Health inspection·September 3, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few they were running behind on their smoke break and CNA D had told Resident #2 to give her a minute and she would take them out. LVN B stated CNA D did not mention denying the residents their smoke break. He stated there were no reports made to him by any residents. LVN B stated if he had to guess which resident was cussing at CNA D, he would guess [Resident #2] because he can be aggressive if staff are late with smoke breaks. During an interview on 9/2/2025 at 5:02pm with CNA D, she stated she did not recall the date but that she remembers the night shift being busy and running behind. She stated they were running a little behind on going to smoke and had told the smoking residents they would be late taking them to smoke. She stated Resident #2 was mumbling something, and she told him she would not take him to smoke and that they are not always going to be able to take them at the same time. CNA D stated she did ask Resident #3 if he was recording her, and he stated yes. She stated she did take the residents out to smoke within a few seconds of saying she would not. CNA D stated her behavior was inappropriate and she had just been irritated from being behind on schedule. She stated she understood how she spoke to the residents was not how they were trained and that she had been in serviced on resident rights and customer service. She stated she does have a strong voice, and it is often mistaken for yelling, even when she is not. She stated all residents had a right to be treated with respect and she felt she did not treat the residents with respect when she spoke to them in that manner. She stated she will not do that again and will treat all residents with respect. During an interview on 9/3/2025 at 9:30AM with Resident #2, he stated he did not remember the time or date of that incident. He stated he does not remember what started it or why she was telling him he couldn't go smoke. He stated he did not remember how it made him feel but he guessed not good. He stated he felt like he was not treated with respect. He stated he had been a fire fighter and an officer for many years and knew he had rights. He stated he felt safe at the facility and did not have any ongoing concerns with staff members or with his care. He stated that incident had passed, and it was over with. During an observation and review of a 36 second video provided by the ADM on 9/3/2025 at 10:32AM, the undated video revealed CNA D being recorded by Resident #3. The video revealed CNA D standing in front of Resident #3 but looking in a different direction. CNA D stated No you're not to a resident not shown in the video. CNA D turned to look at Resident #3 when he spoke to her. Resident #3 stated You can't take his privilege ma'am. CNA D replied, Yes I can, are you recording me? Resident #3 replied Mhm [yes]. CNA D replied, Let me see. CNA D did not reach for the phone and did not yell at Resident #3. CNA D's tone of voice was stern and argumentative. Resident #3 replied I don't have to let you see; this is my phone. CNA D stated, And I don't have to let y'all [you all] go smoke [LVN B]!. CNA D did not yell at residents but did yell out for LVN B. CNA D walked away from Resident #3 and leaned against the hallway wall after calling for LVN B. Resident #3 stated Do what you want to do ma'am. CNA D was seen leaning against the wall with bag on her shoulder. After a few seconds CNA D walked back down the hall shaking her head and stated, that's alright, I'll talk to administration about it.y'all should be glad someone is taking y'all. CNA D walked towards smoking door exit, and door is heard opening. Resident #3 followed a few seconds later, video ended. During an interview on 9/3/2025 at 2:39pm with the DON, she stated she was not sure what date the interaction had occurred, but they had received a grievance from Resident #3 on 7/30/2025. She stated from her understanding, smoke break had run a little behind on schedule one night. She stated Resident #2 got defensive and was cussing at the staff member. She stated the staff member told him she didn't have to take him out to smoke and that's when the other resident started recording. The DON stated Resident #3 told CNA D that she could not take away his [Resident #2's] smoke break away and she [CNA D] said yea I can. The DON stated she did feel CNA D violated the residents right for respect and she did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 2 of 9 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 09/03/2025 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete not have the authority to refuse to take any resident out to smoke. She stated CNA D did take the residents out to smoke. She stated CNA D was in-serviced on customer service training and educated on not speaking to residents rudely. She stated CNA D was educated that she can not deny or revoke residents right to smoke and that if smoke break is going to run late, to let the ADON, or DON know, and they can notify the residents in a timely manner. She stated the potential negative outcome of residents not being treated with respect could be the residents having emotional distress and fearful of not being able to do things freely in the facility. Record review of facility document titled Employee Corrective Action form dated 8/7/2025 revealed; Type of