Health inspection·September 20, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 09/20/23 at 01:35 PM with the ADM, she stated staff should have provided privacy when they leave bedside to wash hands. She stated all staff have been trained on privacy. She stated the ADON does training and skills checkoffs quarterly. She stated the potential negative outcome could be a dignity issue being exposed. She stated her expectations were to provide privacy on all occasions. During an interview on 09/20/23 at 01:50 PM with the DON, she stated the resident should be covered with a towel or sheet when the CNA leaves to wash hands. She stated the ADON was responsible for training and monitoring CNA's using the skills checkoffs. She stated the CNA's do skills checkoffs every 3-4 months. She stated the potential negative outcome of not providing resident privacy could be someone walking in room, resident embarrassed or frightened. She stated her expectations were for staff to provide privacy and not expose the resident to the world. During an interview on 09/20/23 at 02:03 PM with the ADON, she stated when asked if resident should be provided privacy when a CNA leaves to wash hands Absolutely. She stated the CNA's should pull the curtain and closed the door to residents' room. She stated the staff had been trained to provide privacy during incontinent care. She stated she does skills checkoffs with CNA's every 3-4 months. She stated her expectations were for everyone to provide privacy. She stated the potential negative outcome could be a dignity issue. Record review Perineal Care (cleaning the private areas of a resident) Return Demonstration dated 2022 revealed CNA B completed skills demonstration on 07/21/23. Record review of the following policy labelled Resident Rights dated 02/21 revealed the following: Policy Statement: Employees shall treat all residents with kindness, respect and dignity. Policy Interpretation and Implementation: 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: a. a dignified existence; b. be treated with respect, kindness, and dignity; . Record review of the following policy labelled Resident Rights Guidelines for All Nursing Procedures dated 10/10 revealed the following: Purpose: To provide general guidelines for resident rights while caring for the resident. Preparation: l. Prior to having direct-care responsibilities for residents, staff must have appropriate in-service training on resident rights, including: . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 2 of 33 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 09/20/2023 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 0550 b. Resident dignity and respect; . Level of Harm - Minimal harm or potential for actual harm f. Close the room entrance door and provide for the resident's privacy . Record review of policy labelled Perineal Care dated 01/20/23 revealed the following: Residents Affected - Few Policy Statement: Perineal Care is providing cleanliness and comfort to the resident, to prevent infections, skin irritation, and to observe the resident's skin condition. Steps in the Procedure . 2. Provide privacy. i.e., pull curtain, close door . 5. Adjust bedding to resident's comfort and provide dignity during care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 3 of 33 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 09/20/2023 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview and record review, the facility failed to ensure sure each resident had a right to a safe, clean, comfortable, and homelike environment in the facility and failed to provide housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior in 4 of 5 common baths (100/200, 300, 500 and 600), reviewed for environment, in that: The facility failed to ensure resident use common areas were clean, safe and did not need repair. These failures could place residents at risk for living in an unsafe, unclean, uncomfortable, and unhomelike environment which could cause a decline in resident psychosocial well-being. The findings include: On 9/18/23 at 4:27 PM an observation was made of the 100/200 bath. The shower chair in the room had a heavy buildup of residue and dirt on the mesh back. There were three dried brown mounds on the floor in the shower stall. The mounds were approximately an inch in diameter. On 9/18/23 at 4:32 PM an observation was made of the hall 300 bath. The shower chair had a buildup of residue on the mesh back and there was a gallon of body wash, stored on the floor. There was a bag of clean folded linens in the sink. On 9/18/23 at 4:49 PM an observation and interview were conducted in the hall 500 bath with CNA D. She stated that the shower chairs were cleaned after each resident. Regarding any deep cleaning of shower chair, she stated, CNAs were not responsible for this duty. She added she was unsure who deep cleaned the shower chairs. There was also a dirty unlabeled hairbrush. On 9/18/23 at 5:07 PM an observation was made of the hall 600 shower. The shower chair mesh back had a buildup of residue, and the mesh was frayed and pulling apart. There was a large bag of clean folded linens in the chair. There was a gallon jug of body wash on the floor with no cap on. The light was not operational in the toilet area. On 9/18/23 at 6:01 PM an interview was conducted with the DON regarding cleaning of the baths. She stated the nursing department had new aides. Regarding any deep cleaning of the shower chairs, she stated staff should conduct deep cleaning. Regarding what could result from unclean shower chairs, she stated infection control. On 9/19/23 at 9:27 AM an observation was made of the hall 600 shower. The pink shower chair had mesh back that was frayed and pulling from the frame. The light was out at the toilet area. There was a large amount of towels that were bagged and clean and placed in a chair. On 9/19/23 at 11:31 AM an observation was made of the hall 100/200 bath. One of one shower chair had heavy buildup residue on the mesh back. There was a heavy accumulation of dirt on one of two ceiling vents. The privacy curtain was missing at the toilet. On 9/19/23 at 10:38 AM an interview was conducted with Housekeeper A, regarding housekeeping duties in the baths. She stated, they take out the trash, wipe down the shower, sweep and clean shower chairs. She stated that they conduct deep cleaning every other day. For deep cleaning they use DC 33 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 4 of 33 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 09/20/2023 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 0584 and use a scrub brush. She stated, she was new and had only been here a week and a half. Level of Harm - Minimal harm or potential for actual harm On 9/20/23 at 1:38 PM an interview was conducted with the Housekeeping Supervisor. Regarding shower cleaning duties, she stated, housekeeping staff only cleaned the shower room and brought soap and towels. She added housekeeping staff did not clean the shower chairs, but wheelchairs and shower chairs were cleaned by nurse aides on the night shift. Residents Affected - Some Observation on 9/20/23 at 1:52 PM in the hall 100/200 bath revealed the wall cabinet bottom shelf had an unlabeled dirty brush. On 9/20/23 at 3:50 PM an interview was conducted with the Administrator regarding issues found in the facility. Regarding the cleanliness of resident baths, she stated the cleanliness issues occurred because staff were not doing as good a job cleaning. Regarding what she expected staff to have done, she stated staff should have cleaned the entire shower chairs between residents and label the hairbrushes. Regarding whom was responsible for ensuring that the baths and shower chairs were clean, she stated nursing staff was responsible. Regarding what could result from the cleaning issues, she stated possible contamination and the spread of bacteria. On 9/20/23 at 3:03 PM an interview was conducted with the DON regarding the resident shower chairs. Regarding whom was responsible for ensuring the shower chairs were clean, she stated the DON. Regarding why the situation happened with the shower chairs being dirty, she stated nursing staff were paying attention to what was seen (shower chair front area) and not the things not seen (shower chair mesh backs). She added she expected staff to clean the equipment. She further stated she had not had a chance to train this rotation staff shift (9/20/23) regarding the cleaning of shower chairs. Record review of the In-Service Attendance Record dated 9/18/23 revealed staff were given an in-service with the Subject: Cleaning and Disinfection of Resident Care Equipment. Further record review of the in-service attendance record revealed the attached guidelines did not cover specifics of cleaning shower chairs. Record review of the facility policy titled Cleaning and Disinfecting Non-Critical Resident Care Equipment, Revised April 2020, revealed the following documentation, Purpose. The purpose of this procedure is to provide guidelines for disinfection of non-critical resident care items. Preparation. General Guidelines. 1. Discard resident care items when damaged or so grossly soiled that a disinfection process is not effective in rendering the item clean. 