Health inspection·April 14, 2023

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few [DATE] 10:19 AM ADMIN and DON - DON - get code stats report nurse to nurse from hsotpial to who ever is [NAME] admission - - will consider them full code until paper is in hand. His file was upladed 3/24. 3/25 admit was DNR. Since -nurse would go to miscellaneout and find the DNR. electronic nurses know to know to lokok in packe for DNR. Has not seen chart - may have waited to see document snd put Full code sitcke pending receipt of document. does not know why the full code is on chart if docuent is in Bienviir packet. the risk of the inconsistency would have to call next of kin to find out if he had DNR or not. Doe not have another Ad policy or one specific to DNR. Try to review code status on admissions. Would hae to look at who admitted him. Training for staff regarding Advance Directiee will have to check. Based on observation, interview, and record review, the facility failed to ensure the right to formulate an advance directive for one (Resident #23) of six residents reviewed for advance directives. The facility failed to ensure that Resident #23 ' s code status was correctly indicated in his physical chart. This failure could result in residents receiving unwanted treatment or not receiving desired treatment. Findings include: Record review of Resident #23 ' s face sheet dated [DATE] documented in part that he was [AGE] years old and was admitted to the facility on [DATE]. Record review of Resident #23 ' s History and Physical dated [DATE] documented in part that he had a history of end stage renal disease, CVA (stroke), and a left below-the-knee amputation. Record review of Resident #23 ' s physician ' s advance directive order dated [DATE] documented that he was a DNR. Record review of Resident #23 ' s physical medical chart on [DATE] at 2:45 PM revealed a sticker on the first page of the chart stating, Full Code. Review of all contents of the physical medical chart revealed no TX OOH DNR. Record review of Resident #23 ' s admission Check List dated [DATE] (hard copy in resident ' s physical chart) documented that the resident ' s code status had been entered into the computer. The admission Check List stated If DNR, signed and completed DNR must be in chart. Record review of Resident #23 ' s electronic Care Plan dated [DATE] documented that he was a DNR. In an interview and observation on [DATE] at 03:03 PM, RN F stated Resident #23 ' s code status was DNR. She then reviewed Resident #23 ' s physical chart and commented that it had a sticker that said full code. She was then observed to review Resident #23 ' s physical chart in full and stated she was not able to find a copy of the TX OOH DNR. She reviewed the Resident's IDT admission Evaluation with Baseline Care plan which was in the chart (date not provided) and stated it indicated the resident had no Advance Directives. She said that the conflicting information on the resident's code status put him at risk of delayed response to emergency situations. In an interview on [DATE] at 09:47 AM, the Social Worker said she had spoken to Resident #23 on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 2 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 [DATE] and he had stated that he was a DNR. She said she documented this on his Psychosocial Profile dated [DATE] but she did not do anything to the physical chart. She said she, the Admissions Coordinator and the Transitional Care Nurse were all involved in assessing and documenting a new resident ' s code status. When asked who was responsible for putting the TXOOH DNR in the electronic record she said the nurses were. She did not know who was responsible for putting together the physical chart. Residents Affected - Few In an interview on [DATE] at 10:08 AM, the admission Coordinator said she interviewed Resident #23 on 03/27/or [DATE] and he said he did not have a DNR. She said she did not document this conversation because the computer defaults to full code. She said that if a resident or resident ' s family had DNR at the time of the admission interview, she (the admission Coordinator) would give a copy to the Social Worker, DON or ADON. She did not know what was done with the completed DNR once given to the Social Worker, DON or ADON. In an interview on [DATE] at 10:19 AM with the DON and Administrator, the DON said Resident #23 ' s TX OOH DNR document was in the Miscellaneous documents in his electronic file, and that his electronic file was uploaded on [DATE], prior to his admission on [DATE]. She did not know why his physical medical record had a Full Code sticker on it. She said that staff may have been waiting for the DNR document to be uploaded in the electronic record and put the Full Code sticker on the chart in the meantime. When asked where the TX OOH DNR was, she said it was in his electronic Miscellaneous file on page six of a document from the resident ' s PACE program (a Managed Care Provider). The DON said that nurses would know to look in the Miscellaneous file to find the DNR. The DON said she did not know if staff had received training regarding Advance Directives but would check her files. Documentation of staff training regarding Advance Directives was not received prior to exit. The DON said that the inconsistency in documenting Resident #27 ' s code status could put him at risk of the facility having to call his next of kin to find out if he had DNR or not. She did not say it put the resident at risk of