Health inspection·May 6, 2023

F 0677 not refused a shower during this time frame. Level of Harm - Minimal harm or potential for actual harm During an interview on 5/03/23 at 8:40 a.m. the complainant said when she changed and cleaned up Resident #1 on 5/01/23 he was full of feces and urine. The complainant said Resident #1 had a powdery substance caked on him that was brown colored. The complainant said Resident #1 was resistive to being cleaned because of the pain. The complainant said once Resident #1 was cleaned he was observed to be excoriated in his groin area. Residents Affected - Few During an interview on 5/03/23 at 12:57 p.m. the DON said Resident #1 refused care. The DON said when Resident #1 refused care staff reported to the family and to the physician the refusal. During an interview on 5/03/23 at 2:55 p.m. CNA M said Resident #1 would refuse care including showers. CNA M said if a resident refused a shower the CNA should reapproach the resident later and offer them a bed bath. CNA M said a resident continued to refuse their shower the nurse should be notified. CNA M said the CNA should document the refusal in the Point of Care system. During an interview on 5/03/23 at 3:00 p.m. LVN L said Resident #1 would refuse care including showers. LVN L said if a resident refused their shower they should be reapproached at a later time. LVN L said refusal were documented on the 24-hour report, but not in the resident's progress notes or medical records. 2. Record review of an undated face sheet indicated Resident #2 was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Parkinson's disease, contracture of the right hand, lack of coordination, and muscle weakness. Record review of the MDS dated [DATE] indicated Resident #2 was usually understood by others and usually understood others. The MDS indicated Resident #2 had a BIMS of 05 and was severely cognitively impaired. The MDS indicated Resident #2 was totally dependent for dressing and personal hygiene. The care plan last revised 4/20/23 indicated Resident #2 had an alteration in comfort related to right hand contracture and decreased mobility. Record review of the Point of Care History dated 4/03/23 through 5/03/23 indicated Resident #2 had not received a shower on 4/23/23. During an observation on 5/03/23 at 10:17 a.m. Resident #2 had a dark brown substance under his fingernails. During an observation on 5/04/23 at 12:22 p.m. Resident #2 had a dark brown substance under his fingernails. 3. Record review of an undated face sheet indicated Resident #5 was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including right below the knee amputation, dementia, and disorder of the skin. Record review of the MDS dated [DATE] indicated Resident #5 understood others and was understood by other. The MDS indicated Resident #5 had a BIMS of 12 and was moderately cognitively impaired. The MDS indicated Resident #5 did not reject evaluation or care. The MDS indicated Resident #5 required extensive assistance with dressing and personal hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 2 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0677 Level of Harm - Minimal harm or potential for actual harm Record review of the care plan revised 10/14/22 indicated Resident #5 had a self-care deficit with interventions including provide one person staff assistance with bathing. Record review of the Point of Care History dated 4/03/23 through 5/03/23 indicated Resident #5 had not received a shower on 4/04/23, 4/06/23, and 4/18/23. Residents Affected - Few During an observation and interview on 5/3/23 at 9:30 a.m. Resident #5 said she did not receive her baths as scheduled. Resident #5 said if she asked for a basin of water and soap they will bring it to her so she can bathe herself. Resident #5's hair was oily. During an interview on 5/04/23 at 2:20 p.m. CNA E said CNAs were responsible for providing resident showers. CNA E said if a resident refused their shower it should be documented in the Point of Care system. CNA E said nail care should be provided with showers. CNA E said the importance of residents receiving their showers was for hygiene and to prevent skin breakdown. CNA E said Resident #5 preferred to wash herself with a basin of water and soap. CNA E said when Resident #5 washed herself it should be documented in the Point of Care system as her receiving a shower/sponge bath/bed bath. During an interview on 5/04/23 at 2:15 p.m. CNA N said she was an agency CNA and had only worked in the facility a few times. CNA N said CNAs were responsible for providing showers to the residents. CNA N said CNAs were responsible for keeping resident's nails clean unless the resident was diabetic and then it was the nurse's responsibility. CNA N said if a resident refused their showers it should be reported to the nurse. During an interview on 5/04/23 at 2:18 p.m. CNA P said CNAs were responsible for providing resident showers and cleaning their nails. CNA