Health inspection·August 7, 2023

F 0580 Review of Resident #4's care plan dated [DATE] revealed: Level of Harm - Immediate jeopardy to resident health or safety Focus: The resident has the potential for pressure ulcer development r/t impaired mobility, incontinence, obesity. Date Initiated: [DATE]. Revision on: [DATE]. Interventions: Notify nurse immediately of any signs of skin breakdown: redness, blisters, bruises and discoloration noted during bath or daily care. Date Initiated: [DATE]. Provide assist with turning and repositioning during rounds. Date Initiated: [DATE]; Focus: The resident has (DTI) pressure injury to Rt medial heel r/t Reduced Mobility. Date Initiated: [DATE]. Revision on: [DATE]. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: [DATE]. Administer treatments as ordered and monitor for effectiveness. Date Initiated: [DATE]. Assess/record/and monitor wound healing weekly. Measure length, width and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: [DATE]. Revision on: [DATE]. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulation/mobility, good nutrition and frequent repositioning. Date Initiated: [DATE]. Residents Affected - Some Record review of Resident #4's physician order revealed the following orders start date [DATE] Location of wound: Plantar right heel with order to be performed topically one time a day for Apply betadine to plantar right heel unstageable ulcer daily apply betadine until healed. Offloading @ all times. F/U with wound care and end date [DATE]. Record Review of Resident #4's TAR dated [DATE] - [DATE] revealed no evidence of treatment being completed on: [DATE] and [DATE]. Record review of Resident #4's physician order revealed the following order start date [DATE] Location of wound: Right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Leptospermum honey in to wound bed cover with border dressing. and end date [DATE]. Record Review of Resident #4's TAR dated on [DATE] - [DATE] revealed no evidence of treatment for order with being completed on: [DATE], [DATE] and [DATE]. Record review of Resident #4 physician order revealed the following order start date [DATE] Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Collagen powder and Calcium alginate with silver cover with border dressing. and end date [DATE]. Record Review of Resident #4's TAR dated on [DATE] - [DATE] revealed no evidence of treatment for order with being completed on: [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE]. Record review of Resident #4's physician order revealed the following order start date [DATE] Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Collagen powder and Calcium alginate with silver cover with border dressing. and end date [DATE]. Record Review of Resident #4's TAR dated on [DATE] - [DATE] revealed no evidence of treatment for order with being completed on: [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE]. Record review of Resident #4's physician order revealed the following order start date [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 2 of 67 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 08/07/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen powder and sodium hypochlorite get (anapest) cover with border dressing. And end date [DATE]. Record Review of Resident #4's TAR dated on [DATE] - [DATE] revealed no evidence of treatment for order with being completed on: [DATE]. Residents Affected - Some Record review of Resident #4 physician order revealed the following order start date on [DATE] Location of wound: Stage 4 right posterior medial heel to be performed every day shift every Tue, Thu, Sat Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date [DATE]. Record Review of Resident #4's TAR dated on [DATE] - [DATE] revealed no evidence of treatment for order with being completed on: [DATE]. Record review of Resident #4 physician order revealed the following order start date on [DATE] Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date [DATE]. Record Review of Resident #4's TAR dated on [DATE] - [DATE] revealed no evidence of treatment for order with being completed on: [DATE], and [DATE]. During interview on [DATE] at 10: 50 AM, the WCS stated he was not made aware of missed treatments or treatment refusals. WCS stated missing treatments and/or delay in treatment would have interfered with improvement of wound. 2. Resident # 1 Review of Resident # 1's closed record face sheet dated [DATE] revealed, [AGE] year-old male originally admitted on [DATE] with most recent hospital readmission date of [DATE], with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease. Review of Resident # 1's closed record admission MDS assessment dated [DATE] revealed, Section CCognitive Behavior revealed a BIMS score of 10 (moderate cognitive impairment); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. Review of Resident #1's closed record care plan dated [DATE] (revised on [DATE]) revealed: Focus: The resident is at risk for pressure injury r/t History of Pressure Injuries, Poor nutrition, Reduced Mobility, Sheering/friction problems. Date Initiated: [DATE] Revision on: [DATE]; Perform and document weekly assessment form of skin for changes or observations. Date Initiated: [DATE] Protect elbows and heels from friction. Date Initiated: [DATE] Protect heels-offload when in bed. Administer medication as ordered. Date Initiated [DATE]. Follow facility policy and procedures for line listing, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 3 of 67 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 08/07/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some summarizing infections. Focus The resident has a stage 1 pressure injury to his R buttocks r/t Reduced Mobility, Incontinence, Sheering/Friction. Date Initiated: [DATE] Revision on: [DATE]. Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: [DATE]. Administer treatments as ordered and monitor for effectiveness. Date Initiated [DATE] Assess/record/monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: [DATE]. Revision on: [DATE]. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition and frequent repositioning. Date Initiated: [DATE]. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated [DATE]. Provide low air loss mattress to bed. Date Initiated: [DATE]. Provide pressure relieving cushion to wheelchair. Monitor for placement and condition. Notify supervisor if cushion needs to be replaced. Date Initiated: [DATE]. Record review of Resident #1's closed record physician orders revealed start date [DATE] stating Location of wound: left foot with order to be performed every day shift Treatment order: Cleanse with NS or Wound Cleanser and pat dry. Swab with betadine swab. Cover with 4x4 and secure with tape. and no end date written. Record Review of Resident #1's closed record TAR dated [DATE] - [DATE], revealed no evidence of treatment for order being completed on: [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE]. Record review of Resident #1's closed record physician orders revealed start date [DATE] Location of wound: Unstageable Rt Ischium (hip) with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Leptospermum honey to wound bed cover border gauze dressing and no end date written. Record Review of Resident #1's closed record TAR dated [DATE] - [DATE], revealed no evidence of treatment for order being completed on: [DATE], [DATE], [DATE], [DATE] and [DATE]. Record review of Resident #1's closed record physician orders revealed start date [DATE] stating Location of wound: right Ischium with order to be performed every day shift Treatment order: Cleanse with NS/wound cleanser. Pat dry Apply Triad cream and cover with silicone dressing with end date [DATE]. Record Review of Resident #1's TAR dated [DATE] - [DATE], revealed no evidence of treatment for order being completed on: [DATE], [DATE], [DATE]. Record review of Resident #1's closed record physician orders revealed order with start date [DATE] stating Location of wound: Unstageable right Ischium with order to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Anasept and TAO to wound bed cover bordered gauze dressing with end date [DATE] written. Record Review of Resident #1's closed record TAR dated [DATE] - [DATE], revealed no evidence of treatment for completed on: [DATE], [DATE], [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE]. Record review of Resident #1's closed record physician orders dated [DATE] revealed start date [DATE] stating Location of wound: Unstageable right Ischium with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 4 of 67 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 08/07/2023 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 0580 Leptospermum honey to wound bed cover border gauze dressing and no end date written. Level of Harm - Immediate jeopardy to resident health or safety Record Review of Resident #1's closed record TAR dated [DATE] - [DATE], revealed no evidence of being completed on: [DATE] and [DATE]. Residents Affected - Some During an interview on [DATE] at 4:30 PM, RN OS stated OS had concerns with facility not showing up for appointments or calling to reschedule. RN OS stated Resident #1 was scheduled for one week follow up on [DATE] after surgery and missed appointment. RN OS stated the facility never called to clarify treatment orders, or to called to reschedule appointment. RN OS stated when she called to reschedule, facility stated visits were missed because another resident had an appointment. RN OS stated Resident #1 did not make it to the office for 3 weeks. The bandage had not been changed in 3 weeks and had to be soaked to remove dressing and Resident #1 received bandage burns to his skin. During an interview on [DATE] at 11:50 AM, the OS stated he had concerns Resident #1 was a no call/no show for his first scheduled post-operation visit on [DATE]. The OS stated the facility never called to reschedule visit or to clarify orders. The OS stated Resident #1 went over 3 weeks without bandage being changed, which led to the bandage had to be soaked to be removed and Resident #1 had bandage burns. The OS stated he was never notified of missed wound treatments. The OS stated Resident #1 missing wound care treatments postponed his foot healing. During an interview on [DATE] at 4:46 PM, MR stated she is responsible for making transportation arrangements. She stated she doesn't make the doctor's appointments and when residents are discharged from hospital with a card, the nurse is responsible to make the appointments. MR stated she did not have documentation to why Resident #1 missed appointment on [DATE]. MR stated there were days when the transportation van was not working in order to take residents to appointments; however, it was functioning and working properly on [DATE]. 3. Resident #2 Review of Resident # 2's face sheet dated [DATE] revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of [DATE], with the following diagnosis unspecified dementia (primary), need for assistance with personal care, flaccid hemiplegia (inability to move without assistance) affecting right dominant side. Review of Resident # 2's annual MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 8 (moderate); Section G- Functional Status revealed Resident #2 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bowel and Bladder revealed always incontinent for bowel; Section M-Skin Conditions revealed Resident #2 was at risk of developing pressure ulcers/injuries. Review of Resident #2's care plan dated [DATE] revealed: Focus: The resident is at risk for pressure ulcer development r/t disease process and immobility. Date Initiated: [DATE] Revision on: [DATE]; Interventions: administer medications as ordered. Monitor/document for side effects and effectiveness. Date initiated [DATE]. Administer treatments as ordered and monitor for effectiveness. Date initiated [DATE]. Follow facility policies/protocols for the prevention/treatment of skin breakdown. Initiate initiated: [DATE]. Inform the resident/family/caregivers of any new area of skin breakdown. Date initiated: [DATE]. Monitor/document/report PRN any changes in skin status: appearance, color, wound healing, S/SX of infection, wound size (length X width X depth), stage. Date Initiated: [DATE]. Obtain and monitor lab/diagnostic work as ordered. Report results to MD and follow up as indicated. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 5 of 67 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 08/07/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Weekly skin assessments. Date initiated: [DATE]. Revision on: [DATE]; Focus: patient has a stage 4 pressure injury to right posterior calf with potential for further skin breakdown R/T: disease process, immobility, impaired mobility, lack of sensation, non-compliance with therapeutic regimen. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: [DATE]. Assist resident with turning/repositioning during rounds. Date Initiated: [DATE]. Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: [DATE]. Review of Resident # 2's nurses notes dated [DATE] at 11:00 PM written by LVN T revealed: Aide has brought to my attention that [Resident #2] has open area on back of right ankle area. When this nurse assessed, I found wound that is denuded, partial thickness and has black eschar in wound bed. I cleansed wound with wound cleanser, applied hydrophilic ointment and covered with bordered gauze. Entire leg and foot have severe outward rotation. It is stroke effected side. Heel is elevated off bed and wound area is hanging free with no pressure. Review of Resident # 2's nurses note dated [DATE] at 1:37 PM written by LVN A revealed: Resident noted to have a DTI per night nurse to his right lower calf area cleaned Review of Resident #2's physician orders revealed no evidence of pressure ulcer treatment between [DATE] and [DATE]. Review of Resident #2's physician orders revealed: Order date [DATE] at 2:15 PM Cleanse right lower posterior calf with dermal wound cleaner apply Triad Debriding Cream to wound bed and cover with boarder dressing. Every day shift every Mon, Wed, Fri for promote Wound healing and every 1 hour as needed for skin irritation. During an interview on [DATE] at 5:35 PM, the DON stated she had completed skin assessment on [DATE] for Resident #2. The DON stated the system was new to her, and she must have gotten confused between patients. The DON stated she had not completed a thorough assessment and that her assessment did not give an accurate assessment of Resident # 2. The DON stated the negative affect on residents, if wound care treatments were not completed, could have caused skin breakdown, and could have caused the wounds to worsen in various ways. During interview on [DATE] at 10: 50 AM, the WCS stated he was not made aware of missed treatments or treatment refusals. WCS stated missing treatments and/or delay in treatment would have interfered with improvement of wound. 4. Resident # 6 Review of Resident # 6's face sheet dated [DATE] revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of [DATE], with the following diagnosis Type 2 diabetes (primary), age-related physical debility, cognitive communication deficit, and unspecified dementia. Review of Resident # 6's significant change in status MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 99 (Unable to complete interview); Section G- Functional Status revealed patient had extensive dependence with most activities (1 physical assist); Section F- Bowel and Bladder revealed always incontinent to bowel and bladder. Section M-Skin Conditions revealed Resident #6 had a risk of developing pressure ulcers/injuries. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 6 of 67 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 08/07/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Review of Resident #6's care plan dated [DATE] revealed no intervention related to Deep Tissue Injury prevention or care. Review of Resident #6's Weekly Skin Integrity Review dated [DATE] completed TX D revealed; Suspected Deep Tissue Injury to left heel measuring 4cm in length by 3cm in width. Review of Resident #6's physician orders revealed no evidence of wound treatment order for Deep Tissue Injury between [DATE] and [DATE]. Review of Resident #6's physician orders dated [DATE] revealed Skin prep to left heel every day and prn every day shift for wound care related to weakness. During an interview on [DATE] at 5:35 PM, the DON stated orders for new skin issues should be obtained within the shift but not later than 24 hours after identified. During interview on [DATE] at 10: 50 AM, the WCS stated he was not made aware of missed treatments or treatment refusals. WCS stated missing treatments and/or delay in treatment would have interfered with improvement of wound. During an interview on [DATE] at 8:19 AM TX G stated she had been the treatment nurse until mid-July. TX G stated she documented when she performed wound care. TX G stated if there were blanks in the TAR treatments were not done. TX G stated she had to work the floor on day or night shifts on several occasions and was not able to complete her duties as treatment nurse. TX G stated when she worked the floor, if she was am not the treatment nurse that day or not working, the charge nurses were responsible for wound care of their patients. During an interview on [DATE] at 9:38 AM, the ADM stated her expectation was that treatments were followed per physician's order. The ADM stated if treatment orders were missed it should have been documented why the treatment was missed and notify the physician that treatments were missed. The ADM stated missed treatments could have caused wounds to worsen. The DON was to monitor that treatments were completed. The ADM stated missing treatment could have put the residents at risk of neglect. The ADMN stated what led to the failure of physician not being contacted for orders and/or updating the physician was that staff got busy with other tasks or assumed that another shift had contacted physician. During an interview on [DATE] at 11:08 AM TX D stated neglect was not contacting a doctor when new issues were identified, not following doctor and/or performing a doctor's order. TX D stated the doctor should be contacted immediately when resident had a change of condition. TX D stated there was not any reason that a resident should have to wait for over 24 hours for orders. TX D stated missed wound treatments could have resulted in poor wound healing or worsening of wound. Record Review of Facility policy titled, Pressure Ulcer/Injury Risk Assessment dated [DATE] revealed: If the resident refuses the treatment, the reason for refusal and the resident's response to the explanation of the risks of refusing the procedure, the benefits of accepting and available alternatives. Document family and physician notification. Notify attending MD {Medical Director} if new skin alteration noted. This was determined to be an Immediate Jeopardy (IJ) on [DATE] at 5:15pm. The Administration was informed of the IJ. The Administrator was provided with the IJ template on [DATE] at 5:15pm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 7 of 67 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 08/07/2023 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 0580 Record review of the Plan of Removal accepted on [DATE] at 2:35 PM reflected the following: Level of Harm - Immediate jeopardy to resident health or safety What corrective actions have been implemented for the identified residents? Residents Affected - Some B. Resident # 2 was assessed by Director of Nursing on [DATE] at the time the concern was identified. No new concerns were identified. Wound Care physician also assessed patient on 8/3. No new concerns were identified A. Resident # 1 was unable to be assessed (expired 7/23). C. Resident # 4 was assessed by Director of Nursing on [DATE] at the time the concern was identified. No new concerns were identified. Wound Care physician also assess patient on 8/3. No new concerns were identified. D. Resident # 6 was assessed by Director of Nursing on [DATE] at the time the concern was identified. No new concerns were identified. E. Facility nurse management (Assistant Directors of Nursing) completed a skin audit on residents residing in the facility on [DATE], [DATE] and [DATE]. Skins audits were reviewed by DON and Nurse management team. Two residents were identified that had open areas. Physician was notified and orders received by facility for treatment. F. Residents physician will be notified upon the identification of a new wound, any wounds that have progressively worsened and any missed treatment or treatments that were refused by the resident. This notification will be documented in the resident's chart. G.DON and/or designee will review and ensure that orders, treatments and notification to the physician are completed through the facilities daily clinical meeting. Any concerns identified will be addressed immediately. How were other residents at risk to be affected by this deficient practice identified? A. All residents residing in the facility have the potential to be affected by this proposed deficient practice. B. Facility nurse management (Assistant Directors of Nursing) completed a skin audit on residents residing in the facility on [DATE], [DATE] and [DATE]. Skins audits were reviewed by DON and Nurse management team. Two residents were identified that had open areas. Physician was notified and orders received by facility for treatment. The facility has 15 total residents with skin issues. The physician has been notified of all issues. The two additional residents were identified on the 8/2 skin round. Resident A had two areas (irritant dermatitis from body fluid) on this scrotum/anterior thigh. Resident B had one area on each buttock. Hospice and physician were notified on both patients. What does the facility need to change immediately to keep residents safe and ensure it does not happen again? (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 8 of 67 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 08/07/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some A. During the facilities morning clinical meeting the DON and/or designee will review any new wounds, any new treatments, wounds that have progressively worsened and any treatments that were missed or refused and ensure physician notification was completed and documented appropriately in the residents chart. B. On [DATE] Corporate Clinical Services Director in-serviced the DON and nurse managers on properly and accurately assessing resident's skin, monitoring for change of condition, wound care documentation, clinical records documentations, and any omissions of treatments in the treatment record. This in-service included MD notification. DON, ADONs and Treatment Nurse will verbalize teach back of education provided to them. Any staff not available will be required to receive in-service prior to their next schedule shift. C. Facility direct care staff was in-serviced by the Clinical Management team on [DATE] regarding pressure ulcer prevention. This in-service included MD notification. Any staff not available will be required to receive in-service prior to their next schedule shift. D. An in-service was initiated on [DATE] by Director of Nursing and ADONs with the licensed nursing staff on properly assessing resident's skin, monitoring for change of condition, wound care documentation, clinical records documentation, and omissions of treatments in the treatment record. Licensed staff will verbalize teach back of education provided to them. This in-service included MD notification. Any staff not available will be required to receive in-service prior to their next schedule shift. E. Newly hired nurses and contract staff will be in-serviced by the Director of Nursing or ADON on properly assessing resident's skin, monitoring for change of condition, wound care documentation, clinical records documentation, and omissions of treatments in the treatment record. This in-service included MD notification. Licensed staff will verbalize teach back of education provided to them. F. Facility has implemented/re-implemented the following procedure to ensure How will the system be monitored to ensure compliance? Facility Director of Nursing and/or designee will review skin assessments, treatment administration records, documentation and physician notification through facilities clinical morning meeting. Any identified concerns will be address immediately. Facility Administrator and/or designee will attend the clinical morning meeting and ensure system is being followed. Any concerns identified will be addressed immediately. This process began immediately on [DATE] and will continue weekly DON will Monitor and the Administrator will oversee Clinical documentation review upon admission/readmission noting pressure injury/skin and that physician was notified, orders were received, and area treated. Any identified concerns will be addressed immediately with staff and physician. Monitoring will continue 5x weekly for the next 8 weeks. DON will monitor and the Administrator will oversee that upon admission/readmission that the charge nurse on duty has completed the full body skin assessment - intentionally assessing the resident head to toe for evidence of any pressure injury or skin concerns. DON and facility treatment nurse will review to ensure accuracy and to ensure the physician was notified of any identified concerns. Monitoring will continue 5x weekly for the next 8 weeks. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 9 of 67 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 08/07/2023 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some DON will monitor and Administrator will oversee conducting weekly skin assessments shall be completed upon admission/readmit at least every 7 days thereafter. This will be monitored through the facility's clinical morning meeting. Monitoring will continue 5x weekly for the next 8 weeks. DON will monitor and Administrator will oversee the signing out for weekly skin assessments on the MAR and signing out the treatments as ordered and administered by licensed nurse a minimum of 5x weekly for three months during the morning clinical meeting. If there is an omission in the TAR or an assessment showing not completed the assigned nurse will be called immediately to verify if there was a reason for the omission. If truly missed the resident will be assessed immediately and the physician notified of the missed treatment/assessment. DON will monitor and Administrator will oversee that the Charge Nurse / Wound Care Nurse conducts a head - to - toe skin assessment upon admission / readmission and that physician is notified and orders received and that this is documented in the resident chart. Charge nurses will perform a complete skin assessment for each admission/re-admission including notifying the physician, receiving orders and documenting such. DON, ADONs or Treatment Nurse will conduct post admission skin assessments within 24 -72 hours after the initial admission/readmission skin assessment to validate accuracy of documentation of skin condition. Any remedial education or reprimand will occur at this time. DON will monitor and the Administrator will oversee weekly for the next 8 weeks that the IDT will review the plan of care to ensure appropriate interventions are in place to address the prevention of or minimizing the risks associated with skin injury in relation to the identified residen[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 10 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to protect the resident's right to be free from neglect for 6 of 8 residents (Resident #4, Resident #1, Resident #2, Resident #6, Resident #7, Resident #8) reviewed for neglect. 1. The facility failed to follow physician's orders to prevent Resident #4's Deep Tissue Injury to right medial heel to deteriorate to a stage 4 pressure ulcer. 2. The facility failed to follow physician's orders to prevent Resident #1's Right Ischium(hip) pressure ulcer to deteriorate from a stage 2 to a stage 3. 3. The facility failed to obtain orders from Resident #1's Podiatrist when appointments were missed status post amputation of 5th digit of left foot. 4. The facility failed to obtain physician orders for treatment of Resident #2's pressure ulcer on right posterior calf. Resident #2 went 12 days without treatment to wound. Resident #2 was assessed on 08/03/2023 with Stage IV. 5. The facility failed to obtain physician orders for treatment of Resident #6's left heel Deep Tissue Injury. Resident #6 went 5 days without treatment to wound. 6. The facility failed to complete skin assessments of Resident #7 which led to the development of a stage 2 pressure ulcer to the right upper buttocks and stage 2 to the right lower buttocks. 7. The facility failed to complete weekly skin assessments which led to Resident #8 developing stage 2 pressure ulcer to left buttock and stage 2 pressure ulcer to right buttock. 8. The facility failed to ensure Resident # 2 and Resident #4 ' s skin assessments were completed, assessed accurately and accurately documented by the DON. 9. The facility failed to ensure Resident #1, Resident #4 and Resident #5 ' s wound treatments were completed and accurately documented by DON and ADON E. 10. The facility failed to maintain accurate list of residents with pressure ulcers. The facility did a skin sweep and found Resident #7's and Resident #8's wounds after surveyor intervention requesting accurate lists of residents with pressure ulcers. An Immediate Jeopardy (IJ) was identified on 08/03/23. While the IJ was lowered on 08/07/23, the facility remained out of compliance at a severity level of actual harm with a scope of pattern due to the facility's need to evaluate the effectiveness of their corrective actions. These failures could place residents at risk of infections, worsening of wounds, injuries, emotional distress, and even death. Findings included: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 11 of 67 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 08/07/2023 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 0600 1.Resident #4 Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Residents Affected - Some Record Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section HBowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer. Record review of Resident #4's care plan dated 05/15/2023 revealed: Focus: The resident has the potential for pressure ulcer development r/t impaired mobility, incontinence, obesity. Date Initiated: 08/23/2022. Revision on: 08/23/2022. Interventions: Notify nurse immediately of any signs of skin breakdown: redness, blisters, bruises and discoloration noted during bath or daily care. Date Initiated: 08/23/2022. Provide assist with turning and repositioning during rounds. Date Initiated: 08/23/2022; Focus: The resident has (DTI) pressure injury to Rt medial heel r/t Reduced Mobility. Date Initiated: 03/29/2023. Revision on: 03/29/2023. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 03/29/2023. Administer treatments as ordered and monitor for effectiveness. Date Initiated: 03/29/2023. Assess/record/and monitor wound healing weekly. Measure length, width and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 03/29/2023. Revision on: 06/05/2023. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulation/mobility, good nutrition and frequent repositioning. Date Initiated: 03/29/2023. Record review of Resident #4's physician order revealed start date 03/14/2023 Location of wound: Plantar right heel with order to be performed topically one time a day for Apply betadine to plantar right heel unstageable ulcer daily apply betadine until healed. Offloading @ all times. F/U with wound care and end date 04/13/2023. Record Review of Resident #4's TAR dated 04/01/2023 - 04/30/2023 revealed no evidence of treatment being completed on: 04/08/2023 and 04/09/2023. Record review of Resident #4's physician order revealed the order start date 04/13/2023 Location of wound: Right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Leptospermum honey in to wound bed cover with border dressing. and end date 05/04/2023. Record Review of Resident #4's TAR dated on 04/01/2023 - 04/30/2023 revealed no evidence of treatment for order with being completed on: 04/14/2023, 04/15/2023 and 04/23/2023. Record review of Resident #4's physician order revealed the following order start date 05/04/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 12 of 67 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 08/07/2023 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 0600 Collagen powder and Calcium alginate with silver cover with border dressing. and end date 06/27/2023. Level of Harm - Immediate jeopardy to resident health or safety Record Review of Resident #4's TAR dated on 05/01/2023 - 05/31/2023 revealed no evidence of treatment for order with being completed on: 05/08/2023, 05/15/2023, 05/16/2023, 05/22/2023, 05/29/2023, 05/30/2023 and 05/31/2023. Residents Affected - Some Record Review of Resident #4's TAR dated on 06/01/2023 - 06/30/2023 revealed no evidence of treatment for order with being completed on: 06/02/2023, 06/03/2023, 06/04/2023, 06/12/2023, 06/19/2023, 06/20/2023, 06/21/2023 and 06/24/2023. Record review of Resident #4's physician order revealed the following order start date 06/27/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen powder and sodium hypochlorite get (anapest) cover with border dressing. And end date 06/29/2023. Record Review of Resident #4's TAR dated on 06/01/2023 - 06/30/2023 revealed no evidence of treatment for order with being completed on: 06/28/2023. Record review of Resident #4's physician order revealed the following order start date on 06/29/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift every Tue, Thu, Sat Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date 07/10/2023. Record Review of Resident #4's TAR dated on 07/01/2023 - 07/31/2023 revealed no evidence of treatment for order with being completed on: 07/01/2023. Record review of Resident #4's physician order dated 07/29/2023 revealed the following order start date on 07/10/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date 07/20/2023. Record Review of Resident #4's TAR dated on 07/01/2023 - 07/31/2023 revealed no evidence of treatment for order with being completed on: 07/14/2023, 07/15/2023, and 07/23/2023. Record review of Resident #4's Medication Administration Audit Report generated by CSD revealed: -Scheduled for 07/14/2023 at 06:00AM and charted as completed on 07/29/2023 8:58PM by DON. -Scheduled for 07/15/2023 at 06:00AM was charted as completed on 07/29/2023 9:06PM by DON. -Scheduled for 07/23/23 at 6:00AM was charted as completed on 7/29/23 at 9:53PM by DON. Record review of Resident #4's nurse's skin assessment dated [DATE] revealed DTI (deep tissue injury) to right medial heel. Record review of Resident #4's nurse's skin assessment dated [DATE] completed by DON revealed Skin Intact. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 13 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #4's WCS physician note dated 05/18/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.8cm in length by 2.4cm in width by 0.3cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. Record review of Resident #4's WCS physician note dated 05/25/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.8cm in length by 2.4cm in width by 0.3cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. Treatment options - risks - benefits and the possible need for subsequent additional procedures on this wound were explained on 04/13/2023 to the patient. Record review of Resident #4's WCS physician note titled dated 07/27/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.4cm in length by 2.2cm in width by 0.2cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. During an observation and interview on 08/01/2023 at 4:30PM Resident #4 was sitting up in wheelchair with offloading boot to right foot and elevated with extended wheelchair footrest. Resident #4 stated she gave permission to observe foot and take a photograph of wound. Resident #4's right foot pressure ulcer had thick green tinged skin surrounding a circular wound with beefy red granulation tissue observed to wound bed. Observation of small amount of drainage observed to bandage and no odor. Resident #4 stated she had no concerns with her wound. 2. Resident # 1 Record review of Resident # 1's closed record face sheet dated 07/29/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent hospital readmission date of 06/03/2023, with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease. Record review of Resident # 1's closed record admission MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 10 (moderate cognitive impairment); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. Record review of Resident #1's closed record care plan dated 05/15/2022 (revised on 06/04/2023) revealed: Focus: The resident is at risk for pressure injury r/t History of Pressure Injuries, Poor nutrition, Reduced Mobility, Sheering/friction problems. Date Initiated: 08/20/2020 Revision on: 02/21/2022; Perform and document weekly assessment form of skin for changes or observations. Date Initiated: 08/20/2020 Protect elbows and heels from friction. Date Initiated: 08/20/2020 Protect heels-offload when in bed. Administer medication as ordered. Date Initiated 11/29/2022. Follow facility policy and procedures for line listing, summarizing infections. Focus The resident has a stage 1 pressure injury to his R buttocks r/t Reduced Mobility, Incontinence, Sheering/Friction. Date Initiated: 08/18/2022 Revision on: 10/24/2022. Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 08/18/2022. Administer treatments as ordered and monitor for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 14 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some effectiveness. Date Initiated 08/18/2022 Assess/record/monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 08/18/2022. Revision on: 08/23/2022. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition and frequent repositioning. Date Initiated: 08/18/2022. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated 08/18/2022. Provide low air loss mattress to bed. Date Initiated: 08/18/2022. Provide pressure relieving cushion to wheelchair. Monitor for placement and condition. Notify supervisor if cushion needs to be replaced. Date Initiated: 08/18/2022. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed no new areas, continue tx{treatment} to diabetic ulcer to lt{left} foot. Record review of Resident #1's closed record admission Summary Progress Note dated 06/03/2023 revealed stage 2 pressure wound on coccyx. Record review of Resident #1's closed record progress note titled Skin/Wound Note dated 06/15/2023 revealed WCS here this am to see resident. Stage 3 on rt ischium measures3x4.5x0.3. Light serous drainage with45% slough 5% granulation, 50% skin. Deterioration noted. [NAME] tinge to drainage concerning for Pseudomonas. No signs of infection. WCS preformed surgical excisional debridement to remove necrotic tissue and establish the margins of viable tissue. Record review of Resident #1's closed record nurses progress note dated 06/21/2023 revealed Resident return from OS per physician progress notes: 1) Please do NOT change the patients dressing 2)RTC on June 25 @ 1130AM. Transportation notified of f/u appt. and Info updated on 24 hour report. Record review of Resident #1's closed record nurses progress note dated 06/30/2023 revealed Resident return from OS office per physician progress notes Please change Resident #1's foot wound dressing daily. No further need for ACE wrap. Please see that patient gets his augmentin as ordered. Call placed to OS office for clarification on orders what does provider want for dressing orders and orders for augmentin. Per [NAME] nurse at OS office to cleanse wound then swab with betadine cover with 4x4 and secure. Augmentin 875mg q12 hours x10days. Orders updated in chart and placed on24 hr{hour} report. Record review of Resident #1's closed record nurses progress note dated 07/07/2023 revealed Resident return from OS appointment per physician's progress notes: Continue daily dressing changes with betadine to wound base . Return in 1 week appt of 7/14/23 @ 1045am Transportation notified. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 4 pressure ulcer to R Ischium with wound care and left leg dressing intact. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 3 pressure ulcer to R Ischium measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth and left leg dressing intact. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 3 pressure ulcer to R Ischium measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 05/18/2023 revealed diabetic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 15 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety wound of the left, distal, plantar, lateral foot full thickness. Surgical excisional debridement procedure indicated for removal of necrotic tissue and establish the margins of viable tissue. No mention of R Ischium wound. Record review of Resident #1's closed record WCS physician notes dated 06/08/2023 revealed R Ischium wound measuring 2.3cm in length by 4.5cm in width by 0.3cm in depth. Residents Affected - Some Record review of Resident #1's closed record WCS physician notes dated 06/15/2023 revealed R Ischium wound measuring 3.0cm in length by 4.5cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/22/2023 revealed R Ischium wound measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/29/2023 revealed R Ischium wound measuring 3.5cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 07/06/2023 revealed R Ischium wound measuring 4.0cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record hospital records dated 05/16/2023 revealed Stage 2 coccygeal & gluteal PI-POA. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed start date 06/27/2023 Location of wound: Unstageable Rt Ischium with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Leptospermum honey to wound bed cover border gauze dressing and no end date written. Record Review of Resident #1's closed record TAR dated July 1, 2023 - July 31, 2023, revealed no evidence of treatment for order being completed on: 07/01/202, 07/03/2023, 07/05/2023, 07/07/2023 and 07/12/2023. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed start date 06/05/2023 stating Location of wound: right Ischium with order to be performed every day shift Treatment order: Cleanse with NS/wound cleanser. Pat dry Apply Triad cream and cover with silicone dressing with end date 06/09/2023. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of treatment for order being completed on: 06/07/2023, 06/08/2023, 06/09/2023. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed order with start date 06/09/2023 stating Location of wound: Unstageable right Ischium with order to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Anasept and TAO to wound bed cover bordered gauze dressing with end date 06/27/2023 written. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of treatment for completed on: 06/09/2023, 06/14/2023, 06/19/2023, 06/20/2023, 06/21/2023, 06/24/2023, 06/25/2023 and 06/26/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 16 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #1's closed record physician orders dated 7/29/23 revealed start date 06/27/2023 stating Location of wound: Unstageable right Ischium with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Leptospermum honey to wound bed cover border gauze dressing and no end date written. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of being completed on: 06/27/2023 and 06/30/2023. Record review of Resident #1's physician orders dated 7/29/23 revealed no evidence of treatment orders for Resident #1 left foot from 06/01/2023 to 06/30/2023. Record review of Resident # 1 physician orders revealed start date 06/30/2023 Location of wound: left foot with order to be performed every day shift Treatment order: Cleanse with NS or Wound Cleanser and pat dry. Swab with betadine swab. Cover with 4x4 and secure with tape. and no end date. Record Review of Resident #1's TAR dated July 1, 2023 - July 31, 2023, revealed no evidence of treatment for order being completed on: 07/01/2023, 07/03/2023, 07/05/2023, 07/07/2023, 07/09/2023 and 07/12/2023. Record review of Resident #2's Progress note dated 08/03/23 revealed: DON performed skin assessment of this resident who has stage 4 pressure wound to right posterior, lower extremity, measures 3.2 x 1.8 x 1.0cm with minimal serous drainage noted, peri wound of normal skin color for resident. 70% granulation tissue noted, no slough, and tendon and bone noted. Suprapubic cath site to mid-lower abdomen area, no drainage or leakage to area noted. No sis of infection or further abnormalities noted. Signed DON 8/3/23 at 7:40PM Record review of Resident #2's Wound Care Physician Assessment Note dated 08/03/23 revealed: Focused Wound Exam (Site 1) STAGE 4 PRESSURE WOUND OF THE RIGHT, LATERAL CALF FULL THICKNESS. Etiology (quality), Pressure. Stage. 4. Duration > 1 days During an interview on 07/29/2023 at 12: 59 PM Resident # 1's family member stated he/she had concerns about Resident 1's care while at the facility. Resident #1's family member stated he/she felt Resident #1 was neglected by the facility which led to his death. Resident #1's family member stated his room always smelled like urine and that Resident #1's dressing on his wounds were never changed timely. During an interview on 08/03/2023 at 11:50 AM the OS stated he had concerns Resident #1 was a no call/no show for his first scheduled post-operation visit. The OS stated the facility never called to reschedule visit or to clarify orders. The OS stated Resident #1 went over 3 weeks without bandage being changed, which led to the bandage had to be soaked to be removed and Resident #1 had bandage burns. The OS stated he was never notified of missed treatments. The OS stated Resident #1 missing wound care treatments postponed his foot healing. 3. Resident #2 Review of Resident #2's face sheet dated 08/03/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 10/05/2022, with the following diagnosis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 17 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some unspecified dementia (primary), need for assistance with personal care, flaccid hemiplegia affecting right dominant side. Review of Resident #2's annual MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 8 (moderate); Section G- Functional Status revealed Resident #2 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bowel and Bladder revealed always incontinent for bowel; Section M-Skin Conditions revealed Resident #2 was at risk of developing pressure ulcers/injuries. Review of Resident #2's care plan dated 07/04/2022 revealed: Focus: The resident is at risk for pressure ulcer development r/t disease process and immobility. Date Initiated: 06/26/2018 Revision on: 04/15/2021; Interventions: administer medications as ordered. Monitor/document for side effects and effectiveness. Date initiated 06/26/2018. Administer treatments as ordered and monitor for effectiveness. Date initiated 06/26/2018. Follow facility policies/protocols for the prevention/treatment of skin breakdown. Initiate initiated: 06/26/2018. Inform the resident/family/caregivers of any new area of skin breakdown. Date initiated: 06/26/2018. Monitor/document/report PRN any changes in skin status: appearance, color, wound healing, S/SX of infection, wound size (length X width X depth), stage. Date Initiated: 06/26/2018. Obtain and monitor lab/diagnostic work as ordered. Report results to MD and follow up as indicated. Weekly skin assessments. Date initiated: 06/26/2018. Revision on: 03/03/2023; Focus: patient has a stage 4 pressure injury to right posterior calf with potential for further skin breakdown R/T: disease process, immobility, impaired mobility, lack of sensation, non-compliance with therapeutic regimen. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 07/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 07/29/2023. Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 07/29/1013. Review of Resident #2's nurses notes dated 07/15/2023 at 11:00 PM written by LVN T revealed: Aide has brought to my attention that [Resident #2] has open area on back of right ankle area. When this nurse assessed, I found wound that is denuded, partial thickness and has black eschar in wound bed. I cleansed wound with wound cleanser, applied hydrophilic ointment and covered with bordered gauze. Entire leg and foot have severe outward rotation. It is stroke effected side. Heel is elevated off bed and wound area is hanging free with no pressure. Review of Resident #2's nurses note dated 07/17/2023 at 1:37 PM written by LVN A revealed: Resident noted to have a DTI per night nurse to his right lower calf area cleaned Review of Resident #2's physician orders revealed no evidence of pressure ulcer treatment between 07/15/2023 and 07/27/2023. Review of Resident #2's physician orders revealed: Order date 07/27/2023 at 2:15 PM Cleanse right lower posterior calf with dermal wound cleaner apply Triad Debriding Cream to wound bed and cover with boarder dressing. Every day shift every Mon, Wed, Fri for promote Wound healing and every 1 hour as needed for skin irritation. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by DON revealed Skin Intact. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by TX D revealed Right lower leg stage 3 pressure ulcer measuring 2.5cm in length by 2.7cm in width by 0.5cm in depth. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 18 of 67 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 08/07/2023 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #2's nurse's skin assessment dated [DATE] completed by TX D revealed right lower leg unstageable pressure ulcer measuring 2.5cm in length by 2.0cm in width by 0.5cm in depth. During an observation on 07/29/2023 at 4:10PM of Resident #2 revealed Resident #2 lying in bed with right leg on pillow. Resident #2's right lower leg was covered by gauze and secured with tape. The dressing did not have a date on the outside. Residents Affected - Some During an observation on 7/30/2023 at 3:30 PM of Resident #2 revealed Resident #2's lower right leg had a wound that had red tissue present, surrounding skin within normal limits for race, no tendon or bone observed, no necrosis observed, measurements were not taken appeared to be a Stage 3. During an interview on 07/30/2023 at 5:35 PM, the DON stated she had completed skin assessment on 7/20/2023 for Resident #2. The DON stated that she should have looked at the nurses notes to verify that Resident #2 did have a pressure ulcer. The DON stated the system was new to her, and she must have gotten confused between patients. The DON stated she had not completed a thorough assessment and that her assessment did not give an accurate assessment of Resident # 2, because if nurses note on 07/13 and 7/15 stated he had a pressure ulcer then her assessment on 7/20 should have reflected that. The DON stated the negative affect on residents, if wound care treatments were not completed, could have caused skin breakdown, and could have caused the wounds to worsen in various ways. 4. Resident # 6 Review of Resident #6's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 08/31/2018, with the following diagnosis Type 2 diabetes (primary), age-related physical debility, cognitive communication deficit, and unspecified dementia. Review of Resident #6's significant change in status MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 99 (Unable to complete interview); Section G- Functional Status revealed patient had extensive dependence with most activities (1 physical assist); Section F- Bowel and Bladder revealed always incontinent to bowel and bladder. Section M-Skin Conditions revealed Resident #6 had a risk of developing pressure ulcers/injuries. Review of Resident #6's care plan dated 5/15/2023 revealed no intervention related to Deep Tissue Injury prevention or care. Review of Resident #6's Weekly Skin Integrity Review dated 07/25/2023 completed TX D revealed; Suspected Deep Tissue Injury to left heel measuring 4cm in length by 3cm in width. Review of Resident #6's physician orders dated 07/29/2023 revealed no evidence of wound treatment order for Deep Tissue Injury between 07/25/2023 and 07/29/2023. Review of Resident #6's physician orders dated 07/30/2023 revealed Skin prep to left heel every day and prn everyday shift for wound care related to weakness. During an observation and interview on 08/01/2023 at 4:25 PM revealed Resident #6 laying on her back not wearing her offloading boot, the boot was to the left side of her foot. Resident #6's wound was located on left heel, the wound was circular and purple in color, there was no drainage and skin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 19 of 67 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 08/07/2023 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 0600 appeared. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 08/01/2023 at 4:25 PM ADON C stated Resident #6 should have been wearing the offloading boot while in laying bed. ADON C stated that Resident #6's wound was not healed and needed further treatment. Residents Affected - Some 5. Resident #7 Review of Resident #7's face sheet dated 08/02/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 07/27/2023, with the following diagnosis cerebral infarction (primary), muscle weakness, need for assistance with personal care, and Type 2 diabetes. Review of Resident #7's quarterly MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed limited to extensive assist needing 1 - 2+ persons for assistance; Section- H Bowel and Bladder revealed occasionally incontinent to bladder and frequently incontinent to bowel. Section M- Skin Conditions revealed resident is at risk for developing pressure ulcers/injuries. Review of Resident #7's care plan dated 05/31/2023 revealed: Focus: The resident has pressure injury to Rt buttock stage 3 with potential for further skin breakdown r/t: chronic progressive disease, impaired mobility, obesity. Date Initiated: 03/02/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 03/02/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 03/02/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 03/02/2023. Document wound appearance, color, wound healing, s/sx of infection, wound size (length X width X depth) and stage, and report to MD PRN any changes in skin status. Date Initiated: 03/02/2023. Notify Nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 03/02/2023. Provide pressure relieving device in bed. Date Initiated: 03/02/2023. Refer to dietician and follow recommendation. Date Initiated: 03/02/2023. Serve diet as ordered. Date Initiated: 03/02/2023. Review of Resident #7's Weekly Skin Integrity Review dated 07/28/2023 completed by TX D revealed redness to right buttock. Review of Resident #7's Skin Note dated 07/31/2023 completed by TX D revealed Wounds to bilateral gluteal ischium tuberosities are healed, discontinue wound care to these areas, will continue to monitor. Review of [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 20 of 67 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 08/07/2023 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement written policies and procedures that prohibited and prevented abuse and neglect for 6 of 8 residents (Resident #4, Resident #1, Resident #2, Resident #6, Resident #7, Resident #8) reviewed for neglect. Residents Affected - Some 1. The facility failed to follow physician's orders to prevent Resident #4's Deep Tissue Injury to right medial heel to deteriorate to a stage 4 pressure ulcer. 2. The facility failed to follow physician's orders to prevent Resident #1's Right Ischium(hip) pressure ulcer to deteriorate from a stage 2 to a stage 3. 3. The facility failed to obtain orders from Resident #1's Podiatrist when appointments were missed status post amputation of 5th digit of left foot. 4. The facility failed to obtain physician orders for treatment of Resident #2's pressure ulcer on right posterior calf. Resident #2 went 12 days without treatment to wound. Resident #2 was assessed on 08/03/2023 with Stage IV. 5. The facility failed to obtain physician orders for treatment of Resident #6's left heel Deep Tissue Injury. Resident #6 went 5 days without treatment to wound. 6. The facility failed to complete skin assessments of Resident #7 which led to the development of a stage 2 pressure ulcer to the right upper buttocks and stage 2 to the right lower buttocks. 7. The facility failed to complete weekly skin assessments which led to Resident #8 developing stage 2 pressure ulcer to left buttock and stage 2 pressure ulcer to right buttock. 8. The facility failed to ensure Resident # 2 and Resident #4 ' s skin assessments were completed, assessed accurately and accurately documented by the DON. 9. The facility failed to ensure Resident #1, Resident #4 and Resident #5 ' s wound treatments were completed and accurately documented by DON and ADON E. 10. The facility failed to maintain accurate list of residents with pressure ulcers. The facility did a skin sweep and found Resident #7's and Resident #8's wounds after surveyor intervention requesting accurate lists of residents with pressure ulcers. An Immediate Jeopardy (IJ) was identified on 08/03/23. While the IJ was lowered on 08/07/23, the facility remained out of compliance at a severity level of actual harm with a scope of pattern due to the facility's need to evaluate the effectiveness of their corrective actions. These failures could place residents at risk of infections, worsening of wounds, injuries, emotional distress, and even death. Findings included: 1.Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 21 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Record Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section HBowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer. Record review of Resident #4's care plan dated 05/15/2023 revealed: Focus: The resident has the potential for pressure ulcer development r/t impaired mobility, incontinence, obesity. Date Initiated: 08/23/2022. Revision on: 08/23/2022. Interventions: Notify nurse immediately of any signs of skin breakdown: redness, blisters, bruises and discoloration noted during bath or daily care. Date Initiated: 08/23/2022. Provide assist with turning and repositioning during rounds. Date Initiated: 08/23/2022; Focus: The resident has (DTI) pressure injury to Rt medial heel r/t Reduced Mobility. Date Initiated: 03/29/2023. Revision on: 03/29/2023. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 03/29/2023. Administer treatments as ordered and monitor for effectiveness. Date Initiated: 03/29/2023. Assess/record/and monitor wound healing weekly. Measure length, width and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 03/29/2023. Revision on: 06/05/2023. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulation/mobility, good nutrition and frequent repositioning. Date Initiated: 03/29/2023. Record review of Resident #4's physician order revealed start date 03/14/2023 Location of wound: Plantar right heel with order to be performed topically one time a day for Apply betadine to plantar right heel unstageable ulcer daily apply betadine until healed. Offloading @ all times. F/U with wound care and end date 04/13/2023. Record Review of Resident #4's TAR dated 04/01/2023 - 04/30/2023 revealed no evidence of treatment being completed on: 04/08/2023 and 04/09/2023. Record review of Resident #4's physician order revealed the order start date 04/13/2023 Location of wound: Right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Leptospermum honey in to wound bed cover with border dressing. and end date 05/04/2023. Record Review of Resident #4's TAR dated on 04/01/2023 - 04/30/2023 revealed no evidence of treatment for order with being completed on: 04/14/2023, 04/15/2023 and 04/23/2023. Record review of Resident #4's physician order revealed the following order start date 05/04/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Collagen powder and Calcium alginate with silver cover with border dressing. and end date 06/27/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 22 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record Review of Resident #4's TAR dated on 05/01/2023 - 05/31/2023 revealed no evidence of treatment for order with being completed on: 05/08/2023, 05/15/2023, 05/16/2023, 05/22/2023, 05/29/2023, 05/30/2023 and 05/31/2023. Record Review of Resident #4's TAR dated on 06/01/2023 - 06/30/2023 revealed no evidence of treatment for order with being completed on: 06/02/2023, 06/03/2023, 06/04/2023, 06/12/2023, 06/19/2023, 06/20/2023, 06/21/2023 and 06/24/2023. Record review of Resident #4's physician order revealed the following order start date 06/27/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen powder and sodium hypochlorite get (anapest) cover with border dressing. And end date 06/29/2023. Record Review of Resident #4's TAR dated on 06/01/2023 - 06/30/2023 revealed no evidence of treatment for order with being completed on: 06/28/2023. Record review of Resident #4's physician order revealed the following order start date on 06/29/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift every Tue, Thu, Sat Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date 07/10/2023. Record Review of Resident #4's TAR dated on 07/01/2023 - 07/31/2023 revealed no evidence of treatment for order with being completed on: 07/01/2023. Record review of Resident #4's physician order dated 07/29/2023 revealed the following order start date on 07/10/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date 07/20/2023. Record Review of Resident #4's TAR dated on 07/01/2023 - 07/31/2023 revealed no evidence of treatment for order with being completed on: 07/14/2023, 07/15/2023, and 07/23/2023. Record review of Resident #4's Medication Administration Audit Report generated by CSD revealed: -Scheduled for 07/14/2023 at 06:00AM and charted as completed on 07/29/2023 8:58PM by DON. -Scheduled for 07/15/2023 at 06:00AM was charted as completed on 07/29/2023 9:06PM by DON. -Scheduled for 07/23/23 at 6:00AM was charted as completed on 7/29/23 at 9:53PM by DON. Record review of Resident #4's nurse's skin assessment dated [DATE] revealed DTI (deep tissue injury) to right medial heel. Record review of Resident #4's nurse's skin assessment dated [DATE] completed by DON revealed Skin Intact. Record review of Resident #4's WCS physician note dated 05/18/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.8cm in length by 2.4cm in width by 0.3cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 23 of 67 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 08/07/2023 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 0607 establish the margins of viable tissue. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #4's WCS physician note dated 05/25/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.8cm in length by 2.4cm in width by 0.3cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. Treatment options - risks - benefits and the possible need for subsequent additional procedures on this wound were explained on 04/13/2023 to the patient. Residents Affected - Some Record review of Resident #4's WCS physician note titled dated 07/27/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.4cm in length by 2.2cm in width by 0.2cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. During an observation and interview on 08/01/2023 at 4:30PM Resident #4 was sitting up in wheelchair with offloading boot to right foot and elevated with extended wheelchair footrest. Resident #4 stated she gave permission to observe foot and take a photograph of wound. Resident #4's right foot pressure ulcer had thick green tinged skin surrounding a circular wound with beefy red granulation tissue observed to wound bed. Observation of small amount of drainage observed to bandage and no odor. Resident #4 stated she had no concerns with her wound. 2. Resident # 1 Record review of Resident # 1's closed record face sheet dated 07/29/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent hospital readmission date of 06/03/2023, with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease. Record review of Resident # 1's closed record admission MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 10 (moderate cognitive impairment); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. Record review of Resident #1's closed record care plan dated 05/15/2022 (revised on 06/04/2023) revealed: Focus: The resident is at risk for pressure injury r/t History of Pressure Injuries, Poor nutrition, Reduced Mobility, Sheering/friction problems. Date Initiated: 08/20/2020 Revision on: 02/21/2022; Perform and document weekly assessment form of skin for changes or observations. Date Initiated: 08/20/2020 Protect elbows and heels from friction. Date Initiated: 08/20/2020 Protect heels-offload when in bed. Administer medication as ordered. Date Initiated 11/29/2022. Follow facility policy and procedures for line listing, summarizing infections. Focus The resident has a stage 1 pressure injury to his R buttocks r/t Reduced Mobility, Incontinence, Sheering/Friction. Date Initiated: 08/18/2022 Revision on: 10/24/2022. Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 08/18/2022. Administer treatments as ordered and monitor for effectiveness. Date Initiated 08/18/2022 Assess/record/monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 08/18/2022. Revision on: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 24 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety 08/23/2022. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition and frequent repositioning. Date Initiated: 08/18/2022. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated 08/18/2022. Provide low air loss mattress to bed. Date Initiated: 08/18/2022. Provide pressure relieving cushion to wheelchair. Monitor for placement and condition. Notify supervisor if cushion needs to be replaced. Date Initiated: 08/18/2022. Residents Affected - Some Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed no new areas, continue tx{treatment} to diabetic ulcer to lt{left} foot. Record review of Resident #1's closed record admission Summary Progress Note dated 06/03/2023 revealed stage 2 pressure wound on coccyx. Record review of Resident #1's closed record progress note titled Skin/Wound Note dated 06/15/2023 revealed WCS here this am to see resident. Stage 3 on rt ischium measures3x4.5x0.3. Light serous drainage with45% slough 5% granulation, 50% skin. Deterioration noted. [NAME] tinge to drainage concerning for Pseudomonas. No signs of infection. WCS preformed surgical excisional debridement to remove necrotic tissue and establish the margins of viable tissue. Record review of Resident #1's closed record nurses progress note dated 06/21/2023 revealed Resident return from OS per physician progress notes: 1) Please do NOT change the patients dressing 2)RTC on June 25 @ 1130AM. Transportation notified of f/u appt. and Info updated on 24 hour report. Record review of Resident #1's closed record nurses progress note dated 06/30/2023 revealed Resident return from OS office per physician progress notes Please change Resident #1's foot wound dressing daily. No further need for ACE wrap. Please see that patient gets his augmentin as ordered. Call placed to OS office for clarification on orders what does provider want for dressing orders and orders for augmentin. Per [NAME] nurse at OS office to cleanse wound then swab with betadine cover with 4x4 and secure. Augmentin 875mg q12 hours x10days. Orders updated in chart and placed on24 hr{hour} report. Record review of Resident #1's closed record nurses progress note dated 07/07/2023 revealed Resident return from OS appointment per physician's progress notes: Continue daily dressing changes with betadine to wound base . Return in 1 week appt of 7/14/23 @ 1045am Transportation notified. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 4 pressure ulcer to R Ischium with wound care and left leg dressing intact. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 3 pressure ulcer to R Ischium measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth and left leg dressing intact. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 3 pressure ulcer to R Ischium measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 05/18/2023 revealed diabetic wound of the left, distal, plantar, lateral foot full thickness. Surgical excisional debridement procedure indicated for removal of necrotic tissue and establish the margins of viable tissue. No mention of R Ischium wound. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 25 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #1's closed record WCS physician notes dated 06/08/2023 revealed R Ischium wound measuring 2.3cm in length by 4.5cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/15/2023 revealed R Ischium wound measuring 3.0cm in length by 4.5cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/22/2023 revealed R Ischium wound measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/29/2023 revealed R Ischium wound measuring 3.5cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 07/06/2023 revealed R Ischium wound measuring 4.0cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record hospital records dated 05/16/2023 revealed Stage 2 coccygeal & gluteal PI-POA. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed start date 06/27/2023 Location of wound: Unstageable Rt Ischium with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Leptospermum honey to wound bed cover border gauze dressing and no end date written. Record Review of Resident #1's closed record TAR dated July 1, 2023 - July 31, 2023, revealed no evidence of treatment for order being completed on: 07/01/202, 07/03/2023, 07/05/2023, 07/07/2023 and 07/12/2023. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed start date 06/05/2023 stating Location of wound: right Ischium with order to be performed every day shift Treatment order: Cleanse with NS/wound cleanser. Pat dry Apply Triad cream and cover with silicone dressing with end date 06/09/2023. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of treatment for order being completed on: 06/07/2023, 06/08/2023, 06/09/2023. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed order with start date 06/09/2023 stating Location of wound: Unstageable right Ischium with order to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Anasept and TAO to wound bed cover bordered gauze dressing with end date 06/27/2023 written. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of treatment for completed on: 06/09/2023, 06/14/2023, 06/19/2023, 06/20/2023, 06/21/2023, 06/24/2023, 06/25/2023 and 06/26/2023. Record review of Resident #1's closed record physician orders dated 7/29/23 revealed start date 06/27/2023 stating Location of wound: Unstageable right Ischium with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Leptospermum honey to wound bed cover border gauze dressing and no end date written. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 26 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of being completed on: 06/27/2023 and 06/30/2023. Record review of Resident #1's physician orders dated 7/29/23 revealed no evidence of treatment orders for Resident #1 left foot from 06/01/2023 to 06/30/2023. Record review of Resident # 1 physician orders revealed start date 06/30/2023 Location of wound: left foot with order to be performed every day shift Treatment order: Cleanse with NS or Wound Cleanser and pat dry. Swab with betadine swab. Cover with 4x4 and secure with tape. and no end date. Record Review of Resident #1's TAR dated July 1, 2023 - July 31, 2023, revealed no evidence of treatment for order being completed on: 07/01/2023, 07/03/2023, 07/05/2023, 07/07/2023, 07/09/2023 and 07/12/2023. Record review of Resident #2's Progress note dated 08/03/23 revealed: DON performed skin assessment of this resident who has stage 4 pressure wound to right posterior, lower extremity, measures 3.2 x 1.8 x 1.0cm with minimal serous drainage noted, peri wound of normal skin color for resident. 70% granulation tissue noted, no slough, and tendon and bone noted. Suprapubic cath site to mid-lower abdomen area, no drainage or leakage to area noted. No sis of infection or further abnormalities noted. Signed DON 8/3/23 at 7:40PM Record review of Resident #2's Wound Care Physician Assessment Note dated 08/03/23 revealed: Focused Wound Exam (Site 1) STAGE 4 PRESSURE WOUND OF THE RIGHT, LATERAL CALF FULL THICKNESS. Etiology (quality), Pressure. Stage. 4. Duration > 1 days During an interview on 07/29/2023 at 12: 59 PM Resident # 1's family member stated he/she had concerns about Resident 1's care while at the facility. Resident #1's family member stated he/she felt Resident #1 was neglected by the facility which led to his death. Resident #1's family member stated his room always smelled like urine and that Resident #1's dressing on his wounds were never changed timely. During an interview on 08/03/2023 at 11:50 AM the OS stated he had concerns Resident #1 was a no call/no show for his first scheduled post-operation visit. The OS stated the facility never called to reschedule visit or to clarify orders. The OS stated Resident #1 went over 3 weeks without bandage being changed, which led to the bandage had to be soaked to be removed and Resident #1 had bandage burns. The OS stated he was never notified of missed treatments. The OS stated Resident #1 missing wound care treatments postponed his foot healing. 3. Resident #2 Review of Resident #2's face sheet dated 08/03/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 10/05/2022, with the following diagnosis unspecified dementia (primary), need for assistance with personal care, flaccid hemiplegia affecting right dominant side. Review of Resident #2's annual MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 8 (moderate); Section G- Functional Status revealed Resident #2 had mostly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 27 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bowel and Bladder revealed always incontinent for bowel; Section M-Skin Conditions revealed Resident #2 was at risk of developing pressure ulcers/injuries. Review of Resident #2's care plan dated 07/04/2022 revealed: Focus: The resident is at risk for pressure ulcer development r/t disease process and immobility. Date Initiated: 06/26/2018 Revision on: 04/15/2021; Interventions: administer medications as ordered. Monitor/document for side effects and effectiveness. Date initiated 06/26/2018. Administer treatments as ordered and monitor for effectiveness. Date initiated 06/26/2018. Follow facility policies/protocols for the prevention/treatment of skin breakdown. Initiate initiated: 06/26/2018. Inform the resident/family/caregivers of any new area of skin breakdown. Date initiated: 06/26/2018. Monitor/document/report PRN any changes in skin status: appearance, color, wound healing, S/SX of infection, wound size (length X width X depth), stage. Date Initiated: 06/26/2018. Obtain and monitor lab/diagnostic work as ordered. Report results to MD and follow up as indicated. Weekly skin assessments. Date initiated: 06/26/2018. Revision on: 03/03/2023; Focus: patient has a stage 4 pressure injury to right posterior calf with potential for further skin breakdown R/T: disease process, immobility, impaired mobility, lack of sensation, non-compliance with therapeutic regimen. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 07/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 07/29/2023. Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 07/29/1013. Review of Resident #2's nurses notes dated 07/15/2023 at 11:00 PM written by LVN T revealed: Aide has brought to my attention that [Resident #2] has open area on back of right ankle area. When this nurse assessed, I found wound that is denuded, partial thickness and has black eschar in wound bed. I cleansed wound with wound cleanser, applied hydrophilic ointment and covered with bordered gauze. Entire leg and foot have severe outward rotation. It is stroke effected side. Heel is elevated off bed and wound area is hanging free with no pressure. Review of Resident #2's nurses note dated 07/17/2023 at 1:37 PM written by LVN A revealed: Resident noted to have a DTI per night nurse to his right lower calf area cleaned Review of Resident #2's physician orders revealed no evidence of pressure ulcer treatment between 07/15/2023 and 07/27/2023. Review of Resident #2's physician orders revealed: Order date 07/27/2023 at 2:15 PM Cleanse right lower posterior calf with dermal wound cleaner apply Triad Debriding Cream to wound bed and cover with boarder dressing. Every day shift every Mon, Wed, Fri for promote Wound healing and every 1 hour as needed for skin irritation. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by DON revealed Skin Intact. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by TX D revealed Right lower leg stage 3 pressure ulcer measuring 2.5cm in length by 2.7cm in width by 0.5cm in depth. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by TX D revealed right lower leg unstageable pressure ulcer measuring 2.5cm in length by 2.0cm in width by 0.5cm in depth. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 28 of 67 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 08/07/2023 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an observation on 07/29/2023 at 4:10PM of Resident #2 revealed Resident #2 lying in bed with right leg on pillow. Resident #2's right lower leg was covered by gauze and secured with tape. The dressing did not have a date on the outside. During an observation on 7/30/2023 at 3:30 PM of Resident #2 revealed Resident #2's lower right leg had a wound that had red tissue present, surrounding skin within normal limits for race, no tendon or bone observed, no necrosis observed, measurements were not taken appeared to be a Stage 3. During an interview on 07/30/2023 at 5:35 PM, the DON stated she had completed skin assessment on 7/20/2023 for Resident #2. The DON stated that she should have looked at the nurses notes to verify that Resident #2 did have a pressure ulcer. The DON stated the system was new to her, and she must have gotten confused between patients. The DON stated she had not completed a thorough assessment and that her assessment did not give an accurate assessment of Resident # 2, because if nurses note on 07/13 and 7/15 stated he had a pressure ulcer then her assessment on 7/20 should have reflected that. The DON stated the negative affect on residents, if wound care treatments were not completed, could have caused skin breakdown, and could have caused the wounds to worsen in various ways. 4. Resident # 6 Review of Resident #6's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 08/31/2018, with the following diagnosis Type 2 diabetes (primary), age-related physical debility, cognitive communication deficit, and unspecified dementia. Review of Resident #6's significant change in status MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 99 (Unable to complete interview); Section G- Functional Status revealed patient had extensive dependence with most activities (1 physical assist); Section F- Bowel and Bladder revealed always incontinent to bowel and bladder. Section M-Skin Conditions revealed Resident #6 had a risk of developing pressure ulcers/injuries. Review of Resident #6's care plan dated 5/15/2023 revealed no intervention related to Deep Tissue Injury prevention or care. Review of Resident #6's Weekly Skin Integrity Review dated 07/25/2023 completed TX D revealed; Suspected Deep Tissue Injury to left heel measuring 4cm in length by 3cm in width. Review of Resident #6's physician orders dated 07/29/2023 revealed no evidence of wound treatment order for Deep Tissue Injury between 07/25/2023 and 07/29/2023. Review of Resident #6's physician orders dated 07/30/2023 revealed Skin prep to left heel every day and prn everyday shift for wound care related to weakness. During an observation and interview on 08/01/2023 at 4:25 PM revealed Resident #6 laying on her back not wearing her offloading boot, the boot was to the left side of her foot. Resident #6's wound was located on left heel, the wound was circular and purple in color, there was no drainage and skin appeared. During an interview on 08/01/2023 at 4:25 PM ADON C stated Resident #6 should have been wearing the offloading boot while in laying bed. ADON C stated that Resident #6's wound was not healed and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 29 of 67 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 08/07/2023 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 0607 needed further treatment. Level of Harm - Immediate jeopardy to resident health or safety 5. Resident #7 Residents Affected - Some Review of Resident #7's face sheet dated 08/02/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 07/27/2023, with the following diagnosis cerebral infarction (primary), muscle weakness, need for assistance with personal care, and Type 2 diabetes. Review of Resident #7's quarterly MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed limited to extensive assist needing 1 - 2+ persons for assistance; Section- H Bowel and Bladder revealed occasionally incontinent to bladder and frequently incontinent to bowel. Section M- Skin Conditions revealed resident is at risk for developing pressure ulcers/injuries. Review of Resident #7's care plan dated 05/31/2023 revealed: Focus: The resident has pressure injury to Rt buttock stage 3 with potential for further skin breakdown r/t: chronic progressive disease, impaired mobility, obesity. Date Initiated: 03/02/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 03/02/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 03/02/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 03/02/2023. Document wound appearance, color, wound healing, s/sx of infection, wound size (length X width X depth) and stage, and report to MD PRN any changes in skin status. Date Initiated: 03/02/2023. Notify Nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 03/02/2023. Provide pressure relieving device in bed. Date Initiated: 03/02/2023. Refer to dietician and follow recommendation. Date Initiated: 03/02/2023. Serve diet as ordered. Date Initiated: 03/02/2023. Review of Resident #7's Weekly Skin Integrity Review dated 07/28/2023 completed by TX D revealed redness to right buttock. Review of Resident #7's Skin Note dated 07/31/2023 completed by TX D revealed Wounds to bilateral gluteal ischium tuberosities are healed, discontinue wound care to these areas, will continue[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 30 of 67 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 08/07/2023 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received proper treatment in accordance with professional standards of practice for 1 of 4 residents (Resident #1) reviewed for quality of care. Residents Affected - Few 1. The facility failed to ensure Resident #1 was making appointments with the Podiatrist/Orthopedic Surgeon (OS) post amputation of 5th digit of left foot. 2. The facility failed to obtain orders from Resident #1's Podiatrist/Orthopedic Surgeon (OS) Podiatrist when appointments were missed status post amputation of 5th digit of left foot. 3. The facility failed to follow Podiatrist/Orthopedic Surgeon (OS)'s orders for daily dressing changes. An Immediate Jeopardy (IJ) was identified on [DATE]. While the IJ was lowered on [DATE], the facility remained out of compliance at a severity level of actual harm with a scope of isolated due to the facility's need to evaluate the effectiveness of their corrective actions. These failures could place residents at risk of infections, worsening of wounds, injuries, emotional distress, and even death due to missed appointments, lack of follow-up, dressing changes, and lack of monitoring of amputations Findings include: Resident # 1 Review of Resident # 1's closed record face sheet dated [DATE] revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of [DATE] and discharge date of [DATE] with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease Review of Resident #1's hospital records dated [DATE] revealed Resident #1 was admitted to local hospital on [DATE] with stroke like symptoms, diabetes, and end stage renal disease requiring dialysis. Further review of hospital records revealed metatarsal resection (amputation of toe) on [DATE]. Further review of hospital record revealed resident Resident #1 was discharged from local hospital on [DATE] at 4:30pm with diagnosis of ulcer of left foot due to necrosis (death of tissues) of bone because of chronic osteomyelitis (inflammation of bone due to infection) of left foot with orders to follow up with Podiatrist/Orthopedic Surgeon in two weeks ([DATE]). Review of Resident # 1's closed record admission MDS assessment dated [DATE] revealed, Section CCognitive Behavior revealed a BIMS score of 10 (moderate cognitive impairment); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 31 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #1's closed record care plan dated on [DATE] revised on [DATE] revealed: Focus The resident has infection of the left foot r/t candidiasis. Date Initiated: [DATE] Revision on: [DATE]. Interventions: Administer medication as ordered. Date Initiated [DATE]. Follow facility policy and procedures for line listing, summarizing infections. Date Initiated: [DATE]. Maintain universal precautions when providing resident care. Date Initiated: [DATE]. Perform and document weekly assessment of skin for changes or observations. Residents Affected - Few Record review of Resident #1's closed record progress note on [DATE] written by NP revealed Patient was admitted for sepsis of multi sourced infection sites. Patient was started on empiric antibiotics and blood cultures were negative. Patient underwent a left fifth metatarsal head resection on [DATE]. Patient was medically stabilized and subsequently discharged to facility on [DATE] . Patient to have follow-up with OS on [DATE] at10:30 a.m. Dressing is to remain on the left foot until he is seen by the orthopedic surgeon. Further review of Resident #1's closed record revealed no evidence of documentation of missing Resident #1's appointment with OS on [DATE]. Record review of Resident #1's closed record nurses progress note dated [DATE] revealed Resident return from OS per physician progress notes: 1) Please do NOT change the patients dressing 2)RTC on [DATE] @ 1130AM. Transportation notified of f/u appt. and Info updated on 24 hour report. Record review of Resident #1's closed record nurses progress note dated [DATE] revealed Resident return from OS office per physician progress notes Please change Resident #1's foot wound dressing daily. No further need for ACE wrap. Please see that patient gets his augmentin as ordered. Call placed to OS office for clarification on orders what does provider want for dressing orders and orders for augmentin. Per nurse at OS office to cleanse wound then swab with betadine cover with 4x4 and secure. Augmentin 875mg q12 hours x10days. Orders updated in chart and placed on24 hr{hour} report. Record review of Resident #1's closed record nurses progress note dated [DATE] revealed Resident return from OS appointment per physician's progress notes: Continue daily dressing changes with betadine to wound base . Return in 1 week appt of [DATE] @ 1045am Transportation notified. Record review of Resident # 1 physician orders revealed start date [DATE] Location of wound: left foot with order to be performed every day shift Treatment order: Cleanse with NS or Wound Cleanser and pat dry. Swab with betadine swab. Cover with 4x4 and secure with tape. and no end date. Record Review of Resident #1's TAR dated [DATE] - [DATE], revealed no evidence of treatment for order being completed on: [DATE], [DATE], [DATE], [DATE], [DATE] and [DATE]. Review of Resident #1's hospital records dated [DATE] revealed Resident #1 was re-admitted to local community hospital on [DATE] due to complications related to End Stage Renal Disease requiring dialysis. Further review of Resident #1's hospital records revealed resident was discharged [DATE] to in house hospital hospice. During an interview on [DATE] at 12: 59 PM, Resident # 1's family member stated he/she had concerns about Resident 1's care while at the facility. Resident #1's family member stated he/she felt Resident #1 was neglected by the facility which led to his death. Resident #1's dressing on his wounds were never changed timely. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 32 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview on [DATE] at 5:35 PM, the DON stated documentation for wound care should have been on the TAR. The DON stated if there were no initials of nursing staff then it meant that the wound treatment was not provided. The DON stated her expectation was that wound care orders be followed and need to be completed, and if resident refused the refusal should have been documented that resident refused wound care. The DON stated she was not aware of missed treatments, she stated she thought treatments were done because she saw TX G's pushing treatment cart up and down the hall. The DON stated that was why she went in and initiated some of the treatment dates. The DON stated that missed treatments could have caused resident decline in wounds. The DON stated if nurse did not document there was no way to prove treatments were done. The DON stated the negative affect on residents, if wound care treatments were not completed, could have caused skin breakdown, and could have caused the wounds to worsen in various ways. The DON stated that RNWS J and LVN F should have provided wound care on the blank entry dates for missed wound care for Resident #1. During an interview on [DATE] at 6:13 PM, RNSW J stated he had never heard of Resident #1. RNWS J stated if wound care was not done it could have caused infection, or resident to become septic. RNWS J stated he had never not documented work, if you do not document it did not happen. During an interview on [DATE] at 6:32 PM, LVN F stated she had never done wound care on Resident #1. LVN F state skin assessments were completed by treatment nurse, and for new admissions the nurse on unit would complete skin assessments. During an interview on [DATE] at 12:05 CSD stated thru her audits she discovered issues with TX G documentation and reeducated TX G. CSD stated she continued to see missed documentation and TX G was removed from treatment nurse about the [DATE]th. TX G stated if someone were to document late then there should be a progress note that explained the late documentation. CSD stated NA was not appropriate entry into TAR, that documentation needed to reflect what was assessed and observed during treatment. CSD stated skin assessments needed to be completed weekly. CSD stated she could run a report that would identify who documented and the date and time they completed the documentation. During an interview on [DATE] at 4:00 PM CSD stated she had ran a report, Medication Admin Audit Report. CSD stated the report showed that DON and ADON E had completed documentation after surveyors had entered the building. During an interview on [DATE] at 4:30 PM, RN OS stated OS had concerns with facility not showing up for appointments or calling to reschedule. RN OS stated Resident #1 was scheduled for one week follow up o [DATE] after surgery and missed appointment. RN OS stated the facility never called to clarify treatment orders, or to called to reschedule appointment. RN OS stated when she called to reschedule, facility stated visits were missed because another resident had an appointment. RN OS stated Resident #1 did not make it to the office for 3 weeks. The bandage had not been changed in 3 weeks and had to be soaked to remove dressing and Resident #1 received bandage burns to his skin. During an interview on [DATE] at 11:50 AM, the OS stated he had concerns Resident #1 was a no call/no show for his first scheduled post-operation visit on [DATE]. The OS stated the facility never called to reschedule visit or to clarify orders. The OS stated Resident #1 went over 3 weeks without bandage being changed, which led to the bandage had to be soaked to be removed and Resident #1 had bandage burns. The OS stated he was never notified of missed wound treatments. The OS stated Resident #1 missing wound care treatments postponed his foot healing. During an interview on [DATE] at 4:46 PM, MR stated she is responsible for making transportation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 33 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few arrangements. She stated she doesn't make the doctor's appointments and when residents are discharged from hospital with a card, the nurse is responsible to make the appointments. MR stated she did not have documentation to why Resident #1 missed appointment on [DATE]. MR stated there were days when the transportation van was not working in order to take residents to appointments; however, it was functioning and working properly on [DATE]. This was determined to be an Immediate Jeopardy (IJ) on [DATE] at 5:15pm. The Administration was informed of the IJ. The Administrator was provided with the IJ template on [DATE] at 5:15pm. Record review of Plan of Removal accepted on [DATE] at 2:35 PM reflected the following: What corrective actions have been implemented for the identified residents? A. Resident # 1 was unable to be assessed (expired 7/23). B. Transportation Log, Hospital Discharge Paperwork and Nurses notes will be reviewed during clinical morning meeting - appointments will be placed in log for Medical Records and Appointments will be reviewed with Administrator/Designee to ensure transportation for residents is provided. C. Transportation barriers will be communicated to Administrator/Designee to ensure appointments are followed. In event of transportation barrier facility will utilize outside resources (ie local transportation company, rental companies) to provide transportation for residents. D. Clinical Staff will notify Medical Records (via appointment sheets) of resident's MD appointments of cancelations or requests for rescheduling of appointment by family members. Medical Records will coordinate with MD office for appointment changes, cancelations or rescheduling of appointments. Clinical Staff will confirm with MD if current orders will remain in place or change any orders until next appointment. Clinical Staff will document changes in appointments in EHR. E. Medical Records / Designee with call family members and resident MD office to verify appointments, place on transportation log, upon return from MD appointment new appointment sheet will be made to reflect next appointment if necessary. How were other residents at risk to be affected by this deficient practice identified? All residents residing in the facility have the potential to be affected by this proposed deficient practice. What does the facility need to change immediately to keep residents safe and ensure it does not happen again? A. On [DATE] Administrator in-serviced the DON, Medical Records and ADONs on reviewing hospital discharge records and nursing documentation in clinical records for any MD appointments, place appointments on appointment sheet for medical records to coordinate transportation. DON and ADONs verbalized teach back of education provided to them. B. An in-service was initiated on [DATE] by Medical Records with clinical staff on appointment sheets for hospital discharge appointments, and MD appointment follow ups. Licensed staff verbalized teach back of education provided to them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 34 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few C. Newly hired nurses and contract staff will be in-serviced by the Director of Nursing or ADON on appointment sheets for hospital discharge appointments, and MD appointment follow ups. Licensed staff will verbalized teach back of education provided to them. How will the system be monitored to ensure compliance? A. Medical Records / Designee will review during morning clinical meeting any clinical notes, hospital discharge records for MD appointments, will place on Transportation log, verify appointments. B. Medical Records / Designee will communicate with family prior to appointments, if family is unable to attend Medical Records will communicate with MD office on reschedule, will notify Charge Nurse and document in nurses note reason for change of MD appointment. C. Medical Records and Administrator will communicate regarding any appointment conflicts or families who are unable to attend appointments to ensure staff able to attend if needed. Quality Assurance Administrator / Designee will conduct 3 random transportation calendar audits a week for 2 months. Findings of audits and system management will be reported to the QAPI committee during the monthly meetings for the next 2 months, identifying system compliance or need for further education and clinical oversight. Administrator / Medical Records / IDT will conduct on [DATE] Ad Hoc QAPI meeting to review issue and response plan as indicated. An impromptu Quality Assurance and Performance Improvement review of the plan of removal will be completed on [DATE] with the Medical Director. The Medical Director has reviewed and agrees with this plan. Surveyors monitored the facility's Plan of Removal and confirmed it was sufficient to remove the IJ through observations, interviews, and record reviews from [DATE] at 8:00 am to [DATE] at 2:35pm as follows: During an interview on [DATE] at 11:08AM with TX D, she said neglect was not performing a doctor order, not documenting a doctor order, and not changing a resident's wound care dressings. She said the nurse aides were to notify the nurse about any new skin issue and at that time the nurse was supposed to go and do a skin assessment on the resident and notify the resident's physician and family. TX D said that would be the time to get an order from the physician and document the work in the resident's record. She said orders needed to be instant and should never take longer than an hour much less days from the physician and they needed to be implemented immediately as well. She said the treatment nurse was responsible for completed weekly skin assessments and they should reflect the actual picture of resident and their skin. TX D said progress notes and the TAR were supposed to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 35 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few completed daily with an assessment of the wounds on the TAR and that NA was not an appropriate answer for the assessment of the wound, as it was not an accurate finding. During an interview on [DATE] at 11:25AM with CNA N, she said neglect from an aide would be to not report a skin issue to a nurse and not turning or repositioning a resident so not to put pressure on their wounds or causing pressure sores. CNA N said that the aides did not have an area to document issues, only that they were supposed to report abnormal things to their nurses. is report Nurse first, Skin issue get nurse to look at the skin issue, does not have a place to document. During an interview on [DATE] at 11:33AM with CNA P, she said that neglect from the aides would be not turning and repositioning a resident at least every 2 hours or not telling the nurse about a new skin problem when it was first seen. She said that the residents ran the risk of developing sores or their sores getting worse if the aides didn't frequently reposition the residents. During an observation and interview on [DATE] at 3:30PM with CNA R and Resident #8. Residnet #8 had a pillow behind her right shoulder, and she was inclined approx 45 degrees in the bed wearing oxygen. Resident #8 said the pillow was uncomfortable. While talking with Resident #8, CNA R came into her room, and told her that she wanted to be repositioned. CNA R said she would get help. While waiting for help to arrive, CNA R said the nurse aides were supposed to notify the charge nurses for any change in residents. For residents that had incontinence, the facility had barrier cream they could use for each change, but if they noticed reddened or open sores they were to call the charge nurse immediately. The residents were supposed to be repositioned at least every 2 hours. Resident #8 had an additional mattress overlay on her bed. CNA R said Resident #8 was on hospice, and they must have brought that overlay that morning. Resident #8 said the overlay was fine and she liked it, just didn't like the pillow at her shoulder. CNA R reminded Resident #8 that she had a sore on her lower back and bottom that they needed to try and take some pressure off to help it heal. During an interview on [DATE] at 12:06PM with ADON M, she said she had not been the RN that has been monitoring the skin of the residents of the facility. She said she became