Health inspection·February 29, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation on 2/27/24 at 11:55 AM Resident #324 was sitting at a dining room table for the noon meal. Resident #324's catheter bag was on her wheelchair in full view of the dining room. There was no privacy cover on the catheter bag. During an interview on 2/28/24 at 8:27 AM, the ADON stated that all nursing staff are responsible for catheter care, but primarily CNAs. The ADON stated that catheter bags are supposed to always be covered for privacy regardless if resident is in bed or in their wheelchair. The ADON stated a possible negative outcome for not having a privacy bag in place would be indignity for the resident. During an interview on 2/28/24 at 8:44 AM, CNA D stated that during catheter care she makes sure that the door and curtains are shut for privacy and that the catheter bag is to be covered at all times. CNA D went on to state that a possible negative outcome for not having a catheter bag covered would be that it could make the resident upset and that if other residents saw, they could lose their appetite. During an interview on 2/28/24 at 10:44 AM, Resident #324 stated that it does not bother her when her catheter bag is uncovered in her room, but it does bother her when she is out in the facility, in public view. Record review of facility provided policy titled, Catheter Care, Urinary dated 08/2022 revealed no pertinent information concerning the use of privacy bags. Record review of facility provided policy titled, Resident Rights dated 02/2021 revealed in part: Employees shall treat all residents with kindness, respect, and dignity. Record review of facility provided policy titled, Dignity dated 02/2021 revealed in part: Each resident shall be cared for in a manner that promotes and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem. Residents are treated with dignity and respect at all times. Demeaning practices and standards of care that compromise dignity are prohibited. Staff are expected to promote dignity and assist residents; for example: helping the resident to keep urinary catheter bags covered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 2 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 - Few 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 that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknow source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for one (Resident # 126) of 18 residents reviewed for abuse. A CNA failed to report to the Abuse Prevention Coordinator an allegation of verbal abuse made by Resident #126 regarding another CNA. This failure could place residents at risk of verbal abuse. Findings included: Record review of Resident #126's admission record dated 02/27/24 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, Parkinson's disease (chronic and progressive movement disorder that initially causes tremors in one hand and stiffness or slowing of movement), hemiplegia (partial paralysis) affecting left nondominant side , chronic obstructive pulmonary disease (inflammation of lung tissue due to non-infectious causes, which results in cough without mucus or phlegm, shortness of breath, and fatigue), chronic diastolic heart failure (a progressive heart disease that affects the pumping action of the heart muscles resulting in shortness of breath and fatigue), overactive bladder (muscles of the bladder start to contract on their own even when the volume of urine in the bladder is low), and long term use of anticoagulants (use of blood thinners, can cause serious bleeding). Record review of Resident #126's EHR MDS face sheet revealed an admission MDS In Progress with an ARD date of 02/26/24. Section C of this MDS was completed and revealed a BIMS of 15 which indicated intact cognition. Record review of Resident #126's care plan initiated on 02/20/24 revealed a focus area regarding Parkinson's disease. An intervention associated with this focus area was for staff to monitor Resident #126 for signs and symptoms of Parkinson's including poor coordination, tremors, incontinence, and muscle cramps. Record review of staffing schedule provided by DON for Saturday 02/24/24 revealed CNA J and CNA L (CNA L was an agency employee) worked the day shift and CNA R (a male) and CNA K worked the night shift on the rehabilitation wing of the facility. During an observation and interview on 02/26/24 at 08:31 AM Resident #126 was lying in bed with HOB raised to sitting position, her breakfast tray was in front of her on a bedside table, and bi-lateral bedrails were in the upright position on her bed. She stated she was waiting to go to the bathroom. She said staff told her they were too busy passing out breakfast trays to take her to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 3 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 bathroom. Resident #126 said, I am peeing in my brief, and I have had accidents in my pants. Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 02/27/24 at 08:45 AM Resident #126 was sitting on the edge of her bed with her legs hanging over the edge. Her bed was unmade, and bilateral bedrails were in the upright position. She stated some staff members did not treat her with respect and dignity. When asked for an example, Resident #126 said, The other day they came to take me to the bathroom and every time I got up, I started peeing. I told her (staff member) and I kept saying, 'I am peeing.' And she (staff member) said, 'Stand up.' And she stood me up and she is yelling at me and started pulling my pants down and yelling and me and I did not want to get my pants wet. It made me feel bad. Resident #126 stated she did not remember who the staff member was who yelled at her. When asked if she told anyone about the staff member yelling at her and making her feel bad, she stated, I told one of the girls, but I don't remember who it was, and she said she was going to tell her boss. Residents Affected - Few During an interview on 02/27/24 at 09:23 AM CNA G stated she had worked for the facility for two days. When asked if Resident #126 ever told her about a staff member yelling at her, CNA G stated, She (Resident #126) told me that on Sunday (02/25/24). She mentioned to me that the aide that was working the day before, I guess she had to go to the bathroom and I don't know if they took a long time or what, and she (Resident #126) said when they took her to the bathroom she started dribbling (urine) and she (staff member) made her feel some kind of way. I told the aide that was working over there. When asked which aide she told about the incident, CNA G gave the first name of CNA I. During an interview on 02/27/24 at 10:10 AM DON stated ADM was the Abuse Prevention Coordinator of the facility. During an interview on 02/27/24 at 10:21 AM CNA I stated she heard about the incident with a staff member yelling at Resident #126. She stated CNA G did not tell her, but she did hear about the incident. During an interview on 02/27/24 at 10:27 AM CNA J stated she does not work on Resident #126's side of the rehabilitation wing. When asked if she heard anything about a staff member yelling at Resident #126 during a trip to the bathroom she stated, I didn't hear anything about that. During an interview on 02/27/24 at 10:32 AM Resident #126 stated the staff member who yelled at her was female, tall, and white. During an interview on 02/27/24 at 10:39 AM DON and RN A stated CNA K and CNA J were white. They stated CNA K was short and CNA J was tall. They stated they did not know what CNA L looked like as she was an agency staff. During an interview on 02/27/24 at 10:43 AM CNA K stated she had not heard anything about a staff member yelling at Resident #126. During an interview on 02/27/24 at 11:57 AM CNA L stated Resident #126 did not say anything to her about a staff member yelling at her during a trip to the bathroom. She stated at one time when she was caring for Resident #126, Resident #126 dribbled urine on the floor of the bathroom and kept apologizing over and over to her. CNA L stated she reassured Resident #126 that it was okay, and she (CNA L) would clean it up easily. During an interview on 02/28/24 at 09:44 AM DON stated a possible negative outcome of not reporting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 4 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 - Few an allegation of verbal abuse of a resident by a staff member was, Well it could continue. The resident that was spoken to might withdraw and not have their needs met. The staff person might continue to verbally abuse residents. She stated staff have been trained to report suspicion of abuse directly to ADM. When asked if staff are trained at orientation regarding reporting abuse she said, Yes, and regularly after that. During an interview and observation on 02/28/24 at 02:02 PM LVN M stated a possible negative outcome of not reporting allegations of verbal abuse of a resident was, People could get away with it and residents would be abused. LVN N nodded her head in agreement. Both LVN M and LVN N stated they had received training on reporting allegations of abuse to ADM. During an interview on 02/28/24 at 02:12 PM CNA G was asked if she reported the allegation of verbal abuse to ADM. She stated, I have been an aide long enough I should have reported it .but I didn't. Record review of sign-in sheets for staff in-services regarding abuse for the last month did not reveal CNA G's signature. Record review of facility policy titled Resident Abuse/Neglect/Exploitation and Reporting Requirements and dated 09/08/22 revealed in part: Each resident has the right to be free from abuse . Residents must not be subjected to abuse by anyone, including, but not limited to, team members . For purposes of our abuse policy, abuse includes verbal abuse . It is the policy of the [name of facility] to provide an environment that is free from all types of resident abuse. Team members must report abuse or suspected abuse and/or neglect to appropriate [name of the facility] management personnel. Abuse or suspected abuse, neglect, and/or exploitation should be reported to the Administrator, Director of Nursing, or designated Community Abuse and Neglect Prevention Coordinator. [name of the facility] will follow state-specific and federal abuse reporting regulations. Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. It includes verbal abuse . Report all instances of concern, suspicion or observations immediately. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 5 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to develop and implement a baseline care plan for each resident that includes the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care. The baseline care plan must be developed within 48 hours of a resident's admission, include the minimum healthcare information necessary to properly care for a resident including, but not limited to initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASRR recommendation for 1 (Resident #73) of 3 closed resident records reviewed for baseline care plans. The facility failed to develop a baseline care plan for Resident #73 that addressed his diagnoses and physician's orders. This failure could place newly admitted residents at risk of not receiving necessary care. Findings Included: Record review of Resident #73's admission MDS completed on 12/28/23 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it, stroke), hemiplegia and hemiparesis (partial paralysis) affecting left non-dominant side, generalized anxiety disorder (inability to control constant worrying), hypertensive urgency (severe elevation in blood pressure), and long term (current) use of anticoagulants (blood thinner use can lead to minor or severe bleeding and bruising). Section C of the MDS revealed a BIMS of 15 which indicated intact cognition. Section E of the MDS revealed Resident #73 had verbal behavioral symptoms directed toward others and other behavior symptoms not directed toward others 1-3 days of the 7-day look back period. Section GG revealed Resident #73 needed partial/moderate assistance with toileting, bathing, dressing, transferring, moving from sitting to lying/standing, moving from lying to sitting, and personal hygiene. Section I of the MDS indicated Resident #73's primary reason for admission was a stroke. Section N of the MDS revealed Resident #73 had received injections on 5 of the 7 days of the look back period and he was taking antidepressant medication and anticoagulant medication. Record review of Resident #73's care plan initiated 12/08/23 revealed one focus area of Risk for Falls with one goal of Resident Will Be Free of Falls and one intervention of Assist Resident with ambulation and transfers, utilizing therapy recommendations. The care plan was one page long and did not include any other information except for a list of Resident #73's diagnoses, his date of birth , his admission date, and the name of his physician. Record review of Resident #73's orders dated 12/17/23 revealed an order dated 12/13/23 for an antianxiety medication, an order dated 12/09/23 for a calcium channel blocker for high blood pressure, an order dated 12/08/23 for a medication to lower cholesterol, and an order dated 12/08/23 for a muscle relaxing medication. According to the orders in his EHR Resident #73 had an order dated 12/09/23 to wear a pressure relieving boot to manage heel pressure and foot drops while in his bed. He also had orders to be monitored for behaviors, anticoagulant medication side effects, and antianxiety medication side effects all three orders were dated 12/09/23. Resident #73 had an order dated 12/08/23 for PT, OT, and ST to evaluate and treat as needed. Resident #73's orders revealed an order dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 6 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0655 12/08/23 for general diet. Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 02/28/24 at 08:56 AM MDS RN was asked to locate the baseline care plan for Resident #73. She attempted to locate the baseline care plan in Resident #73's EHR and was unable to do so. Residents Affected - Few During an observation and interview on 02/28/24 at 08:58 AM MDS LVN attempted to find a baseline care plan in Resident #73's EHR. She stated she could not find one. She stated the admitting nurse was usually responsible for the baseline care plan but stated it could be another nurse from another shift. MDS LVN stated the baseline care plan had to be completed within 48 hours of admission. During an interview on 02/28/24 at 09:44 AM DON stated the admitting nurse was responsible for completing a baseline care plan. She stated a negative outcome of not having a baseline care plan was the facility would not know who the resident was or what they needed and if there was a change in condition the facility would not know it due to having no baseline. Record review of facility policy titled Care Plans-Baseline and dated March 2022 revealed in part: . A baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within forty-eight (48) hours of admission. 1. The baseline care plan includes instructions needed to provide effective, person-centered care of the resident that meet professional standards of quality care and must include the minimum healthcare information necessary to properly care for the resident including, but not limited to the following: a. Initial goals based on admission orders and discussion with the resident/representative; b. Physician orders; . d. Therapy services; . 2. The baseline care plan is used until the staff can conduct the comprehensive assessment . The baseline care plan is updated as needed to meet the resident's needs until the comprehensive care plan is developed. written summary of the baseline care plan . that includes, but is not limited to the following: a. The stated goals and objectives of the resident; b. A summary of the resident's medications and dietary instructions; c. Any services and treatments to be administered by the facility and personnel acting on behalf of the facility; . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 7 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement a comprehensive care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment and describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 2 of 18 Residents (Resident #55 and #65) reviewed for comprehensive care plans. - The facility failed to update the code status in the comprehensive person-centered care plan for Resident #55. - The facility failed to include code status in the comprehensive person-centered care plan for Resident #65. This failure could affect all residents in the facility receiving care per comprehensive person-centered care plans resulting in resident not being able to attain or maintain their highest practicable physical, mental, and psychosocial well-being. Finding include: Resident #55 Record review of the clinical record for Resident #55 revealed a [AGE] year-old female resident admitted to the facility on [DATE] with diagnoses of unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, delusional disorders, cognitive communication deficit, other seizures, depression, rheumatoid arthritis, unspecified. Resident #55's last MDS was dated 11-17-2023 listing her with a BIMS of 00 indicating she is severely cognitively impaired, and she requires supervision to partial assistance with most activities. Further record review of the clinical record for Resident #55 revealed on her care plan dated, 12/01/2023 that resident is a full code. Resident #55's MDS, dated [DATE] revealed that resident entered into Hospice care and a signed DNR is in Resident #55 clinical record. There was no revision to the care plan to indicate that the resident is a DNR. Observation on 02/26/24 at 08:34 AM revealed Resident #55 sitting at a table in the dining area having breakfast set up for her. Resident was dressed for the day. Observation on 02/26/24 at 09:47 AM revealed Resident #55 participating in activities with other residents., Resident appeared to be enjoying the activity. Observation on 02/27/24 at 11:53 AM revealed Resident #55 sitting in dining area waiting for her lunch to be served to her. Resident #65: Record review of the clinical record for Resident #65 revealed an [AGE] year-old male resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 8 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few admitted to the facility on [DATE] with diagnoses of unspecified dementia, unspecified severity, with other behavioral disturbance, Alzheimer's disease with late onset, depression. Resident #65's last MDS was dated 01-10-2024 listing him with a BIMS of 05 indicating he is severely cognitively impaired, and he is independent with most activities. Further record review of the clinical record for Resident #65 revealed that there is no mention of his code status on his care plan. A signed DNR was discovered in his clinical record. During an observation on 02/26/24 at 08:36 AM revealed Resident #65 was pacing in the dining area of the memory unit. Resident #65 was dressed in a t-shirt, sweat pants, shoes, and a baseball cap. Resident #65 had an empty coffee cup in his hand and was walking in dining area while staff tried to redirect him. During an observation on 02/27/24 at 11:49 AM revealed Resident #65 sitting at table in dining area waiting for lunch to be served. Resident #65 would not answer any questions directed towards him. During an interview on 02/27/24 01:54 PM MDS RN was asked what a negative outcome would be for a resident's care plan not to be updated with current information. MDS RN stated that the interdisciplinary team would not have updated information. During an interview on 02/27/24 02:04 PM MDS LVN was asked what a negative outcome would be for a resident's care plan not be updated with current information. MDS LVN stated that the social worker would not be reading code status from the care plan, the social worker would be reading code status from the resident's chart. During an interview on 02/27/24 02:20 PM DON was asked what a negative outcome would be for a resident's care plan not to be updated with current information. DON stated that a resident could have a full code called when in fact they are a DNR. During an interview on 02/27/24 at 02:27 PM RN B was asked what a negative outcome would be for a resident's care plan not being updated with current information. RN B stated that there would be a breakdown in the continuation of care. Record review of facility provided policy titled Goals and Interventions, Care Plans: dated Revised February 2024, reads in part: 1. Care plan goals and interventions are defined as the desired outcome for a specific resident problem or focus. .4. Goals and interventions are entered on the resident's care plan so that all disciplines have access to such information and are able to report whether or not the desired outcomes are being achieved. 5. Goals and interventions are reviewed and/or revised: a. when there has been a significant change in the resident's condition; b. when the desired outcome has not been achieved; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 9 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0656 c. when the resident has been readmitted to the community from a hospital/rehabilitation stay; and Level of Harm - Minimal harm or potential for actual harm d. at least quarterly. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 10 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to attempt to use appropriate alternatives prior to installing a side or bed rail, assess the resident for risk of entrapment from bed rails prior to installation, and review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation for one (Resident #126) of 18 residents reviewed for bed rails. Resident #126 had quarter bed rails on both sides of her bed with an assessment that indicated no use of bed rails and no consent in the EHR. This failure could place residents at risk of entrapment or injury. Findings Included: Record review of Resident #126's admission record dated 02/27/24 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, Parkinson's disease (chronic and progressive movement disorder that initially causes tremors in one hand and stiffness or slowing of movement), hemiplegia (partial paralysis) affecting left nondominant side , chronic obstructive pulmonary disease (inflammation of lung tissue due to non-infectious causes, which results in cough without mucus or phlegm, shortness of breath, and fatigue), chronic diastolic heart failure (a progressive heart disease that affects the pumping action of the heart muscles resulting in shortness of breath and fatigue), and long term use of anticoagulants (use of blood thinners can cause serious bleeding). Record review of Resident #126's EHR MDS face sheet revealed an admission MDS In Progress with an ARD date of 02/26/24. Section C of this MDS was completed and revealed a BIMS of 15 which indicated intact cognition. Record review of Resident #126's care plan initiated on 02/20/24 revealed a focus area regarding Parkinson's disease. An intervention associated with this focus area was for staff to monitor Resident #126 for poor coordination and a decline in cognitive function. The care plan revealed a focus area regarding Resident #126's high blood pressure. One of the interventions for this focus area was to monitor Resident #126 for confusion, disorientation, and seizure activity. The care plan revealed a focus area regarding Resident #126's diagnosis of diabetes mellitus (high blood sugar). An intervention for this area was to monitor Resident #126 for confusion, tremor, and lack of coordination. The care plan revealed no mention of bed rails. Record review of Resident #126's active orders dated 01/27/24 revealed no order for bed rails. Record review of the Assessments tab of Resident #126's EHR revealed a Side Rail/Bed Evaluation dated 02/20/24. This evaluation had a section titled Use of Rails/Bars. Question one of this section was: Indicate the type and size of the bed rails/bars to be used The answer checked for this question was a. No bed rail(s)/Bar(s) used. This evaluation was marked as Signed but did not indicate who had signed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 11 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0700 Record review of the Miscellaneous tab of Resident #126's EHR revealed no consent for bed rails for 2024. Level of Harm - Minimal harm or potential for actual harm During an observation on 02/26/24 at 08:31 AM Resident #126 was lying in bed with the HOB of the bed raised to sitting position and bilateral quarter bed rails in upright position. Residents Affected - Few During an observation and interview on 02/27/24 at 08:52 AM Resident #126 was sitting on her bed with both legs hanging off the side. Her bed had bilateral quarter bed rails in the upright position. She stated she has had the bed rails since she admitted to the facility. She stated the bed rails helped her move around in bed and get out of bed. During an observation on 02/28/24 at 10:47 AM Resident #126 was seated in her w/c next to her bed. Her bed had bilateral quarter bed rails in the upright position. During an interview on 02/28/24 at 01:28 PM DON stated nursing staff were responsible for doing bed rail assessments. She stated nurses were responsible for having bed rail consents signed. DON said a possible negative outcome of a resident having bed rails without a consent or assessment was, They (residents) can be harmed. When asked why Resident #126 had bedrails without a consent and with an assessment that said no bed rails were used DON replied, I'll have to look into that. Record review of facility policy titled Bed Safety and Bed Rails and dated August 2022 revealed in part: . The use of bed rails is prohibited unless the criteria for use of bed rails have been met. 10. Additional safety measures are implemented for residents who have been identified as having a higher than usual risk for injury including bed entrapment (e.g., altered mental status .). Use of Bed Rails 3. The use of bed rails or side rails (including temporarily raising the side rails for episodic use during care) is prohibited unless the criteria for use of bed rails have been met, including attempts to use alternatives, interdisciplinary evaluation, resident assessment, and informed consent. 4. Prior to the installation or use of a side or bed rail, alternatives to the use of side or bed rails are attempted. 5. If attempted alternatives do not adequately meet the resident's needs the resident may be evaluated for the use of bed rails. This interdisciplinary evaluation includes; a. An evaluation of the alternatives to bed rails that were attempted and how these alternatives failed to meet the resident's needs; b. the resident's risk associated with the use of bed rails; c. input from the resident and/or representative; and d. consultation with the attending physician. 8. Before using bed rails for any reason, the staff shall inform the resident or representative about the benefits and potential hazards associated with bed rails and obtain informed consent. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 12 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review it was determined the facility failed to ensure drugs and biologicals were stored and labeled in accordance with currently accepted professional principles and include the appropriate accessory and cautionary instructions, and the expiration date when applicable on 2 of 3 Medication Carts (East side cart #1 and East side cart #2) in that: 1 expired medication found in Medication Cart #1 on East side of building. 