Health inspection·March 16, 2023

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 3/16/23 at 11:00 AM with Director of Therapy, stated he received Resident #20 grievance form provided by the Activity Director. Director of Therapy stated IDT is held every week, to discuss how residents progress and discharge planning and concerns with residents. He stated that no IDT meeting or morning meeting to address Resident #20 complaint was held. State he addressed the complaint with Resident #20 in a one-to-one conversation explaining the process of scheduling residents for their therapy. Director of Therapy filled out his portion in the grievance form and signed it. Interview on 03/17/23 at 04:50 PM Administrator stated, the grievance process includes we receive the form, we discussed it as a team. Then it is given to the appropriate department head, to address the issue and discuss the resolution with the resident or resident family. After the grievance is addressed, the form is filled out completely and returned for I can review it and sign it. If the issue is a pattern, it will be included in our QAPPI meeting. The grievance process is important because if it's not done right residents run the risk of not getting their grievances heard. Resident #55 Review of Resident #55's face-sheet dated 03/14/23 revealed an [AGE] year-old Male with an admission date of 02/20/2023. Face-sheet revealed as emergency contact his daughter and grandson who reside out of town. Observation on 03/14/23 at 10:15 AM, Resident #55 room reveal personal soiled clothing on the floor in front of his closet. Observation 03/15/23 at 9:40 AM, notice a translucent plastic bin uncovered that contained resident soiled laundry and soiled laundry on the floor in Residents #55 room. Resident #55 observed telling LVN I in a loud tone of voice if she could help him with his dirty clothes or who wash them for him. LVN I observed responding I will go check. Observation on 03/16/23 at 02:16 PM, in Resident #55 room his soiled clothing remained in a translucent plastic bin. Noted bin to be almost filled to the top with soiled laundry, and no clean clothing in resident's room. Interview on 03/14/23 at 10:15 AM, Resident #55 stated, here the family takes the residents laundry and washes it then brings it back. But I have no family so my laundry is all dirty and I have been wanting to get assistance, but no one here helps. I have mentioned it to everyone, the Activity Director is aware, but no one washes it I will even pay for they can take it to the laundry mat. Resident #55 verbalized he did have a daughter, but she lived out of town and was not involved in his care. Interview on 03/16/23 at 02:16 PM with Resident #55 revealed the resident was upset the facility had still not given him an answer about who was going to wash his laundry. Resident #55 stated, I have told everyone in this facility who can help me I have $5 on the counter to pay for them to wash my clothes. I do not have any clean clothes left. I have been asking over and over who can wash my clothes, everything is dirty what am I supposed to wear? Interview with Activities Director on 3/15/23 at 09:57 AM, she denied being aware of Resident #55 needing assistance with his laundry, however has never asked. Activities Director stated she has not never done this and would require permission to go to the laundry mat for residents. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 2 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with DON on 3/13/23 at 3:13 PM, DON stated laundry services not provided here in the facility. If the resident has no family, then it would be the Activities Director or housekeeping who would have to go offsite to wash their clothing. The staff use refer to the social assessment, and hospital referrals or the resident will tell us they do not have any family. The therapy room has a washer and drier but that is only utilized for therapy services exercises/activities by the residents. No staff are allowed to use it, not even for residents' dirty clothes. DON stated, Resident #55 had never complained to her and he a daughter in El Paso, who brought him his belongings. The DON, will assign a staff member to take a Resident #55 laudry to the laudry mat. Review of facility-provided policy titled Grievance Policy, issuing date;10/1/16, revised date 2/8/21 read in part each patient and visitors have the right to voice complaints and or grievances without discrimination or the fear of reprisal. All grievance will be reviewed in morning meeting with IDT members. All actions taken on grievances including meetings with patients, action plans, revisions of care plans must be documented on the grievance form. Any patient who wishes to do so my express his/her grievance in writing or verbally to any staff member. If the complaint is verbal, it is the responsibility of the staff member who received the complaint to to properly complete the grievance form on behalf of the complainant. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 3 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0645 PASARR screening for Mental disorders or Intellectual Disabilities Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that each resident was screened for a mental disorder or intellectual disability prior to admission for 10 of 16 residents (Resident #'s 48,29,47,19,44,5,32,211,55,and 11) reviewed for PASRR compliance. Residents Affected - Some The facility failed to ensure that an initial PASSR screening (Level 1 screen) was completed prior to admission to the facility for Resident #'s 48,29,47,19,44,5,32,211,55 and 11. These failures could place residents at risk of not receiving specialized and/or habilitation services as needed to meet their needs Findings include: Record review of TULIP (Texas Unified Licensure Information Portal), bed notes revealed effective 01/01/2023 the facility became dually certified with 6 Medicaid beds and 74 Medicare beds. Resident #48 Record review of Resident #48's face sheet dated 3/15/23 revealed [AGE] year-old female who was admitted on [DATE]. Record review of Resident #48's history and physical dated 2/1/23 revealed diagnoses of depression. Record review of Resident #48's admission MDS assessment dated [DATE] active diagnoses section revealed depression was marked as yes. Record review of Resident #48's electronic clinical record revealed PASRR level 1 screening had not been completed. Resident #28 Record review of Resident #28's face sheet dated 3/15/23 revealed [AGE] year-old female who was admitted on [DATE]. Record review of Resident #28's history and physical dated 2/9/23 revealed diagnoses of end stage renal disease, dependence on renal dialysis, lack of coordination, and cognitive communication deficit. Resident #28 did not have a diagnoses of mental illness, intellectual disability, and/or developmental disability. Record review of Resident #28's admission MDS assessment dated [DATE] active diagnosis section revealed diagnoses of renal insufficiency, lack of coordination, cognitive communication deficit. Resident #28 did not have a mental illness, intellectual disability, and/or developmental disability. Record review of Resident #28's electronic clinical record revealed PASRR level 1 screening revealed it had not been completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 4 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0645 Resident #47 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #47's