Health inspection·August 1, 2023

F 0550 can interpret for surveyor. Level of Harm - Minimal harm or potential for actual harm During an interview on 08/01/2023 at 10:02am, Dietary Manager stated she was able to interpret for surveyor with housekeeper. Housekeeper was asked via interpreter why the tray of Resident #3 was removed before the resident was done eating. Housekeeper's response was that she asked resident if she was finished. Surveyor asked if the question was asked in English, which is the resident's native language. The interpreter (Dietary Manager) and the housekeeper went back and forth in Spanish. Housekeeper then stated via interpreter that Resident #3 pushed the tray to the housekeeper and told her to take the tray. Surveyor asked if this was spoken to Resident #3 in Spanish or if the housekeeper understood the Resident #3 well enough to know what Resident #3 wanted/needed. Housekeeper stated via interpreter that she would not take tray from resident again. Residents Affected - Few During an inteview on 08/01/2023 at 3:00pm, DON was asked what a negative outcome would be if a resident's food tray was removed from the resident and this resident already had weight loss issues. DON stated that the tray should not be taken from the resident at any time, and if the tray is removed from the resident who has weight loss issues this will increase the weight loss even more. Rcord review of Resident #2's clinical record revealed Resident #2 is a [AGE] year-old female, who was admitted to the facility on [DATE] with diagnoses including unspecified dementia, mild, without behavioral disturbance; psychotic disturbance, mood disturbance, anxiety, major depressive order, recurrent severe without psychotic features; generalized anxiety disorder and psychotic disorder with delusions due to know physiological condition. Record review of Resident #2's most recent MDS assessment indicated Resident #2 had a BIMS of 00, indicating severe cognitive impairment and a functionality of extensive assistance with a 2x assist. Record review of Resident #2's Care Plan does indicate that resident does yell out and ask for help and states that she is scared continuously throughout the day. During an interview on 08/01/2023 at 9:26am, LVN A stated that she has been with the facility for about a year and a half-ish. LVN A stated that she does have a few residents that do call out for help. LVN A stated that these residents have behaviors. LVN A stated that there is one lady that just calls out constantly help, help, I am scared!. LVN A stated that she will ask What can I do for you? What are you scared of? LVN A stated that this resident is on psych services for these behaviors. During an observation on 08/01/2023 at 10:55am, Resident #2 was being wheeled down the hallway on a shower chair with a sheet draped over her being taken down to the shower room. The resident appeared to have a hospital gown on under the sheet. Resident #2 was uncovered from mid-thigh down to her feet. During an observation on 08/01/2023 at 10:59am, Resident #2 was receiving a shower by CNA B. Resident #2 was sitting in shower chair with a night gown on up over her belly button. No brief in place. Resident #2 was then undressed, and water was started to get to a comfortable temp for resident. Resident #2 placed her hand under the running water. Resident #2 was pleased with temp and CNA B started to wash resident's hair. Shampoo and conditioner were applied respectfully and rinsed. Body was washed in a clean to dirty manner. Resident #2 did state throughout the entire process Help me, I'm scared. CNA B gave constant reassurance and redirection. CNA B asked Resident #2 why she was scared, and Resident #2 stated, I don't know. This was constant throughout the shower. CNA B was asked if this was a normal behavior, CNA B stated that it was. Surveyor asked Resident #2 what she was afraid of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 2 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0550 Level of Harm - Minimal harm or potential for actual harm and Resident #2 responded with I don't know. Resident #2 was dried, and dressed, CNA B flipped the light for assistance with the transfer of the resident from the shower chair to the wheelchair. After 7 minutes CNA C came to assist. Hand hygiene was performed, and gloves donned to help with the assist. CNA B and CNA C assisted Resident #2 to a standing position. Brief and pants were pulled up and resident was placed in wheelchair. Resident #2 was taken from shower room and placed next to the Nurses station. Residents Affected - Few During an interview on 08/01/2023 at 11:34am, CNA B was asked if the asking for help was a normal behavior for Resident #2. CNA B stated that it was and stated that it is getting worse. CNA B was asked what is done to help redirect resident, CNA B stated that she is asked what is the resident afraid of, and that Resident #2 will say I don't know. CNA B stated that there is no other resident within the facility that exhibits this behavior. CNA B was asked why Resident B wasn't covered more before transported out of her room to the shower room. CNA B stated that the resident had a brief on under the sheet, so her bottom wasn't exposed while transport. Resident #2 would need to be provided more privacy while transporting due to residents thighs and lower legs being exposed. During an interview on 08/01/2023 at 3:00pm, DON was asked what a negative outcome for a resident who is being wheeled down the hall in a shower chair and that resident is not covered all the way. DON stated that this would be considered a