Inspection·March 6, 2024

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #1's progress notes did not reveal any ongoing prevention or intervention about Resident #1 wandering. Review of Resident #2's face sheet (undated) indicated Resident #2 was a [AGE] year-old male admitted to the facility on [DATE]. Resident #2 had a diagnosis of hemiplegia and hemiparesis following cerebral infarction (paralysis of partial or total body function and aphasia (language disorder making it difficult to communicate). Resident #2 resided on Hall 500. Review of Resident #2's MDS dated [DATE] revealed Resident #2 had a BIMS score of 06 which indicated Resident #2 cognition was severely impaired. An interview on 03/06/24 at 10:32 AM with the ADM revealed an incident between Resident #1 and Resident #2 in the hall of 400. She said she was unsure what provoked Resident #2 but that it resulted in Resident #2 hitting Resident #1. She said that Resident #1 would reach out and try to hug and or stick out her hands to others. She said she was curious to know if Resident #1 did either of these things to provoke Resident #2. She said she could not interview Resident #2 because he was upset the day the incident happened. She stated the physical incident between Resident #1 and Resident #2 had not happened before. An Interview on 03/06/24 at 10:33 AM with the DON revealed that there was a physical incident that occurred between Resident #1 and Resident #2 but this had not happened before. An interview on 03/06/24 at 11:18 AM with LVN A revealed that she did not have much information about the physical altercation between Resident #1 and Resident #2, but that Resident #1 wanders the halls. She said Resident #1 would sometimes bump into other people and enter their rooms. An interview on 03/06/24 at 11:31 AM with LVN B revealed that an incident occurred in the hallway between Resident #1 and Resident #2. She was unsure of the date and time. She said they must have been crossing paths, she observed Resident #2 with Resident #1 wrist in his hand, and Resident #2 was screaming. She said she broke them apart and could not get what happened from Resident #1 because he was upset. She said Resident #1 was confused all the time and wanders over the facility. An interview on 03/06/24 at 11:48 AM with the Activity Director revealed that she had not been present for the physical incident with Resident #1 and #2. She said she does know there have been at least two incidents. She said one occurred by his room door, and he kicked her. The second incident she witnessed was when they were near the nurse's station, and she observed Resident #2 hand go up in the air and Resident #1 was near him. She said she yelled for LVN B to look and ran to get Resident #1 away from Resident #2. She said she could not remember the exact date of the incident, but it was about two months ago. An interview on 03/06/24 at 12:01 PM with CNA C revealed that she was not present when the physical altercation occurred between Resident #1 and Resident #2, but that report was given to her that Resident #1 was attempting to wander into Resident #2 room and Resident #1 kicked her. She said Resident #1 had a history of wandering all over the facility. An interview on 03/06/24 at 12:06 PM with the CNA D revealed that Resident #1 does try to go in other resident's room. She said she tried to go in Resident #2 room Resident #2 did not like it. An interview on 03/06/24 at 12:28 PM with CNA E revealed that she did not have any information (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 2 of 13 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 03/06/2024 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few regarding the physical altercation between Resident #1 and Resident #2 but that she had worked with both residents. She said Resident #1 has a history of wandering around the facility. She said she repeatedly tried to keep Resident #1 off 500 Hall. An interview on 03/06/24 at 1:26 PM with Resident #2 revealed that Resident #1 tried to come into his room multiple times. He said she had tried to come into his room at least five times. He said that he did not know the exact date and time. He said he had not reported these attempts to staff but that there was always staff around when Resident #1 tried to come into his room. He said that he does not like it when residents come into his room. He said Resident #1 entered his room because she wanted to steal from him. An observation was made on 03/06/24 at 1:55 of Resident #1 self-propelled slowly near the nurse's station. An observation was made on 03/06/24 at 2:03 PM, Resident #1 self-propelled slowly down the hall. She entered room [ROOM NUMBER]. Another resident (unknown) propelled behind her, telling her not to go into the room. Resident #1 enter room [ROOM NUMBER] in her wheelchair. She went to the nightstand in the room and began to rummage. The Investigator notified the DON, and she and another staff (unknown) intervened. They redirected her physically out of the resident's room. An interview on 03/06/24 at 2:38 PM with the MDS