Health inspection·November 25, 2025

F 0761 Level of Harm - Minimal harm or potential for actual harm revealed the following: Policy StatementThe facility stores all drugs and biologicals in a safe, secure, and orderly manner.Policy Interpretations and Implementation1. Drugs and biologicals used in the facility are stored in locked compartments.8. Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes) containing drugs and biologicals are locked when not in use.9. Unlocked medication carts are not left unattended. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 2 of 9 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 11/25/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were complete and accurately documented for 8 of 16 residents (Residents #1, #2, #3, #4, #5, #6, #7, #8) reviewed for clinical records. The facility failed to ensure evening medications refused by Residents #1, #2, #3, #4, #5, #6, #7 and #8 were accurately documented in the Medication Administration Record by CMA A, on 09/21/25. This failure could place residents at risk of not receiving the intended therapeutic effects of their medications and could contribute to possible adverse reactions.Findings include: 1. Record review of Resident #1's, undated, face sheet revealed in part, an [AGE] year-old female with an original admission date of 08/27/24. Resident #1 had diagnoses which included: unspecified dementia (loss of cognitive functioning), unspecified severity with other behavioral disturbance and Intermittent Explosive Disorder (mental health condition characterized by sudden, intense episodes of anger or aggression). Record review of Resident #1's quarterly MDS, dated [DATE], revealed a BIMS score of 99, which indicated the resident's cognitive status could not be determined using the BIMS assessment as the assessment may have been completed properly or the resident required a different evaluation method to assess cognitive function. Record review of Resident #1's active physician orders, as of 10/01/2025, revealed in part: Mirtazapine Oral Tablet 7.5mg, give one at bedtime for appetite stimulation, start date 10/07/24. Olanzapine Oral Tablet, give 2.5mg one by mouth at bedtime related to Intermittent Explosive Disorder, start date 03/22/25. Divalproex Sodium Oral Capsule Delayed Release Sprinkle 125mg, Give 4 capsules two times daily related to Intermittent Explosive Disorder, start date 03/22/25. Record review of Resident #1's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Mirtazapine 7.5mg Give one at bedtime for appetite stimulation, start date 10/07/24 at 1900 (7:00PM). Olanzapine 2.5mg Give one at bedtime related to Intermittent Explosive Disorder, start date 03/22/25 at 1900 (7:00PM). Divalproex 125mg Give 4 capsules twice daily related to Intermittent Explosive Disorder, start date 03/22/25 at 1900 (7:00PM). 2. Record review of Resident #2's, undated, face sheet revealed in part, a [AGE] year-old male with an original admission date of 07/31/25. Resident #2 had the following diagnoses which included: anoxic brain damage, not elsewhere classified (brain injury), cognitive communicate deficit (inability to communicate), and tremor unspecified (involuntary shaking). Record review of Resident #2's annual MDS, dated [DATE], revealed a BIMS score of 05, which indicated the resident's cognitive ability was severely impaired. Record review of Resident #2's active physician orders, as of 09/30/2025, revealed in part: Sinemet Oral Tablet 25/100mg (Carbidopa/Levodopa), Give one two times daily related to tremor, unspecified, start date 07/31/25. Record review of Resident #2's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Sinemet Oral Tablet 25/100mg (Carbidopa/Levodopa), Give one two times daily related to tremor, unspecified, start date 07/31/25 at 1900 (7:00PM). 3. Record review of Resident #3's, undated, face sheet revealed in part, a [AGE] year-old male with an original admission date of 09/02/22. Resident #3 had the following diagnoses: Bipolar disorder, current episode manic without psychotic features, severe (mental health disorder), intermittent explosive disorder (mental health condition characterized by sudden, intense episodes of anger or aggression), and hyperlipidemia, unspecified (plaque in the blood vessels). Record review of Resident #3's annual MDS, dated [DATE] revealed a BIMS score of 02, which indicated the resident's cognitive ability was severely (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 3 of 9 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 11/25/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some impaired. Record review of Resident #3's active physician orders, as of 10/01/2025, revealed in part: Carbamazepine ER Oral Tablet Extended Release 12-hour 400mg. Give one tablet by mouth every 12 hours related to bipolar disorder, current episode manic without psychotic features, severe, do not crush or chew, start date 01/05/24. Depakote Oral Tablet Delayed Release 125mg (Divalproex Sodium). Give one tablet two times a day related to intermittent explosive disorder, start date 08/27/25. Gemfibrozil Oral Tablet 600mg. Give one two times a day related to hyperlipidemia unspecified, start date 04/02/24. Record review of Resident #3's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Carbamazepine ER Oral Tablet Extended Release 12-hour 400mg. Give one tablet by mouth every 12 hours related to bipolar disorder, current episode manic without psychotic features, severe, do not crush or chew, start date 01/05/24 at 2000 (8:00PM). Depakote Oral Tablet Delayed Release 125mg (Divalproex Sodium). Give one tablet two times a day related to intermittent explosive disorder, start date 08/27/25 at 1900 (7:00PM). Gemfibrozil Oral Tablet 600mg. Give one two times a day related to hyperlipidemia unspecified, start date 04/02/24 at 1900 (7:00PM). 