Health inspection·December 1, 2022

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some initiation and completion of all baseline care plans within 48 hours upon a resident's admission into the facility. The DON stated he was aware that Resident #10, Resident #62, and Resident #171 baseline care plans were not completed timely. He stated most new admission occur on a Friday and the baseline care plans would need to be completed over the weekend, which would require him to work seven days a week. The DON stated going forward he would have the weekend RN complete the baseline care plans that would be due over the weekend. The DON stated in his review of the baseline care plans for Resident #10, Resident #62, and Resident #171, the plans were not specific to each resident's need. He stated that he did not personalize the care plans, but instead the interventions were chosen from computer generated options. The DON stated not having a personalized care plan would not allow for the most appropriate care to be given to the resident which could lead to harm, injury, and death. Review of the facility's Comprehensive Person-Centered Care Planning policy dated 2017 reflected .within 48 hours of the resident's admission, the facility will develop and implement a baseline care plan that includes instructions to provide effective and person-centered care. The baseline care plan will include the minimum healthcare information necessary to properly care for a resident including, but not limited to initial goals based on admission orders, physician orders, dietary orders, therapy services, social services, and PASARR recommendations, if applicable . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 2 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to develop a care plan for interventions for removal of facial hair for one (Residents #23) of eight residents reviewed for comprehensive care plans. The facility failed to develop a care plan Resident #23's care plan for interventions for removal of facial hair. This failure could place residents at risk for possible decreased quality of life, isolation and embarrassment. Findings include: Record review of Resident #23's quarterly MDS dated [DATE], revealed an [AGE] year-old female admitted to the facility 10/02/2020, re-admitted on [DATE] with diagnosis of diabetes mellitus, cerebrovascular accident, and dementia with a BIMs of six severely confused. She requires total care with bathing and personal hygiene of one staff assistance. Review of Resident#23's care plan undated reflected resident had a self-care performance deficit. The care plan did not address Resident #23's ADL interventions for removal of facial hair. Observation on 11/29/22 at 10:27 a.m. revealed Resident #23 was sitting in her wheelchair neat and clean. She had long white and gray facial hair approximately 0.5 inches in length on her chin area, her upper lip and underneath her chin. When asked if she would like for the facial hair to be removed, she replied yes, its, embarrassing. Hospitality Aide stated she would get her care giver to took care of Resident #23's chin hair that she was a hospitality aid. Resident #23's facial hair was removed shortly after it was brought to the CNAs attention. In an interview with CNA D on 11/30/22 at 10:02 a.m. she revealed there was nothing on the bathing sheet to inform the CNAs when to shave the female residents. The CNAs just use their judgments when to shave a female's facial hair depending on how long it is because if it's too short it will cause skin irritations. Residents should be shaved at the same time of their showers. Review of the facility's undated Care Plans, Comprehensive Person-Centered policy: A comprehensive, person-centered care plan that includes measurable objective and timetables to meet the resident's physical, Psychosocial and functional needs is developed and implemented for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 3 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 a resident, who is unable to carry out activities of daily living, receives the necessary services to maintain grooming, and personal hygiene for two (Resident #6 and Resident #23) of eight residents reviewed for personal hygiene and bathing. Residents Affected - Few The facility failed to ensure staff provided consistent showers/baths to Resident #6. The facility failed to ensure staff removed Resident #23's facial hair. These failures could affect the residents who require assistance with care from facility staff by placing them at risk for social isolation, loss of dignity and self-worth. Findings included: 1. Review of Resident #6's MDS re-admission assessment, dated 10/22/22, revealed an [AGE] year-old female, re-admitted to the facility on [DATE] with diagnoses of Chronic Obstructive Pulmonary Disease ( respiratory disease) . Further review revealed the resident was alert and oriented to person, place, and time and required total assistance with two-person assistance for bathing. Review of Resident #6's Comprehensive Care Plan, undated, revealed her shower days were three times a week on Tuesdays, Thursdays and Saturdays. She required assistance with personal hygiene. Observation and interview on 11/29/22 at 10:27 a.m. Resident #6 were setting in wheelchair well