Health inspection·May 24, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #1 was listed as a 0 meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #1 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #1 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #1 was listed as a 0 meaning Resident #1 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #1 was listed as a 0 meaning Resident #1 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Interview with Resident #1 on 05/22/2023 at 3:23 pm. Resident #1 stated that she was in the dining room and did witness the fight with LVN A and Kitchen staff I. Resident #1 stated that LVN A went to the kitchen door and was yelling at Kitchen staff I. Resident #1 stated that LVN A was cursing at Kitchen staff I am saying, We only have one fucking aide, you dumb bitch. Resident #1 stated that LVN A is always cursing at staff and residents. Resident #1 stated that when Kitchen staff I told LVN A, I'm sorry I did not know, that LVN A stated, Shut your fucking mouth, I am going to the Administrator about this. Resident #1 appeared to have distress by explaining the situation of what happened in the kitchen by crying and saying that Kitchen staff I did not deserve to be treated like that and it makes me so sad to see that. Resident #1 stated that the residents in the dining room were all yelling at LVN A to stop. Resident #1 stated that she is scared that LVN A will get worse because the DON is his mother, and she does not do anything to change the situation. Resident #1 stated that LVN A even yells and curses at her while flipping her off. Resident #1 stated that when she uses her call light when she needs something and LVN A is working he will come in her room and told her, Shut up, Fucker, while flipping her off. Resident #1 stated it makes her feel like she cannot ask for help. Resident #1 stated it also makes her feel like she is below him and it does not feel too good. Resident #1 stated that when she had gone to the DON to report the situation, the DON stated, My son would not do that. Resident #1 stated that she does not feel like she can tell anyone because even the Administrator is best friends with the DON and the DON is the mother of LVN A. Resident #1 stated that not only does LVN A curse at everyone, but he does not do anything if the residents need help. Resident #1 stated that LVN A will just sit there and do nothing. Resident #1 stated that she has tried to make complaints to the DON about other things not involving LVN A and the DON would yell at her saying, Quit complaining about shit. Resident #1 stated that she has tried to go to the Administrator, and she does nothing either about LVN A. Resident #1 stated she does not like LVN A's behavior, that it is ugly and mean and makes people feel bad. Resident #2: Review of Resident #2's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of schizoaffective disorder bipolar type, muscle spasms, muscle weakness, unsteadiness on feet, abnormalities of gait and mobility, peripheral vascular disease (a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), anxiety, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), major depressive disorder, high blood pressure, chronic obstructive pulmonary disease (a group of lung diseases that block the airflow and make it difficult to breathe), overactive bladder, edema, need for assistance with personal care, abnormal posture, acid reflux, insomnia, abscess of bursa (septic bursitis occurs when a bursa becomes infected and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 2 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 inflamed), pruritus (itching). Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #2's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 15, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #2 was listed as a 0 meaning Resident #2 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #2 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #2 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #2 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #2 was listed as a 0 meaning Resident #2 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #2 was listed as a 0 meaning Resident #2 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Residents Affected - Many Observations of Resident #2 during interview process on 05/18/2023 at 10:40 am. Observed Resident #2 eyes tearing up during explaining the events of the altercation that occurred with LVN A and Kitchen staff I. Observed Resident #2 showing signs of distress by means of nervousness by biting her nails and looking around to see if anyone was watching her talk to Surveyor. Interview with Resident #2 on 05/18/2023 at 10:40 am. Resident #2 stated that had been a couple of different situations in which LVN A has gotten aggressive with his mouth. Resident #2 stated that one-time LVN A had told her, Fuck you, and flipped her off. Resident #2 stated that she was scared to tell the Administrator because she did not want to get in trouble. Resident #2 stated that LVN A's mouth will really get out of hand at times. Resident #2 stated that she was in the dining room when LVN A went off on kitchen staff I. Resident #2 stated that she heard LVN A tell Kitchen staff I, shut your fucking mouth bitch. Resident #2 stated that she heard Kitchen staff I tell LVN A, Don't talk to me like that. Resident #2 stated that she heard LVN A tell Kitchen staff I, What are you going to do about it? Resident #2 stated that it was very sad, and she was crying because it made her sad to see Kitchen Staff I being treated like that. Resident #2 stated, I felt helpless. Resident #2 stated that she was scared because LVN A was capable of getting verbally aggressive badly and sometimes it will get worse. Resident #2 stated that LVN A is mouthy and thinks that he can treat people however he wants, and it is okay. Resident #2 stated that she is scared that the facility will find out that she is saying anything about it and then she will lose her cigarette break or LVN A will refuse to provide her care because he has done it before, or he will yell at her. Resident #2 stated that when she witnessed the fight it made her cry and felt nervous. Resident #2 stated, I don't want to live in chaos. Resident #3: Review of Resident #3's face sheet revealed she was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of end stage renal disease, abnormal posture, need for assistance with personal care, viral hepatitis C, anemia in chronic kidney disease, diabetes mellitus due to underlying condition with chronic kidney disease, hypertensive emergency (an acute, marked elevation in blood pressure that is associated with signs of target-organ damage), heart failure, acid reflux, cirrhosis of the liver, muscle weakness, abnormalities of gait (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 3 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 - Many and mobility, lack of coordination, dependent on renal dialysis, hyperkalemia (high potassium), sepsis, unsteadiness on feet, anemia, history of pulmonary embolism (blood clot in lungs), mild protein calorie malnutrition, pure hyperglyceridemia (high concentration of triglycerides in the blood), stroke, metabolic encephalopathy, chronic respiratory failure with hypoxia (an absence of enough oxygen in the tissues to sustain bodily function), pulmonary hypertension (a type of high blood pressure that affects arteries in the lungs and heart), fluid overload, dizziness, hypothyroidism (a condition in which the thyroid gland does not produce enough thyroid hormone). Review of Resident #3's Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 14, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #3 was listed as a 0 meaning Resident #3 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #3 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #3 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #3 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #3 was listed as a 0 meaning Resident #3 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #3 was listed as a 0 meaning Resident #3 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #3 during the interview process on 05/18/2023 at 3:50 pm. Observed Resident #3 getting agitated talking about the incident between LVN A and Kitchen Staff I. Observed Resident #3 tightening his lips and shaking his head at one point during the interview. Observed Resident #3 showing signs of distress talking about the incident that he witnessed. Interview with Resident #3 on 05/18/2023 at 3:50 pm. Resident #3 stated that he was sitting in the dining room when LVN A came into the kitchen door and started yelling and cursing at kitchen staff member I. Resident #3 stated that LVN A told Kitchen staff I, You dumb bitch, I only have one fucking CNA. Resident #6 stated that he didn't understand why LVN A would call her that and that LVN A yelled it too. Resident #3 stated LVN A seemed angry at Kitchen staff I. Resident #3 stated that LVN A is known for being verbally aggressive towards staff and residents. Resident #3 stated that LVN A doesn't work either because he is not made to work, he's allowed to do nothing but be mean to people. Resident #3 stated that Kitchen Staff I told LVN A, Why are you cursing at me? Resident #3 stated that Kitchen Staff I said, I'm sorry I did not know that you only had one CNA. Resident #3 stated that residents were yelling at LVN A to stop and Kitchen staff I was crying. Resident #3 stated that LVN A had no reason to fly off the handle like that. Resident #3 stated that it made him feel bad for Kitchen staff I because no one should be talked to like that. Resident #3 stated that he wanted to help Kitchen Staff I. Resident #3 stated that what LVN A did made him