Health inspection·February 15, 2024

F 0600 chronic kidney disease, chronic obstructive pulmonary disease, and mild cognitive impairment. Level of Harm - Minimal harm or potential for actual harm Review of Resident #48's Quarterly MDS assessment dated [DATE] revealed she scored a 9 on her mental status exam (indicating moderate cognitive impairment), she had no reported behaviors, she required only supervision for all ADLs, and used a wheelchair for mobility. Residents Affected - Few In a resident council interview on 02/13/24 at 2:13 PM Resident #31 stated that CNA C frequently came to work smelling like marijuana. Ten of the twelve residents present (including Resident #48 who was sitting next to Residnet #31) for the meeting agreed with Resident #31. In an interview on 02/14/24 at 8:08 AM Resident #31, stated that he had gone to speak with the Activity Director that morning about an issue he had regarding retaliation from CNA C and was told by the Activity Director that CNA C was caught listening to the resident council meeting held by the surveyor the previous day (02/13/24). Resident #31 stated that in the dining room last night (02/13/24) he and Resident #48 both witnessed CNA C make comments like he doesn't care if he gets fired and he hates being around all these snitches and then stated that he was going to come to work smelling like marijuana on Friday (02/16/24) and see who rats him out. The comments were made last night after CNA C slammed Resident #31's meal tray on the table. He stated he did not feel comfortable eating his food after that because he was worried that CNA C might have spit in the food or something, so he did not have dinner. In an interview on 02/14/24 at 10:11 AM the Activity Director confirmed that she did catch CNA C listening at the door during the surveyor-led resident council meeting yesterday (02/13/24) and had to ask him to leave the area because the meeting was confidential for the residents. She also stated that the residents had complained to her about CNA C in the past and that the Administrator had been doing coaching with him. She stated that Resident #31 told her that morning that CNA C had retaliated against him (Resident #31) and Resident #48 because of what had been said at the meeting with the surveyor, when he slammed dinner trays and made comments about people ratting on him and that he (CNA C) did not like snitches. In an interview on 02/14/24 at 2:00 PM CNA C came into the conference room and stated he wanted to clear himself of some allegations that had been said about him. CNA C stated he had started working at the facility since April 2023 but had been terminated for a little while due to something against policy but had been re-hired within a week or so. CNA C stated that one of the residents present during the resident council meeting told him that Resident #31 had made false allegations such as him smelling like marijuana when coming to the facility which was not true. CNA C stated he had just talked to the Administrator and the DON, and they had suspended him because of the allegations. CNA C denied he had ever mentioned that he better not hear the resident's snitching on him or any type of snitching in general. CNA C stated he did look through the dining room door yesterday (02/13/24) while the resident council was going on, but he was not sure what was going on. CNA C stated he was not standing at the dining room door listening in to hear what was being discussed at the resident council meeting, he said that he was just checking in on the residents. In an interview on 02/15/24 at 9:15 AM the Activity Director stated that she had personally witnessed CNA C arrive at work smelling like marijuana as well as returning from break smelling like it . She stated she had not reported CNA C to the Administrator but she did plan to. She stated several residents had complained to her about it, but none had reported it to the Administrator or filed a grievance until Resident #31. She stated that she told the residents to immediately go to the DON or Administrator to report their concerns so that the issues could be investigated right then. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 2 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that when Resident #31 told her that CNA C had been slamming the dinner trays and making comments about snitches, she immediately took him to the Administrator to report his concerns. In an interview on 02/15/24 at 9:39 AM Resident #48 stated that at dinner on 2/13/24, CNA C came into the dining room and was slamming the dinner trays on the table she shared with Resident #31 and saying that he did not want to be around all these snitches . She confirmed that Resident #31 refused to eat his meal that night because he was afraid that CNA C had spit in the food. She admitted to being startled by the trays being slammed on the table and the way CNA C was speaking about snitches. In an interview on 2/15/24 at 5:11 PM the Social Worker stated that on 2/14/24, the Administrator asked her to speak to Resident #31 to get a statement about CNA C retaliating for what was said during about him the resident council meeting. She stated that Resident #31 told her that at dinner the previous night (2/13/24) CNA C slammed his (Resident #31) tray down on the table and said something about how are you going to rat a cuz out. Resident #31 