dignity issue if the resident was in her right mind. DON proceeded to state that if a male resident who was in his right mind saw this female resident covered this way could possibly try to be sexual with female resident. Record review of policy for Residents Rights and Dignity. Both policies were revised February 2021 Residents Rights Policy statement Employees shall treat all residents with kindness, respect, and dignity Policy Interpretation and Implementation 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to a. A dignified existence. b. Be treated with respect, kindness, and dignity; . Dignity Policy Statement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 3 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0550 Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. Level of Harm - Minimal harm or potential for actual harm Policy Interpretation and Implementation Residents Affected - Few 1. Residents are treated with dignity and respect at all times. 2. The facility culture supports dignity and respect for residents by honoring resident goals, choices, preferences, values, and beliefs. This begins with the initial admission and continues throughout the resident's facility stay. 3. Individual needs and preferences of the resident are identified through the assessment process . 4. Residents may exercise their rights without interference, coercion, discrimination or reprisal from any person or entity associated with the facility. 5. When assisting with care, the residents are supported in exercising their rights. For example, residents are: a. Groomed as they wish to be groomed (hair styles, nails, facial hair, etc.); b. Encouraged to attend the activities of their choice, including religious, political, civic, recreational or social activities; c. Encouraged to dress in clothing that they prefer; d. Allowed to choose when to sleep, eat, and conduct activities of daily living; and e. Provided with a dignified dining experience. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 4 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care within 48 hours of a resident's admission for 2 (Resident #1 and Resident #5) of 5 residents reviewed for care planning. Resident #1 and Resident #5 did not have baseline care plans. This failure could place newly admitted residents at risk of not receiving effective, person-centered care. Findings include: Record review of Resident #1's face sheet, dated 08/01/23, revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, aftercare following explantation of hip joint prosthesis (hip replacement), urinary tract infection, atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow) nicotine dependence, hypertension (high blood pressure), arthropathy (joint disease of which arthritis is a type), sleep apnea (common condition in which breathing stops and restarts many times while sleeping, can result in body not getting enough oxygen),hyperglycemia (high blood sugar) and anemia (lower than normal amount of healthy red blood cells). The face sheet further revealed resident #1 was discharged from the facility on 07/26/23. Record review of Resident #1's EHR under the care plan tab revealed no care plans for Resident #1. Record review of Resident #1's admission MDS dated [DATE] and completed on 06/28/23 revealed a BIMS of 15 which indicated intact cognition. Record review of Resident #5's face sheet, dated 08/01/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, orthopedic aftercare, fracture of left femur (broken bone in left upper leg), hypertension (high blood pressure), atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow), age-related osteoporosis (weakening of the bones), asthma (chronic condition that affects the airways in the lungs), rheumatoid arthritis (inflammatory disease causing painful swelling in affected areas of the body), muscle weakness, difficulty walking, reduced mobility, and need for assistance with personal care. Record review of Resident #5's EHR under the care plan tab revealed no care plans for Resident #5. Record review of Resident #5's admission MDS dated [DATE] and completed on 07/17/23 revealed a BIMS of 14 which indicated intact cognition. During an interview on 08/01/23 at 03:49 PM, ADM stated the reason the baseline care plans were not done for Resident #1 and Resident #5 was a lack of training. She said, MDS RN is supposed to do them, but she has not been trained on how to do them. We have been asking for training since February from the new company that bought the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 5 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 08/01/23 at 04:04 PM, MDS RN stated Resident #1 and Resident #5 did not have baseline care plans completed because it had been overlooked due to a lack of training. She said she has been in her position since February and the new company will not train her on how to do care plans. During an interview on 08/01/23 at 04:19 PM, Regional Nurse was asked if anyone from the regional office has trained MDS RN on how to do care plans. She replied, I spoke to her on the phone when she had a question and told her how I'd done them in the past, by just pulling the order summary and making sure everything is checked. But as far as going in and actually showing her the care plan tab and how they are done I do not think anyone has trained her. Regional Nurse was asked when MDS RN will be trained and she stated, I can do it at any point. I am going to work with both her and the DON because the DON doesn't know how to do them either. When asked who has been doing the care plans for the facility since the new company bought them and no one on staff knows how to do them, Regional Nurse said, I don't know if anybody has been. I know I have done some on some of the orders for things like bedrails when I see those kinds of things. I don't know if anyone has had a baseline or comprehensive care plan completed. Regional Nurse said a possible negative outcome of not having baseline and comprehensive care plans completed was staff not knowing how to care for the residents. Record review of facility policy titled Care Plans - Baseline and dated 2001 revealed the following: A baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within forty-eight (48) hours of admission. 