Health inspection·November 17, 2023

F 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few lacks the capacity to do some, but not all, of the tasks necessary to care for himself or herself to manage his or her property. SW hand wrote he does not have the capacity to make decisions on his own, due to his dementia. Ability to attend court section SW checked off no to the Proposed [NAME] would be able to attend, understand, and participate in hearing. The referral was signed by SW. Record review of Resident #10 ' s progress note dated 11/09/2023 written by SW revealed On this date, SW spoke to Resident #10 ' s Next of Kin. He was at the facility to see [Resident #10]. SW spoke to the Resident #10 ' s Next of Kin regarding the code status here at the facility is still a full code. SW explained the difference between being a full code vs. being a DNR. SW explained to the Resident #10 ' s Next of Kin that [Resident #10] is declining and he can sign as his next of kin. Resident #10 ' s Next of Kin stated he try and talk to [Resident #10] to see what he wants and get back to the facility. For now, he said he wants to spend time with [Resident #10] only. SW also explained to him that the facility could also get a two-physician rule (two physicians can make the decision, one must be the attending physician)for [Resident #10] if needed. However, he still said he is not going to make a decision on this date. Record review of Resident #10 ' s progress note dated 10/16/2023 written by SW revealed SW spoke to the DON and/or Administrator and explained to them that local hospice agency does not want to continue with referral unless family member signs the consents for [Resident #10] DON stated to try another hospice company to see if they can assist in getting the consents signed by the Resident #10 ' s Next of Kin, If possible, or by a priest. Therefore, SW submitted the hospice referral again to local hospice agency. Outcome of referral pending. Will monitor. During an interview on 11/16/2023 at 3:27 pm, the SW stated Resident #10 had stated back in August 2023 that he did not want family member to visit and/or make any medical decisions on his behalf. The SW stated a referral to hospice and/ or DNR suggestion was typically brought up for consideration to the family when a change in condition was noted in which the resident could no longer make his own medical decisions. The SW stated she explained the process which was consult with the family and educate regarding Hospice and/or DNR options. The SW stated the family had the right to refuse Hospice and/ or DNR services. The SW stated if family did not want to be held responsible or make any decisions on behalf of a resident, the family could either seek legal guardianship, get 2 physician consent, or find a priest to sign for consents. The SW stated Resident #10 ' s Next of Kin had voiced several times he did not want to make medical decisions and could not recall if she had asked Resident #10 if he wanted Resident #10 ' s Next of Kin to be the one making his decisions. The SW stated she had a lot of documentation reflecting Resident #10 ' s Next of Kin ' s refusal to make medical decisions and local legal guardianship was contacted. During an interview on 11/17/2023 at 8:51 am, Resident #10 ' s Next of Kin stated that he felt a lot of pressure from the facility to sign DNR consents. Resident #10 ' s Next of Kin stated on several occasions he went to the facility to visit Resident #10 the SW would ask to speak to him and at times lie that Resident #10 was not in the facility and in the hospital to get him to sign consents. Resident #10 ' s Next of Kin said he never said he did not want to make any medical decisions. Resident #10 ' s Next of Kin stated he just wanted some time to discuss the DNR with Resident #10 prior to making the decision to sign. Resident #10 ' s Next of Kin stated at one point was told by the SW that if he did not sign the DNR consent the facility could obtain 2 doctors to sign the DNR consent and felt pressured, overwhelmed, and threatened. Resident #10 ' s Next of Kin stated he did not sign the DNR and was not aware/notified of the facility seeking out legal guardianship. During an observation and interview on 11/17/2023 at 9:21 am, Resident #10 was in bed at a local (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 2 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few hospital. Resident #10 was alert and oriented to person, place, and event. Resident #10 stated he remembered asking the facility to remove family member from making any medical decisions and did not want family member to visit him. Resident #10 stated after the facility removed family member from making any medical decisions, he was comfortable and trusted his Next of Kin to make medical decisions on his behalf. Resident #10 stated he was not told of the facility seeking local guardianship and did not agree with it due to Next of Kin being present and involved. During an interview on 11/17/2023 at 3:59 pm, the DON stated it was suggested for Resident #10 to be evaluated by hospice on his last hospitalization due to failure to thrive and multiple visits to the hospital. The DON stated Resident #10 had several hospitalizations and would not comply with the treatment and had started to debilitate. The DON stated there had been family dynamics and Resident #10 Next of Kin was appointed to make medical decisions. The DON stated she does not recall Resident #10 ' s Next of Kin stating he did not want to make medical decisions; he opted for Hospice services. The DON stated if Resident #10 refused to sign DNR he was within his rights to do and for SW to mention physician order overwrite could come off threating. During an interview on 11/17/2023 at 4:50 pm, the SW stated she sent Resident #10 ' s referral for local legal guardianship in October due to Resident #10 ' s Next of Kin refusing to sign DNR consent with hospice services. The SW stated since Resident #10 ' s Next of Kin had refused to sign DNR consent, it meant he was refusing to make all medical decisions on Resident #10 ' s behalf. The SW stated did not want to answer questions on family notification of facility seeking legal guardianship in attempt to get DNR consent. The SW did not answer the difference between refusing DNR services and refusing all medical decisions. The SW could not provide any documentation that reflected Resident #10 ' s Next of Kin refusal to make any medical decisions. The SW stated in general, a family member had the right to refuse to sign consent for DNR. During an interview on 11/17/2023 at 5:24 pm, the Administrator stated it was her expectation for the SW to have all the documentation available to support the decision to pursue legal guardianship referral for Resident #10. The Administrator stated if Resident #10 ' s Next of Kin had refused to sign the DNR consent, it should had been respected. The Administrator stated if the SW used approached of the facility could get 2 doctor signature approach would not be considered as respecting his right to refuse DNR. The Administrator stated if this approach was said to her it would make her retract and would not be an ideal approach to attempt to get a DNR consent signature. Record review of Resident Rights policy dated December 2016 read in part Employees shall treat all residents with kindness, respect, and dignity. Federal and State laws guarantee certain basic rights to all residents of this facility. These rights include the resident ' s right to: I- exercise his or her rights without interference, coercion, discrimination or reprisal from the facility; K-appoint a legal representative of his or her choice. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 3 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the prompt resolution of all grievances to include ensuring that all written grievance decisions include the date the grievance was received, a summary statement of the resident ' s grievance, the steps taken to investigate the grievance, a summary of the pertinent findings or conclusions regarding the resident ' s concerns, a statement as to whether the grievance was confirmed or not confirmed, any corrective action taken or to be taken by the facility as a result of the grievance, and the date the written decision was issued for 1 of 8 (Resident # 44) reviewed for resident rights. The facility failed to ensure an investigation was initiated promptly for Resident #44 ' s grievance of missing money and debit card. This failure could place residents at risk for grievances not being addressed or resolved promptly in turn leading to resident ' s lost properties not being replaced. Findings include: Record review of Resident #44 ' s face sheet dated 11/17/2023 revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Record review of Resident #44 ' s history and physical dated 11/11/2023 revealed diagnoses of COPD (group of lung diseases that block airflow and make it difficult to breathe), HTN (condition in which the force of the blood against the artery walls is too high), cirrhosis (Chronic liver damage from a variety of causes leading to scarring and liver failure), anxiety (Intense, excessive, and persistent worry and fear about everyday situations. Fast heart rate, rapid breathing, sweating, and feeling tired may occur), atrial fibrillation (irregular, often rapid heart rate that commonly causes poor blood flow), and history of cocaine and heroin use. Record review of Resident #44 ' s admission MDS assessment dated [DATE] revealed a BIMS score of 14, indicating his cognition was intact. Record review of Resident #44 ' s inventory sheet dated 10/28/2023 revealed 1 Lonestar card, 1 chase bank, 1 1892 one-dollar coin, 1 black man purse, 1 black wallet with $0. Record review of Resident Concern Report dated 11/11/23 written by RN E revealed the concern was filed on behalf of Resident #44. Nature of concern section revealed Resident #44 had complained of missing $40 cash and debit card that were in his drawer. This concern file was not included in the grievances provided to the survey team upon entrance on 11/14/2023. The concern file was provided to Surveyor on 11/15/2023 along with Grievance Form completed by SW on 11/14/2023. Record review of Grievance form dated 11/14/2023 initiated by SW revealed description [Resident #44] is reporting that he lost $40 that his family member had taken the previous week. The money was inside a black bag inside the night dresser and noticed they were missing on Friday 11/10/2023, along with his bank card and 2 other cards. Section persons/ department contacted revealed nursing and administration on 11/15/2023. Summary findings were: 1- report was made by Weekend Supervisor on 11/11/2023. 2statements were received by staff on 11/11/2023. 3- a second grievance report was completed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 4 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few on 11/15/2023. 4- police report was filed 5- money was reimbursed to him cash in amount of $40 pending investigation. 6- incident reported to State Office on 11/15/2023 pending investigation. 7- [Resident #44] ' s card was cancelled. 8- Food stamp card will be reported stolen. 