Health inspection·June 1, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was dialyzed .05/02/2023 Note Text: Aide and this nurse attempted to get resident up and ready for dialysis. He stated several times that he is not going. I asked him why and he stated that his leg hurt. I offered him Tylenol and he declined stating that he just wanted to rest. Unable to notify dialysis at this time as they don't open till 6am.Will attempt again . 05/09/2023 Note Text: Notified by night nurse that resident refused to go to dialysis stating that he is just to tired and in pain. Called dialysis and notified that as of now resident is agreeing to go tomorrow for a make up appt. She states that they have a chair open for 7am.Scheduling notified. Resident has an app on 5/12/23 to get his pain meds. Notified Dr. to see if we could get something before then. Awaiting a response . 05/09/2023 ESRD: Patient with dialysis every Tuesday, Thursday, Saturday. Patient was educated today on the importance of his compliance with dialysis sessions. Patient verbalized understanding.05/04/2023: I spoke with the patient extensively today on the importance of compliance with his dialysis sessions and the consequences of not attending his dialysis to include but are not limited to hyperkalemia, arrhythmia, heart attack, death. Patient verbalized understanding. Approximate time spent20 minutes. 05/09/2023: I spent 20minutes speaking to this patient on the importance of his compliance with his dialysis sessions as well as the consequences of not going to his dialysis sessions. Patient verbalized understanding and endorses pain as well keeping him from going to his sessions . 05/12/2023 Refused dialysis, resident stating he's trough with life and wants to go home on hospice . 05/17/2023 Resident refused dialysis because he doesn't have his dialysis bag, blanket, wheelchair or shoes. All left in the room contaminated with bed bugs. C/O of being uncomfortable and restless. 05/18/2023 This nurse spoke with CN at Center who reports Resident #1 refusing several sessions of HD is baseline for him. CN reports patient misses several sessions and then ends up in the hospital due to the missed HD sessions . 05/18/2023 Note Text: SW followed up with Res regarding what he wanted to do as he refused dialysis session today. Restated he was still thinking about everything and went back to sleep. SW will continue to follow up . 05/18/2023: I discussed with the patient at length today the consequences of refusals of dialysis. From my understanding, patient has not been to dialysis and has missed x3sessions now. I discussed with him the implications of missing his dialysis ultimately leading to demise and patient verbalized understanding . 05/20/2023 Note Text: Resident sent to ER this morning due to multiple miss dialysis treatment. Follow up this evening and found out that resident will be admitted to the hospital. Family is aware. DON was notified for the update of the president. Record review of Resident #1's Careplan initiated 05/05/2023 revealed: No dialysis care area initiated with a Focus, Goal, or Approach. No reference to resident refusing dialysis treatments. Record review of Resident #1's census information was that he discharged to the hospital on [DATE] and as of 06/01/2023, he had not returned to the facility. During an interview on 05/25/2023 at 5:10PM with Medical Records staff, she said Resident #1 only had 3 dialysis communication forms completed during his stay, because he frequently refused to go to dialysis. During an interview on 05/25/2023 at 5:45PM with the ADM, she said they did not have a policy for residents that utilized dialysis. She said they only had the dialysis contracts for the dialysis centers. During an interview on 06/01/2023 at 11:30AM with ADM, she said that the SW did most of the behavioral care plan areas, the treatment nurse did the careplan area for skin, but she was not sure who did the other health part of care plans. She said they did discuss changes during the morning meetings. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 2 of 8 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 676376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601 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 During an interview on 06/01/2023 at 11:45PM with the transport driver, he said Resident #1 had a very early morning appointment time of 6AM for T, TH, S. Transport driver said in the short time Resident #1 was in the building, he had frequently refused to go to dialysis. He said Resident #1 went maybe 1 time a week to dialysis. During an interview on 06/01/2023 at 1:50PM with LVN A, she said all staff had access to resident care plans. She said the admission nurse would begin the resident care plan as they were completing the admission packet. She said that although any of the nurses could add items to the resident care plan, the issues were discussed during a morning meeting each day and it was the responsibility of the Nurse Managers to make and update resident care plans. LVN A said that a resident that needed dialysis should have had it addressed on their care plan, it would have included any of the orders for dialysis to include where the resident went to dialysis, what days they went to dialysis, as well as any monitoring of the dialysis port and the completing of the dialysis communication forms with the dialysis center. LVN A said that if a resident was frequently refusing to go to dialysis that it would also have been addressed in the resident's care plan. LVN A said she did not have Resident #1 as her resident during his short time in the facility, but that she had been aware that he did have