Health inspection·December 4, 2025

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some observation on 12/02/25 at 9:55 AM, revealed CNA E entered Resident #3's room to provide incontinent care. The resident was lying in bed and resident's family member was at her bedside. The resident's family member told the CNA Resident #3 had been waiting a long time to be changed. The CNA said, I know the nurse had told me she was wet, but I was changing other residents. The CNA washed her hands, put on gloves and prepared to change the resident. The divider curtain was pulled for privacy. The sheets were pulled back and it was observed the fitted sheet was wet with urine. The brief was removed, and perineal area was cleaned with cleaning wipes. It was observed the resident did not have any skin irritation in the perineal area or skin breakdown on buttocks. Once the disposable brief was changed, she changed the sheets, gown and changed gloves. During an interview on 12/02/25 at 12:22 PM, with LVN B assigned to the 100 Hall from 6:00 AM - 6:00 PM, revealed they only had two CNAs assigned to the 100 and 200 Resident Halls and each CAN was assigned 18-19 residents and they tried to do rounds every two hours. She said they should have three CNAs on each shift but were short of CNAs off and on for the past three weeks due to high staff turnover. She said she assisted the CNAs at times to change incontinent residents and answer call lights as time permitted because she was busy doing her work. She said sometimes the families and residents complained the residents were left wet for long periods of time. She said she never found residents with dried urine rings or dried feces. During an interview on 12/02/25 at 12:28 PM with LVN C revealed, there were three LVNs and two CNAs working today. She said they had been working with only two CNAs for about a month. She said, today we have two CNAs and one new CNA in training. She said the CNAs did not have time to make rounds every two hours. She said the CNAs usually checked the residents for incontinence at the start of shift, before lunch and in-between as time permitted. She said the CNAs tried to make rounds every 2-3 hours, depending on the needs of the residents. She said she assisted the CNAs at times to answer call lights and change incontinent residents. She said they tried to promptly answer call lights but at times they were in resident rooms caring for other residents. She said families and residents complained about being left wet for long periods of time, especially at the change of shift. During a confidential interview on an undisclosed date at an undisclosed time revealed, today there were only two CNAs and one CNA training. It was reported the regular staff pattern for CNAs was for three CNAs per shift. It was reported that when there were only two CNAs on duty, they had to look for someone to assist with turning & repositioning, transfers, and answering call lights. It was reported rounds were not made every two hours and they tried their best to care for the residents. It was reported it took a long time to change incontinent residents and to assist the residents as needed due to only having two CNAs for more than 50 residents. During a confidential interview on an undisclosed date at an undisclosed time revealed, there were only two CNAs and one CNA training. It was reported the regular staff pattern for CNAs was for three CNAs per shift and the facility was scheduling two CNAs for approximately two and half weeks. It was reported there was not enough time to make rounds every two hours, answer call lights, and change incontinent residents on a timely basis. It was reported residents were left wet for long periods of time. It was reported residents frequently were not showered according to shower schedules due to not having sufficient time and assistance to do the work. During a confidential interview on an undisclosed date at an undisclosed time revealed, it took a long time for staff to answer call lights, due to the facility always being short of staff. It was reported the CNAs were too busy taking care of all the residents and did not have time to check on the residents on a regular basis. It was reported the staff did not make rounds every two hours, and it took 30 minutes or more to answer resident call lights which resulted in residents being left wet for long periods of time. It was reported that concerns had not been reported to the facility's (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 12/04/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some management for fear of retaliation. During an interview on 12/03/25 at 9:42 AM with CNA H revealed, they were short of staff and at times worked with only two CNAs, and on those days, there was not sufficient time to make rounds every two hours. She said they were only able to make 3-4 rounds during the twelve-hour shifts. She said each CNA was assigned 18 residents, and that was why it took a long time to change the incontinent residents and showers were not given according to shower schedules when there were only two CNAs on the floor. She said the staff tried to catch up with showers the next day, depending on how busy they were. During an interview on 12/03/25 at 9:45 AM with Resident #4 revealed the resident was alert, oriented to person, time, and place, and was admitted for rehabilitation services a week ago. She said the facility was short of help at times and it took long for the staff to answer the call lights. She said today she called for assistance to use the toilet, and they took a long time to come and help her, so she had a bowel movement in her brief. She said she felt bad, because the CNAs were very busy and worked very hard and she did not want to give them extra work. During a confidential interview on an undisclosed date at an undisclosed time revealed, the facility had been short of CNAs for the last four months. It was reported that residents and families complained it took a long time for call lights to be answered, and residents were left wet for long periods of time. It was reported the staff were always very busy, and they tried to do as much as possible for the residents. During a confidential interview on an undisclosed date at an undisclosed time revealed, the facility was always short of staff and did not have sufficient CNAs to care properly for the residents. It was reported that because of not having sufficient staff the residents were not showered according to shower schedules and were left wet for long periods of time. During an interview on 12/03/25 at 9:59 AM, the Executive Director revealed he had been employed at the facility for several months and was aware of the CNA shortage due to staff leaving for more pay. He said they did not have a policy and procedure on staffing. He said they determined the number of staff based on PPD information. He said, So the number of staff is determined by resident census. He said all the facility staff, including him, assisted the CNAs with answering call lights. He said he was not aware of any concerns related to call lights not being answered timely or residents were left wet for long periods of time. The state surveyor requested the Grievance Binder. During an interview on 12/03/25 at 10:34 AM with CNA K revealed the usual staffing pattern should be for three CNAs on each shift. However, the facility only had two CNAs for more than 50 residents. She said because of not having sufficient staff, residents were not showered according to shower schedules and were left wet for long periods of time. She said there was not sufficient time to make rounds every two hours because each CNA was assigned 18 residents. During an interview and record review on 12/03/25 at 3:01 PM with Assistant Chief Nurse Officer of the facility's untitled staffing schedules revealed:- Review of the facility's untitled staffing schedule for September 2025 for three resident halls (100/200/300) documented that on weekdays and weekends there were always three CNAs scheduled on the first shift from 6 AM - 6 PM shift and second shift there were always three CNAs from 6 PM - 6 AM shift. The scheduled documented there were only two CNAs scheduled 15 times for the first shift. -Review of the facility's untitled staffing schedule for November 2025 for three resident halls (100/200/300) documented that on weekdays and weekends there were always three CNAs scheduled on the first shift from 6 AM - 6 PM shift and second shift there were always three CNAs from 6 PM - 6 AM shift. The scheduled documented there were only two CNAs scheduled 