P said resident nails should be cleaned during the resident's shower. CNA P said if a resident refused their shower or nail care the resident had to sign they refused, and it should be reported to the nurse. CNA P said the importance of residents receiving their showers was for hygiene, to prevent skin breakdown, and for dignity. During an interview on 5/04/23 at 2:25 p.m. LVN Q said the nurses were responsible for ensuring the CNAs gave the residents their showers and cleaned their fingernails. LVN Q said showers should be given 3 times a week. LVN Q said if a resident refuses the resident should be asked again. LVN Q said if the resident continues to confuse it should be documented in the nursing progress notes. LVN Q said the importance of the residents receiving their showers was to decrease risk of infection, an additional skin observation, and for dignity. During an interview on 5/04/23 at 3:43 p.m. the DON said she expected residents to showered as often as they wanted to be. The DON said resident nails should be cleaned with their showers and as needed. The DON said if a resident refused she expected staff to try again a couple times or send a different staff member to ask the resident. The DON said if a resident continued to refuse she expected staff to report the refusal to the family and document the refusal. The DON said the importance of residents receiving their showers was for dignity, quality of life, and for skin assessment. Record review of the facility's Bathing-Showering policy dated March 2019 indicated, Bathing and showers were provided to provide personal hygiene and stimulate circulation . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 3 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice 1 of 4 (Resident #1) residents reviewed quality of care. Residents Affected - Few The facility failed to assess Resident #1's right contracted hand for skin breakdown. The facility failed to provide treatment for the contracted hand to prevent skin breakdown. The facility failed to provide treatment for wound to Resident #1's right palm. The facility failed to develop a care plan for Resident #1's contracted hand and need for management. The facility failed to notify the physician of Resident #1's wound to the right hand. This failure resulted in an identification of an Immediate Jeopardy (IJ) on 5/03/23 at 4:45 p.m. While the IJ was removed on 5/06/23, the facility remained out of compliance at actual harm that is not immediate jeopardy with a scope identified as isolated due to the facility's need to complete in-service training and evaluate the effectiveness of the corrective systems. This failure could place 5 residents who had contractures at risk for pain, worsening contracture, wounds, and infection. Findings included: 1. Record review of the undated face sheet indicated Resident #1 an [AGE] year old male admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), ataxia (impaired balance or coordination, can be due to damage to the brain, nerves, or muscles), aphasia (loss of ability to understand or express speech, caused by brain damage), and flaccid hemiplegia affecting the right dominant side (severe of complete loss of motor function on the right side). Record review of the MDS dated [DATE] indicated Resident #1 was rarely/never understood by others and understood others. The MDS indicated Resident #1 had a BIMS of 00 and was severely cognitively impaired. The MDS indicated Resident #1 evaluation or care 1 to 3 days over the 7-day look back period. The MDS indicated Resident #1 required extensive assistance with personal hygiene and dressing. The MDS indicated Resident #1 did not have any skin conditions. Record review of the care plan revised on 9/20/22 indicated Resident #1 was at high risk for alteration in skin integrity. The care plan indicated Resident #1 had the potential for complication due to pain related to decreased mobility. The care plan indicated Resident #1 was unable to express needs related to aphasia. Record review of a skin assessment dated [DATE] indicated Resident #1 had no new areas of skin impairment. Record review of a skin assessment dated [DATE] indicated Resident #1 had no new areas of skin impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 4 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of the nursing progress notes dated 4/07/23 through 5/02/23 indicated Resident #1 had not refused a skin assessment. Record review of the hospital records dated 5/3/23 indicated Resident #1 was Resident #1 was sent to the emergency room (ER) for chief complaint of wound check. The ER note indicated Resident #1 was sent from the nursing facility for a wound to his right hand. The ER note indicated discharge orders for Resident #1 included wound clinic referral and Lamisil (a medication to treat fungal infections) 250 mg tablet daily. Record review of the facility's skin reports dated 4/22/23 through 4/28/23 indicated Resident #1 did not have any skin condition or wound. Record review of the physician's progress note dated 5/05/23 indicated the physician agreed with the ER assessment of Resident #1's wound to his right hand. The physician wound care note indicated Resident #1 would be seen by the wound care doctor on 5/10/23. The physician progress note indicated Resident #1's right palm did not appear necrotic (dead or dying) or infected. Record review of the schedule of nurses assigned for skin assessments indicated the facility had a nurse assigned to completed skin assessments on 2/09/23, 2/11/23. 