Health inspection·January 16, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #54's Quarterly MDS dated [DATE] revealed that Resident #78's BIMS score was 12 indicating Resident #54 had moderate impairment. Observation on 100 hall on 01/14/2025 at 09:30 am revealed that CNA A did not knock on Resident #54's door before entering. Residents Affected - Some Observation of lunch trays being passed on 100 hall on 01/14/2025 at 12:17 pm revealed that CNA A did not knock on Resident #34's door before entering. Observation on 100 hall on 01/15/2025 at 09:04 am revealed that the BOM walked into Resident #40's room without knocking. An interview with Resident #54 on 01/14/2025 at 10:23 am revealed that staff did not always knock on the door when going into his room. He stated that the staff should knock before they entered into the room. He said he did not get upset but he did want staff to knock. An interview with Resident #34 on 01/14/2025 at 12:40 pm revealed that staff do not always knock on her door. She said that when the door was closed the staff will just walk in and she had to tell them to knock before coming in. She said that staff just walked in, and did not say anything. She said she did not appreciate them walking in and not speaking. An interview with Resident #40 on 01/15/2025 at 9:06 am revealed that staff did not knock all the time. He said that he wanted staff to knock all the time. He also said that if his door was closed or half closed, and staff do not knock that is when it bothered him because he could be changing. An interview with CNA A on 01/16/2025 at 1:26 pm revealed that she had been trained on resident rights. She stated the policy for knocking was that all staff were to knock before entering the resident's room. She said that a resident may feel like his or her privacy was being invaded or may feel as if the facility was not their home. She said nurses were responsible for monitoring to ensure staff were knocking. She said it was monitored by observations and when the facility did skill checks. She said she did not realize she did not knock because she was probably in a rush to do something. An interview with the BOM on 01/16/2025 at 3:41 am revealed that she had been trained on resident rights. She said that staff were required to knock, try to wait for a response and if no response crack the door and greet the resident. She said staff should always knock except in an emergency. She said if staff do not knock residents may feel like their privacy is invaded. She said management was responsible for monitoring to ensure staff were Knocking on the residents door. She said that management monitors by watching staff on the halls. She said she did not remember knocking on the resident's door. Record Review of Resident Rights Dignity and Respect Policy dated 03/2024 revealed the staff shall display respect for Resident's when speaking with, caring for or talking about them, as constant affirmation of their individuality and dignity as human beings. Staff members shall knock before entering the Resident's room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 2 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide a safe, comfortable, and homelike environment for the 1 of 8 residents (Resident #29) reviewed for a safe and comfortable environment. The facility failed to report maintenance issues to the MAIN and make repairs to a broken door in Resident #29's bathroom. This failure could have placed the resident at risk of decreased resident's satisfaction with their environment and a lack of a homelike environment. Findings included: Record review of Resident #29's admission record, dated 01/16/2025, revealed a [AGE] year-old male, admitted on [DATE], with diagnoses including end stage renal disease (the kidneys are not filtering waste appropriately), major depressive disorder (persistent feelings of sadness and loss of interest), heart failure (the heart's inability to pump blood effectively to meet the needs of the body), monoplegia of lower limb following cerebral infarction (paralysis of one leg after having a stroke), irritable bowel syndrome with diarrhea (a syndrome that causes diarrhea, belly pain and frequent bowel movements), type 2 diabetes mellitus (the body's inability to regulate blood sugar levels), and chronic viral hepatitis C (a long lasting infection that causes inflammation of the liver). Record review of Resident #29's quarterly MDS assessment, dated 12/19/2024, revealed a BIMS score of 13 which indicated mild cognitive impairment. The resident was occasionally incontinent of bladder and continent of bowel. Record review of Resident #29's care plan revealed no care plans associated to physical environment surroundings. An observation on 01/14/2025 at 10:02 AM revealed the bathroom door for Resident #29 had more than 15 holes including one hole that was the width of half of the door and up to approximately 2 inches tall in some areas for the largest hole on the side of the door that faces the bathroom. The side of the door that faces the room had approximately 14 holes with one hole being about the side of a golf ball. No residents observed in the room. During an interview on 01/15/2025 at 1:30 PM with ADM, he revealed he had no knowledge of any holes in the bathroom door for Resident #29. During an interview and observation on 01/16/202 at 08:36 AM, Resident #29 stated the bathroom door had been like that a long time. Resident #29 stated he told someone about the holes a long time ago, before the renovation, but nothing had been done. He stated he was not sure when or who he talked to about the door. Observation of the bathroom door revealed holes remained in the door on both sides. During an interview on 01/16/2025 at 02:30 PM with HKS, she stated she was aware of the holes in Resident #29's bathroom door. She stated that she put in a work order in maintenance tracking system a long time ago although she could not recall when. She stated she was under the impression that