Inspection·October 18, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm An observation was made on 10/16/23 at 12:20 PM of Resident #3 lunch tray and it did not have any puree bread on the plate. During an interview on10/16/23 at 12:05 pm, the DM said she had pureed everything that she had to for the meal. Residents Affected - Few During an interview on 10/17/23 at 9:00 am Resident # 3 stated he would like all the same foods as the other residents receive. Resident #3 stated he does not receive bread or desserts (cake, pie cookies or churros) for meals when the other residents are served desserts or bread. Resident #3 stated he felt sad and left out when he sees other residents eating desserts and he was not served the same foods. Resident #3 stated he wanted the same foods as other resident's receive. During a confidential interview on 10/17/23 at 9:30 am an employee stated Resident # 3 was never given bread or desserts (cake pie cookies or churros) when residents who are not on a pureed diet are served bread or desserts. The employee stated Resident #3 gets pudding or applesauce when desserts are served. The employee stated Resident #3 also gets pudding or applesauce when snacks are served in the morning and the afternoon snack times. The employee stated Resident #3 has seen other residents get desserts (cake pie cookies and churros) and has asked for the desserts when he sees the other residents eating them. The employee stated when he asks for bread and dessert, the staff tell him he cannot have the bread or desserts. The employee stated Resident #3 always looks sad that he is told he cannot have the same foods as other residents. During an interview on 10/17/23 at 9:45 am Resident #3 family member stated Resident #3 liked anything sweet. The family member stated Resident #3 loved to eat, and he will eat anything he was served. The family member stated Resident #3 loved pie and cake. The family member stated Resident #3 loves pumpkin pie and in the past at Thanksgiving, the facility would give Resident #3 pumpkin pie The family member stated she used to take Resident #3 candy bars and the previous food manager would puree the candy bars for him. The family member stated Resident #3 would feel sad and left out if he saw other residents with pie and cake and he was told he could not have any desserts. The family member stated she was not aware Resident #3 was not being given bread or sweets for meals. During an interview on 10/17/23 at 12:10 pm the DM said none of the residents who receive a pureed diet were served bread or pureed desserts. She stated when the menu listed desserts( cake, pie, cookies or churros ) for residents with regular diets, she does not puree desserts (cake, pie, churros or cookies.) She stated the RD told her not to puree desserts as well as bread for Resident #3. During an interview on 10/17/23 at 1 :45 pm, the facility MD stated he was not aware Resident #3 who was on a pureed diet were not receiving pureed bread or desserts. He stated there was no reason Resident #3 could not have bread or desserts. The MD stated there was no reason residents with pureed meals should not get bread or desserts like everyone else. The MD further stated Resident #3 should get whatever he wants. During an interview on 10/17/23 at 3:00 pm the RD stated she has trained the DM to not serve pureed bread or desserts to residents on a pureed diet. The RD stated We do not puree bread. You have to puree it with milk, and it ends up really gross and was not appetizing. The RD was asked about pureeing cake, pie, and cookies. The RD stated she has trained the DM to not give residents with a pureed diet any cakes, cookies, or pies either. She stated even if the residents ask for pureed bread, cake, pie or cookies they cannot have it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 0561 Level of Harm - Minimal harm or potential for actual harm During an interview on 10/18/23 at 10:00 am the DON stated he was not aware Resident #3 was not receiving pureed bread or desserts. The DON stated residents would feel left out and caloric intake is lacking if Resident #3 was not provided the same diet as the rest of the residents. Record review of the facility's policy titled, Menus, revised October 2008 revealed: Residents Affected - Few [NAME] will provide a variety of foods from the basic daily food groups and will indicate standard portions at each meal. If a food group is missing from a resident's daily diet (e.g. diary products) the resident will be provided an alternate means of meeting the residents nutritional needs. Menus will be varied for the same day of consecutive weeks. Record review of the facility policy titled, Therapeutic Diets, dated November 2015 revealed: Diet will be determined in accordance with the resident's informed choices, preferences, and wishes. The resident has a right not to comply with therapeutic diets. Snacks will be compatible with the therapeutic diet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the menu was followed, for 2 out of 3 residents that received pureed food (Resident #3 & Resident # 29), in that: 1. The facility failed to ensure Resident # 3 received pureed bread on 10/16/23. 