Inspection·January 18, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 01/16/24 at 2:12 PM CNA D said it had not been that long since Resident #42 was able to help more with assistance. CNA D said at other times they used to transfer the resident by one staff taking him from under his armpit and under his leg and the other staff doing the same on the other side. CNA D said she had not used the gait belt while transferring Resident #42 but maybe they should or also consider using the mechanical lift. CNA D said she knew what transfer status each resident was by looking at that resident's care plan on their POC. CNA D demonstrated where the POC was on the computer and searched Resident #42's POC which indicated resident required 1-2 staff for transfers. During an interview on 01/17/24 at 3:28 PM the DOR said they had done some training with a new CNA class about a month ago regarding transferring residents. The DOR was made aware of the transfer observation conducted on Resident #42 by LVN C and CNA D. The DOR said that she did not recommend residents by transferred liked that as that was not a proper way. The DOR said Resident #42 should probably be transferred with a mechanical lift from now on and that she would be looking into that. The DOR said unfortunately she was not aware too much of the transfer status of Resident #42 since his payor source and the resident being on hospice would not cover him receiving therapy services. During an interview on 01/18/24 at 11:53 AM the DON was made aware of Resident #42's transfer observation. The DON said that was not a proper way to transfer a resident. The DON said staff could see on the resident's POC and see what their transfer status was and all staff had access to that. The DON said they had conducted training transferring yesterday regarding proper transferring as they were already aware of the transfer. The DON said it was expected for staff to clarify what the resident's transfer status was and apply a gait belt almost during any situation for transfers unless they were a mechanical lift transfer. The DON said the staff could drop the resident, cause a skin tear or bruise them by transferring them like that. The DON said she believed the failure occurred because of possible lack of experience from the staff. During an interview on 01/18/24 at 12:34 PM the Administrator was made aware of the transfer observation. The Administrator said he was aware of the transfer and it that was inappropriate and they would conduct more trainings on transfers. Review of the facility's policy titled Moving a resident bed to chair/chair to bed and dated 2003 indicated in part: The purposes of this procedure are to allow the resident to be out of his or her bed as much as possible and to provide for safe transferring of the resident. If moving a resident from chair to bed: Place the chair so that it touches the side of the bed and faces the foot of the bed. Position a gait belt around the resident's waist and clasp it. Make sure it is tight enough that only a slight hand movement will guide the patient but not so tight that you cannot firmly grasp the belt without making the patient uncomfortable. If the resident requires two person (one on each side) should grasp the gait belt and gently stand and turn the resident and sit him or her on the edge of the bed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 2 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that residents who received nutrition by enteral means received the appropriate treatment and services for 1 of 1 resident (Resident #2) reviewed for enteral feeding. The facility failed to ensure that Resident #2's enteral feeding bag was correctly labeled and dated. This failure could result in the resident receiving formula that is not appropriate for the treatment/service for the resident. Findings included: Record review of Resident #2's admission summary revealed resident was a [AGE] year-old-male admitted on [DATE] with diagnoses which included Traumatic brain injury, dysphasia (difficulty swallowing), aphasia (difficulty with speech), muscle wasting atrophy (loss of muscle mass), and gastroesophageal reflux (liquid content of the stomach back flows into the tube connecting the mouth and stomach). MDS dated [DATE] shows the resident relies on tube feeding for 51% or more for caloric intake, receiving 501 cc/ml of tube feeding daily. BIMS is not calculated. Resident was able to answer Yes/No questions by shaking his head. Observation on 1/16/2024 at 12:30 pm of Resident #2's room revealed an enteral feeding bag labeled only with the resident's name infusing via pump at 50 cc per hour. Interview on 01/17/24 at 03:08 PM LVN G stated everything used for tube feeds such as the feeding itself, tubing, syringe, and water should be dated every time the feeding was changed to ensure accurate care. LVN G stated if items were not dated staff could not guarantee when it had been changed. Interview on 01/18/24 at 09:51 AM LVN F stated that the tube feeding bag should be labeled with the name of resident, initial of who hung the feeding and date when the feeding was hung. She