Health inspection·June 7, 2023

F 0604 Record review Resident #10's medical record revealed no consent or evaluation of need for scoop mattress. Level of Harm - Minimal harm or potential for actual harm Observation on 06/05/23 at 11:30 AM revealed resident #10 in bed lying on a scoop mattress. Residents Affected - Some Resident #18 Review of Resident #18's Face Sheet, dated 06/07/23, revealed he was an 79 -year-old male admitted on [DATE] with the following diagnosis: dementia (loss of brain function), major depression, muscle weakness, diabetes (high blood sugar) and hypertension (high blood pressure). Review of Resident #18's Comprehensive MDS, dated [DATE] stated he was mildly cognitively intact with a BIMS score of 07. He required extensive assistance and total dependence of two person for bed mobility, toilet use, and personal hygiene. Further review of the MDS revealed resident has had one fall since admission with no injury and did not address restraint. Record review of Resident #18's Comprehensive Care Plan dated 12/15/22 revealed the resident was at risk for falls related to lower body weakness, history of falls, poor safety awareness and will not call staff for assistance. The interventions included scoop mattress while in bed. Record review of Resident #18's orders dated 06/01/23 to 06/30/23 and signed by physician revealed no Physician Order for scoop mattress. Record review Resident #18's medical record revealed no consent or evaluation of need for scoop mattress. Observation on 06/05/23 at 11:31 AM revealed Resident #18 in bed with head elevated lying on a scoop mattress. Resident #22 Review of Resident #22's Face Sheet, dated 06/07/23, revealed he was an 92 -year-old male admitted on [DATE] with the following diagnosis: myocardial infarction (heart attack), muscle weakness, dementia (loss of brain function), anxiety, diabetes (high blood sugar) and hypertension (high blood pressure). Review of Resident #22's Comprehensive MDS, dated [DATE] stated he was not cognitively intact with a BIMS score of 03. He required extensive assistance of one person for bed mobility, toilet use, and personal hygiene. Further review of the MDS reveals resident has had one fall since admission with two or more injuries and used bed and chair alarm daily. Record review of Resident #22's Comprehensive Care Plan dated 04/13/23 revealed the resident was at risk for falls related to impaired cognition due to diagnosis of dementia. He has poor safety awareness and does not call for assistance to get out of bed, get out of wheelchair or go to the bathroom. Care plan further documented four falls. The interventions included fall matt at the bed side while in bed, low bed while in bed, ensure resident is in a common area while up in wheelchair, place bed alarm to remind resident to call for assistance to get out of bed at wife's request, place chair alarm to remind resident to call for assistance to get out of wheelchair at wife's request, place in falling star program, remind resident to call staff for assistance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 2 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #22's physician orders dated 06/07/23 revealed an order for the resident to utilize a bed alarm when in bed and chair alarm when in wheelchair due to decreased safety awareness. Order written 03/31/23. Observation on 06/05/23 at 11:25 AM revealed Resident #22 up in wheelchair with chair alarm box hanging on wheelchair handle. Bed alarm box attached to resident side rail on bed. Record review Resident #22's medical record revealed no consent and evaluation for bed and chair alarm for fall prevention. During an interview on 06/07/23 at 09:31 AM with ADON, she stated Resident #22 had a bed and chair alarm but no consent or evaluation for need. She stated Resident #18 had a scoop mattress but no physician order, consent or evaluation for need. She stated Resident #10 had a scoop mattress but no consent or evaluation for need. She stated the alarms and scoop mattress they currently have in the facility were requested by the family. She stated the nurses or DON are responsible for doing the evaluation of need, getting an order and consent. She stated she did not realize alarms and scoop mattress needed a consent. During an interview on 06/07/23 at 10:45 AM with LVN A, she stated chair/bed alarms do not prevent falls. She stated some residents can turn the chair/bed alarm off. She stated the chair/bed alarms are loud and startles the residents. She stated the chair/bed alarms are in place to let the staff know the resident is up. She stated when the chair/bed alarms sound it reminds the resident to sit down. She stated chair/bed alarms require an order, consent and evaluation of need. She stated the evaluation should be the medical record under assessments. She stated the potential negative outcome could be the resident has more falls and a decline in ADL's. During an interview on 06/07/23 at 10:50 AM with DON, she stated items needed before placing a chair/bed alarm or scoop mattress was an order, consent and evaluation of need. She stated chair/bed alarms and scoop mattress are a form of restraints. She stated Resident #10 and #18 did have a scoop mattress and Resident #22 had a chair and bed alarm. She stated she was not sure who put the scoop mattress or chair/bed alarm in place. She stated family did request them be put back in place. She stated she was not sure how often a resident should be re-evaluated. She stated chair/bed alarms do not prevent falls. She stated the potential negative outcome of scoop mattress and chair/bed alarms could be not being able to mobilize and decline in ADL's. She stated Resident #18 did not have an order or consent for scoop mattress. She stated Resident #10 did not have a consent for scoop mattress. She stated Resident #22 did not have consent or evaluation of need for chair/bed alarm. She