Health inspection·January 27, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm the staff would cut her nails at times. She said she did not know when the staff had cut her nails last. She said she wanted her nails cut. Observation on 01/26/23 at 08:53 AM revealed Resident # 7 still had long nails. They did not appear to be shorter. Residents Affected - Few In an interview with DON on 01/26/23 at 4:20 PM, she said it was important to cut Resident # 7's nails because it could reopen the residents' callus on her palm. She said it could cause an infection and could cut her. She said it was not correct to have Resident # 7's nails be long. She said Resident # 7's nails were long and they should have been cut. She said the nails appeared to be 2cm long. Observation and interview with CNA Supervisor I on 01/26/23 at 4:43 PM, revealed she was cutting Resident #7's nails. She said she was cutting them because Resident #7 had been eating Cheetos and they had gotten dirty. She said they were longer than they should be, but that Resident #7 sometimes liked her nails longer. In an interview with CNA G on 01/27/23 11:10 AM, she said the reason it was important to cut a residents' nails was to ensure they did not scratch themselves on the skin. She said she had no cut Resident #7's nails in the past. In an interview with CNA H on 01/27/23 at 11:29 AM, she said she had not cut Resident # 7's nails because she had told her supervisor to cut them. She said there were times where she was scared of cutting the residents' nails because she did not want to hurt them, therefore she would not cut them. She said Resident # 7 had refused to have her nails cut in the past. She said Resident #7 would wear the carrot cushion to help with her contracture, but there were times she would refuse to wear it. Review of facility policy titled NAIL CARE POLICY AND PROCEDURE undated read in part .Policy: to prevent irritation, to prevent break in skin integrity, to promote cleanliness .care of fingernails and toenails is part of the bath, be certain nails are clean, if nails are difficult to cut, inform the charge nurse, nails are to be clipped and filed smoothly, residents who refuse nail care should be reported to the nurse . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 2 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for 1 (Resident # 28) of 8 residents reviewed for medication administration in that: -CMA E prepared medication without following medication order. -CMA E left prepared medication on Resident #28's bedside after administration. This deficient practice could cause a decline in health of residents due to incorrect medication preparation and administration. Findings included: Review of Resident #28's Face sheet dated 1/27/2023 showed a [AGE] year-old female with an admission date of 10/17/2017. It showed diagnosis of dementia and paraplegia (paralysis). Review of History and Physical dated 11/7/2022 showed Resident #28 had medication orders for Miralax which is used for constipation. Review of Physician orders for 9/20/2022 showed Miralax Powder 17GM/SCOOP Give 17 gram by mouth in the morning for constipation. Mix with 4-8ounces of water or beverage of choice. Review of Care Plan dated 04/27/2022 showed Resident #28 was at risk for constipation related to decreased mobility & medication side effects. Goal was for Resident #28 to have normal bowel movements through interventions such as administering medication as ordered. Review of Quarterly MDS assessment dated [DATE] showed a BIMS score of 15 , meaning the resident was cognitively intact and was able to answer questions and make decisions. Observations on 01/25/23 at 09:02 AM revealed CMA E was preparing Miralax medication for Resident #28. CMA E took scoop filled with Miralax powder and poured it inside cup. CMA E then took pitcher of water and poured water into the cup without measuring amount of water. Cup was observed to be filled 3/4 full of an 9oz cup. CMA E then proceeded to administer medications to Resident # 28. Resident #28 drank some of the Miralax mixture but did not finish it. CMA E then left the remaining medication on the bedside table and walked out of the room. In an interview with CMA E on 01/25/23 09:08 AM, she said the order for Miralax stated for 4-8oz of water to be mixed with the powder. She said she did not measure the water because that is how she would normally do it. She said the amount that she poured of water was about a cup. She said she left the leftover Miralax in the room and said she was not supposed to leave the medication in the room without it being administered. She said the risks of doing so were that another resident could go into the room and take it, or the resident could accidently spill it. In an interview with LVN F on 01/25/23 at 11:21 AM, she said the water measurement for Miralax (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 3 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few should have been what the order stated. She said there are measuring cups that are used to measure liquid for medications. She said the importance of doing so was to follow the physician order to ensure that it was given correctly. Observation of measuring cups revealed cup had marks in ounces. Cups were available on the medication cart. In an interview with DON on 01/25/23 at 12:32 PM, she said the nursing staff had measuring cups that they were able to use to measure liquids. She said the cups should have been used to measure 6-8oz of water for the Miralax. She said CMA E should have measured the water instead of pouring it without measuring. She said it was important to follow orders because then too much or too little could be given if not measured correctly. She also stated CMA E should have not left the remaining Miralax on the bedside table because CMA E should have stayed to ensure the resident completed the dose. She said the staff had been trained in administering medication during their yearly competencies and in-services but could not provide a specific date. Review of facility policy titled MEDICATION ADMINISTRATION POLICY AND PROCEDURE undated read in part .The individual administering a medication shall verify the medication selected for administration is the correct medication based on the medication order .No medication shall be left at the resident's bedside . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 4 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. 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 obtain laboratory services to meet the needs of its residents for 1 (Resident #20) of 8 residents reviewed for laboratory services. The facility is responsible for the quality and timeliness of the services in that: Residents Affected - Few The facility did not follow up on Resident #20 STAT lab orders on 01/06/23. This failure could affect residents by placing them at risk for delay in identifying or diagnosing a problem, adjusting medications, and ensuring treatments needs were identified and addressed. Findings include: Record review of Resident #20 face sheet dated 01/26/23 revealed a [AGE] year-old female was re-admitted to the facility on [DATE]. Record review of Resident #20 physician order dated 01/26/23 revealed STAT CBC and BMP. Record review of daily lab and diagnostic monitoring log dated 01/06/23 revealed Resident #20's CBC and BMP lab results were received on 01/06/23. It was initialed by Unit Manager. Record review of Resident #20's local hospital lab results dated 01/06/23 revealed message left at facility 05:17 PM on 01/06/23. Top left corner reveals report was printed on 01/07/23 and location was at facility. Interview on 01/26/23 at 9:14 AM LVN J stated she saw Resident #20's STAT CBC and BMP lab results on 01/07/23 after breakfast at approximately 9 AM. LVN J stated she saw the lab results the on fax machine. LVN J stated it was routine for her to check fax machine daily for any new orders, lab and diagnostic results, and any other documents. LVN J stated at the time she was not aware Resident #20n had pending lab results. LVN J stated when she reviewed Resident #20 lab results, she immediately called NP to notify of critical potassium lab results. LVN J stated she then received orders to send Resident #20 to local hospital. LVN J stated during shift change report the morning on 01/07/23 she had not received report of pending lab results for Resident #20. Interview on 01/26/23 at 10:49 AM Unit Manager stated she had received STAT CBC and BMP orders for Resident #20 on 01/06/23. Unit Manager stated she received the orders, obtained blood work for lab, and sent lab work to local hospital across the street. Unit Manager stated it was around 2-3 PM when lab work was taken to hospital to process. Unit Manager stated for STAT lab orders lab results were usually ready within the hour. Unit Manager stated she called the local hospital laboratory around 5 or 6 PM, could not recall the time, and stated she was told that the laboratory system was down, and they had a lot of labs pending. Unit Manager stated she did not remember who she spoke to and failed to document her attempt on getting results on the 24-hour report. Unit Manager stated she had been trained to follow up on STAT orders within a reasonable time frame, 2 hours after labs obtained, and before shift ended. Unit Manager stated she had been trained to report to DON and NP/MD if she had trouble obtaining STAT lab orders results. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 5 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0770 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 01/26/23 at 11:51 AM DON stated nursing staff had been trained to follow up on STAT lab orders within an hour and before end of shift upon hire and as needed. DON stated if by end of shift they still need not have results they were to report to oncoming nurse to continue monitoring and follow up with laboratory. DON stated they had been trained to report to herself and NP/MD if they had issues with retrieving STAT lab order results. DON stated by not following up could essentially delay care and treatment for residents if there was any abnormal findings. DON stated she had not been notified of critical lab results or delay in pending lab results. Interview on 01/26/23 at 2:49 PM Director of Lab Services stated when STAT lab work was received from nursing facility, they had to register the lab work first then they would run the lab. Director of Lab Services stated for STAT lab work the laboratory would usually have results ready in an hour at the most. Director of Lab Services referred to her electronic records and stated Resident #20 STAT CBC and BMP results were completed and available on 01/06/23 and the laboratory had called the facility to report critical high potassium (7.8 therapeutic level 3.5-5.1) levels at 5:17 PM. Director of Lab Services stated there was a note on Resident #20 lab results that stated the facility did not answer and a voicemail was left. Director of Lab Services stated there had not been a call back from the facility for the evening of 01/06/23 and essentially faxed Resident #20 CBC and BMP lab results to facility the morning of 01/07/23. Director of Lab Services stated Resident #20 lab results were available for the facility as of 01/06/23 at 5:17 PM and had they called they would have been able to provide results. Director of Lab Services stated there was no documentation of the facility calling for results and denied the laboratory having issues with their system being down. Review of Lab/Diagnostic Monitoring Log policy undated revealed to ensure all labs and diagnostics are completed and followed up on for all residents as ordered by the physician. 