Inspection·August 28, 2025

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that were identified in the comprehensive assessment for 1 of 2 residents (Resident #8) reviewed for care plans.1. Resident #8 did not have a care plan developed to address his need for one-on-one in-room individual activity pursuits.2. Resident #8's care plan was not revised and updated with a care plan to address his bedbound status. This failure placed the resident at risk for social isolation, decreased awareness of his surroundings, and decreased feelings of well-being.The findings included: Record review of Resident #8's admission Record, dated 8/28/2025, revealed a [AGE] year-old male initially admitted to the facility on [DATE]. The resident's diagnoses included Alzheimer's disease (progressive brain disorder that slowly destroys memory, thinking skills, and eventually the ability to carry out simple tasks), chronic kidney disease stage 3 (mild to moderate kidney damage, leading to a reduced ability to filter waste and excess fluid from the blood), hypertension (high blood pressure), hearing loss, nuclear cataracts bilaterally (clouding and hardening of the central part of the eye's lens), osteoporosis (a condition that weakens bones and increases the risk of fracture), fracture of neck of right femur (right hip fracture), low back pain, chronic pain syndrome, dysphagia (swallowing problem), atherosclerosis of left leg (hardening of arteries). Record review of the Activity Participation Note, dated 2/03/2025, revealed the AD documented the following: Resident prefers independent in own room activities. It is very important for resident to be able to watch TV and movies. It is very important for resident to go outside in the sunshine, but with a blanket. Resident enjoys hunting and fishing. Resident has no other activity concerns at this time.Review of Resident #8's Significant Change in Condition MDS Assessment, dated 6/28/2025, revealed a BIMS score of 1 out of 15 (severe cognitive impairment) and documented activity preferences as being very important for doing favorite activities, keeping up with the news, going outside for fresh air, and participating in religious services or practices. Review of Resident #8's comprehensive care plan, dated as initiated 12/03/2024 and revised 6/30/2025, revealed it did not include a care plan to address the resident's activity interests or need for in-room one-on-one activities. The care plan had been updated to include hospice care services, but did not address the resident's bedbound status. Observation on 8/26/2025 at 10:59 AM revealed Resident #8 was lying on his back in bed with his eyes closed. He was wearing eyeglasses. The room door was open to the hallway. Observation on 8/27/2025 at 8:10 AM revealed Resident #8 was lying in bed with the head of bed elevated. His eyes were closed. The room door was open to the hallway. During an interview and record review on 8/28/2025 at 10:37 AM, the Activity Director stated Resident #8 was assisted into his wheelchair by the CNAs. She stated Resident #8's family member visited about 1 time per week and took the resident outside. She stated Resident #8 liked to be outside. The AD stated Resident #8 did not like group activities or being around people. She reviewed his electronic health record and stated the last documented activity progress note was dated 2/03/2025. She stated she was supposed to document a progress note every 3 months, every time an MDS assessment was due, and she had not done that for Resident #8. The AD reviewed Resident #8's electronic health record and stated he had a quarterly MDS assessment and activity progress note due now. She reviewed his care plan and did not see a care plan for activities. The AD stated Resident #8 liked music and she had taken a tablet into his room and played u-tube live music videos for him. She stated the resident did not really like the tablet. The AD stated the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 2 of 10 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 08/28/2025 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 used to like hunting and fishing. She stated she had not been able to find any TV programs with fishing or hunting, other than programs with people shooting deer. She stated maybe he would like to watch people shooting deer. In an interview on 8/28/2025 at 11:08 AM, the AD stated she did not document one-on-one activity programming for Resident #8. Observation on 8/28/2025 at 11:16 AM revealed Resident #8 was lying on his back in bed. The TV was on in the room, but volume was low. The resident was not wearing his eyeglasses, which were on the bedside nightstand. The room door was open to the hallway. In an interview on 8/28/2025 at 11:16 AM, C.N.A. A stated she had been employed in the facility since December 2024 and she worked from 6:00 AM to 6:00 PM on the hall were Resident #8's room was located. She stated Resident #8 