4. Record review of Resident #4's, undated, face sheet revealed in part, a [AGE] year-old male with an original admission date of 09/08/24. Resident #4 had the following diagnoses: unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety unspecified dementia (decline in cognitive function, which may include memory loss, difficulty in problem-solving, and impaired judgement), generalized anxiety disorder (mental health condition), impulse disorder (difficulty controlling behaviors), major depressive disorder (persistent low mood and loss of interest in activities), and gastro-esophageal reflux disease without esophagitis (backflow of stomach acid in the esophagus). Record review of Resident #4's annual MDS, dated [DATE], revealed a BIMS score of 09, which indicated the resident's cognitive ability was moderately impaired. Record review of Resident #4's active physician orders, as of 10/01/2025, revealed in part: Buspirone HCL Oral Tablet 5mg. Give one tablet by mouth two times a day related to generalized anxiety disorder, start date 08/09/24. Memantine HCL Oral Tablet 5mg. Give 2 tablets by mouth two times a day related to unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, start date 10/28/24. Protonix Oral Tablet Delayed Released 40mg (Pantoprazole Sodium). Give one tablet by mouth two times a day related to gastro-esophageal reflux disease without esophagitis, start date 2/18/25. Record review of Resident #4's Medication Administration Record dated 09/01/25-09/30/25 revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Buspirone HCL Oral Tablet 5mg. Give one tablet by mouth two times a day related to generalized anxiety disorder, start date 08/09/24 at 1900 (7:00PM). Memantine HCL Oral Tablet 5mg. Give 2 tablets by mouth two times a day related to unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, start date 10/28/24 at 1900 (7:00PM). Protonix Oral Tablet Delayed Released 40mg (Pantoprazole Sodium). Give one tablet by mouth two times a day related to gastro-esophageal reflux disease without esophagitis, start date 2/18/25 at 1900 (7:00PM). 5. Record review of Resident #5's, undated, face sheet revealed in part, an [AGE] year-old male with an original admission date of 05/21/2020. Resident #5 had the following diagnoses which included: Alzheimer's disease with late onset (memory loss and cognitive decline), Intermittent Explosive Disorder (mental health condition characterized by sudden, intense episodes of anger or aggression), hypercholesterolemia, unspecified (high cholesterol), and benign prostatic hyperplasia without lower urinary tract symptoms (enlarged prostate gland). Record review of Resident #5's annual MDS, dated [DATE], revealed a BIMS score of 02, which indicated the resident's cognitive ability was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 4 of 9 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 11/25/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some severely impaired. Record review of Resident #5's active physician orders, as of 10/01/2025, revealed in part: Atorvastatin Calcium Tablet 10mg. Give one tablet by mouth at bedtime related to hypercholesterolemia, unspecified, start date 05/21/20. Tamsulosin HCL Capsule 0.4mg. Give one capsule by mouth in the evening related to benign prostatic hyperplasia (enlarged prostate gland) without lower urinary tract symptoms, start date 01/21/25. Depakote Sprinkles Oral Capsule Delayed Release 125mg (Divalproex Sodium) Give 4 capsules by mouth two times a day related to intermittent explosive disorder, start date 09/09/25. Memantine HCL Tablet 10mg. Give 1 tablet by mouth two times a day related to unspecified dementia, without behavioral disturbance, start date 05/21/20. Record review of Resident #5's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Atorvastatin Calcium Tablet 10mg. Give one tablet by mouth at bedtime related to hypercholesterolemia, unspecified, start date 05/21/20 at 1900 (7:00PM). Tamsulosin HCL Capsule 0.4mg. Give one capsule by mouth in the evening related to benign prostatic hyperplasia without lower urinary tract symptoms, start date 01/21/25 at 1800 (6:00PM). Depakote Sprinkles Oral Capsule Delayed Release 125mg (Divalproex Sodium) Give 4 capsules by mouth two times a day related to intermittent explosive disorder, start date 09/09/25 at 1900 (7:00PM). Memantine HCL Tablet 10mg. Give 1 tablet by mouth two times a day related to unspecified dementia, without behavioral disturbance, start date 05/21/20 at 1800 (6:00PM). 