Health inspection·December 1, 2023

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents had the right to be free misappropriation of resident property for 1 of 8 residents (Resident #57) reviewed for drug diversion. Residents Affected - Few The facility failed to prevent an employee with access to controlled medications from diverting an unknown number of Tylenol #3 tablets (a Schedule III narcotic drug used to treat pain) tablets belonging to Resident #57 from a medication cart. This failure could place residents at risk for unrelieved pain due to his medication not being readily available. Findings included: Record review of Resident #57's Face Sheet dated 11/29/23 revealed the resident was an [AGE] year-old male admitted to the facility on [DATE] with diagnoses including vascular dementia, unspecified open wound of the right lessor toe, non-pressure chronic wound of the right foot, pressure ulcer of other site Stage 2, pain in unspecified joint, and pain unspecified. Record review of Resident #57's Physician's orders dated 11/30/23 revealed the following entries: Acetaminophen-codeine tablet 100-30 mg 1 tab every 6 hours PRN. Order start date: 12/23/22, end date: 8/23/23. Acetaminophen-codeine tablet 100-30 mg 1 tab every 6 hours PRN. Order start date: 8/24/23, end date: 11/28/23. Acetaminophen-codeine tablet 100-30 mg 1 tab every 6 hours PRN. Order start date: 11/28/23, end date: Open Ended. Record review of Resident #57's MAR dated 8/1/23-8/31/23 revealed the following entries: Acetaminophen-codeine tablet 300-30 mg; Administer 1 tab every 6 hours PRN. The MAR reflected no doses were signed as administered on 8/23/23. Acetaminophen tablet 325 mg 2 tablets every 6 hours PRN. The MAR reflected one dose was signed as administered on 8/23/23 at 8:45 PM. An observation and interview on 11/28/23 at 12:40 PM with Resident #57 revealed he was sitting up in bed, clean and well groomed. He stated his care in the facility was good and he had no complaints. Resident #57 stated he did not have any concerns about his pain medications. He stated he heard they ran out of Tylenol a few months ago and did not understand why. Resident #57 denied missing any doses of his pain medication or having any unrelieved pain. Record review of a facility Provider Investigation Report dated 8/24/23 revealed ADON K was accused by ADON D of taking medications from a medication cart. ADON K was also accused by LVN L of attempting to remove medications from another nurses' medication cart. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 2 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 A written statement by ADON D included in the report reflected: 8/23/23 Level of Harm - Minimal harm or potential for actual harm I, [ADON D], was the LVN working the floor on 2 Central today. I clocked in at 0610 (6:10AM) and came to get report from the night nurse. When I arrived on the floor, the night nurse .was gone and [ADON K] had my medication cart keys and stated she had taken over all the carts on the floor and sent the night nurse home. When I walked around the corner to get my keys from the ADON, she was in the narcotic box on my cart. I asked her what she was doing. She stated she was getting a Tylenol 3 out for [Resident #57]. After she had administered the medication to the resident, I counted the cart to take over the shift and then noticed [Resident #57's] card and count sheet were not in the count. I asked the ADON about the narcotic for [Resident #57] and why it was not on the cart anymore and she stated, He doesn't use it enough, so I am going to discontinue it and I am going to give it to [DON]. She had the narcotic medication and the count sheet in her hand and took it to her office. I then looked at the documentation Residents Affected - Few and saw that the narcotic that the [ADON K] allegedly gave to [Resident #57] was not signed off on the EMAR, but I had no sheet to verify the count. I notified the DON of the situation immediately. Later that day the ADON pulled me into her office and told me, They are looking for [Resident #57's] narcotic medication. Don't tell them l have it. I walked out of the office and immediately reported the situation to the DON. The statement was signed by ADON D and dated 8/23/23. A written statement by LVN L included in the report reflected: 8/23/23 I, [LVN L] clocked in and went to get report. [ADON K] was at the nurses' station and had the keys to the medication cart. She stated that the night nurse was sent home and she would be giving me report and counting with me. I counted with her and noticed that a narcotic card and sheet were missing from the shift from the previous day. I asked the ADON where the narcotic card and sheet were. She stated that she was going to discontinue them and give them to the DON, l advised her that was not the procedure that was to be followed. I reminded her that only the DON was to receive narcotics that were to be destroyed. I requested that she put the narcotics back on the cart. She was hesitant to do so and again I asked her to put the narcotics back on the cart for the DON to pick up. She gave me back the card and sheet to give to the DON for destruction. I gave the DON narcotic card and sheet for destruction. The statement was signed by LVN L and dated 8/23/23. A written statement by RN M included in the report reflected: 8/23/23 I, [RN M], clocked in to start my shift. When l arrived to the nurses' station, the night nurse was there. l asked her if she was ready to count the carts and she stated the ADON had counted the carts and had the keys. I then called the ADON and asked her to come count with me. She told me over the phone, 'Come get the keys'. I then walked down to the office and passed her in the hallways. She attempted to give the keys to me without counting the cart and I advised her that this is not the procedure. I then told her that she needed to count with me before I took the keys to the cart. We counted the cart and it was correct. The statement was signed by RN M and dated 8/23/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 3 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 A written statement by the DON included in the report reflected: Level of Harm - Minimal harm or potential for actual harm 8/23/23 Residents Affected - Few [Resident #57] was interviewed by DON and stated that he did receive 'one white pill' this morning from the nurse for pain. He states he usually gets 'two white pills'. Resident was unable to state if this was Tylenol 325mg or a Tylenol #3. Neither medication was signed off on the EMAR by the nurse, [ADON K], who allegedly administered this medication. The statement was signed by the DON and dated 8/23/23. No written statement from ADON K was included in the report. The Provider Investigation Report also included the following: Agency Immediate Response: Interviews conducted with off-going and in-coming staff Statements obtained from nurses Narcotic was verified and accurate with exception of narcotics missing for [Resident #57] Resident interviewed - denies pain or distress Regional nurse and HR notified Accused nurse suspended until investigation completed Nurses who worked that cart were sent for drug screening Medication administration monitoring began Safe surveys initiated - no Issues noted In-Services Initiated - Abuse/Neglect, Medication administration, Narcotic Count procedures Pharmacy consultant and director notified Medical director notified Resident's physician notified . Ombudsman notified Accused nurse terminated after Investigation Events reviewed in stand up for potential diversion discussed daily Narcotic count done daily by DON - no issues noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 4 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 Investigation Summary: Level of Harm - Minimal harm or potential for actual harm Monitoring sheets were put in place to monitor medication administration 5 days a week for 4 weeks Residents Affected - Few Narcotic count sheets audited per following schedule by DON/designee (5 times a week for 2 weeks, then 2 times a week for 2 weeks, then 1 time a week for 4 weeks) Daily monitoring of narcotic medication receipt log and delivery manifests Ongoing education of nursing staff regarding handling of narcotic medications, discontinuing unused medications, and Ongoing In servicing of nursing staff Medical director notified, ombudsman notified, family notified No negative outcomes from drug screens. No other negative outcomes from investigation. Resident does not show any signs not symptoms of distress related to incident. No other residents were involved in the incident. Resident does not have pain, nor S/S of distress He did not miss any medications, Employee [ADON K] was terminated from employment. Investigation Findings: Agency Action Post-Investigation Ombudsman, physician, RP/Resident, Medical director notified of outcome. Inservices on ANE and handling of narcotic medications, discontinuing narcotic medications were initiated. Resident does not show any signs not symptoms of distress related to incident. An interview with the ADON D on 11/28/23 at 11:32 AM revealed she had reported Resident #57's missing Tylenol #3 medication to the DON back in August. She stated she remembered coming in that morning and ADON K told her the night nurse had already gone home and she tried to hand her the keys to her medication cart. She stated she told ADON K she was not accepting the keys until they counted the cart together. She walked away to put her things away and when she returned, ADON K was in her cart. She stated ADON K told her she had just given Resident #57 Tylenol #3. ADON D stated the thought that was odd because he rarely wanted it and was usually fine with regular Tylenol. She stated they counted the cart together and the counts were correct. ADON D stated was not an ADON at that time and was working as an LVN. She initially let ADON K take the card and count sheet because, at that time, they were allowed to turn medications over to the ADONs for destruction and she thought she recalled (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 5 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the physician talking about discontinuing the medications. ADON D said she checked Resident #57 who stated he may have received the Tylenol #3 but wasn't sure because the pills looked similar, and his pain was not bad that morning. ADON D stated she spoke with ADON K and asked if she had given the medication to the DON yet. She stated ADON K told her, not yet and don't tell her I have them. ADON D stated she immediately reported the occurrence to the DON. She stated the DON had asked ADON K about the meds and she denied having them. ADON D explained they typically give the DON medications for destruction, but ADON K had previously been allowed to accept them as the DON had just started working there. She stated she had never given any other meds for destruction to ADON K but did that day because she was already there. She became suspicious when she saw it wasn't signed out on the MAR, only the count sheet. ADON D could not recall how many pills were left on the card. An interview with the DON on 11/29/23 at 9:00 AM revealed she just started working in the facility at the beginning of August 2023. She stated on August 23 she began getting calls from nursing staff around 5:45 AM asking why ADON K was taking keys from the night shift. She began quickly heading to the facility. She stated she received a call from ADON D who told her ADON K had taken a card and count sheet for Tylenol #3 for Resident #57. She stated she called ADON K and asked her about the keys but got no real explanation. She described ADON K as talking around everything. She stated ADON K was not aware she was already pulling into the facility at that time. The DON stated when she arrived, she went straight to ADON D's cart, checked it with her, then checked all the other carts. She stated she spoke with LVN L who told her ADON K had attempted to remove a card of Tylenol #3 from her cart that morning, but she would not allow it. The DON stated she wanted to give ADON K a little time to turn the meds into her for destruction. The DON stated, before her arrival that month, ADON K was performing the drug destruction for the facility so she could see why it did not initially come as a surprise to ADON D. She stated, when ADON D noticed on the MAR that Resident #57 had continued to periodically request the med and ADON K failed to sign it out, she called her right away. The DON stated she could not initially locate ADON K in the building. She checked on Resident #57 who told her he received a white pill that morning but could not tell the difference between regular Tylenol and #3. He denied being in pain. She alerted the Administrator. The DON stated when ADON K came to her office, she asked the ADON if she had any medications for destruction and was told, no. When she asked the ADON why she had taken the keys from the night staff, she replied she wanted to let them go early. When the DON told her she had never done that before, ADON K just said, 'ok'. The DON stated she contacted the Administrator and Regional Nurse consultant and explained the situation and reported ADON D's allegation that ADON K told her not to tell the DON she had the drugs. The DON stated she and the Administrator pulled ADON K into the office and confronted her. She said they told her they knew the medications were missing on her watch. The DON stated ADON K denied everything and was not acting right and she suspected the ADON was under the influence of something. The DON stated they contacted HR who took ADON K, ADON D and LVN O for a drug screen. She stated the HR representative rode with them. The DON explained LVN O was only sent because the Regional Nurse Consultant requested a random night nurse get checked as well, they had no suspicions of her. The DON stated ADON K's drug screen returned positive for codeine, and she had no prescription for the medication. She stated ADON K was suspended immediately and ultimately terminated. They were unable to recover the medications and ADON K was not allowed to work in the facility while the investigation was under way. She stated ADON K refused to write a statement. She stated Resident #57's medications were immediately replaced and he did not miss any doses. The DON stated she believed the overall failure was they nurses were counting medications and not actual cards as well [6 inch x 9 inch cards with numbered cavities (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 6 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few containing pills that allow the staff to punch out individual doses]. She stated a full audit had been completed and the Pharmacy Consultant was involved as well. They did not note any other medications missing during the time she was assisting with drug destructions. The DON explained she had immediately written a new procedure and in-serviced all staff. She stated she checked carts daily herself to ensure all controlled medications are accounted for. The DON did not know how many tablets were remaining on the missing card containing the acetaminophen with codeine. During a follow-up interview on 11/29/23 at 10:50 AM, the DON stated the police had been called and notified by the Administrator, but no one ever came to investigate. Observation and interview with RN M on 11/29/23 at 11:59 PM she stated she was aware of the drug diversion that had occurred in August. She stated she remembered clocking in that morning and seeing the night nurse at the nurses' station. She told the nurse, Let's go count as usual but was told ADON K had already counted the cart with the night shift nurse, RN M stated that was very unusual and had never happened before. She stated the night nurse told her it was because she was late and she told them she was not late, it was 6:05 AM. RN M stated she called ADON K on her cell and was told to come and get the keys from her. She stated she went to