Health inspection·October 5, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few coordinator that ensured residents completed the entire admission packet and she uploaded it to the electronic health record. She said she thought a smoking policy might be in the packet but didn't know. She reviewed resident uploaded documents and did not see the file; she was going to speak to the admissions coordinator. During an interview on 10/04/23 at 11:23 AM with ADM-C, she said she considered snuff to be a smoking paraphernalia, per say, but that she would find their smoking policy to see what it had to say. CNS-S said that it would probably be just the same as E cigarettes, and they would look at their policy, it might just need some updating. During an interview on 10/04/23 at 02:29 PM with Resident #31, he was again adamant that he wanted his tobacco/snuff back. He said his snuff was not smoking paraphernalia. Resident #31 said he was fine if they could not do it but felt the staff should not be able to do it either. Record review of ADM-C email sent on 10/04/23 at 11:53 AM that stated: has smoking policy, but we are non-smoking, so admission packet is what we follow for smoking-free facility. Paraphernalia includes tobacco, but mgmt. office has agreed to expand on the paraphernalia working on admission packet. Record review of facility policy labeled Resident Rights revised 10/2009 revealed: Federal and state laws guarantee certain basic rights to all residents of this facility Residents are entitled to exercise their rights and privileges to the fullest extent possible. Our facility will make every effort to assist each resident in exercising his/her rights to assure that the resident is always treated with respect, kindness, and dignity. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 2 of 25 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 10/05/2023 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 - Minimal harm or potential for actual harm Based on interviews and record reviews, the facility failed to implement written policies and procedures that prohibit and prevent residents from abuse, neglect, exploitation, and misappropriation of resident property for 1 of 15 employees (CNA-P) reviewed for criminal history checks and EMR/NAR's. Residents Affected - Few The facility failed to perform an initial criminal and EMR/NAR checks for CNA-P. These failures placed residents at risk of abuse, neglect, exploitation and misappropriation of property. Findings included: Record review of facility policy titled Abuse Prevention Program last revised 08/2006 revealed: Our facility conducts employee background checks and will not knowingly employ any individual who has been convicted of abusing, neglecting, or mistreating individuals. Comprehensive policies and procedures have been developed to aid our facility in preventing abuse, neglect, or mistreatment of our residents. Our abuse prevention program provides policies and procedures that govern, as a minimum: a. Protocols for conducting employment background checks. Record review of facility policy titled Personnel Records last revised 04/2008 revealed: a. Criminal History Check (completed prior to hire) . d. Misconduct Registry Check (completed prior to hire and annually) Record review of Personnel Files revealed: CNA-P had a hire date of 1/23/23 with an initial criminal history ran on 1/25/23 and an initial EMR/NAR ran on 1/30/23. During an interview on 10/04/23 at 02:48 PM with ADM- C, she said the facility had a computer virus that took away their access to get the EMR/NAR and criminal histories during the months of August and September of 2023 so new employees or employees that needed annual history checks in the months of August and September 2023 did not get them done timely. She said if the employee was hired or their annual was in the months prior to August and September or after September then they should have been completed timely. During an interview on 10/05/23 at 04:17 PM with HR-T and HRA-V, HR-T said she had been working as HR for about a month. HRA-V said he had been working about 8 months. HR-T said she did a criminal history and EMR/NAR check before the employee was hired, but only did a criminal hx annually after that. HR-T said she could just do them all in January each year, not on their anniversary date. She said she was unaware that the criminal history and the EMR/NAR was to be ran annually on the employee's anniversary date. They both said they got a few days training by former HR personnel. HR-T said the criminal history and EMR/NAR check was to ensure that the facility did not hire someone that had committed certain crimes like abuse, assault, felony theft. HR-T said she understood that some things might not come through when someone was first hired or that they may have had a conviction after they are working. HRA-V said the criminal history and the EMR/NAR should have been ran before an employee was hired, not days after they were hired . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 3 of 25 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 10/05/2023 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record reviews, the facility failed to assure that each resident received an accurate assessment, reflective of the resident's status at the time of the assessment, for 1 of 1 (Resident #71), resident reviewed for accuracy of assessments. Residents Affected - Few The facility failed to include accurate discharge for Resident #71 on MDS. This failure placed residents at risk of not receiving an accurate assessment, reflective of the resident's status. Findings included: Review of resident #71's face sheet revealed resident was admitted to facility 05/17/2023 and discharged on 07/13/2023. Review of r esident #71's MDS dated [DATE] revealed resident #71 was discharged to a local community hospital. Review of resident #71's progress notes on 07/13/2023 at 12:23 PM by SW A revealed that resident #71 was transferred to a skilled nursing facility. During an Interview on 10/05/2023 at 3:45 pm the MDS coordinator stated that it was her responsibility to ensure that the MDS was accurate. She stated that she received the information on the resident by reading the resident's chart in the electronic health record. She stated that she reviewed the resident's progress notes, assessments, discharge summary as well as interviewed staff regarding