Inspection·November 22, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Review of Resident #'18s Quarterly MDS dated [DATE] revealed a [AGE] year-old female with an admission date of 09/16/11. No BIMS as resident rarely/never understood. With severely impaired cognitive ability to make decisions. An active diagnosis list that included Alzheimer's disease, dementia, schizophrenia. During an observation on 11/21/22 at 9:14 AM, Resident #18 was crawling outside her room (room [ROOM NUMBER]) near the nurse's station. During an interview on 11/21/22 at 9:21 AM, LVN-G stated that Resident #18 had dementia. She stated that Resident #18 frequently crawled on the floor. She said Resident #18 was blind and was a former aerobics instructor. LVN-G said other residents on the unit would just walk or wheel around Resident #18. LVN-G said she had not noticed if Resident #18 ever picked at anything or picked things off the floor. During an observation on 11/22/22 at 9:00 AM, several splotches of white paint spots on floor near doorway below handrails of Resident #18's room. During an interview on 11/22/22 at 9:01 AM, CNA-I stated the paint spots on the floors in the memory care unit near Resident #18's doorway had been there since she began working at the facility 2 months ago. During an observation on 11/22/22 at 9:03 AM, Resident #18 room had a hole in sheetrock above resident bed measuring approximately 6 inches in length and ½ inch in width. The bathroom door had a whole measuring approximately 6 inches in length and 2 inches wide, exposing the wood. Resident #33 Review of Resident #33's Quarterly MDS dated [DATE] revealed [AGE] year-old female who was admitted to the facility on [DATE] with an active diagnosis list of diabetes and high blood pressure. Resident had a BIMS score of 10 indicating moderate cognitive decline. During an observation and interview on 11/20/22 at 2:40 PM, Resident #33 stated it would be nice if the patches of unpainted drywall beside my bed were painted. Resident #33 also stated the baseboards that led to bathroom also needed to be painted. Resident #40 Record review of Resident #40 Quarterly MDS dated [DATE] revealed a [AGE] year-old female admitted to the facility on [DATE]. Resident did not have Resident had a BIMS due rarely/never understood with difficulty with short, long-term memory and disorganized inattention thought processes. Active diagnosis list included Alzheimer's disease, Aphasia, Dementia. During an observation on 11/21/22 at 10:25 AM, Resident #40 had missing tile in entry way to room. During an observation and interview on 11/21/22 at 10:45 AM, Resident #40 was sitting in memory care living room with bare feet. LVN-G stated the resident, does not like to wear shoes. She said that the resident would take them off and staff were unable to find them, or they were found in unexpected places. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 2 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 Resident #43 Level of Harm - Minimal harm or potential for actual harm Review of Resident #43's Quarterly MDS dated [DATE] revealed resident was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnosis of Huntington Disease (a rare, inherited disease that causes the progressive breakdown of nerve cells in the brain). Resident had a BIMS of 9 indicating moderate cognitive decline. Residents Affected - Some During an observation on 11/20/22 at 2:19PM of Resident #43's room, he had no bed but only a recliner with pillows and blankets placed on top of the recliner headrest. During an interview on 11/20/22 at 2;19 PM, RN-E stated, Resident #43 sleeps in recliner every night. During an interview on 11/22/22 at 9:56 AM, Resident #43 stated he would like to have had a bed, but the facility took it out. During an interview on 11/22/22 at 2:15 PM, DON stated, Resident #43's bed was taken out of his room because there was not room for both the bed and recliner for him to maneuver. She also stated the blankets and pillows on the floor was an increased risk of Infection for Resident #43. The failure was not having anything to place the residents' belongings on with her expectations for staff to as well as herself to pay closer attention as to where residents belongings are placed. Resident #46 Review of Resident #46's Quarterly MDS dated [DATE] revealed a [AGE] year-old female with an admission date of 12/30/20. Resident had a BIMS of 9 indicating moderate cognitive decline. With a diagnosis of Dementia, Anxiety and Depression. During an observation and interview on 11/21/22 at 9:50 AM, Resident #46 stated her door looks like crap. Her room had missing tile in entry way and Velcro strips on the doorframe that was attached with staples and screws. The door jam was sitting crooked, and Resident #46 stated sometimes have to pull up on the handle to open or close the door right. Resident #48 Review of Resident #48's Quarterly MDS dated [DATE] revealed an [AGE] year-old male admitted to the facility on [DATE]. Resident had a BIMS of 3 indicating a severe cognitive decline. With diagnosis of anxiety and dementia. During an observation on 11/21/22 at 11:07AM, Resident #48's room had closet doors a that were 2 different colors. The bathroom floor was sticky with grime and had a foul smell of urine. During an interview on 11/22/22 at 8:56 AM, Resident #48 stated the facility was supposed to clean his room every day, but it continued to be dirty. He also stated the facility staff such as housekeeping, and maintenance did not do their daily jobs in cleaning and repairs. Resident # 48 continued to state he would like his room to be cleaned more often than it was and should have been cleaned every day. Resident #51 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 3 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 - Some Review of Resident #51's Quarterly MDS dated [DATE] revealed a [AGE] year-old male with a most recent readmission of 10/14/22. Resident had a BIMS score of 9 indicating moderate cognitive decline. With a diagnosis list that included Dementia, Anxiety, Depression. During an observation and interview on 11/21/22 at 9:50 AM, Resident #51 door had many chips of the wood in the door, brown grime running down door and chipped tile in threshold. He stated the doors sometimes looks bad, but what can you do? Resident #111 Record review of Resident #111 Facesheet dated 11/22/22 revealed a [AGE] year-old male with an admission date of 11/11/22. A diagnosis list of Adjustment disorder with mixed anxiety and depressed mood, Metabolic encephalopathy, Dysphagia. During an observation on 11/21/22 at 10:28 AM, Resident #111 room had screws protruding from the baseboard behind room door, door jam had gaps of missing wood and exposed screw on the door trim. During an observation on 11/20/22 at 11:18 AM, the memory care unit living area had brown grime on baseboards and wall and doors throughout unit. Chips in the wood on the doors to resident rooms 62-76. There were numerous areas of white marks through the brown wood patterned vinyl floor tiles of the hallway. During an observation on 11/21/22 at 9:43 AM, the memory care unit living area had brown grime on baseboards, wall and doors. During an interview 11/21/22 at 10:04 AM, MM stated the facility was remodeled not long ago. He stated she had worked for the facility 17 years ago and the facility had been remodeled during that time. He stated that the facility had 76 resident rooms. He stated that his focus was to get the building ready for state. MM stated he had spoken to corporate regarding the floors and he was told that corporate was planning on remodel which included replacing all the floors throughout the building. He stated that the floor buffing machine was pulling the design off the floors leaving white patches. He stated that he had not made a list of all the issues because his focus had been to get absolute immediate safety issues, equipment maintenance, and fire drills updated prior to state survey before anything else. He stated his focus was more on the front of the building that the memory care unit. MM also stated that the residents on the memory care unit had less awareness of unsafe environment, and those residents could pick at the chipped paint of the walls which was a safety concern. He stated he does not supervise the housekeeping staff because they are contracted separately with the facility; however, he feels the housekeeping staff should be cleaning the walls and doors daily. During an interview on 11/21/22 at 10:15 AM, LVN-G said housekeeping came to the unit daily, but she had never seen them clean the walls or doors for the drips and grime. During an interview on 11/22/22 at 9:34 AM, CNA-D said maintenance was working