Coordinator revealed that Resident #1 likes to wander around the facility. She said sometimes Resident #1 would go into the wrong room. She said Resident #1 had wandered since being admitted to the facility. She said usually, staff intervene. She said when Resident #1 gets into the room across from hers, the resident in that room will yell at her, and then staff will get her. She said that she was responsible for completing the MDS assessments for all the residents in the facility. She said the DON was responsible for the resident care plans. She said she believed that Resident #1 behavior for wandering was in the care plan but was not sure. She said the behavior should be captured in the care plan. She said she did not believe there was a potential negative outcome for Resident #1's wandering behavior not being reflected in the care plan. She said the only potential negative outcome that she could think of for the wandering not being reflected in the MDS assessment was there could be a monetary penalty. She said the staff that provide direct care do not look at the MDS assessment to provide care, but they do look at the care plan. She said Resident #1's wandering was not reflected in the MDS assessments because she did not consider her wandering up and down the halls without a purpose significant enough to put in the MDS. She said Resident #1 was not trying to leave the facility or bother other residents. She said she does obtain information from staff for her assessments. She said she knew that a male resident became upset about Resident #1 going into his room, but she did not know when. She said she had been trained on how to complete MDS assessments. She said she taught herself. She said another reason the wandering may not have been in the MDS assessments was that there was a time when Resident #1 did not wander. An interview on 03/06/24 at 2:54 PM with the DON revealed the potential negative outcome for the inaccurate MDS that could affect the care plan. She said it could cause the care plan to not be appropriate for the resident. Regarding Resident #1, all the staff knew her very well. She said she was unaware that the quarterly or the latest comprehensive MDS assessment did not capture Resident #1's wandering behavior. She said she had been trained regarding the accuracy of MDS assessments. She said her training was 3-4 years ago. She said Resident #1 does wander and had exhibited the behavior since she had been employed at the facility. She said Resident #1 was intentional when she wanders. She said Resident #1 would go to the same people daily to see staff she knew. She said she expected that the MDS be completed accurately and reflect current information. She said the MDS Coordinator was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 3 of 13 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 03/06/2024 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 0641 responsible for completing the MDS assessments. Level of Harm - Minimal harm or potential for actual harm An interview on 03/06/24 at 3:24 PM with CNA E revealed Resident #1 had always had a history of wandering around the facility and into other residents' rooms since she had been employed at the facility. She said she had been employed at the facility for six months. She said that when she stated in her earlier interview that she tried to keep Resident #1 from Hall 500, it was because of Resident #2. She said she had observed him kick Resident #1 out of his room. She said she did not know what a care plan was and had not looked to see if wandering was on it. She said she had not been specifically trained on what to do about Resident #1's wandering behavior. She said she knew about Resident #1 behavior from working with her. Residents Affected - Few An interview on 03/06/24 at 3:32 PM with the LVN A revealed Resident #1 had always exhibited wandering behavior. She said the only time Resident #1 does not wander was if she does not feel well or was in bed. An interview on 03/06/24 at 3:37 PM with the ADM revealed the potential negative outcome for the MDS not being accurate was billing could be off or skewed. She said she was unaware that Resident #1's wandering behavior was not reflected in her most recent quarterly and Significant Change MDS assessment. She said there was no specific system in place to monitor MDS assessments. She said they do not look at the assessment's individual sections but look at if there was an overall decline. She said she had not been trained in completing accurate MDS Assessments. She said she expected MDS assessments to be accurate and reflect current information regarding residents. She said she had observed Resident #1 wandering around the facility. She said the MDS Coordinator was responsible for accurately completing the MDS assessments. She said she had no reason the MDS was not completed accurately. She said the potential negative outcome of not reflecting Resident #1's behavior of wandering or current behaviors in the care plan was that she or other residents may not receive the care they need. She said Resident #1 had exhibited wandering behavior the entire time she had known her. She said she was unaware that Resident #1 had been in Resident #2's room multiple times. An interview on 03/06/24 at 03:51 PM with CNA D revealed that Resident #1 had always wandered around the facility and in other residents' rooms. She stated she had seen Resident #1 enter Resident #2 room more than once. An interview on 03/06/24 at 03:52 PM with CNA C revealed that Resident #1 had always wandered around the facility and in other residents' rooms. She stated she had seen Resident #1 enter Resident #2 room more than once. She said she observed Resident #2 blocking Resident #1 and attempting to wave her out of his room because he could not speak. An interview on 03/06/24 at 04:20 PM with the ADM revealed that there was no specific policy for the MDS assessments but that they use the Long-Term Care RAI manual. An interview on 03/06/24 at 04:19 PM with the DON revealed she stated she was unaware if Resident #1's wandering was tracked. An interview on 03/11/24 at 05:08 PM with the social worker revealed that on 01/29/24, there was a physical altercation between Resident #1 and Resident #2. She said she could not interview Resident #1 because of her cognitive status. She said she was able to interview Resident #2 through the use of his communication board. She said Resident #2 told her he grabbed Resident #1's arm because she grabbed his leg as she rolled by. She said he motioned that the incident happened in the hallway. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 4 of 13 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 03/06/2024 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few said she did not, and he did not clarify if the incident specifically happened in Hall 500 or where it happened. She assumed it was outside his room because of how he motioned. She said Resident #1 goes up and down the hallways and wanders throughout the facility. She said sometimes she would go into other residents' rooms, but some residents were familiar with her. She said she could not answer the potential negative outcome if Resident #1 went into a room where she was unwanted. She said she could not say what risks Resident #1 would be at if she went into a resident's room that she was unwanted in because it would all depend on the other resident. She said she hoped they would tell Resident #1 to leave, and she would listen and leave. Review of the Intake Investigation Worksheet 480251, dated 01/29, revealed the following: The incident occurred on 01/29/24 at 10:00 AM. LVN B witnessed Resident #2 grabbing Resident #1's arm and twisting it. The Social Worker was told by Resident #2 that Resident #1 touched his leg when she rolled by. Review of the Intake Investigation Worksheet 480251, dated 01/29, revealed the following: The incident occurred on 01/29/24 at 10:00 AM. LVN B witnessed Resident #2 grabbing Resident #1's arm and twisting it. The Social Worker was told by Resident #2 that Resident #1 touched his leg when she rolled by. Review of the facility policy, Behavioral, Intervention and Monitoring, Revised December 2021, revealed the following: Policy Statement: The center will provide, and residents will receive behavioral health services as needed to attain or maintain the highest practicable physical, mental and psychosocial well-being in accordance with the comprehensive assessment and plan of care. Behavioral symptoms will be identified using center-approved behavioral screening tools and the comprehensive assessment. The center will comply with regulatory requirements related to the use of medications to manage behavioral changes. Policy Interpretation and Implementation General Guidelines 1. Behavior is the response of an individual to a wide variety of factors. These factors may include medical, physical, functional, psychosocial, emotional, psychiatric, or environmental causes. a. Behavior is regulated by the brain and is influenced by past experiences, personality traits, environment, and interactions with other people. b. Behavior can be a way for an individual in distress to communicate unmet needs, indicate discomfort, or express thoughts that cannot be articulated. As part of the comprehensive assessment, staff will evaluate, based on input from the resident, family and caregivers, review of medical record and general observations: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 5 of 13 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 03/06/2024 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 0641 a. The resident's usual patterns of cognition, mood and behavior; Level of Harm - Minimal harm or potential for actual harm 4. New onset or changes in behavior will be documented regardless of the degree of risk to the resident or others. Residents Affected - Few Cause Identification 1. The interdisciplinary team will evaluate new or changing behavioral symptoms in order to identify underlying causes and address any modifiable factors that may have contributed to the resident's change in condition, including: Management 1. The interdisciplinary team will evaluate behavioral symptoms in residents to determine the degree of severity, distress and potential safety risk to the resident, and develop a plan of care accordingly. Safety strategies will be implemented immediately if necessary to protect the resident and others from harm. a. Atypical behavior will be differentiated from behavior that is dangerous or problematic for the resident(s) or staff, or behavior that signals underlying distress. b. If the behavior is atypical but not problematic or dangerous and the resident does not appear to be in distress, then the IDT will monitor for changes but not necessarily intervene to normalize the behavior. 