Mountain View Health & Rehabilitation

F 0572 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

care, of treatment alternative or treatments options and to choose the alternative or option he or she prefers.Respect and Dignity - The right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences.Information and communication - The resident has the right to be informed of his or her rights and of all rules and regulations governing resident conduct and responsibilities during his or her stay in the facility. Required notices as specified in this section. The facility must furnish to each resident a written description of legal rights which includes - list of names and telephone numbers to all pertinent state regulatory and informational agencies, such as advocacy groups as the State Survey Agency, the State Licensure office, the Ste Long Term Care Ombudsman program, the protection and advocacy agency. The facility must inform each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the facility. Record review of the facility's Health Care Center Policies, Information, and required Notices Policy, revealed, Acknowledgement of Receipt of Policies, Information, & required Notices - Items Not Allowed in Residents Room, Privacy Notice, Statement of Resident Rights, Self-Determination End of Life Measures and Advance Directive, Policy for Raising and Addressing Concerns - Grievances Procedure, Connected Care Center Information, Emergency Communication Policy, Resident Group and Family Council Information and etc.The parties here to (parties or individual party) agree as set forth herein as of blank. All Parties identified and signing below as Co-Responsible Parties shall also be deemed to be a Party to this Agreement and hereby agree to all its terms and provisions. The Responsible Party and Co-Responsible Parties are hereinafter singularly and collectively referred to as ‘Responsible Party' and Facility was hereinafter referred to as ‘facility.' The Resident and Responsible Party understand that they have choices and options other than placement of

the Resident in this facility and that this Agreement contains several provisions intended to reduce the cost of items such as legal fees, settlement costs, administrative time and similar costs to all the Health Care Center to spend more money in other areas which may be of benefit to the Resident. Accordingly, the Resident and/or Responsible Party hereby freely choose this Health Care Center understanding their rights, obligations, and remedies as set forth herein and the future implications thereof. Record review of

the facility's, undated, Admission/readmission Policy revealed, Inform of visiting time and private space for visiting. Provide written policies regarding services available and payment requirements.Obtain admission packet and perform interview for admission history and complete the admission or readmission assessment.Provide the resident and family member with a copy of resident rights. Explain the resident's rights in a language they understand and answer any questions about the rights.Obtain a signature of receipt from the resident and/or family member and place a signed copy of the rights on the clinical record.

Provide the resident with a copy of the signed form.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Health & Rehabilitation

1600 Muchison Rd El Paso, TX 79902

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 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

on the weekend of 08/09/25-08/10/25. The Receptionist stated Resident #1 was having behaviors as she saw facility staff bringing Resident #1 back into the building in a wheelchair on 08/09/25. The Receptionist stated the Family Member arrived to the facility on [DATE REDACTED]. The Receptionist stated she provided the admission packets on the weekends if she was given instruction to by the admission Coordinator. The Receptionist stated that weekend she did not have any instructions which indicated she needed to give Resident #1 or the Family Member who was the RP the admission packet. The Receptionist stated the purpose of the admission packet was to let the resident or RP/Family Member know the resident rights and

the way the facility worked as well as the times of everything. The Receptionist stated the admission packet gave the resident or the RP/Family Member all the information they needed to know and that was where the facility acquired their signatures acknowledging understanding. The Receptionist stated there would be a risk if the admission packet was given being there was a reason that they were given. During an interview

on 09/05/25 at 1:35 PM with the DON, she stated Resident #1 was at the facility for therapy as he was involved in an accident. The DON stated during her admission process she found Resident #1 to be appropriate for the facility. The DON stated based on the admission, on 08/08/25, Resident #1 was not showing any signs of behaviors until later that early morning on 08/09/25. The DON stated Resident #1 was physically aggressive by spitting at staff and trying to hit them as well as screaming for his kids. The DON stated Resident #1 was sent to the hospital for aggressive behaviors and then the hospital sent him right back the same day on 08/09/25. The DON stated she was unsure if the family or resident received an admission packet which also included the Resident Rights policy. The DON stated after the behavioral issues they deemed Resident #1 as unsafe to be at the facility and it was in the best interest that Resident #1 discharged from the facility. The DON stated the Family Member received discharge instructions and had set them up with home health to ensure a safe discharge. The DON stated the Family Member did not agree with the discharge and took Resident #1 home. Record review of the facility's, undated, Admission/readmission Policy revealed, -Obtain admission packet and perform interview for admission history and complete the admission or readmission assessment.-Provide the resident and family member with a copy of resident rights. Explain the resident's rights in a language they understand and answer any questions about the rights.-Obtain a signature of receipt from the resident and/or family member and place

a signed copy of the rights on the clinical record. Provide the resident with a copy of the signed form.Record review of the facility's Health Care Center Policies, Information, and required Notices Policy, revealed on 09/05/25, revealed, Acknowledgement of Receipt of Policies, Information, & required Notices Items Not Allowed in Residents Room, Privacy Notice, Statement of Resident Rights, Self-Determination End of Life Measures and Advance Directive, Policy for Raising and Addressing Concerns - Grievances Procedure, Connected Care Center Information, Emergency Communication Policy, Resident Group and Family Council Information and etc.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Health & Rehabilitation