4 times for the first shift. -Review of the facility's untitled staffing schedule for December 2025 for three resident halls (100/200/300) documented that on weekdays and weekends there were always three CNAs scheduled on the first shift from 6 AM - 6 PM shift and second shift there were always three CNAs from 6 PM - 6 AM shift. The scheduled (continued on next page) 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 12/04/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete documented there were only two CNAs scheduled 3 times for the first shift. The Assistant Chief Nurse Officer said they had a high turnover of CNAs and were in the process of hiring staff. Record review of the Grievance Binder revealed:-September 2025: Grievance Form dated 09/15/25 documented, Staff voiced they were understaffed, call lights taking longer than expected to be answered. Date Grievance Occurred: 09/15/25. Date resolved: 09/16/25. Staff re-educated on answering calls in a timely manner. -Grievance Form dated 09/15/25 documented, Staff voiced they were understaffed, call lights taking longer than expected to be answered. Resident's son is upset over staff, telling his father that information. Date Grievance Occurred: 09/13/25. Date resolved: Was left blank. No resolution documented. The form was signed by the previous Executive Director.-Grievance Form dated 09/15/25 documented, Resident's son stated, staff had voiced that they were under staff, taking long to answer call lights. Son upset over staff, telling his father that information. Grievance Follow Up: Spoke to The Sun over the weekend and reassured staff will be re-educated on letting guests know they are understaffed. Son is OK with reeducation. The form was signed by the previous Executive Director.October 2025: -Grievance Form dated 10/15/25 documented, Daughter stated pt. not being changed in timely manner - no water at bedside. Findings of investigation: Pt. brief has been changed as needed. No complaints from pt. Pt. had no skin irritation or rash. Date resolved: 10/17/25, Signed by Executive Director.November 2025:-Grievance Form dated 11/23/25 documented, Resident's family requesting more monitoring during the night shift and more continuous CNAs checks due to them believing resident needing more care and attention during the night. Grievance follow-up: Option to move closer to nurse's station for close monitoring. Family refused, demanding patient be transferred home and discharged from this facility. Date resolved: 11/23/25, Signed by Executive Director.-Grievance Form dated 11/21/25 documented, Resident's Spouse reported we were giving very poor care to his wife and complained that why he should have to pay co-payment. Person completing this form: BOM. No resolution documented related to complaint. Date resolved: 11/21/25, Signed by Executive Director. 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 12/04/2025 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observations, interviews, and record review the facility failed to ensure nurse staffing data was posted daily and readily accessible to residents and visitors, for 1 of 1 nursing unit reviewed for nurse staffing information. The facility failed to post and maintain the required nursing staffing information since 11/20/25. These failures could place residents, their families, and facility visitors at risk of not having access to information regarding facility regarding staffing schedule and facility census. Findings included: During an observation and record review on 12/01/25 at 12:55 PM revealed, the daily staffing sheet posting information, posted by the main entrance to the facility, was dated 11/20/25. During an interview and record review on 12/01/25 at 4:46 PM with RN D Assistant Chief Nursing Officer revealed, the previous Chief Nurse Officer's last day of work was on 11/20/25 and she posted the nurse staff data daily. She said she had requested access to the electronic PPD reports to complete the nurse staff data daily and as of today she had not been granted access to the needed information. She said, that is why she has not posted an updated nurse staff data sheet since 11/20/25. The Assistant Chief Nurse Officer said that the purpose of the nurse staff data was to communicate with visitors' information on the number of staff available at the facility. The Assistant Chief Nurse Officer said the risk of not having the information posted was that staff members and family members would not know the current staffing situation at the facility. During an interview and record review on 12/02/25 at 12:06 PM with Executive Director revealed the nurse staff data posted by the main entrance to the facility was dated 11/20/25. He said, the previous Chief Nurse Officer's last day of employment was on 11/20/25 and she was responsible for posting the nurse staff data daily. He said he had requested access to the electronic PPD reports for the Assistant Chief Nurse officer on 11/20/25 and as of today, she still had not been granted access to the electronic PPD reports to be able to complete the nurse staff data to post daily. The state surveyor requested the facility's policy on nurse staff data and was not provided prior to exit by the Assistant Chief Nurse Officer. Residents Affected - Many 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 12/04/2025 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 Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 5 (Resident #1, #2, #,3, #4, and #5) of 5 residents reviewed for pharmacy services. 1. The facility failed to administer Dapagliflozin Propanediol, Levothyroxine, Acetylcysteine Solution, Eliquis, Memantine HCI, to Resident #1 according to physician's orders. 2. The facility failed to administer Farxiga and Folic Acid, to Resident #2 according to physician's orders. 3. The facility failed to administer Pravastatin Sodium, Alendronate Sodium, Sodium Chloride, Linagliptin, and Calcium 600 + D to Resident #3 according to physician's orders. 4. The facility failed to administer Levothyroxine, Rifaximin, Symbicort Inhalation Aerosol to Resident #4 according to physician's orders. 5. The facility failed to immediately consult with and/or Nurse Practitioner when the facility did not have Dapagliflozin Propanediol, Levothyroxine, Acetylcysteine Solution, Eliquis, Memantine HCI, for Resident #1 to administer as ordered. 6. The facility failed to immediately consult with and/or Nurse Practitioner when the facility did not have Farxiga and Folic Acid, for Resident #2 to administer as ordered. 7. The facility failed to immediately consult with and/or Nurse Practitioner when the facility did not have Pravastatin Sodium, Alendronate Sodium, Sodium Chloride, Linagliptin, and Calcium 600 + D for Resident #3 to administer as ordered. 8. The facility failed to immediately consult with and/or Nurse Practitioner when the facility did not have Levothyroxine, Rifaximin, Symbicort Inhalation Aerosol for Resident #4 to administer as ordered. 9. The facility failed to immediately consult with and/or Nurse Practitioner when the facility did not have Aspirin, Colace, Farxiga, Latanoprost Ophthalmic Solution, Lidocaine External Patch, Pravastatin Sodium, Prenatal Vitamin, Calcium Antacid Chewable, Vitamin C, Advanced Probiotic, Lisinopril, and Amoxicillin for Resident #5 to administer as ordered. These failures could place residents at risk of inadequate therapeutic outcomes and a decline in health due to not receiving medication as ordered. Findings include: 1. Record review of the admission Record dated 12/01/25 for Resident #1 revealed an admission date of 11/10/25. discharge date [DATE] to an Acute Care Hospital.Record review of the Hospital Physician Progress Note for Resident #1 dated 11/09/25, revealed an [AGE] year-old male with a history of esophageal cancer (abnormal cells grow out of control in the food pipe, making it hard to swallow, causing pain, weight loss, and a persistent cough or hoarseness as the tumor blocks the passage or irritates the area) on enteral feedings (giving liquid nutrition formulas directly into their stomach through a tube), and CAD with history of mitral valve replacement (blocked heart arteries damaged the heart muscle, causing the mitral valve to leak, both problems are fixed bypass surgery for the arteries and replacing the faulty valve with a new mechanical one, to improve blood flow and heart function). Record review of the admission MDS assessment, dated 11/16/25, for Resident #1 revealed, Entry Date: 11/10/25. BIMS Summary Score - 10 (cognition was moderately impaired). Clear speech, makes