Health inspection·May 18, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 05/18/23 at 11:57 AM the DON said her expectation on cell phone use was not to have the staff using the cell phone while in a resident room at all. The DON said if the staff had to take a call they could step into the 'cut out' (storage space on the hallway) or go to the break room. She said her expectation was staff not be on social media while on duty. The DON said she did not want staff on their phones while residents were in the shower, especially not hiding in the shower room having a long conversation. The DON said she monitored for cell phone use by making rounds which was usually every couple hours. The DON said she wouldn't like it if the staff were on the phone while they were taking care of her and it would make her upset and mad and sad, that the staff did not have their full attention on her during care. The DON said she was frustrated about the cell phone use because they had a major in-service about cell phone use in the bathrooms. She said it occurred because of one of the resident council meetings. Observation on 05/18/23 02:56 PM revealed NA J in front of the nurse's station standing behind Resident #32 on the phone. Review of the Resident Council Minutes, dated 4/11/23, revealed 21 residents attended and they informed the facility that the residents were not changed in a timely manner; and CNAs told residents to use restroom in pull -up or brief and the CNA would change the resident later. Review of the in-service dated 4/12/23 revealed: Residents are to be changed every 2 hours and as needed. The staff could not tell residents to use restroom on themselves. Review of the Resident Council Minutes, dated 5/3/23, revealed the residents communicated to the facility that CNAs were always on the phone and have their headphones in. Review of the in-services, dated 5/3/23, revealed phones are to only be used on break times and are to only be out in breakroom or outside of the facility. No phones in common areas or res areas. Ear pods /headphone are not to worn . We have to be able to focus on our jobs and be able to direct all of our attention to the residents. Review of the Complaint Book documented: On 2/2/23 Resident #21 reported staff were rude and left her in the bathroom alone. She also communicated the staff refused to change her when she was wet. On 4/12/23 Resident #4 told an aide Resident #4 needed to go use the bathroom. Resident #4 communicated the aide totally ignored Resident #4 and the aide said no, no go to the dining room. The complaint form documented Resident #4 got upset. The follow up documented the aide was counseled that if any resident asks to go to the restroom the aide needed to take the resident and not to ignore the resident. Review of In-services documented: 1/28/23 Ear buds - ear buds are not permitted inside of facility. 2/6/23 staff were in-serviced on Resident Rights and Statement of Resident Rights. 2/28/23 partially covered Statement of Resident Rights (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 2 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0550 3/6/23 partially covered the Statement of Resident Rights Level of Harm - Minimal harm or potential for actual harm 3/9/23 Statement of Resident Rights 3/18/23 Both the Resident [NAME] of Rights and the Statement of Resident Rights Residents Affected - Some 4/27/23 Phones: Do not be hiding in closets on phone Review of the Statement of Resident Rights posted in the facility and in staff orientation book documented: 4. Residents had the right to be treated with courtesy, consideration, and respect. Review of the [NAME] of Rights: the resident has a right to a dignified existence and self-determinization. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 3 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 2 of 2 residents (Resident #5 and #310) reviewed for accident/hazards/supervision, in that: LVN E and CNA F transferred resident #310 from his wheelchair to his bed by hooking their arms under the resident's armpits and without the use of a gait belt. CNA I and CNA H transferred Resident #5 from her bed to her wheelchair by hooking their arms under the resident's armpits and with the improper use of a gait belt. These failures could put residents at risk of accidents and serious injuries which could result in a reduced quality of life. The findings included: Review of Resident #5's admission Record, dated 5/17/23, revealed she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses which included cellulitis of the right lower limb, arthritis, muscle weakness, hemiplegia (paralysis on one side), and stroke. Review of Resident #5's quarterly MDS Assessment, dated 4/10/23, revealed: Cognitive Ability was not assessed. She needed extensive assistance of two staff for transfers. She had range of motion impairment on one side of the lower extremity and used a wheelchair. Review of Resident #5's care plan, revised 2/12/19, revealed: Problem - Resident #5 has an ADL self-care performance deficit related to stroke. Goal - The resident will maintain current level of function through the review date. Interventions - Transfer - The resident needs extensive assistance with this task. Review of Resident #5's Care Plan, initiated 10/11/22 revealed: Problem - Resident Requires assist with ADLs. Goal - Resident is able to perform self-care to optimal level and maintains strength and endurance for 90 days. