Health inspection·March 27, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An observation was made on 03/27/25 at 11:42 AM of Dietary Aide B entering the food preparation from the facility hallway. No hand hygiene was performed. Observed her hairnet only covering her ponytail. All hair surrounding her face and around the nape of her neck was exposed. She grabbed condiments and exited the food preparation area at 11:45 AM. An observation was made on 03/27/25 at 11:47 AM, when Dietary Aide A entered the food preparation area from the facility hallway. No hand hygiene was performed. Dietary Aide A's hair was exposed outside the hairnet around her face and at the nape of her neck. She was observed opening the refrigerator and not obtaining anything. She exited the food preparation area at 11:48 AM. An observation was made on 03/27/25 at 11:49 AM , Dietary Aide C grabbing a pan of rolls from the cooling rack. She pulled a pair of gloves from her pockets and placed the gloves on without performing hand hygiene. She placed the pan of rolls on the counter. She pulled the rolls with her gloved hands and placed them inside a large bowl. At 11:59 AM, she emptied the pan of rolls. She took the empty pan to the dishwashing area and observed her washing the pan. She washed multiple trays and placed them on top of the empty serving line located in the food preparation area. She was observed not changing her gloves. At 12:01 PM, she was observed grabbing a second tray of rolls from the cooling rack. She removed three rolls and placed them in the trash. She stopped touching the rolls and was observed wrapping silverware at an alternated counter. At 12:06, she was observed back at the counter with the rolls, pulling them from the tray, and placing them in the large bowl. No glove change or hand hygiene was observed. An observation on 03/27/25 at 11:50 AM was made of Dietary Aide A and Dietary Aide B entering the food preparation area from the facility hallway. Both staff did not perform hand hygiene. Dietary Aide A's hair was exposed, outside the hairnet, around her face and at the nape of her neck. Dietary Aide B's hairnet only covered her ponytail. All hair surrounding her face and around the nape of her neck was exposed. Each staff grabbed a stack of clean plates with their bare hands. Dietary Aide B was observed with her plates pressed up against her clothing. They exited the food preparation area at 11:52 AM. An observation on 03/27/25 at 11:53 AM of CNA D entering the food preparation area from the facility hallway. She was observed not wearing a hairnet. Hand hygiene was not performed. She was observed going to the drink station and filling a pitcher with cranberry juice. She exited the food preparation area at 11:57 AM. An observation on 03/27/25 at 11:54 AM was made of Dietary Aide A and Aide B entering the food preparation area from the facility hallway. Both staff performed no hand hygiene. Dietary Aide A's hair was exposed, outside the hairnet, around her face and at the nape of her neck. Dietary Aide B's hairnet only covered her ponytail. All hair surrounding her face and around the nape of her neck was exposed. Dietary Aide B entered the dry pantry (the state surveyor did not see her exit). Dietary Aide A grabbed oven mittens and placed an unknown warm liquid on the rolling cart. Both staff were observed at 11:56 AM grabbing clean cups and exiting the food preparation area at 11:57 AM. An observation on 03/27/25 at 11:59 AM was made of Dietary Aide A and Dietary Aide B entering the food preparation area from the facility hallway. Both staff did not perform hand hygiene. Dietary Aide A's hair was exposed, outside the hairnet, around her face and at the nape of her neck. Dietary Aide B's hairnet only covered her ponytail. All hair surrounding her face and around the nape of her neck was exposed. Dietary Aide A grabbed one additional cup, and Dietary Aide B grabbed additional plates. They both exited the food preparation area at 12:00 PM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675874 If continuation sheet Page 2 of 7 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 675874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An observation on 03/27/25 at 12:03 PM was made of Dietary Aide A and Dietary Aide B entering the food preparation area from the facility hallway. Both staff did not perform hand hygiene. Dietary Aide A's hair was exposed, outside the hairnet, around her face and at the nape of her neck. Dietary Aide B's hairnet only covered her ponytail. All hair surrounding her face and around the nape of her neck was exposed. Dietary Aide B obtained condiments from a lower cabinet. Dietary Aide A obtained soup with a mitten on. When Dietary Aide A removed her mittens, gloves (latex/plastic) were observed. Dietary Aide A exited the food preparation area at 12:06 PM. Dietary Aide B exited the food preparation area at 12:07 PM. Investigator exited the food preparation area at 12:07 PM. During an interview on 03/27/25 at 1:30 PM, Dietary Aide A stated she did not notice that she was entering and exiting the food preparation area without performing hand hygiene. She stated she was unaware that all her hair was not secured in her hairnet. She said she was familiar with the facility's policy regarding handwashing and proper wearing of the hair net in the food preparation area. She stated the purpose of wearing a hair net was so hair would not get in the resident's food. She said the purpose of handwashing was, so germs did not spread. She said germs could get under their nails. She said the potential negative outcome of not correctly wearing her hairnet and exercising hand hygiene was hair and food could get all over, including residents' food. As said, she was unaware that she was not wearing her hairnet properly. She said she was unaware that she was not washing her hands each time she entered the food preparation area. She said that their system to monitor proper hand hygiene and proper wearing of the hairnet was each time they go outside, take a break, or go to the restroom, they should wash their hands. She said sometimes they remind each other to wash their hands and to fix their hairnets. She said she had been trained to ensure she had a hairnet each time she entered the food preparation area and to secure all of her hair in the hairnet. She said sometimes she did not see her hair out unless she went to the restroom. She said it was expected of her to have her hair secure in the hair net and wash her hands according to policy. She said she was responsible for washing her hands and securing her hair. She said she