Health inspection·January 29, 2025

F 0656 in her room. Scoop mattress was on Resident #23's bed frame. Level of Harm - Minimal harm or potential for actual harm During an interview on 01/28/2025 at 01:26 PM with LVN E, she stated Resident #23 had falls in the past and they may be using the scoop mattress for that, but she was unsure. She stated that using a scoop mattress should be care planned. Residents Affected - Few Record review of Resident #61's face sheet dated 01/29/2025 revealed an [AGE] year-old male admitted on [DATE] with diagnoses including dementia (a disorder affecting thought process and memory), heart failure (the heart is unable to adequately pump blood to meet the demands of the body), and Type 2 diabetes mellitus (a disorder where the body cannot regulate blood sugars). Record review of Resident #61's Quarterly MDS dated [DATE] revealed the resident had a BIMS score of 5, which indicated his cognition was moderately impaired. Record review of Resident #61's order history dated 9/25/2024-01/29/2025 revealed an order as follows: Code status: DNR with a start date of 01/08/2025 and Code Status: Full Code with a start date of 09/26/2024 and an end date of 01/08/2025. Record review of Resident #61's Care Plan dated 10/10/2024 revealed Problem: Resident with Full Code Status Directive to MD and Family; MPOA no D/C plans anticipated. During an interview on 01/28/2025 at 08:49 AM with the DON revealed that MDSC is responsible for updating care plans. During an interview on 01/28/2025 at 08:52 AM with MDSC revealed she had been employed at the facility for approximately 20 years. She stated she and a coworker work together to update care plans. She stated care plans should have been updated for a change in condition, new order for hospice, new order for therapy, change in diet or new order for antibiotics. She stated she monitored for care plan revision needs during the morning meetings. The MDSC stated care plans should have been updated with advanced directive changes and falls, including all interventions utilized. She stated the care plan helped the team communicate needs of residents so appropriate care can be provided. During an interview on 01/29/2025 at 11:06 AM with LVN G revealed she had been employed with the facility for 8 months. She stated the MDSC is responsible for updating the care plans. LVN G stated care plans should have been updated with any change in conditions. She stated that using a scoop mattress and changing the code status should have been care planned. She stated nurses used the care plans to provide custom care for the residents. During an interview on 01/29/2025 at 1:11 PM with the DON revealed, she expected staff to update the care plans for any change with the resident's care. She stated there was a meeting in the morning that reviewed all changes for all residents and the changes should occur after the meeting. She stated that scoop mattresses were used for the resident to be able to determine where the edge of the bed was in order to prevent falls. The DON stated scoop mattress should have been put in the care plan and the care plan should have been updated with a change in code status order. She stated not updating the care plan could lead to not honoring the resident's preferences, injury, or hospitalization. During an interview on 01/29/2025 at 01:25 PM with the CRN revealed Resident #23 did not have a care plan for a scoop mattress. The CRN stated the scoop mattress was utilized for this resident to indicate where the edge of the bed was. She stated it should have been updated after the last fall. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 2 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 stated Resident #61 was care planned as full code status for advanced directives. Level of Harm - Minimal harm or potential for actual harm During an interview on 01/29/2025 at 02:57 PM with the ADM, she stated she expected the MDSC to update care plans when changes occur, including fall and code status. She stated the nursing staff used the care plans and not updating them could affect the care provided to the resident. Residents Affected - Few Record Review of facility policy titled Fall-Clinical Protocol dated 2001 and revised in December 2016 revealed: Policy Statement 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. Policy Interpretation and Implementation 13. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 14. The Interdisciplinary Team must review and update the care plan: a. When there has been a significant change in the resident's condition; b. When the desired outcome is not met; c. When the resident has been readmitted to the facility from a hospital stay; and d. At least quarterly, in conjunction with the required quarterly MDS assessment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 3 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who is fed by enteral means receives the appropriate treatment and services to prevent complications for 1 of 2 residents (Resident #84) reviewed for tube feeding. The facility failed to ensure Resident #84's formula bag and tubing set were changed out daily. This failure could place the resident as risk of illness, altered nutrition, and equipment malfunction. Findings included: Record review of Resident #84's face sheet dated 1/28/2025 revealed an [AGE] year-old female admitted on [DATE] with diagnoses including cerebral infarction (blood supply to the brain is disrupted causing a stroke), acute bronchiolitis (inflammation of the small airways of the lungs), dysphagia (difficulty swallowing), Gastrostomy status (presence of an artificial opening to the stomach in order to provide nutrition), and pneumonia (infection of air sacs in the lungs). Record review of Resident #84's admission MDS dated [DATE] revealed a BIMS score of 10 indicating mild cognitive impairment. Section K-Swallowing/Nutritional Status indicated resident received nourishment exclusively through a feeding tube. Record review of Resident #84's order history dated 10/29/2024-01/29/2025 revealed Enteral Feeding: Change bag QD and Enteral Feeding: Change irrigation set QD. Record review of Resident #84's care plan dated 11/11/2024 revealed Problem: Resident is NPO. Meds, nutrition, and fluids via j-tube. Goal: Effort will be made to prevent experience of an adverse effects from J-tube next 90 days. During observation on 01/27/2025 at 10:47 AM in Resident #84's room revealed Resident #84 receiving formula through an enteral feeding tube. The formula bag was dated and timed 1/27/25 0100 [01:00AM] in black marker. During interview and observation on 01/28/2025 at 01:56 PM in Resident #84's room with LVN G revealed resident receiving formula through an enteral feeding tube. The formula bag was dated and timed 1/27/25 0100 [01:00AM] in black marker. LVN G stated all enteral feeding bags had orders to be changed on the second shift (03:00PM-11:00PM). She stated she needed to review the documentation to verify the bag was changed. She then left the interview and returned with the DON. During an interview on 01/28/2025 at 02:13 PM with the DON revealed the nurse that was responsible for changing out the feeding bags was not at work. She stated that the nurse had worked extra hours and must have gotten the date wrong when she dated the bag. During an interview on 01/29/2025 at 11:06 AM, LVN G stated if a formula bag wasn't changed out as ordered then it could cause infection or spoilage. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 4 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 0693 Level of Harm - Minimal harm or potential for actual harm During an interview on 01/29/2025 at 01:11 PM with the DON revealed she expected her nursing staff to follow the orders. She stated not changing out the formula bag could lead to infections in the resident. During an interview on 01/29/2025 at 02:57 PM with the ADM revealed she expected staff to follow policy. She stated she was unsure of any impact to residents by not following policy. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 5 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 needed respiratory care were provided such care, consistent with professional standards of practice, for 5of 7 residents (Residents #1, Residents #15, Residents #25, Residents #44 and Resident #84) reviewed for respiratory care Residents Affected - Some The facility failed to ensure: 1. Resident #1, Resident #25, Resident #15, and Resident #44's nebulizing mask and tubing were bagged for sanitation when not in use as per the physician's order. 2. The nasal cannula of Resident #84 was uncovered and tucked under the handle of the oxygen concentrator, as observed on 01/27/25. This failure could affect residents who received respiratory services and place them at risk for respiratory infections. The findings included: Record review of Resident #1's face sheet on 01/28/25 revealed a [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses were psychotic disturbance, mood disturbance, anxiety, Influenza due to unidentified influenza virus, Hypertension, Dementia and Acute respiratory disease. Record review on 01/28/25 of Resident #1's quarterly MDS assessment, dated 01/19/25 revealed a BIMS assessment could not be completed. Record review on 01/28/25 of Resident #1's care plan dated 12/04/24 did not indicate any respiratory issues or the need for medication using a nebulizer. Record review of Resident #1's physician's order reflected: 1.Ipratropium-Albuterol solution for nebulization; 0.5 mg-3 mg (2.5 mg base)/3 ml. Amount to Administer: One Vial (a small container); Inhalation. Frequency: Every 6 Hours. Start/end date: 01/23/2025 -Open Ended. 