used to get up in his wheelchair for all meals in the main dining room before he fell and broke his hip and stated he still went to the dining room after he broke his hip. C.N.A. A stated about 2 months ago Resident #8 started staying in bed. She stated Resident #8's daughter did not want him to get up because he was in too much pain. C.N.A. A stated the hospice aide gave Resident #8 a bed bath on Tuesday and Thursday and sometimes on Saturday. She stated Resident #8 did not ever get up [out of bed]. C.N.A. A stated she had not seen the AD go into Resident #8's room to visit him and had not seen anyone go into the resident's room to do an activity with him. She stated Resident #8 was visited by his family member who lived out of town and came to stay for a week or longer a couple times a month. She stated the family member stayed in Resident #8's house and visited him daily during her stays. C.N.A. A stated Resident #8 had other family members who visited and his military friends visited when they could get a ride [to the facility], and they were old too. She stated she turned on the TV, but left the volume at the level the daughter had it on during her last visit. During an interview and record review on 8/28/2025 at 12:09 PM, the MDS Coordinator stated she oversaw care plans and sometimes each department entered their own care plans and sometimes she did it. She reviewed Resident #8's electronic health record and stated his last care plan conference was held 7/10/2025 and was attended by the resident's responsible family member, MDS Coordinator, SW, Dietary Manager, treatment nurse, and hospice nurse. She stated the Activity Director was not there and she was usually doing activities when care plan meetings were held. The MDS Coordinator stated activities were discussed and resident's family member did not want Resident #8 to be transferred from the bed with a mechanical lift due to the risk for injury. She stated the family member did not want him transferred at all. The MDS Coordinator stated she had added a care plan for activities today after the AD came and talked with her about a care plan for activities and she added one. The MDS Coordinator stated Resident #8 did not like large groups of people. She stated Resident #8 did not like eating in the dining room, either, when he had been assisted into the wheelchair and was taken to the dining room. On 8/28/2025 at 12:26 PM, the MDS Coordinator reviewed Resident #8's progress notes and found activity notes dated 12/03/24, 2/03/25, 5/06/25, 6/28/25 and printed them for the surveyor. The notes documented the similar entry: Resident prefers independent in own room activities. It is very important for resident to be able to watch TV and movies. It is very important for resident to go outside in the sunshine, but with a blanket. Resident enjoys hunting and fishing. Resident has no other activity concerns at this time. The MDS Coordinator stated the notes were documented before the care plan conference was held with Resident #8's responsible family member on 7/10/25, when she had stated she did not want him transferred from the bed. Record review of the facility's Lifetime Wellness Policies and Procedures for One-On-One Program, dated 1/01/2023, revealed the following [in part]: PolicyOne-on-one wellness visits will be provided for those residents whose physical or intellectual impairments prohibit their active involvement in group programs and/or those residents who prefer not to attend group programs and/or for identified short term rehab (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 3 of 10 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 08/28/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete patients.ProcedureThe resident's individual care plan must include identified need and interventions as well as the number of visits he/she is to receive per week. Review of the facility's policy and procedure for Care Plans, Comprehensive Person-Centered, dated as reviewed January 2023, revealed the following [in part]: Policy StatementA comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident.Policy Interpretation and Implementation1. The Interdisciplinary Team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident.2. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. Event ID: Facility ID: 675128 If continuation sheet Page 4 of 10 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 08/28/2025 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 0679 Provide activities to meet all resident's needs. 