shook his head yes. When Resident #3 was asked if he was offered to change rooms, he shook his head no. Resident #3 then spelled out on his alphabet card, Three Weeks. When Resident #3 was asked if it had been three weeks of not having a call light, he shook his head yes. Resident #4: Record review of Resident #4s face-sheet revealed an [AGE] year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of: absence of right knee, lower abdominal pain, abnormal weight loss, high blood pressure, Chronic obstructive pulmonary disease, hypothyroidism, hyperlipidemia, anxiety disorder, lack of coordination, cognitive communication deficit, muscle weakness, osteoporosis, stroke. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 3 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of Resident #4s admission MDS dated [DATE] revealed that Resident #4 has a BIMS (Brief Interview Mental Status) of 11 meaning moderately impaired. Under Section G for Functional Status indicates that Resident #4 is listed for supervision with one person assist for bed mobility, transfers, dressing and toilet use. For locomotion on and off the unit Resident #4 Is listed as independent with no assistance. For walking in room and corridor, Resident #4 is listed as activity occurring only once or twice with one-person physical assist. For bathing Resident #4 is listed as physical assistance for transfer only with one person assist. Record Review of Resident #4 Care Plan dated 05/04/2022 revealed that Resident #4 is incontinent with interventions of apply moisture barrier to skin as needed, check for incontinent episodes at least every 2 hours, provide incontinence care after each incontinent episode. Record Review of Resident #4 Care Plan dated 04/25/2022 revealed ADL Functional Status/Rehabilitation Potential with interventions of assess residents' mobility, keep call light in reach, re-evaluate the need for bed rails every 3 months. Ambulation/Transfers amount of assist x1, bathing/hygiene amount of assist x1, dressing/grooming amount of assist x1, eating amount of assist for setup only, Record Review of Resident #4 Care Plan dated 04/24/2022 revealed Resident #4 is at risk for falls with interventions of encourage use of call light, keep call light within reach. Interview with Resident #4 on 05/01/2023 at 2:28 pm. Resident #4 stated that the staff do not come around often to check on the residents since the call lights have not been working. Resident #4 stated that the call lights have been out for about 2 to 3 weeks, and she is not sure when they will be working. Resident #4 stated that she was not offered another room, but she was given the bells and whistles. Resident #4 stated that the staff cannot hear them when she uses them because she asks the staff when they come in the room finally why they did not come in earlier when she used the bells or whistle, and they say that they did not hear them. Resident #4 stated that it does not make sense to her why the call lights have not been fixed yet because it should not have taken so long. Resident #4 stated that it makes her worry because if she were to have an accident, she would have no way to get help. Resident #5: Record review of Resident #5s face-sheet revealed a [AGE] year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of: congestive heart failure, upper respiratory infection, dysuria (night time wetting), pain, urinary tract infection, bradycardia (slow heartrate), morbid obesity, atrial fibrillation, schizoaffective disorder, bipolar, urinary incontinence, chronic obstructive pulmonary disease, high blood pressure, anxiety, type 2 diabetes, hyperlipidemia, chronic respiratory failure, hypoxia, muscle weakness, coronary artery disease. Record Review of Resident #5s admission MDS dated [DATE] revealed that Resident #5 has a BIMS (Brief Interview Mental Status) of 14 meaning cognitively intact. Under Section G for Functional Status indicated that Resident #5 is listed as extensive assistance with 2-person physical assist for bed mobility, transfers, walk in room, walk in corridor, and toilet use. Resident #4 is listed as total dependent with 2-person physical assist for locomotion on and off of unit, dressing, and bathing. Record Review of Resident #5's Care Plan dated 05/13/2021 indicated that Resident #5 is at risk for fall with interventions of encourage use of call light, keep call light within reach. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 4 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review of Resident #5's Care Plan dated 05/13/2021 indicated that Resident #5 is incontinent with interventions of apply moisture barrier to skin, check for incontinent episodes at least every 2 hours, provide incontinent care after each incontinent episode, report signs of skin breakdown Interview with Resident #5 on 05/01/2023 at 10:50 am. Resident #5 stated that she was given small bells and whistles, but they do not work well, and the staff does not come when you use the bells because they can't hear them. Resident #5 stated that she can not use the whistle because she is on oxygen, and it is too hard for her to use. Resident #5 stated that she has just started using her cell phone to call the facility when she needs help because the bells and whistles do not work. Resident #5 stated that it makes her feel like she has to make her own accommodations if she needs help. Resident #5 stated what about the residents that do not have cell phones and do not have that option. Resident #6: Record review of Resident #6s face-sheet revealed a -year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of: dementia, anxiety, constipation, wedge compression fracture of T11-T12 vertebra, pain in thoracic spine, insomnia, acute respiratory disease, depression, acid reflux, alcoholic cirrhosis of liver, muscle weakness, type 2 diabetes, hypothyroidism, hypotension, hypothyroidism, iron deficiency, hypothyroidism, hyperglyceridemia, low blood pressure. Record Review of Resident #6's annual MDS revealed Resident #6 has a BIMs (Brief Interview Mental Status) of 7 indicating severe impairment. Under Section G for Functional Status indicated Resident #6 was listed as independent with no physical help in the areas of bed mobility, transfer, walk in room, locomotion on unit, locomotion off unit, dressing, eating, toilet use and hygiene. Under Section G for Functional Status for bathing is listed as physical help transfer only with one person assist. Record Review of Resident #6s Care Plan dated 09/1/2021 indicated Resident #6 was at risk for falls with the interventions of encourage use of call light, keep call light within reach. Record Review of Resident #6s Care Plan dated 09/17/2021 indicated Resident #6 indicated that Resident #6 had urinary incontinence with catheter care with interventions of check for incontinence, keep call light in reach, toileting every 2 hours. Record Review of Resident #6s Care Plan dated 09/17/2021 indicated Resident #6 indicated for ADLs that Resident #6 was listed as assistance with one-person physical assist for ambulation/transfers, bathing/hygiene, dressing/grooming, Record review of progress notes for Resident #6 revealed under additional notes: Resident #6's daughter called the nurses station and stated that her mother was on the floor and couldn't get to her whistle or bell. The nurse along with LVN F, went to assess Resident #6 and found her laying on the right side in the bed. Water pitcher was spilt on the floor and Resident #6's gown was wet. This nurse asked Resident #6 what happened, and she stated, I went to the restroom and fell trying to get back in bed, I guess I slipped and landed on my back. Head to toe assessment completed, no injuries noted. No redness or bruising. Resident denies hitting her head. Assistant out of bed so wet clothes and bedding could be changed. Unable to interview Resident #6 because she was in the hospital. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 5 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with Administrator on 05/01/2023 at 10:15 am. Administrator stated the call light system has been out approximately 2 or 2.5 weeks. Administrator stated that the system has not been fixed yet because parts are on back order. Administrator stated that the fire panel was giving an error. Administrator stated that the vendor was contacted by the maintenance man and the vendor did a reset on the call system. Administrator stated that when the maintenance man checked the resident rooms they were not working. Administrator stated that the vendor stated that the best determination that they could come up with is that it may be a power surge. Administrator stated that an order has been placed to replace the base to the call light system, but the parts are on back order and might be here on 05/05/2023. Administrator stated that is not a guarantee. Administrator stated that for the rooms that were affected, the staff has been doing 30 minutes rounds for the 21 rooms. Administrator stated that the resident's seem okay with the small ball bells and the plastic whistles. Administrator stated that the residents that were affected by the call light system have the option to move to another room. Administrator stated that only one resident wanted to move to another room temporarily. Administrator stated that an electrician had been out to the facility prior to the call light system failing for a different reason. Administrator stated that for the intake with Resident #6 having a fall had suffered no injuries. Administrator stated that she would have to look at the notes but does not believe that it was due to not having the call light system not working. Interview with Maintenance Supervisor on 05/01/2023 at 11:02 am. Maintenance Supervisor stated that he had gotten a call at 1:25 on the day of 04/12/2023. Maintenance Supervisor stated that he went to the facility to check on it and it just kept beeping. Maintenance Supervisor stated that he reset it and then the system showed a yellow light and gave a trouble code. Maintenance Supervisor stated that he reset it again and at that time it was good. Maintenance Supervisor stated that he went to all the rooms and started to check and realized that they were not working. Maintenance Supervisor stated that he called the vendor for electrical work to come look at the system. Maintenance Supervisor stated that the vendor was not able to go look at it until the next day on 04/13/2023. Maintenance Supervisor stated that he was not sure if the system had a short of what the problem was. Maintenance Supervisor stated that the vendor was at the facility on 04/06/2023 for another situation and he is thinking that this was a result of the vendor doing something that made this happen. Maintenance Supervisor stated that the call light system was working on 04/06/2023 and thereafter until 04/12/2023 when it started to malfunction. Maintenance Supervisor stated that he has contacted the vendor every other day and was told that it should be fixed on Friday 05/05/2023. Maintenance Supervisor stated he is not positive if it will definitely be fixed on Friday or not because the parts were on back order. Maintenance Supervisor stated that this is the only place that carries the part because the system is so old. Maintenance Supervisor stated that the day that the call system malfunctioned he reached out to the charge nurse and told her to go ahead and start 30-minute rounds. Maintenance Supervisor stated that he told the administrator and DON that this is an electrical issue because of the burnt wires and stated that an electrician needed to look at it. Maintenance Supervisor stated that he is not sure how it could a power surge because the weather is not bad. Interview with ADON on 05/01/2023 at 12:14 pm. ADON stated that she mainly works in the office, but she is aware that the call light system has stopped working and that the residents were supplied with small bell balls and whistles. ADON stated that she can only hear if the Residents are using the bells or whistles if she is close to the resident's rooms. ADON stated that she guesses it just depends on how well someone could hear. ADON stated that she does not think that is an effective way to call for help because the staff don't really know where the noise is coming from. Interview with Administrator on 05/01/2023 at 3:29 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 6 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some pm. Administrator stated the parts are on back order and had to get the parts from the vendor because they are the only place to get the parts. Administrator stated that it is an older system, and this is the only place to get the parts. Administrator stated that she had gotten the small bells when the call light system went out but quickly realized that you could not hear the small bells. Administrator stated that she went and got the plastic whistles and then she realized that the whistles were not loud, she went out and got better whistles. Administrator stated that she did not assess every resident with their health issues and if they had the capability of using the whistle. Administrator stated that the staff would be able to see if a resident had fallen or were in respiratory distress when the staff the made their 30-minute rounds. Administrator stated that is why she gave the residents bells so they could notify the staff. Administrator stated that she did notify the corporate and they had told her if they can help in any way to let them know. Administrator stated that corporate knew about the bells and whistles. Administrator stated that corporate had told her to make sure to do the 30-minute resident rounds. Administrator stated that she feels that the residents had an effective means of communication to get the help that they need. Administrator stated that the policy states that the facility must have a working call light system. Administrator stated that the way she monitors the 30 minutes rounds is because the staff will initial the paper indicating that they have made the rounds. Administrator stated that when they take