Health inspection·July 21, 2023

F 0600 Record review of Resident #5's MDS assessment dated [DATE] reflected a BIMS score of 15. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #13's face sheet reflected a [AGE] year old female with an admission date of 3/13/2023 and with diagnoses including chronic obstructive pulmonary disease, anxiety disorder, alcohol use unspecified with alcohol-induced persisting dementia, essential (primary) hypertension, major depressive disorder, recurrent, unspecified, unspecified atrial fibrillation. Residents Affected - Some Record review of Resident #13's MDS assessment dated [DATE] reflected a BIMS score of 8. Record review of Resident #14's face sheet reflected a [AGE] year old male with an admission date of 10/20/2016 and with diagnoses including acute upper respiratory infection, obesity, major depressive disorder, chronic obstructive pulmonary disease, dementia, unspecified severity, without behavioral, disturbance, psychotic disturbance, mood disturbance, and anxiety, schizoaffective disorder, bipolar type, unspecified psychosis not due to a substance or known physiological condition, bipolar disorder, current episode manic without psychotic features. Record review of Resident #14's MDS assessment dated [DATE] reflected a BIMS score of 15. Record review of Resident #26's face sheet reflected a [AGE] year old male with an admission date of 12/22/2021 and with diagnoses including chronic obstructive pulmonary disease, hypertensive chronic kidney disease with stage 1 through stage chronic kidney disease, or unspecified chronic kidney disease, other psychotic disorder not due to a substance or known physiological condition, bipolar disorder, unspecified, major depressive disorder, recurrent, moderate, anxiety disorder, unspecified, other seizures, essential (primary) hypertension, atherosclerosis of coronary artery bypass graft(s), unspecified with unstable angina pectoris, pneumonia due to coronavirus disease, gastro-esophageal reflux disease with esophagitis. Record review of Resident #26's MDS assessment dated [DATE] reflected a BIMS score of 15. Record review of Resident #29's face sheet revealed a [AGE] year old female with an admission date of 8/4/2016 with diagnoses including hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left dominant side, pressure ulcer of other site, stage 2, dysphagia, oral phase, diabetes mellitus, essential (primary) hypertension, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety bipolar disorder, unspecified, major depressive disorder, recurrent, unspecified, unspecified mood [affective] disorder, anxiety disorder. Record review of Resident #29's MDS assessment dated 6/9//2023 reflected a BIMS score of 14. During an interview on 7/19/2023 at 10:18AM with CNA F was asked when you see abuse and neglect who do you report it to and how soon do you report it and CNA F replied report it as soon as you see it, the abuse coordinator is Admin, if she isn't there you go up the chain of command. When asked if they have seen staff yell at residents before, CNA F stated yes, one in particular, she has a high-pitched voice, she doesn't yell at residents, but she talks loudly. When asked who, CNA F stated, Charge RN. CNA F was asked if they have any concerns about abuse and neglect in the facility at this time and CNA F replied, not right now. Interview with Resident #13 on 7/19/2023 at 10:32AM: Resident #13 was asked what occurred before, during and immediately after the incident and Resident #13 stated Charge RN was in there yelling at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 2 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #29 like always. All of the employees know. Charge RN told her to quit her damn yelling. Charge RN looks mean, she's intimidating. Very stern. When she goes past the line, I can recognize it. When asked what the tone of the perpetrator was Resident #13 replied she was ugly and horrible. When asked if they think retaliation has occurred, Resident #13 stated not that I know of. They take Resident #29 to her room to eat now. Its better now because of that. As for me, I've been getting some looks from some nurses. Nurse glares at me all the time. One of them ignored me when I tried to speak to her. Resident #13 was asked if this was reported to who and when, and Resident #13 stated to Admin, the administrator. I've gone to her before about issues that have happened, she just says that she knows, and she'll take care of it. When asked how the resident and the perpetrator interacted before and after the incident, Resident #13 stated just yelling like always since she got here and always at Resident #29. After- she's just a weekend nurse so she's only here 2 days a week. She doesn't interact with me at all now. Not everyone is Charge RN's favorite. On the weekend we all stay in our rooms, so we don't make her mad. Resident #13 was asked if the perpetrator exhibited inappropriate behaviors to the resident or other residents in the past such as derogatory language, rough handling or ignoring residents while giving care and Resident #13 stated no, no one else, just Resident #29. In an Interview on 7/19/2023 at 10:42AM with family member of Resident #13: Family member was asked while here have they seen any concerns about abuse and neglect and the family member of Resident #13 stated Resident #13 has had issues with Charge RN because of how she talks to the residents. She (Charge RN) just rubs people the wrong way. In an Interview on 7/19/2023 at 10:58AM with Charge LVN was asked when they see abuse and neglect who do they report it to and how soon do they report it and Charge LVN replied Admin and immediately. Charge LVN was asked how they watch the staff to ensure they are caring for residents and Charge LVN stated I watch them providing care at times. When asked if they seen staff yell at residents before, Charge LVN stated Charge RN, but she's just loud, I wouldn't consider it abuse, it's almost like she's hard of hearing. When asked if they have any concerns about abuse and neglect in the facility at this time, Charge LVN replied no. Interview with Resident #26 on 7/19/2023 at 11:05AM: Resident #26 was asked if they like it here and Resident #26 replied it's alright. When asked if staff treat them with dignity and respect, Resident #26 stated mostly. Resident #26 was asked if they ever see staff yell at residents and Resident #26 replied they yell at Resident #29, it happens all the time, Resident #29 yells at people and staff yells back. When asked what the tone of the staff when they yell, Resident #26 stated I don't think it's in a mean or rude way. When asked if they have a problem or concern, who would they talk to, Resident #26 stated well the staff I would guess. Resident #26 asked if they feel comfortable going to staff to talk to them about your concerns and Resident #26 replied not extremely and said, well I don't want to get yelled at. Resident stated that they are familiar with Charge RN and when asked if they see her yell at residents Resident #26 responded sure, she yells at people. Staff and residents, mostly Resident #29. When asked if they are afraid of her, Resident #26 replied it's impossible not to be, she has a voice that says I'm right. Interview with Resident #5 on 7/19/2023 at 12:13PM: Resident #5 was asked if they see interactions between their roommate Resident #29 and staff and Resident #5 stated all the time. When asked how staff treat Resident #29, Resident #5 replied Charge RN yells at her and gets tough with her, but Resident #29 just takes it. Resident #5 stated it makes me feel bad for her. When asked if they have seen staff yell at any other residents, Resident #5 stated no. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 3 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Interview with Resident #3 on 7/19/2023 at 12:20PM: Resident #3 was asked how they like living there and Resident #3 replied I like it here. When asked if the staff treat them with dignity and respect, Resident #3 stated yes they treat me good, but not everyone is treated well and it only happens on the weekends with Charge RN. When asked if they have seen it happen, Resident #3 replied yes, I've seen her yell at Resident #29, I've seen her yell at staff and stated, sometimes I'm afraid of Charge RN. When asked if they are afraid of retaliation Resident #3 stated yes I am. Resident #3 stated she's verbally abusive and it goes on all the time. When asked if this has been reported to staff, Resident #3 replied lots of people have, everyone knows about it, I don't think they'll ever do anything about it. When asked how the weekend is at the facility, Resident #3 stated I try to stay out of their way or stay in my room. In an Interview on 7/19/2023 at 12:33PM with Resident #15: When asked if they have any concerns about abuse and neglect in the facility right now, Resident #15 replied I don't like how some of the staff holler at the residents. Resident #15 stated Charge RN, she gets mad at Resident #19 or Resident #29 and yells at them. When asked if they are afraid of Charge RN, Resident #15 replied I'm not afraid of her, I'll stand up for myself but I'm afraid if I say something they'll take it out on me. Charge RN yells at people that can't help themselves and that's not right. When asked how the weekend is at the facility, Resident #15 stated I stay in my room, so I don't get yelled at or caught up in it. Interview with Resident #14 on 7/19/2023 at 12:41PM: When asked if they could describe the incident that happened between Resident #29 and RN Charge RN in the dining room earlier this month, Resident #14 stated I was there. Charge RN kept yelling the louder Resident #29 got. It happens a lot. When asked if they have any concerns about abuse and neglect in the facility at this time, Resident #14 responded no concerns, just Charge RN and Resident #29. When asked if they are afraid of Charge RN, Resident #14 stated no I'm not. When asked if they are afraid of retaliation if they were to tell someone, Resident #14 stated well there's no one to tell because everyone see is, but no I'm not afraid of retaliation. Charge RN just isn't using any common sense, she's mean. When asked how the weekend is at the facility, Resident #14 stated it's ok. In an Interview on 7/19/2023 at 12:49PM with CNA B stated, Charge RN yells at Resident #29 only, it happens often. When asked what they think the tone of Charge RN is when this happens, CNA B responded, it's aggressive, it makes the other residents uncomfortable. Interview with Resident #29 on 7/19/2023 at 12:54PM: When asked if they remember the incident, Resident #29 stated not really. When asked if they like it here, Resident #29 stated it's ok. Resident #29 was asked if the staff treat them with dignity and respect and Resident #29 replied I guess so. When asked how Charge RN treat them, Resident #29 replied sometimes she yells but that's just Charge RN doing her thing. When asked how that makes them feel, Resident #29 responded sometimes bad or sad. When asked if they are afraid of Charge RN, Resident #29 replied I'm not afraid of her, she's a good nurse. Resident #29 was asked if they feel safe here and Resident #29 stated yeah. When asked if they remember if there have been past occurrences like this, Resident #29 replied no I don't. In an interview on 7/19/2023 at 1:01PM DON: DON was asked to describe the incident that occurred on 7/9/2023 and DON stated, Charge RN called me when it happened and told me that another resident was yelling 'abuse, abuse', so she called me to tell me that I needed to come and relieve her. When asked if the resident/perpetrator exhibited any behaviors that would provoke one another and if so, what actions were being taken to address this, DON stated no, but we interviewed Charge RN and issued her an EDR, it's like a write up. When asked if the perpetrator exhibited inappropriate behaviors to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 4 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some the resident or other residents in the past such as derogatory language, rough handling or ignoring residents while giving care, DON stated no. When asked if DON did a psychosocial assessment on all the residents the DON replied, only Resident #29. When asked if they were aware that some of the residents are afraid of Charge RN, DON replied no, I did not know that. In an interview on 7/19/2023 at 1:06PM Admin: When asked how long Charge RN was suspended, Admin stated she was suspended on Sunday and was allowed to come back on Tuesday, but she only works on the weekends. When asked how long the investigation lasted, Admin stated 2 days on Sunday and Monday. Admin was asked to describe the incident and Admin replied Resident #29 yells a lot and Charge RN was trying to tell her not to yell. You do have to raise your voice when talking to Resident #29. Charge RN is loud, and Resident #13 felt like the situation was out of hand. When asked if there were discrepancies and how this was investigated, Admin stated there were, yes. I went and spoke with each of them and none of them had the same story. Resident #13 has a thing against Charge RN. When asked did the resident/perpetrator exhibit any behaviors that would provoke one another and if so, what actions were being taken to address this, the Admin responded yes. I counseled with Charge RN and explained to her to tone it down. Admin was asked if the perpetrator exhibited inappropriate behaviors to the resident or other residents in the past such as derogatory language, rough handling or ignoring residents while giving care and Admin responded no. When asked if annual performance reviews identified issues with the provision of care, treatment or other concerns the Admin stated Charge RN's always been this way. I constantly tell her to be quiet. When asked what the result of your investigation was, Admin stated my result was she was not abusive. She was just trying to make the resident understand. Admin was asked if their previous warnings or incidents at the facility and Admin replied, yes it was between Resident #13 and about Charge RN yelling. When asked if they came up to the facility on the weekends to check in on Charge RN to see how she was doing after the incident the Admin stated, no I did not. When asked how they assure retaliation does not occur when a staff or resident reports an allegation of abuse the Admin stated, I go visit with the residents and assure them that door is always open. Admin was asked if anyone talked to all of the residents and the Admin responded no, we did not. When asked if they were aware that some of the residents are afraid of Charge RN, Admin responded no I was not aware of that. We did have a mention in our full book survey that the residents were afraid of retaliation, but we talked to the residents and did in-services with staff. Admin as asked what the EDR done for on Charge RN and Admin stated, it was for the incident about her voice and demeaner on that day. When asked if it was for the incident on 7/9/23 the Admin stated yes. Interview on 7/19/2023 at 1:31PM with Admin stated: When