Health inspection·November 16, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some walked around and crouched to talk to unidentified Resident #6. At 11:45 AM CNA E sat next to Resident #32, CNA E took her cell phone out of her pocket and tapped her fingers on Resident #32's wheelchair arms in a sequential fashion. Observation on 11/16/23 at 9:42 AM revealed CNA F stood while feeding Resident #31. CNA F turned and fed unsampled resident #10 while standing. Interview on 11/16/23 at 09:45 AM LVN G stated her expectation for staff while feeding residents was, they needed to speak and visit with the residents. LVN G said she did not prefer them standing except for Resident #3 who you could sometimes sneak in a bite if you said, here trying this, give her a bite and walk away. LVN G said some staff had to stand while feeding Resident #32 because she was so tall the staff had to support her head. LVN G said cell phone use depended on the aide. LVN G stated she did not agree with staff texting but did not mind staff playing music on their phones. LVN G said she monitored by looking over the window into the dining room from the nurses' station. LVN G said she would wait and get the aides by themselves because she did not like being called out in front of someone else. Interview 11/16/23 04:34 PM the DON stated the expectation for staff feeding dependent residents was for them to do it. The DON said she expected staff to sit with residents and feed the residents at the resident's speed and the staff did not need to be on their phone. The DON said standing was ok in certain circumstances. The DON elaborated that there was one resident who would gaze up so to make eye contact, the staff would have to stand to feed the resident. The DON said the computer training program had trained on resident rights in the last year but did not know if it specifically covered feeding or being on the phone. Interview on 11/16/23 at 05:15 PM the DON said the last in person in-service on cell phone use was done prior to the last annual survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 2 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to complete a comprehensive assessment within 14 days after a significant change in the physical condition for 3 of 9 residents (Residents #19, #31 and #32) whose records were reviewed for assessments after significant change. Residents Affected - Some The facility failed to complete a comprehensive MDS assessment after Resident #19, Resident #31 and Resident #32 developed pressure ulcers. These failures placed residents at risk of having assessments that do not reflect significant changes in their conditions and need for additional care/treatment. The findings included: Review of Resident #19's Face Sheet, dated 11/16/23, revealed he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including pulmonary embolism, acute kidney failure, dementia, chronic obstructive pulmonary disease, heart failure, high blood pressure, anemia, and depression. Review of Resident #19's most recent MDS Assessment, dated 10/11/23 revealed: He scored a 3 on his mental status exam, indicating severe cognitive impairment. He required substantial to maximal assistance with all ADLs and used a wheelchair for mobility. He had no documented pressure ulcers at the time of the assessment. Review of Resident #19's Physician's Orders for November 2023 revealed the following orders: Apply medi-honey to buttocks, cover with foam border dressing every day and PRN (start date 10/22/23) Multivitamin 1 tablet by mouth every day (start date 11/15/23) Push Powder in 8oz beverage of choice to aid in wound healing twice a day (start date 11/13/23) Vitamin C 500mg 1 by mouth twice a day (start date 11/15/23) Air mattress every shift (start date 11/13/23) Turn every 2 hours (start date 9/23/23) Right buttocks wound care: clean with normal saline/wound cleanser, pat dry, apply Santyl to eschar, cover with padded dressing every day and PRN (start date 11/13/23) Review of Resident #19's Care Plan, most recent revision date 11/14/23, revealed: Care Plan Description: Pressure Ulcer, Stage 2 (start date 10/30/23) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 3 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 0637 Goal: Ulcer will heal Level of Harm - Minimal harm or potential for actual harm Interventions: Repositioning - two person assist to avoid skin friction/shearing; Refer to dietician for evaluation of current nutritional status, provide supplemental nutritional support; Perform wound care as ordered; Mechanical lift to avoid skin friction/shearing; Full skin evaluation with bath/shower; Float heals off the bed; encourage good nutritional intake; Provide pressure reducing surfaces on bed and chair; Assess wound healing weekly; Assess skin daily with routine care; Administer pain medication prior to initiating treatment Residents Affected - Some Review of Resident #31's Face Sheet, dated 11/15/23, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses included diabetes, weight loss , kidney disease disorders of the skin of subcutaneous tissue, and skin cancer. Review of Resident #31's Quarterly MDS assessment dated [DATE] revealed (an 11/9/23 quarterly MDS assessment was in progress): He had long- and short-term memory loss and had severely impaired decision-making skills (indicating he was not interview-able). He needed extensive assistance from staff for ADLs. There were no identified skin issues. Review of Resident #31's November 2023 Physician's Orders, printed 11/15/23, revealed: Order dated 10/5/23 Cleanse Stage II to left inner buttock with wound cleanser, apply hydrocolloid dressing and change every three days and as needed if soiled until healed. Review of Resident #31's Care Plan, dated 5/23/23, revealed: Resident #31 had a history of pressure ulcer and skin issues., he moves his heels against bed sheets frequently, at high risk for further break down. The goal was Remain free from skin break down. Identified interventions included: perform wound care as ordered, asses changes in skin status that indicate worsening of pressure ulcer and notify the physician, keep skin clean and dry, provide pressure reducing surfaces on bed and chair, repositioning assist to avoid friction/shearing/contact with other body part or objects, monitor for signs of infection or spreading, provide incontinent care as needed, apply moisture barrier to peri area as indicated, turn and reposition every two hours, keep heels off bed, may have heel boots to relieve pressure, stage II area to left inner buttock apply treatment as ordered, monitor skin weekly if area is not improving notify hospice/doctor, administer vitamins per dietary consultant recommendations to promote healing. Review of Resident #32's Face Sheet, dated 11/15/23, revealed she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Alzheimer's Disease, psychotic disorder with hallucinations due to known physiological conditions, and stage III of the sacral region (tail bone). Review of Resident #32's Annual MDS Assessment, dated 9/27/23, revealed: She had short- and long-term memory impairment with severely impaired decision-making skills (indicating she was not interviewable). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 4 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 0637 She was totally dependent on staff for all ADLs. Level of Harm - Minimal harm or potential for actual harm She had no identified pressure injuries. Review of Resident #32's Care Plan for Pressure Ulcer, Stage 2 to Coccyx, started 10/2/23, revealed: Residents Affected - Some Care Plan Goal: Area will remail free of infection with interventions including perform wound care as ordered, assess changes in skin status that indicate worsening of pressure ulcer and notify the physician, reposition every two hours off back as much as possible, encourage nutritional intake provide protein supplement if intake less than 50%, and administer vitamins per dietary consultant recommendations. Review of Resident #32's Physician's Orders for November 2023 revealed: Cleanse Stage II to coccyx and right side of coccyx with wound cleanser, pat dry and apply hydrocolloid dressing every three days and as needed if soiled, dated 10/2/23. In an interview on 11/16/23 at 5:04 PM, the MDS Coordinator stated that a Significant Change MDS was required when a resident had 2 or more changes in their care, significant weight loss, and when a resident started on or went off hospice. She stated that a significant change assessment could be done with only 1 change if the IDT (Interdisciplinary Team) agreed. She stated that the IDT's decision-making process was normally based on the severity of the diagnosis. When asked if the development of new pressure ulcer required a significant change assessment, she stated that she thought it still required a change in level of care for 2 care areas, but she would have to look at the CMS (Centers for Medicare and Medicaid Services) resident assessment tool to be certain. The MDS Coordinator logged onto the CMS RAI (Resident Assessment Instrument) guide during the interview to double check and she stated that, according to the tool, Resident #19, Resident #31, and Resident #32 all should have had significant change assessments done when they developed pressure ulcers. She stated that she was not notified by the nursing staff that those residents had new pressure ulcers. The MDS Coordinator stated that she was made aware of changes with the residents primarily by the ADONs via email. She stated that skin issues were not addressed during the morning meeting unless a new skin tear or bruise was identified. In an interview on 11/16/23 at 5:33 PM, ADON A stated that she was not aware that the MDS Coordinator needed to be notified when a resident developed a pressure ulcer. She stated that when a CNA charted a new skin issue it alerted the nurse to follow up, and the way the nurse charted should alert her (MDS Coordinator). ADON A stated that when she was informed of a new pressure ulcer by staff, she would send a text message to the DON and the Administrator to let them know. She stated that the weekend RN did skin checks for the residents, but she was not aware if they notified the MDS Coordinator of their findings. In an interview on 11/16/23 at 5:58 PM, the DON and Administrator were informed that significant change MDS assessments had not been completed for Residents #19, #31, and #32. Neither was able to offer any further information regarding why the significant change assessments were not done. The facility did not have a policy regarding resident assessment per the DON. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 5 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to develop and implement a comprehensive, person-centered care plan for each resident that included measurable objectives and time frames to meet, attain, and/or maintain the resident's highest practicable physical, mental, and psychosocial well-being for 3 of 9 residents (Residents #17, #19, and #32) reviewed for care plans in that: Resident #17 did not have a care plan in place for fall risk. Resident #19 did not have a care plan in place for skin integrity risk, bipolar disorder, or psychotropic medication use. Resident #32 did not have a care plan in place for an indwelling catheter. This failure could affect residents by placing them at risk of not receiving individualized care and services to meet their needs. The findings included the following: Review of Resident #17's Face Sheet, dated 11/16/23, revealed he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including Parkinson's disease, Lewy Body dementia, high blood pressure, generalized osteoarthritis, and pain. Review of Resident #17's Annual MDS Assessment, dated 4/20/23, revealed: Fall risk CAA triggered and to be added to care plan. Review of Resident #17's Care Plan, most recent revision date 10/25/23, revealed no fall risk care plan. Review of Resident #17's Quarterly MDS Assessment, dated 11/2/23, revealed: He had short-term and long-term memory loss, and severely impaired decision-making skills (indicating he was not interviewable). He had behavioral symptoms not directed towards others which occurred less than daily. He required maximum assistance and was dependent on staff for all ADLs except for eating. He used a wheelchair for mobility. He had no reported falls in the previous 6 months. He received antipsychotic medication, antidepressant medication, opioid medication, and antiplatelet medication. Review of Resident #17's Physician's Orders for November 2023 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 6 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 Quetiapine 12.5mg by mouth every night - give ½ of 25mg tablet (start date 5/9/32) Level of Harm - Minimal harm or potential for actual harm Tylenol with codeine #3, 1 tablet by mouth three times a day as needed for breakthrough pain (2/16/19) Cymbalta 60mg 1 capsule by mouth daily (start date 5/16/17) Residents Affected - Some Metoprolol succinate ER 50mg 1 tablet by mouth daily (start date 2/15/22) Memantine 10mg tablet by mouth twice a day (start date 10/20/17) Carbidopa-Levodopa 25-250mg 1 tablet by mouth four times a day before meals and at bedtime (start date 6/23/17) Neurontin 600mg 1 by mouth every evening (start date 2/16/19) Trazodone 50mg 1 tablet by mouth at bedtime (start date 11/4/19) Neurontin 300mg 1 by mouth every morning and noon (start date 4/2/19) MS Contin ER 15mg tablet give 1 by mouth every 12 hours, hold for lethargy (start date 2/9/23) Review of Resident #19's Face Sheet, dated 11/16/23, revealed he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including pulmonary embolism, acute kidney failure, dementia, chronic obstructive pulmonary disease, heart failure, high blood pressure, anemia, and depression. Review of Resident #19's most recent MDS Assessment, dated 10/11/23 revealed: He scored a 3 on his mental status exam, indicating severe cognitive impairment. He required substantial to maximal assistance with all ADLs and used a wheelchair for mobility. He had no documented pressure ulcers at the time of the assessment (10/11/23). He was taking an antipsychotic medication and a hypnotic medication. Review of Resident #19's Physician's Orders for November 2023 revealed the following orders: Temazepam 15mg give 1 by mouth at bedtime PRN (start date 9/15/23) Quetiapine fumarate 25mg give two (50mg) by mouth daily (start date 9/15/23) Offload heels while in bed every shift (start date 11/13/23) Air mattress every shift (start date 11/13/23) Monitor right heel every shift and PRN for openings and report to ADON (start date 11/13/23) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 7 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 Monitor left heel every shift and PRN for openings and report to ADON (start date 11/13/23) Level of Harm - Minimal harm or potential for actual harm Turn every 2 hours (start date 9/23/23) Residents Affected - Some Review of Resident #19's Care Plan, most recent revision date 11/14/23, revealed no care plan for skin integrity, bipolar disorder , or his use of psychotropic medication. Review of Resident #32's Face Sheet, dated 11/15/23, revealed she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Alzheimer's Disease, psychotic disorder with hallucinations due to known physiological conditions, neurogenic disorder of the bladder, and stage III pressure ulcer of the sacral region (tail bone). Review of Resident #32's Annual MDS Assessment, dated 9/27/23, revealed: She had short- and long-term memory impairment with severely impaired decision-making skills (indicating she was not interviewable). She was totally dependent on staff for all ADLs. She had an indwelling catheter. Review of Resident #32's Care Plan, most recent revision date 11/2/23, revealed no care plan for indwelling catheter use. Review of Resident #32's Physician's Orders for November 2023 revealed: Foley catheter care every shift (start date 9/21/22) Foley output every shift (start date 9/21/22) Continue foley catheter 20 French change every month and as needed (start date 12/27/22) In an interview on 11/16/23 at 5:04 PM, the MDS Coordinator stated that she was responsible for creating care plans for the skilled residents and the ADONs were responsible for creating care plans for the rest of the residents. She stated that if a CAA was triggered