Health inspection·July 10, 2023

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 07/08/2023 at 7:20 a.m., the Administrator said the previous food service manager quit on him, due to burn out and the quality was not good. The Administrator said he had several staff members walk out on him. The Administrator said he hired new dietary manager who had been working about two weeks. The Administrator stated there are great challenges with dietary services and he was prioritizing on improvements in dietary services. The Administrator said his expectations would be dietary services would have menus and follow the menus when preparing meals. During an interview on 07/10/2023 at 10:46 a.m., the Dietary Manager said he had been working in his current position for about two weeks. The Dietary Manager said he was aware there are meal quality issues that he was working on. He said prior dietary services staff walked out on the facility and that he had to come in a week earlier than his hire date to help prepare meals. The Dietary Manager said he started with two left over staff and himself and now was staffed with eight. He said the previous dietary services staff most likely took the menu with them, so he was preparing and serving meals based on his previous nursing facility experience. He said he did have all the facility resident diet orders, recipe book, and allergies list but did not have a menu to follow. He said he used food items that he found at the facility to prepare meals. During a telephone interview on 07/10/2023 at 1:40 p.m., the Dietician said she had been the facility dietician for about seven years. She said the facility menus come from the distributor and are already planned. She said she had some concerns of the adjustment of the new dietary manager transitioning into the role. She said she visited the facility weekly and had received one complaint about food being served cold. Review of facility Nutrition Services Policies and Procedures: Food Preparation dated 06/2019, reads in part, the cook is responsible for food preparation. Menu items are prepared according to production count sheet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 2 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 provide residents with food and drink that was palatable, attractive, and at a safe and appetizing temperature for four of eight residents (Residents #1, #2, #3, and #10) reviewed for palatable food, in that: Residents Affected - Some The facility failed to provide palatable food served at an appetizing temperature or taste to Resident #1, Resident #2, Resident #3, and Resident #10, who complained the food was served cold and/or did not taste good. This failure could place residents at risk of decreased food intake, weight loss, altered nutritional status, and a diminished quality of life. Findings included: Resident #1 Record review of Resident #1's face sheet dated 07/10/2023, revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Resident# 1's diagnoses included dysphagia (difficulty or discomfort in swallowing), protein-calorie malnutrition (state of inadequate intake of food), and gastro-esophageal reflux disease (occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach). Record review of Resident #1's quarterly MDS dated [DATE], revealed Resident #1 with BIMS score of 12 indicating moderate cognitive impairment. Record review of Resident #1's orders dated 07/10/2023 revealed resident on a regular diet, mechanical soft texture, regular/thin consistency. During an interview on 07/07/2023 at 2:15 p.m., Resident #1 said that there have been several times that the food he received was cold. He said sometimes the food was good with flavor and sometimes it was not. Resident #2 Record review of Resident #2's face sheet dated 07/10/2023, revealed an [AGE] year-old female who was admitted to the facility on [DATE] and originally admitted on [DATE]. Resident 2's diagnoses included chronic kidney disease (longstanding disease of the kidneys leading to renal failure), deficiency of other vitamins, gastro-esophageal reflux (occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach), and protein-calorie malnutrition (state of inadequate intake of food). Record review of Resident #2's quarterly MDS dated [DATE], revealed Resident #2 with BIMS score of 14 indicating the resident is intact cognitively. Record review of Resident #2's orders dated 07/10/2023 revealed resident on a regular diet with regular texture, thin liquids consistency. