Health inspection·January 30, 2026

F 0637 Level of Harm - Minimal harm or potential for actual harm (Medicare-certified or State-licensed hospice provider) or changes hospice providers and remains a resident at the nursing home. The ARD must be within 14 days from the effective date of the hospice election (which can be the same or later than the date of the hospice election statement, but not earlier than). An SCSA must be performed regardless of whether an assessment was recently conducted on the resident. This is to ensure a coordinated plan of care between the hospice and nursing home is in place. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 2 of 6 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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, and serve food under sanitary conditions in 1of 1 kitchen when they failed to: A. Ensure facility staff wore hair restraints and beard guards while in the kitchen.B. Ensure stored and cooked food was properly labeled, dated and covered.C. Ensure menu substitutions were documented.D. Ensure expired foods were discarded.These failures placed all residents who ate food served by the kitchen at risk of cross contamination and food-borne illness. Findings included:In an interview and record review on 1/28/26 at 10:20 am, the DM produced the menu titled Menu Manager -Weekly menu for the facility for the Fall Winter-week 3 dated 12/5/25. The DM stated the planned menu for lunch was Rueben sandwiches, onions and peppers, potato salad, fried pickles, and chocolate turtle cake. She stated there were 4 residents with pureed diets. The DM stated these food items were all the foods to be served for the week for the residents. In an observation of the freezer on 1/28/26 at 10:20 am revealed the following:1 box of frozen bread, open to air and unsecured.1 bag of ham, not in original box, open to air, 3 bags of hamburger patties, not in original box, no label or date In an observation of the kitchen cabinets on 1/28/26 at 10:35 am, the following was observed: Lemon pie filling mix, open to air Sweet Cream Pancake mix, open to air2 boxes of cream of Wheat, open to airIn an observation and interview on 1/28/26 at 11:30 am revealed the DM's hair had been sticking out of her hair net in the back, and [NAME] B had a beard cover on his beard but did not cover the full extent of his beard on the sides of his face or his moustache. [NAME] B stated he was aware his beard and moustache needed to be covered. He stated the beard cover would not stay up over his moustache. He stated the consequences of not having his facial hair covered would be food borne illness and his hair could fall into the food. The DM stated she was not aware of her hair sticking out of the hairnet and pushed the hair back into the hairnet. She stated she was aware the beard cover did not fit [NAME] B and she had ordered different beard covers for him but had not received them. In an interview and observation of the foods being pureed for the lunch meal, there had been no fried pickles pureed. At the conclusion of the purees this writer asked why the fried prickles were not pureed. The DM stated the residents with a pureed diet were getting green beans instead of fried pickles. She stated she did not think the fried pickles would puree correctly so she had decided to puree green beans instead. In an observation on 1/28/26 at 12:10 pm [NAME] B had a beard cover on his beard. The beard cover did not cover [NAME] B's full extent of his beard or his moustache. In an observation of the noon meal on 1/28/26 at 12:30 pm, residents with pureed diets were not served pureed fried pickles for the lunch meal. The residents with a pureed diet were served green beans instead. In an observation of the freezer on 1/29/26 at 10:45 am revealed the following:1 box of frozen cookie dough, unsecured and open to air.1box of biscuits, unsecured and open to air, 1 box of hamburger patties, unsecured and open to air1bag of rolls, with a use by date of 1/191bag of cauliflower, with a use by date of 1/19/261 bag of Brussel sprouts with a use by date of 1/261 bag of fish with a hole in the bag, not in original box, open to airIn an interview on 1/29/26 at 2:02 pm the RD stated she had not trained the current DM, but the DM had been trained by the previous RD. She stated she expected all foods to be labeled and dated in the kitchen as well as sealed securely to be sure the food had not been exposed to air. She stated she expected all expired foods to be discarded. She stated she expected all menu substitutions to be documented on the menu substitution list. The RD stated she expected hairnets, and beard covers to be worn and to cover all hair. She stated the consequences of all issues would be food borne illness. In