face sheet dated 3/15/23 revealed a [AGE] year-old male who was admitted on [DATE]. Residents Affected - Some Record review of Resident #47's history and physical dated 1/30/23 revealed diagnoses of schizophrenic disorder (disorder that affects a person's ability to think, feel, and behave clearly), PTSD (disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event), and bipolar disorder (disorder associated with episodes of mood swings ranging from depressive lows to manic highs). Record review of Resident #47's admission MDS assessment dated [DATE] active diagnoses section revealed anxiety, depression, schizophrenia, and PTSD were marked as yes. Record review of Resident #47's electronic clinical record revealed PASRR level 1 screening revealed it had not been completed. Resident #19 Record review of Resident #19's face sheet dated 3/15/23 revealed a [AGE] year-old male who was admitted on [DATE]. Record review of Resident #19's history and physical dated 1/18/23 revealed diagnoses of diabetes mellitus type two, hypertension, hyperlipidemia, spina bifida, physical deconditioning and bed bound. Resident #19 did not have a mental illness, intellectual disability, and/or developmental disability. Record review of Resident #19's admission MDS assessment dated [DATE] active diagnoses section revealed had type two diabetes with foot ulcer. Resident #19 did not have any mental illness, intellectual disability, and/or developmental disability. Record review of Resident #19's electronic clinical record revealed PASRR level 1 screening revealed it had not been completed. Resident #44 Record review of Resident #44's face sheet dated 3/15/23 revealed [AGE] year-old male who was admitted on [DATE]. Record review of Resident #44's history and physical dated 1/25/23 revealed diagnoses of metastatic liver cancer with and diabetes mellitus. Resident #44 did not have any mental illness, intellectual disability, and/or developmental disability listed. Record review of Resident #44's admission MDS dated [DATE] revealed active diagnoses section revealed bipolar disorder was marked as yes. Record review of Resident #44's electronic clinical record revealed PASRR level 1 screening revealed it had not been completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 5 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0645 Resident #5 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #5's face sheet dated 3/15/23 revealed [AGE] year-old female who was admitted on [DATE]. Residents Affected - Some Record review of Resident #5's history and physical dated 1/21/23 revealed diagnoses of diabetes mellitus type two, hypertension, hypothyroidism, and altered mental status. Resident #5 did not have any mental illness, intellectual disability, and/or developmental disability. Record review of Resident #5's admission MDS assessment dated [DATE] active diagnoses section revealed depression was marked yes. Record review of Resident #5's electronic clinical record revealed PASRR level 1 screening revealed it had not been completed. Resident #32 Record review of Resident #32's face sheet dated 3/15/23 revealed [AGE] year-old male who was admitted on [DATE] to the facility. Record review of Resident #32's history and physical dated 2/8/23 revealed diagnoses of coronary artery disease (when the arteries that supply blood to heart muscle become hardened and narrowed), hyperlipidemia (condition in which there are high levels of fat particles (lipids) in the blood), hypertension (high blood pressure), hypothyroidism(condition in which the thyroid gland doesn't produce enough thyroid hormone), urinary retention with chronic foley catheter, dysphagia with peg tube placement, and stage 5 decubitus ulcer. Resident #32 did not have any mental illness, intellectual disability, and/or developmental disability. Record review of Resident #32 admission MDS assessment date 2/13/23 active diagnoses section revealed anemia, coronary artery disease, orthostatic hypotension (low blood pressure that happens when standing up from sitting or lying down), pneumonia, septicem ia (life-threatening complication of an infection), diabetes mellitus, hyperlipidemia, malnutrition. The MDS did not document resident had mental illness, intellectual disability, and/or developmental disability. Record review of Resident #32 electronic clinical record revealed PASRR level 1 screening revealed it had not been completed. Resident #11 Record review of Resident #11's face-sheet dated 03/14/23 revealed an [AGE] year-old female with an admission date of 01/25/2023. Record review of an MDS dated [DATE] documented Resident'#11's BIMS score was 99 indicating she was severely cognitively impaired and no behaviors documented. Record review of a History and physical dated 1/27/23 revealed diagnoses of diabetes mellitus type two, hypertension, hypothyroidism, and arthritis. Record review of Resident #11's PASSR level 1 screening revealed it had not been completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 6 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0645 Resident #55 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #55's face-sheet dated 03/14/23 revealed an [AGE] year-old Male with an admission date of 02/20/2023. Residents Affected - Some Record review of a History and physical dated 2/27/23 revealed diagnoses of schizophrenia and dementia with behavioral disturbances. Record review of Resident #55 PASSR level 1 screening revealed it had not been completed. Resident #211 Record review of Resident #211's face-sheet dated 03/15/23 revealed an [AGE] year-old female with an admission date of 02/03/2023. Record review of an MDS dated [DATE] revealed Resident #211 BIMs was 15 indicating she was cognitively intact, no behaviors documented. Record review of a History and physical dated 2/3/23 revealed Resident #211 had diagnoses of diabetes mellitus type two, polio, hard of hearing, end stage renal disease, and depression. Record review of Resident #211 PASSR level 1 screening revealed it had not been completed. Interview on 3/15/23 at 2:30 PM, Administrator stated the facility did not require PASRR screening due to not being dually certified. The Administrator stated TULIP documented under bed notes that stated the facility had 6 Medicaid beds as of 1/1/23 and stated he was not aware the facility was dually certified. Administrator stated none of the residents had been screened for PASRR level 1 since the beginning of 2023. Record review of PASRR policy dated 2/8/21 revealed PASRR is guided by federal regulations that require all individuals being considered for admission to a Medicaid-certified nursing facility (NF) be screened prior to admission. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 7 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to develop and implement comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident medical and nursing needs to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 1 of 6 residents (Resident #41) reviewed for care plans in that: The facility failed to implement a comprehensive person-centered care plan for Resident #41's history of refusing showers. This deficient practice could place residents in the facility at risk of not receiving the necessary care or services and having personalized plans developed to address their needs. Findings include: Record review of Resident #41's face sheet dated 3/14/23 revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Record review of Resident #41's history and physical dated 1/2/22 revealed diagnoses of delusional disorder (belief or altered reality that is persistently held despite evidence or agreement to the contrary, generally in reference to a mental disorder), dementia (memory loss that interferes with daily functioning) due to medical condition with behavioral disturbances, and anxiety disorder (intense, excessive, and persistent worry and fear about everyday situations. Fast heart rate, rapid breathing, sweating, and feeling tired may occur.) Record review of Resident #41's MDS admission assessment dated [DATE] revealed a BIMS score of 8, which indicated moderate cognitive impairment. Section G: personal hygiene revealed Resident #41 required limited assistance with one-person physical assist. Record review of Resident #41's care plan dated 2/7/23 revealed no intervention addressing Resident #41's history of refusing showers. Record review of Resident #41's POC (plan of care) response history: bathing on Wednesday and Saturday nights and PRN for last 30 days (2/16/23- 3/12/23) revealed resident refused the 7 days he was scheduled to receive a shower. Observation and interview on 03/13/23 at 1:11 PM, Resident #41 refused to talk, appeared upset and asked surveyor to leave. Resident #41 hair was not combed, appeared very greasy, had long fingernails, was not shaved, and had body odor. Observation on 03/14/23 at 9:32 AM, Resident #41 was in room, hair was not combed and appeared greasy, long fingernails noted, was not shaved. Observation and interview on 03/15/23 at 10:57 AM, LVN G stated if a resident had refused more than 2 showers during a week, she would then report to nursing administration for further assistance. LVN G referred to electronic record to review Resident #41's history of showers and stated it was a first time she had seen the number of times it was documented he had refused a shower. LVN G stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 8 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she had not received any reports of Resident #41 refusing showers in the past month she had been working in the facility. LVN G stated she had been trained to report to DON if there was a pattern of shower refusals on any residents. LVN G stated if this was a pattern for Resident #41 would be something that should be addressed in his care plan for proper monitoring and set goals addressing his history of refusing showers. LVN G opened Resident #41 care plan on PCC and stated there was nothing addressing Resident #41's refusal in care. LVN G stated all nurses had access to updating care plans. Interview on 03/15/23 at 3:38 PM, the DON stated CNAs had been trained upon hire regarding shower refusals, they were expected to report to their charge nurse and document on residents POC. The DON stated nurses were trained upon hire to follow up on residents who CNAs reported refused showers to offer different options and to see why they did not want to shower. The DON stated if there was a pattern of at least 3 showers refused consecutively the charge nurse was trained and required to report to nursing administration for further assistance. The DON stated she had not received reports regarding Resident #41 refusing so many showers. The DON stated Resident #41's pattern in refusing showers was something that would need to be care planned to address and monitor his ADLs. The DON did not have reason for refusal in care not being included in Resident #41 care plan. Record review of Care Plan policy dated 2/8/21 revealed It is the policy of the facility to promote seamless interdisciplinary care for our residents by utilizing the interdisciplinary plan of care based on assessment, planning, treatment, service, and intervention. It is utilized to plan and manage resident care as evidenced by documentation from admission through discharge for each resident. The care plan will contain information about the physical, emotional/psychological, psychosocial, spiritual, educational, and environmental needs as appropriate. It is our purpose to ensure that each resident is provided with individualized, goal directed care, which is reasonable, measurable, and based on residents' needs. The care plans will be modified when needed to meet the residents' current needs, problems, and goals. Any revision, additions, or deletion to the care plan will be dated. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 9 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 ensure residents are given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living (ADLs) for 1 of 6 residents (Resident #41) reviewed for hygiene. Residents Affected - Few A. Resident #41 appeared disheveled, had long fingernails, hair was not combed and greasy, he was not shaved, and had body odor. This deficient practice could place residents who required assistance with showering and maintaining good personal hygiene at risk for not receiving care and services to meet their needs and avoid ADL decline. Findings include: Record review of Resident #41's face sheet dated 3/14/23 revealed an [AGE] year-old male who was admitted to the facility on [DATE]. Record review of Resident #41's history and physical dated 1/2/22 revealed diagnoses of delusional disorder, dementia due to medical condition with behavioral disturbances, and anxiety disorder. Record review of Resident #41's MDS admission assessment dated [DATE] revealed a BIMS score of 8, which indicated moderate cognitive impairment. Section G: personal hygiene revealed Resident #41 required limited assistance with one-person physical assist. Record review of Resident #41's care plan dated 2/7/23 revealed no focus or intervention addressing Resident #41 history of refusing showers. Record review of Resident #41's POC (plan of care) response history: bathing on Wednesday and Saturday nights and PRN for last 30 days (2/16/23- 3/12/23) revealed resident refused the 7 days he was scheduled to receive a shower. Observation and interview on 03/13/23 at 1:11 PM, Resident #41 refused to talk, appeared upset and asked surveyor to leave. Resident #41 hair was not combed and appeared very greasy, had long fingernails, was not shaved, and had body odor. Observation on 03/14/23 at 9:32 AM, Resident #41 was in room, hair was not combed and appeared greasy, long fingernails noted, was not shaved. Observation and interview on 03/15/23 at 9:15 AM, CNA F stated residents received showers twice a week and sometimes more upon their requests and preferences. CNA F stated if a resident were to refuse a shower, she was trained to attempt at a different time and report to the nurse in charge. CNA F stated if a resident did not receive a shower in her shift she was required to report to the next shift and document on the plan of care in PCC. CNA F stated Resident #41 was under her care this morning and stated she did not know when his last shower was. CNA F walked to Resident #41 room and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 10 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0676 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated his hair was not combed and appeared greasy, and stated he had long fingernails and had body odor. CNA F stated she had not received report of Resident #41 refusing showers recently. CNA F stated he had history of refusing care at times like eating or going to activities and when he refused, she would report to the charge nurse. Observation and interview on 03/15/23 at 9:23 AM, Resident #41 was in his room in wheelchair, alert and orientated to person only. Resident #41 stated he did not need help with showers, he stated he was able to shower on his own and would shower every day. Resident #41 stated he hoped staff would help if needed help with showers and did not know if the staff ever helped him with a shower. Resident #41 stated he did not remember the last time he took a shower and could not remember if the facility staff had offered assistance with hygiene. Resident #41 did not mention anything about refusing showers. Interview on 03/15/23 at 10:57 AM, LVN G stated resident received showers at least twice a week and more upon requests and residents' preferences. LVN G stated if a CNA reported to her that a resident had refused a shower, she had been trained to follow up few minutes later and ask if they prefer a shower in a different shift, a different CNA to assist, or type of shower they preferred. LVN G stated if a resident had refused more than 2 showers during a week, she would then report to nursing administration for further assistance. LVN G referred to electronic record to review Resident #41 history of showers and stated it was a first time she had seen the number of times it was document he had refused a shower. LVN G stated she had not received any reports of Resident #41 refusing showers in the past month she had been working in the facility. LVN G stated she saw Resident #41 this morning and noticed he could use a shower, stated his hair appeared greasy and not combed and had faint smell of body odor. LVN G stated she was not sure if the long beard and mustache was a preference of his. LVN G stated Resident #41 had a history of refusing shower was concerning due to lack of monitoring and reporting affecting his dignity and hygiene. Interview on 03/15/23 at 3:38 PM, the DON stated residents were scheduled to receive two showers per week and more upon request and preferences. The DON stated CNAs had been trained upon hire regarding shower refusals, they were expected to report to their charge nurse and document on residents POC. The DON stated nurses were trained upon hire to follow up on residents who CNAs reported refused showers to offer different options and to see why they did not want to shower. The DON stated if there was a pattern of at least 3 showers refused consecutively the charge nurse was trained and required to report to nursing administration for further assistance. The DON stated she had not received reports regarding Resident #41 refusing so many showers. The DON stated the lack of communication and monitoring from staff that worked with Resident #41 had potentially affected his quality of life and dignity due to his poor hygiene that had not been maintained. The DON did not have answer for Resident #41 poor hygiene. The DON stated she had found 2 shower refusal forms for Resident #41. Record review of Showers policy dated 2/8/21 revealed The purpose of the shower is to promote cleanliness and provide comfort to the patient and observe skin condition. 3. Patients will be offered 2 showers weekly if patient does not have a preference. 4. Staff will respect the patients right to refuse showers. Staff will complete a shower refusal form. The policy did not address patterns of shower refusals or if they were required to report to anyone. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 11 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0687 Provide appropriate foot care. 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 provide proper treatment and care to maintain mobility and good foot health in accordance with professional standards of practice, including to prevent complications from the resident's medical conditions and if necessary, assist the resident in making appointments with a qualified person, and arranging for transportation to and from such appointments for 1 of 6 residents (Resident #19) reviewed for foot care. Residents Affected - Few The facility failed to provide access to podiatrist for Resident #19. This deficient practice placed residents at risk of poor foot hygiene and decline in residents' physical condition. Findings include: Record review of Resident #19 face sheet dated 3/15/23 revealed a [AGE] year-old male who was admitted to the facility on [DATE]. Record review of Resident #19's history and physical dated 1/18/23 revealed diagnoses of diabetes mellitus type II , Record review of Resident #19's admission MDS assessment dated [DATE] revealed a BIMS score of 15, which indicated resident was cognitively intact. Active diagnoses section revealed had type II diabetes with foot ulcer. Observation and interview on 03/13/23 at 9:34 AM, Resident #19 stated he had been in the facility for at least 3 months. Resident #19 stated he had heard an unidentified female staff member asking residents if they wanted their nails trimmed a few weeks ago and requested for his toenails to be trimmed but he was told she could not assist because he had diabetes and required professional assistance. Resident #19 left foot toenails appeared a dark yellow color, thick and long. Resident #19 stated he had requested for help because he had mild discomfort and he wanted to feel good about himself like the other residents would have after their nails were trimmed. Resident #19 also stated he wanted his toenails trimmed to prevent his socks from getting stuck to his toenails. Resident #19 stated he did not report to a nurse about wanting his toenails trimmed because he assumed the unidentified female staff had reported to the nurse about his request. Interview on 03/15/23 at 9:28 AM, CNA F stated they conducted skin assessments during scheduled showers. CNA F stated they looked for any bruises, skin tears, and fingernail and toenails status during showers. CNA F stated they are not able to trim or cut fingernails or toenails for residents who had diabetes. CNA F stated Resident #19 had complained about discomfort to his toenails several days ago and she reported to the charge nurse, she could not remember who the charge nurse was, and had also reported his toenails were long and very thick. Interview on 03/15/23 at 10:57 AM, LVN G stated nurses conduct a skin assessment weekly, a head-to-toe assessment. LVN G stated they looked for new bruises, scratches, lumps, anything out of the ordinary of a resident's baseline. LVN G stated for residents with diabetes they assess fingernails and toenails. LVN G stated residents with diabetes required toenail treatment and care from podiatrist. LVN G stated she noticed Resident #19 had long toenails this morning and stated he had not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 12 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0687 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few complained about any discomfort. LVN G stated licensed nurses were responsible for reporting to NP/ MD to obtain a referral to podiatrist to get them the necessary care and treatment. LVN G stated she had not received any reports regarding Resident #19 concerns.LVN G stated she did not know when Resident #19's last podiatrist appointment was or if he had received podiatrist services since his admission. LVN G stated by not providing podiatrist services to residents with diabetes could affect them by not feeling good about themselves . Interview on 03/15/23 at 3:38 PM, DON stated nursing staff were not able to trim or cut toenails for residents who had a diabetes diagnosis. The DON