receiving unwanted treatment or not receiving desired treatment. The facility policy Cardiopulmonary Resuscitation dated [DATE] stated the facility would adhere to resident ' s rights to formulate advance directives. Basic life support including CPR would be provided in the absence of advance directives or DNR orders. The policy did not say where DNR orders would be placed in residents ' electronic record or physical chart. In an interview on [DATE] at 10:19 AM with the DON and Administrator, additional policies related to DNRs or other Advance Directives were requested. The DON stated that the policy Cardiopulmonary Resuscitation dated [DATE] was the only policy the facility had related to DNRs or other Advance Directives. The policy provided, Cardiopulmonary Resuscitation dated [DATE] did not say where DNR orders would be placed in residents ' electronic record or physical chart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 3 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0655 Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Resident #96 Residents Affected - Few Unnecessary Meds, Psychotropic Meds, and Med Regimen Review 04/12/23 11:16 AM Resident is in the Initial Pool. According to RR the resident takes an Antianxiety. Buspiron 10 mg TID According to RR the resident takes an Anticoagulant. - Lovenoz 30 MG Q AM According to RR the resident takes an Insulin. - she is not taking insulin - Actos 15 MG - for blood sugar but not insulin. According to RR the resident takes an Opioid. - Tramaol 50 MG Q 6 hrs PRN - Has not requested this According to RR the resident takes an Antidepressant. - Lexapro 20 MG Q day. Anticoagulant is on the MDS but not on either care plan baseline or comprehensive care plan. 04/14/23 11:17 AM DON - anticoagulans shouldb on base [NAME] care plan - If resident is h ere long enough woul be o n comprehansive. Staff standrd woul dlook for brusiing bleeding stool collor, Wouild be lok infor this because thins the bllo - increased tenedency to bleeding. Nursing practice is to monitor - it does not matter if it is ion the care plan or not. risk to patient is for bleeding but any change of contidion i sreported to doctor. Based on interview and record review, the facility failed to develop and implement a baseline care plan that included instructions needed to provide effective and person-centered care of the resident for one (Resident #96) of six residents reviewed for baseline care plans. The facility failed to include a care plan for anticoagulants on Resident #96 ' s baseline care plan. This failure could put residents at risk of undetected medication side effects. Findings include: Record review of Resident #96 ' s face sheet documented that she was [AGE] years old and was admitted to the facility on [DATE]. Record review of Resident #96 ' s History and Physical dated 03/27/2023 documented in part that she had diagnoses of intra-articular tibial plateau fracture (Broken bone at the knee joint) and she was to have DVT prophylaxis (something to prevent blood clots). Record review of Resident #96 ' s physician ' s order dated 03/31/2023 documented that she was to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 4 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few receive 30 MG/0.3 ML of Enoxaparin Sodium (an anticoagulant to prevent blood clots) by subcutaneous injection (a shot) each morning as a preventive. Record review of Resident #96 ' s MAR for April 2023 documented in part that she received 30 MG/0.3 ML of Enoxaparin Sodium through subcutaneous injection daily from 04/01/2023 through 04/13/2023 when the MAR was reviewed. Record review of Resident #96 ' s IDT admission Evaluation with Baseline Care Plan dated 03/31/2023 documented no care plans related to anticoagulants. In an interview on 04/14/23 at 11:17 AM, the DON said that the admitting nurse was responsible for completing the baseline care plan. She said it did not matter whether anticoagulants were on Resident #96 ' s care plan or not because the nurses monitor residents and notify the doctor if changes are identified. She said that residents should have anticoagulants on their care plan since anticoagulants thin the blood and residents may have an increased tendency to bleed. She said nurses should monitor residents who take anticoagulants for bruising, bleeding, or changes in stool color. Record review of the facility policy Baseline Care Plan dated 08/16/2017 documented in part that the facility would develop and implement a baseline care plan for each resident that includes instructions needed to provide effective and person-centered care. The baseline care plan would include the minimum healthcare information necessary to properly care for a resident. The policy did not specify who in the facility would complete the baseline care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 5 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. 