Health inspection·October 25, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm trying to reach her call light so she could call for assistance but hasn't been able to reach it. Resident #23 continued to try to reach her call light but was not able to reach it due to her limited range of motion and where the call light was located. The location of the call light was on the resident's right side of bed on a bed rail, the call light's cord was wrapped around the bed rail and was placed at the top of the bed rail out of reach and sight of resident. Residents Affected - Few During an interview on 10/24/2023 at 2:49 PM, DON stated that the facility does not have a policy regarding call lights. During an interview on 10/25/2023 at 9:26 AM, CNA E stated that when she makes the resident's bed, she puts both bed rails down and lays the call light on the bed. CNA E stated that she believes it was the night staff that attaches the call light to the bed rails. CNA E stated the negative outcome for a resident not being able to reach their call light would be that they would not be able to call for assistance. During an interview on 10/25/2023 at 9:49 AM, LVN B stated that she puts the call light in reach of her residents, LVN B stated that a negative outcome of not putting the call light in reach would that a resident could fall. During an interview on 10/25/2023 at 9:50 AM LVN C stated that she puts the call light where the resident requests it to be, sometimes it is on the bed rail, blanket, or clothes. LVN C stated that the negative outcome for a resident not being able to reach the call light would be that the resident may try to get up and get hurt. During an interview on 10/25/2023 at 10:52 AM, Resident #23 stated that her call light placement has always been a problem. During the exit conference on 10/25/2023 at 1:15 PM, ADM asked about the potential reasonable accommodations cite, Surveyor stated that on two occasions she observed a resident not being able to see or reach her call light. Administrator referred to resident by name and indicated that she has always had issues with her call light. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0578 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. Based on interview, and record review, the facility failed to ensure all residents had the right to formulate an advance directive for 1 (Resident #61) of 18 residents reviewed for DNR orders. Residents Affected - Few Resident #61 had an Out-of-Hospital DNR order that was invalid, as the date of signature of the Physician, Medical Power of Attorney and Notary did not match. This failure could place residents with DNR orders at risk for receiving, or not receiving, life-saving measures that align with their medical preferences. Findings included: Record review on 10/24/23 at 9:50AM revealed that the DNR was signed by MPOA (Medical Power of Attorney), who was her family member, on 1/13/23. The Physician's signature was dated 1/13/22 and the Notary's signature had no date. The last section of the DNR states that all 3 (MPOA, Physician and Notary) must agree that the document has been completed accurately. All 3 had signed that section. In an interview at on 10/24/23 at 9:59AM the DON confirmed that there had been a Care Plan entry on 1/13/23 which changed Resident #63 from Full Code status to DNR. The DNR with the Physician's signature was produced. She stated that the Physician's signature did not match the date of the change in status from Full Code to DNR. In an interview on 10/24/23 at 10:11AM LVN D revealed that he would have to speak with the DON in the event of an emergency, due to the date of the physician's signature on the DNR not matching the change in status of the Care Plan. He stated that he could not execute the DNR and would have to get an update from the DON before life-saving measures were put in place. In an interview on 10/24/23 at 10:22AM the MPOA (Medical Power of Attorney) revealed he had signed his family member's DNR in January 2023. Prior to this, his family member had been a Full Code and he had helped her change the status from Full Code to DNR. He was unaware that the physician's signature was dated 1/13/22, making the DNR inactive. He understood the difference between Full Code status and DNR and wondered what would be done for Resident #63 in the event of an emergency. He stated that he did not want life-saving measures taken for Resident #63 and that her wishes, matched his. In an interview on 10/24/23 at 10:43AM the DON stated that the SW was tasked with ensuring the accuracy of final wishes for residents and would immediately speak with the SW to ensure the proper changes to the DNR were made and signed by the appropriate parties. In an interview on 10/24/23 at 10:46AM the SW stated that the DON had brought the inaccuracy to her attention, and she had reached out to the MPOA, to execute a new and accurate DNR. The SW stated that in the event of an emergency, prior to execution of the new DNR, the MPOA would have to be called to verbally execute Resident #63's wishes. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interviews and record review the facility failed to provide a homelike environment, which allowed comfortable temperature levels for 3 of 5 residents in a confidential group interview. Residents Affected - Few The facility failed to maintain comfortable temperature levels between 71 degrees and 81 degrees in 1 of 4 dining rooms at the facility. This failure could place residents at risk of an uncomfortable environment and diminish their quality of life. Findings included: Observation of 2nd floor South Dining Room on 10/23/23 at 12:13 PM, observation of thermostat located on the interior wall which divided the dining room revealed it was 68 degrees in the dining room where 19 of the 21 residents that were in the dining room were wearing a jacket or had a blanket covering them. Confidential interview and observation on 10/23/23 beginning at 12:16 PM resident was observed sitting in the 2nd floor South Dining Room, resident stated that she was cold. Confidential Interview on 10/24/23 at 10:00 AM, 3 out of 5 residents stated that the dining room and the activity room upstairs were always cold. One of the five residents stated that the cold was uncomfortable as some of us take blood thinners. Observation of 2nd floor South Dining Room on 10/24/23 11:41 AM, observation of thermostat that was located on the interior wall dividing the dining room, thermostat read 68 degrees. Confidential interview/observation on 10/24/23 11:46 AM, resident was observed sitting at a table in the 2nd floor South Dining Room wearing a long-sleeved shirt and a sweater cardigan, and a double ply flannel clothing protector: Resident stated it was always cold in the dining room. Resident said It's never hot! I think it is the air conditioner, they keep it going. Observation of 2nd floor South Dining Room on 10/25/23 08:13 AM, observation of thermostat that was located on the interior wall dividing the dining room, thermostat read 69 degrees. Interview with MS on 10/25/2023 at 8:06 AM, MS stated that the air conditioning is on an automated system, which he controls. MS stated MS went to the 2nd floor South Dining room where he observed the thermostat to read 69.5 degrees. MS stated he is not sure what the comfortable temperatures for the facility but would guess between 69 degrees and 78 degrees. Interview with MS on 10/25/2023 at 8:40 AM, stated that he turned the temperature up 3 degrees for both dining rooms on the south side. Interview with LVN C on 10/25/2023 at 9:49 AM, LVN C was on the second floor near the 2nd floor dining room. LVN C stated that she has had some residents recently complain about the cold air; LVN C stated she offers residents blankets or sweaters when they complain. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Interview with DON on 10/25/2023 at 9:53 AM, DON stated that she had been told that residents have complained about the coldness in the upstairs Activity Room and upstairs dining room. Record Review of Quality-of-Life Policy, subject: Environment, Closet Space, Lighting, Temperature and Sound Level dated 1/15/2019 revealed that the comfortable and safe temperature level ranges between 71-81 degrees Fahrenheit will be maintained by the facility. Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0641 Ensure each resident receives an accurate assessment. 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 that the resident's assessment accurately reflected the resident's status for 1 (Resident #19) of 18 residents reviewed for accurate assessments. Residents Affected - Few The facility failed to correctly code bed rails for Resident#19. The facility had bed rails incorrectly coded as restraints on the MDS Assessments of Resident #19. This failure could place residents at risk of receiving inaccurate/unnecessary levels of care. Findings included: Record review of Resident #19's face sheet dated 10/24/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, fibromyalgia (a chronic disorder characterized by widespread pain and other symptoms such as fatigue, muscle stiffness, and insomnia), hypertension (high blood pressure), and generalized muscle weakness. Record review of Resident #19's care plan dated 10/11/23 revealed a focus area of [Resident #19] is at risk for impaired skin integrity related to limited mobility. One of the interventions related to this focus area was, Side rails for positioning/support and/or comfort. A second focus area revealed, [Resident #19] requires assistance from staff with performance of daily living . One of the interventions for this focus area was, [Resident #19] may use ½ rails for mobility, positioning, and comfort. Record review of Resident #19's Quarterly MDS completed on 10/10/23 revealed a BIMS of 15 which indicated intact cognition. Section GG of the MDS revealed Resident #19 was independent across all ADLs except for upper body dressing where she required partial assistance. Section P of the MDS coded Resident #19's bed rail as a restraint used less than daily. Record review of Resident #19's active orders dated 10/24/23 revealed an order of, Side rails in use for positioning, mobility and/or comfort with a date of 11/23/22. Record review of Resident #19's Bed Rail Assessment revealed Resident #19 had expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #19 and an LVN from the facility and dated 10/03/23. During an observation and interview on 10/23/23 at 12:38 PM Resident #19 was in her room sitting in her w/c next to her bed. She had bed rails up on both sides of the top half of her bed. She stated she used the bed rails to position herself in bed. During an observation on 10/24/23 at 09:46 AM Resident #19 was asleep in her bed with bed rails up on both sides of the top half of the bed. During an observation and interview on 10/25/23 at 08:14 AM Resident #19 was sitting in her w/c next to her made bed. The bed rail on the right side of her bed was still up but the left side was down. Resident #19 stated she used her bed rails every day and she was able to move them up and down as desired. She said, In fact, this morning I put that one down [gesturing to the left side bed rail]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0641 Level of Harm - Minimal harm or potential for actual harm During an interview on 10/25/23 at 08:20 AM MDS RN was asked why Section P of the MDS for Resident #61 and Resident #19 coded bed rails as a physical restraint she stated, I didn't do those. When asked who does the MDS assessment she said she usually does them, but RN N helped her occasionally. She said, She [RN N] is my backup for MDS. MDS RN said RN N believed if the resident had bed rails they had to be coded as a restraint. MDS RN said, We had a disagreement about that. Residents Affected - Few During an interview on 10/25/23 at 08:38 AM RN N was asked when a bed rail was a restraint and she stated, I don't really think it is a restraint, it's just the RAI manual, and I think it is important to document that. I just follow the RAI instructions. During an interview on 10/25/23 at 09:51 AM DON stated, regarding residents who had bedrails coded as restraints on the MDS, I was just talking to MDS RN about that because we use them [bed rails] as enablers and back up coordinator [RN N] thinks you have to code them as restraints. DON stated the facility did not use bed rails as restraints. She said a possible negative outcome of having inaccurate medical records was, Well, inaccurate care of the resident, specifically restraint related, looking at potential for injuries affecting their dignity and their rights. During an interview on 10/25/23 at 10:28 AM MDS RN stated a possible negative outcome of having bedrails incorrectly coded as restraints was residents could get entangled in the bed rail and choke or get strangled. Record review of facility policy titled, Restraint Policy and dated 09/01/16 revealed in part: [Name of facility] makes every effort to maintain a restraint free environment. The Facility will prohibit the use of restraints for discipline or convenience and will limit the use of restraints; either physical or chemical, to circumstances in which the resident's medical symptoms warrant the use of a restraint. Record review of facility policy titled, Clinical Records, Contents and Service Requirements Policy and dated 02/01/2017 revealed in part: . The Facility will maintain clinical records on each resident, in accordance with accepted professional health information management standards and practices that are: . 2. Accurately documented . Record review of Long Term Care Facility Resident Assessment Instrument 3.0 User's Manual (RAI) revealed in part: . Definition Physical Restraints Any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or normal access to one's body . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to attempt to use appropriate alternatives prior to installing a side or bed rail for 7 (Residents #4, #6, #10, #17, #19, #23, and #61) of 18 residents reviewed for bed rails. The facility placed bed rails on the beds of Residents #4, #6, #10, #17, #19, #23, and #61 on the day the residents were admitted without attempting other interventions first. This failure could place residents at risk of entrapment or injury due to bed rails. Finding included: Record review of Resident #4's face sheet dated 10/24/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, Alzheimer's disease (a progressive disease that destroys memory and other important mental functions), hypertensive heart disease (heart problems that occur because of high blood pressure), and chronic atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow). Record review of Resident #4's care plan dated 09/13/23 revealed a focus area indicating Resident #4 was at risk for impaired skin integrity. One of the interventions related to this focus area was the use of side rails for positioning/support and/or comfort. This intervention had an initiation date of 09/01/23. The care plan revealed a second focus area which stated, [Resident #4] requires assistance from staff with performance of daily living . One of the interventions related to this focus area was, [Resident #4] may use ½ rails for positioning, mobility and/or comfort. Record review of Resident #4's admission MDS completed on 09/12/23 revealed a BIMS of 13 which indicated intact cognition. Section G of the MDS revealed Resident #4 required extensive assistance by one to two staff members across all ADLs. Record review of Resident #4's active orders dated 10/24/23 revealed no order for side rails. Record review of Resident #4's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. Low bed, frequent staff monitoring, assisted toileting, and reminders to use call light had been checked as Attempted but Failed. Resident #4's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was signed by Resident #4's POA and dated 08/31/23. The second signature line stated, This Informed Consent for use of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given. This signature line had a place for the nurse to sign and indicate who gave consent on what date at what time. This line was unsigned. Record review of Resident #4's Bed Rail Assessment revealed Resident #4 was non-ambulatory, had displayed poor bed mobility or difficulty moving to a sitting position on the side of the bed, had difficulty with balance or poor trunk control, and expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #4's POA and an RN from the facility and dated 08/31/23. Record review of Resident #6's face sheet dated 10/25/23 revealed an [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, fracture of neck, fracture of arm, fracture of leg, unspecified dementia (a group of thinking and social symptoms that interferes with daily functioning), and senile degeneration of the brain (a state of mental, emotional, and social deterioration resulting primarily from degeneration of the brain in old age). Record review of Resident #6's care plan dated 10/04/23 revealed a focus area of [Resident #6] requires assistance from staff with performance of daily living related to self care deficit . One of the interventions related to this focus area was, [Resident #6] may use ½ rails for mobility, positioning, and comfort. This intervention had an initiation date of 03/14/23. The care plan revealed another focus area of [Resident #6] is at risk for impaired skin integrity related to impaired mobility . One of the interventions related to this focus area was, Side rails for positioning/support and/or comfort. This intervention had an initiation date of 03/14/23. Record review of Resident #6's quarterly MDS completed on 10/04/23 revealed a BIMS of 3 which indicated severely impaired cognition. Section GG of the MDS revealed Resident #6 was dependent across all ADLs except for eating where she required partial to moderate assistance. Record review of Resident #6's active orders dated 10/25/23 revealed an order for Side rails in use for positioning, mobility and/or comfort. The order date was 03/13/23. Record review of Resident #6's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. The options of low bed, frequent staff monitoring, assisted toileting, and reminders to use call light had been checked as Attempted but Failed. Resident #6's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was blank. The second signature line stated, This Informed Consent for use of Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given by [Resident #6's POA] date 03/13/23 time 1100 [11 AM] This signature line had a place for the nurse to sign and was signed by a facility nurse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #6's Bed Rail Assessment revealed Resident #6 was non-ambulatory, had fluctuation in her level of consciousness, had a history of fall, displayed poor bed mobility or difficulty moving to a sitting position on the side of the bed, had difficulty with balance or poor trunk control, and expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #6's POA and an LVN from the facility and dated 03/13/23. Residents Affected - Some Record review of Resident #10's face sheet dated 10/24/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, generalized osteoarthritis (degenerative joint disease), hypertension (high blood pressure), and repeated falls. Record review of Resident #10's care plan dated 09/13/23 revealed a focus area indicating Resident #10 was at risk for impaired skin integrity. One of the interventions related to this focus area was the use of side rails for positioning/support and/or comfort. The care plan revealed a second focus area which stated, [Resident #10] requires assistance from staff with performance of daily living . One of the interventions related to this focus area was, [Resident #10] may use ½ rails for mobility, positioning, and comfort. Record review of Resident #10's Significant Change MDS completed on 09/11/23 revealed a BIMS of 12 which indicated moderately impaired cognition. Section G of the MDS revealed Resident #10 required extensive assistance by one staff member for bed mobility, transfer, locomotion on unit, locomotion off unit, dressing, and toilet use. Resident #10 required supervision by one staff member for walking in her room, walking in the corridor, eating, and personal hygiene. Record review of Resident #10's active orders dated 10/24/23 revealed an order for Side rails for positioning, comfort and mobility with an order date of 11/16/22. Record review of Resident #10's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. No options were checked on the form. Resident #10's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was signed by Resident #10 and dated 01/28/20. The second signature line stated, This Informed Consent for use of Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given. This signature line had a place for the nurse to sign and indicate who gave consent on what date at what time. This line contained only the nurse's signature and was dated 01/28/20. Record review of Resident #10's Bed Rail Assessment revealed Resident #10 was non-ambulatory, had a fluctuating level of consciousness, had alteration