Inspection·February 22, 2024

F 0641 wheelchair; and section P for restraints had bed rail coded as not used. Level of Harm - Minimal harm or potential for actual harm During an observation on 02/20/2024 at 2:59 p.m., bed rails present on resident's bed. Resident #27 Residents Affected - Some Record review of Resident #27's electronic face sheet dated 02/22/2024 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: COVID 19, anemia (low iron in blood), and mild cognitive impairment . Record review of Resident #27's quarterly MDS dated [DATE] revealed resident had a BIMS of 1 meaning moderate cognitive impairment; resident normally used wheelchair in the last seven days for mobility; helper provided verbal cues and/or touching for bed mobility; helper provided less than half of the effort with sitting to lying, lying to sitting on the side of bed, sitting to standing, bed to chair transfer; and section P for restraints had bed rail coded as not used. During an observation on 02/20/2024 at 11:58 a.m., half rails on resident's bed. During an interview on 02/22/2024 at 1:52 p.m., the MDS Coordinator stated that she never claimed bed rails on MDS as the facility did not consider bed rails a restraint. She stated she was unsure if the facility policy had any direction about assistive devices. She stated she used the RAI manual as a guide on how to code the MDS. She stated she was trained six years ago by another company on how to perform MDS Coordinator duties and she had a RUG certification. The MDS Coordinator stated she should have been coding bed rails as a restraint after reviewing the RAI manual online. She stated she did not feel the failure would cause any negative effect on the residents. She stated the DON monitored that her assessments had been completed accurately. During an interview on 02/22/2024 at 2:37 p.m., the DON stated the MDS assessments were not accurately coded after reviewing the RAI manual. She stated the assessments were coded incorrectly due to training. The DON stated she was responsible for monitoring that the MDS assessments were accurate. She stated the failure did not have negative outcomes to the residents because she did not consider bed rails as restraints . Review of facility policy titled Certifying Accuracy of the Resident Assessment dated November 2019 revealed: Any person completing a portion of the Minimum Data Set/MDS (Resident Assessment Instrument) must sign and certify the accuracy of that portion of the assessment .Any health care professional who participates in the assessment process is qualified to assess the medical, functional and/or psychosocial status of the resident that is relevant to the professional's qualifications and knowledge .The Resident Assessment Coordinator is responsible for ensuring that an MDS assessment has been completed for each resident. Each assessment is coordinated and certified as complete by the Resident Assessment Coordinator, who is a registered nurse. Inquiries concerning the signing of the MDS should be referred to the Assessment Coordinator, Director of Nursing Services, or to the Administrator. Any individual who willfully and knowingly certifies (or causes another individual to certify) a material and false statement in a resident assessment is subject to disciplinary action. According to the Centers for Medicare & Medicaid Services (CMS) website https://www.cms.gov/files/document/finalmds-30-rai-manual-v11811october2023.pdf accessed on 02/22/2024: P0100: Physical Restraints (cont.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 2 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some o Bed rails include any combination of partial or full rails (e.g., one-side half-rail, one-side full rail, two-sided half-rails or quarter-rails, rails along the side of the bed that block three-quarters to the whole length of the mattress from top to bottom, etc.). Include in this category enclosed bed systems. - Bed rails used as positioning devices. If the use of bed rails (quarter-, half- or three-quarter, one or both, etc.) meet the definition of a physical restraint even though they may improve the resident's mobility in bed, the nursing home must code their use as a restraint at P0100A. - Bed rails used with residents who are immobile. If the resident is immobile and cannot voluntarily get out of bed because of a physical limitation or because proper assistive devices were not present, the bed rails do not meet the definition of a physical restraint. For residents who have no voluntary movement, the staff need to determine if there is an appropriate use of bed rails. Bed rails may create a visual barrier and deter physical contact from others. Some residents have no ability to carry out voluntary movements, yet they exhibit involuntary movements. Involuntary movements, resident weight, and gravity's effects may lead to the resident's body shifting toward the edge of the bed. When bed rails are used in these cases, the resident could be at risk for entrapment. For this type of resident, clinical evaluation of alternatives (e.g., a concave mattress to keep the resident from going over the edge of the bed), coupled with frequent monitoring of the resident's position, should be considered. While the bed rails may not constitute a physical restraint, they may affect the resident's quality of life and create an accident hazard. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 3 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 person-centered, comprehensive care plan for each resident, consistent with resident rights, that included measurable objectives and timeframes to meet residents medical, nursing, mental and psychosocial needs that were identified in the comprehensive assessment for 4 (Resident #8, Resident #13, Resident #23, and Resident #83) of 4 residents reviewed for care plans. The facility failed to ensure care plans specified measurable objectives that could be evaluated or quantified for Resident #8, Resident #13, Resident #23, and Resident #83. This failure could place residents at risk for not receiving care and services individualized to meet their specific physical, mental, and/or emotional needs. Findings included: Record review of Resident #8's electronic face sheet revealed a [AGE] year-old female, admitted on [DATE]. Resident #8's medical diagnoses included dementia, stroke, low red blood cell count, vitamin deficiency, and chronic obstructive pulmonary disease (a groups of diseases that cause airflow blockage and breathing-related problems). Record review of Resident #8's Quarterly MDS assessment dated [DATE], revealed Section C Cognitive Patterns C0500 BIMS Summary Score revealed Resident #8 scored 12 out of 15 indicating moderate cognitive impairment. Review of Resident #8's Comprehensive Care Plan reviewed/revised 01/04/2024 revealed the following focus care areas and goals: Focus Code Status: Full Code with the goal Her wishes will be respected; Focus The resident has an ADL self-care performance deficit r/t Activity Intolerance with the goal The resident will improve current level of function in ADLs . ; Focus The resident is/has potential to be verbally aggressive and manipulative with the goal The resident will demonstrate effective coping skills . ; Focus The resident is resistive to care r/t Anxiety and refuses showers, getting up for meals, yelling for help instead of using call light with the goal The resident will cooperate with care . ; Focus The resident has Congestive Heart Failure with the goal The resident will verbalize less difficulty breathing (Dyspnea) and be more comfortable . ; Focus The resident has had an actual fall with (Fx hip) Poor communication/comprehension, Unsteady gait/Recent CVA with left hemiparesis. with the goal The resident sent to [hospital] ER where she was x-rayed, now has fx left hip sent to [hospital] for Tx and she will be successfully treated; and Focus The resident has a psychosocial well-being problem potential due to transfer from [assisted living] to [facility] with the goal The resident will demonstrate adjustment to nursing home placement . Record review of Resident #13's electronic face sheet revealed a [AGE] year-old male, admitted on [DATE] with medical diagnoses of traumatic brain injury, dementia, anxiety, low back pain, kidney stones, heartburn, and low thyroid function. Record review of Resident #13's MDS assessment dated [DATE], Section C Cognitive Patterns C0500 BIMS Summary Score revealed Resident #13 scored 10 out of 15 indicating moderate cognitive impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 4 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 Review of Resident #13's Comprehensive Care Plan reviewed/revised 11/21/2023 revealed the following focus care areas and goals. Focus Resident has a new motorized scooter with the goal He will have not accident harming himself or others; Focus The resident is/has potential to be verbally aggressive r/t poor impulse control when not allowed to do certain things ie: walk over to his [family member's] house with the goal The resident will demonstrate effective coping skills. ; Focus :The resident has a communication problem r/t neurological symptoms with the goal The resident will restore communication losses when communication with others, understanding others, engaging in every day decision making). ; Focus 8/3/23 The resident has had an actual fall with no injury, r/t Unsteady gait. He says, (tripped over his own feet). 10/22/23 fell trying to balance himself on a rolling bedside table. 