they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 3 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were going to replace all the interior doors with the recent renovation. HKS stated if something was broken or not working then her staff were supposed to report the issue to her so that she could enter it into the maintenance tracking system. She stated she did not follow up on the work order. During an interview on 01/16/2025 at 03:13 PM with the ADM, he revealed an online database that showed no work orders (opened or closed) for Resident #29's bathroom door. During an interview on 01/16/2025 at 05:22 PM with the MAIN, he revealed he checked the online maintenance database daily and hourly when in the facility. He stated he carried around a walkie talkie for issues that may arise throughout the day. He stated the staff have notified him immediately for maintenance issues related to TVs, call lights, and water, everything else was put in the maintenance online tracking system. The MAIN stated if a resident had a request, then they have told the front desk employee in the past, and she has put it in the system. He stated he conducted a walk through the facility on Friday afternoons and Monday mornings to assess for any needs. He stated there was a new system in place to contact him on the weekends for emergent needs. The MAIN stated he was unaware of any issues for Resident #29's room, and he was last in that bathroom around early November. He stated that holes in the bathroom door could affect the dignity of the resident. During an interview on 01/16/2025 at 05:58 PM, the DON stated management staff was responsible for conducting daily rounds to look for trash, dirty dishes, oxygen tubing, and any other issues. She stated the rounds should include the bathrooms, and a hole in the door should have been addressed. She stated that a hole in the bathroom door could be a potential safety issue from sharp edges or it could affect the resident's quality of life. During an interview on 01/16/2025 at 06:18 PM, the ADM stated every day the managers should be rounding on their designated rooms to check for physical environment. He stated the bathroom was not part of the sheet that they were responsible for checking off, and he should have added bathrooms to it. He stated his expectation for staff if they saw something that was broken to put a work order in the maintenance tracking system if they were able to, if not then tell someone that was able to put in a work order. The ADM stated holes in the door or wall could impact each resident differently, but for the facility to be more homelike they wanted to fix any holes in the walls or doors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 4 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being for 3 of 5 (Residents #86, #87 and #13) residents reviewed for activities. Residents Affected - Some This facility failed to implement an ongoing resident centered activities program for Residents #86, #87 and #13 that incorporated these residents interests, hobbies and cultural preferences. This failure could put residents at risk for a decrease quality of life. Findings included: Review of the 01/15/2025 face sheet for Resident #86 reflected an [AGE] year-old female had an original admission date of 09/24/2024 with diagnoses of Major depressive disorder, difficulty in walking, other seasonal allergic rhinitis, Acquired deformities of toes, unsteadiness of feet, unspecified abnormalities of gait and mobility, adjustment disorder with mixed anxiety and depressed mood, other insomnia not due to a substance or known physiological condition, COVID-19, Vitamin D deficiency, unspecified dementia. Review of the annual MDS for Resident #86 dated 11/19/2024 reflected a BIMS score of 13, indicating that the resident is cognitively intact. Review of the care plan for Resident #86 dated 09/24/2024 reflected the following: Resident #86 experienced altered mood related to diagnosis of depression, ineffective coping skills, dementia with evidence of tearfulness. Goal: Resident #86 will remain free of signs and symptoms of depression, anxiety or sad mood by through review date. Interventions: Assist in developing/providing with a program of activities that is meaningful and of interest. Encourage and provide opportunities for exercise, physical activity. Antidepressant medication use related to depression. Interventions: Does not enjoy usual activities. Non-pharmacological interventions: take to activities. Review of face sheet for Resident #87 reflected an [AGE] year-old-male with an original admission date of 09/24/2024 with the following diagnoses: Hemiplegia and hemiparesis following cerebral infarction (a type of stroke that occurs when brain tissue dies due to reduced blood flow) affecting right dominant side, type 2 diabetes mellitus without complications, essential primary hypertension, hyperlipidemia (a condition where there are high levels of fats in the blood), cerebral infarction, difficulty walking, insomnia, type 2 diabetes mellitus with proliferative diabetic retinopathy (a chronic eye condition that occurs when diabetes damages the blood vessels in the retina) with macular edema (a condition that occurs when fluid builds up in the macula, the central part of the retina at the back of the eye), bilateral, lack of coordination, muscle weakness, anemia, unsteadiness on feet, abnormalities of gait and mobility. Review of Resident #87's admission MDS dated [DATE] reflected resident had a BIMS score of 15 indicating that his cognition was intact. Review of Resident #87's Comprehensive Care Plan dated 09/25/2024 reflected resident has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 5 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some acute/chronic pain related to history of CVA with right sided weakness. Goal: will not have an interruption in normal activities due to pain through the review date. Interventions: Report to nurse any change in usual activity attendance patterns or refusal to attend activities related