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 3 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 0804 Level of Harm - Minimal harm or potential for actual harm During an interview on 07/07/2023 at 2:36 p.m., Resident #2 said the food served at the facility is not good. She said she has been at the facility for about nine years and has seen a decrease in the quality of food served. She said she the food lack flavor and is often served cold. She said the food is worse on the weekends and usually served cold. Residents Affected - Some Resident #3 Record review of Resident #3's face sheet dated 07/10/2023, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Resident 3's diagnoses included type-2 diabetes mellitus (body does not use insulin properly), protein-calorie malnutrition (state of inadequate intake of food), and gastro-esophageal reflux (occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach). Record review of Resident #3's quarterly MDS dated [DATE], revealed Resident #3 with BIMS score of 15 indicating the resident is intact cognitively. Record review of Resident #3's orders dated 07/10/2023 revealed resident on a CCD NAS (carbohydrate controlled) diet, mechanical soft texture, regular/thin consistency, no concentrated sweets /double portions related to unspecified protein-calorie malnutrition. During an interview on 07/07/2023 at 12:20 p.m., Resident #3 said the food lacks flavor and it seems that foods are not seasoned. He said he is not provided any seasonings for his food. Resident #3 said that portions are small and often had to ask for seconds, which he does receive. Resident #3 said there have been times his hot meals are served cold for an unknown reason. Resident #10 Record review of Resident #10's face sheet dated 07/10/2023, revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Resident 10's diagnoses included dysphagia (difficulty or discomfort in swallowing). Record review of Resident #10's quarterly MDS dated [DATE], revealed Resident #10 with BIMS score of 11 indicating moderate cognitive impairment. Record review of Resident #10's orders dated 07/10/2023 revealed resident on regular diet, regular texture, clear liquids consistency. During an interview on 07/07/2023 at 2:06 p.m., Resident #10 said that her food is often served cold. She said she believes it is served cold because of construction going on at the campus and the distance the food had to travel to get to the residential building. She said she received cold noodles last night for dinner and at times uncooked vegetables that are cold. She said there is no flavor to the food and portion sizes have decreased. She said she had not received salt or pepper with her food tray. She said she noticed the quality of the food served had gone down in the last month or so. She said that she can request more food and/or substitutes which she does receive but the problem is the food is not palatable. Observation and interview on 07/08/2023 from 6:55 a.m. to 8:15 a.m., revealed breakfast food items were prepared without a menu. Scrambled eggs with chopped tomatoes and peppers were prepared without any seasoning. Food temperatures were taken while food was placed in a steaming table. Pancakes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 4 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some were served and no syrup included for pancakes. Trays placed in the food cart individually with some plates had plate warmers others did not. [NAME] G said they use as many plates warmer as available but only have approximately forty working warmers for over 60 plates. Observed [NAME] G pull ed a beverage cart and pushed the food tray cart out of the kitchen building and down a sidewalk leading to the residential building. The building was located approximately a block away from the kitchen. During the transport, one food tray at the bottom fell out of the cart while going over tiled sidewalk area delaying the transport. It took approximately 18 minutes for plates to arrive at residential floor from the kitchen, and approximately five minutes for the plates to be served to residents. During an interview on 07/08/2023 at 7:05 a.m., the Administrator said he has been at the facility for less than two months and has experienced several challenges with dietary services. He said the previous food service manager quit on him. He said he had received complaints from residents regarding food service quality. He said there have been several dietary service staff members who had walked out of the job. He said he recently hired a new Dietary Manager who had to come in and immediately start preparing meals with only two other staff members. He said in the last few weeks he has hired kitchen staff to help with dietary services. He said the new Dietary Manager has identified issues in the kitchen that need to be addressed. He said there are still areas where they need improvement such as in serving food that is appetizing and they are working to improve the quality of services. During an observation on 07/08/2023 at 7:45 a.m., a test tray was sampled by State Surveyor. The eggs were bland with no condiments available, and the pancake was dry without syrup. The food was warm but not hot. During an interview on 7/10/2023 at 10:46 a.m., the Dietary Manager said he had received reports of residents being served cold food. The Dietary Manager said that food is prepared in the kitchen and food temperatures are taken and recorded. He said food is placed in the food steaming line and temperatures are taken right before serving the plates. The Dietary Manager said that he started about two weeks ago and learned that several of the plate warmers at the facility were not working. He said approximately forty