Health inspection·September 26, 2023

F 0552 was intact. Section N of the MDS for medications the resident took within the past 7 days of the comprehensive assessment reflected no medications listed in the section. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #06's order summary report dated 09/24/23 revealed the following orders: Residents Affected - Some Melatonin Oral Tablet 5 mg (give 3 tablets at bedtime) ordered 08/04/23. Record review of Resident #06's medication administration record dated 09/01/23-09/26/23 revealed the following medications were given: Melatonin 5 mg was given at 9:00 PM on 09/01/23-09/03/23, 09/05/23-09/14/23 and 09/20/23-09/25/23. Record review of the care plan, dated 09/08/23 for Resident #06 revealed no focus for use of melatonin. Record review of Resident #06's electronic medical record revealed no consent for melatonin. During an interview on 09/26/23 at 8:01 PM Resident #06 said he did not know if the facility staff had explained the side effects of his melatonin. He said he knew that he needed it to help him sleep. He said he did not know any of the side effects. 3. Record review of Resident #25's face sheet, dated 09/24/23, revealed an [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include Alzheimer's disease (brain disorder), shortness of breath and major depressive disorder (mood disorder). Record review of the comprehensive MDS assessment dated , 09/14/23, revealed Resident #25 was usually understood. The MDS revealed Resident #25 had a BIMS of 00 which indicated the resident's cognition was severely impaired. Section N of the MDS for medications the resident took within the past 7 days of the comprehensive assessment reflected, Antidepressant: 7 out of 7 days. Record review of the care plan, dated 09/19/23 for Resident #25 revealed a focus for Depression Management: [Resident #25] has a dx of depression and has noted that she feels down, depressed, or hopeless. She takes an anti-depressant and is at risk for adverse reactions. Record review of Resident #25's order summary report dated 09/24/23 revealed the following orders: Remeron tablet 15mg (mirtazapine) Give 15mg by mouth at bedtime related to mood disorder with major depressive-like episodes, dated 12/03/23. Record review of Resident #25's medication administration record dated 09/29/23 revealed the following medications were given: Remeron 15mg at bedtime from the 09/01/23-09/28/23 at 7:00 PM. Record review of Resident #25's electronic medical record revealed no consent for Remeron. During a phone interview on 09/26/23 at 9:06 AM, Family member B stated she was not aware of Resident #25 taking Remeron. Family member B stated the facility had called about another medication, but she was unaware of the Remeron and had not given consent for the medication. 4. Record review of Resident #33's face sheet, dated 09/24/23, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include unspecified dementia (loss of cognitive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 2 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0552 functioning), psychotic disorder with delusions, and gastrostomy status. Level of Harm - Minimal harm or potential for actual harm Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #33 was sometimes understood. The MDS revealed Resident #33 had a BIMS of 00 which indicated the resident's cognition was severely impaired. Section N of the MDS for medications the resident took within the past 7 days of the comprehensive assessment reflected, Hypnotic: 0 out of 7 days. Residents Affected - Some Record review of the care plan, dated 07/10/23 for Resident #33 revealed a focus for Sleeping: [Resident #33] has difficulty sleeping and staying asleep with the intervention: Administer medication as ordered. Record review of Resident #33's order summary report dated 09/24/23 revealed the following orders: Melatonin 10mg Give 1 tablet enterally at bedtime for insomnia, dated 06/16/23. Record review of Resident #33's medication administration record dated 09/29/23 revealed the following medications were given: Melatonin 10mg at bedtime from the 1st - 28th at 7:00 PM. Record review of Resident #33's electronic medical record revealed no consent for melatonin. During a phone interview on 09/26/23 at 9:27 AM, Family member C stated the facility did call him to speak with him regarding Resident #33's medications. Family member C stated he was aware of the medication melatonin being given. He said he was not given informed consent. 5. Record review of Resident #37's face sheet, dated 09/24/23, revealed an [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include sarcopenia (loss of muscle and strength), urinary tract infection, and anxiety. Record review of comprehensive MDS assessment dated [DATE] revealed Resident #37 was usually understood. The MDS revealed Resident #37 had a BIMS of 03 which indicated the resident's cognition was severely impaired. Section N of the MDS for medications the resident took within the past 7 days of the comprehensive assessment reflected, Antianxiety: 7 out of 7 days. Record review of the care plan, dated 08/21/23 for Resident #37 revealed a focus for Anti-Anxiety Management: [Resident #37] uses anti-anxiety medications. Record review of Resident #37's order summary report dated 09/25/23 revealed the following orders: Buspirone tablet 10mg Give 1 tablet by mouth three times a day related to anxiety disorders, dated 04/27/22. Record review of Resident #37's medication administration record dated 09/29/23 revealed the following medications were given: Buspirone 10mg three times a day from the 09/01/23-09/28/23 at 8:00 AM, 2:00 PM and 7:00 PM. Record review of Resident #37's electronic medical record revealed no consent for Buspirone. During a phone interview on 09/26/23 at 9:20 AM, Family member D stated the facility had not contacted her regarding Resident #37's order for buspirone. Family member D stated she did not recall the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 3 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some facility going over risks and benefits regarding the medication buspirone and she did not recall giving consent for the medication to be given. 6. Record review of Resident #39's face sheet, dated 09/24/23, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include congestive heart failure and sleep apnea (sleep disorder). Record review of comprehensive MDS assessment dated [DATE] revealed Resident #39 was usually understood. The MDS revealed Resident #39 had a BIMS of 14 which indicated the resident's cognition was intact. Section N of the MDS for medications the resident took within the past 7 days of the comprehensive assessment did not reflect the use of a hypnotic. Record review of the care plan, dated 08/23/23 for Resident #39 revealed no focus for the use melatonin. Record review of Resident #39's order summary report dated 09/24/23 revealed the following orders: Melatonin Oral Tablet 5 mg (give 1 tablet at bedtime for insomnia) ordered 08/09/23. Record review of Resident #39's medication administration record dated 09/01/23-09/26/23 revealed the following medications were given: Melatonin Oral Tablet 5 mg at 9:00 PM on 09/01/23-09/25/23. Record review of Resident #39's electronic medical record revealed no consent for melatonin. The surveyor attempted to interview Resident #39 on 09/26/23 at 8:30 AM but she was sleep. During an interview on 09/26/23 at 10:21 AM, the ADM said the potential negative outcome of not having medication consent was that the facility would not have the families or the residents' permission to administer the medication. She said they would not know the side effects of the medication to make an informed decision about taking the medication. She said she was unaware of any issues with the residents' consents. She said that she was not aware that melatonin needed a consent. She said that she would look at new orders, and if she saw a medication needing consent, she would follow up to ensure the consent was obtained. She said if there was no consent, she would request one. She said she had no formal training regarding consents but knew the general requirement that antipsychotics needed a consent. She said she expected that if a resident was on an antipsychotic, the facility staff should get consent. During an interview on 09/26/23 at 11:22 AM, the DON said she was unaware that melatonin needed a consent, which was why residents who took melatonin did not have consent. She said she was unaware of any residents or responsible parties being uneducated. She said the potential negative outcome of not educating or providing consent for approved medications was that the resident or responsible party might not realize a resident was having side effects and not know what was happening. She said the residents and responsible parties should know so they could refuse them if they wanted to. She said the ADONs typically were the staff that monitored the consents, and that was her system for monitoring, but she had new ADONs. She said that all nursing staff, including the ADONs, medication aides, and DON, were responsible for completing the medication consent. She said antianxiety and antidepressants did not fall under antipsychotics. She said antipsychotics were a class of their own. She said she had been trained on medication consent. She said she expected to have all consents signed or at least a conversation before the administration. She said the melatonin prescribed for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 4 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0552 facility's residents was for sleep. Level of Harm - Minimal harm or potential for actual harm A record review of the facility policy titled Psychotropic Drugs, revised October 2017, revealed the following: The intent of this policy is that each resident's entire drug/medication regimen is managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial wellbeing, the facility implements gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. Residents Affected - Some A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories: (i) Anti-psychotic; (ii) Anti-depressant; (iii) Anti-anxiety; and (iv) Hypnotic Consent A psychotropic consent form explains the risks and benefits of psychotropic medication. The resident or their representative must provide documented consent prior to administration of a newly ordered psychotropic medication. If needed, consent can be obtained by telephone from the resident's representative for Antidepressants; Antimania; Antianxiety agents; Sedatives, hypnotics, or other sleep-promoting drugs; or Psychomotor stimulants. Consent for antipsychotics must be in a written form. Phone or verbal consent is not allowed. Permission given by or a request made by the resident and/or representative does not serve as a sole justification for the medication itself. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 5 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 - Few 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 record review and interview, the facility failed to develop a comprehensive care plan to meet the highest practicable physical, mental, psychosocial well-being for 1 of 21 residents (Resident #2) reviewed for care plans as follows: Resident #2 did not have a care plan for mood state. These failures could place residents at risk of not receiving the care required to meet their Individualized needs. Findings include: Record review of Resident #2's face sheet, dated 09/24/23, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include dementia and mood disorder. Record review of comprehensive MDS assessment dated [DATE] revealed Resident #2 was usually understood (difficulty communicating some words or finishing thoughts but was able if prompted or given time). The MDS revealed Resident #02 had a BIMS of 06 which indicated the resident's cognitive state was severely impaired. Section D (Mood) of the MDS reflected, Feeling tired or having little energy: Symptom present 2-6 days (several days); Moving or speaking so slowly that people could have noticed, Or the opposite being so fidgety or restless that you have been moving around a lot more than usual: Symptom present 12-14 days (nearly every day). Section V Care Area Assessment (CAA) Summary reflected, CAA Results: (List the CAA that triggered and not Care Planned) 08. Mood State. Record review of the care plan, dated 09/20/23 for Resident #2 revealed no care plan for mood state. During an interview on 09/26/23 at 10:07 AM, MDS Coordinator stated if a resident was missing a triggered care plan, the staff would not know how to deal with the resident. Specifically for mood, the staff may not know how to give Resident #2 effective care if she experiences mood changes. A care plan was based on all of the resident's behavior. She said the care plan should be individualized. She said all the clinical staff use the care plan. She said she was unaware that the triggered care plan for mood was not included in the care plan. She said she was not sure how and why she missed it. She said that the DON would check them after her. She said her care plans were audited quarterly. She said the last audit of her care plans would have been in June 2023. She said the missing care plan should have been caught. She said she had been trained in creating care plans. She said she expected that all the triggered CAAs should have been care planned. She said everyone was responsible for care plans, especially all of nursing. During an interview on 09/26/23 at 10:21 AM, the ADM stated she was unaware any residents were missing care plans until the surveyor told her. She said she was not sure why the care plan was not done. She said the potential negative outcome could have been that the Resident #2 would not receive the care needed regarding the triggered care plan. She said they have care plan meetings, and all the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 6 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 - Few information is reviewed. She said the respective discipline reviews them. She said her expectation was all triggered care areas should be care-planned and have the appropriate interventions. She said she had not received specific training as an administrator regarding care plans. She said the MDS Coordinator and nursing were responsible for care plans. During an interview on 09/26/23 at 11:22 AM, the DON stated she said she was unaware that Resident #2 was missing any care plans and was unsure why it was not done. She said a care plan tells a story about the resident. She said missing a care plan could cause staff to miss something when providing care. She said she reviews care plans daily, during morning meetings and standard of care meetings. She said she expected all needs to be care planned. She said she was not aware of the CAAs from the MDS. She said she has not specifically been trained on care plans. A record review of the facility policy titled Comprehensive Care Planning, undated, revealed the following: The facility will develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan will describe the following The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being; and Each resident will have a person-centered comprehensive care plan developed and implemented to meet his other preferences and goals, and address the resident's medical, physical, mental and psychosocial needs. Residents' goals set the expectations for the care and services he or she wishes to receive. Measurable objectives describe the steps toward achieving the resident's goals, and can be measured, quantified, and/or verified. The comprehensive care plan will reflect interventions to enable each resident to meet his/her objectives. Interventions are the specific care and services that will be implemented. When developing the comprehensive care plan, facility staff will, at a minimum, use the Minimum Data Set (MDS) to assess the resident's clinical condition, cognitive and functional status, and use of services. If a Care Area Assessment (CAA) is triggered, the facility will further assess the resident to determine whether the resident is at risk of developing, or currently has a weakness or need associated with that CAA, and how the risk, weakness or need affects the resident. Documentation regarding these assessments and the facility's rationale for deciding whether or not to proceed with care planning for each area triggered will be recorded in the medical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 7 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the residents environment remained as free from accidents and hazards as possible, for 6 of 21 residents (Residents #32, #44, #53, #62, #66, and #70) observed for bathroom sink water temperature in that: 6 residents (Residents #32, #44, #53, #62, #66, and #70) were living in resident rooms where the sink water temperature was not held between the state regulated water temperature of 100-110 Fahrenheit (F) degrees (Rooms #35, #37, #41 and #42). This failure could place residents at risk for diminished quality of life, injury and burns. The findings included: Record review of Resident #66's admission record, dated 09/25/23, revealed an [AGE] year-old female was admitted to the facility on [DATE] with diagnoses to include Alzheimer's disease (brain disorder), anxiety and pain. Record review of Resident #66's comprehensive MDS assessment, dated 09/07/23, revealed Resident #66 was usually understood. The MDS revealed Resident #66 had a BIMS of 00 which indicated the resident's cognition was severely impaired. Section G of the MDS revealed Resident #66 was able to walk in her room with supervision and set-up help only. Observation on 09/24/23 at 9:45 AM in the women's secure unit, room [ROOM NUMBER] revealed the water temperature from the resident-use sink was 125.8 degrees F, checked with the surveyor's digital thermometer. Resident #66 was lying in bed and was non-interview able. Record review of Resident #44's admission record, dated 09/25/23, revealed an [AGE] year-old female was admitted to the facility on [DATE] with diagnoses to include metabolic encephalopathy (problem in the brain), anemia (decreased healthy red blood cells), and unspecified dementia (loss of cognitive functioning). Record review of Resident #44's comprehensive MDS assessment, dated 07/19/23, revealed Resident #44 was understood. The MDS revealed Resident #44 had a BIMS of 03 which indicated the resident's cognition was severely impaired. Section G of the MDS revealed Resident #44 was able to walk in her room with supervision and one person physical assist. Record review of Resident #62' admission record, dated 09/24/23, revealed a [AGE] year-old female was admitted to the facility on [DATE] with diagnoses to include unspecified dementia (loss of cognitive functioning), Alzheimer's disease (brain disorder), and anxiety. Record review of Resident #62's comprehensive MDS, dated [DATE], revealed Resident #62 was understood. The MDS revealed Resident #62 had a BIMS of 11 which indicated the resident's cognition was moderately impaired. Section G of the MDS revealed Resident #62 was able to walk in her room with supervision and set-up help only. Observation on 09/24/23 at 9:49 AM in the women's secure unit, room [ROOM NUMBER] revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 8 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some water temperature from the resident-use sink was 121 degrees F, checked with the surveyor's digital thermometer. Resident #44 was not in the room and Resident #62 was lying in bed and was non-interview-able. Record