angry, and he wanted to beat him up for what he did to Kitchen Staff I. Resident #3 stated that it was uncalled for. Resident #3 stated that he wanted to protect Kitchen staff I but couldn't do anything about it and that makes him mad. Resident #4: Review of Resident #4's face sheet revealed he was an [AGE] year-old male originally admitted to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 4 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 - Many the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of psychosis not due to substance abuse, cellulitis, protein calorie malnutrition, metabolic encephalopathy, high blood pressure, polydipsia, anemia, alcohol abuse with other disorder, seizures, gout, restlessness and agitation, peripheral vascular disease, cirrhosis of the liver, muscle weakness, abnormal gait and mobility, lack of coordination. Review of Resident #4's Annual Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 10, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #4 was listed as a 0 meaning Resident #4 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #4 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #4 was listed as a 1 meaning usually understands-misses some part/intent of message but comprehends most conversation. Under section C1310 for Delirium, Resident #4 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #4 was listed as a 0 meaning Resident #4 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #4 was listed as a 0 meaning Resident #4 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observation of Resident #4 during interview on 05/18/2023 at 1:51 pm. Observed Resident #4 free from any kind of distress. Resident #4 did not display any distress during interview process. Interview with Resident #4 on 05/18/2023 at 1:51 pm. Resident #4 stated that he was not in the dining room when the incident occurred. Resident #4 stated that he does know LVN A. Resident #4 stated that he does curse a lot at the staff and some residents. Resident #4 stated that LVN A has cursed at him before saying, Fuck off. Resident #4 stated that he does not like it (cussing), but he was not sure if LVN A was meaning it or just playing around. Resident #4 stated that sometimes it makes him mad, but he has not fought with LVN A because of it. Resident #4 stated that he has heard LVN A tell Resident #1 to, Shut the fuck up. When she is yelling or something. Resident #4 stated, that is not nice of him. Resident #5: Review of Resident #5's face sheet revealed he was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of type 2 diabetes, cellulitis of left upper limb, reduced mobility, long term use of anticoagulants, repeated falls, hypertensive crisis, heart disease, glaucoma, unqualified visual loss of left eye, normal vision in right eye, anemia, insomnia, hypothyroidism, hyperlipidemia, major depression disorder, high blood pressure, acid reflux, muscle weakness, end stage renal disease, unsteadiness on feet, lack of coordination, complete traumatic amputation at level between right hip and knee, need for assistance with personal care, dependent on renal dialysis. Review of Resident #5's Annual Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 14, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #5 was listed as a 0 meaning Resident #5 has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 5 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 - Many clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #5 was listed as a) meaning resident was understood. Under section B0800 for Ability to Understand Others, Resident #5 was listed as a 0 meaning understands. Under section C1310 for Delirium, Resident #5 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #5 was listed as a 0 meaning Resident #5 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #5 was listed as a 1 for verbal behaviors meaning Resident #5 did display verbal symptoms directed towards others such as threatening, screaming at others, cursing at others but not physical, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #5 during interview process on 05/18/2023 at 2:27 pm. Observed Resident #5 sitting in his wheelchair and pulled up next to his bed with his head laying on the side of the bed. Observed Resident #5 did not show distress during interview. Interview with Resident #5 on 05/18/2023 at 2:27 pm. Resident #5 stated that he has not worked with LVN A much but stated that he used to work nights and his attitude and mouth was bad at that time. Resident #5 stated that LVN A would cuss at resident's for asking for help. Resident #5 stated that he is not sure, but he does think that by LVN A moving to days has helped the situation some. Resident #5 stated that LVN A does not seem as moody as he did when he worked the night shift. Resident #5 stated that when LVN A was working nights he would not help the residents and was lazy. Resident #5 stated that he does not work with him a whole lot now. Resident #5 stated that he does not like to complain too much about anything because then you will lose your cigarette breaks. Resident #5 stated, I can't lose my breaks, it's the only thing keeping me going right now. Resident #5 stated that he has made complaints to the Administrator about people stealing money out of his room and missing vape and nothing was done but less time for breaks, so I try to not complain. Resident #6: Review of Resident #6's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of stroke, insomnia, acid reflux, cirrhosis of the liver, obstruction of bile duct, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), hypokalemia (low potassium), schizophrenia, bipolar disorder, major depression, anxiety, encephalopathy, muscle weakness, lack of coordination. Review of Resident #6's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 11, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #6 was listed as a 0 meaning Resident #6 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #6 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #6 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #6 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #6 was listed as a 0 meaning Resident #6 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #6 was listed as a 0 meaning Resident #6 did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 6 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 - Many display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Interview with Resident #6 on 05/19/2023 at 1:55 pm. Resident #6 stated that it took her a while to get to know LVN A because he is just always sitting at the desk doing nothing. Resident #6 stated that even if the residents call for help, he will either just sit there and ignore the residents or he will cuss at them to stop using the call lights. Resident #6 stated that she thinks that the facility has not fired him yet because his mother was the DON. Resident #6 stated that the Administrator does not do anything about the situation either. Resident #6 stated that all the Administrator will do is threaten to take resident's cigarettes away if they say anything. Resident #6 stated that the Administrator threatens the residents often about taking away their cigarettes or their breaks. Resident #6 stated that she did not witness the incident in the dining room between LVN A and Kitchen Staff I but she has seen LVN A curse at residents before. Resident #6 stated that she has witnessed LVN A tell Resident #1, shut up fucker, or he has also told Resident #1, you annoying bitch. Resident #6 stated that LVN A tried talking to her like that one time, but she just stayed quiet about it because if she were to tell anyone then they get punished. Resident #6 stated that the residents will get punished especially if LVN A goes and tells because his mother who was the DON, and she always has his back. Resident #6 stated that one time when LVN A was just ignoring the residents she told him, When are you going to get up and do something? Resident #6 stated that LVN A stated, Never. Resident #6 stated that she told LVN A, Probably because your mom is the DON and she's in charge. Resident #6 stated that LVN A stated, Wouldn't you do it if your mom were in charge? So shut the fuck up now. Resident #6 stated that she does not like to hear the cursing from LVN A. Resident #6 stated that it is ugly and it's offensive to her. Resident #6 stated she has seen LVN A curse at other staff and residents before. Resident #6 stated that she was afraid that eventually he will do something bad since he is allowed to get away with the small stuff. Resident #8: Review of Resident #8's face sheet revealed she was a [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of Alzheimer's disease, peripheral vascular disease, muscle weakness, lack of coordination, unsteadiness on feet, schizoaffective disorder bipolar type, major depressive disorder, glaucoma, high blood pressure, asthma, hormone replacement therapy, Review of Resident #8's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 11, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #8 was listed as a 0 meaning Resident #8 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #8 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #8 was listed as a 0 meaning understands. Under section C1310 for Delirium, Resident #8 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #8 was listed as a 0 meaning Resident #8 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #8 was listed as a 0 meaning Resident #8 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 7 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 symptoms like screaming or disruptive sounds. Level of Harm - Immediate jeopardy to resident health or safety Observations made of Resident #8 during