Inspection·November 10, 2023

F 0689 Level of Harm - Immediate jeopardy to resident health or safety dropped her, and the nurse on duty, whose name she did not know, did not seem very worried about it. She said she had been visiting with her family member, and after shift change he noticed that her leg was swelling and said it looked like she had two knees on one leg. She said the nurse who had come on duty (LVN A) was alarmed and got X-rays for her and she had a broken leg. She said her leg had a knot which was discolored and as large as a fist. She said they fired a nurse and an aide over the incident. She was unable to identify the staff members by name. Residents Affected - Some An interview on 11/09/23 at 11:01 AM with Asst. Administrator revealed she had been employed at the facility for about a week when the Administrator discovered the incident with Resident #33's leg during a mock survey. She said they immediately put a PIP in place and started doing training with staff on related issues. She said they did skills check-offs for all of the nurses and CNAs. She said at the time they discovered it, in July, the people involved in the transfer were not working at the facility. She had been told that day (11/09/23) initially that the staff involved in the incident were not working at the facility at the current time, and when she learned that they actually were still employees, she knew that was bad. An interview on 11/09/23 at 11:05 AM with the DON revealed the former DON had been terminated for not performing her job duties, which included not reporting things that should have been reported. She said the former DON was very avoidant of reporting and some other aspects of her job, and when she was at the facility she created a culture of similar attitudes among the staff, and they had worked very hard to change that since she had been there, including terminating some staff and hiring new, and a lot of training. She said their QAPI process included many PIPs due to the former DON's lack of performance, and the incident with Resident #33 was one of the things they QAPI'd. She said in July 2023, when they discovered the issue, the former DON (at that time the active DON) told them the staff involved were no longer employed at the facility. She said the Administrator had been at the facility for less than a week when they discovered the issue with Resident #33 and they felt absolutely sick about it and immediately began to re-train the direct care staff. An interview and record review on 11/09/23 at 3:18 PM with the ADON revealed she started around the time that they did the mock survey and discovered the incident with Resident #33. At that time she was not able to find skills check-offs for the direct care staff left by the former administrative staff, so she initiated new ones. She said she did them with all of the already existing staff, and when they hired new staff they had seven days to get all of their check-offs completed. At the time of this interview, she provided a binder with all of the skills check-offs she had done, organized by hallway, and including full time and PRN employees. An interview on 11/09/23 at 4:08 PM with CNA D revealed she had been the CNA who had an incident with Resident #33 during a transfer, but there had been one on the shift before hers, as well. She said she had come in for her 6PM to 6AM shift, and Resident #33 was complaining about pain in her leg when she got there. She said the resident was in her wheelchair, visiting with her when she got to work, and there was no sling under her, so she and LVN A attempted to transfer her with a gait belt. She said that they stood the resident up and when she went to push the wheelchair out of the way something was wrong, and it would not move. At that time Resident #33 started to drop, and she tried to stop her with the belt, but the way her arm was extended she was not able to, so she yelled at the nurse that she was falling, and she fell with the resident. She said she landed on the floor, partially on the leg of the wheelchair, and Resident #33 landed on top of her. She said LVN A also went down on the side, while slowing the fall. She said the fall happened very slowly and she cushioned Resident #33 from the floor and wheelchair, but it was scary. She said the nurse assessed Resident #33 and they got a sling and got the resident back into her bed. She said after that the resident was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 2 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some still complaining about pain in her leg, so she told LVN E, who said the CNAs had to set her on the floor earlier that day too, and that she had normal pain for her when she checked on her. She then told LVN A, because the resident kept complaining, and LVN A sent Resident #33 out to the hospital right away . CNA D said Resident #33 was new to her at that time, and she did not know the resident was lift, but had been trained since on how to know. She said she would look at the [NAME] (information regarding care in the electronic chart) and talk to the nurse, and if there was not a sling under the resident, she would put one under them and use the mechanical lift to transfer them. She said the two CNAs who had the fall with the resident earlier that day did not work there anymore, and she thought she remembered their first names, but did not know their last names, and they had not worked there for a long time. An interview on 11/10/23 at 10:04 AM with the DON revealed there was a disciplinary notice for LVN E back in January, when this incident happened for not reporting the first of two incidents to administrative staff. At the time of this interview she provided an incident report for the second of the two falls the resident had that day, but said there was no incident report for the other one. An interview on 11/10/23 at 10:50 AM with Resident #33 revealed she had been a mechanical lift for years, before she even came to this facility. She