2. The care plan will incorporate findings from the comprehensive assessment and PASRR Level II determinations (as appropriate), and be consistent with current standards of practice. 3. The resident and family or representative will be involved in the development and implementation of the care plan. Resident and family involvement, or attempts to include the resident and family in care planning and treatment, will be documented. 4. The resident and family/representatives will be informed of the resident's condition as well as the potential risks and benefits or proposed interventions. 5. The resident and/or resident surrogate will have the right to refuse treatment. 6. Interventions will be individualized and part of an overall care environment that supports physical, functional and psychosocial needs, and strives to understand, prevent or relieve the resident's distress or loss of abilities. 7. Interventions and approaches will be based on a detailed assessment of physical, psychological and behavioral symptoms and their underlying causes, as well as the potential situational and environmental reasons for the behavior. The care plan will include, as a minimum: a. A description of the behavioral symptoms, including: (1) Frequency; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 6 of 13 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 03/06/2024 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 0641 (2) Intensity; Level of Harm - Minimal harm or potential for actual harm (3) Duration; (4) Outcomes; Residents Affected - Few (5) Location; (6) Environment; and (7) Precipitating factors or situations. b. Targeted and individualized interventions for the behavioral and/or psychosocial symptoms; c. The rationale for the interventions and approaches; d. Specific and measurable goals for targeted behaviors; and e. How the staff will monitor for effectiveness of the interventions. Monitoring 1. If the resident is being treated for altered behavior or mood, the IDT will seek and document any improvements or worsening in the individual's behavior, mood, and function. 2. The IDT will monitor the progress of individuals with impaired cognition and behavior until stable. New or emergent symptoms will be documented and reported. 3. Interventions will be adjusted based on the impact on behavior and other symptoms, including any adverse consequences related to treatment. Review of the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.18.11, October 2023, revealed the following: an accurate assessment requires collecting information from multiple sources, some of which are mandated by regulations. Those sources must include the resident and direct care staff on all shifts, and should also include the resident's medical record, physician, and family, guardian and/or other legally authorized representative, or significant other as appropriate or acceptable. It is important to note here that information obtained should cover the same observation period as specified by the MDS items on the assessment and should be validated for accuracy (what the resident's actual status was during that observation period) by the IDT completing the assessment. As such, nursing homes are responsible for ensuring that all participants in the assessment process have the requisite knowledge to complete an accurate assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 7 of 13 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 03/06/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation and interview, the facility failed to develop a comprehensive care plan to meet the highest practicable physical, mental, psychosocial well-being for 1 of 7 residents (Resident #1) reviewed for care plans as follows: 1. Resident #1 did not have a care plan for her ongoing behavior for wandering that had occurred since her admission on [DATE]. These failures could place residents at risk of not receiving the care required to meet their Individualized needs. Findings include: Review of Resident #1's face sheet (undated) indicated Resident #1 was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #1 had a diagnoses of dementia with agitation (loss of cognitive functioning), generalized anxiety disorder (feelings of worry, tension and fear), and intermittent explosive disorder (repeated , sudden bouts of impulsive of physical or verbal outburst). Resident #1 resided on Hall 100. Review