Health inspection·August 5, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and impact on cognition.- Anticipate the resident's need for pain relief and respond immediately to any complaint of pain.- Monitor/document for probable cause of each pain episode. Remove/limit causes where possible.- Notify physician if interventions are unsuccessful or if current complaint is a significant change from resident's experience of pain.- Monitor/document for side effects of pain medication. Observe for constipation; new onset or increased agitation, restlessness, confusion, hallucinations, dysphoria; nausea; vomiting; dizziness and falls. Report occurrences to the physician.- Report to Nurse any change in usual activity attendance patterns or refusal to attend activities related to s/sx or c/o pain or discomfort.Monitor/record/report to Nurse resident complaints of pain or requests for pain treatment.Monitor/record/report to Nurse any sign/symptoms of non-verbal pain: Changes in breathing(noisy, deep/shallow, labored, fast/slow); Vocalizations (grunting, moans, yelling out,silence); Mood/behavior (changes, more irritable, restless, aggressive, squirmy,constant motion); Eyes (wide open/narrow slits/shut, glazed, tearing, no focus); Face(sad, crying, worried, scared, clenched teeth, grimacing) Body (tense, rigid, rocking, curled up, thrashing). Record review of Physician Order Summary dated 07/31/25 for Resident #3, revealed Observation: Pain - Observe every shift. If pain present, complete pain flow sheet and treat trying non pharmaceutical interventions prior to medicating if appropriate. Document and the progress note every shift for pain management. Ortho consult status post femur fracture. Portable x-ray of right knee for diagnosis of knee pain. PT to eval and treat as warranted. Orthopedic appointment on 04/15/25 at 9:00 AM. Acetaminophen-Codeine 300-30 mg give 1 tablet by mouth every 6 hours as needed for pain. Gabapentin 300 mg at bedtime for right thigh pain. Tylenol 325 mg give 650 mg by mouth every 4 hours as needed for pain. Record review of Nurse Practitioner Progress Note dated 03/07/25 for Resident #3, revealed encounter at 11:00 PM. History of Present Illness: Patient recently had a fall and injured her right leg and currently in brace. Patient was admitted due to worsening pain and swelling of right lower extremity. Plan: Admit to SNF, PT and OT to evaluate.Record review of Physical Therapy Evaluation dated 03/24/25 for Resident #3, revealed Diagnoses: Unsteadiness on feet, Muscle weakness, other abnormalities of gait and mobility, other lack of coordination. Current Past Medical History: [AGE] year-old female transferred to hospital from SNF on 03/18/25. Previous hospitalization due to progressive LE edema x 6 months and fall 2 days prior to admission. X-ray RLE negative for fracture per medical chart. R knee immobilizer for comfort. Pain Assessment at rest: Intensity = 0/10. She continued to report pain to right lower extremity from knee to ankle level. For nurse, X-rays have been done at this facility which were negative. Patient is very guarded to right lower extremity. Record review of Physical Therapy Treatment Note dated 04/01/25 written by, PTA for Resident #3 revealed, Right quad tightness (the muscles on the front of your right thigh feel stiff, tense, or shortened) noted. C/O pain with Right hip flexion (lifting your right thigh or knee towards your chest). Record review of Nurse Practitioner Progress Note dated 04/01/25 at 11:00 PM, for Resident #3, History of Present Illness: Patient recently had a fall and injured right leg and currently in brace. Patient was admitted due to worsening pain and swelling of right lower extremity. Plan: PT and OT, Multimodal Pain control strategies (using a combination of different methods to manage pain, rather than just one), Fall precautions. Record review of Nursing Progress Note dated 04/02/25 written by LVN A for Resident #3, revealed New Order after x-ray results. Reported to NP, continue Tramadol 50 mg po Q6H PRN pain. New order for Tylenol 650 mg po Q4H PRN pain. New order Gabapentin 300 mg po Q HS. Record review of Nurse Practitioner Progress Note dated 04/03/25 for Resident #3, revealed Interval History of Present Illness: Physical Therapy was reporting patient was having increased swelling to her lower extremities. X-ray does show femur fracture. No reports of falls or traumatic injuries while at SNF. Medical chart review (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few performed to review acuity of her fracture given remote history of acute traumatic injuries. She will need to follow up with Ortho clinic. I requested nursing staff to assist patient with that follow up appointment. Physical examination: No acute distress. Assessment: RLE fracture. Plan: Follow up with Ortho clinic, requested nursing staff to assist patient with that follow up appointment. The case was discussed with attending physician, and he provided medical decision in this case. Physician documented on the progress note, I have reviewed the patient's information as well as discussed all the events and plans with NP, and agree with the findings, assessment, and recommendations. Record review of Nurse Practitioner Progress Note dated 04/10/25 at 11:00 PM, for Resident #3, revealed Interval History of Present Illness: No reports of falls or traumatic injuries as per nursing management this SNF admission. Pain is well controlled. Medical chart reviewed to investigate the acuity of RLE fracture. Pt. is pending follow up with Ortho clinic. Physical examination: No acute distress. Assessment: RLE fracture. Record review of Discharge summary dated [DATE] written by NP for Resident #3, revealed Date of admission: [DATE]. Date and time the encounter: 04/15/25 at 6:00 PM. Discharge Diagnosis: RLE fracture. History of Present Illness: Patient recently had a fall and injured her right leg and currently in brace. Patient was admitted due to worsening pain and swelling of right lower extremity. Discharge Disposition: She was sent to ER as per ortho for ongoing medical management. During an interview and record review on 08/04/25 at 2:00 PM, with