Health inspection·February 15, 2024

F 0552 disturbance and anxiety dated 12/28/23. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #6's medication administration records dated 02/14/24 for the month of February 2024 revealed Resident #6 received Depakote 250 mg orally at bedtime on February 1st through February 13th. Resident #6 received Depakote 125 mg orally in the morning on February 1st through February 14th. Residents Affected - Some Record review of Resident #6's electronic medical record scanned documents on 02/14/24 revealed no consent for Depakote. Record review of the psychotropic consent book provided by facility revealed no consent for Depakote for Resident #6. Resident #16 Record review of Resident #16's admission record, dated 02/15/24, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses of traumatic brain injury (brain injury caused by outside force), major depressive disorder (persistent depressed mood), and quadriplegia (paralysis affecting all four limbs). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #16 was understood the majority of the time. The MDS revealed Resident #16 had a BIMS score of 13 which indicated the resident's cognition was mostly intact. Record review of a care plan dated 12/15/23 for Resident #16 revealed a Focus - I have major depressive disorder Goal - I will have fewer or no episodes of depression by the due date; date initiated 5/26/23 and target date of 11/14/23. Record review of Resident #16's order summary report dated 02/15/24 revealed the following orders: Depakote Oral Tablet Delayed Release 250MG give one tablet by mouth two times a day for aggression. Record review of Resident #16's electronic medical record revealed no consent for Depakote. Resident #25 Record review of Resident #25's admission record, dated 02/15/24, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses of traumatic brain injury (brain injury caused by outside force), major depressive disorder (persistent depressed mood), dementia (progressive loss of intellectual functioning), anxiety disorder (persistent worry and fear), and psychotic disorder (disconnection from reality). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #25 was not understood the majority of the time. The MDS revealed Resident #25 had a BIMS score of 4 which indicated the resident's cognition was severely impaired. Record review of a care plan dated 4/4/23 for Resident #25 revealed Focuses - I have major depressive disorder Goal - I will have fewer or no episodes of depression by the due date, date initiated 4/4/23 and target date of 4/4/24, I have a diagnosis of dementia with impaired ability to make decisions, impaired communication, and impaired safety awareness Goal - My needs/preferences will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 2 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 anticipated by staff and dignity maintained through the next review date, date initiated 4/4/23 and target date of 4/4/24, I have episodes of anxiety and at risk for fluctuation in moods currently taking Buspirone, Goal - My anxiety will be maintained at level tolerable to resident and will demonstrate reduced anxiety as evidenced by response to proper medication over the next review date, date initiated 4/4/23 and target date of 4/4/24. Residents Affected - Some Record review of Resident #25's order summary report dated 02/15/24 revealed the following orders: Depakote Oral Tablet Delayed Release 250mg give one tablet by mouth three times a day for psychotic disturbances, Seroquel 250mg give one tablet 1 time a day for psychotic disturbances, Mitazapine 15mg give 2 tablets one time a day for major depressive disorder, and Buspirone 10mg give 1 tablet 2 times a day for anxiety. Record review of Resident #25's electronic medical record revealed no consent for Depakote, Seroquel, Mitazapine, and Buspirone. Resident #26 Record review of Resident #26 face sheet, dated 02/14/24, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses to include: anoxic brain damage (injury from lack of oxygen to the brain), chronic obstructive pulmonary disorder (lung disease that blocks airflow), bipolar disorder (mood swings), hypertension (high blood pressure), anxiety disorder (feelings of worry or fear), insomnia (problems sleeping) and muscle weakness. Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #26 was understood. The MDS revealed Resident #26 had a BIMS of 15 which indicated the resident's cognition was intact. MDS further revealed resident potential indicators of psychosis were delusions. Record review of a care plan for Resident #26 dated 02/09/24 revealed focus area for episodes of adverse behaviors: verbally aggressive - cursing, racial slurs, yelling/screaming, fabricates facts, unreliable historian, manipulates staff. Record review of Resident #26's order summary report dated 02/13/24 revealed the following orders: Lithium Carbonate Oral Capsule 150 mg orally at bedtime related to bipolar disorder. Restoril Oral Capsule 15 mg (Temazepam) orally at bedtime related to insomnia. Record review of Resident #26 medication administration records for the month of February 2024 revealed Resident #26 received Lithium Carbonate Oral Capsule 150 mg orally at bedtime on February 8th through February 15th. Resident #26 received Restoril Oral Capsule 15 mg (Temazepam) orally at bedtime on February 8th through February 15th. Record review of Resident #26 electronic medical record scanned documents on 02/14/24 revealed no consent for Depakote. Record review of the psychotropic consent book provided by facility revealed no consent for Depakote for Resident #26. Resident #28 Record review of Resident #28's admission record, dated 02/15/24, revealed a [AGE] year-old-female (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 3 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 was admitted to the facility on [DATE] with diagnosis of dementia (progressive loss of intellectual functioning), type 2 diabetes (high blood sugar), anxiety disorder (persistent worry and fear), and psychotic disorder with delusions (disconnection from reality). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #28 was never understood and was unable to complete the mental assessment. The MDS revealed Resident #28 had a BIMS score of 99 which indicated the resident's cognition was not intact. Record review of a care plan dated 1/2/24 for Resident #28 revealed a Focus - I have a diagnosis of dementia with impaired ability to make decisions, impaired communication, and impaired safety awareness Goal - My needs/preferences will be anticipated by staff and dignity maintained through the next review date; date initiated 1/15/23 and target date of 1/16/24. Record review of Resident #28's order summary report dated 02/15/24 revealed the following orders: Depakote Oral Tablet Delayed Release 250MG give one tablet by mouth one times a day related to psychotic disorder with delusions due to known physiological condition. Record review of Resident #28's electronic medical record revealed no consent for Depakote. Resident #33 Record review of Resident #33's admission record, dated 02/15/24, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses of bipolar disorder (alternating periods of elation and depression), major depressive disorder (persistent depressed mood), and anxiety disorder (persistent worry and fear). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #33 was understood the majority of the time. The MDS revealed Resident #33 had a BIMS score of 15 which indicated the resident's cognition is intact. Record review of a care plan dated 10/16/23 for Resident #33 revealed a Focus - I have a diagnosis of depression/Bipolar and am at risk for fluctuation in moods, little interest or pleasure in doing things, and decreased socialization. Currently receiving: (Mirtazapine). Goal - I will have fewer or no episodes of depression and will voice positive feelings about self through next review date 1/16/24. I have episodes of anxiety and at risk for fluctuation in moods Date Initiated: 10/16/2023. Goal- My anxiety will be maintained at level tolerable to resident and will demonstrate reduced anxiety as evidenced by response to proper medication over the next review date of 1/16/24. Record review of Resident #33's order summary report dated 02/15/24 revealed the following orders: Hydroxyzine Oral Tablet Delayed Release 50MG give one tablet by mouth two times a day for anxiety. Record review of Resident #33's electronic medical record revealed no consent for Hydroxyzine. Resident #34 Record review of Resident #34's admission record, dated 02/15/24, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnoses of major depressive disorder (persistent depressed mood), hypertension (high blood pressure), and hypothyroidism (deficiency of thyroid hormones). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 4 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #34 was understood the majority of the time. The MDS revealed Resident #34 had a BIMS score of 14 which indicated the resident's cognition was intact. Record review of a care plan dated 12/9/23 for Resident #34 revealed a Focus - I have a DX of depression and at risk for fluctuation in moods, little interest, or pleasure in doing things, and decreased socialization. Currently receiving: Zoloft 50mg daily. Goal- I will have fewer or no episodes of depression and will voice positive feelings about self through next review date; date initiated 12/04/2023, target date 02/26/2024. Record review of Resident #34's order summary report dated 02/15/24 revealed the following orders: Zoloft Oral Tablet 50MG give one tablet by mouth one time a day for depression. Record review of Resident #34's electronic medical record revealed no consent for Zoloft. Resident #35 Record review of Resident #35's face sheet dated 02/14/24 revealed a [AGE] year-old male with an admission date of 12/04/23 with the following diagnoses: stroke, peripheral vascular disease (narrowed blood vessels reduce blood flow to the limbs), and hypertension (high blood pressure). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #35 was understood (clear comprehension). The MDS revealed Resident #35 had a BIMS of 12 which indicated the resident's cognition was moderately impaired. Record review of a care plan for Resident #35 dated 06/06/22 revealed no focus area for Remeron. Record review of Resident #35's order summary report dated 02/14/24 revealed the following orders: Remeron 15mg by mouth at bedtime dated 12/28/23. Record review of Resident #35's medication administration records dated 02/14/24 for the month of February 2024 revealed Resident #35 received Remeron 15mg orally at bedtime on February 1st through February 13th. Record review of Resident #35's electronic medical record scanned documents on 02/14/24 revealed no consent for Depakote. Record review of psychotropic consent book provided by facility revealed no consent for Remeron for Resident #35. Resident #39 Record review of Resident #39's face sheet, dated 02/14/24, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include stroke, diabetes (high blood sugar), depressive episodes (mental illness), dementia (cognitive loss), and hypertension (high blood pressure). Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #39 was usually understood (difficulty communicating some words or finishing thoughts but was able if prompted or given time). The MDS revealed Resident #6 had a BIMS of 06 which indicated the resident's cognition was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 5 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 severely impaired. The MDS further revealed resident had verbal behaviors and behaviors towards others. Level of Harm - Minimal harm or potential for actual harm Record review of a care plan for Resident #39 dated 12/16/23 revealed a focus area for depression with interventions to administer meds per order. Care plan further revealed a focus area for episodes of adverse behaviors with interventions to anticipate behaviors, encourage social activities, maintain a calm environment, and monitor behaviors. Residents Affected - Some Record review of Resident #39's order summary report dated 02/14/24 revealed the following orders: Nuedexta 20-10 mg 1 capsule by mouth one time a day related to visuospatial deficit and spatial neglect following a stroke (ignore one side of the body) dated 1/22/24. Record review of Resident #39's medication administration records dated 02/14/24 for the month of February 2024 revealed resident #39 received nuedexta 20-20 mg orally one time a day in the morning on February 1st through February 14th. Record review of Resident #39's electronic medical record scanned documents on 02/14/24 revealed no consent for Nuedexta. Record review of the psychotropic consent book provided by facility revealed no consent for Nuedexta for Resident #39. Resident #47 Record review of Resident #47's face sheet dated 2/13/24 revealed a [AGE] year-old female with an initial admission date of 2/15/22 with the following diagnoses: peripheral vascular disease (blood circulation disorder), type 2 diabetes (high blood sugar), vascular dementia , unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (cognitive loss lacking symptoms of behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety), other specified depressive episodes (mental illness), other specified hypothyroidism (thyroid condition), and chronic systolic (congestive) heart failure (heart failure). Record review of Resident #47s quarterly MDS dated [DATE] revealed Resident #47 was usually understood. The MDS revealed Resident #2 had a BIMS score of 09 which indicated the resident's cognition was moderately impaired. Record review of a care plan dated 2/23/22 for Resident #47 revealed a Focus - Resident #47 psychosocial well-being problem potential problem related to suicidal attempts and recent admission.; Goal - Resident #47 will demonstrate adjustment to nursing home placement by/through review date. Resident #47 will effectively cope with his/her feelings of by the review date. Resident #47 will identify the reasons for her feelings of depression by the review date. Resident #47 will have no indications of psychosocial well-being problems by/through the review date. Date initiated 2/23/22, revised 11/22/23, target date 5/19/24. Record review of Resident #47's order summary report dated 2/14/24 revealed the physician orders dated 1/9/2023 for Escitalopram Oxalate Tablet, 20 milligrams. Give 20 milligrams by mouth, one time a day for depression related to schizoaffective disorder, bipolar type (F25.0). Give 30 minutes to 1 hour before breakfast. A signed consent form was not provided or located by the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 6 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 Resident #52 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #52s face sheet dated 02/14/24 revealed a [AGE] year-old male with an admission date of 04/04/23 with the following diagnoses: Parkinson's disease (central nervous system disorder), neurocognitive disorder (decline in cognition) depressive episodes (long periods of depressed mood), schizoaffective disorders (schizophrenia and mood disorder). Residents Affected - Some Record review of the comprehensive MDS assessment dated [DATE] revealed Resident #52s was understood. The MDS revealed Resident #52s had a BIMS score of 08 which indicated the resident's cognition was mildly impaired. Record review of a care plan for Resident #52s dated 12/17/23 revealed focus area for schizoaffective disorders- at risk for fluctuation in moods, little interest or pleasure in doing things, and decreased socialization. Record review of Resident #52s order summary report dated 02/13/24 revealed the following orders: Wellbutrin XL Oral Tablet Extended Release 24 Hour 300 mg (Buproprion HCl) orally once per day related to other specified depressive episodes. Olanzapine Oral Tablet 5 mg (Olanzapine) orally two times daily for behaivors related to other schizoaffective disorders. Record review of Resident #52s medication administration records dated 02/14/24 for the month of February 2024 revealed Resident #52 received Wellbutrin XL Oral Tablet Extended Release 24 Hour 300 mg once daily on February 9th through February 15th and Olanzapine Oral Tablet 5 mg orally two times daily on February 1st through February 15th. Record review of Resident #52's electronic medical record scanned documents on 02/14/24 revealed no consent for Wellbutrin XL or Olanzapine. Record review of the psychotropic consent book provided by facility revealed no consent for Wellbutrin XL or Olanzapine for Resident #52. During an interview on 02/15/24 at 11:15 AM with the ADON, she cannot find a consent for Resident #6 Depakote, Resident #35s Remeron or Resident #39s Nuedexta. She stated she had not been able to find several consents since the last DON left. She stated she was in the process of updating all consents. She stated all staff had been trained on obtaining consents. She stated the nurses were responsible for obtaining consent for medications when they receive the order. She stated the potential negative outcome could be giving unnecessary medications to residents or giving medications against the residents or family wishes. During an interview on 2/15/24 at 2:55 PM, the ADM stated currently the ADON, or the charge nurses were responsible for obtaining a signed consent form for psychotropic medications from the resident or their responsible party on the same day it was received from the physician. The ADM stated the DON was also responsible for obtaining consents, however the facility currently does not have a DON. The ADM stated the consent should have been obtained prior to the residents being given psychotropic medications. The ADM stated she believes the reason 18 consent forms were missing was because nursing staff were not completing them with the resident or their responsible party. The ADM stated a potential negative outcome to the residents was the resident was receiving a medication without consent. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 7 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 Policy Interpretation and Implementation: Level of Harm - Minimal harm or potential for actual harm 1. A psychotropic medication is any medication that affects brain activity associated with mental processes and behavior. Residents Affected - Some 2. Residents, families, and/or the representative are involved in the medication management process. Resident Evaluations: 3. Residents (and/or representatives) shall be educated on the risks and benefits of psychotropic drug use. Consent will be given by resident and/or resident representative prior to giving psychotropic medications. a. The staff and physician will review with the resident/representative the risks related to not taking the medication as well as appropriate alternatives. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 8 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 1 of 18 residents (Residents #39) reviewed for advanced directives, in that: Residents #39 was listed as a DNR but had OOH-DNR forms that were incorrectly filled out or missing required information. These failures could place residents at risk for not having their end of life wishes honored and incomplete records. Findings included: Record review of Resident #39's face sheet, dated [DATE], revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnoses to include stroke, diabetes (high blood sugar), depressive episodes (mental illness), dementia (cognitive loss), and hypertension (high blood pressure). The face sheet also revealed under the advance directive section - Code Status: DNR. Record review of Resident #39's physician order summary dated [DATE] revealed the following order: Code Status: DNR dated [DATE]. Record review of Resident #39's care plan, dated [DATE], revealed care plan for DNR. Record review of Resident #39's Out of Hospital Do Not Resuscitate form dated [DATE] revealed under the physician's statement that the physician's signature, date, printed name and license number was blank. During an interview on [DATE] at 11:15 AM with the ADON, she stated the social worker was responsible for completing the OOH DNR form. She verified Resident #39's DNR was missing the physician signature. She stated an OOH DNR was not valid unless the form was completely filed out. She stated the OOH DNR was a physician order. She stated she had been trained on completing OOH DNR's. She stated the DON and SW verifies the OOH DNR was complete. She stated she was not sure why Resident #39's OOH DNR was put into place without a physician signature. She stated the OOH DNR needs to be complete, so the nurses were able to do their job appropriately. She stated the potential negative outcome could be wrongful death and going against residents wishes. During an interview on [DATE] at 02:30 PM with the SW, she stated she verified the original OOH DNR did not have a physician signature. She stated she sent the original OOH DNR to the physician office for signature. She stated an incomplete OOH DNR was not valid. She stated she was responsible for making sure OOH DNR were completely filled out and accurate. She stated she was not sure why Resident #39 did not have a physician signature on it unless it got scanned into the EMR and never brought to her. She stated this was her first time working in a long-term care. She stated she has not had any training on how to complete an OOH DNR. She stated the potential negative outcome could be going against residents wishes. She stated the resident could receive CPR since the OOH DNR was not complete. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 9 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on [DATE] at 04:30 PM with the ADM, she stated Resident #39's OOH DNR was sent out to the physician to be signed. She stated the order for DNR should not be in the resident EMR until it was filled out. She stated the OOH DNR was not a valid order until it has a physician signature and filled out. She verified Resident #39's code status in EMR was DNR. She stated she does not know why the OOH DNR does not have a physician signature. She stated she was not aware of a system in place to monitor OOH DNR, but the SW was working on doing an audit. She stated the potential negative outcome could be providing CPR when he did not want it or not providing CPR when we did not have an order. She stated her expectations were for OOH DNR to be filled out complete and order not put into the EMR until OOH DNR has been verified. Record review of the facility policy titled Do Not Resuscitate Order dated [DATE] revealed the following: Policy Statement: Our facility will not use cardiopulmonary resuscitation and related emergency measures to maintain life functions on a resident when there is a Do Not Resuscitate Order in effect. Policy Interpretation and Implementation . 2. A Do not resuscitate (DNR) order form must be completed and signed by the Attending Physician and resident (or resident's legal surrogate as permitted by State law) and placed in the front of the resident's medical record . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 10 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that residents who need respiratory care were provided such care consistent with professional standards of practice for 4 of 18 residents (Resident #19, Resident #32, Resident #35, and Resident #45) reviewed for Respiratory Care. Residents Affected - Some 1. The facility failed to follow MD orders for initial and dating oxygen supplies/equipment for Resident #19 and Resident #32. 2. The facility failed to implement procedures that ensure the safe and sanitary use and storage of oxygen supplies/equipment for Resident #19, Resident #32, Resident #35, and Resident #45. 3. The facility failed to obtain MD orders for oxygen use for Resident #32, Resident #35, and Resident #45. These failures could affect residents by placing them at an increased risk of respiratory compromise, infections, pneumonia, respiratory distress, and sepsis. Findings include: Resident #19 Record review of Resident #19's face sheet dated [DATE] revealed a [AGE] year-old female with an admission date of [DATE] with the following diagnoses: Severe persistent asthma (severe breathing-related problems), morbid obesity (severely overweight), acute kidney failure (kidney condition), major depressive disorder (mental illness), other specified hypothyroidism (thyroid condition), and essential hypertension (high blood pressure). Record review of Resident #19's quarterly MDS dated [DATE] revealed resident #35 had a BIMS of 15, which indicated residents' cognitive status was cognitively intact. Additionally, Section O - Special Treatments, Procedures and Programs revealed Resident #19 used oxygen therapy while a resident. Record Review of Resident #19's Care Plan, dated [DATE], revealed Resident #19 used oxygen related to risk of respiratory infections/distress, hypoxia, shortness of breath, and cough related to DX of Chronic Obstructive Pulmonary Disease (COPD) and respiratory failure with hypoxia. Interventions included to apply oxygen as ordered. Record Review of Resident #19's current Physician Orders dated [DATE] revealed an order dated [DATE] to change humidifier bottle as needed, initial and date. Every night shift PRN, sign out only when changed. To change oxygen equipment and clean filters weekly on Sunday nights. (Every night shift, every Sunday). Resident #32 Record review of Resident #32's face sheet dated [DATE] revealed an [AGE] year-old female with an original admission date of [DATE] with the following diagnoses: heart failure, cerebrovascular disease (condition that affects blood flow to the brain), peripheral vascular disease (narrow blood vessels restrict blood flow to the limbs), atrial fibrillation (irregular, rapid heart rhythm), major (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 11 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some depressive disorder (persistent feeling of sadness), generalized anxiety disorder (feeling restless or worried) and hypertension (high blood pressure). Record review of Resident #32's admission MDS dated [DATE] revealed resident #32 had a BIMS of 14, which indicated residents' cognitive status was cognitively intact. Additionally, Section O - Special Treatments, Procedures and Programs revealed Resident #32 did not use oxygen therapy while a resident. Record Review of Resident #32's Care Plan, dated [DATE], revealed no care plan for oxygen. Record Review of Resident #32's current Physician Orders dated [DATE] revealed no order for oxygen administration. Additionally, orders revealed oxygen care were to change oxygen equipment and clean filter weekly on Sunday nights. Resident #35 Record review of Resident #35's face sheet dated [DATE] revealed a [AGE] year-old male with an admission date of [DATE] with the following diagnoses: stroke, peripheral vascular disease (narrowed blood vessels reduce blood flow to the limbs), and hypertension (high blood pressure). Record review of Resident #35's quarterly MDS dated [DATE] revealed resident #35 had a BIMS of 12 which indicated residents' cognitive status was moderately impaired. Additionally, Section O - Special Treatments, Procedures and Programs revealed Resident #35 used oxygen therapy while a resident. Record Review of Resident #35's Care Plan, dated [DATE], revealed no care plan for oxygen. Record Review of Resident #35's current Physician Orders dated [DATE] revealed no order for oxygen or oxygen equipment. Resident #45 Record review of Resident #45's face sheet dated [DATE] revealed a [AGE] year-old male with an admission date of [DATE] with the following diagnosis: dementia (cognitive loss), chronic respiratory failure with hypoxia (lack of oxygen in the tissue), diabetes (high blood sugar) and hypertension (high blood pressure). Record review of Resident #45's comprehensive MDS dated [DATE] revealed resident #45 had a BIMS Score of 04 which indicated residents' cognitive status was severely impaired. Additionally, Section O Special Treatments, Procedures and Programs revealed Resident #45 did not used oxygen therapy while a resident. Record Review of Resident #45's Care Plan, dated [DATE], revealed no care plan for oxygen. Record Review of Resident #45's current Physician Orders dated [DATE] revealed no order for oxygen or oxygen equipment. During an observation on [DATE] at 10:05 AM, Resident #19 was observed using oxygen via nasal cannula. Oxygen tubing and humidifier bottle were not labeled with date or initials. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 12 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an observation on [DATE] at 10:31 AM, Resident #45's oxygen concentrator was beside the head of bed with oxygen tubing wrapped around the humidification bottle. There was no date on the tubing or humidification water bottle. During an observation on [DATE] at 10:35 AM, Resident #35's oxygen concentrator was at the foot of bed with oxygen tubing laying on the floor. There was no date on the oxygen tubing. The date on humidification bottle was [DATE]. During an observation on [DATE] at 10:42 AM, Resident #32's oxygen concentrator was at the head of the bed with the nasal cannula laying on the floor. There was no date on the tubing or the humidification water bottle. During an observation on [DATE] at 12:15 PM, Resident #19 was observed using oxygen via nasal cannula. Oxygen tubing and humidifier bottle were not labeled with date or initials. During an observation on [DATE] at 04:38 PM, Resident #32's oxygen concentrator was at the head of the bed with nasal cannula laying on the floor. There was no date on the tubing or the humidification water bottle. During an observation on [DATE] at 9:48 AM, Resident #19's oxygen concentrator was beside the nightstand that was on the left side of the head of the bed. Oxygen tubing and humidifier bottle were not labeled with date or initials. Additionally, oxygen tubing and nasal cannula were observed lying on the floor with Resident #19's walker lying on top of the oxygen tubing and nasal cannula. During an observation on [DATE] at 10:07 AM, Resident #32's oxygen concentrator was at the head of the bed with the nasal cannula laying in the floor. There was no date on the tubing or the humidification water bottle. During an observation on [DATE] at 11:30 AM, Resident #45's oxygen concentrator was beside the head of the bed with the oxygen tubing wrapped around the humidification water bottle. There was no date on the tubing or the humidification water bottle. During an observation on [DATE] at 11:35 AM, Resident #35's oxygen concentrator was at the foot of the bed with the oxygen tubing lying on the floor. There was no date on oxygen tubing. The date on the humidification bottle was 2/1. During an observation on [DATE] at 11:42 AM, Resident #19's oxygen concentrator was beside the nightstand that was on the left side of the head of the bed. Oxygen tubing and humidifier bottle were not labeled with date or initials. Additionally, oxygen tubing and nasal cannula were observed lying on the floor with Resident #19's walker lying on top of the oxygen tubing and nasal cannula. During an interview on [DATE] at 9:30 AM, CNA A stated she did not change Resident #19's oxygen tubing and humidifier bottle. She stated she was trained that staff must follow physician's orders by dating and initialing oxygen tubing and humidifier bottles. She stated it was important for staff to date and initial oxygen tubing and the humidifier bottles when changing the equipment so staff can know how long the equipment has been in use and to know if the equipment was old. She stated there was no way for staff to know how long the equipment has been in use if it was not dated or initialed by the staff that changed it. She stated the negative effects of not labeling the tubing and humidifier bottle as ordered were that the equipment could be dirty and have germs that could cause (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 13 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0695 Level of Harm - Minimal harm or potential for actual harm sickness. She stated old equipment may not work properly and affect the resident's ability to breathe, which could cause additional respiratory problems. During an observation on [DATE] at 9:34 AM, Resident #19 was observed using oxygen via nasal cannula. Oxygen tubing and humidifier bottle were not labeled with date or initials. Residents Affected - Some During an interview on [DATE] at 9:35 AM, LVN A stated he has worked at the facility for four or five months. He stated staff change oxygen tubing and humidifier bottles weekly or when residents request it. He stated he did not know what specific day of the week staff change the oxygen equipment. He stated he observed Resident #19's tubing and humidifier bottle were not labeled with a date and initials. He stated he was trained to follow physician orders. He stated he was also trained to date and initial oxygen equipment when changing it and to place oxygen equipment in a plastic bag when not in use. He stated he would not be able to determine when Resident #19's oxygen equipment was last changed because the staff that changed it last did not label it with a date or their initials. He stated the oxygen equipment could be old and oxygen tubing on the floor could be dirty and both issues could cause an infection in the nose and lungs. He stated staff receives oxygen therapy training annually and as needed. During an interview on [DATE] at 11:15 AM, the ADON stated oxygen use requires an order for use and to change equipment. She verified Residents #35 and #45 did not have an order for oxygen use or equipment. She stated oxygen tubing should have a date on it. She stated oxygen tubing and humidification bottles were supposed to be changed weekly on Wednesdays. She stated oxygen tubing should be stored in a plastic bag. She stated all staff had been trained on oxygen therapy. She stated, oxygen tubing should not be on the floor. She stated a potential negative outcome of no orders for oxygen would be a resident receiving oxygen who didn't need it. She stated the potential negative outcome could be infection control and contamination. During an interview on [DATE] at 2:45 PM, the ADM stated the facility policy was that staff follow physician orders. She stated it was the responsibility of all nursing and clinical staff to follow physician orders, to ensure tubing was bagged, to ensure tubing was not left on the floor, and to ensure oxygen tubing was labeled with a date and initialed when changed. She stated she expected for staff to follow physician's orders and to document their observations and tasks in nursing progress notes in the resident's electronic health record. She stated she expected for new physician orders to be followed and relayed to the on-coming charge nurse for the next shift. She stated she expected all tubing to be bagged and not left on the floor. She stated nursing staff were expected to call the physician and get orders for oxygen if they feel a resident needs it, because staff cannot give residents oxygen without physician orders. She stated this must be done prior to giving oxygen to a resident. She stated the charge nurse, ADON, or DON could call the physician to get the orders. She stated there was no other monitoring system in place to ensure nursing staff obtain physician orders prior to giving resident's oxygen. She stated oxygen tubing and humidifier bottles were to be changed, dated, and initialed on Sunday nights. She stated she was not aware oxygen tubing and humidifier bottles were not being dated and initialed by nursing staff. She stated she was not aware oxygen tubing was left on the floor. She stated she was not aware residents were being given oxygen without physician orders. She stated she believes the former DON who left the facility in [DATE] provided training on oxygen equipment and respiratory care to nursing staff however, she was not sure if nursing staff have received any respiratory or oxygen equipment training since then. She stated there was another DON who worked at the facility from [DATE] to [DATE], but she does not know if they provided training on oxygen equipment and respiratory care to nursing staff during that time. She stated herself, the DON, and the ADON were all responsible for training staff to follow physician's orders, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 14 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0695 Level of Harm - Minimal harm or potential for actual harm storing, changing, dating, and initialing oxygen tubing and humidifier bottles. She stated it was important for oxygen equipment to be labeled with a date and staff initials to ensure the equipment was working properly and not expired. She stated a potential negative outcome was that it could cause physical harm such as illness or death to the resident. Residents Affected - Some Record review of a facility policy titled Oxygen Administration, dated 10/2010 revealed the following: Preparation: 1) Verify that there is a physician's order for this procedure. Review the physician's orders of facility protocol for oxygen administration. 2) Review the resident's care plan to assess for any special needs of the resident. 3) Assemble the equipment and supplies as needed . Equipment and Supplies: The following equipment and supplies will be necessary when performing this procedure. 1) Portable oxygen cylinder (strapped to the stand); 2) Nasal cannula, nasal catheter, mask (as ordered); 3) Humidifier bottle . Documentation: After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 15 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to use the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week for 5 out of 30 days (02/02/24, 02/03/24, 02/04/24, 02/08/24, and 02/12/24) reviewed for RN coverage. The facility failed to ensure they had RN coverage 8 hours a day, 7 days a week for the following days: 02/02/24, 02/03/24, 02/04/24, 02/08/24, and 02/12/24 This failure could place residents at risk for inconsistency in care and services. Findings include: Record review of the facility's employee roster dated 02/13/24 revealed there were 7 RNs employed at the facility (RN A, RN B, RN C, RN D, RN E, RN F). Record review of RN A's time sheets dated 02/14/24 for the dates 01/01/24 to 02/14/24 reflected no coverage for 02/02/24, 02/03/24, 02/04/24, 02/08/24, and 02/12/24. Record review of RN B's time sheets dated 02/14/24 for the dates 01/01/24 to 02/14/24 reflected no coverage for 02/02/24, 02/03/24, 02/04/24, 02/08/24, and 02/12/24. Record review of RN C's time sheets dated 02/14/24 for the dates 01/01/24 to 02/14/24 reflected no coverage for 02/02/24, 02/03/24, 02/04/24. On 02/08/24 time in was 06:11 PM and time out was 02:36 AM. On 02/12/24 time in was 06:28 PM and time out was 02:48 AM. Record review of RN D's time sheets dated 02/14/24 for the dates 01/01/24 to 02/14/24 reflected on 02/02/24 time in was 05:18 PM and time out was 06:19 AM. On 02/03/24 time in was 05:17 PM and time out was 06:10 AM. On 02/04/24 time in was 05:31 PM and time out was 06:14 AM. On 02/08/24 time in was 05:58 PM and time out was 06:14 AM. On 02/12/24 time in was 05:41 PM and time out was 06:38 AM. Record review of RN E's time sheets dated 02/14/24 for the dates 01/01/24 to 02/14/24 reflected no coverage for 02/02/24, 02/03/24, 02/04/24, 02/08/24, and 02/12/24. Record review of RN F's time sheets dated 02/14/24 for the dates 01/01/24 to 02/14/24 reflected no coverage for 02/02/24, 02/03/24, 02/04/24, 02/08/24, and 02/12/24. During an interview on 02/15/24 at 04:30 PM with the ADM, she stated she knew the following days did not have RN coverage for 8 consecutive hours: 02/02/24, 02/03/24, 02/04/24, 02/08/24 and 02/12/24. She stated she just did not realize at the time of scheduling it was not 8 consecutive hours. She stated the DON was responsible for scheduling RN coverage, but they currently do not have a DON. She stated the new DON will start on Monday (02/19/24). She stated the need to have a RN for 8 consecutive hours a day was to oversee the clinical part of the facility. She stated the potential negative outcome was not meeting the needs of the residents. She stated her expectations were to always have 8 hours of RN coverage a day. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 16 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0727 Level of Harm - Minimal harm or potential for actual harm On 02/25/23 at 01:00 PM survey requested policy on RN coverage from the ADM. No policy provided from facility. During exit conference on 02/15/23 at 6:00 PM the ADM was asked if she had any additional information to provide that was requested and she stated No, we do not. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 17 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 PRN orders for psychotropic drugs were limited to 14 days unless the attending physician or prescribing practitioner believed, and documented, that it was appropriate for the PRN order to be extended beyond 14 days for 2 of 18 residents (Resident #3 and #25) reviewed in that: Residents #3 and #25 continued to have a PRN order for Lorazepam 0.5mg after 14 days without an evaluation by the physician for continued treatment. This failure could result in residents receiving psychotropic and antipsychotic medications when contraindicated and could also result in residents experiencing adverse drug reactions. The findings include: Resident #3 Record review of Resident #3's face sheet, dated 02/14/24, revealed an [AGE] year-old-female who was admitted to the facility on [DATE] with diagnoses to include Alzheimer's disease (cognitive loss), Major depressive disorder (mental illness), hypertension (high blood pressure), and muscle weakness. Record review of Resident #3's comprehensive MDS , dated 11/28/23, revealed Resident #3 BIMS was a 0 which indicated resident was severely cognitive impaired. Section N - Medication Resident #3 had not received any antianxiety medication during the last 7 days. Record review Resident #3's care plan dated 12/15/23 revealed no care plan related to Lorazepam medication. Record review of Resident #3's physician order summary dated 02/14/24 revealed an order start date 01/04/24 with an indefinite end date for Lorazepam Oral Concentrate 2 mg/ml, give 0.5 ml by mouth every 6 hours as needed for pain, sob, anxiety. Order start dated 01/04/24 with an indefinite end date for Lorazepam Oral Concentrate 2 mg/ml, give 1 ml by mouth every 6 hours as needed for anxiety. Record review of Resident #3's PRN MAR dated 02/15/24 revealed Lorazepam Oral Concentrate 2 mg/ml, give 0.5 ml by mouth every 6 hours as needed for pain, sob, anxiety. Date 01/04/24 - open ended. Lorazepam Oral Concentrate 2 mg/ml, give 1 ml by mouth every 6 hours as needed for pain, sob, anxiety. Date 01/04/24 - open ended. No medication was administered for the month of February. Resident #25 Record review of Resident #25's face sheet, dated 02/13/2024, revealed [AGE] year-old female admitted to the facility on [DATE] with diagnoses to include vascular dementia with anxiety (problems with reasoning, planning, judgement, memory and other thought processes caused brain damage from impaired blood flow to the brain with a feeling of fear, dread, and uneasiness), major depressive disorder (persistently low or depressed mood, anhedonia decreased interest in pleasurable activities), and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 18 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 anxiety disorder (feeling of fear, dread, and uneasiness). Level of Harm - Minimal harm or potential for actual harm Record review of Resident #25's significant change MDS assessment dated [DATE] revealed Resident #25 had a BIMS of 04 which indicted residents' cognition was severely impaired. Section N - Medications revealed resident received antianxiety medications in the last seven days. Residents Affected - Few Record review Resident #25's care plan dated 01/18/24 revealed no care plan related to Lorazepam medication. Record review of Resident #25's physician orders revealed the following medications were prescribed: Lorazepam Oral Concentrate 2 MG/ML give 0.25 ml by mouth every 4 hours as needed for Moderate pain 0.25 to 0.5 ml prn q 4 hours order date 01/12/2024 and start date 01/12/2024 with no end date. Record review of Resident #25's PRN MAR dated 02/01/2024 - 02/29/2024 revealed resident received: Lorazepam oral concentrate 2mg/ml, give 0.25 ml by mouth every 4 hours as needed for moderate pain 0.25 to 0.5 ml prn q 4 hrs. Start date 01/12/2024, no mediation was documented given to Resident #25 from 02/01/24-02/15/2024. During an interview on 02/15/24 at 11:15 AM with the ADON, she stated Residents #3 and #25 did have an order for Lorazepam PRN with no stop date. She stated both residents were on hospice services. She stated she did not have any documentation related to Residents #3 or #25 being evaluated by the physician every 14 days. She stated all prn psychotropic medications should have a 14 day stop date. She stated the DON was responsible for monitoring PRN psychotropics, but since they do not have a DON at this time it was her responsibility. She stated she does not know the reason it why it has not stop date. She stated all nurses have been trained on PRN psychotropics. She stated the potential negative outcome could be administering medications when residents do not need them and could cause resident harm. During an interview on 02/15/24 at 04:30 PM with the ADM, she stated she was not aware they had PRN psychotropics without a stop date until today. She stated Lorazepam was a psychotropic medication. She stated the DON was responsible for monitoring prn psychotropics but they do not have a DON, so it was the ADON responsibility. She stated the PRN psychotropic need to be evaluated every 14 days to make sure it was helping or if there needed to be changes. She stated the potential negative outcome could be altered mental status. She stated she does not know why there was not stop date put on the orders for Resident #3 and #25. Record review of the facility policy titled Antipsychotic Medication Use dated December 2016 revealed the following: Policy Interpretation and Implementation . 13. Residents will not receive PRN doses of psychotropic medications unless that medication is necessary to treat a specific condition that is documented in the clinical record. 14. The need to continue PRN orders for psychotropic medications beyond 14 days requires that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 19 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 practitioner document the rationale for the extended order. The duration of the PRN order will be indicated in the order. Level of Harm - Minimal harm or potential for actual harm 15. PRN orders for antipsychotic medications will not be renewed beyond 14 days unless the healthcare Residents Affected - Few practitioner has evaluated the resident for the appropriateness of that medication. 16. The staff will observe, document, and report to the Attending Physician information regarding the effectiveness of any interventions, including anti-psychotic medications . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 20 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 - Few 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 ensure all drugs and biologicals were stored properly for 1 of 2 medication carts (medication cart for hall 100-200), and 1 of 1 medication storage rooms. 1. The medication cart assigned to hall 100-200 had loose pills. 2. An expired medication was stored in the refrigerator in the medication storage room. These failures could place residents at risk of not receiving prescribed medications as ordered, receiving medications that are less effective or have altered composition, and drug diversions. The findings include: 1. During an observation on 02/14/24 at 09:34 AM of the medication cart for hall 100-200 with CMA A, two loose pills were found in the medication cart drawer. CMA A placed the loose medications in a dispensing cup and the ADON identified the medications as claritin and gabapentin, using a medication identification app. Observed the ADON destroy both loose medications in a cup of liquid, place in a biohazard bag and place in box of medications to be destroyed in the ADON office. During an interview on 02/14/24 at 09:44 AM with CMA A, she stated she wasn't sure why there were loose medications on the cart. She stated sometimes they get knocked out of the blister packs when lots of cards were in the drawers. She stated it was her responsibility to check the medication cart for loose medications before every shift. She stated a potential negative outcome of loose medications on the medication cart would be that the resident may miss the dose of medication. During an interview on 02/15/24 at 09:27 AM, the ADON stated there should not be loose medications on the medication cart. She stated it was her responsibly to train staff on proper storage of medications on the cart. She stated training was conducted through in services and spot checks of medication carts. She stated it was her expectation of staff to check medication carts twice daily for loose medications. The ADON stated a potential negative outcome of loose medications on the cart would be cross contamination of medications. During an interview on 02/15/24 at 02:39 PM, the ADM stated there should not be any loose medications on the cart. She stated the policy when loose medications were found, was to notify the DON/ADON immediately. She stated staff were trained on proper medication storage by the ADON. The ADM stated a potential negative outcome of loose medications on the medication cart would be drug diversion and residents possibly not getting medications. 