Health inspection·January 25, 2024

F 0550 Resident #65 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #65's face sheet, dated 01/29/24, revealed a [AGE] year-old female was admitted to the facility on [DATE] with diagnoses to include diabetes (high blood sugar), morbid obesity, muscle wasting and cognitive communication deficit (impaired thought organization). Residents Affected - Few Record review of comprehensive MDS assessment dated [DATE], revealed Resident # 65 had a BIMS score of 15, indicating the resident's cognition was intact. The MDS further revealed Resident #65 had an indwelling catheter. Record review of a baseline care plan for Resident #65 dated 11/29/23 revealed a care plan for indwelling catheter. Interventions included: Position catheter bag and tubing below the level of the bladder and in a privacy bag. Check tubing for kinks and maintain the drainage bag off the floor. Record review of consolidated orders for Resident # 65, dated 01/23/24 revealed a physician order for 16 Fr/10ml foley to gravity drainage. Order for catheter bag to be placed in privacy bag while resident is in bed or in wheelchair, and to be checked every shift. Record review Resident #65 treatment administration record dated 01/29/24 for the month of January 2024 revealed privacy bag checked and verified every shift from January 1st through January 28th. 01/23/24 at 2:27 PM, it was observed by two surveyors that Resident #65 was propelling self in wheelchair down hallway to activity room with foley bag hanging from the back of the wheelchair with no privacy bag. Foley collection bag was bulging with urine and visible to others. 01/24/24 at 9:26 AM, observed resident # 65 in bed. It was noted that no privacy bag was covering the collection bag. 01/24/24 at 10:06 AM, entered resident room with LVN B. No privacy bag was covering the collection bag. During an interview on 01/24/24 at 1:48 PM with LVN B, she stated a resident's catheter bag should be in a privacy bag at all times. She stated nursing staff were responsible for making sure catheter drainage bags were in a privacy bag or have a cover. She stated the potential negative outcome was a dignity issue. During an interview on 01/24/24 at 1:52 PM, CNA A stated a resident's catheter drainage bag should always be in a privacy bag. She stated the CNA's and nurses were responsible for making sure drainage bag have a privacy bag. She stated the potential negative outcome could be resident dignity. During an interview on 01/25/24 at 11:40 AM with the DON, she stated the catheter drainage bag should have a privacy bag or cover at all times. She stated the nursing staff were responsible for making sure the catheter drainage bag was covered. She stated the negative outcome could be tension on the bag, and compromise of the bag integrity. She stated her expectations were for everyone to have a privacy bag or cover. During an interview on 01/25/24 at 11:50 AM with the ADM, she stated privacy bags should be on catheter bags anytime the resident is in bed or in the wheelchair. She stated nursing staff are responsible for proper bag placement and privacy of bag and that she was not aware until yesterday that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 2 of 28 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 01/25/2024 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 0550 catheter bags lacked privacy coverings. Level of Harm - Minimal harm or potential for actual harm Record review of facility-provided training titled Catheters dated 10/15/23, stated catheters should be covered at all times and was signed by 16 staff members. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 3 of 28 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 01/25/2024 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 0576 Ensure residents have reasonable access to and privacy in their use of communication methods. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure that residents received mail for 9 of 12 residents reviewed for rights to forms of communication for 1 of 1 facility reviewed for mail being delivered on Saturdays. Residents Affected - Some The facility failed to: 1.) Ensure that mail had been delivered to all residents on all days that the United Postal Service delivered mail. This failure could result in a decline in the resident's psychosocial well-being and cause them to feel disconnected from family, friends, and current world issues. The findings include: During a confidential interview on 01/24/2024 at 2:00 PM, 12 residents reported that the facility does not deliver mail on the weekends, the resident stated, We only get mail M-F because offices are closed. An interview with BOM on 01/25/2023 at 9:44 AM revealed the mail will be delivered when it was dropped off by the carrier. BOM stated the mail usually gets to the facility around 5-6 PM, Monday through Friday. BOM stated that the mail was supposed to be delivered on Saturdays, but she has never seen it delivered on Saturdays since she has worked for the facility. BOM stated she called the post office and spoke with one of the workers and was told they were shorthanded. BOM stated she had not put in a formal complaint. BOM stated if the mail were to be delivered on Saturday, then the post carrier would leave it at the front and a staff member would put it all in her box until Monday so she could go through the mail and sort it out and then it would be delivered on Monday. BOM stated she worked for the facility for a while. BOM stated she does not work the weekends. BOM stated she only knows the mail had not been delivered on Saturdays because staff will tell her it had not been delivered. BOM stated there was not a designated staff member to pick up the mail if it were to be delivered on Saturdays, just any staff member could pick up the mail. BOM stated she was unsure what the policy stated about residents receiving mail on the weekends. BOM stated the negative potential outcome of residents that had not received their mail is that they may feel that their rights are restricted, An Interview with AD on 1/25/2024 at 10:00 AM. AD stated that she had been working in the facility for two years. AD stated that normally the BOM will go through the mail first to retrieve anything for the business office first and then she will give her what is supposed to be delivered to the residents. She stated that there is not a designated person to pick up mail from the front when mail is delivered on the weekends. AD stated that no formal complaints have been made. AD stated that the mail does come on the weekends but there had been times that it had not been delivered on the weekends. AD stated that had not happened too many times. AD stated that sometimes she will come in to work on the weekends and if she is there, she will pass out the mail, but she is not scheduled to work. AD stated that on the weekends the staff is instructed by the BOM to pick up mail and put it all in the BOM mailbox until she has a chance to go through the mail and then the BOM will do that on Monday. She stated that the negative potential outcome of residents not receiving their mail on weekends could be that they are expecting a certain piece of mail and could not get it when they need it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 4 of 28 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 01/25/2024 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 0576 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some An Interview with Marketing Administration on 1/25/2024 at 10:12 AM. Marketing Administration Staff stated that she had worked in the facility for nine years. She stated that the mail does get delivered to the facility on the weekends but there are times that they do not get the mail. She stated that the staff is supposed to pick the mail up from the front and put in the BOM mailbox until the BOM gets to work on Monday to go through the mail and then it is passed out to the residents. Marketing Administrator stated that the BOM does not work on the weekends and that she only works Monday -Friday 8 am-5pm. She stated that she is not designated to pass out the mail to the residents, but the Activity Director is designated to pass out the mail after the BOM goes through it, Monday through Friday but not the weekends. An Interview with Administrator, Area Director of Operations, and Regional Nurse on 1/25/2024 at 10:32 AM. Administrator stated that the mail is delivered every day except Sunday. Administrator stated mail is delivered on the weekend and a manager on duty is supposed to pick it up and pass it out to the residents. Administrator stated that Monday-Friday, when the mail is delivered, the BOM will go through the mail and then it will be dispersed to the residents. Area Director of Operations stated that he had not heard of any residents not getting their