1/24/24 fell when pants got caught on scooter with the goal The resident will resume usual activities without further incident . ; Focus The resident has chronic pain r/t Disease process hammer toes both feet and takes Tylenol or Tramadol (C)Norco q 6hr prn / Takes Meloxicam routinely with the goal The resident will verbalize adequate relief of pain or ability to cope with incompletely relieved pain . ; and Focus The resident has impaired visual function r/t Myopia (nearsightedness) with the goal The resident will have no indications of acute eye problems . Record review of Resident #23's electronic face sheet revealed a [AGE] year-old male, admitted on [DATE] with medical diagnoses of Alzheimer' disease, anxiety, depression, hallucinations, inability to control bowels or bladder, difficulty walking, history of falling, and chronic pain. Record review of Resident #23's Quarterly MDS assessment dated [DATE], Section C Cognitive Patterns C0500 BIMS Summary Score revealed Resident #23 scored 1 out of 15 indicating severe cognitive impairment. Review of Resident #23's Comprehensive Care Plan reviewed/revised 12/06/2023 revealed the following focus care areas and goals. Focus Code Status: DNR, with the goal He and family's wishes will be respected; Focus The resident is/has potential to be verbally and physically aggressive r/t dementia with the goal The resident will demonstrate effective coping skills . ; Focus The resident has had an actual fall with 10/4/22 in floor. 4/14/23 attempted self-transfer with the goal The resident will resume usual activities without further incident . ; Focus The resident has chronic pain r/t chronic physical disability, with the goal He will verbalize adequate pain management; and Focus The resident has a terminal prognosis r/t Alzheimer's and here for 5 days respite 8/17/22 Returned to RCC for in pt. cont. Hospice, with the goal The resident's comfort will be maintained . Record review of Resident #83's electronic face sheet revealed a [AGE] year-old male, admitted on [DATE] with medical diagnoses of chronic pain, high blood pressure, left side paralysis related to a stroke, blood circulation problems, and depression. Record review of Resident #83's Brief Interview for [NAME] Status assessment dated [DATE], revealed Resident #83 scored 12 out of 15 indicating moderate cognitive impairment. Review of Resident #83's Comprehensive Care plan dated 02/08/2024 revealed the following focus care areas and goals. Focus The resident has an ADL self-care performance deficit r/t Activity Intolerance, Fatigue, S/P CVA with left hemiparesis(paralysis). May use hoyer lift with the goal The resident will demonstrate the appropriate use of assistive adaptive device(s) to increase ability/strength in adl's . ; and Focus The resident has a psychosocial well-being problem r/t Disease Process and prognosis, with the goal The resident will demonstrate adjustment to nursing home placement . During an interview on 02/22/24 at 10:12 AM, LVN A stated the DON was responsible for care plans. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 5 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 LVN A stated she did not attend care plan meetings and rarely reviewed the care plans. Randomly selected goals were reviewed and LVN A was not able to explain how the goals could be measured or determined as met. She stated not having measurable goals could affect residents because the staff may not understand a resident's needs, what needed to be done, or what needed to be achieved. LVN A stated she had not had training on care plans not since she was in nursing school. Residents Affected - Some During an interview on 02/22/24 at 10:18 AM, the MDS Coordinator stated the DON was responsible for creating care plans. She stated she had attended a few care plan meetings but not on a routine basis. The MDS Coordinator stated the DON did consult her on changes on the care plans. She was not able to state how goals that were not measurable could affect residents. During an interview on 02/22/24 at 11:23 AM, the DON stated she was responsible for care plans. She stated the reason for the failure to have measurable goals was the way the electronic records system was set up. She stated although the system allowed for editing to individualize goals there were standardized goals to select in the system. The DON stated the effect of goals without a means to measure was residents may not progress as rapidly. She explained the care plans were updated every 3 months or as needed. She stated care plans should be reviewed/revised by the target date but if no revisions were made, the original target date did not change. Review of facility policy title Comprehensive Care Plans revised December 2016 revealed: 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. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 6 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to assess the residents for risk of entrapment from bed rails prior to installation, review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation of bed rails for 3 of 5 residents (Resident #7, Resident #25, and Resident #27) reviewed for bed rails. The facility failed to ensure Resident #7, Resident #25, and Resident #27 had assessments and/or informed consents for the use of bed rails. This failure could place the residents at risk for entrapment, injury, or harm. Findings included: Resident #7 Record review of Resident #7's electronic face sheet dated 02/21/2024 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: infection of hip, respiratory infection, difficulty walking, altered mental status, and chronic pain. Record review of Resident #7's quarterly MDS dated [DATE] revealed resident had a BIMS of 12 meaning moderate cognitive impairment; helper provided half the effort for bathing, dressing