the resident. The MDS coordinator demonstrated in the electronic health record that Resident #71 had no discharge summary. The MDS coordinator then showed in the resident's progress notes of the electronic health record a note reflected Resident #71 was discharged on 07/13/2023 from the facility to another skilled nursing facility with medications. She then showed in the MDS section of the electronic health record where Resident #71 entered to be discharged to an acute hospital. The MDS coordinator stated that it was her error. She stated that she entered the incorrect code and information on Resident #71's discharge status in the Minimum Data Set. She stated that it should have been entered as 02 another nursing home and instead she entered 03 acute hospital. During an interview on 10/05/2023 at 4:40 PM, DON D stated that she was the person responsible to sign off on MDS assessments . Record review of policy for Resident Assessment Instrument dated revised September 2010, reflected All persons who have completed any portion of the MDS Resident Assessment Form MUST sign such document attesting to the accuracy of such information. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 4 of 25 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 10/05/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to Incorporate Level II Recommendations from the PASRR level II determination and the PASRR (Pre-admission screening and resident review) evaluation for 1 of 2 residents (Resident #13) reviewed for PASRR in that: The facility failed to follow up with the LA for PASRR Level II determination when Resident #13's PASRR Level 1 Screening reflected she was positive for mental illness. This failure could place the residents with a documented mental illness, intellectual and/or developmental disability at risk for not receiving needed services. The findings are: Record review of Resident #13's Face Sheet dated 10/03/2023 revealed a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: major depressive disorder, recurrent severe without psychotic features; and post-traumatic stress disorder. Record review of Resident #13's PASRR Level 1 Screening dated 08/16/2023 revealed the resident was positive for mental illness. Record review of Resident #13's admission MDS dated [DATE] revealed the resident was not currently considered by the state level II PASRR process to have serious mental illness and/or intellectual disability or a related condition. Record review of Care Plan dated 08/16/2023 revealed Resident #13 had focus that included taking antidepressant, mood problem, and psychosocial wellbeing problem. Record review of Behavioral Health progress note by the behavioral therapist dated 09/15/2023 revealed that patient would be receiving therapy for major depressive disorder, recurrent severe without psychotic features, post-traumatic stress disorder, chronic, and Insomnia due to other mental disorder. Current Psychotropic Medications included: Clonazepam 0.5mg quantity 1 twice a day, Cymbalta 90mg quantity 1 at bedtime, Gabapentin 100mg quantity 1 at bedtime, and Gabapentin 800mg quantity 1 three times a day. During an interview on 10/04/2023 at 3:12 p.m., SW A stated that the MDS coordinator was responsible for completing the MDS PASRR section . During an interview on 10/04/2023 at 3:13 p.m., MDS coordinator B stated that the PASRR 1 form was submitted to the local authority on 08/23/2023. She provided that PASRR 1 submitted on 08/23/2023 at 9:39a.m. On 08/23/2023 at 9:39 AM the resident was placed in nursing facility Exempted Hospital Discharge. On 08/23/2023 at 9:39 a.m., the resident had been admitted to the nursing facility and required less than 30 days of nursing facility services. On 09/15/2023 at 9:19 a.m. status was awaiting PE. MDS coordinator B stated that Resident #13 planned to reside in facility longer than 30 days and information was inputted wrong. MDS coordinator B could not provide information on when the PE (was to be performed. After surveyor requested information, she voiced that she would follow up with local authority today on the status of the PE. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 5 of 25 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 10/05/2023 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 10/05/2023 at 10:50 a.m., the ADMN stated the facility was in the process of having a PE scheduled for Resident #13. She stated that she had spoken to MDS coordinator B, and that the local authority voiced they would perform the PE but was unsure of the time. She stated she would provide the policy and procedure. During an interview on 10/05/2023 at 11:06 a.m., MDS coordinator B stated that she spoke to local authority on the telephone, and the facility had Resident #13's PE scheduled. She could not state the effect on the resident for failing to have completed PASRR II assessment. Review of the PASRR clinical policy on 10/05/23 01:55 p.m. revealed If documentation entered on the PL1 Indicates MI/ID/DD, a PE must be completed. The PL1 must be completed and submitted via the LTC Online Portal for every individual seeking admission to a Medicaid certified nursing facility prior to admission, regardless of funding source. The Referring Entity (RE) will perform the PL1 Screening Form for individuals admitted to the HMG Facility under the Preadmission process. Only a Local Authority (LA) or HMG Facility can submit a PL1 on the LTC online portal .The PL1 submission procedure: 1. Enter the data from the had written PL1 Screening paper form into the online version of the PL1. 2. Retain a copy of the handwritten PL1 Screening paper form, with the appropriate original signatures, in the resident's record in the Business Office. The handwritten PL1 Screening paper form with the appropriate original signatures will be kept as a part of the resident's record for 5 years after resident's discharge or death. 3. The PL1 Screening must include the address of the individual, or LAR or the address where the individual or LAE can be contacted. 4. The PL1 Screening must include at least 1 nursing facility choice entered in Section D regardless of PASRR eligibility .Section C; PASRR Screen (Screener) INTENT: This section to be completed for resident's suspected of having Mental Illness .A mental disorder is defined as the following: a schizophrenic, mood, paranoid, panic or other severe anxiety disorder, somatoform disorder; personality disorder; other psychotic disorder; or another mental disorder that may lead to a chronic disability Nursing Responsibilities 5. The MDS/DON and/or designee will monitor the LTC Online Portal daily for submitted PE's. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 6 of 25 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 10/05/2023 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents had a discharge summary for 1 (Resident #71) of 1 resident reviewed for discharge summaries. The facility failed to ensure a dDischarge sSummary for Resident # 71 was completed which included a complete recapitulation of the resident's stay for a resident discharged to another facility. This failure could place residents discharged from the facility at risk for incorrect, incomplete, or misleading information recorded regarding discharged residents, and failure in the continuity of care for residents. The findings included: Record review of Resident #71's electronic face sheet dated 10/05/2023 indicated a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses: Chronic Obstructive Pulmonary Disease, Shortness of Breath, Depression, Anxiety Disorder, and Chronic Respiratory Failure with Hypoxia Review of Resident #71's discharge MDS dated [DATE] revealed a BIMS of 15 indicating the resident was cognitively intact . Review of Resident #71's comprehensive care plan dated 06/20/2023 revealed the resident was independent in ADLs. Review of Resident #71's progress notes by SW A dated 07/12/2023 revealed r esident #71 was accepted to another facility. Review of Resident #71's progress notes by nursing dated 07/13/2023 revealed Resident #71 was discharged to another facility. Review of Resident #71's record revealed no evidence of a physician's discharge summary. During an interview on 10/05/2023 at 1:50 pm, the Adm C stated that discharge summaries had been stopped by the nurses at some point but stated that she did not know when. Adm C looked in Resident #71's electronic medical record and stated that there was not a discharge summary. Adm C stated it was the responsibility of the nurses to ensure it was done. She stated the facility had a new form for the discharge summary they will begin now. During an interview on 10/05/2023 at 2:30 pm RN L stated that she had been employed by the facility less than two weeks. She stated the discharge summary was to be done on each resident. RN L stated that the facility must first have an order to do discharge summaries. She then stated that discharge summaries were completed in the resident's electronic medical record. During an interview on 10/05/2023 at 2:40 pm LVN K stated that all residents' discharge planning began when the resident was admitted . LVN K stated that the discharge summary was under the section assessments in the resident's electronic medical record. She stated that the social worker opened the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 7 of 25 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 10/05/2023 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few discharge document in resident's electronic medical record. She stated that it was the nurse's responsibility to make sure that all areas of care were done. She stated that the facility printed the discharge summary. She said the nurse would go over the discharge summary with the resident and or the facility if the resident was being transferred. She stated that the resident would sign the printed discharge summary. She stated that the resident and or facility receiving the resident would receive a copy. She then stated that the original signed discharge summary would be put in the social worker's box. LVN K stated that there was not a discharge summary when asked if she could locate the discharge summary on Resident # 71 in the electronic medical record. Record review of policy for Discharge Summary and Plan dated revised December 2016, reflected when a resident's discharge is anticipated, a discharge summary and post-discharge plan will be developed to assist the resident to adjust to his/her new living environment. A copy of the following will be provided to the resident and receiving facility and a copy will be filed in the resident medical records: a. An evaluation of the resident's discharge needs; b. The post-discharge plan; and c. The discharge summary. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 8 of 25 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 10/05/2023 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a medication error rate of less than 5%. The medication error rate was 7.41% with 2 errors in 27 opportunities involving 2 staff; RN E and LVN F and 2 of 5 residents (Resident # 125 and Resident # 31) reviewed for medication errors. Residents Affected - Some 1.) The facility failed to ensure RN E administered the medication Aspirin 325mg to Resident #125 as ordered by the physician. The facility administered the wrong dose 81mg to Resident #125 instead. 2.) The facility failed to ensure LVN F administered the medication Admelog SoloStar 100 unit/ML Solution to Resident #31 as ordered by the physician. The facility administered the wrong medication insulin glargine to Resident #31 instead. The facility's failure could place residents at risk of uncontrolled pain, decreased circulation, low blood sugar readings or seizures. Findings included: 1. Review of Resident #125's Face Sheet dated 10/03/2023 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses including encounter for other orthopedic aftercare, low back pain, high blood pressure, and fibromyalgia (disorder that affects muscle and soft tissue characterized by chronic muscle pain, tenderness, fatigue, and sleep disturbances). Review of Resident #125's admission MDS dated [DATE] revealed Resident #125 had a BIMS of 15 indicating the resident was cognitively intact. Review of Resident #125's Physician's Orders dated 10/03/2023 revealed an order with start date of 09/28/2023 for Aspirin Oral Tablet 325MG with directions to be give one tablet by mouth twice a day. Review of drugs.com accessed on 10/09/2023 at https://www.drugs.com/aspirin.html revealed that Aspirin is used to treat pain, reduce inflammation, and to treat and prevent heart attacks, strokes, and chest pain. During an observation on 10/02/2023 at 10:12 a.m., RN E administered Aspirin 81 MG one tablet by mouth to Resident #125 