Health inspection·August 21, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some within reach and encourage the resident to use it for assistance as needed. said the care plan reflected the resident needed prompt response to all requests for assistance and the resident needed a safe environment with a working and reachable call light. In an observation and interview on 08/21/25 at 09:13 AM, revealed Resident #87 was sitting in his wheelchair on the right side of his bed. The resident was asked if he knew where his call light was, he answered no. The call light was at the head of the bed on the left side. In an observation and interview on 08/21/2025 at 09:25 AM, revealed Resident #87 was sitting in his wheelchair on the right side of the bed. The call light was on the bed. The DON asked Resident #87 if he wanted the call light on his chest. He said yes, the DON placed the light on his chest. The DON said sometimes the staff forget to place call bells within reach of the residents after moving them or making the bed. Resident #96 Record review of Resident #96's admission record dated 08/21/2025 indicated she was admitted to the facility on [DATE] with diagnoses of cerebral palsy (a group of conditions that affect movement and posture), reduced mobility, muscle weakness, muscle wasting and muscle atrophy. She was [AGE] years of age. Record review of Resident #96's annual MDS assessment dated [DATE] revealed a BIMS score of 03, her cognitive ability was severely impaired. Mobility devices = Wheelchair. She was dependent on staff for eating, oral hygiene, toileting, showering, and dressing. Bladder and bowel: Urinary/bowel continence = always incontinent. Record review of Resident #96's care plan dated 6/25/2025 revealed she was at risk for falls due to cerebral palsy. The care plan reflected the staff needed to ensure the resident's call light was within reach and encourage the resident to use it for assistance as needed. The care plan reflected the resident needed prompt response to all requests for assistance. The care plan reflected the she had an ADL performance deficit related to cerebral palsy and limited range of motion. It was revealed that staff were to encourage the resident to use bell to call for assistance and touch pad call used for assistance. In an observation and interview on 08/20/25 at 10:31 AM, revealed a procedure on the roommate of Resident #96 was being observed by the surveyor. CNA D knocked on the door, entered, and asked LVN B if he needed something because the call light was on. LVN B responded no and asked if it was Resident #96's light. CNA D responded No, it is not in her hand. before exiting the room. Resident #96 was observed in her wheelchair on the left side of the bed and the call pad was hanging in between the seat and the right wheel of the wheelchair. At 10:48 AM LVN B exited the room. The call pad for Resident #96 was hanging in between the seat and the right wheel of the wheelchair. At 10:55 AM LVN B entered the room again to perform another procedure for the roommate of Resident #96. At 10:56 AM LVN B said he was not sure why the call light kept going off, then exited the room. Resident #96's call pad was hanging in between the seat and the right wheel of the wheelchair. In observations on 08/20/25 at 11:08 AM and 11:17 AM, revealed Resident #96 remained in her wheelchair and the call pad remained in between the seat and right wheel of her wheelchair. In an observation on 08/20/25 at 2:35 PM, revealed Resident #96 was in her wheelchair on the left side of the bed. The call pad was on the bed. In an interview on 08/20/25 at 2:37 PM with LVN B, he said Resident #96 could push the call pad if it was placed real close. In an observation on 08/20/25 at 2:47 PM, revealed Resident #96 remained in her wheelchair on the left side of the bed. The call pad remained on the bed. In an interview with the DON, she said Resident #96 could push the call pad if it was placed close to her hands. In observations on 08/20/25 at 4:15 PM and 4:42 PM, revealed Resident #96 was in bed on her left side. The call pad was placed on the right side of the head of the bed. In an observation and on 08/21/25 at 9:11 AM, revealed Resident #96 was in her wheelchair on the left side of the bed. The call pad was on the bed. In an observation and interview on 08/21/2025 at 09:25 AM, revealed Resident #96 was in her wheelchair on the left side of the bed. The call pad was on the bed. The DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 2 of 13 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 08/21/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some said Resident #96 would not be able to reach the call pad where it was. The DON placed the pad on Resident #96's chest, between her hands. The DON said sometimes the staff forget to place call bells within reach of the residents after moving them or making the bed. Resident #37 Record review of Resident #37's admission record dated 08/21/2025 indicated he was admitted to the facility on [DATE] with diagnoses of shortness of breath, difficulty in walking and unsteadiness on feet. He was [AGE] years of age. Record review of Resident #37's quarterly MDS assessment dated [DATE] revealed a BIMS score of 08 