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 4 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0689 Interventions - provide level of support to complete transferring needs every shift. Level of Harm - Minimal harm or potential for actual harm Review of Resident #5's ADL Flow Sheet on Transfers for 5/5/23 through 5/17/23 revealed Resident helped stand without plopping nine times and Resident #5 did not help with the transfer 19 times. Residents Affected - Some Observation on 5/15/23 at 11:10 AM revealed Resident #5 needed help sitting up in bed. The aides helped her sit up and CNA I set the wheelchair up at the end of the bed and locked the wheels. CNA H put the gait belt around Resident #5. Both aides (CNA I and CNA H) hooked their arms under Resident #5's arms, grabbed the back of the gait belt and helped Resident #5 stand. The gait belt slid up to the bottom of Resident #5's shoulder blades. Resident #5 had difficulty staying in a standing position as her legs shook. The aides assisted Resident #5 in pivoting and sitting in the wheelchair. Review of Resident #310's admission Record dated 5/16/23 revealed that he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses which included malignant neoplasm of unspecified lung, malignant neoplasm of bone, orthopedic aftercare, aftercare following surgery for neoplasm, unspecified fracture of T9-T10, neoplasm related pain, and stroke. Review of Resident #310's admission MDS assessment dated [DATE], revealed: He scored a 15 on his mental status exam (indicating he was cognitively intact). He required extensive assistance with mobility ADLs and moderate assistance with all other ADLs. He used a wheelchair for mobility. He had spinal (involving lamina, discs, or facets) and other orthopedic (repair fractures of the pelvis, hip, leg, knee, or ankle) surgery in the 100 days prior to admission. Review of Resident #310's Baseline Care Plan initiated 5/11/23, revealed: Problem - Resident requires assist with ADLs Goal - Resident is able to perform self-care to optimal level and maintains strength and endurance for 90 days Interventions - Encourage independence in performance of self-care and mobility within limitations; Provide level of support to complete dressing, toilet use, personal hygiene, and bathing needs every shift; Therapy to evaluate and treat if indicated. Observation on 05/15/23 at 03:18 PM revealed Resident #310 required assistance getting into bed after incontinent care performed in his bathroom. LVN E positioned the resident's wheelchair at the bedside and locked both wheels. LVN E made sure that the footpath was clear of any trip hazards. LVN E came to Resident #310's right side and CNA F came to his left side. LVN E placed his arm under the resident's right armpit and CNA F placed her arm under the resident's left armpit and together they lifted Resident #310 out of the wheelchair by his arms and pivoted him in a half circle and placed him on his bed. LVN E and CNA F then repositioned Resident #310 until he was comfortable in the bed. There was no gait belt used during this transfer. In an iInterview on 05/17/23 at 11:47 AM, the DON was asked how staff is trained to perform a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 5 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some two-person transfer. She stated the resident must be weight bearing. The staff would sit the resident up, put a gait belt around them, and the resident's feet should be on the floor. She stated staff could hook their arm under the resident's arm if the staff's weight was on the gait belt and not used to pull someone up by their arm. She stated that any time staff used their arms to hook under a resident's arms to transfer, they should be using a gait belt for the transfer. The DON stated that all transfers should be done with a gait belt, so they had something to hold onto if the resident fell. Regarding Resident #5, DON was informed of the observed transfer in which the gait belt was not tight enough and the staff were pulling the resident by her arms, and the observation of the resident's leg shaking while trying to bear weight. DON stated I don't have her as a mechanical lift. I don't remember her being on a mechanical lift. She had been on therapy recently She gets physical therapy right now. In an interview on 05/17/23 at 12:00 PM, the DON stated that the facility determined the type of transfer by whether the resident was an unreliable weight-[NAME]. She explained that if the resident could stand but the staff knew the resident would drop in the middle of a transfer, they would assign the resident a mechanical lift. She stated most of time we have therapy come and they determine who uses a mechanical lift or sliding board, those kinds of things. If they come in with an order for non-weight bearing, we'll go by the order, then if we're unsure of that we'll contact therapy. In the mean time we'll use a mechanical lift. We have therapy assess them as needed. Surveyor requested the policy and any in-services on transfers completed in the previous three (3) months. In an interview on 05/17/23 at 01:08 PM, the DOR stated that regarding staff training she did transfers, any specific resident needs which could be positioning or equipment. She stated when she trained staff to do two-person transfers she wanted them to make sure the area was clear, use a gait belt, and make sure the wheels were locked on whatever transferring to and from (wheelchair/shower chair, mechanical lift). DOR stated she trained staff that during transfers the correct positioning for a two-person transfer was one person in front and the second person to assist on the side, one person grabbed both sides in back, while