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 change midline dressing in accordance with physician orders and the comprehensive care plan for 1 (Resident #39) of 16 residents reviewed for quality of care Residents Affected - Few The facility failed to change Resident #39 Midline dressing according to physician ' s orders. These deficient practices could have placed residents at risk for cross-contamination resulting in acquiring infections. Findings included: Record Review of Resident #39 ' s face sheet dated 04/14/23 revealed an [AGE] year-old male with an admission date of 03/24/23. Record Review of Resident #39 ' s History and Physical dated 03/14/23 revealed a diagnosis of Periprosthetic Joint infection, left shoulder and MRSA (Methicillin-Resistant Staphylococcus Aureus). Record Review of MDS assessment dated [DATE] revealed Resident #39 had a BIMS score of 15 indicating he was cognitively intact. In section I of the MDS assessment Resident #39 revealed active diagnosis of infection due to unspecified internal joint prosthesis, and infection due to other internal joint prosthesis. Record Review of the comprehensive care plan dated 03/25/2023 revealed Resident #39 has a Midline and interventions included change dressing every 7 days and as needed per facility protocol. Record Review of physician orders dated 03/30/23 instructed to change dressing once weekly and PRN (every dayshift every Sun IV therapy). Resident physician orders dated 03/ 24/23 instructed to administer ceftriaxone 2gm (IV antibiotics) for joint infection via midline once a day. Observation at 03:00 PM on 04/11/23 revealed Resident #39 was in his room during the interview and noted dressing on Midline dated 4/3/23. Interview and record review with the DON on 04/13/2023 at 11:30 AM confirmed the physician order for Resident #39 was to change the Midline dressing every 7 days and was scheduled to be changed on Sundays. DON verified the treatment record and documented the Midline dressing was changed on 04/03/2023. DON stated failure to change Midline dressing according to the physician ' s orders can place the resident at risk for infection. Record Review of Policy titled Wound Treatment Guidelines dated 08/17/2017 in part stated wound care treatments will be provided in accordance with physician orders, including the frequency of dressing change. Record Review of Policy titled Catheter Insertion and Care dated 4/1/2011 in part documented change transparent semi-permeable membrane dressing at least every 7 days and as needed when wet, soiled, or not intact. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 6 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure that a resident who needs respiratory care is provided such care, consistent with professional standards of practice for 3 (Resident #8, Resident #5, and Resident #96) of 5 residents observed for oxygen management. Residents Affected - Few 1. The Facility failed to change oxygen tubing for Resident # 8 according to physician's orders. 2. The facility failed to ensure Resident # 5's oxygen sign was posted on entrance door to resident's room. 3. The facility failed to store Resident #96 ' s respiratory treatment mask with a protective cover. These failures could place residents on oxygen therapy at risk of receiving incorrect or inadequate oxygen support, decline in health, and expose them to oxygen hazards. Findings included: Resident #8 Record review of the facility's Hospital Transfer/Discharge Report Sheet for Resident #8 revealed admission to nursing facility on 01/04/2023. Record review of History and Physical dated 01/06/2023 for Resident #8 revealed a [AGE] year-old female with a diagnosis of influenza A virus- and age-related physical debility (general weakness or feebleness that may be a result or an outcome of one or more medical conditions that produce symptoms such as pain, fatigue, cachexia and physical disability, or deficits in attention, concentration, memory, development and/or learning). Record review of Resident #8 MDS Significant change assessment dated [DATE], was diagnosed dementia and occlusion and stenosis of right middle cerebral artery (Atherosclerotic plaques accumulate in the walls of the arteries and cause them to narrow (stenosis) or become so thick they completely block the flow of blood (occlude), no shortness of breath was marked or oxygen therapy. Record review of hospice comprehensive assessment and plan of care update report dated 03/31/2023, of Resident #8 revealed a diagnosis of dependence on supplemental oxygen and occlusion and stenosis (Atherosclerotic plaques accumulate in the walls of the arteries and cause them to narrow (stenosis) or become so thick they completely block the flow of blood (occlude) of right middle cerebral artery. On 01/04/2023 Resident #8 was on oxygen 2.5 liters per minute as needed for shortness of breath. Record review of facility's order recap for Resident #8 ordered on 04/12/2023 revealed an order for oxygen at 3 liters per minute via nasal cannula as needed for hypoxia and shortness of breath. Change oxygen tubing/equipment weekly on Sunday every night shift. Observation on 04/11/2023 at 9:57 AM in Resident #8's room revealed resident was on a concentrator with nasal cannula dated 01/29/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 7 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 04/12/2023 at 10:15 AM with LVN A revealed Resident #8 was getting oxygen by concentrator, and oxygen nasal cannula was dated 01/29/2023. Interview on 04/12/2023 at 10:28 AM with the risk of not having a sign posted outside of a resident's room when using oxygen could be flammability. DON stated Resident #8s nasal cannula needed to be changed. DON stated the nurses are responsible for changing the cannula. Resident #5 Record review of facility Transfer/Discharge Report Sheet Resident #5 revealed admission to facility on 03/29/2023. Record review of History and Physical dated 03/29/2023 for Resident #5 revealed an [AGE] year-old female with a diagnosis of asthmatic bronchitis and unspecified asthma. Record review of admission