Health inspection·November 4, 2022

F 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some activities occurring in the Memory Care Unit; the residents in attendance at Resident Council stated they feel sorry for the residents in the Memory Care Unit because they are never offered activities and only one resident is allowed to leave the Memory Care Unit. The resident who is allowed to leave the Memory Care Unit was in attendance at Resident Council, this resident stated group or individual activities are never offered in the Memory Care Unit, this resident stated the AD never enters the Memory Care Unit. The residents stated they are tired of activities involving food; for example, waiting an hour for an appetizer is not interactive; the resident stated eating is not interactive, they want to have activities that are entertaining and interactive. The residents state they have voiced their complaints in regard to activities, but nothing changed or improved. The residents stated fishing and eating at a restaurant were added to the calendar once in October, but not all residents that wanted to attend could attend due to limited van space and the staff would not offer more than one trip to the restaurant. Observation of resident rooms on 11/02/2022 at 3:45pm revealed there were updated calendars in resident rooms; the activity calendar had very small font; approximately size 8 font. The calendar was not easily identified as the Activity Calendar. The November Activity Calendar was posted in every resident's room in the Memory Care Unit; however, daily observations of the Memory Care Unit indicated only one resident is allowed to participate in the activities outside of the unit. Observation of secure Memory Care Unit on 11/2/2022 at 10:00am five residents are sitting idle in the dining area of the unit staring at the walls. Surveyor interviewed CNA A sitting at the desk in the dining room, the CNA stated there were no planned activities for the Memory Care Unit. Furthermore, the CNA A stated the activity director did not come into the Memory Care Unit. Surveyor was informed there were magazines in the dining area, paints, and adult coloring pages she could give to the residents when she chose. Observation of the Memory Care Unit on 11/2/2022 at 2:00pm six residents were sitting in the dining room area, the television was on, the volume is very low, residents continued to stare at walls. CNA A remained sitting at the desk. Observation on 11/03/2022 at 9:00 am revealed there were no residents in the activity to room to engage in the hydration activity as the November activity calendar indicated. The activities director was observed in her office sitting at her desk on her computer at 9:15am, 9:35am, and 9:50am. Observation of the 10:00am Japanese Alphabet activity revealed no residents in attendance; the activity director was observed at 10:10am, 10:22am, 10:35am, and 10:55am sitting at her desk on her computer. The next activity on the calendar was an Appetizer activity at 11:00am; observed 10 residents in the dining room just sitting at tables with nothing to do; the activity director was observed retrieving a can of fruit from the kitchen and walking the fruit to a cart to prepare the appetizer; observed the activity director continuing to prepare the appetizer at 11:20am while residents sat in the dining room with no interaction. At 11:35am residents were sitting in the dining room while the activity director continued to stand at the cart preparing the appetizer. At 11:50am observed the activity director serve the first resident the appetizer. The dining room was now filled with residents as lunch was served at 12:00pm. Observation on 11/3/2022 at 9:10am there were no activities in the secure, Memory Care Unit. There were 4 residents in the dining room area, one resident was flipping through the pages of a magazine, the other 3 residents were staring at a low volume television; the CNA A on duty was walking around interacting with the residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Big Spring Center for Skilled Care 3701 Wasson Rd Big Spring, TX 79720 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation of dining room in secured unit on 11/03/2022 at 3:00 pm revealed there were no activities being implemented. Six residents were observed sitting in the dining room with no interaction, the television was on with a low volume. Observed most residents in their rooms. Observation on 11/4/2022 at 2:00pm Bingo was being held in the activity room, 3:30pm Bingo continued, the next activity was scheduled at 3:00pm. Observation in the activity room at 4:00pm, Bingo has ended. Observation at 4:15pm there were no residents in the activity room for the 4:00pm activity; the activity director was sitting at her desk on her computer. Observation of dining and living area on the memory care unit on 11/04/2022 at 9:00 am revealed that there were no activities being implemented for this time. Observation of dining and living area on the memory care unit on 11/04/2022 at 11:00am revealed that there were no activities being implemented for this time. Observation of dining living area on the memory care unit on 11/4/2022 at 2:00pm revealed that there were no activities being implemented for this time. Interview on 11/04/2022 at 2:30PM, AD said she has been employed at the facility for 7 years, 1 year as the AD. AD is completing online training and working under another staff member until she obtains her license. the Activity Director stated she has an activity calendar posted in the memory care unit and she confirmed there is only one resident who is allowed to leave the memory care unit for activities on the activity calendar. Surveyor inquired about how residents are supposed to attend the scheduled activities posted when they are not allowed to leave the memory care unit; AD stated she had never thought of that. Surveyor inquired if the memory care unit has their own activity calendar; AD stated there is not a calendar, but she does provide paint, paper, and coloring books for the memory care unit. AD stated she feels there are behavioral issues if there are scheduled activities in the memory care unit. Surveyor inquired about the size of the font on the activity calendar; she states she plans to change the calendar to a larger font there 15 days on the front of the calendar and 15 days on the back of the calendar. Surveyor informed AD resident council participant stated they would like access to the activity room; AD stated the activity room remains locked unless there is an activity; AD stated she is unsure why the room remains locked. AD stated she seeks out residents if there is no attendance at an activity or she will change the activity; Surveyor informed AD she was sitting at her desk when surveyor observed no attendance. Surveyor inquired why the calendar is not followed; AD stated she follow the calendar pretty much. Surveyor inquired if the residents