the interview process on 05/18/2023 at 2:27 pm. Observed Resident #8 in slight signs of distress by lowering her head and slightly shaking her head with slight tightening of the lips. Residents Affected - Many Interview with Resident #8 on 05/18/2023 at 2:27 pm. Resident #8 was interviewed with Resident #5 because they shared a room together. Resident #8 stated that she had not worked with LVN A much either. Resident #8 stated that she had not had any issues with LVN A herself. Resident #8 stated that he had never cursed at her or called her named or yelled at her. Resident #8 stated that she had been in the dining room when LVN A has cursed at other staff members, but she does not remember their names because she has a hard time remembering people's names. Resident #8 stated that she had heard him one time call a female staff a, Bitch. Resident #8 stated that she does not like to talk like that, and it bothers her. Resident #8 stated she just does not like it. Resident #8 stated she does not know why people use those words. Resident #8 stated, I would not want someone talking to me like that. Resident #8 stated that she would prefer not to have to hear those words. Resident #8 did not specify if she was distressed because of the cursing, she just kept stating that she did not like to hear it. Interview with Administrator on 05/18/2023 at 10:03 am. Administrator stated that she did do an investigation for the incident that had happened in front of the residents. Administrator stated that it is just a lot of he said she said stuff. Administrator stated that she got complaints of LVN A not wanting to work and a lot of his call in's. Administrator stated that a resident had complained that LVN A is unprofessional and said the word, Shit. Administrator stated that no safe surveys were completed for residents. Administrator stated that LVN A was aware that he had been suspended pending investigation process as of 05/17/2023. Administrator stated that she does not normally get complaints from residents for anything. Administrator stated that she was told by Resident #1 and Resident #2 that they heard LVN A say the word, Shit. Administrator stated that she had called her boss (Corporate) and stated that she needed their help. Administrator stated that she does not give LVN A special treatment, but it has been said in the facility before. Administrator stated that she had not gotten any complaints from staff about LVN A cursing or not caring for the residents. Administrator stated she would just have to get through with her investigation to see what will happen with LVN A. Interview with DON on 05/18/2023 at 10:25 am. DON stated that she had not gotten any complaints about LVN A from staff or residents. DON stated that LVN A did have an altercation with the kitchen staff. DON stated that LVN A just stands up for the nurse aides because kitchen staff try to run over them. DON stated that LVN A does not put up with resident-to-resident bullying, so he does stand up for residents also. DON stated that LVN A will stand between the residents and redirect them to a different area. DON stated that she had not heard of LVN A having any kind of aggressive behavior or cursing whatsoever. DON stated that she had not gotten any complaints of LVN A not caring for the residents from residents or staff members. Interview with Kitchen staff H on 05/18/2023 at 11:33 sm. Kitchen staff H stated that Kitchen staff I had went and told LVN B to give menus to the resident. Kitchen staff H stated that the next thing she knew that LVN A had come to the kitchen and was yelling and cursing at Kitchen Staff I saying, you need to get your shit together, you dumb bitch. Kitchen staff H stated that Kitchen staff I told LVN A to stop cursing and yelling at her. Kitchen staff H stated that LVN A told Kitchen staff I, What are you going to do about it? Kitchen staff H stated that there were many residents in the dining room which witnessed the incident. Kitchen staff H stated that residents were yelling at LVN A to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 8 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 stop. Kitchen staff H stated then LVN A just walked away. Kitchen staff H stated that Kitchen staff I did not want to even come to work after this and neither did anyone else. Kitchen staff H stated it, made her nervous to be there. Kitchen staff H stated that she witnessed two residents crying when the incident occurred and that others were clearly concerned. Kitchen staff H stated that the two residents that were crying were Resident #1 and Resident #2. Kitchen staff H stated that it made her feel bad that they had to see all that. Residents Affected - Many Interview with LVN B on 05/18/2023 at 11:56 am. LVN B stated that he was a witness to the incident that happen[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 9 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure an allegation of abuse was reported immediately but no later than 24 hours after teh allegation was made for 7 of 7 residents (Resident #1, #2, #3, #4, #5, #6, #8) reviewed for reporting. The facility staff did not immediately report an allegtion of Abuse when LVN A yelled and cursed at staff in front of residents. This failure could affect residents by placing them at risk of abuse if the reportable allegations are not reported timely after they are discovered. Findings included: Resident #1: Review of Resident #1's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of diabetes mellitus due to underlying condition with neuropathy (weakness, numbness, and pain from nerve damage usually in the hands and feet), muscle weakness, lack of coordination, chronic viral hepatitis C, anemia (a condition in which the blood does not have enough healthy red blood cells), sickle cell trait, iron deficiency anemia, mild protein calorie malnutrition, schizophrenia, bipolar disorder, polyneuropathy (the simultaneous malfunction of many peripheral nerves throughout the body), high blood pressure, asthma, acid reflux, rheumatoid arthritis (a chronic inflammatory disorder affecting many joints, including those in the hands and feet), hypoxemia (low level of oxygen in the blood), urinary incontinence, Bacteremia (the presence of viable bacteria in the circulating blood). Review of Resident #1's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 12, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #1 was listed as a 0 meaning Resident #1 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #1 was listed as a 0 meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #1 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #1 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #1 was listed as a 0 meaning Resident #1 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #1 was listed as a 0 meaning Resident #1 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Interview with Resident #1 on 05/22/2023 at 3:23 pm. Resident #1 stated that she was in the dining room and did witness the fight with LVN A and Kitchen staff I. Resident #1 stated that LVN A went to the kitchen door and was yelling at Kitchen staff I. Resident #1 stated that LVN A was cursing at Kitchen staff I am saying, We only have one fucking aide, you dumb bitch. Resident #1 stated that LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 10 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A is always cursing at staff and residents. Resident #1 stated that when Kitchen staff I told LVN A, I'm sorry I did not know, that LVN A stated, Shut your fucking mouth, I am going to the Administrator about this. Resident #1 appeared to have distress by explaining the situation of what happened in the kitchen by crying and saying that Kitchen staff I did not deserve to be treated like that and it makes me so sad to see that. Resident #1 stated that the residents in the dining room were all yelling at LVN A to stop. Resident #1 stated that she is scared that LVN A will get worse because the DON is his mother, and she does not do anything to change the situation. Resident #1 stated that LVN A even yells and curses at her while flipping her off. Resident #1 stated that when she uses her call light when she needs something and LVN A is working he will come in her room and told her, Shut up, Fucker, while flipping her off. Resident #1 stated it makes her feel like she cannot ask for help. Resident #1 stated it also makes her feel like she is below him and it does not feel too good. Resident #1 stated that when she had gone to the DON to report the situation, the DON stated, My son would not do that. Resident #1 stated that she does not feel like she can tell anyone because even the Administrator is best friends with the DON and the DON is the mother of LVN A. Resident #1 stated that not only does LVN A curse at everyone, but he does not do anything if the residents need help. Resident #1 stated that LVN A will just sit there and do nothing. Resident #1 stated that she has tried to make complaints to the DON about other things not involving LVN A and the DON would yell at her saying, Quit complaining about shit. Resident #1 stated that she has tried to go to the Administrator, and she does nothing either about LVN A. Resident #1 stated she does not like LVN A's behavior, that it is ugly and mean and makes people feel bad. Resident #2: Review of Resident #2's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of schizoaffective disorder bipolar type, muscle spasms, muscle weakness, unsteadiness on feet, abnormalities of gait and mobility, peripheral vascular disease (a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), anxiety, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), major depressive disorder, high blood pressure, chronic obstructive pulmonary