indicating he was moderately impaired. Mobility devices = Wheelchair. Resident required supervision or touching assistance for chair/bed-to-chair transfer and toilet transfer. Record review of Resident #37's care plan dated 08/03/2025 revealed the resident is at risk for falls due to new environment and/or age. The resident will be free of falls through the review date. Be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs a safe environment with: Clutter free, reachable call light, the bed in low position at night. In an interview on 08/19/25 at 11:58 AM Resident #37 said the night shift aides did not do their job and that they took a long time to answer the call lights. The resident said he clocked them when his roommate Resident # 87 pressed his call light and they took about an hour and half to answer it. Resident #37 said he had seen the lights on the hallway and the aides were just sitting elsewhere and not answering the lights. Resident #37 said he had voiced his complaints to the administration people but that nothing was done about it. In an interview on 8/19/25 at 4:01 p.m. Resident #37 stated there were nights when he could not sleep and he would get up to work puzzles in the day room and there would be 4 or 5 call lights going off. Resident #37 said there was no one on the hall whatsoever because the aides were all in the break room. Resident #37 stated he had been telling the DON and the Administrator for he didn't know how long but nothing was done about it. Resident #37 added Who did we not tell? Resident #83 Review of Resident #83's admission Record, dated 8/21/25, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including cerebral palsy (a group of permanent disorders of the development of movement and posture, causing activity limitation including difficulty with holding things), feeding difficulties, hemiplegia (one side paralysis), and need for assistance with personal care. Review of Resident #83's Quarterly MDS assessment, dated 6/29/25, revealed:He had a mental status interview score of 15 of 15, indicating he was cognitively intact.Resident #83 was completely dependent on staff for all ADL care including eating and chair/bed-to-chair transfers. Resident #83 used a motorized wheelchair.Resident #83 was frequently incontinent of bowel and bladder. Review of Resident #83's Care Plan Report, saved 8/21/25, revealed problems:Dated 3/18/24 Problem: Resident requires assist with ADL's.Goal: Resident is able to perform self-care to optimal level and maintain strength and endurance for 90 days. Revised 7/26/25.Interventions included: Hoyer lift for all transfers.Problem 7/25/25 The resident has limited physical mobility related to cerebral palsy and poor trunk control. May have pancake call like to enable resident to utilize call light himself as desired.Goal: The resident will remain free of complications related to immobility, including contractures, thrombus (blood clot) formation, skin break down, fall related injury through the next review date. Interventions included provide supportive care, assistance with mobility as needed. Problem 3/18/24:The resident is at risk for falls due to new environment end or age. No other indicators that would suggest high fall risk. Date initiated 03/18/2024Goal: the resident will be free of falls through the review dateinterventions included: the be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. The resident needs prompt response for all requests for assistance. Interview on 8/19/25 at 4:01 PM Resident #83 revealed it could take up to an hour for the call light to be answered on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 3 of 13 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 08/21/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some night shift. Resident #83 stated he had no idea why it took so long. Resident #83 stated it was some of the day rotations as well. Resident #83 shared that the only way to get help sometimes was to get his roommate to go get help. Resident #83's roommate was present and confirmed that happened. Resident #83 stated it made him angry because the staff were not paying attention, or he was told they were too busy. Resident #83 stated he knew the staff were doing the best they could, but their best could bet better. Resident #83 said on the days there were days when two aides could not handle his hall. Resident #83 stated he thought it took so long because he was a two-person assist for everything and if both people were working, there would be no one on the hall to help everyone else. Resident #83 stated he had aides tell him it was not their job to help him. Resident #83 said that was especially true when he had to eat in his room. Resident #103 Record review of Resident #103's admission record dated 08/20/2025 indicated she was admitted to the facility on [DATE] with diagnoses of quadriplegia (a pattern of paralysis which is when someone can't deliberately control or move their muscles that can affect someone from the neck down)and lack of coordination. She was [AGE] years of age. Record review of Resident #103's significant change MDS assessment dated [DATE] revealed a BIMS score of 15 indicating the resident was cognitively intact. Mobility devices = Wheelchair. She was dependent Helper does ALL of the effort. Resident does none of the effort to complete the activity for . eating, oral hygiene, toileting, showering and dressing. Bladder and bowel: Urinary continence = resident had a catheter. Bowel continence = always incontinent. Record review of Resident #103's care plan dated 07/02/2025 revealed Resident has a history of falling. Anticipate and meet resident needs. Be sure the resident's call light is within reach and encourage resident to use it for assistance as needed. At risk for contractures- Reposition every two hours and prn. In an interview on 08/19/2025 at 3:20 PM Resident #103 said the staff would take a long time to answer her call light. She said that at times it was from breakfast time like 8am until lunchtime which was around noon time. Resident #103 said she had no complaints about the staff but that she felt bad that the staff would ignore her call light for such a long time. Resident #103 said she was totally dependent on staff to help her as she was paralyzed from the neck down and needed help with even getting a drink of water. Resident #103 said most of the times it was something minor that she needed help with such as repositioning her pillow so if the staff went in to help her with that it wouldn't take them that long. The resident said she believed the staff did not answer her call light was because they thought it was probably something minor that she needed help with which unfortunately was probably true, but she still needed their help. Resident #103 said that this would occur about every other day, and it would mostly occur on the day shift but sometimes also on the evening shift. In an interview on 08/20/2025 2:05 PM CNA A said she had been working at the facility since June 2024. The CNA said she and another CNA were working hall 200 and would both answer the call lights. CNA A said she normally answered a call light within 5 to 10 minutes which she considered a fair amount of time for the resident to wait for assistance. In an interview on 08/20/2025 2:10 PM CNA F said she had been working at the facility since February 2025. CNA F said she would try to answer the call light as soon as possible. CNA F said she considered 5 to 10 minutes a fair amount time to answer the call light. In an interview on 08/20/2025 at 6:22 PM with CNA H said that she worked the night shift which was from 6pm to 6am. CNA H said answering a call light within 5 minutes was what she considered a fair amount time for the resident to wait to be attended. CNA H said she believed she was answering the call lights timely. In an interview on 08/20/2025 at 6:25 PM with CNA I said that she worked the night shift which was from 6pm to 6am. CNA I said answering a call light within 5 to 10 minutes was what she considered a fair amount time for the resident to wait to be attended. CNA I said she believed that she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 4 of 13 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 08/21/2025 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete able to answer her call lights timely and not heard residents complain about left waiting too long for their light to be answered. In an interview on 08/21/2025 at 5:02 PM the DON and the Administrator said they considered a call light being answered timely within 15 minutes and that was depending on what staff were doing at the time the call light was on. The DON and Administrator said they would expect for staff to answer the call lights as soon as possible. They said they were not aware that the call lights were being left on for over an hour. Record review of the resident council meeting form dated June 26, 2025, indicated in part: Residents state some are not getting changed in a timely manner wait 30 minutes or more. Record review of the Call Lights policy (undated) read in part Answer call light promptly; especially if it involves the bathroom light. The call light must always be within resident's reach before you leave the room. Event ID: Facility ID: 676179 If continuation sheet Page 5 of 13 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 08/21/2025 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one of seven residents (Resident #23) reviewed for quality of care. The facility failed to provide wound care for Resident #23 using professional wound care standards and failed to follow the physician's treatment order. This failure could place residents at risk of improper wound management, deterioration in existing wounds, leading to infection and pain. Findings include: Record review of Resident #23's Face Sheet dated 7/14/2025 revealed he was a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE]. He had diagnoses of infection following a procedure, unspecified severe protein-calorie malnutrition, chronic respiratory failure, resistance to multiple antibiotics, systemic inflammatory response syndrome (a life threatening condition that occurs when the body overreacts to a stressor, causing severe inflammation throughout the body), methicillin resistant staphylococcus aureus infection (a type of staph bacteria resistant to many common antibiotics), chronic respiratory failure, methicillin susceptible staphylococcus