Health inspection·December 8, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm nails need to be cut. LVN G said he had been out of the facility for about ten days, and this was his first day back. LVN G said when CNAs reported long fingernails, the nurse would trim and file the nails. LVN G said Resident #6 did not have any known history of refusing to have his nails cut that he was aware of. LVN G said Resident #6 was able to voice his needs and did not know if he communicated needing his nails cut. LVN G said the risk was Resident #6 could scratch himself causing injury with long fingernails. Residents Affected - Few During an interview on 12/08/2023 at 2:44 p.m., the Administrator said staff in the hall including CNAs and nurses had to make sure fingernails are trimmed and filed per resident preferences. The Administrator said Resident #6 did not have any refusal behaviors that she was aware of. The Administrator said that nail care is performed as needed like in the showers and upon request. The Administrator said the potential risk of residents not having their nails trimmed was possibly hurting themselves or others with their nails. Record review of facility policy titled Nail Care dated 2003, reads in part Nail management is the regular care of the toenails and fingernails to promote cleanliness, and skin integrity of tissues, to prevent infection, and injury from scratching by fingernails . Goals: Nail care will be performed regularly and safely. The resident will be free from abnormal nail conditions. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Giles Nursing and Rehabilitation Center 950 Camino Del Rey Drive El Paso, TX 79927 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. Based on observation, interview, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for professional standards for food service safety. -1 bag of thin fillet steaks found in freezer removed from the original package without a label of its contents. -1 bag of frozen French fries found in freezer removed from the original package without label of its contents and opened to air, stored in box on top of frozen corn. -Approximately 40 half ham and cheese sandwiches found in walk-in refrigerator on two trays not labeled or dated. -Aluminum foiled pieces of bacon found in walk-in refrigerator partially open to air and not labeled or dated. These failures could place residents at risk of food-borne illness. Findings include: Observation and interview on 12/07/2023 at 11:00 a.m., of the walk-in freezer revealed a storage bag of approximately 6-8 fillets removed from original package and without a label of its contents. The Dietary Manager (DM) identified fillets to be thin steak fillets. The DM said the bag should have been labeled with contents and dated. Observation and interview on 12/07/2023 at 11:00 a.m., of the walk-in freezer revealed an open bag of French fries removed from the original package without a label of contents and opened to air. The bag of fries was found inside a box of frozen corn. The DM said he did not know the date of when the bag was opened. The DM said the bag should have been labeled with contents and dated. The DM said the bag should have been sealed. The DM said the risk is freezer burn spoiling food. Observation and interview on 12/07/2023 at 11:05 a.m., of the walk-in refrigerator revealed two trays of approximately 40 half sandwiches that were not labeled or dated. The DM said the tray where the sandwiches were on should have been dated on when they were made. The DM said he did not know when the sandwiches were made. The DM asked the cook in the kitchen who told him the sandwiches had been made earlier that morning and for residents who wanted to substitute meals. The DM said that it is important that all food is labeled to ensure food served from the kitchen was fresh. Observation and interview on 12/07/2023 at 11:05 a.m., of the walk-in refrigerator revealed an aluminum foiled item partially opened to air and placed on a shelf. The DM opened the foil revealing several pieces of cooked bacon. The DM said he did not know why the item was in the refrigerator and stored without being properly sealed or labeled. The DM said he did not know how long the bacon was in the refrigerator. During an interview on 12/08/2023 at 2:44 p.m., the Administrator said that dietary service staff must follow the policy when it comes to food storage including labeling and ensuring food is sealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Giles Nursing and Rehabilitation Center 950 Camino Del Rey Drive El Paso, TX 79927 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 properly. The Administrator said the risk was food quality could be poor and the food could become stale. Level of Harm - Minimal harm or potential for actual harm Review of facility policy Food Safety dated 2012, reads in part, Food shall be handled in a safe manner. Food is to be tightly wrapped or sealed and covered in clean containers. Opened food shall be labeled, dated, and stored properly. Residents Affected - Some Review of Food Code 2022 revealed: (C) PACKAGED FOOD shall be labeled as specified in LAW, including 21 CFR 101 FOOD Labeling, 9 CFR 317 Labeling, Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under § 3-202.18. 3-202.15 Package Integrity. FOOD packages shall be in good condition and protect the integrity of the contents so that the FOOD is not exposed to ADULTERATION or potential contaminants. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Giles Nursing and Rehabilitation Center 950 Camino Del Rey Drive El Paso, TX 79927 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to maintain clinical records on each resident that were complete and accurately documented in accordance with accepted professional standards and practices for 1 of 7 (Resident #1) residents reviewed for accuracy of records. -The facility failed to accurately document Resident #1's weight in her weight record on 11/21/2023. This failure could place residents at risk of having incomplete and inaccurate records with the risk of not receiving potential needed services. Findings include: Review of Resident #1's admission Record dated 12/07/2023, revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included hypertensive heart disease with heart failure (heart problems that occur because of high blood pressure that is present over a long time), constipation (a condition in which there is difficulty in emptying the bowels usually associated with hardened feces), hypothyroidism (condition in which the thyroid gland doesn't produce enough thyroid hormone), type 2 diabetes mellitus (chronic condition that