Health inspection·March 6, 2024

F 0600 Resident # 8's electronic admission record, undated, revealed they were a [AGE] year-old female admitted [DATE]. Level of Harm - Actual harm Residents Affected - Some Resident # 9's electronic admission record, undated, revealed they were a [AGE] year-old female admitted [DATE]. Resident # 10's electronic admission record, undated, revealed they were a [AGE] year-old female admitted [DATE]. Observation on 3/6/2024 at 11:55 am of lunch on the memory care unit, residents clean, dry, and appropriately dressed, no odor or clutter noted. Staff interacting with residents and assisting with meal set-up. Two residents being assisted to eat. All residents appear calm and staff member is calm and appropriately redirects behaviors. Interview with DON on 3/6/2024 at 1:00 pm she stated that LVN B reported to her and the administrator the events of 2/28/2024 during her shift on 2/29/24, an investigation was started, and the ADM contacted LVN C and placed her on administrative leave. The residents on the memory care unit had a safe assessment and none reported memory of the event. Facility wide Abuse and neglect in service was completed by all staff on duty and Inservice was available at change of shift for staff review and acknowledgement prior to reporting for duty. She stated that usually on days the staff on the Memory care unit was an LVN and a CNA. She stated that her expectations are that residents are treated with respect and verbal abuse was not acceptable. She stated that verbal abuse could be harmful to the resident for decline and withdrawal and fear. Interview with LVN C on 3/6/2024 3:15 pm attempted by phone, no answer, message left with request for return call, as of exit on 3/6/2024 at 5:00 pm no call back received. Interview with LVN B on 3/6/24 3:30 pm by phone, stated that LVN C was yelling in the common room on the secured unit, she was not yelling at one resident but in general stating for them to leave her alone and go away. She stated that this agitated the residents. Interview with CNA A on 3/6/24 3:45 pm by phone, she stated that LVN C was agitated and yelling at the residents all day on 2/28/2024. She stated this was not the first time she raised her voice at the residents in the memory care unit. When asked why she did not report this, she stated that she was usually back there with only LVN C and she was afraid of retaliation. Interview with ADM on 3/6/24 at 4:00 pm He stated when he called LVN C to inquire about the events of 2/28/24 she replied okay and made no other comment, when he stated she would be placed on administrative lead pending an investigation her reply was okay, thank you and she ended the phone call. He stated that after interviewing both LVN B and CNA A, and the observations he had made of LVN C since she has been working here, that the incident actually happened. He stated his plan was to terminate LVN C. Abuse of any kind was not tolerated. He stated his expectation was that all employees follow policy and procedure and ask in a professional manner. Record review 3/6/24 at 1: 30 pm Policy Abuse, neglect, exploitation and misappropriation prevention program revised April 2021 revealed Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual, and physical abuse ., further is revealed protect residents from abuse, neglect exploitation or misappropriation of resources by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676473 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 676473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Caraday of Lampasas 1000 E Ave J Lampasas, TX 76550 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 0600 anyone including a. Facility, staff. Level of Harm - Actual harm Record Review 3/6/2024 at 1:45 pm of LVN C employee record revealed documentation of phone call on 2/29/2024 placing on administrative leave pending outcome of investigation. Residents Affected - Some Record review 3/6/2024 at 1:50 pm of Written witness statement of LVN B, revealed that LVN C was yelling at the residents in the common room on 2/28/2024, no a particular resident just in general and that the resident were agitated the rest of the day. Record Review 3/6/2024 at 1:50pm of written witness statement of CNA A revealed that LVN C was yelling at the residents in the common room This noncompliance was identified as Past Noncompliance (PNC). The noncompliance began on 2/28/2024 and ended on 2/29/24. The facility had corrected the noncompliance before the survey began. The facility took the following actions to correct the non-compliance: 1. 2/29/24 Administrator immediately notified LVN C, that she was on administrative leave. 2. 2/29/24 DON has been in-serviced on abuse and neglect by the ADM. 3. 2/29/24 The Facility self-reported the incident to Health and Human Services 4. 2/29/24 The facility notified the families of the residents. 5. 02/29/24 The facility notified the facility's medical director. 6. 2/29/24 The facility in-serviced staff on Preventing Abuse, reporting and Abuse Coordinator. Verification of facility steps by Surveyor 1. Interviews were conducted with staff across multiple shifts on 3/6/24 from 10:54 AM through 4:00PM, including Maintenance Director, Culinary Director, Lead Housekeeper revealed they had all been in-serviced by the Facility of staff. Staff stated they were educated on abuse, neglect, and exploitation, who to report abuse to, types of abuse, residents' rights and where to find the resident rights posted in the facility. 2. Interviews were conducted with staff across all shifts on 03/0624 from 10:22 PM including 2 CNAs, 2 LVN revealed they had all been in-serviced by the facility staff. Staff stated they were educated on abuse, neglect, and exploitation, who to report abuse to, types of abuse, residents' rights and where to find the resident rights posted in the facility. 10. Per interview on 3/6/24 at 4:00 pm with ADM, plans to terminate LVN C. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676473 If continuation sheet Page 3 of 3