resident's in they are accepting the responsibility to take care of their needs. When asked if it is possible that it could make the resident's feel helpless when they are not getting their needs met by answering the call lights? Administrator stated, yes, probably so. Interview with CNA C on 05/01/2023 at 4:18 pm. CNA C stated that she usually makes her rounds every two hours. CNA C stated that every 30-minute rounds are unreasonable and impossible because if they are changing a resident, it may take 15 to 20 minutes. CNA C stated that they usually have 2 to 3 CNAs for 6 halls, and it is impossible to do every 30-minute rounds for the 21 rooms that do not have call lights. CNA C stated she can hear the bells and it depends if she is able to find where the bells or whistles are coming from because there are 6 halls. CNA C stated that she does not feel that this is an effective method. CNA C stated that the facility needed to get a better method for the call system. CNA C stated that she is sure that some residents have gone without help because it is difficult to find where the noise is and there is no light so you can not see where it is coming from, you just have to kind of hunt for it. CNA C stated that some residents can not even use the whistles or bells or may get overly exhausted trying to use the bells or whistles. CNA C stated that the negative potential outcome for residents is that they may get injured or fall trying to help themselves because the can not call for help when they need it. Interview with CNA D on 05/01/2023 at 4:31 pm. CNA D stated that she makes her rounds approximately every two hours. CNA D stated that she has not been told or notified that she needs to be making 30-minute rounds for the residents that are without a call light. CNA D stated that she cannot hear the bells or the whistle, but she can sometimes hear the whistles. CNA D stated that it gets frustrating because she has to run around trying to find where the whistle is coming from and if the resident stops blowing the whistle, it is impossible to find which resident was using the whistle. CNA D stated that some of the residents cannot even use the whistle because of the oxygen and it is too much for them. CNA D stated that she does not think this method is effective because many residents are getting skipped because the staff cannot find where the whistle is coming from. CNA D stated that the call light system has been out for weeks and does not know how much longer it will be until it is fixed. CNA D stated that even with the call lights it takes some time to get to the resident because there is not many staff that are there to work, so can you imagine having no light and trying to hunt (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 7 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some down a whistle sound when there is only 3 or 4 staff members that are trying to locate the resident needing help. CNA D stated that makes it impossible to do 30-minute rounds and that is beside trying to provide care for all residents. CNA D stated that the negative potential outcome for not having effective call light system would be that the resident is not getting the needed care they deserve, or they could get injured. Interview with DON on 05/01/2023 at 4:47 pm. DON stated that she can hear the bells and whistles at night. DON stated that she does not usually work nights, but she has from time to time. DON stated that in order to find where the bells and whistles are coming from, she would have to go look for where the noise is coming from. DON stated that she does not guess that would be an effective means of notifying staff that a resident needs help or for a long period of time. When asked if she is willing to work nights until the call light system Is fixed since she can hear the bells and whistles at night when the rest of the staff can not hear it, her response was that she is not willing to work every day until then. DON stated that she does not know other than getting cow bells what they can do. DON stated that the negative potential outcome for residents not being able to get staff attention when they need help is they could possibly get hurt or not get what they need taken care of. DON stated that she can not speak for her staff, but she can only speak for herself, and she believes that she could hear the whistles and bells. DON stated that the way that she monitors the staff making the 30-minute rounds is by checking the log to see if they have initialed the 30-minute round log. DON stated that the parts to fix the call light system are on back order and she does not know if that is the only vendor that is available for the parts or not. When asked why the staff have not made 30-minute rounds while Surveyor has been in the building, DON stated she was not sure why they have not done this. DON stated that the system that they have in place is effective when the staff can hear the whistles or bells and the staff work together and do what they need to do. The DON stated it is the responsibility of the facility to make sure to provide for the needs of the residents. Interview with Maintenance Supervisor on 05/01/2023 at 5:40 pm. Maintenance Supervisor stated that the open area in Resident #3's room should not have been exposed and open with wiring hanging out. Maintenance Supervisor stated that it should be fine though because the wiring is not hot. Maintenance Supervisor stated that there would be a potential for injury if the wiring was hot. When the Maintenance Supervisor was asked, Could one of the wires potentially poke the resident's finger if the resident was touching it? Maintenance Supervisor stated that that could possibly happen but why would a resident be messing with the wires even if it uncovered. Maintenance Supervisor stated that he is aware that he is responsible for coving the exposed wiring and opened wall. Maintenance Supervisor then questioned surveyor if she was talking with a resident that was his family member. Surveyor stated that information is confidential. Maintenance Supervisor got hostile verbally and ended the interview. Record Review of facility provided policy on 05/01/2023, labeled, Resident Call System, dated December 2019, revealed: Policy: The facility is equipped with a functioning communication system from rooms, toilets, and bathing facilities in which the resident calls are received and answered by staff. Procedure: 1). Resident calls are relayed directly to a staff member or to a centralized staff work area. 2). The communication may be through audible or visual signals and may include wireless systems. 3). All portions of the system are functioning a). Systems are on at nursing station, b). Staff are available at the nursing station, c). The volume is loud enough to be heard by the nursing staff, d). Th light above the room or rooms is working, e). calls are being answered, f). For wireless (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 8 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some systems, staff who answer resident calls, have functioning devices in their possession, and are answering resident calls. 