stated nurses were the ones in charge of obtaining referral to podiatrist or setting up appointments for further treatment if there were any concerns related to toenail care. DON stated Resident #19 had not complained about toenail discomfort to her and had not received any reports from nursing staff regarding voiced toenail discomfort. DON stated it was expected for the nurses to obtain a podiatrist appointment based on their assessments, if toenails appeared to be long, they did not have to wait for resident to voice toenail discomfort to take action. DON stated by not providing podiatrist services affected the residents foot health. DON did not have answer for podiatrist services not being offered or provided to Resident #19. DON stated there was no policy that addressed foot care for diabetic residents . Record review of Medical Appointment policy dated 5/3/22 revealed To ensure that patients obtain needed medical services. Centers will assist with arranging medical appointments that are deemed medically FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 13 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review the facility failed to post the following information on a daily basis: (1) Facility name. (2) Current date. (3) The total number and the actual hours worked by Register Nurses, Licensed Vocational Nurses, Certified nurse's aides and Resident census at the beginning of each shift in a prominent place readily accessible to residents and visitors. Residents Affected - Many The facility did not post and maintain the required staffing information from March 10, 2023 to March 13, 2023. This failure could place residents and visitors at risk of not knowing how many nursing staff were on duty and the actual hours worked per shift daily. Findings include: During an observation on 03/13/23 at 08:18 AM, Nursing Staffing Information dated 03/10/23 was posted up in the facility main entrance visible to all residents and visitors. In an interview on 03/17/23 at 4:50 PM, DON revealed the Nursing Staffing Information is usually posted by the secretary during the weekdays in the morning. DON stated, if we have any change in the census or staff call-in, I will modify the nursing staffing sheets as needed. This would be completed in the morning when I come to work. DON stated, During the week I check it, on the weekends the weekend supervisor is responsible for the Nursing Staffing Information. DON confirmed that the staffing sheet was placed in the morning slightly after the survey team had arrived. DON stated, the staffing sheet were not done for this weekend, because my weekend supervisor called in last minute since she resigned. I do not know the negative outcome of not having the Nursing Staffing sheet posted, the family will not be aware of much staff is present in the facility. DON and Administrator stated they did not have a policy Nursing Staffing Information/Postings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 14 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 resident (Resident #51) of 4 reviewed for medication administration and failed to keep drug records to account of all controlled drugs to be maintained and periodically reconciled for 2 of 4 ( 200 hall North and South) narcotic count sheets reviewed for controlled medications in that: The facility failed to ensure: -LVN D administered Resident #51 medication through feeding tube without checking for residuals first. -LVN E signed narcotic sheet before doing end of shift narcotic count for 200 Southside Hall. -Narcotic count sheet on 200 Northside Hall was missing signatures from staff for three days. -1st and 2nd floor medication storage rooms had expired medications. -2nd floor medication refrigerator had expired medications. This deficient practice could result in a decline in health due to incorrect medication administration and inaccurate count of controlled medications that could result in drug diversion. Findings included: Review of Resident #51's face sheet dated 03/15/23 revealed a [AGE] year-old male with an admission date of 02/15/23. Review of Resident #51's History and Physical dated 02/27/23 revealed he had a feeding tube and was receiving tube feedings, after suffering from a brain bleed. Review of physician orders dated 2/15/2023 revealed Enteral Feed Order every shift Check g-tube (feeding tube) placement via auscultation (using stethoscope to stomach to listen for tube placement) prior to medication or tube feeding administration. Review of 5-Day MDS assessment dated [DATE] revealed Resident #51 had a feeding tube and was receiving tube feedings. Review of comprehensive care plan dated 03/13/23 revealed Resident #51 had the potential for inability to maintain my Nutrition and his goal was to follow the diet recommendations through interventions such as providing equipment for feeding and monitoring. Observations during medication pass on 03/15/23 at 8:24 AM, LVN D administered medications to Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 15 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some #51 without checking for residuals or tube feeding placement. LVN D was checking residuals, by seeing how much of the tube feeding is in the stomach. In an interview with LVN D on 03/15/23 at 8:58 AM, she revealed she was nervous, and had forgotten to check for residuals and tube placement prior to medication administration. She said she had been trained to check for residuals and tube placement before administering medications through the feeding tube. She said she had been trained during orientation about tube feeding medication administration. LVN D said the risk of not checking for residuals or placement before administering medications could place the resident at risk of aspiration or the tube could be dislodged and not in the stomach. In an interview with ADON #1 on 03/15/23 at 3:56 PM, she revealed since she had been hired in November 2022, there had not been training on tube feeding administration. She said the nurses had to check for placement of the feeding tube and check for residuals before giving any medication. ADON #1 also stated if the placement of the tube was not checked and the tube was not in the correct place, it could cause harm to the resident. In an interview with DON on 03/15/23 at 4:19 PM, she revealed it was Nursing 101 to check for residuals and tube placement before administering medications to residents with a feeding tube. DON said she had started an in-service on 03/15/23 and could not remember the last training to nurses on tube feeding medication administration. The process for administering medications through a feeding tube was to always check for placement and residuals. The risk of not doing so was the feeding tube could be out of place. Record review on 03/13/23 at 11:21 AM, revealed narcotic count sheet for 200 Northside Hall was missing staff signatures for March 9th for On-shift and Off-shift as well March 12th and 13th for On-shift. Record review on 03/13/23 at 3:22 PM, revealed narcotic count sheet for 200 Southside Hall had nurse signature for On-shift and Off-shift. In an interview on 03/13/23 at 4:50 PM with LVN E, she revealed she was new to the facility and had only been working for 3 weeks. She said she would sign the On-shift section when she did narcotic count at the beginning of her shift with the nurse that was leaving for the day. LVN E said that she would then sign Off-shift at the end of her shift when she did narcotic count