also told the Social Worker that the Activity Director caught CNA C listening at the door during the resident council and that during dinner while he made comments about snitches CNA C had repeated things word for word that Resident #31 had said during the meeting. Resident #31 told the Social Worker that he was afraid to eat his meal that night because he thought CNA C might have spit in it. Resident #31 told her that CNA C always talks all big and bad and that he felt like if he came back up to the facility, he would come looking for him. She stated there had been complaints about CNA C before, but for him being lazy or speaking too informally to the residents. She stated that Resident #31 had brought his concerns about CNA C coming to work smelling like marijuana to the administration last week and they had started looking into it but he had not filed a grievance on it. She stated she had never received a complaint of a resident feeling threatened or afraid of CNA C before. In an interview on 2/15/24 at 5:46 PM the DON stated that she would consider retaliation going after someone that said something about you or told on you for something. She stated that it was abuse. The DON stated that there was no facility in-service specifically regarding retaliation that she was aware of but she believed there might be training on the online learning platform the facility used and in the employee handbook. She stated she was made aware of the situation regarding Resident #31 and CNA C by the Administrator, and they immediately asked the Social Worker to speak with Resident #31. She stated that she and the Administrator spoke to CNA C and he denied slamming the dinner trays on the table and making any comments about snitches to or around Resident #31 and Resident #48. The DON stated CNA C was immediately suspended on 2/14/24, pending an investigation of the retaliation allegation and had been terminated earlier that afternoon (2/15/24). In an interview on 02/15/24 at 6:26 PM the Administrator stated that retaliation was getting back at someone for reporting an event that was considered an infraction. He stated that for the residents of the facility, retaliation was a violation of resident rights and a form of abuse. He stated he believed that the facility handled the situation with CNA C according to the facility's policy and procedures as the employee in question was terminated and placed on the no rehire list. When asked why he believed CNA C would have felt comfortable acting in a retaliatory manor towards a resident he stated that he felt CNA C was trying to scare the resident into not saying anything about his actions and that the facility would not do anything because they had invested money into him by sending him to CNA school. Review of facility policy titled Abuse/Neglect dated 3/29/18, revealed, in part: Residents should not be subjected to abuse by anyone, including, but not limited to, facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 3 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians, or other individuals. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Verbal abuse is any use of oral, written or gestured language that willfully includes disparaging and derogatory terms to residents, or within their hearing distance, regardless of their age, ability to comprehend, or disability. Mental abuse includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation. Event ID: Facility ID: 675317 If continuation sheet Page 4 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review the facility failed to residents who are incontinent of bladder received appropriate treatment to prevent urinary tract infections for 2 of 3 residents (Residents #6 and #25) by 1 of 3 nurse aide staff (NA A) reviewed for incontinence care. NA A failed to change her gloves after they became contaminated during incontinent care while assisting Residents #6 and #25. NA A failed to wash or sanitize her hands prior to putting on gloves and after removing them during incontinent care while assisting Residents #6 and #25 These failures could place residents at risk for not receiving nursing services by adequately trained and certified aides and could result in a decline in health and infection. Finding include: RESIDENT #6 Record review of Resident #6's admission record dated 02/14/24 indicated she was admitted to the facility on [DATE] with diagnoses of metabolic encephalopathy (brain problems resulting in memory loss and confusion), dementia (memory loss and judgement impairment), absence of right and left leg, Diabetes mellitus 2, and chronic kidney disease (kidney damage that affects filtering of blood). She was [AGE] years of age. Record review of Resident #6's care plan revised date 12/20/23 indicated in part: Focus: The resident has bladder incontinence. Goals: The resident will remain free from skin breakdown due to incontinence and brief use through the review date. Interventions: Staff will apply barrier cream after each incontinent episode. Incontinent care as indicated and apply moisture barrier after each episode. Provide pericare after each incontinent episode. Record review of Resident #6's MDS dated [DATE] indicated in part: Urinary and Bowel continence = Always incontinent. During an observation on 02/14/24 at 10:15 AM NA A performed incontinent care for Resident #6. NA A entered the room and put on some gloves without first washing her hands and proceeded to perform the incontinent care. NA A used the bed control to place the resident on a flat position. NA A pulled Resident #6's brief down from the front and the resident was noted to be wet from urine. NA A wiped the peri area from dirty to clean (back to front) with wet wipes instead of clean to dirty (front to back ). Resident #6 rolled herself to her right side and NA A wiped the residents bottom with wet wipes. NA A removed the wet brief, opened a container of ointment, and applied the ointment to the residents bottom while still wearing the same gloves. While still wearing the same gloves, NA A fastened a clean brief to Resident #6 and then removed her soiled gloves. NA A then left the resident's room without sanitizing or washing her hands. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 5 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 0690 RESIDENT #25 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #25's admission record dated 02/15/24 indicated she was admitted to the facility on [DATE] with diagnoses of rheumatoid arthritis, contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) to right and left hand. She was [AGE] years of age. Residents Affected - Some Record review of Resident #25's care plan revised date 02/13/24 indicated in part: Focus: Resident has bladder incontinence. Resident has bowel incontinence. Goals: Resident will remain free from skin breakdown due to incontinence and brief use through the review date. Interventions: INCONTINENT care as indicated and apply moisture barrier after each episode. Provide pericare after each incontinent episode. Record review of Resident #25's MDS dated [DATE] indicated in part: Urinary and Bowel continence = Always incontinent. During an observation 02/14/24 at 09:34 AM revealed NA A performed incontinent care for Resident #25. NA A put some gloves on and proceeded to undo the resident's brief. The resident's brief was noted to be wet from urine. NA A then took some wet wipes and wiped the resident's vagina from front to back. NA A then turned the resident on her right side and wiped the resident buttocks and rectal area with a back to front motion going towards the vaginal area. While still wearing the same gloves, NA A took a container of cream and applied it to the residents peri-area. While still wearing the same gloves NA A grabbed the bed rail and then fastened the new brief on Resident #25. NA A then removed her gloves and put on a new pair of gloves without washing her hands or applying hand sanitizer. NA A then proceeded to help dress the resident and transferred the resident from her bed to her wheelchair with a mechanical lift. During an interview on 02/15/24 at 02:00 PM NA A said she had worked at the facility for approximately one and a half years as a NA. NA A said whenever she performed incontinent care, she would clean from front to back. NA A said she was supposed to wipe from front to back during the incontinent care but that she had messed up and wiped back to front when she had cleaned Residents #6 and #25. NA A said she should have washed her hands or used hand sanitizer prior to putting on clean gloves. NA A said she should have changed her gloves before she applied the new brief on the residents. NA A said if she wiped from back to front it could lead to infections such as UTI's or cross contamination. NA A said she had gotten nervous and forgot to wash her hands and wipe from front to back during the incontinent care. NA A said she had received training on incontinent care as indicated on the NA proficiency audit. During an interview on 02/15/24 at 02:40 PM the DON said the expectation was for staff to wipe from front to back during incontinent care so that they did not containment the clean area or vagina as it could lead to an infection. The DON said staff were expected to change their gloves when going from dirty to clean to prevent contamination of the clean areas. The DON said staff were supposed to use hand sanitizer or wash their hands in between glove changes. The DON said a NA proficiency was done upon hire and on a yearly basis. The DON said the proficiency was done by the ADON or herself but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 6 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the ADON was not here today. The DON said the failure probably occurred because the NA got nervous and forgot the correct steps during the incontinent care. During an interview on 02/15/24 at 03:14 PM the Administrator said it was expected for NAs to wipe from front to back during incontinent care. The Administrator said the NA's were expected to wash or use hand sanitizer prior to putting on clean gloves on in between glove change. The Administrator said staff were expected to change their gloves once they became contaminated to prevent cross contamination. The Administrator said he believed the failure occurred because the staff got nervous and felt the pressure of being observed by the state surveyor and forgot the correct steps. Record review of NA A's NA proficiency audit dated 09/18/2023 indicated in part: Skills hand washing = S, Perineal care: female = S. Infection control awareness = S. (S = Satisfactory). Conducted by ADON on 09/18/23. Record review of the facility's document titled Phase 2 competencies for aides-Perineal care/incontinent care