Inspection·July 13, 2023

F 0552 Findings include: Level of Harm - Minimal harm or potential for actual harm Record review of Resident #7's face sheet revealed admission date of 05/30/2017 with diagnoses of Type 2 Diabetes Mellitus, depressive disorder, dementia and anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety and fear, strong enough to interfere with ones' daily activities). He was [AGE] years of age. Residents Affected - Some Record review of Resident #7's quarterly MDS, dated [DATE], indicated he had a BIMS score of 14, which indicated he was not cognitively impaired. The MDS also indicated Resident #7 was diagnosed with anxiety and depression. Record review of Resident #7's care plan, dated 06/12/2023 indicated, in part: Focus: Resident uses psychotropic medications related to anxiety and depression. Goal: The resident will remain free of drug related complications, including movement disorder, discomfort, hypotension, gait disturbance, constipation/impaction or cognitive/behavioral impairment through the next 90 days. Intervention: Administer antidepressant medications as ordered by physician. Monitor/document side effects and effectiveness. Record review of Resident #7's medication profile dated 04/13/2022 indicated in part: Nortriptyline 5mg, give one capsule by mouth at bedtime related to depressive disorder. Record review of Resident #7's clinical records revealed no consent on file. Record review of Resident #18's face sheet revealed admission date of 06/09/2023 with diagnoses of Type 2 Diabetes Mellitus, end stage heart disease and chronic kidney disease. He was [AGE] years of age. Record review of Resident #18's admission MDS, dated [DATE], indicated he had a BIMS score of 13, which indicated he was not cognitively impaired. The MDS also indicated Resident #18 was diagnosed with Type 2 Diabetes Mellitus, end stage heart disease and chronic kidney disease. Record review of Resident #18's care plan, dated 06/20/2023 indicated, in part: Focus: Resident has impaired respiratory status and is at risk for shortness of breath, respiratory distress, increased anxiety, and hypoxia. Goal: Resident will have no reports of unrelieved shortness of breath through the next review date. Intervention: Administer medications as ordered. Monitor/Document for side effects and effectiveness. Monitor for shortness of breath, respiratory distress, wheezing, fatigue, increased anxiety and implement appropriate ordered interventions. Notify physician if interventions are not effective. Record review of Resident #18's medication profile dated 06/09//2023 indicated in part: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 2 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0552 Haloperidol 2mg/ml, give 0.5ml by mouth every 6 hours as needed for nausea/anxiety/restlessness. Level of Harm - Minimal harm or potential for actual harm Lorazepam 1mg tablet by mouth, every 4 hours, as needed for nausea/anxiety/restlessness. Record review of Resident #18's clinical records revealed no consent on file. Residents Affected - Some Record review of Resident #20's face sheet revealed admission date of 10/14/22 with diagnoses of Chronic Obstructive Pulmonary Disorder (a group of lung diseases that block airflow and make it difficult to breathe), Post Traumatic Stress Disorder PTSD (difficulty recovering after experiencing terrifying event), Major depressive disorder (persistent feeling of sadness and loss of interest that interferes in daily life) and anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety and fear, strong enough to interfere with ones' daily activities). She was [AGE] years of age. Record review of Resident #20's quarterly MDS, dated [DATE], indicated she had a BIMS score of 15, which indicated she was not cognitively impaired. The MDS also indicated Resident #20 was diagnosed with anxiety disorder, post-traumatic stress disorder (PTSD) and depression. Record review of Resident #20's care plan, dated 02/06/2023 indicated, in part: Focus: Resident mood problem related to disease process, PTSD. Goal: The resident will have improved mood state (happier, calmer appearance, less signs/symptoms of depression, anxiety or sadness) through the review date. Intervention: Administer medications as ordered. Monitor/document for side effects and effectiveness. Record review of Resident #20's medication profile dated 05/02/2023 indicated in part: Diazepam 2 mg, give one tablet by mouth twice a day related to anxiety. Record review of Resident #20's clinical records revealed no consent on file. Record review of Record review of Resident #21's face sheet revealed admission date of 02/11/2023 with diagnoses of anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety and fear, strong enough to interfere with ones' daily activities), Alzheimer's disease (a progressive disease that destroys memory and other important mental functions). He was [AGE] years of age. Record review of Resident #21's quarterly MDS, dated [DATE], indicated he had a BIMS score of 07, which indicated he was severely cognitively