Health inspection·October 11, 2023

F 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of Resident #34's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE] Her diagnoses included: Parkinson's disease(Primary), Pneumonia, unspecified organism, Encephalopathy, unspecified, Polyneuropathy, unspecified, Acute candidiasis of vulva and vagina, Personal history of urinary (tract) infections, Urinary tract infection, site not specified, Personal history of COVID-19, Constipation, unspecified, Age-related osteoporosis without current pathological fracture, Candidiasis, unspecified, Rash and other nonspecific skin eruption, Rhabdomyolysis, Unspecified convulsions, Major depressive disorder, recurrent, moderate, Generalized anxiety disorder, Epilepsy, unspecified, not intractable, without status epilepticus, Hypothyroidism, unspecified, Hyperlipidemia, unspecified, Bipolar disorder, current episode mixed, unspecified, Major depressive disorder, single episode, mild, Chronic pain syndrome, I10 Essential (primary) hypertension, Gastro-esophageal reflux disease with esophagitis, Functional dyspepsia, Constipation, unspecified, Hormone replacement therapy, Other muscle spasm, Cough, Repeated falls, Fever, unspecified, Pain, unspecified Review of the electronic MDS tab for Resident #34 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #26's face sheet dated 10/10/2023 reflected a [AGE] year-old male. He was admitted to the facility on [DATE] his diagnoses included: Alzheimer's disease, unspecified(Primary), Personal history of COVID-19-Recovered on 9/6/22, Other symptoms and signs concerning food and fluid intake, Urinary tract infection, site not specified(History of), Pressure-induced deep tissue damage of right heel, Nutritional deficiency, unspecified-APPETITE STIMULENT, Streptococcus, group A, as the cause of diseases classified elsewhere, Edema, unspecified, Fever, unspecified(Prelim.), Pain, unspecified(Prelim.), Edema, unspecified(Prelim.), Cough(Prelim.), Frequency of micturition(Prelim.), Hypokalemia(Prelim.), Other specified mental disorders due to known physiological condition(Prelim.), Major depressive disorder, recurrent, unspecified(Prelim.), Parkinson's disease(Prelim.), Essential (primary) hypertension(Prelim.), Functional dyspepsia(Prelim.), Constipation, unspecified(Prelim.), Hypokalemia, Frequency of micturition Review of the electronic MDS tab for Resident #26 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #10's face sheet dated 10/10/2023 reflected a [AGE] year-old male. He was admitted to the facility on [DATE] his diagnoses included: Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety(Primary), Encephalopathy, unspecified, Acute kidney failure, unspecified, Hypo-osmolality and hyponatremia, Rash and other nonspecific skin eruption(Prelim.), Raynaud's syndrome without gangrene, Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral(History of), Anorexia, Obsessive-compulsive disorder, unspecified, Dry eye syndrome of bilateral lacrimal glands, Candidiasis, unspecified, Bipolar disorder, unspecified, Acute gastric ulcer without hemorrhage or perforation(History of), Unspecified osteoarthritis, unspecified site, Contracture of muscle, unspecified site(Prelim.), Other muscle spasm(Prelim.), Functional dyspepsia(Prelim.), Constipation, unspecified(Prelim.), Primary biliary cirrhosis(Prelim.), Major depressive disorder, recurrent, unspecified(Prelim.), Anxiety disorder, unspecified(Prelim.), Insomnia, unspecified(Prelim.), Hypothyroidism, unspecified, Hypo-osmolality and hyponatremia(Prelim.), Essential (primary) hypertension(Prelim.), Gastro-esophageal reflux disease without esophagitis(Prelim.), Cough(Prelim.), Fever, unspecified(Prelim.), Pain Review of the electronic MDS tab for Resident #10 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. (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 10/11/2023 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 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of Resident #2's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE] Her diagnoses included: Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety(Primary), Acute respiratory failure with hypoxia(Admission), Zoster with other complications, E55.9 Vitamin D deficiency, unspecified, Hypertensive heart disease with heart failure, Other forms of acute ischemic heart disease, Chronic obstructive pulmonary disease, unspecified, Pneumonitis due to inhalation of food and vomit, Fibromyalgia, Hypocalcemia, Insomnia, unspecified, Cutaneous abscess of right upper limb-Shoulder(History of), Heart failure, unspecified, Other malaise, K59.00 Constipation, unspecified, Allergy, unspecified, initial encounter(Prelim.), Nausea with vomiting, unspecified, Rash and other nonspecific skin eruption, Other specified disorders of nose and nasal sinuses, Mononeuropathy, unspecified, Unspecified