Health inspection·May 30, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assistance with late loss ADLs and the use of wheelchair for locomotion. The identified goal was Resident was able to perform self-care to optimal level and maintains strength and endurance for 90 days. Interventions included encourage independence in performance in self-care and mobility within limitations. Review of Resident #3's admission Record, dated 5/30/24, revealed he was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including stroke, dementia, and dysphagia (difficulty swallowing) Review of Resident #3's Significant Change MDS, dated [DATE], revealed: He scored a 0 of 15 on his mental status exam (indicating severe cognitive impairment). He needed supervision for eating. Review of Resident #3's care plan, dated 1/4/24 revealed a focus of Resident requires assist with ADLs. The identified goal was Resident was able to perform self-care to optimal level and maintain strength and endurance for 90 days. Interventions included encourage independence in performance of self-care and mobility within limitations. Review of Resident #3's care plan, updated 2/23/24 revealed, No added salt diet, regular texture, regular consistency. The goal was resident will maintain adequate nutritional status as evidenced by maintain weight through review date. Interventions included: 4/16/24 Resident no longer needs feeding assistance. Observation on 5/29/24 at 12:27 p.m., revealed CNA A stood while feeding Resident #1. CNA B stood while feeding Resident #2 and CNA C stood while feeding Resident #3. The lead CNA observed the three standing and brought two of them chairs, while CNA B reached behind her to another table to get a spare chair. While feeding Resident #1, CNA A had difficulty remaining seated because she kept kneeling up in the chair and then looking at the lead CNA or a nurse and sitting again. Interview on 5/29/24 at 12:41 p.m., the lead CNA stated CNAs needed to sit down while feeding because it was a dignity thing. The lead CNA stated the three aides forgot to get chairs and when he got them chairs, they remembered they needed to do that. The lead CNA stated the aides were monitored daily but he was responsible for monitoring the aides every Thursday. He said it had been a while since he had issues with the aides standing in the dining room while feeding. Observation on 5/30/24 at 12:43 p.m., staff were observed standing while feeding Resident #2. Interview on 5/30/23 at 1:24 p.m., the DON stated her expectation for the meal served was that the staff be seated while feeding the residents. She said it was inappropriate for the staff to be standing because the staff were supposed to be at eye level of the resident and be able to talk to the resident about what the resident was eating to see if the resident liked something or not within the resident's therapeutic diet. The DON said there was a meal monitor in the dining room and a nurse who were responsible to monitor for that. The DON stated normally the aides' put chairs where the dependent residents were fed prior to the meal service but the dining room was currently being remodeled so it was crowded so the staff were just trying to get residents into the dining room in where they could to feed them. The DON said she did see staff sitting to feed residents. Surveyor requested a policy for feeding residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676430 If continuation sheet Page 2 of 3 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 676430 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashton Medical Lodge 801 South Loop 250 West Midland, TX 79703 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 5/30/24 at 1:58 p.m., the Administrator was informed of the staff standing while feeding observations. The Administrator stated he did not feel this was an issue due to the chaos going on related to the remodel in the dining room. He stated there were not chairs available. Surveyor pointed out the lead CNA was able to bring 2 chairs immediately to the table and the third CNA was able to go to the table immediately behind her for a chair. Surveyor also pointed out chairs could have been set up at the assisted table while the dining room was half-empty rather than waiting until the dining room was full. The Administrator said sitting while feeding was not outline specifically in the facility's policy. Follow up interview on 5/30/24 at 3:38 p.m., the Administrator said he did some investigation and the staff only reported that they only stood while cutting up the resident's meals during set up. Review of in-services provided by the facility revealed the staff were in-serviced: 4/19/24 Resident Rights on 4/19/24 that residents had the right to be treated with dignity, courtesy, consideration, and respect. (CNA A did attend this in-service) 5/6/24: Ombudsman's Resident's rights: Resident rights include being treated with respect, dignity and consideration. Review of the facility's undated policy and procedure on Feeding Residents in the Dining Room revealed: Purpose: To be sure all residents in the dining room have the assistance needed to complete their meal. Procedure: Staff member should position themselves so that the resident is at eye level with the staff member for better communication with the resident and to provide feeding in a dignified manner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676430 If continuation sheet Page 3 of 3