Health inspection·May 21, 2025

F 0641 Resident #11 Level of Harm - Minimal harm or potential for actual harm Review of Resident #11's electronic face sheet revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis to include: heart failure, infection of the heart, and kidney failure. Residents Affected - Few Review of Resident #11's MDS dated [DATE] revealed BIMS of 11 which indicated moderate cognitive impairment. Review of Section M revealed no antibiotics during the last 7 days. Review of Resident #11's Comprehensive Care Plan, last revised 03/20/2025, revealed no evidence of IV antibiotic therapy of infection. Review of Resident #11's electronic physicians orders revealed: Daptomycin-sodium Chloride Intravenous Solution Use 700 mg intravenously at bedtime for infection until 06/27/2025, start date 05/01/2025 and Rifampin Oral Capsule 300 mg give 1 tablet by mouth for infection until 06/27/2025, start date 05/01/2025. During an interview on 05/21/25 at 10:55 AM, ADON stated residents' leg braces and antibiotics should have been claimed on the MDS. She stated she was responsible for MDS, and she must have just missed it. She stated this did not have any negative effect on the residents. During an interview on 05/21/25 at 11:01 AM, the DON stated the ADON was responsible for MDS, and it was just missed. She stated that the leg braces and the antibiotic should have been claimed in the MDS. DON stated the facility does not have a policy for MDS. She stated the facility follows the RAI. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 If continuation sheet Page 2 of 6 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 05/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan with measurable objectives to meet resident's highest practicable physical, mental, and psychosocial well-being for 3(Resident #1, Resident #11, and Resident #31) of 12 residents reviewed for comprehensive person-centered care plans. The facility failed to develop care plans based on the assessed needs with measurable objectives and timeframes in area of leg braces for Resident #1. The facility failed to develop care plans based on the assessed needs with measurable objectives and timeframes in area of intravenous antibiotics and infection for Resident #11. The facility failed to develop care plans based on the assessed needs with measurable objectives and timeframes in area of feeding tube for Resident #31. This failure could place the residents at risk for decreased quality of life and not having their needs met. Findings include: Resident #1 Review of Resident #1's electronic face sheet revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis to include: diabetes, muscle wasting, unsteadiness on feet. Review of Resident #1's MDS dated [DATE] revealed: BIMS of 10 which indicated moderate cognitive impairment. Review of O revealed no Splint or brace assistance. Review of Resident #1's Comprehensive Care Plan, last revised 11/18/2024, revealed no evidence of right and left leg braces. Review of Resident #1's electronic physicians revealed no evidence of an order to right and left leg braces. Observation on 05/19/25 at 10:18 AM, Resident #1 up in wheelchair with right and left leg braces in place. Observation and interview on 05/20/25 at 02:44 PM, Resident #1 resting in bed with braces sitting in wheelchair. She stated she had to wear her braces anytime that she was out of bed because her feet turn inward. Resident #11 Review of Resident #11's electronic face sheet revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnosis to include: heart failure, infection of the heart, and kidney failure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 If continuation sheet Page 3 of 6 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 05/21/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Review of Resident #11's MDS dated [DATE] revealed BIMS of 11 which indicated moderate cognitive impairment. Review of Section M revealed no antibiotics during the last 7 days. Review of Resident #11's Comprehensive Care Plan, last revised 03/20/2025, revealed no evidence of IV antibiotic therapy of infection. Residents Affected - Some Review of Resident #11's electronic physicians orders revealed: Daptomycin-sodium Chloride Intravenous Solution Use 700 mg intravenously at bedtime for infection until 06/27/2025, start date 05/01/2025 and Rifampin Oral Capsule 300 mg give 1 tablet by mouth for infection until 06/27/2025, start date 05/01/2025. Resident #31 Review of Resident #31's electronic face sheet revealed a [AGE] year-old male who was admitted to the facility on [DATE] with diagnosis to include: diabetes, high blood pressure, and depression. Review of Resident #31's MDS dated [DATE] revealed: BIMS of 13 which indicated no cognitive impairment. Review of Section: K revealed resident had a feeding tube. Review of Resident #31's Comprehensive Care Plan, initiated 04/24/2025, revealed no evidence of feeding tube. Review of Resident #31's electronic physicians revealed: Enteral Feed Order every day shift complete enteral site care every shift cleanse stoma with wound cleanser pat dry apply split gauze every day as needed, start date 05/21/2025 and Enteral Feed Order every shift