Inspection·August 31, 2022

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 provide respiratory care consistent with professional standards of practice for 1 of 12 residents (Resident #46) reviewed for respiratory care, in that: Residents Affected - Few Resident #46's oxygen concentrator bottle and nasal cannula did not have a date. This failure could place residents who receive oxygen at risk for infection and respiratory compromise. The findings included: Record review of Resident #46's face sheet, dated 08/28/22, revealed an admission date of 11/14/2018 with diagnoses that consisted of: Emphysema (a lung condition that causes shortness of breath),; Dysphasia (difficulty or discomfort swallowing),: and Cervicalgia (pain or significant discomfort in your neck, especially at the back and/or sides). Record review of Resident #46's Quarterly MDS, dated [DATE], revealed the resident's BIMS was not completed which indicated the resident was unable to complete the interview. Section O of the Quarterly MDS revealed documentation of yes for Oxygen usage. Record review of Resident #46's care plan, dated 07/21/2022, revealed Resident #46 had oxygen therapy; Resident has Emphysema, Oxygen PRN. Record review of Resident #46's, medication order report, dated 08/28/2022, revealed, OXYGEN TUBING AND WATER BOTTLE: CHANGE AND DATE PRN (as needed). Observation on 08/28/2022 at 10:00 a.m. revealed Resident #46's oxygen concentrator water bottle and nasal cannula were not dated. During an interview on 08/28/2022 at 10:00 a.m. LVN B stated Resident #46's disposable oxygen bottle and nasal cannula did not have a date on it, which indicated it was unknown when it was placed. LVN B stated the oxygen bottles and nasal cannulas should have a date written on them to indicate when they were opened. LVN B stated the night shift changed the oxygen bottles and nasal cannulas weekly on Sunday's or when they were empty or dirty, and the date was to be written on the bottles and nasal cannulas. LVN B stated this was to prevent infection or bacteria build-up. During an interview on 08/28/2022 at 12:00 p.m. the DON stated the oxygen bottles for the concentrators and nasal cannulas were to be dated when opened by the nurse on duty. The DON stated the night shift changed the bottles weekly as needed. The DON stated it was her expectation that the charge nurses on duty did this. The DON stated all the nurses should date oxygen bottles and nasal cannulas with dates on them. Record review of the facility's policy, titled Nasal Cannula, dated October 2002 and revised June 2006, revealed, replace entire set up every 7 days. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 2 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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 - Few 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 observation, interview and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biological's) to meet the needs of each resident, for 1 of 12 residents (Resident #48) reviewed for medication storage, in that: Inhaled medication for Resident #48 was found on the nurse's medication cart even though the had been discharged on 08/02/2022. This deficient practice could affect patients by receiving the wrong medication, causing medication errors. The findings were: Record review of Resident #48's face sheet, dated 08/29/22, revealed the resident was admitted to the facility on [DATE] with diagnoses that consisted of: Emphysema (lung condition that causes shortness of breath); Alzheimer's Disease (a progressive mental deterioration that can occur in middle or old age, due to generalized degeneration of the brain); andAnxiety Disorder (involves a persistent feeling of doom or dread). Record review of Resident #48's physicians' orders, dated 08/28/2022, revealed an order dated 08/02/2022, for Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML administer 1 applicatorful inhale orally via nebulizer every 4 hours related to shortness of breath. Record review of Resident #48's MDS, dated [DATE], revealed that the resident had a BIMS score of 00, which indicated the resident was unable to complete the interview. Observation of the nurse's' medication cart on 08/28/2022 at 10:40 a.m. revealed Resident #46's Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/ 3 ML was on the medication cart. During an interview with LVN A 08/28/2022 at 11:10 a.m., LVN A confirmed that inhaled medication for Resident #48 was in medication cart and that resident had been discharged on 08/02/2022. LVN A was asked what the potential for harm to resident if medication was left in medication cart, and LVN A stated the risk was a possible medication error if medications were not removed from cart after a patient discharges. During an interview with the DON on 08/30/2022 at 9:10 a.m., the DON stated it was good nursing practice to remove residents discharged medications from medication cart to help prevent medication errors. The DON further confirmed medications on the cart for Resident #48 should have been removed and placed in discharged /discontinued box in the medication room as the patient had been discharged from the facility on 08/02/2022. The DON stated the facility had no policy for medication reconciliation, but it was her expectation that nurses remove discharge medication upon resident discharge . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 3 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for 6 of 12 (Residents #43, #44, #45 # 24, #29, and #7) reviewed for pharmacy services, in that: 1. Resident #43's Insulin Basaglar Kwik Pen was observed without an open date. 2. Resident #44's Insulin Novo Log bottle was observed without an open date. 3. Resident #45's Insulin Glargine Kwik Pen was observed without an open date. 4. Resident #29's Albuterol Sulfate Nebulization Solution was observed without an open date. 5. Resident #24's Ipratropium-Albuterol Solution was observed without an open date. 6. Resident #7's Albuterol Sulfate Nebulization was observed without an open date. These deficient practices could affect the residents who receive insulin and aerosol medication by placing them at risk for harm by receiving expired medication. The findings were: 1. Record review of Resident #43's face sheet, dated [DATE], revealed an admission date of [DATE] with diagnoses which consisted of: Heart Failure (When the heart cannot pump enough blood and oxygen to support other organs in your body); Diabetes Mellitus (a disorder of carbohydrate metabolism characterized by the impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar/glucose in the blood); and Alzheimer's Disease (progressive disease, where dementia symptoms gradually worsen over several years). Record review of Resident #43's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 15, which indicated the resident was cognitively intact. Record review of Resident #43's physician's orders, dated [DATE], revealed an order dated [DATE] for Insulin Basaglar Kwik Pen administer 24 units subcutaneously every day 2. Record review of Resident #44's face sheet, dated [DATE], revealed an admission date of [DATE] with diagnoses which consisted of: Diabetes Mellitus (a disorder of carbohydrate metabolism characterized by the impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar/glucose in the blood); Hypothyroidism (condition where the thyroid doesn't create and release enough thyroid hormone into your bloodstream); and Overactive Bladder (condition in which uncontrolled need or urge to urinate). Record Review of Resident #44's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 14, which indicated the resident was cognitively cognitive intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 4 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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 Record review of Resident #44's Physician orders, dated [DATE], revealed an order for NovoLog dated [DATE]. Solution Inject as per sliding scale subcutaneously: if 0 - 150 = 0 units; 151 - 200 = 2 units;201 250 = 4 units; 251 - 300 = 6 units; 301 - 350 = 8 units; 351 - 400 = 10 units If >350 give 10 U. 3. Record Review of Resident #45's face sheet, dated [DATE],2 revealed an admission date of [DATE] with diagnoses which consisted of: Diabetes Mellitus (a disorder of carbohydrate metabolism characterized by the impaired ability of the body to produce or respond to insulin and thereby maintain proper levels of sugar/glucose in the blood); Heart Failure (a condition that develops when your heart does not pump enough blood for the body's needs); and Spinal Stenosis (a condition that causes pressure on the spinal cord and the nerves within the spine). Record review of Resident #45's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 11, which indicated the resident was moderately cognitively impaired. Record Review of Resident #45's physician's orders, dated [DATE], revealed an order for Insulin Glargine inject 15 units subcutaneously at bedtime dated [DATE], and Insulin Lantus inject 15 units subcutaneously at bedtime. 4. Record review of Resident #29's face sheet, dated [DATE], revealed an admission date of [DATE] with diagnoses which consisted of: Hypertension (when your blood pressure, the force of your blood pushing against the walls of your blood vessels, is consistently too high); Bradycardia (a condition where your heart beats fewer than 60 times per minute); and Spondylosis (a type of arthritis spurred by wear and tear to the spine). Record review of Resident #29's Quarterly MDS, dated , [DATE], revealed the resident had a BIMS score of 14, which indicated the resident was cognitively intact. Record review of Resident #29's physician's orders, dated [DATE], revealed an order dated [DATE] for Albuterol Sulfate Nebulization Solution 0.63 MG/3 ML administer one vial inhale orally via nebulizer two times a day related to COUGH. 5. Record review of Resident #24's face sheet, dated [DATE], revealed an admission date of [DATE], with diagnoses which consisted of: Gastroesophageal reflux disease (GERD) (occurs when stomach acid repeatedly flows back into the tube connecting your mouth and stomach); Hypertension (when your blood pressure, the force of your blood pushing against the walls of your blood vessels, is consistently too high); and Hypothyroidism (condition where the thyroid doesn't create and release enough thyroid hormone into your bloodstream). Record review of Resident #24 Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 12, which indicated the resident was moderately cognitively impaired. Record review of Resident #24's physician's orders, dated [DATE], revealed an order dated [DATE] for Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3 ML administer 1 vial inhale orally every 4 hours as needed for cough/ shortness of breath. 6. Record review of Resident #7's face sheet, dated [DATE], revealed an admission date of [DATE] with diagnoses which consisted of: Emphysema (a lung condition that causes shortness of breath); Alzheimer's Disease (a progressive mental deterioration that can occur in middle or old age, due to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 5 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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 generalized degeneration of the brain); and Anxiety Disorder (involves a persistent feeling of doom or dread). Record review of Resident #7's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 3, which indicated the resident was severely cognitively impaired. Residents Affected - Some Record review of Resident #7's physician's orders, dated [DATE], revealed an order, dated [DATE] for Albuterol Sulfate Nebulization Solution (2.5 MG/3 ML)0.083% administer 1 unit inhale orally via nebulizer every 6 hours as needed for shortness of breath. Observation of the nurse's' medication cart on [DATE] at 10:40 AM revealed the insulin for Residents #43, #44, and #45 were partially used and were not dated with when they were opened. Further observation of the nurse's medication cart revealed the nebulizer treatments unit dose packages for Residents #29, #24, and #7 nebulizer treatments were not dated with the dates they were opened. During an interview on [DATE] at 11:05 AM, the ADON stated Residents #43's, 44's, and #45's insulin did not have an open date and should have as they had been opened. The ADON stated inhaled medication in the nurse's' medication cart for Residents #29, #24 and #7 were being used by the residents and the nurse did not date the packaging when they were opened. During an interview on [DATE] at 11:10 AM, LVN A confirmed the insulin for Residents #43, #44, and #45 had been used and did not have open dates. When asked what the process for dating insulin was, LVN A stated the nurse that administered the first dose usually dated the insulin with an open date. When asked what the potential harm was of administering insulin to a resident that did not have an open date LVN A stated the resident risked receiving insulin that was possibly expired which affected the potency and could lead to hyperglycemia - Low blood sugar. LVN A further confirmed that inhaled medication for Residents #29, #24, and #7 had no open date on the packaging. When asked what the potential for harm was of administering inhaled medication to a resident who did not have an open date LVN A stated that she risked administering a medication that was not as potent leading to the resident's respiratory symptoms not improving. During an interview with the DON on [DATE] at 9:10 AM, the DON stated it was expected for all nurses to date insulin and inhaled medications with an open date to ensure medication potency was delivered to resident patient. The DON stated the facility did not have a policy to address this issue . During an interview with the facility's Consultant Pharmacist on [DATE] at 1:45 PM, the Consultant Pharmacist stated all insulins and inhaled medications were to be dated at a minimum with the date opened to ensure the product maintained potency as per manufacturer instructions. Record review of web site on [DATE], https://diabetesstrong.com/does-insulin-expire/, titled, Does Insulin Expire?, dated [DATE] revealed, Per manufacture guidelines Insulin Glargine (Basaglar), (Novolog): Throw away pen/vials after 28 days, even if it still has insulin left and Insulin Aspart. Record review of web site on [DATE], https://www.hdrxservices.com/did-you-know-nebulizer-storage-recommendations/, titled, Did you know, dated [DATE], revealed, Per manufacture guidelines store unit-dose vials in a protective foil pouch at all times. Once removed from the foil pouch, use vial within one week. Record review of the facility's policy titled, Storage of Medication, undated, revealed, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 6 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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 discontinued outdated or deteriorated drugs or biologicals are to be returned to dispensing pharmacy or destroyed. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 7 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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 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, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen and 1 of 2 medication carts reviewed for sanitation, in that: 1. There was a 5-lb. bag of chopped lettuce in the reach-in cooler that was past its use-by date. 2. There was tub of pudding in medication cart drawer with date of 08/18/2022 , present with mold . These deficient practices could place residents who received meals and snacks from the kitchen at-risk for food borne illness. The findings were: 1. Observation on 08/28/2022 at 12:45 p.m. in the reach in cooler revealed there was a 5-lb. bag of factory-sealed chopped lettuce. The bag was unopened. Approximately half of the lettuce in the bag had turned brown and approximately one fifth of the lettuce was spoiled to the point of liquification. There was a facility label indicating that it was received on 08/09/2022, and a manufacturer label that reflected, Use by 08/13/2022. During an interview with the DM on 08/28/2022 at 12:46 p.m.the, DM stated the lettuce was past its use-by date and not appropriate for service. When asked what the process was for receipt of food from the supplier, the DM stated the facility received deliveries on Tuesdays and all food products were labeled upon receipt before storage. When asked about training, the DM stated all dietary staff were trained monthly on food service topics by her or the facility's consultant dietitian. 2. Observation of the medication cart on 08/28/2022 at 10:30 a.m. revealed there was a tub of pudding, dated 08/18/2022, with mold on it. During an interview with MA C on 08/28/2022 at 10:35 a.m., MA C confirmed there was a tub of pudding with mold was in the medication cart and did not know why it was there. Record review of facility's policy titled, IC 00-8.0, Food Storage and Supplies, Dietary Services Policy & Procedures Manual 2012, revealed: 4. Open packages of food are stored in closed containers with covers or in sealed bags and dated as to when opened. 6. When items are received from the vendor, they should first be examined for expiration date, and if an expiration date is present, it is beneficial to mark it by circling it so it is readily visible and noticeable. Any product with a stamped expiration date will be discarded once that date passes 9. Non-perishable items that are refrigerated once opened should be dated once opened but do not need to be discarded until their expiration date or until the quality has deteriorated. Record review of the August 2021 version of the TFER reflected the following: (b) The department adopts by reference the U.S. Food and Drug Administration (FDA) Food Code 2017 (Food Code) and the Supplement to the 2017 Food Code. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2017, U.S. Department of H&HS, 3-501.17, revealed: Ready-to-Eat, Time/Temperature Control for Safety Food, Date Marking. (B) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675938 If continuation sheet Page 8 of 9 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 675938 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Shiner Nursing and Rehabilitation Center Inc 1213 N Ave B Shiner, TX 77984 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 FORM CMS-2567 (02/99) Previous Versions Obsolete Except as specified in (E) -(G) of this section, refrigerated, ready-to-eat time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety. Event ID: Facility ID: 675938 If continuation sheet Page 9 of 9