did not have a reason for her hair not being secure and did not wash her hands. During an interview on 03/27/25 at 1:57 PM, Dietary Aide B stated she did not notice she was entering and exiting the food preparation area without performing hand hygiene. She stated she was unaware all her hair was not secured in her hairnet. She said she was familiar with the facility's policy regarding handwashing and proper wearing of the hair net in the food preparation area. She said she did not feel her hairnet move back. She said she had been trained to wash her hands when entering the food preparation area. She said she was off on this date (03/27/25). She said she was called in to work on her day off. She said she was rushed, and she thought something had happened. She said she knew she should practice good hand hygiene and wear her hair net properly. She said the purpose of handwashing was to prevent germs from getting everywhere. She said the purpose of the hairnet was to keep hair from getting in the food. She said the potential negative outcome was germs could spread, people could get sick, and hair could get in the food. She said no one would like hair in their food. She said the system for monitoring the staff's hairnet was sometimes she physically checked her hairnet, but then the other girls in the kitchen would check. She said the shift she was working on was not her regular shift. She said she was unaware she had placed the clean plates on her shirt. She said she was usually more prepared and was caught off guard being called in. She said it was expected that she washed her hands each time she entered the food preparation area and wore her hair net in the food preparation area properly. She said she was responsible for ensuring her hairnet was worn properly and responsible for washing her hands when she entered the food preparation area. She said she failed to wash her hands because she felt rushed and was half (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675874 If continuation sheet Page 3 of 7 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 675874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some asleep when she entered work. She said she usually washed her hands when she entered the food preparation area, typically did not place clean plates on her clothing, and wore her hair net properly. During an interview on 03/27/25 at 2:23 PM, CNA D stated she did not wash her hands when she entered the food preparation area because she washed her hands while she was in her hall before she entered the food preparation area. She said she did not have on a hairnet because there were none outside of the entrance into the food preparation area. She said she did not ask the staff in the food preparation area for one because they did not speak English. She said she was familiar with the handwashing policy and wearing the hairnet. She said the purpose of the hairnet and handwashing was so cross-contamination did not occur. She said the potential negative outcome of not wearing a hairnet and practicing proper hand hygiene in the food preparation area was they could get the resident's sick. She said there could have been something nasty on their hands. She said a potential negative outcome of not wearing a hairnet was hair could get into the food and contaminate it. She said she was aware she was not wearing the hairnet. She said she had been trained to wash her hands each time she entered the food preparation area. She usually said the kitchen staff brought their drinks, but it was not abnormal that they would go to the food preparation area at least three times a day to obtain extra drinks/juice. She said they should wash their hands and wear a hair net properly. She said everyone was responsible for hand washing and ensuring they wore a hairnet. During an interview on 03/27/25 at 2:34 PM, the [NAME] stated she had not noticed that any of her staff had entered and exited the food preparation area without performing hand hygiene. She stated she was unaware that any of the staff were not properly wearing their hair net, but at one moment, she saw Dietary Aide B's hair net only covering her ponytail. She said she was familiar with the facility's policy regarding handwashing and proper wearing of the hair net in the food preparation area. She said the purpose of handwashing was so staff would not get sick. She said it prevents illness to the residents. She said the purpose of the hair net was to keep hair from getting in the food. She said the system to monitor and ensure that hand hygiene was occurring, and the staff were properly wearing their hair nets was they should place the hairnet on before entering the food preparation area, and as soon as they entered the food preparation area, they should wash their hands. She said she had been trained on proper hand hygiene in the food preparation and how to wear the hairnet properly. She said all the staff had been trained. She said that they were trained through the original course to work in the kitchen and through in-services. She said they redirected the staff verbally. She said she would tell them and remind staff to wear a hair net and wash their hands. She said her Dietary Manager was not in the facility, but she (The Cook) was left in charge. She said she expected all staff to practice proper hand hygiene according to policy and wear their hair restraints properly. She said everyone was responsible for proper hand hygiene and properly wearing their hair restraints in the food preparation area. She said she had no reason for these procedures to not be followed on 03/27/25. During an interview on 03/27/25 at 3:06 PM, Dietary Aide C stated she remembered not changing her gloves performing multiple tasks but stated she had been trained if she was wearing gloves, this was ok. She stated she did wash her hands while washing dishes. She said she was unaware if she had done anything else. She said she had been trained to wash her hands each time she placed a new pair of gloves on and had been trained to change her gloves each time she did something different, such as a new task. She said the potential negative outcome was that she could pass germs to the residents. She said it was important to practice proper hand hygiene because they carry bacteria on their hands. She said she was unaware if she was not changing her gloves and did not have a reason; she did not change them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675874 If continuation sheet Page 4 of 7 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 675874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 03/27/25 