disease (a group of lung diseases that block the airflow and make it difficult to breathe), overactive bladder, edema, need for assistance with personal care, abnormal posture, acid reflux, insomnia, abscess of bursa (septic bursitis occurs when a bursa becomes infected and inflamed), pruritus (itching). Review of Resident #2's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 15, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #2 was listed as a 0 meaning Resident #2 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #2 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #2 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #2 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #2 was listed as a 0 meaning Resident #2 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #2 was listed as a 0 meaning Resident #2 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 11 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observations of Resident #2 during interview process on 05/18/2023 at 10:40 am. Observed Resident #2 eyes tearing up during explaining the events of the altercation that occurred with LVN A and Kitchen staff I. Observed Resident #2 showing signs of distress by means of nervousness by biting her nails and looking around to see if anyone was watching her talk to Surveyor. Interview with Resident #2 on 05/18/2023 at 10:40 am. Resident #2 stated that had been a couple of different situations in which LVN A has gotten aggressive with his mouth. Resident #2 stated that one-time LVN A had told her, Fuck you, and flipped her off. Resident #2 stated that she was scared to tell the Administrator because she did not want to get in trouble. Resident #2 stated that LVN A's mouth will really get out of hand at times. Resident #2 stated that she was in the dining room when LVN A went off on kitchen staff I. Resident #2 stated that she heard LVN A tell Kitchen staff I, shut your fucking mouth bitch. Resident #2 stated that she heard Kitchen staff I tell LVN A, Don't talk to me like that. Resident #2 stated that she heard LVN A tell Kitchen staff I, What are you going to do about it? Resident #2 stated that it was very sad, and she was crying because it made her sad to see Kitchen Staff I being treated like that. Resident #2 stated, I felt helpless. Resident #2 stated that she was scared because LVN A was capable of getting verbally aggressive badly and sometimes it will get worse. Resident #2 stated that LVN A is mouthy and thinks that he can treat people however he wants, and it is okay. Resident #2 stated that she is scared that the facility will find out that she is saying anything about it and then she will lose her cigarette break or LVN A will refuse to provide her care because he has done it before, or he will yell at her. Resident #2 stated that when she witnessed the fight it made her cry and felt nervous. Resident #2 stated, I don't want to live in chaos. Resident #3: Review of Resident #3's face sheet revealed she was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of end stage renal disease, abnormal posture, need for assistance with personal care, viral hepatitis C, anemia in chronic kidney disease, diabetes mellitus due to underlying condition with chronic kidney disease, hypertensive emergency (an acute, marked elevation in blood pressure that is associated with signs of target-organ damage), heart failure, acid reflux, cirrhosis of the liver, muscle weakness, abnormalities of gait and mobility, lack of coordination, dependent on renal dialysis, hyperkalemia (high potassium), sepsis, unsteadiness on feet, anemia, history of pulmonary embolism (blood clot in lungs), mild protein calorie malnutrition, pure hyperglyceridemia (high concentration of triglycerides in the blood), stroke, metabolic encephalopathy, chronic respiratory failure with hypoxia (an absence of enough oxygen in the tissues to sustain bodily function), pulmonary hypertension (a type of high blood pressure that affects arteries in the lungs and heart), fluid overload, dizziness, hypothyroidism (a condition in which the thyroid gland does not produce enough thyroid hormone). Review of Resident #3's Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 14, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #3 was listed as a 0 meaning Resident #3 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #3 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #3 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #3 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #3 was listed as a 0 meaning Resident #3 did not display hallucinations or psychosis. Under section E0200 for Behavioral (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 12 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Symptoms-Presence and Frequency, Resident #3 was listed as a 0 meaning Resident #3 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Residents Affected - Some Observations made of Resident #3 during the interview process on 05/18/2023 at 3:50 pm. Observed Resident #3 getting agitated talking about the incident between LVN A and Kitchen Staff I. Observed Resident #3 tightening his lips and shaking his head at one point during the interview. Observed Resident #3 showing signs of distress talking about the incident that he witnessed. Interview with Resident #3 on 05/18/2023 at 3:50 pm. Resident #3 stated that he was sitting in the dining room when LVN A came into the kitchen door and started yelling and cursing at kitchen staff member I. Resident #3 stated that LVN A told Kitchen staff I, You dumb bitch, I only have one fucking CNA. Resident #6 stated that he didn't understand why LVN A would call her that and that LVN A yelled it too. Resident #3 stated LVN A seemed angry at Kitchen staff I. Resident #3 stated that LVN A is known for being verbally aggressive towards staff and residents. Resident #3 stated that LVN A doesn't work either because he is not made to work, he's allowed to do nothing but be mean to people. Resident #3 stated that Kitchen Staff I told LVN A, Why are you cursing at me? Resident #3 stated that Kitchen Staff I said, I'm sorry I did not know that you only had one CNA. Resident #3 stated that residents were yelling at LVN A to stop and Kitchen staff I was crying. Resident #3 stated that LVN A had no reason to fly off the handle like that. Resident #3 stated that it made him feel bad for Kitchen staff I because no one should be talked to like that. Resident #3 stated that he wanted to help Kitchen Staff I. Resident #3 stated that what LVN A did made him angry, and he wanted to beat him up for what he did to Kitchen Staff I. Resident #3 stated that it was uncalled for. Resident #3 stated that he wanted to protect Kitchen staff I but couldn't do anything about it and that makes him mad. Resident #4: Review of Resident #4's face sheet revealed he was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of psychosis not due to substance abuse, cellulitis, protein calorie malnutrition, metabolic encephalopathy, high blood pressure, polydipsia, anemia, alcohol abuse with other disorder, seizures, gout, restlessness and agitation, peripheral vascular disease, cirrhosis of the liver, muscle weakness, abnormal gait and mobility, lack of coordination. Review of Resident #4's Annual Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 10, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #4 was listed as a 0 meaning Resident #4 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #4 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #4 was listed as a 1 meaning usually understands-misses some part/intent of message but comprehends most conversation. Under section C1310 for Delirium, Resident #4 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #4 was listed as a 0 meaning Resident #4 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #4 was listed as a 0 meaning Resident #4 did not display physical, verbal, or other behavioral (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 13 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observation of Resident #4 during interview on 05/18/2023 at 1:51 pm. Observed Resident #4 free from any kind of distress. Resident #4 did not display any distress during interview process. Interview with Resident #4 on 05/18/2023 at 1:51 pm. Resident #4 stated that he was not in the dining room when the incident occurred. Resident #4 stated that he does know LVN A. Resident #4 stated that he does curse a lot at the staff and some residents. Resident #4 stated that LVN A has cursed at him before saying, Fuck off. Resident #4 stated that he does not like it (cussing), but he was not sure if LVN A was meaning it or just playing around. Resident #4 stated that sometimes it makes him mad, but he has not fought with LVN A because of it. Resident #4 stated that he has heard LVN A tell Resident #1 to, Shut the fuck up. When she is yelling or something. Resident #4 stated, that is not nice of him. Resident #5: Review of Resident #5's face sheet revealed he was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of type 2 diabetes, cellulitis of left upper limb, reduced mobility, long term use of anticoagulants, repeated falls, hypertensive crisis, heart disease, glaucoma, unqualified visual loss of left eye, normal vision in right eye, anemia, insomnia, hypothyroidism, hyperlipidemia, major depression disorder, high blood pressure, acid reflux, muscle weakness, end stage renal disease, unsteadiness on feet, lack of coordination, complete traumatic amputation at level between right hip and knee, need for assistance with personal care, dependent on renal dialysis. Review of Resident #5's Annual Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 14, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #5 was listed