impaired. The MDS also indicated Resident #21 was diagnosed with anxiety disorder and depression. Record review of Resident #21's care plan, dated 05/19/2023 indicated, in part: Focus: Resident uses psychotropic medications (antidepressants, antipsychotics, anxiolytics, or hypnotics) related to depression, generalized anxiety disorder Goal: Resident will maintain the highest level of function possible and not experience a decrease (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 3 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0552 in functional abilities related to psychotropic drug use during the next 90 days. Level of Harm - Minimal harm or potential for actual harm Intervention: Administer medications as ordered. Monitor/document for side effects and effectiveness. Record review of Resident #21's medication profile dated 06/19/2023 indicated in part: Residents Affected - Some Buspirone HCL 10mg, give one tablet by mouth three times a day related to anxiety. Record review of Resident #21's clinical records revealed no consent on file. Record review of Resident #23's face sheet revealed admission date of 03/16/2022 with diagnoses of intellectual disability ( disability that affects the acquisition of knowledge), obsessive compulsive disorder (unreasonable thoughts and fears that lead to compulsive behaviors), major depressive disorder (persistent feeling of sadness and loss of interest that interferes in daily life) , anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety and fear, strong enough to interfere with ones' daily activities). She was [AGE] years of age. Record review of Resident #23's quarterly MDS, dated [DATE], indicated he had a BIMS score of 05, which indicated she was severely cognitively impaired. The MDS also indicated Resident #23 was diagnosed with anxiety disorder and depression. Record review of Resident #23's care plan, dated 05/30/2023 indicated, in part: Focus: uses psychotropic medications (antidepressants, antipsychotics, anxiolytics) related to intellectual disabilities, chronic behaviors such as kleptomania. Goal: The resident will maintain the highest level of function possible, will not experience a decrease in functional abilities and will have side effects and interactions kept to a minimum related to psychotropic drug use during the next 90 days. Intervention: Administer medications as ordered. Monitor/document for side effects and effectiveness. Record review of Resident #23's medication profile dated 06/01/2023 indicated in part: Lorazepam 1 mg, give one tablet by mouth every 4 hours, as needed for anxiety. Record review of Resident #23's clinical records revealed no consent on file. Record review of Record review of Resident #28's face sheet revealed admission date of 06/13/2022 with diagnoses of senile degeneration of brain (loss of intellectual ability associated with age), Alzheimer's disease, depression, dementia (loss of intellectual functioning, impairment of memory and abstract thinking) and anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety and fear, strong enough to interfere with ones' daily activities). He was [AGE] years of age. Record review of Resident #28's quarterly MDS, dated [DATE], indicated he had a BIMS score of 01, which indicated he was severely cognitively impaired. The MDS also indicated Resident #28 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 4 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some diagnosed diagnoses of senile degeneration of brain, Alzheimer's disease, depression, dementia, and anxiety disorder. Record review of Resident #28's care plan, dated 06/25/2023 indicated, in part: Focus: Resident uses psychotropic medications (antidepressants, antipsychotics, anxiolytics, or hypnotics) related to depression, anxiety, and senile degeneration of the brain. Goal: The resident will maintain the highest level of function possible and not experience a decrease in functional abilities related to psychotropic drug use during the next 90 days. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Record review of Resident #28's medication profile dated 02/07/2023 indicated in part: Diazepam gel 10mg/ml, apply to wrist topically every 4 hours as needed for anxiety. Record review of Resident #28's clinical records revealed no consent on file. During an interview and record review on 07/12/23 at 11:55 AM, the ADON stated that consents for the mentioned residents (Resident #7, Resident #18, Resident #20, Resident #21, Resident #23, and Resident #28) were not in the paper charts or the computer charts. The ADON stated that it is her responsibility to ensure that consents are obtained and scanned into the resident charts. The ADON stated that she audits charts and missed these missing consents. The ADON stated that she will get consents immediately. During an interview and record review on 07/12/23 at 4:15 PM, Regional Nurse Consultant stated that she does chart audits every 6 months, the last audit was completed 3 months ago. Regional nurse consultant stated that she is unsure why those consents were missed and will be doing a full audit to fix the problem. Staff nurses are responsible for getting the consents signed, and the ADON ensures that the consents are scanned into the resident chart. Record review of the facility's policy revised 01/08/2021, titled Psychotropic Medications indicated, in part: Policy: It is the facility's policy that each resident drug regimen is free from unnecessary drugs, including psychotropic drugs. Procedure: Informed consent will be obtained prior to administration; consents will be obtained as per state guidelines. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 5 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **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 4 of 15 residents (Residents #18 #19, #21 and #29) reviewed for care plans in that: Resident #18 did not have a care plan to address his diuretic use. Resident #19 did not have a care plan for needs related to Parkinson's Disease (progressive disease of nervous system causing tremors, muscle stiffness, and slow imprecise movements). Resident #21 did not have a care plan to address his antipsychotic use or his antianxiety use. Resident #29 did not have a care plan to address his dietary preference of being a Vegetarian or signs and symptoms of delirium. 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 #18's admission Record dated 7/12/23 revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnosis including chronic heart failure. Review of Resident #18's admission MDS assessment dated [DATE] revealed he took a diuretic medication for 6 of 7 days prior to the assessment. Review of Resident #18's Care Plan, initiated 6/27/23, revealed no care plan for the use of diuretics. Review of Resident #19's admission Record dated 7/12/23 revealed she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Parkinson's Disease. Review of Resident #19's Quarterly MDS assessment dated [DATE] revealed other neurological conditions as her primary medical condition with Parkinson's Disease identified in the Neurological section of the diagnoses. Review of Resident #19's Care Plan, last revised on 6/26/23, revealed no care plan for Parkinson's Disease. Review of Resident #21's admission Record, dated 7/12/23, revealed he was an [AGE] year-old male admitted on [DATE] with diagnoses including Alzheimer's disease, depression, anxiety, arthritis, and abnormal weight loss. Review of Resident #21's quarterly MDS Assessment, dated 5/10/23, revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 6 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0657 He scored a 7 of 15 on his mental status exam Level of Harm - Minimal harm or potential for actual harm He had delusions He received scheduled and as needed pain medications Residents Affected - Some Triggering medications included an antipsychotic for 4 of 7 days, and an anti-anxiety medication for 4 of 7 days; and an opiate for 7 of 7 days. Review of Resident #21's Care plan, last revised on 6/2/23, revealed no care plan for the delusions. The facility's care plan for psychotropic medications interventions only addressed monitoring for antidepressant side effects. Review of Resident #29's admission Record, dated 7/12/23, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including neurocognitive disorder with Lewy Bodies (a form of dementia caused by clumps of abnormal proteins that build up in the brain) and chronic pain. Review of Resident #29's quarterly MDS Assessment, dated 5/17/23 revealed He showed signs of delirium including disorganized thinking and altered level of consciousness both fluctuated. Active diagnoses Primary Medical Condition was progressive neurological conditions. The neurological section of the diagnoses indicated Resident #29 had Non-Alzheimer's Dementia and Parkinson's Disease. He weighed 128 pounds and was on a mechanically altered diet. Resident #29 received scheduled pain medication. Interview on 7/11/23 at 3:18 p.m., Resident #29 stated he was vegetarian. He stated he was sick of peanut butter and jelly sandwiches or tomato soup. Resident #29 said to address this the therapist got a menu from the kitchen for the week to include the alternatives and they would pick what was appropriate for this. He stated this was only fixed a few weeks prior 7/11/23. Review of Resident #29's Care Plan, last revised on 5/26/23, revealed no care plan for delirium; no care plan for being vegetarian, no care plan for the mechanically altered diet, and no care plan for his pain. Interview on 7/13/23 at 11:28 AM, the DON said she expected care plans to address specific diagnoses and what needs to happen from there, physician or specific providers, or what the facility expected to accomplish with that resident. She stated she expected ADL status, things the facility could do to improve the resident and what needs to happen for them which mean meant daily xyz care and communicated ADLs provided. The DON stated the ADON did care plans more than anyone else. The DON stated the ADON would review care plans. The DON said herself and the ADON shared an office so they