at 3:32 PM, the ADM stated she was familiar with the facility's policy regarding handwashing and wearing the hairnet properly. She said proper handwashing aimed to mitigate and prevent the spread of germs. She said the purpose of the hair net was to keep hair out of the food and prevent the spread of germs. She said the potential negative outcome was the residents could get sick. She said she was unaware the kitchen staff did not wash their hands when they entered or did not practice proper hand hygiene in the food preparation area. She said she was unaware kitchen staff were not properly wearing their hair nets. She said their system to monitor proper handwashing and wearing the hair nets in the food preparation area was they completed in-services, daily monitoring, and educating the staff as needed. She stated she had been trained if she entered the food preparation area and touched something (food or drinks) then she should wash her hands. She said she had been instructed to wear a hairnet before entering the food preparation area. She said she could see why, maybe the aide thought that if she washed her hands at the nurse's station, it would be okay. She said she expected handwashing to occur when they enter the food preparation area if they will be touching anything. She said everyone was responsible but would not have a reason they failed to wash their hands and wear their hairnets properly without speaking to them. During an interview on 03/27/25 at 3:45 PM, the DON stated she was familiar with the facility's handwashing policy and should wear hair nets properly in the food preparation area. She said the potential negative outcome of not adhering to the policy regarding handwashing and wearing the hairnets was germs and infection could spread to the residents. She stated the system to monitor hand washing and that staff wore hair nets when entering the food preparation area was through education using in-services. She said she had been trained, and all clinical staff had been trained on handwashing and wearing hair nets in the food preparation area. She said she expected the staff to wear a hairnet and wash their hands if they entered the food preparation area. She said everyone was responsible for proper hand hygiene and wearing a hairnet when they entered the food preparation area. She said without talking to the staff (CNA A), she would not have a reason for not having a hair net or not washing her hands. Record review of CNA A's completion certificate revealed she had a satisfactory completion of hand hygiene as of 03/12/25. Record review the Cook's completion certificate indicated she completed the Food Service Manager training on 06/29/24. Record review of Dietary Aide C's completion certificate indicated she completed the Food Handler (Employee Food Safety Online Course and Exam) on 09/03/24. Record review of Dietary Aide B's completion certificate indicated she completed the Food Handler (Employee Food Safety Online Course and Exam) on 01/03/24. Record review of Dietary Aide A's completion certificate indicated she completed the Food Handler Safety Program on 11/24/24. Record review of the facility's In-service, hairnets and handwashing, dated 12/3/24, revealed: When clocked in be sure to put your hairnets and if you have a beard put beard guard on. Also make sure you wash your hands before beginning your duty. Record review of the facility's In-service, hairnets and handwashing, dated 1/3/25, revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675874 If continuation sheet Page 5 of 7 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 675874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 When you come in be sure to wear your hairnet and make sure your hair is in the hairnet. Make sure you wash your hands before starting. Level of Harm - Minimal harm or potential for actual harm The following staff signed indicating they had been trained: The Cook Residents Affected - Some Record review of the facility policy, Staff Attire, Revised September 2017, revealed: Policy Statement All employees wear approved attire for the performance of their duties. Procedures All staff members will have their hair off the shoulders, confined in a hair net or cap, and facial hair properly restrained. Record review of the facility policy, Food: Preparation, Revised September 2017, revealed: Policy Statement All foods are prepared in accordance with the FDA food Code. Procedures All staff will practice proper hand washing techniques and glove use. Dining services staff will be responsible for food preparation procedures that avoid contamination by potentially harmful physical, biological, and chemical contamination. Record review of 2022 Food Code U.S. Food and Drug Administration revealed: 2-402 Hair Restraints 2-402.11 Effectiveness. (A) Except as provided in (B) of this section, FOOD EMPLOYEES shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from FDA Food Code 2022 Duties The person in charge shall ensure EMPLOYEES are effectively cleaning their hands, by routinely monitoring the EMPLOYEES' handwashing; 2-301.11 Clean Condition The hands are particularly important in transmitting foodborne pathogens. Food employees with dirty hands and/or fingernails may contaminate the food being prepared. Therefore, any activity which may contaminate the hands must be followed by thorough handwashing in accordance with the procedures outlined in the Code. 2-301.12 Cleaning Procedure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675874 If continuation sheet Page 6 of 7 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 675874 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lamun-Lusk-Sanchez Texas State Veterans Home 1809 N Hwy 87 Big Spring, TX 79720 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Handwashing is a critical factor in reducing fecal-oral pathogens that can be transmitted from hands to RTE food as well as other pathogens that can be transmitted from environmental sources. Many employees fail to wash their hands as often as necessary and even those who do may use flawed techniques. 2-301.14 When to Wash. Residents Affected - Some The hands may become contaminated when the food employee engages in specific activities. The increased risk of contamination requires handwashing immediately before, during, or after the activities listed. The specific examples listed in this code section are not intended to be all inclusive. Employees must wash their hands after any activity which may result in contamination of the hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675874 If continuation sheet Page 7 of 7