the ADON as of [DATE] and started at facility at the very end of May as an RN. she said CSD went over information regarding treatments, skin assessments, documenting in a timely manner, notifying the Dr of changes or if a resident had a refusal of treatment, and scheduling appointments. She said, if you did treatment and didn't sign the MAR, make a late entry to show that it was completed and forgot the documentation but do not go back and fill in the hole after the shift. She said the nurses were supposed to place any and all information on the 24-hour report sheets to help with continuity of care. ADON M said the treatment nurse was supposed to do the treatments and skin assessments, but if not, then the nurse for each resident should do them. She said at least 1 nurse key set has the treatment cart key to access supplies. ADON M said when she did treatments she would date and initial the bandage on the resident so anyone else could see when it was done last. She said, Personally, as a nurse if I see that it wasn't done, or the dates are old I would do a treatment myself. She said with the EHR you can go and change the date in the computer and lookback at the MAR and TAR to see the holes and back date for an assessment. She said, she would not see that as a competent nurse that it would be as a standard of nurse practice to, sign for another person or write something that you had not done yourself. She said she wouldn't want someone to fill in her own work. ADON M said she didn't think that could be a 28-day gap of knowing what I had done at work. I work 2 jobs, so it would definitely be hard to think back more than a couple of days what I had done. She said she would talk to the person that worked previously and ask them then to make a late entry if she seen that documentation had been missed. ADON M said she felt like the window of time that the information was not in the resident's records did not make them an accurate record for the resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 36 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview on [DATE] at 12:49PM with ADON E, he said he had been an LVN for 20 years and he had been working at the facility since May of 2023. ADON E said he started training as a floor nurse first with the expectation as he was going to be the ADON. He said as he was an LVN, he was not managing or monitoring wounds in the facility. He said TX G was managing wounds then TX D was and starting [DATE] it would be ADON C, all of those which were LVN's, so there were no RNs overall who were managing the wounds. ADON E said it had been himself and ADON C that had performed the skin sweep on [DATE] using a resident roster and the full body sheets to mark any skin issue a resident had. He said they did not do an assessment on the residents named in the allegations, as that was the responsibility of DON. He said after they completed the skin sweep, they took their paperwork to DON, but did not do new individual skin assessments in any of the resident's EHR's. ADON E said, So, I learned my lesson, will leave it red and put in a progress note, regarding filling in holes in the MAR and TAR. He said he would do treatment, or an assessment and just didn't get the documentation done, stating, days have just run together. He said, No it is not a standard of practice to go back in and back date or fill in holes in the MAR, TAR or assessments. It's the wrong thing to do. He said you do not chart the next date or later that something was done in a timely manner and never chart for someone else's work or lack of work. I wouldn't know how to defend that in court. He said he would not feel comfortable if someone else did his charting because you never know if you have an enemy. ADON E said he did inservice staff on wounds, charting, just make a note if it was wrong or late, aide to notify the nurse and the nurse needed to notify the doctor that there was a new skin issue. He said they had the 24-hour clip board for the writing of issues. ADON E said Have your shift to document your work. He said the nurses should make a note that the something was not done. He said for any changes, or refusals, the nurses should notify the dr sometime in the shift. During an interview on [DATE] at 1:28PM with MR, she said now they had 2 binders for appointments so each nurses station had 1. She said she was to look at the binders each day and transfer them to the appointment logs. MR said she was in-serviced on the doctor's notes to follow up about an appointment. She said ADM was her manager and if an appointment needed to be rescheduled, then she was to tell ADM and give an explanation. MR said she would be part of the clinical meetings each morning so she could also find out about resident issues and possible appointments, then further check on the binders. She said the facility had their own van and could use local van services or a taxi if needed to get residents to the doctor. MR said, if a family wanted to be with the resident, they did their best to accommodate. She said she a new change would be that they had to follow-up within the day with the family and the doctor's office to confirm appointments and rescheduling of appointments. She said the nurse looked through the admission paperwork for needed appts, and she would as well. During an interview on [DATE] at 1:45PM with ADON C she said, she had been an LVN for 16 yrs and had been working at the facility for 2 yrs. and 2 months. She said yesterday ([DATE]) she became the treatment nurse and before that she was an ADON. The weekend supervisor was the treatment nurse for the weekends. She said new admissions had to have a skin assessment and if they had any types of wounds they needed to have something as far as treatment orders in place within 24 hrs even on weekends. ADON C said every resident had a weekly skin assessment and they were able to run a report for the list of residents with skin assessments to see if they were done. She said, If you didn't document, it wasn't done. Regarding skin assessments and holes in MAR and TAR. She said she wouldn't feel comfortable to have another nurse document for her or doing so for another nurse. She said, That would be false documentation. ADON C said, There is no way I can even remember what I ate for supper last night. There is no way I would remember what I did last week or even further than that, regarding documentation that was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 37 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few days and weeks later. She said CSD was monitoring and managing the skin assessment reports and TAR's to make sure the nurses were getting their work done. She said herself and ADON E did the skin sweep on [DATE] and took skin sweep sheets to DON that had her notes on them. She said they used a skin sheet with the body, if there was nothing on the residents skin, they just put an x or line over body, if there was an area then they circled it with quick description, like redness or sore. ADON C said they didn't do any measurements, just noted any issue. She said CSD in-serviced them to document as you go and at latest the end of the shift, if its after the shift then have to write a progress note indicating it's a late entry and the reason documentation might have been missed or if it wasn't completed. Do not back date or fill in holes. Do not strike out an inaccurate assessment, just do a progress not to indicate the inaccuracy. ADON C said not doing a treatment or a skin assessment was a neglectful action. She said that was how skin issues were identified past a redness or stage 1 and why some wounds got worse. The intact then open sore or intact then DTI within days proved to be inaccurate representation of the resident's skin. She said the admission nurse had to look at new resident's paperwork to see if a resident either had an appointment or needed a follow up appointment and it was the admission nurse's responsibility to call and make the appointment and to put the information in the appointment book at the nurses station. ADON C said she worked with other orthopedic doctors in the past that at times would have orders not to touch the surgical dressing until follow-up appointments and it would sometimes be 2 weeks before a resident could be seen. She said that after the incident with Resident #1, they would now have to make follow-up calls for clarification of the treatment orders with those situations as well as follow up calls to the dr if the dressings were becoming dirty or heavy drainage through the dressing. ADON C said the biggest fix that she could do herself was to step down as an ADON and go back to being the treatment nurse herself. It had been several months since it was her responsibility so she would have to take some time to familiarize herself with wounds again. During an interview on [DATE] at 3:00PM with LVN B, she said she had been an LVN since 2005 and had been working at the facility since December of 2022. She said she had been in serviced regarding wound care in that the nurses needed to complete documentation on wounds either through the skin assessment sheets or the TAR when they were due and to make sure to notify doctor if something was new or a treatment was not completed due to a refusal. She said the nurse that admitted the resident had a skin assessment as a part of the admission paperwork. LVN B said the assessment would include what the skin looked like and if there were any wounds then should describe what the wound looked like, the approximate the size and the location of the wound. She said if there were wounds already present on the resident, they were to review the resident's paperwork for treatment orders and if there were not any orders then the nurses were supposed to notify the doctor to get treatment orders. In the case of resident doctors appointments, most especially if a resident had wounds, LVN B said the nurses reviewed the resident's paperwork for an already scheduled follow-up appointment or if an appointment needed to be scheduled for a resident. She said the nurses were responsible for calling the doctors office to confirm or set up an appointment and to clarify if a treatment was supposed to stay in place, or due to the extended period that it would be before the resident would be seen by the doctor, if the doctor would like to make an order for wound care treatments until the resident could be seen by the doctor. LVN B said each nurses station had an appointment book that the nurses were supposed to either place the appointment card in or write down the resident's name, date of appointment, which doctor and their address in the book. During an interview on [DATE] at 3:20PM with DON, she said she had been a nurse since 2008. She said she had been the DON since [DATE]th of 23. DON said there had been a big learning curve on the change of EHR system (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 38 of 67 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 08/07/2023 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete from what she had been used to in other facilities in the past. She said she is just very overwhelmed. DON said her orientation was really just a welcoming to the company not a EHR orientation. She said she did not really know how to pull reports to see what the nurses were completing or not. The CSD had been at the facility 3 times since DON came to facility. DON said the CSD has been available by phone has only recently showed her how to run reports. She said the CSD brought it to her attention that skin assessments had not been completed several times for several residents. DON said nursing management started with audits and was having daily all-day meetings checking on the nurses work, and TX G (former tx nurse) didn't want to participate, was not doing her work, would not communicate with DON that she could not get her work done. DON said the CSD said that there was a lot of issues with no documentation regarding treatments and said there was an issue back in March and April of 23 with TX G not getting her work done or her documentation done. She did not know the full description of which nurses did skin assessments for which residents but thought that the floor nurses split odd rooms day shift and even rooms night shift maybe. She said the treatment nurse should be the person that did residents skin assessments that had wounds. DON said she just got hyper focused on catching up the skin assessments and was just so overwhelmed that I was on auto pilot trying to get the documentation caught up. DON said, knows that you should not fill in holes in the MAR and TAR. Said she had never just maliciously done something like that before. She said, I know I have made mistakes, if someone will just tell me it is a mistake, I can fix it, but if you don't tell me whats wrong, I can't fix it. She said the last few days CSD had been going through the system showing her how to run different reports. She said she did a skin sweep when she first came to the facility with the other ADON's s and TX, and over the last week the ADON's s and TX had been doing them almost daily. She said Thursday ([DATE]) she went to the residents that had wounds and had the wound care doctor's notes from that morning and just made sure that there were no [TRUNCATED] Event ID: Facility ID: 676376 If continuation sheet Page 39 of 67 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 08/07/2023 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that a resident received care, consistent with professional standards of practice, to prevent pressure ulcers that were avoidable and failed to ensure a resident with pressure ulcers received necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing for 6 of 8 residents (Resident #4, Resident #1, Resident #2, Resident #6, Resident #7, Resident #8) reviewed for skin integrity. Residents Affected - Some 1. The facility failed to follow physician's orders to prevent Resident #4's Deep Tissue Injury to right medial heel to deteriorate to a stage 4 pressure ulcer. 2. The facility failed to follow physician's orders to prevent Resident #1's Right Ischium(hip) pressure ulcer to deteriorate from a stage 2 to a stage 3. 3. The facility failed to obtain physician orders for treatment of Resident #2's stage 4 pressure ulcer on right posterior calf. Resident #2 went 12 days without treatment to wound. 4. The facility failed to obtain physician orders for treatment of Resident #6's left heel Deep Tissue Injury. Resident #6 went 5 days without treatment to wound. 5. The facility failed to complete skin assessments of Resident #7 which led to the development of a stage 2 pressure ulcer to the right upper buttocks and stage 2 to the right lower buttocks. 6. The facility failed to complete weekly skin assessments which led to Resident #8 developing stage 2 pressure ulcer to left buttock and stage 2 pressure ulcer to right buttock. 7. The facility failed to ensure Resident #2 and Resident #4's skin assessments were completed, assessed accurately and accurately documented by the DON. 8. The facility failed to ensure Resident #1, Resident #4 and Resident #5's wound treatments were completed and accurately documented by DON and ADON E. 9. The facility failed to maintain accurate list of residents with pressure ulcers. The facility did a skin sweep and found Resident #7's and Resident #8's wounds after surveyor intervention requesting accurate lists of residents with pressure ulcers. An Immediate Jeopardy (IJ) was identified on 08/03/23. While the IJ was lowered on 08/07/23, the facility remained out of compliance at a severity level of actual harm with a scope of pattern due to the facility's need to evaluate the effectiveness of their corrective actions. These failures could place residents at risk of wound deterioration, wound development, and infection. Findings include: 1.Resident #4 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 40 of 67 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 08/07/2023 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Record Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section HBowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer. Record review of Resident #4's care plan dated 05/15/2023 revealed: Focus: The resident has the potential for pressure ulcer development r/t impaired mobility, incontinence, obesity. Date Initiated: 08/23/2022. Revision on: 08/23/2022. Interventions: Notify nurse immediately of any signs of skin breakdown: redness, blisters, bruises, and discoloration noted during bath or daily care. Date Initiated: 08/23/2022. Provide assist with turning and repositioning during rounds. Date Initiated: 08/23/2022; Focus: The resident has (DTI) pressure injury to Rt medial heel r/t Reduced Mobility. Date Initiated: 03/29/2023. Revision on: 03/29/2023. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 03/29/2023. Administer treatments as ordered and monitor for effectiveness. Date Initiated: 03/29/2023. Assess/record/and monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 03/29/2023. Revision on: 06/05/2023. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulation/mobility, good nutrition, and frequent repositioning. Date Initiated: 03/29/2023. Record review of Resident #4's physician order revealed start date 03/14/2023 Location of wound: Plantar right heel with order to be performed topically one time a day for Apply betadine to plantar right heel unstageable ulcer daily apply betadine until healed. Offloading @ all times. F/U with wound care and end date 04/13/2023. Record Review of Resident #4's TAR dated 04/01/2023 - 04/30/2023 revealed no evidence of treatment being completed on: 04/08/2023 and 04/09/2023. Record review of Resident #4's physician order revealed the order start date 04/13/2023 Location of wound: Right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Leptospermum honey in to wound bed cover with border dressing. and end date 05/04/2023. Record Review of Resident #4's TAR dated on 04/01/2023 - 04/30/2023 revealed no evidence of treatment for order with being completed on: 04/14/2023, 04/15/2023 and 04/23/2023. Record review of Resident #4's physician order revealed the following order start date 05/04/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound area. Apply Collagen powder and Calcium alginate with silver cover with border dressing. and end date 06/27/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 41 of 67 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 08/07/2023 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record Review of Resident #4's TAR dated on 05/01/2023 - 05/31/2023 revealed no evidence of treatment for order with being completed on: 05/08/2023, 05/15/2023, 05/16/2023, 05/22/2023, 05/29/2023, 05/30/2023 and 05/31/2023. Record Review of Resident #4's TAR dated on 06/01/2023 - 06/30/2023 revealed no evidence of treatment for order with being completed on: 06/02/2023, 06/03/2023, 06/04/2023, 06/12/2023, 06/19/2023, 06/20/2023, 06/21/2023 and 06/24/2023. Record review of Resident #4's physician order revealed the following order start date 06/27/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen powder and sodium hypochlorite get (anapest) cover with border dressing. And end date 06/29/2023. Record Review of Resident #4's TAR dated on 06/01/2023 - 06/30/2023 revealed no evidence of treatment for order with being completed on: 06/28/2023. Record review of Resident #4's physician order revealed the following order start date on 06/29/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift every Tue, Thu, Sat Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date 07/10/2023. Record Review of Resident #4's TAR dated on 07/01/2023 - 07/31/2023 revealed no evidence of treatment for order with being completed on: 07/01/2023. Record review of Resident #4's physician order dated 07/29/2023 revealed the following order start date on 07/10/2023 Location of wound: Stage 4 right posterior medial heel to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around peri wound. Apply Collagen power cover with border dressing. and end date 07/20/2023. Record Review of Resident #4's TAR dated on 07/01/2023 - 07/31/2023 revealed no evidence of treatment for order with being completed on: 07/14/2023, 07/15/2023, and 07/23/2023. Record review of Resident #4's Medication Administration Audit Report generated by CSD revealed: -Scheduled for 07/14/2023 at 06:00AM and charted as completed on 07/29/2023 8:58PM by DON. -Scheduled for 07/15/2023 at 06:00AM was charted as completed on 07/29/2023 9:06PM by DON. -Scheduled for 07/23/23 at 6:00AM was charted as completed on 7/29/23 at 9:53PM by DON. Record review of Resident #4's nurse's skin assessment dated [DATE] revealed DTI (deep tissue injury) to right medial heel. Record review of Resident #4's nurse's skin assessment dated [DATE] completed by DON revealed Skin Intact. Record review of Resident #4's WCS physician note dated 05/18/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.8cm in length by 2.4cm in width by 0.3cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 42 of 67 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 08/07/2023 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 0686 establish the margins of viable tissue. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #4's WCS physician note dated 05/25/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.8cm in length by 2.4cm in width by 0.3cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. Treatment options - risks - benefits and the possible need for subsequent additional procedures on this wound were explained on 04/13/2023 to the patient. Residents Affected - Some Record review of Resident #4's WCS physician note titled dated 07/27/2023 revealed stage 4 pressure wound of the right, posterior, medial heel full thickness measuring 1.4cm in length by 2.2cm in width by 0.2cm in depth. Surgical excisional debridement procedure indicated to remove necrotic tissue and establish the margins of viable tissue. During an observation and interview on 08/01/2023 at 4:30PM Resident #4 was sitting up in wheelchair with offloading boot to right foot and elevated with extended wheelchair footrest. Resident #4 stated she gave permission to observe foot and take a photograph of wound. Resident #4's right foot pressure ulcer had thick green tinged skin surrounding a circular wound with beefy red granulation tissue observed to wound bed. Observation of small amount of drainage observed to bandage and no odor. Resident #4 stated she had no concerns with her wound. 2. Resident # 1 Record review of Resident # 1's closed record face sheet dated 07/29/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent hospital readmission date of 06/03/2023, with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease. Record review of Resident # 1's closed record admission MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 10 (moderate cognitive impairment); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. Record review of Resident #1's closed record care plan dated 05/15/2022 (revised on 06/04/2023) revealed: Focus: The resident is at risk for pressure injury r/t History of Pressure Injuries, Poor nutrition, Reduced Mobility, Sheering/friction problems. Date Initiated: 08/20/2020 Revision on: 02/21/2022; Perform and document weekly assessment form of skin for changes or observations. Date Initiated: 08/20/2020 Protect elbows and heels from friction. Date Initiated: 08/20/2020 Protect heels-offload when in bed. Administer medication as ordered. Date Initiated 11/29/2022. Follow facility policy and procedures for line listing, summarizing infections. Focus The resident has a stage 1 pressure injury to his R buttocks r/t Reduced Mobility, Incontinence, Sheering/Friction. Date Initiated: 08/18/2022 Revision on: 10/24/2022. Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 08/18/2022. Administer treatments as ordered and monitor for effectiveness. Date Initiated 08/18/2022 Assess/record/monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed, and healing progress. Report improvements and declines to the MD. Date Initiated: 08/18/2022. Revision on: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 43 of 67 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 08/07/2023 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 0686 Level of Harm - Immediate jeopardy to resident health or safety 08/23/2022. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition, and frequent repositioning. Date Initiated: 08/18/2022. