Health inspection·December 14, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 12/14/23 at 8:50 AM, CNA B stated the residents' hair was supposed to be combed every day. CNA B stated the residents' hair could knot up if not combed daily. CNA B stated residents' self-esteem could be affected. In an interview on 12/14/23 at 9:05 AM, LVN J stated residents' hair should be combed every day when getting up. LVN J stated residents' hair could become matted and could cause skin conditions such as lice. In an interview on 12/14/23 at 9:46 AM, Resident #129 stated her head itched and she hated it being tangled. Resident #129 stated the staff did not take the time to detangle her hair. Resident #129 stated the staff combed her hair from the scalp instead of the ends, and it hurt. Resident #129 stated the staff had not combed her hair in about a month. In an interview and observation on 12/14/23 at 10:15 AM, CNA D stated the residents should be groomed daily. CNA D confirmed Resident #129's hair was matted and tangled. CNA D stated not caring for the residents' hair could cause an infection, flaky skin, and lice. In an interview on 12/14/23 at 10:22 AM, RN M stated when getting the residents up their hair should be groomed every day. RN M stated residents were at risk of tangled hair and looking unpresentable. In an interview on 12/14/23 at 10:43 AM, the DON stated the residents' daily requests and preferences for hair grooming were honored. The DON stated that refusal of grooming would be documented on the residents' care plans. Record review of Resident #129's care plan revealed no documentation of refusals for ADLs. Record review of the facility's current, undated Activities of Daily Living (ADLs), Supporting policy reflected: .residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming, and personal hygiene 5. Resident ability to perform ADLs .Total dependence- Full staff performance of an activity with no participation by resident . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676145 If continuation sheet Page 2 of 5 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 676145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Estates 1350 Main St Frisco, TX 75034 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, distribute, and serve food in accordance with professional standards for food safety in the facility's only kitchen. Residents Affected - Some 1. The facility failed to ensure the ice machine was maintained in a clean and sanitary manner free of white crust and scale. 2. The facility failed to ensure food items and clean dishes were kept away from soiled surfaces and airborne contaminants. 3. The facility failed to ensure Styrofoam containers were stored away from the kitchen cleaning products and equipment. 4. The facility failed to ensure the microwave was maintained in a clean and sanitary manner free of dust and sticky residue. These failures could place residents, who received food from the kitchen, at risk for food contamination and food-borne illness. Findings included: An observation and interview with the Nutrition Supervisor, on 12/12/2023 at 8:45 AM, revealed the ice machine in the food tray assembly area of the kitchen to have white crust/scale around the lid, front, and sides. She said it was cleaned weekly and the kitchen staff were responsible to keep it clean. She stated there should not be any scale on the machine as it could flake off and contaminate the ice or other food in the kitchen. Dust and grey fuzz were observed on the utensil rack next to the three-compartment sink. The Nutrition Supervisor said the utensils hanging on the rack were clean and the rack should not have any dust on it because it could come into contact with the clean utensils and possibly cause food-borne illness. A fire extinguisher hanging on the wall beside the utensil rack had a coating of black grime, grease, and dust on the top and handle. A food preparation area was observed adjacent to the utensil rack and fire extinguisher. The Nutrition Supervisor said maintenance would be responsible to keep the fire extinguisher clean. An observation and interview with the Nutrition Supervisor, on 12/12/2023 at 8:55 AM revealed, a room with a wash basin on the floor along with brooms, mops, and cleaning supplies. Boxes of Styrofoam plates and bowls were also stored in the room. The Nutrition Supervisor said they did not have anywhere else to store them while they awaited staff to return them to another storage area. She said they should not be in the same area that they stored cleaning items because they could become contaminated with dirt, or cleaning products. She said she had a cleaning schedule and staff were expected to initial when they have completed each task on the schedule. She said she monitored this. In an interview on 12/12/2023 at 9:20 AM, the Dietitian stated she came to the facility weekly to answer any dietary questions. She said she expected the kitchen to be clean and free of any potential cross-contamination or food-borne illness concerns. An observation and interview with the Nutrition Supervisor, on 12/13/2023 at 7:30 AM, revealed the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676145 If continuation sheet Page 3 of 5 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 676145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Estates 1350 Main St Frisco, TX 75034 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some [NAME] plating breakfast trays at the steam table. A microwave in a shelf over the right side of the area was observed to have a sticky coating and dust covering the top and back of the microwave. The backside of the microwave was open to the tray assembly area and