MDS dated [DATE] for Resident #5 revealed resident was on oxygen therapy for respiratory treatment for shortness of breath or trouble breathing when lying flat. Record review of Resident #5 order summary report dated 03/30/2023 revealed Resident #5 was on oxygen at 2 liters per minute as needed and every shift for shortness of breath and hypoxia. Change oxygen tubing/equipment on Sundays. Record review of Resident #5 care plan dated 03/31/2023 revealed resident had constriction of the airways and difficulty or discomfort in breathing and will be getting oxygen via nasal cannula at 2 liter per minute 04/11/2023 that Resident #5 had oxygen therapy for ineffective gas exchange and will be continuous oxygen via nasal cannula at 2 liter per minute. Observation on 04/11/2023 at 9:05 AM revealed no oxygen sign posted outside of Resident #5's entrance door while resident was using oxygen. Interview on 04/12/2023 at 10:06 AM with LVN A revealed anytime there was a concentrator in the room, there must be an oxygen sign posted outside of the room. LVN A stated the risk of not having an oxygen sign posted outside of the resident's room was a fire hazard. LVN A stated the nasal cannula must be changed out every Sunday, once a week, if not the risk could be respiratory infection. Observation and interview on 04/12/2023 at 10:30 AM with DON inside Resident #5's room revealed she had her nasal cannula on with the concentrator on and in use. DON stated the nasal cannula dated 01/29/2023 was outdated and needs to be changed. DON stated nasal cannulas are changed out every Sunday once a week. DON stated the night shift nurses are responsible for changing out the nasal cannulas on Sunday. DON started Resident #5 needed to have an oxygen sign posted outside of her room since she was using oxygen. Interview on 04/13/2023 at 2:44 PM with LVN B who was the charge nurse both Resident #5 and Resident #8 stated if a concentrator was in use in the resident's room, then the resident needed to have an oxygen sign. LVN B stated the risk to not having an oxygen sign posted could be flammability. LVN B stated the oxygen tubes are changed out once a week or as needed by the night shift nurse. LVN B stated she would not know the risk of not changing out the oxygen tubes weekly. Record review of facility policy Oxygen concentrator dated 06/05/2023 indicated to place an oxygen (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 8 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0695 warning sign on the resident's door. Cannulas and masks should be changed weekly or as necessary. Level of Harm - Minimal harm or potential for actual harm Resident #96 Residents Affected - Few Record review of Resident #96 ' s face sheet documented that she was [AGE] years old and was admitted to the facility on [DATE]. Record review of Resident #96 ' s History and Physical dated 03/27/2023 documented in part that she had diagnoses including chronic obstructive pulmonary disease (lung disease where the small airways in the lungs are damaged making it harder for air to get in and out.) Record review of Resident #96 ' s physician ' s order dated 04/05/2023 documented an inhaled breathing treatment (Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 1 IUD) every 8 hours to treat wheezing. Record review of Resident #96 ' s April 2023 MAR documented that she was administered Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML by inhalation three times a day (6:00 AM, 2:00 PM and 10:00 PM) daily from 04/05/2023 to 04/14/2023. An observation on 04/11/23 at 09:04 AM revealed a nebulizer machine with attached tubing and a nebulizer mask on top of Resident #96's bedside dresser. In an interview on 04/11/23 09:10 AM, RN H stated that Resident #96 ' s nebulizer mask should be stored in a plastic bag when not in use because of infection control concerns. RN H said if the mask was not covered, dust and germs might get in the mask and the resident might breathe those in during treatment and cause her to get an infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 9 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0755 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** FACILITY Residents Affected - Some Medication Administration 04/11/23 04:28 PM Based on observation, interview, and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 resident (Residents #247) of 3 reviewed for medication administration. The facility failed to ensure LVN D administered Resident # 247 medications according to the physician ' s order. This deficient practice could place residents with g-tubes at risk of not receiving their medication in accordance with the physician ' s order. Findings included: Record Review of Resident #247 face sheet dated 4/14/2023 Resident #247 was a 70 yr. old female admitted on [DATE]. Record Review of Resident #247 ' s History and Physical dated 03/16/23 revealed a diagnosis of Alzheimer ' s dementia, cva (stroke), and dysphagia (difficulty swallowing). Record Review of MDS assessment dated [DATE] revealed Resident #247 had a diagnosis of dysphagia (difficulty swallowing). Section K, in the MDS documented Resident #247 has a feeding tube (a medical device used to provide nutrition). Record Review of the comprehensive care plan dated 03/30/2023 revealed Resident #247 has a g-tube related to dysphagia. Record Review of physician orders dated 03/30/23 revealed an order for every shift to ensure routine care check of enteral tube placement via aspiration & auscultation before