23 expired oral (buccal) dose of medication, 1 packaged medication without an expiration date, 1 box of expired medication, and 6 loose pills were found in Medication Cart #2 on East side of building. The facility's failure to ensure drugs and biologicals were stored and labeled in accordance with currently accepted professional principles, medications that have been compromised could result in residents not receiving an accurate dose of medication as well as not being maintained at their best therapeutic level. Findings include: Observation on 02/26/24 at 09:16AM of Medication Cart #1 East side of building with MA E, revealed a bottle of expired Antacid and anti-gas medication with an expiration date of 11/20/23. Observation on 02/26/24 at 09:33AM of Medication Cart #2 East side of building with LVN F, revealed 6 loose pills, that could not be identified by LVN F, 23 oral syringes (one time use) of Morphine for a resident which expired on 11/2023, Morphine for another resident did not have an expiration date on the packing, and 1 box of Zzz Quil melatonin 2mg tabs with an expiration date of 01/2024. LVN F could not identify any of the 6 loose pills. LVN F took the expired narcotics to DON for her to destroy them. Interview on 02/26/224 at 10:29AM with MA E was asked what a negative outcome would be for giving an expired medication. MA E replied, I might get wrote up and it could hurt their stomach. Interview on 02/26/24 at 10:31AM with LVN F was asked what a negative outcome would be for giving an expired medication. LVN F stated, Well it's not gonna work, it will lose its strength. Interview on 02/26/24 at 10:33 AM the DON was asked what a negative outcome would be for administering an expired medication. The DON stated, The medication will less likely to be effective, and will lose its efficacy. The DON was asked what the process is for removing expired medications. The DON stated she wasn't sure and would look to see what the policy states. Record Review of facility policy titled, 'Medication Labeling and Storage' dated revised 02/2023, states the following, but not limited to: Medication Storage: 2. The nursing staff is responsible for maintaining medication storage and preparation areas in a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 13 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0761 clean, safe, and sanitary manner. Level of Harm - Minimal harm or potential for actual harm 3. If the facility has discontinued, outdated or deteriorated medications or biologicals, the dispensing pharmacy is contacted for instructions regarding returning or destroying these items. Residents Affected - Few Medication Labeling: 1. Labeling of medications and biologicals dispensed by the pharmacy is consistent with applicable federal and state requirements and currently accepted pharmaceutical practices. 2.The medication label includes, at a minimum: a. medication name (generic and/or brand) d. expiration date, when applicable. 4. For over the counter (OTC) medications in bulk containers (if permitted by state law) the label contains: a. the medication name, b. strength c. quantity d. accessory instructions e. lot number; and f. expiration date (if applicable). Discontinued Medications: 3. Discontinued medications are destroyed or returned to the issuing pharmacy in accordance with facility policy and state regulations. (See Discarding and Destroying Medications policy.) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 14 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, in accordance with accepted professional standards and practices, the facility failed to maintain medical records on each resident that were complete, accurately documented, readily accessible, and systematically organized for 1 (Resident #324) of 27 residents reviewed for accurate medical records. The facility failed to correctly transcribe the Nurse Practitioner orders for Resident #324 related to blood sugar. This failure could place resident at risk of not receiving needed care or treatments by misleading care providers regarding what care or treatment resident should receive. The findings include: Record review of Resident #324's face sheet dated 02/26/24 revealed a [AGE] year-old female admitted to the facility on [DATE]. She had diagnoses that included, but were not limited to, chronic congestive heart failure (fluid around the heart), acute respiratory failure (sudden failure of lungs to deliver oxygen to the body), type 2 diabetes mellitus without complications (high blood sugar), morbid obesity, depression, muscle weakness, encounter for fitting and adjustment of urinary device, and need for assistance with personal care. Record review of Resident #324's entry MDS dated [DATE] revealed a BIMS score of 14 out of 15 which indicated her to be cognitively intact as assessed by staff. Record review of Resident #324's progress notes dated 02/08/24 revealed the following: patient had been admitted from the hospital due to the emergency department findings out what appeared to be x-ray changes consistent with slight heart failure. Record review of Resident #324's hospital records dated 02/06/24, revealed the following: patient had received 2 units of insulin lispro (HumaLOG) injection on 02/04/24. Blood sugars were monitored on 02/05/24 & 02/06/24 twice daily with blood sugar readings being over the normal mark of 120 