9-an in-service on abuse and neglect, exploitation was completed on 11/15/23 and 11/16/23. During an interview on 11/14/2023 at 8:57 am, Resident #44 stated he reported missing money, a debit card, and an old coin on Saturday to the Weekend Supervisor. Resident #44 stated he had his $40, debit card, and old coin in a black bag that was placed inside the dresser at his bedside. Resident #44 stated he noticed it was missing on Friday, late evening, and waited until Saturday (11/11/2023) to report it because it was late. Resident #44 stated when he made the report of missing $40, debit card, and old coin he was told by Weekend Supervisor he would write down the report on paper and report to the Administrator so she could further investigate it. Resident #44 stated as of that day he was still waiting for the Administrator to give any update on the missing $40, debit card, and old coin. Resident #44 stated he was concerned that the debit card could be used. Resident #44 stated he reported to CNA G yesterday (11/13/23) in the afternoon and was told she notified the Administrator immediately. The Administrator stated she had not followed up with the SW on the status on missing money grievance. During an interview on 11/14/2023 at 12:43 pm, CNA G stated she had worked with Resident #44 the day before (11/13/2023) and he told her that he was missing $40 and a debit card. CNA G stated when Resident #44 reported the missing money and debit card, it was at beginning of second shift around 2:30 pm and she immediately called the Administrator to notify her. CNA G stated the Administrator stated she had received the report the day before (11/12/2023) and had already started looking into it. During an interview on 11/15/2023 at 9:15 am, Resident #44 stated he had not yet received any updates from the Administrator. During an interview on 11/15/2023 at 3:19 pm, the Weekend Supervisor stated she had received a report from Resident #44 on Saturday 11/11/2023 of missing money and debit card. The Weekend Supervisor completed a concern file on behalf of Resident #44, obtained witness statements from LVN E and CNA F, and reported it to the Administrator via phone. The Weekend Supervisor stated she left the completed concern file for Resident #44 and witness statements for the Administrator. The Weekend Supervisor she did not mention where she placed the written report. During an interview on 11/15/2023 at 3:24 pm, the Administrator stated she had received a complaint from a nurse, who she could not remember, yesterday (11/14/2023) of missing $20 from a resident on the 4th floor (Resident #44 was located on the 4th floor) but nothing regarding a debit card. The Administrator stated she reported to the SW since she was the Grievance Officer. The Administrator stated it was her expectation that the SW should have already started a formal grievance and followed up with the resident. During an interview on 11/15/2023 at 3:34 pm, the SW stated she had received a notification of Resident #44 ' s missing money yesterday (11/14/2023). The SW stated she had not yet started a Grievance file and she had 24 hours to initiate and report. The SW then looked at the clock in her computer and stated she would have to refer to her policy to determine the time frame for reporting. The SW stated she had not followed up with Resident #44 yet. During an interview on 11/16/2023 at 8:36 am, Resident #44 stated the facility had finally updated him on the missing money and he was reimbursed the money. Resident #44 stated he was still concerned (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 5 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete about the delay due to him calling the bank and was notified the debit card had been used twice on Tuesday (11/14/2023) at a gas station for about $10 on each transaction. Resident #44 stated the bank card was cancelled but was after it had already been used. Record review of Grievances/Complaints policy dated April 2017 read in part Residents and their representatives have the right to file a grievance, either orally or in writing, to the facility staff or to the agency designated to hear grievances. The Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative. The Administrator has delegated the responsibility of grievance and/pr complaint investigation to the Grievance Officer who is the SW. The Grievance Officer will coordinate actions with the appropriate state and federal agencies, depending on the nature of the allegations. All alleged violations of neglect, abuse and/or misappropriation of property will be reported and investigated under the guidelines for reporting abuse, neglect, and misappropriation of property, as per state law. Event ID: Facility ID: 675106 If continuation sheet Page 6 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source, are reported immediately, but no later than 2 hours after the event, if the events result in serious bodily injury, or no later than 24 hours if the events do not result in serious bodily injury, to the Administrator of the facility and to other officials (including to the State Survey Agency) in accordance with state law through established procedures for 1 of 8 (Resident # 44) reviewed for misappropriation of property. The facility failed to report an allegation of misappropriation of property (money, old coin and debit card) to the State Survey Agency within 24 hours of being made by Resident #44. This failure could place residents at risk of allegations of abuse, neglect, misappropriation of property not fully investigated and emotional distress. Findings include: Record review of Resident #44 ' s face sheet dated 11/17/2023 revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Record review of Resident #44 ' s history and physical dated 11/11/2023 revealed diagnoses of COPD (group of lung diseases that block airflow and make it difficult to breathe), HTN (condition in which the force of the blood against the artery walls is too high), cirrhosis (Chronic liver damage from a variety of causes leading to scarring and liver failure), anxiety (Intense, excessive, and persistent worry and fear about everyday situations. Fast heart rate, rapid breathing, sweating, and feeling tired may occur), atrial fibrillation (irregular, often rapid heart rate that commonly causes poor blood flow), and history of cocaine and heroin use. Record review of Resident #44 ' s admission MDS assessment dated [DATE] revealed a BIMS score of 14, he was cognitive intact. Record review of Resident $44 ' s inventory sheet dated 10/28/2023 revealed 1 Lonestar card, 1 chase bank, 1 1892 one-dollar coin, 1 black man purse, 1 black wallet with 0$. Record review of Resident Concern Report dated 11/11/23 written by RN E revealed concern filed on behalf of Resident #44. Nature of concern section revealed Resident #44 had complained of missing $40 cash and debit card that were in his drawer. This concern file was not included in the grievances provided to the survey team upon entrance on 11/14/2023. The concern file was provided to Surveyor on 11/15/2023 along with Grievance Form completed by SW on 11/14/2023. Record review of Grievance form dated 11/14/2023 initiated by SW revealed description [Resident #44] is reporting that he lost 40$ that his family member had taken the previous week. The money was inside a black bag inside the night dresser and noticed they were missing on Friday 11/10/2023, along with his bank card and 2 other cards. Section persons/ department contacted revealed nursing and administration on 11/15/2023. Summary findings were: 1- report was made by Weekend Supervisor on 11/11/2023. 2statements were received by staff on 11/11/2023. 3- a second grievance report was completed on 11/15/2023. 4- police report was file 5- money was reimbursed to him cash in amount of 40$ (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 7 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pending investigation. 6- incident reported to State Office on 11/15/2023 pending investigation. 7- [Resident #44] card was cancelled. 8- Food stamp card will be reported stolen. 9-an in-service on abuse and neglect, exploitation was completed on 11/15/23 and 11/16/23. During an interview on 11/14/2023 at 8:57 am, Resident #44 stated he reported missing money, debit card, and old coin on Saturday to Weekend Supervisor. Resident #44 stated he had his 40$, debit card, and old coin in a black bag that was placed inside the dresser at bedside. Resident #44 stated he noticed it was missing on Friday late evening and waited until Saturday (11/11/2023) to report because it was late. Resident #44 when he made the report of missing 40$, debit card, and old coin he was told by Weekend Supervisor he would write down the report on paper and report to the Administrator so she could further investigate it. Resident #44 stated as of today he was still waiting for the Administrator to give any update on the missing 40$, debit card, and old coin. Resident #44 stated he was concerned that the debit card could be used. Resident #44 stated he reported to CNA G yesterday (11/13/23) in the afternoon and was told she notified the Administrator immediately. During an interview on 11/14/2023 at 12:43 pm, CNA G stated she had worked with Resident #44 the day before (11/13/2023) and had told her that he was missing 40$ and a debit card. CNA G stated when Resident #44 reported the missing money and debit card it was at beginning of second shift around 2:30 pm and immediately called the Administrator to notify her. CNA G stated the Administrator had stated she had received the report the day before (11/12/2023) and had already started looking into it. During an interview on 11/15/2023 at 9:15 am, Resident #44 stated he had not yet received any updates from the Administrator. During an interview on 11/15/2023 at 3:19 pm, the Weekend Supervisor stated she had received a report from Resident #44 on Saturday 11/11/2023 of missing money and debit card. The Weekend Supervisor completed a concern file on behalf of Resident #44, obtained witness statements from LVN E and CNA F, and reported it to the Administrator via phone. The Weekend Supervisor stated she left the completed concern file for Resident #44 and witness statements for the Administrator, she did not mention where. During an interview on 11/15/2023 at 3:24 pm, the Administrator stated she had received a complaint from a nurse, who she could not remember, yesterday (11/14/2023) of missing 20$ from a resident on the 4th floor (Resident #44 was located on the 4th floor) but nothing regarding a debit card. The Administrator stated she reported to the SW since she was the Grievance Officer. The Administrator stated she reported missing money to the State Office depending on the amount that was alleged. The Administrator stated $20 would normally be refunded and dealt with in that way. The Administrator stated she had not reported Resident #44 missing money to State Office because it was only $20 missing that was reported. The Administrator stated she was not aware of debit cards and old coin were missing. During an interview on 11/15/2023 at 3:34 pm, the SW stated she had received a notification of Resident #44 ' s missing money yesterday (11/14/2023). The SW stated she had not yet started a Grievance file and she had 24 hours to initiate and report. The SW then looked at the clock in her computer and stated she would have to refer to her policy to determine the time frame for reporting. The SW stated she had not followed up with Resident #44 yet. During an interview on 11/16/2023 at 8:36 am, Resident #44 stated the facility had finally updated him on the missing money and was reimbursed money. Resident #44 stated he was still concerned about (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 8 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the delay due to him calling the bank and was notified the debit card had been used twice on Tuesday (11/14/2023) at a gas station for about 10$ on each transaction. Resident #44 stated the bank card was cancelled but was after it had already been used. During an interview on 11/16/2023 at 10:03 am, the Administrator stated she was not aware the witness statements were obtained on 11/11/2023 due to the Weekend Supervisor not leaving paperwork where she usually tended to. The Administrator did not answer if she had followed up with Weekend Supervisor on the missing money and debit card on Monday 11/13/2023, after the allegation was made on Saturday 11/11/2023. The Administrator stated after reviewing the completed concern form for Resident #44 on 11/11/2023, she saw missing debit card and reported to State Office. Record review of Grievances/Complaints policy dated April 2017 read in part Residents and their representatives have the right to file a grievance, either orally or in writing, to the facility staff or to the agency designated to hear grievances. The Administrator and staff will make prompt efforts to resolve grievances to the satisfaction of the resident and/or representative. The Administrator has delegated the responsibility of grievance and/pr complaint investigation to the Grievance Officer who is the SW. The Grievance Officer will coordinate actions with the appropriate state and federal agencies, depending on the nature of the allegations. All alleged violations of neglect, abuse and/or misappropriation of property will be reported and investigated under the guidelines for reporting abuse, neglect, and misappropriation of property, as per state law. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 9 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure the assessment accurately reflected the resident ' s status for 2 (Residents #7 and #22) of 23 residents reviewed for accuracy of MDS assessments. Residents Affected - Few - The facility failed to ensure that Resident #7 ' s MDS accurately reflected her refusal of care. - The facility failed to ensure that Resident #22 ' s MDS accurately reflected use of restraints. These failures could put residents at risk of not having their need for help with removal of facial hair or the use of bedrails assessed accurately . Findings included: Resident #7 Record review of Resident #7 ' s face sheet dated 11/17/2023 revealed she was an [AGE] year-old female, was initially admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #7 ' s History and Physical dated 03/31/2023 revealed she had dementia without behavioral disturbance, and fracture of the right femur (broken right thigh bone). She was alert and oriented times one (knew her name) and was confused and agitated. Record review of Resident #7 ' s quarterly MDS assessment dated [DATE] revealed her BIMS score was 6 (severe cognitive impairment). She had periods of inattention and disorganized thinking. She had no behavioral symptoms including rejecting care. She needed supervision/touching for personal hygiene, including assistance shaving. Record review of Resident #7 ' s Care Plan revealed she had adverse behaviors including refusing haircuts and refusing the Dental Program. Record review of Resident #7 ' s nurse's progress notes from 05/23/2023 to 11/16/23 revealed no instances of resident refusing baths or personal hygiene other than a haircut on 06/14/2023. Record review of Resident #7 ' s Point of Care bath flow sheet (where CNAs document assistance provided to residents) from 10/19/2023 through 11/17/2023 (30 days) revealed she was scheduled for baths on Mondays, Wednesdays and Fridays. She had refused baths 3 times and Not Applicable was documented five times. Record review of Resident #7 ' s Point of Care Personal Hygiene Flow sheet (documents hygiene assistance including) shaving from 10/19/2023 through 11/17/2023 (30 days) revealed she was scheduled for baths on Mondays, Wednesdays and Fridays. She had refused baths 3 times and Not Applicable was documented five times. Observation and interview on 11/14/23 at 09:06 AM, Resident #7 was observed to have stringy, uncombed hair, and had a large amount of facial hair on her chin and upper lip. The hair on her chin was about ¾ to 1 inch long and on her upper lip it was about ¼ inch long. When asked if she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 10 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0641 Level of Harm - Minimal harm or potential for actual harm received help with showering and personal care, she stated she was waiting for a shower that morning. She did not know which days she was scheduled to receive showers. When asked if she had gotten help removing facial hair, she acknowledged that she had facial hair and laughingly asked Am I a man? She said she would like the facial hair removed because it was embarrassing. She did not remember if removal of facial hair had been offered to her. Residents Affected - Few In observation and interview on 11/17/23 at 08:25 AM, Resident #7 was seated in a wheelchair in her room. She still had hair growth on her chin and upper lip that were noted on 11/14/2023 at 09:06 AM. When asked if the staff had offered to remove the facial hair on her chin and upper lip, she did not remember. In an interview on 11/17/23 at 08:31 AM, CNA C revealed Resident #7 had the tendency to refuse baths and to be shaved. CNA C said she recorded refusals using the refused prompt on the Point of Care flow sheets. She said she did not use not applicable to indicate the resident refused a service and did not know why it might have been used. In an interview on 11/17/23 at 03:42 PM, the DON when asked about Resident #7 ' s facial hair said Resident #7 had a history of refusing personal care. Resident #22 Record review of Resident #22 ' s face sheet dated 11/16/2023 revealed he was [AGE] years old, was initially admitted to the facility 04/09/2018, and readmitted on [DATE]. Record review of Resident #22 ' s History and Physical dated 08/31/2023 revealed he had a history of dementia with behavioral disturbance, anxiety, depression, paraplegia, and bed bound. Record review of Resident #22 ' s quarterly MDS assessment dated [DATE] revealed his BIMS was 11 (Moderate cognitive impairment). No restraints were documented on the MDS. The use of bed rails was not documented in the MDS section for restraints. Record review of Resident #22 ' s physician ' s orders revealed an order active between 08/31/2022 through 09/11/2023 that ¼ side rails were ordered to serve as enablers. His physician ' s order dated 07/18/2023 revealed an order for side rails as enablers. Record review of Resident #22 ' s care plan initiated 12/29/2022 revealed he required the use of bed enablers to help him with turning and repositioning within the bed or transfers in and out of bed. The goals for the enablers were for the resident to have a safe and comfortable bed and sleeping environment, to help maintain his functional ability by allowing him to sit at the edge of the bed or participate with his ADL's. Interventions initiated 12/29/2022 included assessing his need for enablers on a quarterly and as-needed basis to determine if he continued to meet the criteria for use of enablers. In observation on 11/14/23 at 11:08 AM, Resident #22 was lying in bed. It was observed that there were full bed rails attached to both sides of his bed. In an interview on 11/17/2023 at 10:00 AM, the MDS Nurse revealed restraints should have been reflected on Resident #22 ' s MDS. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 11 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete In an interview on 11/17/23 at 03:46 PM, the DON revealed she was not aware Resident #22 had full bed rails on his bed. She said if he could not get out of bed without assistance because of bed rails would be considered a restraint. She said the physician ' s order did not specify a diagnosis that the rails helped address. Record review of the facility ' s policy MDS Completion and Submission Time frame (dated July 2017) revealed the facility would conduct and submit resident assessments in accordance with current federal and state guidelines. Event ID: Facility ID: 675106 If continuation sheet Page 12 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to coordinate assessments with the pre-admission screening and resident review (PASARR) program for 4 (Resident #22, Resident #30, Resident #11 and Resident #237) of 23 residents reviewed for PASARR coordination. -The facility failed to ensure that Resident #22 ' s PASARR status was reviewed when he was given a new psychiatric diagnosis and prescribed antipsychotic medication -The facility failed to ensure that Resident #30 ' s PASARR status was reviewed when he received a new diagnosis and began receiving psychological services -The facility failed to submit a request for specialized services for Resident #11 in order for him to continue his therapy. -The facility failed to submit a request for initial specialized services for Resident #237. This failure could result in residents not receiving specialized services to address their unique needs. Findings included: Resident #22 Record review of Resident #22 ' s face sheet dated 11/16/2023 revealed he was [AGE] years old, was initially admitted to the facility 04/09/2018 and readmitted on [DATE]. Record review of Resident #22 ' s History and Physical dated 08/31/2023 revealed he had diagnoses including dementia w/behavioral disturbance, anxiety, depression, bipolar disorder, and depression. Record review of Resident #22 ' s quarterly MDS assessment dated [DATE] revealed his BIMS was 11 (Moderate cognitive impairment). He had no symptomatic behaviors. His diagnoses included bipolar disorder. He was receiving antipsychotics on a routine basis. Record review of Resident #22 ' s care plan initiated 09/01/2020 revealed the resident had a diagnosis of Depression/Bipolar disorder. He was at risk for fluctuation in moods, little interest or pleasure in doing things, and decreased socialization. He also displayed aggressive and combative behaviors. He was receiving Risperidone, an antipsychotic medication. His care plan initiated 04/12/2023 revealed he used psychotropic medications Risperdal and Wellbutrin for Bipolar Disorder and Depression. Record review of Resident #22 ' s medication recap of physician ' s orders dated 11/17/2023 revealed Resident #22 had orders to receive risperidone (an antipsychotic) to treat bipolar disorder beginning on 08/31/2022, and an active order in place for risperidone for bipolar disorder dated 08/08/2023. Record review of Resident #22 ' s PASSAR PL1 dated 4/9/2018 documented that there was no evidence (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 13 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0644 that the resident had mental illness. Level of Harm - Minimal harm or potential for actual harm In an interview on 11/16/2023 5:02 PM, the MDS Nurse revealed that no PASSAR evaluation was done for Resident #22. Residents Affected - Some In an interview on 11/17/23 at 04:21 PM, the MDS Nurse revealed that the administration of a new antipsychotic medication should have triggered a rescreen of Resident #22 for PASSAR. She stated the risk of not having an PASSAR evaluation done was that the resident might not receive specialized services for which he qualified. Resident #30 Record review of Resident #30 ' s face sheet dated 11/16/2023 revealed he was [AGE] years old, was initially admitted to the facility on [DATE], and readmitted on [DATE]. Record review of Resident #30 ' s electronic diagnosis listing revealed a diagnosis on 08/05/2020 of delusional disorders. Record review of Resident #30 ' s History and Physical dated 09/06/2023 revealed he had diagnoses including Delusional Disorder. Record review of Resident #30 ' s annual MDS dated [DATE] revealed his BIMS was 14 (Cognitively intact). He had signs of delirium including intermittent inattention and disorganized thinking. He had no behavioral symptoms indicating psychosis. His diagnoses included non-Alzheimer's dementia, depression and a psychotic disorder other than schizophrenia. Record review of Resident #30 ' s quarterly MDS dated [DATE] revealed his BIMS was 12 (Moderate cognitive impairment). He had no signs of delirium. He had no behavioral symptoms indicating psychosis. His diagnoses included non-Alzheimer's dementia, depression and a psychotic disorder other than schizophrenia. Record review of Resident #30 ' s electronic Care plan revealed it did not contain a care plan specific to delusional disorder or psychotic disorder other than schizophrenia. Record review of Resident #30 ' s electronic record revealed an initial psychological assessment by a local provider on 1/24/2022 and continued bi-monthly service provision of psychological services through 10/12/2023. Record review of Resident #30 ' s PASSAR Level I screening revealed it was conducted on 03/14/2018. No evidence was found that the resident had mental illness. Record review of Resident #30 ' s electronic chart revealed no completion of a Level II PASSAR Evaluation. In an interview on 11/16/2023 at 5:02 PM, the MDS Nurse revealed that no Level II PASSAR Evaluation Level II was done for Resident #30. In an interview on 11/17/23 at 04:08 PM, the MDS Nurse revealed that Resident #30 ' s referral for psychological services should have triggered a reassessment for PASAAR services. She said if a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 14 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0644 Level of Harm - Minimal harm or potential for actual harm person was PASSAR positive (had mental illness diagnosis and/or intellectual/developmental disability qualifying them for specialized PASSAR Services). and was not assessed they were at risk of losing services. She revealed that she took the MDS nurse position in January of 2023 and there was no process in place to review the status of residents with changes in their condition who should be re-screened for PASSAR eligibility. Residents Affected - Some In an interview on 11/17/23 at 05:29 PM, the Administrator revealed she was not aware there was no process to review residents who became PASSAR eligible before the new MDS nurse took over. She said the risk to residents meeting PASSAR criteria was that they would not receive specialized services. The Administrator said the facility did not have PASSAR policies but followed state and federal guidelines. Resident #11 Record review of Resident #11 ' s face sheet dated 11/17/2023 revealed a [AGE] year-old male with an initial date to the facility of 05/16/2008, and at re-admission date of 07/02/2022. Record review of Resident #11 ' s History and Physical dated 08/31/2023 revealed a diagnosis of intellectual disabilities and psychosis. Record review of Resident #11 ' s electronic diagnosis list undated revealed a diagnosis of intellectual disabilities and psychosis. Record review of Resident #11 ' s Comprehensive MDS assessment dated [DATE] revealed Resident #11 was considered PASRR positive due to intellectual disabilities. He had a BIMS score of 1 indicating he had a severe cognitive impairment. Record review of Resident #11 ' s comprehensive care plan initiated on 06/13/2018 revealed Resident #11 had been identified as having PASRR positive status related to an intellectual/developmental disability. The goal was to maintain the highest level of practicable well-being for the next 90 days. Interventions included inviting the LIDDA representative and responsible party to the quarterly care plan meeting to discuss my function status, provide the Habilitative Services as authorized and report any need to evaluate for habilitative services. Record review of Resident #11 ' s Habilitative Service Plan dated 03/23/2023 revealed a customized manual wheelchair was needed and would be requested. Record review of Resident #11 ' s NFSS CMWC dated 08/21/2023 revealed the required