1. Labs and diagnostics are entered on the log form each day (routine, STAT, and PRN). 3. Labs and diagnostics are to be reviewed at the shift change during report to ensure that all nursing staff is aware of pending labs or diagnostics. 4. If labs/diagnostics results are not received in a timely fashion it is the nurses responsibility to contact the lab or diagnostic center as to why. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 6 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to meet the nutritional needs of residents in accordance with established national guidelines for 1 (Resident #43) of 8 residents reviewed for therapeutic diets. Resident #43 received cheesecake on for lunch on 01/25/23, NCS diet was not followed. This deficient practice could place residents who consume food prepared by the facility kitchen at risk of having their nutritional needs unmet. Findings include: Record review of Resident #43 face sheet dated 01/27/23 revealed a [AGE] year-old female admitted on [DATE]. Record review of Resident #43 history and physical dated 12/29/22 revealed a diagnoses of diabetes mellitus type two (chronic condition that affects the way the body processes blood sugar). Record review of Resident #43 physician order dated 12/29/22 revealed NAS/ NCS diet. Record review of Resident #43 meal ticket dated 01/25/23 revealed NCS/ NAS/ Mechanical soft Interview on 01/24/23 at 02:13 PM Resident #43 was in wheelchair had just finished eating her lunch, she was alert and oriented to person, place, time, and event. Resident #43 stated she was on a diabetic diet due to her type two diabetes mellitus. Resident #43 stated she often gets foods she is not supposed to eat like cake and cheesecake. Resident #43 stated she had reported this concern with few nurses but could not remember their names. Observation and interview on 01/25/23 at 12:31 PM Resident #43 was in her room with lunch tray in front of her. Resident #43 consisted of spaghetti with meatball, vegetables, and cheesecake. Meal ticket dated 01/25/23 noted NAS/ NCS diet at the top. Interview on 01/25/23 at 12:43 PM Dietary Director stated diabetics were on a NCS diet, which meant no concentrated sweets. Dietary Director stated residents who were on a NAS diet typically would receive non sweetened desserts or fruits to replace the dessert provided. Dietary Director stated the cheesecake served for lunch was not a non-sweetened cheesecake therefore diabetic resident should had received fruit instead. Dietary Director stated meal ticket was checked at the moment plate was served by kitchen staff, then nurse checks meal ticket and meal prior to serving the plate to ensure proper diets and consistency was followed and was last checked by the staff who delivered the meal to the resident. Dietary Director stated by not following the resident's diet, in this case diabetic diet, could results in increase of blood sugars. Record review of Diet Orders policy undated revealed when there is a nutritional indication, the facility will provide a therapeutic diet that is individualized to meet the clinical needs and desires (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 7 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0803 Level of Harm - Minimal harm or potential for actual harm of the resident to achieve outcomes/ goals of care. 1- Diets will be offered as ordered by the physician. A therapeutic diet is a diet intervention ordered by a health care practitioner as part of the treatment for a disease or clinical condition manifesting an altered nutritional status, to eliminate, decrease, or increase certain substances in the diet. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 8 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on the observations, interviews, and record reviews, the facility failed to provide food that was palatable, attractive, and at a safe and appetizing temperature for residents who consume foods orally from 1 of 1 kitchen. Residents Affected - Some 1. Little milk bottles/ desserts were outside of fridge and not placed in an appropriate cooling temperature. 2. Food during mealtime (Lunch) and test trays were served lukewarm and not at temperature. 3. Resident #35 and Resident #16 complained that the food was coming to them cold. This failure could result in reduced consumption of food intake, weight loss, and food-borne illnesses. Findings include: Observation on 01/24/2023 at 11:28 a.m., in the facility kitchen 8 oz bottles of [NAME] whole vitamin milk were placed into a mediums sized plastic see through container in which all the bottles did not fit. Half of the milk products were submerged into the container with ice while the other half where on top and did not have ice to keep them cool. Two red trays each carrying 19 fruit cups and five other trays carrying drinks of all kinds were not kept cool with either ice or cool by some other form. The fruit cups are seen to have condensation as there lids are see through. Observation on 01/25/2023 at 11:30 p.m., the kitchen was serving spaghetti, mixed veggies, bread roll, and cheesecake. Cooks (Two unidentified cooks) were on one side placing the food onto the plate and would pass it over to the other side of dietary staff. These dietary staff (Two unidentified dietary staff were putting the tray together. At 11:55 a.m., the trays on the side where they were