1. The baseline care plan includes instructions needed to provide effective, person-centered care of the resident that meet professional standards of quality care and must include the minimum healthcare information necessary to properly care of the resident including, but not limited to the following: a. initial goals based on admission orders and discussion with the resident or representative b. Physician orders; c. Dietary orders; d. Therapy services; e. Social Services; and f. PASARR [sic] recommendation, if applicable 2. the baseline care plan is used until the staff can conduct the comprehensive assessment and develop an interdisciplinary person-centered comprehensive care plan (no later than 21 days after admission). The baseline care plan is updated as needed to meet the resident's needs until the comprehensive care plan is developed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 6 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop a comprehensive care plan within 7 days after completion of the comprehensive assessment and/or review and revise the care plan after each assessment including comprehensive and quarterly review assessments for 5 (Resident #1, Resident #2, Resident #3, Resident #4, and Resident #5) of 5 residents reviewed for care plan timing. 1. Resident #1 had a comprehensive assessment completed on 06/21/23 and his EHR did not contain a care plan. 2. Resident #2 had a comprehensive assessment completed on 07/06/23 and her most recent care plan was developed on 01/12/23. 3. Resident #3 had a comprehensive assessment completed on 06/16/23 and her most recent care plan was developed on 12/07/22. 4. Resident #4 had a comprehensive assessment completed on 06/22/23 and her most recent care plan was developed on 01/03/23. 5. Resident #5 had a comprehensive assessment completed on 07/17/23 and her EHR did not contain a care plan. These failures could place residents at risk of not receiving appropriate levels of care for needs identified in the comprehensive assessment. Findings include: Record review of Resident #1's face sheet, dated 08/01/23, revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, aftercare following explantation of hip joint prosthesis (hip replacement), urinary tract infection, atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow) nicotine dependence, hypertension (high blood pressure), arthropathy (joint disease of which arthritis is a type), sleep apnea (common condition in which breathing stops and restarts many times while sleeping, can result in body not getting enough oxygen),hyperglycemia (high blood sugar) and anemia (lower than normal amount of healthy red blood cells). The face sheet further revealed resident #1 was discharged from the facility on 07/26/23. Record review of Resident #1's admission MDS completed on 06/28/23 revealed a BIMS of 15 which indicated intact cognition. Record review of Resident #1's EHR under the care plan tab revealed no care plans for Resident #1. Record review of Resident #2's face sheet, dated 08/01/23, revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, chronic kidney disease (longstanding disease of the kidneys leading to kidney failure), dementia (a group of thinking and social symptoms that interferes with daily functioning), chronic congestive heart failure (a progressive heart disease that affects the pumping action of the heart muscles resulting in shortness (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 7 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some of breath and fatigue), atherosclerotic heart disease of native coronary artery (fats, cholesterols, and other substances collected on the inner walls of heart arteries), hypertensive heart disease with heart failure (heart problems that occur because of high blood pressure over a long time), type 2 diabetes (insufficient production of insulin, causing high blood sugar), cognitive communication deficit, psychotic disorder with delusions (a condition of the mind that results in difficulties determining what is real and what is not real accompanied by an unshakable belief in something that is untrue), alcohol dependance in remission, major depressive disorder (a mental disorder characterized by persistent low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities), generalized anxiety disorder (inability to control constant worrying), and cellulitis of right and left lower limbs (common bacterial skin infection that causes redness, swelling, and pain). Record review of Resident #2's Quarterly MDS completed on 07/06/23 revealed a BIMS of 00 which indicated severely impaired cognition. Record review of Resident #2's care plan revealed a completion date of 01/12/23 with the most recent revisions on 01/04/23 Record review of Resident #3's face sheet, dated 08/01/23, revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, viral hepatitis C (a liver infection), hypertension (high blood pressure), major depressive