said she only remembered one fall, and it was with a CNA and nurse who still worked at the facility. She said they did send her to the hospital after it happened, and she only remembered falling one time. She said she thought she remembered that the aide had not used the mechanical lift because there was something wrong with it, but she could not remember what. She said since that happened all the staff had done a good job transferring her with the mechanical lift. An observation on 11/10/23 at 11:34 AM of Resident #27 being transferred by mechanical lift ed by CNA I and CNA J. Correct procedures were followed by the CNAs and no concerns were noted. A telephone interview on 11/10/23 at 1:09 PM with LVN E revealed two CNAs (CNA B and CNA C) had lifted Resident #33 with a gait belt on her shift, but she talked to the CNAs at the time, and they said they had looked at the [NAME] and it said to use a gait belt. She did not check at that time to see if the [NAME] said the resident was a gait belt transfer. She said the resident did not really fall, but was slowly sat down on the floor by the CNAs and she assessed the resident. She was not in the room during that transfer, so she did not see it, but the resident was able to talk to her and tell her what happened. She said Resident #33 always had pain, to the point where you could touch her and she would say it hurt, and her pain was at her baseline when she assessed her . LVN E said there was no indication of injury at that time, and she told the resident's that if she started to have increased pain to let her know and she could contact the physician and get Xray orders, and he seemed like he was fine with that. After she assessed her, she and the CNAs put her back in her wheelchair using the gait belt, with no problems. She said after the incident the resident and her were outside talking and laughing, and she does not remember her acting like or saying she was in additional pain. She said she and the two CNAs involved were suspended related to the incident, and then terminated. Review of an incident report for Resident #33, dated 01/05/23, by LVN A, reflected Nursing Description: Pt was being transferred to bed from w/c using gait belt when her body became flaccid. CNA and this nurse low [missing text] floor. Resident Description: Pt stated that her leg was hurting and she wanted to sit. Description: Pt lowered to floor into seated position. VS taken at that time and WNL; Pt c/o pain in LLE; Mechanical lift and sling gathered and [missing text] from floor; EMS called and transported to (name of hospital); Family/DON/ADON/PCP notified of event. The report reflected (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 3 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some bruising on the front of the resident's left lower leg, that the resident was alert and oriented, and had pain of eight on a scale from one to ten. Review of a nursing progress note for Resident #33, by LVN E, dated 01/05/23 at 4:00 PM, reflected resident wanted to get up in w/c chair, CNA;s was [sic] getting resident up using gait belt. had to assist resident to floor. this nurse assessed resident. No injuries are [sic] bruising noted at this time. resident stated she had little pain to left LLE asked her resident if pain was different from her normal pain stated no. gave resident pain pill. resident up there told him if she states pain is worse i will notify DR to get x ray. Review of a nursing progress note for Resident #33, by LVN A, dated 01/05/23 at 8:52 PM, reflected Pt lowered into floor after attempting to transfer her from the w/c to the bed; Gait belt in use; C/o pain in LLE prior to transfer; Bruise noted at site of pain after transfer; EMS contacted and transported to TMC for eval; Appropriate parties notified. Review of a nursing progress note for Resident #33, by LVN O, dated 11/07/23, reflected Resident #33's return to the facility from the hospital. Resident is readmitted from TMC ( .) Resident is happy to be back home, alert and oriented though feeling bad about her L tibia fracture that is nonsurgical. The patient is post fall, history of CVA, and left hemiparesis. The left leg is immobilized and in a non-weight bearing status. Interviews beginning at 8:00 AM on 11/09/23, and concluding at 4:00 PM on 11/10/23 with the following staff (covering all shifts and halls) revealed staff had been trained, and was knowledgeable about all aspects involved in the incident with Resident #33, including what to do if the mechanical lift did not work properly, what to do if a mechanical lift resident does not have a sling underneath them, where to find transfer information about a resident, how to do a proper mechanical lift transfer, and reporting incidents, accidents, or concerns. Interviewed staff were: CNA D, LVN E, ADON, LVN F, CNA G, CNA H, CNA I, CNA J, CNA K, CNA L, CNA M, CNA N, LVN P, CNA Q, CNA R, LVN Y, LVN Z, and CNA AA. The Former DON and LVN A were not available for interview on 11/10/23. Review of QAPI documents for a Performance Improvement Plan, dated 07/26/23, reflected plans which included training of all staff due to concerns regarding mechanical lift transfers and reporting incidents. Review of the binder of skills check-offs, which included all full time and PRN staff, reflected completed, correct skills check-offs and competency quizzes which included mechanical lift transfers, for a sample of CNAs covering all halls and all shifts (CNA D, CNA G, CNA I, CNA J, CNA K, CNA L, CNA M, and CNA N). Review of the policy Safe Lifting and Moving of Residents, revised 07/2017, reflected the following: Policy Statement: In order to protect the safety and well-being of staff and residents, and to promote quality care, this facility uses appropriate techniques and devices to lift and move residents. ( .) 2. Manual lifting of residents shall be eliminated when feasible. 4. Staff responsible for direct resident care will be trained in the use of manual (gait/transfer belts, lateral boards) and mechanical lifting devices. 