Health inspection·December 12, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 12/12/24 at 12:03 PM, the ADM stated that it was her or a designee's responsibility to make sure discharge/transfer notices were sent to the Ombudsman and that if it was not sent, the Ombudsman would not be aware of what was going on with the resident . Record Review of Transfer/Discharge Report for Resident #1 revealed it was, dated and signed by Resident #1 on 12/11/24 at 02:27 PM. Review of the facility's policy, provided by the DON, titled Transfer and Discharge, not dated, reflected in part: It is the policy of this facility to permit each resident to remain in the facility, and not initiate transfer or discharge for the resident from the facility, except in limited circumstances. .Generally, the notice must be provided at least 30 days prior to a facility-initiated transfer or discharge of the resident. Exceptions to the 30-day requirement apply when the transfer or discharge is affected because: An immediate transfer or discharge is required by the resident's urgent medical needs. In these exceptional cases, the notice must be provided to the resident, resident's representative if appropriate, and the LTC ombudsman as soon as practicable before the transfer or discharge. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676186 If continuation sheet Page 2 of 4 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 676186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castro County Nursing & Rehabilitation 1621 Butler Dimmitt, TX 79027 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 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on interview and record review, the facility failed to employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, taking into consideration resident assessments, individual plans of care and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment requirement for 1 of 1 kitchen staff (Dietary Manager) reviewed for qualifications. The Dietary Manager failed to have the appropriate license, certification, or qualifications to function as the Director of Food and Nutrition Services. This failure could place residents who consume food prepared from the kitchen at increased risk of food borne illness and not receiving adequate nutrition. Findings included: Record Review of a current facility employee roster including hire date, indicated the DM's date of hire was 04/30/2024. During an interview on 12/12/24 at 7:14 AM, the DM stated she had been employed at the facility since April , 2024 but had been the DM since June , 2024. When asked for her certification for DM, she stated she was not certified or enrolled in a class to become certified at this time. The DM stated that she was waiting for corporate to send her an email so she could get enrolled in the class. During an interview on 12/12/24 at 9:00 AM, the ADM stated the DM was not certified but will be taking classes soon, hopefully the beginning of next year. She stated that they do have a RD who the DM consults with, but she was not full time. In an interview on 12/12/24 at 11:55 AM, the DON stated she was responsible for making sure staff were trained appropriately and that a negative outcome for not having a DM that was trained could be weight loss in residents, wrong orders given to residents in regard to purees, mechanical diets, and portion sizes. In an interview on 12/12/24 at 12:03 PM, the ADM stated that all department heads and herself were responsible for making sure that staff were properly trained and that she was not here when the DM was hired for that position. The ADM stated possible negative outcomes for not having a DM that was certified could be possible weight loss and dietary requirements not being met for residents, for example, making sure diabetic residents were not getting sugary desserts. Record Review of the facility policy titled Dietary Services-Staffing, not dated, included in part: Policy: The facility employs sufficient staff with the appropriate competencies and skill sets to carry out the functions of the Food and Nutrition Services, taking into consideration resident assessments, individual plans of care and the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment. .3. If a qualified dietitian or other clinically qualified nutrition professional is not employed full-time, the facility will designate a person to serve as the director of food and nutrition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676186 If continuation sheet Page 3 of 4 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 676186 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Castro County Nursing & Rehabilitation 1621 Butler Dimmitt, TX 79027 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 0801 services who is: Level of Harm - Minimal harm or potential for actual harm i. A certified dietary manager. Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676186 If continuation sheet Page 4 of 4