signatures from therapist, physician and administrator were completed. Record review of Resident #11 ' s NFSS CMWC dated 08/31/23 revealed the required signatures from therapist, physician and administrator were completed. Record review of PASRR HHSC Out of compliance report April 2023 revealed Resident #11 needed a CMWC and the facility had to submit a NFSS form in LTC portal by 8/21/2023. It also revealed the NFSS form had not been submitted by the deadline. In an interview on 11/17/2023 at 9:09 AM with MDS Nurse revealed she has been working for over a year, and she was responsible for coordinating PASRR services with the Local Authority. She stated if (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 15 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some a resident was PASRR positive, the local authority would set up meetings with the facility to discuss plan of care, medical equipment needed and therapies. She stated the needs were addressed based on a residents ' diagnosis and functional ability. She said there had been a confusion on who was supposed to order the mechanical chair for Resident #11. She revealed she was not aware she had to order it. She revealed someone from the local authority (unknown) told her she had to submit a request for the chair. She stated the request was initially submitted on 08/21/2023, however it was done with the NP signature and not the MD. Therefore, it got resubmitted on 08/31/2023. She denied being told that she had to submit the NFSS form by a certain date or that there was a deadline. She stated the importance of submitting the request for services was to ensure the resident received the specialized services needed. Resident #237 Record review of Resident #237 ' a face sheet dated 11/17/2023 revealed a [AGE] year-old male with an admission date to the facility of 10/07/2022. Record review of Resident #237 ' s History and Physical dated 09/19/2022 revealed a diagnosis of an intellectual disability. Record review of Resident #237 ' s electronic diagnosis list undated revealed a diagnosis of intellectual disabilities and epilepsy. Record review of Resident #237 ' s Comprehensive MDS dated [DATE] revealed a BIMS was not conducted due to Resident #237 not understanding. The assessment revealed he had been considered by the state level II PASRR process to have serious mental intellectual disability. The PASRR conditions listed were Intellectual Disability and epilepsy. Record review of Resident #237 ' s Habilitative assessment dated [DATE] revealed Resident #237 needed specialized occupational therapy, specialized speech therapy, and specialized physical therapy. Record review of PASRR HHSC Out of compliance report November 2023 revealed Resident #237 needed specialized therapies and the facility had to submit a NFSS form in LTC portal by 02/09/2023 to request for those services. It also revealed the NFSS form had not been submitted by the deadline. In a follow-up interview on 11/17/2023 at 9:38 AM with MDS Nurse she revealed the facility had a care plan meeting on 01/24/2023 but she was not aware that the request for services had not been completed. She revealed based on the assessment, Resident #237 would require a specialized OT assessment, specialized OT therapy, specialized ST assessment, specialized PT assessment, and specialized PT therapy. She stated although he was receiving rehabilitative therapy, she had not noticed that he was not receiving his required specialized therapy. She could not state why she had not submitted a request for Resident #237 ' s services. She revealed the negative effect on the residents if they did not receive their specialized care could be decrease in ADL function, and overall decline in health. In a follow-up interview on 11/17/2023 at 4:52 PM with MDS Nurse, she revealed the facility did not have a policy on PASRR and used the Preadmission Screening and Resident Review Mental Illness Handbook as guidance. In an interview on 11/17/2023 at 2:58 PM with the DON revealed it was important to ensure PASRR services were provided to residents because their care should be tailored to their needs. She also (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 16 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete revealed the facility had to ensure if they were accepting residents with PASRR diagnosis they would be able to fulfill their needs. Record review of Preadmission Screening and Resident Review Mental Illness Handbook: Provision of Mental Illness Specialized Services revised on August 25, 2020, read in part . the NF is responsible for the successful submission of a complete and accurate prior authorization request for NF specialized services in the Long-Term Care Online Portal (LTCOP) within 20 business days after the date of the IDT meeting . Event ID: Facility ID: 675106 If continuation sheet Page 17 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 observation, interview, and record review, the facility failed to develop and implement comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident medical and nursing needs to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 2 of 27 residents (Resident #13 and Resident #237) reviewed for care plans in that: - The facility failed to include Resident #13 ' s smoking on his care plan. - The facility failed to include in Resident #237 ' s comprehensive care plan that he was PASSAR positive (had mental illness diagnosis and/or intellectual/developmental disability qualifying him for specialized PASSAR Services). This deficient practice could place residents in the facility at risk of not receiving the necessary care or services and not having personalized plans developed to address their needs. Findings include: Resident #13 Record review of Resident #13 ' s face sheet revealed he was [AGE] years old and was admitted to the facility on [DATE]. Record review of Resident #13 ' s electronic diagnosis listing revealed he had diagnoses including dementia and Alzheimer ' s disease. Record review of Resident #13 ' s quarterly MDS assessment dated [DATE] revealed he had a BIMS score of 6 (severe cognitive impairment). He had intermittent periods of inattention and disorganized thinking. He required substantial/maximal assistance for eating, oral hygiene, and personal hygiene. He had diagnoses including dementia and Alzheimer ' s disease. Record review of Resident #13 ' s Care Plan accessed 11/17/2023 revealed no care plan for smoking. An intervention to address hypertension was to warn him of the dangers of smoking. Record review of the undated Smoking List (received from the Administrator on 11/14/2023) revealed that Resident #13 was on the smoking list. Record review of Resident #13 ' s Smoking Risk assessment dated [DATE] documented that Resident #13 required a smoking apron, someone to light his cigarette for him, that he might not be able to handle or carry smoking materials and required supervision when smoking. Observation on 11/17/23 at 9:46 AM of the facility ' s outside smoking area revealed that Resident #13 was smoking and was wearing a smoking apron. Staff were present and were monitoring residents ' smoking. In an interview on 11/17/23 at 03:45 PM, the DON if a resident is a smoker this should be on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 18 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 care plan. Level of Harm - Minimal harm or potential for actual harm Record review of the facility ' s document Smoking Schedule for Residents (undated) stated Residents should have a smoking contract signed, evaluation completed and a doctor ' s order prior to smoking. Residents Affected - Some Resident #237 Record review of Resident #237 ' a face sheet dated 11/17/2023 revealed a [AGE] year-old male with an admission date to the facility of 10/07/2022. Record review of Resident #237 ' s History and Physical dated 09/19/2022 revealed a diagnosis of an intellectual disability and a history of colostomy use. Record review of Resident #237 ' s electronic diagnosis list undated revealed a diagnosis of intellectual disabilities and epilepsy. Record review of Resident #237 ' s Comprehensive MDS dated [DATE] revealed a BIMS was not conducted due to Resident #237 not understanding. The assessment revealed he had been considered by the state ' s level II PASRR process to have a serious mental intellectual disability. The PASRR conditions listed were Intellectual Disability and Epilepsy. Record review of Resident #237 ' s PASRR Level 1 screening dated 10/07/2022 revealed Resident #237 had an intellectual disability and a development disability. Record review of Resident #237 ' s PASRR Evaluation dated 10/11/2022 revealed Resident #237 was PASRR positive. Record review of Resident #237 ' s comprehensive care plan dated 01/18/2023 revealed no documentation of Resident #237 ' s positive PASSAR status. An interview on 11/17/2023 at 4:43 PM with the MDS Nurse revealed a comprehensive care plan had to have information that was discussed in the care plan meetings. She revealed it had to include anything that pertained to the residents ' care to ensure their safety such as incontinent care, behaviors, or ADL needs. She stated the PASSAR positive status should have been in Resident #237 ' s care plan because the care plan should have covered all of his needs. She stated if the nurse was to use the care plan to plan the needs of the residents, it would not be accurate. An interview on 11/17/23 at 3:07 PM with the DON revealed Resident#237 ' s positive PASSAR status should have been on the care plan because the care plan was meant to tell the story of the resident and their social needs. Record review of facility policy titled Goals and Objectives, Care Plans revised April 2009 read in part Care plans shall incorporate goals and objectives that lead to the resident ' s highest obtainable level of independence .care plan goal and objectives are derived from information contained in the resident's comprehensive assessment and: are resident oriented, are behaviorally started, any measurable and contain timetables to meet the resident ' s needs in accordance with the comprehensive assessment . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 19 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 observations, interviews, and record review, the facility failed to ensure that residents are unable to carry out activities of daily living receive the necessary services to maintain good grooming for 1 (Resident #7) of 23 residents reviewed for quality of life. Residents Affected - Few The facility failed to ensure that Resident #7 did not have facial hair on her chin and upper lip. This failure put residents at risk of embarrassment and a negative self-image. Findings included: Resident #7 Record review of Resident #7's face sheet dated 11/17/2023 revealed she was an [AGE] year-old female, was initially admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #7's History and Physical dated 03/31/2023 revealed she had dementia without behavioral disturbance, and fracture of the right femur (broken right thigh bone). She was alert and oriented times one (knew her name) and was confused and agitated. Record review of Resident #7's quarterly MDS assessment dated [DATE] revealed her BIMS score was 6 (severe cognitive impairment). She had periods of inattention and disorganized thinking. She had no behavioral symptoms including rejecting care. She needed supervision/touching assistance to bathe and for personal hygiene such as shaving. Record review of Resident #7's Care Plan revealed she had adverse behavior including refuses haircuts and the Dental Program. Record review of Resident #7's nurse's progress notes from 05/23/2023 to 11/16/23 revealed no instances of resident refusing baths or personal hygiene other than a haircut. Record review of Resident #7's Point of Care Bath Flow sheet (where CNAs document assistance provided to residents) from 10/19/2023 through 11/17/2023 (30 days) revealed she was scheduled for baths on Mondays, Wednesdays and Fridays. She had refused baths 3 times and Not Applicable was documented five times. Her last bath was documented on 11/03/2023. Record review of Resident #7's Point of Care Personal Hygiene Flow sheet (documents hygiene assistance including) shaving from 10/19/2023 through 11/17/2023 (30 days) revealed she was scheduled for baths on Mondays, Wednesdays and Fridays. She had refused baths 3 times and Not Applicable was documented five times. Observation and interview on 11/14/23 at 09:06 AM Resident #7 was observed to have stringy hair and hair growing on her chin and upper lip. The hair on her chin was about ¾ to 1 inch long and on her upper lip it was about ¼ inch long. When asked if she received help with showering and personal care, she stated she was waiting for a shower that morning. She did not know which days she was scheduled to receive showers. When asked if she had gotten help removing facial hair, she acknowledged that she had facial hair and laughingly