would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 7 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some talk about what the resident needed and what needed to be on the care plan. The DON stated for Resident #29 she expected to see his hospice, getting up in his chair (therapy), lack of activities, ADLs, his lack of movement once he was in his chair and his supports only being a couple of neighbors who would come check on him. She said because of that Resident #29 needed a little extra listening and attention from the staff. The DON stated if there was an expectation for a pain care plan was a good question and a facility could not over care plan for a resident. Interview on 7/13/23 at 11:41 AM, the ADON stated she did the base line care plan and would initiate care plans in the computer after completing the MDS but someone else was responsible for doing the care plan. The ADON said things that needed to be included on the care plan were ADLs, behaviors, psychotropic medications, code status, anticoagulants, diagnoses and go from there. The ADON stated she would go through the resident's chart including notes and if something happened to that resident, she (the ADON) would add it to the care plan like falls. The ADON described Resident #29 as vegetarian, had no family, was on hospice, did not like the food, rarely watched TV, and he was usually pretty with it. The ADON stated she would expect to see a care plan for Resident #29 being vegetarian; the ADON explained the DM would usually do the diet expectations but the facility's last 2 DM's were less than stellar and did not do the care plans. The ADON stated she expected to care plan his occasional confusion. The ADON said she did not if Resident #29 was on scheduled pain would expect a care plan on pain medication if he was. The ADON said Resident #18 should have a care plan for diuretic use. should have detail on cath. The ADON stated Resident #19 should definitely have a care plan for her Parkinson's. Interview on 7/13/23 at 12:11 PM, the Regional DM stated she would make sure that the care plans got updated. The DM stated the dietary department was responsible for updating care plans. Interview on 07/13/23 at 03:31 PM, the MDS Coordinator stated she initiated the care plan and nursing and whoever was able to make the changes that needed to be made. She stated dietary care plans were supposed to be done by the DM, but the facility did not have one so she did not know who would be responsible for it. Review of the facility's policy and procedure on Care Plans, revised 5/6/16, revealed: It is the intent of the [corporation] to meet and abide by all State and Federal regulations that pertain to resident care plans and subsequent Care Area Assessments completion. Purpose: the purpose of this guide is to ensure that an interdisciplinary approach is utilized in addressing the Care Area Triggers that were generated by the completion of the Minimum Data Set in order to effectively address the Care Area Assessments and ultimately achieve the completion of an effective comprehensive plan of care for each resident. Procedure: All comprehensive care plans will be completed utilizing the [computer software documentation program] electronic system. The facility Interdisciplinary Team members are responsible for addressing their assigned Care Area Assessments triggered by the MDS at the time of the MDS assessment. Case Mix Manager or designee will be responsible for: Delirium, psychotropic drug use, and pain. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 8 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0657 Dietary Manager or designee will be responsible for Nutritional Status. Level of Harm - Minimal harm or potential for actual harm Care Plan Updates Residents Affected - Some The Interdisciplinary Team will review the care plans Annually, Quarterly, and as needed to ensure all goals and approaches are appropriate. Acute Care Plans: As acute problems or changes to interventions or goals are identified as appropriate care plans will be developed or modified by a Nursing staff member. Care Plan Meetings. Review of the facility's policy and procedure on Baseline Care Plans, revised 5/13/21, revealed: Resident person-centered baseline care plans are developed and implemented for new admission and readmission residents. Fundamental Information Resident person-centered baseline care plans communicate fundamental approaches and goals for resident related clinical diagnosis, identified concerns, and as a result of the admission evaluation/assessment of each healthcare discipline. The baseline care plans are developed and implements to support effective individualized resident care that meet professional standards of quality care and services. Resident person-centered baseline care plans describe services not provided due to the resident's exercise of rights, including the right to refuse treatment. A. Desires and refusals of the resident will be documented in the clinical record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 9 