lack of coordination, Unspecified osteoarthritis, unspecified site, Pain in unspecified shoulder, Muscle wasting and atrophy, not elsewhere classified, unspecified site, Pain, unspecified, Anemia, unspecified, Iron deficiency anemia, unspecified, Age-related osteoporosis without current pathological fracture, Shortness of breath, Edema, unspecified, Hypothyroidism, unspecified, Hyperlipidemia, unspecified, Anxiety disorder, unspecified, Essential (primary) hypertension, Mononeuropathy, unspecified, Pruritus [NAME], Traumatic arthropathy, unspecified shoulder, Fever, unspecified Review of the electronic MDS tab for Resident #2 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident 19 #s face sheet dated 10/10/2023 reflected a [AGE] year-old male. He was admitted to the facility on [DATE] his diagnoses included: Bipolar II disorder(Primary), Local infection of the skin and subcutaneous tissue, unspecified, Secondary hypertension, unspecified, Acute pharyngitis, unspecified, R09.82 Postnasal drip, Pityriasis versicolor, Otalgia, unspecified ear, Wheezing, Insomnia, unspecified, Candidiasis, unspecified, Abrasion of right wrist, initial encounter, Obstructive and reflux uropathy, unspecified, Calculus of kidney with calculus of ureter, Calculus of kidney(Prelim.), Constipation, unspecified, I10 Essential (primary) hypertension, Metabolic encephalopathy, Hypothyroidism, unspecified, Type 2 diabetes mellitus with diabetic neuropathy, unspecified, Type 2 diabetes mellitus without complications, Hyperlipidemia, unspecified, Idiopathic gout, unspecified site, Urinary tract infection, site not specified, Benign prostatic hyperplasia without lower urinary tract symptoms, Acute kidney failure, unspecified Review of the electronic MDS tab for Resident #19 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #22's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE]. Her diagnoses included: Cerebral infarction, unspecified(Primary), Insomnia, unspecified, Other specified soft tissue disorders, Unspecified systolic (congestive) heart failure, Other constipation, Acute candidiasis of vulva and vagina, Muscle weakness (generalized), Acute kidney failure with tubular necrosis, Diarrhea, unspecified, Unsteadiness on feet, Other abnormalities of gait and mobility, Other lack of coordination, Unspecified lack of coordination, Cognitive communication deficit, Pain, unspecified, Depression, unspecified, Encephalopathy, unspecified, Essential (primary) hypertension, Unspecified atrial fibrillation, Gastro-esophageal reflux disease without esophagitis, Paralytic ileus, Unspecified protein-calorie malnutrition, E Hyperlipidemia, unspecified, Hypokalemia Review of the electronic MDS tab for Resident #22 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. (continued on next page) 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 10/11/2023 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 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of Resident #51's face sheet dated 10/10/2023 reflected a [AGE] year-old male. He was admitted to the facility on [DATE]. His diagnoses included: Alzheimer's disease, unspecified(Primary), Repeated falls, Chronic kidney disease, unspecified, Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, Unspecified acute conjunctivitis, unspecified eye, Disturbances of salivary secretion, Constipation, unspecified, Insomnia, unspecified, Pain, unspecified, Other long term (current) drug therapy, Cough, unspecified, Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance, Diarrhea, unspecified, Rash and other nonspecific skin eruption. Review of the electronic MDS tab for Resident #51 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #33's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE]. Her diagnoses included: Malignant neoplasm of upper-inner quadrant of left female breast(Primary), Nausea, Restlessness and agitation, Generalized anxiety disorder, Acute pharyngitis, unspecified, Pain, unspecified, Constipation, unspecified, Tremor, unspecified, Allergic rhinitis, unspecified, Gastro-esophageal reflux disease without esophagitis, Idiopathic gout, unspecified site, Muscle weakness (generalized), Primary insomnia, Other idiopathic peripheral autonomic neuropathy, Chronic diastolic (congestive) heart failure, Hyperlipidemia, unspecified, Hypokalemia, Schizophrenia, unspecified, Other recurrent depressive disorders, Adult failure to thrive, Unspecified fall, sequela, Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization, Fever presenting with conditions classified elsewhere, Hypoxemia, Acute kidney failure with tubular necrosis. Review of the electronic MDS tab for Resident #33 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #37's face sheet dated 10/10/2023 reflected a [AGE] year-old male. He was admitted to the facility on [DATE]. His