4). If a resident has disabilities that make use of the facility's communication system inaccessible, alternative, auxiliary aids, or services are provided to meet the resident's needs as identified in the resident's assessment or plan of care. Record Review of facility provided policy on 05/01/2023, labeled, Dignity, date Revised on February 2021, revealed: Policy Statement: Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. Policy Interpretation and Implementation: 1. Residents are treated with dignity and respect at all times. Record Review of in-service provided by facility on 05/01/2023 dated 04/12/2023, labeled, Call Light Malfunction, revealed: Under topic: Due to the malfunction of the call light system, Staff will do every 30-minute checks on residents who's call light is not working. Whistle and bells have been provided to each resident until the system I fixed. The signature sheets showed 30 employee signatures. Record Review of 30-minute resident check sheet provided on 05/01/2023, dates provided for 04/13/2023-04/30/2023 revealed: Each sheet indicated the resident name at the top and 30-minute increment times on the side with employee initialed signed to each slot. The sheet did not indicate what was the resident being check, if the resident needed anything. There was no documentation on what was done. The sheets do not indicate that the staff was checking due to call light system malfunction. No receipt provided for call light system repair or estimated time of arrival upon request of receipt from facility. Record Review of falls for facility provided on 05/01/2023 revealed: Resident #6 had a fall on 04/15/2023 stated unwitnessed fall with no injuries. Resident #6 call light is not working. Resident #7 had a fall on 04/12/2023 stated sitting on floor, near wheelchair and room entrance. It was listed that Resident #7 was one of the residents with no working call light in this timeframe. Was not able to interview resident. Record Review of facility provided list for non-working call lights and map on 05/01/2023 revealed: Not-Working Call lights: 103, 104, 105, 106, 107, 108, 205, 206, 207[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 9 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. 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 ensure the facility was adequately equipped to allow residents to call for staff assistance through a communication system which relayed the call directly to a staff member or to a centralized staff work area in 19 of 51 of resident call light systems that resident in the facility: Residents Affected - Some 1)The facility failed to ensure that 19 of 51 had operable call systems in their rooms. The facility provided ball bells and plastic whistles in which could not be heard by staff. One resident had a fall and could not reach the whistle or ball bells to call for help because they were on the bedside table. Other residents state they could not get assistance or help from staff. These failures could place residents at risk of not receiving assistance when needed as well as possible injury. The findings included: Resident #1: Record review of Resident #1s face-sheet revealed a [AGE] year-old female, admitted to the facility on [DATE] with a readmit date of 11/09/2020 with a diagnosis of: hemiplegia and hemiparesis (muscle weakness or partial paralysis on one side of the body) following a stroke, muscle weakness, stenosis of vertebral artery (a condition in which the lumen of the vertebral artery is condensed and narrowed) , acute respiratory disease, Basal cell carcinoma of skin on ear (a type of skin cancer that begins in the basal cells), abnormal weight loss, acute kidney failure, congestive heart failure, history of urinary tract infections, type 2 diabetes, high blood pressure, aphasia (loss of ability to understand or express speech), cognitive communication deficit, abnormalities of gait and mobility, hypocalcemia (a condition in which the blood has too little calcium), iron deficiency, hypothyroidism (a condition in which the thyroid gland doesn't produce enough thyroid hormone). Record Review of Resident #1 Care Plan dated 03/28/2018 revealed that Resident #1 was at risk for falls with interventions of transfer resident with 2 staff members, keep areas free of clutter and monitor for proper body alignment while utilizing current mobility devices, Keep call light in reach. Record Review of Resident #1 Care Plan dated 03/28/2018 revealed that Resident #1 has a visual function impairment, blind in left eye and tunnel vision in right eye with interventions of assure that the lenses of the glasses are clean and in good repair, Keep call light in reach at all times. Record Review of Resident #1 Care Plan dated 03/28/2018 revealed that Resident #1 has urinary incontinence requiring assist with transfers to toilet with interventions of apply moisture barrier to skin as needed and as ordered, keep call light in reach, provide assistance for toileting transfer with staff x2, provide incontinence care after each incontinent episode, report any signs of skin breakdown such as soreness, tenderness, redness, and/or broken areas. Record Review of Resident #1 Care Plan dated 04/30/2023 revealed that Resident #1indicated that Resident #1's ADL Functional Status/Rehabilitation Potential, Resident #1 uses ¼ bed rails for assist with interventions of keep call bell in reach of resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 10 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Record Review of Resident #1s admission MDS dated [DATE] revealed that Resident #1 had a BIMS (Brief Interview Mental Status) of 12 meaning moderately impairment. Under section G for Functional Status indicated that Resident #1 was listed as total dependence with one-person physical assist for bed mobility, transfer, dressing, toilet use, and hygiene. Resident #1 was listed as independent with no assistance for locomotion on and off unit. Residents Affected - Some Interview with Resident #1 on 05/01/2023 at 4:00 pm. Resident #1 stated that she was given small bells and a plastic whistle to use to call staff when she needs help. Resident #1 stated that she has tried to use both, and the staff do not come because they do not hear the bells or whistles. Resident #1 stated that she has to go to the restroom to use the call light in there to get help. Resident #1 stated that it is hard for her to get to the restroom to do that every time so sometimes she just has to wait until a staff member just comes in the room. Resident #1 stated that it makes her frustrated because when she needs something, and she cannot get help then she feels helpless. Resident #2: Record review of Resident #2s face-sheet revealed a [AGE] year-old female, admitted to the facility on [DATE] with a diagnosis of: congestive heart failure, pressure ulcer on the left buttock, iron deficiency anemia, depression, insomnia, high blood pressure, type 2 diabetes, hyperlipidemia, anxiety, muscle