as a 0 meaning Resident #5 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #5 was listed as a) meaning resident was understood. Under section B0800 for Ability to Understand Others, Resident #5 was listed as a 0 meaning understands. Under section C1310 for Delirium, Resident #5 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #5 was listed as a 0 meaning Resident #5 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #5 was listed as a 1 for verbal behaviors meaning Resident #5 did display verbal symptoms directed towards others such as threatening, screaming at others, cursing at others but not physical, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #5 during interview process on 05/18/2023 at 2:27 pm. Observed Resident #5 sitting in his wheelchair and pulled up next to his bed with his head laying on the side of the bed. Observed Resident #5 did not show distress during interview. Interview with Resident #5 on 05/18/2023 at 2:27 pm. Resident #5 stated that he has not worked with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 14 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some LVN A much but stated that he used to work nights and his attitude and mouth was bad at that time. Resident #5 stated that LVN A would cuss at resident's for asking for help. Resident #5 stated that he is not sure, but he does think that by LVN A moving to days has helped the situation some. Resident #5 stated that LVN A does not seem as moody as he did when he worked the night shift. Resident #5 stated that when LVN A was working nights he would not help the residents and was lazy. Resident #5 stated that he does not work with him a whole lot now. Resident #5 stated that he does not like to complain too much about anything because then you will lose your cigarette breaks. Resident #5 stated, I can't lose my breaks, it's the only thing keeping me going right now. Resident #5 stated that he has made complaints to the Administrator about people stealing money out of his room and missing vape and nothing was done but less time for breaks, so I try to not complain. Resident #6: Review of Resident #6's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of stroke, insomnia, acid reflux, cirrhosis of the liver, obstruction of bile duct, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), hypokalemia (low potassium), schizophrenia, bipolar disorder, major depression, anxiety, encephalopathy, muscle weakness, lack of coordination. Review of Resident #6's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 11, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #6 was listed as a 0 meaning Resident #6 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #6 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #6 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #6 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #6 was listed as a 0 meaning Resident #6 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #6 was listed as a 0 meaning Resident #6 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Interview with Resident #6 on 05/19/2023 at 1:55 pm. Resident #6 stated that it took her a while to get to know LVN A because he is just always sitting at the desk doing nothing. Resident #6 stated that even if the residents call for help, he will either just sit there and ignore the residents or he will cuss at them to stop using the call lights. Resident #6 stated that she thinks that the facility has not fired him yet because his mother was the DON. Resident #6 stated that the Administrator does not do anything about the situation either. Resident #6 stated that all the Administrator will do is threaten to take resident's cigarettes away if they say anything. Resident #6 stated that the Administrator threatens the residents often about taking away their cigarettes or their breaks. Resident #6 stated that she did not witness the incident in the dining room between LVN A and Kitchen Staff I but she has seen LVN A curse at residents before. Resident #6 stated that she has witnessed LVN A tell Resident #1, shut up fucker, or he has also told Resident #1, you annoying bitch. Resident #6 stated that LVN A tried talking to her like that one time, but she just stayed quiet about it because if she were to tell anyone then they get punished. Resident #6 stated that the residents will get punished especially if LVN A goes and tells because his mother who was the DON, and she always (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 15 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some has his back. Resident #6 stated that one time when LVN A was just ignoring the residents she told him, When are you going to get up and do something? Resident #6 stated that LVN A stated, Never. Resident #6 stated that she told LVN A, Probably because your mom is the DON and she's in charge. Resident #6 stated that LVN A stated, Wouldn't you do it if your mom were in charge? So shut the fuck up now. Resident #6 stated that she does not like to hear the cursing from LVN A. Resident #6 stated that it is ugly and it's offensive to her. Resident #6 stated she has seen LVN A curse at other staff and residents before. Resident #6 stated that she was afraid that eventually he will do something bad since he is allowed to get away with the small stuff. Resident #8: Review of Resident #8's face sheet revealed she was a [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of Alzheimer's disease, peripheral vascular disease, muscle weakness, lack of coordination, unsteadiness on feet, schizoaffective disorder bipolar type, major depressive disorder, glaucoma, high blood pressure, asthma, hormone replacement therapy, Review of Resident #8's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 11, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #8 was listed as a 0 meaning Resident #8 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #8 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #8 was listed as a 0 meaning understands. Under section C1310 for Delirium, Resident #8 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #8 was listed as a 0 meaning Resident #8 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #8 was listed as a 0 meaning Resident #8 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #8 during the interview process on 05/18/2023 at 2:27 pm. Observed Resident #8 in slight signs of distress by lowering her head and slightly shaking her head with slight tightening of the lips. Interview with Resident #8 on 05/18/2023 at 2:27 pm. Resident #8 was interviewed with Resident #5 because they shared a room together. Resident #8 stated that she had not worked with LVN A much either. Resident #8 stated that she had not had any issues with LVN A herself. Resident #8 stated that he had never cursed at her or called her named or yelled at her. Resident #8 stated that she had been in the dining room when LVN A has cursed at other staff members, but she does not remember their names because she has a hard time remembering people's names. Resident #8 stated that she had heard him one time call a female staff a, Bitch. Resident #8 stated that she does not like to talk like that, and it bothers her. Resident #8 stated she just does not like it. Resident #8 stated she does not know why people use those words. Resident #8 stated, I would not want someone talking to me like that. Resident #8 stated that she would prefer not to have to hear those words. Resident #8 did not specify if she was distressed because of the cursing, she just kept stating that she did not like to hear it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 16 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview with Administrator on 05/18/2023 at 10:03 am. Administrator stated that she did do an investigation for the incident that had happened in front of the residents. Administrator stated that it is just a lot of he said she said stuff. Administrator stated that she got complaints of LVN A not wanting to work and a lot of his call in's. Administrator stated that a resident had complained that LVN A is unprofessional and said the word, Shit. Administrator stated that no safe surveys were completed for residents. Administrator stated that LVN A was aware that he had been suspended pending investigation process as of 05/17/2023. Administrator stated that she does not normally get complaints from residents for anything. Administrator stated that she was told by Resident #1 and Resident #2 that they heard LVN A say the word, Shit. Administrator stated that she had called her boss (Corporate) and stated that she needed their help. Administrator stated that she does not give LVN A special treatment, but it has been said in the facility before. Administrator stated that she had not gotten any complaints from staff about LVN A cursing or not caring for the residents. Administrator stated she would just have to get through with her investigation to see what will happen with LVN A. Interview with DON on 05/18/2023 at 10:25 am. DON stated that she had not gotten any complaints about LVN A from staff or residents. DON stated that LVN A did have an altercation with the kitchen staff. DON stated that LVN A just stands up for the nurse aides because kitchen staff try to run over them. DON stated that LVN A does not put up with resident-to-resident bullying, so he does stand up for residents also. DON stated that LVN A will stand between the residents and redirect them to a different area. DON stated that she had not heard of LVN A having any kind of aggressive behavior or cursing whatsoever. DON stated that she had not gotten any complaints of LVN A not caring for the residents from residents or staff members. Interview with Kitchen staff H on 05/18/2023 at 11:33 sm. Kitchen staff H stated that