flush feeding tube with 10 cc water between each medication and 30 cc water before and after med administration, start date 05/21/2025. During an interview on 05/21/25 at 10:55 AM, the ADON stated that's leg braces, feeding tube, and antibiotics should be care planned. She stated the DON was currently responsible for updating the care plans. During an interview with on 05/21/25 at 11:01 AM, the DON stated she was responsible for updating the care plans and the leg braces, feeding tube, and antibiotics should have been care planned. She stated she must have just missed them with the new charting system change. Review of facility's policy Care Plans, Comprehensive Person-Centered revised December 2020 revealed: The comprehensive, person-centered care plan will: A. include measurable objectives and time frames; B. describe the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; C. Describe services that would otherwise be provided for the above, but are not provided due to the resident exercising his or her rights, including the right to refuse treatment; . E. Include the resident's stated goals upon admission and desired outcomes G. Incorporate identified problem areas; H. Incorporate risk factors associated with identified problems . Reflect treatment goals, timetables and objective in measurable outcomes; L. Identify the professional services that are responsible for each element of care; M. Aid in preventing or reducing decline in the residents functional status and or functional ; N. Enhance the optimal functioning of the resident by focusing on a rehabilitative program, and O. Reflect current recognized standards of practice for problem areas and conditions . Care plan interventions are chosen only after careful data gathering, proper sequence of events, careful consideration of the relationship (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 If continuation sheet Page 4 of 6 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 05/21/2025 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 0656 between the resident's problem areas and their causes, and relevant clinical decision making. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 If continuation sheet Page 5 of 6 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 05/21/2025 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 - Some Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interviews and records review, the facility failed to provide the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week for 5 (10/19/24, 10/20/24, 11/16/24, 11/17/24, 12/27/24) of 201 days reviewed. There was no RN coverage on the following dates: 10/19/24, 10/20/24, 11/16/24, 11/17/24, 12/27/24. This failure could place residents at risk for injury, decline or death during a situation requiring the advanced knowledge and skills of an RN to intervene and supervision of the direct care staff. Findings included: Review of the Payroll Based Journal Staffing Data Report from CMS dated FY Quarter 1 (October 1 to December 31) accessed on 05/15/25 revealed the facility failed to report RN hours on 10/19/24 (SA); 10/20/24 (SU); 11/16/24 (SA); 11/17/24 (SU) and 12/27/24 (FR). During an interview on 05/21/25 at 08:49 AM, the Administrator stated there was no RN coverage on 10/19/24 and 10/20/24. He stated the weekend RN scheduled quit without notice. The Administrator stated the DON covered on 11/16/25 and 11/17/25 and there was RN coverage on 12/27/24 but he was unable to produce documentation of the coverage. The Administrator stated there were no RN's available for coverage on 10/19/24 and 10/20/24. The Administrator stated he could not think of consequences for the residents due to no RN weekend coverage because the DON and a regional nurse was available by phone. He explained the issue had been resolved by hiring 3 RN's. During an interview on 05/21/25 at 10:22 AM, the ADON, responsible for nursing staff scheduling, stated she could recall not having RN coverage one weekend in October 2024. She explained the RN scheduled quit without notice. The ADON stated she could not state adverse effects on residents for failing to have an RN in the facility because there was always at least one LVN on duty. She stated the situation had been resolved by hiring 3 RN's and the DON would cover a shift if needed. During an interview on 05/21/25 at 10:27 AM, The DON stated she started in the DON position in March 2025. She stated the reason for the failure to provide RN coverage on weekends may have been because it was difficult to attract and hire RNs in a rural area. The DON stated consequences of failing to have an RN on site may be a condition change would be missed, signs and/or symptoms of a disease process such as a developing infection would be identified by an RN. She explained the situation was fixed when the facility hired 3 RNs. Review of facility policy titled Staffing, Sufficient and Competent Nursing, revised August 2022, Policy Interpretation and Implementation, Sufficient Staff, item 3. A registered nurse provides services at least eight (8) consecutive hours every 24 hours, seven (7) days a week. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675364 If continuation sheet Page 6 of 6