on the front of the building on safety issues. He said there was a potential for a resident to pick at the walls with the exposed sheetrock, but the current residents on the memory care unit did not seem to be doing that. He said most of the concern with residents on the memory care unit was, they are like kids, they want affection. Families are more concerned about the care then they are the cosmetics. CNA-D said he would not consider this homelike, I would not live in a house like this. He said he had not seen housekeeping clean the walls or doors at any time in the 8 months he had been working on the unit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 4 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 - Some During an interview on 11/22/22 at 9:51 AM, DON stated she visits the memory care unit daily. She stated she had seen brown grime on the walls and doors, missing pain on the doors, and holes in the walls. She stated she had cleaned the walls herself in the past. She stated that housekeepers do not clean well. DON stated she was more focused on the care of the residents and that the facility appearance was a concern. DON did state that the missing tile, holes in the walls and doors, and exposed wood screws would be a safety concern to the resident. She stated that the facility was not a comfortable or homelike environment but that the concerns for the residents on the memory care unit are not that big of a deal because those residents do not care about that, as a resident from the front has more cognition and awareness would care about those types of things. DON also stated that the family members of residents on memory care unit also do not care about the appearance of the memory care unit because they are more concerned about the care they receive. During an interview on 11/22/22 at 11:10 AM, HK stated they are contracted out and are shorthanded with only 2-3 staff members. He also stated, housekeeping staff are to sweep and mop hallways, touchup common areas, then proceed to dining rooms and resident rooms. HK also stated the housekeeping staff are to be wiping walls and rails as they go then sweep and mop resident rooms that included under resident beds daily. He stated that his expectation was that the housekeeping staff are to be cleaning restrooms and toilets daily. He stated that there was just himself and one other staff and we are doing the best we can. HK stated Resident #43's bathroom was not acceptable and homelike. He stated the failure was not staying on top of cleaning when needed. He also stated his expectations was for the residents to live in a comfortable, clean, sanitary, and homelike environment. During an interview on 11/22/22 at 11:45 AM, RMD stated there had been no improvements of windows and walls since previous survey. RMD stated the failures had been due to the previous maintenance staff had not maintained a homelike environment. He stated his expectation was for current maintenance staff to correct the issues immediately. During an interview at 11/22/22 at 2:30 PM, Admin stated the facility did have issues with comfortable and homelike environment. Admin stated that the cleanliness of the facility was unacceptable due to problems maintaining housekeeping staff. She continued to state the cleanliness of the resident rooms needed more attention to detail. Admin also stated that the floors should clean because some residents crawl on the floor. She stated that she had been trying to figure out what to do, to keep her off the floor and feels they are not clean enough for her to do that. It is unacceptable for the residents to be living in these conditions. Admin stated the failures fell on the facility but ultimately it was all on her, with the unacceptable lack of comfortable and homelike environment for the residents. She stated that her expectations were for each resident room to be cleaned every day or more often if the floors are dirty with spills. Review of Maintenance Service policy, revised December 2009, revealed the following the maintenance department is responsible for maintaining the building, grounds, and equipment in a safe and operable manner at all times, maintaining building in compliance with current federal, state and local laws, regulations, and guidelines, maintaining the building in good repair and free from hazards, provide routine scheduled maintenance service to all areas and maintain records of work order requests . Review of facility policy titled Resident Rights with revision date February 2021 revealed: Policy statement: employees shall treat all residents with kindness, respect, and dignity. Policy interpretation and implementation: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 5 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 1.Federal and state laws guaranteed certain basic rights to all residents of this facility. These rights include the residents right to: Level of Harm - Minimal harm or potential for actual harm a.Dignified existence Residents Affected - Some b.Be treated with respect, kindness, and dignity Review of facility policy titled Homelike Environment with revision date February 2021 revealed: Policy statement: residents are provided with the safe, clean, comfortable and homelike environment and encouraged to use their personal belongings to the extent possible. Policy interpretation and implementation: 1.Staff provides person centered care that emphasizes the residents comfort, independence and personal needs and preferences. 2.The facility staff and management maximize, to the extent possible, the characteristics of the facility that reflect a personalized, home like setting. These characteristics include: a.clean, sanitary and orderly environment; b. c.Inviting colors and decor; d.Personalized furniture and room arrangements; e.Clean bed and bath linens that are in good conditions FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 6 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a Baseline Care Plan within 48 hours of a resident's admission for 3 of 3 Resident's (#39, #43, and #48's) reviewed for baseline care plan completion. The facility failed to complete baseline care plans for Resident #39, Resident #43, Resident #48 within the required 48-hour timeframe. This failure could place residents who were newly admitted at risk of not receiving necessary care and services or having important care needs identified. Findings included: Resident #39 Review of Resident #39's electronic face sheet revealed an [AGE] year-old male admitted on [DATE] with diagnoses including: Restlessness and agitation, acute respiratory disease, Cellulitis, muscle spasm, dementia with behavioral disturbance Record review of Resident #39's Minimum Data Set (MDS) dated [DATE] revealed: A Brief Interview for Mental Status (BIMS) Summary Score was, 03 (severe impairment). Record review on 11/22/2022 of Resident #39's electronic care plan revealed no evidence of baseline care plan. Resident #43 Review of Resident #43's electronic face sheet revealed a 28 -year-old male admitted on [DATE] with diagnoses including: Huntington's disease (condition that stops parts of brain working properly over time), mild cognitive impairment, muscle spasms, and unsteadiness on feet with lack of coordination. Record review of Resident # 43's Minimum Data Set (MDS) dated [DATE] revealed: A Brief Interview for Mental Status (BIMS) of a 09 (moderate impairment). Record review on 11/22/2022 of Resident #43's electronic care plan revealed no evidence of baseline care plan. Resident #48 Record review of Resident #48's Electronic Face Sheet revealed an [AGE] year-old male with an initial admit date of 03/26/2021 with latest return 08/18/2022 with diagnosis including Dementia, altered mental status, Cognitive communication deficit, unsteadiness on feet and unsteady on feet. Record review of Resident #48's Minimum Data Set (MDS) dated [DATE] revealed: A Brief Interview for Mental Status (BIMS) of a 03 (severe impairment). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 7 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review on 11/22/2022 of Resident #48's electronic care plan revealed no evidence of baseline care plan. During an interview on 11/22/2022 at 1:45 PM, the CCM stated baseline care plans should be completed within 24 hours of admission and comprehensive care plans should be completed within 21 days of admission. CCM was not able to locate baseline care plans for Resident #39, #43 and #48 in the electronic medical chart. CCM stated that the DON was in charge of completing baseline care plans and he was in charge of completing comprehensive care plans. During an interview on 11/22/2022 at 2:00 PM, the DON stated she does the baseline care plans for residents. DON stated the baseline care plans were located in the resident's electronic medical charts. She continued to state Resident #39, #43 and #48's baseline care plans should have been done and updated accordingly but those residents were most likely not completed. She stated the failure was time management on her part, with the expectations of getting them completed within 48 hours of resident's admission. During an interview on 09/22/21 at 1:50 PM, the ADMIN stated the failure of Baseline Care plans not being completed was the DON has had to work the floor, and her expectations was for the facility to get staff that will work harder so the DON can do her job. Review of the facility's policy titled: The Care Plans-Baseline dated December 2016 indicated A baseline plan of care to meet the resident's immediate needs shall be developed for each resident within forty-eight (48) hours of admission. 1. To assure that the resident's immediate care needs are met and maintained, a baseline care plan will be developed within forty-eight (4838) hours of the resident's admission. 2. The Interdisciplinary Team will review the healthcare practitioner's orders (e.g., dietary needs, medications, routine treatments, etc.) and implement a baseline care plan to meet the resident's immediate care needs including but not limited to: a. Initial goals based on admission orders; b. Physician orders; c. Dietary orders; d. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 8 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0655 Therapy services; Level of Harm - Minimal harm or potential for actual harm e. Social services; and Residents Affected - Some f. PASARR recommendation, if applicable 3. The baseline care plan will be used until the staff can conduct the comprehensive assessment and develop an interdisciplinary person-centered care plan. 4. The resident and their representative will be provided a summary of the baseline care plan that includes but is not limited to: a. The initial goals of the resident; b. A summary of the resident's medications and dietary instructions; c. Any services and treatments to be administered by the facility and personnel acting on behalf of the facility; and d. Any updated information based on the details of the comprehensive care plan, as necessary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 9 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a comprehensive person-centered care plan based on assessed needs to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 2 (Resident #52 and Resident #7) of 20 residents reviewed for comprehensive person-centered care plans. 1. The facility failed to develop a comprehensive person-centered care plan based on assessed needs to address antipsychotic and antidepressant medication use for Resident #52 and to accurately address the diet texture for Resident #52 who had an order for a mechanical soft diet but was stated to be on a puree diet on the comprehensive care plan. 2. The facility failed to develop a comprehensive person-centered care plan based on assessed needs to address the diet or swallowing difficulty for Resident #7. These failures could affect the residents by placing them at risk for not receiving care and services to meet their needs. Findings included: Resident #52 Record review of Resident #52's electronic face sheet accessed 11/20/2022 revealed resident was a [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis to include brain stroke, difficulty swallowing, dementia, schizophrenia, and anxiety. Record review of Resident #52's Quarterly MDS dated [DATE] revealed: Section C: Cognitive Patterns: BIMS score interview not conducted. Section I: Active Diagnosis: Anxiety and Schizophrenia. Section K: Swallowing/Nutrition Status: Swallowing Disorder: Loss of liquids/solids from mouth when eating or drinking, Nutritional Approach: Mechanically altered diet. Section N Medications received: Antipsychotic and Antidepressant. Review of Resident's #52's electronic care plan initiated 05/26/2022 revealed no evidence of a focus, objective, or interventions related to the use of antipsychotic and antidepressant medication. Further review of the electronic care plan revealed: Category: Nutritional Status Pureed Diet. Goal: No choking incidents. Approach: Offer correct diet, allow time to chew and swallow, and make sure position is correct. Record review of Resident #52's electronic physicians orders accessed 11/20/2022 revealed the following orders: 04/05/2022- Remeron 15 mg tablet 0.5 tablet oral at bedtime for depression, 10/20/2022-Risperdal 0.5 mg 1 tablet at bedtime for schizophrenia, 10/14/2022- Risperdal 3 mg 1 tablet at bedtime for schizophrenia, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 10 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0656 12/15/2021- Diet: Regular Texture: Mechanical Soft Fluid Consistency: Thin. Level of Harm - Minimal harm or potential for actual harm Resident #7 Residents Affected - Some Review of Resident #7's electronic face sheet accessed 11/20/2022 revealed resident was a [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis to include difficulty swallowing. Review of Resident #7's Quarterly MDS dated [DATE] revealed: Section C: Cognitive Patterns: BIMS score of 03 indicating severe cognitive impairment. Section I: Active Diagnosis: Dysphagia. Section K: Swallowing/Nutrition Status: Swallowing Disorder: None of the above. Nutritional Approaches: None of the above. Review of Resident's #7's electronic care plan last revised 09/23/2022 revealed no evidence of a focus, objective, or interventions related to diet or swallowing difficulty. Review of Resident #7's electronic physicians orders accessed 11/2/2022 revealed: Diet: Regular Texture: Puree Fluid Consistency: Thin dated 03/09/2021. During an interview on 11/22/2022 at 2:00 PM, the CCM stated he was only responsible for comprehensive care plans. He stated he did not update the comprehensive care plan with new or acute information. He stated he reviewed the comprehensive care plan when he did care plan conferences and updated them. He stated that anything related to resident care should have been on the comprehensive care plan which included code status, diet, behaviors, medications, and any specialty services such as Hospice, PASSAR, or Dialysis. During an interview on 11/22/22 03:00 PM, the DON stated the CCM was responsible for all other care plans including updating and adding new or acute problems. She stated she was ultimately responsible for ensuring that care plans were updated. She stated the failure occurred due to miscommunication on who was responsible for updating acute issues on the comprehensive care plan. She stated not having accurate care plans could lead to residents not receiving the care that they need. Record review of the facility's policy titled Care Plans, Comprehensive Person-Centered revised December 2020 revealed: t . 8. The comprehensive person-centered care plan will: a. Include measurable objectives and time frame; b. Describe the services that are to be furnished to attain or maintain the residents highest practical physical, mental, and psychosocial well-being; .g. Incorporate identified problem areas; h. incorporates risk factors associated with identified problems; i. Build on the resident strengths; j. Reflect the residence expressed wishes regarding care and treatment goals; k. Reflect treatment goals, the timetables, and objectives in measurable outcomes; .9. Areas of concern that are identified during the resident assessment will be evaluated before interventions are added to the careful .13. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents Commission changed. 14. The interdisciplinary team must review, update the residence diagnosis within the clinical software system: a. When your diagnosis is resolved, b. When the diagnosis is established; and c. Reviewed at least quarterly in conjunction with the required MSDS assessment schedule. 15. The interdisciplinary team must review and update the care plan: a. When there has been a significant change in the residence position; b. When the dust desired outcome is not met . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 11 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure residents drug regimen were free from unnecessary drugs for 1 of 5 (Resident #41) reviewed for unnecessary drugs. Residents Affected - Few The facility failed to address pharmacist consultant recommendations for duplicate therapy in the months of December of 21, March of 22, September of 22 for Resident #41 inhaler medications of Symbicort and Advair. The facility failed to discontinue Advair in October of 22 after physician agreed with pharmacist consultant recommendation of duplicate therapy for Resident #41. These findings placed residents at risk of receiving unnecessary medications Findings included: Record review of Resident #41's Facesheet dated 11/21/22 revealed a [AGE] year-old male with an active diagnosis list that included COPD, Acute upper respiratory infection and Other seasonal allergic rhinitis. Record review of Resident #41's Quarterly MDS dated [DATE] revealed Resident had a BIMS of 3, meaning severe cognitive impairment, and an active diagnosis list that included COPD. Record review of Resident #41's Careplan last revised 09/16/22 revealed: Problem: I have SOB, wheeze related to emphysema/COPD. I have history of acute upper respiratory infections. Goal: Resident will not exhibit signs of respiratory distress (restlessness, wheezing, dyspnea, difficulty with expectoration, diaphoresis, crackles, bubbling, tachycardia, cyanosis, decreased breath sounds). Interventions: Provide medications: Advair, albuterol. Explain medication regime, actions, and side effects. Record review of Resident #41 Physician Order dated 11/22/22 revealed: Advair Diskus (fluticasone propion-salmeterol) blister with device; 250-50 mcg/dose; AMt: 1 puff; inhalation. Twice A Day. Start Date: 12/26/2019 open ended, meaning no stop date. Record review of Pharmacist Consultant Recommendations reviewed from December 2021 through November 2022, revealed the following: Normal MRR date 12/15/21 recommendation. Duplicate therapy refers to multiple medications of the same pharmacological class/category or any medication therapy that substantially duplicates a particular effect of another medication that the individual is taking. This resident is receiving Advair and Symbicort which have similar effects and may be considered duplicative therapy please consider doing one of these. Notation in margin stated, sent to MD. Normal MRR date 3/28/22 Recommendation: Duplicate therapy refers to multiple medications of the same pharmacological class/category or any medication therapy that subsequently duplicates a particular effect of another medication that the individual is taking. This resident is receiving Advair and Symbicort which have similar effects and may be considered duplicative therapy please consider doing one of these recommendations. Status Pending. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 12 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note to attending physician prescriber dated 3/28/22 by the consultant pharmacist with no documentation a physician agreeing or disagreeing with the recommendation. Note to attending physician prescriber MRR date 9/16/22 Duplicate therapy refers to multiple medications of the same pharmacological class/category or any medication therapy that substantially duplicates a particular effect of another medication that the individual is taking this resident is receiving Advair and Symbicort which have similar effects and may be considered duplicate therapy please consider doing one of these. Physician Agree with the note to Discontinue Advair dated 10/03/22. During an interview on 11/22/22 at 03:43 PM with DON and ADON, DON said she did pharmacy recommendations until mid-September then ADON took over. ADON said they get the recommendations from pharmacist, fax recommendations to MD, then give a week then call MD if no response. ADON said as soon as they got a decision for the pharmacist recommendations, then they would get the orders changed. DON said she was, 1 woman and had a PIP (Performance Improvement Plan) because I know that I had issues with getting those done. DON said herself and ADON, work the floor a lot and it just wasn't getting done. ADON said she took over the pharmacist consultant recommendations mid-September or first of [DATE] but didn't realize they did not do the follow through for the inhalers for Resident #41. Record review of Performance Improvement Plan dated 9/15/22 revealed: Topic identified: Pharmacy recommendation. Identified problem: Not followed up on timely. Plan of Action: Pharmacy letter to physician will be forwarded to physician within 24 hours of receipt. Physician recommendations will be followed up to ensure responsible response received within 7 days and documented in residence MAR. Nursing recommendations will be reviewed and documented follow up within 7 days of receipt recommendations and follow up will be maintained in a binder for review. Person responsible DON/ADON. Resolution: ADON delegated to start pharmacy recommendations as of 10/01/22. Record review of Advair accessed on 12/01/22 at https://www.advair.com/ revealed: ADVAIR DISKUS 250/50 helps significantly improve lung function* so you can breathe better and is clinically proven to help reduce the number of COPD exacerbations in people who have had an exacerbation . ADVAIR contains an ICS and a [NAME]. When an ICS and [NAME] are used together, there is not a significant increased risk in hospitalizations and death from asthma problems . Do not take ADVAIR with other medicines that contain a [NAME] for any reason. Record review of Symbicort accessed 12/01/22 at https://www.mysymbicort.com/ revealed: SYMBICORT combines an ICS, budesonide and a [NAME] medicine, formoterol. [NAME] medicines, such as formoterol, when used alone can increase the risk of hospitalizations and death from asthma problems. When an ICS and [NAME] are used together, this risk is not significantly increased . While taking SYMBICORT, do not use another medicine containing a [NAME] for any reason . Using too much of a [NAME] medicine may cause chest pain, fast and irregular heartbeat, tremor, increased blood pressure, headache or nervousness . COPD: SYMBICORT 160/4.5 mcg is used long-term to improve symptoms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, for better breathing and fewer flare-ups. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 13 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 - Many 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 interview the facility failed to prepare, store, distribute, and serve foods in accordance with professional standards for food service safety in the facility's only kitchen reviewed for labeling and storage of food inventory. The facility failed to label and/or date food items stored in freezers, refrigerators, and dry storage areas. The facility failed to remove damaged food cans from inventory and disposed of expired food items. These failures could place residents at risk of contamination, acquiring a food-borne illness, and weight loss. Findings included: During an observation on 11/20/22 from 10:40 AM to 12:15 PM of the walk-in cooler, refrigerators, dry storage area, and food preparation areas revealed the following: The walk-in cooler contained the following: 1. Two clear plastic bags of yellow semi-liquid substance in refrigerator. No label and no date opened or use by date on the bags. One bag was lying on a plastic serving tray and one bag was lying on top of a cardboard box. 2. One clear plastic bag with round, sliced lunchmeat. No label and no date opened or use by date on the bag. Manufacturers use by date on the plastic container in the bag was 11/19/22. 3. Fifteen 6 ounce. clear plastic cups containing brown liquid: 11 cups without lids. Fifteen cups with no label and no date opened or use by date. 4. One metal pan covered with foil labeled Don't Touch for tomorrow. No notation of contents or date. 5. One 4-ounce clear plastic cup with brown liquid. No label and no date opened or use by date. 6. One 6-ounce clear plastic cup with brown liquid. No label and no date opened or use by date. 7. One 6-ounce clear plastic cup with purple liquid. No label and no date opened or use by date. 8. Two thaw & serve pies. No expiration date or use by date. A shelf above the food preparation area revealed the following: 1. one open bag containing 1/3 of a loaf of white bread. The bag did not have an opened or use by date. 2.One 5-pound open tub BBQ sauce. The tub did not have an opened or use by date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 14 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 The free-standing freezer contained the following: Level of Harm - Minimal harm or potential for actual harm 1. One open box labeled sliced carrots. The box did not have an opened or use by date. 2. One open box labeled chicken breasts. The box did not have an opened or use by date. Residents Affected - Many 3. One open box labeled pork loin. The box did not have an opened or use by date. 4. One open box labeled pork patties. The box did not have an opened or use by date. 5. Two open boxes labeled 30-pounds broccoli cuts. The box did not have an opened or use by date. 6. One open box labeled frozen pasta. The box did not have an opened or use by date. 7. One open box labeled okra. The box did not have an opened or use by date. 8. One open box labeled Italian beans. The box did not have an opened or use by date. 9. Six 2-pound turkey breasts. The box did not have an opened or use by date. 10. One 20-pound open box labeled cut corn. The box did not have an opened or use by date. 11. 