affects the way the body processes blood sugar), hypertension (high blood pressure), overactive bladder (a problem with bladder function that causes the sudden need to urinate), abnormalities of gait and mobility (change to walking pattern), lack of coordination (not able to move different parts of the body together well or easily), and major depressive disorder (mood disorder that causes a persistent feeling of sadness and loss of interest). Review of Resident #1's quarterly MDS dated [DATE], revealed Resident #1 had a BIMS of 11 indicating resident had moderate cognitive impairment. Resident #1 required extensive assistance with bed mobility, transfer, locomotion, dressing, toilet use, and personal hygiene. The Swallowing/Nutritional Status section revealed Resident #1's weight was 266. No weight loss or weight gain in the last 6 months noted. Review of Resident #1's comprehensive care plan dated 12/07/2023 revealed Resident #1 had a diet order other than regular and is at risk for unplanned weight loss or gain. Resident non-compliant with diet, keeps snacks in her room. Date initiated 07/14/2023. Goal: Resident will maintain ideal weight and receive proper nutrition daily through the review date (target date 02/15/2024). Interventions included: Monitor weight per facility protocol. Review of Resident #1's weight record from 06/20/2023 to 11/28/2023 revealed on 11/13/2023 Resident #1 weighed using a mechanical lift 285.6; on 11/21/2023 weighed using a mechanical lift 265.6; and on 11/28/2023 weighed using a mechanical lift 288.6. During an interview on 12/07/2023 at 2:05 p.m., the DON said there is one CNA (CNA H) who was delegated to weigh all residents on Mondays and Tuesdays. The DON said Resident #1 was weighed using a mechanical lift scale. The DON said after CNA H weighs the patients, provides the weights to the DM so that weights are documented. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Giles Nursing and Rehabilitation Center 950 Camino Del Rey Drive El Paso, TX 79927 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 0842 Level of Harm - Minimal harm or potential for actual harm During an interview on 12/07/2023 at 2:26 p.m., Resident #1 said she was admitted to the facility July 2023 and had lost about 12 pounds from July 2023 to the present. Resident #1 said she wants to lose weight for her health. Resident #1 said she had not had any significant weight loss then weight gain in a short period of time while at the facility. Resident #1 said there was a staff member who came to weigh her sometimes monthly and sometimes weekly. Residents Affected - Few During an interview on 12/07/2023 at 2:45 p.m., the DM said the designated CNA H weighs the patients and writes them down their weights. The DM said he and the DON, nursing, dietary, social worker, wound care reviews the weights and then he inputs the information. The DM said the weight difference noted on 11/21/2023 should have triggered for a re-weigh. The DM said he was not involved in the review during the review of 11/21/2023 weights because he was busy having dietary staff prepare for a Thanksgiving luncheon. During an interview on 12/07/2023 at 3:54 p.m., the DON said she was starting a performance improvement plan because of possible inaccuracies documenting weights. During an interview on 12/08/2023 at 9:00 a.m., the Administrator was asked for policies regarding weighing patients and accuracy of documentation. During an interview on 12/08/2023 at 9:12 a.m., the MDS Coordinator said Resident #1's quarterly MDS was done on 11/24/2023. The MDS Coordinator said the information related to weight loss and weight gain should have captured the weight loss documented. The MDS Coordinator said she did not do the MDS for Resident #1 and that the other coordinator completed the assessment. The MDS Coordinator said the other coordinator was out of the facility at the time due to being positive for Covid. The MDS Coordinator said after reviewing of the quarterly MDS and Resident #1's weight records that MDS missed it which could result in inaccurate assessment that could affect the treatment plan of the resident. The MDS Coordinator said there were no changes to Resident #1's care plan. During an interview on 12/08/2023 at 9:40 a.m., the facility Regional Compliance Nurse (RCN) said she reviewed the documentation and believes it was a human error documenting the weight. The RCN said this error should have been caught during weight review and a re-weigh should have been done. The RCN said the facility process was patient weights were done on a Mondays and then reviewed by the DON and re-weighs done on Tuesday when there were any concerns. The RCN said Resident #1's weight record should have triggered a re-weigh. During an observation and interview on 12/08/2023 at 1:31 p.m., CNA H demonstrated how she performs weighing patients. CNA H weighed Resident #1 using the mechanical lift weight scale. Resident weighed 288.8. CNA H said around August or September 2023 she was delegated to weigh all the residents at the facility including Resident #1. CNA H said she comes in on Mondays and facility staff give her a list of residents who need to be weighed and she weighs them. CNA H said she then comes in on Tuesdays and facility staff tell her who needs to be re-weighed because of a difference in weights that was noticed. CNA H said from what she remembers she weighed Resident #1 on 11/21/2023 in the resident's room performing the same method she demonstrated. CNA H said after reviewing the weights taken from 11/13/2023, 11/21/2023, and 11/28/2023 that she wrote down the wrong number for the day of 11/21/2023. CNA H said she re-weighed Resident #1 on 11/28/2023 and she documented it correctly. CNA H said that she had to be more careful with her documentation and said that inaccurate documentation could affect a resident's plan of care. Review of facility policy Resident Assessment dated 2003, reads in part, The results of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St Giles Nursing and Rehabilitation Center 950 Camino Del Rey Drive El Paso, TX 79927 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete assessment are used to develop, review, and revise the resident's comprehensive plan of care. Each assessment will be conducted or coordinated with the appropriate participation of health professionals. Each individual who completes a portion of the assessment must sign and certify the accuracy of that portion of the assessment. At time of exit on 12/08/2023 at 3:30 p.m., no policy regarding weighing residents was provided from the Administrator. Event ID: Facility ID: 676375 If continuation sheet Page 7 of 7