make requests for activities, she stated not really. AD then elaborated and stated the residents had asked to go to a restaurant and fishing; both activities were accommodated. Surveyor inquired if all residents were given the opportunity to attend these activities; she stated only the residents that could ride in the van on the one trip offered to the restaurant and to the fishing spot. Activity director stated that she understands how it may affect the residents and how frustrating it might be for the residents to not know what activities are being offered. Activity director stated that the possible negative for the residents would be that they may become more depressed or irritable that may cause behaviors. Interview on 11/04/2022 at 1:35 pm with the Administrator, he stated his expectation is for the AD to follow the activities on the calendar, ask for resident preferences for activities, and inform residents of any changes to the calendar. The Administrator stated he expects the AD to seek out residents if there is an activity and no one is in attendance. Administrator stated he thought activities were happening in Memory Unit and activities should be occurring in the Memory care Unit. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Big Spring Center for Skilled Care 3701 Wasson Rd Big Spring, TX 79720 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Administrator stated there is a plan to increase the font on the Activities calendar and that should be completed for the December calendar. The December calendar will have 15 activities on the front of the calendar and 15 activities, the font will be doubled in size. Administrator stated he potential negative of residents not having activities is a decreased in quality of life. Administrator stated the AD is almost done with her course so that she will be licensed; she meets with her advisor once a week for assistance with planning activities. Interview on 11/04/2022 at 2:30pm with the CNA B on the Memory Care Unit; CAN said she has been employed at the facility for one year. CNA B stated there are puzzles, magazines, paper, crayons, and paints in the Memory Care Unit, staff utilize the materials with residents two to three times a day. CNA B stated there is no activity calendar for the Memory Care Unit and the AD does not come to the Memory Care Unit to complete activities. CAN B stated no one takes the residents of the Memory Care Unit to activities and there is only one resident who is allowed to leave the unit to attend activities. CNA B stated she feels the residents of the Memory Care Unit should have their own activities calendar and be offered activities several times a day, she feels activities would improve the quality of life for residents in the Memory Care Unit. Record review of facilty Resident Council Minutes for past 6 months revealed Resident concerns with activities in the facility. Residents not satisfied with activity program at faciltiy at this time. Record Review of facility activity calendar policy dated 2011 reflected the following: Activity Programming Standard: The Activity Director and staff will provide for ongoing Activity Programs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Big Spring Center for Skilled Care 3701 Wasson Rd Big Spring, TX 79720 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 Based on observation, interview and record review, the facility failed to provide food that was palatable, attractive and at a safe and appetizing temperature for residents who consumed foods orally from 1 of 1 kitchen. Residents Affected - Some Test Trays revealed foods were cold, lukewarm and had altered flavor not like the original food. These failures could place residents at risk of decreased food intake, hunger, and unwanted weight loss. The findings include: Observation on 11/02/22 at 12:36 PM revealed meatloaf on plate with pink center and cooked outer edges. Confidential interviews during the Resident Council meeting on 11/02/22 at 2:00 PM, five of eight residents voiced concerns regarding food palatability. All five stated the meatloaf that was served for lunch today was raw. In addition, previous meals included hamburgers that were burnt on the bottom and raw in the middle; corn dogs were burned on outside, raw dough in the next layer, and in the center, it was a frozen hot dog. In addition, residents stated every time they had waffles that were frozen in the middle. On 11/03/22 at 5:20 AM the surveyor requested a test tray from the Dietary Manager for the breakfast meal. Observations of the test trays on 11/3/22 at 8:10 am were as follows: Regular texture: Eggs - lukewarm, bland Mechanical soft: Sausage - cold, too much pepper, burned mouth (pepper), not palatable Puree: Toast - not safe and not palatable, thick and sticky texture Egg - multiple large chunks of yolk, cold (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 676380 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Big Spring Center for Skilled Care 3701 Wasson Rd Big Spring, TX 79720 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 - Level of Harm - Minimal harm or potential for actual harm Sausage - not palatable, gritty texture, in appropriate flavor -The following observations were made during a kitchen tour beginning on 11/3/22 at 11:40 AM: Residents Affected - Some Foods on the service line at this time were: Sausage and peperoni with onions 183 degrees Fahrenheit Ranch style beans 160 degrees Fahrenheit Mixed vegetables 190 degrees Fahrenheit Puree meat 207 degrees Fahrenheit Puree break 204 degrees Fahrenheit Mashed potatoes 145 degrees Fahrenheit Interview on 11/04/22 at 10:51 AM with Resident #33, they stated the food was bad and undercooked. Interview on 11/04/22 at 3:20 PM, [NAME] A revealed the dietary staff were aware of food concerns for residents. [NAME] A stated the Dietary Supervisor was not available for interview at this time. [NAME] A stated the residents were at risk of getting sick due to undercooked food. [NAME] A stated the residents were at risk of weight loss due to unsavory food and lack of variety. [NAME] A stated the Dietary Manger oversees all of their work and they received training a few weeks ago regarding the food complaints at the facility. Interview on 11/04/22 at 3:58 PM, ADM stated he expected the dietary staff to follow the policies and menu posted. ADM stated the Dietary Supervisor should be overseeing the other dietary staff and he (ADM) oversees the Dietary Supervisor. ADM stated the residents were at risk of illness and weight loss. Interview on 11/04/22 at 04:15 PM Resident #34 said the food was burnt on outside, and raw on inside. Record review of facilities Preparation of Foods policy dated 2012 revealed the following: We will establish safe and nutritional preparation of food. Food is to be prepared in such a manner as to maximize flavor, appearance, and nutritional value FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 6 of 6