1600 Muchison Rd El Paso, TX 79902

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 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

his room and placed into another room where he was by himself as he was disturbing the other resident that was in the room. The Administrator stated Resident #1 was sent to the local hospital and then returned sometime in the afternoon. The Administrator stated he had a conversation on 08/09/25, with the Family Member in which he told her Resident #1 needed specialty services. The Administrator stated he suggested Resident #1 could be better off in a secured unit which they did not have. The Administrator stated the Family Member decided to go ahead and take Resident #1 home. The Administrator stated a 30-day notice was not given and the list of discharges to the Ombudsman was going to be sent out as the facility sent it out once a month. The Administrator stated there was no risk of no notification to the Ombudsman, as he was still going to be notified as per their facility policy where they were going to send out the list at the end of the month by the SW. revealed .Notification of Discharges - For a facility initiated non-emergent transfer or discharge of a resident, the facility will notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand with at least 30 days' notice prior to discharge. Additionally, the facility will send a copy of the notice of transfer or discharge to the representative of the Office of the State LTC Ombudsman.Written notice will be given to Resident/Responsible Party for all planned discharges and transfers. Unless waived by the Resident/Responsible Party, thirty (30) days written notice will be given for discharge and transfers planned.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Health & Rehabilitation

1600 Muchison Rd El Paso, TX 79902

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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

infection control issue. ADON F stated it was the nurse's responsibility to ensure it was hooked on the bed.

During an interview on 09/04/25 at 10:53 AM with NP I, she stated the catheter bags should not be on the floor as it was an infection control issue. NP I stated it was the nurses responsibility to ensure they were hooked onto the bed or wheelchair appropriately and not on the floor. During an interview on 09/05/25 at 9:51 AM with the DON, she stated the catheter bags were not meant to be on the floor and could be a risk of infection. The DON stated it was everyone's responsibly to ensure the catheter bags were placed on the bed or wheelchair correctly.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Health & Rehabilitation

1600 Muchison Rd El Paso, TX 79902

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 0740 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

on-call of having that resource as to assist in keeping the resident safe. During an interview on 09/05/25 at 8:21 AM with the NP, he stated the facility called him on 08/09/25 and informed him Resident #1 was being aggressive and impulsive as he was confused. The NP stated he already placed an order for psychiatric referral upon admission to the facility. The NP stated the facility sent Resident #1 out to the hospital on [DATE REDACTED], and then later was cleared to go back to the facility. The NP stated he was trying to figure out what was happening at the facility with Resident #1, but could not figure it out. The NP stated Resident #1 would have benefited from using the MH if the facility would have used the on-call. The NP stated using the MH could have helped Resident #1 with psych medication management and other services related to mental health regarding his behavioral issues as interventions. During an interview on 09/05/25 at 1:35 PM with

the DON, she stated Resident #1 was at the facility for therapy as he was involved in an accident before being admitted to the facility. The DON stated during her admission process she found Resident #1 to be appropriate for the facility. The DON stated the only behaviors she noted from the hospital was refusing hospital food. The DON stated based on the admission on [DATE REDACTED] Resident #1 was not showing any signs of behaviors until the early morning on 08/09/25. The DON stated Resident #1 was being physically aggressive by spitting at staff and trying to hit them as well as screaming for his kids. The DON stated they were re-directing the resident and also why he was sent out to the hospital. The DON stated Resident #1 was sent to the hospital for the aggressive behaviors and then the hospital sent him right back the same day on 08/09/25. The DON stated after the behavioral issues they deemed Resident #1 as unsafe to be at

the facility and it was in the best interest for Resident #1 to discharge from the facility. Record review of the facility's, undated, Behavior Management Policy revealed, Policy- Behavior management includes the management of anger, confusion, hallucinations, and other behavior by utilizing techniques such as area limitations, self-responsibility, group interactions, limit setting, and behavior modifications depending on individual needs. Behavior changes can be attributed to dementia disorders or psychological conflicts resulting from loss of control over the body, environment, and unmet needs. This may include combativeness, arguing, agitation, and aggressiveness.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/05/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Mountain View Health & Rehabilitation

1600 Muchison Rd El Paso, TX 79902

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 - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

and local health agencies as per protocol.Record review of the facility's, undated, Fundamentals of Infection Control Precautions revealed, Resident Placement - Appropriate resident placement was a significant component of isolation precautions. A private room with appropriate air handling and ventilation was particularly important for reducing the risk of transmission of microorganisms from a source resident to susceptible residents and other persons in hospitals when the microorganism was spread by airborne transmission. Record review of the facility's Infection Control Plan: Overview Policy, dated 10/2022, revealed, Infection Control - The facility will establish and maintain an Infection Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection.Investigates, controls, and prevents infections in the facility. Decides what procedures, such as isolation, should be applied to an individual resident, and maintains a record of incidents and corrective actions related to infections. Preventing Spread of Infection - When the Infection Control Program determines that a resident needs isolation to prevent the spread of infection, the facility will isolate the resident. The facility will prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease. The facility will require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice. The facility will require staff to Donn (put on or wear an item of clothing) and Doff (process of removing) PPE (Personal Protective Equipment) before and after contact with resident who needs isolation to prevent the spread of infection to others in the facility.

Event ID:

Facility ID:

If continuation sheet