the other person grabbed in the middle of the back and the resident's open side. DOR stated she did not train staff to do a hug transfer because they were unsafe for the staff and the resident. She stated if the resident can hold the person's hug , it would prevent them from performing the task and if they were not able to take hold of the staff's arms, she would expect staff to put on a gait belt and the resident to hold onto the staff by their bicep . She stated that she did not like to transfer by the arms because the risk to the resident could be dislocation of shoulder, discomfort, and it was not safe. She stated that long term residents were reassessed at least quarterly and if something changed and nurses notified therapy her department would reassess as needed. She stated that if a resident was not able to reliably bear weight or not safe during a transfer (not able to follow commands or participate in transfer) they would be changed to a mechanical lift only transfer status. DOR stated that she taught the CNAs how to do transfers especially if it was a difficult transfer. She stated she thought her last staff in-service was in April or the week prior. She stated she did one-on-one teaching with new residents, usually the in the rehab hall. Regarding the two-person transfer with Resident #5 she stated she did not know where the staff would learn that kind of transfer, and it seems that the gait belt was too loose. She stated that a gait belt would be snug and if the resident did not like it the staff would need to explain that it would loosen when they stand. She stated Resident #5 has a history of wanting to bear weight on her toes. She stated that Resident #5's legs shaking could be a sign she was having trouble in therapy. DOR stated Resident #5 had been able to bear weight in therapy and take a few steps, but she had gone back and forth with her progress. In an interview on 05/17/23 at 4:50 PM regarding the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 6 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some transfer done with Resident #310 on 5/15/23, LVN E stated that Resident #310 was able to do sit to stand transfers with assistance. He stated after he (LVN E) and CNA F got the resident cleaned up in the bathroom and back over to the bed in his wheelchair, they got him some new non-slip socks and he had him use his arms and push himself up to standing and then helped him to pivot over to the bed and sit, then got him positioned comfortably on the bed. When he was advised of how the transfer was done from surveyor notes, he stated, oh no and shook his head. LVN E then stated, and with no gait belt and shook his head again. He stated that they should have used a gait belt and that a resident should never be lifted by their arms in that manner. He stated that he knew better than to transfer a resident in that way especially without a gait belt but that sometimes it did happen even though it shouldn't. He stated that he had received the most recent facility in-service on transfers in April which included two-person transfers. He stated that Resident #310 did have orders for non-weight bearing on his right leg due to his recent surgeries and he (LVN E) had been educating him about using his call light for assistance as well as the proper way to do transfers since he was admitted so he had no excuse for why he did the transfer incorrectly. In an interview on 5/18/23 at 8:40 AM, the DON and Corporate RN stated the facility's competency checklist on transfers for aides just had a line to address if the aide completed the appropriate transfer, not the steps involved in the transfer. Interview on 05/18/23 at 01:00 PM CNA H stated she did do the transfer with Resident #5 on Monday. She stated she remembered grabbing the gait belt in the front and back but denied hooking her arms under the resident's arms. When advised she did hook her arms under Resident #5's arms during the transfer, she raised her hands in a 'hands off not arguing motion' and stated Resident #5 bears weight, and she didn't notice her legs shaking. She stated that Resident #5 was able to push up from a seated position by herself. Review of undated facility procedure Two Person Pivot Transfer revealed: Purpose: To safely get resident from one surface to another by allowing resident to participate by weight bearing during transfer. Staff will use gait belt to assist in getting resident to stand and guiding resident to pivot. Equipment: 1. Gait Belt 2. Two staff members Procedure: 1. Explain procedure to resident. 2. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 7 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0689 Clear obstacles. Lock wheels/brakes; remove leg rests and/or wheelchair arms if able. Position wheelchair next to bed. Level of Harm - Minimal harm or potential for actual harm 3. Residents Affected - Some Assist resident to get on nonslip footwear. 4. Assist resident to sit at bedside with feet on the floor. The resident's knees should be separated to provide a wide base of support. 5. Apply gait belt snugly around waist. 6. Stand in front of the resident. Each staff member places one hand under the front of the belt and one hand under the back of the belt, using an underhand grip. 7. The staff member closest to the chair stands in a position so that he or she can pivot and move away, allowing the resident unobstructed access to the chair. 8. On the count of three both nursing assistants will move the resident at the same time. Coordination of the movement is important. 