action taken: Final WarningState subject of code of conduct rule violated: Conduct, attitude and behavior.Incident: A resident presented to both the DON and ADM that [CNA D] engaged in an unprofessional verbal exchange with a resident. In the exchange [CNA D] is speaking inappropriately to the resident and implying that smoking privileges could be taken away.Follow up review date: 9/7/2025.Consequences: Could lead to further disciplinary action up to or include termination. Signed by CNA D, DON and ADM on 8/7/2025.Record review of facility policy titled Conduct, attitude and behavior last revised December 2019, revealed; .Employees must maintain good attitude toward his/her job positions, co-workers, residents and visitors. All employees will treat residents, visitors and co-workers with respect kindness and dignity.6. Examples of conduct and behavior that are considered inappropriate and are therefore prohibited by this policy include, but are not limited to the following: a. Failure to treat all residents, visitors and fellow employees with kindness respect and dignity.Record review of facility policy titled Resident Rights implemented 7/2025 revealed; .Respect and Dignity: The resident has the right to be treated with respect and dignity. Event ID: Facility ID: 455871 If continuation sheet Page 3 of 9 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 09/03/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few 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 each resident received adequate supervision and assistance devices to prevent accidents for 1 of 8 residents (Resident #1) reviewed for accidents and supervision. The facility failed to ensure adequate supervision of Resident #1 who was newly admitted to the facility on [DATE] and was exhibiting signs of confusion and exit-seeking behavior. Resident #1 then eloped from the facility approximately 27 (twenty-seven) hours later on 07/20/25 between 7:45 PM and 8:00 PM. Staff were unaware of Resident #1's elopement when the facility was notified by a citizen of the community via telephone on 07/20/25 at approximately 8:15 PM that the resident had wandered to a nearby apartment complex and appeared confused. The noncompliance was identified as PNC. The IJ began on 07/20/25 and ended on 07/21/25. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of harm, serious injury or death.Record review of Resident #1's face sheet, dated 09/02/25 revealed Resident #1 was admitted to the facility on [DATE] with the following diagnoses: dementia (progressive decline in cognitive functions), and anxiety disorder (a mental health condition characterized by excessive and persistent worry, fear and nervousness). Record review of the Assessment for Risk of Elopement, created by LVN C and dated 07/19/25 at 5:09 PM, revealed Resident #1 was not at risk for elopement. Record review of Resident #1's Baseline Care Plan, dated 07/20/25 revealed elopement risk factors would be evaluated to minimize risk of elopement. Record review of Resident #1's Resident Progress Report, created by LVN B on 07/20/25 at 5:47 AM revealed: Resident restless continues to wander in and out of rooms with exit seeking behavior, gave 1 ml lorazepam. Increased supervision and had resident sit with me at the nurse's station. Gave resident a memory board to help keep her busy. Record review of Resident #1's Resident Progress Report, created by LVN B on 07/20/25 at 8:54 PM revealed LVN B received a phone call that the resident was outside at a nearby apartment complex. Resident #1 was observed by LVN B at the apartments next door to the facility sitting down talking to the people. The resident was redirected back to the facility and assessed without noted injury. The hospice agency, Medical Director, and the resident's family member were contacted. No new orders were received. The resident was placed on one-to-one monitoring. Record review of the facility's Form 3613-A (Provider Investigation Report), dated 7/20/25, revealed LVN B was notified via telephone on 07/20/25 at 8:15 PM, of Resident #1's elopement from the facility. A community member called the facility and reported that Resident #1 had been found at the neighboring apartment complex and was confused. LVN B and CNA F went to the apartment complex and assisted Resident #1 back to the facility. The resident was assessed and found to have no injuries and did not require medical treatment. Resident #1 stated she was trying to go home. Resident #1 was placed on one-to-one supervision upon return to the facility and remained on one-to-one supervision until being discharged on 07/21/25 with family. A head count was conducted to account for all residents. Door alarms were checked and found to be functioning properly. Staff in-services were initiated for ANE, elopement, and responding to door alarms. Following the elopement, proper functioning of door alarms continued to be monitored, and elopement assessments and care plans were updated for all residents who were deemed at-risk for elopement. Additionally, a sign was placed at the lobby door directing visitors to notify staff if the door alarm was sounding upon approach. An elopement binder was updated for current at-risk residents and placement at the nurse's station was verified. Record review of Resident #1's Discharge MDS, dated [DATE], revealed:Section C - Cognitive Patterns - BIMS was blank and did not