self-understood, and understands others. Active Diagnoses: Cancer, Heart Failure (the heart cannot pump enough blood and oxygen to meet the body's needs), Hypertension (is when the force of blood against your artery wall is consistently too high), Diabetes Mellitus (a chronic disease where the body had high blood sugar levels, either because the pancreas does not produce enough insulin or the body cannot use insulin effectively), Non-Alzheimer's Dementia (brain disorder causing memory, thinking, and behavior problems), Dysphagia (difficulty swallowing, which can make it hard for food and liquids to move from the mouth down to the stomach), lack of coordination, and Gastrostomy (is a feeding tube that goes directly into the stomach through a small (continued on next page) 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 12/04/2025 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 opening in the stomach, by bypassing your mouth and throat, to deliver liquid food, medicine, or to help air and fluids come out). Record review of the Care Plan for Resident #1, initiated 11/10/25 revealed: the Resident has an ADL self-care performance deficit and limitations in physical mobility. Interventions: Partial/moderate assistance with toileting hygiene, dressing and turning and repositioning in bed. Resident is NPO, G-tube on bolus feedings every six hours. The resident was receiving anticoagulant therapy and was prone to bleeding and bruising. Interventions: Labs as ordered. Report abnormal results to the MD. Monitor/document/report PRN (as needed) black tarry stools, sudden changes in mental status, significant or sudden changes in vital signs. Record review of the Order Summary Report, dated 12/03/25, for Resident #1 revealed, Farxiga (Dapagliflozin Propanediol) Oral Tablet 10 mg give one tablet via G-Tube one time a day for DM, Levothyroxine Sodium Oral tablet 50 mg give one tablet via G-Tube one time a day for Hypothyroidism, Eliquis 2.5 mg give one tablet via G-Tube every 12 hours for PPX (Prophylaxis-preventive treatment), Memantine HCI 5 mg give one tablet via G-Tube every 12 hours for Dementia, Acetylcysteine Solution 10% 10 ml inhale orally every 6 hours for mucous secretions. Record review of the Medication Administration Record dated November 2025 for Resident #1 revealed:- 11/11/25 at 9:00 AM, Dapagliflozin Propanediol Oral Tablet 10 mg give one tablet via G-Tube one time a day for DM was not administered, it documented on the MAR code 9 (Other/See Nurses Notes). - 11/11/25 at 6:00 AM, Levothyroxine Sodium Oral tablet 50 mg give one tablet via G-Tube one time a day for Hypothyroidism was not administered it documented on the MAR code 9 (Other/See Nurses Notes).- 11/11/25 at 9:00 AM, Eliquis 2.5 mg give one tablet via G-Tube every 12 hours for PPX was not administered it documented on the MAR code 9 (Other/See Nurses Notes).- 11/10/25 at 9:00 PM and 11/11/25 at 9:00 AM, Memantine HCI 5 mg give one tablet via G-Tube every 12 hours for Dementia was not administered it documented on the MAR code 9 (Other/See Nurses Notes).- 11/09/25 at 9:00 AM, Acetylcysteine Solution 10% 10 ml inhale orally every 6 hours for mucous secretions was not administered it documented on the MAR code 9 (Other/See Nurses Notes).- 11/21/25 12:00 AM, 6:00 AM, 12:00 PM, and 6:00 PM, Acetylcysteine Solution 10% 10 ml inhale orally every 6 hours for mucous secretions was not administered the MAR documented code 9 (Other/See Nurses Notes). - 11/22/2025 at 12:00 AM, 6:00 AM, and 12:00 PM Acetylcysteine Solution 10% 10 ml inhale orally every 6 hours for mucous secretions was not administered, it documented on the MAR code 9 (Other/See Nurses Notes). During an interview and record review on 12/01/25 at 3:39 PM, with LVN A in the presence of the Assistant Chief Nurse Officer revealed Resident #1 had an order for Acetylcysteine Solution to be given every 6 hours for mucous secretions. She said the Acetylcysteine Solution had not been administered as ordered from 11/11/25 through 11/22/25 due to the medication not being available to administer according to physician's orders. She said, sometimes the medications are not dispensed from the pharmacy because they are pending cost approval. She said she had not notified the physicians that the medication was not administered according to physician's order due to not having the prescribed medication. he said they were trained to immediately notify the physicians if the medications were not on hand to administer the scheduled doses according to physician's orders. LVN A could not give a reason why she had not notified the physician. During an interview and record review on 12/01/25 at 3:48 PM, the Medical Director said he was not aware the residents were not administered medications as ordered by the physicians due to medications not being available. He said, We would expect the nurses notify the physicians right away if medications are not administered as ordered for whatever reason. He said the facility should attempt to get the medication from the contracted local pharmacy to start new medications as soon as possible.During an interview and record review on 12/01/25 at 4:40 PM, with the Assistant Chief Nurse Officer revealed, the licensed staff had documented in the Medication (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 12/04/2025 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 Administration Record a code of 9 which meant medications were not administered according to physician's orders due to not being available and/or medication pending delivery. She said the licensed staff were trained to notify the attending physician and Assistant Chief Nurse Officer when medications were not available to administer according to the physician's orders. During an interview on 12/03/25 at 9:33 AM with RN G revealed, she said for the most part they had the medications at the facility to administer as ordered. She said they were trained to notify the Chief Nursing Officer and Assistant Chief Nursing Officer when medications were not available to administer and to document on the Medication Administration Record when the medications were not administered according to physician's orders. She said she was not aware if they needed to notify the physician if medications were not administered due to not having the medication available to administer at facility. During a telephone interview 12/03/25 at 11:49 PM, with physician on coverage on 11/22/25 revealed he was not notified by the licensed staff that Resident #1 was not administered the Acetylcysteine Solution 10% nebulizer treatment as ordered on 11/10/25 according to physician's orders. He said the Acetylcysteine Solution 10% nebulizer treatment opened helped bring up lung secretions. He said he gave an order for a chest x-ray on 11/10/25 and it was clear. He said the failure to administer the Acetylcysteine Solution 10% nebulizer treatment would not have changed his condition. He said he expected the nurses to notify the physicians right away if medications were not available to administer according to physician's orders. 2. Record review of admission Record dated 12/01/25, for Resident #2 revealed an admission date of 09/06/25 and discharge date of 09/10/25 at 11:54 AM to an Acute Care Hospital. Record review of Hospital History & Physical, dated 08/2025for Resident #2 revealed, a [AGE] year-old-female. Resident #2 had diagnoses which included Congestive heart failure (Heart muscle is not pumping as well it should, causing blood and fluid to back up in the lungs and body, leading to symptoms of shortness of breath, swollen legs, fatigue and difficulty exercising as the heart struggles to deliver enough oxygen-rich blood to meet the body's needs), Ischemia of left lower extremity (legs and feet are not getting enough blood flow), Status post above knee amputation of right lower extremity, Diabetes Mellitus (A chronic disease. Where the body has high blood glucose levels. Either because the pancreas doesn't produce enough insulin or the body cannot use insulin effectively), Hypertension (when the force of blood against your artery wall is consistently too high), Status post left foot transmetatarsal amputation (surgical procedure to remove the damaged part of the front of the foot, including some toes and the long bone to stop severe infection or tissue death, saving the rest of the foot and ankle) and Left. foot ulcer. Record review of 5-day PPS MDS, dated [DATE], for Resident #2 revealed, Date of Entry: 09/06/2025. BIMS Summary Score 6 (cognitively severely impaired); GG0115: Functional limitation and range of motion - Impairment on both sides of lower extremities. Section I - Active Diagnoses: Heart failure, Peripheral vascular disease, Diabetes Mellitus, Non-pressure chronic ulcer to left foot, Status post. Below the knee amputation to right leg, Surgical Wound. High-Risk Drug Classes: Antidepressant, Opioid, Antiplatelet, Hypoglycemic and anticonvulsant. Record review of the Care Plan for Resident #2, dated 09/06/25, revealed:-Resident has actual impairment of skin integrity r/t surgical wound. Interventions: Treat per physician's orders.