medication administration, before performing the gastric residual check, flush with 10 ml of water between each individual medication, and with 30 ml of water before and after medication administration. Include the orders for the Carvedilol, Memantine, Januvia, and Metformin. Record Review of Resident #247 medication administration record for Resident #247 revealed she was scheduled to receive Carvedilol 25mg 1 tablet every 12 hrs., Memantine 10mg 1 tablet daily, Januvia 100mg 1tab daily, metformin HCI 500mg 1 tablet twice a day. All medications were scheduled for medication administration at 09:00 AM crush via g-tube. Observation on 4/11/23 at 09:26 AM LVN D revealed LVN D crushed Carvedilol, Memantine, Januvia, and Metformin each medication individually and mix the medication in a 9 oz cup with approximately 8 oz of water mix until mostly dissolved. LVN D checked for g-tube placement and residual obtain 5ml of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 10 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some residual. LVN D administered the medication mixture after g-tube was flushed with 6 oz of water. Resident #247 tolerated well; left at a 35-degree angle. Interview with LVN D on 4/11/23 at 9:40 AM revealed she was trying to save time and was unaware she was not able to mix medication and did not realize the order specified the amount of fluid needed between medications. She stated that since a bolus was given didn ' t think it would harm the patient, but too much fluid can put the resident at risk for abdominal distention. Interview with the DON and the Administrator on 4/14/23 at 11:30 revealed when administering medications via g-tube, they should not be mixed together, and the order did specify a specific amount and LVN D should have followed the order. Stated nurses are trained in medication administration yearly and upon hire, confirmed orders for the fluid amount used during medication administration. DON stated too much fluid administration in the g-tube can place a resident at risk for fluid overload. Record Review of Policy titled Preparation and General Guidelines dated 2006 in part stated medication is administered in accordance with written orders of the attending physician. Confirmed with DON no other available policy for G-tube medication administration. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 11 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 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** FACILITY Residents Affected - Few Infection Control [DATE] 04:08 PM Resident [NAME] - 310 - [NAME] - worked for the state 1991 - worked as a case worker eligibility - Has been does not know. - Fell and has been here because of fractured tibia - Feels very lucid today - usually feels confused and asks that I call husband - they treat her very good. Bath room looks fine. Infection control concern the treatment mask is not bagged. [DATE] 09:04 AM Licely [NAME], RN - states that treatment mask should be in bag because of infection control concerns. Resident might breath in things that get in mask like germs. on her hospital paper work said Buspirone 2 5 MG pills - TID for anxiety. Mitirats a pin 7.5 MG at HS depression. escitaopran - 20 MG q day - Depression. admit date [DATE] [DATE] 11:15 AM DON - between treatments masks whold be stored in bags - for infecgtion prevention risk to resident of infection. FACILITY Infection Control [DATE] 11:35 AM resident done with quarantine on [DATE] wound care cart observation red bag not being utilized and nurse observed caring around the facility [NAME] Resident #39 FTag Initiation [DATE] 01:43 PM wound care - order indicated for change every Sunday Resident #199 FTag Initiation [DATE] 01:44 PM - wound dressing was not dated Based on observation, interviews, and record review, the facility failed to label drugs and biologicals in accordance with currently accepted professional principles, and included the appropriate accessory and cautionary instructions, and expiration date when applicable for 1 (Resident #247) of 2 residents reviewed for labeling in that: 1. The facility failed to ensure Resident # 247's Glucerna feeding bag was labeled with the date or the time the bag was hung. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 12 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 2. The facility failed to ensure the flush bag was not labeled at all. Level of Harm - Minimal harm or potential for actual harm These deficient practices could cause a decline in health in residents. Findings included: Residents Affected - Few Record review of facility Transfer/Discharge Report Sheet for Resident #247 revealed admission to facility on [DATE]. Record review of Resident # 247's History and Physical dated [DATE] revealed a [AGE] year-old female with a diagnoses of stroke, Alzheimer disease, diabetes mellitus (A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine). Record review of admissions MDS assessment dated [DATE] revealed Resident #247 was diagnosed with dysphagia (difficulty swallowing) and feeding tube. Record review of Resident # 247's care plan dated [DATE] revealed gastrostomy tube in place due to dysphagia (difficulty swallowing), aspiration, will maintain adequate nutrition and hydration. Record review of order recap dated [DATE] for Resident #247 revealed enteral feedings and feeding pump 6 cans per day of Glucerna continuous at 60 milliliters per hour. Observation on [DATE] at 9:32 AM revealed the feeding bag label did not have date the