upper and lower body, sitting to standing and lying to sitting on side of the bed; helper set up or cleaned up for eating, oral hygiene, toileting hygiene, and personal hygiene; resident able to use manual wheelchair; and section P for restraints had bed rails coded as not used. Record review of Resident #7's EMR on 02/21/2024, did not reveal a side rail assessment or a consent for the use of side rails. During an observation on 02/20/2024 at 3:52 PM, revealed Resident #7 was in her room sitting up in her wheelchair. Resident #7 had ½ bed rails up to each side of her bed. Resident #25 Record review of Resident #25's electronic face sheet dated 02/20/2024 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: vitamin deficiency, type 2 diabetes, myotonic muscular dystrophy (progressive muscle weakness), and major depressive disorder (depression). Record review of Resident #25's quarterly MDS dated [DATE] revealed resident had a BIMS of 12 meaning moderate cognitive impairment; resident normally used wheelchair in the last seven days for mobility; helper provided less than half of the effort with bed mobility, lying to sitting on side of bed, sitting to standing, and transferring from bed to chair; able to independently use motorized wheelchair; section P for restraints had bed rails coded as not used. Record review of Resident #25's EMR on 02/21/2024, did not reveal a side rail assessment or a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 7 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 0700 consent for the use side rails. Level of Harm - Minimal harm or potential for actual harm During an observation on 02/20/2024 at 10:11 AM, Resident #25 was sitting in her motorized wheelchair. Resident #25 had ½ bed rails up to each side of her bed. Residents Affected - Some Resident #27 Record review of Resident #27's electronic face sheet dated 02/22/2024 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included: COVID 19, anemia (low iron in blood), and mild cognitive impairment. Record review of Resident #27's quarterly MDS dated [DATE] revealed resident had a BIMS of 1 meaning moderate cognitive impairment; resident normally used wheelchair in the last seven days for mobility; helper provided verbal cues and/or touching for bed mobility; helper provided less than half of the effort with sitting to lying, lying to sitting on the side of bed, sitting to standing, bed to chair transfer; section P for restraints had bed rail not used coded. Record review of Resident #27's EMR on 02/22/2024, did not reveal a side rail assessment or a consent for the use side rails. During observation on 02/20/2024 at 11:58 AM, Resident #27 was sitting in her wheelchair and had ½ bed rails up to each side of her bed. During an interview on 02/22/2024 at 11:50 AM the OTR stated she had not performed any assessments for entrapment regarding bed rails and stated she did not know who would have performed those. During an interview on 02/22/2024 at 11:53 AM the PTA stated he had not performed any entrapment assessments regarding bed rails. He stated he did not know who would have performed those. During an interview on 02/22/2024 at 11:57 AM, LVN-A stated she did not know what the policy was for bed rails. She stated she was not sure who had done the entrapment risk assessment. During an interview on 02/22/2024 at 12:04 PM the ADMN stated she did not know who should have been performing the entrapment risk assessments. She stated the DON had filled out the facility assessment which would have included that information. During an interview on 02/22/2024 at 12:15 PM the DON stated she was unsure about what the policy stated about bed rails. During an interview on 02/22/2024 at 12:56 PM the DON stated she had previously done assessments for the residents with bedrails, but they were in her head and had not documented any of them. She stated the assessments as well as consents for bed rails should have been documented. The DON stated the assessment and consent process should have begun on admission. She stated the resident side rail waivers or consents for each resident bed with installed side rails should have been signed by the resident or the resident representative. The DON stated an assessment should have then been done with that resident. She stated there should been less restrictive alternatives previous to the residents having side rails to make sure there would be no entrapment to the resident. The DON stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 8 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some nurses and CNAs monitored the residents on a daily basis and stated if there were any problems upper management should be told. She stated the possibility of entrapment could bring harm to residents if they were to get entangled with a body part in between the bed and the rail. She stated she had not considered side rails a restraint as she felt and considered a restraint to keep the resident in the bed. The DON stated the failure was failing to have the waiver consent form filled out as well as a failure of not documenting the assessments. She