dialysis and that he frequently refused to go to dialysis. During an interview on 06/01/2023 at 3:35PM with the DON, she said that a resident care plan should address their dialysis care needs. She said the care plan would address that the resident did have dialysis and any monitoring of the dialysis port. DON said if a resident would refuse to go to dialysis, then that should have also been part of the care plan. She said she was new to the facility so she was not sure of the corporation's expectation of how specific the dialysis area should have been on the care plan; however, dialysis should definitely have been addressed on the resident's comprehensive care plan. DON said the admission nurse was responsible for a resident's interim plan of care that was to be followed up by the MDS nurse with the comprehensive care plan. Any further revisions to care plans would fall to the nurse managers to complete. Record review of Facility Policy labeled Care Plans Comprehensive Person Center revised December 2016 revealed: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the residents physical, psychosocial and functional needs is developed and implemented for each resident. The interdisciplinary team, in conjunction with the resident and his or her family or legal representative, develops and implements A comprehensive, person-centered care plan for each resident. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. Each residence comprehensive person-centered care plan will be consistent with the residents right to participate in the development and implementation of his or her care plan, including the right to participate in the planning process; request revisions to the plan of care; participate in establishing the expected goals and outcomes of the care; . The care planning process will: facilitate resident and or representative involvement; include an assessment of the resident strengths and needs; and incorporate the residence personal and cultural preferences and developing the goals of care. the comprehensive person centered care plan will: include measurable objectives and timeframes; describe the services that are to be furnished to attain or maintain the residence highest practicable physical, mental, and psychosocial well-being; describe services that would otherwise be provided for the above, that are not provided due to the resident exercising his or her right, including the right to refuse treatment; describe any specialized services to be provided as a result of past our recommendations; include the resident stated goals upon admission and desired outcomes; include the residents stated preference and potential for future discharge, including his or her desire to return to the community and any referrals made to local agencies or other entities and support such a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 3 of 8 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 676376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601 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 desire; incorporate identified problem areas; incorporate risk factors associated with identified problems; built on the resident strengths; reflect treatment goals, timetables and objectives and measurable outcomes identify the professional services that are responsible for each element of care; aid in preventing or reducing decline in the residence functional status and or functional levels; enhance the optimal functioning of the resident thing on a rehabilitative program; and reflect currently recognized Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 4 of 8 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 676376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to revise resident care plans based on changing goals, preferences and needs of the resident and in response to current interventions for 3 of 5 (Resident # 2,3,4) reviewed for care plan timing and revision. The facility failed to update Resident #2's care plan for an actual fall on 04/27/2023. The facility failed to update Resident #3's care plan for an actual fall on 05/17/2023 and 05/22/2023. The facility failed to update Resident #4's care plan for an actual fall on 05/17/2023. These failures place residents at risk of meeting and addressing their changing medical, physical, mental and psychosocial needs. Findings included: Resident #2 Record review of Resident #2's Facesheet dated 06/01/2023 revealed: an [AGE] year-old female that was admitted to the facility on [DATE]. She had a diagnosis list that included: Repeated falls, Need for assistance with personal care, Unspecified lack of coordination, Abnormal posture, Muscle weakness, Other difficulty in walking, not elsewhere classified, unsteadiness on feet other lack of coordination, Fracture of superior rim of left pubis, subsequent encounter for fracture with routine healing, Other specified fracture of left pubis, subsequent encounter for fracture with routine healing. Record review of Resident #2's Quarterly MDS dated [DATE] revealed: A BIMS of 2 meaning severe cognitive impairment. Her balance during transitions was not steady but able to stabilize without staff assistance, and walking was an activity that had not occurred. She only needed limited 1-person physical assistance for transfers. Resident #2 did not have any impairments in her range of motion for upper or lower extremities and she utilized a wheelchair. Resident#2 had not had any falls documented since the previous MDS assessment (3 months prior). Record review of Incident/Accident Log dated 03/25/23 -05/25/23 revealed Resident #2 had an actual fall on 04/27/2023. Record review of Resident #2's Care plan Area for