Health inspection·April 13, 2023

F 0644 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #11's Preadmission Screening and Resident Review Level One (PL1) form dated 01/10/2019 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #36: Residents Affected - Some Record review of Resident #36's undated electronic facesheet revealed an 85 -year-old female admitted to the facility on [DATE]. The facesheet listed under additional current diagnoses, MDD, PTSD, and psychotic disorder with delusions due to a known physiological condition. Record review of Resident #36's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of depression, non-Alzheimer's dementia, psychotic disorder, and post-traumatic stress disorder. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 11 indicating the resident was mildly cognitively impaired. Record review of Resident #36's most recent care plan, which was undated, revealed a focus area with problem onset date of 09/24/2021 which read in part that Resident #36 is at high risk for side effects/physical injury due to need for psychotropic medications with appropriate interventions in place. Record review of Physician progress notes for Resident #36 dated 02/26/2023 revealed under past medical history, diagnoses including PTSD and MDD. Under current medications, documentation indicated the resident was prescribed buspirone (anxiolytic or anti-anxiety) 7.5 mg three times daily, fluoxetine (antidepressant) three 10mg capsules daily, and Abilify (antipsychotic) 5mg once daily. Record review of Resident #36's Preadmission Screening and Resident Review Level One (PL1) form dated 09/24/2021 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. Resident #52: Record review of Resident #52's electronic face sheet dated 4/12/23 revealed an [AGE] year-old male most recently admitted to the facility on [DATE]. The face sheet listed under additional current diagnoses, MDD, recurrent severe without psych features, heart failure, Alcohol Dependence, in remission, and PTSD. Record review of Resident #52's Quarterly MDS dated [DATE], revealed under section I Active Diagnoses, a diagnosis of depression, anxiety disorder, and PTSD. Additionally, under Section C Cognitive Patterns, the MDS revealed a BIMS of 14 indicating the resident was cognitively intact. Record review of Resident #52's most recent care plan, which was undated, revealed a focus area with problem onset date of 04/19/2020 which read in part that Resident #52 is at high risk for altered mood state/behavioral problems an isolation due to PHQ-9 score indicates major depression, and PTSD. As well as, high risk for side effects/physical injury due to need for psychotropic medications - depression, PTSD with appropriate interventions in place. Record review of Resident #52's Preadmission Screening and Resident Review Level One (PL1) form dated 06/5/2019 revealed under section C0100 Mental Illness an answer of No, indicating the resident did not have a mental illness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675462 If continuation sheet Page 2 of 3 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 675462 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Nursing and Rehabilitation Center 3200 Parkway Big Spring, TX 79720 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 0644 Resident #60 Level of Harm - Minimal harm or potential for actual harm Review of Resident #60's undated face sheet revealed a [AGE] year-old-female with an admission date of 08/25/21 with a primary diagnosis of Parkinson's Disease, hypertension (high blood pressure), major depressive disorder, recurrent severe without psychotic features, and psychotic disorder with hallucinations due to known physiological condition. Residents Affected - Some Record review of Resident #60's physician orders dated 04/11/23 revealed Sertraline HCL 50mg tablet give 1.5 tabs (=75mg) by mouth daily for depression dated 09/01/21. Review of Resident #60's PASRR assessment Level 1 Screening dated 08/23/21, under Section C0100 revealed documentation indicating Resident #60 did not have a mental illness. The PASRR Level I screening was also certified by the Assessor on 08/23/21 indicating the information was true and accurate. Review of Resident #60's Annual MDS assessment dated [DATE], revealed in section A1500 revealed the resident was not currently considered by the state level II PASRR process to have a serious mental illness and/or intellectual disability or related condition. L1s During an interview with the Administrator on 04/13/23 at 9:48 AM, she said it was the Admissions' nurses' responsibility to review enter PL1 into electronic records; she stated the facility does not have a process for screening PL1s for accuracy when residents were admitted . The Administrator stated PL1s are not screened for accuracy, the facility assumes the hospital completed the PL1 correctly; when the PL1 arrives to the facility it is entered into electronic records. The Administrator stated they do not have a working relationship with the hospital who completes the PL1s. The Administrator stated the PL1s were completed by the local hospital. The Administrator stated Residents #11, #36, #52 and #60 did not have a PASRR Evaluation completed, she also stated the PL1s for these residents were not accurate; due to Major Depression and PTSD being diagnosis. The Administrator stated the facility does not have a process for updating the PL1 if a resident was diagnosed with a new diagnosis because she did not know the PL1 would need to be updated due to a new diagnosis. The Administrator stated she did not know PTSD and Major Depression warrant a positive PL1. When asked what the potential harm would be to residents could be if they did not receive an accurate PL1 or subsequent PL2 evaluation, she said the residents were at risk of not receiving proper services. During an interview with the Admissions' Nurse on 4/13/23 at 10:35am, she stated there was no process to ensure the PL1 was accurate at admission; the Admissions' Nurse stated she simply inputs the information received from the hospital regarding the PL1 at the time of admission. The Admissions' Nurse said she did not know a new PL1 needed to be completed if a resident was diagnosed with a new diagnosis. The Admissions' Nurse stated Residents #11, #36, #52 and #60 did not have PASRR Evaluations and their PL1s were incorrect as they were negative and should be positive due to a diagnosis of PTSD and Major Depression. The Admissions' Nurse stated she did not know Major Depression and PTSD triggered a positive PL1. The Admissions' Nurse stated there was no process to correct a PL1 if it was incorrect at admission. During an interview with the Administrator conducted on 04/13/23 at 11:00 AM she stated the facility did not have a policy on PASRR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675462 If continuation sheet Page 3 of 3