Health inspection·August 29, 2025

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete resident's urethra. LVN B stated she did not know why Resident #49 and Resident # 52 were not wearing a leg strap but lack of wearing such devices risked both Residents having foley catheter pulled out. During an interview with the DON on 08/26/25 at 12:45 p.m., the DON stated Resident #49 and Resident # 52 should have been wearing a leg strap to prevent the urinary catheter from possibly dislodging. The DON stated she expected that all residents with a urinary catheter wear a secure device to prevent the catheter from pulling or becoming dislodged. Record review of the facility's policy titled, Catheter Care Urinary, March 2024, revealed, Secure catheter using a leg band Event ID: Facility ID: 675446 If continuation sheet Page 2 of 8 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 675446 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Meadows Rehabilitation and Healthcare Cent 1615 Eleventh St Floresville, TX 78114 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that residents who needed respiratory care were provided such care, consistent with professional standards of practice, for 1 of 3 the residents (Resident # 49) reviewed for oxygen in that: The facility failed on 8/26/2025to ensure that Resident #49's nebulizer tubing was bagged. This deficient practice could place residents who received oxygen therapy at risk for an increase in respiratory complications. The findings included: Record review of Resident #49's face sheet, dated 8/16/25, revealed an [AGE] year old male admitted to facility on 3/1/2025 with the diagnosis that included: Benign Prostatic Hyperplasia ( an enlarged prostate ), Type 2 diabetes ( is a chronic condition where your body either doesn't use insulin properly, leading to high blood sugar levels) and Pleural effusion,(is the buildup of excess fluid in the pleural space between the lungs and chest wall) Record review of Resident #49's Quarterly MDS, dated [DATE], revealed a BIMS score of 13, which indicated intact cognition Record review of Resident #49's Physician monthly orders dated August 2025 revealed an order start date of 08/17/25: Albuterol Sulfate Inhalation Solution for nebulization 0.5 mg -3mg twice a day for 7 days. Observation on 08/26/24 at 10:50 a.m. revealed that Resident #49's nebulizer tubing was unbagged on the bedside table. In an interview with Resident #49 on 08/26/25, at 11:05 a.m., he stated they only bag the nebulizer tubing at this facility every once in a while, depending on the nurse. In an interview with LVN B on 08/26/25, at 11:38 a.m., LVN B stated she was the assigned nurse for Resident #49. It was revealed that it was every nurse's responsibility to change and bag the nebulizer tubing weekly. However, she did not know why the tubing was not being bagged. LVN B stated Resident # 49 was at risk of possible respiratory infection due to the nebulizer tubing being undated and unbagged. During an interview with the DON on 08/26/25 at 1:00 p.m., it was revealed that Resident #49 should have had their nebulizer tubing changed and bagged by the nurse administering the nebulizer treatment. The DON mentioned that she needed to determine why the nebulizer tubing was not bagged for Resident #49. The DON also stated that she oversaw this task and assured that she would monitor it for compliance. The DON stressed that Resident #49 was at risk of a possible respiratory infection due to the outdated and unbagged nebulizer tubing. Record review of the facility's policy, Administering Medications through a small-volume hand-held Nebulizer, 2001, revealed When equipment is dry, store in a plastic bag. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675446 If continuation sheet Page 3 of 8 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 675446 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Meadows Rehabilitation and Healthcare Cent 1615 Eleventh St Floresville, TX 78114 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 FORM CMS-2567 (02/99) Previous Versions Obsolete 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 that in accordance with State and Federal laws, the facility must store all drugs and biologicals in locked compartments under proper temperature controls, and permit only authorized personnel to have access to the keys for 1 of 3 residents (Resident #58) reviewed for medication storage in that: The facility failed on 8/26/25 to ensure medications were not left on Resident #58's bedside table. This failure could place residents at risk for not receiving the intended therapeutic benefit of their medications as ordered. The findings included: Record review of Resident #58's face sheet, dated 8/26/2025, revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included