2. During an observation on 02/14/24 at 2:34 PM of the medication storage room with CMA B, a vial of expired Insulin Aspart was found in the medication storage refrigerator. The expiration date on the vial was observed to be 02/03/24. CMA B verified that the medication was expired. The vial of insulin was given to the ADON for destruction. During an interview on 02/14/24 at 02:48 PM with CMA B, he stated there should not be expired medications in the storage room. He stated it was the responsibility of the nursing staff to ensure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 21 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 - Few medications were in date and removed when out of date. He stated he has been trained by the ADON to monitor the expiration dates for medications in the storage room. He stated a potential negative outcome of administering expired medications would be the resident getting sick. During an interview on 02/15/24 at 09:27 AM, the ADON stated there should not be expired medications in the medication storage room. She stated it was her responsibly to train staff on proper storage of medications. She stated training was conducted through in services and spot checks of medication in the storage room. She stated it was her expectation for all nursing staff to monitor and check for any expired medications in storage. The ADON stated the facility had recently hired a nurse to help with monitoring medications on carts and in storage areas. The ADON stated a potential negative outcome of expired medications in the storage room would be the resident could potentially receive a medication that was not the correct strength. During an interview on 02/15/24 at 02:39 PM, the ADM stated there should not be any expired medications stored in the medication room. She stated the policy when expired medications were found was to remove the medication and take it to the DON/ADON immediately. She stated staff are trained on proper medication storage by the ADON. The ADM stated a potential negative outcome of expired medications in the storage room would be residents not getting correct medications which could have a bad outcome for the resident. Record review of facility provided policy labeled, Storage of Medications, date revised in April 2007, revealed: Policy Statement: The facility shall store all drugs and biologicals in a safe, secure and orderly manner. Policy Interpretation and Implementation: 1. Drugs and biologicals shall be stored in the packaging, containers or other dispensing systems in which they are received. Only the issuing pharmacy is authorized to transfer medication between containers. 2. The nursing staff shall be responsible for maintaining medication storage AND preparation areas in a clean, safe, and sanitary manner. 4. The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 22 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 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 service safety in two of two kitchens reviewed for dietary services. 1. The facility failed to ensure pureed foods were prepared under sanitary conditions in that the food processor was dried with paper towels and water from faucet of the 3-compartment sink was liquid used to in the puree. 2. The facility failed to ensure serving utensils were stored properly in that the ice scoop was not stored properly. 3. The facility failed to ensure prepared food was covered properly before serving in that desserts and drinks were not covered while sitting under shelving. 4. The facility failed to ensure refrigerator food items were stored and dated properly. 5. The facility failed to ensure equipment was safe to use in that the dietary staff used a writing pen to push in a button on the food processor to run. These failures could place residents at risk for food contamination and foodborne illness. The findings included: The following observations were made in the preparation kitchen tour on 2/13/24: At 9:20 AM observed the end of a stick of butter was exposed and not covered in the far-left refrigerator. At 9:24 AM observed a pre-cooked ham in a zipper plastic bag with no date in the middle refrigerator. In an interview and observation on 02/13/24 at 9:27 AM, the DM stated she was continuing telling the staff to date food and make sure the food was covered properly; observed DM throwing away the butter, taking the ham out and dating it. At 11:20 AM observed [NAME] A prepare to puree the beef stroganoff meat; [NAME] A stated he wanted the puree to look like mashed potatoes. At 11:22 AM, the DM hollered across the kitchen telling [NAME] A that the puree should look like mashed potatoes. In an interview at 11:25 AM, [NAME] A stated he does not taste the puree of the foods he puree, he stated he goes by look. At 11:30 AM Interview and observation revealed [NAME] B coming out of the dish washing room drying the bowl, lid, and blade of the food processor with paper towel. [NAME] B stated he was having to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 23 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 dry the food processor equipment with a paper towel so he could start his dessert puree. He said he knew it should air dry, but they were running behind. In an interview at 11:35 AM, [NAME] B stated he does not taste the puree food that he has pureed. At 11:37 AM Interview and observation revealed [NAME] A pureed noodles in a smaller food processor and used a writing pen inserted in the slot on the bowl where the lid sits to make the machine work. [NAME] A stated this was his fifth day and this was how he has used the machine every time, [NAME] continued to state they had very little training from the facility regarding preparing food. At 11:55 AM Interview and observation revealed dietary staff put metal pans of covered food on a cart and [NAME] A took the cart to the serving kitchen which was in another part of the building. [NAME] A stated he had not had much training. At 12:00 PM observed CNA staff serving drinking glasses from a cart and picking them up by the top of rim using bare hands and serving them to resident in the dining room. No observation of hand washing or use of ABHR between residents. Observation on 02/13/24 in the serving kitchen revealed as follows: At 12:05 PM observed an open plastic bag with tortillas with no date in the refrigerator. At 12:06 PM observed the ice scoop sitting on the cart with ice chest. At 12:07 PM observed the microwave with brown dried puddles on the sides of the microwave and the turn table plate along with several crumbs. At 12:10 PM observation and interview revealed [NAME] A & B began to put the metal pans of food on to the steam table and take off the coverings. [NAME] A started to plate a plate. Surveyor asked if foods were temped before serving, The DM stated, all food was temped in the preparation kitchen, but we can tempt again. The following temps of the food were as follows: At 12:17 PM Sliced Ham was 133°F. [NAME] A took the ham back to the preparation kitchen to bring up to temperature. At 12:35 PM, the ham was served and appeared burned and dry. On 02/14/2024 at 10:00 AM, a sample tray was requested by survey team. The following observations were made in the preparation kitchen on 02/14/24: Observed a metal pan with blueberry pie filling with aluminum covering was torn open exposing the food to air. Observed a paper cardboard box of lemons sitting on top of a metal pan of prepared gelatin; the pan of gelatin had a thin piece of plastic wrap over the top that was not secured tight. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 24 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 Observed [NAME] C at 11:22 AM get hot water out of the faucet from the 3-compartment sink and add to the pork that was being pureed. Observed [NAME] C at 11:25 AM pouring the pureed meat into a metal pan and covered with aluminum covering and placed it in the oven. Residents Affected - Many In an interview on 02/14/24 at 11:26 PM, [NAME] C stated, I never taste the puree, I taste the food before I put in the food processor. At 11:15 AM, [NAME] C began to put the metal pans of food on to the cart and took the cart to the serving kitchen in another part of the building at 11:30 AM. At 11:35 AM, [NAME] C began putting the metal pans of food on the steam table and took the aluminum covering off the pans of food. Observed at 11:35 AM, DS B put the tray with uncovered puree desserts bowls on the second shelf of the four-shelving unit. DS A put trays with uncovered desserts plates on a shelving unit that had three shelves, trays were on the top, middle and bottom shelf (close to the floor). At 11:40 AM observed DS A & B pouring drinks into cups and placed the trays on a top shelf cart uncovered and placed cartons of milk on a tray on the bottom shelf (no ice). In an interview at 11:45 AM, DS B stated this was his first day; he stated he had not had any dietary experience. In an interview at 11:46 AM, DS A stated she had been at that facility for 2 weeks; she had worked in another nursing facility kitchen prior to this job. At 12:00 PM observed CNA A picking up drink glasses from top of rim using bare hands and serving them to residents in the dining room. Observed CMA A picking up glasses from top of rim using bare hands and placing glasses on resident's hall trays before placing hall tray in hall cart. No observation of hand washing or use of ABHR between residents. At 12:08 PM observed [NAME] C started plating plates and did not take temps of the food before serving. In an interview at 12:09 PM, [NAME] C stated he took the temps in the preparation kitchen as he took the pans out of the