Inspection·April 11, 2025

F 0644 Record review of Resident #60's active physician orders dated 04/10/2025 revealed the following: Level of Harm - Minimal harm or potential for actual harm Order for Olanzapine Oral Tablet 20 mg-Give one tablet by mouth at bedtime related to schizoaffective disorder, bipolar type. Residents Affected - Few Order for Cymbalta oral Capsule delayed release particles 30mg-Give 90 mg by mouth at bedtime for anxiety related to schizoaffective disorder, bipolar type. Record review of Resident #60's care plan last updated on 03/14/2025 revealed she was care planned due to behavior problems, yelling throughout the night with interventions that included to intervene as necessary to protect the rights and safety of others. The care plan also stated Resident #60 was utilizing psychotropic medication r/t to bipolar schizoaffective disorder with interventions to administer psychotropic medications as ordered by the physician, monitor for side effects and effectiveness. Record review of Resident #60's psychiatry progress note dated 07/03/2024 revealed the following: Nursing staff request to address a psychiatric issue of concern that requires a timely evaluation and medical intervention. Schizoaffective disorder, bipolar type-patient meets DSM-5 (Diagnostic and Statistical Manual of Mental disorders) criteria. Confirms history of episodes of psychosis outside a disturbance of mood. Diagnosis Assessment and Plan: F25.0: Schizoaffective disorder, bipolar type F41.9: Anxiety disorder, unspecified F10.20 Alcohol dependence, uncomplicated Record review of Resident #60's PASRR Level 1 Screening with date of assessment 12/28/2021 revealed the following: C0100 Mental Illness-No C0200 Intellectual Disability-No C0300 Developmental Disability-No Record review of Resident #60's PASRR Level 1 Screening with date of assessment 01/21/2025 revealed the following: C0100 Mental Illness-No C0200 Intellectual Disability-No C0300 Developmental Disability-No (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 2 of 24 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 04/11/2025 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 04/10/2025 at 8:48 AM, LVN A stated she was one of the two MDS Coordinators for the facility. LVN A stated the MDS Coordinators were responsible for ensuring each PASRR was accurate in a resident's file. LVN A stated if a resident had a new diagnosis, then a new PASRR I would be conducted, and if it was positive then a referral would be made to the local mental health authority for a PASRR II screening. LVN A looked at Resident #60's clinical file and said the new diagnosis on 07/03/2024 of schizoaffective disorder, bipolar type should have triggered a new PASRR I screening. LVN A said the new diagnosis was put in by the previous DON and the screening was missed. LVN A stated that a possible negative outcome for not conducting a new PASRR I screening for a resident after a new diagnosis of mental illness would be the staff would not know what services to provide the resident or if the facility could meet their needs. During an interview on 04/10/2025 at 8:50 AM, LVN B stated a diagnosis of schizoaffective disorder, bipolar type was a diagnosis that would trigger a new PASRR I screening. LVN B stated Resident #60 should have had a new PASRR I screening once she was diagnosed with schizoaffective disorder . During an interview and observation on 04/11/2025 at 9:40 AM, Resident #60 was in bed watching tv, her head slightly raised. Resident #60 stated she was seeing a psychiatrist and received medication for her anxiety. Resident #60 stated she had no concerns about her care and felt her needs were being met by the facility and her psychiatrist. During an interview on 04/11/2025 at 2:00 PM, the DON stated the MDS coordinators and nursing staff were responsible for making sure any new diagnosis of mental disorders or intellectual disabilities were addressed with regard to PASRR screenings, but she was ultimately responsible for overseeing it was getting done. The DON stated a consequence for not screening residents accurately could affect the resident's care pertaining to that specific diagnosis and the resident may not get the services that were needed. Record review of the facility policy, Resident Assessment-Coordination with PASARR Program dated 01/01/2025 revealed the following: Policy explanation and compliance guidelines: This facility coordinates assessment with the preadmission screening and resident review (PASARR) program under Medicaid to ensure that individual with a mental disorder intellectual disability or a related condition receives care and services in the most integrated setting appropriate to their needs. 1. All applicants to this facility will be screened for serious mental disorders or intellectual disabilities and related condition in accordance with the State's Medicaid rules for screening. a. PASARR Level I-initial pre-screening that is completed prior to admission. A Negative Level 1 screen permits admission to proceed and ends the PASARR process unless a possible serious mental disorder or intellectual disability arises later. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 3 of 24 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 04/11/2025 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 0644 2. Level of Harm - Minimal harm or potential for actual harm A positive Level 1 screen-necessitates a PASARR [NAME] II evaluation . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 4 of 24 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 04/11/2025 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 observations, interviews, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights 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 were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 1 (Resident #114) of 17 residents reviewed for care plans. The facility failed to develop a comprehensive person-centered care plan based on assessed needs to address Resident #114's pain and the appropriate interventions. This failure could place residents at risk of not receiving desired and necessary care and treatment. Findings Included: Record review of Resident #114's admission record dated 04/09/2025 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included disease of spinal cord, malignant neoplasm of prostate (cancer), and pain. Record review of Resident #114's admission MDS completed on 03/19/2025 revealed a BIMS score of 15 out of 15 indicating cognition was intact. Section J of the MDS indicated Resident #114 received scheduled pain medication. Section J-Health Conditions also revealed pain was present in Resident #114 that interfered with his therapy activities as well as his sleep. Resident #114 rated his pain in Section J to be a 6 out of 10 with 10 being the worst. Section V-Care Area Assessment Summary- pain was triggered and to be addressed in the care plan. Record review of Resident #114's active physician orders revealed the following medication orders: An order dated 03/16/2025 for fentanyl transdermal patch 72-hour 75 mcg/hr-Apply 1 patch transdermally in the morning every 3 days for pain and remove per schedule. An order dated 03/22/2025 for Hydrocodone-Acetaminophen Oral Tablet 7.5-325mg -Give 2 tablets by mouth every 6 hours for pain related to disease of spinal cord, unspecified. Record review of Resident #114's medication administration record for March 2025 revealed Resident #114 received fentanyl transdermal patch 72-hour 75 mcg/hr on 3/17/25, 3/20/25, 3/23/25, 3/26/25, and 3/29/25. Resident #114 received Hydrocodone-Acetaminophen Oral Tablet 7.5-325mg every six hours from 3/23/25 to 3/31/25. Record review of Resident #114's medication administration record for 4/1/25 through 4/10/2025 revealed Resident #114 received fentanyl transdermal patch 72-hour 75 mcg/hr on 4/1/25, 4/4/25, 4/7/25, and 4/10/25. Resident #114 received Hydrocodone-Acetaminophen Oral Tablet 7.5-325mg every six hours from 4/1/25-4/9/2025. Record review of Resident #114's care plan dated 03/26/2025 had no mention of Resident #114's pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 5 of 24 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 04/11/2025 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 management with no goals or interventions related to the diagnoses . Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 04/09/2025 at 9:30 AM, Resident #114 was lying in his bed watching tv., He started to cry and said he was in pain. He stated he had prostate cancer that spread to his bones. Resident #114 said the facility was giving him his pain medication as ordered. Residents Affected - Few During an interview on 04/10/2025 at 9:39 AM, LVN A stated if a resident was in pain and receiving pain medication it should be in the care plan. LVN A pulled up Resident #114's care plan and the MDS Assessment and stated Resident #114's pain management should have been documented in his care plan. LVN A stated it was the MDS Coordinator and the DON's responsibility to ensure care plans were completed accurately. LVN A stated a possible negative outcome for not having services in the care plan would be staff would not know about the care and services needed for the resident. During an interview on 04/10/2025 at 3:00 PM, LVN M stated RN's were responsible for ensuring care and services were put in the care plan. LVN M stated a resident's care plan was generated from the MDS Assessment and not having all the services for a resident in the care plan could impede their progress and cause the resident to stay in the facility longer . During an interview on 04/11/2025 at 2:03 PM the DON stated she was responsible for ensuring care plans were completed accurately. She stated each morning she would conduct a morning meeting with her staff and each resident's care would be discussed and if anything changed or came up in the meeting then the MDS Coordinators were responsible for updating the resident's care plan. The DON stated if the care or services needed was not put in the care plan then care could be missed . Record review of facility policy titled Care Plans, Comprehensive Person-Centered revised March 2022. A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident. .The comprehensive, person-centered care plan includes measurable objectives and timeframes, describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental and psychosocial well-being . .Assessments of residents are ongoing and care plan are revised as information about the residents and the residents' conditions change . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 6 of 24 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 04/11/2025 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that residents who need respiratory care were provided such care consistent with professional standards of practice for 1 (Resident #39) of 17 residents reviewed for oxygen thearpy. Residents Affected - Few The facility failed to ensure Resident #39 had physician's order in his chart for oxygen. This failure could place residents at risk of having records that do not reflect their current status or needs. Findings Included: Record review of Resident #39's Face Sheet dated 04/10/2025 revealed an [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included, but were not limited to, encounter for orthopedic aftercare following surgical amputation, acquired absence of left leg above knee, type 2 diabetes mellitus (high blood sugar), chronic obstructive pulmonary disease (COPD refers to a group of diseases that cause airflow blockage and breathing-related problems), peripheral vascular disease (blood circulation disorder), heart failure, and unspecified atrial fibrillation (abnormal heartbeat). Record review of Resident #39's admission MDS completed on 03/25/2025 revealed a BIMS of 15 out of 15 which indicated cognition was intact. Section O of the MDS revealed Resident #39 was not receiving oxygen On Admission or While a Resident. Record review of Resident #39's care plan dated 03/30/2025 revealed a focus area of I have Congestive Heart Failure. One of the interventions listed for this focus area was OXYGEN SETTINGS: O2 via nasal cannula @2L. Care plan for Resident #39 also revealed a focus area of I have COPD. One of the interventions for this focus area was OXYGEN SETTINGS: O2 via nasal cannula @ 2L. Record review of Resident #39's active physician's orders with last order review date of 