6. Record review of Resident #6's, undated, face sheet revealed in part, a [AGE] year-old male with an original admission date of 09/13/2023. Resident #6 had the following diagnoses: paranoid schizophrenia (experience of paranoia of delusions), extrapyramidal and movement disorder, unspecified (unvoluntary movements caused by side effects from certain medications), hypercholesterolemia, unspecified (high cholesterol), and other seizures (abnormal electrical activity in the brain). Record review of Resident #6's annual MDS, dated [DATE], revealed a BIMS score of 02, which indicated the resident's cognitive ability was severely impaired. Record review of Resident #6's active physician orders, as of 10/01/2025, revealed in part: Mirtazapine 7.5mg Give one tablet by mouth at bedtime related to hypercholesterolemia, unspecified, start date 05/21/20. Levetiracetam Oral Tablet 500mg. Give one tablet by mouth two times daily related to other seizures, start date 09/13/23. Benztropine Mesylate Oral Tablet 0.5mg. Give one tablet by mouth two times a day for extrapyramidal side effects (unvoluntary movements caused by side effects from certain medications), related to extrapyramidal and movement disorder, unspecified, start date 09/13/23. Oxcarbazepine Oral Tablet 300mg. Give 1 tablet by mouth two times a day related to other seizures, start date 09/09/25. Zyprexa Oral Tablet 10mg (Olanzapine). Give 10mg by mouth two times a day related to paranoid schizophrenia, start date 12/08/23. Record review of Resident #6's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Mirtazapine 7.5mg Give one tablet by mouth at bedtime related to hypercholesterolemia, unspecified, start date 05/21/20 at 1900 (7:00PM). Levetiracetam Oral Tablet 500mg. Give one tablet by mouth two times daily related to other seizures, start date 09/13/23 at 1900 (7:00PM). Benztropine Mesylate Oral Tablet 0.5mg. Give one tablet by mouth two times a day for extrapyramidal side effects related to extrapyramidal and movement disorder, unspecified, start date 09/13/23 at 1900 (7:00PM). Oxcarbazepine Oral Tablet 300mg. Give 1 tablet by mouth two times a day related to other seizures, start date 09/09/25 at 1900 (7:00PM). Zyprexa Oral Tablet 10mg (Olanzapine). Give 10mg by mouth two times a day related to paranoid schizophrenia, start date 12/08/23 at 1900 (7:00PM). 7. Record review of Resident #7's, undated, face sheet revealed in part, a [AGE] year-old female with an original admission date of 04/11/2024. Resident #7 had the following diagnoses which included: Alzheimer's disease with late onset (memory loss and cognitive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 5 of 9 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 11/25/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some decline) and mood disorder due to known physiological condition, unspecified (mood disturbances caused by a medical condition) . Record review of Resident #7's quarterly MDS, dated [DATE], revealed a BIMS score of 99, which indicated the resident's cognitive status could not be determined by using the BIMS assessment as the assessment may have been completed properly or the resident required a different evaluation method to assess cognitive function. Record review of Resident #7's active physician orders, as of 10/01/2025, revealed in part: Trileptal Oral Tablet 150mg (Oxcarbazepine). Give 1 capsule by mouth two times a day related to mood disorder due to known physiological condition, unspecified, start date 05/19/25. Depakote Sprinkles Oral Capsule Delayed Release 125mg (Divalproex Sodium) Give 1 capsule by mouth two times a day related to mood disorder due to known physiological condition, unspecified, start date 04/10/25. Record review of Resident #7's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Trileptal Oral Tablet 150mg (Oxcarbazepine). Give 1 capsule by mouth two times a day related to mood disorder due to known physiological condition, unspecified, start date 05/19/25 at 1900 (7:00PM). Depakote Sprinkles Oral Capsule Delayed Release 125mg (Divalproex Sodium) Give 1 capsule by mouth two times a day related to mood disorder due to known physiological condition, unspecified, start date 04/10/25 at 1900 (7:00PM). 8. Record review of Resident #8's, undated, face sheet revealed in part, a [AGE] year-old male with an original admission date of 06/11/2025. Resident #8 had the following diagnoses which included: paranoid schizophrenia (experience of paranoia of delusions), hyperlipidemia, unspecified (plaque in the blood vessels), and benign prostatic hyperplasia with lower urinary tract symptoms (enlarged prostate gland). Record review of Resident #8's quarterly MDS, dated [DATE], revealed a BIMS score of 05, which indicated the resident's cognitive ability was severely impaired. Record review of Resident #8's active physician orders, as of 09/30/2025, revealed in part: Zyprexa Oral Tablet 10mg (Olanzapine). Give 1 tablet by mouth two times a day related to paranoid schizophrenia, start date 08/18/25. Tamsulosin HCL Capsule 0.4mg. Give 0.4mg by mouth at bedtime related to benign prostatic hyperplasia with lower urinary tract symptoms, start date 07/16/25. Atorvastatin Calcium Tablet 40mg. Give 40mg by mouth at bedtime related to hyperlipidemia, unspecified, start date 06/11/25. Record review of Resident #8's Medication Administration Record, dated 09/01/25-09/30/25, revealed in part CMA A documented the following medications as taken by the resident on 09/21/25: Zyprexa Oral Tablet 10mg (Olanzapine). Give 1 tablet by mouth two times a day related to paranoid schizophrenia, start date 08/18/25 at 1900 (7:00PM). Tamsulosin HCL Capsule 0.4mg. Give 0.4mg by mouth at bedtime related to benign prostatic hyperplasia with lower urinary tract symptoms, start date 07/16/25 at 1900 (7:00PM). Atorvastatin Calcium Tablet 40mg. Give 