feeding bag was hung. The water flush bag did not have a label. Interview on [DATE] at 10:28 AM DON stated tube feedings needed to be labeled correctly as it was missing the date and time it was hung. DON stated the risk of the feeding bags not being labeled correctly, the staff would not know if the feeding bags had been changed or if the resident would have an expired bag. Interview on [DATE] at 2:44 PM with LVN B stated the requirement for labels on feeding bags are the name of resident, room, formula, rate, time, and date. LVN B stated water flush bags also needed to be labeled. LVN B stated the feeding bag/flush from Resident #247 was labeled incorrectly because it was missing the physician's name and date it was hung. LVN B stated the risk to the residents for not labeling correctly could be loose stoles and the nursing staff would not knowing if the formula given to the resident was being tolerated. Interview on [DATE] at 3:00 PM with DON stated they did not have a feeding tube policy regarding labeling. Record review of facility Appropriate use of feeding tubes dated [DATE] revealed feeding tubes (nasogastric, gastrostomy, jejunostomy) will be utilized in accordance with current clinical standards of practice, with interventions to prevent complications to the extent possible. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 13 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 - Few Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure food was prepared in a form designed to meet the individual needs for 1 (Resident # 246) of 2 residents reviewed for dietary services. The facility failed to ensure Resident #246's lunch meal was a thin liquid consistency diet as ordered by the physician. This failure could place residents at risk of choking and aspiration by not serving the prescribed liquid consistency. Findings included: Record review of facility Transfer/Discharge Report Sheet for Resident #246 revealed admission to facility on 09/27/22 and readmitted on [DATE]. Record review of Resident #246 History and Physical dated 03/31/2023 revealed an [AGE] year-old male with a diagnosis of Parkinson's disease (a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination). Record review of the baseline care plan dated 04/06/2023 for Resident #246 revealed dietary/nutritional status as fluid consistency of regular. Record review of comprehensive care plan dated 04/06/2023 for Resident #246 revealed potential nutritional problem with diet restriction, swallowing problem, puree, and thin liquids. Observe and report any of the following to the nurse: choking, coughing, drooling, holding food inside of mouth and not swallowing, making repeated unsuccessful attempts to swallow food, refusing to eat, or appearing concerned during meals. Refer resident to speech therapist for swallowing evaluation as ordered by MD. Record review of order recap of physician's orders dated 04/06/2023 for Resident #246 revealed a renal diet of puree texture and thin consistency. Record review of Resident #246 Nutrition assessment from the Dietitian dated 04/11/2023 revealed no indication of liquid consistency for Resident #246. Record review of ST Daily Treatment Note dated 04/07/2023 indicated Resident #246 was evaluated and was determined safe swallow and kept at pureed foods and thin liquids. Record review of ST Daily Treatment Noted dated 04/11/23 indicated Resident #246 was reevaluated for coughing when lying flat on his bed and exhibited safe swallowing and remained pureed foods with thin liquids with no signs of aspiration. Observation on 04/11/2023 at 12:50 PM revealed Resident #246 had received a meal ticket that indicated puree texture with thin liquids but was being given nectar liquid consistency during the lunch meal. Meal ticket revealed diet: renal, diet texture: pureed and no indication of liquid consistency. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 14 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 - Few Interview on 04/11/2023 at 12:53 PM, CNA C stated the ticket shows thin liquids but was told by LVN D that Resident #246 was on nectar consistency. CNA C stated if she did not know Resident #246 was not nectar consistency, she would not have given it to him and gone back to ask for the correct liquid consistency. CNA C stated the risk to the resident would be aspiration if it was a different liquid consistency. Interview on 04/11/2023 at 12:58 PM with LVN D stated she had received in a report that Resident #246 was changed to nectar liquids by the night shift nurse. LVN D stated the Speech Therapist would also inform them if Resident #246 was nectar liquids. LVN D stated the risk to Resident #246 could have been aspiration if they would have given him the wrong liquid consistency. Record review on 04/11/2023 1:04 PM with LVN D revealed a communication slip dated 04/07/23 for Resident #246 indicating the speech therapist recommended puree texture with thin liquids and signed by the physician. Interview on 04/13/2023 at 2:14 PM DON stated if residents are coughing or showing signs of difficulty swallowing, depending on the resident's texture and liquid consistency, nursing staff may downgrade but not upgrade. DON stated if the resident shows these signs throughout the day, then the nursing staff would make recommendations to the doctor and let the speech therapist know so he may conduct his evaluation assessment. DON stated the kitchen was notified of changes in diet orders through a communication order that is given to