Health inspection·October 12, 2022

F 0677 activities due to trauma and history of falling. Level of Harm - Minimal harm or potential for actual harm Record review of an annual MDS dated [DATE] reflected Resident #16's functional assessment indicated he was totally dependent on one-person physical assist for personal hygiene. Residents Affected - Some Record review of a care plan for Resident #16 revised on 08/03/2022 reflected she had an ADL self-care deficit r/t Dementia. Check nail length and clean and trim on bath days and as necessary. Observation on 10/10/2022 at 10:42 AM in the facility lobby revealed Resident #16 was being assisted up onto a walker by PT. His fingernails on both hands were noted to be long, ¾ to 1 inch past his fingertips and jagged with brown debris underneath. Resident #16 was very HOH and unable to be interviewed. Record review of a face sheet dated 10/11/2022 reflected Resident #27 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of Asthma, (condition in which airways become inflamed, narrow and swell and produce extract mucus which makes it difficult to breath), Covid-19, Psoriasis, (condition in which skin cells build up and form scales, and itchy dry patches), limitation of activities due to weakness and Cerebral Infarction (brain stroke) Record review of a quarterly MDS quarterly dated 08/22/2022 reflected Resident #27 functional assessment indicated she required extensive assistance and one-person physical assist for personal hygiene. Record review of a care plan for Resident #27 dated 06/09/2022 reflected she had a rash of the upper and lower extremities r/t Psoriasis. Avoid scratching. The resident has an ADL self-care deficit r/t aggressive behavior, Hemiplegia (paralysis of one side of the body), impaired balance. The resident requires skin inspection. Observe for redness, open areas and scratches. Observation and interview on 10/10/2022 at 10:00 AM revealed Resident # 27 had what appeared to be Psoriasis plaques on her arms. Her fingernails were curved and 3/4-inch-long with brown debris underneath. She stated her psoriasis was bad and something on her back itched. She stated her nails needed care and they were curling over. She stated it bothered her to have long dirty nails. Record review of a face sheet dated 10/11/2022 reflected Resident #11 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of nutritional Anemia (lack of red blood cells in the body leading to reduced oxygen flow to the body's organs), Covid-19, Essential (Primary) Hypertension, Dementia, Psoriasis and muscle weakness. Record review of a quarterly MDS quarterly dated 07/25/2022 reflected Resident #11 functional assessment indicated he required extensive assistance and one-person physical assist for personal hygiene. Record review of a care plan for Resident #11 dated 11/17/2016 and revised on 11/05/2019 reflected he had an ADL self-care deficit r/t aggressive behavior, confusion, Dementia. The resident is dependent on staff for personal hygiene. The resident has a history of rash of body r/t Psoriasis. Avoid scratching. Monitor skin rashes for increased spread or signs of infection. Observation on 10/10/2022 at 8:55 am revealed Resident #11 in a chair trying to scoot it down the hall. He had long, jagged fingernails approximately ¾ to 1 inch long past the fingertips with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675518 If continuation sheet Page 2 of 7 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 675518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hilltop on Main 1015 N Main Meridian, TX 76665 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 0677 brown debris underneath. Level of Harm - Minimal harm or potential for actual harm Record review of a face sheet dated 10/11/2022 reflected Resident #25 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Dementia, Cerebral Infarction, Neurosyphilis (infection of the central nervous system in a patient with syphilis, causing abnormal gait, numbness in toes, feet or legs, problems with thinking, mental problems. Loss of bladder control), Schizoaffective Disorder Bipolar type (chronic mental health condition characterized by hallucinations or delusions with some episodes of mania and some depression), cocaine dependence, in remission, Hypertension and alcohol dependence in remission. Residents Affected - Some Record review of an annual MDS dated [DATE] reflected Resident #25's functional assessment reflected he required supervision of personal hygiene and one-person physical assist. Record review of a care plan for Resident #25 dated 08/14/2018 and revised on 02/10/2022 reflected he had an ADL self-care performance deficit r/t Dementia. Check nail length and trim and clean on bath day and as necessary. Observation on 10/10/2022 at 10:38 am revealed Resident #25 had fingernails on both hands ¾ - 1 inch long past the fingertips with brown debris underneath . Record review of a face sheet dated 10/11/2022 reflected Resident #15 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Hemiplegia and Hemiparesis (paralysis on one side of body and weakness on one side of body) following Cerebral Infarction. Type 2 Diabetes, Chronic Obstructive Pulmonary Disease (group of disease that cause airflow blockage and breathing related problems), Aphasia (inability to speak) following Cerebral Infarction. Psychotic Disorder with delusions (presence of one or more delusions. Delusion is unshakeable belief in something that isn't true). Record review of a quarterly MDS dated [DATE] reflected Resident #15's functional assessment indicated he required extensive assistance and one-person physical assist for personal hygiene. Record review of a care plan for Resident #15 dated 07/20/2018 and revised on 11/06/2018 reflected he had an ADL self-care performance deficit r/t activity intolerance, Hemiplegia, limited ROM and stroke. Check nail length and trim and clean on bath day and as necessary. Observation and interview on 10/10/2022 10:50 am with Resident #15 revealed he had fingernails on both hands ¾ - 1 inch long past the fingertips with brown debris underneath and a contractured