stated the purpose of the chair/bed alarms is to notify staff if a resident is getting up and the scoop mattress sets boundaries so they do not roll out of bed. During an interview on 06/07/23 at 11:03 AM with CNA D, she stated the purpose of the chair/bed alarms at to let staff know when a resident is moving or trying to get up. She stated the chair/bed alarms are loud, I can hear them from one end of the hall to the other. She stated Resident #22 can turn his chair/bed alarms off, so we have to place them out of his reach. She stated chair/bed alarms prevents falls and notifies staff. She stated Resident #22 does not like the chair/bed alarms. She stated he tells her I'm not a baby I am an old man. Take them off he don't need them. She states Resident #22 becomes agitated when the alarm goes off. She stated Resident #22 does need the chair/bed alarms as he requires assistance with walking due to an unsteady gait. During an interview on 06/07/23 at 11:11 AM with ADON, she stated items needed before placing a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 3 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0604 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chair/bed alarm or scoop mattress was an order, consent and evaluation of need. She stated chair/bed alarms and scoop mattress are a form of restraints. She stated Resident #10 and #18 did have a scoop mattress and Resident #22 had a chair and bed alarm. She stated the facility put the scoop mattress on the beds and the chair/bed alarms in place per family request. She stated restraints are re-evaluated once a quarter. She stated chair/bed alarms do not prevent falls. She stated the potential negative outcome of scoop mattress and chair/bed alarms could cause a resident to fall. She stated the purpose of the chair/bed alarms is reduction of injury from falls. She stated Resident #22 can turn his alarms off, but he does not usually turn them off. During an interview on 06/07/23 at 12:10 PM with Admin, he stated an order is needed, consent and evaluation of need before placing a chair/bed alarm or scoop mattress. He stated chair/bed alarms and scoop mattress are a form of restraints. He stated Residents #10 and #18 did have a scoop mattress and Resident #22 had a chair and bed alarm. He stated the facility put the scoop mattress on the beds and the chair/bed alarms in place. He stated chair/bed alarms prevent half of falls. He stated the potential negative outcome of scoop mattress and chair/bed alarms could cause scaring a resident and the sudden reflex reaction to alarm cause them to fall. He stated Resident #18 did not have an order or consent for scoop mattress. He stated Resident #10 did not have a consent for scoop mattress. He stated Resident #22 did not have consent or evaluation of need for chair/bed alarm. He stated the purpose of the chair/bed alarms is to notify you someone has fallen, so they won't lay in floor until someone finds them. Record review of facility nursing policies and procedure titled, Restraints with a revised date of 05/5/23 revealed the following: Policy: 1. Patients/Residents have the right to be free from a restraint of any kind and the right to function at their highest level in the least restrictive environment possible. Restraints will not be used unless the facilities interdisciplinary team has completed an assessment and evaluation to identify causative medical or environmental factors and has considered less restricted alternatives, except in the case of an emergency. If the resident needs emergency care, restraints may be used for brief periods to permit medical treatment to proceed unless the facility has a notice indicating that the resident has previously made a valid refusal of the treatment in question. If a residence unanticipated violent or aggressive behavior places him/her or others in imminent danger, the resident does not have the right to refuse the use of restraints. In this situation the use of restraints is a measure of last resort to protect the safety of the resident or others and must not extend beyond the immediate episode. 2. Chemical or physical restraints will never be used as a disciplinary action or for staff convenience. 4. Medical symptoms that warrant the use of restraints will be documented in the patient/resident's medical record, ongoing assessments, and care plan. 5. The physicians order for restraint should reflect the presence of a qualifying medical symptom. 6. The facility will engage in a systematic and gradual process towards reduction of restraint use. 7. Restraints must be reviewed at least monthly to evaluate necessity and appropriateness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 4 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0604 Level of Harm - Minimal harm or potential for actual harm 8. Balls do not constitute self-interest behavior or a medical condition that warrants the use of physical restraint. In the past some types of restraints were used to prevent falls. However, the risk for serious injury related to restraints and the lack of supporting evidence for restraint efficiency and fall prevention, have led to the eradication of the practice period additionally, falls that occur while a person is physically restrained often results in more serious injuries (e.g., strangulation, entrapment). Residents Affected - Some Procedures: New Restraint Orders: 1. Complete restraint assessment if appropriate then: 2. obtain order for A. the type of restraint B. duration time frame to be utilized C. medical diagnosis or symptoms necessitating restraint use D. parameters for use including release schedule E. frequency of checking F. removal schedule 3. obtain consent from the patient resident, family, surrogate, or health care representative if the patient resident lacks medical decision-making capacity. 4. Apply restraint for manufacturers guidelines. 