from OTC bottle in the top of medication cart. During an observation and interview on 10/03/2023 at 3:36 p.m., RN E said that he was just used to giving 81MG and did not realize that the resident was ordered a different dosage. He looked in the resident's records and verified that the order reflected to give 325MG Aspirin twice a day. He stated the effect on the resident getting the wrong dose could affect the resident's circulation or pain. 2. Review of Resident #31's Face Sheet dated 10/03/2023 revealed a [AGE] year-old male initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including type 2 diabetes mellitus with foot ulcer (an open sore or wound on the foot of a person with diabetes), and type 2 diabetes mellitus with diabetic neuropathy (nerve damage that is caused by diabetes). Review of Resident #31's Quarterly MDS dated [DATE] revealed Resident #31 had a BIMS score of 15 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 9 of 25 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 10/05/2023 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 0759 indicating he was cognitively intact. Level of Harm - Minimal harm or potential for actual harm Review of Resident #31's Physician's Orders dated 10/03/2023 revealed an order with start date of 08/01/2023 for Insulin Glargine Solution 100units/ML with directions to give 35 units subcutaneous at bedtime. Residents Affected - Some Review of Resident #31's Physician's Orders dated 10/03/2023 revealed an order with start date of 08/09/2023 for Admelog SoloStar also known as insulin lispro 100unit/ML Solution with directions to give per sliding scale (if FSBS 201-250 give 6 units). Review of drugs.com accessed on 10/09/2023 at https://www.drugs.com/mtm/insulin-glargine.html revealed that Glargine is long-acting insulin that starts to work several hours after injection to improve blood sugar control in people. Review of drugs.com accessed on 10/09/2023 at https://www.drugs.com/admelog.html revealed that Admelog is a fast-acting insulin that starts to work in about 15 minutes to improve blood sugar control in adults. During an observation on 10/03/2023 at 11:30 a.m., revealed LVN F checked Resident #31's finger stick blood sugar using the glucometer with a reading of 235 and then administered 6 units of insulin glargine 100units/ML into subcutaneous tissue. During an interview on 10/03/2023 at 3:28 p.m., LVN F stated she had verified that she had given insulin glargine thinking that it was the correct insulin as it was the only insulin in the medication cart. LVN F stated if she was not familiar with a medication, she would have to look it up on her phone. She stated she was not aware of any medication books for reference provided by the facility. She stated she did not know what the adverse effect the medication error could had been on the resident but did voice that his FSBS had been good. During an interview on 10/03/2023 at 4:16 p.m., the DON said that it was the ADONs' and pharmacy representatives' responsibility to monitor if medications were administered correctly. The DON said the pharmacy representatives would follow nurses and watch medication administration when they were in the facility. She stated the lack of education was what led to the medication error failure. She stated that RN E and LVN F had notified her of the medication errors observed by the surveyor and that the medication error process had been done including notifying the ordering physician. She stated that insulin was a high-risk medication. She stated that she did provide LVN F medication interchange guide that the pharmacy had given the facility. She stated that the effect of insulin not being administered correctly (correct dose or correct medication) would have caused the resident to have low/high blood sugars or worse. Her expectation was that medications were given correctly using the 8 rights of medication administration (right Resident, right medication, right dose, right route, right time, right documentation, right reason, and right response). She stated that correct insulin was found in medication room fridge and education given to LVN F. Review of the facility's policy for Administering Medications on 10/03/2023 at 4:32 p.m. revealed 7. The individual administering the medication must check the label to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication. Review of [Pharmacy name] Therapeutic Interchange Form on 10/03/2023 revealed [Pharmacy name] is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 10 of 25 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 10/05/2023 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 0759 offering the following therapeutic interchange protocols. Original Medication Prescribed Novolog vials, pen and Therapeutic Interchange Admelog pen, vial or generic lispro pen, vial. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 11 of 25 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 10/05/2023 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents were free of any significant mediation errors for 1 of 5 residents (Resident #31) reviewed for medication administration. Residents Affected - Few The facility failed to ensure LVN F administered the medication Admelog SoloStar 100 unit/ML Solution to Resident #31 as ordered by the physician. The facility administered the wrong medication insulin glargine to Resident #31 instead. This failure could place resident at risk of his medication not being administered in accordance with physician's orders, which could place resident at an increased risk of experiencing adverse effects such as low blood sugar that could lead to seizures and may be life threatening. Findings include: Review of Resident #31's Face Sheet dated 10/03/2023 revealed a [AGE] year-old male initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including type 2 diabetes mellitus with foot ulcer (an open sore or wound on the foot of a person with diabetes), and type 2 diabetes mellitus with diabetic neuropathy (nerve damage that is caused by diabetes). Review of Resident #31's Quarterly MDS dated [DATE] revealed Resident #31 had a BIMS score of 15 indicating he was cognitively intact. Review of Resident #31's Physician's Orders dated 10/03/2023 revealed an order with start date of 08/01/2023 for Insulin Glargine Solution 100units/ML with directions to give 35 units subcutaneous at bedtime. Review of Resident #31's Physician's Orders dated 10/03/2023 revealed an order with start date of 08/09/2023 for Admelog SoloStar also known as insulin lispro 100unit/ML Solution with directions to give per sliding scale (if FSBS 201-250 give 6 units). Review of drugs.com accessed on 10/09/2023 at https://www.drugs.com/mtm/insulin-glargine.html revealed that Glargine is long-acting insulin that starts to work several hours after injection to improve blood sugar control in people. Review of drugs.com accessed on 10/09/2023 at https://www.drugs.com/admelog.html revealed that Admelog is a fast-acting insulin that starts to work in about 15 minutes to improve blood sugar control in adults. During an observation on 10/03/2023 at 11:30 a.m., revealed LVN F checked Resident #31's finger stick blood sugar using the glucometer with a reading of 235 and then administered 6 units of insulin glargine 100units/ML into subcutaneous tissue. During an interview on 10/03/2023 at 3:28 p.m., LVN F stated she had verified that she had given insulin glargine thinking that it was the correct insulin as it was the only insulin in the medication cart. LVN F stated if she was not familiar with a medication, she would have to look it up on her phone. She stated she was not aware of any medication books for reference provided by the facility. She stated she did not know what the adverse effect the medication error could had been on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 12 of 25 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 10/05/2023 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 0760 resident but did voice that his FSBS had been good. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/03/2023 at 4:16 p.m., the DON said that it was the ADONs' and pharmacy representatives' responsibility to monitor if medications were administered correctly. The DON said the pharmacy representatives would follow nurses and watch medication administration when they were in the facility. She stated the lack of education was what led to the medication error failure. She stated that RN E and LVN F had notified her of the medication errors observed by the surveyor and that the medication error process had been done including notifying the ordering physician. She stated that insulin was a high-risk medication. She stated that she did provide LVN F medication interchange guide that the pharmacy had given the facility. She stated that the effect of insulin not being administered correctly (correct dose or correct medication) would have caused the resident to have low/high blood sugars or worse. Her expectation was that medications were given correctly using the 8 rights of medication administration (right Resident, right medication, right dose, right route, right time, right documentation, right reason, and right response). She stated that correct insulin was found in medication room fridge and education given to LVN F. Residents Affected - Few Review of Pharmacy name Therapeutic Interchange Form on 10/03/2023 provided by DON revealed Pharmacy name is offering the following therapeutic interchange protocols. Original Medication Prescribed Novolog vials, pens .Therapeutic Interchange Admelog pen, vial or generic lispro pen, vial. Review of facility's policy for Administering Medications on 10/03/2023 at 4:32 p.m. revealed 7. The individual administering the medication must check the label to verify the right resident, right medication, right dosage, right time, and right method (route) of administration before giving the medication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 13 of 25 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 10/05/2023 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide food that was palatable, and at a safe and appetizing temperature for 1 of 1 meal reviewed for palatability and appetizing temperature. Residents Affected - Some The facility failed to serve meals that were palatable and at an appetizing temperature. These failures could affect the residents who ate food from the facility kitchen by placing them at risk of poor food intake and/or dissatisfaction of the meals served. Findings included: During an observation on 10/03/2023 at 1:06 PM the facility tray was provided and consisted of a beef hamburger with cheese, tater tots, [NAME] slaw, fruit cocktail and peaches. The hamburger's internal temperature at the time of service was 106 degrees Fahrenheit. It was not palatable. During an interview on 10/04/2023 at 3:00 PM Resident #39 stated that food is cold . During an Interview on 10/05/2023 at 9:20 AM, the Dietary M anager stated that everyone in the kitchen from the cooks, the aides, whatever personnel that was in the kitchen was responsible to ensure that food was served at the proper temperatures of 165 degree Fahrenheit. The Dietary manager stated that the negative effects of foods not being served at the proper temperatures could make a resident sick, cause them to get salmonella, E.coli and it could cause them to have a decreased palatability. She stated that her expectations of staff are that temperatures are to be done on all food items to be served to the residents. During an interview on 10/05/2023 at 9:40 AM, the [NAME] stated the staff responsible for serving were responsible to ensure meals were served at the correct temperature of 165 degrees Fahrenheit. She stated that the negative effects of food not at correct temperatures could cause residents that consume the meals to get bacteria, food poisoning and sicknesses. She also stated residents would not want to eat their meals and they could lose weight. Record review of the policy for Food Quality and Palatability HCSG Policy 006 dated 05/2014, revised 09/2017, reflected Food will be prepared by methods that conserve nutritive value, flavor and appearance. Food will be palatable, attractive and served at a safe and appetizing temperature. Record review of the facility policy for Food Preparation HCSG 016 dated 05/2014, revised 09/2017, reflected All foods will be held at appropriate temperatures, greater than 135 for hot holding. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 14 of 25 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 10/05/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen. The facility failed to: A. dispose of food items after the use by or expiration date . B. store, seal and date food items. These failures could place residents receiving oral nutritional intake at risk for foodborne illness and a decline in health status. The findings included : During observations on 10/02/2023 from 10:01am to 11:30am of the kitchen revealed: Dry Storage: One unsealed opened bag containing fish fry seafood breading mix in an unlabeled 25-pound box One can of cream of mushroom soup with a dent on the side of the can Refrigerator One box of individual one pound margarine sticks in a 30pound box with no arrive or open date One 32 once container labeled vanilla yogurt with no arrive or open date Freezer One fourth full unsealed opened bag containing frozen sliced carrots in an unlabeled 30-pound box One plastic bag labeled ham with ice around the ham with a date of 01/01/2023 One half full unsealed opened bag of sweet green peas in an unlabeled 30-pound box One, one fourth full unsealed opened bag of lima beans in a 30-pound box with an open date of 09/21/2023 One three fourths full unsealed opened bag containing crinkled cut potato fries in an unlabeled 30-pound box (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 15 of 25 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 10/05/2023 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 0812 One unopened 32-ounce bag of sugar snap peas with no arrive date Level of Harm - Minimal harm or potential for actual harm During an interview 10/05/2023 at 09:20 AM Dietary Manager stated that her expectation of her staff was to correctly store, seal and label all foods. The Dietary Manger stated that if foods were not stored, labeled and dated properly that it could cause residents to get food borne illnesses. She stated that everyone in the kitchen is responsible to ensure foods are stored properly. She stated that as the dietary manger she is responsible to ensure that staff are properly trained on sealing, labeling and storing of foods. The dietary manger stated that all residents eat from the kitchen. Residents Affected - Many During an interview on 10/05/2023 at 9:40 AM the [NAME] stated that she was trained by the dietary manager on how to properly store foods. She stated that she was trained by in-services and physically shown how to properly store foods. The c ook stated that if food was not stored properly that it could make residents sick. Review of facility policy HCSG 017, 019 titled Food Storage and Receiving of Food, revised 2022, revealed: All foods will be stored wrapped or in covered containers, labeled and dated and arranged in a manner to prevent cross contamination. Review of the FDA Food Code 2022 revealed: 3-602.11 Food Labels. (A) FOOD PACKAGED in a FOOD ESTABLISHMENT, shall be labeled as specified in LAW, including 21 CFR 101 - Food labeling, and 9 CFR 317 Labeling, marking devices, and containers. (B) Label information shall include: (1) The common name of the FOOD, or absent a common name, an adequately descriptive identity statement; (2) If made from two or more ingredients, a list of ingredients and sub-ingredients in descending order of predominance by weight, including a declaration of artificial colors, artificial flavors and chemical preservatives, if contained in the FOOD; (3) An accurate declaration of the net quantity of contents; (4) The name and place of business of the manufacturer, [NAME], or distributor; and (5) The name of the FOOD source for each MAJOR FOOD ALLERGEN contained in the FOOD unless the FOOD source is already part of the common or usual name of the respective ingredient. Pf (6) Except as exempted in the Federal Food, Drug, and Cosmetic Act § 403(q)(3) - (5), nutrition labeling as specified in 21 CFR 101 - Food Labeling and 9 CFR 317 Subpart B Nutrition Labeling. (7) For any salmonid FISH containing canthaxanthin or astaxanthin as a COLOR ADDITIVE, the labeling of the bulk FISH container, including a list of ingredients, displayed on the retail container or by other written means, such as a counter card, that discloses the use of canthaxanthin or astaxanthin. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 16 of 25 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 10/05/2023 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 0812 Time/temperature control for safety refrigerated foods must be consumed, sold or discarded by the expiration date. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 17 of 25 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 10/05/2023 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for 2 of 2 resident rooms. Residents Affected - Few The facility failed to ensure call lights were connected to the light in the hallways for room [ROOM NUMBER] and room [ROOM NUMBER]. These failures could place residents at risk of receiving staff assistance for quality of care issues. Findings included: During observations on 10/02/2023 between 11:08 AM and 2:53 PM revealed the call lights did not connect to the light in the hallway when pressed for room [ROOM NUMBER]A/B and room [ROOM NUMBER]A/B During an observation and interview on 10/02/2023 at 02:53 PM, revealed the call light did not light in the hallway when resident pushed her call light button. LVN G stated sometimes she had to jiggle and reset the restroom lights in order for the light in the hallway to work. During an interview on 10/05/2023 at 10:42 AM, LVN H, stated there should have been maintenance in the facility. She stated once they changed the overhead light chords out, they worked fine. She stated when the residents broke them, the staff would have placed the work order in the facility computer program for maintenance to review and repair. LVN H stated she had not ever followed up on how long it took for maintenance to repair the orders she had previously placed; she would resubmit the order if she saw that it had not been corrected. She stated, the staff, including herself had to troubleshoot the call light systems in a few rooms. She stated the scuffs and holes in the residents' walls were related to the beds rubbing on them and had been there at least a couple of months. An interview on 10/05/2023 at 11:08 AM, the ADM stated the staff had discussed why the call system was not fully engaging with the lights in the hallway outside the residents' rooms. She stated, when the residents told the staff their lights outside of their rooms had not worked, the staff would know to go troubleshoot and jiggle the wires where it was connected into the wall. The