putting them together started to back up. Plates were covered with a top cover. The two unidentified cooks kept placing the food on the plates and sat on the line waiting to be transfer over to the other side of the line. One unidentified dietary staff on the side of putting tray together looked confused and the other unidentified dietary staff just stood there waiting on the other unidentified dietary staff. There was a tray cart with trays waiting on the rest of the trays to be taken to whatever location they were going to go to. At 12:04 p.m., all the trays were finally in the tray cart and barely being taken to their location. At 12:05 p.m., the next cart tray was being filled up and left for Hall 200 at 12:12 p.m. (Dietary Staff were heard saying that they would not eat the food that they were going to give to the surveyors). Interview on 01/24/23 03:19 p.m., Resident #35 stated the food was okay and that sometimes the food is cold. Resident # 35 stated she did not like to eat cold eggs. Resident # 35 stated, Who would want to eat cold eggs? (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 9 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 01/24/2023 at 2:44 p.m., Resident # 16 stated she did not like the food. Resident # 16 stated there were times where the food had no flavor and was not good. Resident # 16 stated the food was terrible. Interview on 01/24/2023 at 1:00 p.m., Dietary A stated that all staff are trained on labeling and temperatures. Dietary A stated dietary staff are trained by going through the food handler's course. Dietary A stated the risk to the residents would be the food spoiling and the resident could get sick if not kept at the right temperature. Interview on 01/25/2023 at 12:30 p.m., Dietary A was in conference room with surveyors taking temperatures (with a temperature gun) of food from food tray. Dietary A stated the temperature of the veggies and spaghetti was 106 degrees. Dietary A stated the temp of the cheesecake was at 55 degrees. Dietary A stated the puree was at 111 and 116.6 degrees. Dietary A stated the bread puree was at 85 degrees. Dietary A stated the appropriate temperature when serving to resident was at 165 and the desserts were at 52 degrees. Dietary A stated the temperature had changed from the test trays since they had been sitting on the line. Dietary A stated she remember the conversation of trays sitting on the line for a long time. Dietary A stated that trays sitting on the line and then being placed into the cart and still going to the hall; the temperature would have changed. Dietary A stated the risk to the resident was that it could get the residents sick by not giving them the meal at the appropriate temperature. Interview on 01/25/2023 at 8:40 a.m., Dietitian D stated she shows the dietary staff how to stir and take temperatures. Dietitian D stated she showed the dietary staff how to put foods in the ice baths. Record review on 01/25/2023 at 4:10 p.m., was reviewed for all dietary staff and noted that dietary staff take the American Safety Council Course (Texas Online Food Handlers Program) and receive a Certificate of Completion indicating they have been trained on the requirements of working with food (This entails labeling, temperatures, foodborne illness prevention, etc.). Record review on 01/25/2023 at 4:15 p.m., of undated facility Food Safety and Sanitation Policy and Procedure stated foods are refrigerated and stored at or below 41 degrees F. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 10 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, the facility failed to ensure food was prepared in a form designed to meet individual needs for 1 of 1 meal (lunch) reviewed for residents with a diet order for pureed texture for provision of food in a form designed to meet individual needs. Dietary [NAME] C failed by not following the established facility recipes when preparing pureed food to feed nine residents that had orders for Pureed Diets. This failure could place residents who received pureed diets at-risk of inadequate nutrition and weight loss. Findings include: Observation on 01/25/2023 at 2:49 p.m., Dietary [NAME] C placed chopped up ham into a food processor (unknown how many lbs. or ounces). Grabbed a clear disposable non measuring cup and used a white tipped rubber spatula and dripped it into a small black container indicating it was ham base. Dietary [NAME] C grabbed some of the ham base with the spatula and smeared it on the cup. Dietary [NAME] C went over to the prep sink and poured water into the cup and mixed it. Dietary [NAME] C than started the food processor (ham began to be chopped up) and started to pour the liquid into the mixture. It was noted that the Dietary [NAME] C was not using the recipe Puree Ham Potato Au Gratin as it was still in the recipe book. Dietary [NAME] C kept stopping the food processor and was checking the consistency by smearing the puree across the side of the processor. Observation on 01/25/2023 at 12:01 p.m., Dietary Staff (two unidentified Cooks) were heard saying that they would not eat the food that they were going to give to the surveyors. Observation on 01/25/2023 at 11:54 a.m., Test tray of puree were tasted. Meal was in puree texture and consisted of bread, meatballs, green vegetables and cheesecake. Tasting started with meatballs which had flavor and did taste like pureed meat. The puree that was supposed to be bread did not taste like bread as it was bland and lacked flavor. The pureed vegetables did not have flavor and could not tell what vegetables they were. The cheesecake was sweet. The meatballs, bread and vegetables were warm and not hot. Observation on 01/25/2023 at 11:55 a.m., Test