Health inspection·August 7, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2 diabetes mellitus with other circulatory complications (refers to the development of cardiovascular issues, like heart disease or stroke, as a consequence of type 2 diabetes), muscle weakness, lack of coordination (voluntary movements are not smooth or well-coordinated), acquired absence of eye (he loss of an eye due to injury, disease, or surgical removal), unspecified abnormalities of gait and mobility (various walking difficulties), unspecified dementia, major depression disorder, major anxiety disorder, and Alzheimer's disease.Record review of Resident #12's quarterly MDS assessment, dated June 10, 2025, section C revealed a BIMS score of 3 out of 15 which indicates severe cognitive impairment. The quarterly MDS assessment section GG further revealed Resident #12 required supervision or touching assistance (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity) for toileting hygiene (the ability to maintain perineal hygiene, adjust clothes before and after voiding or having a bowel movement), and upper and lower body dressing (the ability to dress and undress above and below the waist; including fasteners, if applicable). Review of section H revealed Resident #12 is always urinary incontinent (no episodes of continent voiding) and bowel incontinent (no episodes of continent bowel movements).Record review of Resident #12's care plan, initiated November 14, 2024, revised on June 17, 2025, states Resident #12 was at risk for falls and an intervention for this focus area was to ensure the resident's call light was within reach and Resident #12 needs prompt response to all requests for assistance.Observation on 08/06/2025 at 1:40 PM Resident #12 was lying in bed with their covers on. He stated he was okay and didn't need anything, but they had to repeat the answer 2 times due to speaking in a whisper. Call light was same position as it was on 08/05/2025 at 10:25 AM. The resident was not asked about the call light.Record review of Resident #36's face sheet dated August 7, 2025 revealed a [AGE] year-old male who admitted on [DATE], with diagnoses of hemiplegia, unspecified, affecting the right dominant side (a medical condition where the right side of the body experiences paralysis or weakness due to unspecified brain or spinal cord damage, and the affected individual is right-handed), muscle weakness (generalized) (a condition where muscle weakness is not localized to a specific area of the body but affects multiple muscle groups or the entire body), chronic obstructive pulmonary disease, vascular dementia, unspecified combined systolic (congestive) and diastolic (congestive) heart failure (a condition where the heart struggles to pump blood effectively due to issues with both the contraction (systolic) and relaxation (diastolic) phases of the heart muscle), muscle wasting and atrophy, not elsewhere classified, affecting multiple sites (muscle wasting is not specifically localized to one area, but rather affects multiple parts of the body), unspecified convulsions (specific type of convulsion is unknown), and age-related physical debility (a decline in physical function and reserve as people age, leading to increased vulnerability and difficulty coping with stressors).Record review of Resident #36's quarterly MDS assessment dated [DATE], section C revealed a BIMS score of 14 out of a 15 indicates intact cognitive function. The quarterly MDS section GG further revealed Resident #36 showed an impairment on their upper extremity (shoulder, elbow, wrist, hand). Resident #36 required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, lower body dressing, sit to lying (the ability to move from sitting on side of bed to lying flat on the bed), lying to sitting on side of bed (the ability to move from lying on the back to sitting on the side of the bed), and chair/bed-to-chair transfer (the ability to transfer to and from a bed to a chair or wheelchair). Resident #36 required partial/moderate assistance (helper does less than half the effort) for upper body dressing and personal and oral hygiene. Review of section H revealed Resident #36 is always urinary incontinent (no episodes of continent voiding) and bowel incontinent (no episodes of continent bowel movements).Record review of Resident #36's care plan date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 2 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete initiated on November 3, 2021, and revised August 9, 2023, target date October 14, 2025, states Resident #36 is at risk for falls and an intervention for this focus area was to ensure the resident's call light was within reach and Resident #36 needs prompt response to all requests for assistance.Observation on 08/05/2025 at 10:55 AM CNA D opened the door to Resident #36 room, closed the door behind him and less than a minute later CNA D left Resident #36's room and closed the door behind him. Resident #36 was observed lying in bed with blanket on. He was able to answer close ended questions, when he spoke, it was in a soft whisper. The call light was on the floor under the bed. (The resident was not asked about