2. The facility failed to ensure Resident # 29 received pureed bread on 10/16/23. These failures could place residents at risk for unwanted weight loss, hunger, unwanted weight gain, and metabolic imbalances. The findings include: Resident # 3 Record review of Resident # 3's face sheet revealed a [AGE] year-old-male admitted to the facility on [DATE] with diagnoses to include vascular dementia (defective memory), dysphagia (difficulty swallowing), and anxiety. Record review of comprehensive MDS assessment dated [DATE] revealed Resident # 3 was usually understood. The MDS revealed Resident # 3 had a BIMS of 10 which indicated the resident's cognition was moderately impaired. Section K indicated Mechanically altered diet: Require change in texture of food or liquids. Record review of a care plan, dated 08/28/23 for Resident # 3 revealed the following: Category: Nutritional Status Resident was on regular pureed diet with thin liquids. Record review of Resident # 3's order summary report dated 10/18/23 revealed the following orders: Diet ordered 07/09/23: Regular diet, Pureed texture, thin liquids consistency. Resident # 29 Record review of Resident #29's face sheet revealed a [AGE] year-old-female admitted to the facility on [DATE] with diagnoses to include dementia, anxiety and psychotic disorder. Record review of comprehensive MDS assessment dated [DATE] revealed Resident #29 was rarely or never understood. The MDS revealed Resident # 29 had a BIMS of 0 which indicated the resident's cognition was severely impaired. Section K indicated Mechanically altered diet: Require change in texture of food or liquids. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 0803 Record review of a care plan, dated 09/26/23 for Resident # 29 revealed the following: Level of Harm - Minimal harm or potential for actual harm Category: Nutritional Status Resident was on regular pureed diet with thin liquids. Residents Affected - Few Record review of Resident # 29's order summary report dated 9/8/23 revealed the following orders: Diet ordered 07/09/23: Regular diet, Pureed texture, thin liquids consistency. On 10/16/23 at 11:41 AM an observation of the pureed process was conducted. The DM began the process at 11:41 am. No bread or rolls were pureed during this process. During an interview on10/16/23 at 12:05 pm, the DM said she had pureed everything that she had to for the meal Record review of Resident #3's diet card dated Wednesday 10/16/23 revealed he should have received a bread or roll. An observation was made on 10/16/23 at 12:20 PM of Resident #3 lunch tray and it did not have any puree bread on the plate. Record review of Resident # 29's diet card dated Wednesday 10/16/23 revealed he should have received a bread or roll. An observation was made on 10/16/23 at 12:31pm of Resident #29's lunch tray and it did not have any puree bread on the plate. During an interview on 10/17/23 at 1:45 pm the DM said she did not puree any bread because the dietician had told her not to give any of the residents with pureed diets bread. She stated the substitute for bread was mashed potatoes. The dietary manager further stated residents were not served pureed desserts. She stated she did not puree cake, pie churros or cookies. She stated the RD told her not to puree desserts as well as bread. During an interview on 10/17/23 at 1 :45 pm, the facility MD stated he was not aware residents who are on a pureed diet were not receiving pureed bread. He stated there was no reason the residents with pureed diets could not have bread. During an interview on 10/17/23 at 3:00 pm the RD stated she has trained the DM to not serve pureed bread to residents on a pureed diet. The RD stated We do not puree bread. You have to puree it with milk, and it ends up really gross and is not appetizing. The RD stated she has trained the DM to not give residents with a pureed diet any cakes, cookies, or pies either. She stated even if the residents ask for pureed bread, cake, pie or cookies they cannot have it. During an interview on 10/18/23 at 10:00 am the DON stated he was not aware residents on a pureed diet were not receiving pureed bread or desserts. The DON stated residents would feel left out and caloric intake would be lacking if residents on a pureed diet were not provided the same diet as the rest of the residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 0803 Record review of the facility's policy titled, Menus, revised October 2008 revealed: Level of Harm - Minimal harm or potential for actual harm [NAME] will provide a variety of foods from the basic daily food groups and will indicate standard portions at each meal. If a food group is missing from a resident's daily diet (e.g. diary products) the resident will be provided an alternate means of meeting the residents nutritional needs. Menus will be varied for the same day of consecutive weeks. Residents Affected - Few Record review of the facility policy titled, Therapeutic Diets, dated November 2015 revealed: Diets will be determined in accordance with the resident's informed choices, preferences, and wishes. The resident has a right not to comply with therapeutic diets. Snacks will be compatible with the therapeutic diet. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, and serve food under sanitary conditions in 1of 1 kitchen observed for kitchen sanitation. Residents Affected - Many The facility failed to: A. Ensure general cleanliness was maintained. B. Ensure food items were properly stored. These failures placed all residents who ate food served by the kitchen at risk of cross contamination and food-borne illness. Findings include: Observations on 10/16/23 at 10:15 am of the pantry revealed: 1. An opened jar of jelly with a label that stated refrigerate after opening. Observations on 10/16/23 at 10:20 am of the walk-in cooler revealed: 1. A package of shredded cheese, open to air. 2. A package of sliced cheese, open to air. 3. A large bottle of Coffee Mate liquid creamer on the shelf. Label stated do not refrigerate or freeze. Observations on 10/16/23 at 10:20 am of the walk-in freezer revealed: 1. A box of frozen burritos, open to air. Observation of the lunch meal service on 10/16/23 at 12:05 pm revealed the following: The DM was observed with gloved hands touching various kitchen workstation surfaces, rolling a hot box to the steam table, and picking up utensils and a plate to begin plating the lunch meal. The DM did not change her gloves or wash her hands. The DM picked up a roll with her gloved hand and placed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 the roll on the plate. The DM set the plate cover on the plate and put the plate into the hot box. The DM then separated all the rolls from each other using her gloved hands to pull all the rolls apart. The DM was stopped by the surveyor and asked if she was supposed to use tongs when touching the rolls. The DM stated she did not know that she was supposed to use tongs to serve the rolls. Residents Affected - Many Observations on 10/17/23 at 9:30 am of the pantry revealed: 2. An opened jar of jelly with a label that stated refrigerate after opening. Observations on 10/17/23 at 10:20 am of the walk-in cooler revealed: 4. A package of shredded cheese, open to air. 5. A package of sliced cheese, open to air. 6. A large bottle of Coffee Mate liquid creamer on the shelf. Label stated do not refrigerate or freeze. Observations on 10/17/23 at 10:20 am of the walk-in freezer revealed: 2. A box of frozen burritos, open to air. In an interview and observation of the issues in the kitchen on 10/ 17/23 at 11:00 AM, the DM was shown the opened jar of jelly in the pantry and told the label stated jelly needed to be refrigerated. The DM stated she did not know why the jelly was on the shelf. The DM was shown the creamer in the refrigerator and the label for storage was reviewed. The DM stated she did not know why the creamer was in the cooler. The DM stated the shredded cheese and sliced cheese should be closed to air. The DM was shown the box of burritos in the walk-in freezer and stated the burritos should be closed to air. The DM stated cross contamination could occur when foods were not stored and served properly. The DM stated all kitchen employees are supposed to change gloves and use tongs when handling food. The DM stated the dietician trained the staff in kitchen sanitation. Record review of the facility policy titled, Food Receiving and Storage, dated October 2017, documented all foods stored in the refrigerator will be covered labeled and dated. Wrappers of frozen food must stay intact until thawing. Record review of the facility policy titled, ' Preventing Food Borne Illness- Food Handling with a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676079 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 676079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing Care Center 1100 W Ave J Muleshoe, TX 79347 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 - Many FORM CMS-2567 (02/99) Previous Versions Obsolete revision date of July 2014 , documented all employees who handle prepare or serve food will be trained in the practices of safe handling and preventing food borne illnesses. Employees must wash their hands after handling soiled equipment or utensils, before coming into contact with any food surfaces, during food preparation as often as necessary to remove soil and contamination and to prevent cross contamination. Food service employees will be trained in the proper use of utensils such as tongs, gloves, deli paper and spatulas to prevent food borne illness. Gloves are considered single use items and must be discarded after completing the task for which they are used. The use of gloves does not substitute for proper handwashing. Event ID: Facility ID: 676079 If continuation sheet Page 9 of 9