review of Resident #32's admission record, dated 09/26/23, revealed a [AGE] year-old male was admitted to the facility on [DATE] with diagnoses to include chronic atrial fibrillation (irregular heartbeat), anxiety, and unspecified dementia (loss of cognitive functioning). Record review of Resident #32's comprehensive MDS, dated [DATE], revealed Resident #32 was understood. The MDS revealed Resident #32 had a BIMS of 10 which indicated the resident's cognition was moderately impaired. Section G of the MDS revealed Resident #32 was able to walk in his room with supervision and set-up help only. Observation on 09/24/23 at 10:13 AM in the men's secure unit, room [ROOM NUMBER] revealed the water temperature from the resident-use sink was 118 degrees F, checked with the surveyor's digital thermometer. Resident #32 was sitting on bed in room and was non-interview-able. Record review of Resident #70's admission record, dated 09/25/23, revealed a [AGE] year-old male was admitted to the facility on [DATE] with diagnoses to include chronic obstructive pulmonary disease (lung disease), mild cognitive impairment and personal history of traumatic brain injury. Record review of Resident #70's comprehensive MDS, dated [DATE], revealed Resident #70 was sometime understood. The MDS revealed Resident #70 was unable to complete the BIMS interview and staff assessment for mental status was conducted. The staff assessment revealed Resident #70 had moderately impaired cognitive skills for daily decision making. Section G of the MDS revealed Resident #70 was able to walk in his room with supervision and set-up help only. Record review of Resident #53's admission record, dated 09/24/23, revealed a [AGE] year-old male was admitted to the facility on [DATE] with diagnoses to include neurocognitive disorder with Lewy bodies (progressive loss of cognitive functioning), essential hypertension (high blood pressure) and wandering. Record review of Resident #53's comprehensive MDS, dated [DATE], revealed Resident #53 was understood. The MDS revealed Resident #53 had a BIMS of 03 which indicated the resident's cognition was severely impaired. Section G of the MDS revealed Resident #53 was able to walk in his room with supervision and two person physical assist. Observation on 09/24/23 at 10:17 AM in the men's secure unit, room [ROOM NUMBER] revealed the water temperature from the resident-use sink was 114.8 degrees F, checked with the surveyor's digital thermometer. Resident #70 was not in the room and Resident #53 was sitting on the edge of the bed in room and was non-interview-able. During an interview on 09/24/23 at 2:09 PM the ADM was asked about the hot water in rooms #35, #37, #41 and #42. The ADM stated the Maintenance Supervisor was responsible for checking the water temperatures. The ADM stated the Maintenance Supervisor should be doing random room checks every week and he should have all the documentation. The ADM stated she had no idea why some of the water temperatures in the rooms are too hot. The ADM stated the potential negative outcome to the residents was they could be burned or scalded. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 9 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 09/25/23 at 10:09 AM, with the Maintenance Supervisor regarding hot water temperatures for rooms #35, #37, #41, and #42, the Maintenance Supervisor stated he randomly checks the water temperatures every Monday and he keeps a log for record. The Maintenance Supervisor stated he thinks the waters were too hot in some of the rooms because about a week and a half ago, around 09/15/23, the generators were getting worked on at the facility and the facility lost power for a few minutes. The Maintenance Supervisor stated all the hot water temperatures were controlled electronically, so him and his assistant had to manually turn the hot water back on. The Maintenance Supervisor stated he thinks the water temperatures were accidentally increased at that time. The Maintenance Supervisor stated the water temperatures were checked the day after the hot water was turned back on and thinks him and his assistant didn't check them good enough. The Maintenance Supervisor stated the potential negative outcome to the residents was they could burn their hands or more. Record review water temperature logbook for dates 08/07/23 through 09/11/23 revealed no high-water temperatures. Record review grievance report from June 2023 through September 2023 revealed no hot water concerns. Record review of the facility's incident/accident log, dated 09/24/23, revealed no incidents/accidents regarding burns. Time frame reviewed was from 04/24/23 to 09/24/23. Record review of facility's policy title, Hot Water Systems, dated 2013, reflected the following: .6. Water temperatures should be maintained at 100 degrees F at a minimum, and 110 degrees F at a maximum FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 10 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who is fed by enteral means receives the appropriate treatment to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and stomach ulcers for 1 of 1 resident fed by gastrostomy tube (g-tube) (Resident #33), in that: LVN A did not administer meds by gravity, she pushed them in via g-tube. This failure could result in residents aspirating (inhaling into airway) gastric contents and/or stomach ulcers in residents with a g-tube. The findings include: Record review of Resident #33's face sheet, dated 09/24/23, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include unspecified dementia (loss of cognitive functioning), psychotic disorder with delusions, and gastrostomy status (g-tube). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #33 was sometimes understood. The MDS revealed Resident #33 had a BIMS of 00 which indicated the resident's cognition was severely impaired. The MDS further documented Nutritional Approach While Resident was feeding tube. Record review of the current care plan for Resident #33, dated 07/10/23, revealed a focus area for Nutrition: NPO - Tube feeding. Record review of the order summary report for Resident #33, dated 09/24/23, revealed orders for: - NPO diet for peg tube in place related to encephalopathy (brain disease), dated 08/06/22. - buspirone 15mg via PEG-tube three times a day for anxiety, agitation, dated 09/19/23. -eliquis 2.5mg Give 2.5mg enterally two times a day for acute pulmonary embolism (blood clot in the lungs), dated 06/13/23. -folic acid 1mg Give 1 tablet enterally one time a day related to alcohol dependence, dated 06/13/23. -levetiracetam oral solution 100mg/5mL Give 5mL enterally two times a day related to seizures, dated 03/27/23. -potassium chloride solution 20meq/15mL (10%) Give 7.5mL via g-tube two times a day related to hypokalemia (low potassium in blood), dated 09/13/23. -thiamine HCL tablet 100mg Give 1 tablet enterally one time a day related to alcohol dependence, dated 06/13/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 11 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0693 Level of Harm - Minimal harm or potential for actual harm Observation on 09/25/23 at 8:09 AM, revealed LVN A began to administer morning medications to Resident #33 via g-tube. LVN A began by flushing the g-tube with 30mL of water via push, not by gravity. LVN A then diluted the first medication with water and pushed the medication into the g-tube. LVN A then flushed the g-tube with 10mL of water via push, not gravity. LVN A administered all morning medications and flushes by push, not gravity. Residents Affected - Few Interview on 09/25/23 at 11:03 AM, LVN A stated she normally administered Resident #33's medications via gravity, not by pushing them in. LVN A stated she was nervous, and she knows she messed up. LVN A stated she had been trained to administered g-tube medications via gravity. LVN A stated she was unsure what the potential negative outcome to the resident could be. Interview on 09/25/23 at 11:29 AM, the DON stated she expects the nurses to administer medications to residents with a g-tube via gravity. The DON stated knows LVN A was nervous and that is why she messed up. The DON stated the facility has provided some g-tube care education during staff meetings, but she did not have any specific competencies to show for g-tube medication administration for LVN A. The DON stated the potential negative outcome to the residents is pushing in a lot of air, and that could do some damage. Record review of facility policy, titled, Enteral Medication Administration, dated 01/25/13 reflected the following: .10. Do not force any medication or fluid into the tube. Allow gravity to work. If necessary, gentle pressure may be applied after repositioning the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 12 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents receiving psychotropic medications had an approved diagnosis and PRN orders for psychotropic drugs were limited to 14 days unless the attending physician or prescribing practitioner believed, and documented, that it was appropriate for the PRN order to be extended beyond 14 days, for 1 of 21 residents (Resident #14): Resident #14 continued to have a PRN order for Clonazepam 0.5mg after 14 days without an evaluation by the physician for continued treatment. This failure could result in residents receiving psychotropic and antipsychotic medications when contraindicated and could also result in residents experiencing adverse drug reactions, decreased quality of life and dependence on unnecessary psychotropic medications. The findings include: Record review of Resident #14's face sheet, dated 09/25/23, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include unspecified dementia (loss of cognitive functioning), restless legs syndrome, and major depressive disorder (mood disorder). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #14 was understood. The MDS revealed Resident #14 had a BIMS of 08 which indicated the resident's cognition was moderately impaired. Section N revealed the resident took the following medication within the past 7 days of the comprehensive assessment: No medications listed in the section. Record review of a care plan dated 08/08/23 for Resident #14 revealed a focus for: Anti-Anxiety Medication: Resident #14 has anxiety/panic disorder and uses anti-anxiety medications. Record review of the order summary report for Resident #14, dated 09/25/23, revealed an order for: Clonazepam oral tablet 1mg Give 0.5 tablet by mouth as needed for anxiety once daily as needed, dated 06/07/23. Record review of the treatment administration record for Resident #14 for August 2023, dated 09/25/23, revealed Resident #14 received the medication Clonazepam 1mg 0.5 tablet by mouth on 08/14/23 at 10:45 AM. Record review of Resident #14's progress notes and physician's notes from 06/01/23 to 09/25/23 revealed no documentation related to the evaluation for the continued use of PRN Clonazepam. Record review of the facility's pharmacy consult reports for July 2023 and August 2023 revealed no recommendations for Resident #14's medications. Interview on 09/25/23 at 12:01 PM, the DON stated she knew of the 14-day stop order for PRN anti-psychotic medications. The DON stated she and the ADON were responsible for monitoring for PRN anti-psychotic medications, and it should have been done daily. The DON stated she thought the medication (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 13 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was missed because she had been covering a lot of shifts and the ADON was still new at the facility. The DON stated the potential negative outcome to the resident was they could need more or less of the medication. Interview on 09/25/23 at 12:06 PM, the ADM stated the DON and the ADON were responsible for monitoring the residents' medications for PRN anti-psychotic medications. The ADM stated she did not know why the medication was missed. The ADM stated she did not know the potential negative outcome to the resident. Record review of the facility's policy, titled Psychotropic Drugs, dated 10/15/17, reflected the following: The intent of this policy is that each resident's entire drug/medication regimen is managed and monitored to promote or maintain the resident's highest practicable mental, physical, and psychosocial wellbeing, the facility implements gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. A psychotropic drug is any drug that affects brain activities associated with mental processes and behavior. These drugs include, but are not limited to, drugs in the following categories: (iii) Anti-anxiety; . The facility must will ensure that4. PRN orders for psychotropic drugs are limited to 14 days. Except as provided in §483.45(e)(5), if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, he or she should document their rationale in the resident's medical record and indicate the duration for the PRN order. 5. PRN orders for anti-psychotic drugs are limited to 14 days and cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident for the appropriateness of that medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 14 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 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, in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to for 1 of 21 residents reviewed for medication administration (Resident #46). The facility failed to ensure Resident #46 medication was not left unattended. This failure could place residents at risk to having access to unauthorized medication and/or lead to possible harm or drug diversion. Findings include: Record review of Resident #46's face sheet, dated 09/24/23, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include schizoaffective disorder, major depressive disorder, anxiety and diabetes. Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #46 was usually understood. The MDS revealed Resident #46 had a BIMS of 14 which indicated the resident's cognition was intact. Section N revealed the resident took the following medication within the past 7 days of the comprehensive assessment: Antipsychotic (7 days), D. Antianxiety (1 day) E. Antidepressant (7 days) F. Hypnotic (7 days) .H. Opioid (7 days) Record review of a care plan, dated 08/02/23 for Resident #46 did the following: Cognitive Function: [Resident #46] has impaired cognitive function and impaired thought processes r/t psychotropic drug use for dx of schizophrenia. Anti-Depressant Use: [Resident #46] requires antidepressant medication for dx of major depressive disorder. Record review of Resident #46's order summary report dated 09/24/23 revealed the following orders: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 15 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 Clopidogrel Bisulfate Tablet 75 MG Give 1 tablet by mouth one time a day Level of Harm - Minimal harm or potential for actual harm Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Give 1 tablet by mouth one time a day Prozac Oral Capsule 20 MG (Fluoxetine HCl) Give 1 capsule by mouth one time a day Residents Affected - Few Sertraline HCl Tablet 100 MG Give 2 tablet by mouth one time a day Amoxicillin Give 875 mg by mouth two times a day Colace Oral Capsule 100 MG Give 1 capsule by mouth two times a day Tamsulosin HCl Capsule 0.4 MG Give 1 capsule by mouth two times a day amlodpine Besylate Tablet 10 MG Give 1 tablet by mouth one time a day Gabapentin Capsule 300 MG Give 1 capsule by mouth three times a day Aspirin Tablet 325 MG Give 1 tablet by mouth one time a day Atorvastatin Calcium Tablet 80 MG Give 1 tablet by mouth one time a day Record review of Resident #46's medication administration record dated 09/01/23-09/26/23 revealed the following medications were given on 09/24/23 by Medication G at 8:00 AM: Clopidogrel Bisulfate Tablet 75 MG Give 1 tablet Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Give 1 tablet Prozac Oral Capsule 20 MG (Fluoxetine HCl) Give 1 capsule Sertraline HCl Tablet 100 MG Give 2 tablet Amoxicillin Give 875 mg Colace Oral Capsule 100 MG Give 1 capsule Tamsulosin HCl Capsule 0.4 MG Give 1 capsule amlodpine Besylate Tablet 10 MG Give 1 Gabapentin Capsule 300 MG Give 1 capsule Aspirin Tablet 325 MG Give 1 tablet Atorvastatin Calcium Tablet 80 MG Give 1 tablet The following observations were conducted on 09/24/23: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 16 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 At 11:41 AM, the surveyor observed 12 pills in a medication cup located on Resident #46 bedside table. Level of Harm - Minimal harm or potential for actual harm During an interview on 09/24/23 at 11:41 AM, Resident #46 said the pills on the table were from the morning. He said he did not feel well. Residents Affected - Few At 1:36 PM observed 12 pills in a medication cup located on Resident #46's bedside table. At 2:30 PM, the 12 pills inside the medication cup on Resident #46 bedside table were no longer present. During an interview on 09/24/23 at 2:30 PM, Resident #46 said he was feeling better and had taken his morning medication 30 minutes before speaking with the surveyor (2:00 PM). During an interview on 09/26/23 at 10:21 AM, the ADM said she was unaware of the identified resident's medications on his bedside table in his room. She said that she had addressed that in the past with other staff but not with Medication Aide G. She said the potential negative outcome of leaving medications in the room and not monitoring the resident take them was staff would not know when the resident may have taken them. Staff may not know if the resident or another resident took them. She said the resident may take them too close to the next dose of medications. She said she does rounds, and they have what is called champion rounds, and staff should also be looking for medications. She said she had not been trained in medication administration. She said she expected the medication aides to watch the residents take their medications. She said if the resident does not take their medications, the nursing or clinical staff must take them back and destroy them. She said she does not believe that any resident in the facility has been checked off to administer their medications independently. She said if they had, they would have been assessed by nursing staff, and the resident would have a lock box in their room. She said Resident #46 was known to be difficult and mean. During an interview on 09/26/23 at 11:22 AM, the DON said she was not aware that Resident #46's medications had been left on his bedside table. She said she typically checks because he had a behavior of not wanting to take his medications at the time of administration. She said he had done that for the past 4 months that she had worked at the facility. She said she had not care planned the behavior because she was just learning, and care plans were one of those things that she was not familiar with. She said when she would do champion rounds, she noticed that medications were in his room. She said she believed some of the nursing staff were intimidated. She said that she believed Medication Aide G was intimidated. She said the medication aide normally does not leave medications in the room. She said the potential negative outcome of leaving medications unattended in the room was that staff would not know if the resident took the medication. She said if he took the medication at 2:30 PM, it could be close to the next medication pass. She said that anyone could have taken the medications. She said her system for monitoring was following behind the medication aides. She said she had been trained in medication administration. She said she