mail. Administrator stated that she had only been in the facility for a brief time (couple of months) but was unaware of residents not getting mail. Regional Nurse stated that the BOM is now completing a complaint form on the computer on the post office. All staff stated they have not been in the facility long. Area Director of Operations stated that he expects the residents to receive their mail when it is delivered to the facility. Area Director of Operations and Administrator stated that the facility had recently gone through staff changes including Administrator. Administrator stated that she will do an in-service with the staff. An Interview with Post Office Manager on 1/25/2024 at 10:58 AM. Post Office Manager stated that he is not aware of any complaints of the mail not being delivered to the facility. He stated that he had not had any recent complaints of people not receiving their mail on the weekends. He stated that he is in the building and the facility staff could have called or came in to voice their concerns if they had not been receiving their mail. Post Office Manager did look on the computer to confirm that no complaints had been made by the facility at any time. He stated that he had been the manager at this post office for 4 years and he is not aware of any complaints from the facility at all. He stated that he does check up on his mail carriers from time to time by sending other employees out with that carrier or they will do a spot check. He stated that the mail is delivered to the facility on all days if there is mail to be delivered at the facility. Record review of the facility policy titled, Resident Mail Delivery and Distribution, Revised 2011, revealed the following documentation: Standard Statement The health care center will develop a system to deliver and distribute resident mail in accordance with privacy and confidentiality regulations. Practice Guidelines: 1. The Activity Department appoints a specific staff member to coordinate mail delivery every day that the facility receives mail or parcels. 2. All resident mail is delivered to residents unopened. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 5 of 28 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 01/25/2024 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to recognize the residents right to formulate an advance directive for one of six residents (Resident #47) reviewed for Do Not Resuscitate (DNR) status. The facility failed to enter a do not resuscitate code status for Residents #47 in his chart between the dates of [DATE] to [DATE]. This failure could place residents at risk of not having their end of life wishes met. Findings include: Record review of the Face Sheet for Resident #47 reflected he was admitted on [DATE] with diagnoses of End Stage Renal Disease. Record Review of physician orders dated [DATE], for Resident #47 reflected an order for full code initiated on [DATE]. Record review of the Care Plan for Resident #47 with a Date Initiated of [DATE] and a Target Date of [DATE] reflected interventions were in place for a full code. Interventions included Request for CPR to be initiated if resident #47 was without a heartbeat or not breathing. Record review of Resident #47's Out of Hospital Do not Resuscitate Order (OOH-DNR) reflected the resident's signature on [DATE] and the physician's signature on [DATE]. The DNR was included in his electronic file. In an interview on [DATE] at 10:14 AM with LVN A, she said the nurses can determine who was a full code or DNR by looking at the face sheet of a resident's chart. She said she thought they have a list of residents who were DNR, but she was not sure if they do have that list or not. She said resident #47 was a full code per his chart face sheet. She said in an emergency where CPR (cardio-pulmonary resuscitation) may be required, she would determine the resident to be a full code and proceed to provide emergency rescue to this resident. She said when residents sign a DNR they will call their physician for an order and fax a copy of the DNR to the physician. She said receiving orders for the DNR depend on how busy the physician was. She said if there was an out of hospital DNR but no order, she would follow the current order which was a full code for Resident #47. In an interview with the DON on [DATE] at 11:50 AM, she said staff knows a resident was a DNR by the OOH-DNR form and the electronic chart. She said if a resident has a DNR on file, but no physician order has been placed in the chart, she expected her staff to follow the signed DNR. She said she was made aware of Residents #47's signed DNR after surveyor intervention and his code status has been corrected. She said the negative consequences of not following a signed DNR were not following the residents wishes and a violation of their rights. She said staff has annual training on advanced directives. She said when a new DNR was signed, if required, she expected nursing to put the request for the order and follow up. She said the social worker was responsible for obtaining the DNR and sending it to the nurse. The nurse was then to put it into the chart. She said as of [DATE] their policy will change on who was responsible for managing the DNR orders. She said the DNR's will come to the DON to follow-up and make sure the orders were placed in the electronic record. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 6 of 28 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 01/25/2024 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview with the ADM on [DATE] at 11:53 AM, she said nurses can see who was a Do Not Resuscitate by looking in point click care (electronic chart system), and by looking at the resident's face sheets. She said when the DNR was signed by the family, the resident, and the physician the DNR becomes valid. She said she was not aware of Resident #47's DNR form being in his electronic medical record, but it would be revised immediately. She said the negative consequences of not following a signed DNR was not following the residents wishes. She said staff expectation after a new DNR was signed by the resident or power of attorney (POA), was to be given to medical records and they will scan it into the chart. She said the nurses oversee calling the physician's office and obtaining an order for the DNR status. She said staff was trained on advanced directives with their yearly competency. She said she was not sure when the last training was. She said when a resident has a new DNR the DON and ADON were responsible for checking the orders were in place. She said the social worker can do the audits of the orders as well. The facility policy titled Advance Directives Policy and Record with a revised date of [DATE] stated: It is the facility's policy to recognize and implement the resident's rights under state law to make decisions concerning medical care, including the right to accept or refuse medical treatment and the right to formulate Advance Directives. 1. Decisions concerning medical care and a valid advance directive. Facility agrees to honor: a. Decisions concerning medical care, including the right to accept and refuse treatment, when made in accordance with state law. b. Valid Advanced Directives made in accordance with state law. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 7 of 28 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 01/25/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a resident who was incontinent of bladder, received appropriate treatment and services to prevent urinary tract infections for 1 of 1 residents with a urinary catheter (Resident #65); in that: 1. The facility failed to position the catheter collection bag and tubing in a manner to prevent infections. 2. The facility staff failed to use proper infection control precautions when proving foley care. These failures could place residents at risk for urinary tract infections. The findings include: Resident #65 Record review of Resident #65's face sheet, dated 01/29/24, revealed a [AGE] year-old female was admitted to the facility on [DATE] with diagnoses to include diabetes (high blood sugar), morbid obesity, muscle wasting and cognitive communication deficit (impaired thought organization). Record review of comprehensive MDS assessment dated [DATE], revealed Resident # 65 had a BIMS score of 15, indicating the resident's cognition was intact. The MDS further revealed Resident #65 had an indwelling catheter. Record review of a baseline care plan for Resident #65 dated 11/29/23 revealed a care plan for indwelling catheter. Interventions included: Position catheter bag and tubing below the level of the bladder and in a privacy bag. Check tubing for kinks and maintain the drainage bag off the floor. Record review of consolidated orders for Resident # 65, dated 01/23/24 revealed a physician order for 16 Fr/10ml foley to gravity drainage. 