Actual Falls last revised 09/28/2021 revealed: No revision to include the addition of the most recent fall on 04/27/2023. During an observation of Resident #2 on 06/01/2023 at 3:30PM, she was resting in bed with her eyes closed. Her bed was in a comfortable height position meaning it was not in the lowest position available. Resident did not arouse to sound of person talking. Resident #3 Record review of Resident #3's Facesheet dated 06/01/2023 revealed: An [AGE] year-old female that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 5 of 8 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 676376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was admitted to the facility on [DATE]. She had a diagnosis list that included: Muscle weakness, Primary osteoarthritis, unspecified site, Primary generalized (osteo)arthritis, Age-related physical debility, Age-related osteoporosis without current pathological fracture, Repeated falls, Other lack of coordination, Weakness. Record review of Resident #3's Quarterly MDS dated [DATE] revealed: A BIMS of 6 meaning severe cognitive impairment. Resident #3 needed extensive 2-person physical assistance with transfers, she was not steady and was unable to stabilize herself without staff assistance for transfers and she did not walk. She utilized a wheelchair for mobility. Resident #3 did not have any documented falls since the last MDS (3 months prior). Record review of Resident #3's Careplan Area for Risk of Falls last revised 03/28/2020 revealed: The resident is at risk for falls r/t Confusion, Deconditioning, Gait/balance problems. Date Initiated: 02/14/2020 Revision on: 03/28/2020. Goals: The resident will be free of minor injury through the review date. Date Initiated: 02/14/2020 Revision on: 03/05/2023. Target Date: 05/30/2023. Interventions. Anticipate and meet the resident's needs. Date Initiated: 02/14/2020. Encourage resident to use call light and/or ask for assistance with ADL and mobility tasks if feeling weak or dizzy. Date Initiated: 02/14/2020. Encourage the resident to participate in activities that promote exercise, physical activity for strengthening and improved mobility. Date Initiated: 02/14/2020. Ensure that the resident is wearing appropriate footwear when ambulating or mobilizing in w/c. Date Initiated: 02/14/2020. PT evaluate and treat as ordered. Date Initiated: 02/14/2020. Revision on: 02/14/2020. The resident needs a safe environment with: even floors free from spills and/or clutter; adequate, glare-free light; a working and reachable call light, the bed in low position at night; handrails on walls, personal items within reach. Date Initiated: 02/14/2020 Revision on: 02/14/2020 Resident care plan did not address actual falls on 05/17/2023 and 05/22/2023 of which she sustained a fracture. Resident was utilizing a stabilizing metal brace to heal on her right leg, she had her bed in the lowest position, mobility bars on the bed and had 1 fall mat on each side of her bed for a total of 2 fall mats. Record review of Incident/Accident Log dated 03/25/23 -05/25/23 revealed Resident #3 had an actual fall on 05/17/2023 and 05/22/2023. During an observation and interview on 06/01/2023 at 2:10PM with Resident #3. She was laying in bed near the window of the room. Her bed was in the lowest position near the floor, a mobility ½ rail on both sides of the bed, with a fall mat on both sides of her bed. Resident was unable to recall both of her falls from 05/17/2023 and 05/22/2023. Resident did say that she had a little pain and that she had a brace on. Resident #3 did have an open, metal brace with a dial at the knee on her right leg that extended from her thigh to near ankle. Resident #3 was resting on her back with a slight elevation to her right side and her head was elevated to approximately 45 degrees. Her right leg was resting on a pillow. Resident began speaking in a word salad. During an interview on 06/01/2023 at 2:20PM with CNA B, she said she had been working at the facility for less than a month at that time. She said Resident #3 and Resident #4 were residents that she always worked with. CNA B said that during the time she had been working both Resident #3 and Resident #4 were to be in a low positioned bed if the staff was not performing care. She said that Resident #3 had the brace on her right leg and had the 2 fall mats at her bedside, with 1 on either side of the bed since she started. CNA B said Resident #3 frequently tried to remove her brace and it had prompted that the staff was supposed to monitor her more frequently. She said she did not know how to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 6 of 8 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 676376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601 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 0657 access residents care plans at that time, but she would reach out to another CNA or a nurse to find out. Level of Harm - Minimal harm or potential for actual harm Resident #4 Residents Affected - Some Record review of Resident #4's Facesheet dated 06/01/2023 revealed: An [AGE] year-old female that was admitted on [DATE]. She had a diagnosis list that included: Unspecified fracture of right femur, subsequent encounter for closed fracture with routine healing, Displaced fracture of medial malleolus of left tibia, subsequent encounter for open fracture type i or ii with routine healing, Displaced comminuted fracture of shaft of right fibula, subsequent encounter for open fracture type i or ii with routine healing, Displaced comminuted fracture of shaft of left fibula, subsequent encounter for open fracture type i or ii with routine healing, Encounter for