Kitchen staff I had went and told LVN B to give menus to the resident. Kitchen staff H stated that the next thing she knew that LVN A had come to the kitchen and was yelling and cursing at Kitchen Staff I saying, you need to get your shit together, you dumb bitch. Kitchen staff H stated that Kitchen staff I told LVN A to stop cursing and yelling at her. Kitchen staff H stated that LVN A told Kitchen staff I, What are you going to do about it? Kitchen staff H stated that there were many residents in the dining room which witnessed the incident. Kitchen staff H stated that residents were yelling at LVN A to stop. Kitchen staff H stated then LVN A just walked away. Kitchen staff H stated that Kitchen staff I did not want to even come to work after this and neither did anyone else. Kitchen staff H stated it, made her nervous to be there. Kitchen staff H stated that she witnessed two residents crying when the incident occurred and that others were clearly concerned. Kitchen staff H stated that the two residents that were crying were Resident #1 and Resident #2. Kitchen staff H stated that it made her feel bad that they had to see all that. Interview with LVN B on 05/18/2023 at 11:56 am. LVN B stated that he was a witness to the incident that happened with LVN A and Kitchen Staff I. LVN B stated that Kitchen staff I had brought the menu choice papers to him and LVN B stated that he told her, It will be just a moment because we only have one aide. LVN B stated that CNA D had grabbed the papers from him and stated, That was kind of rude of her. LVN B stated that LVN A had walked by and overheard the conversation and stated, What happened? LVN B stated that he had explained what happened and LVN A took the papers and went to the Kitchen. LVN B[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 17 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure all allegations of Abuse, neglect, exploitation , or mistreatment had evidence that all allegaed violations were throughly investigated for 7 residents (Resident #1, #2, #3, #4, #5, #6, #8). Residents Affected - Some The facility failed to investigate and protected 7 residents from verbal abuse by LVN A yelling and cursing at staff in front of residents and yelling and cursing at residents. This failure could affect all residents that reside in the facility placing them at risk of emotional and psychosocial abuse. Findings included: Resident #1: Review of Resident #1's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of diabetes mellitus due to underlying condition with neuropathy (weakness, numbness, and pain from nerve damage usually in the hands and feet), muscle weakness, lack of coordination, chronic viral hepatitis C, anemia (a condition in which the blood does not have enough healthy red blood cells), sickle cell trait, iron deficiency anemia, mild protein calorie malnutrition, schizophrenia, bipolar disorder, polyneuropathy (the simultaneous malfunction of many peripheral nerves throughout the body), high blood pressure, asthma, acid reflux, rheumatoid arthritis (a chronic inflammatory disorder affecting many joints, including those in the hands and feet), hypoxemia (low level of oxygen in the blood), urinary incontinence, Bacteremia (the presence of viable bacteria in the circulating blood). Review of Resident #1's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 12, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #1 was listed as a 0 meaning Resident #1 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #1 was listed as a 0 meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #1 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #1 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #1 was listed as a 0 meaning Resident #1 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #1 was listed as a 0 meaning Resident #1 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Interview with Resident #1 on 05/22/2023 at 3:23 pm. Resident #1 stated that she was in the dining room and did witness the fight with LVN A and Kitchen staff I. Resident #1 stated that LVN A went to the kitchen door and was yelling at Kitchen staff I. Resident #1 stated that LVN A was cursing at Kitchen staff I am saying, We only have one fucking aide, you dumb bitch. Resident #1 stated that LVN A is always cursing at staff and residents. Resident #1 stated that when Kitchen staff I told LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 18 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A, I'm sorry I did not know, that LVN A stated, Shut your fucking mouth, I am going to the Administrator about this. Resident #1 appeared to have distress by explaining the situation of what happened in the kitchen by crying and saying that Kitchen staff I did not deserve to be treated like that and it makes me so sad to see that. Resident #1 stated that the residents in the dining room were all yelling at LVN A to stop. Resident #1 stated that she is scared that LVN A will get worse because the DON is his mother, and she does not do anything to change the situation. Resident #1 stated that LVN A even yells and curses at her while flipping her off. Resident #1 stated that when she uses her call light when she needs something and LVN A is working he will come in her room and told her, Shut up, Fucker, while flipping her off. Resident #1 stated it makes her feel like she cannot ask for help. Resident #1 stated it also makes her feel like she is below him and it does not feel too good. Resident #1 stated that when she had gone to the DON to report the situation, the DON stated, My son would not do that. Resident #1 stated that she does not feel like she can tell anyone because even the Administrator is best friends with the DON and the DON is the mother of LVN A. Resident #1 stated that not only does LVN A curse at everyone, but he does not do anything if the residents need help. Resident #1 stated that LVN A will just sit there and do nothing. Resident #1 stated that she has tried to make complaints to the DON about other things not involving LVN A and the DON would yell at her saying, Quit complaining about shit. Resident #1 stated that she has tried to go to the Administrator, and she does nothing either about LVN A. Resident #1 stated she does not like LVN A's behavior, that it is ugly and mean and makes people feel bad. Resident #2: Review of Resident #2's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of schizoaffective disorder bipolar type, muscle spasms, muscle weakness, unsteadiness on feet, abnormalities of gait and mobility, peripheral vascular disease (a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs), anxiety, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), major depressive disorder, high blood pressure, chronic obstructive pulmonary disease (a group of lung diseases that block the airflow and make it difficult to breathe), overactive bladder, edema, need for assistance with personal care, abnormal posture, acid reflux, insomnia, abscess of bursa (septic bursitis occurs when a bursa becomes infected and inflamed), pruritus (itching). Review of Resident #2's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 15, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #2 was listed as a 0 meaning Resident #2 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #2 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #2 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #2 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #2 was listed as a 0 meaning Resident #2 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #2 was listed as a 0 meaning Resident #2 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations of Resident #2 during interview process on 05/18/2023 at 10:40 am. Observed Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 19 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some #2 eyes tearing up during explaining the events of the altercation that occurred with LVN A and Kitchen staff I. Observed Resident #2 showing signs of distress by means of nervousness by biting her nails and looking around to see if anyone was watching her talk to Surveyor. Interview with Resident #2 on 05/18/2023 at 10:40 am. Resident #2 stated that had been a couple of different situations in which LVN A has gotten aggressive with his mouth. Resident #2 stated that one-time LVN A had told her, Fuck you, and flipped her off. Resident #2 stated that she was scared to tell the Administrator because she did not want to get in trouble. Resident #2 stated that LVN A's mouth will really get out of hand at times. Resident #2 stated that she was in the dining room when LVN A went off on kitchen staff I. Resident #2 stated that she heard LVN A tell Kitchen staff I, shut your fucking mouth bitch. Resident #2 stated that she heard Kitchen staff I tell LVN A, Don't talk to me like that. Resident #2 stated that she heard LVN A tell Kitchen staff I, What are you going to do about it? Resident #2 stated that it was very sad, and she was crying because it made her sad to see Kitchen Staff I being treated like that. Resident #2 stated, I felt helpless. Resident #2 stated that she was scared because LVN A was capable of getting verbally aggressive badly and sometimes it will get worse. Resident #2 stated that LVN A is mouthy and thinks that he can treat people however he wants, and it is okay. Resident #2 stated that she is scared that the facility will find out that she is saying anything about it and then she will lose her cigarette break or LVN A will refuse to provide her care because he has done it before, or he will yell at her. Resident #2 stated that when she witnessed the fight it made her cry and felt nervous. Resident #2 stated, I don't want to live in chaos. Resident #3: Review of Resident #3's