with the nurse that was coming in for night shift. She stated that on 3/13/23 she had signed both the On-shift and Off-shift spots on the narcotic sheet prior to counting narcotics at the change of shift. LVN E stated she was trained to count narcotics at the change of shift with the on-coming nurse and at the end of the shift with off-going nurse. In an interview 3/13/23 at 4:58 PM with ADON #2, revealed she was notified by charge nurse of blanks in documentation on the narcotic sheet on March 9th the 6PM shift going and exiting, March 12th on the 6 AM shift going in, and March 13 the 6 AM shift going in. ADON #2 stated nursing staff had been trained regarding initialing the narcotic sheet after narcotic count in the beginning and end of the shift with incoming and off-shift nurse. ADON #2 stated the nurses were trained to only initial when they worked the shift and after narcotic count was completed. In an interview on 3/13/23 at 5:01 PM with DON, she revealed she had been notified of blanks on narcotic sheets. DON stated nurses were trained upon hire and as needed regarding narcotic counts at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 16 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the change of shift. DON stated the narcotic sheet would only be signed at the beginning and end of their shift after they completed count with the incoming and off-going nurse. DON stated both ADONs were responsible for randomly checking the narcotic count sheets for accuracy in documentation. DON could not state a reason for the failure or state a risk for doing so. Observations with ADON #1 on 03/13/23 at 2:55 PM, of 1st floor medication storage room revealed a package of Phosphorus Supplement with Sodium and Potassium packets had an expiration date of 06/2022. There were over 30 individual packets. Observations with ADON #2 on 03/13/23 at 3:29 PM of 2nd floor medication storage room revealed an unopened 7-Day Vaginal Cream with an expiration date of September 2021. Observations with ADON #2 on 03/13/23 at 3:36 PM of 2nd floor medication refrigerator revealed Bisacodyl suppositories with an expiration date of 02/2023 and Acetaminophen suppositories with an expiration date of 12/2022. In an interview on 03/13/23 at 2:58 PM with ADON #1, revealed she trained to check the medication rooms and medication refrigerators for expired medication. ADON #1 was responsible for checking the medication rooms and medication refrigerators for expired medications and could not remember what date she had done it. ADON #1 said they should not have been in the medication storage room due to being expired and they would not have the same strength, potency or effect. In an interview on 03/16/23 at 2:59 PM with DON, she revealed she expected all the nurses to check for expiration dates for medication in the medication rooms. She could not state a risk to the resident. Review of facility policy titled Storage of Medication: Policy dated 1/23/2022 read in part .outdated medications .should be removed from stock and disposed of according to the medication disposal policy . Record review of facility policy titled Tube Feeding/Enteral Nutrition Policy dated June 2022 read in part .Prior to feeding administration . nurse will review order to confirm .placement check and residual specifications. Unless otherwise indicated by physician orders, nurse will check for placement for continuous feedings via auscultation prior to feeding administration. Residual will be checked at least once per shift . Policy did not have anything specific on medication administration via tube feeding. Review of facility policy titled Storage of Medication: Policy dated 01/13/2022 read in part .At each shift change or when keys are rendered, a physical inventory of all Schedule II medications should be conducted by two licensed nurses or per state regulation and documented on the controlled substances accountability record . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 17 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to ensure that resident was free of any significant medication errors for 1 resident (Resident #51) of 4 reviewed for medication administration in that: Residents Affected - Few -Blood pressure medication was not administered according to prescribed parameters for Resident #51. This deficient practice could cause a decline in health of residents who receive medication that are not according to physician orders. Findings included: Review of Resident #51's face sheet dated 03/15/23 revealed [AGE] year-old male with an admission date of 02/15/23. Review of Resident #51's History and Physical dated 02/27/23 revealed he had a diagnosis of hypertension. Review of a 5-Day MDS assessment dated [DATE] revealed Resident #51 had a diagnosis of hypertension. Review of physician orders dated 2/27/2023 revealed Propranolol HCl Oral Tablet 10 MG: Give 1 tablet via PEG-Tube two times a day for tremors. Hold medication if blood pressure less 110/60 and pulse less 55. Review of Resident #51's MAR for March 2023 revealed medication was administered 9 times without checking the blood pressure and pulse prior to medication administration according to physician's orders. Review of Resident #51's vital signs for March 2023 revealed for the 9 times he received the medication; his systolic blood pressure was less than 110. They were as follows; March 1st, 105/60, March 3rd, 98/60, and 95/56, March 4th, 103/50, March 10th, 92/51, March 11th, 86/50, 103/51, March 14th, 92/70, March 15th, 105/62. Observations during medication pass on 03/15/23 at 8:43 AM, revealed LVN D administered Propranolol medication to Resident #51 without checking his blood pressure measurement before administration. In an interview on 03/15/23 at 8:58 AM with LVN D, revealed she did not know Resident # 51's Propranolol order had blood pressure parameters. She said she did not check his blood pressure before giving the medication and said he usually ran low. She said his latest blood pressure from the morning was 105/62. At this time, she looked at the order for Propranolol that read Hold if BP is <110/60. She said she should have not given him the medication because his blood pressure was low and less than the parameter. She said the risk for that would be to drop his blood pressure even more. She said she had been trained on medication administration during on-hire training. In an interview on 03/15/23 at 10:40 AM with NP, revealed the Propranolol was a beta-blocker type of medication that should have been held if the blood pressure was low. (A beta-blocker is a type of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 18 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few medication that causes low blood pressure). He said he would expect the nurses to check his order and blood pressure reading before administering medication. He stated the risks of not doing so could be the blood pressure would drop even more. In an interview on 03/15/23 at 3:49 PM with ADON #1, stated the nurses had been trained in medication administration but could not recall the day. ADON #1 said the process for medication administration was to check the physician orders and ensure they were correct before administering the medication. She stated she was aware that LVN D had administered the medication without checking the blood pressure according to the physician order. She stated LVN D should not have given the medication because Resident #51's blood pressure was lower than the blood pressure parameters, and he could suffer from hypotension. In an interview on 03/15/23 at 4:19 PM with DON, she said LVN D should have checked the medication order and not administered it to Resident #51 because his blood pressure had been out of the parameters. DON could not recall when the nurses had been trained last in medication administration. Review of facility policy titled Medication Administration dated 2/8/2021 read in part .Medications must be administered in accordance with the written orders of the attending physician . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 19 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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. Based on the observations, interviews, and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for Food and nutrition services, in that: 1. Foods in containers and or zip lock bags in dry storage, walk in, and freezer not dated or labeled properly. 2. Stove food catchers/food traps not being cleaned regularly as there was grease built up and food pieces. 3. Therapist and Maintenance staff not wearing hair nets. 4. Sanitation logs and buckets checks are not being documented on logs to ensure the sanitation liquid was in the appropriate parts per million and sanitation cleaning duties of equipment are being done. 5. Daily Scheduled logs not being followed to ensure sanitation of kitchen equipment and labeling/ rotation of foods. These failures could affect residents by placing them at risk of food borne illness. Findings include: Observation of the kitchen on 03/14/2023 at 9:00 AM with the Dietary Manager, revealed in the walk-in refrigerator a bag of opened liquid eggs was not dated, labeled, or sealed properly. A clear bag of lettuce was moist, dark greenish black, and slimy and not sealed properly. 9 cup desserts of cake on a sheet rack not labeled. Bread bag was open and not completely sealed and was stored in the walk-in refrigerator. In the freezer on a sheet rack were 3 wrapped undated/unlabeled racks of ribs, hamburger patty not sealed properly and not labeled/dated, tater tots and fries not labeled. Freezer floors had pieces of chicken and a tater tot on the floor near and under the shelves. Interview on 03/14/2023 at 9:05 AM, the Dietary Manager revealed dietary staff had been trained on labeling and dating to ensure dietary staff are using food items before their expiration date. Dietary Manager stated food items not labeled, dated or rotated can be spoiled which might be served to residents and they should not be served. Dietary Manager revealed he oversees that labeling and dating are being done. Dietary Manager revealed he had not been doing the review of labels and dating of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 20 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 food items. Level of Harm - Minimal harm or potential for actual harm Observation on 03/14/2023 at 10:00 AM, with the Dietary Manager in the kitchen revealed 3 opened bags of cheese that were not completely sealed or dated. 3 containers of seasoning: meat tenderizer, Cajun seasoning, and salt container on the serving line were not sealed properly with their lids. Seasoned meat tenderizer had residual on the cover. Powdered sugar container on the serving line had residual on the cover. Residents Affected - Some Interview on 03/14/2023 at 10:02 AM, the Dietary Manager revealed that open spice containers could attract pests and could become contaminated. Dietary Manager stated staff had been trained to clean spice containers etc. after each use. Observation on 03/13/2023 at 10:09 AM, with Dietary Manager, on the wall there was a facility daily cleaning schedule log which was not signed off by staff every day. Observation on 02/13/2023 at 10:09 AM, with Dietary Manager, on the wall there was a facility daily check in log for dating and rotation revealed that they had not been checking for the month of march since March 7th, 2023. Interview on 03/13/2023 at 10:10 PM, Dietary Manager revealed the sanitation log was from February 2023 and there was no documentation that staff were following the cleaning schedules. Dietary Manager stated he was responsible for checking that cleaning schedules were being followed. Dietary Manager stated that not ensuring tasks were being done could get resident's sick. Observation and interview on 03/13/2023 at 10:15 AM, with the Dietary Manager revealed the stove/grill in greasy trap and food trap had food pieces and grease. Dietary Manager stated the food traps were supposed to be cleaned daily and had not been cleaned for a week as per Dietary Manager. Dietary Manager revealed the failure to clean the food traps could catch on fire and attract pests/rodents. Observation on 03/13/2023 at 10:20 AM Dietary Aid A was not wearing a beard guard exposing his beard on his face. Interview on 03/13/2023 at 10:21 AM, Dietary Manager revealed dietary staff that have a beard must wear a beard guard. Dietary Manager revealed the kitchen did not have a sanitizer log to check that the sanitation fluid was at the appropriate PPM to sanitize. Dietary Manager revealed the sanitary fluid was to be changed every hour to prevent cross contamination and food borne illness. Dietary Manager revealed staff were not documenting on the sanitation log and checking the fluid every hour. Dietary Manager stated this could lead to cross contamination between equipment and food items as well as residents could get sick. Observation on 03/13/2023 at 11:40 AM, Speech Therapist enter the kitchen with no hair net or beard guard and was speaking to [NAME] B. Observation on 03/13/2023 at 12:08 PM, outside of the kitchen was a sign posted by the entrance to the kitchen stated, Must wear a hair net and a mask before entering the kitchen. Interview on 03/14/2023 at 2:08 PM, the Dietitian revealed dietary staff had been trained to date and label opened food containers be to keep dust out and maintain the quality of the foods. Dietitian (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 21 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 stated food containers should be labeled, dated and rotated. Dietitian stated that food items not dated or labeled must be thrown out. Dietitian revealed wearing hairnets must be worn for sanitation to keep all the hair out of the food. Dietitian revealed basic food sanitation with residents if proper procedures were not followed the residents could get sick. Observation and interview on 03/15/2023 at 2:40 PM, Maintenance C entered the kitchen not wearing a hairnet. Maintenance C revealed he was told by the kitchen before, to put on a hairnet when entering the kitchen. Maintenance C revealed he forgot to put on a hairnet. Maintenance C revealed the risk to the residents would be infection and he said he would not like hair in his food. Interview on 03/14/2023 at 2:56 PM, [NAME] B revealed they are trained in labeling, dating, safety, and pureeing foods. [NAME] B revealed that labeling and dating foods ensures expired foods are not served to the residents. [NAME] B revealed that not labeling/dating/ or wearing a hairnet can result in residents becoming sick if the food has mold, bugs, or has hair in it. Foods not sealed properly can result in cross contamination. [NAME] B revealed that not following facility recipes could affect the flavor of the foods. [NAME] B revealed the cooks sign off on the daily logs to ensure daily cleaning duties and sanitation are being followed. [NAME] B stated that not following the daily cleaning schedule and sanitation log could lead to cross contamination. [NAME] B revealed there are no sanitation logs, and the kitchen should have one. [NAME] B revealed the risk to the residents is salmonella. Interview and record review on 03/14/2023 at 9:00 AM, with Dietary Manager revealed dietary staff had completed food Handlers Course that included training on how to label and date foods, take temps, food preparation, sanitization, rotation of food containers, and proper storage of waste. Record review of in-service training dated 02/15/2022 on labeling and dating food revealed dietary staff who was where responsible for labeling, dating, how to prevent foodborne illness which dietary staff have sign off completing. Record review of facility Use of Gloves, Hairnets, and Covering of food policy dated 10/12/2022 revealed hairnets, beard guards for facial hair to be used when cooking or preparing food. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 22 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 0814 Dispose of garbage and refuse properly. Level of Harm - Potential for minimal harm Based on the observations, interviews, and record reviews the facility failed to dispose of garbage and refuse properly for 2 of 2 dumpsters (Dumpster #1 and #2) reviewed for food safety requirements. Residents Affected - Many 1. Dumpsters #1 and #2 located at the back of the facility had trash on the ground outside and around the dumpsters. 2. One dumpster was to the left of the fryer oil container was uncovered. This failure could result in providing harborage and breeding areas for insects, rodents and other pests which could infest the facility placing the residents at risk of illnesses, and living in an unsafe, unsanitary, and uncomfortable environment. Findings include: Observation on 03/14/2023 at 8:50 AM, with the Dietary Manager revealed Dumpster #1 was uncovered. Trash and clear plastic bags noted on the ground. There were purple gloves, disposable incontinent briefs, emptied water bottles, cardboard boxes, plastic spoon, napkins, Styrofoam cups/plates, emptied cigarette box, empty foil pill rack, and alcohol shot bottles on the ground. In the back of the dumpster were more bags filled with yellow isolation gowns, gloves, and disposable briefs round dumpster #1. Interview on 03/14/2023 at 8:52 AM, the Dietary Manager revealed he does not know who was responsible for ensuring the trash was placed in the dumpsters and was not on the ground. Dietary Manager revealed he does not know if there is a garbage refuse policy. Interview on 03/16/2023 at 11:00 AM, the DON revealed the facility had no Garbage Refuse policy and did not know who took care of the garbage. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 23 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 disease and infection for 2 of 24 residents (Resident #162 and Resident #1) reviewed for infection control in that: Residents Affected - Some 1.PPE (Protective equipment such as gowns and gloves) were not disposed of properly for Resident #162. 2.Resident #1's tube feeding was not properly capped. These deficient practices could place residents at risk for infection due to improper care practices. Findings include: Resident #162 Record review of Resident #162 history and physical dated 3/7/23 revealed diagnosis of C diff (Inflammation of the colon caused by the bacteria Clostridium difficile) Record review of Resident #162 electronic physician order dated 3/8/23 revealed resident on contact isolation due to diagnosis of c-diff. Observation on 03/14/23 at 09:53 AM, revealed Resident # 162 was in contact precautions for C.diff infection (an infection of the large intestine that causes diarrhea and can be transmitted thorough contact with others). There was no PPE disposal container inside the room. PPE was being disposed of in the regular trash. Interview on 03/16/23 at 9:37 AM, the DON stated when residents were placed in isolation rooms, isolation signs were placed on their door. PPE signs were placed on door as well to show staff and visitors the type of PPE they required to use prior to entry. DON stated a PPE cart was placed outside of room with gloves, mask, biohazard bags for PPE disposal, and gowns. DON stated biohazard bags were required to be placed inside the room close to the door. DON stated biohazard bags were important for safely disposing of PPE especially if residents were in isolation due to C-Diff. DON stated nursing administration were in charge of doing daily rounds to ensure PPE were properly used and disposed of. DON stated by not disposing PPE properly, it could be a cross contamination issue. DON stated all nurses were trained regarding PPE use and disposal upon hire and as needed. Resident #1 Review of Resident #1's face sheet dated 03/15/23 revealed an [AGE] year-old female with an admission date of 01/25/2023. Review of Resident #1's History and Physical dated 01/27/2023 revealed a diagnosis of Dysphagia (difficulty swallowing) and was receiving tube feedings through a feeding tube. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 24 of 25 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 745005 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Center at Zaragoza, LLC 12660 Pebble Hills Blvd. El Paso, TX 79938 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 Review of physician orders dated 01/26/23 revealed Change enteral tube feeding administration set daily during night shift and PROVIDE GTUBE SITECARE DAILY AND PRN. Review of a 5-Day MDS assessment dated [DATE] revealed Resident #1 had a diagnosis of dysphagia and required tube feedings through a feeding tube. Residents Affected - Some Review of a comprehensive care plan dated 02/14/2023 revealed Resident #1 had a potential and was at risk for inability to maintain nutrition due to trach, and weakness. Goal was to maintain her weight and nutritional status through intervention such as providing enteral feeding as ordered. Observations on 03/14/23 at 9:58 AM, revealed tube feeding was disconnected from Resident #1 and the end of the tube was on holder uncapped and exposed to air and dust . In an interview on 03/16/23 at 10:32 AM, LVN I revealed when a resident is disconnected from the tube feeding, the end of the tube would be capped and placed on the holder. She stated the way the tube feeding had been left on 03/14/23 was not correct because it was exposed and it could be an infection control issue, LVN I stated by leaving it that way, it would be a port for bacteria and bacteria could be introduced to the resident. In an interview on 03/16/23 at 2:59 PM, the DON revealed once a resident would get disconnected from the tube feeding the tube would get capped, and it would be placed on the holder. DON stated by not doing so, it could pose an infection risk for the resident. Record review of the facility policy Infection Prevention, Control & Immunization revised date 01/13/2023 read in part . the staff will use standard precautions (hand hygiene and appropriated PPE equipment). PPE equipment is to be worn for contact with blood, body fluids, mucus membranes, or non-intact skin. Appropriated PPE to be worn for infection/ illnesses. Staff will implement appropriate Transmission-Based precautions . Policy did not address capping of g-tube and proper disposal of PPE. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745005 If continuation sheet Page 25 of 25