Health inspection·April 11, 2023

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 04/11/23 at 09:18 AM with LVN A when questioned about wound care on the wound vac for Resident #2, when she was observed using the sharp end of the bandage scissors, what was the reasoning and what could have been a negative outcome? LVN A stated she has seen MD's use pens to pierce the seal to lay it flat. LVN A stated she has watched videos on how to use scissors or pens to fix leaks. A negative outcome could be that I could cut the patient. LVN A stated RN was a witness to her utilizing her scissors. When questioned about LVN A's wound care training, LVN A stated she has never been trained. She states she rounds with doctors and nurses and watches YouTube videos on how to do wound care dressing changes. LVN A stated RN has started to teach and educate her on wound care and wound vac dressing changes beginning last week. During an interview with the RN on 04/11/23 at 09:48 AM RN was questioned when would he utilizes his bandage scissors or any type of scissors. RN stated The only time I use my scissors is to make a slit for the coccyx (buttocks) to fix a leak. But you don't want to use your scissors because you do not want to hurt the resident. RN stated he had already cut a slit into the seal (adhesive film) prior to placing it on Resident #2 due to where the wound is located (on buttocks and the seal must go between the cheeks of the buttocks) to create a seal. When asked if he witnessed LVN A using her scissors on Resident #2's wound vac seal, RN stated I did not see her use her scissors, I went to wash my hands. RN stated he has just transitioned into this role as Nurse Educator. but has been a wound care nurse for a 'very long time'. RN states he is the one that in-services all staff on wound care. Record review of facility wound care in-service training was completed on 4/3/23 and indicates .LVN A did attend in-service . .important to do wound care per protocol utilizing proper infection control, dignity and privacy for the resident . wound care is not done as scheduled, nurse should notify responsible party and physician and monitor or change dressing the next day . wounds should be measured weekly condition of wound should be documented and any change reported to physician and responsible party . .Notify DON of any wound issues . .wound nurse not in building, floor nurses are responsible to view Treatment Administration Record and Wound Administration Record on Point Click Care and complete wound care . .wound care was not done, note in progress not of reason for missed wound care, family and physician notification . Record review of facility policy for wound treatment management dated 2021 indicates . Policy: To promote wound healing of various types of wounds . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676347 If continuation sheet Page 2 of 6 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 676347 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Amarillo Center for Skilled Care 6641 W Amarillo Blvd Amarillo, TX 79106 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 0726 Policy Explanation and Compliance Guidelines: Level of Harm - Minimal harm or potential for actual harm 1. Residents Affected - Few Wound treatments will be provided in accordance with physician orders including the cleansing method, type of dressing and frequency of dressing change. 2. In the absence of treatment orders, the licensed nurse with notify physician to obtain treatment orders. 3. Dressings changes may be provided outside the frequency parameters in certain situations: a. Feces has seeped underneath the dressing b. The dressing has dislodged c. The dressing is soiled otherwise or is wet. .6. The facility will follow specific physician orders for providing wound care. 7. Treatments will be documented on the Treatment Administration Record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676347 If continuation sheet Page 3 of 6 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 676347 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Amarillo Center for Skilled Care 6641 W Amarillo Blvd Amarillo, TX 79106 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 designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communication diseases and infections for 1 of 2 staff (LVN A and MA C) observed for hand hygiene. Residents Affected - Few The facility failed to ensure LVN A doffed gloves and performed hand hygiene appropriately during wound care. During an observation on 04/10/23 at 06:04 PM of wound care was performed on resident #1. LVN A washed hands and place clean gloves and paper measuring tape on 2nd bed in room. Resident was positioned in a supine position. After gloves were donned, nurse proceeded to perform skin assessment. Nurse proceeded to remove a bandage located on the right elbow of the resident and verbalized that the wound had deteriorated. No hand sanitization or doffing or donning of new gloves was performed. LVN A then proceeded to raise the bed with controller of the resident, and never removed her gloves or perform hand hygiene before touching the controller. LVN A returned to room and washed hands, donned gloves, still no privacy provided for resident. MA C came to assist nurse with wound care. MA C and LVN A turned resident to right side so that skin assessment could be performed on residents back. Nurse proceeded to remove sacral dressing that covered a wound dated 04/07/2023. Nurse removed bandage and the packing fell out of wound onto the bandage. LVN A then moved to wound on left posterior calf without changing gloves, washing hands or utilizing ABHR. LVN A proceeded to remove bandage and dressing from the wound without wetting gauze which caused resident #1 discomfort. Once discomfort was noted, nurse proceeded to remove gloves, perform hand hygiene, don new gloves and spray gauze with cleansing spray to gauze to moisten gauze for removal. Hand hygiene and donning of new gloves was performed before packing of the wound. Hand hygiene and donning of clean gloves was performed before the packing of sacral wound. Pressure dressing was applied to packing and all new bandages were dated and initialed by LVN