face sheet revealed she was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of end stage renal disease, abnormal posture, need for assistance with personal care, viral hepatitis C, anemia in chronic kidney disease, diabetes mellitus due to underlying condition with chronic kidney disease, hypertensive emergency (an acute, marked elevation in blood pressure that is associated with signs of target-organ damage), heart failure, acid reflux, cirrhosis of the liver, muscle weakness, abnormalities of gait and mobility, lack of coordination, dependent on renal dialysis, hyperkalemia (high potassium), sepsis, unsteadiness on feet, anemia, history of pulmonary embolism (blood clot in lungs), mild protein calorie malnutrition, pure hyperglyceridemia (high concentration of triglycerides in the blood), stroke, metabolic encephalopathy, chronic respiratory failure with hypoxia (an absence of enough oxygen in the tissues to sustain bodily function), pulmonary hypertension (a type of high blood pressure that affects arteries in the lungs and heart), fluid overload, dizziness, hypothyroidism (a condition in which the thyroid gland does not produce enough thyroid hormone). Review of Resident #3's Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 14, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #3 was listed as a 0 meaning Resident #3 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #3 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #3 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #3 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #3 was listed as a 0 meaning Resident #3 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #3 was listed as a 0 meaning Resident #3 did not display (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 20 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #3 during the interview process on 05/18/2023 at 3:50 pm. Observed Resident #3 getting agitated talking about the incident between LVN A and Kitchen Staff I. Observed Resident #3 tightening his lips and shaking his head at one point during the interview. Observed Resident #3 showing signs of distress talking about the incident that he witnessed. Interview with Resident #3 on 05/18/2023 at 3:50 pm. Resident #3 stated that he was sitting in the dining room when LVN A came into the kitchen door and started yelling and cursing at kitchen staff member I. Resident #3 stated that LVN A told Kitchen staff I, You dumb bitch, I only have one fucking CNA. Resident #6 stated that he didn't understand why LVN A would call her that and that LVN A yelled it too. Resident #3 stated LVN A seemed angry at Kitchen staff I. Resident #3 stated that LVN A is known for being verbally aggressive towards staff and residents. Resident #3 stated that LVN A doesn't work either because he is not made to work, he's allowed to do nothing but be mean to people. Resident #3 stated that Kitchen Staff I told LVN A, Why are you cursing at me? Resident #3 stated that Kitchen Staff I said, I'm sorry I did not know that you only had one CNA. Resident #3 stated that residents were yelling at LVN A to stop and Kitchen staff I was crying. Resident #3 stated that LVN A had no reason to fly off the handle like that. Resident #3 stated that it made him feel bad for Kitchen staff I because no one should be talked to like that. Resident #3 stated that he wanted to help Kitchen Staff I. Resident #3 stated that what LVN A did made him angry, and he wanted to beat him up for what he did to Kitchen Staff I. Resident #3 stated that it was uncalled for. Resident #3 stated that he wanted to protect Kitchen staff I but couldn't do anything about it and that makes him mad. Resident #4: Review of Resident #4's face sheet revealed he was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of psychosis not due to substance abuse, cellulitis, protein calorie malnutrition, metabolic encephalopathy, high blood pressure, polydipsia, anemia, alcohol abuse with other disorder, seizures, gout, restlessness and agitation, peripheral vascular disease, cirrhosis of the liver, muscle weakness, abnormal gait and mobility, lack of coordination. Review of Resident #4's Annual Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 10, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #4 was listed as a 0 meaning Resident #4 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #4 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #4 was listed as a 1 meaning usually understands-misses some part/intent of message but comprehends most conversation. Under section C1310 for Delirium, Resident #4 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #4 was listed as a 0 meaning Resident #4 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #4 was listed as a 0 meaning Resident #4 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 21 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observation of Resident #4 during interview on 05/18/2023 at 1:51 pm. Observed Resident #4 free from any kind of distress. Resident #4 did not display any distress during interview process. Interview with Resident #4 on 05/18/2023 at 1:51 pm. Resident #4 stated that he was not in the dining room when the incident occurred. Resident #4 stated that he does know LVN A. Resident #4 stated that he does curse a lot at the staff and some residents. Resident #4 stated that LVN A has cursed at him before saying, Fuck off. Resident #4 stated that he does not like it (cussing), but he was not sure if LVN A was meaning it or just playing around. Resident #4 stated that sometimes it makes him mad, but he has not fought with LVN A because of it. Resident #4 stated that he has heard LVN A tell Resident #1 to, Shut the fuck up. When she is yelling or something. Resident #4 stated, that is not nice of him. Resident #5: Review of Resident #5's face sheet revealed he was an [AGE] year-old male originally admitted to the facility on [DATE] and readmitted on [DATE] with a primary diagnosis of type 2 diabetes, cellulitis of left upper limb, reduced mobility, long term use of anticoagulants, repeated falls, hypertensive crisis, heart disease, glaucoma, unqualified visual loss of left eye, normal vision in right eye, anemia, insomnia, hypothyroidism, hyperlipidemia, major depression disorder, high blood pressure, acid reflux, muscle weakness, end stage renal disease, unsteadiness on feet, lack of coordination, complete traumatic amputation at level between right hip and knee, need for assistance with personal care, dependent on renal dialysis. Review of Resident #5's Annual Minimum Data Set, dated [DATE], revealed his BIMS (Brief Interview for Mental Status) was 14, suggesting that the resident's cognitive was cognitively intact. Under section B0600 for Speech Clarity revealed that Resident #5 was listed as a 0 meaning Resident #5 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #5 was listed as a) meaning resident was understood. Under section B0800 for Ability to Understand Others, Resident #5 was listed as a 0 meaning understands. Under section C1310 for Delirium, Resident #5 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #5 was listed as a 0 meaning Resident #5 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #5 was listed as a 1 for verbal behaviors meaning Resident #5 did display verbal symptoms directed towards others such as threatening, screaming at others, cursing at others but not physical, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #5 during interview process on 05/18/2023 at 2:27 pm. Observed Resident #5 sitting in his wheelchair and pulled up next to his bed with his head laying on the side of the bed. Observed Resident #5 did not show distress during interview. Interview with Resident #5 on 05/18/2023 at 2:27 pm. Resident #5 stated that he has not worked with LVN A much but stated that he used to work nights and his attitude and mouth was bad at that time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 22 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #5 stated that LVN A would cuss at resident's for asking for help. Resident #5 stated that he is not sure, but he does think that by LVN A moving to days has helped the situation some. Resident #5 stated that LVN A does not seem as moody as he did when he worked the night shift. Resident #5 stated that when LVN A was working nights he would not help the residents and was lazy. Resident #5 stated that he does not work with him a whole lot now. Resident #5 stated that he does not like to complain too much about anything because then you will lose your cigarette breaks. Resident #5 stated, I can't lose my breaks, it's the only thing keeping me going right now. Resident #5 stated that he has made complaints to the Administrator about people stealing money out of his room and missing vape and nothing was done but less time for breaks, so I try to not complain. Resident #6: Review of Resident #6's face sheet revealed she was an [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of stroke, insomnia, acid reflux, cirrhosis of the liver, obstruction of bile duct, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), hypokalemia (low potassium), schizophrenia, bipolar disorder, major depression, anxiety, encephalopathy, muscle weakness, lack of coordination. Review of Resident #6's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 11, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #6 was listed as a 0 meaning Resident #6 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #6 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #6 was listed as a 0 meaning understands clear comprehension. Under section C1310 for Delirium, Resident #6 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #6 was listed as a 0 meaning Resident #6 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #6 