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, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing program to support residents in their choice of activities, both facility-sponsored group and individual activities and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community, for 1 of 2 residents (Resident #8) reviewed for individual in-room one-on-one activity programming.1. Resident #8 was observed lying in his bed throughout the survey with no observed visitors or in-room activity programs offered to him from 8/26/25 to 8/28/25.2. Resident #8 did not have an individual in-room activities program developed to meet his interests. These failures placed the resident at risk for social isolation, decreased awareness of his surroundings, and decreased feelings of well-being.The findings included: Record review of Resident #8's admission Record, dated 8/28/2025, revealed a [AGE] year-old male initially admitted to the facility on [DATE]. The resident's diagnoses included Alzheimer's disease (progressive brain disorder that slowly destroys memory, thinking skills, and eventually the ability to carry out simple tasks), chronic kidney disease stage 3 (mild to moderate kidney damage, leading to a reduced ability to filter waste and excess fluid from the blood), hypertension (high blood pressure), hearing loss, nuclear cataracts bilaterally (clouding and hardening of the central part of the eye's lens), osteoporosis (a condition that weakens bones and increases the risk of fracture), fracture of neck of right femur (right hip fracture), low back pain, chronic pain syndrome, dysphagia (swallowing problem), atherosclerosis of left leg (hardening of arteries). Record review of the Activity Participation Note, dated 2/03/2025, revealed the AD documented the following: Resident prefers independent in own room activities. It is very important for resident to be able to watch TV and movies. It is very important for resident to go outside in the sunshine, but with a blanket. Resident enjoys hunting and fishing. Resident has no other activity concerns at this time.Review of Resident #8's Significant Change in Condition MDS Assessment, dated 6/28/2025, revealed a BIMS score of 1 out of 15 (severe cognitive impairment) and documented activity preferences as being very important for doing favorite activities, keeping up with the news, going outside for fresh air, and participating in religious services or practices. Observation on 8/26/2025 at 10:59 AM revealed Resident #8 was lying on his back in bed with his eyes closed. He was wearing eyeglasses. The room door was open to the hallway. Observation on 8/27/2025 at 8:10 AM revealed Resident #8 was lying in bed with the head of bed elevated. His eyes were closed. The room door was open to the hallway. During an interview and record review on 8/28/2025 at 10:37 AM, the Activity Director stated Resident #8 was assisted into his wheelchair by the CNAs. She stated Resident #8's family member visited about 1 time per week and took the resident outside. She stated Resident #8 liked to be outside. The AD stated Resident #8 did not like group activities or being around people. She reviewed his electronic health record and stated the last documented activity progress note was dated 2/03/2025. She stated she was supposed to document a progress note every 3 months, every time an MDS assessment was due, and she had not done that for Resident #8. The AD reviewed Resident #8's electronic health record and stated he had a quarterly MDS assessment and activity progress note due now. She reviewed his care plan and did not see a care plan for activities. The AD stated Resident #8 liked music and she had taken a tablet into his room and played u-tube live music videos for him. She stated the resident did not really like the tablet. The AD stated the resident used to like hunting and fishing. She stated she had not been able to find any TV programs with fishing or hunting, other than programs with people shooting deer. She stated maybe he would like to watch Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 5 of 10 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 08/28/2025 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few people shooting deer. In an interview on 8/28/2025 at 11:08 AM, the AD stated she had documented one-on-one activity programming records for 3 other residents but did not have any for Resident #8. She stated she did some in-room activities with the other 3 residents and sometimes they came to the group activities. Observation on 8/28/2025 at 11:16 AM revealed Resident #8 was lying on his back in bed. The TV was on in the room, but volume was low. The resident was not wearing his eyeglasses, which were on the bedside nightstand. The room door was open to the hallway. In an interview on 8/28/2025 at 11:16 AM, C.N.A. A stated she had been employed in the facility since December 2024 and she worked from 6:00 AM to 6:00 PM on the hall were Resident #8's room was located. She stated Resident #8 used to get up in his wheelchair for all meals in the main dining room before he fell and broke his hip and stated he still went to the dining room after he broke his hip. C.N.A. A stated about 2 months ago Resident #8 started staying in bed. She stated Resident #8's family did not want him to get up because he was in too much pain. C.N.A. A