asked Am I a man? several times. She said she would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 20 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 like the facial hair removed. She did not remember if removal of facial hair had been offered to her. Level of Harm - Minimal harm or potential for actual harm In an interview on 11/17/23 at 08:31 AM, CNA C revealed Resident #7 had the tendency to refuse baths and to be shaved. CNA C said she recorded refusals using the refused prompt on the Point of Care flow sheets. She said she did not use not applicable to indicate the resident refused a service and did not know why it might have been used. Residents Affected - Few In observation and interview on 11/17/23 at 08:25 AM Resident #7 was seated in a wheelchair in her room. She still had hair growth on her chin and upper lip that were noted on 11/14/2023 at 09:06 AM. When asked if the staff had offered to remove the facial hair on her chin and upper lip, she did not remember. In an interview on 11/17/23 at 03:42 PM, the DON said the CNAs were trained to shave male residents. She said assistance removing facial hair would be provided to female residents if requested. The DON said that if she (the DON) had facial hair, she would ask for help removing it. She stated that she had known women who did not want their facial hair removed. She said it would depend on the female resident and that there were dignity issues involved in asking about shaving as well as well as not having facial hair removed. She stated that Resident #7 had a history of refusing personal care. Documentation of Resident #7 refusing assistance with personal care was requested but was not received prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 21 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents who are continent of bladder receives services and assistance to maintain continence for one (Residents # 19) of 23 residents reviewed for bladder incontinence. The facility failed to ensure that Resident #19 ' s oxygen tubing was long enough for her to walk to the bathroom, resulting in increased instances of urinary incontinence. This failure put residents at increased risk of urinary tract infections, urinary incontinence, embarrassment, and a negative self-image. Findings included: Resident #19 Record review of Resident #19 ' s face sheet dated 11/16/2023 revealed she was [AGE] years old, was initially admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #19 ' s History and Physical dated 03/31/2023 revealed she had diagnoses including congestive heart failure, acute respiratory failure with hypoxia (a condition where lungs cannot provide enough oxygen to the blood), respiratory neoplasm (lung cancer) and overactive bladder. She was wearing a nasal canula (a thin plastic tube with two prongs for insertion into the nose). She was to continue to receive supplemental oxygen as needed via the nasal cannula. Record review of Resident #19 ' s quarterly MDS assessment dated [DATE] revealed she had a BIMS score of 15 (cognitively intact). She needed substantial/maximal assistance to use the toilet. She was occasionally incontinent of bowel or bladder. Her diagnoses included respiratory failure, chronic respiratory failure with hypoxia, and dependence on supplemental oxygen. She had shortness of breath with exertion, sitting at rest and when lying flat. She was receiving diuretics (water pills). She was receiving oxygen therapy. Record review of Resident #19 ' s physician ' s order dated 01/13/2021 revealed she was to receive 2 liters of oxygen per minute continuously via a nasal canula to treat shortness of breath. Record review of Resident #19 ' s Care plan dated 01/13/2021 revealed she was to receive continuous oxygen due to Congestive Heart Failure (when the heart can ' t pump enough blood to the body). She was at risk for UTIs and skin breakdown due to overactive bladder and mixed urinary incontinence (incontinence due to a combination of problems that lead to leakage issues). Record review of Resident #19 ' s Bladder Program flow sheet from 11/18/2023 back 30 days revealed she consistently used the toilet without soiling her undergarment from 10/19/2023 - 10/30/2023. On 10/30/23, 10/31/2023 and 11/01/2023 she had a total of six occasions when she wet or soiled her undergarment. In an interview and observation on 11/14/23 at 09:25 AM, Resident #19 revealed that for 2 months her oxygen tubing had been too short to reach the bathroom, so she sometimes started urinating on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 22 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few way to the bathroom. She explained that she had to remove the tubing before going to the bathroom, which slowed her down. She said she used to have tubing that was long enough to reach from her bed into the bathroom, but that the tubing was changed out, and the new tubing was too short. She said she felt upset and humiliated when this happened. She said she had asked the nurse to get her longer tubing, but the nurse said they did not have more long tubing. The tubing that was attached to Resident #19 ' s oxygen concentrator was observed to be too short to allow the resident to move from the bed to the bathroom without removing the oxygen tubing. In an interview on 11/14/23 at 09:35 AM, LVN H revealed that Resident #19 could go to the bathroom on her own. The LVN stated Resident #19 was on continuous oxygen. She said Resident #19 ' s long oxygen tubing had been changed to shorter oxygen tubing because the resident had tripped and fallen over the longer tubing. LVN H said Resident#19 had been instructed not to go to the bathroom on her own and to call for help when she needed to use the bathroom. LVN H acknowledged that if the resident followed instructions, she would have to wait for staff response, which could result in Resident #19 urinating in her brief. The LVN said that urinating or soiling herself might result in embarrassment and decreased sense of dignity. The LVN said holding urine too long could cause a urinary tract infection, but that Resident #19 had not had any UTIs. In an interview on 11/14/2023 at 9:40 AM, Resident #19 denied having fallen due to tripping over longer oxygen tubing. Record review of Resident #19 ' s progress notes from 01/17/2023 to 11/16/2023 revealed a note dated 03/04/2023 stating that staff were concerned that the resident might fall due to several factors including a long nasal cannula on the floor. No other notes linking a long cannula to falls was found. In an interview on 11/17/23 at 08:31 AM, CNA C revealed that Resident #19 was able to get out of bed and go to the bathroom by herself. The CNA said the resident had not been incontinent of urine when CNA C was providing care. In an interview on 11/17/23 at 03:36 PM, the DON revealed that the facility carried one length of oxygen tubing. She said this was because the longer tubing could have increased the risk of falls. She said if a resident asked for longer tubing, the request would be honored. The DON said she was not aware that Resident #19 had requested longer oxygen tubing. She did not recall longer oxygen tubing being present in the facility. The facility policy Oxygen Administration dated 10/2010 did not address the length of oxygen tubing to be used. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 23 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that residents who need respiratory care are provided such care, consistent with professional standards of practice for 3 (Residents #4, #19, and #22) of 9 Residents reviewed for oxygen usage. Residents Affected - Few The facility failed to ensure that Residents #4, #19, and #22 ' s oxygen concentrators had clean filters. This failure could put residents at increased risk of breathing in dust and allergens and of decreased effectiveness of oxygen concentrators. Findings include: Resident #4 Record review of Resident #4 ' s face sheet dated 11/16/2023 revealed she was [AGE] years old, was initially admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #4 ' s History and Physical dated 03/13/2023 revealed she had diagnoses including hypoxemia (low levels of oxygen in the blood). Supplemental oxygen was to be given as needed via nasal cannula (a thin plastic tube with two prongs for insertion into the nose). Record review of Resident #4 ' s quarterly MDS dated [DATE] revealed she had diagnoses including hypoxemia. The MDS did not indicate she was receiving oxygen treatments. Record review of Resident #4 ' s Care Plan dated 10/01/2017 revealed she was at risk for respiratory infections, distress, or failure related to episodes of hypoxia or hypoxemia (not enough oxygen in the blood, shortness of breath or cough/congestion. She was to receive oxygen as ordered. Record review of Resident #4 ' s physician ' s order dated 09/26/2023 revealed she was to receive two liters of oxygen via nasal cannula as needed if she was short of breath, had hypoxia (a condition where lungs cannot provide enough oxygen to the blood), or her oxygen blood concentration (a measure of oxygen in the blood) fell below 90%. Observation on 11/14/2023 at 3:11 PM of Resident #4 revealed she was wearing a nasal canula attached to an oxygen concentrator. Observation of the oxygen concentrator filter revealed it was covered with a layer of white powder. Resident #19 Record review of Resident #19 ' s face sheet dated 11/16/2023 revealed she was [AGE] years old, was initially admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #19 ' s History and Physical dated 03/31/2023 revealed she had diagnoses including congestive heart failure, acute respiratory failure with hypoxia (a condition where lungs cannot provide enough oxygen to the blood), and respiratory neoplasm (lung cancer). She was wearing a nasal canula (a thin plastic tube with two prongs for insertion into the nose). She was to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 24 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 continue to receive supplemental oxygen as needed via the nasal cannula. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #19 ' s quarterly MDS dated [DATE] revealed she had a BIMS of 15 (Cognitively intact). Her diagnoses included respiratory failure, chronic respiratory failure with hypoxia, and dependence on supplemental oxygen. She had shortness of breath with exertion, sitting at rest and when lying flat. She was receiving oxygen therapy. Residents Affected - Few Record review of Resident #19 ' s physician ' s order dated 01/13/2021 revealed she was to receive 2 liters of oxygen per minute continuously via a nasal canula to treat shortness of breath. Record review of Resident #19 ' s Care plan dated 01/13/2021 revealed she was to receive continuous oxygen due to Congestive Heart Failure (when the heart can ' t pump enough blood to the body). In observation on 11/14/23 at 09:32 AM Resident #19 was seated in bed with a nasal canula in place which was attached to an oxygen concentrator. Observation of the two black sponge filters on the oxygen concentrator revealed that they were both covered with fine white powder with larger flecks of a white material. Resident #22 Record review of Resident #22 ' s face sheet dated 11/16/2023 revealed he was [AGE] years old, was initially admitted to the facility 04/09/2018 and readmitted on [DATE]. Record review of Resident #22 ' s History and Physical dated 08/31/2023 revealed he had diagnoses including asthma and was to be given supplemental oxygen as needed via nasal cannula. Record review of Resident #22 ' s quarterly MDS assessment dated [DATE] revealed his BIMS was 11 (Moderate cognitive impairment). He was receiving oxygen therapy. Record review of Resident #22 ' s care plan initiated 09/01/2020 revealed the resident had oxygen therapy due to a diagnosis of COPD. The care plan revealed he was to have continuous oxygen via nasal cannula at 3 ml per minute. His care plan initiated on 10/07/2022 revealed he was at risk for respiratory infections/distress, Hypoxia, SOB, and cough related to the diagnosis of COPD (disease that block airflow and make it difficult to breathe). Record review of Resident #22 ' s medication recap of physician ' s orders revealed Resident #22 had an active order beginning 09/01/2022 to receive oxygen at 3 LPM/ via nasal cannula every shift for respiratory compromise/hypoxia/shortness of breath. Observation on 11/14/2023 at 11:00 AM revealed that the grey foam filter on his oxygen concentrator was black with accumulated dust and grime. In an interview on 11/14/2023 at 09:35 AM LVN H Revealed that changing of oxygen filters was done by central supply. In an interview on 11/17/2023 03:31 PM the DON revealed it was the duty of the nurses to remove the black foam oxygen concentrator filter and rinse it on a weekly basis. This was done to ensure the filter is clean because it could affect the concentrator ' s proper function. With dirty filters dust could get into the oxygen being administered to the