Health inspection·August 18, 2025

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few present in the care plan meeting to discuss the services that would be provided to Resident #6. The Hospice SW stated not having hospice present could have services being missed for Resident #6.During an interview on 08/07/25 at 1:34 PM, with the Hospice Case Manager, he stated hospice had been invited to the care plan meeting in September 2025 but before that they had not been invited to any care plan meetings for Resident #6. The Hospice Case Manager stated they had been communicating with the DON and family regarding the review of the care plan and hospice does their own care plan for Resident #6. The Hospice Case Manager stated in the contract with the facility it stated in the delineation of duties that they have to be part of the IDT meetings which would be conducted by the physician, SW, RN, and spiritual care. The Hospice Case Manager stated the facility had a care plan for Resident #6 and it should have been correlating with the one that hospice had. The Hospice Case Manager stated any changes or deviations had to be reported to hospice so it would be updated in the hospice care plan.During an interview on 08/07/25 at 3:52 PM, with the Administrator, she stated the was SW was responsible and would be able to answer if residents who were on hospice had hospice invited to their care plan meetings. The Administrator stated as per facility policy hospice should have been invited to the care plan meeting(s). The Administrator stated the purpose of a care plan was to ensure that all the issues were addressed with all parts of care for the resident. The Administrator stated the care plan was a customized to meet the needs of each resident. The Administrator stated the negative outcome would be an area in care or services in the care plan being missed.During an interview on 08/18/25 at 1:13 PM, with the ADON, she stated the purpose of a care plan was to inform all departments and answer any questions someone may have regarding the resident. The ADON stated it was also the services being provided and what kind for the resident. The ADON stated the purpose of an IDT was also to inform of any changes or information related to the care of the resident. The ADON stated hospice should be invited as well so that all the IDT can be on the same page with care for the resident. The ADON stated hospice had not been present to any care plan meetings and did not know the reason why. The ADON stated the negative outcome of hospice not attending could be confusion on the general plan of care.During an interview on 08/18/25 at 2:35 PM, with the DON, she stated the purpose of a care plan was for family and everyone to know everything that was happening with the resident which addressed any concerns or issues and how to provide care for that resident. The DON stated the IDT was made up of the SW, dietary, nursing, therapy, activities, family members, and other pertinent parties. The DON stated the purpose of the IDT was to discuss everything and get a better understanding of the resident's needs. The DON stated hospice was not part of the care plan meetings and now they are. The DON stated as per facility policy hospice should have been invited to the care plan meetings for Resident #6. The DON stated there was no negative outcome as the facility always communicated with hospice about Resident #6.Record review of the facility Care Planning Policy dated 10/24/22, revealed, Purpose- To ensure that a comprehensive person-centered Care Plan was developed for each resident based on their individual assessed needs. Policy - The Care Plan serves as a course of action where the resident, resident's attending physician, and IDT work to help the resident move towards resident-specific goals that address the resident's medical, nursing, mental, and psychosocial needs. -Procedure- Services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. -Any services that would be required. -The Comprehensive Care Plan must be prepared by the IDT team. The IDT team includes the following: Consultants (as Appropriate) and other individuals as appropriate or necessary.Record review of the facility Care and Services Policy dated 06/2020, revealed, Purpose- To ensure through an interdisciplinary team process, that all residents receive the necessary care and services based on an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675025 If continuation sheet Page 2 of 6 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 675025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Acres Wellness & Rehabilitation 7304 Good Samaritan Court El Paso, TX 79912 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete individualized comprehensive assessment process. Policy- Residents are provided with the necessary care and services to maintain the highest practicable physical, mental, and social well-being level of in an environment that enhances qualify of life in the scope of a long-term care facility. Care and services are provided in a manner that consistently enhances self-esteem and self-worth. -Procedure- The IDT receives and review initial assessment information to ensure that members of the IDT interact with the residents in a manner that enhances self-esteem and self-worth, such as activities related bathing, grooming, dining, recreational and social opportunities.Record review of the facility End of Life Care Policy dated 08/2020, revealed, Purpose- To provide a process to assist the resident in fulfilling their spiritual, physical, and emotional needs, and to provide emotional support to families of residents with terminal illness. Policy- The facility will help residents maintain their dignity and provide comfort and security to residents in a caring environment. Coordination with Hospice - If hospice care was involved, the resident's care plan will reflect hospice interventions. Social Services Staff will coordinate with Hospice staff to ensure that the residents needs are communicated to the hospice. Social Services staff may include the hospice team in the resident's IDT conference. Event ID: Facility ID: 675025 If continuation sheet Page 3 of 6 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 675025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Acres Wellness & Rehabilitation 7304 Good