Health inspection·February 16, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few nails on both hands were approximately 0.5cm in length extending from the tip of her fingers. The nails were discolored tan and the underside had dark brown colored residue, and the bed of the nails had dark brown colored residue Resident #59 stated somebody had to help me cut my nails. Interview on 02/15/23 at 12:10 PM, CNA C stated CNAs were allowed to cut the residents' nails if they were not diabetic. CNA C stated she did not check Resident #13 and Resident #59's nails this morning. Interview on 02/15/23 at 12:15 PM, LVN D stated CNAs were responsible to clean and trim residents' nails during the showers. LVN D stated only nurses cut residents' nails if they were diabetic. LVN D stated she would clean and trim Resident #13 and Resident #59's nails right then. Interview on 02/16/23 at 11:12 AM, the DON stated nail care should be completed as needed and every time aides washed the residents' hands. The DON stated nails should be observed daily. The DON stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. The DON stated he expected CNAs to offer to cut and clean nails if they were long and dirty. The DON stated residents having long and dirty nails could be an infection control issue. Record review of the facility's policy titled Activities of Daily Living, dated 08/30/2017, reflected .The facility provides necessary care to all residents that are unable to carry out activities of daily living on their own to ensure they maintain proper nutrition, grooming, and hygiene. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 2 of 7 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 676326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Rehabilitation and Care Center 1101 Windbell Dr Mesquite, TX 75149 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 Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to ensure drugs and biologicals used in the facility were labeled in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and the expiration date when applicable for 1 of 3 medication carts reviewed for medication storage. The facility failed to ensure vials of insulin, Levemir and Humulin R Regular, that were opened and used were dated in the hall 200 medication cart. This failure could place residents at risk of diminished effectiveness and not receiving the therapeutic benefits of the medications. The findings include: Observation on 02/14/23 at 11:50 AM of 200 hall medication cart revealed a vial of insulin, Levemir and a vial of insulin, Humulin R Regular were opened and had been used and were not dated. Interview on 02/14/23 at 12:05 PM, LVN A stated the vials of insulin, Levemir and Humulin R Regular were opened and the rubber seal breached and were not dated. She stated she did not open the vials and she did not know who opened them. LVN A stated the risk would be potential to give an ineffective medication. LVN A stated the nurses were responsible to check the vials for the open date before use it. LVN A stated the insulin should dated when opened because the insulin should be discarded after 42 days. Interview on 02/16/23 at 11:12 AM, the DON stated all nurses were responsible to check the vials before administration and if it was not dated, they should discard it and order a new one. The DON stated when he was asked what the risk of administering an undated insulin to residents would be, stated he was not an insulin expert. The DON said all nurses were responsible to check the medication carts and the medication rooms for expiration and labeling of medication. Record review of the pharmacy instruction on the Levemir vial reflected discard after 42 days. Record review of the facility's policy titled Storage of Medications, revised 4/1/2022, revealed in part .6. Once any medication or biological package is opened, the facility should follow manufacturer/supplier guidelines with respect to expiration dates of opened medication. 7. Once any multi-dose packaged medication or biological is opened, nursing will mark multi-dose products (inhalers, insulin, and the like) with the date opened and follow manufacture/supplier guidelines with respect to expiration dates FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 3 of 7 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 676326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Rehabilitation and Care Center 1101 Windbell Dr Mesquite, TX 75149 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food safety in the facility's only kitchen. Residents Affected - Some The facility failed to ensure food items past their expiration date were discarded. This failure could place residents at risk for food borne illness. Findings include: In an observation and interview with Dietary Manager on 2/14/23 at 10:20 AM revealed a stainless-steel container that appeared to be covered with aluminum foil marked with the word broccoli and was dated 2/10/23 on a shelf in the walk-in refrigerator. The Dietary Manager stated the broccoli was beyond its expiration date. The Dietary Manager then