3. The following categories are used to distinguish the levels of sterilization/disinfection necessary for items used in resident care. c. Non-critical items are those that come in contact with intact skin but not mucous membranes. d. Reusable items are cleaned and disinfected are sterilized between residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 5 of 33 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 09/20/2023 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based interview and record review, the facility failed to ensure MDS automated data processing requirements were followed regarding encoding data and transmitting data for a discharge of 1 of 1 resident reviewed (Resident #58), in that: Residents Affected - Some 1)The facility failed to submit a discharge MDS for Resident #58 who discharged from the facility on 5/19/23. These failures could lead to inaccuracies in resident MDS records. The findings include: Record review of admission MDS dated [DATE] and Progress Notes dated 3/23/23, for male Resident #58 revealed that he was admitted to the facility on [DATE]. The resident had active diagnoses of CVA (stroke), hypertension (high blood pressure), diabetes mellitus (blood sugar imbalance), hyperlipidemia (elevated cholesterol), hemiplegia (one side weakness). The resident had a BIMS score of 14 indicating the resident was cognitively intact. Record review of the ASEQ Survey documentation system revealed that Resident #58 had a MDS Record over 120 days old. Record review of the Progress Notes for Resident #58 dated 5/19/23 revealed the resident was discharged home on 5/19/23. Record review of the MDS 3.0 Resident Assessments listing revealed Resident #58's final MDS documentation stated, Date - 5/19/23, Status - In Process Entry/Discharge - 10 - Discharge - Return not anticipated . All other MDSs (admission and Entry) had a Status of Production Accepted. On 9/20/23 at 9:29 AM an interview was conducted with the MDS Coordinator regarding Resident #58's discharge MDS dated [DATE]. She pulled it up on the computer and stated, It was not done. Regarding why the discharge MDS was not done, she stated she just missed it. Regarding whom was responsible for ensuring that the discharge MDS's were completed, she stated, she was. She added, she normally would go into the system and complete the MDS upon discharge. Regarding what could result from the discharge MDS not being completed, she stated on discharge, it could not have any effect on the residents. She added if the resident stayed in the facility, he would have been on the regular schedule and his MDS would not have been missed. Regarding her process of tracking when MDS's were due, she stated, she had a handwritten schedule form. She added the MDS system prompts her when MDS's are due, and then she would write it on a handwritten schedule. She further stated if a resident was in house, the system would pick up the due date; if they were discharged , then it's up to her to track. On 9/20/23 at 3:50 PM an interview was conducted with the Administrator. Regarding the MDS submission issue, she stated it was an oversight that caused it to be missed. Regarding what she expected staff to have done, she stated to have completed the MDS when due. Regarding whom was responsible for the completion of MDS submissions, and she stated, the MDS Coordinator. Regarding what could result from not submitting a discharge MDS and she stated no effect on the resident. She further stated regarding Resident #58, that he now participates in outpatient therapy in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 6 of 33 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 09/20/2023 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 0640 Level of Harm - Potential for minimal harm Residents Affected - Some On 9/20/23 at 5:38 PM an interview was conducted with ADON regarding a policy related to MDS submissions. She stated, the facility followed CMS/RAI guidelines on MDS submissions and there was no specific facility policy. On 9/21/23 at 11:35 AM interview was conducted with the MDS Coordinator regarding the deadline for the submission of Resident #58's discharge MDS. She stated, she believed it should have been done within 48 hours of discharge. She added that she completed the discharge MDS for Resident #58 on 9/20/23. Record review of the Centers for Medicare & Medicaid Services, Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.17.1, October 2019 revealed the following documentation, CHAPTER 5: SUBMISSION AND CORRECTION OF THE MDS ASSESSMENTS . 5.2 Timeliness Criteria . Encoding Data: Within 7 days after completing a resident's MDS assessment or tracking record, the provider must encode the MDS data (i.e., enter the information into the facility MDS software). The encoding requirements are as follows: . For a . Discharge, encoding must occur within 7 days after the MDS Completion Date . Transmitting Data: Submission files are transmitted to the QIES ASAP (Quality Improvement and Evaluation System (QIES) Assessment and Submission and Processing) system using the CMS wide area network. Providers must transmit all sections of the MDS 3.0 required for their State-specific instrument . Transmission requirements apply to all MDS 3.0 records used to meet both federal and state requirements . - Assessment Transmission: . All other MDS assessments must be submitted within 14 days of the MDS Completion Date FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 7 of 33 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 09/20/2023 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) Level I residents with mental illness were provided with a PASRR Evaluation assessment for 2 of 18 residents (Residents #35 and #45) reviewed for PASRR screening, in that: Residents Affected - Few Residents #35 and #45 did not have an accurate PASRR Level 1 assessments when they had a diagnosis of mental illness. These failures could place residents with an inaccurate PASRR Level 1 Evaluation at risk for not receiving care and services to meet their needs. The findings were: Resident #35: Record review of Resident #35's electronic face sheet revealed a [AGE] year-old male most recently admitted to the facility on [DATE]. The face sheet listed under Diagnoses Information, Schizoaffective Disorder, Bipolar type. Record review of Resident #35's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of Schizoaffective Disorder, Bipolar type. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 1 indicating the resident was severely cognitively impaired. Record review of Resident #35 most recent care plan, undated, revealed a focus area and diagnosis of Schizoaffective Disorder, Bipolar type, this problem started 06/21/2021. Resident #35 is on Hospice and currently not prescribed psychotropics. Record review of Resident #35's Preadmission Screening and Resident Review Level One (PL1) form dated 3/16/2021 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #45: Record review of Resident #45's electronic face sheet revealed a [AGE] year-old female most recently admitted to the facility on [DATE]. The face sheet listed under Diagnosis Information a diagnosis of Catatonic Schizophrenia. Record review of Resident #45's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of Catatonic Schizophrenia. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 99 indicating the resident was severely cognitively impaired. Record review of Resident #45's most recent care plan, undated, revealed a focus area and diagnosis of Catatonic Schizophrenia, this problem started 03/09/2023. Resident #45 was prescribed Trazadone 100mg once a day to address this diagnosis. Record review of Physician progress notes for Resident #45 dated 09/20/2023 revealed under current medications, Resident #45 was prescribed Trazadone 100mg once a day to address his diagnosis of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 8 of 33 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 09/20/2023 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 0645 Catatonic Schizophrenia. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #45's Preadmission Screening and Resident Review Level One (PL1) form dated 3/09/2023 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Residents Affected - Few During an interview conducted on 09/20/23 at 11:07AM with the Administrator, she verified Residents #35 and #45 had a diagnosis of mental illness. The ADM verified Residents #35, and #45 had inaccurate PASRR 1 Evaluations and no subsequent PASRR 2 Evaluations. The ADM stated it was the MDS nurses' responsibility to ensure every resident admitted to the facility has an accurate PASRR 1 Evaluation. The ADM also stated it was the MDS nurses' responsibility to ensure PASRR 1 Evaluation are completed accurately by comparing them to the residents' medical records. The ADM stated the potential harm if a resident with a diagnosis of a mental illness who had a negative PASRR 1 Evaluation, and no subsequent level two evaluation was the residents could potentially go without services. During an interview with the DON on 09/20/23 at 1:52PM, she verified Residents #35 and #45 had diagnosis of mental illnesses. The DON confirmed Residents #35 and #45 did not have PASRR 2 Evaluation as their PASRR 1 Evaluations were negative after review. The DON stated it was the MDS nurses' responsibility to ensure every resident admitted to the facility has an accurate PASRR 1 Evaluation. The DON also stated it was the MDS nurses' responsibility to ensure PASRR 1 Evaluation are completed accurately by comparing them to the residents' medical records. The DON stated the potential harm to a resident without an accurate PASRR 1 Evaluation and a subsequent PASRR 2 Evaluation was the residents will not receive the services they need. During an interview with the MDS nurse on 9/20/23 at 10:25am, she stated Residents #35 and #45 did not have PASRR 2 Evaluations as their PASRR 1 Evaluations were inaccurately negative. The MDS nurse stated Residents #35 and #45 did not have accurate PASRR 1 Evaluations as both residents have a diagnosed mental illness. The MDS nurse stated it was her responsibility to ensure every resident entering the facility had a completed and accurate PASRR 1 Evaluation. The MDS nurse also stated it was her responsibility to ensure any new mental health diagnosis added after entry to the facility that warranted a new PASRR 1 Evaluation were completed. The MDS nurse stated she did not know why #35 and #45 did not have positive PASRR 1 Evaluation due to having had a mental illness diagnosis. The MDS nurse stated the potential negative outcome for residents not having an accurate PASRR 1 Evaluation and subsequent PASRR 2 Evaluation are the residents may not be offered the services they may need for their diagnosis. [NAME] Oaks Preadmission Screening and Resident Review (PASRR) Policy Revised 2/1/2023: The facility policy for PASARR states all applicants to a Medicaid-certified nursing facility are evaluated for mental health prior to admissions and offered the most appropriate setting for their needs. If the PASARR level one screening indicated the individual may have an Intellectual Disability or a Mental Illness diagnosis the facility will confer with local mental health providers to complete a PASARR level two screening. Following the completion of the level two screening a care plan will be developed by the facility in order to meet the needs of a resident with an Intellectual Disability or a Mental Illness diagnosis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 9 of 33 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 09/20/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that the resident environment remained as free of accident hazards as was possible in 4 of 5 Baths (100/200, 300, 400 and 500) and 1 of 22 resident rooms (room [ROOM NUMBER]) reviewed, in that: The facility failed to maintain resident use hot water at safe and comfortable temperatures. Resident-use hot water was not reliably controlled. Hot