9. Instruct the resident on the count of three to lean forward and push up from the bed with his/her hands while you assist bringing the resident's weight forward with the belt. Support the resident's knees and feet by placing your knees and feet firmly against them. 10. On the count of three, the resident is assisted to a standing position. The staff members pivot slowly and smoothly by moving their feet, legs and hips until the resident can feel the back of the wheelchair with his or her legs. 11. Both staff members bend their knees and assist the resident to lower him or herself into the chair. 12. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 8 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 0689 Remove the transfer belt. Level of Harm - Minimal harm or potential for actual harm 13. Adjust the wheelchair legs and footrests. Residents Affected - Some 14. Reverse the procedure to return the resident to bed. No in-services were provided by the facility before the time of exit on 5/18/23 at 5:30 PM . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 9 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 3 of 10 residents reviewed for pharmacy services (Residents # 15, #34, #43) during review of medication carts. -Warfarin 6mg tab card expired 5/1/23, prescribed to resident #34 -Warfarin 10mg card expired 4/24/23, prescribed to resident #34 -Ondansetron 4mg expired 4/13/23, prescribed to resident #15 -Ondansetron 4mg expired 5/9/23, prescribed to resident #15 -Ondansetron 4mg expired 5/13/23, prescribed to resident #43 -Hydralazine 10mg expired 5/13/23, prescribed to resident #43 This failure could place residents at risk of receiving medications that were expired and not produce the desired effect. Findings included: Record review of Resident #15's admission record dated 5/17/23 indicated she was admitted to the facility on [DATE] with diagnoses which included dementia, type 2 diabetes, and hypertension. She was [AGE] years of age. Record review of Resident #15's care plan dated 03/30/2023 indicated in part: Problem: Resident has history of nausea. Goal: The resident will have minimal or no emesis (vomit) through the review date. Interventions/tasks: Zofran Tablet 4 MG (Ondansetron HCl) Give 1 tablet by mouth every 6 hours as needed for Nausea/Vomiting. Record review of Resident #15's order summary report indicated in part: Ondansetron tablet 4mg, Give 1 tablet by mouth for nausea. Order date 05/10/2022. Record review of Resident #34's admission record dated 5/17/23 indicated she was admitted to the facility on [DATE] with diagnoses which included cerebral infarction (Stroke), dysphagia (difficulty swallowing), aphasia (difficulty with speech), COPD, anxiety, depressive disorder. She was [AGE] years of age. Record review of Resident #34's care plan dated 03/04/2023 indicated in part: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 10 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Problem: Resident was on anticoagulant therapy warfarin sodium r/t cerebral infarction due to occlusion of right cerebral artery. Goal: The resident will be free from discomfort or adverse reactions related to anticoagulant use through the review date. Residents Affected - Some Interventions/tasks: Administer anticoagulant medications as ordered by physician, monitor side effects and effectiveness every shift. Record review of Resident #34's order summary report indicated in part: Coumadin (warfarin sodium) tablet 6mg, Give 2 tablets by mouth one time a day related to cerebral infarction. Order date 05/03/2022. Coumadin (warfarin sodium) tablet 10mg, Give 1 tablet by mouth one time a day related to cerebral infarction. Order date 12/13/2022 Record review of Resident #43's admission record dated 5/17/23 indicated she was admitted to the facility on [DATE] with diagnoses which included congestive heart failure, COPD, major depression, dementia, anxiety. She was [AGE] years of age. Record review of Resident #43's care plan dated 04/23/2023 indicated in part: Problem: Resident had potential nutritional problem. Goal: The resident will be free from problems through the review date. Interventions/tasks: Administer medications as ordered by physician, monitor side effects and effectiveness. Record review of Resident #43's order summary report indicated in part: Hydralazine tablet 10mg, Give 1 tablet by mouth every 8 hours as needed. Order date 02/27/23. Ondansetron 4mg, give 1 tablet by mouth every 6 hours as needed for nausea. Order date 4/04/2022. During an observation and interview on 05/17/2023 at 08:30am of medication cart #1, it was discovered that Warfarin 6mg tab card was expired on 5/1/23, prescribed to resident #34. Warfarin 10mg card was expired on 4/24/23, prescribed to resident #34. Ondansetron 4mg was expired on 4/13/23, prescribed to resident #15. Ondansetron 4mg was expired on 5/9/23, prescribed to resident #15. Ondansetron 4mg was expired on 5/13/23, prescribed to resident #43. Hydralazine 10mg was expired on 5/13/23, prescribed to resident #43. RN D stated that he did not who was in charge of checking medication carts for expired medications. During an interview on 05/17/2023 at 01:10 PM the DON was made aware of the discovery of the expired medications in medication cart #1. The DON stated that the ADON checked the carts for expired medications once a week. The DON stated that she is very surprised there were expired medications found in the cart. The DON stated that the charge nurses were responsible for checking the medication carts on a daily basis. Record review of the facility's policy titled Medications, ordering and