expected the medication aide to monitor the resident taking the medication and not leave until the medication was taken. She said the nurses and the medication aide were responsible for ensuring that the resident's medications were taken properly and not left on the bedside table. She said no residents self-administer meds in the facility, and if they did, then the residents would be checked off that they were able and capable. During an interview on 09/26/23 at 11:30 AM Resident #46 said that multiple staff leave his medications for him. He said that he takes them when he wakes up. He said he wakes up at different times. He said on 09/24/23 he was not feeling well and asked them to leave his medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 17 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 During an interview on 09/28/23 at 11:13 AM, Medication Aide G said on 09/24/23, she went to give Resident #46 his medications, and he asked her to leave the medications. She said she was not aware that he did not take his medications when she administered them. She said he was usually awake, but that particular morning he was asleep. She said it was normal that he asked her to leave them. She said she did not have a reason for leaving them on 09/24/23. She said she never returned to check if he took the medication. She said another resident could have taken the medications. She said she had been trained in medication administration. She said she expected residents to take their medications when they were given and not keep them. A record review of the facility policy titled Recommended Medication Storage revised July 2012, revealed it did not address medication storage specifically. A record review of the facility policy titled Medication Administration Procedures, dated 2003, revealed the following: After the medication administration process is completed, the medication cart must be completely locked, or otherwise secured. If a controlled medication removed from its packaging and is not to be administered (resident refusal or contamination) the does needs to wasted to where the drug is unable to be used and/or destroyed and disposed of. If a controlled medication is wasted it must be documented on the controlled accountability sheet for the medication and witnessed by a nurses. Both staff members must sign on the accountability sheet verifying the drug was wasted. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 18 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on interview and record review, the facility failed to employ sufficient staff with appropriate competencies and skill sets to carry out the functions of the food and nutrition service for the facility's only kitchen reviewed for dietary services. The facility failed to ensure the designated Dietary Manager completed the required dietary managers certification course or had any other qualifying credentials. This failure could place residents at risk for the spread of foodborne illness and residents not having their nutritional needs met. The findings include: During an interview on 09/25/23 at 02:36 PM, the DM said she had not completed the dietary manager training course. She said no other dietary manager was consistently over her at this time. She said that she has the corporate hotline available if she needs it. She said she believed that if she needed help, she could call a travel dietary manager if needed. She said she had not had time to complete the course because she works in the kitchen sometimes. She said she did not have any other higher education in food sanitation. During an interview on 09/26/23 at 10:21 AM, the ADM said the dietician was part-time. She said they recently hired a new dietician, and she has not had a visit to the facility. The dietician should have her first visit on 09/28/23. She said the former dietician's last visit was early September 2023, 09/15/23. She said that the DM had not completed any dietary manager certification course. She said the DM did not have an associate's degree or higher degree in kitchen sanitation. She said she does not know how long she has been enrolled in the course. She did not disclose the name of the course. She said the DM had to get an extension to complete the course. She said when the DM became the dietary manager, she received a pay increase for assuming the role. She said there was a certified dietary manager who came over but that she does not come over routinely. She said someone comes from corporate every 3-6 months. She said the dietician comes once or twice a month. She said the potential negative outcome of having someone who was not certified in the kitchen was the education and monitoring of the kitchen could be lacking. She said it could affect the residents and the food preparation in a negative way. She said the dietary manager's position had been open for a while, and they decided to put the DM into the role. She said her expectation was for the dietary manager to be certified. Record review of an email sent by the ADM on 10/03/23 revealed the following: Dietary Manager-we do not have a policy-we just go by state regulations DM took the dietary manager role 7/14/21 The course is through the [University of Dakota]. She was enrolled in the course in 2021 and the extension was purchased the week of 9/17/23. She has until June 2024 to complete. She only lacks 2 units to have this completed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 19 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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. 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 1 of 1 kitchen reviewed for dietary services, in that: The facility failed to ensure to date and label all food (DM). Dietary staff failed to store flour in the dry storage area properly as it was uncovered (DM) Dietary staff failed to cover food that was not actively being served (DM, Dietary [NAME] A and Dietary [NAME] B) Dietary Staff touched ready to eat foods with their bare hands (Dietary [NAME] A and Dietary [NAME] B) Dietary Staff failed to clean the microwave in the food preparation area (DM, Dietary [NAME] A and Dietary [NAME] B.) Dietary Staff had personal items in the food preparation area (Dietary [NAME] B) Dietary staff exposed the lip of clean cups to the bottom of a tray that could potentially be contaminated and used the cups to serve hydration to residents (Dietary Aide C) Dietary Staff stored cracked eggs with unused eggs (Dietary [NAME] A). The facility failed to serve hot foods at the appropriate temperature of 135 F These failures could place residents at risk for food contamination and foodborne illness. The findings include: The following observations were conducted on 09/24/23: At 9:35 AM, Dietary [NAME] A was cutting sweet potatoes. She was not wearing gloves. She handled two potatoes. At 9:39 AM, observed 14 eggs sitting out on a cart. 2 of the 14 eggs were cracked. At 9:39 AM observed the microwave and the glass plate had unknown food particles on it. The top of the microwave had dried food stuck to it. The food was dark brown in color. At 9:40 AM observed creole seasoning undated. The creole seasoning had been opened. At 9:43 AM observed a tray of empty cups upright with another tray on top of them. The lip of the cups on the bottom were in contact with the bottom of the tray. At 9:48 AM, the flour was open, and the lid was on the floor in the dry storage. The contents of the flour bucket was exposed to air. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 20 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 At 9:58 AM, an open package of fruit punch powder was observed under the serving line. The contents of the package was exposed to air. Observed the fried pork chops uncovered from 11:51 AM- 11:58 AM. Dietary [NAME] B took the pork chops to the serving line. The pork chops remained uncovered until 12:17 PM. Residents Affected - Many At 11:56 AM, observed a personal bottle of water, a cup of red drink with ice and no lid, and a pair of sunglasses on the same shelf with clean drink glasses. At 11:59 AM, Dietary Aide C confirmed that the cups exposed to the bottom of the tray had been filled with drink and were being used for the residents. At 12:04 PM, observed Dietary [NAME] D open the chicken base container. Dietary [NAME] A retrieved some of the chicken base. The chicken base was not closed and remained open until Dietary [NAME] B closed it at 12:09 PM. At 12:08 PM, observed Dietary [NAME] B retrieve the cup with the red drink in it and take it to the back. Observed cornbread uncovered at 12:09 PM when Dietary [NAME] A started cutting pieces to puree. Dietary [NAME] B cut the cornbread at 12:17 PM and placed it in an alternative container. He left the cornbread uncovered at 12:18 PM. The cornbread was placed on the line at 12:30 PM. Dietary [NAME] A started the puree process at 11:51 AM. She completed the puree porkchop at 11:55 AM. She completed the puree black eye peas at 12:05 PM. She completed the puree sweet potatoes at 12:08 PM. She completed the puree cornbread at 12:09 PM. Throughout the process, all pureed food was uncovered. At 12:19 PM, Dietary [NAME] A took the puree food to the serving line. Puree food and the remainder of the food on the serving line was uncovered not being served. Serving did not start until 12:37 PM. At 12:25 PM, Dietary [NAME] B placed spaghetti in the microwave, uncovered, and warmed up the item. Observation revealed the following food temperatures were taken from the food on the steam table on 09/24/23 by Dietary [NAME] A: Regular Fried porkchop 130 F at 12:26 PM Mechanical Soft Fried Porkchop 118 F at 12:29 PM Puree Fried Porkchop 123 F at 12:30 PM Puree Sweet Potatoes 118 F at 12:32 PM Dietary [NAME] A did not attempt to reheat the items. At 01:19 PM, Dietary [NAME] B ate fruit from the large mixing bowl in the food preparation area with his bare hands. Dietary [NAME] D was actively dipping servings of fruit for residents from the same bowl. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 21 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 The following observations occurred on 09/25/23: Level of Harm - Minimal harm or potential for actual harm At 8:52 AM, the microwave in the food preparation area had unknown food particles inside and had a smear of food dried on the handle. The food on the handle was yellow in color. Residents Affected - Many At 9:00 AM observed 7 eggs in the refrigerator in the dry storage. 1 of the 7 eggs was broken. There were 2 cracked eggshells also observed next to the uncracked eggs. At 9:29 AM observed 70 uncooked rolls on the steam table uncovered. At 11:49 AM observed 35 rolls in the food preparation area uncovered. They were not served until 12:27 PM. During an interview on 09/25/23 at 1:54 PM, Dietary [NAME] A said she was not sure who was responsible for the microwave. She said she had not seen the microwave because she did not use it. She said not having a clean microwave could cause contamination. She said she did not know if a system existed to monitor it. She said she was unaware of any personal items in the food preparation area. She said she did not see any personal items. She said it was her understanding that all their items would be kept in the DM's office. She said that she does know that drinks should have lids on them. She said they are all responsible for ensuring their items are not in the food preparation area. She said a potential negative outcome was that the personal items could get messed up. She said she did not know anything about the uncovered bread or cornbread. She said she did realize that the puree items were uncovered. She said not covering the food could cause the food to go bad. She said the dietary aides were responsible for covering the bread. She said she was responsible for covering the puree food and pork chops. She said the food should have been covered right after being prepared. She said staff should not touch food with their bare hands. She said she knew she was touching the food with her bare hand. She said she knew that she should have been using gloves. She said she saw the state surveyor, and that was when she went to get gloves. She said she could have gotten the residents sick by touching food with her bare hands. Dietary [NAME] A confirmed that the fried porkchop was 130 degrees Fahrenheit. She could not confirm any other temperatures she took on 09/24/23. She said the form they used to document the temperatures was difficult to read. She said the hot food on the serving line should have been 165 F or higher. She said she did not have a reason why she did not reheat the food that were not at the appropriate temperature. She said she did not know what the food temperature was supposed to be or that her food temperatures were not right until 09/25/23 when she reviewed the food temps with the DM. She said she was trained three weeks before 09/24/23 and sometimes forgot the things that she had been trained on. She said food served at the wrong temperature to the residents was not good and could make the residents sick. During an interview on 09/25/23 at 02:19 PM, Dietary [NAME] D said everyone in the kitchen was responsible for keeping the microwave clean. She said that the system was for each shift to clean the microwave. She said she was unaware it was dirty on Sunday, 09/24/23, or Monday, 09/25/23. She said using a dirty microwave could get the residents sick. She said she did see the personal items on Monday, 09/25/23 (the cup with a drink) but did not see the sunglasses. She said having personal items in the food preparation could have potentially gotten into the residents food. She said the cooks and the dietary manager are responsible for ensuring that all the staffs items are in the back or the dietary manager's office. She said that it was expected that their drinks were to be covered with a lid. She said the dry storage room was also the responsibility of everyone. She said she was unaware that the lid to the flour was not on the container. She said bugs or rodents could have gotten in the flour. She said she was unaware of the open fruit punch powder, uncovered rolls, uncovered bread, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 22 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 chicken base, and the cups exposed to the tray's bottom. She said the potential negative outcome was that the punch powder could spill or get bugs. She said bugs could have gotten on the uncovered food. She said that staff should not be touching food with their bare hands. She said she did see Dietary [NAME] B eat out of the bowl with the fruit. She said she did not redirect him. She said she did not have a particular reason why she did not. She said he could have contaminated the food. She said she continued to serve the fruit. She said the dietary cooks and the DM were responsible for ensuring that staff were not touching the food with their bare hands. Dietary [NAME] D said food temperatures on the serving line should be 165 degrees Fahrenheit or more for hot foods. She said if the food was not at that temperature, the cook should have reheated it until it was at the correct temperature. She said it could have made residents sick if it was not at the correct temperature. She said she had been trained on the expectations of a dietary worker and was comfortable in her role. During an interview on 09/25/23 at 02:36 PM, the DM said everyone in the kitchen was responsible for the cleanliness of the microwave. She said it was a daily task, and there was a system in place to monitor the cleaning of the microwave. She said there was a log that staff should check off daily. She said she was unaware that the microwave was dirty. She said she did not check it on 09/24/23 and 09/25/23. She said she was nervous that state was there and did not check it. She said the potential negative outcome was cross-contamination. She said the staff could grab the containers and cross-contaminate with the other food items if the microwave was dirty. She said the stuck on cooked food in the microwave could fall into the new food, and no one wants old food cooked with new food. She said on 09/24/23, she did see the personal cup in the food preparation area without the lid. She said she removed the item. She said she expected personal items to be in the back of the kitchen on the shelf. She said she was unaware that the item (personal cup) was in the area until after the surveyor was in the food preparation area. She said the cup's contents could have spilled onto the residents clean dishes, and if not noticed, that could have been served to the residents, and they could have been exposed to foodborne illness. She said having personal items in the food preparation area could get the residents sick. She said if a staff member has a bug or an illness and touched their items and then touched the food, the residents could get the bug or the illness. She said that everyone is responsible for the cleanliness of the dry storage. She said she was not aware that the flour was open. She said she noticed it on 09/24/23 when the surveyor was in the kitchen. She said she observed the lid on the floor. She said the potential negative outcome of the flour being open was bugs and actual critters could have gotten in the flour. She also said if bugs got in the flour and they did not see it, they could have cooked it in the food and made the residents sick. She said her system was that she walks through the pantry daily but had not walked through on 09/24/23. She said she saw the uncovered rolls on 09/25/23 and the cornbread and pork chops on 09/24/23. She said regarding the pork chops, she saw them on the line without a lid, and they were not serving then. She said she did see the fruit punch powder open under the serving line. She said she disposed of it. She said she did not see the chicken base open. The potential negative outcome of the food being uncovered was that it could lose temperature and be too cold to serve. She said flies or other bugs could get on the food and cause cross-contamination. She said the DM ensured the food was covered and stored properly. She said the food was uncovered because it was difficult to cool the bread if it was covered. She said dietary staff should not be touching food with their bare hands. She said that the residents are at risk of cross-contamination if staff touch food. She said she was unaware that any staff had touched any food with their bare hands. She said she had been working with Dietary [NAME] A on wearing gloves and was new. She said that staff should not eat food in the food preparation area. The DM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 23 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 said she was unaware that the food 09/24/23 was not at the right temperature. She said the food should be at 165 degrees Fahrenheit or higher. She said if the food was not at the right temperature, the staff should not have served the food but reheated the food in the microwave or the oven until it was at 165 degrees Fahrenheit. She said not having the food at the correct temperature could cause foodborne illness and make the residents sick. She said if staff need to eat, they should be leaving the food preparation area. She said she has received training on expectations in the kitchen and feels comfortable in her role. During an interview on 09/26/23 at 09:43 AM, Dietary [NAME] B said he knew the microwave was dirty, but they were already late for lunch. He said the spaghetti was frozen, and if he warmed it up without the lid, it would warm faster. He said a potential negative outcome was that