2/12/23, 3/09/23, 3/23/23. 4/06/23, and the week of 4/24/23 through 4/28/23. During an observation 5/03/23 at 12:45 p.m. Resident #1's right hand indicated his right palm was black with the skin peeling off in a sheet and foul smelling. Resident #1's middle and ring fingers were to be black at the base of the fingers. During an interview on 5/03/23 at 12:47 p.m. Resident #1 said his right hand hurt. During an interview on 5/03/23 at 12:57 p.m. the DON said Resident #1 refused care. The DON said Resident #1 refused skin assessments. The DON said she did not know why Resident #1 was not on the list of wounds that was provided to the surveyor. The DON said when Resident #1 refused care the facility reported the refusal to the family and the physician. The DON informed the physician of Resident #1's wound to his right palm while in with the surveyor. During an interview on 5/03/23 at 1:16 p.m. LVN A said she was the previous treatment nurse. LVN A said the last time she had seen Resident #1's right palm was approximately on 4/06/23 when she performed his skin assessment. LVN A said Resident #1's right palm was not discolored and did not have a wound on 4/06/23. During an interview on 5/03/23 at 1:20 p.m. LVN A said she worked out her 2 weeks as the full-time treatment nurse and was no longer a full-time staff member at the facility in February 2023. LVN A said the new treatment nurse started at the facility the week of 4/24/23 through 4/28/23. LVN A said residents had not received skin assessments routinely since February 2023 when she stepped down to PRN from full-time. During an interview on 5/03/23 at 2:35 p.m. the DON said she and the ADON had been responsible in completing skin assessments on the days the facility did not have coverage and that the skin assessments had fell through the cracks. During an interview on 5/03/23 at 3:05 p.m. the DON said from February 2023 until the week of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 5 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0684 Level of Harm - Immediate jeopardy to resident health or safety 4/24/23 through 4/28/23 the facility had several different nurses work that were responsible for skin assessments. During an interview on 5/03/23 at 3:22 p.m. the DON said skin assessments should be performed weekly to monitor residents for impaired skin integrity. The DON said the facility did not have a policy regarding contracture management. Residents Affected - Few During an interview on 5/05/23 at 10:42 am the physician said she was notified of the wound to Resident #1's hand on 5/03/23. The physician said Resident #1 was sent to the ER for evaluation due to her and the nurse practitioner not being available to come to the facility and assess Resident #1's wound. Record review of the facility's Pressure Injury Prevention policy dated September 2018 indicated, Comprehensive skin inspection is an important tool in pressure injury prevention, classification, diagnosis, and treatment .Comprehensive inspection will include .inspection/observation of skin conditions .Document skin condition(s) on admission and regularly thereafter .Repeat skin inspections at regular intervals, at least weekly and with significant changes in skin condition .Develop an initial plan of care based on the area of risk identifies in the comprehensive skin inspection . Record review of the facility's Condition Changes/Episodic Documentation policy dated December 2018 indicated, The facility will document change in a resident/patient's condition or significant resident/patient care issues each shift Document the facts regarding the changes in condition or incident as applicable .Notify physician and document .Notify the family . The Administrator was notified on 5/03/2023 at 4:59 p.m. that an Immediate Jeopardy situation was identified due to the above failure. The Administrator was provided the Immediate Jeopardy template on 5/03/2023 at 5:01 p.m. The facility's Plan of Removal was accepted on 5/04/2023 at 4:42 p.m. and included: DON notified Medical Director of IJ at 6:03 pm 5/3/23 Complete skin checks of all residents will be completed by Licensed Nurses (ADON, PRN Treatment Nurse, Treatment Nurse, 10-6 Charge Nurse, and & MDS Coordinator) beginning immediately. Special attention during skin checks will be observed for any residents with contractures. These checks will be documented