5. Update care plan with the problem, goal and approaches, which must include: A. Observation B. Release C. Repositioning, at least every 2 hours 6. Document in the medial record including: A. Alternatives tried prior to use of physical restraint B. Patient/resident response to restraint (refer to Suggested Restraint Alternatives) 7. Documentation of patient/resident and family/responsible party education and/or notification. 8. documented therapy evaluation. 9. completion of CAA/off-cycle evaluation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 5 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0604 10. Update the patient profile in Matrix. Level of Harm - Minimal harm or potential for actual harm 11. The interdisciplinary Team meets as soon as possible to review the assessment and to consider if all alternatives and interventions have been selected and implemented for how each patient/resident can attain or maintain the highest level of functioning with the least restrictive measures. Residents Affected - Some Ongoing restraint use: A. Review each patient/resident currently using a restraint device, at least monthly and for any change of condition. B. Attempt gradual reduction of restraint use by implementing interventions which may serve as enablers and reminders. Reduction attempts should be documented, including the patient/resident response to the interventions. C. The plan of care should be updated at least quarterly and with any significant change, including the medical symptoms which continue to warrant the need for a restraint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 6 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record interview and record review, the facility failed to ensure all Pre-admission Screening and Resident Review (PASRR) Level I residents with mental illness were provided with a PASRR Evaluation assessment for 6 of 12 residents (Residents #1, 3, 7, 15, 20, and 23) reviewed for PASRR screening, in that: Residents #1, 3, 7, 15, 20 and 23 did not have an accurate PASRR Level 1 assessments when they had a diagnosis of major depressive disorder and schizoaffective disorder, bipolar type, bipolar disorder. These failures could place residents with an inaccurate PASRR Level 1 evaluation at risk for not receiving care and services to meet their needs. The findings were: Resident #:1 Record review of Resident #1's electronic face sheet revealed a [AGE] year-old female most recently admitted to the facility on [DATE]. The face sheet listed under Diagnoses Information, major depressive disorder (MDD), recurrent severe without psychotic features and generalized anxiety disorder. Record review of Resident #1's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of depression and anxiety disorder. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 15 indicating the resident was mildly cognitively impaired. Record review of Resident #1's most recent care plan, undated, revealed a focus area and diagnosis of Major Depressive Disorder and anxiety disorder, this problem started 1/25/2023. Resident #1 was prescribed Buspirone and Cymbalta to assist with these areas of need. Record review of Physician progress notes for Resident #1 dated 05/7/2023 revealed under current medications, Resident #1 was prescribed Cymbalta 60mg one tablet once a day for MDD and Buspirone 7.5mg three times a day for generalized anxiety disorder. Documentation indicated the resident was prescribed Paroxetine (antidepressant) 10mg once daily. Record review of Resident #1's Preadmission Screening and Resident Review Level One (PL1) form dated 04/01/2017 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #3: Record review of Resident #3's electronic face sheet revealed a [AGE] year-old female most recently admitted to the facility on [DATE]. The face sheet listed under Diagnosis Information a diagnosis of Major Depressive Disorder, recurrent and severe. Record review of Resident #3's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of depression. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 3 indicating the resident was severely cognitively impaired. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 7 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #3's most recent care plan, undated, revealed a focus area with problem onset date of 04/21/2023 which read in part that Resident #3 was prescribed antidepressant medication for a history of depression. Record review of Physician progress notes for Resident #3 dated 04/21/2023 revealed under Current Diagnosis, diagnosis of MDD. Resident #3 was prescribed Remeron 15mg for MDD. Record review of Resident #3's Preadmission Screening and Resident Review Level One (PL1) form dated 04/21/2023 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #7: Record review of Resident #7's electronic face sheet dated 6/7/23 revealed a [AGE] year-old male most recently admitted to the facility on [DATE]. The face sheet listed under Diagnosis indicated diagnoses of MDD, recurrent. Record review of Resident #7's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses of depression and an anxiety disorder. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 99 indicating the resident was severely cognitively impaired. Record review of Resident #7's most recent care plan, undated, revealed a focus area with problem onset date of 2/3/2023 which read in part that Resident #7 was at high risk for side effects due to a diagnosis of MDD and an anxiety disorder. Appropriate interventions are in place to assist with the behaviors associated with MDD. Record review of Physician progress notes for Resident #7 dated 05/07/2023 revealed under Current Diagnosis, a diagnosis including MDD. Resident #7 was currently prescribed Celexa 20mg one time a day for MDD and Lorazepam .5mg one tablet, one time a day for generalized anxiety disorder. Record review of Resident #7's Preadmission Screening and Resident Review Level One (PL1) form dated 02/03/2023 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #15 Review of Resident #15's face sheet revealed a [AGE] year-old-female with an admission date of 03/31/2022 with a primary diagnosis of Psychotic Disorder and Major Depressive Disorder. Record of Resident #15 physician orders dated 05/7/23 revealed Resident #15 was prescribed Escitalopram 10mg for Major Depressive Disorder by mouth at bedtime dated 6/7/2023. Record review of Resident #15's most recent care plan, undated, revealed a focus area of Resident #15 was at high risk for side effects due to a diagnosis of Major Depressive Disorder. Appropriate interventions are in place to assist with the behaviors associated with Major Depressive Disorder. Review of Resident #15's PASRR assessment Level 1 Screening dated 03/31/22, under Section C0100 revealed documentation indicating Resident #15 did not have a mental illness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 8 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 Level of Harm - Minimal harm or potential for actual harm Review of Resident #15's Annual MDS assessment dated [DATE], revealed under section I Active Diagnoses of Psychotic Disorder and Major Depressive Disorder. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 6 indicating the resident was severely cognitively impaired. Resident #20 Residents Affected - Some Review of Resident #20's face sheet revealed a [AGE] year-old-female with an admission date of 04/14/22 with a primary diagnosis of schizoaffective disorder, bipolar type, bipolar disorder. Record of Resident #20 physician orders dated 05/07/23 revealed Resident #20 was prescribed Vraylar 3mg once a day for schizoaffective disorder. Review of Resident #20's PASRR assessment Level 1 Screening dated 04/14/22, under Section C0100 revealed documentation indicating Resident #20 did not have a mental illness. Review of Resident #20's Annual MDS assessment dated [DATE], revealed under section I Active Diagnoses of Depression, Bipolar Disorder, and Schizophrenia. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 3 indicating the resident was severely cognitively impaired. Record review of Resident #20's most recent care plan, undated, revealed a focus area of Resident #20 was at high risk for side effects due to a diagnosis of Schizoaffective Disorder, Resident #20 was prescribed Vraylar to assist with this area of concern, the problem start date for this disorder was 5/12/2023. Resident #23 Review of Resident #23's face sheet revealed a [AGE] year-old-female with an admission date of 9/4/22 with a primary diagnosis of Psychotic Disorder with hallucinations and Major Depressive Disorder recurrent severe without psychotic features. Record of Resident #23 physician orders dated 05/7/23 revealed Resident #23 was prescribed Lexapro 10mg one tablet once a day for Major Depressive Disorder and Risperdal 0.5mg one tablet, once a day for psychotic disorder with hallucinations due to known physiological condition. Review of Resident #23's PASRR assessment Level 1 Screening dated 8/18/22, under Section C0100 revealed documentation indicating Resident #23 did not have a mental illness. Review of Resident #23's Annual MDS assessment dated [DATE], revealed under section I Active Diagnoses of Depression and Psychotic Disorder. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 10 indicating the resident was mildly cognitively impaired. Record review of Resident #23's most recent care plan, undated, revealed a focus area of Resident #23 was at high risk for side effects due to a diagnosis of Major Depressive Disorder and a Psychotic Disorder. Appropriate interventions are in place to assist with the behaviors associated with Major Depressive Disorder and a Psychotic Disorder. During an interview with the ADM conducted on 06/07/23 at 10:17AM, he said it was the ADONs responsibility to review PL1s for accuracy by comparing them to resident medical records. The ADM stated the PL1s are kept in paper form in the Resident's chart. The ADM confirmed Residents #1, #3, #7, #15, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 9 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some #20, #23 did not have a PASRR Evaluations completed, he also confirmed the PL1s for these residents were not accurate; due to Major Depression and Schizoaffective Disorder being diagnoses. The ADM stated the facility does not have a process for updating the PL1 if a resident was diagnosed with a new diagnosis. The ADM stated he was aware an updated PL1 would need to be completed if a resident was diagnosed with a new diagnosis after being admitted to the facility. The ADM stated he did not know Major Depression would warrant a positive PL1. When asked what the risks for a resident could be if they did not receive an accurate PL1 or subsequent PL2 evaluation, he said the residents are at risk of not receiving proper services. During an interview with the ADON on 06/07/23 at 10:40AM, she verified Residents #1, #3, #7, #15, #20, and #23 did not have PL2 evaluations as all their PL1s were negative. ADON stated it was her responsibility to ensure every resident admitted to the facility has a PL1. The ADON also stated it was her responsibility to ensure PL1s are completed accurately by comparing them to Resident medical records. ADON stated there is not a procedure in place to update a PL1 if a resident is diagnosed with a new diagnosis after being admitted to the facility. The ADON stated she did not know a diagnosis of MDD would warrant a positive PL1. The ADON stated she was aware Residents #1, #3, #7, #15, #20, and #23 did have a diagnosis of MDD. The ADON stated she has been in communication with the local mental health authority to complete a PL2 Evaluation for resident #20; however, that evaluation had not been scheduled. The ADON stated the potential harm to a resident without a subsequent PL2 evaluation was the residents will not receive the services they need. The facility policy for PASARR states all applicants to a Medicaid-certified nursing facility are evaluated for mental health prior to admissions and offered the most appropriate setting for their needs. If the PASARR level one screening indicated the individual may have an Intellectual Disability or a Mental Illness diagnosis the facility will confer with local mental health providers to complete a PASARR level two screening. Following the completion of the level two screening a care plan will be developed by the facility in order to meet the needs of a resident with an Intellectual Disability or a Mental Illness diagnosis. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 10 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that certified nurse's aides had the appropriate competencies and skills sets to provide nursing services to provide resident needs and assure resident safety and attain or maintain the highest practicable wellbeing for 2 of 2 Residents (Resident #9 and #20) reviewed for incontinent care. The facility failed to ensure CNA A maintained appropriate technique and did not wipe Resident #9's buttocks on either side. The facility failed to ensure CNA C maintained appropriate technique and did not wipe Resident #20's left cheek and wiped buttocks from back to front. This failure had the potential to affect residents by placing them at an increased risk of exposure to communicable diseases and infections. Findings include: Resident #9 Record review of face sheet for Resident #09, dated 06/07/23, revealed a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] the following diagnoses: dementia, anxiety, muscle weakness, hypertension (high blood pressure) and diabetes (high blood sugar). Review of Resident #09's MDS, dated [DATE] revealed she was not cognitively intact with a BIMS score of 02. She required extensive assistance of one person for bed mobility, toilet use, and personal hygiene. She was always incontinent of bladder and bowel. Record review of Resident #09's Comprehensive Care Plan dated 04/27/23 revealed the resident requires extensive assist x 1 with toileting and personal hygiene. The interventions included assist with ADLs as needed. The resident is incontinent of bladder and bowel. The interventions included monitor for incontinence and change, provided peri care, and apply protective skin barrier. The resident is at risk for pressures ulcers related to bowel and bladder incontinence. The interventions included keep clean and dry as possible and minimize skin exposure to moisture. Provide incontinence care after each incontinent episode. Resident #20 Record review of face sheet for Resident #20, dated 06/07/23, revealed a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: diabetes (high blood sugar), muscle weakness, hypertension (high blood pressure), schizoaffective disorder (mental health disorder with mood symptoms) and bipolar disorder (mood disorder). Review of Resident #20's MDS, dated [DATE] revealed she was not cognitively intact with a BIMS score of 03. She required total dependence of one person for toilet use and personal hygiene. Record review of Resident #20's Comprehensive Care Plan dated 04/27/23 revealed the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 11 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0726 Level of Harm - Minimal harm or potential for actual harm requires total dependence x 2 with toileting and personal hygiene. The interventions included assist with ADL's. The resident is incontinent of bladder and bowel. The interventions included check for incontinent episodes at least every 2 hours and provided incontinence care after each incontinent episode. The resident is at risk for pressures ulcers related to bowel and bladder incontinence. The interventions included monitor for incontinence every 2 hours, as needed change promptly. Residents Affected - Some Observation of incontinent care on 06/05/23 at 02:10 PM, CNA A performed incontinent care for Resident #09 and did not wipe the buttocks area on either side. Interview on 06/05/23 at 02:30 PM, CNA A stated she knew she wiped the center area twice and did not wipe either side. CNA A stated that she had been trained on peri care, but she got nervous. CNA A stated the potential negative outcome for improper peri care could be mild infection and skin irritation. Observation of incontinent care on 06/05/23 at 03:58 PM, CNA C performed incontinent care for Resident #20 and did not wipe left buttock cheek and cleaned from back to front. Interview on 06/05/23 at 04:20 PM, CNA C stated she realized she wiped the buttocks are back to front, but it was too late to correct it. She stated she got nervous and, in a hurry, to finish is why she forgot to wipe the left cheek area. She stated she has been trained on peri-care. She stated the possible negative outcome could be infection. Interview on 06/17/23 at 09:30 AM, the DON stated the CNAs were trained on incontinent care quarterly. The DON stated the DON, ADON and CN was responsible for monitoring the CNAs and training them regarding incontinence care. The DON stated she did not know why the CNA failed to wipe the buttocks area from front to back or clean the entire buttocks area. The DON stated she expected the buttocks to be wiped from front to back and the whole buttock area cleaned. The DON stated the potential negative outcome of not properly cleaning the residents was infections and skin breakdown. Interview on 06/07/23 at 09:45 AM, the ADON stated she expected the CNAs to wipe the buttocks from front to back and the whole buttocks area. She stated she along with the DON and CN are responsible for monitoring CNS's skills competences. She stated peri care competences are done yearly unless someone needs reeducation. She stated the potential