residents. Cleaning the oxygen filters was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 25 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete documented on the MAR. She (the DON) and ADON did spot checks to verify that filters were being done. The DON stated there was nothing in infection control policies that addressed cleaning or changing oxygen concentrator filters. Record review of the user manual for oxygen concentrators revealed to avoid damage to the internal components of the concentrator, don ' t operate it with a dirty filter. Clean the cabinet filter with a vacuum clearer or wash with water. Rinse thoroughly. Event ID: Facility ID: 675106 If continuation sheet Page 26 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents were free from any physical restraints that are not required to treat the resident's medical symptoms for 1 (Resident #22) of 23 residents reviewed for restraints. The facility failed to ensure Resident #22 had an evaluation, consent, and correct orders for the bed rails that were on his bed. This failure put residents at risk of unnecessary restraints on their movement. Findings included: Resident #22 Record review of Resident #22 ' s face sheet dated 11/16/2023 revealed he was [AGE] years old, was initially admitted to the facility 04/09/2018 and readmitted on [DATE]. Record review of Resident #22 ' s History and Physical dated 08/31/2023 revealed he had a history of paraplegia (paralysis of the whole body) and was bed bound. Record review of Resident #22 ' s quarterly MDS assessment dated [DATE] revealed his BIMS score was 11 (moderate cognitive impairment). He had no symptomatic behaviors. He was dependent on staff for toileting, bathing, lower body dressing, and personal hygiene. He was dependent on staff to roll to the right and left, to sit up from lying, from lying to sitting on side of bed, and for transfers. His diagnoses included paraplegia. Use of bed rails was not documented in the MDS section for restraints. Record review of Resident #22 ' s care plan dated 12/29/2022 revealed he required the use of bed enablers to help him with turning and repositioning within the bed or transfers in and out of bed. The goals for the enablers were for the resident to have a safe and comfortable bed and sleeping environment, to help maintain his functional ability by allowing him to sit at the edge of the bed or participate with my ADL ' s. Interventions initiated 12/29/2022 included assessing his need for enablers on a quarterly and as-needed basis to determine if he continued to meet the criteria for use of enablers. Record review of Resident #22 ' s physician ' s orders revealed an order active between 08/31/2022 through 09/11/2023 that ¼ side rails were ordered to serve as enablers. His physician ' s order dated 07/18/2023 revealed an order for side rails as enablers. Record review of Resident #22 ' s electronic medical record revealed no documentation of an assessment for enablers or side rails. No consent for enablers or side rails were found upon review of his medical records. In an observation and interview on 11/14/23 at 11:08 AM, Resident #22 was lying in bed. It was observed that there were full bed rails attached to both sides of his bed. The rails extended from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 27 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few within 7 inches of the foot of the bed to within 7 inches of the head of the bed. When asked what the rails were for the resident stated they were used so he did not fall. In an interview on 11/17/23 at 08:45 AM, CNA C revealed that Resident #22 had side rails on his bed so he would not fall. She said he had the rails since December 2022 when she started working at the facility. She said he would grab the rails to help with dressing and brief changes. In an interview on 11/17/23 at 03:46 PM the DON revealed she was not aware resident #22 had full bed rails. She said if the resident could not get out of bed without assistance because of the bed rails the would be would be considered a restraint. She reviewed the physician's order for the bed rails and stated the orders did not speciify a diagnosis the rails were to help address. Record review of the facility policy Use of Restraints dated 12/2007 revealed in part that a restraint was any physical or mechanical device, material or equipment adjacent to the resident ' s body that the individual cannot remove easily, which restricts freedom of movement. Restraints can only be used if there is a specific medical symptom that cannot be addressed by another less restrictive intervention and is required to treat the medical symptom, protect the resident ' s safety and help the resident attain the highest level of his/her wellbeing. Prior to placing a resident in restraints there shall be a pre-restraining assessment. Restraints shall only be used upon written order from the physician and after obtaining consent from the resident and/or representative. The order shall include the specific reason for the restraint as it relates to the resident ' s medical symptom, how the restraint will be used to benefit the resident ' s medical symptom, and the type of restraint and the period of time for the use of the restraint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 28 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of 1 resident (Resident #62) of 4 reviewed for medication orders. The facility failed to re-order pain medication for Resident # 62 after the blister pack had been completed. The facility failed to remove insulin from medication on the second floor for a resident that was moved to the third floor on 10/12/23. The facility failed to remove medications from medication carts when residents were discharged to the hospital. This deficient practice could result in a decline in health if medication was not ordered for residents when needed. Findings included: Resident #62 Record review of Resident #62 ' s face sheet dated 11/17/2023 revealed a [AGE] year-old male with an admission date to the facility of 12/12/2022. Record review of Resident #62 ' s undated electronic diagnosis list revealed a diagnosis of chronic pain syndrome. Record review of Resident #62 ' s History and Physical dated 12/3/2022 revealed a diagnosis of alcoholic liver cirrhosis with ascites (liver failure with fluid buildup) and a history of pain causing for treatment of paracentesis (removal of fluid from the abdomen). Record review of Resident #62 ' s Quarterly MDS assessment dated [DATE] revealed a BIMS score of 11 indicating he had a moderate cognitive impairment. The assessment also revealed he had received PRN pain medication and was receiving an opioid. Record review of Resident #62 ' s comprehensive care plan dated 10/31/2023 revealed Resident #62 was at risk for alteration in comfort, and at risk for pain presence related to chronic back pain. The goal was to have discomfort and or pain maintained at expressed acceptable level. Interventions included to administer pain medications as ordered by physician and assess effectiveness and monitor for pain every shift to ensure routine/prn pain medication is adequate in meeting residents stated or unstated pain goal. Record review of Resident #62 ' s physician order dated 02/27/2023 revealed Tramadol HCl oral tablet 50 mg give 1 tablet by mouth every 8 hours as needed for pain. Record review of emergency drug inventory report for the facility dated 11/15/2023 revealed there (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 29 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0755 were 11 Tramadol 50 mg pills available in the facility. Level of Harm - Minimal harm or potential for actual harm Record review of narcotic count sheet for the months of August 2023 and September 2023 revealed he had last received a dose from the blister pack on September 8th, 2023, and it was the last pill of the blister pack. Residents Affected - Some Record review of October 2023 MAR revealed he received a Tramadol pill two times in the month of October. In an interview on 11/14/23 at 09:36 AM with Resident #62 he revealed he used to take Tramadol and had not received it in a while, stating that it was not available. He stated he got pain once in a while, but not always. He denied needing pain medication currently but would like to know that the medication was available if he needed it. Observation on 11/16/23 at 11:04 AM of the medication cart revealed there was no Tramadol blister pack corresponding to Resident #62. An interview on 11/16/23 at 11:05 AM with LVN A revealed there was not a blister pack of Tramadol for Resident #62 but stated he had not been having pain. She stated she should have re-ordered the medication through the pharmacy before he had run out. She revealed since he had not been complaining of pain or asked for the medication, she did not order the medication. She revealed if he was to complain of pain, she could take a dose from the emergency dispensing kit. She stated she should have taken the residents' identifier slip from the blister pack and added it to the re-ordering binder in order to keep track of what had to be ordered. She revealed the risks to the residents if their medication was not available could be they would have pain. An interview on 11/16/23 at 4:30 PM with LVN B revealed Resident #62 had not been asking for pain medication and had not complained of pain. He stated he thought the medication might have been discontinued. LVN B denied that Resident #62 had asked for pain medication. He stated the process for re-ordering medication was for the nurse to call the pharmacy in order to renew the order. He stated he thought he had ordered the medication but could not remember. He stated the importance of ensuring the medication was re-ordered was to ensure the resident would not be in pain. An interview on 11/17/23 at 2:38 PM with DON revealed if the medication was not ordered on time, the emergency kit was available. She revealed the process for re-ordering medication was for the nurse to notify the pharmacy about the medication. If the pharmacy was called in the morning, the medication would be delivered that same day. She revealed if the medication was not available as a blister pack, it could be pulled from the emergency kit at the facility. She stated there was no risk to the residents because the medication could be pulled from the emergency kit. She stated the facility did not have a policy on re-ordering medications. Observation and interview 11/14/23 at 10:49 AM with LVN L reported revealed there were medication blister packets for two residents that had been discharged to the hospital. The nurse stated, Medications are kept in the medication cart for 7 days and if the residents do not return from the hospital within that time frame, the medications are removed from them medication cart and placed in locked cabinet in medication room pending drug destruction. Interview with Director of Nursing (DON) 11/14/23 at 11:10 AM, revealed medications are kept in the medication carts when residents are discharged to the hospital and are pending readmission. If the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 30 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0755 residents do not return the medications will be removed from the medication carts and stored in locked medication cabinets pending drug destruction. 