5. Mechanical lifting devices shall be used for heavy lifting, including lifting and moving residents when necessary. 6. Only staff with documented training on the safe use and care of the machines and equipment used in this facility will be allowed to lift or move (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 4 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete residents. 7. Staff will be observed for competency in using mechanical lifts and observed periodically for adherence to policies and procedures regarding use of equipment and safe lifting techniques. 8. Mechanical lifts shall be made readily available and accessible to staff 24 hours a day. Back-up battery packs on remote chargers shall be provided as needed so that lifts can be used 24 hours a day while batteries are being recharged. 9. Enough slings, in the sizes required by residents in need, will be available at all times. As an alternative, residents with lifting and movement needs will be provided with single-resident use disposable slings. Event ID: Facility ID: 675212 If continuation sheet Page 5 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview, and record review the facility failed to ensure a Registered Nurse was on duty in the facility for a minimum of eight consecutive hours a day, seven days a week, for five (05/13/23, 05/27/23, 05/28/23, 06/24/23, and 06/25/23) of 90 days reviewed. The facility failed to have RN coverage on 05/13/23, 05/27/23, 05/28/23, 06/24/23, and 06/25/23. This failure could place residents at risk of not having their nursing and medical needs met and receiving improper care. Review of the CMS PBJ Staffing Data Report, a report reflecting data self-reported to CMS by the facility, dated 11/01/23, reflected the facility had not reported RN coverage hours for 05/13/23, 05/27/23, 05/28/23, 06/24/23, and 06/25/23. An interview on 11/07/23 at 10:00 AM with the DON revealed she was regional staff, and had been the sitting DON at the facility since they had to terminate the former DON, and would be until the week following the survey. She said she worked more than full time at the facility. An interview on 11/08/2023 at 3:19 PM revealed when the Asst. Administrator was provided the dates with missing RN hours, she said the company she worked for had taken over the facility on 07/01/23, so she did not have access to some previous information, but she would try to get the information from their corporate office. She said that she knew the former DON did come in on weekends sometimes, but she was salaried so did not clock in, but she would try to get the needed information. She said they had not had any gaps in RN hours since she had been at the facility. An interview on 11/10/23 at 4:08 PM with the Asst. Administrator revealed the corporate office was unable to provide confirmation of RN hours on those dates. Review of the policy for Staffing, Sufficient and Competent Nursing, revised 08/2022, reflected the following: 3. A registered nurse provides services at least eight (8) consecutive hours every 24 hours, seven (7) days a week. RNs may be scheduled more than eight (8) hours depending on the acuity needs of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 6 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to store drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for two (Medication Room A and B) of two medication rooms reviewed for medication storage. The facility failed to store or dispose of medications no longer in use. This failure places residents at risk for incorrect administration of medications due to medications not being stored/disposed of appropriately. Findings include: In an observation and interview on [DATE] at 10:30 am in medication room A revealed, a 16 x 16 x16 brown cardboard box on the floor overflowing with medications. Interview with LVN F revealed that the overflowing medications in the cardboard box contained non-narcotic medications that had been discontinued, expired, or belonged to residents that been discharged from the facility. LVN F said that the medications in the box were for destruction by the pharmacist. She said that she did not know when the pharmacy would come to pick up the medications to be destroyed. In an observation on [DATE] at 11:34 am in medication room B, a 16 x 16 x 16 brown cardboard box was on the floor overflowing with medications. Interview with LVN Y revealed, the nurses placed non-narcotic medications that had been discontinued or expired in the box; No controlled medications are placed in the box. He said that he did not know when the pharmacy would come to pick up the medications for destruction. The ADON stated that medications were placed in the cardboard box until the pharmacist came once a month for medication destruction. She stated the DON had the drug destruction book and has never been responsible for drug log destruction or narcotic log destruction. She reported that the medication had always been in the box on the floor in the corner. She stated behind a locked door, non-narcotics were ok on the floor and two lock doors were required for narcotics. The ADON reported that she was not aware of any risks for boxes being on the floor. She was not aware of any risk of medication diversion with their non-narcotic medications because only the nurses have access to medication room. The ADON stated that she does not know how the tracking system of medication to be destructed works. She reports that not having a tracking system can led to the risk of a drug diversion. The ADON states that staff not washing their hands is a risk of spreading infection. Interview with the DON on [DATE] at 12:45 pm revealed that she was not aware that they did not have a tracking system for the non-narcotics to be destroyed. She also stated that lack of tracking can lead to drug diversion. Record review of the facility's, undated, policy, Storage of Medication, reflected that, will maintain medication storage and preparation areas in a clean, safe, and sanitary manner ( .) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 7 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide one of ten residents (Resident #63) food in a form to meet their needs. The facility failed to process the pureed diet for a correct, pudding-like consistency for Resident #63. This failure could place residents at risk of dietary and nutritional needs not being met. Findings included: Review of Resident #63's face sheet, dated 11/10/23, reflected she was a [AGE] year-old female 08/23/22, and having diagnoses of Alzheimer's, unspecified dementia, dysphagia (trouble swallowing), and an unspecified eating disorder. Review of Resident #63's significant change MDS, dated [DATE], reflected she was rarely able to be understood or to understand others, and had moderate difficulty hearing as well as severely impaired vision. Resident #63 had long and short term memory loss, severely impaired daily decision-making skills, and continuous inattention and disorganized thinking. She required extensive one to two person assistance for most ADLs, except for eating, when she required supervision of one person. Review of Resident #63's diet order, dated 11/15/22, reflected Regular diet Pureed texture, Regular consistency, Serve ice cream w/dinner. Provide scoop plate at every meal.NO DINNER ROLLS AND TORTILLAS. Review of Resident #63's careplans reflected the following: - A careplan initiated 09/13/22 Problem: (Resident #63) is at risk for weight loss and malnutrition r/t poor appetite, swallowing Problems with one of the interventions being to offer diet per orders. - A care plan initiated 09/13/22 Problem: (Resident #63) has a swallowing problem r/t c/o difficulty swallowing, holding food in mouth. Goal: (Resident #63) will not have injury related to aspiration through the review date. Interventions: ( .) Diet to be followed as prescribed. Observation on 11/07/23 at 12:20 PM revealed Resident #63 seated near the nursing station with her lunch in front of her, not eating. The pureed diet consisted of three mounds of food, holding the spherical shape of the scoops used for serving, and one scoop appeared to have gravy on it. An interview with CNA V on 11/07/23 at 12:49 PM revealed Resident #63 was usually able to feed herself, but did not eat well . The CNA said they would attempt to help her if she did not eat, but she would physically hit them when they did, but they continued to offer. CNA V said they offered her the nutritional shakes, and she liked them. She said that was the case on this day, that the resident did not eat, but drank a shake. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 8 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An observation on 11/08/23 at 12:22 PM revealed when three surveyors tested a pureed diet tray, the consistency of the food appeared the same as they day before, and stood in the shape of the scoops, like stiff mashed potatoes, with no puddling. The pureed hamburger with bun was thick, and not smooth. It had a slightly unevenly grainy texture. The pureed french fries were also thick, holding the shape of the scoop and had what appeared to be a thin, slightly dried skin on the scoop. They were not smooth and contained lumps that were not hard, but were firmer than the rest of the pureed dish . An interview on 11/08/23 at 12:26 PM with Dietary Services Manager revealed she tried the food on the test tray and said it was supposed to be pudding-like texture. She said the food on the tray was not that texture. She said cook was the one who made the puree, and used a recipe. She said the cook had worked there for a very long time, so she was not sure who trained her. She said the risk of the food being an improper texture was that a resident could get pieces in their lungs or choke /. An interview and observation on 11/08/23 at 12:41 PM with the Dietician revealed the food was a little thick today. She said the texture was supposed to be smooth like mashed potatoes. She said the manager trained the cooks, and she did education and in-services as well. She said they did not want the puree to be too thin, and that some therapists wanted it to be thicker, so the resident would have a bolus they could swallow better. She placed some of the burger, then some of the french fries between her fingers and thumb and mashed it, and showed it to the surveyor. She said she felt the texture was consistent and acceptable. The surveyor observed the food on her fingers, and it did not appear as a smooth, pudding-like consistency. The Dietician said the risk of not having the appropriate pureed texture was aspiration and choking. An observation on 11/09/23 at 12:35 PM revealed a test tray sampled by four surveyors. The appearance of the food on the tray appeared softer and smoother than the previous test tray, and the texture on the tongue was an appropriate, smooth pureed texture, for all three items on the plate. Review of the undated policy Consistency Modified Diets reflected Pureed: This diet consists of pureed, homogenous, and cohesive foods. Food should be pudding-like; no coarse textures, raw fruits or vegetables, nuts, etc., are allowed. Any foods that require bolus formation, controlled manipulation, or mastication are excluded. This diet is designed for people who have moderate to severe dysphagia, with poor oral phase abilities and reduced ability to protect their airway. Close or complete supervision and alternate feeding methods may be required. ( .) Since oral intake of these meals is generally low, great efforts have been made to improve the taste, texture and nutritional value of many of the recipes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 9 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 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 in the facility's only kitchen reviewed for kitchen sanitation. Residents Affected - Some The facility failed to properly close an opened and partially