Health inspection·August 2, 2023

F 0645 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete had only been at the facility for six months and was not there when Resident #50's PASRR was done. She stated she would submit a new positive PASRR level one for Resident #50. Review of the facility's Policy and Procedure PASRR dated 01/2022 reflected The facility will designate an individual to follow up on all residents have received a PASRR level I screening. If the facility serves a resident with a positive PASRR level I screening, the facility must have obtained a PASRR level II evaluation .nursing individual must .coordinate with local intellectual/ development disability and/ or local mental health authority to ensure a PASRR level II evaluations conducted when an individual's PASRR level I screening indicate the individual may have an ID, DD, or MI. Event ID: Facility ID: 676220 If continuation sheet Page 2 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 residents unable to conduct activities of daily living (ADLs) received the necessary services to maintain good grooming and personal hygiene for two of 15 residents (Resident #60 and #7) reviewed for quality of life. Residents Affected - Few A) The facility failed to provide facial grooming and bathing assistance to Resident #60. B) The facility failed to ensure Resident#7's fingernails were trimmed and cleaned. These failures could place residents at risk for poor hygiene, dignity issues and decreased quality of life. Findings included: A) Review of Resident #60's undated face sheet reflected a [AGE] year-old female admitted on [DATE] with diagnoses of unspecified dementia, dysphagia (difficulty swallowing), anxiety disorder, hyperlipidemia (high cholesterol), and hypertension (high blood pressure). Review of Resident #60's MDS assessment dated [DATE] reflected a BIMS score of 7, which indicated moderately impaired cognition. Review of Resident #60's care plan last revised on 5/29/2023 reflected she had an ADL self-care performance deficit and required assistance from staff with bathing and personal hygiene. Observation and interview on 7/31/2023 at 12:15 PM revealed Resident #60 with chin hair. Resident #60 stated she had heavy hair on her chin, she used to get it trimmed, and it bothered her to have chin hair. Resident #60 stated she had not had a bath in a while because of quarantine but staff used to trim her hair before she got a shower. Resident #60 stated it had been 7-8 days since she had a shower or bath and she hates it when she did not get a shower when she wanted one. Resident #60 was shaky and crying. Observation on 08/01/2023 at 8:59 AM revealed Resident #60 still had chin hair. In an interview on 08/01/2023 at 1:28 PM the Staffing Coordinator stated she sometimes worked as a CNA and was working as CNA on the hall that day where Resident #60 resided. The Staffing Coordinator stated she had not seen Resident #60's beard and had not been asked to trim it but stated staff usually offered to trim it before her showers. Observation on 08/01/20203 at 3:41 PM revealed Resident #60 had untrimmed facial hair on her chin. In an interview on 08/01/2023 at 3:55 PM the DON stated CNA B was the facility's only full-time shower aide, but other CNAs helped with showers as well. In an interview on 8/01/2023 at 3:37 PM the HR stated she had not provided any showers to residents and was not sure how her name was used to document a shower given to Resident #60 on 08/01/2023. In an interview on 08/01/2023 at 3:55 PM the Staffing Coordinator stated she documented in Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 3 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #60's chart that she had received a shower on 7/27/2023 because she observed CNA B taking the resident to the shower room on that day (07/27/2023). The Staffing Coordinator stated she thought CNA B kept a book of shower sheets but did not think CNA B turned them in to nurses but stated [NAME] would let the nurses know if residents refused showers. In an interview on 08/01/2023 at 3:46 PM CNA C stated she could not remember which days Resident #60 got showers, stated she did not provide showers and said shower aides provided showers. In an observation and interview on 8/02/2023 at 8:45 AM Resident #60 stated she used to trim her facial hair herself when she was at home and stated she was really hairy. Resident #60 stated she got a shower the day prior (08/01/2023) and staff had trimmed her facial hair. Observed Resident #60's facial hair to be trimmed and the resident was smiling. In an interview on 08/02/2023 at 9:17 AM CNA B stated she was the facility's only shower aide and was not sure which days Resident #60 received showers but I know it's been a little bit since she got a shower because she had just gone out on leave, Resident #60 had broken her leg, and there had not been a lot of help. CNA B stated she did not think there were enough staff to give showers to all the residents on their scheduled shower days and said the facility needed more than one shower aide. CNA B stated it was going on a week since Resident #60 had received a shower. CNA B stated she did not document showers given in the electronic medical records system but documented on shower sheets which she discarded in the trash daily. CNA B stated Resident #60 did not typically refuse showers. CNA B stated Resident #60's facial hair grew fast and the last time it was shaved would have been the last time the resident received a shower which CNA B could not recall. In an interview on 08/02/2023 at 9:24 AM CNA D stated