office and ADON K tried to hand her the keys. She stated she refused to accept the keys and told ADON K, you know better than that, we're going to count the meds. She stated the two of them counted the cart and everything was correct. She did not believe anything was missing because she knew her residents well and had very few controlled medications in her cart. She stated she had never given controlled medications to ADON K before and would only go to the DON if she needed to. She stated she knew they were without a DON for a bit, but she did not personally have to turn anything in for destruction during that period. RN M explained the DON had implemented a better system and they now count the number of cards as well as the individual medications. She stated she had received training and any discrepancies or questions go straight to the DON. On 11/29/23 at 6:16 PM, attempt to reach ADON K at a number provided by the facility was unsuccessful. A voice message was left. During an interview with the Administrator on 12/1/23 at 8:15 AM, He stated he was surprised when the drug diversion had occurred, and he had not encountered that issue before. He denied having any previous concerns with ADON K. Record review of a facility in-service record on Controlled Medication Procedure dated 08/23/23 revealed the following: All Nurses and Medications Aides: We have implemented the new system for narcotics, and it is the expectation that it will be followed at all times with no exceptions. This is a VERY serious matter and any violations of the procedure will be addressed and disciplined immediately . Use the new narcotic count sheet that was implemented (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 7 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 Do NOT hand your keys to the medication cart for ANY reason (BATHROOM, BREAK, ETC) without COUNTING AND Level of Harm - Minimal harm or potential for actual harm SIGNING FIRST! Residents Affected - Few You are to sign and count every single time you hand your keys off. NO exception. NEVER LEAVE YOUR CART UNLOCKED AND UNATTENDED If you discover the count is off, you are to notify the DON immediately Do NOT hand your keys off if the count is not correct. STOP and notify DON. Nurse/CMA that is going off shift, is NOT allowed to leave the shift until the DON arrives and narcotic count is corrected AGAIN, DO NOT HAND THE KEYS OVER TO ANYONE UNTIL YOUR NARCOTICS ARE COUNTED! THIS INCLUDES THE DON/ADON/UNIT MANAGER, ETC. ONLY the nurse who is caring for the resident, will discontinue narcotics after receiving an order from the physician ONLY nurse will give the DON discontinued narcotics off their cart for destruction. If ANYONE besides the DON takes a narcotic off your cart, notify DON immediately. All narcotic medications will be signed out of the log sheet when the medication is popped or dispersed from the narcotic package. DO NOT SIGN OUT LATER. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 8 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 - Level of Harm - Minimal harm or potential for actual harm All Narcotic medications will be signed out on the EMAR as administered and not AFTER administration - Residents Affected - Few After the last space is used on the narcotic log sheet for the end of the month, the sheet will be turned into the DON and a narcotic log sheet will be started. DO NOT THROW AWAY! If a narcotic is being taken off the cart and destroyed by the DON, the nurse and the DON will count the card, sign and date the count sheet AND THEN MAKE A COPY. This copy will be given to the Administrator for a back-up record. Record review of the facility's Drug Diversion policy and procedure, dated December 2018, reflected: POLICY It is the policy of this home to ensure drug diversions are investigated and reported to the proper authorities, per regulation. PROCEDURE 1. Controlled substances in Schedules II, III and IV are subject to special handling, storage, disposal and record-keeping requirements. Such drugs are to be accessible only to authorized nursing and pharmacy personnel. The Director of Nursing is responsible for the control of such drugs. 2. Drugs listed in Schedules II, III and IV are to be stored under double-lock conditions. The key to the separately locked storage area is not the same key that is used to gain access to other drugs. The medication nurse or medication aide on duty at the time will maintain possession of the key. 3. A physical inventory of these medications will be made at the change of each nursing shift. The persons performing the inventory will sign to verify that the inventory was done. All controlled substances are to be counted every shift, including any controlled substances that are in over-flow storage. 4. Any discrepancy in the inventory of a controlled substance .is to be reported to the Director of Nursing as soon as possible. The Director of Nursing is responsible for promptly investigating and making a reasonable effort to reconcile all reported discrepancies. If a discrepancy is not reconciled, the Director of Nursing is to document the details on the audit record and Incident/Accident Report in the clinical software, including the possible shift or persons responsible for the discrepancy, and the efforts made to reconcile it. If a major discrepancy or a pattern of discrepancies occurs, or there is obvious criminal activity, the Director of Nursing is to notify the administrator and the consultant pharmacist immediately. 5. The Administrator or Director of Nursing will be responsible to notify the local police and to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 9 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0602 immediately notify the appropriate state agency when it is determined or there is reason to believe that the drug diversion was a result of theft. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 10 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the Office of the State Long-Term Care Ombudsman of the transfer or discharge and the reasons for the transfer or discharge in writing for one (Resident #228) of one resident reviewed for transfer and discharge. The facility failed to send a transfer or discharge notice in writing to the facility's Ombudsman as soon as practicable when Resident #228 was discharged on 04/10/23. This failure could affect residents at the facility by placing them at risk of being discharged and not having access to available advocacy services, discharge/transfer options, and the appeal processes. Findings included: Record review of Resident #228's electronic face sheet, dated 11/30/23 revealed the resident was a [AGE] year-old male, admitted to the facility on [DATE] with diagnoses to include dermatitis, contact with COVID, muscle wasting and atrophy. Review of Resident #228's progress notes dated 04/10/23 11:59 PM, indicated Resident #228 discharged via stretcher/ Ambulance, accompanied by sheriff. This was not a planned discharge. Record review of Resident #228 reflected electronic communication via email dated 04/11/23 Ombudsman reflected: I am reaching out regarding the improper discharge of Resident#228 from The Meadows Health and Rehabilitation. He states he has been told that he will not be able to return to The Meadows Health and Rehabilitation after he is discharged from the hospital. He also stated the was not given proper 30-day notice of discharge. Resident #228 is intitled to a proper discharge notice if you all are involuntarily discharging him. He has also the right to return to The Meadows Health and Rehabilitation as well. Please give me a call. During an interview on 11/30/23 at 11:06 AM, the Social Worker revealed in progress notes in the electronic medical records regarding Resident #228 was showing increased agitation with roommates and inciting violence, refused to participate with psych services on-site resulted in initiating a [NAME] Warrant-a legal process through which a person is detained or hospitalized against their will for mental health treatment. The Social Worker revealed the intention was Resident #228 would not return to this facility. The Social Worker revealed the resident was given written notice of discharge the same day as the discharge. The Social Worker revealed he had not put a copy in Resident #228's electronic medical record. The Social Worker revealed he notified Resident #228's family member. The Social Worker indicated the Ombudsman notified the Social Worker next day via email. The Social Worker revealed the ombudsman discharge notice only needed to be at time of a discharge. The Social Worker revealed the notification of the discharge for Resident #228 to the Ombudsman was done the day after resident #228 was discharged due to time of night of the discharge. The Social Worker revealed if the facility feels there was a concern for self or others well-being or increase agitation of a resident the resident will be provided the option to participate in psych services, if the resident declines psych services the facility may obtain a court order and have the resident transferred to a psych hospital via the sheriff's dept. There were no progress notes in resident #228's medical record indicating an increase in agitation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 11 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0623 Level of Harm - Minimal harm or potential for actual harm Interview via phone with Ombudsman on 11/29/2023 revealed Ombudsman contacted the Social Worker after Resident #228 contacted her to say the facility had discharged him. Ombudsman revealed she had not been notified by the facility Social Worker and had emailed the facility Social Worker to inquire. Record review of facility's Discharge - Transfer of the Resident policy, dated December 2017, reflected: Residents Affected - Few It is the policy of this home that residents and/or responsible parties will be notified prior to transfer or discharge. discharged residents will have documentation related to discharge or transfer in clinical software. Record review of facility's Behavior Management-Crisis policy, dated December 2017, reflected: It is the policy of this home to identify and manage residents in a safe and caring manner when they are experiencing a behavior crisis. Including the following procedures 1. Implement measures to ensure safety. 2. Summon additional staff needed. 3. Diffuse crisis through calming communication 4. Assess need for additional intervention. Remove resident from situation. Remove offending stimuli from resident. Place resident in safe environment Remove onlookers from the area. 5. Contact administrator/designee and family/responsible party. 6. Contact physician. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 12 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0623 7. Level of Harm - Minimal harm or potential for actual harm Contact local police if behavior crisis requires immediate removal from home. 8. Residents Affected - Few Document, in the clinical software, the crisis including description of incident, resident's perception, interventions, outcomes and steps taken to prevent reoccurrence. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 13 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents who were unable to carry out activities of daily living received the necessary services to maintain good personal hygiene for one (Residents #15) of two residents reviewed for personal care. Residents Affected - Few The facility failed to provide personal care and skin care for Resident #15 by not trimming his fingernails. This failure could place residents who require staff assistance at risk of dermatitis, infections, and low self-esteem. Findings included: Record review of Resident #15's face sheet, dated 05/18/21, reflected Resident #15 was a [AGE] year-old male admitted to the facility on [DATE]. Resident #15 had diagnoses of Other cerebrovascular disease ( group of conditions that affect blood flow and the blood vessels in the brain), hemiplegia (severe or complete loss of strength leading to paralysis on one side of the body ), unspecified affecting unspecified side, muscle wasting and atrophy( body tissue or an organ waste away), neuromuscular dysfunction(a wide-range of diseases affecting the peripheral nervous system,) site not specified, Contracture of muscle (occurs when your muscles, tendons, joints, or other tissues tighten or shorten causing a deformity), multiple sites, Other reduced mobility, Diabetes mellitus due to underlying condition with diabetic nephropathy (Damage to kidneys caused by diabetes). Record review of Resident #15's [NAME] MDS assessment, dated 10/20/23, reflected he had a blank BIMS which indicted he was severe cognitively impaired. Resident #15 was dependent on staff to complete ADLs of bed mobility, dressing, and personal hygiene. Record review of Resident #15's Comprehensive Care Plan, dated 10/27/23, reflected the following: ADLs functional Status/rehabilitation Potential task- Goal The resident will maintain current level of function. Approach: Check nail length and trim and clean on bath day and as necessary In an observation on 11/30/23 at 3:07 PM, Resident#15 had fresh, red, scratch marks on the right side of his face. Observed on both hands that all nails needed to be trimmed. The nails on both hands were approximately 0.3cm in length extending from the tip of his fingers. In an interview on 11/30/23 at 3:10 PM with RN M revealed Resident#15 nails were supposed to be trimmed when the resident was given a bath by the nurse. In an interview on 11/30/23 at 3:15 PM with RN C revealed the residents nails were supposed to be trimmed by the doctor. RN C revealed she had never trimmed Resident #15 nails. In an interview on 11/30/23 at 4:11 PM with the DON revealed Resident#15 was a diabetic and could only have his nails trimmed by the doctor or nurses. The DON revealed that the CNA's could trim the nondiabetic residents' nails. The DON revealed residents' nails needed to stay trimmed for infection control purposes. The DON revealed all nurses are responsible for the care of the residents staff. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 14 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0677 The ADL policy was requested on 11/30/23 at 4:11 PM to the DON. The facility did not provide a policy for ADL Care at the time of exit Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 15 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to implement measures to prevent further decrease in ROM for 2 of 10 residents (Residents #15 and #21) reviewed for contractures. The facility did not apply a splint on Resident #15's and Resident#21's hands to prevent a decline in ROM. This failure could place residents at risk for further decline in ROM and development of contractures. Findings included: 1. Record review of Resident #15's quarterly MDS assessment dated , 10/20/23, reflected Resident #15 was a [AGE] year-old male admitted to the facility on [DATE]. Resident #15 had diagnoses of Other cerebrovascular disease ( group of conditions that affect blood flow and the blood vessels in the brain), hemiplegia (severe or complete loss of strength leading to paralysis on one side of the body ), unspecified affecting unspecified side, muscle wasting and atrophy( body tissue or an organ) waste away,), neuromuscular dysfunction(a wide-range of diseases affecting the peripheral nervous system,) site not specified, Contracture of muscle (occurs when your muscles, tendons, joints, or other tissues tighten or shorten causing a deformity), multiple sites, Other reduced mobility, Diabetes mellitus due to underlying condition with diabetic nephropathy (Damage to kidneys caused by diabetes). Record review of Resident #15's Comprehensive Care Plan, dated 10/27/23, reflected the following: Restorative nursing- Resident has contracture to left upper extremity. Wears splint. Goal: Resident will not experience worsening of contracture to left upper extremity. Approach: Pt may use Left elbow extension splint and Left wrist brace/support for contracture preventions tolerated. Twice A Day; 07:00, 19:00. Record review of Resident #15 physician order's reflected, Place splint to left hand wrist daily as tolerated on 04/05/22. In an observation on 11/28/23 at 2:30 PM Resident#15's left hand was balled up and did not have on a splint. In an interview on 11/29/23 at 2:37 PM, the ADON revealed she would find out why Resident#15 was not wearing his splint. In an observation on 11/29/23 at 2:40 PM, the ADON searched Resident #15's room for splint. The splint was not found in Resident #15's room. In an interview on 11/29/23 at 03:30 PM with the DON revealed orders were placed under general and not nurses TAR. The DON revealed the nurses who took the order were responsible for putting the order in The DON revealed, that the ADON, nurses and herself are responsible for checking physician orders to prevent resident not receiving their ordered care. The DON revealed if the residents were not wearing their splint the contractures could worsen and pain. The DON revealed Resident #15 contractures had not gotten worse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 16 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0688 Level of Harm - Minimal harm or potential for actual harm In an interview on 11/30/23 at 10:49 AM, the DOR revealed therapy did assessment and consulted on 07/11/23 to determine if the splint was needed. Resident #15 was discharged from occupational therpay on 08/15/23. The DOR revealed after the resident was discharged , it was up to the nurses to continue with splint order. The DOR revealed the splint is used to protect from contractures getting worse, getting indication on the skin and pain . Residents Affected - Few 2. Record review of Resident #21's quarterly MDS assessment dated , 10/21/23 reflected Resident #21 was a [AGE] year-old male admitted to the facility on [DATE]. Resident #21 had diagnoses of Unspecified dementia, unspecified severity, muscle wasting and atrophy, multiple sites, Contracture (occurs when your muscles, tendons, joints, or other tissues tighten or shorten causing a deformity), other specified joint, anxiety disorder due to known physiological condition, Epileptic seizures related to external causes, and brain injury. Record review of Resident #21's Comprehensive Care Plan, dated 10/26/23, reflected no documentation of splint. Record review of Resident #21 physician order reflected, Please apply splint to left hand daily as tolerated .07:00 on 06/03/22. In an observation on 11/29/23 at 2:40 PM,Resident #21 was not wearing the splint and his left hand was balled up. Observed the ADON search Resident #21's room for the splint. The splint was not found in Resident #21's room. In an interview on 11/30/23 at 10:49 AM, the DOR revealed therapy did assessment and consulted on 01/27/23 to determine if the splint was needed. Resident #21 was discharged from Occupational Therapy on 02/28/2023. The DOR revealed after the resident was discharged , it was up to the nurses to continue with the splint order. The DOR revealed the splint was used to protect contractures getting worse, getting indication on the skin and pain. Record review of the facility's Range of Motion Exercises policy, dated December 2017, reflected: It is the policy of this home to provide range of motion for residents in order: .7. To prevent contractures from becoming worse if they are already present ADON D did not respond back by exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 17 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation and interview, and record review, the facility failed to maintain an environment as free of accident hazards as is possible for two of two rooms (storage room and shower room) in the facility's secured unit, reviewed for accidents and hazards. The facility failed to ensure the storage room and shower room doors, in the secured unit were locked. These failures could place residents at risk of accidents, injury, or consuming hazardous personal care products. Findings included: Observation on 11/28/23 at 11:34 AM in the secured unit revealed the storage room door in the secured unit was unlocked. The door had two locks, a dead bold and a regular lock on the doorknob. Both were unlocked. The storage room contained oxygen condensers and bottles,, deodorants and wound care supplies including wound spray labeled, Keep out of reach of children. Shampoo and conditioner, shoes, a fan, fall mats, hand sanitizer, and alcohol pads were also in the room. The room was observed to be clustered with these items which made it difficult to move in the room. Observation on 11/28/23 at 12:23 PM revealed the door to the shower room was unlocked. Inside the shower room a cabinet containing personal care items was also unlocked with the unpadlocked hanging on the door. Shampoo, body spray, and lotion were in the shower area of the shower room. A stick deodorant and shave cream, both with labeling that stated, Keep out of reach of children, was also in the shower area. A sharps container containing an overfilled sharps bin attached to the wall in the shower room. The lid on the bin did not close completely due to used razors inside the bin blocking the closing mechanism. In an interview on 11/28/23 at 12:40 PM, CNA B stated none of the residents in the secured unit wandered in and out of rooms but both doors should be locked to ensure the safety of the residents in the secured unit. She said she believed the nurse had the keys to the doors but the locks on both the storage room door and the shower room door did not work. She said the unlocked doors could be a hazard for residents if they did get into the rooms. She said residents could get into personal care products and ingest them accidentally. She said the sharps bin should be changed because it was full and did not close properly. She said she was not sure where the key to the container was but would ask the nurse. She said she had not told maintenance about the broken locks but knew she should log maintenance concerns in the logbook at the nurse's station. In an interview and observation on 11/28/23 at 12:50 PM, RN C stated the supply closet should be kept locked because there were items in the room that could ham the residents. She said the clutter alone could make anyone fall in the room. She said she did not know why the room was not locked and tried to lock it with keys from her key ring. She said none of her keys worked on the storage room door lock and one of the locks were broken. She went to the shower room and said the sharps bin should be changed because it was filled with used razors. She said the Shower Room door should be locked to ensure the safety of residents. She said personal care items should be secured in the cabinet in the shower room and also locked. She said she did not know why they were not locked but she expected the Shower room to be secured. She pointed out that the lock on the shower room was broken did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 18 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few allow the door to close properly. She said she did not know it was broken and needed to be logged in the maintenance logbook at the nurses' stations. She said she expected CNAs to let her know when things were broken or needed repair so she could follow up with maintenance. She said although the residents in the secured unit did not have a history of wandering into rooms, the unlocked doors posed a risk of accidents to the residents because they did have access to the shower room and storage room. She called the Maintenance Director to repair the locks. In an interview on 11/29/23 at 11:50 PM, the Maintenance Director said he was called to the secured unit yesterday to repair broken locks on the storage room and shower room doors. He said he was not aware the locks were broken. He said he completed the repairs on 11/28/2023 and both doors were secured now. He said nursing staff were expected to log any maintenance issues in the Maintenance Logbook at the nurses' station. He said he checked the logs daily and made weekly door rounds to check them for security but said he had not checked the shower room door or the storage room doors, in the secured unit, recently. In an interview on 11/29/23 at 11:50 PM, the Administrator stated upon learning of the unsecured storage room and shower room doors, in the secured unit, he had the Maintenance Director repair them immediately. He said the repairs were completed on 11/28/2023 when RN C was made aware that they were not secured. He said he recognized the importance of the doors being locked as there were items in both the shower room and the storage rooms that could pose a risk of harm to residents. He said the facility did not have a policy related to accidents or hazards, but he said he expected all staff to record any maintenance issue in the logbooks at the nurses' stations and to notify both the DON and him of the issue. In an interview on 11/30/23 at 9:49 AM, the DON stated she had been made aware the doors to the storage room and shower room, in the secured unit, were not locked on 11/28/2023. She said maintenance repaired the locks the same day. She said there was no history of residents wandering from room to room and most of the residents had mid-range BIMs Scores (mild cognition impairments). She said the doors still needed to be secured to ensure the safety of the residents and minimize any possibility of accident or hazard. She said the facility did not have a policy directing accident and hazards but expected all staff to ensure resident safety. She said it was her and the Administrator's roll to train staff on resident safety and minimizing accidents and hazards. In an interview on 12/01/23 at 4:40 PM the COO stated he was not sure why the facility did not have a policy directing procedures to minimize accidents and hazards. He said he expected the Administrator and DON to train staff on safety procedures and resident safety in the Secured Unit. Record review of the maintenance logbook dated 07/12/23, through 11/28/23, at the nurses' station, reflected no documentation of broken locks on the shower room or storage room doors in the secured unit. Record review of the facility's, Call light and door check log, dated 11/2/23-11/27/23 reflected no documentation of checks on the Secured Unit's indication storage room or shower room doors. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 19 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that a resident who needs respiratory care is provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 1 resident (Resident #1) reviewed for respiratory care. Residents Affected - Few The facility failed to perform routine bi-pap (bilevel positive airway pressure is a machine that helps you breathe) maintenance. This failure has the potential to affect residents who use bi-pap machines in the facility. Findings included: Resident #40 Face Sheet Record Review revealed the resident was a [AGE] year-old male admitted [DATE]. Resident#40 face sheet revealed a BIMS score of 14 indicating the resident was cognitively intact. Resident #40's MDS revealed a diagnosis of Arthritis and Alzheimer's disease. Observation of resident in resident's room on 11/28/23 at 12:04 PM revealed a yellow sediment in the bottom of the water reserve of the ci-pap/bi-pap machine on the resident's bedside table. Revealed no date on the ci-pap/bi-pap tube. The bi-pap tube had tape wrapped around the tube in various places. Interview on 11/29/23 at 02:45 PM with nurse LVN F revealed the resident is on a bipap that connects to his oxygen that he uses at 2300 or when he goes to bed. LVN F revealed the bipap was cleaned weekly at 11pm and the tubing changed weekly. LVN F indicated if the bipap is dirty it would be cleaned as needed. Resident #40's Care Plan dated 06/06/23 reflected the resident refused use of the bipap. Electronic medical records reflect order that began on 05/12/23 for c-pap/bi-pap nightly per preset settings starting at 11:00 PM daily for diagnosis of chronic obstructive pulmonary disease. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 20 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure that pain management was provided to residents who required such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 (Resident #36) of 8 residents reviewed for pain management. Residents Affected - Some The facility failed to ensure Resident #36 received her scheduled pain medication every six hours as ordered when her supply ran out. Resident #36 received no scheduled or PRN pain medication for more than two days until surveyor inquiry causing her to experience severe pain. An immediate Jeopardy (IJ) was identified on 11/30/23. The IJ template was provided to the facility on [DATE] at 1:12 PM. While the IJ was removed on 12/1/23, the facility remained out of compliance at a scope of pattern and a severity level of actual harm because all staff had not been trained on the corrective systems. This failure placed residents who require pain management at risk of suffering severe pain. Findings included: Record review of Resident #36's Face Sheet dated 11/30/23 revealed she was admitted to the facility on [DATE] and re-admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), congestive heart failure, muscle wasting and atrophy (loss of strength), anxiety disorder due to known physiological condition, pain in right knee, pain in right hip, difficulty walking and muscle spasm. Record review of Resident #36's most recent MDS assessment dated [DATE] revealed she had a BIMS score of 8 indicating she had moderately impaired cognition. She had occasional pain that occasionally affected her day-to-day activities and made it hard for her to sleep at night. The MDS Assessment also reflected she received routine and PRN pain medications. Record review of Resident #36's current Care Plan revealed the following entry dated 5/27/21, revised 6/22/23: Category: Medication. The resident is on Pain medication therapy r/t Diabetes Neuropathy. Goal: The resident will be free of any discomfort or adverse side effects from pain medication Approach: Administer medication as ordered: Gabapentin [nerve pain medication]; Norco [hydrocodone-pain medication]; Methocarbamol [muscle relaxer]; hot/cold menthol patch; Tramadol [pain medication] prn, as ordered. Discipline: Nursing, Physician. Record review of Resident #36's Physician Encounter note dated 11/17/23 completed by NP J reflected the following: Subjective: Chief Complaint: Reports low back pain, BL [bilateral] LE [lower extremity-legs] pain, Rt [right] knee pain, left knee pain. History of Present Illness: [AGE] year-old long term care resident with PMH significant for DM, cirrhosis, portal HTN [elevated pressure in vein leading to liver], CVA, seen for chronic [lasting a long time] pain management by the request of the primary care team and the nurse. Pt is requesting to take Norco [hydrocodone] routine. Pain HPI. LOCATION: right leg, left leg, right knee, left knee. QUALITY: aching, throbbing, dull (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 21 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some SEVERITY: 9/10 without medication, 4/10 with medication DURATION: chronic in nature. TIMING: intermittent throughout the day. CONTEXT: DJD [degenerative joint disease-worn down tissue at the end of bones] OA [osteoarthritis] Physical Exam: .Musculoskeletal: general: Pain, weakness. Atrophy: Diffuse Muscular Atrophy . Plan: .Pain Medication Norco [hydrocodone] 7.5/325 1 tab by mouth Q6 H routine, and Robaxin [methocarbamol] 500 mg 1-tab Q6 H PRN. Will closely monitor. Educated about SE [side effects] Record review of Resident #36's Physician Order Report printed 11/30/23 revealed the following entries: Hydrocodone-acetaminophen tablet; 7.5-325 mg 1 tablet every 6 hours 07:00, 13:00, 19:00, 01:00 [administer at 7 AM, 1 PM, 7 PM and 1 AM] Hold when resident is sedative/sleepy. Start date: 8/14/23, End date: 11/28/23. Dx Pain, unspecified. Hydrocodone-acetaminophen tablet; 7.5-325 mg 1 tablet every 6 hours 07:00, 13:00, 19:00, 01:00 [administer at 7 AM, 1 PM, 7 PM and 1 AM] Hold when resident is sedative/sleepy. Start date: 11/28/23, End date: Open Ended. Dx Pain, unspecified. Tylenol Extra Strength tablet 500 mg 1 tablet every 6-hour PRN Start date: 8/14/23, End date: 11/28/23. Dx Pain in right knee. Tylenol Extra Strength tablet 500 mg 1 tablet every 6-hour PRN Start date: 11/28/23, End date: Open Ended. Dx Pain in right knee. Methocarbamol (muscle relaxer) 500 mg 1 tablet every 8 hours PRN. Start date: 3/16/23-End date: Open ended. Dx Other muscle spasm. Pain Assessment Q Shift using the Numeric or PAINAD scale. Special Instructions: DOCUMENT RESULTS Every Shift; Day Shift 06:00 - 14:00, Evening Shift 14:00 - 22:00, Night Shift 22:00 - 06:00 Record review of Resident #36's Medication Administration Record dated 11/1/23 through 11/30/23 revealed the following entries: Hydrocodone-acetaminophen tablet; 7.5-325 mg Amount to Administer: 1 tablet every 6 hours. DX: Pain, unspecified. The last dose initialed as administered was 11/27/23 at 7:00 PM. The remaining doses reflected the following: 11/28/23 1:00 AM: Not Administered: Drug/Item unavailable Comment: script needed. Signed by LVN F 11/28/23 7:00 AM and 1:00 PM: Not Administered: Drug/Item unavailable. Signed by ADON D. 11/28/23 7:00 PM: Not Administered: Drug/Item unavailable. Signed by LVN I. 11/29/23 1:00 AM: Not Administered: Drug/Item unavailable. Signed by LVN H. 11/29/23 7:00 AM and 1:00 PM: Not Administered: Drug/Item unavailable. Signed by ADON D. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 22 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 11/29/23 7:00 PM: Not Administered: Other Comment: med not available, will f/u pharmacy. Signed by LVN G. Level of Harm - Immediate jeopardy to resident health or safety 11/30/23 1:00 AM: Not Administered: Drug/Item unavailable Comment: awaiting pharmacy delivery. Signed by LVN H. Residents Affected - Some 11/30/23 7:00 AM: No entry. Methocarbamol 500 mg every 8 Hours-PRN. Three doses were administered on 11/27/23 for pain and muscle spasms. No doses were signed as administered from 11/28/23 through 11/30/23 [reviewed 11/30/23 8:40 AM]. Tylenol Extra Strength 500 mg Every 6 Hours-PRN. No doses were signed as administered from 11/28/23 through 11/30/23 [reviewed 11/30/23 8:40 AM]. Pain Assessment Q Shift using the Numeric or PAINAD scale revealed the following entries: 11/28/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. 11/28/23 Evening Shift 2:00 PM to 10:00 PM: Pain Level 0 signed by ADON E. 11/28/23 Night Shift 10 PM to 6:00 AM: Pain Level 0 signed by LVN H. 11/29/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. 11/29/23 Evening Shift 2:00 PM to 10:00 PM: No entry 11/29/23 Night Shift 10 PM to 6:00 AM: Pain Level 7/10 signed by LVN H. 11/30/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. During an observation and interview on 11/30/23 at 8:15 AM, Resident #36 was in her room, in her bed, she was frowning and asked if state surveyor could check on her medications for her. She stated she had not been getting her medicine for about four days, the staff kept telling her they were waiting for the pharmacy delivery. She stated the medication was hydrocodone for her pain. Resident #36 stated her legs, knees, and feet were very painful and they were not giving her anything for it. She shook her head, motioned toward her legs and rubbed her thighs. She stated she had been complaining of pain to the staff for days and they won't do anything! Resident #36 appeared upset and asked state surveyor to please let me know what is happening because no one will tell me anything! Resident #36's roommate, Resident #22, stated she had heard Resident #36 complaining of pain for the past couple of days and confirmed the staff had been telling her they were waiting for the pharmacy. She stated she did not have any medication issues herself but was worried about her roommate. During an observation and interview with ADON D and ADON E on 11/30/23 at 8:20 AM, ADON D confirmed she had cared for Resident #36 that week and stated the resident did not have any hydrocodone available on 11/29/23 and she had previously called NP J about it who told her she had sent the prescription to the pharmacy. She stated she called the pharmacy on 11/29/23 and was told it would be on the next delivery, but it was not. ADON D stated today is day two when asked how long she had been out of hydrocodone. ADON D stated Resident #36 was receiving scheduled doses of gabapentin and had muscle (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 23 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some relaxers and Tylenol extra strength ordered as needed. When asked about an emergency medication kit (E-kit), ADON D stated they previously had a box and had recently been switched to a Pyxis (machine that distributes medication) and stated they were just filling it. ADON D checked a computer and stated Resident #36's last dose was 11/28/23. She stated she would call the pharmacy and check the E-kit, then walked away. ADON E was working with a medication cart and confirmed it was the cart that contained Resident #36's medications. She stated she was just coming on and did not know anything about her situation. The medication cart was checked with ADON E , and she confirmed there was no hydrocodone available for her. When asked how often medications were re-ordered for residents, ADON E stated she usually reordered when a resident was down to about 15 tablets or half a card just to be safe. She stated she may order them earlier if a resident takes multiple doses per day. On 11/30/23 at 8:28 AM, ADON D returned and stated she just checked the E-Kit and it only contained hydrocodone 5 mg and 10 mg tablets, and Resident #36 took 7.5 mg tablets. She stated she would contact the pharmacy again. During a follow-up interview and observation with Resident #36 on 11/30/23 at 8:30 AM, she stated she had not been given anything else for pain. ADON D entered the room during the interview and asked Resident #36 if she was in pain. Resident #36 stated she was hurting bad and rated her pain 10/10. When ADON D told the resident she had muscle relaxers and Tylenol available, Resident #36 replied, You know I don't want that Tylenol, it doesn't do anything! ADON D presented her cell phone and pointed out her text messages and stated she had texted NP J on Monday (11/27/23), told her about the scheduled hydrocodone and informed her there was only one tablet left. When asked if that meant she had not received any doses since Monday, ADON D did not answer, walked away toward her office, and took a phone call. Once off the phone, ADON D stated she had called NP J again on 11/29/23 (Wednesday)and told her the medication was not available. She stated she had checked the E-Kit on 11/29/23 as well but did not inform the pain doctor there were other dose strengths available. Interview with the DON on 11/30/23 at 9:26 AM revealed she had just been made aware of Resident #36's lack of available hydrocodone that morning. She stated she had just hung up with NP J and the Medical Director and they were getting a one-time order for hydrocodone 10 mg and pulling one from the E-kit while they get the issue resolved. She stated NP J told her she had sent the prescription to the pharmacy earlier in the week. The DON said she called the pharmacy, and they told her they had not received it. She stated the Medical Director was in the process of sending one at that time. The DON explained controlled medications, like hydrocodone, require special triplicate prescriptions. She stated they normally do not require them for refill order as the physicians will order a six-month supply. The facility has authorized agents, like herself, who can order refills. She explained, in this instance, Resident #36 did not have any more refills and required a new prescription. She stated normally either the pharmacy would have notified her, or the Charge Nurse would have notified the physician. The DON stated ADON D told her she had notified NP J prior to the medication running out. The DON stated she knew Resident #36 had Tylenol available as well as muscle relaxers but did not know if any had been administered. She stated she would not consider Tylenol Extra Strength to be a suitable replacement for hydrocodone but Resident #36 had muscle relaxers ordered as well and she expected her pain to be managed in some form or fashion. The DON sated she did not know if Resident #36's pain had been monitored and said it should have been monitored and documented on the MAR. The DON stated she was aware the E-kit had been stocked but, unfortunately, did not have the hydrocodone 7.5 mg dose available that had been ordered for Resident #36. She stated she did not know if anyone had told NP J or the Medical Director there were alternate doses available in the E-kit. The DON stated, if a resident ran out of pain medication, she expected the nurses to check the E-kit, look for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 24 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some back-up medications or other PRN orders available for the resident. If the medications were not effective, she expected the nurses to notify the physician. When asked if she was aware this was a scheduled medication, she stated she was not, but her expectations would be the same. The DON explained medication reorders were discussed in their stand-up meetings. If a nurse ordered a medication, it was written on a board and followed for three days. She was not aware of Resident #36's medication. She stated they had missed their stand-up meeting on 11/28/23 as the survey began that day so that possibly contributed. She stated there was no facility policy for medication reorders, but she expected her nurses to use their judgement and order medications three to five days ahead of time. The DON stated pain monitoring and medication administration were important because she wanted everyone to be comfortable and pain free for quality of life. She stated, My expectation is for my staff to take care of the patients and manage their pain appropriately. The DON stated medications could be ordered any time of day. When asked about other nurses caring for Resident #36 during the last three days, the DON identified LVN G and LVN I as agency nurses and LVN H as working night shift and PRN. She stated she had the same expectations for Agency nurses as she had for facility staff. She stated, I would think they would know as nurses not to let residents go without pain medications. It is very easy to reorder medications in [the computer software]. She stated the failure was of the nurse who first ordered it to notify her and that did not happen. The DON stated they try to keep their E-kit stocked with whatever medications residents have ordered. When it was noted hydrocodone 7.5 mg was not available, they should have tried to contact the physician for an alternative. Observation and interview with Resident #36 on 11/30/23 at 11:10 AM revealed she was resting in bed with her eyes closed and responded to voice. She stated she had received some medication and was feeling better. She stated she was grateful because I have been asking for days. During a follow-up interview and observation on 11/30/23 at 11:16 AM, ADON D showed her cell phone with text messages. She identified the texts as being between herself and NP J. The text was dated Monday, 11/27/23 at 1:49 PM and reflected, Hey, [Resident #36] has 2 hydrocodone 7.6-325 can you please reorder? The text response reflected, Ok. ADON D stated she called NP J again today and was told she was sending the triplicate again. In an interview on 11/30/23 at 11:30 AM, the Administrator and Regional Operations Manager stated there was no policy regarding reordering medications. The Administrator said the medications should have been ordered and they knew the resident had missed 9 doses of regularly scheduled hydrocodone 7.5.mg. They said the nurse should have informed the ADON or DON and the emergency meds should have contained the correct dose for the resident. The Administrator said they failed to have the appropriate medications on hand, in the emergency dispenser, and the staff did not tell anyone they needed to be ordered - they said this was a concern and placed the resident in harm due to missing their pain medication. The Administrator and Regional Operations Manager stated the Regional Nurse Consultant was at home and ill, but they planned to call her. A telephone interview with the Medical Director on 11/30/23 at 12:08 PM revealed he was Resident #36's attending physician. He stated he had been made aware of an issue with Resident #36's prescription and had just stopped by the facility and provided an order for a one-time dose of pain medication for her while the prescription was sorted out with pharmacy. He stated he was aware she had chronic pain issues which was why he had previously consulted pain management physician. He stated he had not been notified before today there was any issues with her medication availability. He stated Resident #36 had bad arthritis. He stated he had not had any issues or concerns regarding residents receiving their medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 25 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 11/30/23 at 12:12 PM, the DON provided a list of all facility residents receiving pain medications. She stated she had conducted an audit of all medication carts and ensured all residents receiving pain medications had medications available. During an interview on 11/30/23 at 12:16 PM with ADON D stated she should check pain scales when residents receive pain medications and every shift. She stated she recalled checking Resident #36 on Tuesday, 11/28/23 and she was sleeping so she coded a 0/10. She could not recall what time she checked her or if she checked her again during her shift. She did not respond when asked about coding Resident #36's pain level as a 0 on 11/29/23 and again that morning, even though we had both seen she was in pain. She stated Resident #36 received her last dose of hydrocodone on Tuesday, 11/28/23. ADON D was shown Resident #36's MAR and asked to clarify because the last dose was signed out on Monday, 11/27/23 at 7:00 PM. ADON D stated she would check her computer. She stated she contacted the pharmacy on Wednesday, 11/29/23 and was told the medication had been ordered and was enroute. She stated when it hadn't arrived at the end of her shift, she let LVN F know the medication was not there. She confirmed she did not notify the physician the medications were unavailable. An interview on 11/30/23 at 2:09 PM with LVN H revealed he worked the 10:00 PM to 6:00 AM shift and had cared for Resident #36. He stated the day shift had reported her hydrocodone was not available. He stated he discussed the situation with Resident #36 and let her know she had PRN medications available. LVN H stated Resident #36 would sometimes sleep through her dose hydrocodone on his shift and he did not recall her complaining of pain during his shift. He stated lately she had been sleeping better since getting scheduled medications. LVN H stated, if scheduled medications were not available for administration, he would report the information on the 24-hour report, but Resident #36's information had already been documented. He stated if she had been acting like she was in pain or throwing a fit he would have called the physician. When asked about his rating of her pain as 7/10 on her MAR for his shift, LVN H stated, What they say, may or may not be what's happening. He stated he provided other means for relief such as repositioning. In a telephone interview on 11/30/23 at 5:00 PM, NP J confirmed she worked under a pain management specialist. She stated she had received a request to refill Resident #36's hydrocodone on 11/27/23 and sent the prescription to the pharmacy the same day. She stated, for some reason, the