in safety awareness due to cognitive decline, had a history of falls, had difficulty with balance or poor trunk control, and expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #10's family member and an RN from the facility and dated 09/06/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #17's face sheet dated 10/24/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, paraplegia (impairment in motor or sensory function of the lower extremities), hypertension (high blood pressure), and age-related physical debility. Record review of Resident #17's care plan dated 10/17/23 revealed a focus area indicating Resident #17 required assistance from staff with Functional Abilities and performance of daily living related to . limited mobility. One of the interventions related to this focus area was, [Resident #17] may use ½ rails for mobility, positioning, and comfort. Record review of Resident #17's Quarterly MDS completed on 07/17/23 revealed a BIMS of 99 which indicated severely impaired cognition. Section G of the MDS revealed Resident #17 required extensive assistance by one to two staff members for bed mobility, locomotion, dressing, and personal hygiene. She was totally dependent on two staff members for transfer and toilet use and required set up help only for eating. Record review of Resident #17's active orders dated 10/24/23 revealed an order of, Side rails in use for positioning, mobility and/or comfort with an order date of 11/22/22. Record review of Resident #17's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. Low bed, frequent staff monitoring, assisted toileting, and reminders to use call light had been checked as Attempted but Failed. Resident #17's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was signed by Resident #17's family member and dated 04/05/21. The second signature line stated, This Informed Consent for use of Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given. This signature line had a place for the nurse to sign and indicate Resident #17's family member gave consent on 04/05/21 at 16:30 [04:30 PM]. This line was signed by a nurse. Record review of Resident #17's Bed Rail Assessment revealed Resident #17 was non-ambulatory, had fluctuation of consciousness, had alteration in safety awareness due to cognitive decline, had displayed poor bed mobility or difficulty moving to a sitting position on the side of the bed, had difficulty with balance or poor trunk control, was visually challenged, and expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #17 and an LVN from the facility and dated 10/08/23. Record review of Resident #19's face sheet dated 10/24/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, fibromyalgia (a chronic disorder characterized by widespread pain and other symptoms such as fatigue, muscle stiffness, and insomnia), hypertension (high blood pressure), and generalized muscle weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #19's care plan dated 10/11/23 revealed a focus area of [Resident #19] is at risk for impaired skin integrity related to limited mobility. One of the interventions related to this focus area was, Side rails for positioning/support and/or comfort. A second focus area revealed, [Resident #19] requires assistance from staff with performance of daily living . One of the interventions for this focus area was, [Resident #19] may use ½ rails for mobility, positioning, and comfort. Residents Affected - Some Record review of Resident #19's Quarterly MDS completed on 10/10/23 revealed a BIMS of 15 which indicated intact cognition. Section GG of the MDS revealed Resident #19 was independent across all ADLs except for upper body dressing where she required partial assistance. Section P of the MDS coded Resident #19's bed rail as a restraint used less than daily. Record review of Resident #19's active orders dated 10/24/23 revealed an order of, Side rails in use for positioning, mobility and/or comfort with a date of 11/23/22. Record review of Resident #19's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. The options of low bed, frequent staff monitoring, assisted toileting, assistive device at bedside and reminders to use call light had been checked as Attempted but Failed. The option floor mats had been checked as Considered Inappropriate. Resident #19's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was signed by Resident #19's POA and dated 03/31/22. The second signature line stated, This Informed Consent for use of Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given. This signature line had a place for the nurse to sign and indicate who gave consent on what date at what time. This line was signed by a nurse and dated 03/31/23. Record review of Resident #19's Bed Rail Assessment revealed Resident #19 had expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #19 and an LVN from the facility and dated 10/03/23. Record review of Resident #23's face sheet dated 10/24/23 revealed an [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, psoriatic arthritis mutilans (an inflammatory illness that results in stiff joints, joint pain, and ultimately bone loss), Raynaud's syndrome (a medical condition that affects the small arteries in your fingers and toes causing a reduction in blood flow), age-related cognitive decline, and venous insufficiency (condition in which the flow of blood through the veins is blocked, causing blood to pool in the legs). Record review of Resident #23's care plan dated 08/08/23 revealed a focus area of, [Resident #23] requires assistance from staff with performance of daily living . One of the interventions related to this focus area was,[Resident #23] may use ½ rails for mobility, positioning, and comfort. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #23's Quarterly MDS completed on 08/07/23 revealed a BIMS of 15 which indicated intact cognition. Section G of the MDS revealed Resident #23 required extensive assistance by one to two staff members across all ADLs except for eating where she required set up help and supervision only. Record review of Resident #23's active orders dated 10/24/23 revealed an order of, Side rails in use for positioning, mobility and/or comfort. The order was dated 11/22/22. Record review of Resident #23's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. The options of low bed, frequent staff monitoring, and reminders to use call light had been checked as Attempted but Failed. Resident #23's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was signed by Resident #23's family member and dated 07/14/20. The second signature line stated, This Informed Consent for use of Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given. This signature line had a place for the nurse to sign and indicate who gave consent on what date at what time. This line was signed by a nurse and dated 07/14/20. Record review of Resident #23's Comprehensive Assessment revealed Resident #23 requested side rails and preferred for the rails to be raised when she was in bed. Record review of Resident #61's face sheet dated 10/24/23 revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included, but were not limited to, dementia (a group of thinking and social symptoms that interferes with daily functioning), paroxysmal atrial fibrillation (irregular heartbeat), congestive heart failure (a progressive heart disease that affects the pumping action of the heart muscles resulting in shortness of breath and fatigue), hypertension (high blood pressure) and a history of falling. Record review of Resident #61's care plan dated 10/17/23 revealed a focus area which stated, [Resident #61] requires assistance from staff with performance of daily living . One of the interventions related to this focus area was, [Resident #61] may use ½ rails for mobility, positioning, and comfort. This intervention had an initiation date of 01/04/23. The care plan revealed another focus area of, [Resident #61] needs routine licensed services . One of the interventions related to this focus area stated, Requires side rails for mobility and comfort. A third focus area revealed, [Resident #61] is at risk for impaired skin integrity related to impaired mobility and incontinence. One of the interventions related to this focus area was, Side rails for positioning/support and/or comfort. Record review of Resident #61's Quarterly MDS completed on 10/17/23 revealed Resident #61 had moderately impaired cognitive skills for daily decision making and a short and long-term memory problem. Section GG of the MDS revealed Resident #61 was dependent on staff for toileting, bathing, lower (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some body dressing, putting on and taking off footwear, personal hygiene, transfers, and bed mobility. Resident #61 needed partial assistance for oral hygiene and upper body dressing and was independent in eating. Section P of the MDS coded Resident #61's bed rail as a restraint used less than daily. Record review of Resident #61's active orders dated 10/24/23 revealed and order for side rails for mobility, positioning, and comfort with an order date of 01/03/23. Record review of Resident #61's, Informed Consent for use of Side Rail revealed in part: The interdisciplinary Team along with your physician has determined that a side rail is appropriate. The facility has assessed and determined that side rails will promote bed mobility and independence or individual resident has stated a preference to have side rails in place. The form contained a graph with alternatives to bed rails that had been Attempted but Failed or were Considered Inappropriate. Low bed, frequent staff monitoring, assisted toileting, and reminders to use call light had been checked as Attempted but Failed. Resident #61's name and room number were listed at the top of page one. Page two of the form contained two signature lines. The first stated The RISKS and BENEFITS of side rails have been explained to me. I understand and I consent to the use of side rails. This signature line was illegibly signed and dated 01/03/23. The second signature line stated, This Informed Consent for use of Side Rails was read to the legal representative with understanding and verbal consent for use of side rails given. This signature line had a place for the nurse to sign and indicate who gave consent on what date at what time. This line was signed by a facility nurse and the areas for who gave consent and what day at what time contained the same nurse's name, 01/03/23, and 11:30 a.m. respectively. Record review of Resident #61's Bed Rail Assessment revealed Resident #61 was non-ambulatory, had fluctuation in level of consciousness, had alteration in safety awareness due to cognitive decline, displayed poor bed mobility or difficulty moving to a sitting position on the side of the bed, and expressed a desire to have Side Rails/Assist Bar for safety and/or comfort. This form was signed by Resident #61's family member and an LVN from the facility and dated 10/12/23. During an observation on 10/23/23 at 09:04 AM Resident #6's bed had bed rails up on both sides of the top half of the bed. During an observation on 10/23/23 at 09:24 AM Resident #23's bed had bed rails up on both sides of the top half of the bed. During an observation on 10/23/23 at 11:12 AM Resident #4 was in bed with bed rails up on both sides of the top half of her bed. During an observation and interview on 10/23/23 at 12:38 PM Resident #19 was in her room sitting in her w/c next to her bed. She had bed rails up on both sides of the top half of her bed. She stated she used the bed rails to position herself in bed. During an observation and interview on 10/23/23 at 02:24 PM Resident #6 was laying in her bed on her back under a blanket. The bed was in the lowest position and fall mats were on either side of the bed. Bed rails were up on both sides of the top of the bed. When asked if she used her bed rails, Resident #6 stated, That's my bed. When asked again if she used her bed rails, Resident #6 said, You (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 can have it. Level of Harm - Minimal harm or potential for actual harm During an observation on 10/23/23 at 02:35 PM Resident #61 was in her bed with bed at lowest position and bed rails up on both sides of the top of her bed. When asked if she would be able to put the bed rails down if she needed to she said she could if she had the strength to do it but she did not feel like she had the strength at that time. Residents Affected - Some During an observation and interview on 10/23/23 at 02:43 PM Resident # 10 was lying in bed with bed rails up on both sides of the bed. Resident #10 stated she loved the bed rails because they helped her to feel secure. During an observation on 10/24/23 at 09:43 AM Resident #6 was lying in bed. Bed was in lowest position and bed rails were up on both sides of the top half of the bed. During an observation on 10/24/23 at 09:46 AM Resident #19 was asleep in her bed with bed rails up on both sides of the top half of the bed. During an observation on 10/24/23 at 11:08 AM Resident #17 was receiving catheter care in her bed with bed rails upright on both sides of the top half of the bed. Resident #17 used the rails to help herself turn from side to side. During an observation on 10/24/23 at 11:40 AM Resident #17 was seated in her w/c next to her bed. Bed rails were up on both sides of the top half of the bed. During an observation and interview on 10/25/23 at 08:14 AM Resident #19 was sitting in her w/c next to her made bed. The bed rail on the right side of her bed was still up but the left side was down. Resident #19 stated she used her bed rails every day and she was able to move them up and down as desired. She said, In fact, this morning I put that one down [gesturing to the left side bed rail]. During an observation on 10/25/23 at 08:16 AM Resident #17 was asleep in her bed and bed rails were up on both sides of the top half of her bed. During an interview on 10/25/23 at 09:38 AM LVN A stated she had worked for the facility for 12 years. She stated nurses were responsible for filling out bed rail consent forms if we either get a new resident or they have the criteria for bed rails. When asked how the interventions on the consent form were attempted but failed the same day the resident was admitted she said, I guess there is no way we tried them unless the family said they were tried. She stated if any of the interventions in the Attempted but Failed section of the consent form were checked it was because the family said they had been tried. During an interview on 10/25/23 at 09:42 AM LVN C stated she had worked for the company for 20 years. She said bed rail consent forms were filled out by the nurses on admission. When asked about the Attempted but Failed section of the form she said, I don't usually put that on there. I usually explain the pros and cons and of the bed rails. I don't put anything in that section. During an interview on 10/25/23 at 09:42 AM LVN B stated she had worked for the company for 9 years. She said bed rail consents were filled out by the nurses on admission. She stated residents often wanted bed rails as enablers. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/25/23 at 09:47 AM LVN G stated she had worked for the facility for two years. She said nurses were responsible for filling out the bed rail consents when residents were admitted . She said, I usually put that they [residents] requested them [bed rails] on the consent form. During an interview on 10/25/23 at 09:47 AM LVN M stated she had worked for the facility for one year. She said nurses were responsible for filling out the bed rail consents upon admission. She said, A lot of them [residents] request them for safety. During an interview on 10/25/23 at 09:51 AM DON stated she knew about some of the residents having physical restraints coded in the MDS for bedrails. She stated, I was just talking to MDS RN about that because we use them as enablers and back up coordinator thinks you have to code them as restraints. DON stated nurses were responsible for getting bed rail consents filled out. She said, Usually we do it on admission. We visit with the resident and family and ask them when they come in and we get the initial assessment from them and go from there. When asked what the consent form meant when it stated an intervention was Attempted but Failed DON stated, I think during that initial day is when they will try those things it is probably not enough time depending on your view point. When asked how multiple interventions could be attempted but fail on the same day a resident is admitted to the facility, DON stated, I guess that is what we get from the resident or their family member during admission interview. When asked for possible negative outcomes for not attempting other interventions before using bed rails DON stated, Well, you are not using the least restrictive option, I guess. You are not trying something else instead of going to what may be your last resort. During an interview on 10/25/23 at 10:26 AM LVN G was asked if she knew what the facility policy on bed rails stated. She responded, Um .no. During an interview on 10/25/23 at 10:28 AM LVN B was asked if she knew what the facility policy on bed rails stated. She responded, About bed rails in what way? When reminded that the first line of the policy stated bed rails would not be available to residents upon admission she stated, Oh yeah, they [bed rails] are tied down with straps until the resident's family signs [the bed rail consent form] and then we can cut them [the straps]. During an interview on 10/25/23 at 10:33 AM DON was asked if the facility's nurses had received training on the facility's bed rail policy. She stated, You know, I'm not sure. I mean we discuss it, but I don't know if I've ever brought the policy out. I mean, it [a copy of the policy] is in each unit. Record review of facility policy titled Protocol: Side Rails and dated 01/16/19 revealed in part: On admission to [name of facility] side rails will not be available. Alternatives will be utilized and documented. (See informed consent for alternative suggestions.) Charge Nurse will: Document alternative interventions used by facility Assess resident for the use of side rails . If assessment shows side rail use is appropriate for resident to improve mobility or meet their preference, [NAME][TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review it was determined the facility failed to ensure drugs and biologicals were stored and labeled in accordance with currently accepted professional principles and include the appropriate accessory and cautionary instructions, and the expiration date when applicable on 2 of 3 Medication Carts and one Treatment Cart. [DATE] at 8:59AM on Second floor NW Medication Cart, 3 loose medications were found in the second drawer of the Medication Cart 1 expired medication found in Treatment Cart located on the first floor NW Hall, in a room labeled 'Linen Closet.' 1 vial Insulin found open with no expiration date on Medication Cart #2 second floor SW Hall. This failure could place 81 residents receiving medications at risk for drug diversion, drug overdose, and accidental or intentional administration to the wrong resident which could lead to exacerbation of their disease process and deterioration in general health. Findings included: During observation and interview beginning on [DATE] at 08:59AM of Medication Cart #1 for first floor NW Hall with LVN F identified the three loose medications as Aricept, Coreg, and Requip. LVN F was asked what would be done with pills upon discovery. She stated they would be placed in the medication room in a gray liquid that will destroy the medications. During observation on [DATE] at 09:16AM of the Treatment Cart for first floor NW Hall with LVN F, expired medication TP CRM Gabapentin-DIC-LIDO-PRIL expired on [DATE]. LVN F took the medication and placed it with the medications to be destroyed. During observation/interview on [DATE] at 10:43 AM of Medication Cart #2 on second Floor SE Hall with LVN B, observation of drawer holding insulin, found 1 vial of Humalog Insulin, with an opened date penned in as [DATE], but without an expiration date. When LVN B was asked why there was an open date written on the vial, but no expiration date she responded, We don't have to put the expiration date on them all the time. On [DATE] at 1:00 PM an interview with DON, she was asked what could be a negative outcome for a patient who received insulin that was expired? DON responded, Don't know the efficacy. On [DATE] at 1:10 PM an interview with LVN G she was asked what could be a negative outcome for a patient who received insulin that was expired? She responded, Make them sick. May not work so good. On [DATE] at 1:19 PM an interview with LVN H she was asked what could be a negative outcome for a patient who received insulin that was expired? She responded, An adverse reaction. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 0761 Level of Harm - Minimal harm or potential for actual harm On [DATE] at 2:59 PM requested from the DON for the facilities medication policies, as she was delivering the policy on Drug Security. DON was specifically asked for a policy on Expiration Labeling of Medications. She stated, The facility has no policy on expiration labeling of medications. Surveyor did not receive any other medication policies prior to exit. Residents Affected - Few Record Review of facility policy revealed: Policy Section/#: Pharmacy Services #L-6 Drug Security Policy Date: [DATE] Policy: Medications must be properly labeled and stored in a locked medication room, cabinet, or cart. Only authorized personnel have access to the keys. Record Review of Pharmaceutical Company that manufactures Humalog Insulin reflected on their web site on [DATE] states: 'Opened Humalog vials, prefilled pens, and cartridges must be thrown away 28 days after first use, even if they still contain insulin.' FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store, prepare, and serve food under sanitary conditions in 1 of 1 kitchen when they failed to: Residents Affected - Many A. Ensure stored food was properly labeled, dated, and stored. These failures placed all residents who ate food served by the kitchen at risk of food-borne illness. Findings included: An observation of the facility walk-in cooler on 10/23/23 at 8:07AM revealed: 2 watermelons, no date received. 1 Food Service box of head of Romaine lettuce; open to air; no date. 2 8-count packages of pancakes; no label; no date. 1 6-count box of thawed pork tenderloin; no label; no date. 2 boxes, 24-count each, blueberry muffins, no label; no date. 3 thawed briskets; no label; no date. 2 13-ounce bottles of mint flavoring; no date. An observation of the dry pantry on 10/23/23 at 8:33AM revealed: 3 red potatoes laying on the floor of the pantry. 1 50-pound box of red potatoes; sitting on floor; open; no date. 1 50-pound box of white potatoes; sitting on floor; open; no date. 3 12-count packages of hot dog buns, expiration date 9/29/23. 2 12-count packages of hot dog buns, expiration date 10/17/23. An observation of the freezer on 10/23/23 at 8:51AM revealed: 7 ½ Food Service bags of French fries, no date. 1 Food Service bag of tater tots; open to air; no date. 1 box 12-count frozen fudge bar treats; no date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 1 Food Service bag of cauliflower bites; open to air; no date. Level of Harm - Minimal harm or potential for actual harm In an interview on 10/23/23 at 9:18AM, the Dietary Supervisor stated all food should be labeled and dated; there should be no bags of fresh or frozen food, open to air. The DS stated foods should be labeled and dated as soon as they come in or are taken out of their box. Residents Affected - Many The DS stated all kitchen staff know they should secure foods and/or date foods when storing. The DS stated that residents could become sick if these standards are not followed. Record review of the facility's policy entitled Food Storage, Food Safety in Display and Service Policy with a revised date of 1/16/17, documented: The receiving date is written on the top of all food cases or containers. All food in its original containers, will have the expiration date written on it. Record review of the USDA food Code dated 2022, revealed, in part: 3-302.12 Food Storage Containers, Identified with Common Name of Food. Except for containers holding FOOD that can be readily and unmistakable recognize, 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. 3-202.15 Package Integrity. FOOD packages shall be in good condition and protect the integrity of the contents so that the FOOD is not exposed to ADULTERATION or potential contaminants. 3-305.11 Food Storage. (A) Except as specified in (B) and (C) of this section, FOOD shall be protected from contamination by storing the FOOD: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination; and (3) At least 15 cm (6 inches) above the floor. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 25 resident (Resident #232) reviewed for infection control. Residents Affected - Few 1. The facility failed to ensure that contact precaution signage was in place for Resident #232 who was positive for C-diff upon admission. 2. The facility failed to implement isolation precautions for a Resident #232 who was positive for C-Diff. This failure could place the residents at an increased risk for potentially exposing them to infections, which could lead to abdominal cramping, lethargy, increased risk for diarrhea, dehydration, and feelings of isolation. Findings included: Observation on 10/23/23 8:30 AM revealed that Resident #232 was not in room. Asked CNA where patient was, she stated he was eating breakfast but will be back in room after breakfast. Observation on 10/23/23 09:10 AM No posting was observed on room door or wall in hallway stating any type of contact precautions needed to be taken before entering room. Resident #232 was sitting in recliner with blanket over him, Resident #232 opened eyes but did not respond when spoken to and was asked if he would allow an interview. He closed his eyes and did not respond. Interview on 10/23/23 03:31 PM with DON stated Resident #232 was still positive for C-diff. DON stated, The last I heard he was having some loose stools and we still have him on contact precautions. Observation on 10/23/23 03:32 PM revealed outside of room Resident #232, there is a 3-drawer cabinet with gloves on top. Once the drawers were open the top drawer is empty, there are gowns in the second drawer, and third drawer has biohazard bags. There was no signage on the door stating that the resident is on contact precautions for C-Diff. Interview on 10/23/23 03:39 PM with LVN H, she stated that resident does have C-Diff. LVN H stated that since the infection was in the stool, there was no need for signage on the door. LVN H did state that she did talk to the manager about this the lack of signage this morning with no change taking place. LVN H stated that a negative outcome would be the chance of others getting c-diff. Interview on 10/23/23 03:52 PM with Resident #232's family member, she stated that Resident #232 has been positive for c-diff since his admission to facility on 10/13/2023. Family member stated that resident goes to the dining room for every meal in the dining room and the staff was getting him ready to attend the evening meal. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 10/23/2023 3:55 PM Resident #232 was then wheeled out of his room by CNA J and placed at table with family member. Interview on 10/23/23 03:57 PM with CNA J stated that she knows that c-diff is contagious and communicable. What would a negative outcome be if the resident was positive, CAN J stated that it could be given to another resident. Record Review on 10/23/23 04:17 PM of Resident #232's physicians orders revealed an order for Continue contact isolation x 48 hours or until asymptomatic. Interview on 10/23/23 04:26 PM with DON stated that Resident #232 was admitted with c-diff, but no further lab work has been performed in confirming or denying resident was still positive for c-diff. Observation on 10/24/23 07:45 AM revealed sign on door stating Stop please see nurse before entering there was no signage for isolation or contact precautions in place. Interview on 10/24/23 08:12 AM with Resident #232's family member revealed that resident was in no condition to leave his room for the first few days, after his admittance to facility, due to being too weak and unable to leave his room. Family member stated, We really thought we were going to lose him. Family member stated that there was no signage on the door for the first few days that Resident #232 was in facility. Family member stated that she has not observed any hand hygiene for her husband while she was in the facility. She was in facility every day at different times and for extended periods of time. She stated that she has seen staff wash his face, but not his hands. Observation on 10/24/23 08:20 AM Resident #232 was in dining room eating breakfast. Resident #232 requested more biscuits and gravy. Staff got it for him. Interview on 10/24/23 10:27 AM with MD, stated that if the resident was free from symptoms (diarrhea, cramps, lethargic) and the resident was being actively treated there should be no concern regarding the resident being around other residents. Interview on 10/24/23 01:33 PM with LVN J stated that hand hygiene that was performed for a resident with c-diff was to be performed with hot soapy water, LVN J stated that mask, gown, gloves, and shield if needed are to be used. PPE is donned outside of room and doffing of PPE takes place inside of the room. Interview on 10/24/23 01:38 PM with CNA K, stated that hot soapy water was to be used when dealing with a resident with c-diff. Alcohol-Based Hand Sanitizer was not to be used, it won't work. PPE is to be put on before entering the room and taken off right inside the door of the residents room. Interview on 10/25/2023 with DON during exit conference did confirm that Resident #232 was still positive for C-diff, secondary to still having loose stools. Record review of facility policy titled Infection Control with a Subject of Handwashing by residents dated 12/14/2016 states but not limited to the following: POLICY: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 Hand washing by residents is an important part of the infection control program. Level of Harm - Minimal harm or potential for actual harm Residents are encouraged to wash their hands before meals, after using the toilet, and at other times as indicated by the general policy on hand washing. Residents Affected - Few In the case of the non-ambulatory resident, the use of waterless hand cleaners may be appropriate and effective. Education of alert resident, family members and visitors should emphasize the importance of hand washing. Staff will assist residents as needed with hand washing. Record review of facility policy titled Infection Control with a Subject of Clostricium Difficile, dated 12/14/2016 states but not limited to the following: POLICY: Residents with diarrhea of unknown origin or cause will be treated as if contagious in nature. Employees will practice Universal Precautions when coming in contact with any blood or body fluids/waste. Clostridium Difficile (C. Difficile) is a spore forming bacillus that produces toxins that cause gastrointestinal illness. C Difficile can cause asymptomatic colonization or produce illness ranging from severe diarrhea with pseudomembranous colitis to toxic megacolon complicated by bowel perforation and death. C. Difficile infection occurs most often when the following constellation of events has occurred: I. The resident has been treated with antibiotics at some time in the preceding 8 weeks 2. The resident has been exposed to and colonized by C. Difficile 3. The resident's immune system alone cannot suppress the spread of C. Difficile. A. Signs and symptoms: 1. Mild to moderate diarrhea, sometimes accompanied by lower abdominal cramping; 2. Occurs most often when the resident has been treated with antibiotics at some time in the preceding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 8 weeks. Level of Harm - Minimal harm or potential for actual harm 3. Stool; typically very foul smelling and may have a green to dark brown appearance. Residents Affected - Few 4. Diagnosed by culturing stool. 5. May be asymptomatic B. Transmission: 1. . Direct or indirect contact: a. Person to person via hands; b. Environmental surfaces; can persist for long periods on surfaces and is resistant to conventional cleaning and disinfection. C. Clostridium Difficile should be considered as the cause of the diarrhea, especially with residents who have a tube feeding, have received antibiotics or other anti-neoplastics within the past (2) weeks, and those who have had Closttridium Difficile. Record review of facility policy titled Infection Control with a Subject of Transmission-Based Precautions, dated 12/27/2016 states but not limited to the following: POLICY: Transmission-based precautions are used for resident who are known to be, or suspected of being infected or colonized with infectious agents, including pathogens that require additional control measure to prevent transmission. T11e Facility will use standard approaches, as defined by the CDC for transmission-based precautions: airborne, contact and droplet precautions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 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 745022 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ware Memorial Care Center 1510 S Van Buren St. Amarillo, TX 79101 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 Personnel will be notified of the particular type of precautions being utilized. Level of Harm - Minimal harm or potential for actual harm Standard/ Universal precautions will be used in conjunction with transmission-based precautions Residents Affected - Few Record review of facility policy titled Infection Control with a Subject of Contact Precautions, dated 12/13/2016 states but not limited to the following: POLICY: Contact isolation is initiated to prevent the transmission of highly transmissible or epidemiologically important infections or colonization. Diseases or conditions included in this category are spread by close or direct contact with infective material. This category requires the use of personal protective equipment according to the task being done. Microorganisms can be transmitted by direct contact with the resident (skin to skin) or indirect contact (touching) with environmental surfaces or resident care items in the resident's environment. A. Examples of such illnesses include: I. Gastrointestinal, respiratory, skin or wound infections or colonization with multi-drug resistant bacteria judged by the infection control program, based on current state, regional or national recommendations to be of special clinical and epidemiologic significance. 2. Enteric infections with a low infectious dose of prolonged environmental survival including; a. Clostridium difficile b. Enterohemorrhagic Escherichia Coli c. Shigella d. Hepatitis A e. Rotavirus . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 745022 If continuation sheet Page 25 of 25