used shelf stable food item. This failure could place residents at risk for food contamination and food-borne illness. Findings included: Observation on 11/07/2023 at 8:41 AM of the facility's walk-in dry goods pantry revealed that there was a plastic tub of Vanilla Heat 'N Ice Icing on a top shelf with the lid not properly closed and sealed, leaving an approximate ¼ to ½ gap exposing the top of the icing surface for an unknown amount of time. The icing had been used to top the apple dump cake that was served as dessert for lunch on 11/07/2023 as observed upon entry to the kitchen where Dietary Aide S was observed portioning the cake with white icing into individual bowls for the lunch service. The icing tub was on the top shelf on the exterior wall of the pantry. Interview and observation on 11/07/2023 at 9:21 AM with the Dietary Services Manager revealed the container of frosting was improperly closed and as such could lead to contamination of the product if used again. Dietary Services Manager stated that contamination could have come from insects, bacteria, or mold entering the container and being served to a resident which might have led to a resident becoming ill. Interview on 11/07/2023 at 9:32 AM with Dietary Aide S revealed that he had opened and used part of the tub of icing for the dessert cake he was portioning. Dietary Aide S stated he thought the container had been properly closed and did not notice the open portion of the lid. Dietary Aide S was not able to state how long the tub of icing had been sitting in the dry goods pantry. Interview and observation on 11/10/2023 at 10:14 AM with Dietary Services Manager revealed that had not been able to find any policy related to how dry or shelf stable goods were to be stored. The Dietary Services Manager stated the contents of the icing tub were disposed of to not risk exposing any residents to a contaminated food product but had saved the container to use as training aid during in-service with staff to show the dangers and how to properly close that type of container. The Dietary Services Manager stated that the dangers of a lid having been left open, even partially, were that the product can spoil causing anyone who ate the contents to possibly get sick; there was a danger of bacteria building up that can cause food poisoning. The Dietary Services Manager had also stated that an open lid could have let in bugs and gnats and as it's contents of sugary icing might attracted ants as well. The Dietary Services Manager thoroughly reviewed the tub label and found the contents to have been shelf stable and manufacturer had not labeled with a recommendation to refrigerate after opening. The Dietary Services Manager trains and in-services kitchen staff; all kitchen staff hold current food service handler certifications. The Dietary Services Manager was observed multiple times during survey to be in multiple areas of the kitchen assisting and working alongside staff during food preparation and meal service. Interview on 11/10/2023 at 10:24 AM with [NAME] T revealed that staff has been in-serviced by the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 10 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 Dietary Services Manager about improperly stored foods being dangerous as they can grow bacteria and spoil, ruining the product and can make people sick; if bacteria were something like E. coli it could have possibly caused death. [NAME] T stated that shelf stable items needed to be looked at to be sure packaging was intact and not been torn and was not expired. [NAME] T stated that if food items were not stored right they could get bugs that would have brought bacteria or germs and made people sick. Residents Affected - Some Interview on 11/10/2023 at 10:31 AM with Dietary Aide U revealed she did preparation work such as plated desserts, cut fruit, and took carts to halls. Dietary Aide U stated staff could help control contamination of foods by wearing hair nets, washing hands frequently, and using gloves if they may need to touch food directly. Dietary Aide U stated the residents could get sick easily from germs since they are older and may have illnesses. During the interview, Dietary Aide U stated that if food was not correctly stored it would go bad and not be good to serve. Dietary Aide U stated spoiled foods could cause stomach virus' and make people sick. Dietary Aide U stated that if partially used foods were put away, staff would need to make sure and store at correct temperature, in right container/zip lock, label when opened and when to use by. Interview on 11/10/23 at 1:05 PM with the Assistant Administrator stated that not following proper food storage procedure could have resulted in contamination or unsafe kitchen practices. The Assistant Administrator stated that there was no specific food storage policy for the facility or the management company that could be found or was provided prior to the end of the survey. Review of the U.S. Public Health Service Food Code, dated 2022, 3-202.15, Package Integrity. FOOD packages shall be in good condition and protect the integrity of the contents so that the FOOD is not exposed to ADULTERATION or potential contaminants. Review of the U.S. Public Health Service Food Code, dated 2022, 3-305.11 Food Storage. (A)Except as specified in (B) and (C) of this section, FOOD shall be protected from contamination by storing the FOOD: (1)In a clean, dry location; (2)Where it is not exposed to splash, dust, or other contamination; and (3)At least 15 cm (6 inches) above the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 11 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure resident rooms were adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for one of 14 residents (Resident #28) reviewed for resident call system. Residents Affected - Few The facility failed to ensure Resident #28 had an accessible and working call light. This failure could place residents in the facility at risk of being unable to