1 open box labeled crinkle cut fries. The box did not have an opened or use by date. The dry storage shelves contained the following: 1. One 50-pound open box of potatoes. The box did not have an opened or use by date. 2. One 25-pound open bag of onions. The bag did not have an opened or use by date. 3. Two open boxes of frozen bread. The boxes did not have an opened or use by date. 4. Four 6.4-ounce open stuffing mix season packet. The packets did not have an opened or use by date. 5. One 6-pound can pear halves dented below rim and the top rim was warped. 6. One 6-pound can of diced tomatoes was dented at the bottom. 7. One 60-ounce open coffee creamer with cracked lid, triangle shaped piece of lid missing, dated 3/18. 8. One 15.25-ounce Devil's Food Cake mix dated 7/20. 9. One 33.8-ounce bottle of water 2/3 full. The bottle did not have an opened or use by date. The freezer facing the steam table contained the following: 1. One open box labeled homestyle roll dough. The box did not have an opened or use by date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 15 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 2. One open half gallon container of vanilla ice cream 1/2 full. The container did not have an opened or use by date. Level of Harm - Minimal harm or potential for actual harm 3. One open box labeled shredded lettuce. The box did not have an opened or use by date. Residents Affected - Many 4. Twelve 2-pound open bags labeled cauliflower. The bags did not have an opened or use by date. A counter by coffee maker there was one 14.6-ounce canister of coffee with a resident's name on the lid. The canister did not have an opened or use by date. A shelf above the puree food preparation area revealed was the following: 1. One 14-ounce can, labeled cranberry sauce did not have a use by date or legible expiration date and was dented by the top rim. 2. One 8-pound open jug labeled creole seasoning dated 12/26/19. 3. One 1-gallon open jug labeled Worcestershire sauce, half full, dated 1/12/22. 4. One open bag of creamy wheat dated 11/3. During an interview on 11/21/22 at 08:50 AM, the DM stated she was responsible for dating inventory when it came in. She stated since she had been on maternity leave, she could see it might not have been done right. The DM explained it was a team effort if she was not able to do it. She stated she was responsible for monitoring to make sure it got done. The DM described new hire training as shadowing on the first day, hands-on training the second day and the third day staff were on their own and the senior employee was responsible for monitoring the new staff. The DM stated the effect on residents of not dating inventory correctly may be a risk of food poisoning, or the residents could get sick. During an interview on 11/22/22 at 09:05 AM, DA B stated all kitchen staff were responsible for making sure dates were put on inventory. She stated the failure occurred because the kitchen had been short staffed. She stated the consequences to residents for failing to date food items would be if something was old and given to a resident it risks their health. During an interview on 11/22/22 at 04:40 PM, the Administrator stated her expectations of the kitchen staff was to follow policy and procedures on checking in grocery deliveries including marking the date on the inventory and making sure the dates were easily seen when put into stock The administrator explained the dietary manager was responsible for making sure groceries were received and stocked properly. She stated the staff member that shuts down the kitchen at the end of the day was responsible for checking all food items delivered that day were dated and expired items were disposed of. The administrator explained the failure was due to not training according to policy. She stated the employee assigned to cover for the dietary manager while she was out on maternity leave had worked in the kitchen for less than 6 months and was not fully trained to assume the position of dietary manager. Review of the facility's policy titled Food Storage, dated 2018, revealed item #1 Dry storage rooms .d. All containers must be labeled and dated. Item #3 Refrigerators .d. Date, label and tightly seal all refrigerated foods . Item #3 Freezers .e. Store frozen foods in moisture-proof wrap or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 16 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 containers that are labeled and dated. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 17 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 on observation, interviews, and record reviews, the facility failed to maintain a system of infection control to prevent infections for 1 of 5 (Resident # 28) reviewed for infection control. Residents Affected - Few LVN-H failed to perform hand hygiene while providing wound care for Resident #28. This failure placed residents at risk for infection of wounds. Findings included: Record review of Resident #28 Quarterly MDS dated [DATE] revealed a [AGE] year-old male with an admission date of 12/17/21. An active diagnosis list that included CAD, Heart Failure, HTN, Diabetes Melitus. A risk for development of pressure ulcers. Record review of Resident #28's Wound Care Order dated 11/08/22 revealed: Wound Treatment Order: Location: Coccyx: Clean with Normal Saline/Wound Cleanser. Apply hydrocolloid dressing q 3 days. During an observation and interview on 11/22/22 at 08:15 AM of Resident #28 wound care performed by LVN-H. LVN-H donned gloves at treatment cart outside resident room without performing any hand hygiene and prepared all necessary supplies for wound care for Resident #28. She entered Resident #28's room, prepared the resident for wound care to buttocks by pulling down blankets and resident's pants. LVN-H then detached Resident #28's brief and folded it down to expose resident's wound on buttocks. She then proceeded to cleanse wound on Resident #28's buttocks with a spray wound cleanser and used 4x4 gauze to wipe away wound cleanser. LVN-H applied a 2x2 hydrocolloid patch over wound on Resident #28's buttock. LVN-H then removed gloves, reattached residence brief, pulled resident's pants back up and then covered resident backup with the blanket. LVN-H said she knew she forgot to wash her hands before she even started the procedure, she also should have changed her gloves between cleaning the wound and putting on the dressing. She stated, anytime gloves were changed some type of hand hygiene should be performed either using alcohol gel or washing the hands. LVN-H stated, Not washing the hands before or after and not changing the gloves could cause germs to enter the wounds. During an interview on 11/22/22 at 10:05AM with DON, she said staff should always wash their hands before they start doing things like wound care. They should change their gloves between clean and dirty. DON said LVN-H knew that she should have washed her hands and she does not know why she didn't with an area of the buttocks those wounds could get infection easily. LVN-H has recently had infection control training. Record review of LVN-H training record revealed: 06/22/22 Handwashing 06/22/22 F-Tags for Infection Control (F880-F883) 09/07/22 Handwashing Record review of facility policy labeled Wound Care revised June 22 revealed: Perform hand hygiene. Position resident . Put on clean gloves. Loosen tape and remove dressing. Pull glove over dressing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 18 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 Residents Affected - Few and discard in appropriate receptacle. Perform hand hygiene. Put on clean gloves . Use no touch technique . Wash wound in a circular motion from inside out with ordered wound cleanse. Use additional gauze and repeat as needed with fresh gauze each time. Apply treatments and dress wound as ordered by physician. Discard disposable items into a designated container . Remove disposable gloves and discard into designated container. Perform hand hygiene. reposition the bed covers. Make the resident comfortable. Sanitize the over bed table. Perform hand hygiene. Record review of facility policy labeled Handwashing/Hand Hygiene revised August 2019 revealed: This facility considers hand hygiene the primary means to prevent