plate warmers are working but at least thirty more are needed. He said the reason plate warmers are needed is because the facility dietary staff must prepare the food in the kitchen located about a block away from the residential building, and then carefully transport the food down a walkway with some bumps and cracks in the sidewalk to deliver the food. He said that the process of delivering the food can be time consuming and understand why some residents would say their food is cold when it is served. The Dietary Manager said he is in the process of trying to get new equipment to help alleviate the issue related to the duration it takes for the food to be transported warm and being served at an appetizing temperature for the residents. The Dietary Manager said condiments should be part of resident trays served and would follow-up to see where the breakdown is occurring. Review of facility policy Nutrition Services Policies and Procedures: Food Preparation and Safe Food Temperatures dated 06/2019, reads in part Food will be prepared and attractively served using methods that conserve nutritive value, flavor, and appearance. Season the foods served to those on regular diets appropriately according to each recipe. Safe Food Temperatures: It is the policy of this facility that food temperatures will be maintained at acceptable levels during food storage, preparation, holding, serving, delivery, cooling, and reheating. Monitor food temperatures at point of service to the patient/resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 5 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 - Some 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 professional standards for food service safety in that: - Temperature logs for refrigerator and freezers were not updated (had June 2023 information). - Dirty vents noted in dishwashing area. - 1 stalk of wilted celery found in walk-in refrigerator that was loosely wrapped in a plastic wrap and not sealed or labeled. - 1 gallon size bag of chopped lettuce that appeared brown in the walk-in refrigerator with best used by date of 6/23/2023. - 1 green bell pepper that appeared to be cut open sitting on a shelf in the walk-in refrigerator that was not sealed or labeled. These failures could place residents at risk of food-borne illness. Findings included: Observation of kitchen area on 07/07/2023 at 3:00 p.m., kitchen dishwashing area with vents that had dust and debris. Vents were located over the area where dishes are stored. Observation of area outside of walk-in refrigerator and walk-in freezer on 07/07/2023 at 3:05 p.m., revealed temperature logs on posted clipboards with information from June 2023. Observation of walk-in refrigerator on 07/07/2023 at 3:08 p.m., revealed a stalk of celery on top shelf that was loosely wrapped in a plastic wrap with exposed ends. The celery appeared to be wilted. The celery was not labeled with a date. Observed a gallon sized bag of chopped lettuce that appeared to have brownish lettuce. The bag was sealed and read best used by date of 6/23/2023. Observed one green bell pepper on the top shelf that appeared to have been cut into. The bell pepper was outside of its original container and was not packaged, sealed, or dated. During an interview on 07/07/2023 at 3:15 p.m., the Dietary Manager said there were several items in the walk-in refrigerator that should have been thrown out including the celery, bell pepper, and bag of brownish lettuce. The Dietary Manager said he had been working at the facility for about two weeks and when he first started, he had to throw out several food items that were expired. He said he was aware there are meal quality issues that he was working on. He said there should have been current refrigerator and freezer temperature logs on the clipboards located outside of the freezer and refrigerator. He said he was responsible to ensure logs are posted and current. He said he had been working on reorganizing inventory and ordering the correct food items needed for meals. He said the risk of food items not being labeled was residents could get sick from food borne illness. He said the risk of not keeping a temperature log for the refrigerator and freezer was not maintaining correct temperature for food to be fresh and safe. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 6 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Review of facility policy Nutrition Services Policies and Procedures: Safe Food Temperatures, undated, reads in part It is the policy of this facility that food temperatures will be maintained at acceptable levels during food storage, preparation, holding, serving, delivery, cooling, and reheating. Review of facility policy Nutrition Services Policies and Procedures: Food Safety in Receiving and Storage dated 8/12/2019, reads in part It is the policy of this facility that food will be received and stored by methods to minimize contamination ad bacterial growth. General Food Storage Guidelines: store food in its original packaging as long as the packaging is clean, dry, and intact. Place food that is repackaged in a