Health inspection·January 16, 2024

F 0558 located at the foot end of the resident's bed. Resident #4 was asleep. Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 01/10/2024 at 3:56 p.m., RN E entered Resident #4's bedroom and noticed that the call button was attached to a light cord. RN E said the call button was out of reach of Resident #4 due to Resident #4 limited movement. RN E said that Resident #4 had been given a bath earlier and staff must have left the call button on the cord. RN E said that Resident #4 had been bathed about half an hour before. RN E said the call button should be in reach of the resident in case the resident needed assistance. RN E said the risk of the call button being out of reach was Resident #4 may not have his needs met. Residents Affected - Few Resident #6: Record review of Resident #6's face sheet dated 01/16/2024, revealed an [AGE] year-old male, with original admission date of 07/28/2023 and re-admission date of 12/22/2023. Resident #6's diagnoses included: traumatic subdural hemorrhage (significant bleeding inside the skull and pressure against the brain is building rapidly), dysphagia (difficulty or discomfort in swallowing, as a symptom of disease), type 2 diabetes (chronic condition that affects the way the body processes blood sugar), anxiety disorder (characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), seizures (burst of uncontrolled electrical activity between brain cells that causes temporary abnormalities in muscle tone or movements, behaviors, sensations or states of awareness), hypertension (high blood pressure), and gastrostomy status (surgical procedure used to insert a tube through the abdomen and into the stomach). Record review of Resident #6's MDS quarterly assessment dated [DATE] revealed BIMS score of 0, indicating he was severely cognitive impaired. The Functional Abilities and Goals section revealed Resident #4 was dependent on oral hygiene, toileting, bathing, dressing, and personal hygiene. Record review of Resident #6's care plan dated 01/16/2024, revealed Resident #6 had focus areas that included the following: *Resident #6 was risk for falls related to seizure disorder, poor safety awareness. An intervention was to be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. *Resident #6 was at risk for alteration in musculoskeletal status related to vitamin D deficiency. An intervention was to anticipate and meet needs. Be sure call light is within reach and respond promptly to all requests for assistance. Observation and an interview on 01/11/2024 at 11:02 a.m., in Resident #6's room revealed the call light button was not visible. Further observation revealed Resident #6's call button cord was on top of oxygen machine. Resident #6 did not respond to any questions asked regarding contacting someone for needs. Observation and interview on 01/11/2024 at 11:04 a.m., LVN G entered Resident #6's bedroom. LVN G said Resident #6's call button was not in reach of resident due to resident's limited movement. LVN G said resident had been taken early for bathing and resident's bedding was changed. LVN G said it was possible staff did not return the button within reach of the resident. LVN G said that resident had been bathed within an hour ago. LVN G said resident would not be able to let staff know if he needed some assistance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2024 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview on 01/16/2024 at 8:45 a.m., the Administrator said call lights should be within reach of residents. The Administrator said everyone was responsible for ensuring call lights are within reach of residents. The Administrator said the risk was resident's needs not being met. The Administrator said she would look for a facility call light policy and provide to Investigator. During an interview on 01/16/2024 at 10:30 a.m., the Administrator said the facility did not have a call light policy. Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to ensure the resident environment remained free of accidents hazards as was possible and each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #10) of 6 residents reviewed for accidents hazards. The facility failed to ensure that Resident #10 who was a two-person transfer was transferred as a two person transfer instead of a one-person transfer. This failure could place residents at risk of falls or injuries. Findings included: Review of Resident #10's face sheet dated 01/16/2024, revealed a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses that included 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) Review of Resident 10's quarterly MDS dated [DATE], revealed Resident #10 had a BIMS of 11 indicating moderate cognitive impairment. The Functional Abilities and Goals section revealed Resident #10 was dependent for all efforts or the assistance of 2 or more helpers to transfer from chair/bed-to chair transfer. Review of Resident 10's care plan dated 01/16/2024, revealed Resident #10 had focus areas included the following: *Resident #10 was risk for falls related to balance problems, requires mechanical lift transfers, has history of falling, psychotropic medication use. An intervention indicated the transfer status- Hoyer lift x2 person assist with all transfers. *Resident #10 had an ADL Self Care Performance Deficit. interventions included to TRANSFER: The resident requires staff max assistance x2 transfers mechanical lift. During a telephone interview on 01/11/2024 at 1:33 p.m., Resident #10's RP said that facility staff are performing mechanical lift