to signs and symptoms or complains of pain or discomfort. Review of the face sheet dated 01/15/2025 for Resident #13 reflected a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of Type 2 diabetes mellitus, irritant contact dermatitis, primary osteoarthritis, right shoulder, shortness of breath, vitamin D deficiency, Irritant contact dermatitis due friction, disruption of wound, chronic atrial fibrillation (is a condition that causes the heart's upper chambers to beat irregularly and rapidly), localized edema, morbid (severe) obesity with alveolar hypoventilation, dry eye syndrome, muscle wasting and atrophy, unsteadiness on feet, major depressive disorder, cognitive communication deficit, Vitamin B 12 deficiency anemia, hyperkalemia (a condition in which there is too much potassium in the blood), lack of coordination, chronic pain, abnormalities of gait and mobility, major depressive disorder, Vitamin D deficiency, primary insomnia, muscle weakness. Review of the MDS for Resident #13 dated 01/03/2025 reflected a BIMS score of 15 indicating cognitive intact responses. Review of the care plan for Resident #13 with date initiated of 03/06/2021 and revised on 05/19/2021 reflected the following: I am independent in my leisure I can choose activities of interest I can structure my own time. I am at risk for reduction in activity level as evidence by personal loss and health issues Pain and fatigue limits OOR activities at times. Goal. Resident will participate in activities related to interest and health status to promote a daily feeling of well-being, improved mood and enhanced dignity; resident will participate in activities of important/intellectual daily. Interventions: Allow resident to assist with decorations and crafts like cutting material out for activities for residents, encourage participation in activities of choice, offer ongoing supplies for self-initiated activities such as books, writing materials, videos, tapes, music, etc. Review of another care plan for Resident #13 was initiated on 03/06/2021 and revised on 05/19/2021 reflected the following: Resident has an alteration in psychosocial wellbeing problem and patient reporting that she has little interest/pleasure in doing things. Interventions: Encourage participation in favorite activities. Review of progress notes for Resident #13 reflected on 01/10/2025 Patient seen using patient desktop computer in the dayroom, performing therapeutic activities for this visit. Review of the January 2025 Activity Calendar for the week of 01/12/2025 - 01/18/2025 reflected the following: Sunday 01/12/2025 No time indicated Devotional and Independent Leisure all day. Monday 01/13/2025 10:00 Seated Chair Exercises 10:15 Worship Music (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 6 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 11:00 Teatime Level of Harm - Minimal harm or potential for actual harm 7:00 Pizza Night & MNF Vikings Vs Rams Tuesday 01/14/2025 Residents Affected - Some 10:00 Bingo 01:00 300 Activity 02:00 Resident Council Wednesday 01/15/2025 09:30Church Singing 10:30 Rosary 1:00 300 Activity 02:00 p.m. [NAME] Music Thursday 01/16/2025 10:00 Bingo No time indicated: QAPI. 2:00 Popcorn & Movie Friday 01/17/2025 09:00 - 11:30 Walmart Outing 09:00 Volunteer Music 01:30 300 Activity 02:30 Loteria Saturday 01/18/2025 No time indicated: Leisure time. Activity Director Off Review of January Calendar 2025 revealed a note at the bottom of the page that read All activities subject to change. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 7 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 Level of Harm - Minimal harm or potential for actual harm Resident #86 was not observed in any activities on 01/14/2025. Observation of Resident #86 on 01/16/2025 at 11:25 AM walking with physical therapy in the hallway. On 01/16/2025 at 2:47 p.m. Observation of resident #86, sitting in dining room watching a movie during activity time set up by the facility for all residents. Residents Affected - Some Observation on 01/16/2025 at 2:47 p.m. revealed Resident #13, sitting in dining room watching a movie. During an interview on 01/14/2025 at 09:37 a.m., Resident #86 voiced there were no activities on Saturdays and Sundays. A resident has started to run bingo on Sunday's. Interview on 01/15/2025 at 10:13 a.m., Resident #13 verbalized there are no tables in the day room on a regular basis because they do not want anyone eating in the day room. But there are residents who like to color and need the tables. It is loud in the dining room and there are activities going on in there. Resident voiced she would like to color and watch tv in the day room with everyone voiced Resident 13. She added there is not a lot going on, on the weekends. There is not an assistant to do activities on the weekend anymore, but they are looking to hire someone. They have community groups come to visit on the weekend but that is about it. They have over the past year worked to get me out of the facility more. Due to my weight, I cannot just go anywhere because the van will not support my weight, but they have started taking me to [NAME] schnitzel down the road. Interview on 01/16/2025 at 08:35 a.m., Resident #86 answered the following: How important is it to you to have books, magazines, or newspapers to read? I used to read all the time, I loved to read, I used to read several books. I like to do scrap booking, which is one of my favorite. How important is it to you to listen to music that you like? Very much important, I am a Christian and I like to listen to Christian music. Sometimes, I like soft rock to listen to occasionally. How important is it to you to be around animals such as pets? Very important How important is it to you to keep up with the news? Sometimes I do not keep up with the news. How important is it to you to do things with groups of people? I like to be with other people. How important is it to you to do your favorite activities? I like scrapbooking and color the books and everything. I like the chicken soup book for the soul book. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 8 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 How important is it to you to go outside to get fresh air when the weather is good? Level of Harm - Minimal harm or potential for actual harm I like to go outside. How often do you go outside? Residents Affected - Some I have not been out lately because it is cold outside. How important is it to you to participate in religious services or practices? Very important. During an interview on 01/16/2025 at 08:47 a.m., Resident #87 answered the following: How important is it to you to have books, magazines, or newspapers to read? It is important but not super important but because my eyes are so great now . How important is it to you to listen to music that you like? Very important How important is it to you to be around animals such as pets? Important How important is it to you to keep up with the news? Somewhat because I used to watch it all the time, but it is all bad news. How important is it to you to do things with groups of people? Very important How important is it to you to do your favorite activities? Important How important is it to you to go outside to get fresh air when the weather is good? Important How important is it to you to participate in religious services or practices? Very important. One person comes in on Wed that speaks English; There is someone that comes in on Sundays to provide bilingual services, but they focus more on Spanish. Would prefer English too. On Monday, the activity director sings church songs for us in English. In an Interview on 01/16/2025 at 08:47 a.m., Resident #13 answered the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 9 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 How important is it to you to have books, magazines, or newspapers to read? Level of Harm - Minimal harm or potential for actual harm It is very important for it to be available yes. Is it available? Residents Affected - Some It is scattered but it is available. How important is it to you to listen to music that you like? Very imp to have the ability to do so, I am not a music person, but they do have musicians coming to do stuff and I have my tablet. It is availability and they do have several times a month someone comes in and they also have gospel singing on Mondays and Wednesday a gentleman comes in and every other wed a girl comes in and plays guitar for us. How important is it to you to be around animals such as pets? I would love to How important is it to you to keep up with the news? It is not that important to me. How important is it to you to do things with groups of people? Certain things I would like to do with them so, yes, it is important to me. How important is it to you to do your favorite activities? Very important How important is it to you to go outside to get fresh air when the weather is good? Very important How important is it to you to participate in religious services or practices? very important Do you feel like there is enough activities to do here? Most of the times there is but sometimes it is not happening. Interview on 01/15/2025 at 1:25 p.m. the Activities Director (AD ) verbalized when asked I noticed that your activity calendar for January indicates on Saturday and Sundays that residents have independent leisure how do you ensure that residents have things to do? Well because I do not work 7 days a week. We have groups that come out and sing and volunteers fluctuate depending on what they have going on. Managers are here on the weekends sometimes, the activities director voiced. When I am the manager on duty then I will have things planned for residents to do. Some of the things they do is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 10 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bingo. AD verbalized some of the residents have taken it upon themselves to take lead on the bingo games on the weekends. AD verbalized he leaves the bingo supplies out for them to get so they can take lead on the weekends. Interview on 01/16/2025 at 04:30 p.m., the DON stated if residents do not do activities on a regular basis, it could make them feel sad and emotionally depressed. That is if they choose to but sometimes a lot of people do not like to do activities. DON stated residents who are confined to their rooms are cannot come out to the common areas for activities have been offered hallway bingo by the activities director, music and games. In an interview on 01/16/2025 at 09:40 a.m., The Activities Director (AD) verbalized that he does offer tactile activities from time to time to blind and deaf resident. The Activity Director voiced since the building remodel one of the things that the facility wants to do is set up an area where residents can access books to read. He is unsure when that will be completed. AD voiced he does have box of books for residents, but they are locked in his office during the weekends. AD voiced he is trying to get an assistant to come in to assist him when he is not available and on the weekends. Observation on 01/16/2025 at 11:22 a.m., hall 300 (memory care unit) residents were doing activities in the common area. Deck of cards , one resident was observed looking through a coloring book. A blind resident was observed with a stuffed animal on the desk sitting in front of her within reach. In an interview on 01/16/2025 at 11:47 a.m., CNA I stated when asked what kind of activities are offered to residents? Bingo, sometimes they have hospice come out to do paintings and music. They have outings to Walmart or lunch like twice a month. It is done like every 2 weeks, one Thursday or Friday they will go to Lunch and the next time they will go to Walmart. CNA, I verbalized that some residents do activities in their rooms. They do blocks like for mind control to see if they can stack them, pegs are done with therapy and some color. CNA, I voiced residents do activities every day and most of them come out of their rooms to