3/25/2025 and next order review date of 04/25/2025 revealed no orders for oxygen. During an observation on 04/09/2025 at 9:01 AM Resident #39 was sitting in his wheelchair beside his bed with oxygen nasal cannula in nose. O2 reading was 1 ½ Lpm. During an observation and interview on 04/11/2025 at 10:00 AM, Resident #39 was lying on his back in his bed with O2 nasal cannula in nose and O2 read 1 ½ lpm. Resident #39 stated that he used oxygen all the time. During an interview on 04/11/2025 at 10:09 AM LVN K stated he had worked at the facility for 1 ½ years. He stated that he was working the same hall that Resident #39 resided on. LVN K was asked to pull up the orders for Resident #39's oxygen and how much O2 he was supposed to be receiving. LVN K stated he could not find orders for Resident #39's oxygen. He stated that it was the admitting nurse and all the nurses' responsibility to make sure orders were put in correctly. LVN K stated that Resident #39 had COPD and that a possible negative outcome for not having oxygen orders in a resident file who was receiving oxygen could be difficulty breathing and that the facility was providing medication without a doctor's order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 7 of 24 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 04/11/2025 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 04/11/2025 at 10:14 AM, the DON stated that she could not find Resident #39's orders for oxygen. She stated that all nurses were responsible for putting admission orders in and that it was a problem that his orders were not in his file. The DON stated a possible negative outcome for not having accurate orders for O2 on file could be that they would not know how much O2 to give the resident. During an interview on 04/11/2025 at 1:17 PM, LVN B stated that it was the nurse's responsibility for putting orders in for new admissions. He stated that a possible negative outcome for not having accurate records for oxygen could be a possible medication error. Record review of facility policy titled Oxygen Administration and dated October 2010 revealed the following: . 1. Verify that there is a physician's order for this procedure. Review the physician's orders or facility protocol for oxygen administration. 2. Review the resident's care plan to assess for any special needs of the resident. Record review of facility policy titled Physician Orders and dated 8/16/2024 revealed the following: . A physician, physician assistant, nurse practitioner, or clinical nurse specialist must provide written and/or verbal orders for the residents' immediate care and needs. 1. The written and/or verbal orders should include at a minimum: b. Medication orders if indicated c. Routine care orders . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 8 of 24 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 04/11/2025 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 observations, interviews, and record review the facility failed to assess residents for risk of entrapment from bed rails prior to installation. The facility failed to review the risks and benefits of bed rails with 1 (Resident #319) of 17 residents or their resident representatives and obtain informed consent prior to installation of bed rails. Resident #319 had (2) one-quarter bed rails, one on each side of his bed with no documentation of consent or safety assessment prior to installation. This failure could place residents at risk of injury, hinder residents from getting out of bed, and/or cause a decline in resident's ability to engage in activities of daily living. Findings included: Record Review of Resident #319's Face Sheet dated 04/10/2025 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses to include chronic obstructive pulmonary disease (COPD refers to a group of diseases that cause airflow blockage and breathing-related problems), chronic atrial fibrillation (a heart condition where the upper chambers of the heart beat irregularly and can cause stroke and blood clots), pneumonia due to mycoplasma pneumoniae (a bacterial infection which can cause pneumonia, a lung infection), unspecified toxic encephalopathy (brain dysfunction caused by exposure to toxins that can cause altered mental status, memory loss, but without a specific toxin identified), and muscle wasting and atrophy (breakdown of muscles). Record review of Resident #319's admission MDS assessment dated [DATE] revealed the admission MDS was not yet completed. Record review of Resident #319's Care plan dated 04/05/2025 revealed the resident was on antibiotic therapy via IV related to pneumonia and was on enhanced barrier precautions due to the indwelling device. The care plan had no mention of bed rail usage. Record review of Resident 319's clinical record revealed no physician orders for bed rails. Record review of Resident #319's clinical record under assessment tab titled Side Rail/Bed Evaluation revealed the following: Use of Rails/Bars1. Indicate the type and size of the bed rails/bars to be used: a. No bed rail(s)/Bar(s) used. Record Review of Resident #319's clinical record for bed rail consents revealed no documentation of a signed bed rail consent. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 9 of 24 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 04/11/2025 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 During an observation and interview on 04/09/25 at 11:07 AM, Resident #319 was observed lying in bed with the head of the bed raised, (2) one-quarter bed rails were observed at the head of the bed on each side. Resident #319 was alert and interview able and stated he had no concerns about his care. During an interview on 04/11/25 at 8:43 AM, Resident #319 stated he used his bed rails and liked having them for repositioning but could not remember signing a consent form for them. During an interview and observation on 04/11/25 at 2:25 PM, LVN K, the charge nurse on the hallway that Resident #319 resided on, observed the resident's bed, and stated Resident #319 had (2) one-quarter bed rails on his bed. LVN K stated upon admission the residents were asked if they need or want bedrails, and if so, they must be assessed and sign a consent. During an interview on 04/11/25 