the food could have exploded in the microwave. He said old stuck on food could have also fallen in the spaghetti. He said it could have also affected the residents because a resident could have been allergic to whatever food fell in the spaghetti. He said he did not see the personal items in the food preparation area on 09/24/23. He said all drinks should be kept in the DM's office. He said things like jackets and purses could be kept in the back of the kitchen on the white shelf but not in the food preparation area. He said many ladies work there, and if there are personal items such as makeup, things can drop in the milk or the juices and contaminate the residents food. He said staff should not be touching food with their bare hands. He said touching food with their bare hands could cause food to get on the residents food. He said he did not realize he was eating in the food preparation area. He said having food uncovered can cause food to be cold and potentially spoil. He said that could make the residents sick. He said the expectation was that all food should be covered as soon as they were done preparing it. He said that the dry storage room was everyone's responsibility. He said that he was unaware that the lid for the flour was not on the container. He said that potentially flies or bugs could have gotten in the flour. Dietary [NAME] B said hot foods on the hot steam table should be between 175 degrees Fahrenheit and 180 degrees Fahrenheit. He said the residents could get sick if the food was not held at those temperatures. He said he was only trained for one day at the facility but that he can read recipes when needed. He said he had been trained on everything that was discussed. During an interview on 09/26/23 at 10:21 AM, the ADM said she was unaware of any issues with the dry storage. She said the potential negative outcome was it all falls under kitchen sanitation, and things should be clean and germ-free. She said staff should not be using bare hands to touch food or eating the food in the food preparation area. She said that could affect the residents because they were supposed to receive their food in a sanitary manner, and the identified issues were not conducive to sanitary conditions. The ADM said she was unaware of the dietary staff serving food that was not at the appropriate temperature. She said she became aware when the DM told her. She said the potential negative outcome was that the resident could be exposed to foodborne illness. She said the purpose of having temperature regulations was to make the food palatable and prevent foodborne illness. She said the system to prevent low-temperature food from being served was dietary staff should be checking temperatures and writing them on the log. She said that the dietary staff should ensure the food was at the correct temperature; if not, they should have reheated it to the correct temperature. She said the temperature of hot foods should be at 140 degrees Fahrenheit or above. She said the dietary cook was responsible for ensuring the food was at the correct temperature. A record review of the facility policy titled Dietary Food Service Personnel Policy and Procedure , dated 2012, revealed the following: Work Conduct: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 24 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 All personal belongings (cigarette packages, sweaters, papers, books, cell phones, and purses) must be kept out of the food preparation area. There is to be no eating while on duty, except in the employee dining area during scheduled breaks. Cooks are expected to taste their products. NO OTHER EATING WILL BE TOLERATED. Residents Affected - Many Sanitation and Food Handling: All food must be kept at its safest temperature. Room temperature is never acceptable for potentially hazardous foods. If more than 15 minutes holding is necessary, the food must be in a refrigerator at less than 41 degrees [F] or kept hot, above 140 degrees [F]. Do not handle food with bare hands. Use the proper utensil or wear disposable gloves. All unused food must be securely covered. All items are to be dated and labeled as to their content. Store items in their original container unless instructed to do otherwise. A record review of the facility policy titled Storage Refrigerators , dated 2012, revealed the following: Food must be covered when stored, with a date label identifying what is in the container. A record review of the facility policy titled Food Safety, dated 2012, revealed the following: 1. Gloves must be worn for preparation and service of foods where direct hand to food contact is unavoidable. A record review of the facility policy titled Food Safety, dated 2012, revealed the following: 2. Potentially hazardous food shall be maintained at: 41 degrees F or less, or 140 degrees [F] or above. 3. Reheat all leftovers 165 degrees [F] or above for a minimum of 15 seconds. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 25 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. 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 maintain and ensure safe and sanitary storage of residents' food items for 2 of 3 refrigerators reviewed for food safety (Conference Room refrigerator, and room [ROOM NUMBER]) in that: Residents Affected - Some The refrigerator located in in the conference room did not have a thermometer in the freezer or refrigerator. The refrigerator did not have a log. The refrigerator contained staff personal food, residents' food and unlabeled food. The refrigerator located in room [ROOM NUMBER] contained food and did not have a temperature log present nor did it have a thermometer inside the refrigerator. This failure could place resident at risk for food borne illnesses. Findings include: The following observations were conducted on 09/24/23: At 9:32 AM, a white refrigerator was observed in the facility's conference room. There was no thermometer in the refrigerator and no thermometer in the freezer. There was no log on or around the refrigerator. There was a bag of unknown take-out food with a resident's name on the bag and a date of 05/25. In the bottom right drawer were two sets of paper plates. One plate contained spaghetti, and the other set contained garlic bread. There was no label or date on the food item. A half gallon of butter pecan and strawberry ice cream was in the freezer. The ice cream was unlabeled and undated. At 1:57 PM, an observation of the refrigerator in room [ROOM NUMBER] revealed there was no temperature log and no thermometer. The following was observed unlabeled: oranges (oranges in an open container, not peeled), an egg sandwich, and a partially eaten marshmallow treat. The same observation was made on 09/25/23 at 9:12 AM. The following observations occurred on 09/25/23: At 8:46 AM, a white refrigerator was observed in the facility conference room. There was no thermometer in the refrigerator and no thermometer in the freezer. There was no log on or around the refrigerator. There was a bag of unknown take-out food with a resident name on the bag and the date of 05/25; in the bottom right drawer were two sets of paper plates. One contained spaghetti, and the other set contained garlic bread. There was no label or date on the food item. A half gallon of butter pecan and strawberry ice cream was in the freezer. The ice cream was unlabeled and undated. During an interview on 09/25/23 at 1:54 PM, Dietary [NAME] A said the dietary staff was not responsible for the refrigerator in the conference room. She said she did not know who was responsible. She said the refrigerator was for food for the residents. During an interview on 09/25/23 at 02:19 PM, Dietary [NAME] D said the fridge in the conference room was the dietary staff's responsibility, but housekeeping should also help to keep it clean. She said that the housekeeping team is new. She said they kept it clean, but the nursing staff was responsible for the food in the fridge. She said she was not sure who was supposed to monitor the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 26 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0813 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some temperature. She said the failure to monitor could make the residents sick. She said the refrigerator should be checked so that food can be rotated and thrown away. She said the refrigerator in the conference room was for the residents, but staff use it. She said it was her understanding that it was for the family members who brought food in. She said the dietary staff would provide shakes and place them in the refrigerator for the medication aides. She said she was unaware of the items in the fridge. She said she had been trained on the expectations of a dietary worker and was comfortable in her role. During an interview on 09/25/23 at 02:36 PM, the DM said the dietary staff was responsible for cleaning the fridge in the conference room. She said the refrigerator was supposed to be used for residents. She said if the family brought food, it would go in that fridge. She said staff continued to place their items in the fridge. She said that once, she had to place a sign to tell staff not to place their items in that fridge. She said the staff have a fridge where they can place their items in the break room. She said that she had thrown away so many dishes in the past. She said the potential negative outcome of unlabeled food being in the refrigerator is that they do not know how long the food has been there or if the food had been thawed out before. She said not monitoring the temperature could put the resident at risk of bacteria growing if the fridge is not at the proper temperature. She said she was unaware that personal food was in the fridge. She said she had not checked that fridge in several days. She said that she expected all refrigerators