tray of puree was tasted. The puree foods included spaghetti noodles, meat sauces, veggies, bread, and cheesecake dessert. The cheesecake looked like tapioca and was runny. The bread was dark brown and tasted like apple juice and was thick. The meat tasted good. The noodles were light yellowish white and lacked flavor and tasted bland. The veggies were unrecognizable and were a dark greenish in color. Interview on 01/25/2023 at 2:49 p.m., Dietary [NAME] C stated the amount of ham that was used in the food processor was for 9 residents who required puree. Dietary [NAME] C stated that he was using the base mixed with the water for the puree mixture. Dietary [NAME] C stated that the puree ham still needed to be mixed with the mashed potatoes to make the 9 servings. Dietary [NAME] C stated he did not know how much base to water ratio was to be used in the liquid mix. Dietary [NAME] C stated he did not know how much of the ham base mixture was to be poured into the ham that was in the food processor. Dietary [NAME] C stated that he just stops the machine and checks the consistency of the puree and sometimes he tastes the puree which tell him that it is ready. Dietary [NAME] C stated he had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 11 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not been trained at the facility on pureeing foods. Dietary [NAME] C stated that he knew how to puree foods from a previous facility he used to work at. Interview on 01/25/2023 at 3:14 p.m., Dietary A stated that all dietary staff receive training on pureeing (Dietary A was able to process the in-service and or other documentation indicating staff have been trained on puree by the kitchen). Dietary A stated the morning dietary cook trains the other dietary staff. Dietary A stated the Speech Therapist trained the dietary staff on how the puree foods are supposed to stay on the fork and how the texture is supposed to be (Therapist training in-services were provided). Interview on 01/25/2023 at 8:40 a.m., Dietitian D stated dietary staff know what the consistency of puree foods was like. Dietitian D stated puree texture should be pudding like. Dietitian D stated she goes through the trays and sees that the pureed foods are correct. Dietitian D stated that the Dietary Manager was new, and she would get with the company that makes the receipts. Dietitian D stated that all the training the dietary staff have been getting was vocal and they had no in-services or any way to show that they have been trained on pureeing. Dietitian D stated she would provide an in-service to the dietary staff with training on proper amounts with pureeing. Dietitian D stated the risk to the residents was that they would not be getting the nutritional value and safety. Dietitian D stated they did not have a receipt procedure policy. Interview on 01/25/2023 at 312 p.m., Dietitian D stated she was going over the recipe and was given by corporate that the National Dysphasia Diet information. Dietitian D stated this information stated that there were no set guidelines. Dietitian stated when they are pureeing food that they were supposed to pour one or two tablespoons at a time into the puree mixture to see if the liquid consistency is coming out. Dietitian D stated she was going to start with in-service the dietary staff. Dietitian D stated Dietary Manager could provide those in-services. Dietitian D stated that Dietary [NAME] C had not had orientation as of yet. Dietitian D stated Dietary [NAME] C had had training in another facility. Record review dated 11/03/2022 of facility Recipe of Puree Ham Potato Au Gratin stated servicing size for one resident was six ounces. On recipe yields there was no 9 servings for residents. There were 10 services that indicated to use 3 ¾ lbs. of ham and potatoes. Instructions states the fluid amount listed in the recipe is also an estimate that is based on industry standards. To get the actual servicing size, puree the number of portions needed, adding adequate liquid needed to achieve desired consistency as appropriate for resident, then divide the total amount equally by the number of portions pureed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 12 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on the observations, interviews, and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for residents. 1. Food products in dry storage and in refrigerator were not correctly labeled, wrapped, or were expired. 2. Dietary Staff B was not wearing her hair net when entering the kitchen. This failure could affect residents by placing them at risk of food borne illness. Findings include: Observation on 01/24/2023 at 12:55 p.m., in kitchen there was a five bags of Rotella's Italian sandwich bread that did not have any dates on them on a shelve located near the walk-in (Fridge). On the same shelve on the third rung there was a red box Iodized salt (4lbs) that was left open. The dry storage on a shelve on the left side of the hall next to the wall seconded rung had a bag of Lemon Cake Mix (5lbs) that was in a zip lock bag with no label(s) and date, behind it was a bag of bread pudding mix in a zip lock bag that also was not labeled or dated, on the bottom rung was a bag of white frosting mix (4.5lbs) that was in a zip lock bag but was not completed closed. A bag of white cake mix (5lbs) and a Blueberry Muffin Mix (5lbs) were in a zip lock with no labels or dates, 2 lbs. bag of Corn flakes was not labeled/dated and not closed properly, ham burger bread on the shelve located near the walk-in was not labeled. In the walk-in on a shelve was a box was piece of trash and an empty bottle of creamer and a mustard bottle with on its side with