stated the hospice aide gave Resident #8 a bed bath on Tuesday and Thursday and sometimes on Saturday. She stated Resident #8 did not ever get up [out of bed]. C.N.A. A stated she had not seen the AD go into Resident #8's room to visit him and had not seen anyone go into the resident's room to do an activity with him. She stated Resident #8 was visited by his family member who lived out of town and came to stay for a week or longer a couple times a month. She stated the family member stayed in Resident #8's house and visited him daily during her stays. C.N.A. A stated Resident #8 had other family members who visited and his military friends visited when they could get a ride [to the facility], and they were old too. She stated she turned on the TV, but left the volume at the level the family member had it on during her last visit. During an interview and record review on 8/28/2025 at 12:09 PM, the MDS Coordinator stated she oversaw care plans and sometimes each department entered their own care plans and sometimes she did it. She reviewed Resident #8's electronic health record and stated his last care plan conference was held 7/10/2025 and was attended by the resident's responsible family member, MDS Coordinator, SW, Dietary Manager, treatment nurse, and hospice nurse. She stated the Activity Director was not there and she was usually doing activities when care plan meetings were held. The MDS Coordinator stated activities were discussed and resident's family member did not want Resident #8 to be transferred from the bed with a mechanical lift due to the risk for injury. She stated the daughter did not want him transferred at all. The MDS Coordinator stated she had added a care plan for activities today after the AD came and talked with her about a care plan for activities and she added one. The MDS Coordinator stated Resident #8 did not like large groups of people. She stated Resident #8 did not like eating in the dining room, either, when he had been assisted into the wheelchair and was taken to the dining room. On 8/28/2025 at 12:26 PM, the MDS Coordinator reviewed Resident #8's progress notes and found activity notes dated 12/03/24, 2/03/25, 5/06/25, 6/28/25 and printed them for the surveyor. The notes documented the similar entry: Resident prefers independent in own room activities. It is very important for resident to be able to watch TV and movies. It is very important for resident to go outside in the sunshine, but with a blanket. Resident enjoys hunting and fishing. Resident has no other activity concerns at this time. The MDS Coordinator stated the notes were documented before the care plan conference was held with Resident #8's daughter on 7/10/25, when she had stated she did not want her father transferred from the bed. Record review of the facility's Lifetime Wellness Policies and Procedures for One-On-One Program, dated 1/01/2023, revealed the following [in part]: PolicyOne-on-one wellness visits will be provided for those residents whose physical or intellectual impairments prohibit their active involvement in group programs and/or those residents who prefer not to attend group programs and/or for identified short term rehab patients.ProcedureActivity staff may utilize the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 6 of 10 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 08/28/2025 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete One-on-One Tracking form to maintain an up to date list of residents identified for one-on-one programming each month.When visits are completed the date of intervention is noted and the appropriate documentation is completed in the wellness activity participation documentation on PCC.The following interventions for one-on-one programs may include but are not limited to:Health and Wellness EducationWellness on Wheels VisitMaintenance Exercise MusicAromatherapyMusic and MemorySensory StimulationCognitive Stimulation Social VisitSpiritual WellnessThe resident's individual care plan must include identified need and interventions as well as the number of visits he/she is to receive per week.The activity/wellness staff are responsible for documenting each one-to-one session according to the facility documentation process and should include:DateDurationIntervention(s)Response(s)If a one-on-one intervention is offered but the resident refuses, it must also be documented with reason for refusal. Event ID: Facility ID: 675128 If continuation sheet Page 7 of 10 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 08/28/2025 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 the necessary treatment and services, in accordance with comprehensive assessment and professional standards of practice, to prevent development of pressure injuries was provided for 1 of 3 residents (Resident #34) reviewed for pressure injuries. The facility failed to ensure Resident #34's wheelchair had a pressure reduction cushion on 8/28/2025. This