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: 675106 If continuation sheet Page 31 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs and biological were stored in locked storage area and to limit access to authorized personnel for 3 of 3 rooms reviewed for medication storage. -The facility failed to ensure all drugs and biologicals were stored in locked storage area and limited access to authorized personnel. -The facility failed to permanently attach metal box containing controlled substances to the refrigerator rack for 2 of 3 medication refrigerators. The facility's failure could place residents at risk for not receiving prescribed medications as ordered and risk for drug diversion. Findings included: Observation and interview on 11/14/23 at 10:30 AM with LVN J revealed facility did not have designated medication room on any of the floors. The nurse stated there was a room behind the nurse's station on each floor where they kept a locked cabinet to store discontinued medications, OTC (over the counter medications) floor stock, extra medication blister packets, and a locked medication refrigerator to store medications that required refrigeration. The nurse unlocked the refrigerator to show the surveyor -controlled substances were kept in a locked box in the refrigerator. It was observed locked metal box was not permanently attached to the refrigerator metal rack. The nurse stated facility only had one automated dispensing cabinet used for emergencies for the whole facility and was stored in the room on the second floor. He reported that only the nurses could remove medications from the automated dispensing cabinet by entering a security code. The nurse reported the door to the room was kept unlocked for staff to use the copy machine, get personal care products and other nursing supplies as needed. Staff would go in and out of the room while observation was being conducted. Observation and interview on 11/14/23 at 10:45 AM with LVN K revealed facility did not have a designated medication room. The nurse stated there was a room behind the nurse's stations, where they kept medications in a locked cabinet and a locked medication refrigerator. The nurse reported the door to the room was kept unlocked for staff to use the copy machine, get personal care products and other nursing supplies as needed. It was observed that the door was opened and there was a locked medication cabinet and locked medication refrigerator. Observation and interview 11/14/23 at 10:49 AM with LVN L reported revealed there were medication blister packets for two residents that had been discharged to the hospital. The nurse stated, Medications are kept in the medication cart for 7 days and if the residents do not return from the hospital within that time frame, the medications are removed from them medication cart and placed in locked cabinet in medication room pending drug destruction. Observation and interview 11/14/23 11:00 AM with LVN L revealed facility did not have a designated medication room. The nurse stated there was a room behind the nurse's stations, where they kept medications in a locked cabinet and a locked medication refrigerator. The nurse unlocked the medication refrigerator to show surveyor they did not have any controlled substances stored in it. The nurse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 32 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated they did not have a locked metal box in the refrigerator to store controlled substances. It was observed that the door was opened and there was a locked medication cabinet and locked medication refrigerator. The nurse reported the door to the room was kept unlocked for staff to use the copy machine, get personal care products and other nursing supplies as needed. Interview with Director of Nursing (DON) 11/14/23 at 11:10 AM, revealed medications are kept in the medication carts when residents are discharged to the hospital and are pending readmission. If the residents do not return the medications will be removed from the medication carts and stored in locked medication cabinets pending drug destruction. Review of facility policy and procedures for Controlled Substances (Revised December 2012) revealed controlled substances must be stored in the medication room in a locked container, separate from containers for any non-controlled medications. This container must always remain locked, except when it is accessed to obtain medications for residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 33 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record reviews the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation and food storage. -The facility failed to keep floor in the dry storage room free of black grease built up. -The facility failed to keep wall in the dry storage room free of Scraped paint. -The facility failed to keep bottles of vinegar stored on metal storage racks in the dry storage room free of white powder residual on caps. -The facility failed to keep floor in the dry storage room clean, and free of food and paper particles. -The facility failed to keep refrigerator storage racks free of rust. -The facility failed to store foods in refrigerator in sealed containers; food containers had dried food drippings around the caps and dried brown stains on side of food container. -The facility failed to keep large skillets stored on metal racks free of black burnt grease built up on the sides and bottoms of pans. The facility failed to store foods in dry storage room in sealed containers. -The facility failed to to replace loose ceiling tiles throughout the kitchen. -The facility failed to replace rusted vent covers throughout the kitchen. -The facility failed to ensure 4 of 4 oven thermostats were not working properly. -The facility failed to maintain Vegetable in operational condition. -The facility failed to keep 2 of 23 spice bottles stored on metal storage rack in dry storage room sealed and free of residual on tops and around the neck of the bottles. -The facility failed to maintain water drain to ice machine in operational condition. -The facility failed to discard perishable foods stored in in walk-in refrigerator. Vegetables were wrinkled, mushy, black mold, and had prominent sunken places to touch. -The facility failed to maintain wall in front of walk-in refrigerator free of water damage from pipelines. -The facility failed to ensure Pureed foods were not prepared at 9:30 AM and kept in oven until meal service started. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 34 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 These failures could affect residents by placing them at risk of food borne illnesses. Level of Harm - Minimal harm or potential for actual harm Findings include: Residents Affected - Some During an observation on 11/14/23 at 8:14 AM it was revealed the Dry Storage Room by staff locker room floor had black grease build up behind the door, scraped paint on the wall to the left side by the entrance to the room. Several plastic gallon bottles of vinegar had a white powder residual on the tops. There were food particles on the floor and small pieces of paper throughout the storage room. There were several loose ceiling tiles with dried brown water stains. During an observation on 11/14/23 at 8:21 AM, of the Food Refrigerator next to juice machines revealed storage rack was rusted, there was an unsealed opened container of Chicken Base, a Styrofoam cup covered with saran wrap was not sealed, a large container of mayonnaise had dried stains around the bottle below the cap, mustard bottle had dried stains around the bottle below the cap, containers of cottage cheese had dried brown stains on side of container. During an observation on 11/14/23 at 8:27 AM, 2 large skillets stored on metal rack by stove had black burnt grease build up on sides and bottoms of pans. During an observation on 11/14/23 at 8:27 AM, loose ceiling tiles throughout the kitchen with dried brown water stains. During an observation on 11/14/23 at 8:30 AM, rusted air conditioner vents and several ceiling tiles with dried brown water stains by serving line. Observation 11/14/23 8:31 AM, revealed two rusted vent covers by kitchen preparation area and in front of serving line. During an observation and interview on 11/14/23 at 8:36 AM with [NAME] revealed 4 of 4 ovens were not working properly. [NAME] reported they had been having problems with oven temperatures for several months. He demonstrated to the surveyors the oven thermostats did not work. The [NAME] said, The oven will not heat up to the temperature set with the thermostat. Sometimes the oven temperatures are too cold or too hot. Maintenance staff had attempted to fix the problem. However, the problem with oven temperatures continues. We use the food thermometer to check the oven temperature to ensure foods are cooked at the correct temperatures. [NAME] informed surveyors that he had prepared Pureed food at 8:30 AM and kept it in the oven until lunch is served at 11:30 AM-11:45 AM. He reported that he always prepared Pureed food at 8:30 AM. The [NAME] reported vegetable sink had not been working for over 3 months or longer. Water would leak through the PVC pipe under the sink. There was a sign posted alerting staff sink was out of service. During an observation on 11/14/23 at 8:50 AM, two metal racks used to store food in the room between the kitchen and dish washing room revealed 2 spice bottles were opened and not sealed. Multiple spice bottles had residual to tops and around the neck of the bottles. During an observation on 11/14/23 at 8:53 AM, revealed there was water on the floor directly in front of the walk-in refrigerator. There was a slip-resistant mat on the floor by the walk-in refrigerator entrance full of water. During an interview on 11/14/23 at 8:55 AM, Dietary Director stated all kitchen staff had been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 35 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some trained in labeling food when original containers were opened, cleaning and closing spice bottles after each use. She reported that all kitchen staff were responsible for keeping everything clean, store food is sealed containers, and labeling all food containers stored in refrigerators and storage racks in the kitchen and Dry Storage room. The Dietary Director reported the vegetable sink had been out of service for several months. She reported maintenance staff had attempted several times to fix the vegetable sink and were not able to fix it. Dietary Director reported that the water drain to the ice machine had been plugged for about a week, causing water to run down in front of the walk-in refrigerator and under the metal storage racks where dry foods were stored. She reported water was also draining into the walk-in refrigerator and needed to be mopped several times a day to prevent falls. She stated there was a risk of contamination of food stored in walk in refrigerator due to staff walking in with wet shoes. Dietary Director in the walk-in refrigerator revealed green/yellow bell peppers stored in a squared metal pan on metal storage rack had wrinkled skin, softer texture of skin, prominent sunken areas, black mold and were mushy; tomatoes stored in metal storage pan were mushy, with wrinkle skin; metal bowl that contained cherry tomatoes revealed rotting tomatoes, mushy, wrinkled skin, and prominent sunken areas; avocados stored in cardboard box were mushy, and had prominent sunken area; lemons stored in cardboard box were brown in color and mushy. The Dietary Manager stated, You are not going to believe me, but that is the way that the vegetable looks upon delivery. I have talked to the vendor about this, but the problem continues. The vegetable should not be used and thrown away. During an observation on 11/14/23 at 9:07 AM, revealed water damage to wall in front of walk-in refrigerator. During an interview on 11/14/23 at 9:33 AM, with Administrator and Maintenance Director revealed that Administrator was not aware that drain to ice machine was plugged and water was running into walk-in refrigerator and under the metal storage racks where dry foods were stored. The Maintenance Director reported that the drain had been plugged for about a week and he had put the snake down the drain several times, but the problem continued. He said he had not called the plumber because they were changing owners. Administrator stated the vegetable sink had not been working since she had started working at the facility in February 2023. She did not know why the vegetable sink had not been fixed. The Administrator and Maintenance Director reported they were not aware that the thermostats for the kitchen stoves were not working. The Maintenance Director reported kitchen staff had been trained to write a work order and verbally inform him if they were having problems with the equipment in the kitchen. He stated that the kitchen staff had not written a work order for the plugged drain to the ice machine or the oven thermostats not working properly. During an observation on 11/14/23 at 9:50 AM, with administrator and maintenance director confirmed water drain to ice machine was plugged and water was draining into the walk-in refrigerator, and under the metal storage racks where dry food was stored. They also confirmed that the slip resistant mat on the floor by the entrance to the walk-in refrigerator was full of water. During an interview on 11/14/23 at 9:52 AM, Dietitian reported that he was aware that the temperatures to the oven fluctuated due to the oven thermostats not working properly. He said there was a problem with the thermostat causing the issues with the temperatures. He stated the cook ensures oven temperatures were at the required temperatures when cooking food to prevent potential food borne illnesses. The Dietitian confirmed that the vegetable sink had been out of service for several months. Dietitian confirmed [NAME] had informed him he had prepared Pureed Foods today at 9:30 AM and was kept in the oven until it was served. He stated, As long as the food is not boiling, nothing will (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 36 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 happen to the nutritive value food. Level of Harm - Minimal harm or potential for actual harm Observation on 11/14/23 at 11:35 AM, with Dietitian, Cook, and Dietary Director revealed metal containers in serving line that contained Pureed foods had crusted rings around the metal containers. Residents Affected - Some Review of Food Receiving and Storage policy & procedure (Revised July 2014), revealed Policy Statement: Foods shall be received and stored in a manner that complies with safe food practices. Policy Interpretation and Implementation: Food Services, or other designated staff, will always maintain clean food storage areas. All foods stored in the refrigerator or freezer will be covered, labeled, and dated (use by date). Other opened containers must be dated and sealed or covered during storage. Food Code 2022 (C) PACKAGED FOOD shall be labeled as specified in LAW, including 21 CFR 101 FOOD Labeling, 9 CFR 317 Labeling, Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under § 3-202.18. 