Health inspection·November 3, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 11/02/23 at 9:06 a.m. with the ADON revealed she, the other ADON, the DON and the floor nurses (charge nurses) were responsible for updating resident care plans. She further stated We (nursing administration) thought you might be talking to us about the care plans. We have no MDS nurse right now. We have one starting soon and the care plans are either behind or not started. The ADON stated the DON was aware and not having care plans initiated could lead to residents possibly not getting the care that was needed or recommended . Interview on 11/02/23 at 12:00 p.m. with LVN B reveled she did not update care plans; she was never told to update care plans. Interview on 11/03/23 at 8:20 a.m. with LVN A revealed he had worked at the facility since August of 2023, he had been told by the DON to update care plans on the residents he oversaw if he had the time. LVN A stated he had not had time to update any care plans. Interview on 11/03/23 at 1:34 p.m. with the DON revealed the MDS Coordinator was responsible for initiating and updating the care plan as needed. The DON stated the facility had hired a new MDS Coordinator, but she had not started working yet. The DON stated the nursing administrative team had been trying to update and initiate the care plans but had not accomplished the goals. She was not aware Resident #62's care plan was not initiated to reflect the goals required to care of her, to include nutrition and medication. Review of the facility's only policy titled Charting and Documentation dated October 17, 2023, reflected the following: All services provided to the resident, progress toward care plan goals, or any changes in the resident's medical, physical, functional, or psychological, shall be documented. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 2 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 two of the four handwashing sinks had a garbage receptacle next to the sink. 2.The facility failed to ensure food items in the refrigerators (4), freezers (4) and dry storage room were labeled and stored in accordance with the professional standards for food service. 3. The facility failed to discard items stored in refrigerator, freezers or dry storage that were not properly labeled or past the 'best buy', consume by or expiration dates. 4. The facility failed to ensure the ice machine filters and vent/grate and outer surface was free from dirt and dust. 5. The facility failed to ensure the ice machine chute guard was clean. 6. The facility failed to ensure the ice cream in the ice cream freezer was covered. 7. The facility failed to ensure items not in their original containers were labeled and dated. These failures could place residents at risk for food-borne illness and cross contamination. Findings Included: Observation of the small kitchen on 11/01/23 at 10:19 AM revealed the following: -The smaller kitchen area to the right of the main kitchen: -at handwashing sink #1 there was a black large rolling pallet on the floor with a gray dish drying/storing rack on top of it in front of the sink, blocking it. -There was no garbage receptacle next to the handwashing sink #1. -The ice machine had a plastic vent located on the front side of the machine, the vent slats and filters (2) had dirt and dust on them. Ice machine: around the ice machine, just above the ice chest compartment, there was a dried white calcified/hardened substance. -Ice Machine: the chute guard had 4 gray greasy smudges and the right lower corner of the chute guard had some dark colored specks. -Across from handwashing sink #1 was a prep table with a juice machine and cappuccino machine on it. On the table in front of the juice machine were several dried sticky shiny red spots. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 3 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 -The floor on the side of the room (right side) had dried stains of varying colors. Level of Harm - Minimal harm or potential for actual harm -Next to the reach-in freezer, on a shelf near a side door leading out to the dining room: 2nd row from the top there were 2 small white bins with 3 drawers each. -Bin #1 (one on the left): Top drawer- there were white individual sugar packets, no received by date, no consumed by or discard by date. Middle drawerblue individual zero calorie sweetener packets, no received by date, no consumed by or discard by date. Bottom drawer- green individual raw sugar packets no received by date, no consumed by or discard by date. Residents Affected - Some -Bin #2 (one in the middle): Top drawer- yellow individual zero calorie sweetener packets, no received by date, no consumed by or discard by date. Middle drawer- tan individual sweetener packets, no received by date, no consumed by or discard by date. Bottom drawer- pink individual zero calorie sweetener packets, no received by date, no consumed by or discard by date. Bin #3 (one on the right): Top drawer- white individual pepper packets, no received by date, no consumed by or discard by date. Middle drawer- individual packets of ketchup, pepper, sweet & sour sauce, no label of item description, no received by date, no consumed by or discard by date. Bottom drawer- individual yellow mustard packets, no received by date, no consumed by or discard by