failure could place residents at risk for new development or worsening of existing pressure injuries, pain, and decreased quality of life.Record review of Resident #34 ‘s Face Sheet revealed Resident #34 was a -year-old male admitted on with diagnoses of hypertension (high blood-pressure), hemiplegia and hemiparesis (loss of strength or paralysis), cerebral infarction (stroke), muscle wasting (muscle loss). Record review of Resident #34‘s Quarterly MDS assessment dated [DATE] revealed Resident #34 has a BIMS score of 00 (severe cognitive impairment), Section M in Resident #34's MDS revealed that Resident #34 was at risk for developing pressure ulcers/injuries, skin and ulcer/injury treatments, pressure reducing device for wheelchair. Record review of Resident #34 ‘s comprehensive care plan dated 08/07/2025 revealed Resident #34 had the potential to develop a pressure ulcer/injury due to frequent urinary and/or bowel incontinence, immobility, poor nutrition, risk score of 11 (high risk) on Braden risk Assessment (tool used to assess a patient's risk of developing pressure ulcers), sheering/friction. Record review of Resident #34‘s consolidated orders dated 4/30/25, stated ‘Pressure redistribution cushion to wheelchair'. During an observation on 8/26/25 at 12:05 PM, Resident #34 in dining room for lunch, Resident #34 sitting in wheelchair, no cushion on seat. During an interview on 8/28/25 at 8:40 AM, Resident #34 stated he did not have a cushion in wheelchair but thought he would like to have one, stating it would make wheelchair more comfortable. An interview on 8/28/25 at 9:00 AM, RN C, the charge nurse for Hall C and Resident #34. She stated that wheelchair cushion is on the resident's order but did not know if Resident #34 has one for his wheelchair, RN stated that CNA could answer that. RN C stated that if resident has been assessed as high risk for skin issues, having a pressure reducing cushion would help reduce risk of injury. An interview on 8/26/25 at 10:15 AM, CNA D stated that she did not know that resident [NAME][JM1] had an order for wheelchair cushion, CNA D stated she has never placed a cushion on residents' wheelchair. CNA D stated that resident only gets out of bed and uses wheelchair during meals, resident goes to dining room, and resident goes to church services on Thursdays. During an interview on 8/28/2025 at 11:00 AM the DON said the CNAs assisting the residents should be ensuring pressure reduction cushions were present in the resident's wheelchair when they were up[JM2] . She said all direct care staff were trained on hire and annually and she would ensure each resident at risk had a cushion in place. She said that the resident's risk for pressure ulcers was determined through assessments and if the resident was at risk, then there should be a pressure reduction cushion present to prevent skin breakdown. During an interview on 8/28/2025 at 11:30 AM the Administrator said the nursing staff were responsible for ensuring residents that were at risk for skin breakdown had the appropriate pressure reduction cushion in their wheelchair. She said staff were trained on the use of pressure reduction techniques and devices and expected the procedure was followed to prevent pressure injuries. Record review of a facility policy titled Skin Management: Prevention and Treatment of Wounds dated 12/01/2021 indicated [in part]: .the purpose of this procedure is to prevent skin breakdown. 2. Prevention: residents at risk for developing pressure injuries will have pressure reduction cushion devices in their wheelchair . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 8 of 10 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 08/28/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen, by failing to ensure: 1. The food fryer was left in an unsanitary condition, food fryer had not been cleaned after use, food crumbs dried to fryer baskets and inside fryer walls. 2. Cart with clean bowls and plates stored on it was not clean, food particles observed. 3. Floor behind stove, fryer and oven not swiped, food particles and trash found on floor. These failures could place residents at risk for decline in nutritional health status and foodborne illness.On 8/26/25 at 8:54 AM during the observation of dietary kitchen, fryer not clean, has food scrapes on baskets and fryer. Cart with clean bowls and plates stored on it was not clean, food particles observed. The floor behind stove, fryer and oven not swiped, food particles and trash were found on floor. In an interview on 8/26/25 at 11:20 AM, the Dietary Manager stated that fryer and fryer baskets should have been cleaned after last use. The Dietary Manager stated that the clean dish cart should be cleaned before placing clean dishes on cart. Dietary Manager stated that the floors behind equipment should be swept and mopped daily. The Dietary Manager stated that there is a cleaning schedule that staff are to follow and