Health inspection·March 9, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In observation and interview with Resident #175 on 03/08/2023 at 11:23am revealed resident in wheelchair with her oxygen concentrator turned off. Resident did not have a nasal cannula in her nares. She did not appear to be in any distress upon observation and denied any distress upon interview. In observation and interview with RN A on 03/08/2023 at 1:06pm revealed RN A stated that Resident #175 was on oxygen yesterday but did not need oxygen today. RN A was observed referencing the electronic medical record and stated that Resident #175 did not currently have any physician orders for oxygen at this time. She stated she was not certain who applied oxygen to Resident #175 yesterday and that the resident was not capable of doing it herself. RN A stated it was required for residents on oxygen to have a physician order for safety purposes and that she would call the physician next to obtain an order. In interview with the MDS Coordinator on 03/09/2023 at 10:33am, she stated that it was a shared responsibility to ensure care plans were updated and accurate to reflect the resident's care needs and requirements. She stated it was a team effort, as the DON was responsible for completing the initial or admission care plan and she was responsible to updating resident care plans. She stated the physician orders were what triggered her to update resident care plans and unless a physician order was obtained, it would not initiate her to re-evaluate or update resident care plans. She stated if resident care plans were not updated to reflect resident care needs and requirements, the facility cannot ensure that the best care was provided. In interview with the DON on 03/09/2023 at 9:57am she stated oxygen therapy would not necessarily need to be included in Resident #175's care plan, but it would be best if it was on there. She stated that care plans were important as they guide the facility on the care needs and requirements of the resident. She stated it was the MDS nurse's responsibility to ensure updates were completed to resident care plans. Record review of facility policy, Comprehensive Person-Centered Care Planning, rev. Jan. 2022, revealed Policy It is the policy of this facility that the interdisciplinary team shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 2 of 8 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 675004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McKinney Healthcare and Rehabilitation Center 253 Enterprise Dr McKinney, TX 75069 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that a resident who needs respiratory care was provided with such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 2 of 2 residents (Resident #54 and Resident #175) reviewed for respiratory care. Residents Affected - Few 1.The facility failed to ensure Resident #54 and Resident #175 had oxygen concentrator filters free of sediment and debris. 2.The facility failed to ensure Resident #175 had physician orders for her oxygen therapy. These failures could place residents at risk of not receiving proper delivery of oxygen, cross contamination, respiratory compromise and/or infection and residents not having their respiratory needs met. Findings Included: Review of Resident #54's Face Sheet, dated 03/08/23, revealed she was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses (process of identifying a disease, condition or injury) included acute respiratory failure with hypoxia, type 2 diabetes, chronic obstructive pulmonary (lung) disease, major depressive disorder, heart failure, and atrial fibrillation (cardiac dysfunction). Review of Resident #54's admission MDS, dated [DATE] stated she was cognitively intact with a BIMS score of 15. She required limited assistance of one staff with bed mobility, extensive assistance of one staff with toileting, and was independent with personal hygiene. Record review of Resident #54's physician orders revealed: Change 02 tubing & humidifier bottle every night shift every Sunday with a start date of 02/05/2023. Document Temp/O2 sats and monitor for . cough, new shortness of breath or difficulty breathing . every shift . with a start date of 01/06/2023. O2 at 3 L/min continuous per nasal cannula every shift related to chronic obstructive pulmonary disease . with a start date of 01/09/2023. Record review of Resident #54's Comprehensive Care Plan, dated 01/08/2023 revealed that Resident #54 has oxygen therapy r/t respiratory illness . interventions/tasks . oxygen settings: O2 nasal cannula @ 3 LPM continuously humidified. Review of Resident #175's Face Sheet, dated 03/08/23, revealed she was an [AGE] year-old female admitted on [DATE]. Relevant diagnoses included type 2 diabetes, digestive system diseases, chronic obstructive respiratory disease, generalized anxiety, dementia, heart failure. Review of Resident #175's Re-entry MDS, dated [DATE] stated she was moderately cognitively intact with a BIMS score of 12. She required extensive assistance of one staff for bed mobility, toilet use, and personal hygiene. Record review of Resident #175's physician orders revealed: Check & Record O2 Saturation . every shift . with a start date of 03/03/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 3 of 8 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 675004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McKinney Healthcare and Rehabilitation Center 253 Enterprise Dr McKinney, TX 75069 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Elevate HOB to promote lung expansion . every shift related to chronic obstructive pulmonary disease with (acute) exacerbation with a start date of 03/06/2023. No physician orders related to the administration of oxygen therapy were documented during review. Record review of Resident #175's Comprehensive Care Plan, dated 12/15/2022 revealed that Resident #175 had no documentation of oxygen therapy, nor any interventions, or goals related to oxygen therapy. In observation and interview of Resident #54 on 03/07/2023 at 12:09pm revealed resident sitting in her wheelchair with her oxygen concentrator turned on and the end of the nasal cannula positioned appropriately in her nares. Her oxygen concentrator had filter receptacles