water temperatures ranged from 113.5 to 117.9 F, and The facility failed to ensure chemicals were stored in a manner to prevent contamination of resident use items. This failure could place residents at risk for injuries related to chemical contact and could place residents at risk for sustaining scalding injuries when using resident-use/resident accessible hot water. The findings include: Observation on 9/18/23 at 2:09 PM in room [ROOM NUMBER] revealed the hot water at the room's hand sink was 117.5°F. Observation on 9/18/23 at 2:15 PM revealed the hot water in room [ROOM NUMBER] tested at 117.9°F and the Activity Director was a witness at this time. On 9/18/23 at 4:27 PM an observation was made of the 100/200 bath, and it was unlocked. There was a spray bottle of Peroxide Multi Surface Cleaner and Disinfectant on the top shelf of the wall cabinet which was locked. The key to the cabinet lock was attached to the side of the cabinet. This cleaner was stored next to hair moisturizer and disposable briefs. The cleaner was also stored above resident toiletries, dirty razors, and lotion. The peroxide cleaner was labeled, Causes moderate irritation. Harmful if inhaled. Avoid contact with eyes or clothing. On 9/18/23 at 4:32 PM an observation was made of the hall 300 bath. It was unlocked. There was a spray bottle of DC 33 Spray Disinfectant that was leaning at a slant and stored next to hair conditioner, shampoo and body wash, and on the top cabinet shelf. The shelf was located above disposable gloves, deodorant and toothbrushes. This disinfectant was stored in a locked wall cabinet with the key attached to a chain on the side of the cabinet. The hot water in the room was 113.5°F. On 9/18/23 at 4:49 PM an observation was made of the hall 500 bath with CNA D. The locked wall cabinet had a spray bottle of Peroxide Multi Surface Cleaner stored next to disposable briefs and toothbrushes on the top shelf. On the bottom shelf was another spray bottle of the same peroxide cleaner that was labeled, Causes moderate irritation. Harmful if inhaled. Avoid contact with eyes or clothing. Also on the bottom shelf was an aerosol can of Disinfectant Spray label with the name Resident #44. Further labeling on the can was as follows, May cause irritation. Avoid contact with the eyes and skin. There was also an aerosol can of Monterey Mist Odor Eliminator and Air Freshener that was labeled, Danger. Extremely flammable aerosol. Causes serious irritation. May cause allergic skin reaction. May cause drowsiness or dizziness. The lower shelf also had body wash, baby oil cream that was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 10 of 33 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 09/20/2023 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 0689 labeled with the name Resident #41, razors, lotion, and disposable briefs. Level of Harm - Minimal harm or potential for actual harm During an interview on 9/18/23 at 5:06 PM, CNA D stated shower 100/200, had the cleaners stored on the top shelf. Regarding why the cleaners were stored on the top shelf, she stated, when she started working in the facility, that was where they were stored. She stated she was not told anything differently as far as storing chemicals. Regarding what could result from storing chemicals with and above resident use items, she stated, skin breakdown, and chemicals could get in residents' mouths via the toothbrush. Residents Affected - Some Observation on 9/18/23 at 5:12 PM the hall 400 shower was unlocked. The hot water at the sink was 115.9°F. The wall cabinet was empty, but there was a sign on the outside of the cabinets stating, Please do not place disinfectant in cabinet. Observation on 9/18/23 at 5:26 PM in room [ROOM NUMBER] the hot water was still 117.9°F. On 9/18/23 at 5:30 PM an interview was conducted with the Maintenance Supervisor. He stated that he looked for a range of 100 to 110°F as being correct for resident use hot water. He stated that he had never checked the water in room [ROOM NUMBER] on the 400 hall. Regarding his water temperature monitoring routine, he stated he checked rooms randomly every week. Normally he checked temperatures in the morning, and at times later in the day. He added that room [ROOM NUMBER] was closest to the water heater and Halls 300 and 400 were on the same water heater. He stated, everyone was using water in the mornings which could decrease the water temperature readings. Regarding what could result from water temperatures being elevated, he stated, the water could scald residents. He further stated that he had been working in the facility two months. He added that the TELS (online maintenance documentation and scheduling) system was used for the facility. On 9/18/23 at 6:01 PM an interview was conducted with the DON regarding chemical storage in the baths. Regarding what CNA's had been instructed to do regarding the storage of chemicals, she stated, toiletries should not be stored with chemicals. She stated she had conducted in-services on chemical storage, but not recently. She added, the facility had new aides. Regarding when aides would have been instructed about chemical storage, she stated it was probably conducted on hire. Regarding what could result from the storage of chemicals with resident items, she stated, the chemicals could spill on resident items and could hurt somebody. Observation on 9/19/23 at 9:32 AM, revealed bath 300 had DC 33 disinfectant spray stored in the wall cabinet on a lower shelf next to an open box of gloves. On 9/19/23 at 9:37 AM an interview was conducted with TNA A, regarding the hall 300 bath chemical storage. She stated the gloves were used by staff when bathing resident's backs and bodies. She added that chemicals should be stored on the bottom shelf and personal items on the top shelf. She further stated, the DON did not address glove storage related chemical storage. She added, she had asked the DON about chemical storage this morning (9/19/23). She stated she usually used the hall 500 bath and the gloves were stored in a bin and not the cabinet. Regarding what could result from storing chemicals next to the gloves, she stated, chemicals could irritate resident's skin. On 9/19/23 at 4:10 PM an interview was conducted with the Maintenance Supervisor regarding the Water Temperature Log documentation that revealed water temperatures had reached 117 degrees F in previous weeks. He stated he was not sure of what was causing the water temperature fluctuations. He added it could be resident use and the recirculating pumps. He stated the fluctuations seemed random. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 11 of 33 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 09/20/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some also stated that he had not contacted a plumber about the situation. He added, he flushed out a water heater last month. Regarding his reaction when he got temperatures above 110°F, he stated, he just kept track of the temperatures and checked the rooms again. He added he adjusted the water heaters a couple of times when temperatures were high and he would go back and retest, and it usually went down. He added, if the water got excessively high, he would shut off the hot water heater and call the facility's regional corporate staff. On 9/20/23 at 9:00 AM an interview was conducted with the Maintenance Supervisor regarding hot water. He stated the plumber came to the facility today (9/20/23) and explained how the water circulates up one side of the hall and down the other with one recirculating pump. He added the facility replaced a recirculating pump before his employment. He stated the plumber told him that the water temperatures would fluctuate. On 9/20/23 at 1:40 PM an observation and interview were conducted with the Housekeeping Supervisor of the hall 400 janitors closet and the DC 33 Disinfectant. The label documented, Danger. Corrosive. Causes irreversible damage and skin burns. At that time The Housekeeping Supervisor stated, staff should use the tackle boxes (to store the DC 33); each shower room should have one with a bottle of DC 33 and a brush. She added when she checked the showers, the tackle boxes were gone. She further stated all the chemical bottles should have a label. Regarding chemicals being stored with resident toiletries, she stated, staff could not store chemicals with resident use items. Regarding the baths, she stated there may be tackle boxes in the baths, but nothing in the tackle boxes. Observation on 9/20/23 at 1:46 PM, the hall 400 bath tacklebox was empty. Observation on 9/20/23 at 1:49 PM, the hall 500 bath had no tacklebox in the Bath. Observation on 9/20/23 at 1:52 PM in the hall 100/200 bath, the tacklebox only had a brush in it. Observation of the locked wall cabinet revealed the bottom shelf had an unlabeled dirty brush, hair conditioner, foot powder, and deodorant on the shelf next to a spray bottle labeled Peroxide Multi Surface Disinfectant and Cleaner. An Interview was conducted with the Housekeeping Supervisor on 9/20/23 at 1:53 PM. She stated regarding the 100/200 bath peroxide cleaner, That's not even the right bottle. We don't have Peroxide Multi-Surface Cleaner anymore. We have DC 33 Disinfectant Cleaner. I have given nursing staff the correct bottles; I don't know how many times. On 9/20/23 at 3:50 PM an interview was conducted with the Administrator regarding chemical storage in the resident baths and hot water being over 110 degrees F. Regarding why these issues happened, she stated for the chemicals it was an education issue. Regarding the hot water, she stated it was a possible recirculating pump issue. Regarding what she expected staff to have done, she stated chemicals should be stored separately and the plumber should have been called about the hot water. Regarding whom was responsible in these cases, she stated chemicals was Nursing and the hot water was the Maintenance Supervisor. Regarding what could result from these issues she stated the chemicals could have chemical spillage and the water had a potential for burns. On 9/20/23 at 3:03 PM an interview was conducted with the DON. Regarding why staff had issues with the storage of chemicals with resident items, she stated, the regional nurse told her that there was no policy on the storage of chemicals as to what goes where. Their facility guidance just said that all chemicals should be locked and not accessible to residents. Regarding whom was responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 12 of 33 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 09/20/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some