groom at bedside. When asked if he had received her showers. She stated, I have not had a shower since I've been here. Record review of Resident#6's Bathing record dated from 11/17/22 through 11/28/22. The record reflected no showers on were provided on the following days: 11/17/22, 19th, 22nd, 24th, 26th, and 28th. In an interview on 12/01/22 at 9:00 a.m. with LVN C, she revealed a shower list was made out each morning of residents receiving a shower that day. She stated hall 200 did not schedule showers/baths the same as the other halls. Showers were rotated by room numbers. They used to have several residents that were heavy care and required mechanical lift. It was likely that Resident#6 was not put on the shower list. She revealed the CNAs were to document on the residents bathing record if a resident received or refused a shower/bath. If a resident refuses a shower, they are supposed to report to the charge nurse. The charge nurse will talk with the resident and try to encourage him/her to take a shower, then the nurse is to chart in the resident's record. In an interview on 11/30/22 at 11:45 a.m. with CNA E revealed she was the shower aid that assisted with showers on the 6 am-2 PM and 2 PM-10 PM shifts. She stated she gets a list of the residents that are scheduled to receive a shower for that day, and she starts going down the list giving showers. She was not aware Resident #6 had not received a shower which meant she must not have been on her list to shower her. She stated she was supposed to chart the showers and if a resident refuses a shower that she will verbally report to the CNA on that hall. In an interview with the DON 11/30/22 1:27 p.m., he revealed the facility's expectation was all residents to be well groomed including facial hair. He stated if a resident refused a shower then the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 4 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 CNA should report to the charge nurse so she can talk and encourage the resident to take a shower and/ or document the refusal. He stated the risk of for not bathing a resident were body odor, skin breakdown, loss of dignity and isolation. 2. Record review of Resident #23's quarterly MDS dated [DATE], revealed an [AGE] year-old female admitted to the facility 10/02/2020, re-admitted on [DATE] with diagnoses of Diabetes mellitus, Cardiovascular accident and dementia. The resident had a BIMs of six which indicated the resident was severely impaired with decision making. She required total care with one person assistance with bathing and personal hygiene. Review of Resident#23's care Plan undated reflected resident had a self-care performance deficit. The care plan did not address Resident #59's ADL interventions for removal of facial hair. Observation on 11/29/22 at 10:27 a.m. revealed Resident #23 setting in her wheelchair neat and clean. She had long white and gray facial hair approximately 0.5 inches in length on her chin area, her upper lip and underneath her chin. When asked if she would like for the facial hair to be removed, she replied yes, its, embarrassing. The Hospitality Aide stated she would get her care giver to take care of Resident #59's chin hair. Residents' facial hair was removed shortly after it was brought to the CNAs attention. In an interview with CNA D on 11/30/22 at 10:02 a.m. she revealed there was nothing on the bathing sheet to inform the CNAs when to shave the female residents. The CNAs just used their judgment when to shave a female's facial hair depending on how long it was because if it's too short it will cause skin irritations. Residents should be shaved at the same time of their showers. Record review of the facility's policy for bath, tub/shower undated reflected, bathing by tub or shower is done to remove soil, dead epithelial cell and microorganism from the skin, and body to promote comfort, cleanliness, circulation and relaxation. The policy did not address shaving of residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 5 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **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 food that accommodates resident preferences for one resident (Resident #59) of eight residents reviewed for food preferences. The facility failed to ensure Resident#59's likes, and dislike food preferences were honored by combining her food together. This failure could cause residents who ate meals from the kitchen at risk of not having their choices and food preferences accommodated, possible weight loss, and a diminished quality of life. Findings included: Record Review of Resident #59's undated face sheet revealed she was a [AGE] year-old female admitted to the facility on [DATE] and readmitted to the facility on [DATE]. Her diagnoses included Type two Diabetes, protein-calorie malnutrition, and cognitive communication deficit. Record Review of Resident #59's Quarterly MDS assessment dated [DATE] revealed a BIMS score of 7 indicating severe cognitive impairment. Observation on 11/30/22 at 8:40 a.m. revealed breakfast was being served to Resident #59 in the dining room. CNA D set the residents breakfast tray on the table in front of her. She proceeded to set -up the resident's food by opening the jelly container and added the jelly to