stated that equipment should be cleaned and sanitized after each use to prevent food borne illness, and the kitchen should be cleaned daily, and no food scraps or particles should be left out as to not attract pests. [JM1] Record review of the facility's policy for Kitchen Sanitation, dated October 2022, revised June 2024, stated [in part]: Section 1. All utensils, counters, shelves and equipment shall be kept clean, Section 11B. 1. Fixed equipment will be routinely cleaned and maintained, 3. Food contact equipment will be cleaned and sanitized after every use. Event ID: Facility ID: 675128 If continuation sheet Page 9 of 10 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 08/28/2025 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 0940 Develop, implement, and/or maintain an effective training program for all new and existing staff members. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record reviews, the facility failed to implement and maintain an effective training program for 1 of 16 existing staff (LPN E) whose training records were reviewed for multiple training topics, including the following: The facility failed to ensure LPN E was trained in Communication; QAPI; Resident Rights; Infection Control; Dementia; Abuse Neglect and Exploitation; Behavioral Health; HIV; Restraint Reduction; Falls; and Compliance and Ethics.These failures could place residents at risk of receiving care from incompetent/untrained staff.The finding included: Record review of personnel files revealed: LPN E had a hire date of 1-13-2021 and did not receive initial and/or annual trainings or in-services. LPN E had no current training for:CommunicationResident Rights Infection ControlCompliance and EthicsAbuse Neglect ExploitationQAPIBehavioral HealthDementiaHIVRestraint ReductionPrevention of Falls. In an Interview on 8-28-25 at 3:33 PM the ADMN stated her intention for staff training to encompass all employees and to include all resident care areas. She verbalized understanding that employees should have education to provide appropriate care to residents. She stated the negative outcome to not having education up to date would be that staff may not be able to provide appropriate care. In an interview on 8-28-25 at 3:59 PM the HR Coordinator revealed LPN E had been employed as a PRN staff since 1/13/21 and she did not complete trainings in Communication, Resident Rights, Infection Control, Compliance and Ethics, Abuse Neglect and Exploitation, QAPI, Behavioral Health, HIV, Prevention of Falls, Restraint Reduction, Dementia. HR Coordinator is responsible for monitoring staff training. Failure to complete trainings could put residents at risk for negative outcome. In an interview on 8-28-2025 at 5:30 PM the HR Coordinator stated LPN E was a PRN staff nurse and her most current shift worked was 8-16-2025. Record Review of the facility policy provided by ADMN titled In-Service Training, All Staff dated 12/9/2024 and reviewed/revised 8/5/2025 revealed [in part]: Policy StatementAll staff are required to participate in initial orientation and annual in-service training.Policy Interpretation and Implementation #1 All staff are required to participate in regular in-service education.#2 For the purpose of this policy, staff means all new and existing personnel, individuals providing services under contractual agreement, and volunteers.#3 The primary objective of in-service training is to ensure that staff are able to interact in a manner that enhances the residents quality of life and quality of care and can demonstrate competency in the topic areas of training. #5 Training methods and teaching materials are appropriate to the expected roles of those attending.#6 Required training topics include the following: ? Effective Communication with resident sand family (direct care staff)? Resident rights and responsibilities? Preventing abuse neglect exploitation and misappropriation of resident property including:a. Activities that constitute abuse neglect exploitation or misappropriation of resident propertyb. Procedures for reporting incidences of abuse neglect exploitation or misappropriation of resident property; andc. Dementia management and resident abuse prevention.? Elements and goals of the facility QAPI program.? The infection and prevention control program standards, policies and procedures.? Behavioral health; and? The compliance and ethics program standards; policies and procedures.#7 Training requirements are met prior to staff providing services to residents, annually, and as necessary based on the facility assessment.#8 Completed training is documented by the staff development coordinator, or his or her designee and includes:? The date and time of the training? The topic of the training? The method used for training? A summary of the competency assessment; and? The hours of training completed. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675128 If continuation sheet Page 10 of 10