the call light.)Observation on 08/06/2025 at 9:45 AM Resident #36 was lying in bed. The call light was in same position as it was on 08/05/2025 at 10:55 AM.Interview on August 7, 2025, at 11:01 AM CNA I said the call light policy says all call lights should be answered quickly and kept within residents' reach at all times. If a call light was found on the floor or out of reach, she would pick it up and put it next to the resident. She added, residents who were unable to reach their call light would not be affected in any way because room rounds were done every two hours, and all call lights were always within reach of the resident.Interview on August 7, 2025, at 11:07 AM CNA J said the call light policy says all call lights were supposed to be within reach of residents She has never seen a call light on the floor or in an improper location, but if she did, she would immediately place it within the resident's reach. If a resident was not in their room, the call light should be attached to their bed. She stated she does room rounds every two hours or as needed. She noted that if a resident cannot access their call light, it could negatively impact their emotional well-being.Interview on August 7, 2025, at 11:12 AM CNA K stated that call lights should always be within arm's reach of residents. If a call light was not in the proper location, she moves it next to the resident. She reported conducting room rounds every two hours or as needed and noted that if a resident cannot reach their call light, it could impact them both emotionally and physically.Interview on August 7, 2025, at 11:15 AM CNA D said the call light policy says the call light should be by the resident for them to reach it. He said he's never observed a call light out of reach of a resident and if he did, he would move it within reach of the resident. He said if a resident was unable to reach their call light, they could become scared and worried.Interview on August 7, 2025, at 11:22 AM the DON said the facility did not have a call light policy. He said he hasn't observed call lights on the floor. He said call lights were supposed to be positioned within reach of the resident and when residents were put to bed the staff was to make sure the call light was within reach of the resident. When the resident was not in their bed or bedroom the call light was supposed to be attached to their bed.Interview on August 7, 2025, at 11:33 AM the Administrator said the facility doesn't have a call light policy. She said she's never observed a call light on the floor or out of reach of a resident. She said staff does room rounds every two hours or as needed. When residents were put to bed it's staff's job to make sure the call light was within reach. Event ID: Facility ID: 676480 If continuation sheet Page 3 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to ensure the Nutrional supplements were given as the physician had ordered to meet the Nutrional needs of two residents (Resident #21 and #26) of five residents observed. 1. MA B administered Resident #21's Med pass 2.0 (nutritional supplement) without measuring the correct amount. The physician order read to administer 60 ml (2 ounces); the MA administered 4 ounces. 2. MA B administered Resident #26's Med Pass 2.0 (nutritional supplement) without measuring the correct amount. The physician order read to administer 90 ml 93 ounces); the MA administered 4 ounces. These failures could affect the residents, by placing them at risk for not receiving their therapeutic dosage medications as ordered by the physician and decreased healthFindings included: Observation on 08/05/2025 at 3:27 p.m. during a medication pass revealed MA B administered Resident #21's Med Pass 2.0 (nutritional supplement) without measuring the correct amount of supplement to be given. MA B took the Med pass carton and poured the entire, unmarked glass full and gave to the resident to drink. Further observation reflected 4 ounces on the bottom of the plastic cup. MA B did not measure the correct amount of the oral supplement and gave 2 ounces over the ordered amount. Review of Resident #21's current physician orders, dated 08/05/2025, revealed house supplement (Med pass 2.0) three times a day 60 ml (equals 2 ounces). Review of Resident #21's MAR dated 08/01/2025 revealed the House Supplement (Med pass 2.0) 60ml was given at 3:00 p.m. Observation on 08/05/2025 at 3:33 p.m. during a medication pass revealed MA B administered Resident #26's Med Pass (nutritional supplement) without measuring the correct amount to be given. MA B took the Med pass carton and poured the entire, unmarked glass full and gave to the resident to drink. Further observation reflected 4 ounces on the bottom of the plastic cup. MA B did not measure the appropriate amount that was ordered by the physician. MA B should have been given 3 ounces but instead gave 1 ounces over the ordered amount. Review of Resident #26's current physician orders, dated 08/05/2025, revealed house supplement (Med pass 2.0) three times a day 90 ml (equals 3 ounces). Review of Resident #26's MAR dated 08/01/2025 revealed the House Supplement (Med pass 2.0) 90ml was given at 3:00 p.m. Interview