Inspection·February 19, 2025

F 0580 bedtime . Level of Harm - Minimal harm or potential for actual harm Record review of Resident #1's monthly physician orders for January 2025 reflected the resident was on Pramipexole 0.5 mg; give one tablet by mouth one time a day for restless leg syndrome. The physician's orders further reflected the order had been put into the electronic health record by LVN B on 01/01/25 at 1:00 AM. Residents Affected - Few Record review of Resident #1's January 2025 MAR reflected LVN C administered the first dose of the medication Pramipexole on 01/01/25. Record review of Resident #1's clinical record reflected there was no documented evidence reflecting Resident #1's responsible party had been notified that Pramipexole had been added to Resident #1's drug regimen. Record review of Resident #1's facesheet printed on 02/19/25 reflected the resident was discharged to the hospital on [DATE] and did not return to the faciltiy. Interview on 02/18/25 at 4:44 PM with Resident #1's Family Member revealed they were not made aware Resident #1 had been started on the medication Pramipexole. The Family Member stated they had noticed a decline in the resident and when they were asking about Resident #1's medication list, they were told the resident had began taken Pramipexole. The Family Member further stated they were never contacted about the resident's new medication. Interview on 02/19/25 at 2:35 PM with LVN A revealed she recalled the Resident #1 being up one night complaining of her legs and feet bothering her. LVN A stated Resident #1 reported she could not get comfortable due to her restless leg syndrome. Interview on 02/19/25 at 3:34 PM with LVN B revealed she did not recall Resident #1 or the circumstances under which the resident was prescribed the medication Pramipexole. LVN B said if the order was put in at 1:00 AM, she would not have called the family at that time. She stated she would have passed it on to the morning shift nurse to contact the family. Interview on 02/19/25 at 3:55 PM with LVN C revealed she did not recall giving Resident #1 her first dose of the medication Pramipexole. LVN C said if the night nurse would have told her to contact Resident #1's family about the added medication, she would have documented in the nurse's notes in Resident #1's record. LVN C further stated if it was not documented in the notes, she probably did not contact the family. Interview on 02/19/25 at 4:02 PM with the ADON revealed when a new medication was ordered for a resident, the nurse that took the order would be responsible for contacting the resident's responsible party. He was not aware Resident #1's responsible party had not been contacted about the resident's new medication Pramipexole. He stated since the order was put in at 1:00 AM, he would understand the nurse being polite and waiting until the morning to make the call. The ADON said any time a resident's responsible party was contacted about a medication order or change, it should be documented in the system because it was part of their compliance. Record review of the facility's Family Notification policy dated 2003 reflected the following: Objectives: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676004 If continuation sheet Page 2 of 3 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 676004 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Hills Nursing & Rehabilitation 201 E Thompson St Decatur, TX 76234 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 0580 1. Level of Harm - Minimal harm or potential for actual harm To keep families informed Procedure: Residents Affected - Few 1. The family will be notified of any resident change .3. Notification will occur in a timely manner . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676004 If continuation sheet Page 3 of 3