stated her expectations were for every resident to be identified with the appropriateness to use side rails. Record review of the facility's policy titled, Proper Use of Side Rails, dated with a revised date of December 2016, revealed: Purpose: Physical restraints are defined by the Centers for Medicare and Medicaid Services (CMS) as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. General Guidelines: . .3. an assessment will be made to determine the resident's symptoms, risk of entrapment and reason for using side rails. When used for mobility or transfer, an assessment will include a review of the resident's: a. Bed mobility b. Ability to change positions, transfer to and from bed or chair, and to stand and toilet; c. Risk of entrapment from the use of side rails; and that the bed's dimensions are appropriate for the resident's size and weight . .5. Consent for using a restrictive device will be obtained from the resident or legal representative per facility protocol . .7. Documentation will indicate if less restrictive approaches are not successful, prior to considering the use of side rails . .9. Consent for side rail use will be obtained from the resident or legal representative, after presenting potential benefits and risk . .15. Facility staff, in conjunction with the Attending Physician, will assess and document the resident's risk for injury due to neurological disorders or other medical conditions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 9 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to properly store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed. 1. The facility failed to ensure that staff sanitized the thermometer while taking temperature of food. 2. The facility failed to dispose of expired foods. 3. The facility failed to ensure foods were labeled properly in refrigerators. 4. The facility failed to ensure staff used proper hand hygiene. These failures could place residents that eat out of the kitchen at risk for food borne illnesses. The findings included: During an observation on 02/20/2024 at 9:35 a.m. to 9:40 a.m. of the kitchen's refrigerator revealed: 1. 1 plate with sliced tomato, lettuce, and what appeared to be cold creamed meat covered with plastic wrap not labeled with a description, prepared date, or use by date. 2. 1 unsecured bag with 1 head of lettuce that had a brown tint to outer leaves with no open date or used by date. 3. 1 container of 5 plastic containers with a white substance with no description, opened date, or use by date. 4. 1 carton of cultured low-fat buttermilk with an expiration date of [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 10 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 During an observation on 02/20/2024 at 9:40 a.m. of the kitchen's freezer revealed: Level of Harm - Minimal harm or potential for actual harm 1. 1 opened box of sopapilla dough, delivery date of 02/13/2015 and no use by date. Residents Affected - Some During an observation on 02/20/2024 at 10:55 a.m. the DM removed the thermometer from the breaded okra and placed it in the pinto beans, wiping it with paper towel in between taking food temperatures. The DM removed the thermometer from the pinto beans and placed in the meatloaf, wiping it with paper towel in between taking food temperatures. During an observation and interview on 02/20/2024 at 11:28 a.m. the DA stopped setting up trays and took a used coffee cup from a resident sitting at the dining room door back into food prep area to refill the coffee. The DA then gave the cup back to the resident and continued to set up trays without performing hand hygiene . The DA stated that he should not have brought the used cup into the food preparation area when asked. He stated that he had just forgotten that was not appropriate at the time it occurred. During an interview with DM at 11:30 a.m., the DM stated her expectation would be that food stored in the refrigerator be labeled with an expiration date or an opened date and contents. She stated her expectation would be that foods past the use by date be disposed of and not kept in the fridge or freezer. She stated she did not know what led to foods being stored inappropriately but that staff rushing could have contributed. The DM stated storing food inappropriately could lead to residents becoming sick. She stated she was responsible for monitoring that the dietary staff were storing food properly. The DM stated it was appropriate to wipe the thermometer with a dry paper towel in between different foods if all the foods were the appropriate temperatures . She did not voice any negative effects on the residents from not sanitizing thermometer in between foods. The DM stated she expected all used dishes enter the kitchen through the door by the dish washing. She stated no used dishes should enter the food preparation area. She stated the cook should have sanitized their hands in between touching a used cup and preparing foods. She stated education led to the failure. She stated that the effect on the residents would be illness from cross contamination. She stated that she was responsible for