residents' cream of wheat. CNA D then she took the scrambled eggs and added them in with the jelly and cream of wheat. CNA D never asked Resident #59 if she would like for her jelly and eggs to be combined in the cream of wheat. Resident #59 stated she did not like the jelly in her cream of wheat. Review of the breakfast and lunch meal tickets dated 11/30/22 for Resident #59 revealed her likes and dislikes was blank and did not indicate to combine residents' foods at meals. In an interview on 12/01/22 at 10:20 a.m. with CNA D she combined Resident #59's breakfast food together because that was what the therapy staff were doing, and she just done what she had seen. She stated the purpose of the meal tickets were to give instruction on how and what type of food the resident was allowed to eat and their likes and dislike. In an interview on 12/01/22 at 10:02 a.m. with the Dietary Supervisor revealed she was not aware the CNAs were combining Resident #59's foods. She stated the meal tickets was to inform the staff of residents likes and dislikes preferences. His expectations were to follow the meal ticket instructions and to ensure residents eat and enjoy their meals to get the proper nutrition. The risk factors were that the resident could lose weight and not eat their meals. The facility did not provide a food preference policy at the time of exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 6 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow proper sanitation and food handling service by failing to maintain essential equipment for two of two hand washing sinks in the kitchen area reviewed for safe and sanitary water temperatures. Hand Washing, Gloves, and Antimicrobial Gel Employees should never use bare hand contact with any foods, ready to eat or otherwise. Since the skin carries microorganisms, it is critical that staff involved in food preparation, distribution and serving consistently utilize good hygienic practices and techniques. Staff should have access to proper hand washing facilities with available soap (regular or anti-microbial), hot water, and disposable towels and/or heat/air drying methods. The facility failed to regularly check the water temperature of the kitchen handwashing sinks and failed to document and report the water was not getting hot. This failure could affect residents at risk for illness due to unsafe hand washing practices. Findings included: Observation on initial tour of the kitchen on 11/29/22 at 9:31 AM revealed that water in hand washing sink #1 was cold to the touch when surveyor washed her hands. Surveyor proceeded to hand washing sink #2 and it was also cold to the touch. Interview on 11/29/22 at 9:36 AM the Dietary Manager stated that they have been having issues with the two sinks not getting hot for about a week. The dietary manager stated it was verbally reported to Maintenance Supervisor but was not formally documented in a work order. The dietary manager stated water in both sinks have been sporadically getting hot water over the past few days. Observation and interview on 11/29/2022 at 9:50 AM with Maintenance Supervisor check the water temperature in sink #1 and it was 59 degrees and sink #2 was also at 59 degrees. The Maintenance Supervisor revealed that he was aware that the water in the kitchen has not been producing hot water in the hand washing sinks. He stated that there was a problem with the tankless water heater, and he would have to call a plumber to fix it. He stated that it was working 11/28/2022 but he had not checked the temperature today. The Maintenance Supervisor stated a plumber had not been called about the hand washing sinks. Interview with Dietary Aide on 11/29/2022 at 10:23AM revealed that she did use sink #1 in the kitchen to wash her hands when she entered the kitchen. She stated she did not recall if the water was hot or cold but did know that it has been having issues. Interview with [NAME] B on 11/29/2022 at 10:27AM revealed that she did use sink #1 in the kitchen to wash her hands when she entered the kitchen. She stated she remembered the water being kind of chilly but she still used it. She stated that she did not report it to anyone because she did not know it was a problem and thought it could've been because it was cold outside. Interview with [NAME] A on 11/29/2022 at 11:00AM revealed that she was aware of the issue with the kitchen hand washing sinks and washed her hands in an alternative sink located in the dining room area. She was unsure how long the hand washing sinks in the kitchen have been malfunctioning. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 7 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 Record review of Facility Monthly Heater and Boiler Log revealed there were no accurate temperatures documented from January- November. The log revealed that only check marks were used which had no indication of date or actual temperature that was recorded. There was no other documentation to review including nothing being recorded in the Maintenance log addressing the water temperatures in the hand washing sinks. Residents Affected - Some Interview with Maintenance Supervisor on 11/29/2022 at approximately 11:15AM revealed that a plumber has been called and was expected at the facility on 11/29/2022 between 2PM-2:30 PM. Observation and interview on 11/30/2022 at 9:40 AM revealed the water in both hand washing sinks in the kitchen are still producing water that was cold to the touch. The Maintenance Supervisor revealed that the plumber will return today to replace the tankless hot water system that produces hot water for the two hand washing kitchen sinks as it was deemed unfixable by the plumber yesterday. Observation and interview on 11/30/2022 at 3:05 PM revealed that Kitchen hand washing sink #1 temperature was at 111 degrees. Kitchen hand washing sink #2 was at 110 degrees. The Life Safety Facility Coordinator revealed that the tankless water heater had been replaced and the kitchen hand washing sinks had been fixed. Interview with the Administrator on 12/01/2022 at 1:30PM revealed that she was unaware of the issue in the kitchen until it was brought to her attention on 11/29/2022. She expected the Maintenance Supervisor to conduct temperature checks throughout the building including the kitchen sinks on a weekly basis and those temperatures should be clearly documented, dated and signed. She also stated that it was her expectation that any issues should be reported immediately so that they can be addressed timely. Going forward she revealed that her Life Safety Facility Coordinator will be setting up a QR code in the kitchen and other areas around the facility that can be scanned to report maintenance issues. She stated that the QR code will alert the Maintenance Supervisor and Life Safety Facility Coordinator of the issue and can be tracked in real time. She also was now requiring Maintenance Supervisor to turn in Temperature check logs into her on a weekly basis and she will sign and keep them in a logbook. Record Review of a facility in-service dated 11/30/2022 indicated that Life Safety Facility Coordinator trained the Maintenance Supervisor on water temperature expectations and how to properly document temperatures. All areas in the building were checked and verified for appropriate water temperatures. Record review of invoice from [NAME] Service LLC dated 12/01/2022 indicated that tankless water system was replaced with a new tankless water system. Review of the facility's Reporting Malfunction/Error Reporting Policy Number 2G dated 6/2017 stated: Policy: It is the policy of this facility to report all equipment malfunction to the maintenance supervisor so that they may ensure that all equipment is maintained in an operable state. Procedure: 1. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 8 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 When a piece of equipment is observed to be malfunctioning or operating incorrectly, advise the maintenance director of the situation. Level of Harm - Minimal harm or potential for actual harm 2. Residents Affected - Some If maintenance director is unavailable put item in maintenance log. 3. Maintenance director shall facilitate repair/replacement of equipment as soon as possible and notify the department head and administrator when repairs are complete. 4. If equipment must be replaced and will fall under CAPEX criteria, maintenance director shall coordinate with administrator to properly order equipment. Record review of the facility's Hot Water System Policy which was not dated: 1. The temperature will be recorded on the water temperature log daily and maintained by the Maintenance Supervisor weekly. 2. There will be random water temperature checks throughout the facility accessible to the residents. 3. Water temperature should be maintained at 100 degrees F at a minimum, and 110 degrees F at a maximum. 4. The laundry and kitchen areas should be maintained at a temperature of 140 degrees F. 5. Temperature readings will be recorded on the water temperatures log weekly. 6. The hot water tanks should be adjusted accordingly with the readings that are too high or too low. Adjustments will be noted on the water temperature log. 7. The facility will make provisions to repair the hot water problem as soon as possible. Use to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 9 of 10 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 676253 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Oaks Healthcare and Rehabilitation - Ennis 1400 Medical Center Drive Ennis, TX 75119 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 areas affected by the malfunctioning unit will be restricted until repairs are completed. Level of Harm - Minimal harm or potential for actual harm FDA Food Code Chapter 5 [Plumbing, Water and Waste] Section 5-202.12, Handwashing Sink, Installation, paragraph (A), recommends that, A handwashing sink shall be equipped to provide water at a temperature of at least 43°C (110°F) through a mixing valve or combination faucet . Residents Affected - Some A handwashing lavatory shall be equipped to provide water at a temperature of at least 43°C (110°F) through a mixing valve or combination faucet. A steam mixing valve may not be used at a handwashing lavatory. A self-closing, slow-closing, or metering faucet shall provide a flow of water for at least 15 seconds without the need to reactivate the faucet. https://www.fda.gov/food/fda-food-code/food-code-2017 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676253 If continuation sheet Page 10 of 10