weakness, acute kidney failure, stroke. Record Review of Resident #2 Care Plan dated 03/07/2022 revealed that Resident #2 had a cardiac problem with interventions of assess heart rate, blood pressure, respiratory, diet restrictions. Record Review of Resident #2 Care Plan dated 04/30/2023 revealed that Resident #2 had an actual fall with interventions of bed in low position, orthostatic hypotension precautions, encourage use of call light, instruct resident on safety measures, Keep call light within reach. Record Review of Resident #2s admission MDS dated [DATE] revealed that Resident #2 had a BIMS (Brief Interview Mental Status) of 7 meaning severe impairment. Under Section G for Functional Status indicated that Resident #2 was listed at extensive assistance with one-person physical assist for bed mobility, transfers, dressing, and toilet use. Resident #2 was listed as supervision with set up only for walk in room and corridor, Resident #2 was listed as limited assistance with one-person physical assist for locomotion on and off unit. Interview with Resident #2 on 05/01/2023 at 2:41. Resident #2 stated that she does not get the help she needs from staff since the call lights have been out. Resident #2 stated that she is mostly independent but does still need help because she gets weak often. Resident #2 stated that she has used her whistle and bells and none of the staff come help and then she will have to just walk to the nurse's station to get someone to come help her. Resident #2 stated that it was not like this when the call lights worked. Resident #2 stated that she has even had a hard time getting water. Resident #2 stated that the call lights have been broken for a while. Resident #2 was not sure how long it had been broken. Resident #2 stated that she feels like she is not going to get help when she needs it. Resident #2 stated, Like I said, I get weak a lot. Resident #3: Record review of Resident #3s face-sheet revealed a [AGE] year-old male, admitted to the facility on [DATE] with a diagnosis of: hemiplegia and hemiparesis (muscle weakness or partial paralysis on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 11 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some one side of the body) following a stroke, hypokalemia (low potassium), anxiety, inflammation, dysphagia (difficulty swallowing), aphasia (loss of ability to understand or express speech), acid reflux disease, muscle wasting and atrophy (is the thinning of muscle mass), muscle weakness, insomnia, high blood pressure, stroke, depressive episodes, hypercalcemia (too much calcium in the blood), vitamin deficiency. Record Review of Resident #3 Care Plan dated 01/11/2021 revealed that Resident #3 needed assistance with ADLS, Resident #3 has hemiplegia related to cerebrovascular accident (stroke) with interventions of approach resident from affected side t promote attention to the affected side, give resident verbal reminders not to ambulate/transfer without assistance, Keep call light in reach at all times, Observe frequently and place in supervised area when out of bed. Record Review of Resident #3 Care Plan dated 03/26/2021 revealed that Resident #3 was at risk for falls with the interventions of Resident #3 will use call light and wait for staff to assist resident with all transfers. Record Review of Resident #3s admission MDS dated [DATE] revealed that Resident #3 has a BIMS (Brief Interview Mental Status) of 7 meaning severe impairment. Under section G for Functional Status indicated that Resident #3 is listed as total dependent with one-person physical assist for bed mobility, transfers, dressing, and toilet use. For bathing is listed as physical help in part of bathing activity with two-person physical assist. Observation in Resident#3's room on 05/01/2023 at 2:15 pm of open area on the wall with wires hanging out. Observed no face plate on the wall where call light system is supposed to go. Surveyor went to go get DON to show her the open area on the wall with the wires hanging out. DON observed the open area on the wall. DON stated that she would get the maintenance man to cover the open area. Interview with Resident #3 on 05/01/2023 at 2:22 pm. Resident #3 was not able to talk but had a card with letters on it and was able to spell out or use hand gestures to communicate with Surveyor. When Resident #3 was asked if he was able to use the bells or whistle to call for help, Resident #3 shook his head no. Observed the string of bells and a whistle on the bedside table across the room from Resident #3. Resident #3 appeared frustrated by putting his hands up and waving away at the bells and whistles and shaking his head no. When Resident #3 was asked if this is frustrating him, he shook his head yes. When Resident #3 was asked if he was offered to change rooms, he shook his head no. Resident #3 then spelled out on his alphabet card, Three Weeks. When Resident #3 was asked if it had been three weeks of not having a call light, he shook his head yes. Resident #4: Record review of Resident #4s face-sheet revealed an [AGE] year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of: absence of right knee, lower abdominal pain, abnormal weight loss, high blood pressure, Chronic obstructive pulmonary disease, hypothyroidism, hyperlipidemia, anxiety disorder, lack of coordination, cognitive communication deficit, muscle weakness, osteoporosis, stroke. Record Review of Resident #4s admission MDS dated [DATE] revealed that Resident #4 had a BIMS (Brief Interview Mental Status) of 11 meaning moderately impaired. Under Section G for Functional Status indicates that Resident #4 is listed for supervision with one person assist for bed mobility, transfers, dressing and toilet use. For locomotion on and off the unit Resident #4 Is listed as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 12 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some independent with no assistance. For walking in room and corridor, Resident #4 was listed as activity occurring only once or twice with one-person physical assist. For bathing Resident #4 was listed as physical assistance for transfer only with one person assist. Record Review of Resident #4 Care Plan dated 05/04/2022 revealed that Resident #4 was incontinent with interventions of apply moisture barrier to skin as needed, check for incontinent episodes at least every 2 hours, provide incontinence care after each incontinent episode. Record Review of Resident #4 Care Plan dated 04/25/2022 revealed ADL Functional Status/Rehabilitation Potential with interventions of assess residents' mobility, keep call light in reach, re-evaluate the need for bed rails every 3 months. Ambulation/Transfers amount of assist x1, bathing/hygiene amount of assist x1, dressing/grooming amount of assist x1, eating amount of assist for setup only, Record Review of Resident #4 Care Plan dated 04/24/2022 revealed Resident #4 was at risk for falls with interventions of encourage use of call light, keep call light within reach. Interview with Resident #4 on 05/01/2023 at 