negative outcome could be infection and skin breakdown. Interview on 06/07/23 at 12:10 PM, the Admin stated the DON and ADON are responsible for monitoring CNA's skills competences. He stated all CNAs should have been trained on peri care yearly. He stated his expectations are for CNAs to follow proper steps and to clean from front to back. He stated the potential negative outcome could be people get sick, odor and skin breakdown. Record review of facility policy and procedure titled, Perineal and Incontinence Care with a revised date of 05/5/23 revealed the following: Policy: Staff will perform perineal/incontinent care with each bath and after each incontinent episode. Procedures: Reference: Lippincott Nursing Procedures, 9th Ed., Perineal Care, Pages 651-653. Page 652 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 12 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0726 For a female patient Level of Harm - Minimal harm or potential for actual harm Using gentle downward strokes, clean from the front to the back of the perineum to prevent intestinal organisms from contaminating the urethra or vagina. Residents Affected - Some Clean, rinse, and dry the anal area, starting at the posterior vaginal opening and wiping from front to back. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 13 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure PRN orders for psychotropic drugs were limited to 14 days unless the attending physician or prescribing practitioner believed, and documented, that it was appropriate for the PRN order to be extended beyond 14 days, in that 1 of 12 residents (Resident #5) continued to receive psychotropic medications PRN for more than 14 days without a physician addressing the continued use of the medication: - Resident #5 continued to have a PRN order for Lorazepam 0.5mg after 14 days without an evaluation by the physician for continued treatment. This failure could result in residents receiving psychotropic and antipsychotic medications when contraindicated and could also result in residents experiencing adverse drug reactions. The findings include: Record review of Resident #5's face sheet, dated 06/07/23, revealed a [AGE] year-old-female who was admitted to the facility on [DATE] with diagnoses to include generalized anxiety, dementia and hypertension (high blood pressure). Record review of Resident #5's quarterly MDS, dated [DATE], revealed Section N - Medication Section

N0410 - Medications Received: B - Antianxiety - Given 0 out of 7 days. Record review Resident #5 comprehensive care plan dated 07/07/22 revealed resident exhibits signs and symptoms of anxiety. Residents goal was she will have no side effects from medications and was medication as ordered. Record review of Resident #5's physician order summary dated 06/07/23 revealed an order start date 04/27/23 with an indefinite end date for Lorazepam 0.5mg, give ½ to 1 tab every 6 hours as needed for anxiety. Record review of Resident #5's PRN MAR revealed Lorazepam 0.5mg give ½ to 1 tablet by mouth every 6 hours as needed for anxiety. Date 04/27/23 - open ended. No medication was administered for the month of May. Record review of Resident #5's medical records revealed no evaluation documentation for the prn Lorazepam. During an interview on 06/07/23 at 09:15 AM with the ADON, she stated the DON responsible for monitoring PRN psychotropic medications. She stated she was aware that PRN medications are to have a 14 day stop date. She stated Resident #5's PRN lorazepam was discontinued, and hospice rewrote the order with no stop date. She stated monitoring psychotropic medications is important to make sure it is taken appropriately, decrease dosages, monitor behaviors and the need for the medication. She stated the potential negative outcome could be giving residents unnecessary mediations. During an interview on 06/07/23 at 09:30 AM with the DON , she stated she was responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 14 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few monitoring PRN psychotropic medications. She stated Resident #5's PRN lorazepam had been discontinued and hospice rewrote order with order to not discontinue or change without notifying hospice. She stated there was no evaluation to continue past 14days in the medical record. She stated she knew PRN psychotropic medications required a 14 day stop date. She stated psychotropic mediations are mood altering and not indicated for long term use. She stated the potential negative outcome giving unnecessary medications. During an interview on 06/07/23 at 12:10 PM with the Admin, he stated the DON was responsible for monitoring psychotropic medications. He stated all PRN psychotropic medications are to have a 14 day stop dated and be reevaluated by the physician. He stated it is important to monitor psychotropic medications for effectiveness and side effects. He stated the potential negative outcome could be giving unnecessary medication. Record review of the Pharmacy Services Policies and Procedures: Section 6 - Medication Management revision date 4/1/22 revealed the following: Subject: 6.6 Psychotropic Drugs - use of Policy: 2. D. PRN orders for psychotropic drugs are limited to 14 days. Except as provided in 483.45 Euro(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order. 14. PRN orders for Psychotropic Medications A. The facility will only order PRN psychotropic medications to treat a diagnosis specific condition and the indication for the PRN in the medical record and should be ordered for no more than 14 days. For psychotropic medications excluding antipsychotics if the attending physician believes a PRN order for longer than 14 days is appropriate, the attending physician can extend the prescription beyond 14 days for the resident by documenting their rationale along with the specific duration and the resident's medical record. At the time of PRN is administered documentation must be present to justify the need for the medication, the non-pharmacological interventions attempted, and the monitoring for side effects and effectiveness has occurred. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 15 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an infection control program designed to provide a safe, comfortable and sanitary environment to help prevent the development and transmission of diseases for two of two residents (Residents #9 and 20) and 3 of 3 CNAs (CNA A, B, and C) reviewed for infection control. Residents Affected - Some CNA A failed to perform hand hygiene between glove changes when providing incontinent care for Resident #9. CNA B failed to perform hand hygiene between glove changes when providing incontinent care for Resident #20. CNA C failed to change dirty gloves while repositioning resident to side when providing incontinent care for Resident #20. These failures could place residents at risk for spread of infection and cross contamination. Findings include: Resident #9 Record review of face sheet for Resident #09, dated 06/07/23, revealed a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] the following diagnoses: dementia, anxiety, muscle weakness, hypertension (high blood pressure) and diabetes (high blood sugar). Review of Resident #09's MDS, dated [DATE] revealed she was not cognitively intact with a BIMS score of 02. She required extensive assistance of one person for bed mobility, toilet use, and personal hygiene. She was always incontinent of bladder and bowel. Record review of Resident #09's Comprehensive Care Plan dated 04/27/23 revealed the resident required extensive assist x 1 with toileting and personal hygiene. The interventions included assist with ADLs as needed. The resident was incontinent of bladder and bowel. The interventions included monitor for incontinence and change, provided peri care, and apply protective skin barrier. The resident was at risk for pressures ulcers related to bowel and bladder incontinence. The interventions included keep clean and dry as possible and minimize skin exposure to moisture. Provide incontinence care after each incontinent episode. During an observation of incontinent care on 06/05/23 at 02:10 PM, CNA A performed incontinent care for Resident #09. CNA A did not perform hand hygiene between glove change of dirty to clean after wiping urine and removing soiled brief before donning clean gloves and placing clean brief under Resident #9. During an interview on 06/05/23 at 02:30 PM, CNA A stated she did not wash her hands or use hand sanitizer, but she knew to wash hands or use hand sanitizer between glove changes. CNA A stated that she had been trained on peri care, but she got nervous. CNA A stated the potential negative outcome for improper peri care could be mild infection and skin irritation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 16 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Record review skills checklist : Perineal Care provided by facility that was dated 05/22/23 for CNA A. Level of Harm - Minimal harm or potential for actual harm Resident #20 Residents Affected - Some Record review of face sheet for Resident #20, dated 06/07/23, revealed a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: diabetes (high blood sugar), muscle weakness, hypertension (high blood pressure), schizoaffective disorder (mental health disorder with mood symptoms) and bipolar disorder (mood disorder). Review of Resident #20's MDS, dated [DATE] revealed she was not cognitively intact with a BIMS score of 03. She required total dependence of one person for toilet use and personal hygiene. Record review of Resident #20's Comprehensive Care Plan dated 04/27/23 revealed the resident required total dependence x 2 with toileting and personal hygiene. The interventions included assist with ADL's. The resident was incontinent of bladder and bowel. The interventions included check for incontinent episodes at least every 2 hours and provided incontinence care after each incontinent episode. The resident was at risk for pressures ulcers related to bowel and bladder incontinence. The interventions included monitor for incontinence every 2 hours, as needed change promptly. During an observation of incontinent care on 06/05/23 at 02:36 PM, CNA B performed incontinent care for Resident #20. CNA B did not perform hand hygiene between glove change when going from dirty to clean after wiping urine and removing soiled brief before donning clean gloves and placing clean brief under Resident #20. During an interview on 06/05/23 at 03:40 PM, CNA B stated she did not wash or use hand sanitizer between glove changes. She stated she had been trained to wash hand or use hand sanitizer between glove changes. She stated she has been trained on peri-care and infection control. She stated the possible negative outcome could be infection. Observation of incontinent care on 06/05/23 at 03:58 PM, CNA C performed incontinent care for Resident #20. CNA C cleaned urine from Resident #20 front side and turned resident to her side using same gloves. During an interview on 06/05/23 at 04:20 PM, CNA C stated she realized she used dirty gloves when turning resident. She stated she got nervous and, in a hurry, to finish was why she forgot the glove change. She stated she has been trained on peri-care and infection control. She stated the possible negative outcome could be infection and cross contamination. Record review skills checklist : Perineal Care provided by facility that was dated 06/08/23 for CNA C. During an interview with DON on 06/07/23 at 09:30 AM, she stated gloves are to be changed between dirty and clean and wash hands or use hand sanitizer between glove changes. She stated the DON, charge nurse and ADON train CNA's quarterly. She stated the DON, ADON and charge nurse was responsible for