ADM stated that it was a random occurrence but was always fixable. She stated, when the facility had maintenance, the staff notified them. The ADM stated if it happened at night, their upper management was notified in a group message. She stated it was the CNAs and nurses that worked those hallways during the times the call light would not function correctly. She stated staff used a program on the computer to report issues that needed to be maintained, but the facility had been without maintenance for almost a month. The ADM stated once the incidents were reported and logged into their maintenance repair program, it should have been maintenance to follow up with those, with her as the ADM to monitor maintenance. She stated the facility protocols were for staff to have reported the repairs needed with maintenance prioritizing the needed repairs. The ADM stated she would not have liked living in those situations as it was not homelike. The ADM stated the negative impact to the residents was that the environment was not conducive and not beneficial to them. She stated if the call lights were not working, they could then have a possible behavior issue. She stated the failure for not having maintenance led to the failure, which delayed the process of not getting the repairs done. She stated she was not sure if the call lights could be repaired, as she believed it to be a wiring issue between the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 18 of 25 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 10/05/2023 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 0919 bathroom call light when used and the room call light. The ADM stated her expectations were for the facility to look nice for the residents with them feeling like it was their home and being felt taken care of. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's Open & In Progress work orders dated 10/04/2023 revealed: Residents Affected - Few #1566 Pull string for light in room is missing-Medium priority-Room/Area 808A-Not Assigned #1509 Overhead bed light needs string-Low priority-Room/Area 803A-Not Assigned #1521 wall damage-Low priority-Room/Area 706A-Not Assigned #1496 Large hole in wall where recliner use to be-Low priority-Room/Area 501B-Not Assigned #1564 Family states light over the bed is not managed by the cord but by switch-Medium priority-Room/Area 508B-not assigned Record review of the facility policy statement and procedures for Maintenance Service revised December 2009 revealed: Policy Statement: Maintenance service shall be provided to all areas of the building, grounds, and equipment. Policy Interpretation and Implementation: 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include, but are not limited to: a. maintaining the building and compliance with current federal, state, and local laws, regulations, and guidelines. b. Maintaining the building in good repair and free from hazard . d. plumbing fixtures, . In good working order. e. Maintaining lighting levels that are comfortable, and assuring that exit lots are in good working order. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 19 of 25 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 10/05/2023 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 0919 f. Establishing priorities in providing repair service Level of Harm - Minimal harm or potential for actual harm i. Providing routinely scheduled maintenance service to all areas. j. Others that may be become necessary or appropriate. Residents Affected - Few 3. The maintenance director is responsible for developing and maintaining a schedule of maintenance service to assure that the building, grounds, and equipment are maintained in a safe and operable manner. 4. A copy of the maintenance schedule shall be provided to each department director so that appropriate scheduling can be made without interruption of services to residents. 5. Maintenance personnel shall follow the manufacturer's recommended maintenance schedule. 6. Changes in maintenance schedules must be approved by the maintenance director 8. The maintenance director is responsible for maintaining the following record/reports. a. Inspection of building; b. Work order request; c. Maintenance schedule; d. Authorized vendor listing; and e. Warranties and guarantees 9. Records shall be maintained in the maintenance directors office. 10. Maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned. Record review of facility policy Answering the Call Light dated with the revised date of March 2012 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 20 of 25 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 10/05/2023 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 0919 Purpose: Level of Harm - Minimal harm or potential for actual harm The purpose of this procedure is to respond to the resident's requests and needs . .7. Report all defective call lights to the Nurse Supervisor promptly. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 21 of 25 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 10/05/2023 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public reviewed for a safe and homelike environment for 3 (halls 500, 600, and 700) of 4 hallways. The facility failed to have residents' rooms, without damage: 1. hole in the drywall, 2. call lights did not connect to the light in the hallway, 3. scuffed paint with exposed sheetrock, 4. broken blind, 5. light string broken, 6. no toilet cover, and 7. toilet without a flushing handle. These failures could place residents and staff at risk of unsafe and unsanitary environment. Findings included: During observations on 10/02/2023 between 11:08 AM and 2:53 PM revealed: room [ROOM NUMBER]B-There was a hole in the drywall. room [ROOM NUMBER]A/B and room [ROOM NUMBER]A/B-The call lights did not connect to the light in the hallway when pressed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 22 of 25 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 10/05/2023 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 0921 room [ROOM NUMBER]A-There was scuffed paint with exposed sheetrock. Level of Harm - Minimal harm or potential for actual harm room [ROOM NUMBER]A/B- The window blind was broken and with resident unable to easily open, and the resident light string was broken and out of reach. Residents Affected - Some room [ROOM NUMBER]A/B-There was a hole in the drywall at the resident's