-Resident is receiving anticoagulant therapy. Interventions: Labs as ordered. Monitor for adverse reaction of anticoagulant, blood-tinged urine, black tarry stools, bright red blood in stools, bruising, sudden change in vital signs and/or mental status. Record review of the Order Summary Report, dated 12/03/25, for Resident #2 revealed:Farxiga Oral Tablet give 1 tablet by mouth for diabetes one time a day for Diabetes. Folic Acid Oral Tablet 1 mg give 1 tablet by mouth two times a day for supplement. Record Review of the Medication Administration Record, dated September 2025, for Resident #2 revealed:-09/08/25 at (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 12/04/2025 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 9:00 AM, Farxiga Oral Tablet give 1 tablet by mouth for diabetes was not administered and it documented on the MAR code 9 (Other/See Nurse's Notes).-09/09/25 at 9:00 AM, Folic Acid Oral Tablet 1 mg give 1 tablet by mouth two times a day for supplement at 9:00 AM was not administered and it documented on the MAR code 9 (Other/See Nurse's Notes). Record review of Nurse's Progress note, dated 09/08/25 at 9:00 AM, for Resident #2 revealed Farxiga Oral Tablet 10 mg pending delivery. Record review of Nurse's Progress note, dated 09/08/25 at 9:00 AM, for Resident #2 revealed, Folic Acid 1 mg medication pending delivery. Record review of Nurse's Progress note, dated 09/08/25 at 9:00 AM, revealed Folic Acid 1 mg medication pending delivery. 3. Record review of the admission Record dated 12/02/25 for Resident #3 revealed, admission date 11/28/25. Record review of the History & Physical for Resident #3, dated 12/01/25, revealed [AGE] year-old male with a history of hypertension (when the force of blood against your artery walls is consistently too high) diabetes mellitus (A chronic disease where the body has high. Blood glucose levels either because the pancreas doesn't produce enough insulin or the body cannot use insulin effectively), osteoporosis (bones become weak, thin and brittle like a sponge with holes, making them super easy to break, often from a minor), and recent L3 vertebral fracture and kyphoplasty (Is a quick, minimally invasive procedure to fix a painful collapse vertebrae by inserting a tiny [NAME] to lift it back into place and then filling the space with special cement to stabilize it, restoring height, reducing pain and preventing further deformity, often for osteoporosis-related fractures) 2 weeks ago, chronic kidney disease Stage 1 (Kidneys are filtering blood well , but there's subtle damage, often just protein in the urine or high blood pressure with no symptoms), muscle weakness, status post Urinary Tract Infection . Alert and oriented X person, place, and time. Record review of the Entry MDS assessment dated [DATE] for Resident #3 revealed, Entry Date: 11/28/25. Entered From - Short-Term acute hospital. Record review of the Baseline Care Plan for Resident #3 dated 11/28/25 revealed:-Resident has ADL self-care performance deficits and limitations in physical mobility.-Resident is incontinent. Interventions: The resident uses disposable briefs. Change as needed. Clean peri-area after each incontinent episode. Check every 2-3 hours and as needed for incontinence. Record review of Order Summary Report, dated 12/03/25, for Resident #3 revealed,- Alendronate Sodium Oral Tablet 70 mg give 1 tablet by mouth one-time a day every 7 day(s) for supplement.- Calcium 600 + D 600-5 MG-MCG Oral Tablet give 1 tablet by mouth one-time day for supplement,- Pravastatin Sodium Oral Tablet 20 mg give 1 tablet by mouth at bedtime for Cholesterol11/28/25 Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day for supplement for seven days, end date 12/06/25.- 12/01/25 Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth two times a day for supplement. Record review of Medication Administration Record dated November 2025 for Resident #3 revealed:-11/29/25 Alendronate Sodium Oral Tablet 70 mg give 1 tablet by mouth one-time a day every 7 days for supplement at 9:00 AM was not administered. The MAR documented code 9-refer to nurse's note.-11/29/25 Calcium 600 + D Oral Tablet give 1 tablet by mouth one-time day for supplement at 9:00 AM was not administered. The MAR documented code 9-refer to nurse's note.-11/29/25 Linagliptin Oral Tablet give one tablet by mouth one time a day for Diabetes at 9:00 AM was not administered. The MAR documented code 9-refer to nurse's note.-11/28/25 and 11/29/25 Pravastatin Sodium Oral Tablet 20 mg give 1 tablet by mouth at bedtime for Cholesterol at 9:00 PM was not administered. The MAR documented code 9-refer to nurse's note.-11/28/25 and 11/29/25 Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day at 9:00 AM for supplement for 7 days. The MAR documented code 9-refer to nurse's note. Record review of Medication Administration Record dated December 2025, for Resident #3 revealed:-12/01/25 Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day at 9:00 AM, for supplement for 7 days. The MAR documented code 9-refer to nurse's note.-12/02/25 (continued on next page) 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 12/04/2025 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 Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day at 9:00 AM and 9:00 PM, for supplement for 7 days. The MAR documented code 9-refer to nurse's note.-12/03/25 Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day at 9:00 AM, for supplement for 7 days. The MAR documented code 9-refer to nurse's note. Record review of Nurse's Progress Notes for Resident #3 revealed:-11/28/25 at 10:22 PM, Pravastatin Sodium Oral Tablet 20 mg give 1 tablet by mouth at bedtime for Cholesterol. On order.-11/28/25 at 9:36 AM, Alendronate Sodium Oral Tablet 70 mg give 1 tablet by mouth one-time a day every 7 day(s) for supplement. Pending pharmacy delivery.-11/29/25 at 9:37 AM, Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day for supplement for seven days. Pending pharmacy delivery.-11/29/25 9:38 AM Linagliptin Oral Tablet give one tablet by mouth one time a day for Diabetes. Pending pharmacy delivery.-11/29/25 1:37 PM Calcium 600 + D 600-5 MG-MCG Oral Tablet give 1 tablet by mouth one-time day for supplement. Pending pharmacy delivery.-11/29/25 10:40 PM, Pravastatin Sodium Oral Tablet 20 mg give 1 tablet by mouth at bedtime for Cholesterol. On order.-12/01/25 9:37 AM, Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth one time a day for supplement for seven days. Not available.-12/01/25 21:59 PM, Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth two times a day for supplement. The Entry did not document the medication was pending delivery from pharmacy.-12/03/25 10:56 AM Sodium Chloride Oral Tablet 1 GM give 1 tablet by mouth two times a day for supplement. Not available, pending delivery. 