them by the nursing staff. DON stated that nursing staff ensure that diet textures during meals are correct. Interview on 04/14/2023 at 8:51 AM with the Dietitian revealed there had to be a telephone order for changes of dietary orders. The Dietitian stated she can only downgrade and not upgrade diet orders. The dietitian stated diet orders and fluid consistency should be served according to physician's orders. Interview on 04/14/2023 at 9:31 AM with Speech Therapist revealed he does assessment for dysphagia (difficulty swallowing) and then writes his recommendation orders on a communication slip. Speech Therapist stated the physician signs off on his recommendations. The Speech Therapist stated he was informed by LVN D on 04/11/2023 that Resident #246 was having difficulty swallowing but did not tell the nurses to change his liquids consistency from thin to nectar. Speech Therapist stated he was not informed of Resident #246 having any issues with swallowing on the 04/08/23, 04/09/23, & 04/10/23 until 04/11/23. Speech Therapist stated he evaluated Resident #246 on 04/11 and concluded that Resident #246 was to remain thin liquid consistency as the coughing was not coming from difficulty swallowing but from another issues. The Speech Therapist stated that the cough from Resident #246 was coming from the resident being laid down flat causing his diaphragm to cause him problems and when elevated back up the issues would go away not having to do with his swallowing. Speech Therapist stated downgrading his liquid consistency to nectar did not pose a safety risk. Interview on 04/14/23 at 10:57 AM with LVN E stated if a resident was having issues with coughing or swallowing it would be documented on the progress notes, 24-hour report, and other areas. LVN E stated the speech therapist would have to be notified if the resident was coughing or choking if downgraded from liquid consistency from regular thin liquids to nectar thick liquids. LVN E stated she reviewed the progress notes for Resident #246 (for 04/08/23, 04/09/23, 04/10/23) and did not see any reports on Resident #246 coughing or choking when eating or drinking fluids and did not see a notification to the speech therapist or doctor. LVN E stated there was a risk for not documenting but did not know how to appropriately answer the risk. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 15 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 Interview on 04/14/2023 at 1:31 PM with the Administrator and the DON. The Administrator and DON confirmed the facility's policy and procedure on Serving a Meal dated 08/16/17 revealed diets should be served in accordance with the physician's orders. The DON stated that the communication slip that was sent to the dietary department was not a doctor's order. DON reported that when a diet or fluid was downgraded or upgraded, they would need to send an electronic telephone order for the physician to sign. Residents Affected - Few DON stated the speech therapist reevaluated Resident #246 on 04/11/23 but did not approve for the resident to get nectar thick liquids and was kept at thin liquids after his reassessment. DON stated if the resident was served the wrong consistency the risk would be aspiration and choking. DON stated there was no documentation for Resident #246 for physician orders, to upgrade liquid consistency to nectar. Record review of facility policy Serving a meal dated 08/16/17 revealed diets should be served in accordance with the physician's order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 16 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** FACILITY Residents Affected - Some Kitchen 04/11/23 08:02 AM Culinary Director [NAME] - in refrigerator open bag with three hotdog buns with no label. unlabeled open container of chocolate syrup with Exp date of 11/04/2022. Risk - don't know when opened so don't know how long it will be good. Possible a threat to the safety of the product for residents to consume. Residents could have stomach issues, diaharrea. 04/11/23 11:10 AM CD [NAME] and cook [NAME] - issues with gloving in process of doing Puree - Puree OK but issues with infection control - uses same gloves to wash blender parts and then in preparation of pureed vegetables without glove change or hand washing. Wash water seen dripping from inside right hand glove onto surface of blender while in the process of blending the vegetables. When asked about gloving she states without prompt that she should have changed gloves and washed hands , re-gloved after washing the blender parts. That there is a risk of contamination of the food due to the failure, that resident could get sick. 04/13/23 8:28 AM - CD - Just inserviced staff about labeling and gloving. Last time was about three weeks ago. He checks daily using a daily sanitization check list. Also assigned to staff based on detail cleaning check list (list provided) but he is not able to identify this task on the cleaning list. Policy Date Marking for Food safety - dated 2018 (picture in camera). Based on the observations, interviews, 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 food and nutrition services. The facility failed to ensure three hotdog buns were labeled or sealed. An open container of chocolate syrup was not labeled per facility protocol, had a use by date in 2022, and had dried drips of chocolate syrup on the sides of the bottle. Cook G did not change gloves or wash her hands as she moved from washing a dish to preparing food, and dripped dish-washing