head of bed; in the bathroom there was no toilet cover, and no handle for easy access to flush the toilet. During an observation and interview on 10/02/2023 at 02:53 PM, revealed the call light did not light in the hallway when resident pushed her call light button. LVN G stated sometimes she had to jiggle and reset the restroom lights in order for the light in the hallway to work. During an interview on 10/05/2023 at 10:42 AM, LVN H, stated there should have been maintenance in the facility. She stated once they changed the overhead light chords out, they worked fine. She stated when the residents broke them, the staff would have placed the work order in the facility computer program for maintenance to review and repair. LVN H stated she had not ever followed up on how long it took for maintenance to repair the orders she had previously placed; she would resubmit the order if she saw that it had not been corrected. She stated, the staff, including herself had to troubleshoot the call light systems in a few rooms. She stated the scuffs and holes in the residents' walls were related to the beds rubbing on them and had been there at least a couple of months. An interview on 10/05/2023 at 11:08 AM, the ADM stated the staff had discussed why the call system was not fully engaging with the lights in the hallway outside the residents' rooms. She stated, when the residents told the staff their lights outside of their rooms had not worked, the staff would know to go troubleshoot and jiggle the wires where it was connected into the wall. The ADM stated that it was a random occurrence but was always fixable. She stated, when the facility had maintenance, the staff notified them. The ADM stated if it happened at night, their upper management was notified in a group message. She stated it was the CNAs and nurses that worked those hallways during the times the call light would not function correctly. She stated staff used a program on the computer to report issues that needed to be maintained, but the facility had been without maintenance for almost a month. The ADM stated once the incidents were reported and logged into their maintenance repair program, it should have been maintenance to follow up with those, with her as the ADM to monitor maintenance. She stated the facility protocols were for staff to have reported the repairs needed with maintenance prioritizing the needed repairs. The ADM stated she would not have liked living in those situations as it was not homelike. The ADM stated the negative impact to the residents was that the environment was not conducive and not beneficial to them. She stated if the call lights were not working, they could then have a possible behavior issue. She stated the failure for not having maintenance led to the failure, which delayed the process of not getting the repairs done. She stated she was not sure if the call lights could be repaired, as she believed it to be a wiring issue between the bathroom call light when used and the room call light. The ADM stated her expectations were for the facility to look nice for the residents with them feeling like it was their home and being felt taken care of. Record review of the facility's Open & In Progress work orders dated 10/04/2023 revealed: #1566 Pull string for light in room is missing-Medium priority-Room/Area 808A-Not Assigned #1509 Overhead bed light needs string-Low priority-Room/Area 803A-Not Assigned (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 23 of 25 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 10/05/2023 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 0921 #1521 wall damage-Low priority-Room/Area 706A-Not Assigned Level of Harm - Minimal harm or potential for actual harm #1496 Large hole in wall where recliner use to be-Low priority-Room/Area 501B-Not Assigned Residents Affected - Some #1564 Family states light over the bed is not managed by the cord but by switch-Medium priority-Room/Area 508B-not assigned Record review of the facility policy statement and procedures for Maintenance Service revised December 2009 revealed: Policy Statement: Maintenance service shall be provided to all areas of the building, grounds, and equipment. Policy Interpretation and Implementation: 1. The maintenance department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include, but are not limited to: a. maintaining the building and compliance with current federal, state, and local laws, regulations, and guidelines. b. Maintaining the building in good repair and free from hazard . d. plumbing fixtures, . In good working order. e. Maintaining lighting levels that are comfortable, and assuring that exit lots are in good working order. f. Establishing priorities in providing repair service i. Providing routinely scheduled maintenance service to all areas. j. Others that may be become necessary or appropriate. 3. The maintenance director is responsible for developing and maintaining a schedule of maintenance service to assure that the building, grounds, and equipment are maintained in a safe and operable (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 24 of 25 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 10/05/2023 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 0921 manner. Level of Harm - Minimal harm or potential for actual harm 4. A copy of the maintenance schedule shall be provided to each department director so that appropriate scheduling can be made without interruption of services to residents. Residents Affected - Some 5. Maintenance personnel shall follow the manufacturer's recommended maintenance schedule. 6. Changes in maintenance schedules must be approved by the maintenance director 8. The maintenance director is responsible for maintaining the following record/reports. a. Inspection of building; b. Work order request; c. Maintenance schedule; d. Authorized vendor listing; and e. Warranties and guarantees 9. Records shall be maintained in the maintenance directors office. 10. Maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned. Record review of facility policy Answering the Call Light dated with the revised date of March 2012 revealed: Purpose: The purpose of this procedure is to respond to the resident's requests and needs . .7. Report all defective call lights to the Nurse Supervisor promptly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676376 If continuation sheet Page 25 of 25