Halstead Health And Rehabilitation Center

bed-hold policies.

Level of Harm - Potential for minimal harm Based on interviews and record reviews, the facility failed to provide written notification to the Office of the Long-Term Care Ombudsman (LTCO) regarding six residents transferred from the facility, five Residents Affected - Many transferred home and one resident transferred to another facility. Findings included:- Review of the admission/discharge report from 02/14/26 to 04/14/26 indicated one resident transferred to another facility and five residents transferred home. On 04/14/26 at 10:25 AM an interview with Social Service X revealed the only time she notifies the LTCO is when a resident is transferred to the hospital. She has not notified the LTCO with residents transferring to home or another facility. On 04/15/26 at 11:15 AM, an interview with Administrative Staff A revealed she expected any transfers from the facility to be sent to the ombudsman. The facility did not provide a policy regarding notification of the ombudsman on transfers to another facility or to home upon request.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 1 1 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

Level of Harm - Minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on or potential for actual harm observation, interview, and record review, the facility failed to accurately complete the [NAME] Data Set for Resident (R) 13. Findings included:- Resident R13's Electronic Medical Record (EMR) documented Residents Affected - Few diagnoses hemiparesis/hemiplegia (weakness and paralysis on one side of the body), chronic osteomyelitis (local or generalized infection of the bone and bone marrow), and intervertebral disc disorder (occurs when the discs between vertebrae are damaged or degenerate, leading to compression or irritation of nearby nerve roots.) with radiculopathy (pain, tingling, or weakness radiates along the affected nerve, often down the legs). Resident R13's 03/24/26 Quarterly Minimum Data Set (MDS) documented a BIMS of 15. The MDS noted Resident R13 required supervision for walking 10 feet and required partial assistance for walking 50 feet. The MDS incorrectly documented Resident R13 had no falls since the previous MDS assessment. Resident R13's Care Plan, dated 01/16/25, documented Resident R13 continued to do things independently even when he had been educated several times to use his call light. Resident R13's 01/16/26 General Note, under progress notes at 01:59 AM, documented staff went into Resident R13's room because his call light was on and found him lying next to his heater on top of some boxes, papers, and his bed side table. Resident R13 complained of back pain and left hip pain. Resident R13 had swelling behind his left ear from hitting the heater and his left cheek was reddened. Resident R13 reported tenderness when putting weight

on his leg. The nurse encouraged Resident R13 to go to the emergency room, but Resident R13 refused. The provider was notified and gave an order for a hip x-ray and pain medication. Resident R13's 01/16/26 Lab/Diagnostic Note, under progress notes at 08:33 AM, documented mobile X-ray came to the facility to x-ray Resident R13's leg. The facility received the report of a nondisplaced fracture of the left superior pubic ramus, and

the doctor was notified. She states that she will be at the facility within the hour and she will assess

the resident. Resident R13's 01/16/26 Lab/Diagnostic Note, under progress notes at 10:41 AM, documented

the provider arrived to see Resident R13. Resident R13 refused a follow up CT and refused an orthopedic consultation. Resident R13 stated if he decided that he needed additional assistance then he would consider therapy. The provider also explained Resident R13 would not be a good surgical candidate. On 04/13/26 at 10:20 AM, Resident R13 had been working on walking in the hall with therapy. Therapy assisted Resident R13 back to his room. He sat

in his wheelchair and reported he had falls and was working with therapy to get stronger after his last fall. On 04/15/26 at 8:46 AM, Administrative Nurse E stated she coded part of the MDS, but the regional nurse completed some of the coding which included the falls portion of the MDS.

Administrative Nurse E agreed that Resident R13 had a fall the resulted in a hip fracture and it should have been coded as a fall with major injury. Administrative Nurse E stated she would message the regional nurse and find out why she coded it like that. On 04/15/26 at 10:05 AM, Administrative Nurse E stated

the regional nurse stated she coded it in error, and the regional nurse would complete a correction immediately. On 04/15/26 at 10:57 AM, Administrative Nurse D reported she expected the MDS to be completed accurately to accurately reflect the resident. The undated MDS policy documented the facility will conduct a comprehensive MDS assessment according to the Federal regulations and Medicare guidelines. The facility staff will follow the current Resident Assessment Instrument (RAI -

a comprehensive, standardized tool used in long-term care facilities to assess residents, guide care planning, and monitor quality of care) manual for proper procedures on completing the MDS.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 4 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

prevent accidents.

Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide an environment free of accident hazards when staff failed to provide the necessary foot pedals when assisting propelling Residents Affected - Few Resident (R)3 in a wheelchair. Findings included: - Resident R3's Electronic Medical Records (EMR) documented diagnoses that included severe morbid obesity, vascular dementia (a progressive mental disorder characterized by failing memory and confusion caused by a decreased blood flow to the brain), anxiety (mental or emotional reaction characterized by apprehension, uncertainty, and irrational fear), and noncompliance. Resident R3's 12/24/25 Significant Change Minimum Data Set (MDS) documented a Brief Interview for Mental Status (BIMS) score of 15, which indicated intact cognition.

The assessment documented Resident R3 had one fall with minor injury since the previous assessment. Resident R3's 12/24/25 Falls Care Area Assessment (CAA) documented Resident R3 had falls in the previous three months and he was at risk for falls. Resident R3's 3/10/26 Quarterly MDS documented a BIMS score of 15. The MDS documented Resident R3 had one noninjury fall since the previous assessment and was independent with wheelchair mobility. Resident R3's Care Plan, dated 01/10/24, documented Resident R3 was at risk for falls. The plan instructed staff to ensure the walker was within reach. The plan was updated following a fall on 12/24/25. The plan also documented Resident R3's back locked up at times and he needed a wheelchair. During

an observation on 04/13/26 at 09:04 AM, Certified Nurse Aide (CNA) M pushed Resident R3 in his wheelchair to his room, the wheelchair did not have foot pedals attached and Resident R3's feet were crossed and Resident R3 held his feet off the floor. Resident R3 reported he was just coming in from smoking. During an observation on 04/14/26 at 07:42 AM, Resident R3 attempted to go to the door to go out to smoke. Licensed Nurse (LN) HH stood in front of Resident R3 and told him it was one and a half hours until the next smoking break. Resident R3 got frustrated and told LN HH to turn him around in his wheelchair, then LN HH turned him around in the wheelchair and assisted him to the dining room. Resident R3's sock was half off his foot and dragged the floor. Resident R3 held his foot off the floor. During an interview on 04/14/26 at 07:48 AM, LN I stated she thought

she should not have assisted Resident R3 in the wheelchair without foot pedals on but was not sure. LN I then asked Certified Medication Aide (CMA) S if Resident R3 required foot pedals when staff are pushing him in his wheelchair. CMA S stated Resident R3 used the foot pedals when he was assisted in his wheelchair. If he is self-propelling, he does not need them. During an interview on 04/15/26 at 08:46 AM, Administrative Nurse E confirmed staff should not assist Resident R3 in the wheelchair without foot pedals. During an

interview on 04/15/26 at 10:57 AM, Administrative Nurse D stated that staff should use foot pedals when they are assisting residents in the wheelchair. The facility's undated Falls policy documented

the residents would be assessed for risks of falls and interventions would be implemented to reduce risk of falls.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 5 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

catheter care, and appropriate care to prevent urinary tract infections.

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 appropriate care and treatment Residents Affected - Few of a suprapubic catheter (tube surgically inserted through the abdominal wall into the bladder to drain urine) when staff anchored the suprapubic tubing to Resident (R)6's leg instead of his abdomen as indicated by current standards of practice to prevent pulling or dislodgement. Findings included: - Resident R6's Electronic Medical Record (EMR) from the Diagnosis tab documented Alzheimer's disease (progressive mental deterioration characterized by confusion and memory failure), chronic kidney disease-stage three (CKD), benign prostatic hyperplasia (BPH-non-cancerous enlargement of the prostate which can lead to interference with urine flow, urinary frequency, and urinary tract infections), obstructive uropathy (a structural or functional blockage in the urinary tract that prevents urine from flowing freely, causing it to back up and damage the kidneys), and retention of urine (the inability to fully or partially empty the bladder). Resident R6's Quarterly Minimum Data Set (MDS), dated [DATE REDACTED], documented a Brief Interview of Mental Status (BIMS) score of four, which indicated severely impaired cognition. The MDS documented Resident R6 had an indwelling catheter during the

observation period. The Urinary Incontinence Care Area Assessment (CAA), dated 12/09/25, documented a diagnosis of Alzheimer's, obstructive and reflux uropathy, retention of urine, and BPH. Resident R6's Care Plan, dated 08/25/23, documented an order from Resident R6's urologist which directed staff not to remove Resident R6's catheter. On 02/17/25, the plan directed staff were to apply Skin-prep (liquid skin barrier) prior to attaching the Stat-lock (adhesive medical tubing stabilization device) for the suprapubic catheter. During an observation on 04/14/26 at 12:37 PM, Licensed Nurse H assessed and cleaned the suprapubic catheter site on Resident R6's abdomen. The Stat-lock was attached to Resident R6's left upper thigh and was confirmed by Licensed Nurse H. During an observation on 04/15/26 at 9:22 AM, Licensed Nurse I assessed and cleaned the suprapubic catheter site on resident Resident R6's abdomen, then attached a Stat-lock to Resident R6's left upper thigh, securing the tubing from Resident R6's abdomen. During an