Samaritan Court El Paso, TX 79912 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 (Resident #7) of 4 residents reviewed for ADL care for dependent residents.The facility failed to ensure the Hospice CNA provided perineal care with professional standards to ensure Resident #7 was clean, free of contamination. This failure placed residents who were dependent on staff for ADL care at risk for inappropriate transmission-based precautions to be used.Findings include: Record review of Resident #7's face sheet dated 08/18/25, revealed, admission on [DATE] to the facility. Record review of Resident #7's facility history and physical dated 05/14/25, revealed, an [AGE] year-old female diagnosed with Alzheimer's dementia with aggression and failure to thrive (a syndrome characterized by weight loss, poor nutrition, decreased activity, and a decline in overall functional ability, often accompanied by symptoms like depression and cognitive impairment). Record review of Resident #7's quarterly MDS dated [DATE], revealed, severe cognition of impairment BIMS of 6 to be able to recall or make daily decisions. Functional abilities were supervision or touching assistance (staff provides verbal cues and or touching/steadying and or contact guard assistance) with toileting. Resident #7 was always incontinent was urinary continence. Record review of Resident #7's care plan dated 05/14/25, revealed, had bladder incontinence related to activity intolerance. Monitor and document intake and output as per facility policy. Monitor fluid intake to determine if natural diuretics such as coffee, tea, or cola was contributing to increased urination and incontinence. Had terminal prognosis and under hospice's services related to atrial fibrillation. Consult with physician and social services to have hospice care for resident in the facility. Resident #7's ADLs was incontinent of bowel and bladder and required staff assist for cleansing and clothing. Observation on 08/07/25 at 6:11 AM, with Hospice CNA, revealed, perineal care was going to be provided to Resident #7 in her room. Hospice CNA entered the room and put on gloves and prepared the supplies to change Resident #7. Hospice CNA pulled several wipes from the package and placed them on top of the bed. Hospice CNA removed the soiled brief and disposed of it in the trashcan. Hospice CNA did not change gloves and did not perform hand hygiene. Hospice CNA proceeded to clean the resident's genital area with wipes from rectum to perineum (the area between the anus and vulva) and perineum to rectum. Hospice CNA cleaned buttock from front to back, it was observed that the wipes smeared with fecal matter, and she placed them on top of the clean wipes that were on the bed. that were on the bed. Hospice CNA disposed of dirty wipes in the trashcan and did not change gloves and did not perform hand hygiene. Hospice CNA put on the clean brief and continued to dress Resident #7. Hospice CNA was observed going through the drawers and closet with the contaminated gloves. Hospice CNA then proceeded to dress Resident #7, got her out of bed and sat her in the reclining Geri-chair. Hospice CNA then brushed Resident #7's hair. Hospice CNA then pulled the divider curtain with the contaminated gloves, put mousse on Resident #7's hair with the contaminated gloves, cleaned Resident #7's face and handed the resident a container of face cream so she could put cream on her face. During an interview on 08/07/25 at 6:35 AM, with the Hospice CNA, she stated she had been trained to clean the genital area from the top to the back and not go up and down with the same wipes to prevent contamination of the genital area. Hospice CNA said that she had been trained to change gloves and use hand sanitizer when she removed the soiled brief and dispose of the brief in the trash can. Hospice CNA said that she needed to change her gloves and use hand sanitizer each time that she removed the soiled gloves to prevent contamination by touching everything with the soiled gloves. Hospice CNA stated she Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675025 If continuation sheet Page 4 of 6 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 675025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Acres Wellness & Rehabilitation 7304 Good Samaritan Court El Paso, TX 79912 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete had removed her gloves, entered the bathroom to wash her hands in the hand sink, and stated that the soap dispenser was empty. Hospice CNA stated she walked out of the bathroom and used hand sanitizer.During an interview on 08/18/25 at 10:25 AM, with the ADON, she stated when providing perineal care staff are to be washing their hands and putting on gloves. The ADON stated you start by cleaning the resident from front to back and make sure nothing gets soiled. The ADON stated then you throw away the soiled wipe and remove the gloves and clean your hands and reapply gloves. The ADON stated it would not be okay to be having dirty wipes on top of clean ones. The ADON stated not washing your hands and changing out your gloves could be a risk of infection. During an interview on 08/18/25 at 1:40 PM, with the DON, she stated she was the infection control preventionist. The DON stated when conducting perineal care, the staff had to wash their hands and talk to the resident letting them know what was going to happen. The DON stated all staff have to make sure they have their perineal care supplies ready. The DON stated you wash your hands and put on your gloves and open the brief and clean from front to back for females and males from the tip and down. The DON stated if there was any stool it would have to be cleaned first. The DON stated it was not okay to place dirty wipes on top of clean ones. The DON stated anything contaminated should not be touching anything else nor the same contaminated gloves should be touching anything. The DON stated gloves are to be replaced, thrown, and hand washing performed, and reapply new clean gloves. The DON stated it would be a risk of contamination. Record review of the facility Perineal Care Policy dated 06/2020, revealed, Purpose- To maintain cleanliness of the genital area, to reduce odor, and to prevent infection or skin breakdown. Policy- Perineal care was provided as part of a resident's hygienic program, am minimum of once daily and per resident need. 1. Wash hands. 