do activities. CNA I was not sure what kind of activities are offered are provided for residents who cannot come out of their rooms. CNA, I voiced that if residents do not do activities on a regular basis that could make them feel left out and or lonely. In an observation on 01/16/2025 at 11:53 a.m., residents were in the common area in front of nurses station watching TV and talking amongst each other. In an interview on 01/16/2025 at 12:00 p.m., CNA J stated residents do activities in their rooms sometimes. CNA J voiced they watch TV, read books, residents like talking to other people. CNA J voiced residents do activities a lot of the weekends. She added some choose to come out of their rooms on the weekends and some stay in their rooms. CNA J voiced for the residents who cannot get out of their beds staff always help them. Like if they want to get out of the bed. If they do not want to, we keep them in the bed. When CNA J was asked, if they want to stay in the bed what kind of activities do they do? She voiced they watch TV play ball with each other. Mostly like watching TV. Mostly lying in bed. Most people color in their rooms. CNA J voiced I feel like I see them happy when they do activities. But mostly they like talking. Observation on 01/16/2025 at 04:11 p.m., The Activities Director (AD) was walking down the hall passing out popcorn to residents who did not attend the 2:00 p.m. movie and popcorn activity event. In an interview on 01/16/2025 at 04:12 p.m., The Activities Director (AD) verbalized if residents don't get regular activities, they could isolate mentally, physically, or both, which could lead to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 11 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete anxiety or depression. AD stated that the residents can have decreased overall social wellness and might be more difficult to engage in activities they like. He adds the overall quality of life would decrease for sure unless that is what they want because sometimes not participating is their desire. Sometimes they want to stay in their room and that is okay because that is what they want. AD voiced, for instance, if someone is insisting they do not want to socialize or come out of their room, they can become more depressed, and activities can provide social wellness. Event ID: Facility ID: 455960 If continuation sheet Page 12 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to ensure the drug regimen review recommendations from the pharmacy consultant were filled out completely for 2 of 9 residents (Residents #56, and 66) reviewed for pharmacy services. 1. The facility did not follow up on the pharmacy consultant's recommendations for Resident # 56 dated 10/31/2024 and 12/30/2024. 2. The facility did not follow up on the pharmacy consultant's recommendations for Resident # 66 dated 05/30/2024 and 06/26/2024. These failures could put the residents at risk for medications errors, unnecessary medications, and incorrect administration. Findings include: Record review of Resident #56's admission record dated 01/16/2024 revealed a [AGE] year-old female, admitted on [DATE], admitted with diagnoses including Parkinson's disease (progressive disease of the nervous system that affects movement), hypertension (high blood pressure), anxiety disorder (the intense, excessive and persistent worry and fear about everyday situations), atrial fibrillation (an abnormal heart rhythm), delusional disorder (a mental health disorder that causes unshakable beliefs in something that's untrue), insomnia (a sleeping disorder that makes it hard to fall asleep or stay asleep), and dementia (a progressive group of symptoms that affect memory, thinking and social abilities). Record review of Resident #56's quarterly MDS assessment, dated 12/17/2024, revealed a BIMS score of 10 which indicated mild cognitive impairment. Section N-Medications revealed Resident #56 received antipsychotic, hypnotic, antiplatelet and anticonvulsant medications. Record review of Resident #56's order summary dated 01/16/2025 revealed orders for: 1. Pimavanserin tartrate (Nuplazid) 34mg Give 1 capsule by mouth one time a day related to delusional disorders. 2. Quetiapine fumarate (Seroquel) 100mg Give 1 tablet by mouth at bedtime related to psychotic disorder with delusions. 3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 13 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0756 Quetiapine fumarate (Seroquel) 25mg Give 1 tablet by mouth one time a day for psychosis. Level of Harm - Minimal harm or potential for actual harm 4. Residents Affected - Some Quetiapine fumarate (Seroquel) 25mg Give 1 tablet by mouth one time a day related to psychotic disorder with delusions. 5. Quetiapine fumarate (Seroquel) 50mg Give 1 tablet by mouth at bedtime related to psychotic disorder with delusions. 6. Zolpidem Tartrate (Ambien) 5mg Give 1 tablet by mouth at bedtime for insomnia. Record review of Resident #56's Consultant Pharmacist-Physician Communication dated 12/30/2024 revealed Federal guidelines state sedative hypnotic drugs should have an attempt at a gradual dose reduction (GDR) approximately every 6 months, when used routinely and beyond the manufacturer's recommendations for duration of use. This resident has been taking Ambien CR 6.25mg 1 PO QHS since 7/8/24 without a GDR in last 6 months. Could we attempt a dose reduction at this time to verify this resident is on the lowest possible dose? The box next to The drug, dose, duration and indications are clinically appropriate; further reductions are contraindicated due to: was marked and the form was signed off by NP on 1/14/2025 without further clarification. Record review of Resident #56's Consultant Pharmacist-Physician Communication dated 10/31/2024 revealed Patient has been taking 1. Ativan 0.5mg 1 PO Q8HR PRN anxiety since 10/24/24 2. Ativan conc 2mg/ml give 0.5mg PO Q8HR PRN since 10/24/24 PRN orders for psychotropic drugs are limited to 14 days (even in hospice patients). If the physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he/she