a record review on 1/30/26 at 8 :00 am of the facility menu substitution list for the past 3 months, the substitution of green beans for fried (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 3 of 6 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 pickles on the lunch meal for residents on a pureed diet served 1/28/26 had not been documented. In an interview on 1/30/26 at 8:50 am, the DM stated she had been trained by the dietician in running the kitchen and she had trained staff to label, date and keep foods closed to air. She stated she expected all staff to label date and close all foods to air as the food was used. She stated she had not been aware this had not been done. The DM stated she was not aware the freezer had several food items that were expired, and she would throw them out. The DM stated she was aware all staff had to keep hair, moustache and beards covered while in the kitchen. She stated she had been aware the beard cover did not cover [NAME] B's beard and moustache very well. She stated that food borne illness could result from all these issues. Record review of the facility policy titled ' Preventing Foodborne Illness- Employee Hygiene and Sanitary Practices' dated 2001 documented: Hairnets and beard restraints are worn when cooking, preparing or assembling food to keep hair from contacting exposed food, clean equipment, utensils and linens. Record review of the facility's policy titled, 'Food Storage and Supplies' dated 2012, documented:Opened packages of food are stored in closed containers with covers or in sealed bags and dated as to when opened. Record review of the facility's policy titled, ' Food Safety' dated 2012, documented:Food is to be wrapped or sealed and covered in clean containers. Opened food shall be labeled, dated, and stored properly. Perishable foods shall be used within 7 days or less. Record review of the facility's policy titled, ' Dietary Food Service Personnel Policy and Procedures ' dated 2012 documented:Hairnets or hats covering the hairline are worn at all times. [NAME] guards are required for facial hair. Record review of the facility's policy titled, ' Left Over Foods' dated 2012, documented:Leftover foods shall be refrigerated, dated, labeled and properly covered after meal service.Record review of the facility's policy titled, ' Storage Refrigerators ' dated 2012, documented:Food must be covered when stored, with a date, label, identifying what is in the container. Record review of the facility's policy titled, ' Infection Control ' dated 2012, documented:Clean hair is required. It is to be covered with an effective hair restraint. Facial hair is to be closely trimmed and is to be covered with a hair restraint. Record review of the facility's policy titled, ' Nutrient Retention of Foods' dated 2001, documented: Record review of the facility's policy titled, ' Menus ' dated 2012, documented:Menus are planned to meet the Recommended Dietary Allowances of the Food and Nutrition al Board. Alternates will be planned and recorded. Alternates will be of comparable nutritive value, and the alternate food shall come from the same food group. If any meal served varies from the planned menu, the change and the reason for the change shall be noted on the substitution log. The menus will be prepared as written using standardized recipes.Record review of the facility's policy titled, ' Menu Substitution Form ' dated 2012, documented:The DM will be responsible for making sure the menu substitution form is completed when items on the menu must be substituted. Menu Substitution Form should be filled out on every menu substitution. Substitutions must be of equal value as the item to be substituted (ie. Meat for meat, vegetable for vegetable) Event ID: Facility ID: 675945 If continuation sheet Page 4 of 6 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 (CNA A) of 4 staff observed for infection control. -CNA A did not perform hand hygiene properly while performing catheter care for Resident #7. This deficient practice has the potential to affect residents by exposing them to care that could lead to the spread of infections, tissue breakdown, and feelings of isolation related to poor hygiene.Findings included: Record review of Resident #7's face sheet revealed he was a [AGE] year-old male resident admitted to the facility originally on 12/06/24 and readmitted on [DATE] with diagnoses to include dementia (a group of thinking and social symptoms that interferes with daily functioning), benign prostatic hyperplasia (a noncancerous enlargement of the prostate gland that commonly affects men as they age, often causing bothersome urinary symptoms), and flaccid neuropathic bladder (a type of neurogenic bladder characterized by weak bladder muscle (detrusor muscle) that cannot contract prop, leading to seer underactivity, high-capacity retention, and overflow incontinence), Record review of Resident #7's last MDS revealed a quarterly assessment completed on 01/25/26 with a BIMS of 05 indicating he was severely cognitively impaired, he had a functionality of requiring substantial/maximal assistance with his toileting hygiene, and he required an indwelling catheter. Record review of the care plan with admission date of 01/07/26 for Resident #7 revealed the following: Focus:Resident is on enhanced barrier precautions r/t catheter due to obstructive and reflux uropathy (the structural or functional hindrance of normal urine flow causing backpressure). Revision on 01/14/26 Record review of the Order [NAME] Report printed 1/29/2026 with Active Orders as of: 1/29/2026 for Resident #7 revealed the following order:- Change Foley Catheter using _16__fr 10___ml bulb one time a day starting on the 14th and ending on the 14th every month. Active 12/03/2025. During an observation on 01/29/2026 at 09:55 AM CNA A cleaned Resident #7's perineal area and Resident #7's catheter to include the tubing then CNA A noted he did not have enough wipes. CNA A removed his gloves, then removed more wipes from the wipe container with his ungloved hands. CNA A then washed his hands and put on new gloves. CNA A then used the wipes he removed with his ungloved hands to clean the catheter tubing one more time, assisted rolling Resident #7, and then cleaned Resident #7's buttocks and rectal area. CNA A then touched the new brief and stated, I messed up. CNA A then removed his gloves, washed his hands, put on new gloves, used the same brief he touched with the contaminated gloves, and placed the brief on Resident #7. During an interview on 01/29/2026 at 10:18 AM CNA A reported he cleaned Resident #7's perineal area and catheter, then removed his gloves and retrieved more wipes with his ungloves hands. CNA A reported this contaminated the wipes he used because he had not washed his hand yet. CNA A reported he exposed Resident #7 to infection, especially a UTI or worse. CNA A reported he did touch the new brief with dirty gloves after wiping Resident #7's catheter then rectal area and placed the contaminated brief on Resident #7 exposing him again to a UTI or worse. CNA A reported he was asked to complete the catheter care for this survey because he was a recent graduate CNA and had been recently trained in his course. During an interview on 01/30/2026 at 10:20 AM the DON reported she expects her staff to perform hand hygiene when gloves are dirty, especially with incontinent or catheter care. The DON reported improper hand hygiene could result in the resident getting an infection which can result in irritation of their skin. The DON reported the facility was going to retrain all staff on hand hygiene. During an interview on 01/30/2026 at 10:41 AM the Corp RN reported she expects staff to perform hand hygiene prior to starting a resident care such as catheter care, when moving from Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 5 of 6 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 FORM CMS-2567 (02/99) Previous Versions Obsolete the dirty to the clean part of catheter care, and after completing catheter care. The Corp RN reported that if the hand hygiene was not performed properly then contamination could result. Record review of the facility provided training titled Catheter Care provided to staff on 10/28/2025 by the DON revealed CNA A was trained on the following: Catheter CareProcedure:16. Gently was, rinse, and dry around the juncture of the catheter.19. Remove gloves21. Wash hands. Record review of the facility provided training titled Catheter Care provided to staff on 09/30/2025 by the DON revealed CNA A was trained on the following: Handwashing Record review of the facility provided policy titled Fundamentals of Infection Control Prevention 2019 manual, revealed the following: A variety of infection control measure are used for decreasing the risk of transmission of microorganisms in the facility.Hand Hygiene-Before and after direct resident contact.-Upon and after coming in contact with a resident intact skin.-after removing gloves.Gloving-Wearing gloves does not replace the need for hand washing because gloves may have small inapparent defects or be torn during use, and hand can become contaminated during removal of gloves. Failure to change gloves between resident contact is an infection control hazard. Record review of the facility provided policy titled Perineal Care effective 05/11/2022, revealed the following: Important Points - Always perform hand hygiene before and after glove use. Event ID: Facility ID: 675945 If continuation sheet Page 6 of 6