Health inspection·May 26, 2022

F 0761 Level of Harm - Minimal harm or potential for actual harm toward the hallway), unlocked and unattended. Residents were observed coming to/from the dining room after the supper service. Two residents pointed out three wandering residents passing by. During an observation on 5/25/22 at 6:13 PM , MA A did something on the top of the medication cart and walked away leaving it unlocked. Residents Affected - Some During an interview on 05/26/22 at 11:44 AM the DON said the carts were supposed to be locked if the staff were not attending it. The DON said she conducted monitoring rounds to see that carts were locked if unattended. The DON said the nurses and CMAs were responsible to keep the carts locked if they were stepping away from them. The DON said if the carts were left unlocked then there was a possibility of residents, visitors or unauthorized staff having access to it. The DON said she was not sure how the failure occurred as she did not know the circumstances that led to the staff leaving the cart unlocked. During an interview on 05/26/22 at 12:14 PM the Administrator was made aware of the medication carts observed unlocked, unattended, out of view of staff and the discontinued controlled medications not secured by 2 locks in the DON's office. The Administrator said the discontinued controlled medications were kept in the DON's office and were supposed to be under 2 locks. The Administrator said she had been in the DON's office before, and the DON was good about closing the door behind her to keep the controlled medications behind 2 locks. The Administrator said the failure occurred probably because the DON stepped out and forgot to close the door behind her. The Administrator said the CMAs and nurses were supposed to keep their carts locked if they left them unattended. The Administrator said the failure of the staff leaving the carts unlocked probably occurred because they left and did not lock the cart behind them. The Administrator said the medication carts left unlocked, unattended and the controlled medications not secured could lead to someone taking the medications. Record review of the facility's policy, Storage and expiration of medications, biologicals, syringes and needles and dated 10/31/16 indicated in part: The policy 5.3 sets for the procedures relating to the storage and expiration dates of medications, biologicals, syringes and needles. Facility should ensure that only authorized facility staff as defines by facility should have possession of the keys, access cards, electronic codes or combinations which open medication storage areas. Authorized staff may include nursing supervisors, charge nurses, licensed nurses, and other personnel authorized to administer medications in compliance with applicable law. Facility should store scheduled II controlled substance and other medications deemed by facility to be at risk for abuse or diversion in a separate compartment within the locked medication carts and should have a different key or access device. Facility should ensure that all medications and biologicals including treatment items are securely stored in a locked cabinet/cart or locked medication room that is inaccessible by residents and visitors. Facility should ensure that schedule II - V controlled substances are only accessible to licensed nursing, pharmacy and medical personnel designated by facility. After receiving controlled substances and adding to inventory, facility should ensure that schedule II - V controlled substance are immediately placed into a secured storage are (i.e., a safe, self-locked cabinet or locked room in all cases in accordance with applicable law). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675767 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 675767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/26/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency House 3745 Summer Crest Dr San Angelo, TX 76901 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 0910 Ensure resident rooms meet each resident's needs. 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 have certified resident rooms equipped for adequate nursing care, comfort and privacy for 3 of 120 certified beds (Rooms #45, #1, and #15) as evidenced by: Residents Affected - Some Hall C, room [ROOM NUMBER], was certified for one Title 19 (Medicare Certified room) resident bed and was not resident ready. It could not easily be transitioned into a resident-ready room. The room was used as a conference room and was filled with office furniture and a large conference table. The call light jack had been converted into a cable line jack. The room had no resident furniture. Hall A, room [ROOM NUMBER] and #15 were used for Therapy Services and were not resident ready. They could not be easily transitioned into resident-ready rooms. The rooms were used as office spaces for therapy and filled with file cabinets and desks. The rooms had no resident furniture. This failure could affect residents by placing them at risk of residing rooms without proper furnishings and privacy. The findings include: Review of the facility-completed Form 3740 Bed Classification completed and signed by the Administrator on 5/25/22 documented the facility identified Rooms #1 and 15 as Title 18 Medicare-Only beds for both the A and B beds. The form also documented the facility identified room [ROOM NUMBER] as Title 18/19 Dually Certified bed for the A and B beds. Observation on 5/26/22 at 12:18 PM showed: room [ROOM NUMBER] was used as a conference room with a long conference table in it. There were no curtain tracks, and the call light [NAME] had been converted into a cable jack. room [ROOM NUMBER] had an electronic combination lock on it. The room had a filing cabinet and therapy equipment in it. room [ROOM NUMBER] was used as a therapy office. It had multiple file cabinets with wooden planks across them to make desks. Interview on 5/26/22 at 4:46 PM the Administrator stated a previous surveyor cited room [ROOM NUMBER] prior due to the amount of file cabinets in the room and the facility found alternative solutions. She stated she was aware there was not a curtain track for room [ROOM NUMBER]. She said she was not aware there was no call light system in the room. She stated Rooms #1 and #15 could be made resident ready quickly. Interview and observation on 5/26/22 at 5:08 PM the Maintenance Assistant looked at Rooms #1 and #15 and stated it would take him a couple of days to get the rooms resident-ready. He stated the call light jack in room [ROOM NUMBER] was now a cable jack and not a resident call light system. He said he did not know how to change that out. Interview on 5/26/22 at 6:00 PM, the Administrator stated if all the staff were working on it they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675767 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 675767 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/26/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regency House 3745 Summer Crest Dr San Angelo, TX 76901 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 0910 could get Rooms #1 and #15 empty and resident ready . She stated she would have to talk to her corporation about de-certifying room [ROOM NUMBER]. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675767 If continuation sheet Page 4 of 4