oven and before he pureed the food. Survey team took the temperature with of a carton of milk that came off the cart, temperature was 52.4°F. During an interview on 02/14/24 at 04:45 PM with CNA A, she stated she had been trained on how to serve residents. She stated she did pick up drinking glasses from the top rim from the serving cart. She stated she should have picked the glass up by grabbing the side of glass but was not able to because the cart was full of glasses. She stated the potential negative outcome could be cross contamination and could make the residents sick. During an interview on 02/14/24 at 04:54 PM with CMA, A she stated she had been trained to pick up (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 25 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 drinking glasses from the bottom of the glass. She stated she did not know why she picked up the glass from the rim. She stated the potential negative outcome could be cross contamination, spread infection and make residents sick. In an interview on 02/15/2024 at 4:15 PM, DM stated food should be temped checked on the steam table before serving, and puree should be tasted to make sure the consistency was of pudding texture. The DM stated she will in-service staff on washing dishes, air drying, temping food on steam table before serving, and to taste the puree for consistency. She stated not smooth puree could cause choking for those who require puree food. In an interview on 02/15/24 at 04:43 PM, the ADM stated drinking glasses were not to be served to resident by picking them up from the top rim. ADM stated all staff have been trained on how to properly serve drinks. She stated drinks should be served by grabbing the side of glasses and handing to residents. She stated administrative staff and nurses were responsible for monitoring staff. She stated the potential negative outcome was spread of infection to residents. She stated her expectations were for staff to be careful and make sure they were handling them correctly to prevent infection. In an interview on 02/15/2024 at 5:00 PM, the ADM stated the DM was overall responsible of the kitchen staff, their training and the quality of the food. The ADM continued to state that she will notify the registered dietitian about training of dietary staff on proper procedure for cooking, tempting, puree and washing dishes. The ADM stated she will order a new food processor and other equipment the kitchen needs. Record review policy titled Resident Nutrition Service revised date July 2017 revealed: Policy Statement Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident. Policy Interpretation and Implementation 1. The multidisciplinary staff, including nursing staff, the Attending Physician and the Dietitian will assess each resident's nutritional needs, food likes, dislikes and eating habits. They will develop a resident care plan bases on this assessment . 4. Nursing personnel or feeding assistants will inspect food trays as they are delivered to ensure that correct meal has been delivered, that the food appears palatable and attractive, and it is served at a safe and appetizing temperature. No other policies were presented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 26 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 and to help prevent the development and transmission of communicable diseases and infections for 7 of 18 residents (Residents #7, #29, #39, #41, #45, #46, #47) and 4 of 4 staff (CMA A, CMA B, CNA C, CNA B) reviewed for infection control. Residents Affected - Some 1. CMA A failed to properly clean multi-use equipment between each resident. 2. CMA A failed to sanitize hands between residents during medication administration for Resident #29 and Resident # 46. 3. CMA B failed to properly clean multi-use equipment between each resident. 4. CNA C failed to change gloves when providing incontinent care for Resident #39. 5. CNA B failed to perform hand hygiene before and after incontinent care for Resident #45 and Resident #47. CNA B failed to change gloves when providing incontinent care for Resident #45 and Resident #47. These failures could place residents at risk for spread of infection and cross contamination. Findings include: 1. During a medication pass observation on 02/14/24 at 08:45 AM, CMA A took a wrist blood pressure device to Resident #41, who was seated at a dining table, and took her blood pressure on the left wrist. She then took the wrist blood pressure device and placed it on top of the medication cart. Observed CMA A wash her hands at a sink in the dining room. CMA A prepared medications for Resident #29 and took the wrist blood pressure device to Resident # 29's room and took his blood pressure on the right wrist. She took the wrist blood pressure device and placed it on top of the medication cart. CMA A picked up the wrist blood pressure device from the top of medication cart and went to Resident #46, who was coming out of the dining room, and took his blood pressure on the left wrist. She then took the wrist blood pressure device back to the medication cart and placed it on top of the cart. No observation of CMA A sanitizing the blood pressure device between residents. 2. During an observation of medication pass on 02/14/24 at 08:53 AM, CMA A washed her hands then prepared medications for Resident #29. CMA A entered the room of Resident #29 and administered his medications. CMA A did not sanitize her hands after medication administration. CMA A prepared medications for Resident # 46 and administered his medications. No observation of hand hygiene before or after administering medications to Resident #46. During an interview on 02/14/24 at 05:03 PM, CMA A stated she should have sanitized her hands between each resident during medication pass. She stated she should have sanitized the blood pressure cuff before and after use on each resident. CMA A stated she has received training from her ADON for hand hygiene and medical device sanitizing and she's not sure why she failed to do those things during the observation. She stated training is done through in-services every month. CMA A stated a potential negative outcome of these failures would be cross contamination. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 27 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 3. During a medication pass observation on 02/14/24 at 08:45 AM, CMA B took the blood pressure cuff into Resident #31's room and took blood pressure on left wrist. CMA B exited Resident #31's room with the blood pressure cuff in hand and placed it on top of the medication cart. No observation of cleaning blood pressure cuff. CMA B took the blood pressure cuff into Resident #7's room and took blood pressure on Resident #7's left wrist. CMA B exited the room with blood pressure cuff in hand and placed it on top of the medication cart. No observation of cleaning blood pressure cuff between residents. During an interview on 02/15/24 at 11:04 AM with CMA B, he stated he forgot to clean blood pressure cuff between Resident #31 and #7. He stated he should have cleaned it between residents and before placing it on the medication cart. He stated he has been trained to clean multi use equipment between residents. He stated the potential negative outcome could be cross contamination and spreading infection between residents. During an interview on 02/15/24 at 09:27 AM, the ADON stated the policy for sanitizing hands between residents during medication pass and for sanitizing medical equipment was that staff should be performing hand hygiene between each resident and should be sanitizing medical equipment between each resident. She stated staff were trained through in-servicing monthly and on an on-going basis. The ADON stated a potential negative outcome of failure to sanitize hands and medical equipment would be infection. During an interview on 02/15/24 at 2:39 PM, the ADM stated medical equipment should be sanitized between each resident. She stated hand hygiene should be performed before and after administering medications to a resident. She stated the ADON was responsible for training staff on medical equipment sanitizing and hand hygiene. She stated her expectation of staff is that they always follow the policy of the facility. The ADM stated a potential negative outcome of failure to sanitize medical equipment and failure to perform hand hygiene between residents during medication administration would be infection. 4. Record review of Resident #39 face sheet, undated, revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses to include: cerebral infarction (stroke), diabetes mellitus (uncontrolled blood sugar), dysphagia (difficulty swallowing), hemiplegia (paralysis of one side of the body) and moderate dementia (loss of intellectual functioning). Record review of Resident #39's MDS Quarterly assessment dated [DATE] revealed resident has a BIMS score of 07, indicating resident was moderately cognitively impaired. MDS section H revealed Resident #39 was frequently incontinent of bowel and bladder. Record review of Resident #39's care plan dated 03/07/22 revealed resident was incontinent and required assistance with incontinent care. During an observation of incontinent care on 02/14/24 at 04:15 PM for Resident #39, CNA C remove the resident's brief and performed male incontinent care. CNA C rolled the resident to his right side and cleaned the buttocks with wipes. CNA C removed dirty brief and incontinent wipes and placed them in the trash. CNA C then placed a clean brief on the resident and pulled the sheet back up over the resident. No observation of CNA C changing gloves during the procedure. During an interview on 02/14/24 at 4:27 PM, CNA C stated she did not remove gloves or sanitize hands between performing dirty and clean aspects of incontinent care for Resident #39. She said the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 28 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 