its lid open. On the shelve was three packets of fresh strawberries (1lb) that was not labeled/dated. Approximately six bags had flour tortillas that were not labeled/dated. On the bottom rung on the shelve there was deli meat (turkey 2lbs) that was not labeled/dated. On the top shelve was a bag of shredded carrots in a zip lock that was not closed and looked wet with moisture in the bag. On the other side of the shelves was a long pan with possibly puddling that was not covered/labeled/and dated. A white medium sized bucket containing patties sitting on the second rung was not properly covered (Film was not attached to the bucket making a proper seal). In the freezer a bag of chocolate chips was in a zip lock bag that was not dated/labeled. A the door on the fridge on the shelves had nuggets in a package, sausages patties in a clear package, chicken strips in a clear package, and two packets of turkey patties that were all not labeled and dated. In the back prep area there was a huge metal bowl that was holding mini churros that were not labeled/covered. In the fridge there was a (5lb) Parmesan Cheese bag that was wrapped in film but not labeled. A bag of slices of cheddar cheese in a zip lock that was not dated or labeled. The fridge also contained a 25 Fl oz box of Apple Concentrate that was left open. Interview on 01/24/2023 at 1:00 p.m., Dietary A stated that all staff are trained on labeling and temperatures. Dietary A stated dietary staff are trained by going through the food handler's course. (Dietary A walked with surveyor going through the items). Dietary A stated the risk to the residents of not labeling, covering foods, making sure containers are closed properly were that germs could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 13 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some get in the items and cause infections. Dietary A stated she did not realize that pests could get into the open containers. Record review on 01/25/2023 at 4:10 p.m., was reviewed for all dietary staff and noted that dietary staff take the American Safety Council Course (Texas Online Food Handlers Program) and receive a Certificate of Completion indicating they have been trained on the requirements of working with food (This entails labeling, temperatures, foodborne illness prevention, etc.). Record review on 01/25/2023 at 4:15 p.m., undated facility Food Safety and Sanitation Policy and Producers Page 2, states food storage line 1. Food that is stored is protected from contamination and growth of any pathogenic organism. Line 5. Foods are protected from contamination (dust, flies, rodents, and other vermin). Line 9. All times and temperature control for safety (TCS) leftovers are labeled, covered, and dated when stored. Note: Servsafe guidelines allows 7 days for food safety with the day of preparation counted as day 1 of the 7 days, and then food is discarded. Check your local and state regulations and determine which guideline your facility will follow. Observation on 01/25/2023 at 2:40 p.m., Dietary B entered the kitchen through the side hallway linking the kitchen to the hallway with no hair net on. Administrator was by the connecting door of the hallway and kitchen and was seen talking to Dietary B as she was entering and existing the kitchen. Dietary B was seen not having her hairnet on when entering the kitchen. On the door linking the two rooms on the middle right on the wall was hanging a box with hairnets stating to grab a hairnet before entering the kitchen. Interview on 01/25/2023 at 2:45 p.m., Administrator stated he saw Dietary B enter the kitchen without a hairnet. Administrator stated he did remind Dietary B that she was supposed to be wearing a hairnet upon entering the kitchen. Administrator stated that the facility does have a policy on wearing hairnets and protocols for what to wear when entering the kitchen. Administrator stated the risk to the residents of staff of not wearing a hairnet was a of infection. Interview on 01/25/2023 at 2:30 p.m., Dietary A stated dietary staff are trained on polices and producers such as putting on hair nets, washing hands, labeling, temperatures, and so far. Dietary A stated anyone coming into the kitchen had to have a hairnet on. Record review on 01/25/2023 at 4:15 p.m., undated facility Food Safety and Sanitation Policy and Producers Page 1, states all local, state, and federal standards and regulations are followed to assure a safe and sanitary food service department. Procedure line 4, states hair restraints are required and should cover all hair on the head. Record review on 01/26/2023 at 1:00 p.m., undated page 2 facility Prevention Foodborne illness Employee Hygiene and Sanitation Policy and Procedure stated on line 12. Hair nets or caps and/or beard restraints must be worn to keep hair from contacting exposed food, clean equipment, utensils and linens. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 14 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on the observations, interviews, and record reviews the facility failed to dispose of garbage and refuse properly for 1 of 1 dumpster/compacter reviewed for food safety requirements. Residents Affected - Few 1. One dumpster/compacter in the parking lot had trash on the floor outside and around the dumpster. This failure could affect residents by placing them at risk of food borne illness, illnesses, rodents or be provided a unsafe, unsanitary and uncomfortable environment. Findings include: Observation on 01/24/2023 at 12:56 p.m., facility had a sign posted where vehicles parked in the facility that states to not feed the cats. A fat gray cat was seen walking around on the grass near one of the vehicles on the facility property. Observation on 01/25/2023 at 11:11 a.m., the dumpster left side door was left open. Disposable used gloves were on the floor near a black hose that was connected to the dumpster (Trash compacter/dumpster), a straw underneath a blue folded up piece paper next to the dumpster, two feet further back was a white kitchen recipe in a clear paper protector, further back half a foot near the pole was an N95 masks towards the back of the dumpster near a blue piece of paper, in between the mask and recipe was some white cardboard box wrapper, towards the back of the dumpster fence area 2 by 4s were missing. On the ground in the same area there where three two by four approximately five feet in length by four inches across leaning on the curve and pole with a white cardboard wrapping on top. A piece of brown cardboard lays underneath the two by four furthers to the left. [NAME] straw lays underneath a black hose with a red gallon rip off seal. Behind the dumpster is varies white pieces trash plastic in nature, On the other side of the dumpster lays another used glove near the dumpster and pieces of plastic, Underneath the dumpster lays a Styrofoam cup and piece of white cardboard box ties. On the other side of the wooden fence lays twelve two by fours on the ground with an 8 oz bottle of empty juice, a foot further up is a grayish plastic box and in it is two spray bottles that are unknown. There was a tire underneath one of the two by fours next to a white trash bag, there are long white strings of cardboard ties, underneath the tire was a camo shoe, to the side of the tire next to a Conex was a milk crate. In front of the Conex was several broken wooden pallets with white cardboard ties mixed between them, to the right side of the end of the pallets next to the fence was an open cardboard box lying on the ground. On the side of the Conex and in between the Conex and fence was five two by fours on the ground, gray plastic bag wrapped around two two by fours, in the middle of the Conex was a Styrofoam cup and a Styrofoam bowl with more trash mixed and a green soda can lay across for it. There was more trash towards the back of the Conex but was unable to identify. Observation 01/26/2023 at 2:00 p.m., most of the same trash was still laying on the floor minus the gloves and straws. The Dietary A walked around the dumpster/compacter and she picked up some of the trash and saw the other trash laying around the dumpster and area. Interview on 01/25/2023 at 2:00 p.m., Dietary A stated she did not know if the dumpster doors need to be closed. Dietary A stated she did not know if there was a policy or procedure regarding the dumpster and trash. Dietary A stated the risk to residents was that they could get sick if they grabbed any of the trash. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 15 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0814 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 01/27/2023 at 8:19 a.m., Administrator who reviewed facility trash photos stated the kind of trash seen on the photos that were outside would not attract pests. Administrator stated they did have a sign posted outside not to feed the cats. Administrator stated the sign was so that the feeding would stop to not attract pests. Administrator stated he was not concerned that a resident would ingest a bucket or spray can. Administrator stated they do not have residents who wonder outside. Administrator stated the administrator over sees that the pest control policy and procedure is being followed. Record review of an undated page 1, facility Pest Control Policy and Procedure states on Procedure line 3. Garage and trash are not permitted to accumulate and are removed from the facility daily. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 16 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain clinical records that were accurately documented for 2 (Resident #7, Resident #20) of 8 residents reviewed for clinical records in that: -Resident #7's task record inaccurately showed that her nails had been trimmed for the dates of 01/23/23 and 01/25/23. -January 2023 laboratory log record inaccurately showed Resident #20's STAT lab results were received on 01/06/23. -Resident #20's progress daily notes did not have documentation on follow up attempts for lab orders or that it had been reported to next shift nurse. This deficient practice could cause a decline in health in residents by staff not addressing task areas if they are annotated as completed on their medical record. Findings included: Review of Resident #7 Face sheet dated 01/26/2023 showed an [AGE] year-old female with an admission date of 04/17/2020. She had a diagnosis of dementia and hemiplegia (paralysis) affecting the left side of the body. Review of History and Physical dated 11/16/2022 showed Resident #7 had general muscle weakness. Review of Physician Progress notes dated 07/25/2022 showed Resident #7 had been evaluated for a lesion on her left palm due to a contracture to her left hand. Note stated for Resident #7 to use carrot (device) to help with contracture and keep nails trimmed to prevent further damage. Review of Resident #7's Quarterly MDS assessment dated [DATE] showed Resident #7 had a BIMS score of 11 (moderate cognitive impairment). It showed that she required one person assistance with personal hygiene. Review of care plan dated 10/13/2022 showed Resident #7 had an ADL deficit due to weakness. It showed a goal of maintaining level of function through interventions such as requiring assistance from one staff member for bathing activities. Review of ADL bathing task record for the dates of 12/28/2022 through 1/25/2023 showed Resident #7 had activity done every other day. Observation on 01/25/23 at 09:00 AM revealed Resident #7 had long nails. They appeared to be long and dirty. In an interview with Resident #7 on 01/25/23 at 09:03 AM, she said the staff would cut her nails at times but could not remember the last time they had. Observation on 01/26/23 at 08:53 AM revealed Resident # 7 still had long nails. They were not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 17 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0842 shorter. Level of Harm - Minimal harm or potential for actual harm In an interview with CNA G on 01/27/23 at 11:10 AM, she said she had been trained on documenting if a resident is bathed, or if their nails are trimmed. She said if she cut a resident's nails, bathed a resident, or did an activity for the resident, she had to document it on their task record. She said it was to only be documented when a task was done. Residents Affected - Some In an interview with DON on 01/27/23 at 11:27 AM, she said the staff were expected to document accurately. She said some risks of not doing so could be that the staff would think the task has been completed as seen on the task record when it had not been. She said the oncoming staff member would then not complete the task. She said the staff had been trained on accurate documentation during their competencies. In an interview with CNA H on 01/27/23 at 11:29 AM, she said she had not cut Resident # 7's nails because she had told her supervisor to cut them. She said Resident # 7 had refused to have her nails cut in the past but did not document she had refused. She said she documented on the task record as completed because she thought her supervisor was going to cut Resident #7's nails. She said when a resident refused any care, the staff should document it as refusal. She said she had been trained on accurate documentation before when she incorrectly documented on another resident. Record review of Resident #20 face sheet dated 01/26/23 revealed a [AGE] year-old female was re-admitted to the facility on [DATE]. Record review of Resident #20 physician order dated 01/26/23 revealed STAT CBC and BMP. Record review of daily lab and diagnostic monitoring log dated 01/06/23 revealed Resident #20's CBC and BMP lab results were received on 01/06/23. It was initialed by Unit Manager. Record review of Resident #20's local hospital lab results dated 01/06/23 revealed message left at facility 05:17 PM on 01/06/23. Top left corner reveals report was printed on 01/07/23 and location was at facility. Interview on 01/26/23 at 10:49 AM Unit Manager stated she was in charge of monitoring labs and diagnostic orders and results. Unit Manager stated she had received STAT lab orders for Resident #20 on 01/06/23. Unit Manager stated she had called the laboratory for update at the end of her shift around 5 or 6 PM, could not recall the time. Unit Manager stated she had reported to the next shift nurse of pending lab results but could not remember the nurse she reported to. Unit Manager stated she did not document the call made to laboratory to obtain Resident #20 STAT lab results and did not document who reported the pending lab results to. Unit Manager stated she should have documented the attempt to get lab results and what nurse she had reported to of pending lab results. Unit Manager stated facility had trained her to document on 24-hour daily report of any new orders given, pending lab results or changes in condition. Unit Manager did not have answer for not documenting either concern. Interview on 01/26/23 at 11:30 AM DON stated the facility used a daily lab and diagnostic log (tool used by facility) to keep track of when new labs are ordered, obtained and received. DON stated Unit Manager was the one in charge of checking the lab lag daily. Observation and interview on 01/26/23 at 11:43 AM Unit Manger showed surveyor daily lab and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 18 of 19 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 455351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legacy Nursing and Rehabilitation 2817 Kent Street Bryan, TX 77802 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some diagnostic monitoring log for 01/06/23 and stated she signed Resident #20's STAT CBC and BMP were received on 01/06/23. Unit Manager stated the initials were hers. Unit Manager stated the daily lab and diagnostic monitoring log related to Resident #20 was inaccurate due to labs being available on 01/07/23. Unit Manger stated she was used to receiving STAT labs within a few hours that she had signed prior to actually receiving the lab results for Resident #20. Unit Manager stated she had been trained to sign off on labs received only after actually receiving the lab results. Observation and interview on 01/26/23 at 11:45 AM DON stated that the daily lab and diagnostic monitoring lab dated 01/06/23 related to Resident #20 was initialed it was received on 01/06/23. DON stated this was inaccurate. DON stated staff had been trained to sign/initial on labs received only after they actually received laboratory and diagnostic results. DON stated by signing that the results had been received could affect the monitoring on pending STAT orders. Review of facility policy titled MEDICAL RECORD DOCUMENTATION GUIDELINES undated read in part .Make entries as soon as possible after observation is made. Never make an entry in advance. Our primary intent and obligation is to enter records accurately and completely .documentation must reflect who performed the action .document only factual information . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455351 If continuation sheet Page 19 of 19