2. Replace nebulizer mask Q week and store in dated respiratory bag. Frequency Once a day on Sun, Start/end Date: 12/31/2024 -01/19/2025. Observation on 01/27/24 at 10:20am of Resident #1's room revealed, the mask of the nebulizer and tubing on the side table were exposed to the environment as it was not stored in its protective bag. Record review of Resident #44's face sheet on 01/28/25 revealed a [AGE] year-old male who was initially admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses were Dementia , intestinal obstruction, Schizoaffective disorder ( a type of mental illness), Dependence on wheelchair, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 6 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 Pain, Cough Hypertensive heart disease and Unsteadiness on feet. Level of Harm - Minimal harm or potential for actual harm Record review on 01/28/25 of Resident #44's initial MDS assessment, dated 01/15/25 revealed a BIMS of 06 indicating severe cognitive impairment. The MDS identified Resident #44 had active diagnosis of COPD. Residents Affected - Some Record review on 01/28/25 of Resident #44's care plan dated 11/20/24 did not indicate any respiratory issues and the need for medication using a nebulizer. Record review of Resident #44's physician's order reflected: 1.Ipratropium bromide solution; 0.02 %; Amount to Administer: 1 Vial; Inhalation. Frequency: Twice a day. Start/end date: 07/21/2023 -Open Ended. 2. Replace nebulizer mask Q week and store in dated respiratory bag. Frequency: Once a day on Sun, Start/end Date: 12/19/2024 -Open ended. Observation on 01/27/24 at 10:30am of Resident #44's room revealed, the mask of the nebulizer on the side table exposed to the environment as it was not stored in a dated respiratory bag as per the physician's order. Record review of Resident #15's face sheet on 01/28/25 revealed a [AGE] year-old male who was admitted to the facility on [DATE]. His diagnoses were Sepsis, Insomnia (lack of sleep), Hypertensive heart disease congestive heart failure ( Heart failure), Acute respiratory failure , Type 2 diabetes mellitus, Need for assistance with personal care and Muscle weakness. Record review on 01/28/25 of Resident #15's initial MDS assessment, dated 01/02/25 revealed a BIMS of 11 indicating moderate cognitive impairment. Record review on 01/28/25 of Resident #15's care plan dated 01/03/25 did not indicate any respiratory issues and the need for medication using a nebulizer for Resident #1. Record review of Resident #15's physician's order reflected: ipratropium-albuterol solution for nebulization; 0.5 mg-3 mg (2.5 mg base)/3 mL; Amount to Administer: ONE VIAL; inhalation Frequency: Twice a day. Start/end date : 01/22/2025 - 01/27/25. Replace nebulizer mask Q week and store in dated respiratory bag when in use. Frequency: once a day on Sunday. Start/end date : 01/20/2025-Open Ended. Observation on 01/27/24 at 10:40 am of Resident #15's room revealed, the mask of the nebulizer and tubing on the side table was exposed to the environment as it was not stored in a dated respiratory bag as per the physician's order. Record review of Resident #25's face sheet on 01/28/25 revealed a [AGE] year-old male who was admitted to the facility on [DATE]. His diagnoses were Dementia, anxiety, Cough, unspecified, psychotic disturbance, mood disturbance, anxiety, fatigue, Chronic kidney disease, stage 3 (A kidney failure with slow progression) ,Weakness and Shortness of breath. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 7 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 - Some Record review on 01/28/25 of Resident #25's quarterly MDS assessment, dated 01/14/25 revealed a BIMS of 0 indicating severe cognitive impairment. MDS indicate Resident #25 had diagnosis of Acute respiratory failure with hypoxia ( respiratory failure with low oxygen intake) Record review on 01/28/25 of Resident #25's care plan dated 11/20/24 did not indicate any respiratory issues and the need for medication using a nebulizer. Record review of Resident #25's physician's order reflected: 1.Ipratropium-albuterol solution for nebulization; 0.5 mg-3 mg (2.5 mg base)/3 mL Amount to Administer: One Vial. Inhalation. Frequency: Twice a day. Start/end date: 01/15/2025 -01/24/2025. 1. Replace nebulizer mask Q week and store in dated respiratory bag when in use. Frequency: once a day on Sunday. Start/end date: 12/31/2024 -Open Ended. Observation on 01/27/24 at 11:55am of Resident #25's room revealed, the mask of the nebulizer and tubing on the side table was exposed to the environment as it was not stored in a dated respiratory bag as per the physician's order. Record review of Resident #84's face sheet dated 1/28/2025 revealed an [AGE] year-old female admitted on [DATE] with diagnoses including cerebral infarction (blood supply to the brain is disrupted causing a stroke), acute bronchiolitis (inflammation of the small airways of the lungs), dysphagia (difficulty swallowing), Gastrostomy status (presence of an artificial opening to the stomach in order to