the spread of infection . all personnel shall be trained and regularly in serviced on the importance of hand hygiene in preventing the transmission of healthcare associated infection. All personnel shall follow the hand washing hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. Hand hygiene products and supplies sinks, soap, towel, alcohol-based hand rub, etc. Shall be readily accessible and convenient for staff use to encourage compliance with hand hygiene policies. Use an alcohol-based hand rub containing at least 62% alcohol or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: .before and after direct contact with resident . before performing any non-surgical invasive procedures . before handling clean or soiled dressings, gauze pads etc. Before moving from a contaminated body site to a clean body site during resident care. After handling used dressings, contaminated equipment etc . After removing gloves . Hand hygiene is the final step after removing and disposing of personal protective equipment. The use of gloves does not replace hand washing slash hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare associated infection. Single use disposable gloves should be used when in contact with the resident . Perform hand hygiene before applying non-sterile gloves . When removing gloves . Perform hand hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 19 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment in 9 of 112 (room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER], room [ROOM NUMBER]) and Memory Care Unit hallway. Resident room [ROOM NUMBER] A/B had chipped and scraped walls, rotting/missing baseboards, dirty, grimy, sticky floors, dirty and stained toilet. Resident room [ROOM NUMBER]B had only a recliner with no bed. Resident room [ROOM NUMBER] A/B had broken baseboards, unpainted spackling. Resident room [ROOM NUMBER] had a broken window seal, different shades of paint that did not match, and unpainted spackling. Resident room [ROOM NUMBER] A/B had broken baseboards, nail holes and exposed nails, exposed drywall, broken window seal, missing window insulation foam, unclean floors, walls, toilet grout and caulking. Resident room [ROOM NUMBER] had no tile at the entryway. Resident room [ROOM NUMBER] had the flooring scraped wood vinyl laminate as the appearance of the door scrapping the wood grain detail off, paint missing from the door. Resident Room # 72 had a piece of missing tile in entryway. Resident room [ROOM NUMBER] had screws on baseboard, doorjamb had minimal repair with a gap in the frame with missing wood. Door trim had exposed screw. The Memory Care Unit had numerous scuff marks along the floors with dirty/grimy railings and walls. These failures could place residents who reside in the facility in an unsafe and uncomfortable environment. Findings included: During observation on 11/20/22 at 12:19 PM, Resident room [ROOM NUMBER] A/B had chipped and scraped walls, exposing drywall beside bed. There were also rotting baseboards exposing raw wood inside and outside of restroom, with dirty, grimy, and sticky floors. The restroom had dead roaches scattered on the floor. The closet floor presented with dirt and black grime. During observation 11/20/2022 at 2:19 PM at Resident room [ROOM NUMBER] had no bed with only a recliner with pillows and blankets placed on top. During observation on 11/21/22 at 10:19 AM, Resident room [ROOM NUMBER] had no tile at entryway of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 20 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0921 resident's room. Level of Harm - Minimal harm or potential for actual harm During observation on 11/21/22 at 10:25 AM, Resident room [ROOM NUMBER] had the flooring scraped and the vinyl laminate had the appearance of the door scraping the wood grain detail off. The Resident Room door also had a large portion of paint missing from the door. Residents Affected - Many During observation on 11/21/22 at 10:25 AM, Resident room [ROOM NUMBER]'s entry way had a piece of missing tile on floor. During observation on 11/21/22 at 10:28 AM, Resident room [ROOM NUMBER] had entrance doorjamb had minimal repair with a gap in the frame, had missing wood and the door trim had exposed screw that could scrape skin of residents. There were also screws on the baseboard. During an interview on 11/21/22 at 9:21AM, LVN-G stated the facility has had new maintenance and she wasis unaware of finishing what in the logbook had been finished. During an interview on 11/21/22 10:16 AM with LVN-G, she stated housekeeping comes daily, but she had never seen them clean the walls nor the doors for the drips or grime. During an interview on 11/22/2022 at 9:34 AM, CNA-D, he stated the scrapes, broken door jambs, dirty walls, and railing, were not considered homelike to him. During an interview on 11/22/22 at 11:10 AM with HK, he stated they were contracted out and are shorthanded with only 2-3 staff members. He stated his staff are to sweep mop hallways, touch up common areas, then proceed to dining rooms and resident rooms. His staff also should wipe walls and rails as they go, daily sweep and mop resident rooms that included under resident beds. They should have been cleaning restrooms and the toilets daily. He stated on this day of the interview he had one other staff besides himself, and they were doing the best they can. HK stated Resident Room # 43's restroom was not acceptable and unhomelike. The failure is not staying on top of cleaning when needed, his expectations were for the residents to live in a comfortable clean, sanitary, and homelike environment. During an interview on 11/22/22 at 11:45 AM, RMD stated there had been no improvements of windows and walls for Room #'s 16, 20, and 21 since previous survey. The failures had been the previous maintenance that had been with the facility, it is his expectations for this to be corrected immediately. During an interview on 11/22/2022 at 2:15 PM with the DON, she stated, Resident #43's bed was taken out of his room because there was not room for both the bed and recliner for him to maneuver. She also stated the blankets and pillows on the floor was an increased risk of Infection for Resident #43. The failure is not having anything to place the resident's belongings on. Her expectations were for staff and herself to pay closer attention as to where residents belongings are placed. During an interview with ADMIN on 11/22/22 at 2:30 PM, she stated the facility did have issues and would give it a D if graded. The cleanliness of the facility was unacceptable due to problems keeping staff in housekeeping. She stated the cleanliness of the rooms need more attention to detail that unfortunately the residents' level of happiness had been exceeded farther in this facility than (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 21 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0921 Level of Harm - Minimal harm or potential for actual harm where they grew up and whatever they have now she considered a step up. The ADMIN also stated the failures fell on the facility as a whole but ultimately it was all on her, with the unclean and un-updated rooms. She also stated being unclean and un-homelike was unacceptable. Her expectations were, each room should be cleaned every day, even if it was a spill. The floors should still be cleaned with being short staffed and getting good people to do their jobs would make for a better homelike environment. Residents Affected - Many Review of Maintenance Service policy, revised December 2009, revealed the following theThe maintenance department is responsible for maintaining the building, grounds, and equipment in a safe and operable manner at all times, maintaining building in compliance with current federal, state and local laws, regulations, and guidelines, maintaining the building in good repair and free from hazards, provide routine scheduled maintenance service to all areas and maintain records of work order requests . Review of facility policy titled Resident Rights with revision date February 2021 revealed: Policy statement: employees shall treat all residents with kindness, respect, and dignity. Policy interpretation and implementation: 1. Federal and state laws guaranteed certain basic rights to all residents of this facility. These rights include the residents right to: a. Dignified existence b. Be treated with respect, kindness, and dignity Record review of the facility policy statement and procedures for Homelike Environment, revised February 2021 show that Residents are provided with a safe, clean, comfortable and homelike environment and encouraged to use their person belongings to the extent possible. #2 The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These Characteristics include: a. Clean, sanitary and orderly environment; b. Comfortable, adequate lighting; c. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 22 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0921 Inviting colors and décor; Level of Harm - Minimal harm or potential for actual harm d. Personalized furniture and room arrangements; Residents Affected - Many e. Clean bed and bath linens that are in good condition; f. Pleasant neutral scents; FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 23 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0941 Develop, implement, and/or maintain an effective training program that includes effective communications for direct care staff members. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide effective communications mandatory Residents Affected - Some training for 4 of 17 direct care staff (RN E, CNA D, NA C, and DA A) reviewed for training. The facility failed to ensure effective communication training was provided to RN E, CNA D, NA C, and DA A. This failure could affect residents and place them at risk of miscommunication and social isolation due to lack of staff training. Findings included: Record review of the personnel file for RN E revealed a hire date of 09/22/2022 and no evidence of new hire training on effective communication. Record review of the personnel file for CNA D revealed a hire date of 09/13/2022 and no evidence of new hire training on effective communication. Record review of the personnel file for NA C revealed a hire date of 02/26/2021 and no evidence of new hire training on effective communication. Record review of the personnel file for DA A revealed a hire date of 05/10/2022 and no evidence of new hire training on effective communication. During an interview on 11/22/22 at 04:40 PM the Administrator stated her expectations was for all employees to do the trainings when assigned. The Administrator stated she was responsible for making sure new employees were entered into the training system and the password works. The Administrator explained employees received an email when a training module was available and when it was due. She stated department heads were responsible for tracking incomplete training modules and reminding employees to complete. The Administrator stated the DON was responsible for monitoring the nursing staff and the administrator and/or human resources director were responsible for monitoring all other departments. She stated a problem occurs when employees had more than one email address and the employee failed to check the account the notification of training was sent to. The Administrator stated the effect on residents may be care provided was not as it should be. During an interview on 11/22/22 at 04:42 PM, the DON stated she is responsible for monitoring for incomplete training modules of the nursing staff. The DON stated one reason for staff failing to complete training was a breakdown in communication. She stated the consequences to residents was they may not receive the care expected. Review of the facility's titled In-Service Training Program, Nurse Aide, dated May 2019 revealed item #3. In-service training is based on the outcome of the annual performance reviews, addressing weaknesses identified in the reviews. Item #4. Annual in-services: a) Ensure the continuing competence of nurse aides; b) Are no less than 12 hours per employment year; c) Address areas of weakness as determined by nurse aide performance reviews; d) Address the special needs of the resident, as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 24 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0941 determined by the facility assessment; e) Include training that addresses the care of residents with cognitive impairment; and f) include training in dementia management and abuse prevention. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 25 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0942 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents. Based on interview and record review, the facility failed to provide the required education on the rights of the resident and the responsibilities of a facility to properly care for its resident for 4 of 17 employees (RN E, CNA D, NA C, DA A,) reviewed for training. The facility failed to ensure education on the rights of the resident and the responsibilities of a facility to properly care for its residents was provided to RN E, CNA D, NA C, and DA A. This failure could affect residents and place them at risk of being uninformed due to lack of staff training. Findings included: Record review of the personnel file for RN E revealed a hire date of 09/22/2022 and no evidence of new hire training on resident rights and facility responsibilities. Record review of the personnel file for CNA D revealed a hire date of 09/13/2022 and no evidence of new hire training on resident rights and facility responsibilities. Record review of the personnel file for NA C revealed a hire date of 02/26/2021 and no evidence of new hire training on resident rights and facility responsibilities. Record review of the personnel file for DA A revealed a hire date of 05/10/2022 and no evidence of new hire training on resident rights and facility responsibilities. During an interview on 11/22/22 at 04:40 PM, the Administrator stated her expectations was for all employees to do the trainings when assigned. The Administrator stated she was responsible for making sure new employees were entered into the training system and the password works. The Administrator explained employees received an email when a training module was available and when it was due. She stated department heads were responsible for tracking incomplete training modules and reminding employees to complete. The Administrator stated the DON was responsible for monitoring the nursing staff and the administrator and/or human resources director were responsible for monitoring all other departments. She stated a problem occurs when employees had more than one email address and the employee failed to check the account the notification of training was sent to. The Administrator stated the effect on residents may be care provided was not as it should be. During an interview on 11/22/22 at 04:42 PM, the DON stated she is responsible for monitoring for incomplete training modules of the nursing staff. The DON stated one reason for staff failing to complete training was a breakdown in communication. She stated the consequences to residents was they may not receive the care expected. Review of facility titled In-Service Training Program, Nurse Aide, dated May 2019 revealed item #3. In-service training is based on the outcome of the annual performance reviews, addressing weaknesses identified in the reviews. Item #4. Annual in-services: a) Ensure the continuing competence of nurse aides; b) Are no less than 12 hours per employment year; c) Address areas of weakness as determined by nurse aide performance reviews; d) Address the special needs of the resident, as determined by the facility assessment; e) Include training that addresses the care of residents with cognitive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 26 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0942 impairment; and f) include training in dementia management and abuse prevention. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 27 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Give their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation. Based on interview and record review, the facility failed to provide the required training on activities that constitute abuse, neglect, and exploitation and misappropriation of resident property and procedures for reporting related incidents for 4 of 17 employees (RN E, CNA D, NA C, DA A) reviewed for training. The facility failed to ensure training on activities that constitute abuse, neglect, and exploitation and misappropriation of resident property and procedures for reporting related incidents was provided to RN E, CNA D, NA C and DA A. This failure could affect residents and place them at risk of abuse, neglect, exploitation or misappropriation of property due to lack of staff training. Findings included: Record review of the personnel file for RN E revealed a hire date of 09/22/2022 and no evidence of new hire training on abuse, neglect, and exploitation and misappropriation. Record review of the personnel file for CNA D revealed a hire date of 09/13/2022 and no evidence of new hire training on abuse, neglect, and exploitation and misappropriation. Record review of the personnel file for NA C revealed a hire date of 02/26/2021 and no evidence of new