Health inspection·May 12, 2023

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many allergies. The Screener stated if staff answered the screening questions honestly than half the staff would be going home sick. The Screener stated that the purpose of the screening kiosk is to answer the questions to make sure that the staff member did not have COVID symptoms and to not spread infection to residents or other staff members. The Administrator stated it was policy to use the kiosk and to answer the questions honestly and advised the Screener she had to answer the questions honestly and she needed to wear a mask. The RN F showed the COVID-19 test with a negative result for the Screener. The Screener stated she did not want to wear a mask because it would make her allergy symptoms worse, and the Administrator advised that if she would not wear the mask she must go home. The Screener stated she would clock out and go home. The Administrator stated there was no reason to not follow the screening protocol because even allergy symptoms could actually be symptoms of COVID-19. During an observation and interview on 5/12/23 at 9:51 a.m. with the RN F and Administrator, RN F was asked in front of the Administrator if the RN F used the screening kiosk this morning. The RN F stated No, not yet. The RN F stated she knew it was protocol to use the screening station and she did not take the time to screen when she arrived to work. The Administrator advised RN F to go to the kiosk to screen and to also take a COVID-19 test. The Administrator stated, this is a problem if staff are not being screened or not answering the screening questions honestly. The Administrator stated that all staff should use the kiosk to screen for COVID symptoms and should answer the questions honestly to prevent the spread of infection. During an observation on 5/12/23 at 9:55 a.m., near the nurses station, with the Administrator revealed MA A walked past the nurses station and the Administrator asked MA A if she used the screening kiosk today. MA A stated no and walked down the resident hall. The Administrator stated she would notify the DON and the kiosk screening report would be pulled to determine what staff failed to screen upon arrival to the facility for their shift. During an observation and interview on 5/12/23 at 10:01 a.m. revealed MA A not wearing a mask at a medication cart. MA A stated she did not use the COVID-19 screening kiosk upon arrival to the facility. MA A stated the corporate policy was to screen upon entrance into the facility and stated we haven't been doing it for at least 2 weeks. We just don't. MA A stated the purpose of using the screening kiosk and answering the questions honestly was to keep residents safe from exposure to COVID-19 and she was trained to screen but had not been doing it. During an observation and interview on 5/12/23 at 10:09 a.m., revealed MA B not wearing a mask, stated she did not use the screening kiosk upon arrival to the facility today. MA B stated she was trained to use the kiosk, and no one has told her to stop using the kiosk. MA B stated the purpose of screening was to make sure she was not sick before being around residents. MA B stated she had no reason why she did not screen, and stated I just didn't. MA B stated she did not screen prior to every shift at the facility. During an observation and interview on 5/12/23 at 10:38 a.m. OTA D not wearing a mask, stated she arrived at the facility through the therapy department door and did not use the screening kiosk for COVID-19 symptoms. The OTA D stated she worked at the facility for one month and was never advised she needed to screen for symptoms. During an interview on 5/12/23 at 10:42 p.m., ADON E not wearing a mask, stated she was the Infection Control Preventionist for the facility. ADON E stated she was in a hurry this morning and did not use the COVID-19 screening kiosk when she entered the building. ADON E stated she had not probably screened for at least the last week she had worked. ADON E stated she did not have a reason why she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675498 If continuation sheet Page 2 of 4 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 675498 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillside Heights Rehabilitation Suites 6650 South Soncy Road Amarillo, TX 79119 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 0880 Level of Harm - Minimal harm or potential for actual harm was not screening and stated it was important to screen to verify staff did not have symptoms or a fever upon arrival to the facility. ADON E stated the current facility policy was to screen for COVID-19 symptoms and temperature at the screening station upon arrival to the facility and she had been trained to do so. ADON E stated she was unaware of who monitored the kiosk screening station to ensure staff screened upon entrance or how often it was audited. Residents Affected - Many During an interview on 5/12/23 at 10:46 p.m., the DON stated she was now testing all staff who did not use the screening kiosk prior to starting their shift. The DON stated there was a problem because staff failed to screen as they were required. The DON stated she would provide COVID-19 test results when she completed testing staff. During an interview on 5/12/23 at 10:58 a.m., OTA C not wearing a mask, stated he did not use the screening kiosk when he started his shift this morning. OTA C stated, we have been slipping on screening and stated that he had been trained to use the kiosk to screen. The OTA C stated screening was important to make sure they did not have signs or symptoms of COVID-19 so they would not pass COVID-19 onto the residents. During an interview on 5/12/23 at 1:14 p.m., the ADON E stated the risk of spreading COVID-19 was high when staff did not screen. The ADON E stated that all staff, including herself were failing to screen and stated that staff get into the zone when they arrive and bypass the screening kiosk. The ADON E stated that all staff need to get back on track and make sure they are using the screening kiosk when they arrive in the building. The ADON E stated that by failing to screen and honestly answer the COVID symptom screening questions It increases the risk for COVID to residents/staff. The ADON E stated all staff were trained to use the COVID-19 screening kiosk and it was the current facility policy to do so. During an interview on 5/12/23 at 1:45 p.m., the DON stated she pulled a list from the kiosk on who screened this morning and compared it to the list of staff who clocked in. The DON stated she had tested 21 staff who did not screen prior to starting their shift. The DON stated 1 staff member tested positive, MA B who had not been wearing a mask was sent home and had no symptoms. The DON stated the risk of staff not following company policy to screen for COVID-19 symptoms prior to starting their shift was spreading infection, which included COVID-19. The DON stated when staff did not honestly answer the screening questions, it placed staff and residents at risk of infection and COVID-19. The DON stated she was not aware staff were not using the screening kiosk. The DON stated the ADON E was in charge of infection control and tracking COVID-19 in the building. The DON stated the ADON E should have screened this morning because she was in charge of Infection Control. The DON stated that all residents that were exposed to MA B had been tested and all residents tested for COVID tested negative today. Record review of the facility provided list of staff who failed to utilize the screening kiosk on 5/12/23 and were tested for COVID-19 revealed 24 staff failed to screen upon arrival to the facility and 1(MA B) out of 24 staff tested positive for COVID-19. Record review of the facility provided policy Coronavirus Disease (COVID-19), dated 8/29/22, revealed: Facility staff will be screened prior to each shift. The screener will not allow any individual that does not pass the screening to enter the facility. Record review of the facility provided Mitigation Plan, dated 5/12/23, revealed: Facility staff will be re-educated on the requirement that screening is to be done prior to reporting to offices or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675498 If continuation sheet Page 3 of 4 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 675498 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillside Heights Rehabilitation Suites 6650 South Soncy Road Amarillo, TX 79119 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete resident care areas. Screeners will be re-educated on the screening process if manual screening is to be done. In-service objectives: Using kiosk as screen when entering the building and prior to care areas or using screening before entry into the building or any care areas. Although requested, the Facility failed to provide the requested Infection Control Policy and Procedures prior to exit. Event ID: Facility ID: 675498 If continuation sheet Page 4 of 4