obtain assistance for activities of daily living or in the event of an emergency. Findings included: Review of Resident #28's Face sheet, indicated that the resident was a [AGE] year-old male, admitted to the facility on [DATE] with a diagnosis of Pneumonia Due to Pseudomonas (a bacterial infection) and Tracheo-Esophageal Fistula (an abnormal connection between the trachea and the esophagus) following tracheostomy. Review of Resident #28's Care Plan , indicated that the resident was a [AGE] year old male who admitted to the facility on [DATE] with a diagnosis of pain in unspecified joint, obsessive- Compulsive disorder, Anemia, and Schizophrenia. Problem: Resident #28 is known for thrashing about in the bed when he is uncomfortable in an effort to gain assistance with repositioning or attention. Goal: Will have fewer episodes of thrashing and will use call light for assistance. Interventions: ensure call light is in reach. Problem: Resident #28 is at risk for Fall r/t left sided Hemiplegia/CVA. Bil ankle contractures and Right hip contracture. Goal: Resident #28 will have no injuries related to falls. Intervention: Encourage use of call light, Keep call light within reach at all times when in room Observation and interview on 11/07/2023 at 2:32 PM revealed Resident #28 resided in B bed of room [ROOM NUMBER]. Observation revealed resident laying in bed with call light resting on bedside table to the right of the resident. Residence television was on at very high-volume resident was ask to turn down the television in order to be interviewed. Resident attempted to turn down the volume of the television but was unsuccessful due to the television remote not working properly. When the resident attempted to activate his call light located on the bedside table the call light system located behind the residence bed did not activate (the red light did not come on) observation of the call light outside the residence room was not illuminated. When asked does the car light work the resident responded nothing works. The resident stated that he does not know how long the call light has not been working . In an interview on 11/07/2023 at approximately 3:30 PM CNA I stated that she entered residence room when she noticed the call light was on. She was asked if she knew that resident call light B was not working properly and she responded with no she did not know that the call light on B bed was not working properly. She stated that the risk of the call light not working means you don't know if the resident needs assistance. Observation on 11/10/23 at 10:16 AM revealed Resident #28's call light for bed B was still not operational. When the resident attempted to activate the call light by pushing the red button it did not illuminate behind his bed nor did it illuminate on the call light system outside the door. It also (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 12 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0919 failed to activate at nurses station. Level of Harm - Minimal harm or potential for actual harm In an interview 11/10/2023 at 10:20 am with assistant administrator revealed the call lights are needed to alert staff that a resident is in need of assistance. If there is a call light that is not working properly staff should make a report to maintenance in the facility maintenance log so that maintenance can come in and repair the faulty system. She stated that there have been no inputs into the system that the call light is not functioning properly. she stated that the maintenance director is not in the building today he was on leave. Residents Affected - Few Record review of Work Order #487 created by Administrator on 11/10/2023 revealed call light malfunction: Call light malfunction, not lighting up above door nor at call annunciator. Call light cord was not working but when swapped with a new one, it is functioning appropriately. Time log total: 10 minutes . Review of facility's Resident Call Systems revealed: The nurses' station is equipped to receive resident calls through a communication system from resident rooms and toilet and bathing facilities. The call system in resident rooms will be accessible to alert, confined residents, confused resident and the resident will be instructed as to availability and location. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 13 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public for two (Medication Rooms A and B) of two medication rooms reviewed for environment. Facility failed to maintain storage and preparation areas in a clean, safe, and sanitary manner in medications room A and medication room B. This failure places facility staff to not follow proper infection prevention practices for hand washing and cross contamination. Findings include: In an observation and interview on 11/09/23 at 10:30 am in medication room A revealed a white and green colored substance around opening of the faucet of the sink. [NAME] and green casting ring around drain. Black spots on the right corner and on the grout around the sink. The sink was deteriorating with rust forming on the inside of the sink, drain, faucet. The rust was also observed on the left side of the rim sides of the sink. Two covid-19 testing boxes were observed stacked on top of each other on the right-side of the rim of the sink. A lunch box and black bag was observed on the opposite side of the rim of the sink. Also observed was a black colored, fuzzy substance on the grout lines of the counter by the sink. LVN F stated that if she had no choice, she would wash her hands in the sink, however she currently does not wash her hand in medication room A. LVN F said that housekeeping was responsible for sanitation of the medication room. In an observation on 11/09/23 at 11:34 am in medication room B revealed one ceiling light working and the other ceiling light did not work. LVN Y stated that the light had been out for a while. Medication room B observation revealed a 10 x 5 hole in the wall. Some tiles