contracted right hand. He stated the fingernails are hurting my hand. Record review of a face sheet dated 10/11/2022 reflected Resident #33 was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Huntington's Disease (an inherited condition in which nerve cells in the brain break down over time affecting functional abilities and usually result in movement, thinking, and psychiatric disorders), Multiple Sclerosis, (disease in which the immune system eats away at the protective coating of nerves and disrupts communication between the brain and the body), Essential (Primary) Hypertension, Dysphagia (difficulty swallowing) and Schizoaffective Disorder Bi-polar type (chronic mental health condition characterized by hallucinations or delusions with some episodes of mania and some depression). Record review of an annual MDS dated [DATE] reflected Resident #33's functional assessment indicated he required extensive assistance and one-person physical assist for personal hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675518 If continuation sheet Page 3 of 7 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 675518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hilltop on Main 1015 N Main Meridian, TX 76665 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of a care plan for Resident #33 dated 11/17/2018 and revised on 10/28/2019 reflected he had an ADL self-care performance deficit r/t aggressive behavior, confusion and impaired balance. Check nail length and trim and clean on bath day and as necessary. Observation on 10/10/2022 at 12:05 pm revealed Resident #33 attempting to get out of his wheelchair in the dining room and was noted to have ¾ to 1-inch long fingernails with brown debris underneath . Review of the face sheet for Resident #18 reflected he was admitted on [DATE] with diagnoses of: COPD, High blood pressure, Unspecified Joint Pain, Major Depressive Disorder recurrent, Type 2 diabetes and an Anxiety disorder. Review of the quarterly MDS assessment for Resident #18 dated 08/24/2022 reflected a BIMS score of 11 indicating moderate cognitive impairment. His functional assessment reflected he required extensive assistance for bathing and dressing, but only supervision for all other ADLs. He was assessed as occasionally incontinent. Review of care plan for Resident #18 dated 08/22/2022 reflected interventions were in pace for: full code status, ADL self-care performance deficit, will not allow staff to help him up slight uphill grades. Impaired cognitive function r/t COPD and shortness of breath, missing teeth r/t nutrition, joint pain, oxygen therapy. Review of Physician's orders for Resident #18 dated 05/04/2022 and renewed to 10/30/2022 reflected as part of Anti-Depressant Behavior Monitoring, he was to be encouraged not to scratch, fight or finger paint in feces. Monitoring for fingernail length would reduce the chances of injury and infection associated with these behaviors. Observation on 10/10/2022 at 8:32 AM of Resident #18 revealed he was seated in his wheelchair in the television viewing area, holding hands with a female Resident. It was observed his fingernails were long, yellow and pointed. Some fingernails extended 1 and ¼ inches past his fingertips. All were observed to be well past the ends of his fingertips. Review of the face sheet for Resident #29 reflected he was admitted on [DATE] with diagnoses of: Asthma, Legal Blindness, Hypothyroidism, High Blood Pressure, Major Depressive Disorder, Visual Hallucinations and Mood Disorder with Major Depressive symptoms. Review of the annual MDS assessment for Resident #29 dated 09/02/2022 reflected a BIMS score of 15 indicating normal cognitive function. Review of his functional assessment reflected he required extensive assistance for transfers and utilizing his wheelchair, he required only supervision for his other ADLs. He was assessed as always continent of bowel and bladder. Review of the care plan for Resident #29 dated 08/07/2022 reflected interventions were in place for: his Full Code status, Resident had stated dislike of group activities, utilized divided plate to eat independently, ADL self-performance deficit r/t blindness, Fall Risk, antidepressant Mediations. Interventions for Resident #29 reflected he was to keep his fingernails short to avoid scratching related to a dry skin condition. The interventions reflected scratches left the resident at greater risk of infection. Observation and interview on 10/10/2022 at 9:12 AM of Resident #29 revealed he was seated in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675518 If continuation sheet Page 4 of 7 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 675518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hilltop on Main 1015 N Main Meridian, TX 76665 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some his wheelchair in his room with the lights turned out. Light coming in through the window blinds made observation easily performed. Resident #29 had long fingernails ½ inch past the end of all fingers. Resident #29 stated he had no discomfort from his fingernails and was not aware that they had reached such length. Review of Physician's orders for Resident #29 reflected an order was entered on 09/01/2017 for nail care. It reflected he was to have fingernail care on evening shift on the 22nd of every month. Interview on 10/11/2022 at 8:40 AM LVN M stated all residents were supposed to get their fingernails trimmed on Sunday. She stated the Sunday nail trimming had been a facility practice for as long as she could recall . LVN M stated resident's fingernails could be cut on shower days, and shower sheets were used to record skin conditions but not fingernails. She stated she would cut the fingernails for Resident #29 and #18 right away (after surveyor informed her of long fingernails). Observation and interview on 10/11/2022 at 3:06 PM with LVN M who observed Resident #1's fingernails and agreed they needed trimming. LVN M stated Resident #1 is on hospice and the hospice aides are supposed to do his nails, but we do it if they don't. LVN M observed Resident # 11, # 16, #15, and #25's fingernails