prescription did not go through. NP J stated she knew Resident #36 well and she needed her pain medication. She stated the nurses usually sent the request further ahead of time, two to three days before because the pharmacy takes a few days to fill it. She stated the nurses knew they should order it at least two to three days ahead. NP J stated she did not know when Resident #36 received her last dose but when she was told it was still unavailable, she called the pharmacy right away. She stated she did not know the script never went through. NP J stated Resident #36 had orders for [muscle relaxer] and Tylenol as well and the nurses could have administered those. She stated, if the resident was in severe pain, the nurses could have called her for an E-kit order. Record review of Resident #36's progress notes revealed the most recent nurse's entry was dated 11/13/2023. The following entries were made after surveyor inquiry: 11/29/2023 9:14 AM: [Recorded as Late Entry on 11/30/2023 08:35] This writer spoke with pain management about the resident medication is unavailable, resident rated pain 10/10, contacted pharmacy and was told that medication has been ordered, will continue to monitor for any changes in condition. Signed by ADON D 11/30/2023 8:35 AM: This writer assessed resident this morning, pain medication has not been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 26 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some delivered, resident rated pain 10/10, prn are being given, called the physician and received an onetime dose for Hydrocodone 10-325, also reached out to [NP J] (pain management) but no answer yet, left message, will continue to monitor for any changes of condition. Signed by ADON D. 11/30/23 10:49 AM: Interviewed resident about pain. Resident stated that she is improved somewhat from the administration of muscle relaxer but states her pain is still a 10 in the bilateral [both sides] legs. Informed resident that we had a onetime dose of 10-325 hydrocodone for her. Administered the 10/325 hydrocodone and will re-assess pain. Signed by DON. 11/30/23 11:50 AM: Resident notes with eyes closed, easily aroused, resident denies any pain at this time level 0/10. Signed by ADON E. Record review of resident #36's Controlled Drug Record for her hydrocodone 7.5-325 mg revealed the final entry was dated 11/27/23 and reflected the last dose was signed out on Monday, 11/27/23 at 8:00 PM. Amount Remaining reflected 0. Record review of the facility's Policy and Procedure titled Pain Management dated 12/2018 revealed the following: POLICY It is the policy of this home that residents experiencing pain will be assessed and pain management provided to the degree possible to provide comfort and enhance the resident's quality of life. Procedure 1. Each resident's pain will be assessed using the [Pain Assessment] in the clinical software, upon admission, re-admission, the onset or an increase in pain, quarterly and whenever there is a significant change in condition that may cause an increase in pain. 2. The home promotes residents self-reporting as the most reliable indicator of pain. 3. The home recognizes that a resident's response to pain is subjective and individual .5. The home will treat the resident under the premise that pain is present whenever the resident says that it is. 6. Nursing staff will identify situations or interventions where an increase in the resident's pain may be anticipated (i.e., wound care, ambulation, repositioning). Pain medication will be offered appropriately preceding these identified activities. 7. The resident's pain will be evaluated routinely each shift. 8. Residents will be re-assessed 30 - 60 minutes after pain management interventions to determine the effectiveness of the intervention. 9. Nursing staff will evaluate how pain is affecting mood, activities of daily living, sleep and the resident's quality of life including complications (i.e., falls, gait disturbance, social isolation). 10. The physician will order appropriate pain medication intervention both routine and PRN to address the individual's pain. 11. Residents with unrelieved pain will be evaluated by the nurse and the physician notified. Pain interventions will be adjusted accordingly and may include non-pharmacological measures. Record review of the facility's Policy and Procedure titled Medication-Unusual Occurrences dated 12/2017 revealed the following: Policy: It is the policy of this home to administer medications within the Standards of Practice and in compliance with Regulatory Guidelines. Definitions: Medication Error: A medication error occurs when a medication is administered in any manner that is inconsistent with the physician's order for that medication. Medication errors include, but are not limited to, administering the wrong (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 27 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some medication, administering at the wrong time, administering the wrong dosage strength, administering by the wrong route of administration, and/or administering to the wrong resident . Procedure: 1. Unusual occurrences may be medication errors and/or adverse drug reactions. Medication errors and adverse drug reactions shall be immediately reported to the resident's physician and the Director of Nursing .4. Licensed nurses who observe such unusual occurrences are to: a. Take whatever immediate action is necessary to protect the resident's safety and welfare. b. Report the incident immediately to the Director of Nursing. C. Make the appropriate records and notifications required above The Administrator and Regional Operations Manager were notified on 11/30/23 at 12:51 PM that Immediate Jeopardy and Substandard Quality of Care had been identified in the area of pain management. The IJ Template was provided to the Administrator and DON on 11/30/23 06/08/2023 at 1:12 PM and they were informed the POR was due to HHSC by 2:30 PM on 11/30/23. The following Plan of Removal submitted by the facility was accepted on 12/1/23 at 2:48 PM and reflected: 11/30/2023 Plan of Removal - F-697 Pain Management Immediate Action Taken Resident Specific The facility failed to ensure Resident #36 received her physician-ordered pain medication, Hydrocodone 7.5 milligrams (mg), every 6 hours due to the facility failing to re-order the medication after the last dose was administered on Monday, 11/27 /23, at 7:00 PM. As of 11/30/23, the resident has missed a total of 9 doses. The resident reports having pain at a level of 10 out of 10 on the pain scale. Residents was immediate assessed for pain on 11/30/2023 by nursing staff. Physician was notified on 11/30/2023 by DON. Alternate pain medication order was obtained, and medication was given on 11/30/2023 by nursing staff. System Changes Residents will be monitored for pain daily all negative findings will be giving to the DON/designee, Initiated on 11/30/2023 by nursing staff. 100% Audit will be completed of all resident's pain risk to ensure all at risk residents have been identified. Audit initiated on 11/30 by DON/designee and will be completed on 12/1/2023 and report any negative findings. Every shift pain assessment will be completed by nursing and monitored by DON/designee daily Initiated on 11/30/2023. Education (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 28 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Regional Nurse Consultant, RNC provided education to DON/ADON related to re-ordering medication/pain assessment monitoring on 11/30/2023. DON/Designee will educate nursing staff if a resident is out of pain medication to notify the MD and DON immediately/assess resident/ask for alternate medication/call pharmacy related to when the medication will arrive/ask pharmacy to send out stat if possible. Initiated on 11/30/2023 and each nurse/medication aide will be educated prior to working the floor. DON/Designee will educate staff on when to re-order medications in a timely manner following the pharmacy medication card system. Initiated on 11/30/2023 and each nurse/medication aide will be educated prior to working the floor. Monitoring DON/Designee will randomly interview residents with routine pain medication orders daily x4 weeks on pain level/if pain medication was given. Initiated on 11/30/23 and will end on 12/15/2023. Residents will have a pain risk observation completed quarterly by the charge nurse with the MDS or significant change of condition. The facility will ensure residents do not run out of pain medications by the DON/designee conducting a weekly audit for all pain medications to ensure they are ordered timely if needing a [NAME]. The MD will be notified weekly if a [NAME] is needed. The DON/designee will call the pharmacy to ensure the [NAME] was received. DON/designee will check daily to ensure the medication has arrived See Pain Management/Medication Administration policy. The process was initiated on 11/30/2023 and will continue through 12/15/2023. DON/designee will notify the MD if the provider fails to response within 4 hours of requesting the [NAME]. The process will begin 11/30 and continue through 12/15/2023. DON/designee will conduct an in-service related to medications available in the e-kit if not available the physician an alternate medication disciplinary action if instruction not followed. Training initiated on 11/30/2023 and each nurse will be educated before working the and will continue until all nurses have been educated. Administrator and RNC will review each task overseen by DON/Designee weekly beginning 12/1/23 and will end 12/31/2023 to ensure tasks are completed. At that time further review will be conducted through the QAPI process. Monitoring of the facility's Plan of Removal included the following: Interview with the DON on 12/1/23 at 3:00 PM revealed in-service training was initiated on 11/30/23 and was still in progress. The training topics included identification of signs and symptoms of pain, how and when to re-order medications, and proper documentation of pain medication administration. In-service content and sign-in sheets were requested for review. Interviews were conducted on 12/1/23 from 3:40 PM to 4:05 PM with direct care nurses including ADON E, 1 GVN, 1 RN and 2 LVNs. The staff indicated they had been in-serviced on pain management including assessments, medication administration and documentation. The staff stated they would contact the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 29 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some attending physician and DON immediately if any medications were unavailable and check the E-kit for availability. The staff stated medications should be re-ordered one week in advance of the last dose. In an interview on 12/1/23 at 4:20 PM, ADON D stated she had received in-service training from the Regional Nurse Consultant. She stated medications should be re-ordered a week ahead of the last dose available. ADON D acknowledged the failure to administer scheduled medications was a medication error. She described the risks of medications errors as increased blood pressure for a resident who didn't receive their blood pressure medications and stated residents who did not receive their ordered pain medications as at risk suffering more from pain. She stated the resident's physician and DON should be notified of any medication errors. In an interview on 12/1/23 at 4:18 PM, the DON revealed she had been in-serviced by the Regional Nurse Consultant and was still in progress in-servicing all staff. She stated medications should be ordered approximately a week in advance. The DON stated all nurses should be assessing residents for pain every shift and as needed. She explained residents should also be assessed around the administration of pain medications and treatments. She stated she was also in-servicing CNAs regarding pain assessments as well. She had instructed them to report any signs of pain to the charge nurse and to come to her if they felt the resident's pain was not managed. She stated she had begun auditing pain assessments and will continue to monitor to ensure completion. The DON stated, if medications were not available, the nurses should check the E-kit for availability. She stated she printed the inventory and placed it with the E-kit machine so that nurses could more quickly check availability. If the medication was not available, the nurse should contact the physician and the DON to obtain an order. The DON stated any medication errors were to be reported immediately to the physician and herself and FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 30 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 - Immediate jeopardy to resident health or safety Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on 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 #36) of 8 residents reviewed for pharmacy services. 1. The facility failed to obtain the routine scheduled pain medication for Resident #36, who was to receive it every 6 hours, for more than two days after her supply ran out. Resident #36 missed 10 doses of her scheduled pain medication causing her to experience severe pain. The medications were received after surveyor inquiry. An immediate Jeopardy (IJ) was identified on 11/30/23. The IJ template was provided to the facility on [DATE] at 1:12 PM. While the IJ was removed on 12/1/23, the facility remained out of compliance at a scope of pattern and a severity level of actual harm because all staff had not been trained on the corrective systems. This failure could place residents who require pain management at risk of suffering severe pain due to lack of medication availability. 