female undated indicated in part: Purpose: To clean the female perineum without contaminating the urethral area with germs from the rectal area. Emphasizing clean to dirty. Beginning steps - wash hands wear gloves and follow standard precautions. Put on clean gloves before washing perineal area. Obtain a disposable wipe. Wash genital area, start at the inside of the vagina and work outward moving from front to back and using a clean wipe for each stroke. Dry genital area moving from front to back with towel. After washing genital area turn to side then wipe rectal area moving from front to back using a clean area of washcloth for each stroke. Dispose of used wipes and brief in the plastic trash bag. Avoid contact between your clothing and used items. After disposing of used linen and placing used equipment in designated storage area, remove and dispose of gloves (without contaminating self) into waste container and wash hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 7 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that ensure the accurate administering of all drugs to meet the needs of the residents, for 2 of 9 Residents (Resident #42, Resident #25) inspected for medication reconciliation and failed to ensure medications were documented when given. LVN B did not document the administration of a controlled medication on the individual controlled medication records after administering medication for Resident #42 and Resident #25. This failure could place residents at risk of under dose, overdose, and drug diversion. The findings were : During an observation and record review on 02/13/2024 at 02:20 PM the medication cart was inspected with the LVN B. The controlled medication count was incorrect for two residents (Residents #42 and #25). Resident #42's blister pack of APAP/ Codeine 300-60 MG contained 12 pills and the corresponding medication sheet indicated there were 13 pills left. Resident #25's blister pack of APAP/ Codeine 300-60 MG contained 18 pills and the corresponding medication sheet indicated there were 19 pills left . During an interview with LVN B on 02/13/2024 at 02:30 PM, LVN B stated he wasn't sure why the narcotic sheet was incorrect and must have forgotten to sign out the medications. LVN B stated the process of giving medications included signing out the narcotics if they were popped out of the blister pack. LVN B stated there was a medication reconciliation at the end of the shift with the oncoming nurse. LVN B stated that he had not had his count be wrong before . Interview with the DON on 02/15/24 at 10:32 am revealed if a nurse is giving a PRN narcotic medication the narcotic should be signed out of the narcotic sign out sheet if the medication is taken out of the blister pack. The DON stated there were no issues with narcotic counts in the past. Record review of the facility's policy titled Storage and Documentation of Schedule II Controlled Medications , reflected in part, Disposition of controlled substances is maintained on the sheet supplied by the pharmacy with each Schedule II controlled substance and the controlled substances in scheduled III and IV provided by in counters. Entries are to be made in pen each time a controlled substance is used. The nurse administering the medication will record the following information: Date and time drug is administered, amount of drug administered, remaining balance of drug, and signature of nurse administering drug. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 8 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure all controlled drugs and biologicals were stored in separately locked and permanently affixed compartments for 1 of 2 medication rooms (Med room [ROOM NUMBER]) reviewed for labeling/storage of drugs and biologicals. The facility failed to ensure controlled drugs were stored and separately locked and in permanently affixed compartments. These failures could place the residents at risk of drug diversion and access to medications. Findings included: Observation of the facility Med room [ROOM NUMBER] with LVN B on 02/13/2024 at 02:20 pm revealed a narcotic lock box in the unlocked medication refrigerator. The narcotic lock box was not secured to the fridge and was unlocked. The box contained three boxes of lorazepam 2mg/ml. With one box of lorazepam 2mg/mL in the fridge outside of the unlocked box. An interview with LVN B on 02/13/2024 at 02:25 pm, he stated he was unsure why the lock box was not secured and locked. He agreed the controlled drugs needed to be in a permanently affixed compartment and locked to prevent drug diversion . The box did have a chain affixed to the box but was not attached to the refrigerator. An interview with the DON on 02/15/24 at 10:32 am, the DON stated that the narcotic box should be permanently affixed and locked to prevent controlled drug diversion. The DON had no reason the lock box would not be properly locked or affixed. A review of the facility policy titled Storage and Documentation of Schedule II Controlled Medications , reflected in part, All Schedule II controlled medications will be stored under double lock and checked for accountability at each change of shift . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 9 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure that expired foods were discarded. This failure could affect residents who received meals prepared meals from the kitchen at risk for food borne illness and cross-contamination. The findings included: Observation on 02/13/24 at 09:45 AM, of the dry storage pantry revealed: 1-128-ounce bottle of lemon juice expired 2/1/24. 1-128-ounce bottle of enchilada sauce expired 4/7/23. 1-24-ounce bag of powdered orange drink mixes expired 2/1/24. 1-20 ounce opened bag of vanilla wafers expired 2/10/24. In an interview and observation on 12/13/24 at 09:45 AM, the Dietary Manager was informed of the expired food items found during the initial inspection of the kitchen. The Dietary Manager took the items to discard them. The Dietary Manager stated kitchen staff was responsible for discarding expired items. The Dietary Manager stated that she was ultimately responsible for ensuring expired foods are discarded. Review of facility policy dated 03/22 titled Food Storage, revealed in part: All stock must be rotated with each new order received. Rotating stock is essential to assure the freshness and highest quality of foods. .c. Date marking will be visible on all high-risk food to indicate the date by which a ready-to-eat, TCS food should be consumed, sold, or discarded. .f. All foods should be covered, labeled, and dated. All foods will be checked to assure that foods (including leftovers) will be consumed by their safe use by dates, or frozen (where applicable), or discarded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 10 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 3 residents (Resident #6 and Resident #25) reviewed for infection control. Residents Affected - Some CNA A failed to change her gloves after they became contaminated during incontinent care while assisting Residents #6 and #25. CNA A failed to wash or sanitize her hands prior to putting on gloves and after removing them during incontinent care while assisting Residents #6 and #25 This failure could place resident's at risk for cross contamination and the spread of infection. Finding include: RESIDENT #6 Record review of Resident #6's admission record dated 02/14/24 indicated she was admitted to the facility on [DATE] with diagnoses of metabolic encephalopathy (brain problems resulting in memory loss and confusion), dementia (memory loss and judgement impairment), absence of right and left leg, Diabetes mellitus 2, and chronic kidney disease (kidney damage that affects filtering of blood). She was [AGE] years of age. Record review of Resident #6's care plan revised date 12/20/23 indicated in part: Focus: The resident has bladder incontinence. Goals: The resident will remain free from skin breakdown due to incontinence and brief use through the review date. Interventions: Staff will apply barrier cream after each incontinent episode. Incontinent care as indicated and apply moisture barrier after each episode. Provide pericare after each incontinent episode. Record review of Resident #6's MDS dated [DATE] indicated in part: Urinary and Bowel continence = Always incontinent. During an observation on 02/14/24 at 10:15 AM revealed CNA A performed incontinent care for Resident #6. CNA A entered the room and put on some gloves without first washing her hands and proceeded to perform the incontinent care. CNA A used the bed control to place the resident on a flat position. CNA A pulled Resident #6's brief down from the front and the resident was noted to be wet from urine. CNA A wiped the peri area from dirty to clean (back to front) with wet wipes instead of clean to dirty (front to back ). Resident #6 rolled herself to her right side and CNA A wiped the residents bottom with wet wipes. CNA A removed the wet brief, opened a container of ointment, and applied the ointment to the residents bottom while still wearing the same gloves. While still wearing the same gloves, CNA A fastened a clean brief to Resident #6 and then removed her soiled gloves. CNA A then left the resident's room without sanitizing or washing her hands. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 11 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 RESIDENT #25 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #25's admission record dated 02/15/24 indicated she was admitted to the facility on [DATE] with diagnoses of rheumatoid arthritis, contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints) to right and left hand. She was [AGE] years of age. Residents Affected - Some Record review of Resident #25's care plan revised date 02/13/24 indicated in part: Focus: Resident has bladder incontinence. Resident has bowel incontinence. Goals: Resident will remain free from skin breakdown due to incontinence and brief use through the review date. Interventions: INCONTINENT care as indicated and apply moisture barrier after each episode. Provide pericare after each incontinent episode. Record review of Resident #25's MDS dated [DATE] indicated in part: Urinary and Bowel continence = Always incontinent. During an observation 02/14/24 at 09:34 AM revealed CNA A performed incontinent care for Resident #25. CNA A put some gloves on and proceeded to undo the resident's brief. The resident's brief was noted to be wet from urine. CNA A then took some wet wipes and wiped the resident's vagina from front to back. CNA A then turned the resident on her right side and wiped the resident buttocks and rectal area with a back to front motion going towards the vaginal area. While still wearing