with MA B on 08/05/2025 at 3:40 p.m. revealed she did not realize that the supplement needed to be measured, she just fills the cup and gives it to them. It was nutritional so the more they take the better for them. MA B stated she thought there was some marked cups (graduated cups) on another cart, but she just used the cups on the cart. She did not realize that this could create a problem for the resident, she would have to start measuring the amount or find those cups. Interview with the DON on 08/07/2025 at 11:30 a.m. revealed that the staff were supposed to administer all medications that were ordered, including supplements as the physician has ordered. The staff has graduated cups available to measure supplement or water. If more than or less than was given to the resident, it could cause problems with the nutritional base. The DON stated that the staff had annual competency testing with himself or the pharmacy, when it becomes there annual time it is tracked through the Inservice system. The DON stated he was the one who did the follow-up on who is due. Review of the facility policy and procedure titled Documentation of Medication Administration: dated November 2022 reflected, 3. Medication administration incudes, as a minimum: b.strength of drug; c. dosage; d. route of administration; . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 4 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. Based on observations, interviews, and record review the facility failed to ensure that residents had suitable, nourishing meals and snacks outside of scheduled meal service time for 1 of 1 facility reviewed. -The facility failed to ensure snacks were prepared, provided, and offered to residents after breakfast, lunch, and dinner.This failure could affect all residents who received meals served from the facility's only kitchen by placing residents at risk for, unplanned weight loss, and side effects from medication given without food, and diminished quality of life.Findings Included:In a confidential group meeting on 08/06/2025 at 10:05am 6 out of 14 residents stated the facility did not offer or pass out snacks after each mealtime. 6 out of 14 residents stated the facility stopped offering and passing out snacks about three months ago. The residents' stated snacks were not offered or passed this morning after breakfast. The residents stated they wanted snacks to be offered after each meal or always have the snacks visible after each meal. In an interview with LVN F on 08/06/2025 at 10:30am she stated snacks came from the kitchen at 10:00am and the snack tray sat out at the nurse's station. She stated it was the aide's responsibility to offer and pass out snacks to residents. She stated snacks were kept at the nurse's station or in the nourishment room. She stated snacks were passed out this morning at 10:00am to residents by the aides. Observation of the nurse's station on 08/06/2025 at 10:35am revealed no snack tray or snacks present at the nurse's station.Observation of the nourishment room on 08/06/2025 at 10:37am revealed the nourishment room was stocked with only shakes. Observation of the nurse's station on 08/06/2025 at 2:00 pm revealed no snacks or snack tray at the nurse's station.Observation of the nurse's station on 08/06/2025 at 2:10 pm revealed no snacks or snack tray at the nurse's station.Observation of the nurse's station on 08/06/2025 at 2:30 pm revealed no snacks or snack tray at the nurse's station.Observation of the nurse's station on 08/07/2025 at 10:00am revealed no snacks or snack tray at the nurse's station. In an interview with DA G on 08/06/2025 at 10:54am she stated it was the DA's responsibility to prepare snacks for residents. She stated the DA's prepared snacks in the evening so residents could receive their nighttime snacks. She stated the DA's prepared peanut butter and jelly sandwiches and cookies for the residents. She stated once the DAs were done preparing snacks; the snacks were out at the nurse's station. She stated snacks were not provided to residents during the day shifts but if staff or residents requested a snack during the day, the kitchen would prepare a snack. She stated she was unsure what staff was responsible for passing out snacks to residents. In an interview with the DM on 08/06/2025 at 10:55am she stated each shift, the kitchen prepared snacks for the residents. She stated snack times was 10:00am, 2:00pm, and 8:00pm. She stated during the day shifts residents received shakes as their snacks. She stated kitchen staff provided snacks such as peanut butter and jelly sandwiches, cookies, and/or pudding for residents as a nighttime snack. She stated the kitchen closed at 7:30pm and the snacks were prepared and sat out at the nurse's station before the kitchen closed. She stated she was unsure who was responsible for passing out snacks to residents once the tray was brought to the nurse's station. In an interview with Resident #44 on 08/06/2025 at 11:00am she stated snacks were not passed or offered to her this morning. She stated last night and the night before, snacks were not passed out or offered to her. She stated she never received or was offered snacks