ensuring that chemicals were stored properly and not with resident items, she stated, she would check showers on supervisory rounds. She stated that she expected staff to store chemicals correctly. She also added that she had not gotten this staff rotation/shift (9/20/23) trained yet regarding the storage of chemicals in baths. Record review of the facility's current undated guidelines titled TELS Masters, F689 Accidents - Water Temperatures, revealed the following documentation, F689 - Description - the facility must ensure that the resident environment remains free of accident hazards as is possible, and each resident receives adequate supervision and assistance devices to prevent accidents. Purpose - the purpose of recording your water temperatures is to assure the surveyor that your facility is remaining as free from accidental burns and scalds as possible, and that any issues are addressed in a prompt and consistent manner. Surveyors will often test water temperatures at hand sinks, and bathing tubs with a thermometer if they hold their hands under the water and feel it is too hot or note their skin turning red. Common causes - a common cause of tap water burns to the elderly, include slipping and falling in the bathing tub and not being able to get back up. Residents may also not check the water before touching it. Other causes could come from mechanical issues such as temperature changes that occur when the water is being used in other areas of the building, or a plumbing malfunction that causes a sudden burst of scalding water. Please note that long-term care residents may be more susceptible to burns than other individuals due to several factors. These include decreased skin sensitivity, communication abilities, and the inability to react quickly when exposed to hot water. State Regulations - F689 is typically enforced by the state department of health. Each state will have its own regulations on maximum water, temperature allowed, but it typically will fall between 105 to 115° F. Check with your surveyor . To gain even more efficiencies, TELS recommends using TELS mobile to record your water temperatures as you perform the testing. After you've tested the water, record the temperature readings in the attached log and note any concerns in the comment section. You can continue this process until all areas requiring testing are complete. Task Instructions. The rest of the temperature location suggested below may not apply to your type of facility. Please check with your regional support staff. 1. For burn prevention, federal guidelines advise that you keep domestic water temperature is below 120°F, although this temperature can still cause burns if exposure reaches five minutes. Many states have even stricter standards that set maximum temperatures lower than 120°F. Although 100°F is considered a safe water temperature for bathing. 2. Test temperature in shower areas. 3. Test temperatures at the mixing valve. 4. Check resident rooms at the end of each wing on a rotating basis or per facility policy. 5. Common area bathrooms, public bathrooms, and any other area having sinks should be checked and recorded as well. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 13 of 33 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 09/20/2023 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 0689 Record results in the water temperature log. Level of Harm - Minimal harm or potential for actual harm 1. Note any discrepancies. 2. Adjust water heater settings as required. Residents Affected - Some 3. Read test is necessary. Record review of the Logbook Documentation, for water temperatures from 6/19/23 through 9/14/23 revealed of the 12 approximately weekly water temperature checks, eight of the weeks documented water temperatures in the facility above 113°F in resident rooms and resident use areas. Further record review of the 12 weeks of testing revealed that when temperatures were in the range of 113 or above there was no documentation or comments as to any interventions that were taken. Additional Record review of the facility Water Temperature Logs revealed that there were no times documented as to when the temperatures were taken. The documentation was as follows: On 8/28/23, room [ROOM NUMBER], 307 and 308 had hot water temperatures at 115°F. There was no documentation of checking any rooms on Halls 200, 400 and 600. On 8/24/23 rooms [ROOM NUMBERS] had hot water temperatures at 116°F. There was no documentation that water temperatures were taken in resident rooms are baths on hall 400. On 8/14/23 one shower room on hall 100 and one room on halls 100, 200, 300, 400, 500 and 600 were tested. The temperatures range from 113°F to 115°F in the resident rooms tested on hall 100, 300, 400, 500 and 600. On 8/9/23 water temperatures were tested on all six halls except hall 400. Hot water tested in rooms 108, 201 and the 100/200 shower were 113°F. The hot water in room [ROOM NUMBER] was 114°F and the hot water in the 100 hall restroom was 117°F. On 8/3/23 the resident hot water was tested on all six halls except for hall 400. The hot water in the 100/200 bath was 113°F. On 7/18/23 one resident room was tested on all six halls and the shower room on 100 and 600. The hot water in room [ROOM NUMBER] was 113°F. On 7/3/23 temperatures were documented as tested on all six halls, but no specific rooms were documented. On hall 400 the hot water was 114°F. On 6/26/23 the water was tested on all six halls. There were no specific resident rooms documented. On hall 100 the hot water was 113°F. Review of the current American Burn Association Scald Injury Prevention Educator ' s Guide provided the following information: .although scald burns can happen to anyone, .older adults and people with disabilities are the most likely to incur such injuries .High Risk groups .Older Adults .Older adults, .have thinner skin so hot liquids cause deeper burns with even brief exposure. Their ability to feel heat may be decreased due to certain medical conditions or medications so they may not realize water is too hot until (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 14 of 33 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 09/20/2023 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some injury has occurred. Because they have poor microcirculation, heat is removed from burned tissue rather slowly compared to younger adults . People With Disabilities or Special Needs .Individuals who may have physical, mental or emotional challenges or require some type of assistance from caregivers are at high risk for all types of burn injuries including scalds sensory impairments can result in decreased sensation especially to the hands .so the person may not realize if something is too hot. Changes in a person ' s perception, memory, judgment or awareness may hinder the person ' s ability to recognize a dangerous situation .or respond appropriately to remove themselves from danger . Further review of the Guide revealed that 100 degree F. water was a safe temperature for bathing. Water at 120 degrees F. would cause a third degree burn (full thickness burn) in 5 minutes and 124 degrees F. water would cause a third degree burn in 3 minutes. The Guide further documented that water at 127 degrees F. caused third degree burns in 1 minute and water at 133 degrees F. caused third degree burns within 15 seconds. Water temperatures at 140 degrees F. caused third degree burns within 5 seconds. Record review of the facility policy title Maintenance Service, Revised November 2021, revealed the following documentation, Policy Statement. Maintenance service shall be provided to all areas of the building, grounds, and equipment. Policy Interpretation, and Implementation. 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include but are not limited to: a. Maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines. b. Maintain the building in good repair and free from hazards. f. Establishing priorities in providing repair services . i. Providing routinely scheduled maintenance service to all areas. j. Others that may become necessary or appropriate. 3. The Maintenance Director is responsible for developing and maintaining a schedule of maintenance service to assure that the buildings, grounds, and equipment are maintained in a safe and operable manner. 10. Maintenance personnel shall follow, establish safety regulations to ensure the safety and well-being of all concerned FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 15 of 33 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 09/20/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents who were incontinent of bladder or had a urinary catheter received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 2 of 3 Residents (Resident #24 and #32) reviewed for incontinent care. 1. CNA B failed to properly clean labia (middle of vaginal area) and wash hands between glove changes while providing incontinent care to Resident #24. 2. CNA C failed to change gloves and wash hands when going from dirty to clean while providing incontinent care to Resident #32. This failure had the potential to affect residents by placing them at an increased risk of exposure to communicable diseases and infections. Findings include: Resident #24 Record review of face sheet for Resident #24, dated 09/20/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: dementia (cognitive loss), atrial fibrillation (irregular heartbeat), muscle weakness, anxiety (feeling of fear and worry), hypertension (high blood pressure) and diabetes (high blood sugar). Review of Resident #24's MDS, dated [DATE] revealed Resident #24 had a BIMS of 04 which indicated the resident's cognition was severely impaired. The MDS revealed Resident #24 required extensive one person assist with toilet use and limited one person assist with personal hygiene. The MDS further revealed Resident #24 was always incontinent of bladder and bowel. Record review of Resident #24's Comprehensive Care Plan dated 09/12/23 revealed the resident required assist x 1 with bathing/hygiene and toileting. The Resident #24 was incontinent of bowel and bladder. The interventions included check for incontinence every 2 hours and toilet every 2 hours. Resident #24 was at risk for pressures ulcers related to incontinence. The interventions included keep clean and dry as possible, provide incontinence care after each episode and report redness or skin breakdown immediately. During an observation on 09/19/23 at 02:27 PM CNA B was providing incontinent care for Resident #24. CNA B did not clean the labia (middle of resident's vaginal area). CNA B removed gloves