asked what they are doing on the weekends to ensure that the situation with Charge RN is no longer happening, the Admin replied I talked with Charge RN and let Residents know to come talk to me. When asked if the Admin has been up there on the weekends the Admin replied no. Interview on 7/19/2023 at 1:50PM with CNA : When asked if they have seen staff yell at residents before CNA B stated yes, all the time and Charge RN yells at Resident #29 all the time. She is loud but there's a difference between yelling at residents and being loud. When asked if they have intervened when they saw this happen, CNA B stated yes, I have, and we've had words about it. I'm very vocal with how she treats Resident #29. Interview on 7/19/2023 at 1:55PM with Admin: When asked on the EDR that was given to Charge RN on 7/12/2023 shows that there are 2 write ups in the last 12 months, Admin responded Oh no, there's no other write ups, that was a mistake, I had used a template to do that and forgo to erase it. When asked what the Admin did about the grievance filed on 5/29/2023 about Charge RN, Admin stated I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 5 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some counseled with her on her demeaner and voice tones. When asked if there were any other investigations about Charge RN the Admin stated no, I always talked to her about her voice and her demeanor with the residents. When asked if the Admin felt like they conducted an effective investigation of this incident on 7/9/2023, Admin stated I know she's a good nurse, she's good to the patients, she takes care of the residents. I don't see her as being abusive, but I know it comes across that way. Admin was asked why Charge RN is still employed, the Admin responded, I don't believe she's abusive. Admin was asked how they know that and Admin stated, Well I asked the residents. When asked if they understand that if the residents are afraid do they think they would be honest and Admin stated, they know Charge RN, but I didn't know anyone was afraid of her. Interview on 7/19/2023 at 2:14PM with Charge RN: Charge RN described the incident and stated I was at the nurse station charting, Resident #29 she was yelling for me at the top of her lungs as I was going down the hall. Resident #29 didn't have her hearing aids. I told her to stop yelling. When asked how they usually respond to the Residents behaviors requests for assistance, Charge RN stated I usually do it right away. I was caring for another Resident at the time. I tried to tell her that I would be back. Charge RN was asked to describe what contact they have with Resident #29 since the investigation and Charge RN replied I worked last weekend with her. When asked what type of training Charge RN had related to abuse and neglect they have received and Charge RN replied we had in-services about it and who to contact. Charge RN stated during the incident that there was a Resident yelling abuse going down the hall so I called the DON to relieve me and she called the Admin. When asked if they have any other information they wish to share in regards to the investigation, Charge RN stated Resident #29 is very hard of hearing. I wasn't being ugly to her. The kitchen supervisor was right there cleaning tables when it happened. Interview on 7/19/2023 at 2:25PM with LVN D: When asked if they have worked with RN Charge RN on the weekends, LVN D stated yes. When asked how Charge RN interacts with residents, LVN D replied I've known her a long time, we work together on Saturdays. She comes off very gruff and she's just loud. I don't think that she means harm or is bad. She just doesn't have any tone control. She's not mean spirited, she just doesn't have elderly gloves and she needs restraint. Interview on 7/19/2023 at 2:39PM with LVN A: When asked if they have worked with RN Charge RN on the weekends, LVN A stated yes. When asked how Charge RN interacts with residents, LVN A stated, I've heard more complains than what I've seen, the main thing is she's just loud, nothing physical. LVN A stated, she's loud and residents don't like it. Interview on 7/19/2023 at 2:47PM with LVN I: When asked if they have worked with RN Charge RN on the weekends, LVN I stated, I'm coming in as she's leaving. When asked how Charge RN interacts with residents, LVN I replied, I haven't seen any interactions, I haven't heard any complaints from the residents. When asked if they have any concerns about abuse and neglect in the facility at this time, LVN I stated I haven't seen anything, I've just heard stuff. I've heard that Charge RN yelled at a few resident, Resident #13 on the other side of the hall, other than that I heard she's always yelling back and forth with Resident #29. Interview on 7/19/2023 at 2:37PM with LVN J: When asked if they have worked with RN Charge RN on the weekends, LVN J responded, yes I do sometimes. When asked how Charge RN interacts with residents, LVN J stated, she's mean, and she yells at them. When asked if they have any concerns about abuse and neglect in the facility at this time, LVN J stated, just that but everyone knows about it, and they don't do anything about it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 6 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Interview on 7/19/2023 at 2:50PM with CNA G: When asked if they have seen any staff yell at residents, CNA G replied, Charge RN, yes she has and she has a rude attitude and a loud voice with residents. When asked if they have ever reported it, CNA G stated, well the residents haven't complained to me. When asked if they have seen Charge RN yell at residents, CNA G stated, I haven't seen it, but I always hear her. When asked if they have any concerns about abuse and neglect in the facility at this time, CNA G replied yes, it's degrading for the residents. This is their home. Residents Affected - Some In an interview on 7/21/2023 at 11:31AM Admin: Admin was asked if there are other investigations on Charge RN and Admin stated, there are no other investigations, what's in her file is what I have. When asked if their investigation prevented further abuse, neglect or mistreatment of the resident, Admin replied well, yes because when I did interviews and tried to find out more information, I didn't get the same answers that you guys got. When asked if they felt that the investigation was adequate the Admin stated, yes I do. The Admin was asked if they think that they took appropriate corrective action as a result of the findings and Admin stated yes, I think I did. If I would have got different information, I would have done it differently. When asked if they interviewed other residents to ask them how the yelling/verbal abuse made them feel the Admin responded no. Admin was asked if they monitored Resident #29 and other residents at risk such as conducting unannounced management visits at different times and shifts and Admin replied Yeah, me and DON come in at different times, DON is good at popping up. When asked if on the weekends did the Admin specifically come in to monitor Charge RN's interactions with residents the Admin stated no, I did not come in to observe her. Admin was asked what actions were taken to protect the residents and the Admin replied, well we did the plan of removal after. Admin was asked if they felt that the facility's ANE policies and procedures are implemented well within the staff and the Admin replied they are now, but before it's hard to say really. I don't know. Admin was asked if they are conducting ongoing oversight and supervision of staff to assure