during an assessment, a care plan should automatically be created. She stated that she was not aware if the new system generated care plans based on the MDS or if the care plans had to be done manually. In an interview on 11/16/23 at 5:33 PM ADON A stated that she was responsible for care plans for all the rehab and long-term care residents. She stated that she would expect a care plan to address admitting diagnosis and other pertinent diagnoses, psychotropic medication, pain and pain medication, pressure ulcers, consent for psychotropic medication, code status, dietary changes, antibiotics, lab work, fall risk, catheter care. When asked if a pressure ulcer care plan would override a skin integrity care plan, she stated she would have both because if the sore heals the resident would still be at risk. She stated that any type of preventative care, air mattress, moon boots things like that should be care planned. ADON A stated that she had to manually add everything into the computer program when something needed to be care planned. She stated that if a CAA triggered, she would add it on the care plan. She stated she did not have an answer as to why there were no care plans for Resident #17 for fall risk, Resident #19 for skin integrity, depression, or psychotropic medication use, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 8 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 or Resident #32 for her catheter. Level of Harm - Minimal harm or potential for actual harm In an interview on 11/16/23 at 5:58 PM the DON stated that all resident care plans had been redone recently and she was not surprised that some were missed. She stated that she would not expect a skin integrity care plan and a pressure ulcer care plan for the same resident because it was apples to apples and apples to oranges even though they would have different interventions. She stated that psychotropic medications, depression, catheters, and fall risk would require care plans. On review of care plans with surveyor, she acknowledged that Residents #17, #19, and #32 were missing care plans. The DON stated that the facility did not have a policy regarding care plans. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 9 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 3 residents (Residents #18) reviewed for indwelling catheters. The facility failed to ensure Resident #18's indwelling catheter was secured to prevent pulling or tugging. The facility failed to ensure CNA B performed urinary catheter care for Resident #18 during incontinent care. These failures could place residents at risk for discomfort, urethral trauma and urinary tract infections. Findings included: Record review of Resident #18's face sheet dated 11/15/2023 indicated he was admitted to the facility on [DATE] with diagnoses of retention of urine and Alzheimer's disease. He was [AGE] years of age. Record review of Resident #18's physician order report for the month of November 2023 indicated in part: Foley catheter care (Q = every) shift. Start date 03/29/2017. Record review of Resident #18's care plan dated 04/18/2023 indicated in part: Care plan description urinary catheter : Indwelling due to urinary retention. Care plan goal: will reduce the risk of infection. Interventions; Assess color, clarity and character of urine, assess for acute behavioral changes that may indicate UTI. Catheter care every shift. Monitor catheter tubing for kinks or twists in tubing. Record review of Resident #18's MDS dated [DATE] indicated in part: Cognitive skills for daily decision making = Severely impaired-never/rarely made decisions. Appliances: indwelling catheter. Bowel continence = Always incontinent. During an observation on 11/14/23 at 09:50 AM Resident #18 was in bed resting and had a urinary catheter which hung on the side of the bed. The urinary catheter tube was not secured to the resident's leg. The resident was not able to state if the catheter had caused him any discomfort due to his cognitive status. During and observation and interview on 11/14/23 beginning at 11:45 AM CNA B and CNA C performed incontinent and urinary catheter care for Resident #18. CNA B put some gloves on and undid the resident's brief and performed catheter care. CNA B took some wipes and wiped the resident's penis with front to back motions. CNA B did not cleanse the catheter tubing that entered the resident's penis. Both CNAs then turned the resident on his side and CNA B wiped the resident's bottom as he had a bowel movement. CNA B then disposed of the soiled brief and pad, removed her gloves and fastened a new brief to the resident. Both CNAs then dressed the resident and got him out of bed with the use of the mechanical lift. CNAs B and CNA C said they had never seen the catheter secured to his leg. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 10 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 11/15/23 at 01:52 PM ADON A said she recalled Resident #18 having his catheter anchored to his leg at times but did not know why he no longer had it. The ADON said the reason it was anchored to his leg was to prevent the catheter from tugging or injury to his urethra. During an interview on 11/16/23 at 10:02 AM LVN D said she did not recall Resident #18 having his catheter anchored as she did not believe the resident would pull on the catheter and staff were careful not to pull on it when they assisted the resident. The LVN said that but now the resident did have his catheter secured to prevent any issues. During an interview on 11/16/23 at 02:58 PM CNA B said she had gotten nervous and forgot to cleanse the catheter tubing during the incontinent care she performed for Resident #18. CNA B said she had been trained on how to properly perform catheter care but again she got nervous during the procedure and forgot to wipe the catheter tubing. During an interview on 11/16/23 at 03:47 PM ADON A said she expected for staff to clean from the meatus up to the catheter tube and from dirty to clean during catheter care. The ADON was made aware of the observation of the catheter care performed by CNA B. The ADON said if the catheter care was not done correctly it could lead to infections. The ADON said she believed the failure occurred because the CNA got nervous and forgot her steps. The ADON said they had just initiated the catheter leg strap this morning 11/16/23 to prevent tugging and pulling on Resident #18's penis. The ADON said the CNAs received in-services and computer training on how to perform catheter care. During an interview on 11/16/23 at 04:14 PM the DON was made aware of an observation of Resident #18's urinary catheter not being secured to his leg. The DON said if a resident was mobile then it would be good to have a leg strap that secured the catheter to prevent it from being tugged. The DON said if the catheter was not secured it could become dislodged. The DON said the staff received training such as in-services and computer training regarding catheter care. The DON said Resident #18 now had a leg strap in place. The DON was made aware of an observation of Resident #18's urinary catheter care. The DON said it was her expectation for the staff to clean the meatus around the penis and then wipe the catheter tubing as well. The DON said if the care was not cone correctly it could lead to an infection. The DON said the failure probably occurred because the CNA got nervous and forgot the steps. The DON said she would do rounds to monitor staff and conducted in-services to include computer training regarding catheter care. During an interview on 11/16/23 at 04:15 PM the Administrator was made aware of an observation of Resident #18's urinary catheter not being secured to his leg and the catheter care performed by the CNA. The Administrator said she was not a nurse and agreed with the DON's answers regarding the catheter not being secured and the catheter care performed by the CNA. Record review of the document provided by the facility on 11/16/23 and titled Catheter and perineal care and dated 2022 indicated in part: Following proper perineal and catheter care procedures can prevent contamination that can lead to urinary tract infections. This course discusses how to perform perineal care and catheter care. It also discusses how to empty a catheter drainage bag. Male catheter care: Using your non-dominant hand retract the foreskin if it is not already retracted. Hold the penis just below the head and use two fingers of the same to grasp the catheter to grasp the catheter to secure it. Remove the excess water from a cloth, apply soap and wash around the meatus using a circular motion and use a clean area of the washcloth with each stroke. Set the used washcloth on the disposable pad on the table. Take another washcloth from the basin and remove excess water. Apply soap to the cloth . Cleanse the catheter working your way down from the meatus about 4 inches or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 11 of 12 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 676015 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mabee Health Care Center 2208 N Loop 250 W Midland, TX 79707 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few farther if needed. Avoid tugging the catheter Set the used cloth on the disposable pad on the table and get a clean cloth, then remove excess water and rinse the meatus in the same manner used to cleanse it. Use a clean area of the washcloth for each stroke. Set the used cloth on the waterproof pad on the table. Take the last washcloth and remove excess water. Rinse the catheter from the insertion site downward at least 4 inches. Return the foreskin to its natural position and gently pat with a dry towel. Follow post procedure instructions. Replace the catheter in the leg strap. Secure the catheter to the individual's leg using a leg strap to prevent pulling or tugging. The catheter and tubing must be free from kinks to allow the urine to drain safely. Review of the online the CDC website - According to the CDC website document, dated 2012, indicated in part: Indwelling Urinary Catheter Insertion and Maintenance. Catheter securement devices act as an anchor to prevent tugging and pulling which can cause irritation and inflammation. When catheters are not secured in male patients, the tugging and pulling can cause pressure sores on the penis tip. Properly secure catheters to prevent movement and urethral traction. Reference. https://www.cdc.gov/infectioncontrol/pdf/strive/CAUTI104-508.pdf Review of the online the CDC website - According to the CDC website document, dated 06/06/2019, indicated in part: Guideline For Prevention Of Catheter-Associated Urinary Tract Infections 2009. Proper Techniques for Urinary Catheter Insertion. Properly secure indwelling catheters after insertion to prevent movement and urethral traction. Reference. https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676015 If continuation sheet Page 12 of 12