date. -2-20 oz. bottles of ketchup, previously opened, there was no received by date, no opened date. -1-16 oz. clear condiment bottle with a white lid containing dry dark granulated material, there was no label of item description, no opened date, no consume by or discard by date. -1-8 oz. clear condiment bottle with a white lid containing a dry white granulated material, there was no label of item description, no opened date, no consume by or discard by date. -3rd row from top: Left bin- clear square bin with brown individual liquid creamer containers, there was no received by date, no opened date, no consume by or discard by date. -Middle bin- clear square bin with white individual liquid creamer containers, there was no received by date, no opened date, no consume by or discard by date. -Right bin- clear square bin with blue individual liquid creamer containers, there was no received by date, no opened date, no consume by or discard by date. -4th row from top: 1 small, opened box of granulated parmesan cheese packets, no received by date, no opened date, no consume by or discard by date. -1 medium, opened box with individual packets of iodized salt with a clear plastic bag with individual packets of iodized salt, previously opened. There was no received by date, no opened date, no consume by or discard by date on the bag or the box it was sitting in. -On prep. table next to the reach-in refrigerator was a clear 4-gallon container with a lid of a thick pale yellow soft formed material, labeled use by 7 days Prepped: 11/01/23 Discard: 11/07/23, no label of item description. -Large Shelf on left side of the small kitchen: 3rd row from top row: more than 10 boxes of various teas, previously opened, no received by dates, no opened dates, no consume by or discard by dates. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 4 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 -2nd shelf, closest to door, top row: -1- 2 lbs. bag of cappuccino mix, previously opened, wrapped in plastic wrap, no received by date, no opened date, no consume by or discard by date. Observations of the Ice Cream Freezer on 11/01/23 at 10:40 AM revealed the following: -1 Extra-large container of strawberry ice cream with a lid, the left side of the lid was up, exposing the ice cream to air. -5 Extra-large containers of varying ice creams with lids, there was no received by date, no opened date, no consume by or discard by date. Observations of the Reach-in freezer on 11/01/23 at 10:52 AM revealed the following: -On a sheet pan there was a medium white foam cooler with dry ice and two orange sticky notes. The first note reflected, don't touch DRY ICE its dangerous to contact the second note read, ask FSD, -On the same sheet pan there was a white plastic bag tied close with a sticky note that had a person's name on it. -On the same sheet pan there was a chocolate chip cookie ice cream sandwich, there was no received by date, no consume by or discard by date. -2-35 oz. lemon meringue pies with lids, there was no received by date, no consume by or discard by date. -1 extra-large container of strawberry ice cream, there was received by date, no opened date, no consume by or discard by date. Observations of the Reach-in refrigerator on 11/01/23 at 10:54 AM revealed the following: -Right side door, top row: -1-12 oz. can of diet cola, no received by date, identifier, if for resident. 1-small clear square container with a green lid with shredded yellow cheese, labeled use by 3 days Prepped: 10/19/23 Discard: 10/22/23, no label of item description and passed its facility set expiration date. -1- small clear square container with ranch dressing packets, there was no received by date, no consume by or discard by date. -2nd row from top: 3-2 pack 42.2 oz. cartons of liquid decaf coffee, no received by date, no consume by or discard by date. -1-2 pack 42.2 oz. cartons of liquid caffeinated coffee, no received by date, no consume by or discard by date. -2 medium white bowls of lemon pieces covered with plastic wrap, labeled use by 3 days Prepped: 10/30/23 Discard: 110/01/23, no label of item description. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 5 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 -3rd row from top: -1 full size sheet pan covered in plastic wrap, with 22 white and 4 black small bowls, containing a swirled pale-yellow formed material, labeled use by 3 days Prepped: 11/01/23 Discard: 11/03/23, no label of item description. -4th row from top: -1 full size sheet pan covered in plastic wrap with 10 small black bowls of a thick white creamy material and yellow shredded cheese and a thick pale yellow thick material, use by 3 days Prepped: 11/01/23 Discard: 11/03/23, no label of item description for each item in the bowl, no individual consume by or discard by dates for each item in the bowl. -On the same sheet pan, 10 mini stainless-steel containers with chopped bacon, no label of item description, no consume by or discard by date. -1 large clear square container covered with plastic wrap that had multiple small clear plastic 2 oz. condiment cups with lids, contained varying colored and thickness of substances. There was no label of item descriptions, no received by, no opened date, and no consume by or discard by for each item or group of same items noted. -1-35 oz. lemon meringue pies