that the ANE policies and procedures are implemented as written and Admin responded, I am now yes. When asked if they feel that the staff is able to identify, correct and intervene in situations in which abuse, neglect and exploitation is more likely to occur and the Admin stated now, yes. Record Review of staff in-services indicate that Charge RN was in-serviced on Abuse and Neglect on the following dates: 6/14/2023, 7/7/2023, and 7/19/2023. Record Review of staff in-services indicate that Charge RN was in-serviced on Resident Rights on 7/10/2023. Record review of facility's Grievance Log shows a grievance filed on 5/30/2023 by Resident #13 describes the incident as follows: Charge RN yells at Residents causing Resident #13 to feel uncomfortable. Resident #13 feels Charge RN yells at her and others. The Disposition of Complaint states: talk to RN about her loud voice dealing with Residents. The findings of the incident as follows: Charge RN has a very loud demeanor when dealing with anyone or anything. The Recommendations/Corrective Action states: Counsel with Charge RN on her demeanor and voice tones. Record Review of Facility Grievance Investigation Report dated 5/30/2023 shows a written statement as follows: Resident #13 states they feel like Charge RN verbal abusive to her and the other Residents. Resident #13 states that Charge RN yells at other Residents and makes them feel uncomfortable. Resident #13 states that Charge RN yelled at them for going into the dining room for smoke break and Charge RN yelled at them stating they were in the dining room too early for smoke break. Resident #13 states that sometimes in the dining room Charge RN is so loud that it makes them uncomfortable so they go back to their room. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 7 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record Review of Facility Notice of Disciplinary Action for Charge RN is dated 10/13/2022 is detailed as follows: Arguing with Resident in a non-professional manner in a loud tone. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from DON that states: Charge RN was in lobby and Resident #29 was yelling out at staff to come here. Charge RN went over to Resident and told them to stop yelling and Resident #29 told Charge RN that she was not their boss and to not tell them what to do. Charge RN continued to argue with Resident about this but I was talking to someone else at the time and didn't hear the whole conversation. MDS LVN stepped out of their office and told Charge RN to walk away and they did so. After Charge RN got back to their office, Resident #29 then yelled at Charge RN to come back over there. Charge RN did not do so. Earlier in the shift I was asking Resident #29 to stop yelling out and at the same time Charge RN came over and interrupted me to tell Resident #29 the same thing. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from Bus Office that states: This is what I heard but did not see from my office. Resident #29 was in the living area, requesting different things from everyone in a loud tone. Charge RN went up to Resident #29 and in their very loud voice tone told them that they needed to stop yelling and that someone would get to them. I'm not sure if Resident #29 told Charge RN she was not her boss, but Charge RN told Resident #29 you are not by boss, that they worked at the nursing home and cared for them. I then heard MDS LVN tell Charge RN to walk away. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from MDS LVN that states: Charge RN was working 6-2 as RN coverage. Resident #29 was in the lobby after breakfast, and they were wanting to go to bed. Charge RN was yelling at her tell her she had to stay up for 30 min. Charge RN kept arguing with Resident #29. DON told them that the yelling needs to stop and that they couldn't handle it anymore. Resident #33 was getting anxious and restless because of all the yelling. At lunch Resident #29 yelled for me to come there. Charge RN said just keep walking. I did ask them what they needed, and they wanted me to move Resident #17 to their table. I told them to give me a minute and I will. About 10 minutes later, Resident #29 was yelling for LVN G and Charge RN told them to keep going. LVN K did not listen, and Resident #29 wanted a pain pill. LVN G gave her the medicine. After lunch, Resident #29 told Charge RN to come here. Resident #29 wanted to be laid down. Charge RN told her that she had to wait 30 minutes. Resident #29 told Charge RN something I could not hear. Charge RN leaned over the table and to tell Resident #29 you are not by boss. Resident #29 said loudly I am your boss. Charge RN said no you are not my boss and you will not talk to me that way. I immediately got out of my chair and told Charge RN that they needed to walk away. Charge RN went to walk away, and Resident #29 was asking them something and Charge RN put her hand in the air and walked to the middle office up front. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from LVN G that states: I LVN G was working as a LVN at [facility] on 10/13/22. My RN supervisor was Charge RN. Charge RN has really stern assertive voice and sometimes yells a lot. On this particular day Charge RN was on a roll, Resident #29 was in the dining room yelling at me as I went to walk by them and Charge RN yelled at me and told me to keep walking however I stopped to see what they wanted and they asked me for Tylenol. So I went and got them medication. Then in about 30-45 minutes later Resident #29 was in the lobby and just sitting there in a wheelchair and they yelled at me again. I was at the computer doing my charting and I told Resident #29 it would be just a minute. I could visibly see that Resident #29 was not in any harm where I was sitting and they just wanting to talk to me or ask me something. Charge RN heard her from a office and Charge RN stormed out of that office and yelled at Resident #29 saying what do you need. Resident #29 said she wants to lay down (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 8 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Charge RN told it would be 30 minutes then they said I need to talk to my nurse. Charge R said your nurse is busy what do you need? Resident #29 looked at Charge RN and said just go back to your office and leave me alone and Charge RN stormed closer to Resident #29 and Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 9 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record reviews, the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect and exploitation of residents for 6 of 6 residents (Residents #3, #5, #13, #14, #26, #29) reviewed for abuse. Residents Affected - Some The facility failed to implement written abuse and neglect policies to prohibit and prevent abuse for Residents #3, #5, #13, #14, #26 and #29. These failures place Residents at risk for psychosocial harm, fearful of retaliation, being uncomfortable, impaired quality of life and abuse as a result of the verbal abuse. An Immediate Jeopardy (IJ) was identified on 7/19/2023 at 5:08PM. While the immediate jeopardy was lifted on 7/21/2023 at 2:35PM, the facility remained out of compliance at a severity of actual harm with potential for more than minimal harm: and scope of pattern, due to the facility's need to evaluate the effectiveness of their plan of correction to prevent further concerns. Plan of removal of IJ will be included in findings. Findings included: Record review of Resident #3's face sheet revealed a [AGE] year old female with an admission date of 7/29/2019 with diagnoses