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide pharmaceutical services, including procedures that ensure the accurate administering of all drugs to meet the needs of the residents, for 1 of 1 medication rooms (indicate which med room) inspected for medication storage, for 1 of 1 treatment carts (which med cart) inspected for medication storage, and for 1 of 31 residents reviewed for pharmacy services (Residents # 29) during review of medication carts. The facility failed to ensure the Review of the medication room revealed: opened and undated vials of influenza vaccine. Review of the wound care/ treatment cart revealed: Review of the medication cart revealed: expired medications in cart This failure could place residents at risk of receiving medications that were expired and not produce the desired effect. Findings included: Record review of Resident #29's admission record dated 07/13/23 indicated he was admitted to the facility on [DATE] with diagnoses which included neurologic disorder with Lewy bodies (affects chemical in brain and impairs thinking, movement, behavior, and mood), heart failure (heart does not pump blood like it should), anemia, atrial fibrillation (rapid heart rate that causes poor blood flow) and Parkinson's (disorder of central nervous system that causes tremors). He was [AGE] years of age. Record review of Resident #29's quarterly MDS, dated [DATE], indicated he had a BIMS score of 15, which indicated he was not cognitively impaired. The MDS also indicated Resident #29 was diagnosed with heart failure. Record review of Resident #29's care plan dated 05/26/2023 indicated in part: Problem: Resident has altered cardiovascular status r/t Atrial Fibrillation, and heart failure. Goal: The resident will be free from s/s of complications of cardiac problems through the review date. Intervention: Monitor for complaint of chest pain. Enforce the need to call for assistance if pain starts. Record review of Resident #29's order summary report, dated 05/20/2023, indicated in part: Aspirin 81mg tablet, Give 1 tablet by mouth in A.M. for heart failure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 10 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0755 Level of Harm - Minimal harm or potential for actual harm During an observation and record review on 07/12/23 at 10:00 AM, the medication room was observed with LVN E present. Inside the refrigerator there were three opened/undated 5ml vials of influenza vaccine with expiration dates of 6/30/23. The influenza vaccine manufacture pamphlet dated March 2022 indicated in part: Once the stopper of the multi-dose vial has been pierced the vial must be discarded within 28 days. Residents Affected - Some Observation of the wound care cart on 07/12/23 at 10:45 AM revealed: - 1 tube of aspercreme 4% lidocaine 2.5fl oz expired 2/23; -5 bottles of rapid dry 28 ml expired 2/22; -1 tube of medical grade honey gel 1.5 oz expired 2/23; -1 package of alginate wound dressing expired 5/21; -1 bottle of pain and itch spray 2.75 fl oz expired 6/22; -16 packages of honey non adherant dressing 10cmX12.5cm expired 11/19; -1 hydrocolloid dressing 6in X 6in expired 10/18; -15 packages of providone iodine swab sticks expired 9/20; -29 packages of hydrogel 4inX4in squares expired 12/21; -10 medical grade honey 2in X2in expired 6/23; and -1 box of calcium alginate dressing 12-inch rope expired 1/22. During an interview on 07/12/23 at 10:30 AM, LVN E said that all nurses were responsible for ensuring that expired medications and supplies were pulled from medication room and carts. LVN E stated that all nurses have access to the locked cabinet where expired medications are stored for destruction. LVN E stated that she is responsible for the treatment cart and was unaware that the expired wound care supplies were in the cart. LVN E stated that she will start checking for expired medications and supplies from now on. During an observation and interview on 07/12/23 at 11:00 AM, medication cart 1 of 4, revealed a bottle of Aspirin 81mg, expired 5/31/2023, prescribed to Resident #29. LVN F stated that she administered the aspirin to Resident #29 yesterday and today and failed to notice it was expired. LVN F stated that the resident was prescribed Aspirin on 5/20/23. Record review of the MAR dated 00/00/00 for Resident #29 revealed he received Aspirin from the expired bottle every day. LVN F stated that adverse effects of administering expired Aspirin is that the resident will not get the desired effect of the medication. LVN F stated that she is unsure why the failure occurred and nurses were responsible for ensuring that expired medications were pulled from the medication carts. During an interview and record review on 07/13/23 at 09:20 AM the DON stated that all staff nurses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 11 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some have keys to the locked medication cabinet in the medication room, where all expired and discontinued medications are to be stored for disposal. All staff nurses should be checking