Health inspection·August 2, 2025

F 0804 a specific policy related to food palatability . 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: 675985 If continuation sheet Page 2 of 8 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 675985 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Midland 2000 N Main Midland, TX 79705 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 observations, interviews, and record reviews, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation and food storage. - The facility failed to ensure stored foods were properly stored, labeled, and dated.- The facility failed to ensure temperatures were checked for food items prior to serving.The facility failed to ensure food was not handled with bare hands.- The facility failed to ensure residents received preferred portion sizes.- The facility failed to ensure that spoiled food items were disposed of properly.- The facility failed to ensure dietary staff used facial hair restraints properly. - The facility failed to ensure dietary staff wore closed shoes.- The facility failed to ensure personal food items were not stored in 1 of 2 of the kitchen refrigerators. These failures could place residents at risk of food-borne illnesses and cross-contamination. Findings included: - Observation and interview on 08/02/25 at 11:20 AM revealed Dietary Aide (DA) B had on a baseball hat with the bill turned to the side, leaving approximately 1 inch of hair on her forehead not restrained. DA A had slide/open toe sandals on. Temperature logs for refrigerator or freezer were not visible. DA A said she was not aware of the need to take food temperatures before serving. DA A said temperatures were not taken for breakfast. DA A and DA B denied knowing where temperature logs were for food temperatures, refrigerator temperatures, and freezer temperatures. Observation of the dry storage on 08/02/25 at 11:28 AM revealed: a produce box of mushy, wrinkled potatoes; a produce box of yams with sprouts; a produce box of small red potatoes with sprouts; a produce box of potatoes with sprouts; and a bag of chips not sealed. The floor was littered with used gloves, paper, napkins and a packaged cookie. - Observation of the refrigerator on 08/02/25 at 11:37 AM revealed: a bag of sliced turkey breast and sliced cheese opened on 07/30/25 did not have a UBD (use by date); a bag of sliced turkey breast opened on 07/30/25 did not have a UBD and was not sealed; a bag of an unidentified food item opened on 07/29/25 did not have a UBD and was not sealed; a bag of ham opened on 07/23/25 did not have a UBD; a bag of sliced cheese did not have an open date or UBD; a bag of sliced ham opened on 07/18/25 did not have UBD and was not sealed; a bag of grated cheese did not have an open date or UBD and was not sealed; a bag of grated cheese did not have an open date or UBD; a partial case of bottled water; 2 bottles of sports drink, 1 was opened and partially gone; a metal bin of an unidentified food item did not have an open date or UBD; and a bag of yogurt did not have an open date or UBD.- Interview on 08/02/25 at approximately 11:44 AM, DA B said the bottled water in the refrigerator was for staff to stay hydrated. DA B said the bottles of blue sports drink were hers. - Observation on 08/02/25 at 11:46 AM revealed: a bottle of ground turmeric was not sealed; clean bowls, plates, a muffin pan, pitchers and plate covers were facing up; and bins of serving and cooking utensils were not covered. The dish cart next to the steam table held stacks of clean plates. The top plate on one of the stacks of small plates had dried food particles on it. The top plate on another stack of small plates had one mouse dropping on it.- Observation on 08/02/25 at 11:51 AM revealed an overflowing bin labeled Open Cake Mix/Sugar. Please Use contained: a bag of graham cracker crumbs was not sealed; a chocolate cake mix did not have an open date or UBD; a muffin mix opened on 02/15/25 was labeled Use 1st did not have a UBD; a box of corn starch opened on 05/22/25 did not have a UBD and was not sealed; a bag of French fried onions opened on 07/06/25 did not have a UBD date; a peppered gravy mix did not have an open date or UBD and was not sealed; a bag of graham cracker crumbs did not have an open date or UBD and was not sealed; a bag of potato pearls opened on 04/15/25 did not have a UBD and was not sealed; a bag of potato pearls did not have an open date or UBD; a bag of potato pearls opened (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675985 If continuation sheet Page 3 of 8 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 675985 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Midland 2000 N Main Midland, TX 79705 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 on 03/01/25 did not have a UBD; a bag of bread crumbs did not have an open date or UBD and was not sealed; and a bag of cocoa opened on 10/27/24 did not have a UBD and was not sealed. There was an unknown brown powdery substance spilled in the bin. - Observation on 08/02/25 at 12:15 PM revealed the Dietary Manager (DM) entered the kitchen, walked past the steam table, stove, and clean dishes to retrieve a hair restraint from the dry storage. The DM did not wear a beard restraint. - Observation on 08/02/25 at 12:20 PM revealed DA A did not check the temperatures for the gravy or the meat for mechanical soft diets before serving. - Observation on 08/02/25 at 12:35 PM revealed the DM and DA B gathering full trash bags with gloved hands. Without changing gloves, the DM and DA B began placing cut cake in bowls with gloved hands.- Interview on 08/02/25 at 12:39 PM, the DM said he usually printed menus and recipes every day. The DM said he did not print them for today (08/02/25) and tomorrow (08/03/25).