aureus infection (a type of bacterial infection caused by staphylococcus aureus bacteria that are sensitive to methicillin and similar antibiotics), Escherichia Coli as the cause of diseases classified elsewhere (a type of bacteria commonly found in the intestines of humans), aftercare following joint replacement surgery. Record review of Resident #23's admission MDS dated [DATE] revealed he had a BIMS score of 10 of 15 indicating moderate cognitive impairment. Record review of Resident #23's Care Plan dated 07/15/2025 revealed the resident has a skin tear to his left outer forearm. Record review of Resident #23's Physician orders dated 8/08/2025 revealed skin tear left outer forearm: clean with wound cleanser, pat dry, apply xeroform (a fine mesh gauze dressing impregnated with petrolatum for use on low exudating wounds), cover with dry dressing, change Monday, Wednesday, Friday, and as needed. Observation on 08/20/2025 at 9:58 AM of wound care for Resident #23 revealed: LVN E donned (put on) gloves and opened a treatment cart drawer. LVN E used a small tray covered with wax paper to set up a clean field and place supplies in. LVN E knocked on Resident #23's door explained the procedure, washed her hands, applied PPE (personal protective equipment) required for EBP (enhanced barrier precautions), put on gloves, and removed the dressing from the resident's left forearm. LVN E removed her gloves and placed them as trash in the biohazard bag. LVN E washed her hands, put on gloves, cleansed the wound with normal saline from the inside outwards, and patted dry. LVN E washed her hands, put on new gloves, applied a hydrogel dressing (a type of dressing characterized by its high-water content) to Resident #23's left forearm, removed her gloves, and washed her hands. LVN E did not follow physicians orders for applying a xeroform dressing. In an interview on 08/20/2025 at 10:30 AM LVN E stated hydrogel and xeroform were the same dressings and she was going to call the supplier and tell the supplier if they were sending the wrong dressings. LVN E stated she was not wound-care certified but had completed the wound care competency check-off upon hire. In an interview on 8/20/2025 at 2:30PM LVN E stated she talked to the wound care supplier and the hydrogel dressing was to be used as a dry dressing and she should have applied the xeroform under the hydrogel dressing. In an interview on 08/21/2025 at 10:06 AM the DON stated the wound care procedure would be to follow physician's orders. She agreed that LVN E did not use the correct dressing. The DON said incorrect dressings could delay the healing of wounds. Review of the facility's undated wound care policy received from the DON revealed: 1. Treat wounds with the appropriate products. 2. Effectively heal wounds by using approved products 3. Get treatment order form physician 4. Treat wound until it is healed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 6 of 13 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 08/21/2025 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 - Few 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 resident equipment was maintained in a safe, operating condition for 1 of 7 residents reviewed for wheelchair safety. The facility failed to ensure that Resident #62's wheelchair brakes operated. This failure placed residents at risk for unsafe transfers and/or falls if wheelchair rolled out from under the resident during transfers. The findings included:Review of Resident #62's admission Record, dated 8/20/25, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnosis that included hemiplegia (one sided weakness or paralysis) following stroke affecting the right side, reduced mobility, and history of falling. Review of resident #62's quarterly MSDS assessment, dated 7/11/25, revealed:Resident #62 scored a three of 15 on his mental status exam (indicating severe cognitive impairment),Resident #62 had upper and lower range of motion impairment on one side and used a wheelchair.Resident #62 was totally dependent on staff for bed to chair transfers. Review of Resident #62's Care Plan revealed:Revised 4/28/21: Problem: Resident requires assist with Activities of Daily Living. Goal: Resident is able to perform self-care to optimal level and maintains strength and endurance for 90 days. Interventions included: Provide level of support to complete transferring needs each shift; Reinforce use of aides to mobility as indicated. Revised 5/1/25 Problem: The resident has had an actual fall with no injury 3/10/25 fall. The identified goal was the resident will not sustain serious injury through the review date. Interventions included: 3/10/25 CNA reported during transfer the wheelchair brakes did not lock due to being broken and wheelchair rolled out from underneath resident's bottom, resident was using transfer pole during staff assisted transfer. Intervention - two person transfer initiated 3/11/25. Observation on 08/20/2025 9:02 AM revealed the wheelchair specialist was working on fixing another resident's specialized wheelchair. Observation on 08/20/2025 11:12 AM revealed CNA J and CNA L prepared to do a Sit-to-Stand mechanical lift transfer with Resident #62. CNA J put the sling on Resident #62, locked the wheelchair and hooked the sling onto the machine while CNA L prepared the lift. The wheelchair brake on the left side was noted to not be engaging despite being put in place. CNA J noticed the left brake and braced the wheelchair from behind on the left side while the aides completed the rest of the transfer properly. Interview on 08/20/2025 at 4:00 PM CNA J stated he worked at the facility for 2.5 years and usually worked Resident #62's hall. CNA J stated Resident #62 used to use a transfer pole on another hall, but since moving to the current hall Resident #62 used the Sit-to-Stand lift. CNA J said he checked the wheels on the wheelchair during the transfer and realized the brake did not engage. CNA J said the brake had not worked, but he did not now for how long. CNA J felt with him behind the wheelchair bracing it, that the transfer was safe since there were two people performing the transfer. CNA J stated the other side was secure and he stood on the side that was not. CNA J said he did not report the wheelchair brake not working. Interview on 08/20/2025 at 4:24 PM CNA K stated Resident #62 was ok in his wheelchair. CNA K stated the wheelchair worked for her when she locked the wheelchair; but CNA K said the left side brake did not work since she started working about a month ago. CNA K said she told the physical therapy department because she learned maintenance could not work on the type of wheelchair Resident #62 had. Interview on 08/20/2025 at 4:32 PM CNA L said she was the lead aide and she worked everywhere in the building. CNA L said Resident #62 used the Sit-to-Stand lift. CNA L said she did not feel the observed transfer did not go so well because the lock on the custom wheelchair did not lock. CNA L said she knew the facility could not fix it at the facility because she had another resident's wheelchair fixed that morning. CNA L said Resident #62's wheelchair brake had not been working a while. CNA L said she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 7 of 13 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 08/21/2025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete believed therapy was responsible for monitoring if the specialized wheelchairs worked. CNA L said if the aides noticed the wheelchair brakes not working they would document it in the maintenance book. CNA L said she knew the brake did not work for a while because the last time it was fixed the person accidently put the brake on backwards. CNA L said the transfer she and CNA J completed was done safely because CNA J was behind the chair and holding it stead. CNA L said she was notified it was not working today. CNA L said since she moved hallways so much, she could not say how long Resident #62's wheelchair was not working. Interview on 08/20/2025 at 4:45 PM RN G stated he worked Resident #62's hall for the past two years. RN G stated he was not aware Resident #62's wheelchair was not working. RN G said he did not know if therapy would notice because Resident #62 did not do therapy. RN G stated it could take weeks for a specialized wheelchair to be fixed. RN G said the CNAs did not communicate that Resident #62's brakes were not working. RN G said he did expect the CNA to communicate that. RN G stated if the brakes did not engage ultimately it was not a safe transfer. At that time, RN G took the surveyor to the maintenance book and reviewed 8/12/25 through 8/20/25; RN G confirmed there was no documentation about Resident #62's wheelchair brakes not working. Interview and observation on 08/20/2025 at 5:25 PM the DON stated Resident #62 used the Sit-to-Stand lift. The DON said Resident #62 had a customized wheelchair that was maintained by the company that was at the facility earlier that day (8/20/25). The DON said it would depend on the use and wear and tear on the wheelchair brakes to determine how long it would take to go out. The DON said any staff that were assisting Resident #62 could put Resident #62's brakes were not working in the maintenance book and were responsible for monitoring the brakes were in working order. The DON said due to the brakes not working Resident #62's transfer was not safe, but the staff did what they could to make it as safe as they could. The DON stated she would have to get the wheelchair looked at and the wheelchair maintenance company was coming back on 6/21/25 and she would have the wheelchair looked out. The DON and surveyor checked Resident #62's brakes and she said, It looked like the mechanism was not engaging. The Administrator joined the conversation and was shown Resident #62's brakes. Interview and observation on 08/20/2025 at 5:54 PM the Administrator stated the repair company repaired Resident #62's wheelchair in June and July (2025). The Administrator looked at Resident #62's wheelchair and said it looked like the tread on the wheelchair was wearing out and also needed to be replaced. Interview and record review on 08/20/2025 at 6:03 PM the Administrator said he reviewed the maintenance log and showed the surveyor on 6/30/25 the charge nurse documented both wheelchair brakes were out and it was fixed on 7/2/25. Review of the facility's policy on Administrative Requirements for Durable Medical Equipment and Customized Manual Wheelchairs, undated, revealed:A modification, adjustment or repair to a Customized Manual Wheelchair, required in the first six months after delivery of the Customized Manual Wheelchair is the responsibility of the supplier. More than six months after delivery of a Customized Manual Wheelchair, the facility will maintain and repair all medically necessary equipment for a designated resident, including Customized Manual Wheelchairs. Event ID: Facility ID: 676179 If continuation sheet Page 8 of 13 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 08/21/2025 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 0760 Ensure that residents are free from significant medication errors. 