2:28 pm. Resident #4 stated that the staff do not come around often to check on the residents since the call lights have not been working. Resident #4 stated that the call lights have been out for about 2 to 3 weeks, and she is not sure when they will be working. Resident #4 stated that she was not offered another room, but she was given the bells and whistles. Resident #4 stated that the staff cannot hear them when she uses them because she asks the staff when they come in the room finally why they did not come in earlier when she used the bells or whistle, and they say that they did not hear them. Resident #4 stated that it does not make sense to her why the call lights have not been fixed yet because it should not have taken so long. Resident #4 stated that it makes her worry because if she were to have an accident, she would have no way to get help. Resident #5: Record review of Resident #5s face-sheet revealed a [AGE] year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of: congestive heart failure, upper respiratory infection, dysuria (night time wetting), pain, urinary tract infection, bradycardia (slow heartrate), morbid obesity, atrial fibrillation, schizoaffective disorder, bipolar, urinary incontinence, chronic obstructive pulmonary disease, high blood pressure, anxiety, type 2 diabetes, hyperlipidemia, chronic respiratory failure, hypoxia, muscle weakness, coronary artery disease. Record Review of Resident #5s admission MDS dated [DATE] revealed that Resident #5 had a BIMS (Brief Interview Mental Status) of 14 meaning cognitively intact. Under Section G for Functional Status indicated that Resident #5 is listed as extensive assistance with 2-person physical assist for bed mobility, transfers, walk in room, walk in corridor, and toilet use. Resident #4 is listed as total dependent with 2-person physical assist for locomotion on and off of unit, dressing, and bathing. Record Review of Resident #5's Care Plan dated 05/13/2021 indicated that Resident #5 was at risk for fall with interventions of encourage use of call light, keep call light within reach. Record Review of Resident #5's Care Plan dated 05/13/2021 indicated that Resident #5 was incontinent with interventions of apply moisture barrier to skin, check for incontinent episodes at least every 2 hours, provide incontinent care after each incontinent episode, report signs of skin breakdown (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 13 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with Resident #5 on 05/01/2023 at 10:50 am. Resident #5 stated that she was given small bells and whistles, but they do not work well, and the staff does not come when you use the bells because they can't hear them. Resident #5 stated that she cannot use the whistle because she was on oxygen, and it is too hard for her to use. Resident #5 stated that she has just started using her cell phone to call the facility when she needs help because the bells and whistles do not work. Resident #5 stated that it makes her feel like she had to make her own accommodations if she needs help. Resident #5 stated what about the residents that do not have cell phones and do not have that option. Resident #6: Record review of Resident #6s face-sheet revealed a -year-old female, originally admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of: dementia, anxiety, constipation, wedge compression fracture of T11-T12 vertebra, pain in thoracic spine, insomnia, acute respiratory disease, depression, acid reflux, alcoholic cirrhosis of liver, muscle weakness, type 2 diabetes, hypothyroidism, hypotension, hypothyroidism, iron deficiency, hypothyroidism, hyperglyceridemia, low blood pressure. Record Review of Resident #6's annual MDS revealed Resident #6 had a BIMs (Brief Interview Mental Status) of 7 indicating severe impairment. Under Section G for Functional Status indicated Resident #6 was listed as independent with no physical help in the areas of bed mobility, transfer, walk in room, locomotion on unit, locomotion off unit, dressing, eating, toilet use and hygiene. Under Section G for Functional Status for bathing is listed as physical help transfer only with one person assist. Record Review of Resident #6s Care Plan dated 09/1/2021 indicated Resident #6 was at risk for falls with the interventions of encourage use of call light, keep call light within reach. Record Review of Resident #6s Care Plan dated 09/17/2021 indicated Resident #6 indicated that Resident #6 had urinary incontinence with catheter care with interventions of check for incontinence, keep call light in reach, toileting every 2 hours. Record Review of Resident #6s Care Plan dated 09/17/2021 indicated Resident #6 indicated for ADLs that Resident #6 was listed as assistance with one-person physical assist for ambulation/transfers, bathing/hygiene, dressing/grooming, Record review of progress notes dated 04/15/2023 for Resident #6 revealed under additional notes: Resident #6's daughter called the nurses station and stated that her mother was on the floor and couldn't get to her whistle or bell. The nurse along with LVN F, went to assess Resident #6 and found her laying on the right side in the bed. Water pitcher was spilt on the floor and Resident #6's gown was wet. This nurse asked Resident #6 what happened, and she stated, I went to the restroom and fell trying to get back in bed, I guess I slipped and landed on my back. Head to toe assessment completed, no injuries noted. No redness or bruising. Resident denies hitting her head. Assistant out of bed so wet clothes and bedding could be changed. Unable to interview Resident #6 prior to exit because she was in the hospital. Interview with Administrator on 05/01/2023 at 10:15 am. Administrator stated the call light system has been out approximately 2 or 2.5 weeks. Administrator stated that the system has not been fixed yet because parts are on back order. Administrator stated that the fire panel was giving an error. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 14 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Administrator stated that the vendor was contacted by the maintenance man and the vendor did a reset on the call system. Administrator stated that when the maintenance man checked the resident rooms they were not working. Administrator stated that the vendor stated that the best determination that they could come up with was that it may be a power surge. Administrator stated that an order has been placed to replace the base to the call light system, but the parts are on back order and might be here on 05/05/2023. Administrator stated that was not a guarantee. Administrator stated that for the rooms that were affected, the staff has been doing 30 minutes rounds for the 21 rooms. Administrator stated that the resident's seem okay with the small ball bells and the plastic whistles. Administrator stated that the residents that were affected by the call light system have the option to move to another room. Administrator stated that only one resident wanted to move to another room temporarily. Administrator