the same gloves, CNA A took a container of cream and applied it to the residents peri-area. While still wearing the same gloves CNA A grabbed the bed rail and then fastened the new brief on Resident #25. CNA A then removed her gloves and put on a new pair of gloves without washing her hands or applying hand sanitizer. CNA A then proceeded to help dress the resident and transferred the resident from her bed to her wheelchair with a mechanical lift. During an interview on 02/15/24 at 02:00 PM CNA A said she had worked at the facility for approximately one and a half years as a CNA. CNA A said whenever she performed incontinent care, she would clean from front to back. CNA A said she was supposed to wipe from front to back during the incontinent care but that she had messed up and wiped back to front when she had cleaned Residents #6 and #25. CNA A said she should have washed her hands or used hand sanitizer prior to putting on clean gloves. CNA A said she should have changed her gloves before she applied the new brief on the residents. CNA A said if she wiped from back to front it could lead to infections such as UTI's or cross contamination. CNA A said she had gotten nervous and forgot to wash her hands and wipe from front to back during the incontinent care. CNA A said she had received training on incontinent care as indicated on the CNA proficiency audit. During an interview on 02/15/24 at 02:40 PM the DON said the expectation was for staff to wipe from front to back during incontinent care so that they did not containment the clean area or vagina as it could lead to an infection. The DON said staff were expected to change their gloves when going from dirty to clean to prevent contamination of the clean areas. The DON said staff were supposed to use hand sanitizer or wash their hands in between glove changes. The DON said a CNA proficiency was done upon hire and on a yearly basis. The DON said the proficiency was done by the ADON or herself (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 12 of 13 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 675317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Deerings Nursing and Rehabilitation, LP 1020 N County Rd West Odessa, TX 79763 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 but the ADON was not here today. The DON said the failure probably occurred because the CNA got nervous and forgot the correct steps during the incontinent care. During an interview on 02/15/24 at 03:14 PM the Administrator said it was expected for CNAs to wipe from front to back during incontinent care. The Administrator said the CNA's were expected to wash or use hand sanitizer prior to putting on clean gloves on in between glove change. The Administrator said staff were expected to change their gloves once they became contaminated to prevent cross contamination. The Administrator said he believed the failure occurred because the staff got nervous and felt the pressure of being observed by the state surveyor and forgot the correct steps. Record review of the facility's document titled Phase 2 competencies for aides-Perineal care/incontinent care female undated indicated in part: Purpose: To clean the female perineum without contaminating the urethral area with germs from the rectal area. Emphasizing clean to dirty. Beginning steps - wash hands wear gloves and follow standard precautions. Put on clean gloves before washing perineal area. Obtain a disposable wipe. Wash genital area, start at the inside of the vagina and work outward moving from front to back and using a clean wipe for each stroke. Dry genital area moving from front to back with towel. After washing genital area turn to side then wipe rectal area moving from front to back using a clean area of washcloth for each stroke. Dispose of used wipes and brief in the plastic trash bag. Avoid contact between your clothing and used items. After disposing of used linen and placing used equipment in designated storage area, remove and dispose of gloves (without contaminating self) into waste container and wash hands. Record review of the facility document titled Fundamentals of infection control precautions dated 03/2023 indicated in part: A variety of infection control measures are used for decreasing the risk of transmission of microorganisms in the facility. These measures make up the fundamental of infection control precautions. Gloves are worn for three important reasons, to provide protective barrier and prevent gross contamination of the hand when touching blood, body fluids, secretions, excretions, mucous membranes and non-intact skin. The wearing of gloves in specified circumstances will reduce the risk of exposure to bloodborne pathogens and is mandatory for all employees. To reduce the likelihood that hands of personnel contaminated with microorganisms from a resident or a fomite can transmit these microorganisms to another resident, in this situation, gloves must be changed between resident contact, and hands washed after gloves are removed. Wearing gloves does not replace the need for hand washing because gloves may have a small inapparent defects or be torn during use and hands can become contaminated during removal of gloves. Failure to change gloves between resident contacts is an infection control hazard. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675317 If continuation sheet Page 13 of 13