3-202.15 Package Integrity. FOOD packages shall be in good condition and protect the integrity of the contents so that the FOOD is not exposed to ADULTERATION or potential contaminants. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 37 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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, interview and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable disease and infection in 1 of 3 (2nd floor) dining rooms and for 2 of 27 residents (Resident #16 and Resident #57) reviewed for infection control. Residents Affected - Some -The facility failed to ensure staff followed infection control practices when passing out meal trays during dining service. -The facility failed to ensure that Resident #57 ' s catheter tubing did not drag on the floor. -The facility failed to ensure LVN I washed her hands and put on gloves prior to checking for G-Tube Placement. These deficient practices could place residents at risk for infection due to improper care practices. Findings included: Observation on 11/14/23 at 12:34 PM of the second-floor dining room revealed CNA D was observed taking a meal tray from the food cart and passed it out to a resident. She uncovered the plastic wrap from the cup and bowl, and then proceeded to return to the food cart to grab another tray. She touched her hair and then proceeded to take another tray and delivered it to another resident. She returned and grabbed another tray. She placed the tray on the table in front of the resident and assisted in removing plastic wraps of the cup and bowl. She then assisted the resident towards the table by touching the handlebars of the wheelchair. She then proceeded to prepare a cup of coffee. After she delivered the coffee cup, she washed her hands. An interview on 11/14/23 at 12:45 PM with CNA D revealed she had been taught to use hand sanitizer after every 3 trays she passed out. She said she was supposed to use hand sanitizer, but she got nervous. She stated she should have performed hand hygiene because she was touching a lot of surfaces and was in contact with meal trays. She stated the risk could be cross contamination in between trays if hand hygiene was not done. An interview on 11/17/23 at 2:25 PM with the DON, she revealed the nursing staff has been trained to perform hand hygiene with every 3 meal trays that were passed out. She stated the importance of performing hand hygiene was for the safety of the staff and residents. It was important to mitigate and prevent cross-contamination. Record review of facility policy titled Handwashing/Hand Hygiene dated August 2019 read in part .All personnel shall follow the handwashing/hand hygiene procedures to prevent the spread of infections .Use and alcohol-based hand rub containing at least 62% alcohol or alternatively soap and water for the following situations: before and after eating or handling foods before and after assisting a resident with meals . Resident #57 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 38 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 Record review of Resident #57 ' s face sheet dated 11/17/2023 revealed he was [AGE] years old, was initially admitted to the facility on [DATE] and readmitted on [DATE]. Record review of Resident #57 ' s History and Physical dated 08/31/2023 revealed he had diagnoses including benign prostatic hypertrophy (enlarged prostate) and urinary retention, Residents Affected - Some Record review of Resident #57 ' s quarterly MDS dated [DATE] revealed he had a BIMS of 7 (Severe cognitive impairment). He was dependent on staff members for toileting hygiene. He had an indwelling catheter (a tube inserted in the bladder to drain urine). Record review of Resident #57 ' s care plan initiated 09/04/2022 revealed he had a urinary catheter and was to have no complications related to the use of the catheter. Staff were to be made aware of the correct placement of the catheter tubing. Record review of Resident #57 ' s physician ' s order dated 10/1/2022 revealed he was to have a Foley (urinary) catheter in place. In observation and interview on 11/14/23 at 09:13 AM Resident #57 was moving around his room in a wheelchair. He had a urinary catheter tube running from inside his pant leg to a drainage bag attached to the wheelchair. It was observed that the catheter tubing was resting on the ground as he moved around the room. Resident #57 said he had not had any problems with the urinary catheter. In an interview and observation on 11/14/23 at 09:17 AM LVN H revealed that Resident #57 ' s catheter had been changed recently because his urine was very amber colored due to a UTI. She said urinary catheter tubing should not be on the floor because it could pick up all the dirtiness, that it was an infection control issue. When asked who was responsible for monitoring the placement of the urinary catheter, she said all staff were responsible for keeping an eye on it. She stated Resident #57 was currently on an antibiotic to treat a UTI. In an interview on 11/17/2023 at 03:50 PM the DON revealed that catheter tubing should not be on the floor because it was an infection control issue. She said CNAs and nurses were responsible for making sure catheter tubing was not on the floor. Resident #16 Review of Resident #16 admission Record dated 11/14/23 revealed [AGE] year-old male admitted [DATE]; re-admission date 08/06/20. Review of Resident #16 History & Physical dated 03/31/23 revealed dementia without behavioral disturbances, status post gastrostomy, post-traumatic seizures, hypertension. Regular mechanically diet consistency. Bolus PEG (Percutaneous Endoscopic Gastrostomy is a procedure to place a feeding tube) tube feedings with no complications, no residuals reported. Review of Resident #16 Quarterly MDS dated [DATE] revealed most recent re-admission date 11/04/21, from hospital. Hearing minimal difficulty; clear speech; usually makes self-understood; usually understands others; vision impaired; BIMS 6-cognitive status severely impaired; active diagnoses dysphagia following unspecified cerebrovascular disease; mechanically altered diet; proportion of calories the resident received through tube feeding 26-50 %; average fluid intake per day by tube feeding 501 cc/day or more. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 39 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 - Some Review of undated Care Plan for Resident #16 revealed resident required enteral feedings (nocturnal) and maintain status via gastrostomy tube feeding and potential aspiration. Goal: Will be adequately nourished and will not exhibit signs & symptoms of aspiration through next review. Approaches: Administer peg/gastrostomy enteral feedings/flushes per MD orders. Check for proper placement prior to starting feeding. Check for residual before feeding/meds. Monitor for dumping syndrome after any bolus feedings. Cocktail meds per MD and pharmacy review and justification. Position resident properly with HOB up at 35-degree angle to keep esophagus open and decrease risk for aspiration. Observation on 11/14/23 4:22 PM with LVN I revealed she poured Midodrine 10 mg 1 tablet, Misoprostol (Cytotec) 100 mcg 1 tablet and Levetiraceta (Keppra) Solution 100 mg/ml take 5 ml (500 mg) and Vitamin C 500 mg 1 tablet. The nurse placed the 3 tablets in pill crusher pouch and all crushed medications, poured Levetiraceta Solution 5 ml medications into plastic cup and mixed with 30 ml of water. Poured 60 ml of water in a cup to flush G-Tube with 30 ml of water before and after medication administration. Observation 11/14/23 at 4:36 PM, LVN I placed medications to top of bed side table, did not wash hands or use hand sanitizer and proceeded to check for tube placement without using gloves. The nurse checked for G-Tube placement by auscultation with stethoscope (inject air feeding irrigation syringe to hear a growl or rumbling/bubbling sound as the air goes in). The nurse proceeded to check for residual and demonstrated to surveyor resident had no residual. Observation 11/14/23 at 4:38 PM, LVN I flushed G-Tube with 30 ml of water prior to administering medications, poured medication mixture into feeding irrigation syringe, and administered medications by gravity. The nurse flushed G-Tube with 30 ml of water after medication administration and capped the feeding tube. Observation 11/14/23 at 4:40 PM, LVN I went to rinse feeding irrigation syringe in bathroom sink without using gloves, dried syringe with paper towel and left bathroom without washing her hands. The nurse placed the feeding syringe on top of bed side table to air dry and stated she would return later to place feeding syringe in plastic syringe bag that was dated 11/14/23. The nurse washed hands prior to leaving the room. Telephone interview 11/17/23 at 2:30 PM with Pharmacy Consultant and Director of Nursing reported that facility did not have a policy to crush medications separately to administer via G-tube and could cocktail the administration of medications via the G-tube according to physician ' s order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 40 of 41 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 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grace Pointe Wellness Center 2301 N Oregon St El Paso, TX 79902 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on Observation, interviews, and record reviews, the facility failed to maintain essential equipment in safe operating condition for 1 of 1 kitchen reviewed for safe operating equipment. Residents Affected - Some The oven thermostats did not properly set the temperature in the four ovens. Vegetable sink has not been operable in over 3 months. These failures could place residents at risk of foodborne illnesses and injury. Findings included: An initial tour of the kitchen on 11/14/23 started at 8:14 AM, revealed oven thermostats were not working. There was a sign posted above the Vegetable sink that stated it was out of service. Observation and interview on 11/14/23 at 8:36 AM with [NAME] and Dietary Director revealed that 4 of 4 ovens were not working properly. [NAME] reported they had been having problems with oven temperatures for several months. He demonstrated to the surveyors; oven thermostats did not work. The [NAME] said, The oven will not heat up to the temperature set with the thermostat. Sometimes the oven temperatures are too cold or too hot. Maintenance staff had attempted to fix the problem. However, the problem with oven temperatures continues. We use the food thermometer to check the oven temperature to ensure foods are cooked at the correct temperatures. Observation and interview on 11/14/23 at 8:47 AM, with [NAME] revealed vegetable sink had not been working for over 3 months or longer. Water leaked through the PVC pipe under the sink. There was a sign posted alerting staff sink was out of service. Observation and interview on 11/14/23 at 8:59 AM, the Dietary Director reported the vegetable sink had been out of service for several months. She reported maintenance staff had attempted several times to fix the vegetable sink and were not able to fix it. Interview on 11/14/23 at 9:33 AM, with Administrator and Maintenance Director revealed the vegetable sink had not been working since administrator started working at the facility in February 2023. Administrator stated she did not know why the vegetable sink had not been fixed. The Administrator and Maintenance Director reported they were not aware that the thermostats for the kitchen stoves were not working. The Maintenance Director reported kitchen staff had been trained to write a work order and verbally inform him if they were having problems with the equipment in the kitchen. He stated that the kitchen staff had not written a work order for the plugged drain to the ice machine or the oven thermostats not working properly. Interview on 11/14/23 at 9:52 AM, Dietitian reported that he was aware that the temperatures to the oven fluctuated due to the oven thermostats not working properly. He said there was a problem with the thermostat causing the issues with the temperatures. He stated the cook ensures oven temperatures were at the required temperatures when cooking food to prevent potential food borne illnesses. The Dietitian confirmed that the vegetable sink had been out of service for several months. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 41 of 41