near the wall were also missing. A medication cart with over-the-counter medications was placed next to the wall with the hole and missing tile. LVN Y stated that the wall with the hole had been like that for a while. Interview with the ADON on 11/09/23 at 12:40 pm revealed that she was aware of the status of the sink in medication room A and had put a sign on it. She stated that she would never wash her hands in such a sink. She reported that it looked contaminated. She did not say if she had reported the condition of the sink. The ADON reported that there was a sign that said do not uses sink in medication room A in September 2023 when she started working at facility. The ADON states that staff not washing their hands is a risk of spreading infection. Interview with the DON on 11/09/23 at 12:45 pm reveal that she was not aware of the condition of medication room A and medication room B. She reports that she would not wash her hands in the contaminated sink. She said that the ADON was responsible for monitoring the medication rooms. Not washing hands can cause a spread of infection. The DON said that the hole in medication room B was a pest inviter. Interview with the housekeeping manger on 11/10/23 at 09:20 AM reveal that he was aware of medication room A needing to be deep cleaned. He reports that he was told to just empty the trash and mop the floors in both medication room A and medication room B. He also stated that he was surprised that the wall and tile in medication room B hand not been fixed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 14 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0921 Record review of the facility's, undated, policy, Storage of Medication, reflected that, will maintain medication storage and preparation areas in a clean, safe, and sanitary manner ( .) Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 15 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 effective pest control program to keep the facility free of pests for two of (Halls 300 and 400) of six halls. Residents Affected - Some The facility failed to keep the environment free of flies and gnats. This failure could affect by placing them at risk for the potential spread of infection, food-borne illness, bites, and decreased quality of life. Findings included: Review of Resident #31's face sheet, dated 11/10/23, reflected he was an [AGE] year-old male, admitted on [DATE], and had diagnoses of dementia and Crohn's disease (a disease that causes bowel inflammation. Review of Resident #31's Quarterly MDS assessment, dated 09/13/23, reflected he was able to understand others, and be understood by others. He had long and short-term memory problems, but was normally able to recall where is room was located, the season, staff's names and faces, and that he was in a nursing home. His daily decision-making skills were moderately impaired. Review of Resident #43's face sheet, dated 11/09/23, reflected she was a [AGE] year-old female, admitted on [DATE], and had diagnoses of chronic obstructive pulmonary disease, and Parkinson's disease (a disease that progressively affects the nervous system.) Review of Resident #43's Quarterly MDS assessment, dated 10/19/23, reflected she was able to understand others, and be understood by others. She had a BIMS score of 15, indicating she was cognitively intact. Review of Resident #33's face sheet, dated 11/15/23, reflected Resident #33 was a [AGE] year-old female, admitted on [DATE], and had a primary admitting diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (right-sided weakness and paralysis following stroke. Review of Resident #33's annual MDS, dated [DATE], reflected Resident #33 was able to speak clearly, be understood by others, and was able to understand others. The resident had a BIMS of 12, indicating possible moderate cognitive impairment. An observation on 11/07/23 at 11:35 AM revealed a fly flying in the 300 hall, landing on the surveyor's tablet and a nearby housekeeping cart repeatedly. An interview and observation on 11/07/23 at 1:27 PM revealed Resident #31 in his wheelchair with two flies flying in the room, and landing on various surfaces, including the resident's bed, overbed table, resident, surveyor, and surveyor's table. While the resident and surveyor were talking, a fly landed in the middle of his forehead and rested there for a few seconds. Resident #31 had a flyswatter on his bedside table, and was trying to hit the flies in the air. He was not able to answer how frequently they got flies in the facility but he said they did get them sometimes and that was why he kept the flyswatter in his room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 16 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An interview and observation on 11/07/23 at 1:32 PM revealed CNA W swatting at a fly in the 300 hall with her hand when it flew near her face. She said she had worked on the other side of the building for a short time and this was her first day on this side. She said she had not noticed flies being a problem over there, but she had been swatting at flies and gnats all morning on this side. An interview and observation on 11/07/23 at 1:36 PM with Housekeeper X revealed she had seen some flies, but not an ungodly amount and thought it was because the doors at the end of the hall were kept open too long sometimes. She said EMS had been there twice that morning and kept the doors open, and sometimes the staff used the doors to take the trash out and the door stayed open then. In an anonymous group meeting on 11/08/23 at 10:00 AM, the nine residents in attendance were in unanimous agreement that the facility had flies and gnats, but none of them had complained to staff, though the majority of them were bothered by the pests. They all agreed that they had never seen staff doing anything to rid the building of the flies or gnats. One resident said they had seen a staff member looking bothered by a fly and waving their hands around at it in the hall. Two