other orthopedic aftercare, Nondisplaced fracture of medial malleolus of right tibia, subsequent encounter for open fracture type i or ii with routine healing, Other lack of coordination, Need for assistance with personal care, Muscle weakness (generalized), Unspecified lack of coordination, Muscle wasting and atrophy, not elsewhere classified, multiple sites, Age-related osteoporosis with current pathological fracture, vertebra(e), subsequent encounter for fracture with routine healing, Unspecified abnormalities of gait and mobility, Contracture, right knee, Contracture, left knee, Unsteadiness on feet, History of falling. Record review of Resident #4's Quarterly MDS dated [DATE] revealed: A BIMS of 99 meaning she was unable to complete the assessment. She had a short- and long-term memory problem. Resident #4 needed extensive 1-person physical assistance for transfers, she was not steady needing staff to stabilize her, and she did not walk. Resident #4 utilized a wheelchair. She had not had any documented falls since the last MDS (3 months prior). Record review of Resident #4's Careplan for Actual Falls last revised on 01/25/2023 revealed: Falling star program and fall mat at bedside to reduce the risk of injury as interventions. Resident did not have a revision of the care area to address that she had a fall with a fracture on 05/17/2023. Record review of Incident/Accident Log dated 03/25/23 -05/25/23 revealed Resident #4 had an actual fall on 05/17/2023. During an observation on 06/01/202023 at 2:15PM of Resident #4, she was in a low position bed near the floor, laying on her back resting her eyes. She had a fall mat in her floor beside her bed. Resident #4 did not respond to sound of person voice. During an interview on 06/01/2023 at 11:30AM with ADM, she said that the SW did most of the behavioral care plan areas, the treatment nurse did the careplan area for skin, but she was not sure who did the other health part of care plans. She said they did discuss changes during the morning meetings. During an interview on 06/01/2023 at 3:35PM with the DON, she said that a resident care plan should address their actual falls. She said the care plan would address that the resident did have a fall and any injuries that might have occurred. She said it would have addressed any interventions such as fall mats, low beds, injury treatments, etc. She said she was new to the facility so she was not sure of the corporation's expectation of how specific the actual fall care area should have been on the care plan; however, the actual fall should definitely have been addressed on the resident's care plan. DON said the admission nurse was responsible for a resident's interim plan of care that was to be followed up by the MDS nurse with the comprehensive care plan. Any further revisions to care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 7 of 8 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 676376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Silver Spring 1690 N. Treadway Blvd. Abilene, TX 79601 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 0657 plans would fall to the nurse managers to complete. Level of Harm - Minimal harm or potential for actual harm Record review of Facility Policy labeled Care Plans Comprehensive Person Center revised December 2016 revealed: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the residents physical, psychosocial and functional needs is developed and implemented for each resident. The interdisciplinary team, in conjunction with the resident and his or her family or legal representative, develops and implements A comprehensive, person-centered care plan for each resident. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment. Each residence comprehensive person-centered care plan will be consistent with the residents right to participate in the development and implementation of his or her care plan, including the right to participate in the planning process; request revisions to the plan of care; participate in establishing the expected goals and outcomes of the care; . The care planning process will: facilitate resident and or representative involvement; include an assessment of the resident strengths and needs; and incorporate the residence personal and cultural preferences and developing the goals of care. the comprehensive person centered care plan will: include measurable objectives and timeframes; describe the services that are to be furnished to attain or maintain the residence highest practicable physical, mental, and psychosocial well-being; describe services that would otherwise be provided for the above, that are not provided due to the resident exercising his or her right, including the right to refuse treatment; describe any specialized services to be provided as a result of past our recommendations; include the resident stated goals upon admission and desired outcomes; include the residents stated preference and potential for future discharge, including his or her desire to return to the community and any referrals made to local agencies or other entities and support such a desire; incorporate identified problem areas; incorporate risk factors associated with identified problems; built on the resident strengths; reflect treatment goals, timetables and objectives and measurable outcomes identify the professional services that are responsible for each element of care; aid in preventing or reducing decline in the residence functional status and or functional levels; enhance the optimal functioning of the resident thing on a rehabilitative program; and reflect currently recognized Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 8 of 8