disorder (a mental disorder characterized by persistent low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities), age related osteoporosis (weakening of bones), personal history of traumatic brain injury (a head injury that causes damage to the brain by external force; can cause long term complications or death), need for assistance with personal care, cognitive communication disorder (impaired ability to use language and speech to exchange information, thoughts, or feelings), and anxiety disorder (mental disorder characterized by significant and uncontrollable feelings of anxiety and fear). Record review of Resident #3's Quarterly MDS completed on 06/16/23 revealed a BIMS of 8 which indicated moderately impaired cognition. Record review of Resident #3's care plan revealed a completion date of 12/07/22 and no reviews or updates since that time. Record review of Resident #4's face sheet, dated 08/01/23, revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, epileptic seizures (burst of uncontrolled electrical activity between brain cells that causes temporary abnormalities in muscle tone or movement, behaviors, sensations, or state of awareness), acute kidney failure (sudden episode of kidney failure that happens in hours or days), anxiety disorder (mental disorder characterized by significant and uncontrollable feelings of anxiety and fear), cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it, stroke), muscle weakness, and hypertension (high blood pressure). Record review of Resident #4's Quarterly MDS completed on 06/22/23 revealed a BIMS of 15 which indicated intact cognition. Record Review of Resident #4's care plan revealed a completion date of 01/03/23 and most recent revision date of 11/29/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 8 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #5's face sheet, dated 08/01/23, revealed an [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, orthopedic aftercare, fracture of left femur (broken bone in left upper leg), hypertension (high blood pressure), atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow), age-related osteoporosis (weakening of the bones), asthma (chronic condition that affects the airways in the lungs), rheumatoid arthritis (inflammatory disease causing painful swelling in affected areas of the body), muscle weakness, difficulty walking, reduced mobility, and need for assistance with personal care. Record review of Resident #5's admission MDS dated [DATE] and completed on 07/17/23 revealed a BIMS of 14 which indicated intact cognition. Record review of Resident #5's EHR under the care plan tab revealed no care plans for Resident #5. During an interview on 08/01/23 at 03:49 PM, ADM stated the reason the care plans were not completed 7 days after the comprehensive assessments for Residents #1, #2, #3, #4 and #5 was a lack of training. She said, MDS RN is supposed to do them, but she has not been trained on how to do them. We have been asking for training since February. During an interview on 08/01/23 at 04:04 PM, MDS RN stated Residents #1, #2, #3, #4, and #5 did not have comprehensive care plans completed within 7 days of their comprehensive assessments because it had been overlooked due to a lack of training. She said she has been in her position since February and the new company will not train her on how to do care plans. During an interview on 08/01/23 at 04:19 PM, Regional Nurse was asked if anyone from the regional office has trained MDS RN on how to do care plans. She replied, I spoke to her on the phone when she had a question and told her how I'd done them in the past, by just pulling the order summary and making sure everything is checked. But as far as going in and actually showing her the care plan tab and how they are done I do not think anyone has trained her. Regional Nurse was asked when MDS RN will be trained and she stated, I can do it at any point. I am going to work with both her and the DON because the DON doesn't know how to do them either. When asked who has been doing the care plans for the facility since the new company bought them and no one on staff knows how to do them, Regional Nurse said, I don't know if anybody has been. I know I have done some on some of the orders for things like bedrails when I see those kinds of things. I don't know if anyone has had . a comprehensive care plan completed. Regional Nurse said a possible negative outcome of not having comprehensive care plans completed was staff not knowing how to care for the residents. Record review of facility policy titled Care Planning - Interdisciplinary Team and dated March 2022 revealed the following: . 2. Comprehensive, person-centered care plans are based on resident assessments . Record review of a facility policy titled Care Plans, Comprehensive Person-Centered and dated March 2022 revealed the following: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 9 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675327 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pampa Nursing Center 1321 W Kentucky Pampa, TX 79065 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 0657 Level of Harm - Minimal harm or potential for actual harm 2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS assessment .and no more than 21 days after admission. 11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. Residents Affected - Some 12. The interdisciplinary team reviews and updates the care plan: . d. at least quarterly, in conjunction with the required quarterly MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675327 If continuation sheet Page 10 of 10