then turned around and picked up clean brief off bed side table, opened brief and placed brief beside Resident #24. CNA B donned new gloves and put brief on Resident #24. CNA B did not wash hands after doffing gloves or before donning new gloves. During an interview on 09/19/23 at 04:18 PM with CNA B, she stated she should have washed her hands after removing dirty gloves, before touching clean items and donning new gloves. CNA B stated she forgot to wash her hands and close the resident's door. She stated the potential negative outcome could be spread of germs. She stated the potential negative outcome of not properly cleaning a resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 16 of 33 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 09/20/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few could cause skin irritation, infections and UTI's. She stated she had been trained on proper incontinent care, resident privacy and infection control. She stated she does skills checkoffs every 3 to 4 months. Resident #32 Record review of face sheet for Resident #32, dated 09/20/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: dementia (cognitive loss), muscle weakness, hypertension (high blood pressure), and anxiety (feeling of fear or worry). Review of Resident #32's MDS, dated [DATE] revealed Resident #32 had a BIMS of 05 which indicated the resident's cognition was severely impaired. Resident #32 required total dependence with one person assist with personal hygiene and dressing. Resident #32 was frequently incontinent of bladder and bowel. Record review of Resident #32's Comprehensive Care Plan dated 06/23/23 revealed Resident #32 experiences bladder incontinence related to dementia with interventions to ensure adequate bowel elimination and provide incontinence care after each episode. The care plan further revealed Resident #32 required assist x 1 with hygiene and toileting. During an observation on 09/19/23 at 02:52 PM CNA C was providing incontinent care for Resident #32. CNA C cleaned front side of Resident #32 and then turned resident #32 touching her arm and leg with dirty gloves. During an interview on 09/19/23 at 04:41 PM with CNA C, she stated she should have changed her gloves before turning resident #32. She stated the potential negative outcome could be spread bacteria and infection. She stated she had been trained and did skills checkoffs every 3-4 months. During an interview on 09/20/23 at 01:35 PM with the ADM, she stated she does not know the proper steps in incontinent care and defers that to the DON and ADON. She stated gloves should be changed when going from dirty to clean. She stated the ADON trains and monitors CNA's with skill checkoffs every 3-4 months. She stated the DON, ADON and CN were responsible for monitoring staff to ensure they were following proper infection control. She stated the potential negative outcome could be infection. She stated the common infection seen in the facility was occasionally UTI's. She stated the importance of following infection control guidelines was to prevent infections. During an interview on 09/20/23 at 01:50 PM with the DON, she stated the proper way to clean the front side of a resident was down the middle and then side to side. She stated gloves should be changed when visible soiled and before turning resident on their side. She stated hands should be washed with soap and water or ABHR (alcohol based hand rub) if not visible soiled. She stated CNA's do skills checkoffs every 3-4 months with the ADON. She states she was responsible for monitoring CNA's to ensure they were following proper infection control. She stated the potential negative outcome could be spread of infection and UTI's. She stated some common infections in the facility were UTI's. She stated improper incontinent care and infection control could contribute to the infections. During an interview on 09/20/23 at 02:03 PM with the ADON, she stated the proper steps in incontinent care was clean the labia first then side to side. She stated there was no reason the labia would not be cleaned. She stated she was responsible for training the staff and providing skills checkoffs. She stated skills checkoffs were done quarterly. She stated the possible negative outcome could be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 17 of 33 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 09/20/2023 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 0690 spread of infections and UTI's. She stated the facility currently has no common infections. Level of Harm - Minimal harm or potential for actual harm Record review Perineal Care (cleaning the private areas of a resident) Return Demonstration dated 2022 revealed CNA B completed skills demonstration on 07/21/23. Residents Affected - Few Record review Perineal Care (cleaning the private areas of a resident) Return Demonstration dated 2022 revealed CNA C completed skills demonstration on 07/24/23. Record review Perineal Care (cleaning the private areas of a resident) Return Demonstration dated 2022 revealed the following: Procedure Steps: . Used correct technique for peri-care on female vs. male residents. Female: Spread labia, (maintain separation of labia, clean center, then each groin areas/each side - dirty to clean) wipe one side, then the other, and then the middle, wiping toward the rectal area and never wiping back and forth. Dispose of gloves and perform hand hygiene, don new gloves and roll resident to side then proceed to clean the rectal and buttocks area . Maintained resident dignity and privacy throughout entire procedure. Record review policy labelled Perineal Care dated 01/20/23 revealed the following: Policy Statement: Perineal Care is providing cleanliness and comfort to the resident, to prevent infections, skin irritation, and to observe the resident's skin condition. Steps in the Procedure . 2. Provide privacy. i.e., pull curtain, close door . 5. Adjust bedding to resident's comfort and provide dignity during care . A. For a Female Resident: . (2) Separate labia and wash area downward from front to back. (Note: If the resident has an indwelling catheter gently wash the juncture of the tubing from the urethra down the catheter about 3 inches. Gently rinse and dry the area.) (3) Continue to clean the perineum moving from inside outward to the thighs, cleanse the perineum thoroughly in same direction, using a new cleansing wipe, as needed . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 18 of 33 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 09/20/2023 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 provide food that was palatable, and at a safe and appetizing temperature for 1 of 1 meal reviewed for palatability. Residents Affected - Some 1) The facility failed to provide food that was palatable for 3 of 3 food forms served (Regular, Mechanical soft and pureed) at 1 of 1 meal observed (9/20/23 lunch). These failures could place residents at risk of decreased food intake, hunger, and unwanted weight loss. The findings included: During confidential individual interviews, 4 of 14 residents voiced concerns related to the palatability of the foods served. On 9/18/23 At 10:44 AM a resident stated the food was too salty and too cold. On 9/18/23 at 1:30 PM another Resident stated the food was not good and had no seasoning. On 9/19/23 at 9:11 AM one other Resident stated the food is horrible and bland. On 9/19/23 at 9:30 AM yet another Resident stated the food had no flavor. On 9/20/23 at 11:37 AM, an interview was conducted with the Dietary Manager and she was informed of a test tray request for both the hall carts. Observation on 9/20/23 at 11:37 AM revealed Dietary staff C took temperatures on the service line with the following results: Rolls were room temperature. Spaghetti 158°F Meat sauce 197°F. Puréed spaghetti 176°F Puréed meat sauce 170°F Mashed potatoes 174°F Tomato purée 184°F Stewed tomatoes 199° Ground chicken nuggets 173°F Chicken nuggets 206°F. Observation revealed Cart #1 serviced halls 100, 200 and 300 and the tray preparation for it started at 11:50 AM on 9/20/23. This cart was metal and not heated and the plates were not in a warming unit. The last tray was prepared at 11:56 AM and the test trays were prepared 11:56 AM through 11:59 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 19 of 33 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 09/20/2023 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 0804 AM. Cart #1 left the kitchen at 12:01 PM and arrived on hall 200 at 12:02 PM. Level of Harm - Minimal harm or potential for actual harm The last person was served from the Cart #1 was at 12:07 PM and the resident began eating at 12:08 PM. The test for Cart #1 began at 12:14 PM with the following results: Residents Affected - Some Spaghetti and meat sauce - bland, 134°F. Chicken nuggets - cold 97° Ground nuggets - cold 97°F. Puréed spaghetti - bland 108°F. Puréed meat sauce - bland, 108°F. Mashed potatoes - salty/high salt content - flavor 106°F. The tray preparation for Cart #2, which service halls 400, 500 and 600, began at 12:00 PM. This cart was insulated. The last tray was prepared for Cart #2 at 12:07 PM. The test trays were prepared at 12:07 PM and left the kitchen at 12:08 PM. Nursing were checking the cart and the cart left the dining room at 12:13 PM and arrived on hall 500 at 12:13 PM. The cart arrived on hall 600 at 12:22 PM and the last person was served in room [ROOM NUMBER] at 12:23 PM. The resident started eating at 12:25 PM. Observation on 9/19/23 at 12:27 PM, the Cart #2 test tray was sampled with the following results: Spaghetti and meat sauce - bland 135°F. Seven of 17 foods tested had palatability issues related to temperature and flavor On 9/20/23 at 2:20 PM an interview was conducted with the Dietary Manager. Regarding food resident input on food palatability, she stated after resident council meetings, the Activity Director brings any dietary issues to her or any food related issues. She added that she was invited to a resident council meeting one time during COVID (pandemic), and it was about not being able to get eggs. She stated that she does get input from residents one on one verbally. She added a gentleman, about two weeks ago, wanted salt. Regarding why these issues occurred with food being bland and cold, she stated the cart (Cart #1) was not insulated and their plates were not heated. Regarding the food being bland, she stated staff were not testing and tasting the foods for flavor quality. Regarding whom was responsible for ensuring that foods were palatable, she stated it started with the Dietary Manager and includes