provide nutrition), and pneumonia (infection of air sacs in the lungs). Record review of Resident #84's admission MDS dated [DATE] revealed a BIMS score of 10 indicating mild cognitive impairment. Record review of Resident #84's care plan dated 01/03/2024 revealed Problem: Resident is at increased risk for MDRO (Multi drug resistant organism) related to g-tube/foley catheter, enhanced barrier protection to be used. Approaches included check for compliance with infection prevention practices (e.g. hand hygiene and PPE). No other care plans associated to oxygen or infection. Record review of Resident #84's order history dated 10/29/2024-01/29/2025 revealed oxygen during sleep titrates O2 to keep O2 saturations above 92%. During an observation on 01/27/25 at 10:47am in Resident#84's room revealed a nasal cannula (a tube used for administration of oxygen through the nose) tucked under the handle of the oxygen concentrator and not in a protective bag. During observation and interview on 01/27/2025 at 02:23 PM in Resident #84's room with the DON revealed the nasal cannula was uncovered and tucked under the handle of the oxygen concentrator. The DON stated that all soxygen items should have been in a respiratory bag. She stated that a negative impact to the resident could be infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 8 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 During an observations and interview with the DON on 01/27/25 starting at 2:05pm, Resident #1, Resident#44, Resident #15 and Resident #25's rooms revealed the masks and tubing of the nebulizers were not protected in a dated respiratory bag, as per the orders. The DON who witnessed the unprotected nebulizer masks stated masks were supposed to be sanitized before and after use and should have been stored in a protective bag whenever not in use. She stated this was necessary to avoid infections. Residents Affected - Some During an observation by the surveyor and DON, and interview with the DON on 01/28/25 at beginning 9:10am, Resident #1, Resident #15, and Resident #25's rooms revealed the masks and tubing of the nebulizers were not protected in the bags. The DON stated she started in services on 01/27/25 regrading bagging respiratory tubes and masks when not in use. She stated there were staff members still there who had not participated in the refresher in service on bagging masks and tubing when not in use. She stated she would complete the in service for everyone so that all the staff would be educated and ensure that the medical equipment would be protected from contamination. During an interview on 01/29/25 at 1:30pm LVN G stated on 01/28/24 she received an in service on storing respiratory masks and tubing in a protective bag while not in use. She stated it was important to adhere to this practice to reduce the risk of transmitting contagious diseases. She stated she was careful to follow this practice in her nursing career. During an interview on 01/29/25 at 2: 15 pm the ADM stated she heard about the noncompliance in securing the respiratory masks and tubing in the protective bags . She stated the expectation was all staff to be compliant with infection control protocols. She stated the nebulizer masks and tubing were cleaned and safely stored in the protective bags provided. She stated there was a potential for respiratory infectious diseases with such a deficient practice. Record review of facility policies on 01/29/25 revealed there was no policy available for the safe storage of nebulizer and oxygen tubing and masks when not in use. When the Surveyor requested for the policy for safe storage of respiratory tubes and masks , the policy provided was on Oxygen Administration and there was no policy to address the issue in it. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 9 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure residents were free of any significant medication errors for 1 of 3 residents (Resident#40) reviewed for significant med errors . Residents Affected - Few The facility failed to ensure Resident #40's Metoprolol Succinate (prescribed to treat Atherosclerotic heart disease of native coronary artery without angina pectoris) was omitted during medication pass on the morning of 01/27/2025. This failure could place the resident at risk of not receiving the correct/prescribed medications as ordered. Findings include: Review of Resident #40's Face Sheet reflected she was a [AGE] year-old female admitted on [DATE] with diagnoses of Alzheimer's disease, pain, needs for assistance with personal care, Hypertensive heart (a condition that develops when high blood pressure (hypertension) damages the heart over time) and chronic kidney disease (damage or dysfunction of the kidneys), lack of coordination, weakness, fatigue, allergic rhinitis, urinary tract infection and cough. Review of Resident #40's quarterly MDS dated [DATE] reflected a BIMS score