and stated Yes they're all too long. She stated the weekend nurse is supposed to cut all nails on Sundays. It's everyone's responsibility to cut nails. Interview on 10/11/2022 at 3:20 PM CNA A stated the CNAs and the weekend nurse cut fingernails. She stated she had not seen a place to document it. Interview on 10/11/2022 at 3:25 PM the Lead CNA stated she told her charge nurse when she cut fingernails and they document it. She stated she did not think the facility had any nail files. She stated she would have to go to a local store and buy some nail files. Observation on 10/11/2022 at 3:30 PM revealed LVN M found two toenail clippers in a drawer at the nurse's station and two fingernail clippers in a locked treatment cart that was not accessible to CNAs. No nail files were located. Interview on 10/11/2022 at 3:27 PM with the DON who stated she had been at the facility since 10/05/2022. Her expectations were that fingernails would be cleaned and trimmed. She stated she was not sure about the system for documenting nail care. She stated bacteria under fingernails could absolutely cause infections. Interview on 10/12/2022 at 1:40 PM with the Administrator who stated nail care would typically be part of ADLs every day or as needed and as the resident would allow. He agreed the potential issue with dirty fingernails could be bacteria and scratches. Review of a Nail Care policy and procedure dated 04/01/2009 reflected, Responsibility: Licensed Nurse or Podiatrist performs the procedure on high risk residents. Nursing assistants may perform the procedure ifs the resident is not at risk for complications or infection. Purpose: to provide cleanliness. To prevent spread of infection. Equipment: Nail clippers, Nail file. Basin with warm water and soap. Nail brush. Towel. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675518 If continuation sheet Page 5 of 7 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 675518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hilltop on Main 1015 N Main Meridian, TX 76665 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 - Some 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. Based on observation, interview and record review the facility failed to ensure drugs and biologicals were labeled according to accepted professional principals and included cautionary instructions for 2 of 2 medication carts and 1 of 2 medication storage rooms reviewed for labeling and storage of drugs and biologicals. The facility failed to ensure expired medications were removed from the carts; failed to ensure potential contaminants including loose pills and debris were not on the carts and failed to ensure the medication storage room was free of potential contaminants. This failure could place residents at increased risk of receiving expired and/or contaminated medications resulting in adverse health consequences. Findings include: Observation and interview on 10/11/2022 at 1:30 PM of the large medication storage room revealed two pills on the floor, one white and one pink. There was loose debris, empty boxes, dirt, and a large dead roach on the floor. LVN A observed the debris and loose pills on the floor and stated, Only nurses can get into the medication storage rooms. She had no explanation for why the room was in disarray. Observation and interview on 10/11/2022 at 1:40 PM of medication storage cart 1 (one) revealed seven loose pills in the drawers, hair, spilled liquids and debris. There was a bottle of MVI which expired 09/2022, Omeprazole 20 mg expiration date 09/2022 and Famotidine which expired 09/2022. LVN A confirmed the medications were expired and should not be on the cart. She agreed the cart should not have loose pills and debris in it. Observation and interview on 10/11/2022 at 2:00 PM of medication cart 2 (two) revealed a bottle of MVI expiration date 09/2022. There was spilled medication and loose debris in the drawers. LVN A agreed the expired medications should not be on the cart and stated the potential risk was the resident not receiving the desired potency of the medication. She stated any nurse or medications aide could remove the expired medications, clean the medication storage room and the carts. She stated the 10-6 shift used to do it and it was also a weekend nurse responsibility. Observation on 10/12/2022 at 1:30 PM revealed the large medication storage room still had loose debris, empty boxes, dirt, and a dead roach on the floor. LVN M observed the debris on the floor and stated, I'll get housekeeping to come clean it. Interview on 10/11/2022 at 3:27 PM with the DON who when informed there were expired meds on the medication carts stated she would find out who was responsible for ensuring expired medications were removed. She stated the potency of expired medications could be affected. When informed the medication carts were dirty and the large medication storage room was observed to be dirty for two days, she stated there absolutely could be a problem with infection control. Interview on 10/12/2022 at 1:40 PM the Owner stated any medication that was close to expiring should be removed. He stated medication carts needed to be checked weekly and the med rooms could be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675518 If continuation sheet Page 6 of 7 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 675518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/12/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hilltop on Main 1015 N Main Meridian, TX 76665 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete cleaned by housekeeping and the nurse would stand at the door. He stated the medication carts should be deep cleaned one-time a month. He stated if there were spills, our expectations would be for them to be cleaned right away. Review of a policy titled Medication Storage in the Facility dated 2006 reflected All expired medications will be removed from the active supply and destroyed in the facility, regardless of the amount remaining. Medication storage areas are kept clean, well-lit and free of clutter. Event ID: Facility ID: 675518 If continuation sheet Page 7 of 7