including: chronic obstructive pulmonary disease, emphysema and acute kidney failure. Record review of Resident #3's MDS assessment dated [DATE] reflected a BIMS score of 13. Record review of Resident #5's face sheet reflected a [AGE] year old female with an admission date of 10/6/2022 and with diagnoses including chronic kidney disease, altered mental status, hyperparathyroidism, morbid (severe) obesity, unspecified dementia, moderate, with psychotic disturbance, delirium due to known physiological condition, schizophrenia, unspecified, delusional disorders, unspecified psychosis not due to a substance or known physiological condition, bipolar disorder, unspecified, major depressive disorder, recurrent, moderate anxiety disorder, unspecified, insomnia, unspecified, essential (primary) hypertension. Record review of Resident #5's MDS assessment dated [DATE] reflected a BIMS score of 15. Record review of Resident #13's face sheet reflected a [AGE] year old female with an admission date of 3/13/2023 and with diagnoses including chronic obstructive pulmonary disease, anxiety disorder, alcohol use unspecified with alcohol-induced persisting dementia, essential (primary) hypertension, major depressive disorder, recurrent, unspecified, unspecified atrial fibrillation. Record review of Resident #13's MDS assessment dated [DATE] reflected a BIMS score of 8. Record review of Resident #14's face sheet reflected a [AGE] year old male with an admission date of 10/20/2016 and with diagnoses including acute upper respiratory infection, obesity, major depressive disorder, chronic obstructive pulmonary disease, dementia, unspecified severity, without behavioral, disturbance, psychotic disturbance, mood disturbance, and anxiety, schizoaffective disorder, bipolar type, unspecified psychosis not due to a substance or known physiological condition, bipolar (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 10 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 disorder, current episode manic without psychotic features. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #14's MDS assessment dated [DATE] reflected a BIMS score of 15. Residents Affected - Some Record review of Resident #26's face sheet reflected a [AGE] year old male with an admission date of 12/22/2021 and with diagnoses including chronic obstructive pulmonary disease, hypertensive chronic kidney disease with stage 1 through stage chronic kidney disease, or unspecified chronic kidney disease, other psychotic disorder not due to a substance or known physiological condition, bipolar disorder, unspecified, major depressive disorder, recurrent, moderate, anxiety disorder, unspecified, other seizures, essential (primary) hypertension, atherosclerosis of coronary artery bypass graft(s), unspecified with unstable angina pectoris, pneumonia due to coronavirus disease, gastro-esophageal reflux disease with esophagitis. Record review of Resident #26's MDS assessment dated [DATE] reflected a BIMS score of 15. Record review of Resident #29's face sheet revealed a [AGE] year old female with an admission date of 8/4/2016 with diagnoses including hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting left dominant side, pressure ulcer of other site, stage 2, dysphagia, oral phase, diabetes mellitus, essential (primary) hypertension, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety bipolar disorder, unspecified, major depressive disorder, recurrent, unspecified, unspecified mood [affective] disorder, anxiety disorder. Record review of Resident #29's MDS assessment dated 6/9//2023 reflected a BIMS score of 14. During an interview on 7/19/2023 at 10:18AM with CNA F was asked when you see abuse and neglect who do you report it to and how soon do you report it and CNA F replied report it as soon as you see it, the abuse coordinator is Admin, if she isn't there you go up the chain of command. When asked if they have seen staff yell at residents before, CNA F stated yes, one in particular, she has a high-pitched voice, she doesn't yell at residents, but she talks loudly. When asked who, CNA F stated, Charge RN. CNA F was asked if they have any concerns about abuse and neglect in the facility at this time and CNA F replied, not right now. Interview with Resident #13 on 7/19/2023 at 10:32AM: Resident #13 was asked what occurred before, during and immediately after the incident and Resident #13 stated Charge RN was in there yelling at Resident #29 like always. All of the employees know. Charge RN told her to quit her damn yelling. Charge RN looks mean, she's intimidating. Very stern. When she goes past the line, I can recognize it. When asked what the tone of the perpetrator was Resident #13 replied she was ugly and horrible. When asked if they think retaliation has occurred, Resident #13 stated not that I know of. They take Resident #29 to her room to eat now. Its better now because of that. As for me, I've been getting some looks from some nurses. Nurse glares at me all the time. One of them ignored me when I tried to speak to her. Resident #13 was asked if this was reported to who and when, and Resident #13 stated to Admin, the administrator. I've gone to her before about issues that have happened, she just says that she knows, and she'll take care of it. When asked how the resident and the perpetrator interacted before and after the incident, Resident #13 stated just yelling like always since she got here and always at Resident #29. After- she's just a weekend nurse so she's only here 2 days a week. She doesn't interact with me at all now. Not everyone is Charge RN's favorite. On the weekend we all stay in our rooms, so we don't make her mad. Resident #13 was asked if the perpetrator exhibited inappropriate behaviors to the resident or other residents in the past such as derogatory language, rough (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 11 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some handling or ignoring residents while giving care and Resident #13 stated no, no one else, just Resident #29. In an Interview on 7/19/2023 at 10:42AM with family member of Resident #13: Family member was asked while here have they seen any concerns about abuse and neglect and the family member of Resident #13 stated Resident #13 has had issues with Charge RN because of how she talks to the residents. She (Charge RN) just rubs people the wrong way. In an Interview on 7/19/2023 at 10:58AM with Charge LVN was asked when they see abuse and neglect who do they report it to and how soon do they report it and Charge LVN replied Admin and immediately. Charge LVN was asked how they watch the staff to ensure they are caring for residents and Charge LVN stated I watch them providing care at times. When asked if they seen staff yell at residents before, Charge LVN stated Charge RN, but she's just loud, I wouldn't consider it abuse, it's almost like she's hard of hearing. When asked if they have any concerns about abuse and neglect in the facility at this time, Charge LVN replied no. Interview with Resident #26 on 7/19/2023 at 11:05AM: Resident #26 was asked if they like it here and Resident #26 replied it's alright. When asked if staff treat them with dignity and respect, Resident #26 stated mostly. Resident #26 was asked if they ever see staff yell at residents and Resident #26 replied they yell at Resident #29, it happens all the time, Resident #29 yells at people and staff yells back. When asked what the tone of the staff when they yell, Resident #26 stated I don't think it's in a mean or rude way. When asked if they have a problem or