of 07 which indicated she was severely impaired cognitively. Review of Resident #40's Care Plan dated 11/29/2024 reflected; Resident #40 with hypertension potential complications. Prescription in use. Goal: Effort will be made for blood pressure remain within normal limits without further complications over next ninety days. Record review of Resident #40's Orders, start date 01/28/2025, reflected an order for Metoprolol Succinate tablet extended release 24 hour; 25 mg. Special instructions: Hold for systolic blood pressure less than 110 or heart rate less than 60. Give once a day. In an observation of medication pass on 01/27/2025 at 09:20 AM, MA A obtained a blood pressure cuff reading for Resident #40 with the following results of: BP 125/48 (Systolic blood pressure - top number is 125 and Diastolic blood pressure - bottom number is 48) with a heart rate of 66. Record review of Resident #40 medication orders revealed special instructions: Hold (omit) for systolic blood pressure less than 110 or heart rate less than 60. Give once a day. During an interview on 01/28/2025 at 01:10 PM MA A stated she probably got nervous while the surveyor was observing her administer medications and that is probably why she misread the order. MA A stated the whole purpose for the blood pressure medication is to help lower the blood pressure, if the medication is omitted the blood pressure will not go down. MA A stated the resident's blood pressure will not be regulated correctly and that's why they need the medication. MA A voiced she has not rec'd any in-service over med pass administration. During an interview on 01/29/2025 at 10:03 AM the DON stated if a resident doesn't get their blood pressure medication as prescribed it could lead to the resident having long term high blood pressure which could cause problems for the resident. The DON stated depending on how high the blood (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 10 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few pressure was raised would be determine if it would be immediate harm. The DON stated new staff receive medication administration training during new-hire orientation and they get in-serviced all the time over medication administration. Record review on 01/29/2025 at10:36 AM revealed that on 11/19/2024 staff received in-service training over medication administration. MA A attended the training. Review of Policy Review of Administering Medications with a revision date of April 2019. Policy Statement: Medications are administered in a safe and timely manner, and as prescribed. Policy Interpretation and Implementation 4. Medications are administered in accordance with prescriber orders, including any required time frame. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 11 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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, interview, and record review, the facility failed to properly store and label biologicals for 2 (200 and 400 halls and cart for 100 hall) of 6 medication carts reviewed for drug storage. The medication cart for the 200 and 400 halls had three unidentified loose pills. The medication cart for the 100-hall had one loose pill. These deficient practices could affect residents and result in a drug diversion due to medications not being properly disposed and secured. The findings were: Observation of medication cart for the 200 & 400 hall right side cart on 01/27/2025 at 11:07 AM revealed one round orange pill blank on both sides, one small round pill blank on one side and a non-legible letter on the other side. One small round white pill with L16 on one side and blank on the other side. LVN D was able to identify one pill as Levothyroxine, she identified the orange pill as Biscadoyl and thinks the other pill is melatonin. LVN D disposed of the pills into the sharp's container. During an interview on 01/27/2025 at 11:07 AM, LVN D stated she has not ever noticed any loose pills in the medication carts. LVN D stated everybody is responsible for checking the carts for loose pills and checking expiration dates. Staff are to check for loose pills at the beginning of their shifts. LVN D stated if a loose pill accidentally fell out of the cart there could be potential harm if someone accidentally took it. LVN D stated staff have been in-serviced on loose pills in the carts and the last in-service was probably weeks ago. During an interview on 01/27/2025 at 11:20 AM and on 01/28/2025 at 08:52 AM MA B stated she has noticed loose over the counter pills in the medication carts, and she disposes of them in the medication room when she finds them. MA B stated a potential harmful outcome for loose pills in the carts could lead to an issue with infection control. MA B stated the last in-service she received over loose pills in the carts was about a month ago . Observation of medication cart for the 100 hall 01/27/2025 