Health inspection·November 26, 2025

F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete plastic bag. He said the expectation was for the staff to bag the breathing mask to when not in use. He said she would coordinate with the DON to do an in-service about bagging the breathing mask. In an interview on 10/08/2025 at 12:18 PM, the DON stated the breathing mask should be bagged when not in use to prevent any respiratory infection. She said the staff that administer the breathing treatment should have place it inside a bag after the breathing treatment. she said the expectation was for the breathing mask be bagged when not in use and for the staff to scan the rooms to see a breathing mask was not bagged so they could change it. She said it was her responsibility to check if the staff were compliant in bagging the breathing mask. She said she would start an in-service about bagging the breathing mask when not in use. In an interview on 10/08/2025 at 1:01 PM, the Administrator stated the expectation was for the staff to bag the breathing mask when not in use to prevent respiratory issues. He said he would coordinate with the DON to re-educate the staff about bagging the breathing mask when not in use. Policy specific to bagging the breathing mask requested verbally to the Administrator on 10/08/2025 at 1:01 PM but was not provided prior to exit. Record review of the facility's policy entitled Oxygen Administration Nursing Policy & Procedure Manual 2003, undated, reflected Goals . 1. The resident will maintain oxygenation with safe and effective delivery of prescribed oxygen . 3. The resident will be free from infection Event ID: Facility ID: 675939 If continuation sheet Page 2 of 5 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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, in accordance with State and Federal laws, store all drugs and biologicals in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for four (Resident #1, #2, #3, and #4) of ten residents reviewed for medication storage. 1. The facility failed to ensure zinc oxide (medicated cream used to prevent skin irritation) was not left inside the Resident #1's room on 10/08/2025. 2. The facility failed to ensure zinc oxide was not left inside the Resident #4's room on 10/08/2025. 3. The facility failed to ensure a vial of solution used for breathing treatment was not left inside Resident #2's room on 10/08/2025. 4. The facility failed to ensure a tube of topical pain reliever was not inside Resident #3's room on 10/08/2025. These failures could place residents at risk of misuse of medications that could lead to overdosing or underdosing.Findings included: 1. Record review of Resident #1's Face Sheet, dated 10/08/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with hemiplegia (paralysis of one side of the body) and hemiparesis (weakness on one side of the body). Record review of Resident #1's Comprehensive MDS Assessment, dated 09/15/2025, reflected the resident was cognitively intact with a BIMS score of 14. The Comprehensive MDS Assessment indicated the resident had dementia and was incontinent for bladder and bowel. Record review of Resident #1's Comprehensive Care Plan, dated 08/25/2025, reflected the resident had incontinence and one of the interventions was to apply barrier cream after each incontinent episode. Record review of Resident #1' Physician Order, dated 10/09/2024, reflected May apply barrier cream as needed every shift. During an observation and interview on 10/08/2025 at 8:44 AM revealed Resident #1 was in his bed, awake. It was observed that there was a cup of cream on top of the resident's drawer. The cup of cream was visible from the hallway. The resident said the cream was applied to his bottom. He said the staff would usually leave it on top of his drawer or sometimes on top of his side table. 2. Record review of Resident #4's Face Sheet, dated 10/08/2025, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with obesity (excessive accumulation of body fats). Record review of Resident #4's Quarterly MDS Assessment, dated 08/08/2025, reflected the resident was cognitively intact with a BIMS score of 13. The Quarterly MDS Assessment indicated the resident was incontinent for bladder and bowel. Record review of Resident #4's Care Plan, dated 09/10/2025, reflected the resident reflected the resident was incontinent and one of the interventions was to apply barrier cream after every incontinent episode. Record review of Resident #4's Physician Order, dated 01/07/2024, reflected Barrier Cream of facility choice QID and PRN to prevent skin breakdown . four times a day for preventive care. During an observation and interview on 10/08/2025 at 8:56 AM revealed Resident #4 was in her bed awake. It was observed that a cup of cream was on top of her side table. the resident said the cream was used after incontinent care. She said she did not know who left the cream on her side table. During an observation and interview on 10/08/2025 at 9:07 AM, CNA B stated the cream inside the cups were zinc oxide used during incontinent care. She said it should not be left inside the rooms of the residents because they were medicated creams and confused residents might get hold of them and eat them. She said the resident might be allergic to the cream or might give them stomach issue. She went inside the Resident #1's room and took the cup of cream from the top of the drawer. She said Resident #4 was not assigned to her but she would also get the cup of zinc oxide from her room. She went inside Resident #4's room and took the cup of zinc oxide from the Resident #4's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 3 of 5 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 side table. She said she the cups of zinc oxide should be thrown away after incontinent care was done or should not be left inside the residents' rooms for use later. She said she did not know who left the cups of zinc oxide inside the residents' rooms and she did not notice it when she did her round. She said she would check the rooms of the residents and would also tell CNA C to check also the rooms assigned to her for any zinc oxides inside the room so the residents. In an interview on 10/08/2025 at 9:12 AM, CNA C stated CNA B already told her about the zinc oxide on Resident #4's side table. She said zinc oxide should not be left inside the rooms of the residents because the residents might though it was lotion and apply it to their face. She said it might cause irritation of the eyes. She said she would just finish cleaning a resident and then she would check the rooms assigned to her for any zinc oxide. She said she did not notice it when she did her round. 