with lids, there was no received by date, no consume by or discard by date. --35 oz. previously opened lemon meringue pie with lid, there was no received by date, no opened date, no consume by or discard by date. -Left side door, 4th row: -2-118.4 oz. plastic container of cranberry juice from the juice machine, no received by date, no consume by or discard by date. Observations of the Main Kitchen on 11/01/23 at 10:59 AM revealed the following: -Handwashing sink #3, near entrance door, has no garbage receptacle near it or next to it. -On shelf next to reach-in refrigerator, top row: -1 small square clear container with a lid containing 00 pizza flour, labeled: Use by 14 days Prepped: 09/12/23 Discard: 09/25/23. -1 small square clear container with a lid containing brown dry coarse light brown crumbs, labeled, Use by 5 days Prepped: 09/28/23 Discard: 10/02/23, no label of item description. -On 2nd row from top row: 1 medium clear square containers with a lid containing croutons, labeled, Use by 30 days Prepped: 10/30/23 Discard: 11/28/23, no label of item of description. -1 large clear square containers with a lid containing croutons, labeled, Use by 30 days Prepped: 10/30/23 Discard: 11/28/23, no label of item of description. -1 large square clear container with a lid containing croutons labeled: Use by 5 days Prepped: 10/31/23 Discard: 11/04/23, no label of item description. Observations of the Reach-in refrigerator #2 on 11/01/23 at 11:01 AM revealed the following: -3rd row from top: -Medium clear square container with a lid containing a thick white liquid labeled use by 30 days Prepped: 10/18/23 Discard 11/16/23, no label of item description. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 6 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 -1-64 oz previously opened, plastic container of cranberry juice, dated 09/21/23, no opened date, no consume by or discard by date. -Top row: -2-16 oz. plastic containers with lids contained honey vinaigrette labeled, use by 7 days Prepped: 09/11/23 Discard: 09/17/23. Residents Affected - Some -4th row from top: -1 5lb previously opened white plastic tub with a lid of creamy peanut butter, labeled use by 30 days Prepped: 09/23/23 Discard: 10/22/23. -1- 32 oz. cylindrical stainless-steel pan of baked beans covered with plastic wrap, labeled use by 3 days Prepped: 09/19/23 Discard: 09/21/23, and no label of item description. -1 medium square clear container with a lid containing a thick red liquid, labeled, Prepped: 10/31/23 Discard: 11/09/23, there was no label of item description. Observations of the Walk-in refrigerator #3 on 11/01/23 at 11:28 AM revealed the following: - 1st shelf, to the right of the door, 2nd row from the top row: -1 extra-large clear rectangle container with various bags of different colored tortilla products: 1- large clear plastic bag, previously opened, of red triangle tortilla chips. There was no label of item description, no received by date, no opened date, no consume by or discard by date. -2 small bags of more than 20 medium purple tortillas, no label of item description, no received by date, no consume by or discard by date. - 1 small bag of more than 20 medium purple tortillas, with a large tear in the bag, left opened to air, no label of item description, no received by date, no opened date, no consume by or discard by date. -Approximately 15 small bags of more than 20 medium tortillas, no label of item description, no received by date, no consume by or discard by date. -5th row from top: -1 extra-large clear square container with a sheet pan placed on top for a lid; it contained 3 bags of whole peeled potatoes; the pan did was up on the left side leaving the potatoes open to air. There was a whole in one of the bags, no label of item description, no opened date. Observations of the Dry Storage Room on 11/01/23 at 11:43 AM revealed the following: -1 medium box with more than 10-24 oz bags of vanilla pudding mix, previously opened, no received by date, no consume by or discard by date, no manufacturer's expiration date. -Last shelf on left side in the back, bottom row: 1 extra-large clear square container with a lid contained yellow cornmeal, labeled opened 07/05/23, there was no label of item description, no received by date, no consume by or discard by date. -1-50 lbs. bag of triple cleaned pinto beans, previously opened, labeled opened 10/23/23, bag left open to air, no received by date, no consume by or discard by date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 7 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 -3rd row from top: -1-3-gallon clear plastic container with a lid contained white rice, labeled opened 09/17/23, no label of item description, no received by date, no consume by or discard by date. Observations of the Walk-in freezer #2 on 11/11/23 at 11:37 AM revealed the following: -Shelf near the door on the right side, bottom row: a large box of various types of breads in a clear plastic bag, left open to air, no label of item description, no received by date, no opened date, no consume by or discard by date. In an interview on 11/01/23 at 011:40 AM with the Sous Chef, she stated the EC received the inventory, sous chefs, there are 3, dispersed inventory to assigned areas. Then the porter placed the inventory in the areas and on the shelves. The Sous Chef stated they