must document rationale and indicate the duration for the PRN order. The box next to add a longer stop date and document a reason for need to continue past 14 days. Stop date or duration:____________ Rationale:[handwritten] 6 weeks was marked and the form was signed off by NP on 11/5/2024 without further clarification. Record review of Resident #66's admission record dated 01/16/2025 revealed a [AGE] year-old female admitted on [DATE] with diagnoses including major depressive disorder (persistent feelings of sadness and loss of interest), bipolar disorder (a mental condition that causes extreme mood swings), primary insomnia (a sleeping disorder that makes it hard to fall asleep or stay asleep), and generalized anxiety disorder (a condition that causes excessive, ongoing worry and interferes with daily life). Record review of Resident #66's quarterly MDS dated [DATE] revealed a BIMS score of 15 which indicated no cognitive impairment. Section N-Medications revealed Resident #66 received antianxiety, antidepressant, hypnotic, anticoagulant, diuretic, opioid, and hypoglycemic medications. Record review of Resident #66's order summary dated 01/17/2025 revealed orders for 1. Buspirone Hcl (Buspar) 15mg Give 1 tablet by mouth three times a day for anxiety. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 14 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0756 2. Level of Harm - Minimal harm or potential for actual harm Divalproex sodium (Depakote) DR 250mg Give 500mg by mouth three times a day related to bipolar disorder. Residents Affected - Some 3. Duloxetine Hcl (Cymbalta) DR Sprinkle 60mg Give 1 capsule by mouth one time a day for depression. 4. Zolpidem tartrate (Ambien) 5mg Give 1 tablet by mouth every 24 hours as needed for sleep related to primary insomnia. Record review of Resident #66's Consultant Pharmacist-Physician Communication dated 05/30/2024 revealed Federal guidelines state psychopharmacological drugs should have an attempt at a gradual dose reduction (GDR) twice per year for the first year in 2 different quarters with 1 month between attempts, then annually thereafter, when used to manage behavior, stabilize mood, or treat psych disorder. This resident has been taking Cymbalta 60 mg 1 PO daily since 11/13/23 without a GDR. Could we attempt a dose reduction at this time to verify this resident is on the lowest possible dose? If not, please indicate response below: The box next to Use is in accordance with relevant current standards of practice was marked and the form was signed off by NP, but no date or further clarification was noted. Record review of Resident #66's Consultant Pharmacist-Physician Communication dated 06/26/2024 revealed Federal guidelines state psychopharmacological drugs should have an attempt at a gradual dose reduction (GDR) twice per year for the first year in 2 different quarters with 1 month between attempts, then annually thereafter, when used to manage behavior, stabilize mood, or treat psych disorder. This resident has been taking Buspar 15 mg 1 PO TID since 7/28/23 without a GDR. Could we attempt a dose reduction at this time to verify this resident is on the lowest possible dose? If not, please indicate response below: The box next to Use is in accordance with relevant current standards of practice was marked, a notation of resident with increased anxiety, and the form was signed off by NP, but no date was noted. An interview on 01/16/2025 at 05:10 PM with the NP revealed she was responsible for completing the pharmacy consult recommendations. She stated the facility wanted the forms back quickly. The NP stated any residents who were prescribed medication for any psychiatric condition were referred to the psychiatric services to ensure all residents were dosed correctly. When asked about completing forms with a rationale she stated she had not filled out the rationale. She stated the rationale should have been in the notes from the psychologist. The NP stated there are no detrimental effects to taking antipsychotic and antidepressant medications long term for the residents. During an interview on 01/16/2025 at 05:58 PM with the DON, she stated she expected the providers to communicate with her about the GDR recommendations. She stated the rationale should have been documented in the psychologist notes and in the interdisciplinary meeting notes. The DON stated the providers worked together. She stated the NP was responsible for signing the pharmacy recommendations and the psychologist was responsible for documenting a rationale for the medication dosage. The DON stated the residents could become over sedated if GDR are not considered or they could be on medications that are no longer indicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 15 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0756 Level of Harm - Minimal harm or potential for actual harm During an interview on 01/16/2025 at 06:18 PM with the ADM, he stated he expected the pharmacy consults to be completed with a rationale by the provider in a timely manner. He stated he was sure there could be a potential effect, though, he was not sure what for not completing the pharmacy GDR consultation forms. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 16 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to provide pharmaceutical services to assure the accurate acquiring, receiving, dispensing, and administrating of all drugs and biologicals in accordance with currently accepted practices for 3 of 9 (hall 400 and 200 cart) medication carts and 1 of 2 medication rooms (overstock medication room) reviewed in that: The medication cart for the 400 hall and 200 halls had nine unidentified loose pills. The medication room had 39 expired Acetaminophen oral solution medications. These deficient practices could result in a drug diversion due to medications not being properly disposed of in the drug buster and secured. The findings were: Observation of medication cart for the 400-hall right side cart on 01/14/2025 at 03:38 PM revealed one round peach pill with O imprint: on one side and G on the other side, one white round pill with EPV 904 on one side and blank on the other side. One round white pill with L194 on one side and blank on the other side. LVN F was not able to identify the three loose pills. Observation of medication cart for the 400-hall left side cart on 01/14/2025 at 03:49 PM revealed one oblong purple and grey pill with Omeprazole 20mg: on one side and R644 on the other side, one peach round pill with L141 on one side and blank on the other side. One round white pill with no letters or numbers blank on both sides. One big white pill with AZ011 on one side and blank on the other side. One white oval pill with 379 imprinted on one side and 5G on the other side. LVN F was only able to identify the omeprazole pill but could not identify the other 4 pills. Observation of medication cart for the 300-hall cart on 01/14/2025 at 04:14 PM revealed one round white pill with ZD15 on one side and blank on the other side. LVN E could not identify the loose pill. Observation on 01/15/2025 at 08:23 AM revealed the facility Medication room with 39 Acetaminophen oral solution (325mg| 10.15 mL) with expiration dates of November 2024. Observation on 01/15/2025 at 08:46 AM, The Director of Nursing disposed of the expired medications in the drug buster (container used to dispose of medications) found in the medication room during the inspection. In an interview with LVN F on 01/14/2025 at 04:04 PM, she verbalized I don't know why there are loose pills if there are too many pill packets in the carts or if staff are dropping them when they are preparing them for administration. LVN F voiced that residents could not get to the loose pills in the carts. She added that if she ever would ever drop a pill, she would get another pill and go on. LVN F verbalized if staff slowed down that could prevent the loose pills issue from happening. LVN F voiced the Director of Nursing checks the carts for loose pills and expired medications weekly. She added that the individual nurse should be checking carts daily for loose pills and expired medications. If we see it, we fix it voiced LVN F. LVN F stated if she found a loose pill, she would put (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 17 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0761 them in the drug buster for destruction. Level of Harm - Minimal harm or potential for actual harm with LVN E on 01/14/2025 at 04:14 PM, she verbalized she noticed loose pills in the carts. LVN E voiced when she sees loose pills in the cart, she picks them up and put them in the drug buster for destruction. She verbalized that everyone is responsible for upkeeping and inspecting the carts daily. She added that the ADON goes through the carts monthly to check them too. LVN E verbalized residents cannot get the medications from the carts when asked if there could be a potential adverse effect of loose pills in the carts. Residents Affected - Some In an interview with LVN G on 01/14/2025 at 04:28 PM, she verbalized all the nurses upkeep with the medication carts and inspect them regularly. LVN G verbalized she has never noticed loose pills in the bottom of the medication carts. LVN G voiced that if she would ever find a loose pill, she would dispose of it in the drug buster disposal immediately. LVN G verbalized yes, something bad can happen if there are loose pills in the bottom of the cart, because as staff member could accidentally give it to another resident. She added because you really don't know what it is. LVN G voiced staff have not been in-serviced on loose medication in carts, but they have been told verbally to put them in the drug buster destroyer if they did find any loose pills. During an interview on 01/15/2025 at 10:30 AM, LVN H voiced all the nurses should be responsible of checking carts and all staff kept up with it now. LVN H voiced she has never noticed loose pills on the bottom of the cart. If staff find loose pills, they cannot use them; they are to dispose of them in the drug buster disposal. LVN H voiced that a lot of pills that look alike could be dangerous if found at the bottom of the cart and given to a resident and staff would have to monitor for any reactions and contact the doctor if that happened. During an interview on 01/16/2025 at 11:27 AM, RN K verbalized whoever was on shift should be checking the medication carts for loose pills and checking medications for expired dates. RN K added that when she comes on a shift, she makes sure that everything is in order and when she is giving medications, she makes sure to check medication expired dates, and she is hopeful other shifts are doing that too. RN K voiced that she thinks the medications may become loose in the carts because when staff are dispensing them into a medication cup, they are probably holding the blister pack over the cup, but hovered over the medication cart while open. If staff drop pills, they probably look for them but if they cannot find the pills, they just get another one. RN K voiced there could be an adverse effect if the loose pill were ever given to another resident because they would not know what the pills are, and the resident could have an allergic reaction to the pill. RN K voiced staff have been in-serviced on loose pills and expired medications, but she could not recall when the last time was. During an interview on 01/16/2025 at 11:33 AM, LVN L voiced nurses were responsible for expired medications. She stated they are placed in the medication room in the disposal vin and the DON disposes of them with pharmacy. LVN L verbalized she has noticed loose pills in the medication carts sometimes. LVN L voiced if she found loose pills, she would put on a glove and dispose of the pills in the drug buster disposal that is located inside the medication . LVN L voiced there might be loose pills in the carts because staff are not punching it right in the cup or they pull too much over. LVN L verbalized staff