stated the date was important to know to be sure the feeding was running appropriately and to ensure they kept the feeding fresh. Interview on 01/18/24 at 02:10 PM with DON stated that tube feeding bags should be dated, timed, initialed and have what the pump should be running at written on the bag. This was to ensure the pump was set appropriately according to the order and to ensure the feeding was running without complication. If not, the resident could not be receiving nutrition. This practice also helped ensure the feeding was being changed appropriately. The nurses are responsible for ensuring the resident's tube feeding is managed per order. Record review of facility policies titled Enteral Nutrition dated 2003, revised 2/13/07 and Enteral Medication Administration dated 2003, revised 1/25/13 did not address the labeling of the enteral feeding bags used by the facility. The facility used prefilled bags of formula rather than an all-in-one system as described in the facility policy. All identifying information for the resident and formula had to be written onto the bag by the nurse administering or preparing the feeding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 3 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 observations, interviews and record review it was determined the facility failed to provide pharmaceutical services that ensure the accurate administering of drugs for 2 of 3 medication carts and 1 of 1 treatment cart observed for medications stored and properly labeled, in that:. Two of the medication carts had insulin pens that were opened but not dated when placed into use. The treatment cart had an opened undated TB vial. These failures could place residents at risk of receiving medications that were expired and not produce the desired effect. Findings included: During an observation and interview on [DATE] at 11:40 AM the treatment cart was inspected with the interim DON present. The interim DON was shown the opened and undated TB vial. The interim DON said she would have to first see what their policy indicated regarding opened TB vials. The interim DON was shown where the TB vial container indicated Once entered, vial should be discarded after 30 days and Store between (36 degrees and 46 degrees F). The interim DON said that perhaps whichever nurse placed it in the cart could have been in the process of discarding it. The interim DON said she would dispose of the vial. During an observation and interview on [DATE] at 12:28 PM the back hall medication cart was inspected with LVN C present. In the top drawer there were 2 insulin pens that had been opened but were not dated when opened. The manufacturer information on the pens indicated Use within 28 days after initial use. LVN C said she did not know who had opened the pens as other nurses had access to the cart as well. LVN C said she normally dated the pens and it was every nurses responsibility to date them or to check the cart for any undated pens. LVN C said she would remove the insulin pens and get some new pens. During an observation and interview on [DATE] at 12:40 PM the front hall medication cart was inspected with LVN B present. In the top drawer there was 1 insulin pen that had been opened but there was no open date on it. The manufacturer information on the pen indicated Use within 28 days after initial use. LVN B said she thought it was her that opened that pen sometime last week but was not sure what day it was. LVN B said she normally dated the pens when she opened them. LN B said it was each nurse's responsibility to date the pens once they were opened. During an interview on [DATE] at 12:02 PM the DON was made aware of insulin pens and the TB vial that were observed. The DON said her expectations were that they were supposed to be dated and initialed when opened. The DON said it was each nurses responsibility to make sure the insulin pens and TB vials were dated when opened. The DON said if the insulins or TB vials were not dated and then expired the medication would not be as effective or give a false reading. The DON said the failure probably occurred because the staff could have gotten distracted and forgotten to date them. During an interview on [DATE] at 12:34 PM the Administrator said he was aware of the insulin pens and TB vial not dated when opened. The Administrator said the insulins and TB vials were supposed to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 4 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 be dated when opened. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled Pharmacy policy and procedure manual dated 2003 indicated in part: A vial is considered opened if the stopper or seal has been punctured. Insulin storage recommendations at room temperature = KwikPen 28 days. Residents Affected - Some Record review of the facility's policy titled Pharmacy policy and procedure manual dated 2003 indicated in part: Medication that require an Open date as directed by the manufacturer should be dated when opened in a manner that it is clear when the medication was opened. Below is a list of medications that require a date when opening and the recommended time frame the medication should be used. This is not an all-inclusive list and the manufacturer recommendations will supersede this list - Insulins (Vials, cartridge, pens), Multidose vials for injection (sterile water, vaccines, etc) unless otherwise noted-expire 30 days after first puncture. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 5 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review the facility failed to store all drugs and biologicals in locked compartments for 1 of 1 treatment cart and 2 of 3 nurse carts reviewed for medication storage and security. The treatment medication cart was left unlocked and unsupervised. The nurse medication carts were left unlocked and unsupervised. These failures could place clients at risk for drug diversion or accidental ingestion. Findings included: During an observation and interview on 01/16/24 beginning at 11:27 AM a medication cart was seen unlocked and unattended. There were a couple of residents that passed by the unlocked medication cart. LVN A entered into the building from an outside door and said it was her cart and she had just stepped out. LVN A said she usually locked cart when she stepped away. Inside the cart were several medications in blister packets and some insulin pens. During an observation and interview on 01/16/24 at 11:33 AM the treatment cart was seen unlocked and unattended. LVN B said the cart was supposed to be locked at all times and was not sure who left it unlocked. Inside the cart were some antimicrobial wipes, medicated creams, wound cleanser spray bottles and an opened TB vial. During an observation on 01/16/24 beginning at 12:47 PM the back hall nurse medication cart was left unlocked and unattended for approximately 17 minutes. During an interview on 01/16/24 at 1:05 PM LVN C said she had stepped away from the medication cart and forgot to lock it. LVN C said she always locked it and might have been called away and left it unlocked. LVN C said if the cart was left open and unattended residents could get into it and injure themselves. During an interview on 01/18/24 at 12:12 PM the DON was made aware of the unlocked carts observed. The DON said her expectations were that the carts should be locked if unattended. The DON said it was each nurses responsibility to make sure their carts were locked when they stepped away. The DON said the failure probably occurred because the staff could have gotten distracted and walked away and forgot to lock it. During an interview on 01/18/24 at 12:34 PM the Administrator said he was aware of the carts left unlocked and unattended. The Administrator said the carts were expected to be locked when not in use. Record review of the facility's policy titled Medication Carts indicated in part: The carts are to be locked when not in use or under the direct supervision of the designated nurse. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 6 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for two (Resident #42 and #29) of 4 residents reviewed for infection control in that; Residents Affected - Some LVN C closed the faucet with her bare hands after she had washed her hands after assisting Resident #42. CNA E failed to perform incontinent care to Resident #29's peri-area after the resident used the urinal. These failures could place resident's risk for cross contamination and the spread of infection. Finding included: RESIDENT #42 Record review of Resident #42's admission record dated 01/17/24 indicated he was admitted to the facility on [DATE] with diagnoses of Alzheimer's disease and dyspnea (shortness of breath). He was [AGE] years of age. Record review of Resident #42's MDS dated [DATE] indicated in part: BIMS = 08 indicating resident had moderately impaired. Record review of Resident #42's order summary report dated 01/17/2024 indicated in part: O2 @ 2-4 L/M VIA NC PRN as needed. Order date 11/04/2023. During an observation on 01/16/24 at 12:18 PM LVN C transferred Resident #42 into his bed and then placed the oxygen nasal cannula on him. LVN C then turned the faucet on and washed her hands, after she washed them, she closed the faucet with her bare hands and then dried them with some paper towels. LVN C then opened the door of the resident room and exited the room. During an interview on 01/16/24 at 1:46 PM after LVN C said the way she usually washed her hands was by turning the faucet on, washing her hands with soap and water, drying them and then using a paper towel to close the faucet. LVN C said the reason she used a paper towel to close the faucet was to prevent re-contaminating her hands. LVN C said if she closed the faucet with her bare hands then she could possibly re-contaminate herself and spread germs to other people. LVN C said she had messed up and forgot to close the faucet with a paper towel. RESIDENT #29 Record review of Resident #29's admission record dated 01/18/24 indicated he was admitted to the facility on [DATE] with diagnoses of muscular dystrophy (disease that cause progressive weakness and loss of muscle mass) and muscle weakness. He was [AGE] years of age. Record review of Resident #29's