Hypertension (is when the force of blood pushing against your artery walls is consistently too high) , Depression (persistent feeling of sadness and loss of interest), and Spinal Cord Infarction (Injury to the spinal cord ) Record review of Resident #58's Quarterly MDS Assessment, dated 5/09/25, revealed a BIMS score of 15, which indicated cognition was intact. Record review of Resident #58's Patient medication summary for August 2025 did not reveal an order to self-administer medications. Observation on 08/26/25 at 11:45 a.m. in Resident #58's room revealed morning medication in a plastic cup on bed side table. Interview with Resident #58 on 8/26/25 at 11:50 a.m., the resident stated, the MA left the medications there on bed side table for her to take when she was ready as she liked to take her time . Interview with MA C on 8/26/25 at 12:30 PM confirmed she was the MA assigned to pass out medications and revealed that, due to facility culture, she left Resident #58's morning medication on her bedside table this morning. Interview with the DON on 08/26/25 at 1:30 p.m., she reported that no self-medication assessment had been completed for Resident #58 and emphasized that no medications should be left at the bedside for any resident unless the interdisciplinary care planning team and physician had made that decision. The DON was unaware the MA C had left medications out on the bedside table for Resident #58. The DON expressed concern that Resident #58 might self-administer more medication than prescribed by the physician, by the MA C leaving medications on the bedside table. The DON also stated that her ADON would conduct weekly monitoring of bedside medications, while she would oversee this process monthly. Record review of the facility's policy titled, Medication Administration, dated June 2005, revealed, Residents may self-administer their own medications only if permitted by the attending physician, in conjunction with the interdisciplinary care planning team, who has determined that they have the decision-making capacity to do so . Event ID: Facility ID: 675446 If continuation sheet Page 4 of 8 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 675446 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Meadows Rehabilitation and Healthcare Cent 1615 Eleventh St Floresville, TX 78114 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 one of one kitchen. 1. The facility failed to ensure a case of cinnamon rolls was properly sealed in the reach-in freezer. 2. The facility failed to ensure the interior of the ice machine in the kitchen was free of dirt and debris. 3. The facility failed to ensure opened bags of graham cracker crumbs, cookie pieces, cake mix and frosting mix were sealed in the dry storage room [ROOM NUMBER]. The facility failed to ensure opened bag of snacks and cookies were sealed in the kitchen. 5. The facility failed to record the chemical sanitizing solution concentrations of the dish machine on the log sheet in the dish room. These failures could place residents at risk for food borne illness. The findings included: 1. Observation on 08/26/2025 at 10:44 AM revealed one 28-lb. case of mini cinnamon rolls in a chest freezer in the middle of the kitchen. The case was open and the bag inside the case was open, exposing the contents to the ambient air in the freezer and potential exposure to cross contamination and deterioration in quality. During an interview on 08/26/2025 at 10:44 AM, the DM stated the case of cinnamon rolls should have been sealed. It was the responsibility of all dietary staff to ensure products stored in the freezer were properly sealed, labeled and dated. 2. Observation on 08/26/2025 at 10:45 AM of the ice machine in the kitchen revealed there were black spots on the surface of the interior white bin liner of the machine that might indicate the presence of mold, based on location and environmental conditions. During an interview 08/26/2025 at 10:47 AM, the DM stated there were black spots on the surface of the interior white bin liner and there should not have been. The DM further stated that the machine was cleaned monthly or as needed by dietary staff, and all staff was trained on how to clean the machine. 