interview on 04/14/26 at 2:32 PM, Licensed Nurse H stated they were unaware of a Stat-lock being adhered to the abdomen and would ask the Administrative Nurse D for directions on where to place

the Stat-lock for a suprapubic catheter. On 04/14/26 at 02:34 PM, Administrative Nurse D stated she would expect the Stat-lock to be anchored to the leg. During an interview on 04/14/26 at 02:43 PM, Administrative Nurse D stated the facility catheter policy does not state where to place a Stat-lock for a suprapubic catheter, however, the suprapubic catheter replacement competency states the tubing should be anchored to the abdomen. Administrative Nurse D stated they were unaware the competency checklist required the tubing to be anchored to the abdomen the previous times they reviewed the checklist. The facility competency checklist states the catheter tubing should be secured to the abdomen.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 6 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

for Resident R27 to have house shakes TID was changed to one time a day by the facility. She said she would Level of Harm - Minimal harm be involved in the change of recommendation, depending on the resident, but was not currently aware or potential for actual harm that Resident R27's recommendation had been changed. On 04/15/26 at 11:06 AM, Administrative Nurse D and Administrative Nurse E stated the 168 lb. weight should have been reported immediately to the nurse Residents Affected - Few and a re-weight should have been performed for verification, she further stated whoever weighed Resident R27 was to review the previous weight and perform a re-weight if there was a significant change.

Administrative Nurse E then stated on 01/15/26 Resident R27 had a task ordered for weekly weights. The facility policy Weight Loss Prevention, dated 04/20/20, documented that residents with poor or declining nutritional intake, weight loss, BMI <22 and/or pressure ulcers would have nutritional interventions added as needed and the Registered Dietitian should be consulted.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 8 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

stops beating) qualified in the facility and confirmed Resident R2's emergency tracheostomy supplies and Level of Harm - Minimal harm Ambu bag were not readily available at the bedside. LN G said the emergency supplies were kept in or potential for actual harm the hallway under the Hoyer lift and in the medication room. LN G also stated that hospice residents with a tracheostomy had an emergency kit and equipment at the bedside because hospice provided Residents Affected - Few those supplies. On [DATE REDACTED] at 02:50 PM, Administrative Nurse D stated tracheostomy care competency was performed annually for the nursing staff. Administrative Nurse D also stated there was not an available emergency kit or Ambu bag at bedside because staff were told by the physician not to reinsert the tracheostomy if it came out, staff were to immediately call 911. On [DATE REDACTED] at 08:04 AM, Administrative Nurse D said the Ambu bag was directly outside Resident R2's room on the crash cart, not at the bedside. She verified that if staff needed the Ambu bag because Resident R2 was in respiratory distress, staff would have to move the Hoyer lift, uncover the cart, and wheel it into the room. The facility policy Respiratory Care, dated [DATE REDACTED], documented the facility provided necessary respiratory care and services in accordance with professional standards of practice, the resident's care plan, and the resident's choice.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 1 0 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

Level of Harm - Potential for Based on observation, interview, and record review, the facility failed to ensure the posted daily nurse minimal harm staffing sheets included accurate and identifiable information to include the name of the facility and total hours worked, as required. Findings included:- Observed on 04/13/26 at 08:00 AM, the posted Residents Affected - Many staffing sheet lacked the total hours worked. Observed on 04/14/26 at 09:30 AM, the posted staffing sheet lacked the total hours worked and did not list the facility name. Review of the daily staffing sheets from 05/13/25 and 03/18/26 revealed the posted staffing sheets lacked the total hours worked. During an interview on 04/14/26 at 11:48, Administrative Nurse D stated the nightshift nurse filled out the next day staffing sheet and then posted it for display before the start of the next shift.

Administrative Nurse D also said the listed column that was labeled actual hours were the total hours worked. The facility policy Daily Nurse Staff Posting, dated 11/28/17, documented at the beginning of each shift the charge nurse would compute the number of full-time equivalents on duty and record the number on the Daily Nurse Staffing form. The form would then be posted in designated locations in such a manner that it could be easily seen and read. The policy also documented the facility census would be recorded on the form and be updated with any admissions or discharges throughout the day.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 1 2 of 1 2