A. LVN A and MA C slowly placed resident back into a supine position. Resident #1 was placed in a supine position with pillows placed under bilateral arms for comfort, as well as a wedge placed under bilateral legs. A clean sheet was placed on wedge before placing under legs. During an interview on 04/11/23 at 09:18 AM with LVN A when questioned if she had received orders from hospice for Resident #1's right leg and right elbow, LVN A stated she had received verbal orders for covering them but had forgotten to write the orders. When questioned about placing Collagen on Resident #1's right leg and right elbow, LVN A states she had not put Collagen on wounds to right elbow or right calf only covered them per orders received. She states she called Interim Hospice and got orders last night (4/10/23). She states prior to receiving orders she passed on in report to keep an eye on areas and keep resident #1 turned. When questioned about LVN A's training, LVN A states she has never been trained. She states she rounds with doctors and nurses and watches YouTube videos on how to do wound care dressing changes. LVN A states RN has started to teach and educate her beginning last week. How many residents have wounds in the facility currently? LVN states 14. During Resident #1's wound care on 4/10/23 the LVN A was heard by the investigator, the investigator observing her, and facility residents and staff yelling for help. LVN A states I first did a full skin assessment. And I did want help and I asked for help and there were two nurses that came in but then they sent me a CNA to assist me. During an interview with DON on 04/11/23 at 09:48 AM RN was questioned about Resident 1's wound care and LVN A calling for help, RN states I could hear her calling for help and told her she should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676347 If continuation sheet Page 4 of 6 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 676347 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Amarillo Center for Skilled Care 6641 W Amarillo Blvd Amarillo, TX 79106 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 not be yelling and to use the call light instead. There are no orders for collagen for his right elbow or right calf and she wanted to put collagen on them, and I told her to put a dry dressing on them only. RN states, Hospice did not do anything with wounds on Tuesday 4/6/23 and [NAME] was out on 4/5/23. I had assumed that the wound care had been done on everyone except the wound vacs on 4/5/23, which I performed on 4/5/23. Residents Affected - Few During an interview on 4-11-2023 at 10:25 AM with the DON states currently LVN A is on an action plan. DON states hospice did identify Resident #1's wounds to the right elbow and right calf wounds but did not do anything except to report to cover it. There were no wound care orders, and none were written. A physician's order summary dated 04/10/23 indicated Resident # 1 was admitted on [DATE], was a [AGE] years old with diagnoses including pressure ulcer to sacral region stage 4, non-pressure chronic ulcer of left calf with necrosis of muscle, unspecified protein-calorie malnutrition, hypo-osmolality and hyponatremia, hypokalemia, urinary tract infection, major depressive disorder, chronic obstructive pulmonary disease, hypertensive heart disease, polyneuropathy, epilepsy, quadriplegia, body mass index 45-49.9. The MDS was a quarterly completed on 3/29/23. A care plan was initiated on 3/29/23. Wound precautions listed. Physician orders for wound to left calf: apply collagen wet to dry dressing three times a week and prn. One time a day every Monday, Wednesday and Friday for wound healing. Sacrum: wound cleanser: cleanse wound with wound cleanser apply collagen wafer to wound bed, pack with wound with Hydroferablue, cover with border dressing. One time a day every Monday, Wednesday and Friday Dehiscence to lower abdominal incision: apply iodoform packing, gently packed to open wound and cover with ABD pad, secure with tape. One time a day every Monday, Wednesday and Friday for surgical incision. Record review of facility wound care in-service training was completed on 4/3/23 and indicates .important to do wound care per protocol utilizing proper infection control, dignity and privacy for the resident . wound care is not done as scheduled, nurse should notify responsible party and physician and monitor or change dressing the next day . wounds should be measured weekly condition of wound should be documented and any change reported to physician and responsible party . .Notify DON of any wound issues . .wound nurse not in building, floor nurses are responsible to view Treatment Administration Record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676347 If continuation sheet Page 5 of 6 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 676347 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Amarillo Center for Skilled Care 6641 W Amarillo Blvd Amarillo, TX 79106 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 and Wound Administration Record on Point Click Care and complete wound care . Level of Harm - Minimal harm or potential for actual harm .wound care was not done, note in progress not of reason for missed wound care, family and physician notification . Residents Affected - Few Record review of facility policy for wound treatment management dated 2021 indicates . Policy: To promote wound healing of various types of wounds . Policy Explanation and Compliance Guidelines: 1. Wound treatments will be provided in accordance with physician orders including the cleansing method, type of dressing and frequency of dressing change. 2. In the absence of treatment orders, the licensed nurse with notify physician to obtain treatment orders. 3. Dressings changes may be provided outside the frequency parameters in certain situations: a. Feces has seeped underneath the dressing b. The dressing has dislodged c. The dressing is soiled otherwise or is wet. .6. The facility will follow specific physician orders for providing wound care. 7. Treatments will be documented on the Treatment Administration Record. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676347 If continuation sheet Page 6 of 6