leak-proof, pest-proof, non-absorbent, sanitary container with a tight-fitting lid. Label both the container and its lid with the common name of the contents and the date it was transferred to the new container. Check and record refrigerator temperatures at least 2 times per day. Refrigerated, ready to eat Time/Temperature Control for Safety Foods are properly covered, labeled, dated with a use-by date and refrigerated immediately. Event ID: Facility ID: 675723 If continuation sheet Page 7 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for one kitchen, one hallway, and two bedrooms (rooms #214 and #249) reviewed for environment, in that: -Kitchen with an approximate 8-foot hole in the ceiling between cooking area and serving line. Noted water slow drip on floor where staff walk by. -There was a large roach observed room running in resident occupied room [ROOM NUMBER]. -Approximately 2-foot area of blistering paint due to water damage on wall leading into 1st floor South wing. -Resident occupied room [ROOM NUMBER] had a portable air conditioning unit hose attached to a window panel with duct tape. These failures could place residents and staff at risk of living or working in an unsafe, unsanitary, and uncomfortable environment Findings include: Observation on 07/07/2023 at 12:15 p.m., first floor wall above bulletin board leading into South hallway had areas of blistering paint, two approximately two feet long due to apparent water damage. Observation on 07/07/2023 at 3:00 p.m., the kitchen area had an approximately 8-foot opening in the ceiling with exposed pipes located between the food preparation area and the food serving line. Drops of water noted falling to the tiled floor in an area where staff walk through. Observation on 07/10/2023 at 8:30 a.m., a large roach ran in room [ROOM NUMBER] from the closet and under a resident bed. Resident was not in the room at the time of the observation. Observation on 07/10/2023 at 8:45 a.m., room [ROOM NUMBER] portable air conditioning unit hose was attached to a window panel with duct tape. During an interview on 07/10/2023 at 10:22 a.m., the Director of Support Services (DSS) said he had been working at the facility for about a week and half with start date of 6/30/23. The DSS said he was the only maintenance person at the facility. He said he had repaired several water leak damage issues on the second floor. He said the blistering paint issue noted on the wall above the bulletin board on the first floor was from water condensation coming from the air conditioning units. He said each room had an individual air conditioning unit and two rooms are having trouble with their units right now. He said room [ROOM NUMBER] was one of the rooms that was occupied. He said a portable air conditioning unit was placed in the room to keep it cool. He said he believed the resident's family member duct taped the window panel with the hose attached to the portable unit to hold it in place. He said he was going to work on that room today as part of his duties. He said he was made aware of maintenance issues at the facility through work orders. He said he was aware of several areas that need work especially in the kitchen. He said he was getting a contractor to come and work on things (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 8 of 9 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 675723 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Nazareth Living Care Center 1475 Raynolds St El Paso, TX 79903 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 0921 Level of Harm - Minimal harm or potential for actual harm that would take longer than an hour to fix. He said pest control comes every two weeks to address any problem areas. Record review on 07/10/2023 at 10:45 a.m., revealed pest control binder on floors one and two. Last entry shows that pest control visited the facility on 07/05/2023 due to reported roaches. Residents Affected - Some During an interview on 07/10/2023 at 11:30 a.m., the Administrator said he had just hired the Director of Support Services as the facility had been without a maintenance worker since the Administrator started on 05/23/2023. He said the DSS had addressed several maintenance issues since starting. The Administrator said the facility procedure when there was a maintenance issue, was for staff to place a work order in a binder located on each floor of the facility. He said the DSS then reviewed the work orders daily and repairs. Review of facility provided Work Order Policy undated, reads in part a binder is placed at nursing station with work orders. The facility Director of Support Services reviews work orders daily for repairs and maintenance. The facility Director of Support signs work orders after repairs have been made and places back in the Maintenance work order book. The facility Support Services Director reviews work orders daily during the facility morning start-up meetings. On 07/10/2023 at 1:45 p.m., the Administrator said he was not able to locate any other facility maintenance policies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675723 If continuation sheet Page 9 of 9