degrees04/15/26 103 degrees The dish machine temperature log dated April 2026 documented the Level of Harm - Minimal harm supervisor should be notified if the dish machine temperature goes below 120 degrees. During an or potential for actual harm interview on 04/15/26 10:32 AM, Administrative Staff A and Dietary Staff CC stated gloves should be worn when handling ready-to-eat foods, such as bread for sandwiches or toast. Food stored or Residents Affected - Many prepared in the kitchen including spices should be dated with the month, the day, and the year. All stored food in a bag, box, or container should also be sealed or closed and should be labeled with the month, day, and year. All packages of stored food should have the bag or the wrapping sealed and closed properly. All cooked food temperatures should be taken after food preparation, and the food temperature should be taken again before serving the food. Hand hygiene should be done with soap and water or hand sanitizer when preparing food. Dishes such as plates, containers, and bowls should always be inverted. They said they knew the cooler racks were bad and had ordered new ones, but

the racks were on back order and should be there soon. They confirmed the dishwasher temperature should be at a minimum of 120 degrees during the wash cycle. Administrative Staff A and Dietary Staff CC stated they would have maintenance look at the dishwasher and possibly contact the manufacturer of the dishwasher if needed. They stated bags of food should always be sealed and properly dated when stored in the pantry, freezer, or cooler. During an interview on 4/15/26 at 11:28 AM, Administrative Staff A revealed they do not have an answer for the temperatures on the temperature log but stated that it sounded like the facility needed to have some education and initiate

a performance improvement plan for staff regarding this topic. The facility's 04/06/20 Food Storage policy documented staff are to label all food items with the name of the food and the date it was opened or when it should be used by, and food which has passed the expiration date should be discarded. The facility did not provide a hand hygiene policy for dietary staff.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 2 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)

Level of Harm - Minimal harm Based on observation and record review the facility failed to maintain an effective infection control or potential for actual harm program related to Enhanced Barrier Precaution (EBP- infection control interventions designed to reduce transmission of resistant organism which employ targeted gown and gloves use during high Residents Affected - Some contact care) during wound care. Additionally, staff failed to keep laundry cart covered during delivery of clean clothing. Findings included:- An observation of tracheostomy care for Resident (R) 2 on 04/14/26 at 07:50 AM, revealed Licensed Nurse (LN) H performed hand hygiene, donned gloves, and wore a mask, LN H did not don a gown prior to providing cares and changing gloves before placing clean four by four gauze or the tracheostomy cannula (a tube to maintain a patient's airway for breathing). An observation on 04/14/26 at 11:35 AM, during the delivery of resident's personal items, revealed Housekeeping/Laundry Staff U placed the covered cart in hall 100, then took the items off

the cart and carried the items over her shoulder to hall 200 without the cart, uncovered. During an

observation on 04/14/26 at 12:37 PM, prior to doing wound care for Resident R6, LN H performed hand hygiene and applied a gown and gloves. LN H then did the wound care and upon leaving the room after providing the wound care LN H reached down while holding the gauze and wound cleanser inspected and manipulated the suprapubic catheter (a tube inserted through the abdominal wall into the bladder to drain urine) tubing then left the room without performing hand hygiene. On 04/15/26 at 10:19 AM, LN I revealed wound care supplies should be kept in the residents' room or bagged and taken to the wound nurse and hand sanitizing should be performed before/after wound care and if soiled. On 04/16/26 at 08:00 AM, an interview with LN H revealed she should have changed gloves and wore a gown prior to tracheostomy care. On 04/15/26 at 08:04 AM, an interview with Administrative Staff D revealed she expected the staff to wear a gown, gloves, and a mask at minimum for EBP, and hand sanitizing should be completed after the dirty side is done and new gloves applied. On 04/16/26 at 10:10 AM, an interview with Administrative Staff D revealed she expected staff to follow the hand hygiene and glove use during catheter care and if touching a bag or catheter tubing, staff should perform hand hygiene. On 04/16/26 at 10:17 AM, an interview with Housekeeping Staff V revealed she expected the laundry staff to place the covered cart next to the room where they would deliver personal items to the residents and make sure the cart is covered between rooms. The facility's policy Enhanced Barrier Precautions (EBP) dated 04/1/24 Enhanced barrier precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organism that employs target gown and glove use during high contact resident care activities. The facility's policy Hand Hygiene, dated 11/28/17, documented staff are to wash hands with soap and water when hands are visibly soiled, cleanse hands with alcohol-based hand rub before and after contact with the resident, after contact with blood, body fluids or visibly contaminated surfaces or other objects, after removing personal protective equipment, before performing a procedure such as an invasive device urinary catheter and or dressing care.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete 175446 Page 3 of 1 2 Department of Health & Human Services Printed: 06/12/2026 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391 STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.Building 175446 04/15/2026 B. Wing NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Halstead Health and Rehabilitation Center 915 McNair Street Halstead, KS 67056 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)