Inspection·November 16, 2023

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident's sheets to be changed when soiled. She revealed that the failure could place the resident at risk for unsanitary conditions. During an interview on 11/02/2023 at 1:45 PM, Resident #2 and her family said they have requested numerous times that laundry come and pick up Resident #2's dirty laundry. Resident #2 revealed that she did not file a grievance. The family were told that laundry was behind and would get to it when they could. The family said that the stains on the wall were from the previous resident. The family said that the resident would get mad and throw orange juice at the walls. The family said that it had been like that for a long time, at least a few months. The family said that the stains on the privacy curtain were from coffee being spilt over time. The family said that after the previous resident was moved out, the facility never came in to clean the room. The family said that under her bad was dirty and that the facility was trying to keep it clean, but the facility did not have enough staff. The family said that they could not remember the last time the resident's room had been thoroughly cleaned. The family said that they helped keep the room clean when staff could not. During an interview and observation on 11/06/2023 at 1:28 PM, the Housekeeping Manager observed Resident #2's room and said that the walls and the privacy curtain being dirty was unacceptable. She said that somehow it was missed, and she would resolve the issue immediately. She revealed that if it was her room, she would want that clean. She revealed that it was not a homelike environment and that she would make sure the issues were corrected. Review of the facility's Homelike Environment Policies and Procedures dated February 2021, reflect the following: Policy Statement: Residents are provided with a safe, clean, comfortable in home like environment and encouraged to use their personal belongings to the extent possible. Policy Interpretation and Implementation: 1). Staff provides person centered care that emphasizes the residence comfort, independence and Personal needs and preferences. 2). The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics include clean sanitary and orderly environment clean bed and bath linens that are in good condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 2 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 Based on observation, interview, and record review the facility failed to have assessments that accurately reflect the status of 1 of 3 residents (Resident #1) reviewed for resident assessments. Residents Affected - Few Resident #1's Annual MDS did not reflect his current behavioral state. This failure could place residents at risk of a decreased quality of care and not having their individualized needs met or communicated accurately to staff. Findings Include: Record review of Resident #1's admission record dated 11/07/2023, revealed Resident #1 was 86 years-old and was admitted to facility on 07/29/2023 with a diagnoses of encephalopathy (brain disease that alters brain function), Alzheimer's Disease (neurodegenerative disease that destroys memory and other important mental function), Altered Mental Status (changes in consciousness, appearance, behavior, mood, affect, motor activity or cognitive function) and Delirium (serious disturbance in mental abilities that result in confused thinking and reduced thinking and reduced awareness of surroundings). Resident #1 was discharged to another facility on 11/07/2023. Record review of Resident #1's admission MDS assessment Cognitive Patterns section dated 08/05/2023 revealed Resident #1 had a BIMS of 05 which indicated severe impaired cognition; signs and symptoms of delirium such as exhibited inattention behavior and disorganized thinking behavior that was continuously present. Further review of the admission MDS Behaviors section revealed Resident #1 did not exhibit physical behaviors toward others; however, did exhibit verbal behaviors towards others 4 to 6 days a week and the behaviors did not place residents at significant risk for physical illness or injury, nor significantly interfere with the resident's care, nor significantly intrude on the privacy or activity of others, nor significantly disrupt the care or living environment of others. Further review of admission MDS Behaviors section revealed Resident #1 exhibited rejection of care and wandered 1 to 3 days a week; however, Resident #1 did not wander or intrude on the privacy or activities of others. Further review of Resident #1's admission MDS assessment medication section revealed Resident #1 did not receive any medications for anxiety. Further review of Resident #1's admission MDS assessment restraint and alarm sections revealed Resident #1 wore a wander guard alarm. Record review of Resident #1's Comprehensive Care Plan completed on 08/16/2023 revealed Resident #1 was evaluated as a wandering risk related to decreased safety awareness, confusion and wandering