at 11:20 AM, LVN H stated she was the nurse who completed the side rail/bed evaluation that stated Resident #319 had no bedrails. She stated she did not remember Resident #319 having bed rails on his bed and then stated she must have made a mistake. LVN H stated a possible negative outcome for not having a signed consent or assessment for bed rails could be death. During an interview on 04/11/25 at 11:22 AM, the ADM stated she was not sure what the procedure was for bed rails since she was so new. A negative outcome for not having a signed consent form or assessment for a bed rail could be that it could impede a resident from getting out of bed. Record Review of the facility policy titled Bed Safety and Bed Rails dated August 2022 revealed the following in part . The use of bed rails is prohibited unless the criteria for use of bed rails have been met. The use of bed rails or side rails is prohibited unless the criteria for use of bed rails have been met, including resident assessment, and informed consent. 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 10 of 24 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 04/11/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, administering, and documentation of all drugs and biologicals) to meet the needs of 1 out of 5 residents (Residents #8) who was observed for medication administration. -RN I administered medication to Resident #8 via nebulizer and left Resident #8 unattended. These deficient practices can affect residents that receive medications resulting in adverse reactions to medication, deterioration in their health, exacerbation of their disease process, and/or hospitalization. Findings included: Record review of Resident #8's face sheet, dated 04/11/2025, revealed Resident #8 was an [AGE] year-old female resident who was admitted to the facility on [DATE]. Resident #8 had diagnoses of, but not limited to, parainfluenza virus pneumonia, unspecified asthma with acute exacerbation (a sudden worsening of asthma symptoms characterized by difficulty breathing, coughing, wheezing, and chest tightness), chronic obstructive pulmonary disease with acute exacerbation (a sudden worsening of COPD symptoms, like increased shortness of breath, cough, and sputum production), type 2 diabetes mellitus without complications (elevated blood sugar levels in the blood), congestive heart failure (a condition where the heart can't pump enough blood to meet the body's needs), atrial fibrillation (a common heart rhythm disorder characterized by an irregular and often rapid heartbeat, affecting the upper chambers of the heart (atria)), and weakness. Record review of Resident #8's MDS, dated [DATE], revealed that Resident #8's BIMS Score was 15 out of 15, which indicated Resident #8 had not cognitive deficits. Resident #8's functional abilities ranged from partial/moderate assistance needed with lower body dressing and putting on/taking off footwear, and supervision or touching assistance was needed for upper body dressing and shower/bathing. Resident #8 was able to perform toileting hygiene, oral hygiene, and eating with setup or clean-up assistance only. Record review of Resident #8's care plan, dated 04/11/2025, revealed the following: Focus o I have COPD Goal o The resident will be free of s/sx of respiratory infections through review date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 11 of 24 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 04/11/2025 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 0755 Interventions Level of Harm - Minimal harm or potential for actual harm o The resident will display optimal breathing patterns daily Residents Affected - Some through review date. o Give aerosol or bronchodilators as ordered. Monitor/document any side effects and effectiveness. o Head of bed elevated to 45 deress or out of bed upright in a chair during episodes of difficulty breathing. o Monitor for s/sx of acute respiratory insufficiency: Anxiety, Confusion, Restlessness, SOB at rest, Cyanosis, Somnolence. o Monitor/document/report PRN any s/sx of respiratory infection: Fever, Chills, increase in sputum (document the amount, color and consistency), chest pain, increased difficulty breathing (Dyspnea), increased coughing and wheezing. o OT consult for energy conservation recommendations. o OXYGEN SETTINGS: O2 via nasal cannula @ 2-3L prn Record Review of Resident #8's active physicians orders, dated 04/11/2025 revealed the following: Acetylcysteine Inhalation solution 10% (Acetylcysteine)5ml inhale orally four times a day related to PARAINFLUENZA VIRUS PNEUMONIA (J12.2); UNSPECIFIED ASTHMA WITH (ACUTE) EXACERBATION (J45.901) During an observation on 04/10/25 at 07:18 AM revealed Resident #8's nebulizer cup with liquid still in cup. RN I stated it appeared Resident #8 didn't take the entire dose the last time the medication was administered. RN I went to dump the remaining medication in the sink of Resident #8's restroom. During an observation on 04/10/25 at 07:21 AM RN I left the nebulizer treatment on the bedside table when she (RN I) left the room to get Resident #8 new nebulizer tubing. During an observation on 04/10/25 at 07:25 AM RN I administered Resident #8 with her nebulizer treatment and left Resident #8 to administer her the nebulizer treatment alone and left the room. During an observation/interview on 04/10/25 at 07:45 AM Resident #8 was administering her breathing treatment alone in her room. Resident #8 stated the treatment usually takes about 10-15min and the nurses never stay with her to administer nebulizer treatment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 12 of 24 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 04/11/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 04/10/25 at 10:03 AM RN I stated Resident #8 preferred to take her breathing treatment by herself. RN I stated the negative outcome for not staying with the resident during a nebulizer treatment would be the resident might not receive her entire dose. and it would not be as therapeutic as it was supposed to be. RN I then stated she was the only nurse for 21 residents and that is another reason why she didn't stay. She (RN I) didn't want to be caught up in a room if someone else needed