hire training on abuse, neglect, and exploitation and misappropriation. Record review of the personnel file for DA A revealed a hire date of 05/10/2022 and no evidence of new hire training on abuse, neglect, and exploitation and misappropriation. During an interview on 11/22/22 at 04:40 PM, the Administrator stated her expectations was for all employees to do the trainings when assigned. The Administrator stated she was responsible for making sure new employees were entered into the training system and the password works. The Administrator explained employees received an email when a training module was available and when it was due. She stated department heads were responsible for tracking incomplete training modules and reminding employees to complete. The Administrator stated the DON was responsible for monitoring the nursing staff and the administrator and/or human resources director were responsible for monitoring all other departments. She stated a problem occurs when employees had more than one email address and the employee failed to check the account the notification of training was sent to. The Administrator stated the effect on residents may be care provided was not as it should be. During an interview on 11/22/22 at 04:42 PM, the DON stated she is responsible for monitoring for incomplete training modules of the nursing staff. The DON stated one reason for staff failing to complete training was a breakdown in communication. She stated the consequences to residents was they may not receive the care expected. Review of facility titled In-Service Training Program, Nurse Aide, dated May 2019 revealed item #3. In-service training is based on the outcome of the annual performance reviews, addressing weaknesses identified in the reviews. Item #4. Annual in-services: a) Ensure the continuing competence of nurse aides; b) Are no less than 12 hours per employment year; c) Address areas of weakness as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 28 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0943 Level of Harm - Minimal harm or potential for actual harm determined by nurse aide performance reviews; d) Address the special needs of the resident, as determined by the facility assessment; e) Include training that addresses the care of residents with cognitive impairment; and f) include training in dementia management and abuse prevention. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 29 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0945 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program. Based on interview and record review, the facility failed to provide the mandatory training on standards, policies, and procedures for an infection prevention and control program for 3 of 17 employees (RN E, CNA D, and DA A) reviewed for training. The facility failed to ensure infection prevention and control training was provided to RN E, CNA D, and DA A. This failure could affect residents and place them at risk of illness due to lack of staff training. Findings included: Record review of the personnel file for RN E revealed a hire date of 09/22/2022 and no evidence of new hire training on infection prevention and control. Record review of the personnel file for CNA D revealed a hire date of 09/13/2022 and no evidence of new hire training on infection prevention and control. Record review of the personnel file for DA A revealed a hire date of 05/10/2022 and no evidence of new hire training on infection prevention and control. During an interview on 11/22/22 at 04:40 PM, the Administrator stated her expectations was for all employees to do the trainings when assigned. The Administrator stated she was responsible for making sure new employees were entered into the training system and the password works. The Administrator explained employees received an email when a training module was available and when it was due. She stated department heads were responsible for tracking incomplete training modules and reminding employees to complete. The Administrator stated the DON was responsible for monitoring the nursing staff and the administrator and/or human resources director were responsible for monitoring all other departments. She stated a problem occurs when employees had more than one email address and the employee failed to check the account the notification of training was sent to. The Administrator stated the effect on residents may be care provided was not as it should be. During an interview on 11/22/22 at 04:42 PM, the DON stated she is responsible for monitoring for incomplete training modules of the nursing staff. The DON stated one reason for staff failing to complete training was a breakdown in communication. She stated the consequences to residents was they may not receive the care expected. Review of facility titled In-Service Training Program, Nurse Aide, dated May 2019 revealed item #3. In-service training is based on the outcome of the annual performance reviews, addressing weaknesses identified in the reviews. Item #4. Annual in-services: a) Ensure the continuing competence of nurse aides; b) Are no less than 12 hours per employment year; c) Address areas of weakness as determined by nurse aide performance reviews; d) Address the special needs of the resident, as determined by the facility assessment; e) Include training that addresses the care of residents with cognitive impairment; and f) include training in dementia management and abuse prevention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 30 of 31 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 675017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cross Country Healthcare Center 1514 Indian Creek Rd Brownwood, TX 76801 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 0946 Provide training in compliance and ethics. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide the required compliance and ethics training for 3 of 17 employees (RN E, CNA D, and DA A) reviewed for training. Residents Affected - Some The facility failed to ensure compliance and ethics training was provided to RN E, CNA D, and DA A. This failure could affect residents and place them at risk of poor care or victimization due to lack of staff training. Findings included: Record review of the personnel file for RN E revealed a hire date of 09/22/2022 and no evidence of new hire training on compliance and ethics. Record review of the personnel file for CNA D revealed a hire date of 09/13/2022 and no evidence of new hire training on compliance and ethics. Record review of the personnel file for DA A revealed a hire date of 05/10/2022 and no evidence of new hire training on compliance and ethics. During an interview on 11/22/22 at 04:40 PM, the Administrator stated her expectations was for all employees to do the trainings when assigned. The Administrator stated she was responsible for making sure new employees were entered into the training system and the password works. The Administrator explained employees received an email when a training module was available and when it was due. She stated department heads were responsible for tracking incomplete training modules and reminding employees to complete. The Administrator stated the DON was responsible for monitoring the nursing staff and the administrator and/or human resources director were responsible for monitoring all other departments. She stated a problem occurs when employees had more than one email address and the employee failed to check the account the notification of training was sent to. The Administrator stated the effect on residents may be care provided was not as it should be. During an interview on 11/22/22 at 04:42 PM, the DON stated she is responsible for monitoring for incomplete training modules of the nursing staff. The DON stated one reason for staff failing to complete training was a breakdown in communication. She stated the consequences to residents was they may not receive the care expected. Review of facility titled In-Service Training Program, Nurse Aide, dated May 2019 revealed item #3. In-service training is based on the outcome of the annual performance reviews, addressing weaknesses identified in the reviews. Item #4. Annual in-services: a) Ensure the continuing competence of nurse aides; b) Are no less than 12 hours per employment year; c) Address areas of weakness as determined by nurse aide performance reviews; d) Address the special needs of the resident, as determined by the facility assessment; e) Include training that addresses the care of residents with cognitive impairment; and f) include training in dementia management and abuse prevention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675017 If continuation sheet Page 31 of 31