40mg by mouth at bedtime related to hyperlipidemia, unspecified, start date 06/11/25 at 1900 (7:00PM). During an interview on 9/30/25 at 8:31AM, CMA B said she was in the process of preparing her assigned medication cart to begin passing out medications to residents and found several unopened unit-dose medication packages, dated 9/21/25, that were supposed to be given to residents at night in the top drawer. She said she initially thought it was trash but realized the packages were unopened and still contained pills. She said she logged onto the computer and noticed the medications were documented as given to the residents by CMA A. She said she notified LVN E, and they counted the medication cart together. All medications were accounted for. She said she also notified LVN C and LVN D about the incident. She said LVN E was the off-going charge nurse that morning. She said she notified the ADON as soon as he arrived to the facility that morning and he took the unopened medication packets. She said CMA A was already gone because she left at 2:00AM, so she was not able to ask her about the medications. She said she and the ADON then reviewed the narcotics book and medications. She said she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 6 of 9 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 11/25/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some worked until 5:00 PM that day and there were no residents who reported any adverse effects or had medical issues that day. She said there were no residents who reported pain or any additional concerns to her regarding not receiving their medications. During an interview on 09/30/25 at 12:24 PM, the ADON said CMA B showed him the unopened unit-dose medication packages, dated 9/21/25, and CMA A was the nurse responsible to pass them to the residents. The ADON said he took the unopened unit-dose medication packages and compared them to the resident's MARs. He said he determined CMA A documented she gave the medications to the residents. He texted CMA A and asked her to explain why the packages weren't passed out and why she documented she gave them to the residents. The ADON said CMA A responded she needed to fix her documentation because those medications were refused by the residents . The ADON said he told CMA A it appeared she did not try to pass them to the residents because the packages were unopened. The ADON said CMA A said she thought she documented the refusals but could correct it. The ADON said he told the ADM about the situation that same day and was instructed to gather more information and to follow up with him after he was done. He said he followed up with the ADM with CMA A's response that the medications were refused by the residents and he also made all of the notifications to family members and to the medical director. He said there had not been any reported adverse effects from the residents from not taking the medications. He said all narcotic medications were all accounted for after being inventoried. He said there were no missing medications from the medication cart. He said CMA A already went home when the situation brought to his attention. During an observation and interview on 09/30/25 at 2:30 PM revealed several unopened unit-dose medication packages, dated 9/21/25, labeled with the names of Residents #1, #2, #3, #4, #5, #6, #7, and #8. The ADON said the unopened medication packages were found in the top drawer of the medication cart. The ADON said CMA A documented the medications were taken by the resident in their MARs, however, CMA A told him the medications were refused by the resident. Photographs were taken of the unopened unit-dose medication packages. During an interview on 09/30/25 at 9:09 PM, LVN E said he was a charge nurse on the other hallways on the night of 09/21/25. He said he was contracted to work at the facility for several months. He said he had not witnessed CMA A's not pass the medications and he only recalled he saw her push the medication cart down the halls that night. He said he worked from 6:00 PM to 6:00 AM. He said CMA B told him she found medications in the medication cart drawer that were not given to residents on 09/22/25 at around 5:00 AM. He said CMA A charted (documented) she gave the medications to the residents. He said none of the residents complained of pain or were observed to have any adverse reactions during his shift. During an interview on 09/30/25 at 9:30 PM, LVN D said she could see CMA A and LVN C were talking so she approached them and CMA B showed her the medications and appeared to be upset. She said when CMA B told her she found medications that should have been given to residents in her medication cart she would report it to the ADM and ADON . During an interview on 10/01/25 at 12:48 PM, CMA A said she was contracted to work at the facility and had worked at the facility several times since March 2025. She said on 09/21/25, she passed out medications to residents on halls D, E and F. She said she worked from 5:00 PM to 2:00 AM. She said during her shift she passed out medications and then documented the MARs afterwards. She said she was late documenting and forgot to go back and check her drawer for the refusals. She said she normally documented the medications as they were given to the residents as this was how she was trained to pass medications properly. She said the appropriate procedure