on the Weekly Skin Report. Any skin issues identified will also be documented on a Skin Grid. (Skin checks were completed 5/3/23. Completed skin checks were reviewed for completion on 5/4/23 by DON and ADON. No new pressure areas were noted.) Physician will be promptly notified by identifying nurse of any skin issues identified for treatment orders. (DON and ADON currently reviewing for notification and new orders/treatment on any identified skin issues. Any new orders/treatment will be implemented by end of 5/4/23) Therapy will screen/rescreen all residents with contractures in the facility to ensure interventions are in place to manage skin risk. These interventions will be addressed in their plan of care. (Completed 5/4/23 All 5 residents (2 are currently receiving Therapy) ADON in serviced nurses on Therapy suggested resident specific contractures interventions and added to Care Plan (5/4/23). Interventions added to treatment book. Charge nurses to monitor that interventions are in place and Tx nurse to monitor while performing daily skin care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 6 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0684 Level of Harm - Immediate jeopardy to resident health or safety All nurses and C.N.A's present in-serviced by DON/ADON on contracture management and identification 5/4/23 at 3:11pm. All evening shift nursing staff and nurse mangers have been trained as of 3:30pm 5/4/23. All nursing staff will be in-serviced upon their arrival to work until all nurses and C.N.A's have been trained. Any resident with a contracture will be assigned daily skin care/cleansing and inspection by Treatment Nurse (Implemented 5/4/23) Residents Affected - Few Treatment Nurse started 4/24/23 and has been training for her position duties and current responsibilities of position including completing Weekly Skin Assessments, assessing any skin areas of concern as identified by direct care staff/charge nurses, physician notification, obtaining treatment orders, and implementing treatment and monitoring for effectiveness of treatment/healing and reporting ongoing information regarding skin issues to Dr/NP. Completion Date 5/4/23 at 10 am. Trained by DON. DON and ADON to Inservice Licensed Nurses concerning requirement to notify the physician, RP, and Nurse Manager/DON if the resident refuses skin assessment and when skin assessments are indicated to be performed, physician notification of identified skin issues and as well as ensuring physician notification will be documented in the Progress Notes. Licensed Nurses in-serviced on this immediately (5/3/23 6:30 pm) for staff present and as they arrive for work until all licensed nurses have been trained. Staff on all three shifts have been trained as of 6:00 am 5/4/23. DON and ADON In-serviced Direct Care staff to promptly report any skin issues identified during care to Licensed Nurse for assessment. Inservice completed at 6:30 pm 5/3/23 for all C.N.A's that were present. Staff on all three shifts have been trained as of 6:00 am 5/4/23. All C.N.A's will be in-serviced as they arrive to work until all C.N.A's have been trained. On 5/06/2023 the surveyor confirmed the facility implemented their plan of removal sufficiently to remove the Immediate Jeopardy (IJ) by: Interview with the physician on 5/05/23 at 10:42 a.m. in which the physician said she was notified by the Administrator of the immediate jeopardy and was in agreeance with the facility's plan of removal. Record review of residents' skin assessments indicated all residents had skin assessment completed on 5/03/23 and 5/04/23. Record review of therapy screens for the 5 residents in the facility with contractures. Record review of in-services for CNAs and nurse regarding reporting skin concerns to the nurse and physician, completing weekly skin assessments, completing the daily shower schedule, and contracture management. Record review of the TAR for residents with contractures to ensure contracture management was added and completed daily. Record review of the care plans for resident with contractures to ensure all residents with contractures had a care plan in place with interventions. Interview with staff on 5/05/23 at 12:26 p.m. through 2:38 p.m. (LVN A, LVN B, the Treatment Nurse, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 7 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete CNA C, CNA D, CNA E, CNA F, MA G, CNA H, LVN J, LVN K) were performed. During the interviews the staff were able to indicate proper contracture management, how often skin assessment should be completed, when to report skin changes and to whom, and when shower schedules should be complete. While the IJ was removed on 5/06/23, the facility remained out of compliance at actual harm that is not immediate jeopardy with a scope identified as isolated due to the facility's need to complete in-service training and evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 455910 