concern, who would they talk to, Resident #26 stated well the staff I would guess. Resident #26 asked if they feel comfortable going to staff to talk to them about your concerns and Resident #26 replied not extremely and said, well I don't want to get yelled at. Resident stated that they are familiar with Charge RN and when asked if they see her yell at residents Resident #26 responded sure, she yells at people. Staff and residents, mostly Resident #29. When asked if they are afraid of her, Resident #26 replied it's impossible not to be, she has a voice that says I'm right. Interview with Resident #5 on 7/19/2023 at 12:13PM: Resident #5 was asked if they see interactions between their roommate Resident #29 and staff and Resident #5 stated all the time. When asked how staff treat Resident #29, Resident #5 replied Charge RN yells at her and gets tough with her, but Resident #29 just takes it. Resident #5 stated it makes me feel bad for her. When asked if they have seen staff yell at any other residents, Resident #5 stated no. Interview with Resident #3 on 7/19/2023 at 12:20PM: Resident #3 was asked how they like living there and Resident #3 replied I like it here. When asked if the staff treat them with dignity and respect, Resident #3 stated yes they treat me good, but not everyone is treated well and it only happens on the weekends with Charge RN. When asked if they have seen it happen, Resident #3 replied yes, I've seen her yell at Resident #29, I've seen her yell at staff and stated, sometimes I'm afraid of Charge RN. When asked if they are afraid of retaliation Resident #3 stated yes I am. Resident #3 stated she's verbally abusive and it goes on all the time. When asked if this has been reported to staff, Resident #3 replied lots of people have, everyone knows about it, I don't think they'll ever do anything about it. When asked how the weekend is at the facility, Resident #3 stated I try to stay out of their way or stay in my room. In an Interview on 7/19/2023 at 12:33PM with Resident #15: When asked if they have any concerns about abuse and neglect in the facility right now, Resident #15 replied I don't like how some of the staff holler at the residents. Resident #15 stated Charge RN, she gets mad at Resident #19 or Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 12 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some #29 and yells at them. When asked if they are afraid of Charge RN, Resident #15 replied I'm not afraid of her, I'll stand up for myself but I'm afraid if I say something they'll take it out on me. Charge RN yells at people that can't help themselves and that's not right. When asked how the weekend is at the facility, Resident #15 stated I stay in my room, so I don't get yelled at or caught up in it. Interview with Resident #14 on 7/19/2023 at 12:41PM: When asked if they could describe the incident that happened between Resident #29 and RN Charge RN in the dining room earlier this month, Resident #14 stated I was there. Charge RN kept yelling the louder Resident #29 got. It happens a lot. When asked if they have any concerns about abuse and neglect in the facility at this time, Resident #14 responded no concerns, just Charge RN and Resident #29. When asked if they are afraid of Charge RN, Resident #14 stated no I'm not. When asked if they are afraid of retaliation if they were to tell someone, Resident #14 stated well there's no one to tell because everyone see is, but no I'm not afraid of retaliation. Charge RN just isn't using any common sense, she's mean. When asked how the weekend is at the facility, Resident #14 stated it's ok. In an Interview on 7/19/2023 at 12:49PM with CNA B stated, Charge RN yells at Resident #29 only, it happens often. When asked what they think the tone of Charge RN is when this happens, CNA B responded, it's aggressive, it makes the other residents uncomfortable. Interview with Resident #29 on 7/19/2023 at 12:54PM: When asked if they remember the incident, Resident #29 stated not really. When asked if they like it here, Resident #29 stated it's ok. Resident #29 was asked if the staff treat them with dignity and respect and Resident #29 replied I guess so. When asked how Charge RN treat them, Resident #29 replied sometimes she yells but that's just Charge RN doing her thing. When asked how that makes them feel, Resident #29 responded sometimes bad or sad. When asked if they are afraid of Charge RN, Resident #29 replied I'm not afraid of her, she's a good nurse. Resident #29 was asked if they feel safe here and Resident #29 stated yeah. When asked if they remember if there have been past occurrences like this, Resident #29 replied no I don't. In an interview on 7/19/2023 at 1:01PM DON: DON was asked to describe the incident that occurred on 7/9/2023 and DON stated, Charge RN called me when it happened and told me that another resident was yelling 'abuse, abuse', so she called me to tell me that I needed to come and relieve her. When asked if the resident/perpetrator exhibited any behaviors that would provoke one another and if so, what actions were being taken to address this, DON stated no, but we interviewed Charge RN and issued her an EDR, it's like a write up. When asked if the perpetrator exhibited inappropriate behaviors to the resident or other residents in the past such as derogatory language, rough handling or ignoring residents while giving care, DON stated no. When asked if DON did a psychosocial assessment on all the residents the DON replied, only Resident #29. When asked if they were aware that some of the residents are afraid of Charge RN, DON replied no, I did not know that. In an interview on 7/19/2023 at 1:06PM Admin: When asked how long Charge RN was suspended, Admin stated she was suspended on Sunday and was allowed to come back on Tuesday, but she only works on the weekends. When asked how long the investigation lasted, Admin stated 2 days on Sunday and Monday. Admin was asked to describe the incident and Admin replied Resident #29 yells a lot and Charge RN was trying to tell her not to yell. You do have to raise your voice when talking to Resident #29. Charge RN is loud, and Resident #13 felt like the situation was out of hand. When asked if there were discrepancies and how this was investigated, Admin stated there were, yes. I went and spoke with each of them and none of them had the same story. Resident #13 has a thing against Charge RN. When asked did the resident/perpetrator exhibit any behaviors that would provoke one another and if so, what (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 13 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some actions were being taken to address this, the Admin responded yes. I counseled with Charge RN and explained to her to tone it down. Admin was asked if the perpetrator exhibited inappropriate behaviors to the resident or other residents in the past such as derogatory language, rough handling or ignoring residents while giving care and Admin responded no. When asked if annual performance reviews identified issues with the provision of care, treatment or other concerns the Admin stated Charge RN's always been this way. I constantly tell her to be quiet. When asked what the result of your investigation was, Admin stated my result was she was not abusive. She was just trying to make the resident understand. Admin was asked if their previous warnings or incidents at the facility and Admin replied, yes it was between Resident #13 and about Charge RN yelling. When asked if they came up to the facility on the weekends to check in on Charge RN to see how