after any meals. In an interview with CNA H on 08/06/2025 at 11:12am she stated residents were supposed to receive snacks after each meal and it was the aide's responsibility to offer and pass out snacks to residents. She stated she did not offer or pass out snacks this morning. She stated she did not observe snacks at the nurse's station this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 5 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some morning. She stated she could not recall the last time she observed snacks at the nurse's station. She stated if a resident requested a snack, she would let the kitchen staff know and kitchen staff would prepare a snack. She stated when snacks were available, the kitchen prepared peanut butter and jelly sandwiches, cookies, or crackers. She stated snacks not offered or provided to residents could cause the residents to not receive the proper nutrition or hydration. In an interview with Resident #20 on 08/06/2025 at 11:19am she stated snacks were not offered or passed out this morning. She stated snacks were never offered or passed out during the day shifts. She stated snacks were provide consistently at night but the snack that was provided at night were peanut butter and jelly sandwiches. She stated she did not like peanut butter jelly sandwiches and there were no other snacks available, and staff did not offer anything else. She stated the sandwiches were kept at the nurse's station at night and staff did not pass out sandwiches unless residents asked. She stated last night and the night before the peanut butter and jelly sandwiches were on a tray at the nurse's station.In an interview with Resident #40 on 08/06/2025 at 1:04pm he stated he did not receive a snack after breakfast this morning and he never does. He stated he did not receive or was offered a snack last night or the night before. He stated about 3 months ago, was the last time he was offered or received a snack at night. In an interview with Resident #32 on 08/06/2025 at 1:15pm she stated snacks were not offered or passed out. She stated she did not receive a snack this morning or last night. She stated sometimes at night peanut butter and jelly sandwiches were left at the nurse's station but not passed out or offered to residents. She stated she only observed peanut butter and jelly sandwiches at the nurse's station.In an interview with Resident #18 on 08/06/2025 at 3:10pm he stated the facility only offered snacks at night. He stated the only snack offered at night were peanut butter and jelly sandwiches. He stated he did not eat peanut butter and jelly sandwiches and was never offered other snack options. He stated peanut butter and jelly sandwiches were offered last night and the night before. He stated snacks were never offered during the day. In an interview with the ADM on 08/07/2025 at 11:42am she stated snacks were provided to residents frequently. She stated snacks were provided mid-morning and evenings. She stated it was dietary's responsibility to prepare and distribute snacks to residents. She stated dietary prepared peanut butter and jelly sandwiches, and it was the nursing staff responsibility to pass out and offer snacks to residents. She stated she did not receive complaints or grievances about residents not receiving or being offered snacks. She stated residents were offered three meals daily to ensure the residents are receiving the plenty nutrients. She stated she was unsure how residents would be affected if snacks were not provided or offered. In an interview with the AD on 08/07/2025 at 11:55am she stated snacks were provided and kept at the nurse's station at 10:00am and 2:00pm. She stated the snack trays was stocked with a variety of snacks such as peanut butter and jelly sandwiches and bananas. She stated dietary prepared the snacks and it was the aide's responsibility to pass out snacks. She stated during monthly resident council meetings; residents never expressed a concern about not receiving or being offered snacks. She stated she gave out snacks to residents from activities or from donations. Record review of grievance logs from May 2025-August 2025 revealed no complaints regarding snacks not being provided or offered. Record review of resident council meeting minutes from January 2025- August 2025 revealed no complaints regarding snacks not being provide or offered. Record review of the facility's Texture Modified Snacks dated 2018 Policy Statement: The facility will ensure that texture appropriate snacks are available and provided to all residents. 1. Nutrition and Foodservice will provide snacks each night for all residents including residents with orders for a puree diet. 5. All snacks ordered at 10:00am and 2:00 pm will be dated and labeled with the resident's name and will be the appropriate texture for their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 6 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0809 current diet order. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 7 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in the facility's only kitchen reviewed for food safety.1. The facility failed to ensure food items in the freezer were labeled with the item description (handwritten or manufacturer's label), had the received by date, the opened date and/or the consume by or expiration by dates.2. The facility failed to ensure food items in the dining room were labeled with the item description (handwritten or manufacturer's label), had the received by date, the opened date and/or the consume by or expiration by dates.3. The facility failed to ensure dietary staff wore proper hairnets while working in the kitchen.These failures could place residents at risk for food-borne illness and cross contamination.Findings Include:Observation of the side-side refrigerator on 08/05/2025 at 9:01 am revealed the following:- 1 large bag of tater tots (shredded potatoes) sealed with no item description label or distinguishing date.- 1 large bag of steak fries sealed with no item description label or distinguishing date.2 clear beverage dispensers sitting on counter in dining room which appeared to be iced tea and lemonade with no item description label or distinguishing date.- [NAME] A wearing a hair net on his beard with 3 holes.Interview with the DM on 08/05/2025 at 9:09 am, revealed she is responsible for labeling and staff does it when she's unavailable. She stated she puts red first out stickers on items that need to be used before the other items. The DM is responsible for dietary services at the facility.Observed [NAME] A on 08/05/2025 at 9:20 am washing dishes and wearing a hair net on his beard with 3 holes.Interview with [NAME] A on 08/05/2025 at 9:21 am he stated everyone is responsible for doing the dishes and cooking. [NAME] A was informed he had holes in the hairnet. He stated he did not know and replaced the hairnet.The policy for hairnets was requested but was not provided.Record review of the facility's Food Storage Policy, dated 2018, states, Store frozen foods in moisture-proof wrap or containers that are labeled and dated.Review of the U.S. FDA Food Code 2022 reflected: Definitions 3. Food Receiving and Storage When food, food products or beverages are delivered to the nursing home, facility staff must inspect these items for safe transport and quality upon receipt and ensure their proper storage, keeping track of when to discard perishable foods and covering, labeling, and dating all PHF/TCS foods stored in the refrigerator or freezer as indicated. Event ID: Facility ID: 676480 If continuation sheet Page 8 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for three (Resident #20, #31 and #35) of five residents observed for infection control in that: MA B failed to disinfect the blood pressure cuff (to measure the blood pressure) in between vital sign checks for Resident #20, and Resident #31. CNA D failed to change their soiled gloves and wash hands during incontinent care to Resident #35. This failure could place residents at risk for spread of infection through cross-contamination. Findings included: Review of Resident #20's quarterly MDS[VT1] assessment, dated 07/22/2025, reflected she was a [AGE] year-old female admitted to the facility on [DATE], with the following diagnoses: hypertension (high blood pressure), diabetes (high sugar), and heart failure (weak heart). Resident #20 BIMs[VT2] score of 11 indicated the resident had moderate cognitive impairment and required assistance from one staff for activities of daily living. Review of Resident #20's the consolidated physician orders dated August 2025 reflected: order dated 05/08/2025, metoprolol Succinate ER (extended release) (high blood pressure) tablet 50mg one tab by mouth one time a day. Further review revealed physician orders to check blood pressure every shift. Review of Resident #31's quarterly MDS assessment, dated 06/06/2025, reflected she was a [AGE] year-old male admitted to the facility on [DATE] with the following diagnoses: hypertension (high blood pressure) and Cerebral accident (stroke). Resident BIMs score of 9 indicated the resident had moderate cognitive impairment and required assistance from one staff for activities of daily living. Review of Resident #31's consolidated physician orders dated July 2025 reflected: order dated 12/07/2022, amlodipine (blood pressure) 10mg give one tab by mouth one time a day, hydrochlorothiazide tab (for high blood pressure) 12.5mg give one tab by mouth daily, and lisinopril tablet (high blood pressure) 20mg give one tab by mouth daily. Further review revealed physician orders to check blood pressure every shift, prior to giving blood pressure medications. Review of Resident #35's quarterly MDS assessment, dated 05/25/2025, reflected he was a [AGE] year-old male admitted to the facility on [DATE], with the following diagnoses: Hypertension (high blood pressure), and heart failure (heart is weak). Resident BIMs score of 11 indicated the resident had moderate cognitive impairment and required assistance from one staff for activities of daily living. Observation on 08/05/2025 at 8:58 a.m. revealed MA A during medication pass went to the medication cart and started preparing to perform medication administration for Resident #20. MA A took the blood pressure cuff (machine to check blood pressure) to check her blood