If continuation sheet Page 8 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents received appropriate treatment and services to prevent further decrease of ROM for 4 of 4 (Resident #1, Resident #2, Resident #3, Resident #4) residents reviewed with limited range of motion. The facility did not ensure Resident #1, Resident #2, Resident #3, and Resident #4 were receiving contracture management to treat their contracted hands This failure could place residents at risk for decrease in mobility, range of motion and contribute to worsening of contractures. Findings included: 1. Record review of the undated face sheet indicated Resident #1 an [AGE] year old male admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), ataxia (impaired balance or coordination, can be due to damage to the brain, nerves, or muscles), aphasia (loss of ability to understand or express speech, caused by brain damage), and flaccid hemiplegia affecting the right dominant side (severe of complete loss of motor function on the right side). Record review of the MDS dated [DATE] indicated Resident #1 was rarely/never understood by others and understood others. The MDS indicated Resident #1 had a BIMS of 00 and was severely cognitively impaired. The MDS indicated Resident #1 required extensive assistance with personal hygiene and dressing. The MDS indicated Resident #1 had functional limitation in range of motion on one side involving his upper extremity. Record review of the care plan revised on 9/20/22 indicated Resident #1 was at high risk for alteration in skin integrity. The care plan indicated Resident #1 had the potential for complication due to pain related to decreased mobility. During an observation and interview on 5/03/23 at 8:55 a.m. Resident #1 had a contracture to the right hand with no contracture device in place. Resident non-verbal and unable to be interviewed. During an observation on 5/03/23 at 10:22 a.m. Resident #1 had a rolled washcloth in his contracted right hand. During an interview on 5/03/23 at 12:47 p.m. Resident #1's family said they had not ever seen him with a hand roll (a device used specifically for hand contractures to prevent breakdown of the skin and worsening on the contracture) or wash cloth in his contracted hand. They said a family member visits frequently and at different times of the day to check on him and would have seen a hand roll or rolled wash cloth in his hand. 2. Record review of an undated face sheet indicated Resident #2 was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Parkinson's disease, contracture of the right hand, lack of coordination, and muscle weakness. Record review of the MDS dated [DATE] indicated Resident #2 was usually understood by others and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 9 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some usually understood others. The MDS indicated Resident #2 had a BIMS of 05 and was severely cognitively impaired. The MDS indicated Resident #2 was totally dependent for dressing and personal hygiene. The MDS indicated Resident #2 had functional limitation in range of motion to bilateral upper extremities. The care plan last revised 4/20/23 indicated Resident #2 had an alteration in comfort related to right hand contracture and decreased mobility. Record review of Resident #2's occupational therapy evaluation dated 3/31/23 indicated Resident #2 would be seen 4/03/23 through 4/30/23. The occupational therapy evaluation indicated Resident #2 would safely wear a palmar guard on right and left hands for up to three hours a day with minimal signs and symptoms of redness, swelling, discomfort, or pain. Record review of Resident #2's occupational therapy recertification for dated 5/01/23 through 5/30/23 indicated Resident #2 would safely wear a palmar guard on his right and left hands for up to 6 hours a day with minimal signs and symptoms of redness, swelling, discomfort, or pain. During an observation an interview on 5/03/23 at 10:17 a.m. Resident #2 was sitting in his wheelchair in the hallway. Resident #2 had bilateral hand contractures with no contracture device in place. Resident #2 said on 5/02/23 the facility staff put something in his hand to aide with his contracture. Resident #2 said the facility did not put something in his hand daily for his contractures. During an observation on 5/04/23 at 10:00 a.m. Resident #2 was sitting up in his wheelchair in his room with eyes closed. Resident #2 had a rolled washcloth in his left contracted hand. Resident #2 did not have rolled wash cloth in his right contracted hand. 3. Record review of an undated face sheet indicated Resident #3 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Alzheimer's disease and Parkinson's disease. Record review of the physician orders dated 5/01/23 through 5/31/23 indicated Resident #2 had an order to gently flush right contracted hand with normal saline, dry with gauze, and apply triple antibiotic ointment to right