diagnoses included: Urinary tract infection, site not specified(Primary), Other malaise, Pneumonia, unspecified organism, Parkinson's disease, Anxiety disorder due to known physiological condition, Pain, unspecified, Generalized anxiety disorder(History of), Dry eye syndrome of bilateral lacrimal glands, Excoriation (skin-picking) disorder, Candidiasis, unspecified, Pressure ulcer of left buttock, stage 2, Candidiasis of skin and nail, Allergic rhinitis, unspecified, Other obstructive and reflux uropathy, Heartburn, Orthostatic hypotension, Hypothyroidism, unspecified, Essential (primary) hypertension, Insomnia, unspecified, Constipation, unspecified, Gout, unspecified, Dysphagia, unspecified, Pain, unspecified, Benign prostatic hyperplasia with lower urinary tract symptoms(History of), Benign prostatic hyperplasia with lower urinary tract symptoms, Cough, Nausea with vomiting, unspecified, Unilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent, Syncope and collapse. Review of the electronic MDS tab for Resident #37 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #44's face sheet dated 10/10/2023 reflected a [AGE] year-old male. He was admitted to the facility on [DATE]. His diagnoses included: Unspecified diastolic (congestive) heart failure(Primary), Wheezing, Pleural effusion, not elsewhere classified(Prelim.), Displaced fracture of olecranon process without intraarticular extension of left ulna, initial encounter for closed fracture, Constipation, unspecified, obstructive pulmonary disease, unspecified, Personal history of COVID-19-Recovered 1/29/22., Edema, unspecified(Prelim.), Other asthma, Unilateral inguinal hernia, (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 10/11/2023 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 0640 Level of Harm - Minimal harm or potential for actual harm without obstruction or gangrene, not specified as recurrent-Left, Unspecified severe protein-calorie malnutrition, Hyperlipidemia, unspecified, Hypo-osmolality and hyponatremia, Unspecified cataract-Bilateral, Essential (primary) hypertension, Paroxysmal atrial fibrillation, Pain in unspecified hip, Benign prostatic hyperplasia without lower urinary tract symptoms, Cardiac murmur, unspecified(History of), Long term (current) use of anticoagulants, Dysphagia, unspecified. Residents Affected - Some Review of the electronic MDS tab for Resident #44 revealed the MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #21's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE]. Her diagnoses included: Acute on chronic diastolic (congestive) heart failure(Primary, Admission), Rash and other nonspecific skin eruption, MELAS syndrome, Overactive bladder, Urinary tract infection, site not specified(History of), Primary osteoarthritis, right shoulder, Personal history of COVID-19, Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, Cognitive communication deficit, Pulmonary hypertension, unspecified, Pneumonia, unspecified organism, Gastro-esophageal reflux disease without esophagitis, Constipation, unspecified, Unspecified hemorrhoids, Fibromyalgia, Elevated blood-pressure reading, without diagnosis of hypertension, Other recurrent depressive disorders, Anxiety disorder, unspecified, Restless legs syndrome, Other idiopathic peripheral autonomic neuropathy, Unspecified atrial fibrillation, Anemia, unspecified, Hypothyroidism, unspecified, Type 2 diabetes mellitus with diabetic neuropathy, unspecified, Type 2 diabetes mellitus without complications, Vitamin deficiency, unspecified, Nutritional deficiency, unspecified, Pain, unspecified, Unspecified fracture of right patella, initial encounter for closed fracture, Long term (current) use of anticoagulants. Review of the electronic MDS tab for Resident #21 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #49's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE]. Her diagnoses included: Unspecified dementia, mild, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety(Primary), Other toxic encephalopathy(Admission), Vitamin D deficiency, unspecified, Other insomnia, Pruritus, unspecified, Iron deficiency anemia, unspecified, Other specified arthritis, unspecified site, Chronic kidney disease, stage 4 (severe), Urinary tract infection, site not specified, Multiple fractures of ribs, right side, sequela, Other hyperlipidemia, Depression, unspecified, Other hereditary and idiopathic neuropathies, Essential (primary) hypertension, Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety Review of the electronic MDS tab for Resident #49 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. A review of Resident #32's face sheet dated 10/10/2023 reflected a [AGE] year-old female. She was admitted to the facility on [DATE]. Her diagnoses included: Other sequelae of cerebral infarction(Primary), Xerosis cutis, Pressure ulcer of unspecified