4. Record review of admission Record, dated 12/03/25, revealed Resident #4 was admitted to the facility on [DATE]. Record review of History & Physical, dated 12/01/25 for Resident #4 revealed, L2 vertebral compression fracture (a fracture in the second lumbar vertebra, where the bone gets a squished from the sides, often causing the front to collapse into a wedge shape, making it shorter and sometimes causing severe back pain), atrial fibrillation (is an irregular and often rapid heartbeat caused by abnormal electrical signals in the heart's upper chambers, which causes them to quiver instead of contracting properly, right hydronephrosis (A problem with the right kidney causing it to leak protein into the urine, leading to swelling, especially around eyes, legs and belly, foamy urine, low protein and high cholesterol), Hepatic Encephalopathy (temporary loss of brain function that happens when a damaged liver can't remove toxins (like ammonia) from the blood, allowing them to build up and affect the brain, causing confusion, memory problems, personality changes, and event coma in severe cases), Asthma (is a chronic lung disease that makes breathing hard, causing airways to swell, narrow, and produce extra mucus, leading to symptoms like wheezing, coughing, chest tightness, and shortness of breath). Record review of admission MDS, dated [DATE], for Resident #4 revealed, Entry Date: 11/27/25. Review of BIMS Summary Score: 9 Cognitively moderately impaired. Section GG - Functional Abilities Dependent with toileting, shower and lower body dressing; Substantial assistance with upper body dressing and personal hygiene. Mobility - Dependent roll left and right, sit to lying, lying to sitting, sit to stand and chair/be transfer and toilet transfer. Indwelling catheter. Incontinent of bowel. Section I - Active Diagnoses: Renal Insufficiency, Obstructive Uropathy (Urinary system has a blockage, stopping urine from flowing out, causing it to back up, swelling the kidneys and potentially cause pain, frequent infection or difficulty urinating, which can harm the kidneys if not treated), Diabetes Mellitus, Other fracture, psychotic disorder, compression of lumbar vertebrae, muscle weakness, lack of coordination. High-Risk Drug Classes: Anticoagulant, and Antipsychotic. Record review of the Care Plan, dated 11/28/25 for Resident #4 revealed:-The resident has ADL self-care performance deficits and limitations in physical mobility. Interventions: Requires substantial/maximal assistance with toileting, shower, dressing, turning & reposition in bed, toilet transfer.-The resident is incontinent of bowel and bladder. Interventions: The resident uses disposable briefs. Change as needed. Check every two (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 12/04/2025 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 to three hours and as needed for incontinence.-The resident has a urinary catheter. Interventions: Check placement of tubing each shift.-The resident has actual skin integrity. Interventions. Apply barrier cream after incontinent episodes per facility protocol. Evaluate and treat per physicians' orders. Keep skin clean and dry.- The resident is receiving anticoagulant therapy and prone to bleeding and bruising. Interventions: Labs as ordered. Report abnormal labs to physician. Monitor and document adverse reactions to anticoagulant therapy. Record review of Physician Order Summary, dated 12/03/25, for Resident #4 revealed:- Levothyroxine Sodium Oral Tablet 137 MCG give one tablet by mouth one time a day for hypothyroidism.- Rifaximin Oral Tablet 550 mg give one tablet by mouth two times a day for Hepatic Encephalopathy.- Symbicort Inhalation Aerosol 160-4.5 MCG/ACT 2 puffs inhale orally two times a day for SOB. Record review of the Medication Administration Record, dated November 2025, for Resident #4 revealed:-11/28/25 Levothyroxine Sodium Oral Tablet 137 MCG give one tablet by mouth one time a day for hypothyroidism at 6:00 AM was not administered. The MAR documented a code of 9 (refer to Nurse's Note).-11/28/25 Rifaximin Oral Tablet 550 mg give one tablet by mouth two times a day for Hepatic Encephalopathy at 9:00 AM and 9:00 PM were not administered. The MAR documented a code of 9 (refer to Nurse's Note).-11/28/25 Symbicort Inhalation Aerosol 160-4.5 MCG 2 puffs inhale orally two times a day for SOB at 9:00 AM and 9:00 PM were not administered. The MAR documented a code of 9 (refer to Nurse's Note). Record review of the Medication Administration Record, dated December 2025, for Resident #4 revealed:-12/01/25 Levothyroxine Sodium Oral Tablet 137 MCG give one tablet by mouth one time a day for hypothyroidism at 6:00 AM. The entry on the MAR was left blank. Record review of Nurse's IDT progress Notes, dated November 2025, for Resident #4 revealed: -11/28/25 Levothyroxine Sodium Oral Tablet 137 MCG give one tablet by mouth one time a day for hypothyroidism at 6:00 AM. Medication pending from pharmacy.-11/28/25 Rifaximin Oral Tablet 550 mg give one tablet by mouth two times a day for Hepatic Encephalopathy at 9:00 AM and 9:00 PM. Medication pending from pharmacy.-Symbicort Inhalation Aerosol 160-4.5 MCG 2 puffs inhale orally two times a day for SOB at 9:00 AM and 9:00 PM. Medication pending from pharmacy. Record review of Nurse's IDT Progress Notes, dated December 2025, for Resident #4 revealed:-Review of Nurse's Notes did not document if Levothyroxine Sodium Oral Tablet 137 MCG give one tablet by mouth one time a day for hypothyroidism at 6:00 AM was administered as ordered. During an interview on 12/03/24 at 1:40 PM with Resident #4's attending physician revealed, she was not aware medications were not being administered according to physician's orders due to medications pending delivery from the pharmacy, or due to cost approval, or not available in the automated medication management system's formulary. She said she expected the nurses to immediately notify her if medications were not available to administer, especially if they were significant medications such as Levothyroxine. She said the facility had a contract with a local pharmacy to deliver medications after hours and the nurses should have called the pharmacy to order the medication to have on hand to administer the medication as ordered. During an interview on 12/03/25 at 3:10 PM with RN Assistant CNO revealed the nurses were trained to notify her and the attending physician when medications were not available to administer as ordered. 5. Record Review of admission Record dated 12/03/25, for Resident #5 revealed admission date 05/23/2023. Record review of Resident #5's electronic medical records revealed the resident did not have a History & Physical. Record review of the Nurse Practitioner Progress Note, dated 06/25/2025, for Resident #5 provided by RN Assistant Chief Nurse Officer revealed, [AGE] year-old female resident who was alert, oriented to person only; able to follow simple commands. The MPOA expressed concern regarding whether medications are being administered consistently. There were no diagnoses documented on the progress note. Record review of Quarterly MDS, dated [DATE], for Resident #5 revealed BIMS Summary Score 7 Cognitively (continued on next page) 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 12/04/2025 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 Severely Impaired. Active Diagnoses: Heart Failure (the heart cannot pump enough blood and oxygen to meet the body's needs), Hypertension (when the force of blood against your artery wall is consistently too high), Alzheimer's Disease (is a specific disease that slowly destroys brain cells, leading to confusion, memory gaps, personality changes, and difficulty with everyday tasks), Hypothyroidism (a condition where your thyroid gland does not produce enough essential hormones that control body energy use, leading to slow metabolism and symptoms of fatigue, weight gain, feeling cold, and dry skin), Glaucoma (a group of eye diseases that damage the optic nerve, due to increased pressure inside the eye, leading to gradual peripheral vision loss and potentially blindness if untreated), Osteoporosis (when the bones become weak, thin, and brittle making super easy to break) . History of falls. High-Risk Drug Classes: Diuretic, Antiplatelet. Record review of Care Plan, dated 07/29/25, for Resident #5 revealed:-The resident is receiving antiplatelet medication. Interventions: Monitor and report as needed adverse reactions.-The resident has ADL self-care performance deficits and limitations in physical mobility. Alzheimer's, Hypothyroidism, and Hypertension. Interventions: Uses wheelchair. Partial/moderate assistance with personal hygiene, dressing; Dependent for shower, toileting. -The resident has hypothyroidism. Interventions: Obtain and monitor labs as ordered. Administer medication as ordered. -The resident at risk of skin alteration related to incontinence, and decreased mobility. Interventions: Apply skin barrier to help protect skin from excess moisture. -The resident is at risk for falls r/t lack of safety awareness, decreased mobility. Interventions: Keep call light within reach. Bed in low position when in bed. Anticipate needs. Record review of Physician Order Summary Report, dated 12/04/25, for Resident #5 revealed:-11/18/25 Amoxicillin Oral Tablet 500 mg give 1 tablet by mouth three times a day for mouth sore for 7 days.-Aspirin Oral Capsule 81 mg give 1 tablet by mouth one time a day for pain.- Calcium Antacid Chewable 500 mg give 1 tablet by mouth two times a day for supplement.- Colace Oral Capsule 100 mg give 1 capsule by mouth one time a day for constipation.Farxiga Oral Tablet 5 mg give 2 tablets by mouth in the morning for hyperglycemia.- Latanoprost Ophthalmic Solution 0.005% instill 1 drop in both eyes in the evening for glaucoma- Levothyroxine Sodium 25 mcg give 1 tablet by mouth in the morning for hypothyroidism.