Health inspection·June 28, 2024

F 0607 Level of Harm - Minimal harm or potential for actual harm Record review of R#1's current Care Plan (triggered items) indicated on 06/10/24 R#1 stated a staff member pushed him down; however, staff reported no falls were observed. Review of MT B's written statement indicated the incident dated 06/10/24 involved MT A being aggressive to R#1 by rush walking him and like adding force just to get him on the bed. Residents Affected - Few Review of MT A's statement dated 06/10/24 indicated MT B redirected R#1 to his room, and they both called for assistance from the nursing staffs (LVN H, and CNA I). MT A said to his knowledge R#1 never fell. Record review of MT A's Employee Disciplinary Report Action dated 06/10/24 indicated he was suspended pending investigation. Record review of MT A's Employee Disciplinary Report Action dated 06/11/24 indicated he was discharged due to date of infraction on 06/09/24. Record review of MT B's Employee Disciplinary Report Action dated 06/10/24 indicated he was suspended due to date of infraction on 06/09/24. Record review of MT B's Employee Disciplinary Report Action dated 06/11/24 indicated he was discharged due to date of infraction on 06/09/24. During an interview on 06/26/24 at 10:19 am with the MS C indicated on 06/10/24, he was reviewing the facility's videos when he discovered Hall B had a video with the date stamped 06/09/24 at 9:26 pm. This video revealed monitoring techs (MT A and MT B) were walking past Resident #1 (R#1), who was standing next to the handrail and holding on the hall's handrail with his right hand. MT A and MT B stopped next to R#, MT B grabbed R#1's left arm and MT A walked to R#1's right side and pulled and jerked his hand from the rail that he was holding. Afterwards, MT A and MT B walked R#1 to his room and closed the door. MS C said he was interviewing MT B because R#2 alleged he had called her a bitch. That was when MT B asked why he was being investigated, when they should be investigating MT A. MT B said on 06/09/24, he witnessed MT A push R#1 down in his room, after MT B and MT A escorted him to his room. MS C said this video revealed MT A was too aggressive with R#1, when he pulled on his arm and jerked his hand from the handrail. MT A said this video revealed MT A was walking too fast for R#1, because R#1, who walks very slowly, was being pulled by MT A towards his room. During an interview on 06/26/24 at 2:30 pm MT B said he saw R#1 walking around B Hall and he was not supposed to walk around because he was a fall risk. MT B said he was walking past R#1 with MT A, when they stopped and redirected R#1 to go to his room. That was when MT A directed MT B to grab his left arm and he complied, while MT A grabbed his right arm and hand, MT B stated MT A had to pull and jerk R#1's hand and arm, because R#1 was holding on to the handrail. Then MT A and MT B took R#1 by his arms to his room, but MT B had to direct MT A to slow down because R#1 could not keep up. Upon entering the room, MT B said MT A shoved R#1 from behind causing him to fall onto the floor, and they tried to pick him up but were unable to because of his size. MT B said he directed MT A to notify Licensed Vocational Nurse (LVN F) and he complied. MT B said once the nurses entered the room, they were informed R#1 had fallen and the nurses said they should not try to pick up the resident, instead they should notify the nurse first. MT B said he reported this incident to MS C the following day when questioned about another incident. MT B said he did not report this incident immediately after it happened because this was the first time, he has seen this happen, and it was his first time working in this type of facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 2 of 4 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 675019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apex Secure Care Brownfield 1101 E Lake St Brownfield, TX 79316 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 06/27/24 at 8:25 am R#1 indicated a man at the facility pushed him in his room and he did not want to return to the facility because he was afraid of this man. During an interview on 06/28/24 at 10:49 am with MS C indicated as soon as he observed the video involving MT A being too aggressive with R#1 as he and MT B took him to his room, he showed the video to the Administrator. Afterwards, MS C said he and the Administrator called MT A and suspended him over the phone pending an investigation. During an interview on 06/28/24 at 11:51 am with Nurse Practitioner (NP D) indicated staff should not have taken R#1 from the hallway and into his room, if he was not displaying a behavior or was unsteady on his feet. If R#1 was unsteady, staff should have provided him with a wheelchair, gently redirect him, and not make him leave the area, where he was standing and holding to the handrail. During an interview on 06/28/24 at 12:53 pm with LVN E indicated R#1's original Care Plan dated 03/13/24 included wandering and aggression that would be addressed by guiding away the source of distress, engaging him calmly in conversation, and if aggressive, staff were to walk away and respond later. LVN E said the plan did not include pulling R#1 away from the handrail and making him go to his room. During an interview on 06/28/24 at 1:28 pm with the Director of Nurses (DON) indicated R#1's Incident Report dated 06/07/24 at 5:12 pm R#1 revealed he had sustained a witnessed fall and had no new injuries, and this was the last noted fall. During an interview on 06/28/24 at 2:26 pm with LVN F indicated she was working on 06/09/24 and witnessed R#1 place himself on the floor and was not complying with redirection. During this shift, MT A asked her to go the R#1's room because R#1 was on the floor. LVN F said she entered R#1's room and saw him sitting on his bottom upright in front of his bed. LVN F said she it was never reported to her that R#1 had fallen or slipped off his bed. LVN F said she had asked the monitoring techs to redirect R#1 behaviors, turn him around, and guide him to his room, but never to force him away from the handrail or to his room. LVN F said if R#1 was noncompliant with redirection, the monitoring techs should report this to the nurse or leave him alone until he calms down or is easily redirected. During an interview on 06/26/24 at 9:34 am with Resident #3 indicated she had not been mistreated by any monitoring techs. During an interview on 06/27/24 at 2:20 pm with Resident #4 indicated she had not been mistreated by any monitoring techs. During an interview on 06/28/24 at 5 pm with Resident #4 indicated she had not been mistreated by any monitoring techs. During an interview on 06/28/24 at 5:43 pm with Resident #4 indicated she had not been mistreated by any monitoring techs. During an interview on 07/01/24 at 11:53 am with the hospital's Social Worker indicate R#1 was refusing to return to the facility because someone there had hurt him. The Social Worker said they were in the process of making a discharge plan to another facility, per his request. The facility's policy for Abuse Prevention Program dated December 2016 indicated Our residents have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 3 of 4 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 675019 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Apex Secure Care Brownfield 1101 E Lake St Brownfield, TX 79316 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual, or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. This program included as part of the resident abuse prevention, the administration will: protect residents from abuse by anyone including, but not necessarily limited to facility staff, other residents, consultants, volunteers, staff from other agencies, family members, legal representatives, friends, visitors, or any other individual. This program included staff training/orientation programs that include such topics as abusive prevention, identification and reporting of abuse, stress management, and handling verbally or physically aggressive resident behavior. The facility's policy for Recognizing Signs and Symptoms of Abuse/Neglect dated January 2011, indicated Our facility will not condone any form of resident abuse or neglect. To aid in abuse prevention, all personnel are to report any signs and symptoms of abuse/neglect to their supervisor or to the Director of Nursing Services immediately. This policy included examples of abuse/neglect and signs and symptoms of abuse/neglect that should be promptly reported. However, this listing was not all-inclusive. Other signs and symptoms or actual abuse/neglect may be apparent. When in Doubt, report it. The signs of actual physical abuse included welts or bruises; abrasion or lacerations; fractures, dislocation, or sprains of questionable origin; black eyes or broke teeth; improper use of restraints. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 4 of 4