immediately discarded the broccoli and stated the facility could not have expired foods in the walk-in refrigerated space because expired foods could expose residents to food-borne illnesses. In an observation and interview with the Dietary Manager on 2/14/23 at 10:24 AM revealed an opened box of single serve sour cream packets with approximately 40 sour cream packets on a shelf in the walk-in refrigerator with an expiration date of 2/8/23. The Dietary Manager was observed immediately discarding the box and single serve sour cream packets immediately. He stated the facility could not have expired sour cream in the refrigerator that might get served to residents because the residents might get sick from bacterial growth. Record review of the facility's, undated, policy titled Operational/Resident Care Policies page IX.8 under the subtitle Sanitary Conditions stated .Food in unlabeled or damaged containers shall not be accepted or retained. Review of the facility's policy Frozen and Refrigerated Foods Storage, revised November 2017, reflected, 9. Items stored in the refrigerator must be dated upon receipts, unless they contain a manufacturer use by, sell by, best by date, or a date delivered . The Food and Drug Administration Food Code dated 2017 reflected, 3-305.11 Food Storage. (A) .food shall be protected from contamination by storing the food: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination .(B) .refrigerated, ready-to eat time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety 3-501.17 Ready-to-Eat, Time/Temperature Control for Safety Food, Date Marking . Date marking is the mechanism by which the Food Code requires active managerial control of the temperature and time combinations for cold holding. Industry must implement a system of identifying the date or day by which the food must be consumed, sold, or discarded. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 4 of 7 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 676326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Rehabilitation and Care Center 1101 Windbell Dr Mesquite, TX 75149 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an infection prevention and control program designated to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 5 (Resident #8, Resident #20, Resident #46, Resident #53 and Resident #60) of 6 residents reviewed for infection control. Residents Affected - Some 1. The facility failed to ensure MA B disinfected the blood pressure cuff in between blood pressure checks for Residents #20, and #46. 2. The facility failed to ensure LVN A disinfected the blood pressure cuff in between blood pressure checks for Residents #8, #53, and #60. These failures could place residents at-risk of cross contamination which could result in infections or illness. Findings included: 1. Record review of Resident 20's Comprehensive MDS, dated [DATE], revealed the resident was an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included elevated blood pressure, muscle weakness, and anxiety. Record review of Resident #20's physician orders dated 01/16/23 - 02/16/23 reflected, hydralazine tablet; 25 mg, give 1 tablet by mouth, one time per day - Special instruction: Hold for systolic blood pressure less than 100 and or diastolic blood pressure less than 60. Record review of Resident #46's Quarterly MDS, dated [DATE], revealed the resident was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included elevated blood pressure, hemiplegia (partial paralysis on the left side), and muscle weakness. Resident#46 had a BIMS of 6 which indicated he was severely impaired. Record review of Resident #46's Physician Orders dated 01/16/23-02/16/23 reflected, lisinopril-hydrochlorothiazide tablet 20-25 mg, give 1 tablet by mouth, one time a day - Special instruction: Hold for systolic blood pressure less than 110, diastolic blood pressure less than 60, and when the heart rate is less than 60. Observation on 02/15/23 at 7:40 AM revealed MA B performed morning medication pass, during which time MA B checked the blood pressures on Resident #20. MA B did not sanitize the blood pressure cuff before or after using it on Resident #20. MA B put the blood pressure cuff in the drawer of the medication cart after use. Observation on 02/15/23 at 7:50 AM revealed MA B continued to perform morning medication pass, during which time she checked the blood pressure on Resident #46. MA B used the same blood pressure cuff right after using it on Resident#20. MA B did not sanitize the blood pressure cuff before or after using it on Resident #46. She put the blood pressure cuff in the drawer of the medication cart. Interview on 02/15/23 at 8:00 AM, MA B stated reusable equipment, like blood pressure cuffs, should be sanitized with wipes after 3 uses in order to prevent transmitting of infection from one (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 5 of 7 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 676326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Rehabilitation and Care Center 1101 Windbell Dr Mesquite, TX 75149 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 