LVN B on the 6-2 shift nurse assigned to Resident #3 revealed, he did not remember if the PTA had reported to him that Resident #3 was having pain to her right lower extremity with flexion. He said, I checked my notes, and I did not write a note on 04/01/25 for Resident #3. He said licensed staff had been trained to document in their nurse's notes when therapy staff reported to them if residents were having pain while receiving therapy services. During an interview and record review on 08/04/25 at 2:03 PM, with LVN A on the 2-10 pm shift assigned to Resident #3 revealed, resident had complained of pain to the right leg since admission to the nursing facility, and was administered Tylenol and Tramadol for pain and the pain medication was effective. He said he was not aware if resident had a history of fractures to the right leg. He said the resident had not sustained any falls in the nursing facility and did not know if resident had a history of falls at home. He said that he did not remember if the therapy staff had reported to him that the resident had complained of pain to the right leg when she was receiving physical therapy. He said that he did not remember if it was reported during the change of shift that the PTA had reported that resident was having pain to the right lower extremity. He said, I would have documented that in resident's nursing progress notes. During an interview on 08/04/25 at 2:41 PM, with PTA, revealed Resident #3 complained of Quad pain to the right leg. She said, Quad pain was pain in the large muscle at the front of the leg and thigh, extending from the hip and pelvis down to kneecap and below. She said, I reported this to one of the nurses, but I did not document that in my notes. She said that she had been trained to document in the therapy notes when she reported to the nurses when the residents were having pain. Telephone interview on 08/04/25 at 2:47 PM, with Physical Therapist revealed, Resident #3 was evaluated for Physical Therapy services on 03/24/25. She said the resident had sustained a fall at home prior to admission to the nursing facility. She said Resident #3 did not consistently complained of pain to the right lower leg. She said the resident had complained of pain on 04/01/25 with attempted movement to the right leg when therapy was provided. She said that she did not remember the pain level to the right leg. She said the PTA had not documented in her notes that she had notified the nurses that resident complained of pain to the right lower leg with flexion. She said they had been trained to document in their therapy notes when residents complained of pain and when they notified the nurses to ensure that this was communicated to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675106 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675106 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete attending physician. During a second interview on 08/04/25 at 2:58 PM, with PTA, revealed that she had remembered reporting to one of the nurses, but could not remember who she had notified Resident #3 was having pain to the right leg with flexion. She said she had been trained to document the notification of pain to the nurses in her therapy notes. She said, I remember that I went upstairs to notify the nurse, I remember that it was a Friday, but I did not document the notification to the nurse in the therapy notes. During an interview and record review on 08/04/25 at 3:12 PM, with DON revealed, Resident #3 was having pain to the right hip with flexion. She said that therapy staff had been trained to document in their notes when the resident complained of pain and to immediately report the complain of pain to the nurses. She said that the resident was sent to an Orthopedic appointment on 04/15/25 and had been sent from the doctor's office to the ER at UMC. She said the resident had sustained a pathological fracture due to osteoporosis prior to admission to the nursing facility and it was a chronic and not an acute fracture. She said that LVN B had documented resident's level pain was at 4 out of 10, on 04/02/25. The DON confirmed that the facility did not have any documentation in the nurse's notes progress notes that the therapy staff had reported to the nurse that the resident was having pain with flexion to the right leg. She confirmed that the therapy staff, had not documented in their therapy notes that PTA had notified the nurse on 04/01/25 when the resident complained of pain with flexion to the right leg. She said that LVN B and LVN A had not documented in the nursing progress notes that the PTA had reported to them on 04/01/25 that Resident #3 was complaining of pain to the right lower extremity. She said licensed staff and therapy staff had been trained to document notification of pain in the progress notes. During an interview and record review on 08/04/25 at 2:53 PM, with LVN ADON, revealed he had completed the Weekly-Nursing Summary dated 04/01/25 and had documented Resident #3 had pain level of 4.4, and pain intensity was mild. He said that he had been trained to immediately notify the nurse when the resident's complained of pain. He said, I did not document in the progress notes, when I notified the nurse that Resident #3 was having pain to the right leg when I completed the Weekly Nursing Summary on 04/01/25. He said failure to notify the nurse, when a resident complained of pain could result in the pain getting worse. Record review of the facility provided Documentation policy, revised May 2015, read in part Documentation is the recording of all information, both objective and subjective, in the clinical record of an individual resident. It includes observations, investigations, and communications of the resident involving care and treatments. It has legal requirements regarding accuracy and completeness, legibility assessment, care plan, nursing progress notes, flow sheets, medication sheets, incident reports, and summary sheets . Goal .the facility will maintain complete and accurate documentation for each resident on all appropriate clinical record Event ID: Facility ID: 675106 If continuation sheet Page 4 of 4