Inspection·July 21, 2022

F 0607 Record review of AD G's EMR/NAR, dated 07/19/22, revealed no results found. Level of Harm - Minimal harm or potential for actual harm 2. Record review of the staff roster, dated 07/19/22, revealed LVN C's hire date was on 2/24/17. Record review of LVN C's employee file revealed no evidence of an EMR/NAR check within the last year. Residents Affected - Some Record review of LVN C's EMR/NAR, dated 07/20/22, revealed no results found. 3. Record review of the staff roster, dated 07/19/22, revealed LPN D's, hire date was on 07/1/15. Record review of LPN D's employee file revealed no evidence of an EMR/NAR check within the last year. Record review of LPN D's EMR/NAR, dated 07/19/22, revealed no results found. 4. Record review of the staff roster, dated 07/19/22, revealed the DON's hire date was on 02/14/03. Record review of the DON's employee file revealed no evidence of an EMR/NAR check within the last year. Record review of the DON's EMR/NAR, dated 11/17/21, revealed no results found. During an interview on 07/20/22 at 4:55 p.m., BOM H confirmed she had done the EMR/NAR searches for listed staff, AD G, LVN C, LPN D, DON prior to 07/19/22, which was after the state surveyor's initial inquiry for those specific staff members. BOM H stated she was unaware of the EMR/NAR. She stated she came from home health and she did not have to run EMR/NAR checks. BOM H stated she had no clue what the EMR/NAR was until it was asked for during the survey. BOM H stated she was unaware the EMR/NAR had to be done upon hire and yearly thereafter. BOM H stated the facility went months without having a BOM, and she was never trained on the EMR/NAR, employed since 6/28/21 as the BOM. Bom H stated the Regional HR performs all the criminal check and license checks which I had observed for the license staff. BOM H stated she was already working on a spread sheet to keep track of hire dates and EMR/NARs that would need to be done after the surveyor asked her for the EMR/NAR. BOM H stated the risk of not running an EMR/NAR check could put the residents at risk due to an employee being hired that could hurt the resident; they would not know if they were unemployable. During an interview on 07/21/22 at 2:46 p.m., the Administrator stated he thought the EMR/NAR checks had already been completed for all staff and was unaware the checks were not previously done for AD G, LVN C, LPN D, DON. The Administrator stated BOM H, and Regional HR was responsible for making sure the checks were done for all staff. The Administrator stated he should know that, but he didn't. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675614 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675614 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ballinger Healthcare and Rehabilitation Center 2001 6th St Ballinger, TX 76821 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 4 (Resident #19) residents reviewed for indwelling catheters. The facility failed to ensure Resident #19's indwelling catheter was secured to prevent pulling or tugging. The failure could place residents at risk for discomfort, urethral trauma and urinary tract infections. Findings included: Record review of Resident #19's admission record dated 07/21/2022, indicated he was admitted to the facility on [DATE] with diagnosis of neuromuscular dysfunction of the bladder (neuromuscular dysfunction of the bladder is a condition that occurs when either nerves or the brain cannot communicate effectively with the muscles in the bladder). He was [AGE] years of age. Record review of Resident #19's MDS dated [DATE] indicated in part: Brief Interview Mental Status was a 15 indicating the resident was cognitively intact. His urinary incontinence was not rated and the resident had a catheter. Record review of Resident #19's care plan dated 03/18/2022 indicated in part: Focus: At risk for complications related to Indwelling Urinary Catheter. Goal: The resident would have no complications from use of his indwelling catheter such as pain, infection, obstruction. Interventions: Check catheter tubing for proper drainage and positioning. Record review of Resident #19's physician's order report dated 07/21/2022 indicated in part: Catheter leg strap in place, every shift for urine retention. Start date 11/15/2021. During an observation and an interview on 07/21/22 at 09:55 AM revealed Resident #19 was in his bed, awake and alert. The resident's urinary catheter tubing was noted to be unsecured to his leg. The resident said the staff would at times secure it and at other times they would not. Resident #19 said he had a condition which caused him to have several bouts of loose stools and sometimes the catheter strap would get soiled, and the staff would remove it and not replace it. The resident said sometimes when he did not have it secured it would tug on his urethra and make it sore but not always. The resident said he would prefer for it to be secured if possible . During an interview on 07/21/22 at 02:12 PM CNA A said she had just placed a urinary catheter leg strap on Resident # 19's leg. She said she was not aware the resident did not have one and he was supposed to have one to prevent the catheter tubing from tugging. CNA A said if she noticed the resident did not have a leg strap, she would notify the nurse to get a strap for the resident . During an interview on 07/21/22 at 02:28 PM LVN B said it was all of the nursing staff's responsibility to make sure the residents that required a leg strap had one to prevent tugging of their urethras. LVN B said they would see that Resident #19 had a leg strap to secure his catheter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675614 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675614 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/21/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ballinger Healthcare and Rehabilitation Center 2001 6th St Ballinger, TX 76821 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 07/21/22 at 03:30 PM the DON said residents that required a leg strap to secure their catheter tubing were supposed to have one. The DON said if the residents did not have the leg strap it could lead to the catheter being dislodged. The DON said Resident #19 did not have a leg strap because it probably got soiled and the aides forgot to apply a clean one. The DON said it was the CNAs responsibility to report to the nurse if the resident was missing the strap and the nurse was supposed to check it every shift. During an interview on 07/21/22 at 03:36 PM the Administrator was made aware of the observation of Resident #19 without a catheter leg strap. The Administrator said it was the nursing staff's responsibility to make sure the residents had their catheters secured if they required one. The Administrator said it just got missed and they would see that the residents had one if they allowed them to place it on them as some would refuse to wear one or they would take it off. Record review of the facility's undated document titled urinary elimination provided by the DON indicated in part: Secure indwelling catheter with catheter strap or other securement device. Leave enough slack to allow leg movement. Attach securement device at tubing just above catheter bifurcation. Securing catheter reduces risk if urethral erosion, CAUTI (Catheter-Associated Urinary Tract Infections) or accidental catheter removal. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675614 If continuation sheet Page 4 of 4