receiving undated indicated in part: Medication orders are phoned or faxed to the pharmacy and written on a medication order form (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 11 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 provided by the pharmacy for that purpose. Level of Harm - Minimal harm or potential for actual harm The entry includes whether the order is a new or repeat order prescription number, patient's name and room number, medication name and straight, directions for use, if a new order or direction change to a previous order common name of pharmacy supplier, physicians name. Residents Affected - Some Information concerning repeat medication or refills will be written on a medication order form provided by the pharmacy for that purpose. Transferred to the form on a peel off label and ordered as follows: order medication within 72 hours of the last dose available, the nurse who orders the medication is responsible for notifying the pharmacy of changes in directions for you., the refill order is called in faxed or otherwise transmitted to the pharmacy. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 12 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to store all drugs and biologicals in locked compartments under proper temperature controls and permit only authorized personnel to have access to the keys for 1 medication (cart #3) of 4 medication carts reviewed and 1 of 1 treatment carts reviewed for label and storage of drugs and biologicals. The facility failed to ensure medication cart #3 was locked when unattended. The facility failed to ensure that treatment cart 1 of 1 was locked when unattended. This failure could place residents at risk of having access to unauthorized medications and/or lead to possible harm or drug diversions. Findings included: During an observation on 05/15/23 at 10:39 am at nurses station revealed an unlocked treatment cart. The treatment cart revealed: 1 - 2 ounce tube of triple antibiotic 1- 4 ounce tube of desitin 2- 15 gram tubes of triamcinolone acetonide 0.1% 1 -60 gram tube of ketoconazole cream 2% 2- 1.5 fluid ounce tubes of silvasorb gel 2- 22 gram tube of muprocin ointment 2% 2- 30 gram tubes of Santyl collagenase ointment 250 U/gm During an observation on 5/17/23 beginning at 4:32 pm revealed the Hall 300 medication cart unlocked and unattended. At 4:37 pm, the RN passed the cart, looked at the surveyor and then locked the cart. Medication cart #3 had insulins, glucometers, lancets and alcohol swabs in the top drawer. Medication pouches were in the second drawer. Medication cards were in the third drawer and narcotics were in locked compartment. Medication bottles and liquid medications were in the fourth drawer. In an interview on 05/18/23 at 12:00 PM, the DON stated that her expectations were that all unattended medication carts and treatment carts be locked to ensure the safety of residents. Record review of the facility's medication administration proficiency checklist, undated, indicated in part, If the cart is left at any time during medication pass due to an emergency, it must be locked. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 13 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 and interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for kitchen sanitation. The facility failed to ensure stored foods were properly labeled and dated. The facility failed to ensure that expired foods were discarded. These failures could place residents who received prepared meals from the kitchen at risk for food borne illness and cross-contamination. The findings included: Observation of the dry storage on 5/15/23 at 11:05 AM revealed: 4, 46-ounce boxes of thickened apple juice with best by date of 2/14/23 2, 32-ounce boxes of thickened dairy drink with best by date of 10/12/22 5, 24-ounce packets of citrus gelatin mix with no expiration date 4, 6-pound bags of vanilla soft serve mix with no expiration date 17, 24-ounce packets of lemonade drink mix with no expiration date 2, 3-gallon boxes of orange juice blend 4 + 1 concentrate with no expiration date 3, 5-gallon boxes of nectar consistency thickened water with no expiration date 8, 6-pound 9-ounce cans of marinara sauce with no expiration date 6, 105-ounce cans of peeled apricot halves with no expiration date 1, 6-pound 10-ounce can of cream style corn with no expiration date 3, 112-ounce cans of chocolate pudding with no expiration date 2, 6-pound 10-ounce cans of tomato sauce with no expiration date 2, 6-pound 10-ounce cans of seasoned pizza sauce with no expiration date 2, 106-ounce cans of crushed pineapple in juice with no expiration date 7, 27-ounce cans of diced green chiles with no expiration date 1, 8-ounce packet of chicken and dumpling season mix with no expiration date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 14 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 6, 14-ounce packets of roasted chicken gravy mix with no expiration date Level of Harm - Minimal harm or potential for actual harm 26, 3.2-ounce packets of ranch salad dressing mix with no expiration date 4, 24-ounce packets of peppered gravy mix with no expiration date Residents Affected - Many 8, 13-ounce packets of brown gravy mix with no expiration date 1, 32-ounce bag of thick and hearty tortilla chips with expiration date of 5/3/23 1, 56-ounce open container (approximately 28-ounces remaining) of bacon flavored bits with no expiration date 1, 56-ounce container of bacon flavored bits with no expiration date 2, 1-gallon containers of balsamic vinegar with no expiration date 1, 