behaviors; staff were to observe Resident #1 for signs and symptoms of agitation, pacing, repetitive verbalization's of wanting to leave/go home, restlessness. Staff were to also report increased behaviors to nurses for further interventions. Further review of Resident #1's Comprehensive Care Plan revealed that the resident had the potential to be verbally aggressive, yelling loudly, throws arms in the air. Resident #1 was to verbalize his understanding of the need to control his verbally abusive behaviors. Resident #1 was an elopement risk related to being disoriented to place with history of attempts to leave the facility unattended, impaired safety awareness, and wandered aimlessly. Review of Resident #1's of 1:1 (1 Resident with 1 Staff) handwritten observation sheets from 08/15/2023 to 11/05/2023 revealed Resident #1 had 1:1 staffing every day from 08/15/2023 to 11/05/2023 during the day. During a confidential interview on 11/02/2023 at 11:45 AM., it was said Resident #1 was aggressive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 3 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 daily towards staff and tried to get out of the building, so he was placed on 1:1 observation. The confidential interviewee said the facility staff were told not to document the 1:1 observation in the resident's record. During a confidential interview on 11/02/2023 at 12:30 PM., it was said that Resident #1's 1 to 1 observations were not being documented so that another facility would accept him. Residents Affected - Few During a confidential interview on 11/02/2023 at 1:50 PM., it was said that Resident #1 was 1 on 1 in the day and not at night. During an interview on 11/06/2023 at 9:05 AM, the DON said that Resident #1 had a physical and mental decline since he admitted to the facility, which was not captured on the admission MDS assessment. She said it was due to the MDS Coordinator not capturing the assessment correctly. She said that this could cause issues in capturing an accurate picture of the resident. During an interview on 11/06/2023 at 2:13 PM., the MDS Coordinator said that she was new in the position, and she started May 25, 2023. She said she requested help and training with the DON and Corporate. She said that she was not adequately trained, and she let the Admin, DON and corporate know that she did not know what she was doing. She revealed that this failure could place the residents at risk for not assessing all their care needs. A policy on Accuracy of Assessments was requested on 11/06/2023 at 3:00 PM to the DON and was not provided by the time of exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 4 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Based on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, which included measurable objectives and time frames to meet residents' mental and psychosocial needs, for one (Resident #1) of three residents reviewed for care plans. The facility failed to develop and implement a comprehensive person-centered care plan to address Resident #1's physical, verbal, and sexual aggressive behaviors towards staff, visual function, risk for falls, risk for pressure ulcers, antianxiety medications, and 1:1 staffing. This failure could place residents at risk for their medical, physical, and psychosocial needs not being met. The findings were: Record review of Resident #1's admission record dated 11/07/2023, revealed Resident #1 was 86 years-old and was admitted to facility on 07/29/2023 with a diagnoses of encephalopathy (brain disease that alters brain function), Alzheimer's Disease (neurodegenerative disease that destroys memory and other important mental function), Altered Mental Status (changes in consciousness, appearance, behavior, mood, affect, motor activity or cognitive function) and Delirium (serious disturbance in mental abilities that result in confused thinking and reduced thinking and reduced awareness of surroundings). Resident was discharged to another facility on 11/07/2023. Record review of Resident #1's admission Minimum Data Set (MDS) assessment Cognitive Patterns Section, dated 08/05/2023, revealed Resident #1 had a BIMS of 05 which indicated severe impaired cognition. Further review of the admission MDS Care Area Assessment Summary section revealed Resident #1 was triggered to have care plan interventions for Cognitive loss/ Dementia, Visual Function, Communication, ADL Function, Behaviors, Falls, and Risk of Pressure Ulcers. Record review of Resident #1's Comprehensive Care plan, completed on 08/16/2023, revealed no evidence of care plan interventions for Cognitive loss/ Dementia, Visual Function, Communication, ADL Function, Behaviors, Falls, and Risk of Pressure Ulcers. During an interview on 11/06/2023 at 9:05 AM, the DON said that Resident #1's care plan should have captured his 1 to 1 observation, his antianxiety medications, and his behaviors when his Comprehensive Care Plan Assessment was completed. She said that she was not part of the care plan process, and her expectations were for those issues to be addressed. She said that this could cause issues in capturing an accurate picture of the resident. During an interview on 11/06/2023 at 2:13 PM., the MDS Coordinator said that she was responsible for the Comprehensive Care Plan assessments, and she was new in this position when she started May 25, 2023. She had requested help and additional training from the DON and Corporate. She said that she should have captured on the care plan that Resident #1 was receiving 1 to 1 observation, behaviors, his risk for pressure ulcers, his visual loss and his risk for falls, but she did not know that the CAAS areas should have been captured in the care plan. She said that this could cause the resident to not receive to care they need. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 5 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 - Few A copy of the facilities policy and procedures titled Care Plans, Comprehensive Person- Centered was received on 11/06/2023 at 3:00 PM by the DON, revealed the following: Policy Statement: A comprehensive person-centered care plan that includes measurable objectives and timetables to meet the residence physical, psychosocial, and functional needs is developed and implemented for each resident. Policy Interpretation and Implementation: The intra-disciplinary team IDT, is conjunction with the resident and his or her family or legal representative, develop and implement a comprehensive person-centered care plan for each resident. 2. The care plan interventions are derived from my thorough analysis of the gathered information as part of the comprehensive assessment. 8. The comprehensive person-centered care plan will: g. Incorporate identified the problem areas. h. incorporates risk factors associated with identified problems: k. reflects treatment goals, timetables, and objectives in measurable outcomes. m. Aid in preventing or reducing decline in the residence functional status and, or functional levels enhance the optimal functioning of the resident by focusing on rehabilitative program. 13. Assessments of residents are ongoing, and care plans a revised as information about the resident and the residence condition change 14. The interdisciplinary team must review and update the care plan: a. when there has been a significant change in the residence condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 6 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide the necessary services to maintain personal hygiene for one of two residents (Resident #3) reviewed for activities of daily living. Residents Affected - Few The facility failed to provide Resident #3 with assistance with ADLs as care planned. This failure placed residents at risk of not maintaining good hygiene and assistance with ADL's. Findings include: Review of Resident #3's Quarterly MDS dated [DATE] indicated the resident was admitted to the facility on [DATE] with diagnoses which included Alzheimer's Disease (progressive disease that destroys memory) and hypertension (high blood pressure). Review of the Quarterly MDS dated [DATE] revealed the Resident #3 had the following: Section C- BIMS (Brief Interview of Mental Status) score of 0, (severely cognitively impaired). Section GG- ADL's (Functional Abilities) score of 1, dependent (helper does all of the effort, resident does none of the effort). Review of Resident #3's Care plan dated 04/13/2023 indicated the resident needed extensive assistance from staff to complete all activities of daily living. Record review of Resident #3's ADL Documentation Report for July 2023 revealed no evidence of ADLs for bed mobility, dressing, locomotion on and off the unit, personal hygiene, toilet use, transferring, and bladder elimination was not completed on 07/04/2023, 07/10/2023, 07/12/2023, 07/13/2023, 07/18/2023 through 07/24/2023, and 07/27/2023. Further review of ADL documentation report revealed that on the days Resident #3 received ADL care was only once a day. Record review of Resident #3's ADL Documentation Report for August 2023 revealed no evidence of ADLs for bed mobility, dressing, locomotion on and off the unit, personal hygiene, toilet use, transferring, and bladder elimination was not completed 08/02/2023, 08/03/2023, 08/05/2023 through 08/09/2023, 08/11/2023, 08/14/2023 through 08/16/2023, 08/19/2023, 08/20/2023 through 08/23/2023, 08/25/2023, 08/26/2023, and 08/29/2023 to 08/31/2023. Further review of ADL documentation report revealed that on the days Resident #3 received ADL care was only once a day. Record review of Resident #3's ADL Documentation Report for September 2023 was requested and not provided. Record review of Resident #3's ADL Documentation Report for October 2023 revealed no evidence of ADL for bed mobility, dressing, locomotion on and off the unit, personal hygiene, toilet use, transferring, and bladder elimination was not completed 10/01/2023 through 10/31/2023. During an interview on 11/01/2023 at 2:23 PM, Resident #3's Representative said that she had complaints with Resident #3's personal care. She said that there are times Resident #3 