buttock, stage 1, Sjogren syndrome, unspecified, Plantar fascial fibromatosis, Age-related osteoporosis without current pathological fracture, Acute kidney failure, unspecified, Acute cystitis without hematuria(History of), Mixed incontinence, Full incontinence of feces, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits, History of falling, Low back pain, unspecified, Sepsis, unspecified organism(History of), Candidiasis of skin and nail, Anemia, unspecified, Vitamin D deficiency, (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 10/11/2023 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 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some unspecified, Mixed hyperlipidemia, Nicotine dependence, unspecified, uncomplicated, Generalized anxiety disorder, Other chronic pain, Other allergic rhinitis, Gastro-esophageal reflux disease without esophagitis, Other constipation. Review of the electronic MDS tab for Resident #32 revealed the quarterly MDS dated [DATE]. The quarterly MDS status reflected incomplete, assessment was never electronically transmitted to CMS. During an interview with the ADM on 10/10/2023 at 3:15pm she said she was not aware of 14 residents (Resident #'s 1, 34, 26, 10, 2, 19, 22, 51, 33, 37, 44, 21, 49, and 32) Quarterly MDS had not been completed and transmitted, she said they do not have a MDS coordinator and that the corporate MDS was currently responsible to complete and transmit the MDS, she said she is only one person and comes once a week. The failure to submit or complete MDS assessment records leads to inaccurate MDS 3.0 Quality Measures (QMs) data, potentially affecting the resident, the facility's payment and facility liabilities. have a major impact on the clinical assessment process, state survey outcomes, quality measures reporting, and reimbursement. During an interview with the DON/ADON on10/10/23 at 03:31 PM both said the facility did not have a full time MDS Coordinator, the ADON said she would review but has not submitted any MDS. During an interview with administrator on 10/11/2023 at 11:00am she said that the facility does not have an policy for MDS that they follow the RAI guidelines. Review of RAI guidelines dated: October 2017 reflected: §483.20(f) Automated data processing requirement§483.20(f)(1) Encoding data. Within 7 days after a facility completes a resident's assessment, a facility must encode the following information for each resident in the facility: (i) admission assessment. (ii) Annual assessment updates. (iii) Significant change in status assessments. (iv) Quarterly review assessments. (v) A subset of items upon a resident's transfer, reentry, discharge, and death. (vi) Background (face-sheet) information, if there is no admission assessment. §483.20(f)(2) Transmitting data. Within 7 days after a facility completes a resident's assessment, a facility must be capable of transmitting to the CMS System information for each resident contained in the MDS in a format that conforms to standard record layouts and data dictionaries, and that passes standardized edits defined by CMS and the State. §483.20(f)(3) Transmittal requirements. Within 14 days after a facility completes a resident's assessment, a facility must electronically transmit encoded, accurate, and complete MDS data to the CMS System, including the following: (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 10/11/2023 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 0640 (i)admission assessment. Level of Harm - Minimal harm or potential for actual harm (ii) Annual assessment. (iii) Significant change in status assessment. Residents Affected - Some (iv) Significant correction of prior full assessment. (v) Significant correction of prior quarterly assessment. (vi) Quarterly review. (vii) A subset of items upon a resident's transfer, reentry, discharge, and death. (viii) Background (face-sheet) information, for an initial transmission of MDS data on resident that does not have an admission assessment. §483.20(f)(4) Data format. The facility must transmit data in the format specified by CMS or, for a State which has an alternate RAI approved by CMS, in the format specified by the State and approved by CMS. 