her. RN I stated the negative outcome for leaving the medication on the bedside table would be the medication could be knocked over. During an interview on 04/10/25 at 10:09 AM Resident #8 stated she had never stated it was her preference to administer the nebulizer alone. Resident #8 stated, The nurses come in hand it to me and leave. During an interview on 04/11/25 at 11:38 AM DON stated the negative outcome for leaving medication on a bedside table was no medication should be left unattended, someone else could come in and drink it. DON stated the negative outcome for a nurse not staying to watch the administration of a breathing treatment would be that the resident might not complete the medication. Record review of the facility provided policy titled, Medication Administration, reviewed 12/01/2021, revealed the following: . Procedure . . Medications are prepared safely, appropriately labeled, and dispensed safely. Record review of facility provided policy titled, Nebulizer Therapy, date implemented: 04/01/2025, revealed the following: . Care of the Resident . .14. Observe resident during the procedure for any change in condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 13 of 24 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 04/11/2025 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 - Some 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 and record review, the facility failed to store and label drugs and biologics in accordance with professional principles, and include the appropriate accessory and cautionary instructions and the expiration date when applicable to meet the needs of for 1 of 17 (Resident #6,) and 1 of 5 medication carts (LTC Side B medication cart), and 2 of 2 (rehab side and LTC/MC side)medication storage rooms under review. -Medication cart for B side of LTC had a box of anti-diarrheal with an expiration date of 02/2025. -Resident #6's Albuterol inhaler had an expiration date of 01/2025, and a Breo Ellipta inhaler with no open date on medication. -Medication cart for A side of LTC had a box of acid reducer with an expiration date of 12/2024. -Medication cart for A side of LTC had bottle of Geri-Tussin with an expiration date of 03/2025. -Medication cart for Back of Rehab had glucometer control solution with an expiration date of 09/30/2024. -Rehab medication room had 3 bottles of B-Complex with an expiration date of 03/2025, and 1 bottle of Glucosamine Chondroitin complex with an expiration date of 02/2025. -LTC/MC medication room had 3 bottles of B-Complex with an expiration date of 03/2025. The facility's failure 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 could place all residents receiving medication at risk for drug diversion, drug overdose, and accidental or intentional administration to the wrong resident. Findings include: During an observation on 04/09/25 at 08:27 AM of the medication cart for side B of LTC revealed 4 pink pills in a medication cup in the top medication drawer. LVN C stated they were left there by the night shift and appeared to be Benadryl. 2.5 pills were discovered to be loose in the bottom of the medication drawers. LVN C identified 1.5 pills to be Metoprolol and the brown pill to be Famotidine, and a box of anti-diarrheal with the expiration date of 02/2025. Resident # 67's albuterol had an expiration date of 01/2025 and a Breo Ellipta inhaler with no open date on the inhaler. Resident # 6 had a Breyna inhaler with no open date on the inhaler. Resident #1 had a Wixela inhaler with a discard after 04/07 date written on the inhaler. Discard instructions on box stated to discard after 3 months after opening foil pouch. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 14 of 24 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 04/11/2025 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 During an interview on 04/09/25 at 08:41 AM LVN C stated a negative outcome for having loose pills in the medication cart would be the count would be short for the resident at the end of the month. LVN C stated the negative outcome for having expired medications would be the medication would not have the strength that they (medications) need to work. LVN C stated the night shift was responsible for making sure the cart was clean. Residents Affected - Some During an observation on 04/09/25 at 08:46 AM of the Medication cart for side A of LTC revealed a box of acid reducer that had an expiration date of 12/2024 and a bottle of Geri-Tussin with an expiration date of 03/2025. During an observation on 04/09/25 at 08:56 AM of the MC/locked unit medication cart revealed Resident # 218's Breo Ellipta inhaler with no open date on inhaler. Resident # 112 had a Trelegy inhaler with no open date on inhaler. During an observation and interview on 04/09/25 at 09:13 AM of the medication cart for the Back of the rehab side of the facility, revealed Resident # 219 had nasal spray Fluticasone Prop 50mcg spray did not have an open date on the bottle. Control solution for glucometer had an expiration date of 09/30/2024. LVN D stated that the night shift would perform control checks for glucometer machines. During an observation on 04/09/25 at 09:24 AM of the medication cart for the Front of the rehab side of the facility, revealed Resident # 81's Humalog quick pen had an open date of 03/01/2025. During an interview on 04/09/25 at 09:37 AM LVN D stated a negative outcome for having expired controls for the glucometer machines were the blood sugars won't read correctly, they could be wrong. LVN D stated a negative outcome for not having open dates on medications would be the medication might not work because it could be expired. During an observation on 04/09/25 at 09:40 AM of the medication room on the Rehab side of the facility revealed 3 bottles of B-Complex with an expiration date of 03/2025. 