Inspection·December 8, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few revealed MA A administered the following morning medications:Aspirin 81 mg tablet, 1 tablet by mouthClopidogrel 75 mg tablet, 1 tablet by mouthDivalproex 125 mg delayed release tablet, 1 tablet by mouthGuaifenesin 400 mg tablet, 1 tablet by mouthLasix 40 mg tablet, 1 tablet by mouthMetoprolol succinate 25 mg extended-release tablet, 1 tablet by mouthPantoprazole 20 mg delayed release tablet, 1 tablet by mouthPotassium chloride 20 mEq extended-release tablet, 1 tablet by mouthRosuvastatin 5 mg tablet, 1 tablet by mouthSodium chloride 1 gram tablet, 1 tablet by mouthZoloft 50 mg tablet, 1 tablet by mouth During an interview on 10/22/25 at 9:53 AM, Family Member stated Resident #1's morning medications were observed in a plastic cup next to Resident #1's tray during breakfast. Family Member stated a couple of the medications appeared to be wet like they had been in [Resident #1's] mouth. Family Member stated Resident #1 took the medications that were in the cup and MA A was made aware that the resident had taken the medications. Family Member stated Resident #1 had a history of refusing medications at times and holding medications in her mouth or spitting them out. Family Member stated they called the facility to report to a nurse that Resident #1's medications were not properly administered. During an interview on 10/22/25 at 2:45 PM, MA A stated she routinely gave scheduled medications to Resident #1. She stated Resident #1 would occasionally refuse to take her medications. MA A stated she had also observed Resident #1 pocket her medications in her mouth on one occasion, meaning she would hold the pills in her cheek rather than swallowing them. MA A stated she recalled giving Resident #1 her medications in the dining room during breakfast. She stated she prepared the medications in an administration cup and wrote Resident #1's initials on the outside of the cup. She stated she put the medications in Resident #1's mouth and gave her a drink of water from a plastic drinking cup. MA A stated she asked Resident #1 if she swallowed the medication and she nodded her head. MA A stated she walked away and threw the initialed medication cup in the trash on the side of her medication cart. She stated as she was leaving the dining room following the breakfast meal, Resident #1's family member stated, She took her medications. MA A stated she was unsure what the family member was referring to at that time. She stated RN C questioned her about administering Resident #1's medications after RN C received a phone call from Resident #1's family member stating a cup with the resident's medications was observed by her plate at breakfast. MA A stated she showed RN C the administration cup with the resident's initials in her trash on her medication cart and told RN C the resident must have spit the medications out after she walked away. MA A stated she had been trained on proper medication administration and had just renewed her certification recently. She stated the steps to properly administer medication were: check your order, make sure who the resident is, check medication, right dosage, check vital signs, then give the medication and stand there to be sure they take it and swallow it before walking away, then document in the MAR. MA A stated she failed to assure Resident #1 swallowed her medication before walking away. She stated she should have asked Resident #1 to open her mouth so she could be sure the medication was swallowed, especially since she refuses and pockets her meds sometimes. MA A stated she was in-serviced on proper medication administration by RN C on the same day the incident occurred. She stated the DON had also re-educated her on proper medication administration over the phone on the same day. MA A stated a potential negative outcome for failure to observe a resident swallow their medications was the resident getting sick from not taking meds, or another resident taking meds that aren't theirs and becoming sick. During an interview on 10/22/25 at 3:04 PM, RN C stated she received a phone call from Resident #1's family member who stated the resident's cup of pills were observed next to Resident #1's breakfast plate and the family member assisted the resident to take the medication. RN C stated she relayed the information to LVN B who was taking care of Resident #1 that day. RN C stated she then called the DON to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 2 of 4 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 12/08/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few make her aware of the situation. RN C stated MA A showed her the medication administration cup from the trash can on the medication cart with Resident #1's initials on the cup. RN C stated the proper steps to administer medication were: check order, check correct patient, right med, dose, route, time, then administer the medication and be sure they swallow it and check their mouth. RN C stated if a resident is known to hold medications in their mouth, the person administering the medications should check the resident's mouth and under the tongue thoroughly to be sure the medications were ingested. She stated she had not observed medications being left by the MA's for the resident to take without supervision. RN C stated she re-educated MA A on proper oral medication administration following the incident. During an interview on 10/22/25 at 2:18 PM, LVN B stated the facility MA's were responsible for administering all scheduled medication. LVN B stated if medication needs to be given while a resident is in the dining room, the medication cart is left outside the dining room, and the prepared medications are brought in a medication cup to the resident for administration. LVN B stated she was informed by RN C that Resident #1's family member called the facility and stated the family member had observed Resident #1's medications in a plastic cup sitting beside the resident's breakfast plate. LVN B stated she spoke to MA A who stated she had given Resident #1 her medications and she must have spit them out. LVN B stated the steps to administer a medication to a resident were: first, check the order, check you have the right resident, check vitals, check the right route, give the medication and assure the medication was actually swallowed by checking the resident's mouth, then document what was done. LVN B stated she had not observed an MA leave unsupervised medications for a resident to take. LVN B stated if a resident has a history of pocketing medications in their mouth, the person administering medications should check the resident's mouth, cheeks and under the tongue to assure the medication was swallowed before walking away from the resident. During an interview on 10/22/25 at 3:40 PM, the DON stated RN C called her to report Resident #1's medications were observed by Resident #1's family member in a cup by the resident's breakfast plate. The DON stated she called the facility and spoke to RN C and LVN B regarding Resident #1's morning medications. She stated it was determined that the medications belonged to Resident #1 by the description of the pills by the family member. She stated MA A had already given the other two residents at the table their medications prior to those residents entering the dining room. The DON stated the family member told MA A that Resident #1 took the medications in her cup. She stated she instructed RN C to in-service MA A on assuring all residents swallow oral medications at the time of administration. The DON stated she also spoke to MA A on the phone and re-educated her on proper medication administration and assuring the resident takes the medications that are administered. She stated her expectation of the MA was to assure medications were taken properly by checking the resident's mouth after administration. She stated she had not received any complaints from residents or family members that medications were not being administered properly. The DON stated a potential negative outcome for failure to ensure residents take their medications, would depend on the type of medication - a missed seizure med could result in a resident having seizures or a resident not getting good pain control if a pain med is missed or other residents could take medications that are not ordered for them. During an interview on 10/22/25 at 4:07 PM, the ADM stated she was informed by the DON of an incident with Resident #1's medications being found in a cup beside her breakfast tray by her family member. She stated the DON determined that Resident #1 had been given her medications after initially not ingesting them when MA A administered the medications. She stated her expectation of staff was to administer medications according to facility procedure and to assure all medications were taken at the time of administration. She stated the system for monitoring proper medication administration was through (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455871 If continuation sheet Page 3 of 4 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 12/08/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete periodic staff competency assessments. Record review of the facility's competency assessment for Administering Oral Medications dated 09/10/25, was signed by MA A and the facility's ADON. Record review of the facility's document titled, Competency Assessment Administering Oral Medications revised October 2010 revealed: A) PurposeThe purpose of this procedure is to provide guidelines for the safe administration of oral medications.E) Steps in the Procedure 9. Prepare the correct dose of medication.10. Confirm the identity of the resident.16. Allow the resident to swallow oral tablets or capsules at his or her comfortable pace.21. Remain with the resident until all medications have been taken. Event ID: Facility ID: 455871 If continuation sheet Page 4 of 4