monitoring CNAs to ensure they are following proper infection control. She stated CNAs are monitored for proper infection control during skills check offs with CNA, in-services and observed during rounds. She stated it is important to follow infection control guidelines to prevent urinary tract infections and unnecessary infections. She stated there is no reason why a staff member would be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 17 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some exempt from hand washing or using hand sanitizer. She stated the potential negative outcome with improper infection control could be urinary tract infections, resident become septic from urinary tract infections and develop bad routines. During an interview with ADON on 06/07/23 at 09:45 AM, she stated gloves are to be changed between dirty and clean and hands are to be washed at the beginning, after glove change and at the end of peri care. She stated the DON and ADON train and monitor CNA's skills competences yearly or as needed. She stated the DON, ADON and charge nurse was responsible for monitoring CNAs to ensure they are following proper infection control. She stated CNAs are monitored for proper infection control during skills check offs. She stated it is important to follow infection control guidelines to reduce use of antibiotics, prevent infection and we don't want to cause an infection. She stated there is no reason why a staff member would be exempt from hand washing or using hand sanitizer. She stated the potential negative outcome with improper infection control could be urinary tract infections. During an interview with Admin on 06/07/23 at 12:10 PM, he stated gloves are to be changed after each task. He stated the DON trains and monitor CNAs skills competences. He stated the DON and ADON are responsible for monitoring CNAs to ensure they are following proper infection control. He stated it is important to follow infection control guidelines to prevent odor, skin breakdown and prevent people from getting sick. He stated there is no reason why a staff member would be exempt from hand washing or using hand sanitizer. He stated the potential negative outcome with improper infection control could be people getting sick. Record review of the facility's policy titled Hand Hygiene/Handwashing, revision date May 15, 2023: Policy: Proper hand hygiene/hand washing technique will be accomplished at all times that hand washing is indicated. Note: Hand hygiene/hand washing is the most important component for preventing the spread of infection. Maintaining clean hands is important for patient residence visitors as well as staff. Procedures: 1. Hand hygiene/hand washing is done: Before: A. Before patient/resident contact. F. Before performing an aseptic task. After: A. After contact with soiled or contaminated articles, such as articles that are contaminated with body fluids. B. After patient/resident. C. After contact with a contaminated object or source where there is a concentration of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 18 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 microorganisms, such as, mucus membranes, non-intact skin, body fluids, blood or wounds. Level of Harm - Minimal harm or potential for actual harm D. After toileting or assisting others with toileting, or after personal grooming. H. After removal of medical/surgical or utility gloves. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 19 of 20 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 675182 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brownfield Rehabilitation and Care Center 510 S First St Brownfield, TX 79316 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on record review, observation and interview , the facility failed to provide 80 square feet of floor space per resident in 24 of 24 semiprivate resident rooms containing two beds (Rooms 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34). Rooms 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34 semi- private rooms did not have 80 square feet per resident. This failure could result in overcrowding in resident rooms and possible diminished quality of life. The findings included: Record review of CASPER 3 during preparation for survey revealed a waiver for room size requirements had been done yearly by the facility. Record review of Room Size Wavier for Facilities dated 05/06/22, during preparation for survey, revealed a wavier for rooms #s 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34. Record review of Texas Health and Human Services Form 3740 (Bed Classifications (Numbers and Location) dated 09/20/22 documented that rooms #'s 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34 were listed as a Title 18/19 bed classification semi-private rooms for two residents. During an interview on 06/05/23 at 10:23 AM with the Administrator regarding the square footage for room #'s 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34 revealed he wanted to apply for the room size waiver. The administrator stated, Yes, I want to apply for the waiver. He stated room #'s 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34 had a waiver for years and there has been no change to the floor plan. During a general observation tour on 06/05/23 between 11:30 AM and 12:00 PM, it was noted that 24 of 24 semi-private rooms had 156 square feet instead of the required 160 square feet for 2 residents: (Rooms) 1, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 18, 20, 22, 24, 26, 28, 29, 30, 31, 32, 33, and 34. During an interview on 06/07/23 at 9:30 AM with the Administrator , regarding the risk of residents not having the appropriate space, he stated it had not been a problem in the past . He stated there was no facility policy for room size wavier. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675182 If continuation sheet Page 20 of 20