contain a score for Resident #1.Section E - Behavior - revealed the resident exhibited wandering behavior 1 to 3 days. Section GG (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 4 of 9 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 09/03/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Functional Abilities revealed the resident was able to stand from a sitting position with supervision or touching assistance and was able to walk 150 feet independently.Section I - Active Diagnosis - revealed the resident had an anxiety disorder. During an interview on 09/02/25 at 9:15 AM, the DON stated Resident #1 was admitted to the facility on [DATE] around 5:00 PM for a 5-day respite stay. She stated the resident was independently ambulatory upon admission and had a diagnosis of dementia. She stated LVN C admitted Resident #1 then passed care on to LVN B approximately one hour later, due to shift change. The DON stated Resident #1 did not immediately show signs of exit-seeking behavior on the day of admission, but she began to show signs of increased confusion and wandering behavior in the evening shortly after shift change. She stated LVN B implemented interventions for Resident #1's wandering behavior and anxiousness by allowing her to sit at the station with him, provide games for redirection and administer ordered PRN anxiety medication. The DON stated, according to staff, the resident was more content during the day shift on 07/20/25 and wandering and exit-seeking behavior were less pronounced. She stated on the evening shift of 07/20/25 the resident was seen ambulating in the hallways. She stated, according to staff interviews, the front door alarm sounded around 7:45 PM, which was manually silenced by RN A who reported seeing a visitor exiting from the door. She stated RN A believed the door alarm had been set off by the visitor and did not check the exterior of the building to see if a resident had exited. The DON stated another exit door alarm was also sounding around the same time as the front door alarm, which may have been staff taking residents out for the evening smoking break. She stated around 8:15 PM the facility received a call from a community member stating Resident #1 was found at a neighboring apartment complex. LVN B and CNA F went to the apartment complex and redirected Resident #1 back to the facility without incident. The DON stated Resident #1 was assessed and found to have no injuries and was immediately placed on one-to-one supervision. She stated all exit doors were checked and found to be functioning properly. She stated staff in-services for wandering, elopement and responding to door alarms were immediately initiated. The DON stated all staff on duty on 07/20/25 were in-serviced immediately following the incident and other staff were in-serviced upon return to duty on 07/21/25, before being allowed to start their shift. She stated on 07/21/25, the ADM and nursing administration began conducting random drills for staff response time to door alarms and doors continued to be monitored for proper functioning. She stated Resident #1 remained on one-to-one supervision until discharge on [DATE]. During an interview on 09/02/25 at 2:22 PM, LVN B stated he worked the 6 PM-6 AM shift on the evening Resident #1 was admitted . He stated the resident was admitted by LVN C prior to the beginning of his shift and he observed the resident in her room after receiving report at shift change. He stated LVN C did not report any observations of Resident #1 wandering or demonstrating exit-seeking behavior on her shift. LVN B stated Resident #1 became more active and began to demonstrate wandering behavior shortly after shift change. He stated Resident #1 was confused and would answer questions but her answers did not make sense. He stated Resident #1 told him someone was coming to get her and stated, I'm on my way out. He stated he observed the resident's belongings were packed up in the corner of her room. LVN B stated he allowed Resident #1 to ambulate in the hallways with him while doing his medication pass and rounds. He stated she followed along with him in the hallways and seemed like she didn't want to be alone. He stated Resident #1 set off the door alarm for Hall 500 while ambulating with him and he redirected her from the area of the door. LVN B stated Resident #1 sat with him at the nurse's station and he provided her with a memory game to play. He stated he administered Resident #1's PRN anti-anxiety medication, per orders. He stated Resident #1 went to bed around 9:00 PM and slept through the night without incident and he gave report to the oncoming nurse (LVN C) around 6:00 AM. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 5 of 9 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 09/03/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few stated he reported to LVN C that Resident #1 demonstrated wandering and exit-seeking behaviors during his shift. LVN B stated he returned to duty for the 6:00 PM - 6:00 AM shift on 07/20/25 and received report from LVN C who stated Resident #1 had no issues with wandering behavior throughout the day shift. LVN C stated Resident #1 had spent the day doing activities with other residents and had not required PRN medication for anxiety. LVN B stated he observed Resident #1 in areas with other residents and interacting with others during the first part of the shift and he observed her sitting in the tv area when he was on Hall 600 which he estimated was close to 8:00 PM. He stated he recalled a door alarm going off but did not see staff taking residents out for their smoke break. He stated he saw RN A coming from the lobby area. RN A stated the alarm was going off due to a family member exiting the facility. LVN B stated around 8:15 PM he received a call from a community member stating a resident with dementia was found at the apartment complex next to the facility. He stated he and CNA F went to the apartment complex to bring the resident back to the facility. LVN B stated Resident #1 was observed sitting on a bench with several people around. He stated Resident #1 did not appear to be in any distress. He stated Resident #1 was redirected to the facility without incident and he called the ADON on the way back to the facility to notify her of the resident's elopement. LVN B stated he assessed Resident #1 upon re-entry to facility and no injuries were noted. He stated notifications were made to Resident #1's family member as well as the nurse practitioner and no new orders were received. He stated one-to-one supervision was immediately implemented for Resident #1 and no further incidents occurred during his shift. LVN B stated he had been trained on wandering and exit-seeking behavior prior to Resident #1's elopement and was in-serviced again immediately following the elopement. He stated he did not see the admission Elopement Risk Assessment, but he implemented various interventions based on Resident #1's wandering behavior. LVN B stated he did not initially notify nursing administration or the physician on 07/19/25 because Resident #1 was easily redirected by ambulating with him in the facility and engaging in activities at the station. He further stated he did not need to contact the physician since Resident #1 was admitted with a PRN order for anti-anxiety medication which was effective after being administered. During an interview on 09/02/25 at 3:13 PM, RN A stated she worked the 6 AM - 6 PM shift and worked night shift PRN. She stated she worked 6 AM - 10 PM on 07/20/25 but was not assigned to Resident #1. She stated Resident #1 was independently ambulatory and, during her shift, she observed the resident looking at a magazine, walking from her room to the nurse's station and eating two meals in the dining room. She stated Resident #1 was confused and stated she had been at church and asked if it was time to leave. RN A stated she did not observe Resident #1 exhibiting exit-seeking behavior during her shift on 07/20/25. She stated around 8:00 PM she was finishing medication pass and heard the front door alarm sounding. She stated she walked from Hall 100 to the front lobby and saw a family member exiting the front door using a walker. She stated the family member had set the alarm off in the past due to being slower to exit with the walker. RN A stated she silenced the alarm as the family member exited. She stated she did not do a perimeter check because she thought the alarm was sounding due to the family member's exit. RN A stated around the same time another door alarm was sounding and another staff member responded to the door alarm, but she was unsure which door it was, and which staff responded. RN A stated it was unclear whether Resident #1 exited from the front door or another exterior door. She stated interventions for a resident would be implemented based on exit-seeking and wandering behavior exhibited by the resident. She stated she had been trained on elopement, identifying wandering and exit-seeking behaviors, and checking doors when alarms sounded prior to Resident #1's elopement and was in-serviced on ANE, elopement/wandering and door alarms on 07/20/25, following the elopement. During an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 6 of 9 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 09/03/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few interview on 09/02/25 at 3:35 PM, CNA F stated she worked the 6 PM - 6 AM shift on the evening Resident #1 eloped. She stated she worked on a different hall but had observed Resident #1 walking in the hallways without an assistive device. She stated she observed the resident near the nurse's station and observed her interacting with others. CNA F stated Resident #1 was a little confused and she heard the resident say someone was coming to get her. CNA F stated she did not see Resident #1 wandering or exit-seeking prior to her exit from the nursing facility. She stated after the facility was notified that Resident #1 had eloped, she went with LVN B to pick the resident up. She stated Resident #1 was observed outside sitting in a chair talking to another lady. She stated the resident did not have visible injuries or appear to be in distress. CNA F stated LVN B assessed Resident #1 upon return to the facility and one-to-one supervision was implemented for the remainder of the shift. CNA F stated the resident sat at the nurse's station and eventually went to bed and slept through the night. She stated she had been trained on elopement by her charge nurse. She stated since the incident, she had been in-serviced by the DON on ANE, wandering, door alarms and to alert a nurse if a door alarm sounds, so the nurse could account for all residents. During an interview on 09/02/25 at 4:25 PM, CNA E stated