to have a log and thermometer. She said no personal food should have been in that refrigerator, and all food should be dated. She said she has received training on expectations in the kitchen and feels comfortable in her role. During an interview on 09/26/23 at 09:43 AM, Dietary [NAME] B said the dietary staff was responsible for the fridge in the conference room, but they had no control over who put items in it. He said the only thing that should be in the refrigerator were the residents' items. He said they have had this issue and reported it to the ADM. He said he was unsure what the ADM said because the conversation was between the DM and the ADM. He said having personal items in the residents' refrigerators could cause cross-contamination with the residents' food. He said the expectation was that they should not bring in personal food unless it is taken to the staff break room. He said he was only trained for one day at the facility but that he can read recipes when needed. He said he had been trained on everything that was discussed. During an interview on 09/26/23 at 10:21 AM, the ADM she said their policy does not require them to label or monitor food in the resident's room. She said staff should check the fridges to ensure there was no moldy food when they do their champion rounds. She said all refrigerators should have a thermometer. She said they make sure the residents refrigerators had a thermometer. She said the thermometer's purpose was to ensure the fridge was working. When asked what range the thermometer should be in, she said it should be within 32 to 40 degrees Fahrenheit. She said they should notify administration staff if the thermometer was within the red range. She said the red range was a range that indicated that the temperature was not right. She said champion rounds should be conducted daily. She said the staff assigned should throw out the out-of-date snacks. She said the facility staff does not date the residents' food according to their policy. She said the refrigerator in the conference room was monitored by dietary. She said she was unaware of the unlabeled items and personal items identified in the refrigerator in the conference room. A record review of the facility policy titled Food brought to the facility from unapproved sources , dated 2012, did not reveal any information concerning food brought in from family or outside sources. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 27 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0813 A record review of the facility policy titled Personal Refrigerator policy, dated 2012, revealed: Level of Harm - Minimal harm or potential for actual harm Temperature Control The refrigerator compartment should be maintained at temperature of 35-41 degrees [F]. Residents Affected - Some The freezer compartment should be maintained at zero degrees or less, or food frozen to a solid state. Temperatures can monitored by the use of a thermometer designed for a refrigerator/freezer that can be purchased from a department store. A request for policy related to food brought in by family members requested during survey (09/24-09/26/23) and again via email on 10/03/23. Only policy provided was the one for unapproved sources. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 28 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 maintain an effective pest control program to ensure the facility was free of pests for 1 of 1 kitchen and 2 of 32 resident rooms (Kitchen Food Preparation area, room [ROOM NUMBER] and room [ROOM NUMBER]). Residents Affected - Many The facility failed to ensure room [ROOM NUMBER] and the Kitchen Food Preparation area were free from flies. This failure could place residents at risk for the potential spread of infection, cross-contamination, and decreased quality of life. Findings included: Record review of Resident #39's face sheet, dated 09/24/23, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include congestive heart failure and sleep apnea (sleep disorder). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #39 was usually understood. The MDS revealed Resident #39 had a BIMS of 14 which indicated the resident's cognition was intact. The following observations were conducted on 09/24/23: At 11:37 AM observed 2 flies in room [ROOM NUMBER]. Observed a fly swatter hanging from Resident #39's wheelchair. During an interview on 09/24/23 at 11:37 AM, Resident #39 said the flies could be pretty bad. She said she took her fly swatter with her to kill them. At 11:51 AM, the surveyor observed 3 flies in the kitchen food preparation area. They were near the container of fried pork chops and landed on the counter. At 12:05 PM, observed 3 flies. Two were on the clean hanging utensils, and one landed on the lid of an open chicken base. Observed 3 flies near the uncovered puree items in the food preparation area at 12:17 PM. At 12:34 PM, Dietary [NAME] A told Dietary [NAME] D, I know; the flies! and Dietary [NAME] D responded, I know, it's a lot of them, huh? At 1:38 AM observed 10 flies on a resident sleeping in room [ROOM NUMBER]. Observation on 09/25/23 at 8:53 AM revealed a fly landed on clean trays in the kitchen food preparation area. During an interview on 09/25/23 at 1:54 PM, Dietary [NAME] A said she knew about the fly issue and it had been that way for about a month. She said she was not aware of anything that had been done to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 29 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many address the fly issue. She said she did see flies, but mainly around the dishwasher. She said flies could potentially get on the food or the dishes. During an interview on 09/25/23 at 02:19 PM, Dietary [NAME] D said they had been having issues with the flies in the kitchen. She said they come every summer. She said there was no reason why the two doors that led into the kitchen from the dining area were always open. She said that they can be closed. She said she is unsure if anything has been done to address the flies in the kitchen. She said she was not aware that any of the residents had complained. She said the potential negative outcome was that the flies could get into the food. She said she had been trained on the expectations of a dietary worker and was comfortable in her role. During an interview on 09/25/23 at 02:36 PM, the DM said she was aware of the flies and that they had a fly issue. She said as long as she has worked at the facility, they have kept the doors open to the kitchen into the dining room. She said the doors had to be open, so the residents knew the kitchen was open and available. She said the potential negative outcome of having the fly issue was the flies could get into the food. She said no one could determine when a fly would fall dead and fall into the food, which could cause cross-contamination. She said all together, flies are nasty. She said she has received training on expectations in the kitchen and feels comfortable in her role. During an interview on 09/26/23 at 09:43 AM, Dietary [NAME] B said they have always had an issue with flies. He said they cannot do a whole lot about the issues. He said they have a fly swatter that they use. He said it was located in the back by the white shelf where they kept their items. He said that on 09/24/23, he did not think that it was that bad. He said he had seen worse. He said he wished they could get the fly strips or some type of fly paper. He said the flies seem to come in when the residents come in from smoking. He said the doors into the kitchen have always been open. During an interview on 09/26/23 at 10:21 AM, the ADM said in the past, they had issues with flies. She said she was not aware of the issues with flies in the kitchen. She said she may have based that on the observations in the dining room. She said she does sometimes go back to the kitchen. She said the doors to the kitchen have always been open as she can remember, and she never addressed it. She said she visits the kitchen mostly between breakfast and lunch. She said the potential negative outcome of having flies was they could get on the food. She said she believed the flies were coming from the door where the residents go out to smoke. She said the system she had in place for the flies was her fly sconces in the dining room. She said she has not had formal training on pests but knows the residents do not want flies around their food. She said she expected the flies not to be in the food preparation area. A record review of the facility policy titled Insect and Rodent Control dated 2012, revealed the following: Insect and Rodent Control The facility will maintain an effective pest control program in order to provide an insect and vermin free food service department. Procedure: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 30 of 31 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 675527 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whisperwood Nursing & Rehabilitation Center 5502 W 4th St Lubbock, TX 79416 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 0925 1. Arrangements are made with a reputable company for regular spraying for insects which Level of Harm - Minimal harm or potential for actual harm includes rodent control when required. 2. Facility will maintain appropriate screens, close fitting doors, properly sealed water/sewer pipes, Residents Affected - Many structurally maintained walls, baseboards, etc. to prevent entrance access of insects and rodents. 3. Sanitation of facility will be maintained per other stated sanitation policies to prevent food sources, breeding places, etc. for insects or rodents. 4. Deliveries of food and supplies will be monitored for prevention of insect and rodent access. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675527 If continuation sheet Page 31 of 31