one of the head aides, the Staffing Coordinator, had asked her to shower Resident #60's the day prior on 08/01/2023 so CNA D trimmed and showered Resident #60 on the 6 pm - 6 am shift. CNA D stated she did not typically work during the day, so she did not know when Resident #60 had last received a shower. In an interview on 08/02/2023 at 10:41 AM the DON stated Resident #60's shower days were Mondays, Wednesdays and Fridays and female residents should be offered a shave when they had a shower. The DON stated the facility had one full time shower aide, but other CNAs helped give showers too because one person could not give 37 showers. The DON stated any CNA or nurse could give a resident a shower. The DON stated after the facility's nursing staff were questioned about showers the day prior on 08/01/2023, she started working on a quality improvement tool for shower documentation. The DON stated showers were all done in the mornings and the 2-10 p.m. staff did not give showers. The DON stated the facility was trying to hire another shower aide after their other shower aide quit about a month prior. The DON stated Resident #60 was grouchy and sometimes refused showers but stated grouchiness was not a reason not to give a shower. The DON stated she would need to talk to Resident #60 to ask her what a potential negative outcome would be if she did not receive a shower and have her facial hair shaved as often as she wanted. The DON stated if staff on the 2-10 PM shift saw Resident #60's beard they may not have offered to trim it because they knew the shower aides did it on residents' shower days but if residents wanted to be shaved daily, they could do that. B) Review of Resident #7's Face Sheet dated 08/01/2023 reflected a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses Diabetes Mellitus Type II, Hypertension, and legal blindness. Review of Resident #7's admission MDS dated [DATE] reflected Resident #7 was assessed to not have a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 4 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few BIMS score assessment conducted indicating severe cognitive impairment. Resident #7 was assessed to require limited to extensive assist with ADLs. Resident #7 was assessed to have an indwelling catheter. Review of Resident #7's Comprehensive Care Plan reflected a focus are with the start date of 04/01/2023 Resident has an ADL self-care performance deficit related to weakness and deconditioning. Interventions included Personal Hygiene/oral care requires staff participation with personal hygiene and oral care. Observation and interview on 07/31/2023 at 10:00 AM revealed Resident #7 in bed alert. Resident #7's fingernails were long and had a brown substance under her nails. Resident #7 stated her nails were long. When asked if she would like them trimmed, she stated yes, she would. Observation and interview on 08/01/2023 at 1:10 PM revealed the ADON in Resident #7's room to provide care. The ADON stated Resident #7's fingernails were long and should be trimmed. She stated since Resident #7 was a diabetic and she would need a nurse to provide her nail care and it was the nurses responsibility to trim Resident #7 fingernails. In an interview on 08/02/2023 at 9:31 AM the DON stated she expected all resident's nails to be trimmed if the resident wants them trimmed but they should always be cleaned. Review of the facility's policy ADL Services (not dated) reflected It is the policy of this facility that residents are given the appropriate treatment and services to maintain or improve his/her abilities. Residents who are unable to carry out activities of daily living (ADL) will receive necessary services to maintain .Grooming, personal hygiene . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 5 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents who are incontinent of bladder receive appropriate treatment and services to prevent urinary tract infections for one three residents reviewed for catheters (Resident #7). The facility failed to ensure Resident #7's received care to prevent Urinary Tract Infections when they stored her catheter bag on the floor and did not ensure the catheter bag and tubing was positioned below the level of the bladder. These failures could place residents with foley catheters at risk for urinary tract infections and change of condition. Findings included: Review of Resident #7's Face Sheet dated 08/01/2023 reflected a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses Diabetes Mellitus Type II, Hypertension, and legal blindness. Review of Resident #7's admission MDS dated [DATE] reflected Resident #7 was assessed to not have a BIMS score assessment conducted indicating severe cognitive impairment. Resident #7 was assessed to require limited to extensive assist with ADLs. Resident #7 was assessed to have an indwelling catheter. Review of Resident #7's Comprehensive Care Plan reflected a focus are with the start date of 07/31/2023 Resident has indwelling catheter . Interventions included Position catheter bag and tubing below the level of the bladder and away from the entrance room door . Review of Resident #7's Physician orders reflected an order for Catheter type French #16 ML 10 to closed urinary drainage system. Observation on 07/31/2023 at 10:00 AM revealed Resident #7 in room in bed. Resident #7's indwelling catheter was lying flat on the floor next to her bed. Observation and interview on 08/01/2023 at 1:10 PM revealed Resident #7 in bed. Her indwelling catheter was resting on the floor and not hanging properly from her bed frame