stated that an electrician had been out to the facility prior to the call light system failing for a different reason. Administrator stated that for the intake with Resident #6 having a fall had suffered no injuries. Administrator stated that she would have to look at the notes but does not believe that it was due to not having the call light system not working. Interview with Maintenance Supervisor on 05/01/2023 at 11:02 am. Maintenance Supervisor stated that he had gotten a call at 1:25 PM on the day of 04/12/2023. Maintenance Supervisor stated that he went to the facility to check on it and it just kept beeping. Maintenance Supervisor stated that he reset it and then the system showed a yellow light and gave a trouble code. Maintenance Supervisor stated that he reset it again and at that time it was good. Maintenance Supervisor stated that he went to all the rooms and started to check and realized that they were not working. Maintenance Supervisor stated that he called the vendor for electrical work to come look at the system. Maintenance Supervisor stated that the vendor was not able to go look at it until the next day on 04/13/2023. Maintenance Supervisor stated that he was not sure if the system had a short of what the problem was. Maintenance Supervisor stated that the vendor was at the facility on 04/06/2023 for another situation and he is thinking that this was a result of the vendor doing something that made this happen. Maintenance Supervisor stated that the call light system was working on 04/06/2023 and thereafter until 04/12/2023 when it started to malfunction. Maintenance Supervisor stated that he has contacted the vendor every other day and was told that it should be fixed on Friday 05/05/2023. Maintenance Supervisor stated he is not positive if it will definitely be fixed on Friday or not because the parts were on back order. Maintenance Supervisor stated that this is the only place that carries the part because the system is so old. Maintenance Supervisor stated that the day that the call system malfunctioned he reached out to the charge nurse and told her to go ahead and start 30-minute rounds. Maintenance Supervisor stated that he told the administrator and DON that this is an electrical issue because of the burnt wires and stated that an electrician needed to look at it. Maintenance Supervisor stated that he is not sure how it could a power surge because the weather is not bad. Interview with ADON on 05/01/2023 at 12:14 pm. ADON stated that she mainly works in the office, but she was aware that the call light system has stopped working and that the residents were supplied with small bell balls and whistles. ADON stated that she can only hear if the Residents are using the bells or whistles if she is close to the resident's rooms. ADON stated that she guesses it just depends on how well someone could hear. ADON stated that she does not think that is an effective way to call for help because the staff don't really know where the noise is coming from. Interview with Administrator on 05/01/2023 at 3:29 pm. Administrator stated the parts are on back order and had to get the parts from the vendor because they are the only place to get the parts. Administrator stated that it is an older system, and this is the only place to get the parts. Administrator stated that she had gotten the small (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 15 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bells when the call light system went out but quickly realized that you could not hear the small bells. Administrator stated that she went and got the plastic whistles and then she realized that the whistles were not loud, she went out and got better whistles. Administrator stated that she did not assess every resident with their health issues and if they had the capability of using the whistle. Administrator stated that the staff would be able to see if a resident had fallen or were in respiratory distress when the staff the made their 30-minute rounds. Administrator stated that is why she gave the residents bells so they could notify the staff. Administrator stated that she did notify the corporate and they had told her if they can help in any way to let them know. Administrator stated that corporate knew about the bells and whistles. Administrator stated that corporate had told her to make sure to do the 30-minute resident rounds. Administrator stated that she feels that the residents had an effective means of communication to get the help that they need. Administrator stated that the policy states that the facility must have a working call light system. Administrator stated that the way she monitors the 30 minutes rounds is because the staff will initial the paper indicating that they have made the rounds. Administrator stated that when they take resident's in, they are accepting the responsibility to take care of their needs. When asked if it was possible that it could make the resident's feel helpless when they are not getting their needs met by answering the call lights? Administrator stated, yes, probably so. Interview with CNA C on 05/01/2023 at 4:18 pm. CNA C stated that she usually makes her rounds every two hours. CNA C stated that every 30-minute rounds are unreasonable and impossible because if they are changing a resident, it may take 15 to 20 minutes. CNA C stated that they usually have 2 to 3 CNAs for 6 halls, and it is impossible to do every 30-minute rounds for the 21 rooms that do not have call lights. CNA C stated she can hear the bells and it depends if she is able to find where the bells or whistles are coming from because there are 6 halls. CNA C stated that she does not feel that this is an effective method. CNA C stated that the facility needed to get a better method for the call system. CNA C stated that she is sure that some residents have gone without help because it is difficult to find where the noise is and there is no light so you cannot see where it is coming from, you just have to kind of hunt for it. CNA C stated that some residents cannot even use the whistles or bells or may get overly exhausted trying to use the bells or whistles. CNA C stated that the negative potential outcome for residents is that they may get injured or fall trying to help themselves because the cannot call for help when they need it. Interview with CNA D on 05/01/2023 at 4:31 pm. CNA D stated that she makes her rounds approximately every two hours. CNA D stated that she has not been told or notified that she needs to be making 30-minute rounds for the residents that are without a call light. CNA D stated that she cannot hear the bells or the whistle, but she can sometimes hear the whistles. CNA D stated that it gets frustrating because she had to run around trying to find where the whistle is coming from and if the resident stops blowing the whistle, it is impossible to find which resident was using the whistle. CNA D stated that some of the residents cannot even use the whistle because of the oxygen and it is too much for them. CNA D