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 provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, and dispensing of routine drugs and biologicals to meet the needs of each resident for 1of 7 residents reviewed for pharmacy services. (Resident #23) The facility failed to ensure Resident #23's ordered Rifampin (antimicrobial drug used to manage and treat diverse mycobacterial infections and gram-positive bacterial infections) medication was available for administration from 8/8/2025-8/20/25. The facility did not notify physician of unavailability until after resident missed 12 doses of Rifampin. These failures could place residents at risk for not receiving medications as prescribed and a decline in health status. Findings included: Record review of Resident #23's face sheet revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of fracture of unspecified part of neck of left femur (hip fracture), presence of right artificial hip joint, need for assistance with personal care, muscle weakness, osteoarthritis, chronic respiratory failure, elevated white blood cell count. He discharged to the hospital on 7/31/2025 for infection of surgical wound. He readmitted to facility from hospital on [DATE] with diagnoses methicillin susceptible staphylococcus aureus infection (a type of bacterial infection caused by Staphylococcus aureus bacteria that are sensitive to methicillin and similar antibiotics), methicillin resistant staphylococcus aureus infection (a type of staphylococcus bacteria resistant to many common antibiotics), unspecified Escherichia Coli (a type of bacteria commonly found in the intestines of humans). Record review of Resident #23's comprehensive care plan, dated 07/15/2025, revealed he had surgical wound to left hip. The goal was wound will heal without complications through review date. The interventions included: wound treatments per doctor's orders.Record review of Resident #23's admission MDS assessment, dated 07/21/2025, revealed:He had a BIMS (Brief Interview for Mental Status) score of 10, which indicated moderate cognitive impairment. There were no behaviors or refusal of care. Record review of the order summary report for August 20, 2025, revealed Resident #23 had an order for Rifampin oral capsule 300milligrams to be given two times every day from 8/8/2025 to 9/15/2025 indicated for infection after surgical procedure. Record review of the Medication Administration Record for August 2025 reflected Resident #23 did not receive any doses of his Rifampin because the medication was on order. In an interview on 8/20/25 at 11:05AM LVN C stated the Rifampin medication not being available was out of her hands. She stated she was first notified of the medication not being available yesterday evening (8/19/25) but the pharmacy was already closed. LVN C stated she was unsure why the medications had not come into the facility yet. LVN C called the pharmacy on 8/20/25 and the pharmacy stated they would not be sending the medication due to a possible drug interaction. LVN C said she called to notify the Infection Specialist Doctor but was only able to leave a message. LVN C stated the medication not being available could lead to not being able to treat the residents' diseases appropriately. In an interview on 8/20/25 at 11:45AM the DON stated the medication aides should report all unavailable medications to the nurse and the nurse then would look for the medication. The DON said if it was a prescription medication the nurse would verify it was not delivered, check the order, and call the pharmacy. The DON stated the nurse would report all unavailable medications to the DON and doctor. The DON stated it was the ADON's duty to ensure all medications were delivered. The DON stated resident was taking the medication due to an infection after a hip surgery. The DON stated negative effects could include the resident not receiving what medications they needed leading to prolonged sickness. In an interview on 8/20/2025 at 1:30PM Resident #23 said he was not aware he was not receiving the Rifampin. In an interview on 8/21/2025 at 10:30AM the DON stated the medication was Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 9 of 13 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 08/21/2025 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 0760 Level of Harm - Minimal harm or potential for actual harm discontinued by Resident #23's primary physician until follow-up appointment with Infectious Disease Specialist on 9/3/2025. The DON said she was going to implement communication forms to notify her if a medication was unavailable. The DON stated she spoke with the pharmacy about notifying the facility if a medication was not going to be dispensed as ordered. The surveyor requested the policy on medication availability, and one was not provided. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 10 of 13 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 08/21/2025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to store all drugs and biologicals in locked compartments for 1 of 4 nurse medication carts (Hall 200 cart) reviewed for medication storage and security. The 200-hall nurse medication cart was left unlocked while unsupervised. These failures could place clients at risk for drug diversion or accidental ingestion. The findings included: Record review of Resident #115's admission record dated 08/21/2025 indicated she was admitted to the facility on [DATE] with diagnosis of diabetes. She was [AGE] years of age. Record review of Resident #115's order summary report indicated in part: (Insulin Lispro) Inject as per sliding scale: if 60 - 200 = 0 No insulin; 201 - 250 = 4 units; 251 - 300 = 6 units; 301 - 350 = 8 units; 351 - 400 = 10 units; 401 - 499 = 10 units Contact MD subcutaneously before meals for diabetes. Order date 07/25/2025. Record review of Resident #115's care plan dated 04/21/2025 revealed The resident has Diabetes Mellitus - Diabetes medication as ordered by doctor. Monitor/document for side effects and effectiveness. During an observation on 08/21/2025 at 11:38 AM revealed RN G performed a blood sugar check for Resident #115 in her room. RN G took the items needed from his medication cart then entered the resident's room. The medication cart was left unlocked as the RN did not press the lock cylinder back into the medication cart. RN G entered the room and the cart was out of his sight as the cart was parked out to the side in the hallway. After checking the resident's blood sugar, the RN returned to the medication cart and obtained an insulin pen and went back into the resident's room and again left the cart unlocked and unattended. During an interview on 08/21/2025 at 11:42 AM RN G said that the medication carts were supposed to be locked when unattended. The RN was made aware that he had left the medication unlocked when he entered the resident's room. RN G said that he could see the cart from the room, but he was made aware that he had his back turned to the cart and had left it unlocked on 2 occasions. RN G said he should have locked the cart. During an interview on 08/21/2025 at 5:08 PM the DON said if a nursing staff stepped away from their medication cart then they were expected to lock it. The DON was made aware of RN G stepping away from the medication cart and leaving it unlocked and unsupervised. The DON said the nurse should have locked it as the cart had several medications in it. Record review of the facility's undated policy and titled Medication cart administration of drugs indicated in part: If the cart is left at any time during medication pass due to an emergency, it must be locked. Event ID: Facility ID: 676179 If continuation sheet Page 11 of 13 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 08/21/2025 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 observations, interviews, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 2 (Residents #11 and #71) of 5 residents reviewed for infection control in that: The facility failed to ensure LVN B used PPE during PEG tube (percutaneous endoscopic gastrostomy tube-a feeding tube inserted through the abdominal wall into the stomach) care for Resident #11 as the resident was on EBP (enhanced barrier precautions). The facility failed to ensure LVN B sanitized the glucometer with an appropriate sanitizing item after performing a blood sugar test on Resident #71. These failures could place residents at risk for cross contamination and the spread of infection. Findings included: Resident #11 Record review of Resident #11's admission record dated 08/21/2025 indicated she was admitted to the facility on [DATE] with diagnoses of quadriplegia (partial or complete paralysis of both the arms and legs), chronic respiratory failure, tracheostomy (a hole that surgeons make through the front of the neck and into the windpipe), gastrostomy (the creation of an artificial external opening into the stomach for nutritional support or gastric decompression), muscle weakness, and seizures. She was [AGE] years of age. Record review of Resident #11's annual MDS assessment dated [DATE] revealed a Cognitive Skills for Daily Decision Making score of 3, Severely impaired - never/rarely made decisions. Record review of Resident #11's care plan revealed she required a PEG tube for adequate nutritional intake. It was revealed that EBP was implemented due to risk of infection. The care plan revealed she has a tracheostomy related to impaired breathing mechanics. It was revealed that EBP was implemented due to risk of infection. During an observation on 08/20/2025 at 10:48 AM, revealed LVN B entered Resident #11's room, washed his hands, and put gloves on. He performed the PEG tube placement check and residual check. He did not put on any type of PPE