of Resident #1's quarterly MDS dated [DATE] revealed Resident #1 had a BIMS score of 99 which indicated Resident #1 was unable to complete the interview. The MDS Assessment for Resident #1 revealed in section E0900 that the Resident #1 had not exhibited the behavior of wandering. Review of Resident #1's Significant Change MDS dated [DATE] revealed Resident #1 had a BIMS score of 03 which indicated Resident #1's cognition was severely impaired. The MDS Assessment for Resident #1 revealed in section E0900 that the Resident #1 had not exhibited the behavior of wandering. Section E100 did not contain any data regarding the impact of Resident #1 wandering on others. Section E1100 did not capture if Resident #1's wandering had remain the same, worsened or improved. Review of Resident #1's care plan, dated 2/15/24 did not reveal a care plan for the behavior of wandering. Review of Resident #1's progress notes did not reveal any ongoing prevention or intervention about Resident #1 wandering. An interview on 03/06/24 at 11:18 AM with LVN A revealed Resident #1 wanders the halls. She said Resident #1 would sometimes bump into other people and enter their rooms. An interview on 03/06/24 at 11:31 AM with LVN B revealed Resident #1 was confused all the time and wanders over the facility. An interview on 03/06/24 at 12:01 PM with CNA C Resident #1 had a history of wandering all over the facility. An interview on 03/06/24 at 12:06 PM with the CNA D revealed that Resident #1 does try to go in other resident's room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 8 of 13 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 03/06/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview on 03/06/24 at 12:28 PM with CNA E revealed Resident #1 had a history of wandering around the facility. She said she repeatedly tried to keep Resident #1 off 500 Hall. An observation was made on 03/06/24 at 1:55 of Resident #1 self-propelled slowly near the nurse's station. An observation was made on 03/06/24 at 2:03 PM, Resident #1 self-propelled slowly down the hall. She entered room [ROOM NUMBER]. Another resident (unknown) propelled behind her, telling her not to go into the room. Resident #1 entered room [ROOM NUMBER] in her wheelchair. She went to the nightstand in the room and began to rummage. The Investigator notified the DON, and she and another staff (unknown) intervened. They redirected her physically out of the resident's room. An interview on 03/06/24 at 2:38 PM with the MDS Coordinator revealed that Resident #1 likes to wander around the facility. She said sometimes Resident #1 would go into the wrong room. She said Resident #1 had wandered since being admitted to the facility. She said usually, staff intervene. She said when Resident #1 gets into the room across from hers, the resident in that room will yell at her, and then staff will get her. She said the DON was responsible for the resident care plans. She said she believed that Resident #1 behavior for wandering was in the care plan but was not sure. She said the behavior should be captured in the care plan. She said she did not believe there was a potential negative outcome for Resident #1's wandering behavior not being reflected in the care plan. She said the staff that provide direct care do not look at the MDS assessment to provide care, but they do look at the care plan. She said she knew that a male resident became upset about Resident #1 coming into his room, but she did not know when. An interview on 03/06/24 at 2:54 PM with the DON revealed the potential negative outcome for behaviors not being reflected in the residents' plan was that they may need the care and not receive it. She said she was unaware that Resident #1 care plan did not reflect the wandering behavior. She said the system they use to monitor care plans was the level of care meetings. She said that during these meetings, they talk about resident transfer and how many people it takes to complete the transfer. She said she had been trained regarding the completion of care plans, and this was a part of being a registered nurse. She said the MDS Coordinator was responsible for long-term care plans, and the DON was responsible for acute care plans. She said anything that triggered on the CAAs should be care planned. She said specific things that were risk areas should also be care planned. She said she does not know why Resident #1 wandering was not care planned but that the MDS Coordinator would have been responsible. She said the MDS Coordinator had been trained to complete care plans. An interview on 03/06/24 at 3:24 PM with CNA E revealed Resident #1 had always had a history of wandering around the facility and into other residents' rooms since she had been employed at the facility. She said she had been employed at the facility for six months. She said that when she stated in her earlier interview that she tried to keep Resident #1 from Hall 500, it was because of Resident #2. She said she had observed him kick Resident #1 out of his room. She said she did not know what a care plan was and had not looked to see if wandering was on it. She said she had not been specifically trained on what to do about Resident #1's wandering behavior. She said she knew about Resident #1 behavior from working with her. An Interview on 03/06/24 at 3:32 PM with the LVN A revealed Resident #1 had always exhibited wandering behavior. She said the only time Resident #1 does not wander was if she does not feel well or was in bed. She said she was unsure how to access the care plan and if wandering was on the care plan. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 9 of 13 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 03/06/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview on 03/06/24 at 3:37 PM with the ADM revealed the potential negative outcome of not reflecting Resident #1's behavior of wandering or current behaviors in the care plan was that she or other residents may not receive the care they need. She said the information in the kiosk that the CNAs use comes from the care plan. She said she was unaware that Resident #1 behavior of wandering had not been care planned. She said regarding a system to monitor care plans, they review care plans quarterly, and the absence of the behavior should have been caught. She said she was unaware of why Resident #1's wandering behavior was not care planned. She said multiple disciplines are responsible for different areas of the care plan. She said the DON was overall responsible as she ultimately signs off. She said Resident #1 had exhibited wandering behavior the entire time she had known her. She said she was unaware that Resident #1 had been in Resident #2's room multiple times. An interview on 03/06/24 at 03:51 PM with CNA D revealed that Resident #1 had always wandered around the facility and in other residents' rooms. She stated she had seen Resident #1 enter other residents room more than once. She said she used the care plan and had never received specific training for Resident #1's wandering but that she naturally redirected her because she knew her. She confirmed that she did not see a care plan on the kiosk they use for Resident #1's wandering. An interview on 03/06/24 at 03:52 PM with CNA C revealed that Resident #1 had always wandered around the facility and in other residents' rooms. She stated she had seen Resident #1 enter other residents' room more than once. She stated she used the care plan and had never received specific training for Resident #1's wandering but that she naturally redirected her because she knew her. She confirmed that she did not see a care plan on the kiosk they use for Resident #1's wandering. An interview on 03/06/24 at 04:19 PM with the DON revealed that all staff use the care plan. She stated she was unaware if Resident #1's wandering was tracked. An interview on 03/11/24 at 04:19 PM with the DON revealed that all staff use the care plan. She stated she was unaware if Resident #1's wandering was tracked. An interview on 03/11/24 at 05:08 PM with the social worker revealed that on 01/29/24, there was a physical altercation between Resident #1 and Resident #2. She said she could not interview Resident #1 because of her cognitive status. She said she could not answer the potential negative outcome if Resident #1 went into a room where she was unwanted. She said she could not say what risks Resident #1 would be at if she went into a resident's room that she was unwanted in because it would all depend on the other resident. She said she hoped they would tell Resident #1 to leave, and she would listen and leave. Review of the facility policy, Behavioral, Intervention and Monitoring, Revised December 2021, revealed the following: Policy Statement The center will provide and residents will receive behavioral health services as needed to attain or maintain the highest practicable physical, mental and psychosocial well-being in accordance with the comprehensive assessment and plan of care. Behavioral symptoms will be identified using center-approved behavioral screening tools and the comprehensive assessment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 10 of 13 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 03/06/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The center will comply with regulatory requirements related to the use of medications to manage behavioral changes. Cause Identification 1. The interdisciplinary team will evaluate new or changing behavioral symptoms in order to identify underlying causes and address any modifiable factors that may have contributed to the resident's change in condition, including: Management 1. The interdisciplinary team will evaluate behavioral symptoms in residents to determine the degree of severity, distress and potential safety risk to the resident, and develop a plan of care accordingly. Safety strategies will be implemented immediately if necessary to protect the resident and others from harm. a. Atypical behavior will be differentiated from behavior that is dangerous or problematic for the resident(s) or staff, or behavior that signals underlying distress. b. If the behavior is atypical but not problematic or dangerous and the resident does not appear to be in distress, then the IDT will monitor for changes but not necessarily intervene to normalize the behavior. 