- Observation on 08/02/25 at 12:57 PM revealed the DM was placing cake in bowls with gloved hands, the DM removed the left glove to release pressure on the juice machine. Without hand washing, the DM placed a clean glove on his left hand and continued placing cake in bowls with gloved hands. - Observation on 08/02/25 at 1:00 PM revealed DA B with gloves on, removed her baseball cap, rubbed her head and placed her cap back on her head. Without changing gloves, DA B began taking filled plates from DA A to place on trays. DA A touched the food surface area of each plate while dishing food onto the plates. - Observation on 08/02/25 at 1:05 PM revealed DA B picked up a stack of plate covers, leaned the plate covers against her chest, carried them to a tray cart, and began placing them on filled plates.- Observation on 08/02/25 at 1:08 PM revealed the DM leaned over the steam table where foods were not covered, reached on the other side of the steam table to pick up small plates, and the DM's shirt touched the rice on the steam table. DA B washed her hands, rubbed her ear and then picked up clean plates. - Observation on 08/02/25 at 1:20 PM revealed DA B picked up her personal cup with bare hands, placed the cup back down, and started placing cake on plates with her bare hands.- Observation on 08/02/25 at 1:25 PM revealed DA A was out of mixed vegetables for the last 5 plates. The DM said he would make a salad for the last 5 trays. DM retrieved lettuce and tomatoes from the refrigerator. - Observation on 08/02/25 at approximately 1:30 PM revealed DA A told the DM the last 5 trays had gone out for delivery. The DM stopped making the salad and did not substitute another food for the vegetable.- Observation on 08/02/25 at 1:45 revealed DA B blew her nose, placed gloves on, and started making a peanut butter and jelly sandwich without hand washing.- Interview on 08/02/25 at 2:00 PM, the DM said the Dietary Staff were responsible for housekeeping before and after each shift for the kitchen and dry storage. The DM said he started the DM position in February of 2025, and he had not had time to train all staff. The DM said the DA's had not been trained on purees meal preparation and taking food temperatures. The DM said he was responsible for disposing of expired and spoiled food items. The DM said he tried to go through the dry storage, frig, and freezer weekly. The DM said all four produce boxes of potatoes in the dry storage should have been disposed of. The DM said the facility has been battling an infestation of mice and cockroaches. The DM said pest control occurred weekly now due to the pests. The DM said he and the dietary staff performed a deep clean a few weeks ago to dispose of dead cockroaches and mouse droppings. The DM said he disposed of all paper in the kitchen, including temperature logs and has not replaced the temperature logs for the refrigerator and the freezer. The DM said his expectations were: clean dishes should be turned face down; clean utensils should be covered, not open to air; personal items should not be stored in the kitchen refrigerator; all food items should be sealed and labeled after opening with the date received, date opened, and expiration date/UBD; and staff know and need to utilize first-in, first out for all food products. The DM said he did not wear a beard restraint today (08/02/25) because (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675985 If continuation sheet Page 4 of 8 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 675985 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Midland 2000 N Main Midland, TX 79705 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 he was in a hurry. The DM said he kept all recipes in his office, outside of the kitchen. The DM said staff needing to fill in for a position not trained for happens more often that it should. The DM said the plastic tub labeled Open Cake Mix/Sugar. Please Use should not be so full and everything should be sealed and labeled correctly.- Interview on 08/02/25 at 2:37 PM, DA A said handwashing should be performed between glove changes, food items should be sealed and labeled with the open date and UBD and opened items should be used before opening a new one. DA A said the pest problems have improved since she started in September 2024. DA A said she was trained to add what is common sense to purees and to gauge the amount. DA A said she was told when the puree item splats on the blender lid, it is ready. DA A said gloves must be worn if touching food. DA A said the outcome of foods not being stored and served at correct temperatures could cause residents to get a stomach-ache. DA A said residents could get sick more often if correct portions are not served. DA A said she wore slides today because it was the weekend. - Interview on 08/02 25 at 5:28 PM, the contracted Registered Dietician (RD) said the DM has been directed to print menus/recipes for current meal season (started in June) all together or daily and make available to staff. The RD said the DM can trash them after use. - Record review of facility policy Personnel Hygiene revised 10/2023, revealed in part: Food and Nutrition Services staff will follow appropriate hygiene and sanitary procedures to prevent the spread of foodborne illness. All staff who handle, prepare or serve food will be trained in the practices of safe food handling and preventing foodborne illness. Staff will demonstrate knowledge and competency in these practices prior to working with food or serving food to residents. Hair nets or other hair restraint to be worn by employees at all times in the kitchen. Facial hair must be covered with a facial hair restraint.Clean, well fitting, closed comfortable shoes. Staff must wash their hands: after personal body functions (i.e., toileting, blowing/wiping nose, coughing, sneezing, etc.); before coming in contact with any food surfaces; after engaging in other activities that contaminate the hands. Contact between food and bare (ungloved) hands is prohibited. Gloves are considered single-use items and must be discarded after completing the task for which they are used. The use of disposable gloves does not substitute for proper handwashing. Hair nets or caps and/or beard restraints must be worn to keep hair from contacting exposed