4-pound open container (approximately 3-pounds remaining) maraschino cherries with no expiration date 1, 4-pound container of maraschino cherries with no expiration date 3, 1-gallon containers of imitation vanilla flavor with no expiration date 2, 1-gallon containers of soy sauce with no expiration date 1, 10-pound open container (approximately 8-pounds remaining) of baking powder with expiration date of 12/19/20 1, 25-pound open bag (approximately 20-pounds remaining) of yellow corn meal with no expiration date and bag not sealed in any way, just folded over to keep closed 2, 5-pound bags of cornbread and muffin mix with no expiration date 4, 5-pound bags of yellow cake mix with no expiration date 3, 5-pound bags of chocolate cake mix with no expiration date 9, 16-ounce boxes of baking soda with expiration date of 2/12/22 3, 12.6-ounce boxes of French vanilla nutritional drink mixes with expiration date of 1/28/23 In an interview on 5/15/23 at 12:15 PM, the Dietary Manager stated that most of the food that was ordered did not stay on her shelves very long because of the number of residents the facility had. She stated that food rarely had time to go bad in the facility. She stated that she did not know where to go to find expiration dates for food items if they were not on the labels. She stated that she made sure that the kitchen/dietary staff knew to label all food items with the date that it was received but she did not write expiration dates or use by dates on the items that did not already have those dates printed on the packaging. She acknowledged that she did need a better system for dating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 15 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 food due to ingredients and the manufacturer's packaged on dates. She stated she did not know how long certain food items would stay safe for in different storage settings and that she would have to investigate that to improve her process as well as speak with the supplier and her corporate dietician. Observation of the walk-in cooler on 5/15/23 at 12:25 PM revealed: Residents Affected - Many Plastic tub on shelf with resealable plastic bag containing head of lettuce with no label and no date and second head of lettuce sitting in tub not in bag 1, 1-gallon container of lite Italian dressing with no expiration date 1, 1-gallon container of hamburger dill pickle slices with no expiration date 2, 1-gallon open containers (each with approximately 0.5-gallon remaining) of mayonnaise with no expiration date 1, 1-gallon open container (approximately 0.5-gallon remaining) of coleslaw dressing with no expiration date 8, 1-pound containers of chicken flavored base with no expiration date Observation of the refrigerator on 5/15/23 at 12:35 PM revealed: 6, 3.375-ounce gelatin snack cups with expiration date of 5/8/23 2, 32-ounce opened (unable to tell how much remaining) boxes of thickened dairy drink with expiration date of 10/12/22 In an interview on 5/15/23 at 12:40 PM the Dietary Manager stated that kitchen staff should have been checking the dates on all items in the refrigerator daily. She had no explanation for the expired items in the refrigerator. In an interview on 5/18/23 at 9:50 AM, the DON stated that she was not aware that the food items in the kitchen did not have expiration dates. She stated that there should never be expired food in the facility. She stated she would have to speak with the Dietary Manager about the process for checking the kitchen for expired food items as well as how she determined when foods expired when they did not have an expiration date on the package. Review of facility policy Food Safety in Receiving and Storage revision date 1/1/10, revealed, in part: Policy: Food will be received and stored by methods to minimize contamination and bacterial growth. Receiving Guidelines: 5. Check expiration dates and use-by dates to assure the dates are within acceptable parameters. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 16 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 control program designed to prevent the development and transmission of disease and infection for 4 of 10 residents observed for infection control. Residents Affected - Some MA C dropped Resident #77's medication on the medication cart then proceeded to pick it up with her bare hands and placed it in the medication cup to be administered to the resident. MA C failed to wash hands prior to administration of medications. MA C measured blood pressures on two consecutive residents (#60,#65), failing to wipe off the blood pressure cuff between residents. MA C administered nasal spray to Resident #60 with bare hands, failed to wash hands prior to or after procedure. CNA A double gloved during incontinent care for Resident #1 and did not sanitize her hands when going from dirty to clean. These failures could place residents at risk for cross contamination and the spread of infection. Findings included: Record review of Resident #60's admission record dated 05/16/23 indicated she was admitted to the facility on [DATE]. Diagnoses included cerebral infarction (Stroke), Type 2 diabetes, and dementia. She was [AGE] years of age. Record review of Resident #60's MDS dated [DATE] indicated in part: That resident's BIMS score was 07 which shows severely impaired daily decision making related to dementia. That resident received anti-anxiety medication, anti-depressant medication, anti-coagulant medication, and opioid medication. Record review of Resident #60's care plan dated 03/04/2023 indicated in part: Problem: The resident is At Risk for developing impaired cognitive function or impaired thought processes. BIMS showed moderately impaired daily decision making related to dementia. Goal: The resident will maintain current level of cognitive function through the review date. Intervention: Administer medications as ordered. Monitor/document for side effects and effectiveness. Record review of Resident #65's admission record dated 05/16/23 indicated she was admitted to the facility on [DATE]. Diagnosis included major depression and dementia. She was [AGE] years of age. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 17 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 Record review of Resident #65's MDS dated [DATE] indicated in part: Level of Harm - Minimal harm or potential for actual harm That residents BIMS score was 07 which shows severely impaired daily decision making related to dementia. Residents Affected - Some That resident received anti-depressant medication and anti-seizure medication. Record review of Resident #65's care plan dated 05/11/2023 indicated in part: Problem: The resident has a seizure disorder. Goal: The resident will remain free of seizure activity through review date. Intervention: Keppra tablet 500 mg, give 1 tablet by mouth, one time a day for seizures. Record review of Resident #77's admission record dated 05/16/23 indicated she was admitted to the facility on [DATE]. Diagnoses included major depression disorder, anxiety disorder, Parkinson's disease and dementia. She was [AGE] years of age. Record review of Resident #77's MDS dated [DATE] indicated in part: That residents BIMS score was 09 which shows moderately impaired daily decision making related to dementia. That resident received anti-anxiety medication, anti-depressant medication and opioid medication. Record review of Resident #77's care plan dated 04/23/2023 indicated in part: Problem: The resident uses anti-anxiety medications related to anxiety. Goal: The resident will be free from discomfort or adverse reactions related to anti-anxiety therapy through the review date. Intervention: Administer anti-anxiety medications as ordered by physician. Monitor/document for side effects and effectiveness every shift. During an observation on 05/16/23 at 09:48 AM of medication administration by MA C. MA C was attempting to drop a pill into med cup but it fell on the medication cart. MA C picked the pill up with bare hands and placed the pill in the medication cup. MA C administered the medication to Resident #77. MA C then proceeded to place the lidocaine patch on resident's lower leg with bare hands. MA C failed to wash her hands, use hand sanitizer or wear gloves prior to administration of medications and failed to wash her hands after contact with resident #77. During an observation on 05/16/23 at 10:00 AM MA C then proceeded to Resident #60's room and took her blood pressure with bare hands. MA C failed to wipe off the blood pressure cuff prior to contact with resident #60. MA C returned to the medication cart to prepare medications for resident #60. MA C failed to wash hands prior to preparing medications. MA C used hand sanitizer after all medications were placed in cup. MA C then poured a cup of water from a pitcher, and opened a straw, then lifted the lid with her hands to the trash receptacle to dispose of straw wrapper. MA C then administered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 18 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 PO (by mouth) medications to the resident. MA C then administered nasal spray to each nostril with bare hands and failed to wash her hands prior to administering nasal spray and after administering nasal spray. During an observation on 05/16/23 at 10:15 AM MA C then proceeded to Resident #65's room and took her blood pressure with bare hands. MA C failed to wipe off the blood pressure cuff prior to contact with resident #65. MA C returned to medication cart to prepare medications for resident #65. MA C failed to wash hands prior to preparing medications. MA C used hand sanitizer after all medications were placed in a cup. MA C then administered PO (by mouth) medications to resident. During an interview on 05/17/23 at 09:58 am. with MA C. When asked about her failure to wipe off the blood pressure cuff between residents and wash hands between resident contact, MA C stated that she usually uses bleach wipes or alcohol wipes to clean the blood pressure cuff between residents. MA C stated, I don't know why I forgot to do it, I know it is important because of cross contamination and I know residents can get sick. MC A stated she usually carries her hand sanitizer with her but she did not have it at the time. During an interview on 05/17/2023 at 1:10 pm the DON stated that her expectation is that all facility staff would be handwashing between residents and cleaning equipment between residents. The DON stated that after all the training and in-services the facility had during covid, all staff should know the importance of handwashing, transmission precautions, especially when dealing with bodily fluids. DON stated that ADON will be performing a competency on handwashing and medication administration with MA C. Record review of the facility's policy titled Medication: Administration of Drugs undated, indicated in part, Procedure: Properly wash hands prior to starting medication administration. Properly wash hands if contact has been made with the resident or any procedure that would cause infected hands, and leave resident who is to receive medications. Repeat procedure with each resident who