water from the used gloves onto a blender she was using to prepare food. These failures could put residents at increased risk for food borne illnesses. Findings include: An observation on 04/11/2023 at 8:02 AM in the walk-in refrigerator revealed three hotdog buns in an unsealed clear plastic bag with no label on the bag. In an interview on 04/11/2023 at 8:02 AM, the Culinary Director stated that all food was to be labeled with the name of the food item, the date the food item was opened, and the expiration date when the food was to be thrown away. He said that the problem with the unlabeled hot dog buns was that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 17 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 the kitchen workers would not know when they were opened or when they would expire and would need to be discarded. He said that not having this information could put the facility residents at risk of eating spoiled food and it could make them sick. He handed the hot dog buns to an employee and told her to throw them out. Observation on 04/11/2023 at 8:15 AM in the food preparation area of the kitchen, an open bottle of chocolate syrup was observed sitting next to bottles of spices. When picked up it felt light for its size and had visible drips of chocolate syrup down the sides of the bottle. Observation of the bottle revealed that it had no label indicating the name of the item, date it was opened or date to be discarded. Inspection of the product label revealed a Best By date of 11/04/2022. In an interview on 04/11/2023 at 8:15 AM, the Culinary Director said that he did not know why the bottle of chocolate syrup was placed next to the spices. He said that there was no way to know when it was opened or when it might expire, and that as a result they could not know if it was safe for the residents to consume. He said that it could cause resident ' s stomach upset and diarrhea. In observation on 04/11/2023 at 11:05 AM, [NAME] G was observed pureeing chicken using a blender. She washed her hands, donned clean gloves then took the blender jar to the three-compartment sink and washed the blender jar first in soapy water, then dipped it in the sanitization rinse sink. Without changing gloves or washing her hands, she took the blender jar and lid back to the blender and proceeded to blend vegetables. As she was blending the vegetables, water was observed dripping out of the gloves onto the blender. In an interview on 04/11/2023 at 11:10 AM with the Culinary Director and [NAME] G, [NAME] G said that she made a mistake when she did not remove the dirty gloves after washing the blender jar, wash her hands and put on clean gloves before pureeing the vegetables. She said she knew she was supposed to wash hands and change gloves after washing the blender jar because of infection control issues. The Culinary Director said [NAME] G was nervous because she was being observed and had been trained to wash hands and change gloves as part of the food preparation process. The Culinary Director instructed [NAME] G to throw out the pureed vegetables and prepare more. In an interview and record review on 04/13/2023 at 8:28 AM the Culinary Director said that he and kitchen workers were responsible for labeling and checking food items for expiration dates. He stated that he had his own check list he used on occasion to track his duties which included checking labeling and expiration dates. He stated he did not use the list consistently and was not able to provide any recently completed check lists. He also said that employees were given the duty of checking labels and expiration dates on a cleaning detail check list, and one of the duties included checking expiration dates. He provided a list (untitled, undated) but in review of the document was not able to show where it directed staff to check labeling or food expiration dates. He said that the last time kitchen employees had been trained about labeling, expiration dates, gloving and hand washing was about three weeks before the interview (exact date not known). Record review of the policy Date Marking for Food Safety dated 2018 documented in part that the facility adhered to a date marking system to ensure the safety of food. Food shall be clearly marked to indicate the date of day by which the food should be consumed or discarded. The individual opening or preparing a food shall be responsible for date-marking the food at the time the food is opened or prepared. The discard date may not exceed the manufacturer's use-by date or 4 days whichever is the earliest. The head cook or designee shall be responsible for checking the refrigerator daily for food items that are expiring and shall discard accordingly. The Dietary manager shall check (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 18 of 19 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 676428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort El Paso, LLC 3421 Joe Battle Boulevard El Paso, TX 79936 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 refrigerators weekly for compliance. Level of Harm - Minimal harm or potential for actual harm Record review of the policy Handwashing Guidelines – Dietary Employees dated 08/16/2017 documented in part that hands should be washed after touching anything unsanitary such as dirty dishes, when changing food preparation procedures, and before donning gloves for working with food. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676428 If continuation sheet Page 19 of 19