to pass out medication was, she was to document as she administered them to the residents. She said the protocol was to compare the medications to the MAR, then double check them. Then she would open the medication pouch and check the pills in the pouch to make sure they were correct. She said then she would put the pills in a cup and offer them to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 7 of 9 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 11/25/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the residents. She said she understood it looked like she did not offer them to the residents since the packages were not opened. She said that night she asked the residents if they were going to take their medications before she opened the packages. She said those residents refused to take the medications. She said it was a very hectic night and she knew she was not supposed to do it that way . She said she normally did not report refusals to the nurs e so she did not think to do that. She said she only was supposed to document the refusals in the resident's medical records. She said she had not worked at the facility since she was contacted by the ADON about it, since there was a pending investigation. She said the potential negative outcome of inaccurate documentation was they would not receive proper care which could lead to the resident being neglected. During an interview on 10/02/25 at 2:25 PM, the ADON said the facility policy to pass out medication was the staff was to first open MAR, verify the resident's medications, date, time, and route. Then staff were to approach the resident, verify their identity and tell them about the medications they were going to be given and answer questions. Then staff were to offer the medications to the residents. The ADON said while doing that, the process for preparing the medications to be given to the resident was staff were to verify the medications belonged to the resident, compare them to the MAR to ensure they matched. Then open the pill packets and put them in a cup. Take them to the resident and offer them. The ADON said, the staff should document the correct outcome. He said he was not aware the nurse documented after passing out all of the medications to residents prior to this investigation. He said staff were trained in nursing school on how to give medications, they received annual competencies, and also the pharmacist completed training with staff periodically. He said it was the nurses responsibility to ensure their documentation was correct. He said he was also responsible to ensure medications were passed correctly and documentation was accurate. He said he expected nurses to accurately document what they did and to follow the treatments as ordered by the physician. He said inaccurate documentation could potentially cause a resident to have a medical emergency, behaviors could occur, or the resident could have unresolved pain. During an interview on 10/02/25 at 3:15 PM, the ADM said he expected nurses to ensure MARs and TARs were completed accurately. He said he was not aware staff were post-documenting during medication pass. He said the proper procedure was staff were to pull the medication, ensure it was the right resident and medication, then document immediately afterwards to ensure compliance. He said the nurse who passed out the medications were also responsible to inventory them. He said the system in place to ensure compliance was the pharmacist did spot checks on MARs and TARs, and she also did random medication passes with the nurses and provided them with feedback on any issues or concerns. He said the staff member, the DON, and the ADON were all responsible to ensure documentation was accurate. He said he expected staff to document accurately and maintain compliance with their documentation. He said a potential negative outcome of inaccurate documentation was medications may not be given properly, residents may not receive the proper treatment, which could cause the resident to end up with worse behaviors or go to the hospital for a medical issue. Record review of the facility-provided policy titled Documentation of Medication Administration, revised April 2007, revealed: Policy Statement The facility shall maintain a medication administration record to document all medications administered. Policy Interpretation and Implementation 1. A Nurse or Certified Medication Aide (where applicable) shall document all medications administered to each resident on the resident's medication administration record (MAR).2. Administration of medication must be documented immediately after (never before) it is given.3. Documentation must include, as a minimum:a. Name and strength of the drug;b. Dosage;c. Method of administration (e.g., oral, injection (and site), etc.);d. Date and time of administration;e. Reason(s) why a medication was withheld, not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675019 If continuation sheet Page 8 of 9 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 11/25/2025 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 0842 administered, or refused (as applicable);f. Signature and title of the person administering the medication; andg. Resident response to the medication, if applicable (e.g ., PRN , pain medication, etc .). 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: 675019 If continuation sheet Page 9 of 9