2. The facility failed to prevent an employee with access to controlled medications from diverting an unknown number of Tylenol #3 tablets (a Schedule III narcotice used to treat pain) belonging to Resident #57 from a medication cart. This failure could place residents at risk for unrelieved pain due to his medication not being readily available. Findings included: 1. Record review of Resident #36's Face Sheet dated 11/30/23 revealed the resident was re-admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), congestive heart failure, muscle wasting and atrophy (loss of strength), anxiety disorder due to known physiological condition, pain in right knee, pain in right hip, difficulty walking and muscle spasm. Record review of Resident #36's most recent MDS assessment dated [DATE] revealed she had a BIMS score of 8 indicating she had moderately impaired cognition. She had occasional pain that occasionally affected her day-to-day activities and made it hard for her to sleep at night. The MDS Assessment also reflected she received routine and PRN pain medications. Record review of Resident #36's current Care Plan revealed the following entry dated 5/27/21, revised 6/22/23: Category: Medication. The resident is on Pain medication therapy r/t Diabetes Neuropathy. Goal: The resident will be free of any discomfort or adverse side effects from pain medication Approach: Administer medication as ordered: Gabapentin [nerve pain medication]; Norco [hydrocodone-pain medication]; Methocarbamol [muscle relaxer]; hot/cold menthol patch; Tramadol [pain medication] prn, as ordered. Discipline: Nursing, Physician. Record review of Resident #36 Physician Encounter note dated 11/17/23 completed by NP J reflected (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 31 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 the following: Level of Harm - Immediate jeopardy to resident health or safety Subjective: Chief Complaint: Reports low back pain, BL [bilateral] LE [lower extremity-legs] pain, Rt [right] knee pain, left knee pain. Residents Affected - Some History of Present Illness: [AGE] year-old long term care resident with PMH significant for DM, cirrhosis, portal HTN [elevated pressure in vein leading to liver], CVA, seen for chronic [lasting a long time] pain management by the request of the primary care team and the nurse. Pt is requesting to take Norco [hydrocodone] routine. Pain HPI. LOCATION: right leg, left leg, right knee, left knee. QUALITY: aching, throbbing, dull SEVERITY: 9/10 without medication, 4/10 with medication DURATION: chronic in nature. TIMING: intermittent throughout the day. CONTEXT: DJD [degenerative joint disease-worn down tissue at the end of bones] OA [osteoarthritis] Physical Exam: .Musculoskeletal: general: Pain, weakness. Atrophy: Diffuse Muscular Atrophy .Plan: .Pain Medication Norco [hydrocodone] 7.5/325 1 tab by mouth Q6 H routine, and Robaxin [methocarbamol] 500 mg 1-tab Q6 H PRN. Will closely monitor. Educated about SE [side effects] Record review of Resident #36's Physician Order Report printed 11/30/23 revealed the following entries: Hydrocodone-acetaminophen tablet; 7.5-325 mg 1 tablet every 6 hours 07:00, 13:00, 19:00, 01:00 [administer at 7 AM, 1 PM, 7 PM and 1 AM] Hold when resident is sedative/sleepy. Start date: 8/14/23, End date: 11/28/23. Dx Pain, unspecified. Hydrocodone-acetaminophen tablet; 7.5-325 mg 1 tablet every 6 hours 07:00, 13:00, 19:00, 01:00 [administer at 7 AM, 1 PM, 7 PM and 1 AM] Hold when resident is sedative/sleepy. Start date: 11/28/23, End date: Open Ended. Dx Pain, unspecified. Tylenol Extra Strength tablet 500 mg 1 tablet every 6-hour PRN Start date: 8/14/23, End date: 11/28/23. Dx Pain in right knee. Tylenol Extra Strength tablet 500 mg 1 tablet every 6-hour PRN Start date: 11/28/23, End date: Open Ended. Dx Pain in right knee. Methocarbamol (muscle relaxer) 500 mg 1 tablet every 8 hours PRN. Start date: 3/16/23-End date: Open ended. Dx Other muscle spasm. Pain Assessment Q Shift using the Numeric or PAINAD scale. Special Instructions: DOCUMENT RESULTS Every Shift; Day Shift 06:00 - 14:00, Evening Shift 14:00 - 22:00, Night Shift 22:00 - 06:00 Record review of Resident #36's Medication Administration Record (MAR) dated 11/1/23 through 11/30/23 revealed the following entries: Hydrocodone-acetaminophen tablet; 7.5-325 mg Amount to Administer: 1 tablet every 6 hours. DX: Pain, unspecified. The last dose initialed as administered was 11/27/23 at 7:00 PM. The remaining doses reflected the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 32 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 11/28/23 1:00 AM: Not Administered: Drug/Item unavailable Comment: script needed. Signed by LVN F Level of Harm - Immediate jeopardy to resident health or safety 11/28/23 7:00 AM and 1:00 PM: Not Administered: Drug/Item unavailable. Signed by ADON D. Residents Affected - Some 11/29/23 1:00 AM: Not Administered: Drug/Item unavailable. Signed by LVN H. 11/28/23 7:00 PM: Not Administered: Drug/Item unavailable. Signed by LVN I. 11/29/23 7:00 AM and 1:00 PM: Not Administered: Drug/Item unavailable. Signed by ADON D. 11/29/23 7:00 PM: Not Administered: Other Comment: med not available, will f/u pharmacy. Signed by LVN G. 11/30/23 1:00 AM: Not Administered: Drug/Item unavailable Comment: awaiting pharmacy delivery. Signed by LVN H. 11/30/23 7:00 AM: No entry. Methocarbamol 500 mg every 8 Hours-PRN. Three doses were administered on 11/27/23 for pain and muscle spasms. No doses were signed as administered from 11/28/23 through 11/30/23 [reviewed 11/30/23 8:40 AM]. Tylenol Extra Strength 500 mg Every 6 Hours-PRN. No doses were signed as administered from 11/28/23 through 11/30/23 [reviewed 11/30/23 8:40 AM]. Pain Assessment Q Shift using the Numeric or PAINAD scale revealed the following entries: 11/28/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. 11/28/23 Evening Shift 2:00 PM to 10:00 PM: Pain Level 0 signed by ADON E. 11/28/23 Night Shift 10 PM to 6:00 AM: Pain Level 0 signed by LVN H. 11/29/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. 11/29/23 Evening Shift 2:00 PM to 10:00 PM: No entry 11/29/23 Night Shift 10 PM to 6:00 AM: Pain Level 7/10 signed by LVN H. 11/30/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. During an observation and interview on 11/30/23 at 8:15 AM, Resident #36 was in her room, in her bed, she was frowning and asked if state surveyor could check on her medications for her. She stated she had not been getting her medicine for about four days, the staff kept telling her they were waiting for the pharmacy delivery. She stated the medication was hydrocodone for her pain. Resident #36 stated her legs, knees, and feet were very painful and they were not giving her anything for it. She shook her head, motioned toward her legs and rubbed her thighs. She stated she had been complaining of pain to the staff for days and they won't do anything! Resident #36 appeared upset and asked state surveyor to please let me know what is happening because no one will tell me anything! Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 33 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 - Immediate jeopardy to resident health or safety Residents Affected - Some #36's roommate, Resident #22, stated she had heard Resident #36 complaining of pain for the past couple of days and confirmed the staff had been telling her they were waiting for the pharmacy. She stated she did not have any medication issues herself but was worried about her roommate. During an interview with ADON D and ADON E on 11/30/23 at 8:20 AM, ADON D confirmed she had cared for Resident #36 that week and stated the resident did not have any hydrocodone available on 11/29/23 and she had previously called NP J about it who told her she had sent the prescription to the pharmacy. She stated she called the pharmacy on 11/29/23 and was told it would be on the next delivery, but it was not. ADON D stated today is day two when asked how long she had been out of hydrocodone. ADON D stated Resident #36 was receiving scheduled doses of gabapentin and had muscle relaxers and Tylenol extra strength ordered as needed. When asked about an emergency medication kit (E-kit), ADON D stated they previously had a box and had recently been switched to a Pyxis (machine that distributes medication) and stated they were just filling it. ADON D checked a computer and stated Resident #36's last dose was 11/28/23. She stated she would call the pharmacy and check the E-kit, then walked away. ADON E was working with a medication cart and confirmed it was the cart that contained Resident #36's medications. She stated she was just coming on and did not know anything about her situation. The medication cart was checked with ADON E, and she confirmed there was no hydrocodone available for her. When asked how often medications were re-ordered for residents, ADON E stated she usually reordered when a resident was down to about 15 tablets or half a card just to be safe. She stated she may order them earlier if a resident takes multiple doses per day. On 11/30/23 at 8:28 AM, ADON D returned and stated she just checked the E-Kit and it only contained hydrocodone 5 mg and 10 mg tablets, and Resident #36 took 7.5 mg tablets. She stated she would contact the pharmacy again. During a follow-up interview and observation with Resident #36 on 11/30/23 at 8:30 AM, she stated she had not been given anything else for pain. ADON D entered the room during the interview and asked Resident #36 if she was in pain. Resident #36 stated she was hurting bad and rated her pain 10/10. When ADON D told the resident she had muscle relaxers and Tylenol available, Resident #36 replied, You know I don't want that Tylenol, it doesn't do anything! ADON D presented her cell phone and pointed out her text messages and stated she had texted NP J on Monday (11/27/23), told her about the scheduled hydrocodone and informed her there was only one tablet left. When asked if that meant she had not received any doses since Monday, ADON D did not answer, walked away toward her office, and took a phone call. Once off the phone, ADON D stated she had called NP J again on 11/29/23 (Wednesday)and told her the medication was not available. She stated she had checked the E-Kit on 11/29/23 as well but did not inform the pain doctor there were other dose strengths available. Interview with the DON on 11/30/23 at 9:26 AM revealed she had been just made aware of Resident #36's lack of available hydrocodone that morning. She stated she had just hung up with NP J and the Medical Director and they were getting a one-time order for hydrocodone 10 mg and pulling one from the E-kit while they get the issue resolved. She stated NP J told her she had sent the prescription to the pharmacy earlier in the week. The DON said she called the pharmacy, and they told her they had not received it. She stated the Medical Director was in the process of sending one at that time. The DON explained controlled medications, like hydrocodone, require special triplicate prescriptions. She stated they normally do not require them for refill order as the physicians will order a six-month supply. The facility has authorized agents, like herself, who can order refills. She explained, in this instance, Resident #36 did not have any more refills and required a new prescription. She stated normally either the pharmacy would have notified her, or the Charge Nurse would have notified the physician. The DON stated ADON D told her she had notified NP J prior to the medication running out. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 34 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 - Immediate jeopardy to resident health or safety Residents Affected - Some The DON stated she knew Resident #36 had Tylenol available as well as muscle relaxers but did not know if any had been administered. She stated she would not consider Tylenol Extra Strength to be a suitable replacement for hydrocodone but Resident #36 had muscle relaxers ordered as well and she expected her pain to be managed in some form or fashion. The DON sated she did not know if Resident #36's pain had been monitored and said it should have been monitored and documented on the MAR. The DON stated she was aware the E-kit had been stocked but, unfortunately, did not have the hydrocodone 7.5 mg dose available that had been ordered for Resident #36. She stated she did not know if anyone had told NP J or the Medical Director there were alternate doses available in the E-kit. The DON stated, if a resident ran out of pain medication, she expected the nurses to check the E-kit, look for back-up medications or other PRN orders available for the resident. If the medications were not effective, she expected the nurses to notify the physician. When asked if she was aware this was a scheduled medication, she stated she was not, but her expectations would be the same. The DON explained medication reorders were discussed in their stand-up meetings. If a nurse ordered a medication, it was written on a board and followed for three days. She was not aware of Resident #36's medication. She stated they had missed their stand-up meeting on 11/28/23 as the survey began that day so that possibly contributed. She stated there was no facility policy for medication reorders, but she expected her nurses to use their judgement and order medications three to five days ahead of time. The DON stated pain monitoring and medication administration were important because she wanted everyone to be comfortable and pain free for quality of life. She stated, My expectation is for my staff to take care of the patients and manage their pain appropriately. The DON stated medications could be ordered any time of day. When asked about other nurses caring for Resident #36 during the last three days, the DON identified LVN G and LVN I as agency nurses and LVN H as working night shift and PRN. She stated she had the same expectations for Agency nurses as she had for facility staff. She stated, I would think they would know as nurses not to let residents go without pain medications. It is very easy to reorder medications in [the computer software]. She stated the failure was of the nurse who first ordered it to notify her and that did not happen. The DON stated they try to keep their E-kit stocked with whatever medications residents have ordered. When it was noted hydrocodone 7.5 mg was not available, they should have tried to contact the physician for an alternative. Observation and interview with Resident #36 on 11/30/23 at 11:10 AM revealed she was resting in bed with her eyes closed and responded to voice. She stated she had received some medication and was feeling better. She stated she was grateful because I have been asking for days. During a follow-up interview on 11/30/23 at 11:16 AM, ADON D showed her cell phone with text messages. She identified the texts as being between herself and NP J. The text was dated Monday, 11/27/23 at 1:49 PM and reflected, Hey, [Resident #36] has 2 hydrocodone 7.5-325 can you please reorder? The text response reflected, Ok. ADON D stated she called NP J again today and was told she was sending the triplicate again. In an interview on 11/30/23 at 11:30 AM, the Administrator and Regional Operations Manager stated there was no policy regarding reordering medications. The Administrator said the medications should have been ordered and they knew the resident had missed 9 doses of regularly scheduled hydrocodone 7.5.mg. They said the nurse should have informed the ADON or DON and the emergency meds should have contained the correct dose for the resident. The Administrator said they failed to have the appropriate medications on hand, in the emergency dispenser, and the staff did not tell anyone they needed to be ordered - they said this was a concern and placed the resident in harm due to missing their pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 35 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 - Immediate jeopardy to resident health or safety Residents Affected - Some medication. The Administrator and Regional Operations Manager stated the Regional Nurse Consultant was at home and ill. A telephone interview with the Medical Director on 11/30/23 at 12:08 PM revealed he was Resident #36's attending physician. He stated he had been made aware of an issue with Resident #36's prescription and had just stopped by the facility and provided an order for a one-time dose of pain medication for her while the prescription was sorted out with pharmacy. He stated he was aware she had chronic pain issues which was why he had previously consulted pain management physician. He stated he had not been notified before today there was any issues with her medication availability. He stated Resident #36 had bad arthritis. He stated he had not had any issues or concerns regarding residents receiving their medications. During an interview on 11/30/23 at 12:12 PM, the DON provided a list of all facility residents receiving pain medications. She stated she had conducted an audit of all medication carts and ensured all residents receiving pain medications had medications available. During an interview on 11/30/23 at 12:16 PM with ADON D stated she should check pain scales when residents receive pain medications and every shift. She stated she recalled checking Resident #36 on Tuesday, 11/28/23 and she was sleeping so she coded a 0/10. She could not recall what time she checked her or if she checked her again during her shift. She did not respond when asked about coding Resident #36's pain level as a 0 on 11/29/23 and again that morning, even though we had both seen she was in pain. She stated Resident #36 received her last dose of hydrocodone on Tuesday, 11/28/23. ADON D was shown Resident #36's MAR and asked to clarify because the last dose was signed out on Monday, 11/27/23 at 7:00 PM. ADON D stated she would check her computer. She stated she contacted the pharmacy on Wednesday, 11/29/23 and was told the medication had been ordered and was enroute. She stated when it hadn't arrived at the end of her shift, she let LVN F know the medication was not there. She confirmed she did not notify the physician the medications were unavailable. An interview on 11/30/23 at 2:09 PM with LVN H revealed he worked the 10:00 PM to 6:00 AM shift and had cared for Resident #36. He stated the day shift had reported her hydrocodone was not available. He stated