at 11:48 AM revealed one oval pink pill with the number 5 on one side and 894 on the other side. LVN E was only able to identify the pill as Eliquis. LVN E disposed of the pills into the sharps container. During an interview on 01/27/2025 at 11:48 AM, LVN E stated she has not noticed any loose pills in the carts. LVN E stated if she or staff find any loose pills, they should try to figure out what kind of pill they are so they know where to properly dispose them. If narcotic, they are to dispose of them in the drug buster and report loose pills to DON right away. LVN E stated there could be a potential for harm for loose pills in the cart because if it fall out through a small hole in the cart and a resident could take it. LVN E stated every nurse should be checking their carts before they use them. LVN E stated it's been a while since she received an in-service on loose pills. During an interview on 01/28/2025 at 08:52 AM MA B stated sometimes staff get too careless when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 12 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 administering medications and go to fast and that can cause the pills to fall out of the bottles and we forget to find it and or dispose of it immediately. MA B stated if a pill falls staff are to try to find it and dispose of it in the drug buster in the medication room. Staff are to inform the DON of any loose pills in the cart. MA B voiced there could be some potential harm to the residents if there are loose pills in the carts because there are some residents that can't take certain medications and if they take them, it can be dangerous because every pill is different and some of them have to have them crushed and if they take it whole, they can choke. During an interview on 01/29/2025 at 09:09 AM MA C stated she has noticed some loose pills in the carts but not all the time. MA C stated if a pill falls when she is administering medications staff are supposed to dispose of it in the drug buster that is in the medication room. MA C stated loose pills in the medication carts could cause potential harm to the residents because staff might give the wrong medication to another resident by mistake so staff should dispose of any loose pills right away. During an interview on 01/29/2025 at 09:38 AM the ADON stated she has never noticed loose pills in the carts. If staff see loose pills in the carts, they should try to identify it and as long as it is not a narcotic medication, they can throw it away in sharps container. The ADON stated if it is a narcotic medication staff should have a witness with them when they discard of it in the drug buster. The ADON stated staff should let upper management know. The ADON stated if staff don't identify the pills and then give it to a resident that could be harmful to the resident. During an interview on 01/29/2025 at 10:03 AM the DON stated one staff member informed her that she dropped a pill so they searched for the pill in the whole cart and disposed of it in the drug buster. The DON stated staff have been informed to dispose of prescribed medications and or over the counter medications that fall inside the cart into a drug buster in the medication storage room. Staff have also been informed that if the medication is a narcotic, they are to discard the medication with another individual as a witness. The DON stated she does not see any potential harm to residents if there are loose pills in the carts. The DON verbalized nobody will be administering a loose pill that has been dropped in the cart. DON goes into carts to monitor routinely and staff are to check carts before their shifts start. Record review of the Policy/Procedure - Storage of Medications with a revision date of April 2019 revealed: Policy Statement: The facility stores all drugs and biologicals in a safe, secure, and orderly manner. Policy Interpretation and Implementation 2. Drugs and biologicals are store in the packaging, containers or other dispensing systems in which they are received. 3. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. 10. Resident medications are stored separately from each other to prevent the possibility of mixing medications between residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 13 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for kitchen sanitation. Residents Affected - Some The facility kitchen staff failed to label and date 2 foods and discard of 1 food that was beyond use by date stored in the refrigerator. These failures could place residents at risk for food-borne illness and food contamination. The findings include: During an initial tour of the facility kitchen on 01/27/2025 beginning at 09:12 AM revealed the following: 1- 2-quart pitcher with a soup product that was unlabeled 1- serving tray with a sandwich that consisted of 2 pieces of white bread and 2 slices of cheese covered with saran wrap that was