was listed as a 0 meaning Resident #6 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Interview with Resident #6 on 05/19/2023 at 1:55 pm. Resident #6 stated that it took her a while to get to know LVN A because he is just always sitting at the desk doing nothing. Resident #6 stated that even if the residents call for help, he will either just sit there and ignore the residents or he will cuss at them to stop using the call lights. Resident #6 stated that she thinks that the facility has not fired him yet because his mother was the DON. Resident #6 stated that the Administrator does not do anything about the situation either. Resident #6 stated that all the Administrator will do is threaten to take resident's cigarettes away if they say anything. Resident #6 stated that the Administrator threatens the residents often about taking away their cigarettes or their breaks. Resident #6 stated that she did not witness the incident in the dining room between LVN A and Kitchen Staff I but she has seen LVN A curse at residents before. Resident #6 stated that she has witnessed LVN A tell Resident #1, shut up fucker, or he has also told Resident #1, you annoying bitch. Resident #6 stated that LVN A tried talking to her like that one time, but she just stayed quiet about it because if she were to tell anyone then they get punished. Resident #6 stated that the residents will get punished especially if LVN A goes and tells because his mother who was the DON, and she always has his back. Resident #6 stated that one time when LVN A was just ignoring the residents she told (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 23 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some him, When are you going to get up and do something? Resident #6 stated that LVN A stated, Never. Resident #6 stated that she told LVN A, Probably because your mom is the DON and she's in charge. Resident #6 stated that LVN A stated, Wouldn't you do it if your mom were in charge? So shut the fuck up now. Resident #6 stated that she does not like to hear the cursing from LVN A. Resident #6 stated that it is ugly and it's offensive to her. Resident #6 stated she has seen LVN A curse at other staff and residents before. Resident #6 stated that she was afraid that eventually he will do something bad since he is allowed to get away with the small stuff. Resident #8: Review of Resident #8's face sheet revealed she was a [AGE] year-old female admitted to the facility on [DATE] with a primary diagnosis of Alzheimer's disease, peripheral vascular disease, muscle weakness, lack of coordination, unsteadiness on feet, schizoaffective disorder bipolar type, major depressive disorder, glaucoma, high blood pressure, asthma, hormone replacement therapy, Review of Resident #8's Annual Minimum Data Set, dated [DATE], revealed her BIMS (Brief Interview for Mental Status) was 11, suggesting that the resident's cognitive was moderately impaired. Under section B0600 for Speech Clarity revealed that Resident #8 was listed as a 0 meaning Resident #8 has clear speech-distinct intelligible words. Under section B0700 for Makes Self Understood, Resident #8 was listed as a) meaning resident is understood. Under section B0800 for Ability to Understand Others, Resident #8 was listed as a 0 meaning understands. Under section C1310 for Delirium, Resident #8 was listed as a 0 meaning from the resident's baseline there was no evidence of an acute change in mental status and did not display inattention, disorganized thinking, or altered level of consciousness. Under E0100 for Potential Indicator for Psychosis, Resident #8 was listed as a 0 meaning Resident #8 did not display hallucinations or psychosis. Under section E0200 for Behavioral Symptoms-Presence and Frequency, Resident #8 was listed as a 0 meaning Resident #8 did not display physical, verbal, or other behavioral symptoms such as: hitting, kicking, pushing, scratching, grabbing, abusing other sexually, threatening others, screaming at others, cursing at others, scratching self, pacing, rummaging, public sexual acts, disrobing in public, smearing food or bodily wastes, verbal/vocal symptoms like screaming or disruptive sounds. Observations made of Resident #8 during the interview process on 05/18/2023 at 2:27 pm. Observed Resident #8 in slight signs of distress by lowering her head and slightly shaking her head with slight tightening of the lips. Interview with Resident #8 on 05/18/2023 at 2:27 pm. Resident #8 was interviewed with Resident #5 because they shared a room together. Resident #8 stated that she had not worked with LVN A much either. Resident #8 stated that she had not had any issues with LVN A herself. Resident #8 stated that he had never cursed at her or called her named or yelled at her. Resident #8 stated that she had been in the dining room when LVN A has cursed at other staff members, but she does not remember their names because she has a hard time remembering people's names. Resident #8 stated that she had heard him one time call a female staff a, Bitch. Resident #8 stated that she does not like to talk like that, and it bothers her. Resident #8 stated she just does not like it. Resident #8 stated she does not know why people use those words. Resident #8 stated, I would not want someone talking to me like that. Resident #8 stated that she would prefer not to have to hear those words. Resident #8 did not specify if she was distressed because of the cursing, she just kept stating that she did not like to hear it. Interview with Administrator on 05/18/2023 at 10:03 am. Administrator stated that she did do an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 24 of 25 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 675842 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE MI Casita Nursing and Rehabilitation Center 2400 Quaker Ave Lubbock, TX 79410 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some investigation for the incident that had happened in front of the residents. Administrator stated that it is just a lot of he said she said stuff. Administrator stated that she got complaints of LVN A not wanting to work and a lot of his call in's. Administrator stated that a resident had complained that LVN A is unprofessional and said the word, Shit. Administrator stated that no safe surveys were completed for residents. Administrator stated that LVN A was aware that he had been suspended pending investigation process as of 05/17/2023. Administrator stated that she does not normally get complaints from residents for anything. Administrator stated that she was told by Resident #1 and Resident #2 that they heard LVN A say the word, Shit. Administrator stated that she had called her boss (Corporate) and stated that she needed their help. Administrator stated that she does not give LVN A special treatment, but it has been said in the facility before. Administrator stated that she had not gotten any complaints from staff about LVN A cursing or not caring for the residents. Administrator stated she would just have to get through with her investigation to see what will happen with LVN A. Interview with DON on 05/18/2023 at 10:25 am. DON stated that she had not gotten any complaints about LVN A from staff or residents. DON stated that LVN A did have an altercation with the kitchen staff. DON stated that LVN A just stands up for the nurse aides because kitchen staff try to run over them. DON stated that LVN A does not put up with resident-to-resident bullying, so he does stand up for residents also. DON stated that LVN A will stand between the residents and redirect them to a different area. DON stated that she had not heard of LVN A having any kind of aggressive behavior or cursing whatsoever. DON stated that she had not gotten any complaints of LVN A not caring for the residents from residents or staff members. Interview with Kitchen staff H on 05/18/2023 at 11:33 sm. Kitchen staff H stated that Kitchen staff I had went and told LVN B to give menus to the resident. Kitchen staff H stated that the next thing she knew that LVN A had come to the kitchen and was yelling and cursing at Kitchen Staff I saying, you need to get your shit together, you dumb bitch. Kitchen staff H stated that Kitchen staff I told LVN A to stop cursing and yelling at her. Kitchen staff H stated that LVN A told Kitchen staff I, What are you going to do about it? Kitchen staff H stated that there were many residents in the dining room which witnessed the incident. Kitchen staff H stated that residents were yelling at LVN A to stop. Kitchen staff H stated then LVN A just walked away. Kitchen staff H stated that Kitchen staff I did not want to even come to work after this and neither did anyone else. Kitchen staff H stated it, made her nervous to be there. Kitchen staff H stated that she witnessed two residents crying when the incident occurred and that others were clearly concerned. Kitchen staff H stated that the two residents that were crying were Resident #1 and Resident #2. Kitchen staff H stated that it made her feel bad that they had to see all that. Interview with LVN B on 05/18/2023 at 11:56 am. LVN B stated that he was a witness to the incident that happened with LVN A and Kitchen Staff I. LVN B stated that Kitchen staff I had brought the menu choice papers to him and LVN B stated that he told her, It will be just a moment because we only have one aide. LVN B stated that CNA D had grabbed the papers from him and stated, That was kind of rude of her. LVN B stated that LVN A had walked by and overheard the conversation and stated, What happened? LVN B stated that he had explained what happened and LVN A took the papers and went to the K[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675842 If continuation sheet Page 25 of 25