2. Explain procedure to resident. 3. Gather equipment. 4. Provide Privacy. 5. Put on gloves. 6. Wash the pubic area (the region on the lower abdomen, just above the genitals, where the pelvis meets at the front). - A. For a female resident(s): i. Separate the labia (the inner and outer folds of the vulva, at either side of the vagina). Wash the soapy washcloth/cleansing wipe, moving from front to back, on each side of the labia and in the center over the urethra (The tube through which urine leaves the body) and vaginal opening, using a clean washcloth/cleansing wipe for each stroke. ii. Rinse area, moving from front to back using a clean washcloth/cleansing wipe for each stroke. iii. Dry area moving from to back, using a blotting motion (gently dabbing or pressing an absorbent material onto a stain to soak up liquid without spreading it or damaging fibers) with towel. 7. Turn resident to side. 8. Wash, rinse and dry buttocks and peri-anal area without contaminating perineal area (the region of the body located between the anus and the external genital organs). 9. Remove wet linen. 10. Place dry linens or briefs or both underneath resident. 11. Reposition resident. 12. Remove gloves. Wash hands or use alcohol-based hand sanitizer. Note: Do not touch anything with soiled gloves after procedure (i.e. curtain, side rails, clean linen, call bell, etc.) 13. Put on clean gloves. 14. Clean and return all equipment to tis proper place. 15. Place soiled linen in proper container. 16. Remove gloves. 17. Wash hands. Record review of the facility Infection Prevention and Control Program Policy dated 10/24/22, revealed, Purpose-The ensure the facility established and maintained an infection control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection in accordance with Federal and State requirements. Event ID: Facility ID: 675025 If continuation sheet Page 5 of 6 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 675025 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE White Acres Wellness & Rehabilitation 7304 Good Samaritan Court El Paso, TX 79912 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that each resident receives adequate supervision and assistance devices to prevent accidents for 1 (Resident #8) of 4 residents reviewed for accidents hazards.The facility failed to provide safe transfer assistance, using proper transfer techniques for Resident #8. CNA A and CNA B failed to secure the brakes on the mechanical lift prior to lifting Resident #8 off the wheelchair.This failure placed the resident at risk of injury from improper transfer techniques.The findings included:Record review of Resident #8's face sheet dated 08/18/25, revealed, admission on [DATE] and re-admission on [DATE] to the facility. Record review of Resident #8's facility history and physical dated 06/05/25, revealed, a [AGE] year-old male diagnosed with dementia, degenerative disease of the central nervous system (a group of disorders where nerve cells in the brain and spinal cord progressively lose function, leading to a decline in physical and cognitive abilities), and Complete trisomy 21 syndrome (a genetic disorder where a person has a complete extra copy of chromosome 21 in all their cells, resulting from an error during the formation of egg or sperm). Record review of Resident #8's quarterly MDS dated [DATE], revealed, a BIMS was not taken to see the severity of impairment in cognition to be able to recall or make daily decision for Resident #8. It was not coded for mechanical lift. Functional abilities were dependent for roll left/right, sit to lying, lying to sitting on side bed, sit to stand, and chair/bed to chair transfer. Record review of Resident #8's care plan dated 05/17/25, revealed, ADLs self-care performance deficit related to down syndrome (a genetic condition where a person is born with an extra chromosome) and CVA (stroke occurs when a blood vessel in the brain becomes blocked or ruptures, cutting off blood flow to the brain). Transfer - extent/type may fluctuate within a day to day, depending on level of strength, pain, mood, etc. May require more staff assist or less. Resident was normally bedfast. Chair to bed dependent using 2 staff. On 08/06/25 at 8:30 AM a Facility Transfer, and ADLs Policy was requested from the Administrator and DON via e-mail but did not provide one of each by the facility. During an observation and interview on 08/06/25 at 10:27 AM, with CNA A and CNA B, revealed, Resident #8 was going to be transferred from his wheelchair to his bed. CNA B was heard providing instructions to Resident #8 of what was going to happen. CNA A was positioning the mechanical lift in between Resident #8's wheelchair while CNA B was ensuring the sling was placed appropriately underneath Resident #8. Once the mechanical lift was in position CNA A and CNA B began to hook up the sling to the mechanical lift. CNA A, without locking the mechanical lift brakes, began to lift Resident #8 into the air. CNA B moved the wheelchair and CNA A began to move Resident #8 over the bed and then began to lower Resident #8 down onto the bed. After the demonstration CNA A stated she had not locked the mechanical lift brakes. CNA B stated the mechanical lift brakes had to be locked or applied for the safety of Resident #8. CNA A stated not locking or applying the lift brakes could have resulted in injury to Resident #8. During an interview on 08/18/25 at 10:30 AM, with the ADON, she stated the DON/ADONs provide training on transfers to the staff. The ADON stated the mechanical lift brakes had to be applied when lifting a resident into the air for safety. The ADON stated staff should be ensuring the mechanical lift brakes are on before lifting a resident into the air. The ADON stated the risk could be injuries to the resident. During an interview on 08/18/25 at 1:40 PM, with the DON, she stated anytime a resident was going to be lifted into the air while using a mechanical lift the staff had to apply the mechanical lift brakes. The DON stated the negative impact of not applying the mechanical lift brakes could be the mechanical lift moving and possible injury to the resident. The DON stated the DON/ADONs were responsible for training staff on mechanical lifts. Event ID: Facility ID: 675025 If continuation sheet Page 6 of 6