she was doing after the incident the Admin stated, no I did not. When asked how they assure retaliation does not occur when a staff or resident reports an allegation of abuse the Admin stated, I go visit with the residents and assure them that door is always open. Admin was asked if anyone talked to all of the residents and the Admin responded no, we did not. When asked if they were aware that some of the residents are afraid of Charge RN, Admin responded no I was not aware of that. We did have a mention in our full book survey that the residents were afraid of retaliation, but we talked to the residents and did in-services with staff. Admin as asked what the EDR done for on Charge RN and Admin stated, it was for the incident about her voice and demeaner on that day. When asked if it was for the incident on 7/9/23 the Admin stated yes. Interview on 7/19/2023 at 1:31PM with Admin stated: When asked what they are doing on the weekends to ensure that the situation with Charge RN is no longer happening, the Admin replied I talked with Charge RN and let Residents know to come talk to me. When asked if the Admin has been up there on the weekends the Admin replied no. Interview on 7/19/2023 at 1:50PM with CNA : When asked if they have seen staff yell at residents before CNA B stated yes, all the time and Charge RN yells at Resident #29 all the time. She is loud but there's a difference between yelling at residents and being loud. When asked if they have intervened when they saw this happen, CNA B stated yes, I have, and we've had words about it. I'm very vocal with how she treats Resident #29. Interview on 7/19/2023 at 1:55PM with Admin: When asked on the EDR that was given to Charge RN on 7/12/2023 shows that there are 2 write ups in the last 12 months, Admin responded Oh no, there's no other write ups, that was a mistake, I had used a template to do that and forgo to erase it. When asked what the Admin did about the grievance filed on 5/29/2023 about Charge RN, Admin stated I counseled with her on her demeaner and voice tones. When asked if there were any other investigations about Charge RN the Admin stated no, I always talked to her about her voice and her demeanor with the residents. When asked if the Admin felt like they conducted an effective investigation of this incident on 7/9/2023, Admin stated I know she's a good nurse, she's good to the patients, she takes care of the residents. I don't see her as being abusive, but I know it comes across that way. Admin was asked why Charge RN is still employed, the Admin responded, I don't believe she's abusive. Admin was asked how they know that and Admin stated, Well I asked the residents. When asked if they understand that if the residents are afraid do they think they would be honest and Admin stated, they know Charge RN, but I didn't know anyone was afraid of her. Interview on 7/19/2023 at 2:14PM with Charge RN: Charge RN described the incident and stated I was at the nurse station charting, Resident #29 she was yelling for me at the top of her lungs as I was going down the hall. Resident #29 didn't have her hearing aids. I told her to stop yelling. When asked how they usually respond to the Residents behaviors requests for assistance, Charge RN stated I (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 14 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some usually do it right away. I was caring for another Resident at the time. I tried to tell her that I would be back. Charge RN was asked to describe what contact they have with Resident #29 since the investigation and Charge RN replied I worked last weekend with her. When asked what type of training Charge RN had related to abuse and neglect they have received and Charge RN replied we had in-services about it and who to contact. Charge RN stated during the incident that there was a Resident yelling abuse going down the hall so I called the DON to relieve me and she called the Admin. When asked if they have any other information they wish to share in regards to the investigation, Charge RN stated Resident #29 is very hard of hearing. I wasn't being ugly to her. The kitchen supervisor was right there cleaning tables when it happened. Interview on 7/19/2023 at 2:25PM with LVN D: When asked if they have worked with RN Charge RN on the weekends, LVN D stated yes. When asked how Charge RN interacts with residents, LVN D replied I've known her a long time, we work together on Saturdays. She comes off very gruff and she's just loud. I don't think that she means harm or is bad. She just doesn't have any tone control. She's not mean spirited, she just doesn't have elderly gloves and she needs restraint. Interview on 7/19/2023 at 2:39PM with LVN A: When asked if they have worked with RN Charge RN on the weekends, LVN A stated yes. When asked how Charge RN interacts with residents, LVN A stated, I've heard more complains than what I've seen, the main thing is she's just loud, nothing physical. LVN A stated, she's loud and residents don't like it. Interview on 7/19/2023 at 2:47PM with LVN I: When asked if they have worked with RN Charge RN on the weekends, LVN I stated, I'm coming in as she's leaving. When asked how Charge RN interacts with residents, LVN I replied, I haven't seen any interactions, I haven't heard any complaints from the residents. When asked if they have any concerns about abuse and neglect in the facility at this time, LVN I stated I haven't seen anything, I've just heard stuff. I've heard that Charge RN yelled at a few resident, Resident #13 on the other side of the hall, other than that I heard she's always yelling back and forth with Resident #29. Interview on 7/19/2023 at 2:37PM with LVN J: When asked if they have worked with RN Charge RN on the weekends, LVN J responded, yes I do sometimes. When asked how Charge RN interacts with residents, LVN J stated, she's mean, and she yells at them. When asked if they have any concerns about abuse and neglect in the facility at this time, LVN J stated, just that but everyone knows about it, and they don't do anything about it. Interview on 7/19/2023 at 2:50PM with CNA G: When asked if they have seen any staff yell at residents, CNA G replied, Charge RN, yes she has and she has a rude attitude and a loud voice with residents. When asked if they have ever reported it, CNA G stated, well the residents haven't complained to me. When asked if they have seen Charge RN yell at residents, CNA G stated, I haven't seen it, but I always hear her. When asked if they have any concerns about abuse and neglect in the facility at this time, CNA G replied yes, it's degrading for the residents. This is their home. In an interview on 7/21/2023 at 11:31AM Admin: Admin was asked if there are other investigations on Charge RN and Admin stated, there are no other investigations, what's in her file is what I have. When asked if their investigation prevented further abuse, neglect or mistreatment of the resident, Admin replied well, yes because when I did interviews and tried to find out more information, I didn't get the same answers that you guys got. When asked if they felt that the investigation was adequate the Admin stated, yes I do. The Admin was asked if they think that they took appropriate corrective action as a result of the findings and Admin stated yes, I think I did. If I would have got (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 15 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some different information, I would have done it differently. When asked if they interviewed other residents to ask them how the