pressure. MA B did not clean the machine prior to or after using on Resident #20, with Sani Wipes. MA B did use hand gel on his hands prior to collecting supplies. MA B left the room went back to the cart, used hand sanitizer documented on the resident's clinical record and began to prepare for the next medication pass. Observation on 08/05/2025 at 9:07 a.m. revealed MA B during medication pass went to the medication cart and started preparing to perform medication administration for Resident #31. MA B took the blood pressure cuff to check her blood pressure. MA B did not clean the machines prior to or after using on Resident #31. MA B did use hand gel on his hands prior to collecting supplies. MA B left the room, went back to the cart removed, used hand sanitizer documented on the resident's clinical record and began to prepare for the medication pass. Observation of incontinence care on 08/05/2025 at 1:44 p.m. with Resident #35 revealed CNA D did not use hand gel in the hallway and entered the room. CNA D did not wash his hands placing on gloves, CNA D took the clothing protector that Resident #35 was holding and wiped the resident's mouth. CNA D unfastened the resident's brief tabs and wiped the pubic area with a disposable Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 9 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete wipe, discarding the wipe in the trash bag. CNA D wiped the genitals, discarding the wipe in the trash bag. CNA D wiped the shaft of the penis and discarding the wipe in the trash bag, and then cleaned the head of the penis and discarding the wipe in the trash bag. CNA D positioned Resident #35 on his right side with the help of another staff member. CNA D wiped the rectal area that was soiled with bowel movement and discarded the wipe, using another wipe CNA D completed cleaning the rectal area of bowel movement, discarding the wipe. CNA D wiped the right buttocks, which was soiled with urine, discarding the wipe. Repositioning Resident #35 with his soiled gloves to his left side, CNA D cleaned the left buttocks, which was soiled with urine, discarding the wipe. CNA D assisted, with his soiled gloves, the other staff member to reposition Resident #35 on his back. CNA D with his soiled gloves took the clothing protector and wiped Resident #35's mouth, then placed the dirty clothing protector in the linen barrel. CNA D disposed of the dirty brief, the other staff member gave CNA D directions to take off his soiled gloves and wash his hands, as she pulled the clean brief up underneath the resident with clean hands and gloves and fastened the brief. CNA D then assisted the other staff member, pulled the clean sheet up on the resident and continued to assist the other staff member to straighten Resident #35's clothing and his linens and blanket on the bed. CNA D removed his gloves in the room and did not wash his hands. In an interview on 08/05/2025 at 2:00 p.m. with CNA D revealed he normally takes care of Resident #35 on his own, but the other staff member wanted to help (ADON). The CNA stated this confused him and made him nervous because she kept giving him instructions, so I forgot to sanitize and wash my hands and change my gloves when they were dirty. CNA D stated he had in-service concerning infection control and hand washing. The CNA stated if you do not change your gloves and wash your hands you can spread infections. In an interview on 08/06/2025 at 9:02 a.m. with DON revealed all direct care staff must clean equipment, including blood pressure cuffs, after having contact with each resident. The DON stated they have Sani wipes available on all medication and treatment carts. The DON stated if the staff was not cleaning the equipment appropriately this could spread germs to themselves and the residents. Further interview with the DON revealed that the staff should always wash hands before placing on gloves and then change the gloves after washing hands between clean and dirty process when performing incontinent care. If they do not do this it can spread infection to themselves and others. In an interview on 08/06/2025 at 9:30 a.m., MA A stated he was to clean all equipment that was used before and after use on each resident, to prevent the spread of infection. MA A stated the blood pressure cuff must be cleaned after each usage. I guess I did not clean it in front of you, I got to talking and forgot. MA A did state that he had used hand sanitizer before and after using the blood pressure cuff. Review of the in-services given in the past three months reflected an in-service dated June10th, 2025, for infection control and cleaning of equipment. MA A and CNA D had attended the meeting. Review of the facility's policy Infection Control Plan dated revised October 2018, reflected, The facility has established and maintained an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection . b. maintain a safe, sanitary, and comfortable environment for personnel, residents, visitors , and the general public. f. provide guidelines for the safe cleaning and reprocessing of reusable resident-care equipment. Event ID: Facility ID: 676480 If continuation sheet Page 10 