3. Record review of Resident #2's Face Sheet, dated 10/08/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of Resident #2's Quarterly MDS Assessment, dated 09/24/2025, reflected the resident was cognitively intact with a BIMS score of 15. The Quarterly MDS Assessment indicated the resident had chronic obstructive pulmonary disease. Record review of Resident #2's Comprehensive Care Plan, dated 10/08/2025, reflected the resident had chronic obstructive pulmonary disease and one of the interventions was give aerosol (substance released in fine mist) or bronchodilators (medication that caused widening of the air passages) as ordered. Record review of Resident #2's Physician's Order, dated 06/13/2025, reflected Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 3 milliliter inhale orally every 6 hours as needed for SOB or Wheezing via nebulizer. During an observation and interview on 10/08/2025 at 8:47 AM revealed Resident #2 was in his bed, awake. It was observed that a nebulizer was on top of the resident's side table. The resident said it was his nebulizer and would use it on the need basis. He said the solution for breathing treatment must have been left the last time he was given his breathing treatment. 4. Record review of Resident #3's Face Sheet, dated 10/08/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with pain to left shoulder. Record review of Resident #3's Quarterly MDS Assessment, dated 07/14/2025, reflected the resident was cognitively intact with a BIMS score of 13. The Quarterly MDS Assessment indicated the resident had pain to left shoulder. Record review of Resident #3's Care Plan, dated 09/18/2025, reflected the resident had potential for uncontrolled pain and one of the interventions was to monitor side effects of pain medications. Record review of Resident #3's Physician Order, dated 04/09/2025, reflected Voltaren External Gel 1% (Diclofenac Sodium) Apply to Left shoulder topically every 12 hours for pain. During an observation and interview on 10/08/2025 at 9:17 AM, LVN D stated there should be no medications inside the rooms of the residents unless they had an assessment that they could self-administer their medications. She said it might result to overmedication. She went inside Resident #2's room and saw the solution for breathing treatment on the Resident #2's side table and took it. She then went to Resident #3's room and saw the tube of pain reliver ointment on the Resident #2's table and took it. She said she did not notice the medications when she did her rounds. She said the medications should be inside the cart. She said she did not know who left the medications inside the rooms of the residents. In an interview on 10/08/2025 at 11:35 AM, ADON A stated medications should be inside the carts and not left inside the residents' rooms because confused residents could consume them or use the medications using a different route. He said the resident might have allergic reactions or stomach issues if the topical medications where ingested. He said the solution for breathing treatment might be mistaken for eye drops. He said the expectation was for the staff to be mindful not to leave (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 4 of 5 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 FORM CMS-2567 (02/99) Previous Versions Obsolete any medication inside the residents' rooms and to always scan the rooms for any medication. He said they already started an in-service about medication storage as soon as they were notified that medications were observed inside the rooms of the residents. He said they also started a routine checking of the residents' rooms. He said they would also coordinate with the family to let the facility know if they were bringing any medication. In an interview on 10/08/2025 at 12:18 PM, the DON stated the solution for breathing treatment should not have been left inside Resident #2's room. She said the staff should only bring the solution that would be used and the rest of the solutions for breathing treatment should be inside the cart. She said zinc oxide was a form of medications that could be harmful when ingested like the resident getting sick. She said, sometimes, family would bring the medications but at least staff should take note of the medications specially if the medications were in plain view. She said the expectations were for the staff to always scan the residents' rooms for any medication and not to leave any medication inside the rooms of the residents. she said she would also coordinate with the family about the risk of medications inside the rooms of the residents. She said she already started an in-service about medication storage. In an interview on 10/08/2025 at 1:01 PM, the Administrator stated the expectation was for the staff to be mindful that they were not leaving any medications inside the rooms of the residents because it could be harmful for the residents. he said the DON already started an in-service and he would closely monitor the staffs' adherence to the policy. Record review of the facility's policy entitled, Medication Storage in the Facility P & P revised 03/2025 reflected Policy: Medications and biologicals are stored safely, securely . The medication supply is accessible only to license nursing personnel, pharmacy personnel, or staff members lawfully authorized to administer medications. Event ID: Facility ID: 675939 If continuation sheet Page 5 of 5