transfers of Resident #10 with only one person. The RP said she has a camera in Resident #10's room and had observed one-person mechanical lift transfers on multiple days. The RP said that mechanical lift transfers require two-person for safety of resident. The RP said Resident #10 was not harmed but there was a safety risk of failing to follow the care plan. During an interview on 01/11/2024 at 2:43 p.m., Resident #10 said for the most part the facility staff perform two-person mechanical lift transfers. Resident #10 said there are still sometimes when only one staff performed the mechanical lift transfer Resident #10 said she had not been injured during mechanical lift transfers. Resident #10 said she did not remember the last time only one staff used the mechanical lift to transfer her. During an interview on 01/12/2024 at 9:15 a.m., CNA K said she performed multiple mechanical lift transfers of residents including Resident #10. CNA K said all mechanical lift transfers are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few two-person transfers. CNA K said she had received training on ensuring only two-person mechanical lift transfers are performed. During an interview on 01/12/2024 at 9:38 a.m., CNA L said she performed multiple mechanical lift transfers of residents including Resident #10. CNA L said that all mechanical lift transfers are two-person transfers for resident safety. CNA L said she had not performed a transfer alone. CNA L said she had not seen any other employee perform a one-person mechanical lift transfer. CNA L said she had been recently in-serviced on two-person mechanical lift transfers. During an interview and record review on 01/12/2024 at 11:05 a.m., the Administrator said that concerns with 2-person mechanical lift transfers were addressed with training of facility staff. The Administrator said that staff were in-serviced on always ensuring that mechanical lift transfers are completed by 2 clinical staff. The Administrator said that Resident #10's RP presented photos of CNA O performing one-person mechanical lift transfers after training dates. The Administrator said that CNA O was immediately terminated for failing to adhere to job duties on multiple occasions. Record review of in-service training revealed the following: *dated 11/14/2023, reading, Hoyer transfers MUST be completed by 2 clinical staff AT ALL TIMES. *dated 12/15/2023 and noting the following training information: 2 person transfers at all times when using Hoyer to transfer a resident. Record review of CNA O Employee Disciplinary Report indicated that CNA O was terminated for multiple infractions of failing to adhere to Corporate Code of Conduct and Job Duties/Responsibilities as she as observed performing Hoyer transfers by herself on multiple occasions. Review of still photos from 12/13/2023 to 01/13/2024, revealed the following: -12/13/2023 at 1:42 p.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from wheelchair to bed. -12/19/2023 at 8:48 p.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from bed to wheelchair. -12/21/2023 at 2:02 p.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from bed to wheelchair. -12/25/2023 at 10:30 a.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from bed to shower gurney. -12/26/2023 at 9:55 a.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from bed to wheelchair. -12/30/2023 at 8:24 p.m., CNA N performed a one-person mechanical lift transfer of Resident #10 from wheelchair to bed. -12/31/2023 at 1:42 p.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from wheelchair to bed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 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 676375 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2024 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 0689 Level of Harm - Minimal harm or potential for actual harm -01/01/2024 at 10:20 a.m., CNA O performed a one-person mechanical lift transfer of Resident #10 from bed to shower gurney -01/04/2024 at 230 p.m., CNA N performed a one-person mechanical lift transfer of Resident #10 up from bed. Residents Affected - Few -01/13/2024 at 6:17 p.m., CNA M performed a one-person mechanical lift transfer of Resident #10 up from bed. During an interview on 01/16/2024 at 11:00 a.m., the Administrator said she was unaware of any other staff members performing one-person mechanical lift transfers. The Administrator said that no other information had been shared by Resident #10's RP. The Administrator said the actions of any staff performing one-person mechanical lift transfers was unacceptable. The Administrator said there was potential risk of harm to the resident if staff failed to follow their care plan. An attempted interview with CNA M on 01/16/2024 at 11:50 a.m., no contact made. Interview on 01/16/2024 at 3:20 p.m., CNA N said that all residents at the facility who need mechanical lift transfers, must be transferred by two persons. CNA N said she did not remember ever transferring Resident #10 alone. An attempted interview with CNA M on 01/16/2024 at 3:26 p.m., no contact was made. Review of facility in-service training records revealed on 12/15/2023, CNA N and CNA M signed in-service sheet indicating that they were trained on 2 person transfers at all times when using mechanical lift to transfer a resident. Review of facility Hydraulic Lift policy undated, reads in part under procedures: involve as many staff members as needed to ensure feelings of security by the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676375 If continuation sheet Page 6 of 6