01/24/24 at 9:26 AM, observed Resident # 65 in bed with catheter collection bag laying directly on the floor. CNA A was observed leaving the room just prior to surveyor entering room. 01/24/24 at 10:06 AM, entered resident room with LVN B and observed resident # 65 in bed with catheter collection bag laying directly on the floor. LVN B picked catheter collection bag up and stated, it looks like the hook broke off, but this should not be on the floor. LVN B reconnected hook to the collection bag and hung bag from bottom of bedframe. During the same observation on 1/24/24 at 10:06 AM, for foley catheter care for Resident # 65, CNA A was observed cleaning foley catheter tubing beginning approximately 4 from the body and cleaning in the direction towards the urinary meatus (urethral opening). CNA A then repeated the same cleaning method with another cleansing wipe, cleaning catheter tubing in the direction towards urinary meatus. 01/24/24 at 11:23 AM, observed CNA A wheeling Resident # 65 down hallway 200 and around nurse's station to hall 300 with foley bag hanging from the wheelchair and dragging on the ground. The collection bag was full and the top of the foley bag and tubing were dragging on the floor. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 8 of 28 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 01/25/2024 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 01/24/24 at 1:48 PM with LVN B, she stated catheter bags and tubing should not be dragging or laying on the floor. She stated the potential negative outcome of the catheter bag/tubing being on the floor could be the bag gets stepped on, causes a backflow of urine, or puts the resident at risk of infection. LVN B she stated proper catheter care was to hold catheter tubing then use cleansing wipe to clean from the insertion point down about 3-4 inches away from the body. LVN B stated she has been trained on proper catheter care by corporate video training and by nursing administration. She stated the potential negative outcome of improper catheter care would be introducing bacteria into the body and making residents more prone to urinary tract infections. During an interview on 01/24/24 at 1:52 PM, CNA A stated the catheter tubing should not be dragging on the floor and the drainage bag should not be on the floor. She stated the potential negative outcome could be infection. CNA A stated proper catheter care was to clean tubing from about 2 inches away from the body and then wiping in the direction of the body. She stated she has been trained on proper catheter care and receives training about every 3 months. She stated the potential negative outcome of improper catheter care could be infection. During an interview on 01/25/24 at 11:40 AM with the DON she stated catheter tubing should not be dragging on the floor and catheter drainage bags should not be on the floor. She stated the potential negative outcome could be infection. She stated she had been made aware of Resident #65's catheter bag on the floor and had conducted a staff in-service after surveyor intervention. DON stated staff have been trained on foley care and peri care. She stated staff was trained minimum yearly and as needed with skills checks. She stated the DON and ADON oversee training. She stated her expectation of staff when performing foley care and peri care was to follow policy and perform care correctly. She stated negative consequences of improper foley care and peri care can be pushing organisms into the body, UTI, and bladder infections. During an interview on 01/25/24 at 11:50 AM with the ADM, she stated stated catheter bags should not be placed on or dragging the floor. She stated nursing staff were responsible for proper bag placement and that she was not aware until yesterday that catheter bags had been improperly placed on the floor. ADM stated potential negative outcome for improper bag placement would be potential contamination and infections. She stated staff have been trained on foley care and peri care and they are trained annually and as needed if there was a concern. She stated the DON and ADON oversee the training. She stated her expectation during peri care and foley care was to clean from dirty to clean and away from the urethral opening. She stated the negative consequences of improper peri care and foley care are risk of infection and discomfort for the resident. Record review of the facility-provided policy titled Catheter Care, dated [DATE] (revised) revealed the following: General Guidelines: 10. Be sure the catheter tubing and drainage bag are kept off the floor. 16. Gently wash, rinse and dry around the juncture of the catheter and meatus. If using pre-moistened, no-rinse disposable wash cloths, rinsing is not required. 17. Then wash the catheter from the meatus down the tube about 3 inches. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 9 of 28 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 01/25/2024 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure each resident's drug regimen was free of unnecessary medication for 2 of 21 residents reviewed for unnecessary medication (Resident #69 and #123). Residents Affected - Some The facility did not monitor Resident #69 for side effects of the anticoagulation medication Aspirin (blood thinning medication) or Enoxaparin Sodium Injection (a blood thinning medication). The facility did not monitor Resident #123 for side effects of the anticoagulation medication Warfarin (a blood thinning medication). These failures could place the residents at risk for adverse consequences of medication. Findings included: Resident #69 Record review of Resident #69's face sheet dated 01/24/24, revealed a [AGE] year-old-female was admitted to the facility on [DATE] with diagnosis to include atherosclerotic heart disease (buildup of plaques inside the artery), atrial fibrillation (irregular heartbeat), peripheral vascular disease (narrowed blood vessels reduce blood flow to the limbs), and history of stroke. Record review of Resident #69's Comprehensive MDS , dated 01/14/24, indicated Resident #69 had a BIMS score of 14, which indicated the resident's cognition was intact. Section N - medications indicated resident received anticoagulant and antiplatelet during the last 7 days. Record review of the physician orders dated 01/24/24 indicated Resident #69 was prescribed the following medications: *Aspirin (anticoagulant) 81 mg one time a day for anticoagulant with a start dated of 01/09/24. *Enoxaparin Sodium Injection (anticoagulant) 40mg/0.4ml one time a time for DVT (deep vein thrombosis) prophylaxis. The orders did not address monitoring the anticoagulant. Record review of a care plan dated 01/08/24 indicated Resident #69 was on anticoagulant therapy with interventions to monitor/document/report to MD sign or symptoms of anticoagulant complications. Record review of MAR dated 01/24/24 indicated Resident #69 received aspirin 81mg one time a day as ordered from 01/09/24 through 01/24/24. Record review of TAR dated 01/24/24 indicated Resident #69 received enoxaparin sodium injection prefilled syringe 40mg/0.4ml one time a day as ordered from 01/09/24 through 01/24/24. Record review of the electronic record for Resident #69 did not indicate the nurses documented monitoring of side effects of anticoagulant daily with medication administration. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 10 of 28 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 01/25/2024 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 0757 Resident #123 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #123's face sheet, dated 01/23/24, revealed a [AGE] year-old-male was admitted to the facility on [DATE] with diagnosis to include presence of prosthetic heart valve (replacement heart valve) , peripheral vascular disease (narrowed blood vessels reduce blood flow to the limbs), unspecified sequelae of cerebral infarction (neurologic effects that persist after the initial episode of stroke), and diabetes (high blood sugar). Residents Affected - Some Record review of Resident #123's EMR indicated Comprehensive Minimum Data Set was not completed. Record review of the physician orders dated 01/23/24 indicated Resident #123 was prescribed Warfarin (a blood thinning medication) 5 mg daily related to presence of prosthetic heart valve with a start date of 01/23/24. The orders did not address monitoring the anticoagulant medication. Record review of a care plan dated 01/22/24 indicated Resident #123 has peripheral vascular disease with interventions to give medications for improved blood flow or anticoagulants as ordered. No care plan related to monitoring anticoagulants. Record review of MAR dated 01/23/24 indicated Resident #123 received Warfarin 5mg daily as ordered. Record review on 01/23/24 of the electronic record for Resident #123 did not indicate the nurses documented