their medication carts, treatment carts and medication room daily for expired medications and supplies. DON stated that she and the ADON check medication carts every 1 to 2 weeks for expired medications but she had never checked for expired supplies. The DON stated that pharmacy performed monthly audits of medication room and medication carts. Record review of the monthly audits performed by the pharmacist revealed that the pharmacist found expired meds in April 2023 and June 2023 audit. The DON stated that it is ultimately her responsibility to ensure that expired medications are removed from the medication room and medication carts. The DON stated that she thinks that Resident #29 was prescribed aspirin for his heart, to thin his blood. The DON stated that since the aspirin was expired, it was not providing the desired effect for the resident. The DON stated she will implement a plan to ensure that medication carts, treatment carts and medication rooms are reviewed for expired medications and supplies. Record review of the facility's policy titled Storage of Medications revised 9/2018 indicated in part: Outdated, contaminated, or deteriorated medications are immediately removed from inventory, disposed of according to procedures for medication disposal, and reordered from the pharmacy. Drugs dispensed in the manufacturer's original container will be labeled with the manufacturer's expiration date. The nurse will check the expiration date of each medication before administering it. No expired medication will be administered to a resident. All expired medications will be removed from the active supply and destroyed in accordance with facility policy, regardless of the amount remaining. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 12 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that each resident's drug regimen was free from psychotropic drugs unless the medication was necessary to treat a specific condition as diagnosed and documented in the clinical record for two (Resident #18 and #21) of 5 residents reviewed for unnecessary medications. Resident #18 was prescribed the antipsychotic Haloperidol for anxiety or restlessness. Resident #18 was prescribed the antipsychotic Haloperidol and the anti-anxiety Lorazepam as needed for greater than 14 consecutive days without the review of the prescribing doctor. Resident #21 was prescribed an anti-anxiety/antipsychotic medication diazepam/ Haloperidol gel for treatment of agitation, and the antipsychotic quetiapine for dementia. Resident #21 was prescribed an as-needed antipsychotic for more than 14 consecutive days without the review of the prescribing doctor. This failure puts residents at risk of medication adverse effects because of being administered unnecessary antipsychotic medications. Findings include: Review of Resident #18's admission Record dated 7/12/23 revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnosis including chronic heart failure. Review of Resident #18's admission MDS assessment dated [DATE] revealed: He scored a 13 of 15 on his mental status exam (indicating he was cognitively intact) with no signs or symptoms of delirium. He had no potential indicators of psychosis He did not receive the anti-psychotic or anti-anxiety medication in the 7 days prior to the assessment. Resident #18 did receive hospice services. Review of Resident #18's Order Summary Report, dated 7/12/23, revealed: Order dated 6/9/23 Haloperidol 2mg/ml every six hours as needed for anxiety/ restlessness. Order dated 6/9/23 for Lorazepam 1 mg every four hours as needed for anxiety/ restlessness Review of Resident #21's admission Record, dated 7/12/23, revealed he was an [AGE] year-old male admitted on [DATE] with diagnoses including Alzheimer's disease, depression, anxiety, arthritis, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 13 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0758 abnormal weight loss. Level of Harm - Minimal harm or potential for actual harm Review of Resident #21's quarterly MDS Assessment, dated 5/10/23, revealed: He scored a 7 of 15 on his mental status exam Residents Affected - Few He had delusions He received scheduled and as needed pain medications Triggering medications included an antipsychotic for 4 of 7 days, and an anti-anxiety medication for 4 of 7 days: and an opiate for 7 of 7 days. Resident #21 was on hospice services. Review of Resident #21's Care plan, last revised on 6/2/23, revealed no care plan for the delusions. The facility's care plan for psychotropic medications interventions only addressed monitoring for antidepressant side effects. Review of Resident #21's Order Summary Report, dated 7/12/23 revealed: Order dated 4/24/23 Diazepam/ Haloperidol 2/2 mg/ml. Apply 1 ml to inside of wrist as needed for agitation related to anxiety disorder. Order dated 7/2/23 Diazepam Suspension 10mg/ml give 1 ml by mouth every 1 hour as needed for anxiety. Order dated 6/19/23 Quetiapine Fumarate 100mg by mouth at bedtime for dementia. Order dated 7/6/23 Quetiapine Fumarate 50mg by mouth in the morning for