middle finger scab daily starting 2/02/23. Record review of Resident #3's TAR (treatment administration record) for treatment to his left contracted hand for March and April 2023 indicated treatment to his right hand was not performed on 4/13/23, 4/21/23, 3/3/23, 3/12/23, 3/13/23, 3/14/23, 3/15/23, 3/17/23, 3/23/23, and 3/24/23. Record review of the MDS dated [DATE] Resident #3 was usually understood by others and usually understood others. The MDS indicated Resident #3 had a BIMS of 03 and was severely cognitively impaired. The MDS indicated Resident #3 did not reject evaluation or care. The MDS indicated Resident #3 required extensive assistance with dressing and personal hygiene. MDS indicated Resident #3 had functional limitation in range of motion on one side involving his upper extremity. Record review of the care plan last revised on 3/30/23 indicated Resident #3 was at risk for alteration in skin integrity. During an observation on 5/04/23 at 10:50 a.m. Resident #3 did not have a rolled washcloth or contracture device in place to his right contracted right hand. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 10 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 4. Record review of an undated face sheet indicated Resident #3 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Alzheimer's disease, pain, and gout (a form of arthritis characterized by severe pain, redness, and tenderness in joints). Record review of the MDS dated [DATE] indicated Resident #4 was usually understood by others and usually understood others. The MDS indicated Resident #4 had a BIM of 00 and was severely cognitively impaired. The MDS indicated Resident #4 did not reject evaluation or care. The MDS indicated Resident #4 was totally dependent for personal hygiene and dressing. MDS indicated Resident #4 had functional limitation in range of motion on one side involving his upper extremity. Record review of the care plan last revised 10/11/22 indicated Resident #4 was at a high risk for alteration in skin integrity. Record review of an undated, handwritten the list of residents with contractures indicated the facility had 4 residents with contractures. During an observation and interview on 5/03/23 at 2:00 p.m., Resident #4 had a rolled washcloth in place to his contracted hand. Resident #4 said facility did not place a rolled washcloth in his contracted hand daily. During an interview on 5/03/23 at 12:57 pm the DON said that the facility attempted to put a rolled washcloth in Resident #1's contracted hand daily, but he will pull it out. The DON said without an order or care plan she does not know how she will prove the facility has been placing a rolled washcloth in Resident #1's contracted hand. The DON said nursing staff were trained on contracture care and that was how they knew to put the hand roll or wash cloth in a resident's hand that was contracted. During an interview on 5/03/23 at 1:16 pm LVN A said hand rolls or rolled washcloths were put in place for contractures if there was an order for one. During an interview on 5/03/23 at 2:35 The DON said they facility did not have a policy regarding hand rolls for contractures. During an interview on 5/03/23 at 3:22 p.m. the DON said skin assessments should be performed weekly to monitor residents for impaired skin integrity. The DON said the facility did not have a policy regarding contracture management. During an interview on 5/04/23 at 9:20 a.m. the Director of Rehab (DOR) said Resident #2 was receiving occupational therapy services that included treatment for the contractures to Resident #2's bilateral hands. The DOR said he had worked at the facility for a year and a half and in his time of employment staff had not been in-serviced regarding contracture management. The DOR said contracture management was important in preventing wounds. The DOR said Resident #1, Resident #3, and Resident #4 were screened by therapy for contractures on 5/03/23 after surveyor intervention. The DOR said recommendation were made for Resident #1, Resident #3, and Resident #4 to receive gentle passive range of motion and hand hygiene to contracted hands 7 days a week and to place a rolled washcloth(s) in the resident's contracted hands for 2 hours twice a day as tolerated for prevention of wounds. During an interview on 5/4/23 at 2:00 p.m. the Administrator said when she gave the surveyor a list of residents with contractures on 5/3/23 there were 4 residents on the list. The Administrator said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 11 of 12 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 455910 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chandler Nursing Center 300 Cherry St Chandler, TX 75758 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 0688 going through their processes they became aware of a 5th resident with a hand contracture who was receiving therapy services. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 12 of 12