resident to another. MA B stated she received in-service on infection control every month. Level of Harm - Minimal harm or potential for actual harm 2. Record review of Resident 60's Quarterly MDS, dated [DATE], revealed the resident was an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses which included elevated blood pressure, muscle weakness, and need for assistance with personal care. Resident#60 had a BIMS of 10 which indicated he was moderately impaired. Residents Affected - Some Record review of Resident #60's physician orders dated 01/16/23 - 02/16/23 reflected, amlodipine tablet; 5 mg, give 1 tablet by mouth, one time per day - Special instruction: Hold for systolic blood pressure less than 110 and or diastolic blood pressure less than 60. Record review of Resident #53's Comprehensive MDS, dated [DATE], revealed the resident was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included elevated blood pressure, myocardial infarction (blood flow to the heart muscle is blocked), and muscle weakness. Resident#53 had a BIMS of 10 which indicated he was moderately impaired. Record review of Resident #53's Physician Orders dated 01/16/23-02/16/23 reflected, lisinopril tablet 5 mg, give 1 tablet by mouth, one time a day - Special instruction: Hold for systolic blood pressure less than 110, diastolic blood pressure less than 60, and when the heart rate is less than 60. Record review of Resident #8's Quarterly MDS, dated [DATE], revealed the resident was a [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included elevated blood pressure, type 2 diabetes, and anxiety. Record review of Resident #8's Physician Orders dated 01/16/23-02/16/23 reflected, metoprolol tartrate tablet 50 mg, give 1 tablet by mouth, one time a day - Special instruction: Hold for systolic blood pressure less than 110, diastolic blood pressure less than 60, and when the heart rate is less than 60. Observation on 02/15/23 at 8:30 AM revealed LVN A performed morning medication pass, during which time LVN A checked the blood pressures on Resident #60. LVN A did not sanitize the blood pressure cuff before or after using it on Resident #60. LVN A put the blood pressure cuff on top of the medication cart after use. Observation on 02/15/23 at 8:50 AM revealed LVN A continued to perform morning medication pass, during which time she checked the blood pressure on Resident #53. LVN A used the same blood pressure cuff right after using it on Resident#60. LVN A did not sanitize the blood pressure cuff before or after using it on Resident #53. She put the blood pressure cuff on top of the medication cart after use. Observation on 02/15/23 at 9:00 AM revealed LVN A continued to perform morning medication pass, during which time she checked the blood pressure on Resident #8. LVN A used the same blood pressure cuff right after using it on Resident#53. LVN A did not sanitize the blood pressure cuff before or after using it on Resident #8. She put the blood pressure cuff on top of the medication cart after use. Interview on 02/15/23 at 9:05 AM, LVN A stated reusable equipment, like blood pressure cuffs, should be sanitized with wipes after each use (before and after using it on a resident) in order to prevent transmitting of infection from one resident to another. LVN A stated she forgot to do it because she did not want to be late on passing medication. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 6 of 7 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 676326 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewood Rehabilitation and Care Center 1101 Windbell Dr Mesquite, TX 75149 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 Interview on 02/16/23 at 11:12 AM, the DON stated his expectation was staff would sanitize all reusable equipment between each resident use. The DON stated not doing so placed residents at risk of cross contamination of infections from one resident to another. The DON stated he was responsible for training staff on infection control. Record review of the facility's policy Cleaning, disinfecting and sterilizing care and personal protective equipment, dated 2/23/2021, reflected . 3. Non-critical items are those that come in contact with intact skin but not mucous membranes. Such items include .crutches, blood pressure cuffs, face shields, goggles, and other medical accessories. These items rarely transmit disease. However, it is imperative that these items are clean, and are recommended to be disinfected periodically Record review of CDC guidance related to disinfecting patient-care devices - https://www.cdc.gov/infection control/guidelines/disifection/index.html reflected: Disinfect noncritical medical devices (e.g., blood pressure cuff) with an EPA - registered hospital disinfectant using the label's safety precautions and use directions . Ensure that, at a minimum, noncritical patient-care devices are disinfected when visibly soiled and on a regular basis (such as after use on each patient or once daily or once weekly). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676326 If continuation sheet Page 7 of 7