care plan dated 08/27/21 indicated in part: Focus: The Resident has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 7 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 0880 occasional episodes of bowel and bladder incontinence. Goal: Resident will remain clean, dry, Level of Harm - Minimal harm or potential for actual harm odor free and dignity will be maintained through the review date. Interventions: INCONTINENT care at least every 2 hours and apply moisture barrier after each episode. Residents Affected - Some Record review of Resident #29's MDS dated [DATE] indicated in part: BIMS = 15 indicating resident was cognitively intact. During an observation on 01/17/24 at 09:35 AM CNA E performed incontinent care for Resident #29. CNA E first wiped the resident's rectal area as the resident had a bowel movement. CNA E then placed the urinal on the resident's penis to urinate. After Resident #29 urinated CNA E emptied the urinal, covered the resident and did not perform incontinent care to the residents penis or scrotum area. CNA E removed her gloves and then turned the faucet on washed her hands then closed the faucet with her bare hands. During an interview on 01/17/24 at 09:44 AM CNA E said she normally performed incontinent care to the resident's penis and scrotum area but had forgotten this time because she was nervous as she was being observed by the surveyor. CNA E said if she did not perform incontinent to Resident #29's penis area it could lead to infections or bad odors. CNA E said she should have closed the faucet with a paper towel after she washed her hands. CNA E said she got nervous and forgot that step but that she normally closed the faucet with a paper towel to prevent re-contamination of her hands which could possibly lead to the spread of germs. During an interview on 01/17/24 at 09:55 AM Resident #29 said he was not able to move his arms or hands or hold the urinal due to his condition. Resident #29 said he depended on staff to hold the urinal for him and the cleanse his peri-area since he could not do that. During an interview on 01/18/24 at 12:16 PM the DON was made aware of staff using their hands to close the faucet after they had washed them. The DON said it was expected for staff to use a paper towel to close the faucet. The DON said they orientated staff upon hire and conducted yearly audits. The DON said if staff did not use a paper towel to close the faucet, they could re-contaminate their hands. The DON said the failure probably occurred because the staff got nervous and forgot their steps. The DON was made aware of the incontinent observation performed by CNA staff. The DON said her expectation was for staff to perform pericare to the front as well and not just their bottom to prevent infections. The DON said she believed that staff got nervous and just did not do it. During an interview on 01/18/24 12:34 PM the Administrator was made aware of staff using their hands to close the faucet after they had washed them. The Administrator said they would conduct more training and in-services. The Administrator was made aware of the incontinent observation performed by CNA staff. The Administrator said staff were expected to perform thorough incontinent care and would be re-trained on providing personal care. Record review of the facility's policy titled Nursing personal care - Perineal care and dated 05/11/2022 indicated in part: This procedure aims to maintain the resident dignity and self-worth and reduce embarrassment by providing cleanliness and comfort to the resident, preventing infections and skin irritation and observing the resident's skin irritation. Male resident: Pull back the foreskin on uncircumcised males. Hold penis by the shaft. Wash in a circular motion from the tip down to the base. Continue perineal care to the scrotum and inner thigh. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 8 of 9 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 676046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Nursing & Rehabilitation 200 County Rd 616 Brownwood, TX 76802 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of the facility's policy titled Infection control policy and procedure and dated 2019 indicated in part: Hand hygiene continues to be the primary means of preventing the transmission of infection. The following is a list of some situations that require hand hygiene: Before and after resident contact. Recommended techniques for washing hands with soap and water included: Wetting hands first with clean, running warm water, apply the amount of product recommended by the manufacturer to hands and rubbing hands together vigorously for at least 20 seconds covering all surfaces of the hands and fingers then rinsing hands with water and drying thoroughly with a new disposable towel and turning off the faucet on the hand sink with the disposable paper towel. Record review of the facility's policy titled Infection control plan and dated 2019 indicated in part: The facility will establish and maintain an infection control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676046 If continuation sheet Page 9 of 9