- Lidocaine External Patch 4% apply to left shoulder topically in the morning for pain may wear up to 12 hours per day and remove as scheduled.Pravastatin Sodium Oral Tablet give 1 tablet by mouth at bedtime for HLD.- Lisinopril Oral Tablet give 1 tablet in the morning for HTN.- Vitamin C Oral Tablet 1000 mg give 1 tablet by mouth two times a day for supplement. Record review of Medication Administration Record, dated October 2025, for Resident #5 revealed:-10/11/25 - 10/13/25 Aspirin 81 mg give 1 tablet by mouth one time a day at 8:00 AM, was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/17/25 - 10/20/25 Colace Oral Capsule 100 mg give 1 capsule by mouth one time a day at 9:00 AM, for constipation was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/25/25 - 10/27/25 Farxiga 5 mg give tablets give two tablets by mouth in the morning at 9:00 AM, for hyperglycemia were not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/15/25 - 10/16/25 Latanoprost Ophthalmic Solution 0.005% instill 1 drop in both eyes in the evening at 6:00 PM, for glaucoma at 6:00 PM was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/03/25 and 10/11/25 Levothyroxine Sodium 25 mcg give 1 tablet by mouth in the morning at 5:00 AM for hypothyroidism was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/08/25 - 10/09/25 Lidocaine External Patch 4% apply to left shoulder topically in the morning for pain may wear up to 12 hours per day and remove as scheduled. The MAR documented code 9 (see nurses' notes)-10/05/25, 10/07/25, 10/10/25 - 10/12/25, 10/15/25, 10/26/25, 10/20/25, 10/21/25, 10/24/25 10/26/25 Pravastatin Sodium Oral Tablet give 1 tablet by mouth at bedtime at 9:00 PM, (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 12/04/2025 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 FORM CMS-2567 (02/99) Previous Versions Obsolete for HLD (high levels of cholesterol and fats in the blood) was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/24/25 - 10/27/25 Prenatal Vitamin give 1 tablet by mouth one time a day for supplement at 9:00 AM was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/13/25 Spironolactone Oral [NAME] 25 mg give 1 tablet by mouth in the morning at 9:00 AM for HTN was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/13/25 10/20/25 Calcium Antacid Chewable 500 mg give 1 tablet by mouth two times a day for supplement at 8:00 AM and 9:00 PM was not administered as ordered. The MAR documented code 9 (see nurses' notes)-10/16/25 - 10/23/25 Vitamin C Oral Tablet 1000 mg give 1 tablet by mouth two times a day at 9:00 AM and 9:00 PM was not administered as ordered for supplement. The MAR documented code 9 (see nurse's notes). Record review of Medication Administration Record dated October 2025 for Resident #5 revealed:-10/11/25 - 10/13/25 Aspirin 81 mg give 1 tablet by mouth one time a day at 8:00 AM. The MAR documented code 9 (see nurses' notes)-10/17/25 - 10/20/25 Colace Oral Capsule 100 mg give 1 capsule by mouth one time a day at 9:00 AM for constipation. The MAR documented code 9 (see nurses' notes)-10/25/25 - 10/27/25 Farxiga 5 mg give tablets give two tablets by mouth in the morning for hyperglycemia. The MAR documented code 9 (see nurses' notes)-10/15/25 - 10/16/25 Latanoprost Ophthalmic Solution 0.005% instill 1 drop in both eyes in the evening for glaucoma at 6:00 PM. The MAR documented code 9 (see nurses' notes)-10/03/25 and 10/11/25 Levothyroxine Sodium 25 mcg give 1 tablet by mouth in the morning at 5:00 AM for hypothyroidism. The MAR documented code 9 (see nurses' notes)-10/08/25 - 10/09/25 Lidocaine External Patch 4% apply to left shoulder topically in the morning for pain may wear up to 12 hours per day and remove as scheduled. The MAR documented code 9 (see nurses' notes)-10/05/25, 10/07/25, 10/10/25 - 10/12/25, 10/15/25, 10/26/25, 10/20/25, 10/21/25, 10/24/25 10/26/25 Pravastatin S 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 12/04/2025 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 Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 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. Based on observation, interview and record review the facility failed to establish procedures for storing and disposing of drugs and biological in accordance with federal, state, and local laws. -The facility failed to ensure medication deliveries were not left unattended at the nurse's station. -The facility failed to ensure licensed staff did not leave medications unattended at the nurse's station This failure could place residents living at the facility at risk of drug diversion. The findings included:During an observation on 12/03/25 at 9:00 AM, revealed a cardboard box was on top of the nurse's station countertop labeled El Paso with a label on one side that documented Dressing Change Kits. During an observation, interview and record review on 12/03/25 at 9:50 AM revealed, LVN I, was sitting at the nurse's station taking medication blister packets out of the cardboard box that was labeled El Paso, that was on the nurse's station countertop unattended earlier that morning. He said the pharmacy ships medications in cardboard boxes from out of town and the boxes should be received by one of the nurses. He said, These blister packets are controlled substances, and I need to store them in the locked medication room next to the nurse's station. The nurse walked away from the nurse's station for approximately two minutes and left several medication blister packets unattended on top of the counter in front of the computer unattended. It was observed that the housekeeper standing in the hallway directly in front of the nurse's station preparing cleaning equipment to enter a resident's room and the facility driver was standing on the side of the nurse's station talking to a resident. The nurse returned to the nurse's station and continued to pull medication blister packets from the cardboard box. The surveyor requested copies of the packing slips from the cardboard box. Record review of the Packing Slips dated 12/02/2025 revealed the following medications were listed on the packing list. Alprazolam 0.5 mg 42 tablets, Dronabinol 2.5 mg 30 tablets, Tramadol HCL 50 mg 30 tablets, and Tramadol HCL 50 mg 30 tablets. The packing slips documented, By signing below, you acknowledge that the items above have been received. It was observed that the packing slips were not signed by the receiving nurse. During an interview on 12/03/25 at 9:57 AM LVN stated, they had been trained to never leave medications unattended at the nurse's station. During an interview on 12/02/25 at 3:12 PM, with RN Assistant Chief Nursing Officer in the presence of the Executive Director and Chief Nursing Officer revealed, they had contracts with two out-of-town pharmacies that provided pharmaceutical services to the facility and with a local pharmacy for after hour services. It was reported that the delivery people should hand the box of medication to one of the nurses on duty and should never leave the box with medication unattended at the nurse's station. She said the delivery person and receiving nurse had to sign and date the packet delivery slip for the person that delivered the medication to the facility. During an interview 12/03/25 at 3:21 PM, with RN Assistant Chief Nursing Officer in the presence of the Executive Director and Chief Nurse Officer revealed, she had followed up with the nurses and they had reported that the cardboard box that contained medication was just left by the delivery person at the nurse's station and was not left with any of the three nurses that were on duty. Review of facility's policy and procedure on Medication Ordering and Receiving Form from Pharmacy ProviderReturns a signed copy of the delivery receipt/manifest to the pharmacy via driver, fax or other method, as defined by the pharmacy provider. Retains a copy of the delivery for an appropriate time to reconcile any ordering issues. 