was not changed at night and that Resident #3's sheets were dirty. She said that the facility told her that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 7 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility was going to start limiting the residents' briefs and that of the other residents. She said that things have gotten better since she installed a camera in Resident #3's room. She revealed that Resident #3 did not answer to questions, and Resident #3 required full help with ADL's. During an observation on 11/01/2023 at 2:40 PM, Resident #3 was asleep in her bed. She did not respond to knocking or asking to come in. She did not make eye contact, but her eyes did open slightly. Her sheets were dirty with dried brown smeared marks on the left side of the resident. During an interview on 11/02/2023 at 1:50 PM, Confidential Staff stated the staffing sheet did not reflect staffing accurately because the DON would pull staff members to do other things. She said that there have been residents that have needed more care than usual. She said that staff were not completing ADL's and care areas and that she and others have notified the DON. During an interview on 11/02/2023 at 1:40 PM, the DON said that the facility did not do any showers on 11/01/2023 due to the shower nurse calling in. She said she did not know about it until today. She said that the facility was having issues with ADL's being completed and documented, especially by the night shift. She said that her reports showed that there were days where it showed 0% of ADL's were completed for that shift. She could not say for sure that it was or was not completed. She said that if it was not documented, it did not happen. She said that she was working with staff to correct these issues. She said she had been out on medical leave and things just got behind. She said this failure could cause skin issues, and other concerns. A copy of the facilities policy and procedures titled Activities of Daily Living (ADL's), dated March 2018 revealed the following: Policy Statement: Residents will be provided with care, treatment and services as appropriate to maintain or improve their abilities to carry out activities of daily living. Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Policy Interpretation and Implementation: 1) Residents will be provided with care, treatment and services to ensure that their activities of daily living do not diminish unless the circumstances of their clinical condition demonstrate that diminishing ADL's is unavoidable. 2) Appropriate care and services will be provided for residents who are unable to carry out ADL's independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with : a) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 8 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 Hygiene (bathing, dressing, grooming and oral care) Level of Harm - Minimal harm or potential for actual harm b) Mobility (transfer and ambulation, including walking) Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 9 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation and interview the facility failed to ensure that the daily nurse staffing was posted and readily accessible to residents and visitors as required for 1 of 2 days reviewed for nurse staffing Residents Affected - Some The facility failed to update the daily staffing information posting from 10/27/2023 to 11/01/2023. This failure could affect residents, their families, and facility visitors by placing them at risk of not having access to information regarding staffing data and facility census. Findings included: During an observation on 11/01/2023 at 1:40 PM, the daily staffing pattern was posted on the wall by the copier room and the DON's office with a date of 10/27/2023. During an interview on 11/01/2023 at 1:45 PM, the DON stated she knew that the Nurse Staffing Posting was to be updated and posted daily. She said the nurse staffing posting had not been changed on 10/28/2023, 10/29/2023, 10/30/2023, 10/31/2023 and 11/01/2023, due to being short staffed and the person who changed it did not do it, she revealed she did not know who was responsible for it that morning, but said that she was the one responsible for making sure that it was completed after she delegated it. She further stated the failure could cause confusion on staffing and resident care issues. During an interview on 11/01/2023/23 at 2:30 PM, the Administrator stated the facility DON was responsible for the daily Nurse Staffing Posting. A copy of the facilities policy and procedure titled Posting Direct Care Daily Staffing Numbers dated September 2022 was received on 11/07/2023 at 2:00 PM, revealed the following: Policy Statement: Our facility will post on a daily basis for each shift, the number of nursing personnel responsible for providing direct care to residence. Policy interpretation and implementation. 1) Within two hours the beginning of each shift, the number of licensed nurses (RN's LPN's and LVN's) and the number of unlicensed nursing personnel (CNA's) directly responsible for resident care it will be posted in a prominent location accessible to residence and 2visitors and in a clear and readable format. 