on the left and right side of the device. The filter on the left was missing entirely with a thin coat of dust, debris, and sediment present on the plastic where the filter should be located. The filter on the right was present and had a thick layer of dust, sediment, and debris present. Resident #54 stated she was not sure when the oxygen concentrator filter was cleaned, if at all. In observation of Resident #54 on 03/08/2023 at 11:24am revealed resident sitting in her wheelchair with her oxygen concentrator turned on and the distal end of the nasal cannula in her nares. The filter on the left was missing entirely with a thin coat of dust, debris, and sediment present on the plastic where the filter should be located. The filter on the right was present and had a thick layer of dust, sediment, and debris present. In observation and interview with RN A on 03/08/2023 at 11:29am revealed RN A observed Resident #54's oxygen concentrator filter as dirty. She stated she was not sure when it was cleaned last. She stated that if the oxygen concentrator filters are dirty, infection can be caused to the resident. In observation and interview with Resident #175 on 03/07/2023 at 11:53am revealed resident sitting in her wheelchair with her oxygen concentrator turned on and the end of the nasal cannula positioned appropriately in her nares. The filter located on the back of the machine had a thick layer of dust, sediment, and debris present. Resident #175 stated she was not sure when the oxygen concentrator filter was cleaned, if at all. She stated she sometimes needs oxygen upon physical exertion, as she gets short of breath. In observation and interview with Resident #175 on 03/08/2023 at 11:23am revealed resident in wheelchair with her oxygen concentrator turned off. Resident did not have a nasal cannula in her nares. She did not appear to be in any distress upon observation and denied any distress upon interview. The filter located on the back of the machine had a thick layer of dust, sediment, and debris present. In observation and interview with RN A on 03/08/2023 at 1:06pm revealed RN A stated Resident #175's oxygen concentrator filter was dirty. She stated that night shift [nurses] might be responsible for cleaning it [the filters] but she was not certain. She further stated that Resident #175 was on oxygen yesterday but did not need oxygen today. RN A was observed referencing the electronic medical record and stated that Resident #175 did not currently have any physician orders for oxygen at this time. She stated she was not certain who applied oxygen to Resident #175 yesterday and that the resident was not capable of doing it herself. RN A stated it was required for residents on oxygen to have a physician order for safety purposes and that she would call the physician next to obtain an order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 4 of 8 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 675004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McKinney Healthcare and Rehabilitation Center 253 Enterprise Dr McKinney, TX 75069 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In interview with the DON on 03/09/2023 at 9:57am she stated at her facility oxygen is a standing order and if she [Resident #175] needs it [oxygen] she can have it. She further stated that Resident #175 did not need oxygen and she was not sure how that happened. The DON stated that the potential outcome of Resident #175 receiving oxygen without a physician notification and order was not concerning, as oxygen does not hurt her [Resident #175.] She later stated that physician orders are required for resident care and interventions at her facility for safety reasons. She stated that her expectations were for resident oxygen concentrator filters to be present and clean as it was an infection control risk, and that residents can get sick from debris going into resident respiratory systems. She stated that it was the nurse's responsibility to ensure this was performed weekly and as needed. When asked Resident #175's care plan, she stated that oxygen therapy would not necessarily need to be included, but it would be best if it was on there. She stated that care plans were important as they guide the facility on the care needs and requirements of the resident. She stated it was the MDS nurse's responsibility to ensure updates were completed to resident care plans. Record review of facility policy, Comprehensive Person-Centered Care Planning, rev. Jan. 2022, revealed Policy It is the policy of this facility that the interdisciplinary team shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment. Record review of facility policy, Oxygen Concentrator filter, rev. 07/24/2021, revealed The facility shall implement and follow cleaning of the Oxygen concentrator filters as follows: 1. Nursing is responsible to clean the concentrators weekly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 5 of 8 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 675004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McKinney Healthcare and Rehabilitation Center 253 Enterprise Dr McKinney, TX 75069 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety for the facility's only kitchen reviewed for kitchen sanitation. The facility failed to ensure the Iced Tea Dispenser, located in the facility's only kitchen, had the cover placed on top after filing it with tea. This failure could place residents at risk for cross contamination and other air-borne illnesses. Findings include: Observation and interviews on 03/07/23 at 09:30 AM in the facility's only kitchen revealed an Iced Tea dispenser filled with tea, but it did not have a top on it and it was exposed. The Dietary Manager she stated her dietary aide made the tea. The Dietary Manager asked Dietary Aide A when the tea was made, and he advised her that the tea was made around 6:30 AM. The Dietary Manager and Dietary Aide A acknowledged the container was uncovered for over 3 hours. The Dietary Manager stated they had not served any tea to residents from this dispenser, and it will be thrown out. Interview with the Dietary Manager on 03/09/23 at 09:30 AM revealed she expected her staff to ensure the tea dispenser is covered once it had been filled. She stated