3. Observation on 08/26/2025 at 10:48 AM in the dry storage room revealed: a) One bag of graham cracker crumbs stored in a clear plastic bag tied at the top in a half knot with a piece of plastic wrap b) One opened bag of sandwich cookie crumbs, stored in the original bag, tied at the top in a half knot with a piece of plastic wrap c) One opened 5 lb. paper bag of cherry cake mix with approximately 1/3 left in the bag, rolled down and stuffed inside a zipper-lock bag with approximately 1/3 of the cake mix bag protruding outside the zipper-lock bag d) One opened 4.5 lb. paper bag of white frosting, rolled down, not sealed in a zipper-locked bag or storage container. During an interview on 08/26/2025 at 10:49 AM, the DM stated the graham cracker crumbs, cookie crumbs, cake mix and frosting should have all been stored in sealed bags or storage containers to prevent potential contamination from rodents and pests. All dietary staff storing food in the dry storage room were trained on how to properly store food in the dry storage room upon hire and from in-services throughout the year. 4. Observation on 08/26/2025 at 10:55 AM in the kitchen revealed one 9-oz. bag of cheese flavored snacks and one bag, size unknown, of cookies resembling vanilla wafers on a shelf above the preparation table. Both bags had been opened with approximately half the product used in each bag and both bags were rolled down and closed with a binder clip.During an interview on 08/26/2025 at 10:56 AM, the DM stated the bags of snacks and cookies should have been stored in sealed bags or storage containers to prevent contamination and product deterioration. 5. Observation on 08/26/2025 at 10:58 AM in the dish room revealed the facility used a chemical sanitizing, door-type dishwasher. Record review of the Dish Machine Temperature Log Sheet for August 2025 hanging on a clipboard in the dish room revealed the facility recorded only the temperatures of the machine during the wash and rinse cycles two times a day, for breakfast and lunch. There was no documentation indicating the level of chemical sanitizer solution strength of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675446 If continuation sheet Page 5 of 8 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 675446 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Meadows Rehabilitation and Healthcare Cent 1615 Eleventh St Floresville, TX 78114 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 machine for any day to ensure it was the proper concentration.Observation on 08/26/2025 at 11:05 AM revealed [NAME] A tested the chlorine level of the water in the dish machine by placing a chlorine test strip in the water. The color of the strip changed to dark lavender, indicating a chlorine level between 50-100 ppm when compared to the color chart on the container of the test strips, and was within the acceptable range.During an interview on 08/26/2025 at 11:04 AM, the DM stated the facility tested the concentration of chemical sanitizer in the machine three times a day and should have been using a log with columns to document the concentration level of chemical sanitizer every time it was checked. The DM further stated it was important to monitor the concentration of sanitizer in the machine to prevent potential foodborne illness by properly sanitizing dishes and utensils.Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed: 3-305.11, Food Storage, (A) Food shall be protected from contamination by storing the food: (1) in a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination.Record review of the facility policy, Dry Storage, reviewed January 2023, revealed 9. If an item is opened, the food must be tightly sealed.if using large bags to seal open items in their original packaging.bags must be sealed. Record review of the facility policy, Sanitation, revised January 2024, revealed, The food service area shall be maintained in a clean and sanitary manner. I. Ice machines and ice storage containers will be drained, cleaned, and sanitized per manufacturer's instructions and facility policy. The Food Services Manager will be responsible for scheduling staff for regular cleaning of kitchen and dining areas. Food service staff will be trained to maintain cleanliness throughout their work areas during all tasks, and to clean after each task before proceeding to the next assignment. Review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed, 4-602.11 Equipment Food-Contact Surfaces and Utensils. (E) Except when dry cleaning methods are used as specified under S 4-603.11, surfaces of UTENSILS and EQUIPMENT contacting FOOD that is not TIME/TEMPERATURE CONTROL FOR SAFETY FOOD shall be cleaned: (4) In EQUIPMENT such as ice bins and BEVERAGE dispensing nozzles and enclosed components of EQUIPMENT such as ice makers, cooking oil storage tanks and distribution lines, BEVERAGE and syrup dispensing lines or tubes, coffee bean grinders, and water vending EQUIPMENT: (a) At a frequency specified by the manufacturer, or (b) Absent manufacturer specifications, at a frequency necessary to preclude accumulation of soil or mold. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed: 3-302 Preventing food and ingredient contamination. 3-302.11 Packaged and Unpackaged Food - Separation, Packaging, and Segregation. (A) 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. (6) Protecting food containers that are received packaged together in a case or overwrap from cuts when the case or overwrap is opened. 