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 12/04/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure, in accordance with accepted professional standards and practices, medical records were maintained on each resident that were accurately documented for 1 (Resident #22) of 8 residents reviewed for medical records. -The facility failed to ensure LVN A documented in the Nurse's Notes on 11/18/25 when she notified the physician of resident family's non-compliance of NPO status. -The facility failed to ensure that licensed staff promptly wrote physician's telephone orders and entered new orders in the medication administration record. This failure could place residents at risk of residents records not reflecting accurate and complete information. Findings include:Closes Record Review of the admission Record dated 12/01/25 for Resident #1 revealed, admission date 11/10/25. discharge date [DATE] to Acute Care Hospital.Review of the Hospital Physician Progress Note for Resident #1 dated 11/09/25 revealed, [AGE] year-old male with a history of esophageal cancer (abnormal cells grow out of control in the food pipe, making it hard to swallow, causing pain, weight loss, and a persistent cough or hoarseness as the tumor blocks the passage or irritates the area) on enteral feedings (giving liquid nutrition formulas directly into their stomach through a tube), CAD with history of mitral valve replacement (blocked heart arteries damaged the heart muscle, causing the mitral valve to leak, both problems are fixed by bypass surgery for the arteries and replacing the faulty valve with a new mechanical one, to improve blood flow and heart function). Review of the admission MDS assessment dated [DATE] for Resident #1 revealed, Entry Date: 11/10/25. BIMS Summary Score - 10 (cognition was moderately impaired). Clear speech, makes self-understood, and understands others. Active Diagnoses: Cancer, Heart Failure (the heart cannot pump enough blood and oxygen to meet the body's needs), Hypertension, Diabetes Mellitus (a chronic disease where the body had high blood sugar levels, either because the pancreas does not produce enough insulin or the body cannot use insulin effectively), Non-Alzheimer's Dementia (brain disorder causing memory, thinking, and behavior problems), Dysphagia (difficulty swallowing, which can make it hard for food and liquids to move from the mouth down to the stomach), lack of coordination, and Gastrostomy (is a feeding tube that goes directly into the stomach through a small opening in the stomach, by bypassing your mouth and throat, to deliver liquid food, medicine, or to help air and fluids come out). Review of the Care Plan for Resident #1 dated 11/10/25 revealed: Resident has ADL self-care performance deficit and limitations in physical mobility. Interventions: Partial/moderate assistance with toileting hygiene, dressing and turning and repositioning in bed. Resident is NPO (nothing by mouth) on G-tube on bolus feedings (give a single, large amount of liquid food through a feeding tube, instead of a slow, continuous drip) every six hours. The resident was receiving anticoagulant therapy and are prone to bleeding and bruising. Interventions: Labs as ordered. Report abnormal results to the MD. Monitor/document/report PRN (as needed) black tarry stools, sudden changes in mental status, significant or sudden changes in vital signs. Record review of the IDT Notes revealed that LVN A had not documented the physician she had notified the physician on 11/18/25 when she had seen the resident's family member giving Resident #1 water with ice chips and was not following the NPO order. LVN A only documented she had notified the Speech Therapist Record review of the Medication Administration Record dated November 2025 for Resident #1 did not document the orders for the Chest x-ray, Saline Nasal Spray and Oxygen order for 1 Liter. During an interview and record review on 12/01/25 at 3:39 PM with LVN A in the presence of RN Assistant Chief Nurse Officer revealed she was assigned to Resident #1 on 11/22/25 and had worked from 6:00 AM - 6:00 PM on that day. She said on 11/22/25 Resident #1 was having more chest congestion than usual in the (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 12/04/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete morning, and she had notified the physician, and they had given an order for chest x-ray, Saline Nasal Spray, Oxygen at 1 Liter and she did not write the telephone order and had not entered the new orders on the Medication Administration Record. She said, There is no reason why I did not write the Telephone Order and did not enter the order for the Saline Nasal Spray in the Medication Administration Record. She said licensed staff had been trained to immediately write the Telephone Order for new orders and to enter the new order on the Medication Administration Record. LVN A said the resident was NPO and was not aware that he was ever served regular food while at the facility. She said the resident was always requesting ice chips, and the speech therapist had given an order to give ice chips only when directly supervised by the nurses. She said the resident received three bolus enteral feeding via G-Tube during her shift. She said that on 11/18/25 she had seen the resident's family member giving the resident water with ice. She said the Speech Therapist had given orders for only the licensed staff to give ice chips to the resident because he was high risk for aspiration. She said she had immediately reported this to the speech therapist and did not remember if she had notified the physician, because she had not documented the physician notification in her nurse's notes on 11/18/25. During an interview and record review 12/01/25 at 4:40 PM with RN Assistant Chief Nursing Officer revealed LVN A had seen when the resident's family member was giving the resident water mixed with ice chips on 11/18/25 and she had notified the speech therapist. She said that she did not know if the nurse had reported this to the attending physician because the nurse had not documented in the electronic Nursing Progress that the physician had been notified of the non-compliance with the resident's NPO status. She said the nurses had been trained to document in the resident's clinical record physician notifications and to promptly write a Telephone Order and enter the new orders in the Medication Administration Record. She said LVN A had not written the Telephone Order and had not entered the new order for the Nasal Saline spray, and Oxygen order for 1 liter and had not entered in the Resident's Medication Administration Record for the Saline Nasal Spray and Oxygen ordered by the physician on 11/22/25. Review of the facility's policy & procedures on Documentation by Exception revised 11/2024, provided by RN Assistant Chief Officer revealed, Policy: Documentation should include any unusual event or change of condition of the resident. Documentation may be completed under Progress Notes, evaluations, etc. Any communication with a physician, nurse practitioner, consultant physician, or family should also be documented as appropriate. 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 12/04/2025 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review the facility failed to have an adequately equipped system that allowed residents to call for staff assistance through a communication system for 2 of 2 call light systems viewed for resident call system. The facility failed to ensure that residents call lights for 3 of 3 Resident Halls were functioning properly. This failure put residents at risk of not being able to call for assistance when needed. Findings included: During an observation 12/01/25 at 12:53 PM in Hall 200 revealed, two residents had turned on the Nurse Call Lights. It was observed that the corridor lights for Nurse Call were on, room [ROOM NUMBER] and 209, and were not ringing in the residents' rooms or at the nurse's station. There were no staff sitting at the nurse's station. During an observation 12/01/25 at 1:33 PM revealed, the resident in room [ROOM NUMBER] had turned on his Nurse Call Light. It was observed that the corridor light for Nurse Call in room [ROOM NUMBER] was on and was not ringing in the residents' room or at the nurse's station. The Nurse was passing medications in the 200 Hall and CNAs were picking up lunch trays throughout the resident halls. There were no staff at the nurse's station. During an observation 12/02/25 at 9:35 AM revealed, the resident in room [ROOM NUMBER] had turned on his Nurse Call Light. It was observed that the corridor light for Nurse Call in room [ROOM NUMBER] was on and was not ringing in the resident's room or at the nurse's station for room [ROOM NUMBER]. There were no staff at the nurse's station or in the 200 Hall. During an observation 12/02/25 at 9:37 AM revealed, the resident in room [ROOM NUMBER] had turned on his Nurse Call Light. It was observed that the corridor Nurse corridor lights for Nurse Call were turned on and were not ringing in the residents' rooms and were not ringing at the nurse's station. It was observed that the call light monitor at the nurse's station directly in front of room [ROOM NUMBER] was not turned