1 bottle of Glucosamine Chondroitin complex with an expiration date of 02/2025. During an interview on 04/09/25 at 09:44 AM LVN D stated a negative outcome for having expired medications in the medication storage room would be that someone would come in and grab it, to use it, and the medication would not be effective. During an observation on 04/09/25 at 10:13 AM of the medication room on the LTC/Memory care side of facility reveled 3 bottles of B-Complex with an expiration date of 03/2025. During an interview on 04/09/25 at 10:20 AM LVN C stated a negative outcome for having expired medications in the medication storage room would be that someone can pull them (medication), and put them in the med carts and they won't be effective. During an interview on 04/11/25 at 11:44 AM the DON stated a negative outcome of having expired medications would be the medications would not be effective for the residents. The DON stated the negative outcome for having expired glucometer controls would lead to inaccurate glucose checks for residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 15 of 24 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 04/11/2025 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 - Some The DON stated the negative outcome for not writing open dates on medications would be that the staff would not know when the medication would expire and lead to an ineffective drug for the resident. The DON stated the negative outcome for having loose pills in the medication carts would be that anyone could take them, it could lead to a resident not having enough medications for the month. The DON stated the night shift was responsible for maintaining the medication carts, but any nurse was responsible for maintaining a clean and orderly cart. The DON stated the negative outcome for having expired medications in the medication rooms would lead to a nurse putting expired medications on a medication cart and them (medications) not being effective for the residents. Record review of the facility provided policy titled, Medication Labeling and Storage, Revised February 2023, revealed the following: Medication Storage . . 2. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. 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. 4 Compartment (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts, and boxes containing medications and biologicals are locked when not in use, and trays or carts used to transport such items are not left unattended if open or otherwise potentially available to others. 5. Medications are stored in an orderly manner in cabinets, drawers, carts, or automatic dispensing systems. Each resident's medications are assigned to an individual cubicle, drawer, or other holding area to prevent the possibility of mixing medications of several residents. .Medication Labeling . .2. The medication label include, at a minimum: . .d. expiration date, when applicable; . Record review of the facility provided policy titled, Medication Administration, Reviewed 12/01/2021, revealed the following: Procedure . .Medications are properly and safely stored throughout the organization. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 16 of 24 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 04/11/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, and serve food under sanitary conditions in 2 of 2 kitchens when they failed to: Residents Affected - Many A. Ensure stored food was properly labeled, dated and covered. B. Ensure general cleanliness was maintained. These failures placed all residents who ate food served by the kitchen at risk of cross contamination and food-borne illness. Findings included: In an observation on 4/9/25 at 8:20 am, Kitchen # 2 was located inside the LTC facility and had capabilities of storing and preparing food items for the LTC, as well as a steam table for plating and serving foods. In an observation on 4/9/25 at 8;22 am, of the kitchen prep area for Kitchen #2, the following was observed: 1. Food crumbs and spills were observed in the bottom of the 4-door cooler. All 4 door handles were grimy and sticky to the touch. 2. The utensil drawer had food crumbs and debris inside the drawer holding the cooking utensils. There were 5 dirty food caked utensils with food debris inside the drawer with clean utensils. 3. The toaster had food crumbs on the inside of the toaster, the outside of the toaster and around the counter. 4. There were crumbs and food debris on the tops of coffee cups stored in a blue dishwashing crate in the middle of the kitchen. Some of the cups were right side up and laying on their sides. There were plastic lids, plastic jugs, potholders and bowls on top of the coffee cups in the plastic dishwasher crate. 5. The plate holder had food debris and crumbs inside and on top of the plates. 6. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 17 of 24 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 04/11/2025 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 0812 The plate covers were stored right side up and had food crumbs inside the lids and on the shelf. Level of Harm - Minimal harm or potential for actual harm 7. Residents Affected - Many The serving cart had crumbs on the inside crevices of the shelves and the outside cart handles were sticky to the touch. 8. The walls of the kitchen had food splatters and grease on the surface. 9. An opened block of cheese wrapped in saran wrap, dated 3/17/25 had 2 black spots on the surface of the cheese stored in the cooler. In an observation on 4/9/25 at 8;45 am of Kitchen #1, which was located in a free-standing building across the street from the LTC facility. Kitchen #1 had the capabilities and the task for cooking, preparing, storing, and serving meals for the LTC facility. In an observation on 4/9/25 at 8:45 am of the pantry in Kitchen #1, the following was found: 1. A package of vanilla wafers, opened, no label or date not in original box. 2. The plastic sugar, flour and rice bins were sticky and grimy to the touch. There were food crumbs on the sides and top of the bins. The sugar had black and brown specks of food and paper in the sugar. 3. A plastic bin held loose dry rice on the bottom of the bin and loose dried pasta on the top of the rice in the bin. 4. A bag of pasta opened, no label or date, not in original box. 5. A plastic tub of brown rice was sitting on top of a 25-pound bag of cornmeal on a shelf. 