2) Directly responsible for resident care means that individuals are responsible for resident's total care or some aspect of the residence care including, but not limited to, assisting with activities of daily living (ADL's) performing gastrointestinal feeds, giving medication, supervising care given by CNA's, and performing nursing assessments to admit residents or notifying physicians of change of conditions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 10 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 - Few 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 medications were secured on 2 of 2 medication carts reviewed for pharmacy services. The facility did not ensure medications carts were secured and locked. This failure could place the residents at risk of a drug diversion. Findings included: During an observation on 11/06/2023 at 10:23 AM, LVN F left a medication cart unlocked for hall D and unattended with residents near the medication cart. She did not have visual of the medication cart and was unaware she left the medication cart unlocked. The medication cart contained over the counter medications, and prescription (non-controlled) medications. During an observation on 11/06/2023 at 2:30 PM, the ADON left a medication cart unlocked for hall A and unattended with residents walking near the medication cart. She did not have visual of the medication cart and was unaware she left the medication cart unlocked. The medication cart contained over the counter medications, and prescription medications. During an interview on 11/06/2023 at 10:30 AM, LVN F said that she walked away to go to the medication room. She said that she should have locked the medication cart before she left it unattended with residents around it. She said that this could cause a patient to get into it. During an interview on 11/06/2023 at 10:45 AM, the DON said that her expectations were for the medication carts to be locked anytime a nurse walks away from it. She said that she did training and in-service to make sure staff members knew to always lock their carts. She said that staff knew the risk involved with a medication cart that was unlocked and unattended. During an interview on 11/06/2023 at 2:30 PM, the ADON said that she walked away to go to the medication room due to a call light going off down the hall. She revealed that she is not used to working the floor and did not remember to lock it or check if it was locked before she walked off. She revealed that she was out of sight and could not visualize the medication cart. She revealed this failure could possibly put the 5 residents that were by the medication cart in danger, if one of them got ahold of the prescription medications that were in it. A policy and procedure titled Storage of Medication, dated April 1029 revealed the following: Policy Statement: The facility stores all drugs and biologicals in a safe, secure and orderly manner. Policy Interpretation and Implementation: 3. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe and sanitary manner. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 11 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 8. Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts and boxes) containing drugs and biologicals are locked when not in use. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 12 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and record review, the facility failed to maintain medical records on each resident were complete in accordance with accepted professional standards and practices for 1 of 15 residents (Resident #1) whose clinical records were reviewed for accuracy. The facility failed to ensure Resident #1's clinical record had a physician's orders entered for the 1 on 1 observations, scheduled documentation of the observations, missing signatures of who wrote the notes on the 1 on 1 observations on the paper documentation. This failure could place residents at risk for inaccurate or incomplete clinical records. Findings included: Record review of Resident #1's admission record dated 11/07/2023, revealed Resident #1 was 86 years-old and was admitted to facility on 07/29/2023 with a diagnoses of encephalopathy (brain disease that alters brain function), Alzheimer's Disease (neurodegenerative disease that destroys memory and other important mental function), Altered Mental Status (changes in consciousness, appearance, behavior, mood, affect, motor activity or cognitive function) and Delirium (serious disturbance in mental abilities that result in confused thinking and reduced thinking and reduced awareness of surroundings). Record review of Resident #1's admission MDS assessment Cognitive Patterns section dated 08/05/2023 revealed Resident #1 had a BIMS of 05 indicated severe impaired cognition; signs and symptoms of delirium such as exhibited inattention behavior and disorganized thinking behavior that was continuously present. Further