such as a gown except gloves during the process. There was an EBP posting outside the door for Resident #11. The EBP posting indicated to use a gown and gloves and the resident was on enhanced barrier precautions. During an interview on 08/20/2025 at 4:46 PM, LVN B stated he did not forget to put on a gown. He said he did not consider PEG tube placement and residual checks high-contact resident care. He said he does gown up when changing PEG tube dressings. During an interview on 08/20/2025 at 5:23 PM, the DON/Infection Preventionist (IP) said she did consider PEG tube placement and residual checks to be high-contact resident care. Record Review of the facility's policy titled Infection Prevention and Control Program, undated, indicated in part: EBP are used in conjunction with standard precautions and expand the use of PPE to donning of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDRO's (multi drug-resistant organisms) to staff hands and clothing. EBP are indicated for residents with any of the following: Infection or colonization with a CDC-targeted (Centers of Disease Control) MDRO when Contact Precautions do not otherwise apply; or Wounds and/or indwelling medical devices even if resident is not known to be infected or colonized with a MDRO.Indwelling medical device examples include central lines, urinary catheters, feeding tubes, and tracheostomies. Resident #71 Record review of Resident #71's admission record dated 08/21/2025 indicated he was admitted to the facility on [DATE] with diagnosis of diabetes. He was [AGE] years of age. Record review of Resident #11's care plan dated 05/27/2025 revealed The resident has Diabetes Mellitus - Diabetes medication as ordered by doctor. Monitor/document for side effects and effectiveness. During an observation and interview on 08/21/2025 at 11:24 AM revealed LVN B performed a blood sugar check for Resident #71 using a glucometer. After the LVN had performed the blood sugar check he returned to his cart and cleaned the glucometer with an alcohol prep pad. Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676179 If continuation sheet Page 12 of 13 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 08/21/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete The LVN was asked if he normally sanitized the glucometer with an alcohol pad and he replied yes. LVN B said as far as he knew that was an appropriate way to sanitize the glucometer. The LVN was in the process of entering another resident's room to perform a blood sugar check with the same glucometer he had just used on Resident #71 when the surveyor intervened and asked the LVN to stop. LVN B looked in his medication cart and found some germicidal bleach wipes and proceeded to sanitize the glucometer before proceeding to perform another blood sugar check. (A glucometer is a device used to test a person's sugar level by applying a drop of blood unto a test strip that is inserted in the glucometer). During an interview on 08/21/2025 at 5:05 PM the DON said the nurses were expected to use a germicidal wipe to sanitize the glucometers in between resident's blood sugar checks. The DON was made aware of a nurse using an alcohol pad to sanitize the glucometer. The DON said she believed the alcohol pad was an appropriate way to sanitize the glucometer. The DON said she was not sure what their policy indicated but that she would look. Record review of the facility's undated policy and titled Glucometer policy indicated in part: It is the policy of our facilities that the glucometer be cleaned after each use. This procedure will ensure that any area of the glucometer that could possibly come in contact with blood will be cleaned properly to avoid any possible chance of cross-contamination. Each glucometer will be cleaned with an alcohol-free cleaning product that is a germicidal, viricidal and anti-bacterial agent. After each use the glucometer is to be c leaned with an approved alcohol-free cleaning product. Sani-cloth is used in our facilities as the cleaning product of choice for our glucometers. Record review of the CDC's website on 08/21/2025, the website indicated in part: Do not share blood glucose meters. If you must share them in a healthcare or congregate setting, select a device designed for use in professional settings, not an over-the-counter device. Clean and disinfect blood glucose meters after every use, per the manufacturer's instructions. These recommendations apply in: Long-term care settings (e.g., nursing homes and assisted living facilities). https://www.cdc.gov/injection-safety/hcp/infection-control/index.html. Record review of the glucometer's manufacturers recommendation indicated in part: Your EvenCare G2 Meter and lancing device are validated to withstand a cleaning and disinfection cycle of ten times per day for an average period of three years. The following products are validated for disinfecting the EvenCare G2 meter and lancing device. Hospital Cleaner Disinfectant Towels with Bleach, Medline Micro-Kill + Disinfecting, Deodorizing, Cleaning Wipes with Alcohol, Clorox Healthcare Bleach Germicidal and Disinfectant Wipes, Medline Micro-Kill Bleach Germicidal Bleach Wipes. Event ID: Facility ID: 676179 If continuation sheet Page 13 of 13