monitoring of side effects of anticoagulant daily with medication administration. During an interview with LVN A on 01/25/24 at 09:00 AM, she stated anticoagulants should be monitored daily. She stated the documentation was on the TAR. She stated Resident #69 did have an order for aspirin and enoxaparin, but the enoxaparin had been discontinued effective today (01/25/24). She stated Resident #69 did not have an order for monitoring for signs or symptoms related to anticoagulants. She stated there was no documentation on the TAR or progress notes. She stated Resident #123 had an order for Warfarin 5mg daily. She stated Resident #123 did not have an order for monitoring for signs or symptoms of anticoagulants and there was no documentation on the TAR or progress notes. She stated the admission nurse or nurse or received the order for anticoagulant was responsible for putting in the order for monitoring. She stated she had been trained on putting in orders for monitoring anticoagulant medications. She stated the potential negative outcome could be staff not knowing and see bleed and think it's just a scratch and it could be much worse. She stated she does not know why the order for monitoring was not on orders. She stated both Resident #69 and #123 should have had an order because warfarin and enoxaparin were anticoagulants. She stated the monitoring needed to start when the medication was ordered. During an interview with the DON on 01/25/24 at 09:10 AM she stated warfarin and enoxaparin were anticoagulants and required monitoring daily. She stated Residents #69 and #123 does not have an order for monitoring or any documentation on the TAR for monitoring. She stated monitoring started on admit or the date or the anticoagulant order. She stated all staff have been trained to monitor anticoagulants and how to put orders in the EMR. She stated she was not sure why there was no monitoring for Resident #69 or #123. She stated the admission nurse or the nurse who received the order was responsible for putting in the order for monitoring. She stated the MDS nurse reviews medications and orders and will notify her if order was missing. She stated the potential negative outcome could be a resident develop a bleed and not catch it till it's too late. She stated not monitoring anticoagulants does not give opportunity to get PRN PT/INR. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 11 of 28 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 01/25/2024 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 0757 Level of Harm - Minimal harm or potential for actual harm During an interview with the ADM on 01/25/24 at 09:45 AM she stated the nurses should be monitoring residents taking anticoagulant daily. She stated the DON and ADON were responsible for making sure anticoagulants were being monitored. She stated all staff were trained. She stated the potential negative outcome could be bleeding which could have a bad outcome. She stated she expects monitoring to be done daily and documented. Residents Affected - Some On 01/25/24 at 10:30 AM surveyor requested policy related to monitoring anticoagulants. No facility policy provided. On 01/25/24 at 12:15 PM during exit conference ADM and DON were asked if they had any additional information to provide that was requested. ADM and DON replied No. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 12 of 28 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 01/25/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure all drugs and biologicals were stored properly in the cart for 1 of 4 medication carts (med cart on hall 300). CMA B had loose pills in the medication cart assigned to her on hall 300. Medication was identified as Atorvastatin 10 mg and belonging to Resident #17. This failure could place residents at risk of not receiving prescribed medications as ordered and drug diversions . The findings include: Record Review of Resident #17's face sheet documented he was a [AGE] year-old male who was admitted to the facility on [DATE] with a diagnosis of: end stage renal disease, muscle weakness, type 2 diabetes, hyperlipidemia (a condition in which there are high levels of fat particles in the blood), high blood pressure, atrioventricular block (a heart rhythm disorder that causes the heart to beat more slowly than it should), cardiac arrythmias (improper beating of the heart, whether irregular, too fast or too slow), low blood pressure, acid reflux, aphagia (the loss of the ability to swallow), stroke, type 2 diabetes. Record Review of Resident #17s physician orders dated 07/28/2023 revealed: Atorvastatin Calcium Oral Tablet 10 mg, give one tablet by mouth one time a day related to hyperlipidemia, ordered dated on 07/28/2023. Observation of hall 300 medication cart check with CMA B on 1/23/2024 at 3:47 pm. revealed two loose medications that were found in cart drawer. The loose medication was identified as two Atorvastatin 10 mg and belonging to Resident #17. Interview with CMA B on 1/24/2024 at 1:37 pm, CMA B stated there was not supposed to be loose pills in the carts. CMA B stated t she was supposed to check the cart once she assumed responsibility for the cart. CMA B stated she did check the cart once when she came to work but did not notice the loose pills. CMA B helped to identify the two loose pills as Atorvastatin 10 mg (treats high cholesterol and triglyceride levels) (This may reduce the risk of angina, stroke, heart attack, and heart and blood vessel problems) belonging to Resident #17. CMA B stated the policy stated that she was to destroy the medication if it was loose in the cart. CMA B stated the negative potential outcome was the resident would come up short on medication and the pharmacy would not refill the medication if it were too soon so the resident would have to be without the medication. CMA B stated she had been trained in medication storage in the form of in-services. CMA B stated that she had not been in-serviced in a while about medication storage, but it had probably been about a month or so. Interview with LVN A on 1/24/2024 at 1:20 pm. LVN A stated that she was the charge nurse on the 300 hall where the loose medications were found on the cart. LVN A stated that the policy stated the loose medication would need to be discarded properly and the CMA would need to notify charge nurse. LVN A stated that training had been provided for medication storage and is believed to be provided a couple times a year by computer. LVN A stated that the negative potential outcome for loose (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 13 of 28 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 01/25/2024 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medications would be that the pills could be mistaken for something else and accidentally given to someone who did not need them. LVN A stated that the resident that was missing the medication could also have a missed medication causing health to decline. LVN A stated that she would expect CMAs to check their carts and report missing medication found and correctly discard the medication. Interview with DON on 1/25/2024 at 9:52 am, the DON stated that she expects staff to discard medication that is found that is loose in the cart. DON stated that she does expect staff to check carts upon accepting responsibility of the cart. DON stated that the negative potential outcome of loose medications is the resident would have missed the medication that was loose and had to be discarded. DON stated that training has been provided and is in in-services and computer training and is provided often. Record Review of facility provided policy, labeled, Medication Administration Procedure, provided on 1/25/2023 at 11:00 am revealed: 3. Open the unit dose package only when you are administering medications directly to the resident. Removing the medication from its unit dose packaging in advance lessens the ability to positively identify the medication and increases the chance of drug administration errors contamination. Policy heading: The facility stores all medications and biologicals in locked compartments under proper temperature, humidity, and light controls. Only authorized personnel have access to keys. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 14 of 28 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 01/25/2024 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, the facility failed to ensure each resident received, and the facility provided food prepared in a form designed to meet individual needs for 2 of 2 noon meals observed for puree. The facility failed to provide food that was in a form to meet resident needs for 2 of 2 meals observed (01/23/24 and 01/24/24). Foods were not pureed and had chuncks that still had to be chewed. These failures could place residents at risk of decreased food intake, choking and aspiration. The findings included: During an observation on 01/23/24 at 11:15 AM [NAME] A prepared puree BBQ ribs, backed beans, potato salad. Surveyor tasted BBQ ribs had chunks of meat that had to be chewed. The baked beans had large pieces of bean skin and was runny. The potato salad had chunks that had to be chewed. During an interview on 01/24/24 at 06:17 PM [NAME] A stated puree should be mashed potato or pudding consistency. She stated she could not get the BBQ ribs to the consistency she wanted because of the gristle and bones. She stated all puree food items served were not at the right consistency. She stated she had been trained on how to prepare puree foods. She stated the potential negative outcome could be chocking risk or aspiration. During an observation on 01/24/24 at 12:45 AM surveyor tested a puree test tray with the following items: fried chicken, green beans with baby potatoes and honey kissed roll. It was found fried chicken was not smooth had chunks that had to be chewed. [NAME] beans with baby potato had chunks had to be chewed and runny. The honey kissed roll was runny. During an interview on 01/25/24 at 08:30 AM the DM stated puree food should be smooth with pudding consistency with no chunks and should not be runny. She stated all staff have been trained on how to prepare puree foods. She stated the potential negative outcome could be a pocketing food and choking hazard. She stated she was responsible to monitoring staff for correct puree texture. During an interview on 01/25/24 at 09:45 AM the ADM she stated puree food should be pudding consistency, well blended with no chunks or runny. She stated all staff have safe server certificates. She stated the DM, speech therapist and cook were responsible for monitor the consistency of foods. She stated her expectations were for puree to be pudding consistency. She stated the potential negative outcome was chocking or aspiration. She stated, residents were on puree texture diet for a reason. Record review of the facility policy titled Consistency Modification, dated 2012, revealed the following documentation, We will adequately meet nutritional needs of the resident and provide food in a consistency that the resident can tolerate. Procedure: 1. Diets such as regular, renal and diabetic may be combined with texture modifications or other (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 15 of 28 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 01/25/2024 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 0805 consistency changes. All modifications are based upon the resident's needs . Level of Harm - Minimal harm or potential for actual harm 3. The pureed diet is given to residents with chewing, swallowing or chocking problems. The desired consistency for blended foods is that of applesauce to mashed potatoes. Small grains may be present in some foods, but these are acceptable as long as they are no longer than the grains present in applesauce and of a consistent size . Residents Affected - Some Guidelines for pureed diets: 1. Eye appeal is important. Items re served attractively on the plate with appropriate garnishes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 16 of 28 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 01/25/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. 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 reviewed for dietary services and 1 of 1 dining room observed, in that: 1. The facility failed to ensure foods were processed and pureed under sanitary conditions. 2. The facility failed to ensure foods were served at temperature above 135 degrees Fahrenheit. 3. The facility staff failed to use proper infection control precautions by touching the top of open cups and bowls while serving meal trays during one of one dining observation. These failures could place residents at risk for food contamination and foodborne illness. The findings included: The following observations were made on 01/23/24 at 11:15 AM during observation of puree meal preparation: After pureeing potato salad, [NAME] A took processor bowl, lid, and blade to 3 compartments sink and cleaned all 3 parts. [NAME] A took all there parts back to processor base and assembled. Bowl had water in bottom and lid was dripping water. [NAME] A prepared puree baked beans then took processor bowl, lid, and blade to 3 compartments sink and cleaned all 3 parts. She then took bowl, lid and blade to processor base and assembled. The bowl, lid and blade had water on all of them and water was dripping off the processor onto table and floor. Observation was made on 01/23/24 at 11:50 AM while observing [NAME] A temp puree foods. Puree BBQ ribs temperature was 92 degrees Fahrenheit. [NAME] A placed puree BBQ ribs in microwave bowl and microwaved to reheat to temp. [NAME] A re-temped BBQ ribs was 135.5. [NAME] A placed puree BBQ ribs on steam table. During an observation of dining on 1/23/24 at 12:22 pm. CNA B was observed delivering a resident lunch tray in the dining room. CNA B was seen cupping her hand over the uncovered top of the resident cups that was filled with the resident's drinks. During an observation on 01/23/24 at 12:32 PM the ADON was observed serving residents meal by picking the uncovered glass up off tray, by the rim, with bare hands. During an observation on 01/23/24 at 12:35 PM the ADON was observed serving residents meal by picking the uncovered glass and bowl up off the tray, by the rim, with bare hands. During an observation on 01/23/24 at 12:57 PM in the dining room, CNA B was observed passing a drink from a tray to a resident at the assistive feeding table. CNA B was observed handling the cup with her hand over the top of the drink. The cup was observed to have no covering or wrap over the drinking area to protect it from being contaminated. During an Interview with CNA B on 1/23/24 at 12:38 PM CNA B stated that she has been trained in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 17 of 28 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 01/25/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm infection control. CNA B stated that she was aware that she used her open hand to cover the top of the open cups filled with the Residents drink for lunch. CNA B stated that she did not realize that she was not supposed to hold the cups at the top with an open hand. CNA B stated that the training for infection control had been held approximately monthly through in-services. CNA B stated that the negative potential outcome was possible cross contamination. Residents Affected - Some During an interview on 01/23/24 at 02:06 PM with the ADON she stated she has been trained on infection control. She stated she was the infection preventions. She stated she has not finished all her training and was supposed to be going to another facility to train. She stated she has been here one month and was still learning. She stated when she was here, she spends 50 % of her time completing training. She stated she has not been trained at this facility to serve trays to residents, but she has had training in the past. She stated she does not know what their policy says regarding serving meal trays or how to serve meal trays. She stated negative outcomes of not handling trays correctly was risk of infection. ADON stated cups usually have lids that fit to protect the cups but today they did not have them. During an interview on 1/25/24 at 11:50 AM with the DON she stated the ADON was the infection preventionist. She stated handwashing and infection prevention training was conducted quarterly and was ongoing. She stated the negative consequences of not performing handwashing was transferring organisms to resident and self and contaminating high touch areas. She stated her expectation of staff when serving meals was, not grabbing them by the top and to take plates from tray and place on the table without touching and perform handwashing right after. She stated staff are trained to serve meals upon hire, during orientation to the floor and as needed. She stated negative consequences of improper handling of plates and cups during meal service was transferring germs from person to person. During an interview on 1/25/24 at 11:53 AM with ADM, she stated the ADON was the infection preventions. She stated staff was trained on infection prevention and handwashing monthly. She stated they are part of a QIPP program that required the facility to train a percentage of staff monthly. She stated the DON and ADON over that training. She stated the negative consequences of not handwashing or following infection prevention was spreading infection and a poor outcome for the residents. She stated her expectation of staff when serving meals was to delivery it timely and to make sure to wash their hands before and after serving to residents regardless of if they are in the dining room or in their bedrooms. She stated staff was trained to hold the plates and cups by the sides and the negative consequence of improper handling was passing on bacteria or any infection. She stated they shave trained their CNA's but was not sure when the last training was. During an interview on 01/24/24 at 06:17 PM with [NAME] A, she stated she did not have time to allow the puree processor parts to dry. She stated, I tried to shake all the water off. She stated she was supposed to let all parts dry before using. She stated she has been trained to allow the processor parts to dry before use. She stated the potential negative outcome could be the sanitizer mixing into the food and causing a resident to get sick. She stated she did not know what the temp should be when reheating food in the microwave. She stated the puree BBQ ribs were at 135 degrees when she placed them on the steam table. She stated the potential negative outcome could be food borne illness, unpleasant taste and allow bacteria to grow. During an interview on 01/24/24 at 06:25 PM with the dietitian, she stated the temperature for microwave re-heat food was 14 degrees, I think. She stated the potential negative outcome could be bacteria growth and contamination. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 18 of 28 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 01/25/2024 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 0812 Level of Harm - Minimal harm or potential for actual harm During an interview on 01/25/24 at 09:45 AM with the ADM, she stated re-heated food should not have been served at 135.5 degrees. She stated food re-heated in microwave should be at 165 degrees. She stated all staff have been trained in the kitchen. She stated the potential negative outcome could be food borne illness and not serving palatable food. Residents Affected - Some Record review of the facility policy, titled Meal Temperature Record dated 2012, revealed the follow: 2. During meal service, hot foods must be maintained at a minimum internal temperature of 140 degrees F or above while holding and serving . 5. If temperature does not meet minimum standards, food products will be sent back to be heated or chilled to proper temperature prior to service. Hot foods should be reheated to 165 degrees F for at least 15 seconds . 6. Once pureed food has been processed to achieve proper consistency, it shall be reheated to 165 degrees F for 15 seconds prior to service . Record review of the facility policy, titled Equipment Sanitation, dated 2012, revealed the following: We will provide clean and sanitize equipment for food preparation period the facility will clean all food service equipment in a sanitary manner . 8. Blenders and food processors bowls should be inverted after cleaning to drain/dry on shelves or trays with vented slots or bar netting . Record review of facility policy titled Infection Control Plan: Overview from the Infection Control Policy and Procedure Manual 2019, revealed: The facility will establish and maintain, and Infection Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. Preventing Spread of infection: . (3). The Facility will require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice . Intent: Implement hand hygiene (hand washing) practices consistent with accepted standards of practice to reduce the spread of infections and prevent cross-contamination . Hand Hygiene . Before and after assisting a resident with meals. Upon and after coming in contact with a resident's intact skin (e.g., when taking a pulse or blood (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 19 of 28 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 01/25/2024 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 0812 pressure, and lifting a resident) Level of Harm - Minimal harm or potential for actual harm After contact with a resident's mucous membranes and body fluids or excretions. After removing gloves or aprons; Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 20 of 28 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 01/25/2024 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 0880 Provide and implement an infection prevention and control program. 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 establish and maintain an infection prevention and control program, designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. Residents Affected - Some 1. The facility staff failed to use proper infection control precautions by touching the top of open cups and bowls while serving meal trays during one of one dining observation. 2. The facility staff failed to wash their hands before medication administration to Residents #67 and #38. 3. The facility staff failed to use proper infection control precautions when providing incontinence care to Resident #1. These failures could place residents at risk for infection through cross contamination of pathogens. Findings include: During an observation of dining on 1/23/2023 at 12:22 pm. CNA B was observed delivering a resident lunch tray in the dining room. CNA B was seen cupping her hand over the uncovered top of the resident cups that was filled with the resident's drinks. During an observation on 01/23/24 at 12:32 PM the ADON was observed serving residents meal by picking the uncovered glass up off tray, by the rim, with bare hands. During an observation on 01/23/24 at 12:35 PM the ADON was observed serving residents meal by picking the uncovered glass and bowl up off the tray, by the rim, with bare hands. During an observation on 01/23/24 at 12:57 PM in the dining room, CNA B was observed passing a drink from a tray to a resident at the assistive feeding table. CNA B was observed handling the cup with her hand over the top of the drink. The cup was observed to have no covering or wrap over the drinking area to protect it from being contaminated. During an Interview with CNA B on 1/23/2024 at 12:38 PM CNA B stated that she has been trained in infection control. CNA B stated that she was aware that she used her open hand to cover the top of the open cups filled with the Residents drink for lunch. CNA B stated that she did not realize that she was not supposed to hold the cups at the top with an open hand. CNA B stated that the training for infection control had been held approximately monthly through in-services. CNA B stated that the negative potential outcome was possible cross contamination. During an interview on 01/23/24 at 02:06 PM with the ADON she stated she has been trained on infection control. She stated she was the infection preventions. She stated she has not finished all her training and was supposed to be going to another facility to train. She stated she has been here one month and was still learning. She stated when she was here, she spends 50 % of her time completing training. She stated she has not been trained at this facility to serve trays to residents, but she has had training in the past. She stated she does not know what their policy says regarding serving (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 21 of 28 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 01/25/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm meal trays or how to serve meal trays. She stated negative outcomes of not handling trays correctly was risk of infection. ADON stated cups usually have lids that fit to protect the cups but today they did not have them. Resident #67: Residents Affected - Some Record Review of Resident #67's face sheet revealed a [AGE] year-old male who was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with a diagnosis of: heart failure, Chronic Obstructive Pulmonary Disease (a group of lung diseases that block airflow and make it difficult to breath). During an observation of medication pass with CMA A on 1/23/2023 at 4:36 pm. CMA A, did not wash her hands prior to preparing medications for Resident # 67. CMA A did not wash her hands prior to preparing or administering a tramadol at 50 mg 2 tabs for Resident #67. Resident #38: Record Review of Resident #38's face sheet revealed a [AGE] year-old female who was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with a diagnosis of: dementia, high cholesterol, type 2 diabetes, chronic kidney disease, difficulty swallowing, anxiety, depression, acid reflux. muscle weakness. During an observation of medication pass with CMA B on 1/24/2023 at 9:05 AM CMA B she was observed taking Resident #38 blood pressure and did not wash hands before or after taking blood pressure and then proceeded to go into the medication cart to prepare medications for Resident #38. The medications that CMA B prepared for Resident #38 was as listed: pro-stat at 30 ml., aspirin low dose at 81 mg., ferrous sulfate at 40 mg 1 tab, atorvastatin at 40 mg 1 tab, carvedilol at 12.5 mg., furosemide at 20 mg., gabapentin at 100 mg., Januvia at 25 mg., losartan at 100 mg., metoprolol at 25 mg., daily vitamin, potassium chloride