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated 08/18/2022. Provide low air loss mattress to bed. Date Initiated: 08/18/2022. Provide pressure relieving cushion to wheelchair. Monitor for placement and condition. Notify supervisor if cushion needs to be replaced. Date Initiated: 08/18/2022. Residents Affected - Some Record review of Resident #1's closed record admission Summary Progress Note dated 06/03/2023 revealed stage 2 pressure wound on coccyx. Record review of Resident #1's closed record progress note titled Skin/Wound Note dated 06/15/2023 revealed WCS here this am to see resident. Stage 3 on rt ischium measures3x4.5x0.3. Light serous drainage with45% slough 5% granulation, 50% skin. Deterioration noted. [NAME] tinge to drainage concerning for Pseudomonas. No signs of infection. WCS preformed surgical excisional debridement to remove necrotic tissue and establish the margins of viable tissue. Record review of Resident #1's closed record nurses progress note dated 06/21/2023 revealed Resident return from OS per physician progress notes: 1) Please do NOT change the patients dressing 2) RTC on June 25 @ 1130AM. Transportation notified of f/u appt. and Info updated on 24 hour report. Record review of Resident #1's nurses progress note dated 06/30/2023 revealed Resident return from OS office per physician progress notes Please change Resident #1's foot wound dressing daily. No further need for ACE wrap. Please see that patient gets his augmentin as ordered. Call placed to OS office for clarification on orders what does provider want for dressing orders and orders for augmentin. Per [NAME] nurse at OS office to cleanse wound then swab with betadine cover with 4x4 and secure. Augmentin 875mg q12 hours x10days. Orders updated in chart and placed on24 hr{hour} report. Record review of Resident #1's closed record nurses progress note dated 07/07/2023 revealed Resident return from OS appointment per physician's progress notes: Continue daily dressing changes with betadine to wound base . Return in 1 week appt of 7/14/23 @ 1045am Transportation notified. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 4 pressure ulcer to R Ischium with wound care and left leg dressing intact. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 3 pressure ulcer to R Ischium measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth and left leg dressing intact. Record review of Resident #1's closed record nurse's skin assessment dated [DATE] revealed stage 3 pressure ulcer to R Ischium measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 05/18/2023 revealed diabetic wound of the left, distal, plantar, lateral foot full thickness. Surgical excisional debridement procedure indicated for removal of necrotic tissue and establish the margins of viable tissue. No mention of R Ischium wound. Record review of Resident #1's closed record WCS physician notes dated 06/08/2023 revealed R Ischium wound measuring 2.3cm in length by 4.5cm in width by 0.3cm in depth. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 44 of 67 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 08/07/2023 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #1's closed record WCS physician notes dated 06/15/2023 revealed R Ischium wound measuring 3.0cm in length by 4.5cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/22/2023 revealed R Ischium wound measuring 2.2cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 06/29/2023 revealed R Ischium wound measuring 3.5cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record WCS physician notes dated 07/06/2023 revealed R Ischium wound measuring 4.0cm in length by 5.0cm in width by 0.3cm in depth. Record review of Resident #1's closed record hospital records dated 05/16/2023 revealed Stage 2 coccygeal & gluteal PI-POA. Record review of Resident #1's closed record physician orders revealed start date 06/05/2023 stating Location of wound: right Ischium with order to be performed every day shift Treatment order: Cleanse with NS/wound cleanser. Pat dry Apply Triad cream and cover with silicone dressing with end date 06/09/2023. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of treatment for order being completed on: 06/07/2023, 06/08/2023, 06/09/2023. Record review of Resident #1's closed record physician orders revealed start date 06/09/2023 stating Location of wound: Unstageable right Ischium with order to be performed every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Anasept and TAO to wound bed cover bordered gauze dressing with end date 06/27/2023 written. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of treatment for completed on: 06/09/2023, 06/14/2023, 06/19/2023, 06/20/2023, 06/21/2023, 06/24/2023, 06/25/2023 and 06/26/2023. Record review of Resident #1's closed record physician orders revealed start date 06/27/2023 stating Location of wound: Unstageable right Ischium with order to be performed every day shift: Treatment order: Cleanse with NS/wound cleanser. Pat dry. Apply skin prep to peri wound. Apply Leptospermum honey to wound bed cover border gauze dressing and no end date written. Record Review of Resident #1's closed record TAR dated June 1, 2023 - June 30, 2023, revealed no evidence of being completed on: Record Review of Resident #1's closed record TAR dated June 1, 2023 - July 31, 2023, reviewed on 07/29/2023 at 1:17 pm, revealed no evidence of treatment for order being completed on: 06/27/2023, 06/30/2023, 07/01/2023, 07/03/2023, 07/05/2023, 07/07/2023 and 07/12/2023. Record review of Resident #1's closed Medication Administration Audit Report for July 2023 revealed Instructions were: Location of wound: Unstageable Rt Ischium every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to pen wound. Apply Leptospermum honey to wound bed cover border gauze dressing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 45 of 67 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 08/07/2023 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 0686 Record review of Resident #1's closed Medication Administration Audit Report generated by CSD revealed: Level of Harm - Immediate jeopardy to resident health or safety -Scheduled date of 7/1/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:11PM by ADON E. Residents Affected - Some -Scheduled date of 7/3/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:09PM by ADON E. -Scheduled date of 7/12/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:27PM by ADON E. During an interview on 07/29/2023 at 12: 59 PM Resident # 1's family member stated he/she had concerns about Resident 1's care while at the facility. Resident #1's family member stated he/she felt Resident #1 was neglected by the facility which led to his death. Resident #1's family member stated his room always smelled like urine and that Resident #1's dressing on his wounds were never changed timely. 3. Resident #2 Review of Resident #2's face sheet dated 08/03/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 10/05/2022, with the following diagnosis unspecified dementia (primary), need for assistance with personal care, flaccid hemiplegia affecting right dominant side. Review of Resident #2's annual MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 8 (moderate); Section G- Functional Status revealed Resident #2 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bowel and Bladder revealed always incontinent for bowel; Section M-Skin Conditions revealed Resident #2 was at risk of developing pressure ulcers/injuries. Review of Resident #2's care plan dated 07/04/2022 revealed: Focus: The resident is at risk for pressure ulcer development r/t disease process and immobility. Date Initiated: 06/26/2018 Revision on: 04/15/2021; Interventions: administer medications as ordered. Monitor/document for side effects and effectiveness. Date initiated 06/26/2018. Administer treatments as ordered and monitor for effectiveness. Date initiated 06/26/2018. Follow facility policies/protocols for the prevention/treatment of skin breakdown. Initiate initiated: 06/26/2018. Inform the resident/family/caregivers of any new area of skin breakdown. Date initiated: 06/26/2018. Monitor/document/report PRN any changes in skin status: appearance, color, wound healing, S/SX of infection, wound size (length X width X depth), stage. Date Initiated: 06/26/2018. Obtain and monitor lab/diagnostic work as ordered. Report results to MD and follow up as indicated. Weekly skin assessments. Date initiated: 06/26/2018. Revision on: 03/03/2023; Focus: patient has a stage 4 pressure injury to right posterior calf with potential for further skin breakdown R/T: disease process, immobility, impaired mobility, lack of sensation, non-compliance with therapeutic regimen. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 07/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 07/29/2023. Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 07/29/1013. Review of Resident #2's nurses notes dated 07/15/2023 at 11:00 PM written by LVN T revealed: Aide (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 46 of 67 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 08/07/2023 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some has brought to my attention that [Resident #2] has open area on back of right ankle area. When this nurse assessed, I found wound that is denuded, partial thickness and has black eschar in wound bed. I cleansed wound with wound cleanser, applied hydrophilic ointment and covered with bordered gauze. Entire leg and foot have severe outward rotation. It is stroke effected side. Heel is elevated off bed and wound area is hanging free with no pressure. Review of Resident #2's nurses note dated 07/17/2023 at 1:37 PM written by LVN A revealed: Resident noted to have a DTI per night nurse to his right lower calf area cleaned Review of Resident #2's physician orders revealed no evidence of pressure ulcer treatment between 07/15/2023 and 07/27/2023. Review of Resident #2's physician orders revealed: Order date 07/27/2023 at 2:15 PM Cleanse right lower posterior calf with dermal wound cleaner apply Triad Debriding Cream to wound bed and cover with boarder dressing. Every day shift every Mon, Wed, Fri for promote Wound healing and every 1 hour as needed for skin irritation. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by DON revealed Skin Intact. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by TX D revealed Right lower leg stage 3 pressure ulcer measuring 2.5cm in length by 2.7cm in width by 0.5cm in depth. Record review of Resident #2's nurse's skin assessment dated [DATE] completed by TX D revealed right lower leg unstageable pressure ulcer measuring 2.5cm in length by 2.0cm in width by 0.5cm in depth. During an observation on 07/29/2023 at 4:10PM of Resident #2 revealed Resident #2 lying in bed with right leg on pillow. Resident #2's right lower leg was covered by gauze and secured with tape. The dressing did not have a date on the outside. During an observation on 7/30/2023 at 3:30 PM of Resident #2 revealed Resident #2's lower right leg had a wound that had red tissue present, surrounding skin within normal limits for race, no tendon or bone observed, no necrosis observed, measurements were not taken appeared to be a Stage 3. During an interview on 07/30/2023 at 5:35 PM, the DON stated she had completed skin assessment on 7/20/2023 for Resident #2. The DON stated that she should have looked at the nurses notes to verify that Resident #2 did have a pressure ulcer. The DON stated the system was new to her, and she must have gotten confused between patients. The DON stated she had not completed a thorough assessment and that her assessment did not give an accurate assessment of Resident # 2, because if nurses note on 07/13 and 7/15 stated he had a pressure ulcer then her assessment on 7/20 should have reflected that. The DON stated the negative affect on residents, if wound care treatments were not completed, could have caused skin breakdown, and could have caused the wounds to worsen in various ways. 4. Resident # 6 Review of Resident #6's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 08/31/2018, with the following diagnosis Type 2 diabetes (primary), age-related physical debility, cognitive communication deficit, and unspecified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 47 of 67 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 08/07/2023 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 0686 dementia. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #6's significant change in status MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 99 (Unable to complete interview); Section G- Functional Status revealed patient had extensive dependence with most activities (1 physical assist); Section F- Bowel and Bladder revealed always incontinent to bowel and bladder. Section M-Skin Conditions revealed Resident #6 had a risk of developing pressure ulcers/injuries. Residents Affected - Some Review of Resident #6's care plan dated 5/15/2023 revealed no intervention related to Deep Tissue Injury prevention or care. Review of Resident #6's Weekly Skin Integrity Review dated 07/25/2023 completed TX D revealed; Suspected Deep Tissue Injury to left heel measuring 4cm in length by 3cm in width. Review of Resident #6's physician orders dated 07/29/2023 revealed no evidence of wound treatment order for Deep Tissue Injury between 07/25/2023 and 07/29/2023. Review of Resident #6's physician orders dated 07/30/2023 revealed Skin prep to left heel every day and prn every day shift for wound care related to weakness. During an observation and interview on 08/01/2023 at 4:25 PM revealed Resident #6 laying on her back not wearing her offloading boot, the boot was to the left side of her foot. Resident #6's wound was located on left heel, the wound was circular and purple in color, there was no drainage and skin appeared firm. ADON C voiced that facility treatment nurse applying skin prep daily. ADON C placed offloading boot to left foot that was lying to the left of her left leg when surveyor entered room. During an interview on 08/01/2023 at 4:25 PM ADON C stated Resident #6 should have been wearing the offloading boot while in laying bed. ADON C stated that Resident #6's wound was not healed and needed further treatment. 5. Resident #7 Review of Resident #7's face sheet dated 08/02/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 07/27/2023, with the following diagnosis cerebral infarction (primary), muscle weakness, need for assistance with personal care, and Type 2 diabetes. Review of Resident #7's quarterly MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed limited to extensive assist needing 1 - 2+ persons for assistance; Section- H Bowel and Bladder revealed occasionally incontinent to bladder and frequently incontinent to bowel. Section M- Skin Conditions revealed resident is at risk for developing pressure ulcers/injuries. Review of Resident #7's care plan dated 05/31/2023 revealed: Focus: The resident has pressure injury to Rt buttock stage 3 with potential for further skin breakdown r/t: chronic progressive disease, impaired mobility, obesity. Date Initiated: 03/02/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 03/02/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 03/02/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 03/02/2023. Document wound appearance, color, wound healing, s/sx of infection, wound size (length X width X depth) and stage, and report to MD (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 48 of 67 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 08/07/2023 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 0686 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some PRN any changes in skin status. Date Initiated: 03/02/2023. Notify Nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 03/02/2023. Provide pressure relieving device in bed. Date Initiated: 03/02/2023. Refer to dietician and follow recommendation. Date Initiated: 03/02/2023. Serve diet as ordered. Date Initiated: 03/02/2023. Review of Resident #7's Weekly Skin Integrity Review dated 07/28/2023 completed by TX D revealed redness to right buttock. Review of Resident #7's Skin Note dated 07/31/2023 completed by TX D revealed Wounds to bilateral gluteal ischium tuberosities are healed, discontinue wound care to these areas, will continue to monitor. Review of Resident #7's Weekly Skin Integrity Review dated 08/02/2023 completed by TX D revealed new stage 2 right upper gluteal fold pressure ulcer measured 2cm in length by 2cm in width and 0.1cm in depth and stage 2 right lower gluteal fold pressure ulcer measured 1cm in length by 0.3cm in width and 0.1cm in depth. During an interview on 08/02/2023 at 9:40 AM, Resident #7 stated he wished the facility was more proactive and would have prescribed antibiotics for his possible wound infection. 6. Resident #8 Review of Resident # 8's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 07/15/2021, with the following diagnosis Chronic Obstructive Pulmonary Disease (primary), type 2 diabetes mellitus, mild cognitive impairment, muscle weakness, and need for assistance with personal care. Review of Resident # 8's quarterly MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 11 (moderately impaired); Section G- Functional Status revealed patient had extensive dependence with most activities (1-to-2-person assistance with physical assist); Section H- Bowel and Bladder revealed Resident #8 Frequently incontinent to bowel and bladder M-Skin Conditions revealed Resident #8 had a risk of developing pressure ulcers/injuries. Review of Resident #8's care plan on 08/02/2023 revealed: Focus: The resident has the potential for pressure ulcer development r/t disease process, [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 49 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that licensed nurses have the specific competencies and skill sets necessary to care for residents' needs, as identified through resident assessments, and described in the plan of care for 1 of 1 DONs for 5 of 8, (Resident #1, #2, #4, #5, #7) residents reviewed for competent nursing. DON failed to complete accurate skin assessments on Resident #1,2,4,5. DON failed to complete accurate documentation in Resident #1,4,5 TAR. DON failed to complete documentation that included information that she gathered from another source for Resident #2, 4, 5, 7. These failures placed residents at risk of meeting their health care needs appropriately. Findings included: During an interview with Resident #1 Review of Resident # 1's face sheet dated 07/29/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent hospital readmission date of 06/03/2023, with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease. Review of Resident # 1's admission MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 10 (moderate cognitive decline); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. Resident #1 had a DTI and 1 surgical wound. Review of Resident #1's care plan dated 05/15/2022 revealed: Focus: The resident is at risk for pressure injury r/t History of Pressure Injuries, Poor nutrition, Reduced Mobility, Sheering/friction problems. Date Initiated: 08/20/2020 Revision on: 02/21/2022; Goal: The resident will have intact skin, free of pressure injury through review date. Date Initiated: 08/20/2020 Revision on: 08/23/2022 Target Date: 05/20/2023; Interventions: Alert dietitian of pressure injury risk to ensure any nutritional deficits are alleviated. Date Initiated: 08/20/2020 Apply lotion after each shower. DO NOT massage over reddened bony prominences. Date Initiated: 08/20/2020 Assess for restorative program to ensure maximal remobilization Date Initiated: 08/20/2020 Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated: 08/20/2020 Offer fluids in conjunction with turning and positioning Date Initiated: 08/20/2020 Perform and document weekly assessment for of skin for changes or observations. Date Initiated: 08/20/2020 Protect elbows and heels from friction. Date Initiated: 08/20/2020 Protect heels-offload when in bed. Date Initiated: 08/20/2020. Turn and reposition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 50 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some frequently. Keep body in good alignment with pillows for positioning and pressure relief. Date Initiated: 08/20/2020. Use briefs to wick and hold moisture away from resident's skin. Date Initiated. Use lift sheet to move/position resident in bed. Date Initiated: 08/20/2020. Use moisture barrier with incontinent care episodes. Date Initiated: 08/20/2020., Focus The resident has a stage 1 pressure injury to his R buttocks r/t Reduced Mobility, Incontinence, Sheering/Friction. Date Initiated: 08/18/2022 Revision on: 10/24/2022. Goal: The resident's will wound will show signs of healing and remain free from infection by/through review date. Date Initiated: 08/18/2022 Revision on: 08/23/2022 Target Date: 05/20/2023. Interventions: The resident requires the bed as flat as possible to reduce shear. Date Initiated 08/18/2022. Revision on: 08/23/2022 Administer treatments as ordered and monitor for effectiveness. Date Initiated 08/18/2022 Assess/record/monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 08/18/2022. Revision on: 08/23/2022. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition and frequent repositioning. Date Initiated: 08/18/2022. Provide low air loss mattress to bed. Date Initiated: 08/18/2022. Provide pressure relieving cushion to wheelchair. Monitor for placement and condition. Notify supervisor if cushion needs to be replaced. Date Initiated: 08/18/2022. Record review of Resident #1's Skin Assessments revealed: 6/11/23 at 23:12 (11:12PM) revealed Continue treatment to stg 4 on dressing in place to lt leg No measurements, and no reference to pressure injuries to buttock. 6/18/23 locked as completed 06/27/23 at 13:29 (1:29PM) revealed dressing to lt foot remains intact .Site: Other Rt ischium (buttock). Type of skin issue: Pressure, 2.2x5x0.3cm Stage III (3). 6/25/23 locked as completed 0627/23 at 13:30 (1:30PM) revealed: Site: Other Rt ischium (buttock). Type of skin issue: Pressure, 2.2x5x0.3cm Stage III (3). No reference to left foot surgical wound. Record review of Resident #1's Admit/Readmit Screener dated 06/03/23 revealed resident had a surgical wound and a pressure injury. It stated that Resident #1 had a stg II (2) pressure injury to his right gluteal fold (buttocks). The screener did not indicate where the surgical wound was located on the resident, nor did it include any measurements, appearances, or treatments for either wound. Record review of Resident #1's admission summary dated [DATE] revealed that resident had L foot 5th toe partial resection d/t gangrene was performed. From hospitalization. No mention of other skin issues. Record review of Resident #1's Medication Administration Audit Report dated 08/01/23 revealed : Location of wound: Unstageable Rt Ischium PAIN CODE INTERVENTION: 0= no intervention I =reposition resident 2= PRN medication 3= scheduled pain medication 4= gentle range of Motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y=Yellow B=Black G=Green W=White T=Tan PU=Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to pen wound. Apply Leptospermum honey to wound bed cover border gauze dressing Scheduled date of 7/1/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:11PM by ADON E. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 51 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Scheduled date of 7/3/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:09PM by ADON E. Scheduled date of 7/12/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:27PM by ADON E. Residents Affected - Some Location of wound: Left foot PAIN CODE INTERVENTION: 0= no Intervention I = reposition resident 2= PRN medication 3 = scheduled pain medication 4= gentle range of motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y YeIIow B=Black G=Green W=White T=Tan PU=Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse with NS or Wound Cleanser and pat dry. Swab with betadine swab. Cover with 4x4and secure with tape. Scheduled date of 07/01/2023 at 6:00 charted as N/A for assessment of wound bed and completed on 07/29/2023 9:11PM by ADON E. Scheduled date of 07/03/2023 at 6:00 charted as N/A for assessment of wound bed and completed on 07/29/2023 9:09PM by ADON E. Scheduled date of 07/12/2023 at 6:00 charted as N/A for assessment of wound bed and completed on 07/29/2023 9:27PM by ADON E. Resident #2 Review of Resident # 2's face sheet dated 08/03/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 10/05/2022, with the following diagnosis unspecified dementia (primary), need for assistance with personal care, flaccid hemiplegia affecting right dominant side. Review of Resident # 2's annual MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 8 (moderate cognitive impairment); Section G- Functional Status revealed Resident #2 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bowel and Bladder revealed always incontinent for bowel; Section M-Skin Conditions revealed Resident #2 was at risk of developing pressure ulcers/injuries. Review of Resident # 2's Care plan dated 07/04/23 revealed, Focus: patient has an stage 4 pressure injury to right posterior calf with potential for further skin breakdown R/T: disease process, immobility, impaired mobility, lack of sensation, non-compliance with therapeutic regimen. Date Initiated: 07/27/2023. Revision on: 08/02/2023. Goal: Pressure ulcer will show signs of healing and remain free from infection by/through review date. Date Initiated: 07/29/2023. Target Date: 09/18/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 07/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 07/29/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 07/29/2023. Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 07/29/1013. Provide low air loss mattress to bed. Date Initiated: 08/02/2023 Revision on: 08/02/2023. Refer to dietitian and follow recommendation. Date Initiated: 07/29/2023. Serve diet as ordered. Date Initiated: 07/29/2023. Supplements per orders. Date Initiated: 08/02/2023. Revision on: 08/02/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 52 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #2's Progress note dated 08/03/23 revealed: DON performed skin assessment of this resident who has stage 4 pressure wound to right posterior, lower extremity, measures 3.2 x 1.8 x 1.0cm with minimal serous drainage noted, peri wound of normal skin color for resident. 70% granulation tissue noted, no slough, and tendon and bone noted. Suprapubic cath site to mid-lower abdomen area, no drainage or leakage to area noted. No sis of infection or further abnormalities noted. Signed DON 8/3/23 at 7:40PM Record review of Resident #2's Wound Care Physician Assessment Note dated 08/03/23 revealed: Focused Wound Exam (Site 1) STAGE 4 PRESSURE WOUND OF THE RIGHT, LATERAL CALF FULL THICKNESS. Etiology (quality), Pressure. Stage. 4. Duration > 1 days Resident #4 Review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section H- Bowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer Resident #4 Review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Review of Resident # 4's annual MDS assessment that has not been submitted dated 07/30/2023 revealed, M-Skin Conditions revealed Resident #2 had a stage 4 pressure ulcer. Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section H- Bowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer. Review of Resident #4's care plan revised 07/29/23 revealed: Focus: The resident has (DTI) pressure injury to Rt medial heel r/t Reduced Mobility. Date Initiated: 03/29/2023. Revision on: 07/29/2023. Goal: the resident's will wound will show signs of healing and remain free from infection by through review date. Date Initiated: 03/29/2023. Revision on: 07/31/2023. Target Date: 08/15/2023. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 03/29/2023. Administer treatments as ordered and monitor for effectiveness. Date Initiated: 03/29/2023. Assess/record/and monitor wound healing weekly. Measure length, width and depth (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 53 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 03/29/2023. Revision on: 06/05/2023. Educate the resident/family/caregivers as to causes of skin breakdown; including: transfer/positioning requirements; importance of taking care during ambulation/mobility, good nutrition and frequent repositioning. Date Initiated: 03/29/2023. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated: 07/20/2023. Review of Resident #4' Medication Administration Audit Report dated 08/01/23 revealed: Location of wound: Stage 4 it posterior medial heel. PAIN CODE INTERVENTION: 0= no Intervention I =reposition resident 2= PRN Medication 3 = scheduled medication 4= gentle range of motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y=Yellow B= Black G=Green W=White T=Tan PU=Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around pen wound. Apply Collagen powder cover with border dressing Scheduled for 07/14/2023 at 06:00AM and charted as completed on 07/29/2023 8:58PM by DON. Scheduled for 07/15/2023 at 06:00AM stated administered on 07/15/2023at 9:04PM charted as documented on 07/29/2023 9:06PM by DON. Scheduled for 07/23/23 at 6:00AM stated administered on 7/23/23 at 9:52PM, charted as documented on 7/29/23 at 9:53PM Review of Resident #4's Progress Note dated 08/03/23 by DON revealed: DON performed skin assessment of this resident who has a stage 4 pressure wound on her right heel with measurements of 1.4 x 2.2 x 0.2 cm. The periwound is reddened, there is moderate drainage noted that is yellow-green in color. There is 70% granulation tissue and 30% slough. WCS, wound physician has seen this resident's wound today also. Wound culture was ordered and specimen was collected and is waiting for lab pick up. Review of Resident #4's Wound Care Specialist assessment dated [DATE] revealed: STAGE 4 PRESSURE WOUND OF THE RIGHT, POSTERIOR, MEDIAL HEEL FULL THICKNESS. Etiology (quality) Pressure. MDS 3.0 Stage 4. Duration >107 days. Wound Size (L x W x D):1.4 x 2.2 x 0.2 cm. Surface Area: 3.08 cm. Exudate: Moderate Serous. Slough: 30 %. Granulation tissue: 70 %. ADDITIONAL WOUND DETAIL [NAME] drainage concerning for Pseudomonas. Resident #5 Review of Resident # 5's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 03/06/2023, with the following diagnosis Unspecified dementia (primary) and muscle weakness. Review of Resident # 5's quarterly MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 99 (Unable to complete interview); Section G- Functional Status revealed patient had total dependence with most activities (1 to 2 persons physical assist); Section H Bowel and Bladder revealed always incontinent to bowel and bladder. M-Skin Conditions revealed Resident #5 had a risk of developing pressure ulcers/injuries and 1 stage 3 pressure ulcer. Review of Resident #5's care plan dated 07/11/2023 revealed: Focus: The resident has an ADL Self (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 54 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Care Performance Deficit r/t decreased mobility. Date Initiated: 07/12/2023. Revision on: 07/12/2023. Goal: Will maintain current level of function in (Bed Mobility, Transfers, Eating, Dressing, Toilet Use and Personal Hygiene; . SKIN INSPECTION: Observe for redness, open areas, scratches, cuts, bruises and report changes to the Nurse. Date Initiated: 07/12/2023 . Focus: The resident has pressure injury to (on rt mid back stage 3)with potential for further skin breakdown r/t: cognitive impairment, disease process, hx of pressure injuries, immobility, incontinence, lack of sensation, nutritional deficit. Date Initiated: 06/29/2023. Revision on: 06/29/2023. Goal: Pressure ulcer will show signs of healing and remain free from infection by/through review date. Date Initiated: 06/29/2023. Target Date: 07/11/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 06/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 06/29/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 06/29/2023. Document wound appearance, color, wound healing, s/sx of infection, wound size (length X width X depth) and stage, and report to MD PRN any changes in skin status. Date Initiated: 06/29/2023. Notify family of any new area of skin breakdown. Date Initiated: 06/29/2023. Notify nure immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 06/29/2023. Provide pressure relieving device in bed. Date Initiated: 06/29 2023. Provide wound healing supplements as ordered; (MVT, Vit C, Liquid Protein, Zinc, Shakes, Juven, Supplement with medications). Date Initiated: 06/29/2023. Revision on: 07/12/2023. Serve diet as ordered. Date Initiated: 06/29/2023. Use 2 person transfer and use draw sheet to avoid friction/shearing of resident skin. Date Initiated: 06/29/2023. Use draw sheet to reduce friction. Date Initiated: 06/29/2023. Record review of Resident #5's Weekly Skin Integrity Reviews for July of 2023 revealed: 7/7/23-Skin intact 7/18/23- Old open area, Stage 3 pressure injury upper back. 7/25/23-Old open area, Stage 3 pressure injury on sacrum (buttocks), no identification of the pressure injury on upper back. 7/31/23-Old open area, Stage 3 pressure injury on upper mid vertebrae. Record review of Resident #5's Medication Administration Audit Report dated 08/01/23 revealed: Location &wound: Stage 3 right upper back PAIN CODE INTERVENTION: 0 = no Intervention 1=reposition resident 2 = PRN medication 3 = scheduled pain medication 4 = gentle range of motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y=Yellow B=Black G [NAME] W=White T=Tan PU Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply collagen powder to wound bed. skin prep to pen wound cover with island dressing. Scheduled on 07/01/2023 at 06:00am administered on 07/29/2023 at 8:53PM documented on 07/29/2023 at 8:54PM by DON. Scheduled on 07/03/2023 at 6:00AM, administered on 07/29/2023 8:55PM documented on 07/29/2023 8:55PM by DON. Scheduled on 07/14)2023 at 06:00AM administered on 07/29/2023 8:57PM documented on 07/29/2023 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 55 of 67 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 08/07/2023 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 0726 8:57PM by DON. Level of Harm - Minimal harm or potential for actual harm Scheduled on07/15/2023 at 06:00AM, administered on 07/29/2023 at 9:12PM, documented on 07/29/2023 at 9:12PM by DON. Residents Affected - Some Review of Resident #5's Progress Note dated 08/03/23 by DON revealed: DON performed skin assessment on this resident. Mid back in thoracic region has a 0.4 x 0.4 x 0.1 cm wound. The periwound is pink, there is minimal serous drainage. There is 70% granulation tissue and 30% slough. Skin tear to right lateral calf has minimal serous drainage noted, wound tissue is red and periwound is of normal skin color of resident. There are no s/s of infection, or any further abnormalities noted to either wound. Review of Wound Care Specialist assessment dated [DATE] revealed: STAGE 4 PRESSURE WOUND OF THE RIGHT UPPER BACK FULL THICKNESS. Etiology Pressure. MDS 3.0 Stage 4. Duration >55 days. Wound Size {L x W x D): 0.4 x 0.4 x 0.1 cm. Surface Area: 0.16 cm. Exudate: Light Serous. Slough: 30%. Granulation tissue 70%. During an interview on 08/05/23 at 12:06PM with ADON M, she said she had not been the RN that has been monitoring the skin of the residents of the facility. She said she became the ADON as of 6/12/23 and started at facility at the very end of May as an RN. She said, if you did treatment and didn't sign the MAR, make a late entry to show that it was completed and forgot the documentation but do not go back and fill in the hole after the shift. She said the nurses were supposed to place any and all information on the 24-hour report sheets to help with continuity of care. ADON M said the treatment nurse was supposed to do the treatments and skin assessments, but if not, then the nurse for each resident should do them. She said at least 1 nurse key set has the treatment cart key to access supplies. ADON M said when she did treatments she would date and initial the bandage on the resident so anyone else could see when it was done last. She said, Personally, as a nurse if I see that it wasn't done, or the dates are old I would do a treatment myself. She said with the EHR you can go and change the date in the computer and lookback at the MAR and TAR to see the holes and back date for an assessment. She said, she would not see that as a competent nurse that it would be as a standard of nurse practice to, sign for another person or write something that you had not done yourself. She said she wouldn't want someone to fill in her own work. ADON M said she didn't think that could be a 28-day gap of knowing what I had done at work. I work 2 jobs, so it would definitely be hard to think back more than a couple of days what I had done. She said she would talk to the person that worked previously and ask them then to make a late entry if she seen that documentation had been missed. ADON M said she felt like the window of time that the information was not in the resident's records did not make them an accurate record for the resident. During an interview on 08/05/23 at 12:49PM with ADON E, he said he had been an LVN for 20 years and he had been working at the facility since May of 2023ADON E said, So, I learned my lesson, will leave it red and put in a progress note, regarding filling in holes in the MAR and TAR. He said he would do treatment, or an assessment and just didn't get the documentation done, stating, days have just run together. He said, No it is not a standard of practice to go back in and back date or fill in holes in the MAR, TAR or assessments. It's the wrong thing to do. He said you do not chart the next date or later that something was done in a timely manner and never chart for someone else's work or lack of work. I wouldn't know how to defend that in court. He said he would not feel comfortable if someone else did his charting because you never know if you have an enemy. During an interview on 08/05/23 at 1:45PM with ADON C she said, she had been an LVN for 16 yrs and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 56 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some had been working at the facility for 2 yrs. and 2 months. She said yesterday (8/4/23) she became the treatment nurse and before that she was an ADON. The weekend supervisor was the treatment nurse for the weekends. She said new admissions had to have a skin assessment and if they had any types of wounds they needed to have something as far as treatment orders in place within 24 hrs even on weekends. ADON C said every resident had a weekly skin assessment and they were able to run a report for the list of residents with skin assessments to see if they were done. She said, If you didn't document, it wasn't done. Regarding skin assessments and holes in MAR and TAR. She said she wouldn't feel comfortable to have another nurse document for her or doing so for another nurse. She said, That would be false documentation. ADON C said, There is no way I can even remember what I ate for supper last night. There is no way I would remember what I did last week or even further than that, regarding documentation that was days and weeks later. She said CSD was monitoring and managing the skin assessment reports and TAR's to make sure the nurses were getting their work done. She said herself and ADON E did the skin sweep on 8/3/23 and took skin sweep sheets to DON that had her notes on them. She said they used a skin sheet with the body, if there was nothing on the residents skin, they just put an x or line over body, if there was an area then they circled it with quick description, like redness or sore. ADON C said they didn't do any measurements, just noted any issue. She said CSD in-serviced them to document as you go and at latest the end of the shift, if its after the shift then have to write a progress note indicating it's a late entry and the reason documentation might have been missed or if it wasn't completed. Do not back date or fill in holes. Do not strike out an inaccurate assessment, just do a progress not to indicate the inaccuracy. ADON C said not doing a treatment or a skin assessment was a neglectful action. She said that was how skin issues were identified past a redness or stage 1 and why some wounds got worse. The intact then open sore or intact then DTI within days proved to be inaccurate representation of the resident's skin. During an interview on 08/05/23 at 3:20PM with DON, she said she had been a nurse since 2008. She said she had been the DON since May 15th of 23. DON said there had been a big learning curve on the change of EHR system from what she had been used to in other facilities in the past. She said she is just very overwhelmed. DON said her orientation was really just a welcoming to the company not a EHR orientation. She said she did not really know how to pull reports to see what the nurses were completing or not. The CSD had been at the facility 3 times since DON came to facility. DON said the CSD has been available by phone has only recently showed her how to run reports. She said the CSD brought it to her attention that skin assessments had not been completed several times for several residents. DON said nursing management started with audits and was having daily all-day meetings checking on the nurses work, and TX G (former tx nurse) didn't want to participate, was not doing her work, would not communicate with DON that she could not get her work done. DON said the CSD said that there was a lot of issues with no documentation regarding treatments and said there was an issue back in March and April of 23 with TX G not getting her work done or her documentation done. She did not know the full description of which nurses did skin assessments for which residents but thought that the floor nurses split odd rooms day shift and even rooms night shift maybe. She said the treatment nurse should be the person that did residents skin assessments that had wounds. DON said she just got hyper focused on catching up the skin assessments and was just so overwhelmed that I was on auto pilot trying to get the documentation caught up. DON said, knows that you should not fill in holes in the MAR and TAR. Said she had never just maliciously done something like that before. She said, I know I have made mistakes, if someone will just tell me it is a mistake, I can fix it, but if you don't tell me whats wrong, I can't fix it. She said the last few days CSD had been going through the system showing her how to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 57 of 67 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 08/07/2023 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some run different reports. She said she did a skin sweep when she first came to the facility with the other ADON's s and TX, and over the last week the ADON's s and TX had been doing them almost daily. She said Thursday (8/3/23) she went to the residents that had wounds and had the wound care doctor's notes from that morning and just made sure that there were no new areas. She said she used his measurements from that morning because they had just been done and there was no reason to believe that measurements would have changed that much. She said, I don't feel that my documentation was false just that I made a mistake and was just overwhelmed with the need to catch everything up in the residents' records. During an interview on 8/6/23 at 12:50PM with RNWS J, He said he had been an RN for 27 years and had begun working at the facility on the 24th of June 2023 as a weekend RN and basically the weekend rn nursing supervisor. He said it was his responsibility to do the skin assessments for the new admissions and make sure the nurses were doing their charting. RNWS J said the weekend supervisor was supposed to do the wound care. He said he would go through the TAR to see who had treatments and go from there. He said it was also his responsibility to make sure the weekend was staffed and if he could not, then he would cover himself as a nurse or aide, in which case all the nurses were responsible for doing their own wound care and skin assessments. RNWS J said he had only been able to be the supervisor 4 days since he started in June of 2023. He said that a nurse not doing weekly skin assessments or doing daily wound care treatments was neglect and when he had come to work that morning he had been inserviced on completing the wound care and skin assessments in a timely manner daily. RNWS J said he had also been inserviced that all charting was to e completed by the end of each shift. He said if documentation had been forgotten or was not accurate then the nurses were supposed to leave the MAR's and TAR's blank from the previous time and make a progress note to identify that it was a late entry and the work was completed or missed and the reason for the lateness. He said to go into the MAR or TAR and fill in holes that were not your own work just for the sake of filling in the holes in the MAR or TAR were not standards of nursing practice. He said he would not be comfortable to do it for another nurse, nor have another nurse do it for him. RNWS J said he would not be able to chart anything from even the previous weekend of work, much less any further than that and a typical standard of nursing practice that has been taught was that if it were not documented, then it was not done In a time when a skin assessment had not been completed in a timely manner, then he would go and assess a resident and do the skin assessment himself and never back date the assessment stating, As ethics go should not fix others charting, and shouldn't back date charting. He said that the identification of residents' pressure sores as stage 2, 3, or 4 and the sores not decreasing in size and severity were pretty obvious that they were not having their skin assessed accurately and they were not receiving their treatments. RNWS J said they were insereviced on setting up appointments for the residents as well. He said the nurse that admitted a resident was supposed to go through the admitting orders and paperwork to see if the resident either already had a follow up appointment or had the need for 1 to be scheduled. He said on the weekends, they could not schedule an appointment, however they would put a note on the 24-hour report for the nurse at the start of the week to call the Dr's offic[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 58 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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 interviews and record reviews, the facility failed to maintain medical records on each resident that were complete and accurately documented for 7 (Resident #1,2,4,5,6,7,8) of 8 residents reviewed for medical records. Resident #1 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. Resident #2 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. Resident #4 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. Resident #5 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. Resident #6 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. Resident #7 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. Resident #8 did not have an accurate skin assessment, accurate documentation on TAR, and/or accurate progress notes. These failures place residents at risk of health and safety due to inaccurate assessments. Findings included: Resident #1 Review of Resident # 1's face sheet dated 07/29/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent hospital readmission date of 06/03/2023, with the following diagnosis metabolic encephalopathy (primary), encounter for orthopedic aftercare following surgical amputation, chronic systolic (congestive) heart failure, type 2 diabetes mellitus with unspecified complications, need assistance with personal care, dependence on renal dialysis and end stage renal disease. Review of Resident # 1's admission MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 10 (moderate cognitive decline); Section G- Functional Status revealed Resident #1 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bladder and Bowel revealed Resident # 1 always incontinent for bowel and bladder; Section M-Skin Conditions revealed Resident #1 was at risk of developing pressure ulcers/injuries. Resident #1 had a DTI and 1 surgical wound. Review of Resident #1's care plan dated 05/15/2022 revealed: Focus: The resident is at risk for pressure injury r/t History of Pressure Injuries, Poor nutrition, Reduced Mobility, Sheering/friction (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 59 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some problems. Date Initiated: 08/20/2020 Revision on: 02/21/2022; Goal: The resident will have intact skin, free of pressure injury through review date. Date Initiated: 08/20/2020 Revision on: 08/23/2022 Target Date: 05/20/2023; Interventions: Alert dietitian of pressure injury risk to ensure any nutritional deficits are alleviated. Date Initiated: 08/20/2020 Apply lotion after each shower. DO NOT massage over reddened bony prominences. Date Initiated: 08/20/2020 Assess for restorative program to ensure maximal remobilization Date Initiated: 08/20/2020 Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated: 08/20/2020 Offer fluids in conjunction with turning and positioning Date Initiated: 08/20/2020 Perform and document weekly assessment for of skin for changes or observations. Date Initiated: 08/20/2020 Protect elbows and heels from friction. Date Initiated: 08/20/2020 Protect heels-offload when in bed. Date Initiated: 08/20/2020. Turn and reposition frequently. Keep body in good alignment with pillows for positioning and pressure relief. Date Initiated: 08/20/2020. Use briefs to wick and hold moisture away from resident's skin. Date Initiated. Use lift sheet to move/position resident in bed. Date Initiated: 08/20/2020. Use moisture barrier with incontinent care episodes. Date Initiated: 08/20/2020., Focus The resident has a stage 1 pressure injury to his R buttocks r/t Reduced Mobility, Incontinence, Sheering/Friction. Date Initiated: 08/18/2022 Revision on: 10/24/2022. Goal: The resident's will wound will show signs of healing and remain free from infection by/through review date. Date Initiated: 08/18/2022 Revision on: 08/23/2022 Target Date: 05/20/2023. Interventions: The resident requires the bed as flat as possible to reduce shear. Date Initiated 08/18/2022. Revision on: 08/23/2022 Administer treatments as ordered and monitor for effectiveness. Date Initiated 08/18/2022 Assess/record/monitor wound healing weekly. Measure length, width, and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 08/18/2022. Revision on: 08/23/2022. Educate the resident/family/caregivers as to causes of skin breakdown; including transfer/positioning requirements; importance of taking care during ambulating/mobility, good nutrition and frequent repositioning. Date Initiated: 08/18/2022. Provide low air loss mattress to bed. Date Initiated: 08/18/2022. Provide pressure relieving cushion to wheelchair. Monitor for placement and condition. Notify supervisor if cushion needs to be replaced. Date Initiated: 08/18/2022. Record review of Resident #1's Skin Assessments revealed: 6/11/23 at 23:12 (11:12PM) revealed Continue treatment to stg 4 on dressing in place to lt leg No measurements, and no reference to pressure injuries to buttock. 