stated that she does not think this method is effective because many residents are getting skipped because the staff cannot find where the whistle is coming from. CNA D stated that the call light system has been out for weeks and does not know how much longer it will be until it is fixed. CNA D stated that even with the call lights it takes some time to get to the resident because there is not many staff that are there to work, so can you imagine having no light and trying to hunt down a whistle sound when there is only 3 or 4 staff members that are trying to locate the resident needing help. CNA D stated that makes it impossible to do 30-minute rounds and that is beside trying to provide care for all residents. CNA D stated that the negative potential outcome for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 16 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not having effective call light system would be that the resident is not getting the needed care they deserve, or they could get injured. Interview with DON on 05/01/2023 at 4:47 pm. DON stated that she can hear the bells and whistles at night. DON stated that she does not usually work nights, but she has from time to time. DON stated that in order to find where the bells and whistles are coming from, she would have to go look for where the noise was coming from. DON stated that she does not guess that would be an effective means of notifying staff that a resident needs help or for a long period of time. When asked if she is willing to work nights until the call light system Is fixed since she can hear the bells and whistles at night when the rest of the staff cannot hear it, her response was that she is not willing to work every day until then. DON stated that she does not know other than getting cow bells what they can do. DON stated that the negative potential outcome for residents not being able to get staff attention when they need help is they could possibly get hurt or not get what they need taken care of. DON stated that she cannot speak for her staff, but she can only speak for herself, and she believes that she could hear the whistles and bells. DON stated that the way that she monitors the staff making the 30-minute rounds is by checking the log to see if they have initialed the 30-minute round log. DON stated that the parts to fix the call light system are on back order and she does not know if that is the only vendor that is available for the parts or not. When asked why the staff have not made 30-minute rounds while Surveyor has been in the building, DON stated she was not sure why they have not done this. DON stated that the system that they have in place is effective when the staff can hear the whistles or bells and the staff work together and do what they need to do. The DON stated it is the responsibility of the facility to make sure to provide for the needs of the residents. Interview with Maintenance Supervisor on 05/01/2023 beginning at 5:40 pm. Maintenance Supervisor stated that the open area in Resident #3's room should not have been exposed and open with wiring hanging out. Maintenance Supervisor stated that it should be fine though because the wiring is not hot. Maintenance Supervisor stated that there would be a potential for injury if the wiring was hot. When the Maintenance Supervisor was asked, Could one of the wires potentially poke the resident's finger if the resident was touching it? Maintenance Supervisor stated that that could possibly happen but why would a resident be messing with the wires even if it uncovered. Maintenance Supervisor stated that he is aware that he is responsible for coving the exposed wiring and opened wall. Maintenance Supervisor then questioned surveyor if she was talking with a resident that was his family member. Surveyor stated that information was confidential. Maintenance Supervisor got hostile verbally and ended the interview. Record Review of facility provided policy on 05/01/2023, labeled, Resident Call System, dated December 2019, revealed: Policy: The facility is equipped with a functioning communication system from rooms, toilets, and bathing facilities in which the resident calls are received and answered by staff. Procedure: 1). Resident calls are relayed directly to a staff member or to a centralized staff work area. 2). The communication may be through audible or visual signals and may include wireless systems. 3). All portions of the system are functioning a). Systems are on at nursing station, b). Staff are available at the nursing station, c). The volume is loud enough to be heard by the nursing staff, d). Th light above the room or rooms is working, e). calls are being answered, f). For wireless systems, staff who answer resident calls, have functioning devices in their possession, and are answering resident calls. 4). If a resident has disabilities that make use of the facility's communication system inaccessible, alternative, auxiliary aids, or services are provided to meet the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 17 of 18 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 455871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lynwood Nursing and Rehabilitation 803 S Alamo Levelland, TX 79336 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 0919 needs as identified in the resident's assessment or plan of care. Level of Harm - Minimal harm or potential for actual harm Record Review of in-service provided by facility on 05/01/2023 dated 04/12/2023, labeled, Call Light Malfunction, revealed: Under topic: Due to the malfunction of the call light system, Staff will do every 30-minute checks on residents who's call light is not working. Whistle and bells have been provided to each resident until the system I fixed. The signature sheets showed 30 employee signatures. Residents Affected - Some Record Review of 30-minute resident check sheet provided on 05/01/2023, dates provided for 04/13/2023-04/30/2023 revealed: Each sheet indicated the resident name at the top and 30-minute increment times on the side with employee initialed signed to each slot. There was no documentation on what was done. The sheets do not indicate that the staff was checking due to call light system malfunction. No receipt provided for call light system repair or estimated time of vendor arrival time provided by the facility prior to exit. Record Review of falls for facility provided on 05/01/2023 revealed: Resident #6 had a fall on 04/15/2023 stated unwitnessed fall with no injuries. Resident #6 call light is not working. Resident #7 had a fall on 04/12/2023 stated sitting on floor, near wheelchair and room entrance. It was listed that Resident #7 was one of the residents with no working call light in this timeframe. Interview with Resident #6 could not be conducted on 05/01/2023 due to Resident #6 being in the hospital. Record Review of facility provided list for non-working call lights and map on 05/01/2023 revealed: Not-Working Call lights: 103, 104, 105, 106, 107, 108[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 18 of 18