each day. Normal blood sugar readings are between 70-120. On 02/05/24, her reading was 125. On 02/06/24, her reading was 121. Assessment and plan from hospital stated patient has type 2 diabetes (high blood sugar) and she will be placed on sliding scale for blood sugars and hemoglobin A1C (blood test that measures average blood sugar levels over the past 3 months). A1C test at the hospital was 5.8, which was in normal range. Record review of Resident #324's care plan initiated on 02/10/24 revealed no documentation of resident having a diagnosis of diabetes or any mention of resident needing interventions for diabetes. Record review of Resident #324's admission MDS, section I, dated 02/12/24 revealed resident has Diabetes Mellitus (high blood sugar). Record review of Resident #324's progress notes at the facility dated 02/26/24 revealed Diabetes Type 2: continue current treatment regimen and follow blood sugar levels. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 15 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0842 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #324's physicians orders dated 02/27/24 revealed no mention of insulin or orders to monitor blood sugars. Record review of Resident #324's Weight & Vitals for February revealed no documentation of blood sugars taken. Residents Affected - Few During an interview on 02/27/24 at 9:18 AM, resident stated that she has not had her blood sugars checked since being in the facility. She stated she would monitor herself before coming to the facility, but not every day. Also, stated she has not had an A1C since being in the facility. During an interview on 02/27/24 at 10:48 AM, LVN C stated that the admission nurse is the one who uploads admission packets and reviews diagnoses on residents that come in from the hospital and that they usually keep diagnoses the hospital gives residents. She stated that if a resident has a diagnosis of diabetes, that finger sticks and monitoring would need to happen in case of infection, which can inhibit healing if blood sugar is off. Also, resident could be at risk of going back to the hospital because of complications from not having blood sugar monitored. LVN C went on to state that she would look at history of resident and follow baselines and finger sticks with all diabetics. During an interview on 02/27/24 at 10:53 AM, DHCS stated that when a resident is admitted from the hospital, the admitting nurse puts in orders for the resident and that she reads the discharge paperwork from the hospital and uploads it into the residents' charts in medical records. Observed DHCS showing this surveyor where discharge papers for residents were located in electronic health records and printed hard copy for surveyor. During an interview on 02/27/24 at 11:01 AM, MDS LVN stated if a diabetic came into the facility without medications for diabetes, there would be weekly labs done to monitor their blood sugars, even if they were not taking medications. During an interview on 02/27/24 at 2:36 PM, RN A stated a possible negative outcome for not getting all the orders or records in resident's files would be that there could be medication errors and that the resident could be at risk for harm, or it could lead to an emergency. During an interview on 02/27/24 at 2:50 PM, the DON stated that the floor nurse puts orders in for new admits and reconciles with the Nurse Practitioner on what needs to be in the orders from the hospital. She stated it is not odd for them to discontinue hospital orders for resident because Long Term Care is different from hospital care. She stated that there were no orders on this resident to have any finger sticks or insulin but that there would be an A1C with the labs. During an interview on 02/28/24 at 9:37 AM, MDS LVN stated that progress notes from Nurse Practitioner stated that resident has Diabetes Type 2 and to follow blood sugar levels. She stated that she added Diabetes to care plan because even though facility is not treating Resident #324 for diabetes, she felt she needed to add it to her care plan. During an interview on 02/28/24 at 9:50 AM, FNP stated progress notes she had written that say to follow blood sugar levels was a mistake on her part. She stated that she sees so many diabetic residents and that is what she usually puts in their notes but stating that on Resident #324's notes, was an error. She stated she should have written follow A1C and that she would amend the progress notes for Resident #324. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 16 of 17 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 675904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windflower Health Center 5500 SW 9th Ave Amarillo, TX 79106 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 0842 Level of Harm - Minimal harm or potential for actual harm Record review of a facility provided policy titled, Charting and Documentation, dated July 2017, revealed the following: All services provided to the resident, progress towards the care plan goals, or any changes in the resident's medical, physical, functional, or psychosocial condition, shall be documented in the resident's electronic medical record. The electronic medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. Residents Affected - Few Record review of a facility provided policy titled, Charting Errors and/or Omissions, dated February 2024, revealed the following: Accurate medical records shall be maintained. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 17 of 17