Dietary Aide A was responsible for filling the Tea dispenser and he should have placed the top on it once it was filled. She stated the risk of not placing the cover on top of the tea dispenser was things could fall into the dispenser and residents could get sick. Interview with Dietary Aide A on 03/09/23 at 09:40 AM revealed he was responsible for filling the Tea dispenser the morning of 03/07/23 and he was advised by his Dietary Manager that he failed to place the cover on top of the dispenser. He stated he had just finished making coffee and the tea, and he just forgot to place the top back on the dispenser once he had filled it. He stated the risk of the dispenser not being covered could result in something falling in it and the residents could get sick. Interview with Administrator on 03/09/23 at 2:00 PM revealed he was made aware of the Iced Tea Dispenser not having a top placed on it, after just filling it with tea. He stated the expectation is for staff to ensure they are practicing sanitary conditions for residents throughout the facility and the risk to the residents would not be good. Record Review of FDA(Food and Drug Administration) Food Code Guide , dated 2017 revealed, When placed in cooling or cold holding EQUIPMENT, FOOD containers in which FOOD is being cooled shall be:Loosely covered, or uncovered if protected from overhead contamination as specified under Subparagraph 3-305.11(A)(2), during the cooling period to facilitate heat transfer from the surface of the FOOD. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 6 of 8 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 675004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McKinney Healthcare and Rehabilitation Center 253 Enterprise Dr McKinney, TX 75069 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview, and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 (Resident #51) of 5 residents observed for infection control. Residents Affected - Few The facility failed to ensure MA B sanitized blood pressure cuff between Resident #1 and Resident #51's care. This failure placed residents at risk of cross-contamination and infections. Findings included: Review of Resident #1's Face Sheet, dated 03/08/23, revealed he was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses (process of identifying a disease, condition or injury) included quadriplegia (paralysis of all four limbs), chronic kidney disease, pressure ulcer (injury that breaks down the skin and underlying tissue) of the sacral (the triangular bone in the lower back formed from fused vertebrae and situated between the two hipbones of the pelvis) region, bladder and bowel dysfunction with a urinary catheter and colostomy. Review of Resident #1's admission MDS, dated [DATE] reflected he was cognitively intact with a BIMS score of 13. He required extensive assistance of two staff for bed mobility, and limited assistance of one staff for toilet use and personal hygiene. Record review of Resident #1's Comprehensive Care Plan, dated 02/11/2023 revealed that he had an ADL self care performance deficit related to pressure ulcer, colostomy status, foley catheter and neuromuscular dysfunction. Review of Resident #51's Face Sheet, dated 03/08/23, revealed he was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included closed fracture, type 2 diabetes, respiratory (lung) failure, and COVID-19. Review of Resident #51's admission MDS, dated [DATE] reflected he was cognitively intact with a BIMS score of 13. He required extensive assistance of two staff for bed mobility and toilet use, and extensive assistance of two staff for personal hygiene. Record review of Resident #51's physician orders revealed: Isolation Precautions: droplet . every shift for 10 days, with a start date of 03/02/2023. Room Placement: Single Room Isolation (all services be brought to the resident .) every shift for 10 days, with a start date of 03/02/2023. Record review of Resident #51's Comprehensive Care Plan, dated 01/08/2023 revealed that he was at risk for psychosocial well-being related to the pandemic and Resident rested positive for COVID-19 on 3/2/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 7 of 8 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 675004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/09/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE McKinney Healthcare and Rehabilitation Center 253 Enterprise Dr McKinney, TX 75069 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 0880 Level of Harm - Minimal harm or potential for actual harm In observation and interview with MA B on 03/07/2023 at 9:54am, she entered Resident #1's room and applied the blood pressure cuff to his left forearm. She obtained his blood pressure and placed the blood pressure machine on her medication cart afterwards. MA B then administered Resident #1's medications. MA B performed hand hygiene, then exited Resident #1's room. MA B then stated she planned to go to Resident #51's room next. Residents Affected - Few In observation of MA B on 03/07/2023 at 10:05am, she donned PPE and entered Resident #51's room and applied the same blood pressure cuff to his left forearm. She obtained his blood pressure. MA B then administered Resident #51's medications. MA B failed to sanitize the blood pressure cuff between Resident #1 and Resident #51 care. In interview with MA B on 03/07/2023 at 10:12am, MA B stated she did not need to sanitize the blood pressure cuff between Resident #1 and Resident #51's care because Resident #1 is not contagious. In interview with the DON on 03/09/2023 at 10:20am, she stated it was her expectations for facility staff to sanitize reusable equipment between resident use. She stated it was important for infection control, as it could be a source to spread infection. Record review of facility policy, Equipment, Cleaning, rev. 05/2007, Policy It is the policy of this facility to implement the follow procedures to ensure equipment is cleaned and cared for appropriately. Procedures: 1. Reusable resident items are cleaned and disinfected between residents . 4 . disinfectants will be utilized for non-critical items including . blood pressure cuffs/machines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675004 If continuation sheet Page 8 of 8