with the bag being almost level to the resident's bladder. The ADON stated Resident #7's indwelling catheter bag should not be touching the floor and should be hung to ensure her catheter is draining properly. In an interview on 08/02/2023 at 2:00 PM the DON stated it was the facility's policy that indwelling catheter bags are not to be on the floor for infection control reasons. Review of the facility's policy Catheter Drainage Bag dated 01/2022 reflected It is the policy of the facility to maintain continuously closed urinary drainage system whenever possible .position the drainage bag below the level of the resident's bladder . The facility's policy did not address the catheter bag being on the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 6 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure all residents received respiratory care consistent with professional standards of practice and resident preferences for one (Resident #41) of eight residents reviewed for respiratory care. Residents Affected - Few The facility failed to ensure Resident #41 had an order for oxygen which should have specified the L/m required. The facility failed to ensure a licensed nurse adjusted Resident #41's oxygen. These failures placed Resident #41 at risk of respiratory distress. Findings included: A record review of Resident #41's face sheet reflected a [AGE] year-old female admitted on [DATE] with diagnoses of heart failure, Parkinson's disease (progressive disease of the nervous system), chronic respiratory failure, atrial fibrillation (irregular heartbeat), hypertension (high blood pressure), pneumonia, and major depressive disorder (depression). A record review of Resident #41's MDS assessment dated [DATE] reflected a BIMS score of 14, which reflected minimal cognitive impairment. A record review of Resident #41's care plan last revised on 8/01/2023 reflected she was on oxygen therapy related to heart failure. A record review of Resident #41's physician order dated 7/29/2023 reflected Attempt to wean off supplemental oxygen. Keep Sats >92. The order did not specify how many L/m Resident #41 needed. During an observation and interview on 7/31/2023 at 9:34 a.m., Resident #41 was observed sitting in her wheelchair with a nasal cannula on providing oxygen. Resident #41 stated she had been in and out of long-term facilities both as a worker and a resident for 30 years. During an observation and interview on 8/01/2023 at 10:08 a.m., Resident #41 was observed sitting in a wheelchair in her room. Resident #41's oxygen tank was running at 6 L/m. MA G stated Resident #41's oxygen was set to 6 L/m, she was not sure what it was supposed to be set at and said, that's high. Resident #41 stated her oxygen was supposed to be set to 2 L/m. Observed Resident #41's oxygen tubing and humidifier to be dated 8/1/23. Observed Resident #41 turn on her call button. During an observation and interview on 8/01/2023 at 10:11 a.m., LVN E stated 6 L/m oxygen was way too high for Resident #41 and he did not know why anyone would set it up that high. Observed Resident #41's tank was then set at 1.5 L/m. LVN E stated the nurse on the 10 pm - 6 am shift set the oxygen level on Resident #41's tank when they changed the tubing and humidifier. LVN E stated the oxygen being set that high would have a negative impact on Resident #41 because it would take their breath away and make it hard to breath if the setting was that high. During an interview on 8/01/2023 at 10:19 a.m., Resident #41 stated CNA A turned down her oxygen level after HHSC surveyors alerted her that her oxygen was on too high of a setting. Resident #41 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 7 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 stated she could breathe better after CNA A turned down her oxygen. Level of Harm - Minimal harm or potential for actual harm During an interview on 8/01/2023 at 10:20 a.m., CNA A stated she adjusted Resident #41's oxygen level because Resident #41 asked her to. CNA A stated she knew she was not supposed to adjust the level, but she adjusted it to 2 L/m because Resident #41 insisted and she said since her father-in-law used to have an oxygen tank she knew how to do it. Residents Affected - Few During an interview on 8/01/2023 at 10:22 a.m., LVN E stated anyone could check the oxygen level, but nurses were responsible for checking it. LVN E stated he usually checked Resident #41's oxygen level every three hours but he had not checked her oxygen since 7:00 a.m. that morning because the humidifier and tubing had just been changed. LVN E stated an agency nurse named LVN F had changed Resident #41's oxygen tubing and humidifier tank earlier that morning. During an observation on 8/01/2023 at 10:32 a.m., LVN E measured Resident #41's oxygen saturation to be about 95-96%. During an interview on 8/01/2023 at 11:45 am, LVN F stated she had worked the hallway where Resident #41 resided on 10 pm - 6 am the night of 7/31/2023-8/01/2023. LVN F stated since Resident #41 had an order to be weaned off oxygen, she took off her oxygen to check her oxygen saturation but Resident #41 would not let her. LVN F stated Resident #41's oxygen saturation was normal and she did not adjust the L/m setting. LVN F stated when she last saw Resident #41's oxygen level, it was set at 3 L/m. During an interview on 8/01/2023 at 11:21 a.m., CNA A stated the facility had not trained her how to adjust oxygen levels but she had been trained by a provider through her family's home health. During an interview on 8/01/2023 at 1:16 p.m., CNA A stated she changed Resident #41's oxygen tubing and humidifier tank but did not adjust the oxygen level or pay attention to what it was set at. During an interview on 8/02/2023 at 10:41 a.m., the DON stated nurses typically administered residents' oxygen. The DON stated the level of oxygen Resident #41 should have been in the order and staff checked oxygen levels during their shift. The DON stated she did not think Resident #41's oxygen being set to 6 L/m would cause any harm or have a negative effect on Resident #41 and if Resident #41 needed 6 L/m, it would be okay. The DON stated CNAs were trained not to adjust oxygen levels, she was not sure whether that was within their scope, and that CNAs may have adjusted Resident #41's oxygen tubing. A record review of the facility's policy on oxygen administration dated May 2007 reflected the following: Section: Licensed Nurse Procedures Subject: Oxygen Administration POLICY: It is the policy of this facility that oxygen therapy is administered, as ordered by the physician or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 8 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0695 as an emergency measure until the order can be obtained. Level of Harm - Minimal harm or potential for actual harm PURPOSE: The purpose of the oxygen therapy is to provide sufficient oxygen to the blood stream and tissues. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 9 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record reviews the facility failed to ensure PRN orders for psychotropic drugs were limited to 14 days, except if the attending physician or prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days, for two of five residents reviewed for unnecessary medications. (Residents #38 and #181) A) The facility failed to ensure a PRN order for Lorazepam (anti-anxiety) dated 07/07/2023 had a stop date to ensure the medication did not extend beyond 14 days for Resident #38. B) The facility failed to ensure a PRN order for Lorazepam (anti-anxiety) dated 07/27/2023 had a stop date to ensure the medication did not extend beyond 14 days for Resident #181. This deficient practice placed residents with PRN psychotropic drugs at risk for side effects of psychotropic drugs which include nausea, drowsiness, dizziness, confusion, constipation, diarrhea, and delirium and placed residents at risk for receiving unnecessary medications. Findings included: A) Review of Resident #38's Face sheet dated 08/0/2023 reflected a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE] with the following diagnoses aftercare following joint replacement surgery, and Dementia. Review of Resident #38 Quarterly MDS assessment dated [DATE] reflected Resident #38 was assessed to have a BIMS score of 00 indicating severe cognitive impairment. Resident #38 was assessed to require extensive assist with ADLs. Resident #38 was further assessed to not have behaviors. Review of Resident #38's comprehensive care plan reflected a focus area with the start date 02/28/2023 reflected Resident #38 has the potential to demonstrate physical behaviors (hitting, pushing and biting) related to dementia, and poor impulse control. Resident #38's care plan did not address use of antianxiety medication. Review of Resident #38's consolidated physician orders reflected an order for Ativan oral tablet 0.5mg one tablet by mouth every 6 hours as needed for anxiety dated 07/07/2023 (no stop date.) Review of Resident #38's MAR dated July 2023 reflected Lorazepam 0.5mg PRN was administered five times on 07/07/2023, 07/15/2023, 07/16/2023, 07/18/2023 and 07/22/2023. B) Record review of Resident #181's face sheet dated 08/01/2023 reflected a [AGE] year-old female admitted on [DATE] with diagnoses of multiple sclerosis (progressive nerve disease), chronic pain syndrome, intermittent asthma, and dysarthria (slurred speech). Record review of Resident #181's MDS assessment dated [DATE] reflected a BIMS of 15, which indicated no cognitive impairment. Record review of Resident #181's care plan last revised on 07/27/2023 reflected she received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 10 of 11 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 676220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granite Mesa Health Center 1401 Max Copeland Dr Marble Falls, TX 78654 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0758 anti-anxiety medication. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #181's physician order dated 07/27/2023 reflected she was prescribed PRN Ativan (anti-anxiety agent) with an indefinite end date. Residents Affected - Few In an observation and interview on 07/31/2023 at 2:46 PM revealed Resident #181 was lying in bed conversing with family. In an interview on 08/02/2023 at 9:40 AM the Pharmacy Consultant stated ideally all Ativan PRN orders should be written with a stop date. Resident #181's order was new and when it was written should have included a stop date. Resident #38's new order for Ativan should also have been written with a stop date and the NP should be notified if the order needs to be renewed past the 14 days. In an interview on 08/02/2023 the ADON stated she was in charge of doing the pharmacy recommendations. She stated yes, it was the facility's policy that all PRN Ativan have a stop dates. She stated she had done in-servicing, but nurses should catch it when orders are received and contact the MD or NP to get the stop date. A facility policy for PRN psychotropic drugs was requested. No policy was provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676220 If continuation sheet Page 11 of 11