6/18/23 locked as completed 06/27/23 at 13:29 (1:29PM) revealed dressing to lt foot remains intact .Site: Other Rt ischium (buttock). Type of skin issue: Pressure, 2.2x5x0.3cm Stage III (3). 6/25/23 locked as completed 0627/23 at 13:30 (1:30PM) revealed: Site: Other Rt ischium (buttock). Type of skin issue: Pressure, 2.2x5x0.3cm Stage III (3). No reference to left foot surgical wound. Record review of Resident #1's Admit/Readmit Screener dated 06/03/23 revealed resident had a surgical wound and a pressure injury. It stated that Resident #1 had a stg II (2) pressure injury to his right gluteal fold (buttocks). The screener did not indicate where the surgical wound was located on the resident, nor did it include any measurements, appearances, or treatments for either wound. Record review of Resident #1's admission summary dated [DATE] revealed that resident had L foot 5th toe partial resection d/t gangrene was performed. From hospitalization. No mention of other skin issues. Record review of Resident #1's Medication Administration Audit Report revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 60 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Location of wound: Unstageable Rt Ischium PAIN CODE INTERVENTION: 0= no intervention I =reposition resident 2= PRN medication 3= scheduled pain medication 4= gentle range of Motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y=Yellow B=Black G=Green W=White T=Tan PU=Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep to pen wound. Apply Leptospermum honey to wound bed cover border gauze dressing Scheduled date of 7/1/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:11PM by ADON E. Scheduled date of 7/3/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:09PM by ADON E. Scheduled date of 7/12/23 at 6:00AM charted as N/A for assessment of wound bed and completed on 7/29/23 at 9:27PM by ADON E. Location of wound: Left foot PAIN CODE INTERVENTION: 0= no Intervention I = reposition resident 2= PRN medication 3 = scheduled pain medication 4= gentle range of motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y YeIIow B=Black G=Green W=White T=Tan PU=Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse with NS or Wound Cleanser and pat dry. Swab with betadine swab. Cover with 4x4and secure with tape. Scheduled date of 07/01/2023 at 6:00 charted as N/A for assessment of wound bed and completed on 07/29/2023 9:11PM by ADON E. Scheduled date of 07/03/2023 at 6:00 charted as N/A for assessment of wound bed and completed on 07/29/2023 9:09PM by ADON E. Scheduled date of 07/12/2023 at 6:00 charted as N/A for assessment of wound bed and completed on 07/29/2023 9:27PM by ADON E. Resident #2 Review of Resident # 2's face sheet dated 08/03/2023 revealed, [AGE] year-old male originally admitted on [DATE] with most recent readmission date of 10/05/2022, with the following diagnosis unspecified dementia (primary), need for assistance with personal care, flaccid hemiplegia affecting right dominant side. Review of Resident # 2's annual MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 8 (moderate cognitive impairment); Section G- Functional Status revealed Resident #2 had mostly total dependence (needed one to two + persons physical assist with most ADLs); Section H- Bowel and Bladder revealed always incontinent for bowel; Section M-Skin Conditions revealed Resident #2 was at risk of developing pressure ulcers/injuries. Review of Resident # 2's Care plan dated 07/04/23 revealed, Focus: patient has an stage 4 pressure injury to right posterior calf with potential for further skin breakdown R/T: disease process, immobility, impaired mobility, lack of sensation, non-compliance with therapeutic regimen. Date Initiated: 07/27/2023. Revision on: 08/02/2023. Goal: Pressure ulcer will show signs of healing and remain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 61 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some free from infection by/through review date. Date Initiated: 07/29/2023. Target Date: 09/18/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 07/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 07/29/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 07/29/2023. Notify nurse immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 07/29/1013. Provide low air loss mattress to bed. Date Initiated: 08/02/2023 Revision on: 08/02/2023. Refer to dietitian and follow recommendation. Date Initiated: 07/29/2023. Serve diet as ordered. Date Initiated: 07/29/2023. Supplements per orders. Date Initiated: 08/02/2023. Revision on: 08/02/2023. Record review of Resident #2's Progress note dated 08/03/23 revealed: DON performed skin assessment of this resident who has stage 4 pressure wound to right posterior, lower extremity, measures 3.2 x 1.8 x 1.0cm with minimal serous drainage noted, peri wound of normal skin color for resident. 70% granulation tissue noted, no slough, and tendon and bone noted. Suprapubic cath site to mid-lower abdomen area, no drainage or leakage to area noted. No sis of infection or further abnormalities noted. Signed DON 8/3/23 at 7:40PM Record review of Resident #2's Wound Care Physician Assessment Note dated 08/03/23 revealed: Focused Wound Exam (Site 1) STAGE 4 PRESSURE WOUND OF THE RIGHT, LATERAL CALF FULL THICKNESS. Etiology (quality), Pressure. Stage. 4. Duration > 1 days Resident #4 Review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section H- Bowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer Resident #4 Review of Resident # 4's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 01/11/2023, with the following diagnosis Sepsis (primary) and need for assistance with personal care. Review of Resident # 4's annual MDS assessment that has not been submitted dated 07/30/2023 revealed, M-Skin Conditions revealed Resident #2 had a stage 4 pressure ulcer. Review of Resident #4's quarterly MDS assessment dated [DATE] revealed, Section C- Cognitive Behavior revealed a BIMS score of 15 (cognitively intact); Section G- Functional Status revealed Resident #4 had physical help limited to transfer only (mostly setup help or one person physical assist); Section H- Bowel and Bladder revealed always continent for bowel and bladder; Section M-Skin Conditions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 62 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some revealed Resident #4 was at risk of developing pressure ulcers/injuries and that Resident #4 had stage 4 pressure ulcer. Review of Resident #4's care plan revised 07/29/23 revealed: Focus: The resident has (DTI) pressure injury to Rt medial heel r/t Reduced Mobility. Date Initiated: 03/29/2023. Revision on: 07/29/2023. Goal: the resident's will wound will show signs of healing and remain free from infection by through review date. Date Initiated: 03/29/2023. Revision on: 07/31/2023. Target Date: 08/15/2023. Interventions: Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 03/29/2023. Administer treatments as ordered and monitor for effectiveness. Date Initiated: 03/29/2023. Assess/record/and monitor wound healing weekly. Measure length, width and depth where possible. Assess and document status of wound perimeter, wound bed and healing progress. Report improvements and declines to the MD. Date Initiated: 03/29/2023. Revision on: 06/05/2023. Educate the resident/family/caregivers as to causes of skin breakdown; including: transfer/positioning requirements; importance of taking care during ambulation/mobility, good nutrition and frequent repositioning. Date Initiated: 03/29/2023. Monitor nutritional status. Serve diet as ordered, monitor intake and record. Date Initiated: 07/20/2023. Review of Resident #4' Medication Administration Audit Report dated 08/01/23 revealed: Location of wound: Stage 4 it posterior medial heel. PAIN CODE INTERVENTION: 0= no Intervention I =reposition resident 2= PRN Medication 3 = scheduled medication 4= gentle range of motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y=Yellow B= Black G=Green W=White T=Tan PU=Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply skin prep around pen wound. Apply Collagen powder cover with border dressing Scheduled for 07/14/2023 at 06:00AM and charted as completed on 07/29/2023 8:58PM by DON. Scheduled for 07/15/2023 at 06:00AM stated administered on 07/15/2023at 9:04PM charted as documented on 07/29/2023 9:06PM by DON. Scheduled for 07/23/23 at 6:00AM stated administered on 7/23/23 at 9:52PM, charted as documented on 7/29/23 at 9:53PM Resident #5 Review of Resident # 5's face sheet dated 08/02/2023 revealed, [AGE] year-old female originally admitted on [DATE] with most recent readmission date of 03/06/2023, with the following diagnosis Unspecified dementia (primary) and muscle weakness. Review of Resident # 5's quarterly MDS assessment dated [DATE] revealed, Section C-Cognitive Behavior revealed a BIMS score of 99 (Unable to complete interview); Section G- Functional Status revealed patient had total dependence with most activities (1 to 2 persons physical assist); Section H Bowel and Bladder revealed always incontinent to bowel and bladder. M-Skin Conditions revealed Resident #5 had a risk of developing pressure ulcers/injuries and 1 stage 3 pressure ulcer. Review of Resident #5's care plan dated 07/11/2023 revealed: Focus: The resident has an ADL Self Care Performance Deficit r/t decreased mobility. Date Initiated: 07/12/2023. Revision on: 07/12/2023. Goal: Will maintain current level of function in (Bed Mobility, Transfers, Eating, Dressing, Toilet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 63 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Use and Personal Hygiene; . SKIN INSPECTION: Observe for redness, open areas, scratches, cuts, bruises and report changes to the Nurse. Date Initiated: 07/12/2023 . Focus: The resident has pressure injury to (on rt mid back stage 3)with potential for further skin breakdown r/t: cognitive impairment, disease process, hx of pressure injuries, immobility, incontinence, lack of sensation, nutritional deficit. Date Initiated: 06/29/2023. Revision on: 06/29/2023. Goal: Pressure ulcer will show signs of healing and remain free from infection by/through review date. Date Initiated: 06/29/2023. Target Date: 07/11/2023. Interventions: Administer treatments as ordered and monitor effectiveness. Date Initiated: 06/29/2023. Assist resident with turning/repositioning during rounds. Date Initiated: 06/29/2023. Check for incontinence during rounds and provide care as needed. Keep resident clean and dry. Date Initiated: 06/29/2023. Document wound appearance, color, wound healing, s/sx of infection, wound size (length X width X depth) and stage, and report to MD PRN any changes in skin status. Date Initiated: 06/29/2023. Notify family of any new area of skin breakdown. Date Initiated: 06/29/2023. Notify nure immediately of any new areas of skin breakdown: redness, blisters, bruises, discoloration noted during bath or daily care. Date Initiated: 06/29/2023. Provide pressure relieving device in bed. Date Initiated: 06/29 2023. Provide wound healing supplements as ordered; (MVT, Vit C, Liquid Protein, Zinc, Shakes, Juven, Supplement with medications). Date Initiated: 06/29/2023. Revision on: 07/12/2023. Serve diet as ordered. Date Initiated: 06/29/2023. Use 2 person transfer and use draw sheet to avoid friction/shearing of resident skin. Date Initiated: 06/29/2023. Use draw sheet to reduce friction. Date Initiated: 06/29/2023. Record review of Resident #5's Weekly Skin Integrity Reviews for July of 2023 revealed: 7/7/23-Skin intact 7/18/23- Old open area, Stage 3 pressure injury upper back. 7/25/23-Old open area, Stage 3 pressure injury on sacrum (buttocks), no identification of the pressure injury on upper back. 7/31/23-Old open area, Stage 3 pressure injury on upper mid vertebrae. Record review of Resident #5's Medication Administration Audit Report dated 08/01/23 revealed: Location &wound: Stage 3 right upper back PAIN CODE INTERVENTION: 0 = no Intervention 1=reposition resident 2 = PRN medication 3 = scheduled pain medication 4 = gentle range of motion 5 = back rub DRAINAGE: S=Saturated M=Moist D=Dry GENERALAPPEARANCE: R=Red Y=Yellow B=Black G [NAME] W=White T=Tan PU Purple BR=Brown GR=Gray P=Pink SURROUNDING SKIN: M=Macerated R=Reddened F=Firm N=Normal every day shift Treatment order: Cleanse area with NS/wound cleanser. Pat dry. Apply collagen powder to wound bed. skin prep to pen wound cover with island dressing. Scheduled on 07/01/2023 at 06:00am administered on 07/29/2023 at 8:53PM documented on 07/29/2023 at 8:54PM by DON. Scheduled on 07/03/2023 at 6:00AM, administered on 07/29/2023 8:55PM documented on 07/29/2023 8:55PM by DON. Scheduled on 07/14)2023 at 06:00AM administered on 07/29/2023 8:57PM documented on 07/29/2023 8:57PM by DON. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 64 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Scheduled on07/15/2023 at 06:00AM, administered on 07/29/2023 at 9:12PM, documented on 07/29/2023 at 9:12PM by DON. During an interview on 08/04/23 at 11:08AM with TX D, she said the treatment nurse was responsible for completed weekly skin assessments and they should reflect the actual picture of resident and their skin. TX D said progress notes and the TAR were supposed to be completed daily with an assessment of the wounds on the TAR and that NA was not an appropriate answer for the assessment of the wound, as it was not an accurate finding. During an interview on 08/05/23 at 12:06PM with ADON M, she said she had not been the RN that has been monitoring the skin of the residents of the facility. She said she became the ADON as of 6/12/23 and started at facility at the very end of May as an RN. She said, if you did treatment and didn't sign the MAR, make a late entry to show that it was completed and forgot the documentation but do not go back and fill in the hole after the shift. She said the nurses were supposed to place any and all information on the 24-hour report sheets to help with continuity of care. ADON M said the treatment nurse was supposed to do the treatments and skin assessments, but if not, then the nurse for each resident should do them. She said at least 1 nurse key set has the treatment cart key to access supplies. ADON M said when she did treatments she would date and initial the bandage on the resident so anyone else could see when it was done last. She said, Personally, as a nurse if I see that it wasn't done, or the dates are old I would do a treatment myself. She said with the EHR you can go and change the date in the computer and lookback at the MAR and TAR to see the holes and back date for an assessment. She said, she would not see that as a competent nurse that it would be as a standard of nurse practice to, sign for another person or write something that you had not done yourself. She said she wouldn't want someone to fill in her own work. ADON M said she didn't think that could be a 28-day gap of knowing what I had done at work. I work 2 jobs, so it would definitely be hard to think back more than a couple of days what I had done. She said she would talk to the person that worked previously and ask them then to make a late entry if she seen that documentation had been missed. ADON M said she felt like the window of time that the information was not in the resident's records did not make them an accurate record for the resident. During an interview on 08/05/23 at 12:49PM with ADON E, he said he had been an LVN for 20 years and he had been working at the facility since May of 2023. ADON E said, So, I learned my lesson, will leave it red and put in a progress note, regarding filling in holes in the MAR and TAR. He said he would do treatment, or an assessment and just didn't get the documentation done, stating, days have just run together. He said, No it is not a standard of practice to go back in and back date or fill in holes in the MAR, TAR or assessments. It's the wrong thing to do. He said you do not chart the next date or later that something was done in a timely manner and never chart for someone else's work or lack of work. I wouldn't know how to defend that in court. He said he would not feel comfortable if someone else did his charting because you never know if you have an enemy. During an interview on 08/05/23 at 1:45PM with ADON C she said, she had been an LVN for 16 yrs and had been working at the facility for 2 yrs. and 2 months. She said yesterday (8/4/23) she became the treatment nurse and before that she was an ADON. The weekend supervisor was the treatment nurse for the weekends. She said new admissions had to have a skin assessment and if they had any types of wounds they needed to have something as far as treatment orders in place within 24 hrs even on weekends. ADON C said every resident had a weekly skin assessment and they were able to run a report for the list of residents with skin assessments to see if they were done. She said, If you didn't document, it wasn't done. Regarding skin assessments and holes in MAR and TAR. She said she wouldn't feel comfortable to have another nurse document for her or doing so for another nurse. She said, That would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 65 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some be false documentation. ADON C said, There is no way I can even remember what I ate for supper last night. There is no way I would remember what I did last week or even further than that, regarding documentation that was days and weeks later. She said CSD was monitoring and managing the skin assessment reports and TAR's to make sure the nurses were getting their work done. She said herself and ADON E did the skin sweep on 8/3/23 and took skin sweep sheets to DON that had her notes on them. She said they used a skin sheet with the body, if there was nothing on the residents skin, they just put an x or line over body, if there was an area then they circled it with quick description, like redness or sore. ADON C said they didn't do any measurements, just noted any issue. She said CSD in-serviced them to document as you go and at latest the end of the shift, if its after the shift then have to write a progress note indicating it's a late entry and the reason documentation might have been missed or if it wasn't completed. Do not back date or fill in holes. Do not strike out an inaccurate assessment, just do a progress not to indicate the inaccuracy. ADON C said not doing a treatment or a skin assessment was a neglectful action. She said that was how skin issues were identified past a redness or stage 1 and why some wounds got worse. The intact then open sore or intact then DTI within days proved to be inaccurate representation of the resident's skin. During an interview on 08/05/23 at 2:26PM with MDS H, she said she had been an LVN since 2005 and had been working at the facility for 3 years. She said she typically just did the MDS's but would help as an aide and had to work as the floor nurse before as well but didn't even do it very often. She said she would not be able to remember what happened a month ago to be able to chart on something. Said she was using the skin assessments that were in resident EHR that were already completed to complete MDS's. MDS H said she didn't go do her own skin assessments. She said, had she known the skin assessments were wrong, then she would have done her own. And that because the skin assessments were wrong, that also made the MDS's wrong as well. During an interview on 08/05/23 at 3:20PM with DON, she said she had been a nurse since 2008. She said she had been the DON since May 15th of 23. DON said there had been a big learning curve on the change of EHR system from what she had been used to in other facilities in the past. She said she is just very overwhelmed. DON said her orientation was really just a welcoming to the company not a EHR orientation. She said she did not really know how to pull reports to see what the nurses were completing or not. The CSD had been at the facility 3 times since DON came to facility. DON said the CSD has been available by phone has only recently showed her how to run reports. She said the CSD brought it to her attention that skin assessments had not been completed several times for several residents. DON said nursing management started with audits and was having daily all-day meetings checking on the nurses work, and TX G (former tx nurse) didn't want to participate, was not doing her work, would not communicate with DON that she could not get her work done. DON said the CSD said that there was a lot of issues with no documentation regarding treatments and said there was an issue back in March and April of 23 with TX G not getting her work done or her documentation done. She did not know the full description of which nurses did skin assessments for which residents but thought that the floor nurses split odd rooms day shift and even rooms night shift maybe. She said the treatment nurse should be the person that did residents skin assessments that had wounds. DON said she just got hyper focused on catching up the skin assessments and was just so overwhelmed that I was on auto pilot trying to get the documentation caught up. DON said, knows that you should not fill in holes in the MAR and TAR. Said she had never just maliciously done something like that before. She said, I know I have made mistakes, if someone will just tell me it is a mistake, I can fix it, but if you don't tell me whats wrong, I can't fix it. She said the last few days CSD had been going through the system showing her how to run different reports. She said she did a skin sweep (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 66 of 67 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 08/07/2023 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some when she first came to the facility with the other ADON's s and TX, and over the last week the ADON's s and TX had been doing them almost daily. She said Thursday (8/3/23) she went to the residents that had wounds and had the wound care doctor's notes from that morning and just made sure that there were no new areas. She said she used his measurements from that morning because they had just been done and there was no reason to believe that measurements would have changed that much. She said, I don't feel that my documentation was false just that I made a mistake and was just overwhelmed with the need to catch everything up in the residents' records. During an interview on 8/6/23 at 12:50PM with RNWS J, He said he had been an RN for 27 years and had begun working at the facility on the 24th of June 2023 as a weekend RN and basically the weekend rn nursing supervisor. He said it was his responsibility to do the skin assessments for the new admissions and make sure the nurses were doing their charting. RNWS J said the weekend supervisor was supposed to do the wound care. He said he would go through the TAR to see who had treatments and go from there. He said it was also his responsibility to make sure the weekend was staffed and if he could not, then he would cover himself as a nurse or aide, in which case all the nurses were responsible for doing their own wound care and skin assessments. RNWS J said he had only been able to be the supervisor 4 days since he started in June of 2023. He said that a nurse not doing weekly skin assessments or doing daily wound care treatments was neglect and when he had come to work that morning he had been inserviced on completing the wound care and skin assessments in a timely manner daily. RNWS J said he had also been inserviced that all charting was to e completed by the end of each shift. He said if documentation had been forgotten or was not accurate then the nurses were supposed to leave the MAR's and TAR's blank from the previous time and make a progress note to identify that it was a late entry and the work was completed or missed and the reason for the lateness. He said to go into the MAR or TAR and fill in holes that were not your own work just for the sake of filling in the holes in the MAR or TAR were not standards of nursing practice. He said he would not be comfortable to do it for another nurse, nor have another nurse do it for him. RNWS J said he would not be able to chart anything from even the previous weekend of work, much less any further than that and a typical standard of nursing practice that has been taught was that if it were not documented, then it was not done In a time when a skin assessment had not been completed in a timely manner, then he would go and assess a resident and do the skin assessment himself and never back date the assessment stating, As ethics go should not fix others charting, and shouldn't back date charting. He said that the identification of residents' pressure sores as stage 2, 3, or 4 and the sores not decreasing in size and severity were pretty obvious that they were not having their skin assessed accurately and they were not receiving their treatments. RNWS J said they were insereviced on setting up appointments for the residents as well. He said the nurse that admitted a resident was supposed to go through the admitting orders and paperwork to see if the resident either already had a follow up appointment or had the need for 1 to be scheduled. He s[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 67 of 67