2. The care plan will incorporate findings from the comprehensive assessment and PASRR Level II determinations (as appropriate), and be consistent with current standards of practice. 3. The resident and family or representative will be involved in the development and implementation of the care plan. Resident and family involvement, or attempts to include the resident and family in care planning and treatment, will be documented. 4. The resident and family/representatives will be informed of the resident's condition as well as the potential risks and benefits or proposed interventions. 5. The resident and/or resident surrogate will have the right to refuse treatment. 6. Interventions will be individualized and part of an overall care environment that supports physical, functional and psychosocial needs, and strives to understand, prevent or relieve the resident's distress or loss of abilities. 7. Interventions and approaches will be based on a detailed assessment of physical, psychological and behavioral symptoms and their underlying causes, as well as the potential situational and environmental reasons for the behavior. The care plan will include, as a minimum: a. A description of the behavioral symptoms, including: (1) Frequency; (2) Intensity; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 11 of 13 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 03/06/2024 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 0656 (3) Duration; Level of Harm - Minimal harm or potential for actual harm (4) Outcomes; (5) Location; Residents Affected - Few (6) Environment; and (7) Precipitating factors or situations. b. Targeted and individualized interventions for the behavioral and/or psychosocial symptoms; c. The rationale for the interventions and approaches; d. Specific and measurable goals for targeted behaviors; and e. How the staff will monitor for effectiveness of the interventions. Monitoring 1. If the resident is being treated for altered behavior or mood, the IDT will seek and document any improvements or worsening in the individual's behavior, mood, and function. 2. The IDT will monitor the progress of individuals with impaired cognition and behavior until stable. New or emergent symptoms will be documented and reported. 3. Interventions will be adjusted based on the impact on behavior and other symptoms, including any adverse consequences related to treatment. Review of the facility policy, Comprehensive Care Plan, dated 1/27/24, revealed the following: Policy It is the policy of this facility to develop and implement A comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and time frames to meet a residence medical, nursing, mental and psychosocial needs that are identified in the residents comprehensive assessment. The comprehensive care plan will describe, at a minimum of the following: The services that are to be furnished to attain or maintain the resident's highest practicable physical mental and psychosocial well-being. Any services that would otherwise be furnished but are not provided due to the residents exercise of his or her right to refuse treatment. Resident specific interventions that reflect the residents needs and preferences and align with the residents cultural identity, as indicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 12 of 13 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 03/06/2024 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Individualized interventions for trauma survivors that recognize the interrelation between trauma and symptoms of trauma as directed. Trigger specific interventions will be used to identify ways to decrease the residents exposure to triggers which read traumatize the resident, as well as identify ways to mitigate or decrease the effect of trigger on the resident. The comprehensive care plan will be prepared by the interdisciplinary team, that includes, but is not limited to: a registered nurse with the responsibility for the resident a nurse aide with responsibility for the resident The comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive and quarterly and BS assessment. The comprehensive care plan will include measurable objectives and time frames to meet the residents needs as identified in the residence comprehensive assessment. The objectives will be utilized to monitor the residents progress. Alternative interventions will be documented as needed. Qualified staff responsible for carrying out interventions specified in the care plan will be notified of their roles and responsibilities for carrying out the interventions, initially and when changes are made. The services provided were arranged by the facility, as outlined in the comprehensive care plan will meet professional standards of quality, and will be provided by qualified persons and recordings with each resident's written plan of care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 13 of 13