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 10/11/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure individuals with mental health disorders were provided an accurate Preadmission Screening and Resident Review (PASRR) Screening for 2 of 5 residents reviewed for PASRR (Resident's #15 and #20) The facility failed to ensure Resident #15 and Resident #20 had accurate PASRR Level 1 Screenings indicating diagnoses of mental illness. This failure could place residents at risk of not receiving needed assessments (PASRR Evaluation), individualized care, and specialized services to meet their needs. Findings included: 1. Record review of a face sheet dated 10/11/2023 indicated Resident #15 was an [AGE] year-old male who admitted to the facility on [DATE] with diagnoses including mood disorder with depressive features, major depressive disorder, anxiety, and PTSD (post-traumatic stress disorder). Record review of the Comprehensive (admission) MDS assessment dated [DATE] indicated, Resident #15 had a BIMS score of 5, indicating severely impaired cognition. The MDS section, Preadmission Screening and Resident Review, indicated Resident #15 did not have a serious mental illness. The MDS section, Psychiatric/Mood Disorder, indicated Resident #15 had diagnoses of anxiety, depression, PTSD, and mood disorder with depressive features. Record review of the care plan with a date initiated on 03/30/2023 indicated Resident #15 was at risk for adverse consequences related to receiving antidepressant medication for treatment of depression, anxiety, and PTSD. The care plan included interventions to monitor for adverse conditions and side effects related to use of psychotropic medications. Record review of the MAR dated 03/01/2023 - 03/31/2023 indicated Resident #15 had orders for and received the psychotropic medications of Celexa to treat major depressive disorder and Depakote to treat mood disorder on admission. Record review of Resident 15's PASRR Level 1 Screening completed on 03/29/2023 indicated in section C0100 no evidence of this individual having mental illness. 2. Record review of a face sheet dated 10/11/2023 indicated Resident #20 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses including anxiety, delusional disorder, major depressive disorder, mood disorder, and Alzheimer's disease. Record review of the Comprehensive (admission) MDS assessment dated [DATE] indicated, Resident #20 had a BIMS score of 00, indicating severely impaired cognition. The MDS section, Preadmission Screening and Resident Review, indicated Resident #20 did not have a serious mental illness. The MDS section, Psychiatric/Mood Disorder, indicated Resident #20 to have diagnoses of anxiety, depression, and mood disorder. Record review of the care plan with a date initiated on 05/03/2023 indicated Resident #20 was at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete 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 10/11/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some risk for drug related complications related to medications to treat diagnoses of anxiety, depression, mood disorder, and delusional disorder and psychotic disorder. The care plan included interventions to monitor for signs of complications or adverse side effects related to use of psychotropic medications. Record review of the Comprehensive (admission) MDS assessment dated [DATE] indicated Resident #20 had been receiving Seroquel, an antipsychotic used to treat mental illness disorders. Record review of Resident 20's PASRR Level 1 Screening completed on 04/25/2023 indicated in section C0100 no evidence of this individual having mental illness. During an interview with the DON and ADON on 10/10/2023 at 9:45 AM, the DON said the MDS Coordinator was responsible for PASRR functions, but the facility was currently without an MDS Coordinator. The ADON said she was responsible for PASRR in the interim. The ADON said she did not check Resident #15's nor Resident #20's PASRR to ensure accuracy of the PASRR Level 1 Screening. She said the LA (Local Authority) should have been called regarding the incorrect PASRR. She said it was important for the PASRR Level 1 Screening to be accurate because the facility needed to make sure the residents were getting the correct resources. 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 10/11/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident received appropriate treatment and services to prevent urinary tract infections for 1 (Resident #37) of 2 residents reviewed for indwelling urinary catheters. The facility failed to ensure Resident #37's urinary (foley) catheter drainage collection bag was positioned to prevent contact with the floor. The facility failed to ensure Resident #37's catheter was anchored to the resident's thigh to prevent complications. This failure could place residents with urinary catheters at risk for damage to the bladder or urethra, dislodging of the catheter, and urinary tract infections. Findings include: Review of Resident #37's face sheet dated10/11/2023 indicated Resident #37 was a [AGE] year-old male who was admitted to the facility 004/06/2023 with diagnoses including Parkinson's disease, urinary tract infection, obstructive uropathy(a disorder of the urinary tract that occurs due to obstructed urine flow and can cause permanent damage to the kidney), reflux uropathy (a condition that allows urine to go back up into the tubes draining urine from the kidneys and the kidneys), and benign prostatic hyperplasia (enlargement of the prostate that can cause urinary tract infections, kidney stones, or damage to the kidneys). Review of an MDS assessment dated [DATE] indicated Resident #37 had a BIMS score of 5 (severely impaired cognition) and was dependent on staff for activities of daily living including incontinent care, bed mobility, bathing, and dressing. Resident was also noted to be receiving hospice services. Review of Resident #37's physician orders dated 10/01/2023-10/31/2023 indicated an order dated 06/13/2023 that read, Foley Catheter care Daily, Ensure Stat-Lock (a catheter stabilization device that adheres to the skin) is in place. Review of a care plan dated 06/01/2023 indicated Resident #37 had a history of urinary tract infections and had an indwelling urinary catheter. The care plan indicated a goal of minimizing Resident #37's risk for urinary tract infection and included interventions to secure Resident #37's catheter with Velcro tube holder and provide catheter care every shift. Observation of Resident #37 on 10/09/23 at 10:16 AM noted him to have urinary catheter tubing draining amber colored urine into a urine collection bag that was hanging from the bedframe. The bottom of the bag was touching the floor. Resident was asleep. Observation of Resident #37 on 10/09/23 at 3:12 PM noted the catheter collection bag to be lying completely on the floor (not suspended from bed frame). Resident #37 was lying in bed with the head of the bed slightly elevated. Resident was asleep and had some of the bed linen in his hand and pulled slightly over his leg, exposing the urinary catheter. The catheter was draped over his right leg but was not anchored/secured to the thigh. (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 10/11/2023 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 0690 Level of Harm - Minimal harm or potential for actual harm Observation of Resident #37 on 10/10/2023 at 07:45 AM noted the urine collection bag to be hanging from the bed frame with bottom of bag touching the floor. Observation of Resident # 37 on 10/10/23 12:22 PM noted the urine collection bag containing amber colored urine to be lying directly on the floor (not suspended from bed frame). Residents Affected - Few . During observation and interview on 10/10/2023 at 02:40 PM, Nurse Aide G was asked to move bed covers to expose the urinary catheter. The catheter was noted to be draped over Resident #37's right leg and connected to the tubing which was draining amber colored urine into the collection bag. The catheter was not anchored/secured to the thigh nor abdomen. Nurse Aide G said she would tell the nurse if the resident had swelling in the genital area, blood in the urine, or if the catheter was leaking. She said the catheter bag was supposed to be suspended from the bed frame, so it is below the bladder. CNA G did not mention telling the nurse that Resident #37's urinary catheter was not secured to the thigh. During an interview with Nurse D on 10/10/2023 at 04:00 PM, she said the nurses are responsible for monitoring urinary catheters. She said the catheters should be checked at least every shift. She said the nurses should be assessing urine output, checking to ensure there are no kinks in the tubing, and ensure the catheters are secured to the leg. Nurse D said she had checked Resident #37's catheter when she made rounds. She said she did not know if Resident #37's catheter was secured to the thigh or not. During an interview with the DON on 10/10/2023 at 04:10 PM, she said she expected the nurses to check residents with urinary catheters every shift to assess urine characteristics, ensure proper positioning of catheter tubing and collection bag, and ensure the catheter is secured to the leg. She said the facility had Velcro leg straps and Stat-Locks. She said anchoring the urinary catheter prevents complications resulting from tension or pressure on the bladder and urethra. Review of the facility's policy dated March 2019 and titled, Catheter-Urinary Care and Maintenance: Indwelling Catheter reflected: 17. Assure catheter is properly secured. Daily Indwelling Catheter Care 33. Check that the catheter is attached to the thigh or abdomen (male), or as ordered' 34. Check drainage bag and tubing for proper placement. Privacy/Dignity: Infection Prevention 40. Coil and place the tubing and drainage bag inside the catheter cover. Ensure that the tubing is not kinked, and drainage bag and tubing are free of tension. 41. Secure the covered drainage bag off the floor on designated area of the bed and/or chair. (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 10/11/2023 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 0690 42. Monitor proper placement of the catheter cover, drainage bag and tubing every shift. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455910 If continuation sheet Page 12 of 12