staff. Regarding what she expected her staff to have done, she stated to add more seasoning. Regarding what could result from the food palatability issues, she stated residents would not eat and it could cause weight loss. Regarding any in services conducted in the last three months, and she stated that she had not conducted any. On 9/20/23 at 3:50 PM an interview was conducted with the Administrator. Regarding food palatability, she stated foods being bland were due to the amount of seasoning and cold foods could possibly be due to carts not being insulated. Regarding what she expected staff to have done, she stated staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 20 of 33 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 09/20/2023 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some should get food to the residents hot and follow the recipes. Regarding whom was responsible for the palatability of foods, she stated the Dietary Manager. Regarding what could result from these issues, she stated residents might not eat and could lose weight. Record review of the Resident Council meeting notes dated 6/13/23, revealed the following documentation, . Dietary: Hall trays are cold. Record review of the Resident Council meeting notes dated 7/12/23 revealed the following documentation, . Food needs help with taste. Record review of the facility policy titled Food and Nutrition Services, Revised September 2021, revealed the following documentation, Policy Statement. Each resident is provided within nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident. Policy Interpretation and Implementation. 6. Food and nutrition services staff will inspect food trays to ensure that the correct meal is provided to each resident, the food appears palatable and attractive, and it is served at a safe and appetizing temperature. a. If an incorrect meal is provided to a resident, or meal does not appear palatable, nursing staff will report it to the dietary staff, so that the new food tray can be issued. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 21 of 33 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 09/20/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for dietary services, in that: 1)The facility failed to ensure foods were processed and pureed under sanitary conditions, 2) The facility failed to ensure Dietary staff ensured food and non-food contact surfaces were clean, and 3) The facility failed to ensure foods were stored in a manner to prevent contamination, These failures could place residents at risk for food contamination and foodborne illness. The findings included: - The following observations were made during a kitchen tour on 9/18/23 that began at 9:44 AM and concluded at 10:12 AM: 4 of 4 cutting boards had black smears and stored in a rack as clean. There was an unshielded light bulb in the vegetable refrigerator. - The following observations were made, and interviews conducted during a kitchen tour on 9/18/23 that began at 10:53 AM and concluded at 12:24 PM: The underside of the stove upper shelf had a heavy buildup of dry food. Two of two dark blue carts were cracked on the top shelf. One had an approximately 8 x 6 area that was spider patterned cracked. The other had a crack on the top side handle. This cart had a box of lids stored on top. Both carts had a buildup of brown debris in the crevices and grooves. The black cart had brown debris in the grooved areas of the handles. The gray cart had brown debris at the handles and had a buildup of dirt. There were two white bowls, stored on the rack with clean dishes that have black smudges and smears. On the service line, there were six of 25 insulated plate covers and 4 of 25 insulated plate bottoms, ready to use, and were soiled with debris and were dirty. There was dried splatter on the underside of the shelf above the processor area counter. The surveyor checked the processor lid and pot after the processor assembly had gone through the dishwasher and prior to Dietary staff B starting to puree greens. There was an accumulation of food debris in the lid assembly. The Dietary Manager took the parts back to wash in the dishwasher. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 22 of 33 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 09/20/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview on 9/18/23 at 11:33 AM the Dietary Manager stated, they had a second processor assembly to use. Observation at this time of the second processor lid assembly revealed it had a buildup of dry food on the shoot, lid, and rubber seal assembly of the lid. This second processor lid assembly was stored as clean in the processor storage area. On 9/18/23 at 11:36 AM an interview was conducted with a Dietary staff A, dishwasher, regarding the soiled insulated lids and bottoms and processor assembly. She stated, she normally rinsed the food equipment and then placed them in the dishwasher. She added she was trained on how to wash food equipment and had been working in the facility a year. Regarding how she cleaned the processor pot and lid assembly she stated, she removed the seals when cleaning. She added, I do my part. The surveyor checked the processor and lid assembly prior to Dietary staff B pureeing of the corn bread. The processor seals on the lid were again dirty with food debris and were re-washed again. - The following observations were made during a kitchen tour on 9/19/23 that began at 8:18 AM and concluded at 8:35 AM: The rear refrigerator had a broken lightbulb inside that had some remaining glass on the bulb. The vegetable refrigerator had an unshielded light. Three of four kitchen carts had brown debris and buildup. Four of 4 cutting boards were dirty with smears and stored as clean in a rack. - The following observations were made during a kitchen tour on 9/20/23 that began at 11:37 AM and concluded at 12:13 PM: The rear refrigerator had a broken lightbulb inside that had some remaining glass on the bulb. There was an unshielded lightbulb in the vegetable refrigerator. Two to 4 carts (a white and a blue cart) had brown debris in crevices and grooved areas. On 9/20/23 at 2:20 PM an interview and observations were conducted with the Dietary Manager regarding dietary sanitation issues. It was also observed at the time that one of two processor lid units had dried food and debris in the lid assembly. She stated, dietary staff conduct deep cleaning in the kitchen every Sunday and do regular cleaning daily. Regarding why the situations happened regarding dietary sanitation, she stated staff did not check the processors. Regarding whom was responsible to ensure dietary staff perform their duties correctly, she stated the supervisor and employees. Regarding if she had conducted any in-services in the last three months, she stated that she had not. Regarding what she expected staff to have done, she stated she expected staff to have cleaned properly, continuously. She added that she was not aware of the broken light and the unshielded light in the refrigerators. She stated, the carts were wiped with sanitizer, but not scrubbed. Regarding what could result from the issues related to dietary sanitation, she stated residents could get sick. On 9/20/23 at 3:50 PM an interview was conducted with the Administrator regarding issues found in the facility. Regarding why the dietary sanitation problems occurred, she stated staff got used to a routine; it was an oversight. Regarding what she expected staff to have done, she stated to clean (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 23 of 33 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 09/20/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many the processor and make notes for the maintenance supervisor to replace the lights. Regarding whom was responsible for dietary sanitation, she stated the Dietary Manager. Regarding what could result from the dietary sanitation issues, she stated possible contamination. Record review of the facility policy, titled Nutrition and Food Service Policies and Procedures Manual, 2018, Section 4-5, Policy: General Kitchen, Sanitation, Policy Number: 04.003, Date approved: October 1, 2018, revealed the following documentation, Policy: the facility recognizes that foodborne illness has the potential to harm, elderly and frail residents. All nutrition and food service employees will maintain clean, sanitary, kitchen facilities, in accordance with the state and US Food Codes in order to minimize the risk of infection and foodborne illness. Procedure: 1. Clean and sanitize all food preparation areas, food contact surfaces, dining facilities, and equipment. After each use, clean and sanitize, all tableware, kitchenware, and food contact surfaces of equipment, except cooking surfaces of equipment in pots and pans that are not used to hold or store food and are used solely for cooking purposes. 3. Keep food contact surfaces of all cooking equipment free of encrusted grease deposits and other accumulated soil. 5. After cleaning and until use, store and handle all food contact surfaces of equipment and multi-use utensils in a manner that protects the surfaces from manual contact, splash, dust, dirt, insects and other contaminants. 6. Clean non-food contact surfaces of equipment at intervals, as necessary to keep them free of dust, dirt, and food particles and otherwise in a clean and sanitary condition. Record review of the facility policy, titled Nutrition and Food, Service Policies and Procedures. Manual, 2018, Section 4-35, Policy: Mixers, Blenders and Food Processors. Policy number: 04.024, Date approved: October 1, 2018, review of the following documentation, Policy: the facility will maintain mixers, blenders and food processors in a sanitary manner to minimize the risk of food hazards. Mixers, blenders, and food processors will be cleaned after each use. Procedure: . 2. Remove all removable parts. 3. Wash removable parts (including meat grinder attachments and guards) in dishwashing machine or in sink filled with warm water and detergent. 6. Air dry. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 24 of 33 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 09/20/2023 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to dispose of garbage and refuse properly in 1 of 4 dumpsters (#1) and 2 of 2 grease barrels, in that: Residents Affected - Few The facility failed to maintain the dumpster/refuse disposal containers in a manner that effectively prevented the harborage and attraction of pest. These failures could result in providing harborage and breeding areas for insects, rodents and other pests which could infest the facility. The findings include: On 9/18/23 at 10:06 AM an observation was made of the dumpster area. The exterior of two of two grease barrels revealed that they had a heavy buildup of grease and food debris. The ground surrounding the two barrels had an accumulation of grease spillage on the dirt. It was approximately a 1' to 2' perimeter all the way around the two barrels that had the hardened grease and food debris buildup on the ground. The barrels were located away from concrete slab. On 9/19/23 at 8:29 AM an observation of the dumpster area. One of 4 had one of two lids open (#1). The grease barrels, 2 of 2, were heavily coated with grease and debris and there was hardened grease spillage on the dirt surrounding the barrels. The barrels were not on the concrete slab. On 9/20/23 at 9:00 AM an observation was made, and an interview was conducted with the Maintenance Supervisor. Observation of the dumpster area revealed that 1 of 4 dumpsters (#1) was open and there was a fly in the area. There was hardened grease on the ground surrounding the 2 heavily coated grease barrels. The soiled ground area ranged from 1'to 2'. The Maintenance Supervisor stated that he was not aware that the grease barrels and surrounding ground area had a heavy accumulation of grease on the ground. He stated, he would contact the grease vendor and get new barrels. Regarding whom was responsible for ensuring that the grease barrel area was maintained, and the dumpsters were in good condition, he stated, he would think that the dietary department and himself on the grease. He added the dumpster vendor should monitor the condition of the dumpsters. Regarding why he felt this situation happened, he stated lack of staff knowledge. He added the previous Maintenance Supervisor was gone before he was hired. Regarding what he expected staff to have done, he stated staff should have closed the dumpster lids. He stated he had checked the dumpster area this morning (9/20/23) and the lids were closed. Regarding what could result from the dumpster and grease situation he stated, attraction of flies, disease and parasites. He stated that the dumpsters were emptied daily, or at least six days out of the week. Regarding the grease barrels, he stated that they were emptied every three months or every six months. On 9/20/23 at 3:50 PM an interview was conducted with the Administrator regarding issues found in the facility. Regarding the dumpsters being open, and the grease area that was not maintained, she stated the grease, over time, accumulated and staff failed to close the lids. Regarding what she expected staff to have done, she stated to shut the dumpster lids and the grease barrels needed to be moved back onto the concrete slab. Regarding whom was responsible for maintaining the dumpster and grease disposal area, she stated maintenance, and everyone should close the lids. Regarding what could result from the dumpster and grease barrel situation, she stated there could be a potential for pest accumulation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 25 of 33 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 09/20/2023 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 0814 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the facility policy title Maintenance Service, Revised November 2021, review of the following documentation, Policy Statement. Maintenance service shall be provided to all areas of the building, grounds, and equipment. Policy Interpretation, and Implementation. 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include but are not limited to: a. Maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines. b. Maintain the building in good repair and free from hazards. f. Establishing priorities in providing repair services . h. Maintaining the grounds, sidewalks, parking lots, etc., in good order. i. Providing routinely schedule maintenance service to all areas. j. Others that may become necessary or appropriate. 3. The Maintenance Director is responsible for developing and maintaining a schedule of maintenance service to assure that the buildings, grounds, and equipment are maintained in a safe and operable manner. 10. Maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 26 of 33 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 09/20/2023 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 0851 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data. Based on interview and record review, the facility failed to electronically submit to CMS complete and accurate direct care staffing information, including information for agency and contract staff, based on payroll and other verifiable and auditable data in a uniform format according to specification established by CMS for 1 of 1 facility reviewed for administration (Fiscal year 2023 for the third quarter April 1, 2023, to June 30, 2023). The facility failed to submit PBJ (Payroll Based Journal) staffing information to CMS for the third quarter of the fiscal year 2023. This failure could place residents at risk for personal needs not being identified and met. Findings included: Record review of the CMS 672 form dated 9/18/23 and signed by the DON that was provided by the Administrator indicated a total of 64 residents in the facility. Record review of the CMS PBJ Staffing Data Report (payroll based staffing), CASPER Report (Certification and Survey Provider Enhanced Report)1705 D FY Quarter 3 2023 (April 1- June 30), dated 09/14/2023, indicated the following entry: Failed to Submit Data for the Quarter Triggered .Triggered=No Data Submitted for the Quarter. During an interview with the DON on 09/20/23 at 02:00 PM, she said the Compliance Officer with corporate was responsible for submitting the PBJ data. She said she knew the facility must submit the data but was not too familiar with the process. She said corporate has always been responsible for all the payroll, and they provided the information to be submitted to CMS. She said she had not been trained in PBJ. When asked why reporting the information was important, she said that her understanding was the submission was important to monitor staffing. She said PBJ was necessary to ensure nursing facilities have the appropriate staffing. When asked about the potential negative outcome, she said it affects their Star rating. She said the facility did not have any issues with staffing. She said failure to report might give the state inaccurate information, but she could not think of how it would affect the residents negatively because they don't have staffing issues. She said she was unaware of when the PBJ was supposed to be submitted During an interview with the ADM on 09/20/2023 at 2:48PM, she said the Compliance Officer with corporate was responsible for submitting the PBJ data. When asked why the information was not submitted timely, she said she did not know as this task is not her responsibility. When asked if there was a system for monitoring a timely and accurate submission, she said the PBJ submission was usually reported to her after it was completed. She said the Compliance Officer would typically report it directly to her. She said she was aware of the reporting regulation. She said she had been trained in this area because she completed the submission at her previous ADM position. When asked about her understanding of the importance of reporting PBJ data, she said the purpose was to ensure the facility was accurately staffed to care for the residents. She said the facility was fully staffed at this time, there were no nursing issues. When asked what the potential negative outcome was for not submitting the PBJ data, she said failure to report would be that it would not reflect the accuracy of staffing in connection to the census. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 27 of 33 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 09/20/2023 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 0851 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with the Compliance Officer on 09/20/23 at 3:15PM, he said he was responsible for PBJ data submission. He said he had been trained, he was responsible for entering the data, he stated he had no doubt the hours were not entered, and it was his mistake. He stated he has been trained to enter the hours; however, he stated there is definitely room for more training. He said he knew he was supposed to complete the data submission. He said it was important so people could see adequate staffing in facilities. He stated he submits the data on the CMS website. When asked if he was aware of the submission deadlines, he said he was aware. When asked what the potential negative outcome was, he said the lack of submission could affect their Star rating. On 9/20/23 at 5:30PM Surveyor requested the facility's policy for record review, the DON stated the facility follows CMS guidelines for Direct-Care Staffing Information (Payroll-Based Journal), a policy was not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 28 of 33 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 09/20/2023 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe, comfortable and sanitary environment to help prevent the development and transmission of diseases for 2 of 3 (Residents #24 and #32) and 1 of 1 (CNA B) staff reviewed for infection control. Residents Affected - Few 1. CNA B failed to properly serve residents meals by touching the rim of glasses and bowls. 2. CNA B failed to perform hand hygiene between glove changes when providing incontinent care for Resident #24. 