was on the same shelf with hand sanitizer which was observed being used by staff assembling trays. The Nutrition Supervisor said the microwave was cleaned daily and should not have dust or grease on it. She said there was a risk that the dust could blow off and get into food that was prepared in the area. An observation and interview with the Nutrition Supervisor on 12/13/2023 at 7:40 AM revealed, a wired shelving unit on the backside of the food plating area that had utensils and metal food containers on it. The shelves did not have any barrier or matting on them and had rust and dust on them. The Nutrition Supervisor said the rust particles and dust could fall off the shelving and onto the clean dishes causing contamination. She said kitchen staff were expected to keep the shelves clean. In an interview on 12/13/2023 at 7:45 AM, the Corporate Trainer said the Nutrition Supervisor recently took over responsibility of the kitchen and she was in the facility to assist her in getting acclimated with her responsibility. She said she understood the cleaning concerns and agreed they posed a risk of food contamination. In an interview on 12/14/2023 at 2:52 PM, the Maintenance Director said the facility had a contract with a company to take care of the ice machine. He said kitchen staff were responsible to clean the outside of the machine. He said there should not be any scaling on the machine because it could flake off and get into the ice or other food in the kitchen . Record review of the facility's cleaning schedule dated 11/27/2023 through 12/17/2023 reflected the ice machine was cleaned each day up to the review date of 12/12/23. Review of the Cooks cleaning schedule, dated 11/27/2023 through 12/17/2023 reflected the microwave was cleaned on 11/28, 12/1, 12/3, 12/8, 12/9, 12/10, and 12/11/23. Review of the PM Cooks cleaning schedule, Dish washer schedule, and Aides cleaning schedule dated 11/27/2023 through 12/17/2023 reflected no listing for the wire racks holding clean dishes, utensil holder, or cleaning closet. Record review of the facility's policy titled, Sanitation of dietary department, dated 11/3/2004 reflected, The dietary staff shall maintain the sanitation of the dietary department through compliance with a written, comprehensive cleaning schedule. The Dietary Manager shall record all cleaning and sanitation tasks for the department Record review of Federal Drug Administration Food Code dated 2022 section 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils revealed (A) EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch. (B) The FOOD-CONTACT SURFACES of cooking EQUIPMENT and pans shall be kept free of encrusted grease deposits and other soil accumulations. (C) NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris. 3-305.11 Food Storage. (A) Except as specified in (B) of this section, FOOD shall be protected from contamination by storing the FOOD: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination. 14 Food Preparation. During preparation, UNPACKAGED FOOD shall be protected from environmental sources of contamination. 3-307.11 Miscellaneous Sources of Contamination. FOOD shall be protected from contamination that may result from a factor or source not specified under Subparts 3-301 - 3-306. 3-602. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676145 If continuation sheet Page 4 of 5 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 676145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Prairie Estates 1350 Main St Frisco, TX 75034 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly. Residents Affected - Some The facility failed to ensure the trash in the dumpster corral was contained and maintained in a sanitary condition. The failure had the potential to attract rodents and create an unsafe, unsanitary exterior. Findings included: An observation and interview with the Nutrition Supervisor and Corporate Trainer on 12/12/2023 at 9:10 AM revealed, the dumpster corral door to be open. Both dumpsters were closed but one had a clear bag of trash containing adult diapers hanging over the top of the bin. The ground in the dumpster corral was littered with trash. The Nutrition Supervisor named the trash as follows: clothes, plastic straws, rubber gloves, paper and paper products, cups, lotion bottles, and drink bottles. She said the Dietary department shared the dumpsters with nursing. She said it was dietary's responsibility to ensure the bins and the corral area was maintained in a sanitary way. She said trash should not be half in the bins and no trash should be left on the ground in the corral area. She said this could attract rodents or could be a safety hazard to staff who brought trash to the bins. In an interview on 12/13/2023 at 8:17 AM, the Administrator stated housekeeping, dietary, and maintenance were responsible to ensure the dumpster area was kept clean. She stated trash should be contained in the closed bins to limit the attraction of bugs or rodents. In an interview on 12/14/2023 at 2:52 PM, the Maintenance Director said it was all the staff's responsibility to ensure the trash was deposited into the dumpster bin. He said trash should be contained in the bins and not on the ground to promote proper sanitation. Record review of the facility's policy titled, Waste Disposal, dated 11/3/2004, reflected, All garbage will be disposed of daily. Prior to disposal, all trash shall be kept in leakproof, non-absorbent, fireproof containers that are kept covered. Trash bags shall be sealed prior to removing from house. Trash will be deposited into the sealed container outside the premise. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676145 If continuation sheet Page 5 of 5