on. The Nurse was in the 200 Hall passing medications and the CNAs were picking up lunch trays throughout the resident halls. There were no staff at the nurse's station. During an observation 12/02/25 at 9:51 AM, it was revealed two resident corridor lights for Nurse Call were turned on in the 200 Hall and were not ringing in the residents' room and were not ringing at the nurse's station. The call light monitor at the nurse's station was not on. The Nurse was passing medications and CNAs were in resident rooms assisting residents. There were no staff at the nurse's station. During an observation 12/02/25 at 12:45 PM revealed, the resident in room [ROOM NUMBER] had turned on his Nurse Call Light. It was observed that the corridor Nurse call light was turned on for room [ROOM NUMBER] and was not ringing in the resident's room or at the nurse's station. The CNAs were picking up lunch trays throughout the resident halls and nurses were passing medications in the hallways. During an observation and interview on 12/02/25 at 12:52 PM, with LVN B assigned to the 100 Hall on the 6:00 AM - 6:00 PM, demonstrated to the state surveyor that she had turned on the Nurse Call Light in room [ROOM NUMBER] was not ringing in the resident's room and/or at the nurse's station. She said, I noted yesterday that the Nurse Call Lights only rang once when the call light was turned on by the resident and did not continue to ring and Nurse Call Lights were not ring at the nurse's station. She said she had not reported this to the Maintenance Director. During an observation and interview on 12/02/25 at 1:30 PM, the Maintenance Director revealed he was not aware of any issues with the Nurse call light system. He said he conducted monthly QA checks of the Nurse all light system to ensure the system was working properly. He said he received a reminder via telephone when to complete the scheduled monthly QA checks on the Nurse call light system. He said the next QA check on the call light system was due on 12/31/25. The state surveyor requested copies of the QA checks completed on the Nurse call light system. During an interview on 12/03/25 at 9:15 AM with Chief Nursing Officer revealed Residents Affected - Many (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 12/04/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many that the corridor Nurse call lights were not ringing at the nurse's station or when the residents pushed the red button on the call light for assistance for the last six days. She said, I noticed this week that the corridor light for Nurse Call Lights would turn on and were not ringing resident rooms or at the nurse's station. She said, Prior to that I do not remember if the Nurse call lights rang at the nurse's station. She said the nurses, executive director and some of the department heads today had started to help with answering call lights. She said, The Nurse call lights will light up but do not ring to alert the staff when residents are calling for assistance. During an observation and interview on 12/03/25 at 9:33 AM with RN G revealed, the Nurse call lights should ring at the nurse's station or when the residents called for assistance. She said, I noted this past weekend the Nurse call lights were on and were not ringing, but we can see the corridor Nurse call light, lights up when the residents push the button on the call light for assistance. The surveyor asked the nurse to turn on the emergency light in the resident's bathroom in room [ROOM NUMBER]. It was observed that the corridor Nurse call light turned on and was red but was not ringing in the resident's room or the nurse's station directly across from the resident's room. The nurse said, I had not noted that the emergency lights were not ringing. She said, I am not aware of any concerns voiced by families and/or residents about call lights not being answered. During an observation and interview on 12/03/25 at 9:42 AM with CNA H revealed, she had not noticed that the Nurse call lights were not ringing in the resident rooms or the nurse's station. She said the Nurse corridor light turns on and will only ring once when the residents push the red button for assistance and then stops ringing. She said we look to see if the corridor Nurse call lights are on as we walk down the halls while doing our work and try to assist the residents as soon as possible. During a confidential interview on an undisclosed date at an undisclosed time revealed, the Nurse call lights and the central receiver/panel at the nursing stations had not been working for several months. It was reported that the Maintenance Director was aware that the call light system was not working. It was reported that the nursing staff must be on the lookout to see if the corridor Nurse call lights are on so they can go and assist the residents. During a confidential interview on an undisclosed date at an undisclosed time revealed, the Nurse call lights and the central receiver/panel at the nursing stations had not been working for a long time. It was reported that the Maintenance Director was aware that the call light system was not working. It was reported that the nursing staff must be on the lookout to see if the corridor Nurse call lights are on so they can go and assist the residents. During observation and interview on 12/03/25 at 10:19 AM with Maintenance Director revealed both central receiver/panels at the nurse's stations were fried. He demonstrated to the surveyor that the central receiver/panels did not turn on. He said, I don't know how long the receiver/panels have not been working. He said, Since the Nurse call lights are not ringing, the nursing staff must be on the look out to see if the corridor Nurse Call Lights are on, so they can assist the resident. I already contacted the call light company on 12/02/25 by email to come and check the system to see why it's not working properly. Review of email dated 12/02/25 provided by the Maintenance Director sent to the contractor's Territory Manager revealed, Nurse Call Light issues. Please create a service ticket and copy me please sir. The Maintenance Director documented on the copy of the email sent to vendor 12/02/25 at 7:49 AM, Call Light System not working. Not ringing at nurse's stations. During an interview on 12/03/25 at 11:00 AM, with the Executive Director revealed that he was aware that the Resident Call Light System was not ringing in the resident rooms and not ringing at the nurse's station. He said the contractor was still pending to come to the facility to check the call light system. He said he had started a QA plan to address the call light system not working and had asked some of the department heads, including him (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 12/04/2025 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete to assist the nursing staff in answering call lights. Review of QA Logbook Documentation on call system provided by Maintenance Director on 12/02/25 revealed: -11/07/25 documented All lights in good condition. Resident Halls 100, 200 and 300. -10/10/25 documented All Call Lights and main panel properly functioning. Resident Halls 100, 200 and 300.-09/05/25 documented All lights and panels in good working condition. Resident Halls 100, 200 and 300.-08/11/25 documented All call lights in good condition and Main Panel. Resident Halls 100, 200 and 300. Review of facility's policy & procedure on Call-Light Outage revised 11/2024 provided by Maintenance Director on 12/02/25 revealed: General: Call lights are to be answered in a timely and reasonable manner. This is to provide a guideline for the building should the call light system become inoperable. Responsible Party: Administrator, DON, Supervisor. Guideline: Should a staff member find a call light not to be working, they will immediately notify maintenance to replace the call light. Should it occur after hours, the resident will be given an alternate way to call for help until the light can be repaired (bell etc.) If it is discovered that multiple lights are out, the maintenance director will be notified. If the maintenance director is not in the building, the administrator will be notified. An additional staff member will be utilized on each wing where the outage occurs to walk from room to room to monitor residents. Bells or another alternate way to call for help will be distributed to those residents who are able to use the device. If this occurs during the day, residents will be encouraged to be in public area (dining rooms, etc.) for monitoring. Event ID: Facility ID: 676428 If continuation sheet Page 19 of 19