residents said they had flies in their rooms every day, and had flyswatters or bug zappers to kill them with. Six of the nine residents said they had flies in their rooms, including when they were eating. Three of the nine residents said they had been bothered by the flies or gnats when in common areas of the building. One resident said It's gross! Throughout the meeting, a gnat was flying around the room, and residents and surveyor were waving their hands to shoo it away. An observation on 11/09/23 at 7:58 AM revealed Resident #43 self propelling her wheelchair down the 300 hall, carrying a cup of coffee. Twice she stopped to swat at a fly with her hand, and grimaced when she did it. Resident #43 stopped twice to speak with staff in the hall, but did not mention the fly to them. An interview and observation on 11/09/23 at 8:05 AM with Resident #43 in her room revealed the facility did have flies and she did not like them, but she was more concerned with frequent gnats in her room. She said she hated them, and they really bothered her. She said she had not reported them to staff, but thought they came for the food, because staff often left the meal trays for too long after meals instead of removing them immediately. An observation on 11/09/23 at 8:51 AM revealed a fly landing on the surveyor's table in the hall, repeatedly. An interview on 11/09/23 at 8:53 AM revealed LVN F had noticed flies starting after the most recent heavy rain the area had, but was not sure exactly when that had been. She said she had not worked in the facility very long, and was not sure where to document pest complaints, but she would tell the maintenance man about it. She said when she had been at work on 11/06/23 there was a flyswatter at the nurses station, but it was not there on the day of this interview. She turned to talk to Housekeeper X about the flies at that time, then walked away. Housekeeper X told the surveyor there was also a ranch next door, and she thought that was the reason for the flies. LVN F returned to inform the surveyor that they used an electronic notification system for maintenance requests, and they were putting in a request about the flies. An interview on 11/09/23 at 9:25 AM with the Maintenance Director revealed he was near the nurses station with an electric bug zapper, and said that someone had put a work order in for flies, so he was on fly patrol. He said that he had not seen a lot of flies, but some of the residents had complained about them. He said he was using the electric swatter, because the regular ones were a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 17 of 18 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 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 0925 contamination risk, and the electric one trapped the flies inside . Level of Harm - Minimal harm or potential for actual harm An interview on 11/09/23 at 11:30 AM with Resident #33 revealed she complained the facility had gnats that flew around in her room, and got in her face. She said she had not told staff about them, but they could see them just like she could. She also thought the room sometimes had mosquitos, but did not have any bites at the time of the interview. Residents Affected - Some An interview on 11/09/23 at 11:27 AM with the DON revealed the Asst. Administrator was on fly detail on 11/08/23, and they thought the problem might have been a resident on the 400 hall who kept opening the window to their room. She said they also replaced two mattresses in the hall, in case they were contributing to the problem. The DON said they first time she had noticed flies was on 11/08/23, and they had some gnats which were associated with the recent rain. She said they were a problem because they were a sanitation and infection control issue. An interview on 11/10/23 at 3:54 PM with the Asst. Administrator and DON revealed the maintenance man had walked around the past two days dealing with flies, and the flies were gone. The Asst. Administrator said the flies were not a pervasive issue, and she had not noticed them until 11/09/23. She thought they were the result of recent weather changes and being next to a field. Asst. Administrator said they had removed anything they thought could possibly be contributing to the problem, as well as getting rid of the existing flies. She said the staff should have reported them as soon as they saw them, so they could get pest control there as soon as possible, but nobody had reported them to her, the DON, or maintenance. The Asst. Administrator said they had pest control services come out regularly and as needed, and they did not ever delay having them come when they knew there was a problem. Review of the electronic maintenance log, provided on 11/09/23, reflected the past 30 days of maintenance requests, undated. The DON logged in to the computer to check the dates, as they were not reflected on the log, and the only entry for pests on the log was ants, on 09/12/23. Review of the undated Pest Control policy reflected An effective pest control program is maintained so the facility is free of pests and rodents. ( .) A pest control book is maintained at the facility nurse station. Employees are instructed to identify areas of the facility where pests are spotted and log the location in the book. The pest control service will utilize the book for treating specific locations where pests were observed by staff, residents, families and/or visitors. This treatment may occur during routine visits or during an emergency call when the pest control service is contacted to treat areas in the facility during an infestation outbreak or when a resident's health or safety may be affected. Every effort will be made to keep resident areas free of loose food and items which attract pests. Frequent routine inspections are made to all resident's rooms and other areas of the facility to ascertain the effectiveness of the pest control service. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 18 of 18