3-305.11 Food Storage. (A) Except as specified in (B) and (C) of this section, FOOD shall be protected from contamination by storing the FOOD: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination. Record review of the facility policy, Dishwashing Machine Use, dated October 2022, revealed, Food Service staff required to operate the dish washing machine will be trained in all steps of dishwashing machine use by the supervisor or a designee proficient in all aspects of proper use and sanitation. 4. Dish washing machine chemical sanitizer concentrations and contact times will be as follows:Type of Solution Minimum Concentration Contact TimeChlorine 50-100 ppm 10 seconds 5. A supervisor will check the dishwashing machine for proper concentrations of sanitizer solution (measured as parts-per-million [PPM] or mL/L) after filling the dishwashing machine and once a week thereafter. Concentrations will be recorded in a facility approved log.6. Corrective action will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675446 If continuation sheet Page 6 of 8 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 675446 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Meadows Rehabilitation and Healthcare Cent 1615 Eleventh St Floresville, TX 78114 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 FORM CMS-2567 (02/99) Previous Versions Obsolete taken immediately if sanitizer concentrations are too low. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed: 4-501.114 Manual and Mechanical Warewashing Equipment, Chemical Sanitization -Temperature, pH, Concentration, and Hardness.A chemical SANITIZER used in a SANITIZING solution for a manual or mechanical operation at contact times specified under 4-703.11(C) shall meet the criteria specified under S7-204.11 Sanitizers, Criteria, shall be used in accordance with the EPA-registered label use instructions, and shall be used as follows: (A) A chlorine solution shall have a minimum temperature based on the concentration and PH of the solution as listed in the following chart. mg/L pH 10 or Less pH 8 or Less25-49 120 degrees F 120 degrees F50-99 100 degrees F 75 degrees F (C) A quaternary ammonium compound solution shall: (1) Have a minimum temperature of 24 degrees C (75 degrees F), (2) Have a concentration as specified under S 7-204.11 and as indicated by the manufacturer's use directions included in the labeling, and(3) Be used only in water with 500 MG/L hardness or less or in waterhaving a hardness no greater than specified by the EPA-registered label use instructions4-501.116 Warewashing Equipment, Determining Chemical Sanitizer Concentration.Concentration of the SANITIZING solution shall be accurately determined by using a test kit or other device. Event ID: Facility ID: 675446 If continuation sheet Page 7 of 8 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 675446 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Meadows Rehabilitation and Healthcare Cent 1615 Eleventh St Floresville, TX 78114 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation, interview and record review, the facility failed a to dispose of garbage and refuse properly for 2 of 3 Dumpsters (Dumpsters #1 and #3) reviewed for garbage and refuse disposal. The facility failed to ensure Dumpster #1 had a drainage plug and Dumpster #3 was free of gaps. These deficient practices could place residents at risk for exposure to germs and diseases carried by vermin and rodents. The findings included: Observation on 08/28/2025 at 10:17 AM revealed Dumpster #1 was missing a drainage plug. Observation on 08/28/2025 at 10:18 AM revealed the bottom of the left side of Dumpster #3 had a gap approximately 9 in length and 1 in height due to rust. During an interview on 08/28/2025 at 10:19 AM, the DM stated she was unaware Dumpster #1 was missing a drainage plug and Dumpster #3 had the gap caused by rust at the bottom, and it was important for both dumpsters to be completely sealed to prevent leakage and for the proliferation of rodents. Record review of the facility policy Food-Related Garbage and Refuse Disposal, dated October 2022, revealed, Food-related garbage and refuse are disposed of in accordance with state laws. 5. Garbage and refuse containing food wastes will be stored in a manner that is inaccessible to pests. 7. Outside dumpsters provided by garbage pickup services will be kept closed and free of surrounding litter. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed, 5-501.114 Using Drain Plugs. Drains in receptacles and waste handling units for refuse, recyclables, and returnables shall have drain plugs in place. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675446 If continuation sheet Page 8 of 8