review of the admission MDS Behaviors section revealed Resident #1 did not exhibit physical behaviors toward others; however, did exhibit verbal behaviors towards others 4 to 6 days a week and the behaviors did not place residents at significant risk for physical illness or injury, nor significantly interfere with the resident's care, nor significantly intrude on the privacy or activity of others, nor significantly disrupt the care or living environment of others. Further review of admission MDS Behaviors section revealed Resident #1 exhibited rejection of care and wandered 1 to 3 days a week; however, Resident #1 did not wander or intrude on the privacy or activities of others. Further review of Resident #1's admission MDS assessment medication section revealed Resident #1 did not receive any medications for anxiety. Further review of Resident #1's admission MDS assessment restraint and alarm sections revealed Resident #1 wore a wander guard alarm. Record review of Resident #1's Comprehensive Care Plan completed on 08/16/2023 revealed Resident #1 was evaluated as a wandering risk related to decreased safety awareness, confusion and wandering behaviors; staff were to observe Resident #1 for signs and symptoms of agitation, pacing, repetitive verbalization's of wanting to leave/go home, restlessness. Staff were to also report increased behaviors to nurses for further interventions. Further review of Resident #1's Comprehensive Care Plan revealed that the resident had the potential to be verbally aggressive, yelling loudly, throws arms in the air. Resident #1 was to verbalize his understanding of the need to control his verbally abusive behaviors. Resident #1 was an elopement risk related to being disoriented to place with history of attempts to leave the facility unattended, impaired safety awareness, and wandered aimlessly. Record review revealed that Resident #1's consolidated Physician's Orders dated 11/02/2023 revealed no evidence of a physician's order for 1 on 1 observations. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 13 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 Review of Resident #1's of 1:1 (1 Resident with 1 Staff) handwritten observation sheets from 08/15/2023 to 11/05/2023 revealed Resident #1 had 1:1 staffing every day from 08/15/2023 to 11/05/2023 during the day. During a confidential interview on 11/02/2023 at 11:45 AM., it was said Resident #1 was aggressive daily towards staff and tried to get out of the building, so he was placed on 1:1 observation. The confidential interviewee said the facility staff were told not to document the 1:1 observation in the resident's record. During a confidential interview on 11/02/2023 at 12:30 PM., it was said that Resident #1's 1 to 1 observations were not being documented so that another facility would accept him. During a confidential interview on 11/02/2023 at 1:50 PM., it was said that Resident #1 was 1 on 1 in the day and not at night. During an interview on 11/06/2023 at 9:05 AM, the DON said that she should have put an order in for the 1 on 1 observation since they were doing the 1 to 1 observation and she had verbally ordered the staff to do it. She said that corporate told her that she did not have to document it. She said that these issues placed the resident at risk of not improving or receiving the care that should be provided. She said that there was limited documentation done on the resident due to them not scheduling it in EMAR or accurately documenting the resident's 1 on 1 observations. She revealed that the facility was actively trying to transfer the resident to another facility. The facility's policy and procedures titled: Charting and Documentation policy dated July 2017 revealed the following: Policy Statement: All services provided to the resident, progress toward the care plan goals, or any changes in the residents' medical, physical, functional, or psychosocial condition, she'll be documented in the residence medical chart. The medical record should facilitate communication between the introduced disciplinary team regarding the resident's condition in response to care. Policy interpretation and implementation: 7. Documentation of procedures and treatments will include care specific details, including: a) The date and time the procedure/treatment was provided. b) The name and title of the individuals who provided the care. c) The assessment data and/or any unusual findings obtained during the procedure/treatment. d)How the resident tolerated the procedures/treatment. e) Whether the resident refuse a procedure/treatment. f) Notification of family, physician, or other staff, if indicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 14 of 15 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 675128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midwestern Healthcare Center 601 Midwestern Pkwy Wichita Falls, TX 76302 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 g) The signature in title of the individual documenting. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 15 of 15