at 20 meq., tramadol at 50 mg. During an Interview with CMA B on 1/244/2024 at 2:58 pm. CMA B stated that she had received infection control practices training. She stated that she had received training through in-services approximately every two weeks. She stated that the negative potential outcome for not washing hands prior to preparing medications would be spread of infection. She stated that the policy stated that hand hygiene was important. During an Interview with CMA A on 1/24/2024 at 1:37 pm. CMA A stated that she had been trained on infection control practices. CMA A stated that she was to wash her hands before, during, and after caring for residents and prior to preparing medications. She stated the training she had received from the facility was in-services provided approximately once a month and sometimes more often. She stated that all staff had received training upon hiring. She stated that the negative potential outcome for not using proper infection control practices would be spread of infections and could possibly transfer another medication residue from hands to another resident. Resident #1 Record review of Resident #1 face sheet dated 01/24/24 reveals a [AGE] year-old female admitted [DATE] with the following diagnosis: Epilepsy, dementia (cognitive loss), psychotic disorder with delusions (altered reality that was persistently held), major depressive disorder, generalized anxiety, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 22 of 28 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 01/25/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some need for assistance with personal care, muscle weakness, hypertension (high blood pressure), incontinence (loss of bladder control), and hypothyroidism (low thyroid hormone). Record Review or Resident #1 MDS dated [DATE] reveals resident had a BIMS score of 05 which indicated the resident's cognition was severely impaired. The MDS Section GG - Functional Abilities and Goals revealed Resident #1 was dependent with toileting hygiene and required the assistance of 2 or more helpers. Record Review of Resident #1's Care plan dated 1/10/24 reveals Resident #1 had an ADL self-care performance deficit. Resident was incontinent of bowel and bladder. Interventions included two staff assistance for toileting, incontinent care at least every two hours and apply moisture barrier after each episode. Observation of incontinence care on 1/24/24 at 11:10 AM CNA C removed left glove after applying skin barrier cream on Resident #1s buttocks. CNA C assisted CNA D in turning Resident #1 onto her side without a glove to her left hand. CNA C asked CNA D for a glove and donned glove to left hand. CNA C did not perform hand hygiene after doffing glove, before assisting resident to turn, or before donning new glove. During an interview with CNA C on 01/24/24 at 1:45 PM she stated she has been trained on handwashing and she was trained monthly. She stated negative consequences of not washing your hands between glove changes can be spreading germs and infection. She stated she was not sure what the handwashing policy says but she knows to wash between resident care, between meals and after going to the bathroom. She stated she has been at this facility for 3 years but a CNA for 13 years. She stated she had removed her glove because she did not want to get barrier cream on the resident. During an interview on 1/25/24 at 11:50 AM with the DON she stated the ADON was the infection preventionist. She stated handwashing and infection prevention training was conducted quarterly and was ongoing. She stated the negative consequences of not performing handwashing was transferring organisms to resident and self and contaminating high touch areas. She stated her expectation of staff when serving meals was, not grabbing them by the top and to take plates from tray and place on the table without touching and perform handwashing right after. She stated staff are trained to serve meals upon hire, during orientation to the floor and as needed. She stated negative consequences of improper handling of plates and cups during meal service was transferring germs from person to person. She stated her expectation during medication administration was for handwashing to be done between each resident and the negatives consequences of not handwashing was transferring germs from person to person. She stated staff have been trained on foley care and peri care. She stated staff was trained minimum yearly and as needed with skills checks. She stated the DON and ADON oversee training. She stated her expectation of staff when performing foley care and peri care was to follow policy and perform care correctly. She stated negative consequences of improper foley care and peri care can be pushing organisms into the body, UTI, and bladder infections. During an interview on 1/25/24 at 11:53 AM with ADM, she stated the ADON was the infection preventions. She stated staff was trained on infection prevention and handwashing monthly. She stated they are part of a QIPP program that required the facility to train a percentage of staff monthly. She stated the DON and ADON over that training. She stated the negative consequences of not handwashing or following infection prevention was spreading infection and a poor outcome for the residents. She stated her expectation of staff when serving meals was to delivery it timely and to make sure to wash their hands before and after serving to residents regardless of if they are in the dining room or in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 23 of 28 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 01/25/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some their bedrooms. She stated staff was trained to hold the plates and cups by the sides and the negative consequence of improper handling was passing on bacteria or any infection. She stated they shave trained their CNA's but was not sure when the last training was. She stated her expectation during medication administration was for staff to perform handwashing after each resident encounter and before moving onto another room. She stated the negative consequences of no handwashing between medication administration was infection and spreading infection. She stated staff have been trained on foley care and peri care and they are trained annually and as needed if there was a concern. She stated the DON and ADON oversee the training. She stated her expectation during peri care and foley care was to clean from dirty to clean and away from the urethral opening. She stated the negative consequences of improper peri care and foley care are risk of infection and discomfort for the resident. Record review of facility policy titled Infection Control Plan: Overview from the Infection Control Policy and Procedure Manual 2019, revealed: The facility will establish and maintain, and Infection Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. Preventing Spread of infection: . (3). The Facility will require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice . Intent: Implement hand hygiene (hand washing) practices consistent with accepted standards of practice to reduce the spread of infections and prevent cross-contamination . Hand Hygiene . Before and after assisting a resident with meals. Upon and after coming in contact with a resident's intact skin (e.g., when taking a pulse or blood pressure, and lifting a resident) After contact with a resident's mucous membranes and body fluids or excretions. After removing gloves or aprons; Record Review of facility policy titled Perineal Care dated 4/27/2022 revealed: Purpose This procedure aims to maintain the resident dignity and self-worth and reduce embarrassment by providing cleanliness and comfort to the resident, preventing infections and skin irritation, and observing the resident's skin condition 23) Note skin changes and apply moisture barrier cream as directed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 24 of 28 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 01/25/2024 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 0880 24) Doff gloves and PPE Level of Harm - Minimal harm or potential for actual harm 25) Perform hand hygiene Residents Affected - Some Based on observation, interview and record review, the facility failed to establish and maintain an infection prevention and control program, designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 3 of 5 Residents (Residents #1, #38 and #67) observed for infection control. 1. The facility staff failed to wash their hands before medication administration for Residents #67 and #38. 