6. The floor, shelves and trays holding food items had crumbs on all surfaces, were sticky to the touch. There was food and trash in the floor under shelves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 18 of 24 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 04/11/2025 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 0812 In an observation on 4/9/25 at 9:00 am of the walk-in cooler in Kitchen #1, the following was found: Level of Harm - Minimal harm or potential for actual harm 1. Residents Affected - Many 2 trays of individual bowls of fruit uncovered to air, no label or date and 1 tray of individual bowls of salad, uncovered no label or date. The salad was dried up, brown and stuck to the bottom of the bowls. In an observation on 4/9/25 at 9: 08 am of the walk-in freezer in Kitchen #1, the following was found: 1. 2 bags of biscuits, no label or date, not in original box. 2. 2 packages of cookie dough, no label or date, not in original box 3. 2 bags of sweet corn nuggets and 1 bag of okra, no label or date, not in original box. 4. 8 brown bags, no label or date, not in original box. 5. There was trash, paper cups, and food debris in the floor of the freezer. In an observation on 4/9/25 at 9:25 am of the walk-in cooler in Kitchen #1, the following was found: 1. A rack of 6 trays of dessert dough, covered with a plastic sheet with a large hole in the side of the covering that allowed air into the rack, no label or date, 2. The walk-in cooler had trash and food debris on the floor. Observations of Kitchen #2 on 4/10/25 at 9:45 am revealed the same concerns in the kitchen with no corrections. Observations of Kitchen #1 on 4/11/25 at 8:45 am revealed the same concerns in the kitchen with no corrections. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 19 of 24 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 04/11/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many In an interview with the Director of Dining Services, (DDS), on 4/10/25 at 3:30 pm, the DSS stated he expected all staff to label and date all foods as they are used. He stated he expected the discard date on the sticker to be filled out as well like the sticker said. He stated he was not aware it had not been filled out for some foods. He stated staff would not know what date to discard the food if the date was not filled out. The DDS stated he was not aware there were food items in the freezer with no sticker. The DDS stated he was not aware of foods not being covered and stated he expected all foods to be covered, labeled and dated. The DDS stated he expected staff to clean every day and as they go. He stated he had not made any cleaning schedules. The DDS stated he told the staff what to clean and when to do it and expected the staff to follow his directions. He stated he had not been aware of the dirt and grime in the kitchen until this conversation. The DDS stated he trained the staff in the kitchen duties and also oversaw the LTC kitchen #2. He stated he had no policies but would try to locate some policies. In an interview and a walk through with the DM on 4/11/25 at 9:00 am the DM acknowledged the issues in the kitchen. She stated the cheese had been dated with the opened date. She stated she was told she did not have to label it any further or have an expiration date. She stated she expected staff to clean as they went and do what needed to be done. She stated she had no check off list for cleaning and she tried to go behind staff to see if cleaning had occurred. She stated she trained staff in kitchen duties. The DM stated she had no policies for the kitchen. She stated the only thing she had were signs posted around the kitchen and the paper titled Daily Cleanups sheet. Record review of the facility's policy titled, 'Date Marking for Food Safety dated 3/25/25, documented: the facility adheres to a date marking system to ensure the safety of ready to eat, time temperature control for safety food. The food shall be clearly marked to indicate the date by which the food shall be consumed or discarded. The individual opening or preparing the food shall be responsible for date marking the food at the time the food is opened or prepared. The marking system shall consist of a color-coded label, the day/date of opening, and the day/date the item must be discarded. The discard date may not exceed the manufacturers use by date, or 4 days, whichever is earliest. The date of opening counts as one day. The DM shall spot check refrigerators weekly for compliance and document accordingly. Prepared foods that are delivered to the nursing units shall be discarded after 2 hours if not consumed. These items shall not be refrigerated as the time/temperature cannot be verified. Record review of the facility 'Daily Cleanup sheet from the DM in Kitchen #2 revealed the morning shift was responsible for wiping down toaster, wiping down all shelves, wiping down all carts inside and outside, sweeping and mopping and taking out trash. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 20 of 24 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 04/11/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 4 of 6 (LVN C, CNA F, CNA G, and RNI) staff observed for resident care. Residents Affected - Some -LVN C did not perform hand hygiene, use PPE or sterile technique (to minimize the number of microbes present to as few as possible) to flush Resident #27's suprapubic catheter. -CNA F did not change gloves or perform hand hygiene during incontinent care of Resident #60. -CNA G did not change gloves or perform hand hygiene during incontinent care of Resident #60. -EBP signage or PPE for EBP was in place for Resident #319, who has a PICC line. -RN I did not use PPE while administering IV medications via PICC line for Resident #319. -RN I dumped Resident #8's medication down the bathroom sink. These deficient practices affect all residents in the facility by exposing them to care that could lead to the spread of viral infections, secondary infections, communicable diseases. Findings included: During an observation on 04/09/25 at 10:33 AM revealed LVN C was flushing Resident #27's suprapubic catheter. No EBP cart was outside of Resident #27's room and PPE (gown) was not donned. LVN C did not perform hand hygiene before donning gloves to perform the task. No sterile technique was utilized during this procedure. During an observation on 04/09/25 at 10:50 AM revealed LVN C did not perform hand hygiene