yelling/verbal abuse made them feel the Admin responded no. Admin was asked if they monitored Resident #29 and other residents at risk such as conducting unannounced management visits at different times and shifts and Admin replied Yeah, me and DON come in at different times, DON is good at popping up. When asked if on the weekends did the Admin specifically come in to monitor Charge RN's interactions with residents the Admin stated no, I did not come in to observe her. Admin was asked what actions were taken to protect the residents and the Admin replied, well we did the plan of removal after. Admin was asked if they felt that the facility's ANE policies and procedures are implemented well within the staff and the Admin replied they are now, but before it's hard to say really. I don't know. Admin was asked if they are conducting ongoing oversight and supervision of staff to assure that the ANE policies and procedures are implemented as written and Admin responded, I am now yes. When asked if they feel that the staff is able to identify, correct and intervene in situations in which abuse, neglect and exploitation is more likely to occur and the Admin stated now, yes. Record Review of staff in-services indicate that Charge RN was in-serviced on Abuse and Neglect on the following dates: 6/14/2023, 7/7/2023, and 7/19/2023. Record Review of staff in-services indicate that Charge RN was in-serviced on Resident Rights on 7/10/2023. Record review of facility's Grievance Log shows a grievance filed on 5/30/2023 by Resident #13 describes the incident as follows: Charge RN yells at Residents causing Resident #13 to feel uncomfortable. Resident #13 feels Charge RN yells at her and others. The Disposition of Complaint states: talk to RN about her loud voice dealing with Residents. The findings of the incident as follows: Charge RN has a very loud demeanor when dealing with anyone or anything. The Recommendations/Corrective Action states: Counsel with Charge RN on her demeanor and voice tones. Record Review of Facility Grievance Investigation Report dated 5/30/2023 shows a written statement as follows: Resident #13 states they feel like Charge RN verbal abusive to her and the other Residents. Resident #13 states that Charge RN yells at other Residents and makes them feel uncomfortable. Resident #13 states that Charge RN yelled at them for going into the dining room for smoke break and Charge RN yelled at them stating they were in the dining room too early for smoke break. Resident #13 states that sometimes in the dining room Charge RN is so loud that it makes them uncomfortable so they go back to their room. Record Review of Facility Notice of Disciplinary Action for Charge RN is dated 10/13/2022 is detailed as follows: Arguing with Resident in a non-professional manner in a loud tone. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from DON that states: Charge RN was in lobby and Resident #29 was yelling out at staff to come here. Charge RN went over to Resident and told them to stop yelling and Resident #29 told Charge RN that she was not their boss and to not tell them what to do. Charge RN continued to argue with Resident about this but I was talking to someone else at the time and didn't hear the whole conversation. MDS LVN stepped out of their office and told Charge RN to walk away and they did so. After Charge RN got back to their office, Resident #29 then yelled at Charge RN to come back over there. Charge RN did not do so. Earlier in the shift I was asking Resident #29 to stop yelling out and at the same time Charge RN came over and interrupted me to tell Resident #29 the same thing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 16 of 17 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 675534 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wheeler Nursing & Rehabilitation 1000 S Kiowa St Wheeler, TX 79096 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from Bus Office that states: This is what I heard but did not see from my office. Resident #29 was in the living area, requesting different things from everyone in a loud tone. Charge RN went up to Resident #29 and in their very loud voice tone told them that they needed to stop yelling and that someone would get to them. I'm not sure if Resident #29 told Charge RN she was not her boss, but Charge RN told Resident #29 you are not by boss, that they worked at the nursing home and cared for them. I then heard MDS LVN tell Charge RN to walk away. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from MDS LVN that states: Charge RN was working 6-2 as RN coverage. Resident #29 was in the lobby after breakfast, and they were wanting to go to bed. Charge RN was yelling at her tell her she had to stay up for 30 min. Charge RN kept arguing with Resident #29. DON told them that the yelling needs to stop and that they couldn't handle it anymore. Resident #33 was getting anxious and restless because of all the yelling. At lunch Resident #29 yelled for me to come there. Charge RN said just keep walking. I did ask them what they needed, and they wanted me to move Resident #17 to their table. I told them to give me a minute and I will. About 10 minutes later, Resident #29 was yelling for LVN G and Charge RN told them to keep going. LVN K did not listen, and Resident #29 wanted a pain pill. LVN G gave her the medicine. After lunch, Resident #29 told Charge RN to come here. Resident #29 wanted to be laid down. Charge RN told her that she had to wait 30 minutes. Resident #29 told Charge RN something I could not hear. Charge RN leaned over the table and to tell Resident #29 you are not by boss. Resident #29 said loudly I am your boss. Charge RN said no you are not my boss and you will not talk to me that way. I immediately got out of my chair and told Charge RN that they needed to walk away. Charge RN went to walk away, and Resident #29 was asking them something and Charge RN put her hand in the air and walked to the middle office up front. Record Review of Facility Notice of Disciplinary Action dated 10/13/2022 includes a witness statement from LVN G that states: I LVN G was working as a LVN at [facility] on 10/13/22. My RN supervisor was Charge RN. Charge RN has really stern assertive voice and sometimes yells a lot. On this particular day Charge RN was on a roll, Resident #29 was in the dining room yelling at me as I went to walk by them and Charge RN yelled at me and told me to keep walking however I stopped to see what they wanted and they asked me for Tylenol. So I went and got them medication. Then in about 30-45 minutes later Resident #29 was in the lobby and just sitting there in a wheelchair and they yelled at me again. I was at the computer doing my charting and I told Resident #29 it would be just a minute. I could visibly see that Resident #29 was not in any harm where I was sitting and they just wanting to talk to me or ask me something. Charge RN heard her from a office and Charge RN stormed out of that office and yelled at Resident #29 saying what do you need. Resident #29 said she wants to lay down Charge RN told it would be 30 minutes then they said I need to talk to my nurse. Charge R said your nurse is busy what do you need? Resident #29 looked at Charge RN and said just go back to your office and leave me alone and Charge RN stormed closer to Resident #29 and said you are not my boss. Charge RN said yes I am your boss. You could tell in the tone of Charge RN voice that the statement Resident #29 made Charge RN rea[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675534 If continuation sheet Page 17 of 17