proper time to remove gloves was after performing incontinent care and before applying a clean brief or when gloves become visibly soiled. CNA C stated she just forgot to change gloves during care. She stated she has been trained by the staffing coordinator at the facility, but she does not recall when. CNA C stated a potential negative outcome for failure to change gloves during incontinent care would be that the clean brief was contaminated, and the resident could get an infection. Residents Affected - Some 5. Record review of Resident #47's face sheet dated 02/20/24 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of: peripheral vascular disease (narrow vessels reduce blood flow to limbs), diabetes mellitus (uncontrolled blood sugar), schizoaffective disorder (schizophrenia and mood disorder), Parkinson's disease (disorder of central nervous system), and anxiety (worry and fear). Record review of Resident #47's MDS dated [DATE] revealed resident has a BIMS score of 09, indicating mildly impaired cognition. MDS section H-revealed Resident #47 was frequently incontinent of bowel and bladder. Record review of Resident #47's care plan dated 03/08 22 revealed resident required daily assistance with all activities of daily living. During an observation of incontinent care on 02/15/24 at 10:46 AM for Resident #47, CNA B failed to sanitize her hands prior to beginning incontinent care. Observed CNA B perform female incontinent care with incontinent wipes on Resident #47. CNA B rolled the resident to her right side and cleaned the buttocks with wipes. CNA B removed dirty brief and incontinent wipes and placed them in the trash. CNA B then placed a clean brief on the resident. No observation of CNA B changing gloves during the procedure. Record review of Resident #45's face sheet dated 02/20/24 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of: dementia (loss of intellectual functioning), chronic respiratory failure (inability of lungs to pass oxygen to bloodstream) with hypoxia (low blood-oxygen level), diabetes mellitus (uncontrolled blood sugar), metabolic encephalopathy (chemical imbalance affecting the brain) and muscle weakness. Record review of Resident #45 MDS dated [DATE] revealed resident has a BIMS score of 05 indicating severe cognitive impairment. MDS Section H-revealed Resident #45 was always incontinent of bowel and bladder. Record review of Resident #45's care plan dated 12/09/23 revealed resident requires monitoring every two hours and as needed for incontinent episodes. Resident #45 requires incontinent care after each episode of bowel and bladder incontinence. During an observation of incontinent care on 02/15/24 at 11:02 AM for Resident #45, CNA B failed to sanitize her hands prior to beginning incontinent care. Observed CNA B perform male incontinent care with incontinent wipes on Resident #45. CNA B rolled the resident to his left side and cleaned the buttocks with wipes. CNA B used multiple incontinent wipes to remove feces from the buttocks and scrotal area of the resident. CNA B removed dirty brief and incontinent wipes and placed them in the trash. CNA B then placed a clean brief on the resident, placed the sheet up to the resident's chest level and rolled the resident's bedside table back toward the bed. No observation of CNA B changing gloves during the procedure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 29 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 During an interview on 02/15/24 at 11:09 AM, CNA B stated she thought she sanitized her hands with hand sanitizer in the hallway before beginning incontinent care, but she couldn't remember. CNA B stated she did not change her gloves between clean and dirty aspects of incontinent care because she had never been told that she was supposed to. CNA B stated she had not been trained by the facility to change gloves during incontinent care. CNA B stated a potential negative outcome of failing to change gloves between dirty and clean aspects of incontinent care would be the resident could get sick. During an interview on 02/15/24 at 11:15 AM, the ADON stated gloves should be changed between clean and dirty aspects of incontinent care and when gloves were visibly soiled. She stated hands should be sanitized after every glove change, prior to putting on a new pair of gloves. The ADON stated staff were trained by in-services monthly and as needed and through periodic skills checks. She was not able to recall the date of the last skills check. The ADON stated a potential negative outcome of failure to change gloves and perform hand hygiene before, during and after incontinent care would be infection. During an interview on 02/15/25 at 02:39 PM, the ADM stated gloves should be changed between dirty and clean portions of incontinent care and hands should be sanitized after every glove change. She stated staff have been trained by the ADON through in-services. The ADM stated her expectation of staff was to always follow policy. The ADM stated a potential negative outcome of failure to change gloves and perform hand hygiene before, during and after incontinent care was infection. Record review of the facility's policy titled Infection Control Guidelines for all Nursing Procedures; revised August of 2012 revealed: Purpose: To provide guidelines for general infection control while caring for residents. General Guidelines: 3. Employees must wash their hands for ten (10) to fifteen (15) seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: a. Before and after direct contact with residents; c. After contact with blood, body fluids, secretions, mucous membranes, or non-intact skin; d. After removing gloves; e. After handling items potentially contaminated with blood, body fluids, or secretions; 4. In most situations, the preferred method of hand hygiene is with an alcohol-based hand rub. If hands are not visibly soiled, use an alcohol-based hand rub containing 60-95% ethanol or isopropanol for the all the following situations: a. Before or after direct contact with residents; f. Before moving from a contaminated body site to a clean body site during resident care; g. After contact with a resident's intact skin; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 30 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 j. After removing gloves; Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled Handwashing/Hand Hygiene revised August of 2015 revealed: Residents Affected - Some Policy Statement: This facility considers hand hygiene the primary means to prevent the spread of infections. Policy Interpretation and Implementation: 2. All personnel shall follow the hand washing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents and visitors. 7. Use an alcohol-based hand rub containing at least 62% alcohol; Or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: b. Before and after direct contact with residents; h. Before moving from a contaminated body site to a clean body site during resident care; i. After contact with a residence intact skin; m. After removing gloves; 8. Hand hygiene is the final step after removing and disposing of personal protective equipment. 9. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare associated infections. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 31 of 32 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 676163 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Post Acute Care 4510 27th St Lubbock, TX 79410 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview and record review, the facility failed to provide at least 80 square feet per resident in multiple resident bedrooms for 4 (Rooms #407, 602, 604 and 611) of 48 semi-private rooms reviewed for physical environment. The facility failed to ensure resident Rooms #s 407, 602, 604 and 611 met the required minimum of 80 square feet per resident. This failure could place residents at risk of crowding and cause difficulty in providing resident care. Findings include: Record review of CASPER 3(facility assessment report) during preparation for survey revealed a waiver for room size requirements had been done yearly by the facility. Record review of Room Size Wavier for Facilities dated 12/15/22, during preparation for survey, revealed a wavier for rooms #s 407, 602, 604, and 611. Record review of Texas Health and Human Services Form 3740 (Bed Classifications (Numbers and Location) dated 02/15/24 documented that rooms #'s 407, 602, 604 and 611 were listed as a Title 18/19 bed classification semi-private rooms for two residents. During an interview on 02/13/24 at 09:15 AM with the ADM regarding the square footage for room #'s 407, 602, 604 and 611. When asked if she wanted to continue the room wavier for the room size waiver she stated, Yes, I want to continue the room waiver. The ADM stated room #'s 407, 602, 604, and 611 had a waiver in the past. She stated, the rooms are not being used at this time but will if they open that unit back up. During an observation on 02/15/24 from 1:00 PM to 1:30 PM, of the following rooms: Rooms 407,602, 604 and 611 revealed they were not occupied. During an interview on 02/15/24 at 1:35 PM with the ADM, regarding the risk of residents not having the appropriate space, she stated it had not been a problem in the past . Record review facility policy titled Bedrooms dated May 2017 revealed the following: Policy statement: All resident are provided with clean, comfortable, and safe bedrooms that meet federal and state requirements . 2. Bedrooms measure at least 80 square feet of space per resident in double rooms, and at least 100 square feet of space in single rooms. (Note: Individual variations on this may be permitted by federal authorities if it is demonstrated that the variation is in accordance with special needs of the resident and will not adversely affect the resident's health and safety.) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676163 If continuation sheet Page 32 of 32