2. The facility staff failed to use proper infection control precautions when providing incontinence care to Resident #1. These failures could place residents at risk for infection through cross contamination of pathogens. The findings included: Resident #67: Record Review of Resident #67's face sheet revealed a [AGE] year-old male who was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with a diagnosis of: heart failure, Chronic Obstructive Pulmonary Disease (a group of lung diseases that block airflow and make it difficult to breath). During an observation of medication pass with CMA A on 1/23/2024 at 4:36 pm. CMA A, did not wash her hands prior to preparing medications for Resident # 67. CMA A did not wash her hands prior to preparing or administering a tramadol at 50 mg 2 tabs for Resident #67. Resident #38: Record Review of Resident #38's face sheet revealed a [AGE] year-old female who was initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with a diagnosis of: dementia, high cholesterol, type 2 diabetes, chronic kidney disease, difficulty swallowing, anxiety, depression, acid reflux. muscle weakness. During an observation of medication pass with CMA B on 1/24/2024 at 9:05 AM CMA B she was observed taking Resident #38 blood pressure and did not wash hands before or after taking blood pressure and then proceeded to go into the medication cart to prepare medications for Resident #38. The medications that CMA B prepared for Resident #38 was as listed: pro-stat at 30 ml., aspirin low dose at 81 mg., ferrous sulfate at 40 mg 1 tab, atorvastatin at 40 mg 1 tab, carvedilol at 12.5 mg., furosemide at 20 mg., gabapentin at 100 mg., Januvia at 25 mg., losartan at 100 mg., metoprolol at 25 mg., daily vitamin, potassium chloride at 20 meq., tramadol at 50 mg. During an Interview with CMA B on 1/24/2024 at 2:58 pm. CMA B stated that she had received (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 25 of 28 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 01/25/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some infection control practices training. She stated that she had received training through in-services approximately every two weeks. She stated that the negative potential outcome for not washing hands prior to preparing medications would be the spread of infection. She stated that the policy stated that hand hygiene was important. During an Interview with CMA A on 1/24/2024 at 1:37 pm. CMA A stated that she had been trained on infection control practices. CMA A stated that she was to wash her hands before, during, and after caring for residents and prior to preparing medications. She stated the training she had received from the facility was in-services provided approximately once a month and sometimes more often. She stated that all staff had received training upon hiring. She stated that the negative potential outcome for not using proper infection control practices would be spread of infections and could possibly transfer another medication residue from hands to another resident. Resident #1 Record review of Resident #1 face sheet dated 01/24/24 reveals a [AGE] year-old female admitted [DATE] with the following diagnosis: Epilepsy, dementia (cognitive loss), psychotic disorder with delusions (altered reality that was persistently held), major depressive disorder, generalized anxiety, need for assistance with personal care, muscle weakness, hypertension (high blood pressure), incontinence (loss of bladder control), and hypothyroidism (low thyroid hormone). Record Review of Resident #1 MDS dated [DATE] reveals resident had a BIMS score of 05 which indicated the resident's cognition was severely impaired. The MDS Section GG - Functional Abilities and Goals revealed Resident #1 was dependent with toileting hygiene and required the assistance of 2 or more helpers. Record Review of Resident #1's Care plan dated 1/10/24 reveals Resident #1 had an ADL self-care performance deficit. Resident was incontinent of bowel and bladder. Interventions included two staff assistance for toileting, incontinent care at least every two hours and apply moisture barrier after each episode. Observation of incontinence care on 1/24/24 at 11:10 AM CNA C removed left glove after applying skin barrier cream on Resident #1s buttocks. CNA C assisted CNA D in turning Resident #1 onto her side without a glove to her left hand. CNA C asked CNA D for a glove and donned glove to left hand. CNA C did not perform hand hygiene after doffing glove, before assisting resident to turn, or before donning new glove. During an interview with CNA C on 01/24/24 at 1:45 PM she stated she has been trained on handwashing and she was trained monthly. She stated negative consequences of not washing your hands between glove changes can be spreading germs and infection. She stated she was not sure what the handwashing policy says but she knows to wash between resident care, between meals and after going to the bathroom. She stated she has been at this facility for 3 years but a CNA for 13 years. She stated she had removed her glove because she did not want to get barrier cream on the resident. During an interview on 1/25/24 at 11:50 AM with the DON she stated the ADON was the infection preventionist. She stated handwashing and infection prevention training was conducted quarterly and was ongoing. She stated the negative consequences of not performing handwashing was transferring organisms to resident and self and contaminating high touch areas. She stated her expectation during medication administration was for handwashing to be done between each resident and the negatives (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 26 of 28 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 01/25/2024 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 0880 Level of Harm - Minimal harm or potential for actual harm consequences of not handwashing was transferring germs from person to person. She stated staff have been trained on peri care. She stated staff was trained minimum yearly and as needed with skills checks. She stated the DON and ADON oversee training. She stated her expectation of staff when performing peri care was to follow policy and perform care correctly. She stated negative consequences of improper peri care can be pushing organisms into the body, UTI, and bladder infections. Residents Affected - Some During an interview on 1/25/24 at 11:53 AM with ADM, she stated the ADON was the infection preventions. She stated staff was trained on infection prevention and handwashing monthly. She stated they are part of a QIPP program that required the facility to train a percentage of staff monthly. She stated the DON and ADON oversee that training. She stated the negative consequences of not handwashing or following infection prevention was spreading infection and a poor outcome for the residents. She stated her expectation during medication administration was for staff to perform handwashing after each resident encounter and before moving onto another room. She stated the negative consequences of no handwashing between medication administration was infection and spreading infection. She stated staff have been trained on peri care and they are trained annually and as needed if there was a concern. She stated her expectation during peri care was to clean from dirty to clean and away from the urethral opening. She stated the negative consequences of improper peri care are risk of infection and discomfort for the resident. Record review of facility policy titled Infection Control Plan: Overview from the Infection Control Policy and Procedure Manual 2019, revealed: The facility will establish and maintain, and Infection Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. Preventing Spread of infection: (3). The Facility will require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice: Intent: Implement hand hygiene (hand washing) practices consistent with accepted standards of practice to reduce the spread of infections and prevent cross-contamination Hand Hygiene Before and after assisting a resident with meals. Upon and after coming in contact with a resident's intact skin (e.g., when taking a pulse or blood pressure, and lifting a resident) After contact with a resident's mucous membranes and body fluids or excretions. After removing gloves or aprons; Record Review of facility policy titled Perineal Care dated 4/27/2022 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 27 of 28 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 01/25/2024 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 0880 Purpose Level of Harm - Minimal harm or potential for actual harm This procedure aims to maintain the resident dignity and self-worth and reduce embarrassment by providing cleanliness and comfort to the resident, preventing infections and skin irritation, and observing the resident's skin condition Residents Affected - Some 23) Note skin changes and apply moisture barrier cream as directed 24) Doff gloves and PPE 25) Perform hand hygiene FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676380 If continuation sheet Page 28 of 28