used First in First Out (FIFO) system. In an interview on 11/03/23 at 02:50 PM with the EC, she stated personal items were not allowed in the areas (refrigerators, freezers, dry storage, prep. areas) with food items for the residents. She stated condiments, once opened, like the ketchup, were kept for no more than 30 days. The EC stated the AM Sous Chef, and the Lead cook did the inventory. She stated it was everyone's job in the kitchen to check for outdated/expired food items. She said, it is everyone's job to do the labeling. She stated it was the Dietary Aides' responsibility to know the residents' diets/allergies/likes and dislikes. The EC stated leftovers were kept in the refrigerator for 3 days and opened items were kept in the freezer for 3 months. She stated they put opened dates on opened items when they are initially opened. When she was shown the plastic bag in the freezer with a name on it, she told one staff member we need to find out who (person's name on the bag) is . She stated they would do an in-service and the Chefs and Leads will do monitoring to ensure the subject matter of the in-service (labeling, securing closed, dating, etc.) will be put into practice. The EC stated cross-contamination was a risk/harm to residents regarding the vents and filters being dirty. Review of the facility's Food and Nutrition Services Policy dated October 17, 2023: Revised 08/29/23, reflected A Director of Food and Nutrition will be designated to oversee all food and nutrition services with frequently scheduled consultation from a qualified dietitian or other clinically qualified nutrition professional. Food and Supplies Storage: Service Standard: Supplies for 7 days of staple food and 2 days for perishable food will be kept on hand. Food and supplies will be stored according to current standards of practice. Procedure: Safe Food Storage: General standards for food storage will include the following: 1. Dry Food Storage should be maintained in a clean and dry area free of contaminants.2. Refrigerator Storage Safe Practices include: . d. Labeling, dating and monitoring foods. Food Safety: . 6. Food will be stored, prepared, distributed, and served in accordance with professional standards for food service safety. 7. Refrigerator in resident rooms must be monitored by the facility staff for adequate temperature and expiration dates of food. 9. The facility will follow food-handling practices in the distribution of the food. 10. The community will make effort to assure the safe consumption of food. Sanitation: Service Standard: [NAME] strives to prepare, distribute, and serve food under sanitary conditions. Procedure: 1. Food is prepared, distributed, and served to resident under sanitary conditions.3. Follow proper sanitation and food handling practices to prevent the outbreak of foodborne illness. 4. Safe food handing for the prevention of foodborne illnesses begins when food is received from the vendor and continues throughout the facility's food handling processes. Review of the U.S. FDA Food Code 2022 reflected: Chapter 3 . section 3-201.11 Compliance and Food Law: . C. Packaged Food shall be labeled as specified in LAW, including 21 CFR 101 Food Labeling [* (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 8 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 .(b) A food which is subject to the requirements of section 403(k) of the act shall bear labeling, even though such food is not in package form. (c) A statement of artificial flavoring, artificial coloring, or chemical preservative shall be placed on the food or on its container or wrapper, or on any two or all three of these, as may be necessary to render such statement likely to be read by the ordinary person under customary conditions of purchase and use of such food. The specific artificial color used in a food shall be identified on the labeling when so required by regulation in part 74 of this chapter to assure safe conditions of use for the color additive.], 9 CFR 317 Labeling, [*(a) When, in an official establishment, any inspected and passed product is placed in any receptacle or covering constituting an immediate container, there shall be affixed to such container a label .Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under § 3-202.18. Section 3-302.12 Food Storage Containers, Identified with Common Name of Food: Except for containers holding FOOD that can be readily and unmistakably recognized such as dry pasta, working containers holding food or food ingredients that are removed from their original packages for use in the food establishment, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the food. Section 3-501.17 . Commercial processed food: Open and hold cold . B. 1. The day the original container is opened in the food establishment shall be counted as Day 1. 2. The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety. C. 2. Marking the date or day of preparation, with a procedure to discard the food on or before the last date or day by which the food must be consumed on the premises, sold, or discarded as specified under (A) of this section. 3. Marking the date or day the original container is opened in a food establishment, with a procedure to discard the food on or before the last date or day by which the food must be consumed on the premises, sold, or discarded as specified under (B) of this section. 