unlabeled 1- 2-quart pitcher labeled vejetale (sic) soup with use by date of 1-18-25. During an interview on 01/27/2025 at 09:15 AM with the CD she stated the items should be labeled and discarded by use by date. She stated the previous items would be discarded. She stated consumption by the resident could result in illness. During an interview on 01/29/2025 at 12:43 PM with the DS revealed his expectation for dietary staff were for all food to be labeled and dated and discarded when out of date. He stated consumption of unlabeled food or food beyond the use by date could lead to illness. During an interview on 01/29/2025 at 02:57 PM with the ADM revealed her expectation for dietary staff were for all food be marked and labeled. She stated the use by date varied on the food type. The ADM stated if the residents were to consume the food that was unlabeled or beyond the use by date could have caused illness. Record review of facility policy titled Food Storage dated 2021 revealed. Policy: Sufficient storage facilities will be provided to keep foods safe, wholesome, and appetizing. Food will be stored in an area that is clean, dry, and free from contaminants. Food will be stored, at appropriate temperatures and by methods designed to prevent contamination or cross contamination. Procedure: 12. Leftover food should be stored in covered containers or wrapped carefully and securely and clearly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 14 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 labeled and dated before being refrigerated. Leftover food must be used within 7 days or discarded as per the 2017 Federal Food Code. Level of Harm - Minimal harm or potential for actual harm 13. Residents Affected - Some Refrigerated food storage: f. All foods should be covered, labeled, and dated and routinely monitored to assure that foods (including leftovers) will be consumed by their safe use by dates, or frozen (where applicable), or discarded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 15 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 observations, interviews, and record review the facility failed to ensure the facility established and maintained an infection prevention program designed to provide a safe environment and to help prevent the transmission of communicable diseases for one of one staff (MA A) observed for infection control Residents Affected - Few MA A failed to disinfect the blood pressure cuff in between Residents #19 and #40's during usage of obtaining their blood pressure readings for medication administration. This failure could place residents at increased risk of healthcare associated infections. Findings included: Review of Resident #19's Face Sheet reflected she was a [AGE] year-old female with an initial admission date of 10/31/2014 and readmission date of 06/04/2023. Resident #19 has a diagnosis of pneumonia, anxiety, disturbances of salivary secretion, nausea, cellulitis of left lower limb (a common bacterial infection of the skin and underlying tissue), cerebrovascular disease ( a group of conditions that affect the blood vessels in the brain), weakness, pain in left finger(s), cerebral infarction (a condition where blood flow to the brain is interrupted, causing brain tissue to die), hordeolum externum left lower eyelid (refers to a medical term for a stye (bacterial infection) located on the outer edge of the lower left eyelid), essential primary hypertension, nasal congestion, shortness of breath, muscle wasting and atrophy. Review of Resident #19's MDS dated [DATE] reflected a BIMS score of 09 which indicated she is moderately impaired cognitively. Review of Resident #19's Care Plan 01/22/2025 reflected; Resident #19 with hypertension potential for complications. Prescribed medications in use. Effort will be made to have blood pressure within normal limits without further complications and not have any sign or symptoms of dehydration over the next 90 days. Review of Resident #40's Face Sheet reflected she was a [AGE] year-old female admitted on [DATE] with diagnoses of Alzheimer's disease, pain, needs for assistance with personal care, Hypertensive heart (a condition that develops when high blood pressure (hypertension) damages the heart over time) and chronic kidney disease (a long-term condition where the kidneys gradually lose their ability to filter waste products from the blood), lack of coordination (a neurological condition that affects the body's ability to plan and execute smooth, precise movements), weakness (the state or condition of lacking strength), fatigue (a feeling of tiredness, exhaustion, or lack of energy that can interfere with daily activities), allergic rhinitis (a common inflammatory condition of the nasal passages caused by an overreaction of the immune system to allergens), urinary tract infection and cough. Review of Resident #40's quarterly MDS dated [DATE] reflected a BIMS score of 07 which indicated she was severely impaired cognitively. Review of Resident #40's Care Plan dated 11/20/2024 reflected; Resident #40 with hypothyroidism (thyroid gland doesn't make enough thyroid hormone) potential for complications/uncomfortable symptoms. Prescriptions in use. Effort will be made to maintain thyroid hormone level within normal levels. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 16 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 Residents Affected - Few Observation on 01/27/2025 beginning at 09:20 AM revealed MA A did not sanitize the blood pressure cuff in between each resident before and after checking blood pressures for Residents #19 and #40. In an interview on 01/28/2025 at 01:10 PM MA A stated this is her first Medication Aide job. MA A stated she did receive medication administration training during her new hire orientation, and she does not sanitize the blood pressure cuff in between residents. MA A stated she has never witnessed any other staff sanitizing the blood pressure cuffs in between residents. MA A voiced staff receive on going in-services pertaining to falls and cleaning carts, but she can't recall any trainings over blood pressure cuffs. MA A voiced she has been instructed to wash her hands with soap and water in between every three residents when administering medications. In an interview on 01/29/2025 at 08:52 AM, MA B stated she sanitizes the blood pressure cuff in between each resident to ensure infection control and to avoid transferring the flu or germs to other residents. MA B stated she received blood pressure and medication administration training during her new hire orientation and has been instructed to keep 2 blood pressure cuffs on her medication cart so she can alternate cuffs in between residents. MA B could not recall the last time she was in-serviced on blood pressure cuffs, but she verbalized staff are reminded frequently. In an interview on 01/29/2025 at 09:09 AM MA C stated the normal process for using blood pressure cuffs on residents is to wipe it down (sanitize) in between each resident to avoid passing germs. MA C stated staff had been instructed to have two cuffs on their carts so they can alternate them while they are drying off. MA C voiced she did receive blood pressure cuff training during her initial new hire orientation and could not recall the last time she was in-serviced over blood pressure cuffs. In an interview on 01/29/25 at 09:38 AM the ADON stated staff should be sanitizing the blood pressure cuffs with sanitizing wipes for infection control and if staff don't it could lead to germs being spread among residents. The ADON could not recall the last time staff were in-serviced over blood pressure cuffs but voiced they remind staff. In an interview on 01/29/2025 at 10:03 AM the DON stated staff are supposed to wipe blood pressure cuffs down with purple wipes in between each resident if staff don't it could affect infection control and contamination. The DON stated all new staff receive blood pressure cuff and medication administration training during new-hire orientation. The DON voiced staff get in-services anytime they see that type of practice being done in the facility. In an interview on 01/29/25 at 02:02 PM DON stated she is sure MA A received blood pressure cuff training in her new hire orientation. The DON voiced sometimes new hires tend to get overloaded with information and that might be why MA A doesn't recall getting the training during new hire orientation. The DON voiced the way to ensure staff are cleaning the cuffs in between residents it to make staff observations during medication passes and make sure staff are following behaviors. She will make sure to pull MA A to the side to provide a 1:1 education piece to close that gap. Surveyor requested blood pressure cuff and medication administration training records for MA A from DON. Did not receive records prior to exiting the facility. Review of Policy Review of Cleaning and disinfection of resident-care items and equipment with a revision date of October 2018 revealed: Policy Statement: Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 17 of 18 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 675943 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Hope Manor 1623 W New Hope Dr Cedar Park, TX 78613 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 OSHA Bloodborne Pathogens Standard. Level of Harm - Minimal harm or potential for actual harm Policy Interpretation and Implementation Residents Affected - Few 1. (d). Reusable items are cleaned and disinfected or sterilized between residents (e.g., stethoscopes, durable medical equipment). 2. (4). Reusable resident care equipment will be decontaminated and/or sterilized between residents according to manufacturer's instructions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675943 If continuation sheet Page 18 of 18