Health inspection·January 25, 2023

F 0727 02/01/22-02/28/22 had 8 days with no RN for 8 consecutive hours. Level of Harm - Minimal harm or potential for actual harm 03/01/22-03/31/22 had 8 days with no RN for 8 consecutive hours. 04/01/22-04/30/22 had 8 days with no RN for 8 consecutive hours. Residents Affected - Many 05/01/22-05/31/22 had 4 days with no RN for 8 consecutive hours. 06/01/22-06/30/22 had 13 days with no RN for 8 consecutive hours. 07/01/22-07/31/22 had 5 days with no RN for 8 consecutive hours. 08/01/22-08/31/22 had 8 days with no RN for 8 consecutive hours. 09/01/22-09/30/22 had 6 days with no RN for 8 consecutive hours. 10/01/22-01/31/22 had 12 days with no RN for 8 consecutive hours. 11/01/22-11/30/22 had 30 days of no RN for 8 consecutive hours. 12/01/22-12/31/22 had 31 days of no RN for 8 consecutive hours. As per the calendar there were 139 out of 365 days that the facility did not have 8 consecutive hours RN coverage. The facility had 73 out of 365 days that did not have a full-time DON. Record review of facility Job Description Registered Nurse undated revealed: The primary purpose of your job position is to provide direct nursing care to the residents and to supervise the day-to-day nursing activities of your assigned unit. Such supervision must be in accordance with current federal, state, and local standards, guidelines and regulations that govern the long-term care facility, as well as our established policies and procedures, and as may be directed by the director of nursing services, to ensure that the highest degree of quality care is maintained at all times. As a charge nurse you are delegated the administrative authority, responsibility, and accountability necessary to carry out your assigned duties . Periodically review the resident's written care plan. Participate in the updating of this plan as necessary. Admission, transfer and discharge residents as required. Complete accident/incident reports as necessary. Assume the authority, responsibility and accountability of the directing of the unit assigned. Make necessary written and oral reports/recommendations to the Director of Nursing as required concerning personnel. Inspect storage rooms, work rooms, utility closets, medicine rooms, patient rooms, etc. for upkeep and supply control and report any deficiencies immediately. Assist the infection control committee in identifying routine and job-related maintenance functions to ensure that universal precaution tasks are properly taken. Meet with personnel on a regular basis concerning the operation of your assigned area. Assist in identifying and correcting problem areas, and/or the improvement of services . Assure that an adequate number of appropriately trained personnel are on duty at all times to meet the needs of your assigned area by developing work assignments and assisting staff in completing and performing such tasks. Assure that facility personnel, residents, visitors, etc. follow established safety regulations, to include fire protection/prevention, smoking regulations, infection control. Correct all unsafe and hazardous conditions and equipment immediately. Be prepared to handle emergencies as they come up and assuring that all such situations are handled in a timely manner . Participate in the development, implementation and maintenance of the infection control and universal precautions to assure that a sanitary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 environment is maintained at all times and the aseptic and isolation techniques are followed by personnel. Monitor nursing care to assure that residents are treated fairly, with kindness, dignity and respect . Make daily resident visits to observe and evaluate the resident's physical and emotional status. Monitor medication passes and treatment schedules to assure that medications are being administered as ordered and the treatments are provided as scheduled. Provide direct nursing care as necessary and assist and instruct staff. Report problem areas to the DON. Assist in developing and implementing corrective action. Keep the DON informed of the status of residents and other related matters through written reports. Meet with residents and or family members as necessary repeat report problem areas to the DON. Consult with the residents' position in planning resident care, treatment, rehabilitation etc. Notify the residence position and responsible party when there is a change in a residence condition or unusual incident. Make independent decisions concerning nursing care. Start IV's, obtain sputum, urine and other lab tests as ordered. Take vital signs as necessary. Admit, transfer and discharge residence as necessary. Assist the LVN in monitoring seriously ill residents. Inform family members of resident's death when physician is not available or is unable to reach them in a timely manner. Participate in comprehensive assessment of nursing needs of each resident in your assigned area. Participate in the development of care plan. Review the resident's care plan for appropriate resident goals, problems, approaches and revisions based on nursing needs. Ensure that all personnel involved in providing care to the resident are aware of the care plan and that the care plans are used in administering daily care to the resident. Document in the nurses notes appropriate information to indicate that the plan of care is being followed. Must possess a working knowledge of long-term care operational standards as set forth in the Federal Register Cortana conditions of participation and state regulations. Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain two long term care. Must possess leadership and supervisory ability and the willingness to work harmoniously with professional and non-professional personnel. Record review of facility Job Description Director of Nursing undated revealed: The primary purpose of your job position is to plan, develop, organize and direct the day-to-day functions of the nursing services department in accordance with current federal, state and local standards. Also, maintain compliance with our own policies and procedures. Ensure that the highest degree of quality care is maintained at all times. As DON, you are delegated the administrative authority, responsibility, accountability necessary to carry out your assigned duties. In the absence of the administrator, you are charged with carrying out the policies established by this facility. Maintain rights of residents as set forth by the Texas Department of health laws and regulation. Assist in developing and implementing appropriate plans of action to ensure the quality of life and care defined by the resident's comprehensive assessment and care plan. Ensure that all nursing personnel are following their respective job descriptions. Perform administrative requirements such as completion of necessary medical forms, report, evaluations, studies, charting, etc. as required. Attend staff meetings. Maintain a reference library of nursing material that will assist the nursing department in meeting the needs of the residents. Participate in ongoing quality assurance program for the nursing department. Make daily rounds of the nursing services department to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards. Assist in assuring that an adequate number of appropriately trained professional are on duty at all times to meet the needs of the residents, by developing work assignments, adjusting scheduled staff and approving extra shifts. Audit charts to ensure that they are informative and descriptive of the nursing care provided and that they reflect the resident's response to nursing care. Report problem (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 areas to the director of nursing administration. Develop and implement corrective actions. Serve on various committees of the facility: infection control, quality assurance, utilization review, etc. Monitor for safety issues during daily rounds. Report any unsafe conditions to the appropriate department. Report all incidents and accidents immediately. Participate in the infection control program by monitoring staff for compliance to procedures. Monitor handling of linen, dressing changes, isolation techniques, hand washing, and medication pass at least monthly. Ensure that personnel involved in providing care to the resident is aware of the care plan and that the care plans are used in administering daily care to the residents. Monitor to ensure that all nursing care is provided in privacy and that all nursing service personnel knocked before entering the resident's rooms. Monitor nursing care to assure that all residents are treated fairly, with kindness, dignity and respect. Assist with reviewing complaints and grievances made by the resident and make a written report indicating what actions were taken to resolve the complaint or grievance. Participate in nursing on call rotation. Monitor weekly skin assessments and bath sheets. Complete weekly wound report. Must be a registered nurse. Must have a minimum of one year experience in a supervisory capacity in a hospital, a skilled nursing facility or other related health care program. Must possess a working knowledge of long-term care operational standards as set forth in Federal Register, conditions of participation and state regulation. Record review of facility policy labeled Director of Nursing revised August 2006 revealed: The nursing services department is under the direct supervision of a registered nurse. The nursing services is managed by the director of nursing services. The director is a registered nurse, licensed by this state, and has experience in nursing service administration, rehabilitative and geriatric nursing. The director is employed at full-time 40 hours per week and is responsible for, but is not necessarily limited to developing and periodically updating the nursing services objectives and statements of philosophy. Developing standards of nursing practices. Developing and maintaining nursing policy and procedure manuals. Developing and maintaining written job descriptions for each level of nursing personnel. Scheduling of daily rounds to visit residents. Developing methods for coordination of nursing services with other resident services. Recruiting and retaining the number and level of nursing personnel necessary to meet the nursing care needs of each resident. Developing staff training programs for nursing service personnel. Participating in the planning and budgeting for nursing services. Ensuring that all health services notes are informative and descriptive of the supervision and care rendered including the resident's response to his or her care. Assessing the nursing requirements for each resident admitted and assisting the attending physician in planning for the resident's care. Participating in the development and implementation of the resident assessment (MDS) and comprehensive care plan. Establishing resident selection criteria for determining which residents may be fed by paid feeding assistance. Assuring that nursing care personnel are administering care and services in accordance with the resident's assessment and care plan. Record review of facility policy labeled Departmental Supervision revised August 2006 revealed: The nursing services department shall be under the direct supervision of a RN or LVN at all times. A RN/LVN is on 24 hours per day 7 days per week. Supervise the nursing services activity in accordance with physician orders and facility policy. A RN is employed as the Director of Nursing Services (DON). The DON is on duty during the day shift Monday through Friday. During the absence of the DON a nurse supervisor/charge nurse is responsible for the supervision of all nursing department activities including the supervision of direct care staff. The nurse supervisors/charge nurses are RN, or LVN, and are duly licensed by this state. The DON and/or the nurse supervisor/charge nurse, as a minimum, is responsible for: Making daily resident visits to observe evaluation the residents physical and emotional status. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Reviewing medication cards for completeness of information, accuracy in the transcription of physician orders, and adherence to stop order policies. Reviewing individual resident care plans for appropriate goals, problems, approaches, and revisions based on nursing needs. Assuring that the resident's plan of care is being followed. Arranging schedule to allow time for supervision and evaluation of performance of nursing personnel and paid feeding assistants. Informing attending physicians and resident families of changes in the resident's medical condition. Charting and documenting medical records as necessary. Keeping nursing service personnel informed of the status of residents and other related matters through written reports and verbal communications. Assigning work schedules and staffing to meet the needs of residents. Providing direct resident care as necessary or appropriate. Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 for food service safety in the facility's only kitchen. Residents Affected - Many The facility failed to appropriately label, date, seal and/or close items stored in on shelves in the food preparation area, refrigerator, freezers, and dry storage area; The facility failed to discard expired food items; The facility failed to ensure appliance interior surfaces were clean; The facility failed to ensure shelves were clean and maintained in a manner that was able to be sanitized. This deficient practice could affect residents who receive meals prepared from the kitchen by putting them at risk for food borne illness due to cross contamination. Findings included: Observations on 01/23/23 from 09:30 AM to 10:55 AM of the kitchen revealed the following items not properly labeled, dated, sealed and/or closed: A shelf in the food preparation area: One open bag of chips. No date opened or use by date. One open squeeze bottle of chocolate syrup. No date opened, use by date, or legible expiration date. Individual packets of creamer in a clear plastic bag with no use by date or expiration date. Individual servings of jelly without a use by date or expiration date. One 1-gallon size clear plastic bag containing individual sugar packets without a use by date or expiration date. Individual mayonnaise packets without a use by or expiration date. Individual mustard packets without a use by or expiration date. One ½ full box of individual packets of mayonnaise dated 05/27/21. A shelf to the left of the stove contained the following: One 10 lb. can of baking powder dated 08/13/20 and a manufacturer's expiration date of 06/27/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 One open jar of ground ginger dated 10/09/20 without an opened date, a use by date, or legible expiration date. Level of Harm - Minimal harm or potential for actual harm One open jar of all spice dated 01/05/20 without an opened date, a use by date, or legible expiration date. Residents Affected - Many One open jar of garden seasoning without an opened date, a use by date, or legible expiration date. One open jar of meat tenderizer dated 09/10/20 without an opened date, a use by date, or legible expiration date. One open jar of chili powder dated 05/06/21 without an opened date, a use by date, or legible expiration date. One open jar of rubbed sage dated 03/04/21 without a legible expiration date. One 2.5-oz jar of chicken seasoning without an opened date, a use by date, or legible expiration date. One 0.95-oz jar of basil leaves without an opened date, a use by date, or legible expiration date. One 1.76-oz crushed red pepper without an opened date, a use by date, or legible expiration date. One 16-oz jar of parsley flakes dated 04/22/21 with no legible expiration date. One 5 lb. jar of baking soda dated 10/09/20 with a date of June 20 remainder of year was not legible. One bucket labeled BBQ contained rice with no opened date, use by date or expiration date. One 23-oz jar labeled lemon pepper dated 2/20 with no expiration date. The refrigerator contained the following: One 1-gallon size clear plastic bag containing bacon dated 12/29/22. One 1-gallon jug labeled Italian dressing dated 11/10/22 with no expiration date. Twelve 6-oz clear plastic cups with lids dated 01/21 without a label indicating contents. One 16-oz margarine open with no date opened, no use by date, or expiration date. One white foam cup containing liquid with incomplete date of 01/19/2 and without a label indicating contents Two 8-oz clear plastic cups containing dark red liquid and covered with clear plastic wrap without a date prepared, no use by date and without a label indicating contents. One 10-oz bottle of soy sauce with no date opened, no use by date, or expiration date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 The freezers contained the following: Level of Harm - Minimal harm or potential for actual harm Three clear plastic bags containing 12 waffles each with no use by date, or expiration date Residents Affected - Many One 1-gallon clear plastic bag containing 8 frozen waffles with no date opened, no use by date, or expiration date. One frozen food item wrapped in clear plastic and labeled turkey was dated 10/18/22. Significant frost build-up between the food and plastic wrap. Five frozen food items in clear plastic and labeled pork ribblets dated 11/19/22. Significant frost build-up between the food and plastic wrap. One frozen ham wrapped in plastic had no legible date, and significant frost build-up between the food and plastic wrap. One clear plastic bag of individual, rectangle shaped items unknown contents, had no use by date, and significant frost build-up between the food and plastic bag. One clear plastic bag labeled pepperoni did not have a legible date and had significant frost build-up between the food and plastic bag. Two - 2 lb. bags labeled tamales dated 3/17/22 and had significant frost build-up between the food and plastic bags. One clear plastic bag labeled fish patties dated 12/29/22 had significant frost build-up between the food and plastic bag. One frozen item wrapped in clear plastic labeled Italian sausage dated 10/21/21, had significant frost build-up between the food and plastic wrap. One clear plastic bag labeled fish fillets dated 12/21/22, had significant frost build-up between the food and plastic bag. One clear plastic bag with unknown contents, with square shaped breaded items, dated 12/19. One clear plastic bag labeled burritos dated 07/28/22, had significant frost build-up between the food and plastic bag. One 22.5 lb. box half full containing a clear plastic bag labeled cheesy garlic breadsticks not closed or sealed One 30.4 lb. half full box containing a clear plastic bag labeled biscuit dough not closed or sealed Observation of the surfaces in the kitchen revealed: A yellow, gritty substance stuck to the floor of the freezer. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 The clear plastic bin containing 8 wrapped silverware bundles had a dried black substance along the bottom edges. The counter mounted can opener had a dried black substance on the blade and base. The can opener was sticky to touch. Residents Affected - Many The spice shelf to the left of the stove had a gritty, yellow substance stuck to it. Observation of the dry storage area revealed the following: Two 28-oz cans labeled diced red pimiento peppers was dented. One 50-oz can labeled cream of chicken soup was dented. One 102-oz can labeled diced tomatoes was dented. One 6 lb., 10-oz can labeled whole kernel corn was dented. One 100-oz can labeled mixed vegetables was dented. Three 24-oz bags labeled lime gelatin mix dated 09/24/20 did not have expiration dates. One clear plastic bag containing a silver bag twisted closed with masking tape, labeled croutons, was dated 02/15/22. One clear plastic bag containing an open silver bag labeled croutons was dated 05/21/21. One 20 lb. box labeled pinto beans had a best by date of 07/21/21. One clear plastic bag containing rigid pasta noodles was dated 12/01/21. The bag was not labeled to indicate contents. One 66.5-oz can labeled tuna was dented. One 10-oz can labeled chicken soup was dented. One open box containing fourteen taco shells was open to air, no date opened, use by date, or expiration date. During an interview on 01/24/2023 at 11:15 AM the DM stated she started in her current position one week ago. She stated she was being trained by a former dietary manager and the facility administrator. The DM acknowledged that she was responsible for ensuring the inventory was dated when opened, and the inventory was rotated with each delivery. The DM explained she was not able to find a cleaning schedule but was in the process of creating daily, weekly, and monthly cleaning schedules. The DM stated the staff scheduled for the evening meal was responsible for checking expiration dates and disposing of expired stock. She said the dented cans should have been removed from inventory. She explained tasks were not getting done because she only had 3 staff members to work in the kitchen. The DM stated failure to date and rotate the inventory could cause spoiled food to be served to the residents which could make the residents sick. She stated she was learning what chemicals can be used on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 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 675364 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Homestead Nursing and Rehabilitation of Baird 224 E 6th St Baird, TX 79504 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 which pieces of equipment to clean and sanitize items in the kitchen. The DM acknowledged she was responsible for training and monitoring the dietary staff to ensure regulations were followed. During an interview on 01/24/2023 at 3:40 PM, the Administrator acknowledged the condition of the dietary department was not up to regulations. He stated he was responsible for assisting with training the new DM, monitoring progress of improvements, and making sure policy and procedures were followed. The administrator stated his expectations were that the dietary staff was trained to maintain a safe, sanitary kitchen. The administrator stated the failures occurred due to not enough staff and a new DM in training. Review of the facility policy titled Food Receiving and Storage revised December 2008 revealed 1. Food Services, or other designated staff, will maintain clean food storage areas at all times. 7. All foods stored in the refrigerator or freezer will be covered, labeled and dated (use by date). 9. Refrigerated foods will be stored in such a way that promotes adequate air circulation around food storage containers. Refrigerators/walk-ins will not be overcrowded. 10. The freezer must keep frozen foods frozen solid. Wrappers of frozen foods must stay intact until thawing. A record review of the FDA's 2017 Food Code reflected the following: 3-501.17 Ready-to-Eat, Time/Temperature Control for Safety Food, Date Marking. (A) Except when PACKAGING FOOD using a REDUCED OXYGEN PACKAGING method as specified under § 3-502.12, and except as specified in (E) and (F) of this section, refrigerated, READY-TO EAT, TIME/TEMPERATURE CONTROL FOR SAFETY FOOD prepared and held in a FOOD ESTABLISHMENT for more than 24 hours shall be clearly marked to indicate the date or day by which the FOOD shall be consumed on the PREMISES, sold, or discarded when held at a temperature of 5ºC (41ºF) or less for a maximum of 7 days. The day of preparation shall be counted as Day 1. (B) .refrigerated, ready-to-eat time/temperature controlled for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24-hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations (2) The day or date marked by the food establishment ay not exceed a manufacturer's used-by date if the manufacturer determined the use-by date based on food safety. FOOD shall be protected from cross contamination by: (4) Except as specified under Subparagraph 3-501.15(B)(2) and in (B) of this section, storing the FOOD in packages, covered containers, or wrappings FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 If continuation sheet Page 10 of 10