she worked 6 PM - 6AM on the evening Resident #1 eloped. She stated she had observed Resident #1 the previous night (07/19/25) ambulating in the hallway with LVN B. She stated Resident #1 pushed on the door on Hall 500 and set off the alarm and LVN B redirected her. She stated she observed Resident #1 sitting at the nurse's station with LVN B. CNA E stated during her shift on 07/20/25 she observed Resident #1 talking to other residents at the nurse's station. CNA E stated she took the smoking residents outside, which sounded the door alarm. CNA E stated she did not hear another door alarm sound during her shift. She stated when she re-entered the building, she was told Resident #1 had left the facility. She stated she was trained on wandering and elopement prior to the incident and was in-serviced on ANE, wandering, elopement and door alarms immediately after the elopement incident. CNA E stated she participated in the one-to-one supervision of Resident #1 on 07/20/25, following the elopement and stated the resident was in bed asleep most of the remainder of the night. During an interview on 09/03/25 at 9:42 AM, LVN C stated she was on duty on 07/19/25 and admitted Resident #1 around 5:00 PM. She stated she completed most of the admission paperwork and the resident's family was present for admission. She stated Resident #1 answered admission questions and did not appear to be confused at the time of admission. She stated the initial Elopement Risk Assessment was negative and Resident #1 did not exhibit wandering or exit seeking behavior. LVN C stated she passed care on to LVN B about an hour after the resident's admission, due to shift change. LVN C stated she returned to duty on 07/20/25 and observed Resident #1 to be more active but still did not exhibit exit-seeking behavior on her shift. She stated she did not update the Elopement Risk Assessment for Resident #1 and would not have implemented interventions based on lack of observation of exit-seeking behavior by the resident. LVN C stated she had been trained on elopement and door alarms prior to Resident #1 exiting the facility and received in-services for ANE, wandering and elopement and door alarms upon return to duty on 07/21/25. During a follow up interview on 09/03/25 at 3:41 PM, the DON stated the Elopement Risk Assessment was a tool used to help determine whether a resident was at-risk for elopement and was included in the facility admission packet. She stated an assessment alone did not automatically determine whether a resident would require interventions and that a resident's behavior should always be considered when determining a plan of care. The DON stated her expectation of staff if a resident was determined to be at-risk for elopement would be to increase supervision of the resident, implement interventions for wandering behavior, and notify administration, family, and the physician. She stated she and the weekend RN were responsible to assure residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 7 of 9 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 09/03/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few were assessed and interventions were made for any resident deemed at-risk for elopement. The DON stated a potential negative outcome for failure to provide adequate supervision for residents at-risk of elopement would be the resident exiting the facility and potentially being harmed. The facility implemented the following interventions from 07/20/25 - 07/21/25: Record review of the Assessment for Risk of Elopement, created by LVN B and dated 07/20/25 at 10:08 PM, revealed Resident #1 was at risk for elopement and required frequent monitoring. Record review of Resident #1's Comprehensive Care Plan, dated 07/20/25, revealed: Problem: I wander due to my diagnosis of dementia. I am an elopement risk. Goal: I will not elope from the center in the next 90 days. Approach: Assure that I have proper fitting and appropriate foot attire. If I begin to wander, please provide me assistance to where I need to be going. Staff will monitor me and report changes in exit seeking behaviors to the facility Administrator, Director of Nursing, Physician, and guardian/responsible party. Record review of documentation of one-to-one monitoring for Resident #1 from 07/20/25 - 07/21/25 revealed staff signed for the whereabouts of Resident #1 every 15 minutes beginning on 07/20/25 at 8:15 PM through 07/21/25 at approximately 4:00 PM, when Resident #1 was discharged from the facility. Record review of the 07/20/25 facility in-service training, which was conducted by the DON and signed by fifty-eight staff members, for Checking Door Alarms revealed: Always respond immediately to door alarms. Never assume someone else checked - personally verify and ensure no resident is outside Record review of the 07/20/25 facility in-service training, which was conducted by the DON and signed by sixty-two staff members, for Elopement revealed: Elopement is when a resident who is cognitively impaired leaves the facility without staff knowledge or permission, putting them at serious risk of harm. See attached for policy. The policies attached to the in-service were titled Wandering and Elopement and Emergency Procedure - Missing Resident. Record review of the 07/21/25 facility in-service training, which was conducted by the DON and signed by fifty-six staff members, for Alarm door