should pick the pill up and dispose of it, it is contaminated. They should not give it to another resident. This could make a resident's vital signs be all over the place, have an allergic reaction and or affect their mental status. LVN L stated staff have been in-serviced on expired meds but not on loose meds and she could not recall when the in-service was held. During an interview on 01/16/2025 at 04:30 PM, the DON stated everyone is responsible for upkeeping (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 18 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with the medication carts. This includes inspecting for loose pills and checking expired dates on medications. DON verbalized she does spot checks monthly. DON voiced she has found loose pills in the carts while doing spot check inspections in the past, and she has put them in the destruction disposal and has informed all staff to do the same and to let her know. DON verbalized that she cannot say for sure why the pills are loose in the medication carts, but sometimes the pills packs can open if you bump them around in the carts and they can come out of the packaging. DON added the loose pills could be caused by someone being careless and popping the medications out too fast and they fall out into the carts. DON voiced the adverse effects of expired medications could be that they would not be as effective if given to a resident and it could potentially cause harm to the resident depending on what kind of medication it is. DON voiced that she has provided an in-service for staff, and she reminds staff every day during huddle to inspect carts and inspect for loose pills in the carts. During an interview on 01/16/2025 at 06:21 PM, the ADM verbalized his expectations on medication storage for staff was that staff or storing it properly. ADM voiced that staff check for expired medications regularly. ADM added that staff inspect carts for discharged residents' medications to be disposed of, loose pills, and to make sure there is nothing in there that should not be in there. Record review of the Policy/Procedure - Nursing Clinical stated: Policy: It is the policy of this facility to store all drugs and biological in locked compartments under proper temperature controls. The medication supply is accessible only to licensed nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications: Procedures: #13. Stated: Outdated, contaminated, or deteriorated medications and those in containers that are cracked, soiled, or without secure closers are immediately removed from stock, disposed of according to procedures for medication destruction and reordered from pharmacy, if a current order exists. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 19 of 20 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 455960 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hays Nursing and Rehabilitation Center 1900 Medical Pkwy San Marcos, TX 78666 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interviews, and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for one of one kitchen reviewed for sanitation. The facility failed to ensure [NAME] B were practicing proper hand hygiene while preparing foods. This failure could place residents who were served from the kitchen at risk for consuming contaminated food, and/or developing foodborne illnesses. Observation of [NAME] B preparing puree foods on 01/15/2025 at 11:13 am revealed that he threw trash away without washing or sanitizing his hands before going back to prepare puree food . [NAME] B also did not wash his hands after wiping down the counter. An interview with [NAME] B on 01/16/2025 at 1:01 pm revealed that he had been trained on infection control and proper hand washing. He said that the policy for hand washing was staff were to wash their hands with soap and water for 30 seconds. He said that staff were to wash their hands before performing a task and after touching food or any object. He said if staff did not practice proper hand hygiene it could put the resident at risk of getting sick. He said he was nervous and thought that was why he did not wash his hands. An interview with the DS on 01/16/2025 at 1:13 pm revealed that she had been trained on infection control and proper hand hygiene. She said that staff were supposed to wash their hands after each task. She said everyone was responsible for washing their hands when changing tasks. She said if staff did not perform proper hand hygiene it could cause the food to become contaminated and make the residents sick. She said that she thought [NAME] B was nervous. She said she was responsible for monitoring to ensure that all staff are washing their hands. She said that she monitors the hand washing by reminding the staff and observation. An interview with the ADM on 01/16/2025 at 6:24 pm revealed that he had been trained on infection control and hand hygiene. He said that all staff were to wash their hands between tasks regardless of what department they were in. He said that in the kitchen they should wash their hands before and after touching anything. He said that if staff do not perform proper hand hygiene, people could die. He also said that someone could get sick if staff were not washing their hands. He said the DS was responsible for monitoring the kitchen staff hand washing. He said that the did not know why [NAME] B did not wash his hands after touching the trash can or the rag. Record Review of Sanitation and Infection Control: Hand Hygiene Policy dated April 2023 revealed employees were to wash their hands when entering the kitchen, during food preparation, after engaging in other activities that contaminate the hands such as handling trash. Review of 2022 Food Code states: 2-301.14 States: FOOD EMPLOYEES shall clean their hands and exposed portions of their arms as specified under § 2-301.12 immediately before engaging in FOOD preparation including working with exposed FOOD. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455960 If continuation sheet Page 20 of 20