food, clean equipment, utensils and linens. - Record review of facility policy Food Storage revised 04/11/2022, revealed in part: Stock will be rotated first-in, first-out. Food removed from its original packaging will be labeled with the following-receive date, open date, and contents in the package. Opened package or leftover food is to be tightly wrapped or covered in airtight, clean containers. It should be labeled, dated with the opened or use by date. Do not keep leftovers in the refrigerator for more than 7 days. All refrigerators and freezers have thermometers that are monitored daily. Employee beverages and food will be in a closed container stored in designated employee area away from food area. Check food temperatures prior to meal service. If the food temperatures are not within acceptable parameters, the food is reheated or chilled to an appropriate temperature. Food temperatures are taken and recorded at all meals.Review of the FDA Food Code 2022 https://www.fda.gov/food/retail-food-protection/fda-food-code accessed 06/19/2025 revealed: 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers .(B) Label information shall include: (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement .Time/temperature control for safety refrigerated foods must be consumed, sold or discarded by the expiration date.Review of the Food Code, U.S. Public Health Service, U.S. FDA, 2022, U.S. Department of H&HS, revealed, 2-402 Hair Restraints, 2-402.11, Effectiveness., (A) Except as provided in paragraph (B) of this section, FOOD EMPLOYEES (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675985 If continuation sheet Page 5 of 8 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 675985 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Midland 2000 N Main Midland, TX 79705 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 shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed FOOD; clean EQUIPMENT, UTENSILS, and LINENS; and unwrapped SINGLE-SERVICE and SINGLE-USE ARTICLES. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675985 If continuation sheet Page 6 of 8 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 675985 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Midland 2000 N Main Midland, TX 79705 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on observation and interviews, the facility failed to dispose of garbage and refuse properly for 2 of 3 dumpsters in that: The facility failed to ensure the dumpster lids were closed on 2 of 3 dumpsters and the area surrounding the dumpsters were free of garbage and debris.These failures could affect residents who resided in the facility and the public by placing them at risk of exposure to germs, disease, and an environment which could attract pests and rodents. The findings include: In an observation on 8/2/25 at 6:00 PM of 2 of 3 dumpsters located outside the nursing facility, the lids were open on both dumpsters. The dumpsters were not full. A trash bag with trash inside was hanging over the trash can. There was trash outside the dumpster including a toilet and some wooden items. During an interview on 8/2/25 at 6:10 PM, the Administrator stated the expectation is dumpster lids were to always remain closed and area free of trash or debris. The maintenance director does rounds outside the facility on Monday, Wednesday, and Friday. No policy on garbage and refuse disposal was provided by time of exit on 8/2/25 at 8:30 PM. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675985 If continuation sheet Page 7 of 8 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 675985 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Midland 2000 N Main Midland, TX 79705 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 3 of 3 resident smoking areas reviewed for environmental concerns. The facility failed to ensure adequate cleaning in the designated smoking areas. This failure placed the staff and visitors at risk of an uncomfortable and unsafe environment.Findings included: During an observation on 08/2/25 at 6:25 p.m., in smoking area 1 the grass/weeds were approximately 24 inches high. There was trash including used glove, paper, cans, food wrappers. Smoked cigarette butts littered the ground throughout the area. This area is shared by men's locked unit E and men's locked unit F.During an observation on 8/2/2025 at 6:30PM in smoking area 2 Women's Locked Unit from hall C. There was litter scattered on the ground including paper, cans, cups, food wrappers. Smoked cigarette (butts) littered on ground throughout area. The trash can was overflowing. The weeds/grass in this area are up to 1 ft. tall.During an observation on 8/2/2025 at 6:30PM in smoking area 3 located out the door of DR , shared by halls A, B, and D. This area is all cement and no grass. Observed trash including used glove, paper, cans, food wrappers. Also, smoked cigarette (butts) littered on ground throughout area. Cat food bowl w/ food, bag of cat food, 2 cat houses. Cat house 1 has wood chips for bed. Cat house 2 has a blanket for bed. Blanket is covered in cigarette butts, grass, and trash.During an interview on 8/2/2025 at 6:50PM with Regional Maintenance Manager, he said maintenance staff are supposed to clean outside grounds including smoking areas every Monday, Wednesday, and Friday. Mowing is performed by a contractor and they do not [NAME] smoke areas unless requested. Interview and record review with Administrator on 8/2/2025 at 7:00PM revealed a maintenance log check off for smoking area cleaning. Most recent check off was on 7/30/2025. Maintenance staff of facility was not available for interview due to Spanish speaking only. Administrator said mowing was not completed at last scheduled visit by contractor due to mechanical issues and that they were supposed to return today to complete. He said it was the expectation for the facility to be maintained with a clean and sanitary environment. Policy for clean sanitary environment was not received at exit. Event ID: Facility ID: 675985 If continuation sheet Page 8 of 8