ring revealed: If a door alarm sounds and no one is visibly at the door, staff must immediately go outside to ensure no resident has exited. If no one is found outside, a full head count of all residents must be conducted without delay by a nurse. If someone is present at the door, staff should ask whether the alarm was already ringing when they arrived or if it began after they reached the door. Record review of the 07/21/25 facility in-service training, which was conducted by the ADM and signed by fifty-nine staff members, for Abuse and Neglect Policy & Resident to Resident Policy revealed: You must notify the abuse prevention coordinator immediately if there is any type of abuse suspected or alleged. The ADM was listed as the abuse prevention coordinator and contact information was provided. The policy attached to the in-service was titled Abuse, Neglect, and Exploitation. Record review of the facility's documents titled, Door Alarm Check Q Shift, revealed daily checks of door alarms on each shift for the months of July 2025 and August 2025. Record review of the facility's documented record for proper functioning of facility exit doors revealed doors were checked on random dates between 07/07/25 - 08/25/25 and all doors were noted to pass. During an observation on 09/02/25 between 1:01 PM - 1:04 PM, the DON tested staff response to the front door alarm and Hall 200 door alarm sounding. Surveyor observed several staff members respond to both doors within 30 seconds of alarm sounding and check to see if any residents were in the area near the door. During an interview on 09/02/25 at 1:02 PM, the Housekeeping Director- day shift, stated she had been in-serviced on 07/21/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and notifying a charge nurse immediately so the nurse could conduct a head count to assure all residents were safe. During an interview on 09/02/25 at 1:06 PM, the SW stated she had been in-serviced on 07/21/25 regarding ANE, elopement and wandering behavior, responding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 8 of 9 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 09/03/2025 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 - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete immediately to door alarms, checking the exterior perimeter for a residents' exit and notifying a charge nurse immediately so the nurse could conduct a head count to assure all residents were safe. During an interview on 09/02/25 at 2:22 PM, LVN B - night shift, stated he had been in-serviced on 07/20/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and conducting a head count to ensure all residents were accounted for if a door alarm sounded. During an interview on 09/02/25 at 3:13 PM, RN A - day shift, stated she had been in-serviced on 07/20/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and conducting a head count to ensure all residents were accounted for if a door alarm sounded. During an interview on 09/02/25 at 3:35 PM, CNA Fnight shift, stated she had been in-serviced on 07/20/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and notifying a charge nurse immediately so the nurse could conduct a head count to assure all residents were safe. During an interview on 09/02/25 at 4:25 PM, CNA E- night shift, stated she had been in-serviced on 07/20/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and notifying a charge nurse immediately so the nurse could conduct a head count to assure all residents were safe. During an interview on 09/03/25 at 9:42 AM, LVN C - day shift, stated she had been in-serviced on 07/21/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and conducting a head count to ensure all residents were accounted for if a door alarm sounded. During interviews conducted on 09/03/25 between 11:45 AM - 3:00 PM, the following staff members - (PTA I, PTA J, PT, MA H, ADON, and CNA G) reported they had been in-serviced on 07/20/25 and 07/21/25 regarding ANE, elopement and wandering behavior, responding immediately to door alarms, checking the exterior perimeter for a residents' exit and notifying a charge nurse immediately so the nurse could conduct a head count to assure all residents were safe. Record review of the facility's policy titled Wandering and Elopements, Revised April 2025 revealed: Policy StatementThe facility will ensure that residents who exhibit wandering behavior and/or are at risk for elopement receive adequate supervision to prevent accidents and receive care in accordance with their person-centered plan of care.Policy Interpretation and Implementation1. Monitoring and Managing Residents at Risk for Elopement or Unsafe Wanderinga. Residents will be assessed by the IDT for risk of elopement and unsafe wandering on admission, readmission, quarterly, and/or with a change of condition (e.g., increased agitation, changes in mobility, wandering).c. Interventions to increase staff awareness of the resident's risk, modify the resident's behavior, and minimize risk associated with hazards will be added to the resident's care plan and communicated to appropriate staff. d. Adequate supervision will be provided to help prevent accidents or elopements- . The noncompliance was identified as PNC. The IJ began on 07/20/25 and ended on 07/21/25. The facility had corrected the noncompliance before the survey began. Event ID: Facility ID: 455871 If continuation sheet Page 9 of 9