before the 2nd attempt to flush Resident #27's suprapubic catheter. LVN C did not don PPE (gown) or don sterile gloves or utilize sterile technique for the procedure. During an observation on 04/10/25 at 08:40 AM revealed no EBP precautions signage or PPE was outside the room for Resident #319 who had a PICC line and was receiving IV antibiotics. RN I proceeded to enter into room without PPE (gown) to administer IV antibiotics. During an interview on 04/10/25 at 10:03 AM RN I stated that there was not EBP precautions out in front of Resident #319 room earlier but there was now. RN I stated that the negative outcome for not donning PPE would be that it could lead to an increased risk for infection for the resident. During an observation on 04/10/25 at 02:38 PM revealed perineal care for Resident #60 was performed by CNA G and CNA F. Both CNAs' were asked if they had performed hand hygiene before donning PPE and both of them said that they had not. Both CNAs' walked into the resident's room and started to perform peri-care for Resident #60. Cleaning of Resident #60's peri-area was cleaned in an aseptic technique (minimize the risk of infection by preventing the introduciton of bacteria into an area). Resident #60 was cleaned when CNA F reached for a clean brief with the dirty gloves that CNA F just used (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 21 of 24 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 04/11/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm to clean the peri-area of Resident #60. CNA G then took the dirty brief and dirty wipes from CNA F and discarded them, then proceeded to pull the clean brief out of the opposite side of the resident with the dirty gloves that they had worn to discard the dirty brief Both CNA's touched the bedspread of Resident #60 and repositioned Resident #60 in the bed. CNA F did not wash or sanitize their hands after removing EBP or gloves after care was complete. Residents Affected - Some During an interview on 04/10/25 at 02:53 PM with CNA F stated that a negative outcome for not changing gloves and washing hands in between the dirty and clean aspect of peri-care could lead to cross contamination. During an interview on 04/10/25 at 02:55 PM CNA G stated that a negative outcome for not changing gloves and performing hand hygiene could lead to an increased risk for infection for the resident During an interview on 04/11/25 at 11:31 AM DON stated that the negative outcome for not performing hand hygiene would be cross contamination, and the negative outcome not having EBP provided for a resident on EBP precautions was that there was a failure in protecting the resident from being introduced to a new organism. Record review of facility provided policy titled Handwashing/Hand Hygiene, revised October 2003, revealed the following: Policy Statement This facility considers hand hygiene the primary means to prevent the spread of healthcare-associated infections. Policy Interpretation and Implementation Administrative Practices to Promote Hand Hygiene . . 2. All personnel are expected to adhere to hand hygiene policies and practice to help prevent the spread of infections to other personnel, residents, and visitors. .Indications for Hand Hygiene 1. Hand hygiene is indicated: a. Immediately before touching a resident; b. Before performing an aseptic task (for example, placing an indwelling device or handling an invasive medical device); c. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 22 of 24 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 04/11/2025 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 0880 After contact with blood body fluids, or contaminated surfaces; Level of Harm - Minimal harm or potential for actual harm d. After touch a resident; . Residents Affected - Some .f. before moving from work on a soiled body site to a clean body site on the same resident; and g. immediately after glove removal. . Preventing Contamination of sinks and Sink Areas 1. Personnel will refrain from disposing substances that promote the growth of biofilms in handwashing sinks such as: . . b. medications; . Record review of facility provided policy titled Catheter Irrigation, effective date 01/06/2025, revealed the following: Policy Explanation and compliance Guidelines: 1. Urinary catheters shall be irrigated by a licensed nurse using sterile technique . 2. Irrigation through a closed system is the preferred method of irrigation. .b. Perform hand hygiene. Put on gloves and other protective equipment, as needed. .e. Perform hand hygiene, and prepare for sterile procedure. .g. Remove gloves and perform hand hygiene. Record review of facility provided policy titled Perineal Care, revised February 2018, revealed the following: Steps in the Procedure . .2. Wash and dry your hands thoroughly. .9. Discard disposable items into designated containers. 10. Remove gloves and discard into designated container. 11. Wash and dry your hands thoroughly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 23 of 24 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 04/11/2025 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 0880 12. Reposition the bed cover. Make resident comfortable. Level of Harm - Minimal harm or potential for actual harm .16. Wash and dry your hands thoroughly. Residents Affected - Some Record review of facility provided policy titled Enhanced Barrier Precautions, revised 04/05/2025, revealed the following: Procedures 1. Enhanced barrier precautions (EBP) will be implemented for the following (including new admissions . . Indwelling medical devices (e.g., central line, urinary catheter, feeding tube, tracheostomy/ventilator regardless of MDRO colonization status. . 3. For new admissions, the admissions team will inform nursing [NAME] before admission to set up EBP. Clear signage on the door or wall outside of the resident room indicating the type of precautions and required PPE (e.g. gown and gloves) will be in place. .4. All team members will wear appropriate PPE (gown and gloves) for high-contact resident are but not limited to: Peri-care Device care (central line, urinary catheter, ) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675904 If continuation sheet Page 24 of 24