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. Chapter 5 . Section 5-205.11 Using a Handwashing Sink (A) A Handwashing Sink shall be maintained so that it is accessible at all times for Employee use. Section 5-501.16 Storage Areas, Rooms, and Receptacles, Capacity and Availability . (B) A receptacle shall be provided in each area of the Food establishment or premises where refuse is generated or commonly discarded, or where recyclables or returnables are placed. (C) If disposable towels are used at handwashing lavatories, a waste receptacle shall be located at each lavatory or group of adjacent lavatories. Section 5-501.113 Covering Receptacles. Receptacles and waste handling units for refuse, recyclables, and returnables shall be kept covered: . www.fda.gov eCFR- Code of Federal Regulations are indicating within the text by an *- www.ecfr.gov FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 9 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that each resident's written plan of care includes both the most recent hospice plan of care and a description of the services furnished by the LTC facility to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, for 2 of 4 residents (Resident #32 and Resident #43) reviewed for care plans. The facility did not update Resident #32's care plan to reflect specific instructions for hospice and end of life. The facility did not update Resident #43's care plan to reflect specific instructions for hospice and end of life. This failure could place residents at risk for not receiving appropriate care and intervention to meet their current needs. The findings were: Review of Resident #32's MDS annual assessment dated [DATE], reflected she was a [AGE] year-old female admitted on [DATE]. His diagnoses included Parkinsonism (neurological disease), atrial fibrillation (heart rate dysfunction), and mild protein calorie malnutrition. Her BIMs score of 3 reflected her cognitive status was severely impaired. She required moderate to maximum assist of one staff member for activities of daily living. Section O of the MDS was marked for Hospice Care. Record review of the Physician's orders for Resident #32 dated 05/26/23 reflected to admit to Hospice services. Record review of Resident #32's Care Plan initiated on 08/31/23 reflected, there were not a care plan goals to reflect specific instructions for hospice services. Review of Resident #43's MDS annual assessment dated [DATE], reflected he was an [AGE] year-old male admitted on [DATE]. His diagnoses included: Hypertension (increased blood pressure), parkinsonism (neurological disease), dementia, and chronic obstructive pulmonary disease (unable to breath well). His BIMs score of 3 reflected his cognitive status was severely impaired. He required moderate to maximum assist of one staff member for activities of daily living. Record review of Physician orders Resident #43 dated 08/21/23 reflected to admit to Hospice services. Record review of Resident #32's Care Plan initiated on 08/31/23 reflected, there were not a care plan goals to reflect specific instructions for hospice services. Interview on 11/02/23 at 9:06 a.m. with the ADON revealed she, the other ADON, the DON and the floor nurses (charge nurses) were responsible for updating resident care plans. She further stated we (nursing administration) thought you might be talking to us about the care plans, we have no MDS nurse right now, we have one starting soon and the care plans are either behind or not started. The ADON stated the DON was aware and not having care plans initiated could lead to residents possibly not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 10 of 11 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 676483 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ventana by Buckner 8301 N. Central Expressway Dallas, TX 75201 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 0849 getting the care that was needed or recommended. Level of Harm - Minimal harm or potential for actual harm Interview on 11/02/23 at 12:00 p.m. with LVN B reveled she did not update care plans, she was never told to update care plans. Residents Affected - Few Interview on 11/03/23 at 8:20 a.m. with LVN A revealed he had worked at the facility since August of 2023, he had been told by the DON to update care plans if he had the time on the residents he oversaw. LVN A stated he had not had time to update any care plans. Interview on 11/03/23 at 1:34 p.m. with the DON revealed the MDS Coordinator was responsible for initiating and updating the care plan as needed. The DON stated the facility had hired a new MDS coordinator ,but she had not started working yet. The DON stated the nursing administrative team has been trying to update and initiate the care plans but had not accomplished the goals. She was not aware Resident #32's care plan was not initiated to reflect the goals required to care of her and concerning Hospice goals. Review of the facility's policy only titled Charting and Documentation dated October 17, 2023, reflected the following: All services provided to the resident, progress toward care plan goals, or any changes in the resident's medical, physical, functional, or psychological, shall be documented. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676483 If continuation sheet Page 11 of 11