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to maintain an effective pest control program for 1 of 1 facility reviewed for pests in that: Gnats were observed in multiple areas of the facility: Hall100, Hall 400, and Hall 500. This failure could affect residents by placing them at an increased risk of exposure to pests and vector-borne diseases and infections. Findings included: Observation on 08/05/2025 at 9:17 a.m. revealed room [ROOM NUMBER] had three gnats crawling in the bathroom sink. Observation on 08/05/2025 at 9:18 a.m. revealed room [ROOM NUMBER] had five gnats crawling in the bathroom sink. Observation on 08/05/2025 at 9:30 a.m. revealed a medication cart on Hall 400 had three gnats crawling on top of the cart. Observation on 08/05/2025 at 9:32 a.m. revealed room [ROOM NUMBER]B had six gnats crawling on the bedside table. Observation on 08/05/2025 at 10:07 a.m. revealed room [ROOM NUMBER] a gnat flew in the room. Observation on 08/05/2025 at 10:23 a.m. revealed a gnat in the hallway flew outside of room [ROOM NUMBER]. Observation on 08/05/2025 at 10:45 a.m. revealed on Hall 500 there was three gnats on the wall near the doorway to room [ROOM NUMBER]. Further observation revealed three gnats crawling it the [NAME] in room [ROOM NUMBER]. Observation on 08/05/2025 at 10:52 a.m. a gnat flew outside of room [ROOM NUMBER]. In a confidential group meeting on 08/06/2025 at 10:00 a.m. with eleven residents revealed eleven residents stated there was a pest control problem concerning gnats. The Gants were in their bathrooms and rooms. The eleven-resident stated they had mentioned this to staff and the pest control man had come to the facility and treated the drains, but the gnat problem had not improved. In an interview on 08/07/2025 at 8:15 a.m. with MA A revealed he had not seen any gnats. MA A stated if he did see pest, he would report to the Maintenance Man. MA A stated there was a book at the nurse's station you can write your sittings in, but I just tell the Maintenance man. In an interview on 08/07/2025 at 8:45 a.m. with LVN C revealed she would tell the Administrator and the Maintenance man, if she saw pest. LVN C stated she would write it the book at the nurse's station, but she had not written anything in the book. In an interview and record review on 08/07/2025 at 10:30 a.m. with the Maintenance Man and a review of the pest control book at the nurse's station revealed the pest control company comes one time a month. The Maintenance Man stated the pest control company had told him that as long as the residents, keep plants and food in their rooms there will gnats. The maintenance man stated there had been no plan put in place to follow-up on the concerns, but he would call the pest control company back out again. Record review of the Pest control logs at the nurse's station with the maintenance man dated 04/2025 through 08/2025 revealed one mention of gnats. There was no further documentation to review. In an interview on 08/07/2025 at 11:10 a.m. with the Administrator revealed she was not aware of a pest problem in the resident's rooms. The Administrator stated the time of the year and the season it was not unusual to have pest. The Administrator stated she would see that the problem was addressed now that she was aware of the pest. Record review of facility provided pest control log revealed, in part, dates and treatments as follows:Treatment dates and services performed: 7-14-2025-Kitchen and Nurse's station had accumulation of food product from damaged goods noted. Instructed staff to remove food product to prevent attraction by pests. evidence of employees eating outside of cafeteria noted and my attract pests. Please instruct the staff do not take food outside of cafeteria area, and no open top drinks. In the dining hall the insect trap lights are not working properly.schedule serve, and the units have been unplugged.6-11-2025-treated hallways, reception, breakroom, conference room, kitchen, and restrooms. There is a small fly issue (gnats coming from the drains in the dish sink. Instructed employees to regularly clean this sink out to help. Also, rooms need to bed cleaned. Floors are sicky and this Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676480 If continuation sheet Page 11 of 12 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 676480 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mesquite Village Wellness & Rehabilitation 825 W. Kearney Street Mesquite, TX 75149 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete attracts gnats/small flies. 5-14-2025-treated main public restrooms, front lobby, breakroom, kitchen, dining room, nurse's station, and exterior parameters. Serviced fly light stations in the hallways.Species listed in treatment: Flies, rodents, follow-up on bed bugs, mice. insect lights not working in dining room, repaired and drain in the kitchen has built up grease, told facility to clean out the drain in kitchen sink will attract pest. In an interview 08/07/2025 at 11:00 a.m., the Administrator confirmed prior to exit 08/07/2025 there was no policy or procedure for pest control for the facility. Event ID: Facility ID: 676480 If continuation sheet Page 12 of 12