dementia. Interview on 07/13/23 at 8:58 AM, the DON stated the facility expectation on psychoactive medications was the medications to be kept low and to try to get the resident off and/or reduce the medication. The DON said the facility tried to reevaluate the medications every month. The DON stated the facility had triggered care areas to included psychoactive medications in general, a lack of decrease, and the number of residents on them. The DON stated most of the resident did not have an adequate diagnosis because of the doctor. The DON said 'agitation' was not an appropriate diagnosis for the use of an anti-psychotic, but the doctor ordered it. The DON said 'restlessness' was also not an acceptable diagnosis for antipsychotic use. The DON said the residents who were on an antipsychotic had diagnoses that could indicate a need for them but were not indicated as a diagnosis. The DON said the facility usually questioned a diagnosis of dementia with an antipsychotic. The DON explained the facility had to walk a fine line with the doctors because they were resistant to the pharmacy recommendations. The DON said the medical director was an old school doctor and was not receptive to feedback. Interview on 7/13/23 at 2:25 PM, the Corporate RN Consultant stated Hospice agencies would frequently give an inappropriate diagnosis for psychotropic medications. The RN Consultant stated the only (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 14 of 15 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 676034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brady West Rehab & Nursing 2201 Menard Hwy Brady, TX 76825 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few inappropriate diagnosis she found were Resident #18 and #21. The RN Consultant stated she was not sure why restlessness were given as the diagnosis because each resident had another diagnosis that would support the use of the anti-psychotic. The RN Consultant stated the way she read the regulation was that there was a stop date on all as-needed medications after 14 days no matter what and after that the physician needed to come and reassess the resident. She stated terminal anxiety would work because the benefits would outweigh the risks. The RN Consultant said that a Haloperidol prescription should always be a 14-day prescription. The RN Consultant stated when the unnecessary psychotropic medication regulation came out, she did extensive education on it with the facilities. The RN Consultant stated she thought it came out in 2018, but then the Covid Health Crisis happened, and everything became about Covid control. The RN Consultant stated the findings were not a surprise because she (the RN Consultant) had been telling the facility regulation on this would happen. The RN Consultant stated the expectation was to get as needed medication a discontinue date for short duration and that there be a diagnosis that supports the medication. The RN Consultant stated she had a discussion with the hospice provider that day (7/13/23). The RN Consultant stated she did not know what happened since the facility had several layers to prevent this from happening. The RN Consultant said the front-line nurses needed to be educated about what was an appropriate diagnosis, then the ADON was supposed to pull orders each morning to see if the diagnosis was appropriate and that monitoring for side effects and behaviors were in place. The RN Consultant stated the facility's pharmacist also looked at diagnosis monthly and they (the pharmacist) should catch the inappropriate diagnosis. The RN Consultant reiterated we have several layers that should have caught the inaccurate diagnosis. The RN Consultant admitted in the Nursing Facility, this ADON had not been validating the orders correctly. The RN Consultant said she did not know why the pharmacist did not catch the diagnosis. The RN Consultant stated the hospice provider was also supposed to do a monthly review of the medications. The RN Consultant stated she had to do some educating on the care plans because the staff believed that if there was a care plan to cover mood or behaviors it would also cover the medication and that was not the expectation. Review of the facility's policy and procedure on Psychotropic Medication, reviewed 1/8/21, revealed: It is the facility's policy that each resident's drug regimen is free from unnecessary drugs, including unnecessary psychotropic drugs. Procedures: Residents who have not used antipsychotic drugs are not given these drugs unless antipsychotic drug therapy is necessary to treat a specific condition as diagnosed and documented in the clinical record. PRN orders for Psychotropic drugs are limited to 14 days, except if the prescribing practitioner documents appropriate diagnosis and rationale to continue beyond 14 days. Then he/she must document the rationale in the resident's medical record and writes a new PRN prescription every 14 days after the resident has been evaluated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676034 If continuation sheet Page 15 of 15