is to receive medications. Record review of the facility's policy titled Blood Pressure section B, undated, indicated in part, Procedure: Properly clean hands before procedure as appropriate and measure blood pressure. Clean blood pressure cuff with sanitizing wipes or spray. Record review of the facility's medication administration proficiency checklist, undated, indicated in part, Licensed Nurse/ Medication Aide will perform proper hand washing technique/gloves at appropriate times. INCONTINENT CARE: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 19 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #1's admission record dated 05/18/23 indicated she was admitted to the facility on [DATE] with diagnoses which included cerebral palsy and lack of coordination. She was [AGE] years of age. Record review of Resident #1's MDS dated [DATE] indicated in part: Bladder and Bowel: Urinary Continence =. Always incontinent (no episodes of continent voiding). Bowel Continence = Always incontinent (no episodes of continent bowel movements). Record review of Resident #1's care plan dated 08/15/2019 indicated in part: Problem: Resident has bladder incontinence- Resident has bowel incontinence. Goal: The resident will remain free from complications of urinary incontinence through the next review date. The resident will be continent during daytime through the review date Interventions: The resident uses disposable briefs. Check and change every 2-3 hours & PRN. Clean peri-area with each incontinence episode. Check @ least every 2-3 hours and as required for incontinence. Wash, rinse and dry perineum. Change clothing PRN after incontinence episodes. During an observation on 05/16/23 at 11:44 AM CNA A performed incontinent care for Resident #1. CNA A removed the resident's pants and brief. CNA A wiped Resident #1's rectal area with some wet wipes. The wipes had some bowel movement on them. CNA A wiped the resident's rectal area again with wet wipes and more bowel movement was observed which also came in contact with the CNA's gloves. CNA A then removed the soiled gloves and under her soiled gloves, was another pair already on her hands. While wearing the second pair of gloves, CNA A applied the new brief and assisted the resident with putting her pants back on. During an interview on 05/16/23 at 5:32 PM CNA A said after she had wiped Resident #1's rectal area she had removed the first pair of gloves because she wanted to have clean gloves since they were considered contaminated. CNA A said she had learned to double glove at the previous facility she worked at. CNA A said she had been working at the facility for about a year now. CNA A said she was not sure if they could use double gloves at this facility. CNA A said she should have removed her second pair of gloves before she applied the new brief and assisted the resident with her pants. CNA A said she would usually wash her hands when she removed her gloves because her hands could possibly be contaminated. CNA A said the second gloves could possibly become contaminated and she should have not worn the second pair. CNA A said due to her not having changed her gloves that could lead to cross contamination and possibly urinary tract infections. During an interview on 05/17/23 at 5:44 PM the DON said staff were expected to put on gloves if they were going to provide care to a resident. The DON said staff were not allowed to double glove because it could lead to cross contamination and infections. The DON was made aware of the observation of staff wearing double gloves during resident care. The DON said that probably occurred because the staff was nervous and perhaps went to back to old practice because they did not teach that here. During an interview on 05/18/23 at 2:56 PM the staffing nurse said she trained staff regarding infection control procedures. The staffing nurse said if a CNA provided incontinent care and after they wiped bowel movement, they were supposed to change their gloves, wash their hands and apply clean gloves. The staffing nurse said it was considered cross contamination if they did not change their gloves as they were considered contaminated. The staffing nurse said the CNAs were supposed to wash their hands in between glove change because their hands could be dirty. The staffing nurse said if staff used the same gloves that could lead to an infection. The staffing nurse said staff were not allowed to double glove. The staffing nurse said she did not know why the CNA had done that as they did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 20 of 21 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 676179 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Midland Medical Lodge 3000 Mockingbird LN Midland, TX 79705 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 not teach that here. Level of Harm - Minimal harm or potential for actual harm During an interview on 05/18/23 at 03:17 PM the Administrator was made aware of staff using double glove during resident personal care. The Administrator said the staff using double gloves was unacceptable. Residents Affected - Some Record review of the facility's undated policy titled Incontinent care procedure and proficiency evaluation indicated in part: Knock on door identify yourself explain procedure. Perform hand hygiene, don (put on) gloves. Clean rectal area with new wash cloth/wipe using upward gentle strokes. Remove soiled pad and clothing and place in plastic bag. Remove gloves and discard, perform hand hygiene and don gloves. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 21 of 21