3. CNA C failed to perform hand hygiene between glove changes when providing incontinent care for Resident #32. These failures could place residents at risk for spread of infection and cross contamination. Findings include: Observation on 09/18/23 at 12:10 PM CNA B was observed serving residents meal by picking the glass and bowl up off tray by the rim with bare hands. Observation on 09/19/23 at 05:20 PM CNA B was observed serving residents meal by picking the glass and bowl up off the tray by the rim with bare hands. Observation on 09/20/23 at 12:15 PM CNA B was observed serving residents meal by picking the glass and bowl up off the tray by the rim with bare hands. During an interview on 09/20/23 at 01:00 PM with CNA B, she stated she should have served the residents drinks by grabbing the side of cup not the top. She stated, I just forgot. She stated the potential negative outcome was spreading germs. She states she had been trained on how to serve residents drinks. Resident #24 Record review of face sheet for Resident #24, dated 09/20/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: dementia (cognitive loss), atrial fibrillation (irregular heartbeat), muscle weakness, anxiety (feeling of fear and worry), hypertension (high blood pressure) and diabetes (high blood sugar). Review of Resident #24's MDS, dated [DATE] revealed Resident #24 had a BIMS of 04 which indicated the resident's cognition was severely impaired. The MDS revealed Resident #24 required extensive one person assist with toilet use and limited one person assist with personal hygiene. The MDS further revealed Resident #24 was always incontinent of bladder and bowel. Record review of Resident #24's Comprehensive Care Plan dated 09/12/23 revealed the resident required assist x 1 with bathing/hygiene and toileting. The Resident #24 was incontinent of bowel and bladder. The interventions included check for incontinence every 2 hours and toilet every 2 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 29 of 33 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 09/20/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #24 was at risk for pressures ulcers related to incontinence. The interventions included keep clean and dry as possible, provide incontinence care after each episode and report redness or skin breakdown immediately. During an observation on 09/19/23 at 02:27 PM CNA B was providing incontinent care for Resident #24. CNA B did not clean the labia (middle of resident's vaginal area). CNA B removed gloves then turned around and picked up clean brief off bed side table, opened brief and placed brief beside Resident #24. CNA B donned new gloves and put brief on Resident #24. No observation of CNA B washing hands after doffing gloves, before touching clean brief and before donning new gloves. During an interview on 09/19/23 at 04:18 PM with CNA B, she stated she should have washed her hands after doffing gloves, before touching clean items and donning new gloves. CNA B stated she forgot to wash her hands and close the resident's door. She stated the potential negative outcome could be spread of germs. She stated the potential negative outcome of not properly cleaning a resident could cause skin irritation, infections and UTI's. She stated she had been trained on proper incontinent care, resident privacy and infection control. She stated she does skills checkoffs every 3 to 4 months. Resident #32 Record review of face sheet for Resident #32, dated 09/20/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: dementia (cognitive loss), muscle weakness, hypertension (high blood pressure), and anxiety (feeling of fear or worry). Review of Resident #32's MDS, dated [DATE] revealed Resident #32 had a BIMS of 05 which indicated the resident's cognition was severely impaired. Resident #32 required total dependence with one person assist with personal hygiene and dressing. Resident #32 was frequently incontinent of bladder and bowel. Record review of Resident #32's Comprehensive Care Plan dated 06/23/23 revealed Resident #32 experiences bladder incontinence related to dementia with interventions to ensure adequate bowel elimination and provide incontinence care after each episode. The care plan further revealed Resident #32 required assist x 1 with hygiene and toileting. During an observation on 09/19/23 at 02:52 PM CNA C was providing incontinent care for Resident #32. CNA C cleaned front side of Resident #32 and then turned resident #32 touching her arm and leg with dirty gloves. During an interview on 09/19/23 at 04:41 PM with CNA C, she stated she should have changed her gloves before turning resident #32. She stated the potential negative outcome could be spread bacteria and infection. She stated she had been trained and did skills checkoffs every 3-4 months. During an interview on 09/20/23 at 01:35 PM with the ADM, she stated staff should not touch the rim of glasses or bowls. She stated the ADON was responsible for training and monitoring staff. She stated the potential negative outcome could be passing germs or bacteria. She stated her expectations were for staff to handle food containers properly. She stated all staff have been trained. She stated she does not know the proper steps in incontinent care and defers that to the DON and ADON. She stated gloves should be changed when going from dirty to clean. She stated the ADON trains and monitors CNA's with skill checkoffs every 3-4 months. She stated the DON, ADON and CN were responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 30 of 33 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 09/20/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few monitoring staff to ensure they were following proper infection control. She stated the potential negative outcome could be infection. She stated the common infection seen in the facility was occasionally UTI's. She stated the importance of following infection control guidelines was to prevent infections. During an interview on 09/20/23 at 01:50 PM with the DON, she stated drink glasses and bowls should not be picked up by the rim, they should be picked up by the side. She stated the DON and ADON were responsible for training and monitoring staff passing drinks and meal trays. She stated the potential negative outcome could be spread of infection. She stated her expectations were for the staff to pass meals and drinks properly. She states all staff had been trained on how to serve food containers. She stated gloves should be changed when visibly soiled and before turning resident on their side. She stated hands should be washed with soap and water or ABHR (alcohol based hand rub) if not visible soiled. She stated CNA's do skills checkoffs every 3-4 months with the ADON. She states she was responsible for monitoring CNA's to ensure they were following proper infection control. She stated the potential negative outcome could be spread of infection and UTI's. She stated some common infections in the facility were UTI's. She stated improper incontinent care and infection control could contribute to the infections. During an interview on 09/20/23 at 02:03 PM with the ADON, she stated drink glasses and bowls should be picked up by the side not the rim. She stated the CN, DON and ADON were responsible for training and monitoring staff passing drinks and meal trays. She stated the potential negative outcome could be spread of infection. She stated her expectations were for the staff to handle all food containers properly. She states all staff had been trained. She stated hands should be washed between glove changes and gloves should be changed between cleaning the front and back of residents. She stated she was responsible for training the staff and providing skills checkoffs. She stated skills checkoffs were done quarterly. She stated the possible negative outcome could be spread of infections and UTI's. She stated the facility currently has no common infections. Record review of the facility's policy titled Kitchen Sanitation to Prevent the Spread of Viral Illness dated 03/03/20 revealed the following: Policy: The Nutrition & Foodservice employees of the facility will practice good sanitation practices in accordance with the state and US Food Codes in order to minimize the risk of cross contamination and potential illness such as influenza and COVID-19 . ii. Cups, glasses and bowls must be handled so that fingers or thumbs do not contact inside surfaces or lip-contact outer surfaces. Record review of the facility's Perineal Care Return Demonstration dated 2022 revealed the following: Procedure Steps: . Used correct technique for peri-care on female vs. male residents. Female: Spread labia, (maintain separation of labia, clean center, then each groin areas/each side (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 31 of 33 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 09/20/2023 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 0880 Level of Harm - Minimal harm or potential for actual harm - dirty to clean) wipe one side, then the other, and then the middle, wiping toward the rectal area and never wiping back and forth. Dispose of gloves and perform hand hygiene, don new gloves and roll resident to side then proceed to clean the rectal and buttocks area . Record review of the facility's policy titled Standard Precautions, dated 10/18 revealed: Residents Affected - Few Policy Statement - Standard Precautions are used in the care of all residents regardless of their diagnoses or suspected or confirmed infection status. Standard Precautions presume that all blood, body fluids, secretions, and excretions (except sweat), non-intact skin and mucous membranes may contain transmissible infectious agents . Standard precautions include the following practices: 1. Hand hygiene a. Hand hygiene refers to handwashing with soap (anti-microbial or non-antimicrobial) or the use of alcohol-based hand rub (ABHR), which does not require access to water. b. Hand hygiene is performed with ABHR or soap and water: (I) before and after contact with the resident; (2) before performing an aseptic (clean) task; (3) after contact with items in the resident's room; and (4) after removing PPE (personal protective equipment). c. Hands are washed with soap and water whenever: (1) visibly soiled with dirt, blood, or body fluids; (2) after direct or indirect contact with dirt, blood or body fluids; (3) after removing gloves; . 2. Gloves a. Gloves (clean, non-sterile) are worn when in direct contact with blood, body fluids, mucous membranes, non-intact skin, and other potentially infected material. b. Gloves are worn when in direct contact with a resident who is infected or colonized with organisms that are transmitted by direct contact. (For specific pathogens, refer to current CDC isolation precautions guidelines.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 32 of 33 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 09/20/2023 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 0880 c. Gloves are worn when handling or touching resident-care equipment that is visibly soiled or Level of Harm - Minimal harm or potential for actual harm potentially contaminated with blood, body fluids, or infectious organisms. e. Gloves are changed as necessary, during the care of a resident to prevent cross-contamination from Residents Affected - Few one body site to another (when moving from a dirty site to a clean'' one). g. Gloves are removed promptly after use, before touching non-contaminated items and environmental surfaces, and before going to another resident. h. After gloves are removed, wash hands immediately to avoid transfer of microorganisms to other residents or environments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 33 of 33