ensuring dietary staff performed appropriate hand hygiene after touching soiled surface. During an interview on 2/22/2024 at 9:28 a.m., the ADMN stated her expectation would be that all expired goods be discarded immediately, food be labeled with the opened date or used by date prior to storing, the thermometer should be sanitized in between temping different foods, staff perform hand hygiene after touching used dishes and before preparing foods to be served, and no used dished to go into the clean side of the kitchen. She felt that monitoring and education led to the failures. She stated that the effect the failures could have on the residents would be sickness from cross contamination or expired goods being served to residents. She stated the DM was who monitored dietary staff but that she was ultimately responsible for monitoring DM. Review of the FDA Food Code 2022 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. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 11 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 (B) Label information shall include: Level of Harm - Minimal harm or potential for actual harm (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement; Residents Affected - Some (2) If made from two or more ingredients, a list of ingredients and sub-ingredients in descending order of predominance by weight, including a declaration of artificial colors, artificial flavors and chemical preservatives, if contained in the FOOD; (3) An accurate declaration of the net quantity of contents; (4) The name and place of business of the manufacturer, [NAME], or distributor; and (5) The name of the FOOD source for each MAJOR FOOD ALLERGEN contained in the FOOD unless the FOOD source is already part of the common or usual name of the respective ingredient. (6) Except as exempted in the Federal Food, Drug, and Cosmetic Act § 403(q)(3) - (5), nutrition labeling as specified in 21 CFR 101 - Food Labeling and 9 CFR 317 Subpart B Nutrition Labeling. (7) For any salmonid FISH containing canthaxanthin or astaxanthin as a COLOR ADDITIVE, the labeling of the bulk FISH container, including a list of ingredients, displayed on the retail container or by other written means, such as a counter card, that discloses the use of canthaxanthin or astaxanthin . Time/temperature control for safety refrigerated foods must be consumed, sold or discarded by the expiration date . Sanitization of Equipment and Utensils 4-701.11 Equipment food-contact surfaces and utensils shall be sanitized . 4-702.11 Utensils and food-contact surfaces of equipment shall be sanitized before use after cleaning . 4-703 Methods: After being cleaned, equipment food-contact surfaces and utensils shall be sanitized in: (A) Hot water manual operations by immersion for at least 30 seconds and as specified under § 4-501.111; P (B) Hot water mechanical operations by being cycled through EQUIPMENT that is set up as specified under §§ 4-501.15, 4-501.112, and 4-501.113 and achieving a UTENSIL surface temperature of 71oC (160oF) as measured by an irreversible registering temperature indicator; P or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 12 of 13 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 676017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Premier Health Care Center 460 W Main St Ranger, TX 76470 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 - Some (C) Chemical manual or mechanical operations, including the application of SANITIZING chemicals by immersion, manual swabbing, brushing, or pressure spraying methods, using a solution as specified under § FDA Food Code 2022 Chapter 4 Equipment, Utensils, and Linens Chapter 4 - 26 4-501.114. Contact times shall be consistent with those on EPAregistered label use instructions by providing: (1) Except as specified under Subparagraph (C)(2) of this section, a contact time of at least 10 seconds for a chlorine solution specified under 4-501.114(A), P (2) A contact time of at least 7 seconds for a chlorine solution of 50 MG/L that has a PH of 10 or less and a temperature of at least 38oC (100oF) or a PH of 8 or less and a temperature of at least 24oC (75oF), P (3) A contact time of at least 30 seconds for other chemical SANITIZING solutions, P or (4) A contact time used in relationship with a combination of temperature, concentration, and PH that, when evaluated for efficacy, yields SANITIZATION as defined in 1-201.10(B). P . Hand Hygiene According to the FDA (Food and Drug Administration) Food Code (https://www.fda.gov/food/retail-food-protection/fda-food-code accessed 2/22/24), FOOD EMPLOYEES shall clean their hands and exposed portions of their arms . immediately before engaging in FOOD preparation including working with exposed FOOD, clean EQUIPMENT and UTENSILS, and unwrapped SINGLESERVICE and SINGLE-USE ARTICLESP and: .(E) After handling soiled EQUIPMENT or UTENSILS; . (F) During FOOD preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks; . .(I) After engaging in other activities that contaminate the hands. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676017 If continuation sheet Page 13 of 13