he discussed the situation with Resident #36 and let her know she had PRN medications available. LVN H stated Resident #36 would sometimes sleep through her dose hydrocodone on his shift and he did not recall her complaining of pain during his shift. He stated lately she had been sleeping better since getting scheduled medications. LVN H stated, if scheduled medications were not available for administration, he would report the information on the 24-hour report, but Resident #36's information had already been documented. He stated if she had been acting like she was in pain or throwing a fit he would have called the physician. When asked about his rating of her pain as 7/10 on her MAR for his shift, LVN H stated, What they say, may or may not be what's happening. He stated he provided other means for relief such as repositioning. LVN H stated medications should be ordered 3-5 days ahead of time to ensure availability. In a telephone interview on 11/30/23 at 5:00 PM, NP J confirmed she worked under a pain management specialist. She stated she had received a request to refill Resident #36's hydrocodone on 11/27/23 and sent the prescription to the pharmacy the same day. She stated, for some reason, the prescription did not go through. NP J stated she knew Resident #36 well and she needed her pain medication. She stated the nurses usually sent the request further ahead of time, two to three days before because the pharmacy takes a few days to fill it. She stated the nurses knew they should order it at least two to three days ahead. NP J stated she did not know when Resident #36 received her last dose but when she was told it was still unavailable, she called the pharmacy right away. She stated she did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 36 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 - Immediate jeopardy to resident health or safety know the script never went through. NP J stated Resident #36 had orders for [muscle relaxer] and Tylenol as well and the nurses could have administered those. She stated, if the resident was in severe pain, the nurses could have called her for an E-kit order. Record review of Resident #36's progress notes revealed the most recent nurse's entry was dated 11/13/2023. The following entries were made after surveyor inquiry: Residents Affected - Some 11/29/2023 9:14 AM: [Recorded as Late Entry on 11/30/2023 08:35] This writer spoke with pain management about the resident medication is unavailable, resident rated pain 10/10, contacted pharmacy and was told that medication has been ordered, will continue to monitor for any changes in condition. Signed by ADON D 11/30/2023 8:35 AM: This writer assessed resident this morning, pain medication has not been delivered, resident rated pain 10/10, prn are being given, called the physician and received an onetime dose for Hydrocodone 10-325, also reached out to [NP J] (pain management) but no answer yet, left message, will continue to monitor for any changes of condition. Signed by ADON D. 11/30/23 10:49 AM: Interviewed resident about pain. Resident stated that she is improved somewhat from the administration of muscle relaxer but states her pain is still a 10 in the bilateral [both sides] legs. Informed resident that we had a onetime dose of 10-325 hydrocodone for her. Administered the 10/325 hydrocodone and will re-assess pain. Signed by DON. 11/30/23 11:50 AM: Resident notes with eyes closed, easily aroused, resident denies any pain at this time level 0/10. Signed by ADON E. Record review of resident #36's Controlled Drug Record for her hydrocodone 7.5-325 mg revealed the final entry was dated 11/27/23 and reflected the last dose was signed out on Monday, 11/27/23 at 8:00 PM. Amount Remaining reflected 0. Record review of the facility's Policy and Procedure titled Medication Administration dated 12/2018 revealed the following: POLICY It is the policy of this home that medications will be administered and documented as ordered by the physician and in accordance with state regulations. PROCEDURE 1. Medications are prepared, administered, and recorded only by licensed nursing, certified medication aides, medical, pharmacy, or other personnel authorized by state laws and regulations to administer medications . 8. Medications are administered within 60 minutes of scheduled time, unless otherwise specified by the physician. The resident's MAR is initialed by the person administering a medication, in the space provided under the date, and on the line for that specific medication dose administration .10. If a dose of regularly scheduled medication is withheld or refused, the space provided on the front of the MAR for that dosage administration is initialed and circled. The physician will be notified if medication is routinely refused. Record review of the facility's Policy and Procedure titled Pain Management dated 12/2018 revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 37 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 the following: Level of Harm - Immediate jeopardy to resident health or safety POLICY It is the policy of this home that residents experiencing pain will be assessed and pain management provided to the degree possible to provide comfort and enhance the resident's quality of life. Procedure Residents Affected - Some 1. Each resident's pain will be assessed using the [Pain Assessment] in the clinical software, upon admission, re-admission, the onset or an increase in pain, quarterly and whenever there is a significant change in condition that may cause an increase in pain .5. The home will treat the resident under the premise that pain is present whenever the resident says that it is .10. The physician will order appropriate pain medication intervention both routine and PRN to address the individual's pain. 11. Residents with unrelieved pain will be evaluated by the nurse and the physician notified. Pain interventions will be adjusted accordingly and may include non-pharmacological measures. Record review of the facility's Policy and Procedure titled Medication-Unusual Occurrences dated 12/2017 revealed the following: Policy: It is the policy of this home to administer medications within the Standards of Practice and in compliance with Regulatory Guidelines. Definitions: Medication Error: A medication error occurs when a medication is administered in any manner that is inconsistent with the physician's order for that medication. Medication errors include, but are not limited to, administering the wrong medication, administering at the wrong time, administering the wrong dosage strength, administering by the wrong route of administration, and/or administering to the wrong resident . Procedure: 1. Unusual occurrences may be medication errors and/or adverse drug reactions. Medication errors and adverse drug reactions shall be immediately reported to the resident's physician and the Director of Nursing .4. Licensed nurses who observe such unusual occurrences are to: a. Take whatever immediate action is necessary to protect the resident's safety and welfare. b. Report the incident immediately to the Director of Nursing. C. Make the appropriate records and notifications required above The Administrator and Regional Operations Manager were notified on 11/30/23 at 12:51 PM that Immediate Jeopardy had been identified in the area of pharmacy services. The IJ Template was provided to the Administrator and DON on 11/30/23 06/08/2023 at 1:12 PM and they were informed the POR was due to HHSC by 2:30 PM on 11/30/23. The following Plan of Removal submitted by the facility was accepted on 12/1/23 at 2:48 PM and reflected: 11/30/2023 Plan of Removal - F-755 Pharmacy Services Immediate Action Taken Resident Specific The facility failed to ensure Resident #36 received her physician-ordered pain medication, Hydrocodone 7.5 milligrams (mg), every 6 hours due to the facility failing to re-order the medication after the last dose was administered on Monday, 11/27 /23, at 7:00 PM. As of 11/30/23, the resident has missed a total of 9 doses. The resident reports having pain at a level of 10 out of 10 on the pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 38 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 scale. Level of Harm - Immediate jeopardy to resident health or safety 100% orders and medications were immediately audited for medication availability by DON/ADON's no negative findings. System Changes Residents Affected - Some DON/designee will audit medication carts and matching any new orders weekly for medication availability. Audit was initiated on 11/30/2023 and completed on 11/30/2023 by 5 p.m. Pharmacy reordering system will be followed during medication re-ordering and was initiated 11/30/23 and ongoing. E-Kit will be available for charge nurses to use if medication is not available from the pharmacy or if the physician will order alternative drug until the medication is available from the pharmacy. DON/designee will review all medication weekly for medication availability and for re-ordering this will be conducted simultaneously. Don/Designee conducted review for medication availability on 11/30/2023 and competed the process by 4 p.m. on 11/30/23. Education Regional Nurse Consultant, RNC educated DON/ADON on when to re-order medications. Education was conducted on 11/30/2023 and completed on 11/30/2023. DON/Designee will educate LVN/RN/CMA on when to re-order medications. Education was initiated on 11/30/2023 at 2p.m. and will continue until all LVN/RN/CMA are educated and prior to their next shift. Monitoring DON/Designee will randomly check all medication carts for matching medication and orders daily for medication availability. Monitoring began on 11/30/2023 and will end 12/14/2023. DON/designee will audit all medication carts monthly for medication availability matching orders with medication. Monitoring began 11/30/23. DON/Designee will pull medication availability report daily. Process was initiated on 11/30/2023 and will continue daily until 12/31/2023. Administrator and RNC will review each task overseen by DON/ Designee weekly beginning 12/1/ 23 and will end 12/31/2023 to ensure tasks are completed. At that time further review will be conducted through the QAPI process. Monitoring of the facility's Plan of Removal included the following: Interview with the DON on 12/1/23 at 3:00 PM revealed in-service training was initiated on 11/30/23 and was still in progress. The training topics included identification of signs and symptoms of pain, how and when to re-order medications, and proper documentation of pain medication administration. In-service content and sign-in sheets were requested for review. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 39 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 - Immediate jeopardy to resident health or safety Residents Affected - Some Interviews were conducted on 12/1/23 from 3:40 PM to 4:05 PM with direct care nurses including ADON E, 1 GVN, 1 RN and 2 LVNs. The staff indicated they had been in-serviced on pain management including assessments, medication administration and documentation. The staff stated they would contact the attending physician and DON immediately if any medications were unavailable and check the E-kit for availability. The staff stated medications should be re-ordered one week in advance of the last dose. In an interview on 12/1/23 at 4:20 PM, ADON D stated she had received in-service training from the Regional Nurse Consultant. She stated medications should be re-ordered a week ahead of the last dose available. ADON D stated the failure to administer scheduled medications was a medication error. She stated residents who did not receive their ordered pain medications are at risk of suffering more from pain. She stated the resident's physician and DON should be notified of any medication errors. In an interview on 12/1/23 at 4:18 PM, the DON revealed she had been in-serviced by the Regional Nurse Consultant and was still in progress in-servicing all staff. She stated medications should be ordered approximately a week in advance. The DON stated all nurses should be assessing residents for pain every shift and as needed. She stated residents should also be assessed around the administration of pain medications and treatments. She stated she was also in-servicing CNAs regarding pain assessments as well. She had instructed them to report any signs of pain to the charge nurse and to come to her if they felt the resident's pain was not managed. She stated she had begun auditing pain assessments and will continue to monitor to ensure completion. The DON stated, if medications were not available, the nurses should check the E-kit for availability. She stated she printed the inventory and placed it with the E-kit machine so that nurses could more quickly check availability. If the medication was not available, the nurse should contact the physician and the DON to obtain an order. The DON stated any medication errors were to be reported immediately to the physician and herself and monitor the resident. She stated she was responsible for investigating and documenting the errors. The DON stated all staff currently working had received their in-service training. All staff not yet trained will receive in-service prior to beginning their next shift. During an interview on 12/1/23 at 4:50 PM, the Regional Director of Operations stated he felt all the problems identified came down to communication. He stated medication issues should start with the nurse and move up the chain. He stated he had periodically attended the facility stand-up meeting and planned to attend more regularly a[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 40 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents were free of any significant medication errors for one (Resident #36) of 8 residents reviewed for pharmacy services . Residents Affected - Some The facility failed to administer the routine scheduled pain medication for Resident #36, who was to receive it every 6 hours, for more than two days after her supply ran out. Resident #36 missed 10 doses of her scheduled pain medication. An immediate Jeopardy (IJ) was identified on 11/30/23. The IJ template was provided to the facility on [DATE] at 1:12 PM. While the IJ was removed on 12/1/23, the facility remained out of compliance at a scope of pattern and a severity level of actual harm because all staff had not been trained on the corrective systems. This failure could result in residents experiencing severe pain, not receiving medications prescribed by their physician and decreased quality of life. Findings included: Record review of Resident #36's Face Sheet dated 11/30/23 revealed she was re-admitted to the facility on [DATE] with diagnoses including cerebral infarction (stroke), congestive heart failure, muscle wasting and atrophy (loss of strength), anxiety disorder due to known physiological condition, pain in right knee, pain in right hip, difficulty walking and muscle spasm. Record review of Resident #36's most recent MDS assessment dated [DATE] revealed she had a BIMS score of 8 indicating she had moderately impaired cognition. She had occasional pain that occasionally affected her day-to-day activities and made it hard for her to sleep at night. The MDS Assessment also reflected she received routine and PRN pain medications. Record review of Resident #36's current Care Plan revealed the following entry dated 5/27/21, revised 6/22/23: Category: Medication. The resident is on Pain medication therapy r/t Diabetes Neuropathy. Goal: The resident will be free of any discomfort or adverse side effects from pain medication Approach: Administer medication as ordered: Gabapentin [nerve pain medication]; Norco [hydrocodone-pain medication]; Methocarbamol [muscle relaxer]; hot/cold menthol patch; Tramadol [pain medication] prn, as ordered. Discipline: Nursing, Physician. Record review of Resident #36 Physician Encounter note dated 11/17/23 completed by NP J reflected the following: Subjective: Chief Complaint: Reports low back pain, BL [bilateral] LE [lower extremity-legs] pain, Rt [right] knee pain, left knee pain. History of Present Illness: [AGE] year-old long term care resident with PMH significant for DM, cirrhosis, portal HTN [elevated pressure in vein leading to liver], CVA, seen for chronic [lasting a long time] pain management by the request of the primary care team and the nurse. Pt is requesting to take Norco [hydrocodone] routine. Pain HPI. LOCATION: right leg, left leg, right knee, left knee. QUALITY: aching, throbbing, dull SEVERITY: 9/10 without medication, 4/10 with medication DURATION: chronic in nature. TIMING: intermittent throughout the day. CONTEXT: DJD [degenerative joint disease-worn down tissue at the end of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 41 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 bones] OA [osteoarthritis] Level of Harm - Immediate jeopardy to resident health or safety Physical Exam: .Musculoskeletal: general: Pain, weakness. Atrophy: Diffuse Muscular Atrophy . Plan: .Pain Medication Norco [hydrocodone] 7.5/325 1 tab by mouth Q6 H routine, and Robaxin [methocarbamol] 500 mg 1 tab Q6 H PRN. Will closely monitor. Educated about SE [side effects] Residents Affected - Some Record review of Resident #36's Physician Order Report printed 11/30/23 revealed the following entries: Hydrocodone-acetaminophen tablet; 7.5-325 mg 1 tablet every 6 hours 07:00, 13:00, 19:00, 01:00 [administer at 7 AM, 1 PM, 7 PM and 1 AM] Hold when resident is sedative/sleepy. Start date: 8/14/23, End date: 11/28/23. Dx Pain, unspecified. Hydrocodone-acetaminophen tablet; 7.5-325 mg 1 tablet every 6 hours 07:00, 13:00, 19:00, 01:00 [administer at 7 AM, 1 PM, 7 PM and 1 AM] Hold when resident is sedative/sleepy. Start date: 11/28/23, End date: Open Ended. Dx Pain, unspecified. Tylenol Extra Strength tablet 500 mg 1 tablet every 6-hour PRN Start date: 8/14/23, End date: 11/28/23. Dx Pain in right knee. Tylenol Extra Strength tablet 500 mg 1 tablet every 6-hour PRN Start date: 11/28/23, End date: Open Ended. Dx Pain in right knee. Methocarbamol (muscle relaxer) 500 mg 1 tablet every 8 hours PRN. Start date: 3/16/23-End date: Open ended. Dx Other muscle spasm. Pain Assessment Q Shift using the Numeric or PAINAD scale. Special Instructions: DOCUMENT RESULTS Every Shift; Day Shift 06:00 - 14:00, Evening Shift 14:00 - 22:00, Night Shift 22:00 - 06:00 Record review of Resident #36's Medication Administration Record (MAR) dated 11/1/23 through 11/30/23 revealed the following entries: Hydrocodone-acetaminophen tablet; 7.5-325 mg Amount to Administer: 1 tablet every 6 hours. DX: Pain, unspecified. The last dose initialed as administered was 11/27/23 at 7:00 PM. The remaining doses reflected the following: 11/28/23 1:00 AM: Not Administered: Drug/Item unavailable Comment: script needed. Signed by LVN F 11/28/23 7:00 AM and 1:00 PM: Not Administered: Drug/Item unavailable. Signed by ADON D. 11/28/23 7:00 PM: Not Administered: Drug/Item unavailable. Signed by LVN I. 11/29/23 1:00 AM: Not Administered: Drug/Item unavailable. Signed by LVN H. 11/29/23 7:00 AM and 1:00 PM: Not Administered: Drug/Item unavailable. Signed by ADON D. 11/29/23 7:00 PM: Not Administered: Other Comment: med not available, will f/u pharmacy. Signed by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 42 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 LVN G. Level of Harm - Immediate jeopardy to resident health or safety 11/30/23 1:00 AM: Not Administered: Drug/Item unavailable Comment: awaiting pharmacy delivery. Signed by LVN H. 11/30/23 7:00 AM: No entry. Residents Affected - Some Methocarbamol 500 mg every 8 Hours-PRN. Three doses were administered on 11/27/23 for pain and muscle spasms. No doses were signed as administered from 11/28/23 through 11/30/23 [reviewed 11/30/23 8:40 AM]. Tylenol Extra Strength 500 mg Every 6 Hours-PRN. No doses were signed as administered from 11/28/23 through 11/30/23 [reviewed 11/30/23 8:40 AM]. Pain Assessment Q Shift using the Numeric or PAINAD scale revealed the following entries: 11/28/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. 11/28/23 Evening Shift 2:00 PM to 10:00 PM: Pain Level 0 signed by ADON E. 11/28/23 Night Shift 10 PM to 6:00 AM: Pain Level 0 signed by LVN H. 11/29/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. 11/29/23 Evening Shift 2:00 PM to 10:00 PM: No entry 11/29/23 Night Shift 10 PM to 6:00 AM: Pain Level 7/10 signed by LVN H. 11/30/23 Day Shift 6:00 AM to 2:00 PM: Pain level 0 signed by ADON D. During an observation and interview on 11/30/23 at 8:15 AM, Resident #36 was in her room, in her bed, she was frowning and asked if state surveyor could check on her medications for her. She stated she had not been getting her medicine for about four days, the staff kept telling her they were waiting for the pharmacy delivery. She stated the medication was hydrocodone for her pain. Resident #36 stated her legs, knees, and feet were very painful and they were not giving her anything for it. She shook her head, motioned toward her legs and rubbed her thighs. She stated she had been complaining of pain to the staff for days and they won't do anything! Resident #36 appeared upset and asked state surveyor to please let me know what is happening because no one will tell me anything! Resident #36's roommate, Resident #22, stated she had heard Resident #36 complaining of pain for the past couple of days and confirmed the staff had been telling her they were waiting for the pharmacy. She stated she did not have any medication issues herself but was worried about her roommate. During an observation and interview with ADON D and ADON E on 11/30/23 at 8:20 AM, ADON D confirmed she had cared for Resident #36 that week and stated the resident did not have any hydrocodone available on 11/29/23 and she had previously called NP J about it who told her she had sent the prescription to the pharmacy. She stated she called the pharmacy on 11/29/23 and was told it would be on the next delivery, but it was not. ADON D stated today is day two when asked how long she had been out of hydrocodone. ADON D stated Resident #36 was receiving scheduled doses of gabapentin and had muscle relaxers and Tylenol extra strength ordered as needed. When asked about an emergency medication kit (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 43 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some (E-kit), ADON D stated they previously had a box and had recently been switched to a Pyxis (machine that distributes medication) and stated they were just filling it. ADON D checked a computer and stated Resident #36's last dose was 11/28/23. She stated she would call the pharmacy and check the E-kit, then walked away. ADON E was working with a medication cart and confirmed it was the cart that contained Resident #36's medications. She stated she was just coming on and did not know anything about her situation. The medication cart was checked with ADON E and she confirmed there was no hydrocodone available for her. When asked how often medications were re-ordered for residents, ADON E stated she usually reordered when a resident was down to about 15 tablets or half a card just to be safe. She stated she may order them earlier if a resident takes multiple doses per day. On 11/30/23 at 8:28 AM, ADON D returned and stated she just checked the E-Kit and it only contained hydrocodone 5 mg and 10 mg tablets, and Resident #36 took 7.5 mg tablets. She stated she would contact the pharmacy again. During a follow-up interview and observation with Resident #36 on 11/30/23 at 8:30 AM, she stated she had not been given anything else for pain. ADON D entered the room during the interview and asked Resident #36 if she was in pain. Resident #36 stated she was hurting bad and rated her pain 10/10. When ADON D told the resident she had muscle relaxers and Tylenol available, Resident #36 replied, You know I don't want that Tylenol, it doesn't do anything! ADON D presented her cell phone and pointed out her text messages and stated she had texted NP J on Monday (11/27/23), told her about the scheduled hydrocodone and informed her there was only one tablet left. When asked if that meant she had not received any doses since Monday, ADON D did not answer, walked away toward her office, and took a phone call. Once off the phone, ADON D stated she had called NP J again on 11/29/23 (Wednesday)and told her the medication was not available. She stated she had checked the E-Kit on 11/29/23 as well but did not inform the pain doctor there were other dose strengths available. Interview with the DON on 11/30/23 at 9:26 AM revealed she had been just made aware of Resident #36's lack of available hydrocodone that morning. She stated she had just hung up with NP J and the Medical Director and they were getting a one-time order for hydrocodone 10 mg and pulling one from the E-kit while they get the issue resolved. She stated NP J told her she had sent the prescription to the pharmacy earlier in the week. The DON said she called the pharmacy, and they told her they had not received it. She stated the Medical Director was in the process of sending one at that time. The DON explained controlled medications, like hydrocodone, require special triplicate prescriptions. She stated they normally do not require them for refill order as the physicians will order a six-month supply. The facility has authorized agents, like herself, who can order refills. She explained, in this instance, Resident #36 did not have any more refills and required a new prescription. She stated normally either the pharmacy would have notified her, or the Charge Nurse would have notified the physician. The DON stated ADON D told her she had notified NP J prior to the medication running out. The DON stated she knew Resident #36 had Tylenol available as well as muscle relaxers but did not know if any had been administered. She stated she would not consider Tylenol Extra Strength to be a suitable replacement for hydrocodone but Resident #36 had muscle relaxers ordered as well and she expected her pain to be managed in some form or fashion. The DON sated she did not know if Resident #36's pain had been monitored and said it should have been monitored and documented on the MAR. The DON stated she was aware the E-kit had been stocked but, unfortunately, did not have the hydrocodone 7.5 mg dose available that had been ordered for Resident #36. She stated she did not know if anyone had told NP J or the Medical Director there were alternate doses available in the E-kit. The DON stated, if a resident ran out of pain medication, she expected the nurses to check the E-kit, look for back-up medications or other PRN orders available for the resident. If the medications were not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 44 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some effective, she expected the nurses to notify the physician. When asked if she was aware this was a scheduled medication, she stated she was not, but her expectations would be the same. The DON explained medication reorders were discussed in their stand-up meetings. If a nurse ordered a medication, it was written on a board and followed for three days. She was not aware of Resident #36's medication. She stated they had missed their stand-up meeting on 11/28/23 as the survey began that day so that possibly contributed. She stated there was no facility policy for medication reorders, but she expected her nurses to use their judgement and order medications three to five days ahead of time. The DON stated pain monitoring and medication administration were important because she wanted everyone to be comfortable and pain free for quality of life. She stated, My expectation is for my staff to take care of the patients and manage their pain appropriately. The DON stated medications could be ordered any time of day. When asked about other nurses caring for Resident #36 during the last three days, the DON identified LVN G and LVN I as agency nurses and LVN H as working night shift and PRN. She stated she had the same expectations for Agency nurses as she had for facility staff. She stated, I would think they would know as nurses not to let residents go without pain medications. It is very easy to reorder medications in [the computer software]. She stated the failure was of the nurse who first ordered it to notify her and that did not happen. The DON stated they try to keep their E-kit stocked with whatever medications residents have ordered. When it was noted hydrocodone 7.5 mg was not available, they should have tried to contact the physician for an alternative. Observation and interview with Resident #36 on 11/30/23 at 11:10 AM revealed she was resting in bed with her eyes closed and responded to voice. She stated she had received some medication and was feeling better. She stated she was grateful because I have been asking for days. During a follow-up interview on 11/30/23 at 11:16 AM, ADON D showed her cell phone with text messages. She identified the texts as being between herself and NP J. The text was dated Monday, 11/27/23 at 1:49 PM and reflected, Hey, [Resident #36] has 2 hydrocodone 7.5-325 can you please reorder? The text response reflected, Ok. ADON D stated she called NP J again today and was told she was sending the triplicate again. In an interview on 11/30/23 at 11:30 AM, the Administrator and Regional Operations Manager stated there was no policy regarding reordering medications. The Administrator said the medications should have been ordered and they knew the resident had missed 9 doses of regularly scheduled hydrocodone 7.5.mg. They said the nurse should have informed the ADON or DON and the emergency meds should have contained the correct dose for the resident. The Administrator said they failed to have the appropriate medications on hand, in the emergency dispenser, and the staff did not tell anyone they needed to be ordered - they said this was a concern and placed the resident in harm due to missing their pain medication. The Administrator and Regional Operations Manager stated the Regional Nurse Consultant was at home and ill. A telephone interview with the Medical Director on 11/30/23 at 12:08 PM revealed he was Resident #36's attending physician. He stated he had been made aware of an issue with Resident #36's prescription and had just stopped by the facility and provided an order for a one-time dose of pain medication for her while the prescription was sorted out with pharmacy. He stated he was aware she had chronic pain issues which was why he had previously consulted pain management physician. He stated he had not been notified before today there was any issues with her medication availability. He stated Resident #36 had bad arthritis. He stated he had not had any issues or concerns regarding residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 45 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 receiving their medications. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 11/30/23 at 12:12 PM, the DON provided a list of all facility residents receiving pain medications. She stated she had conducted an audit of all medication carts and ensured all residents receiving pain medications had medications available. Residents Affected - Some During an interview on 11/30/23 at 12:16 PM with ADON D stated she should check pain scales when residents receive pain medications and every shift. She stated she recalled checking Resident #36 on Tuesday, 11/28/23 and she was sleeping so she coded a 0/10. She could not recall what time she checked her or if she checked her again during her shift. She did not respond when asked about coding Resident #36's pain level as a 0 on 11/29/23 and again that morning, even though we had both seen she was in pain. She stated Resident #36 received her last dose of hydrocodone on Tuesday, 11/28/23. ADON D was shown Resident #36's MAR and asked to clarify because the last dose was signed out on Monday, 11/27/23 at 7:00 PM. ADON D stated she would check her computer. She stated she contacted the pharmacy on Wednesday, 11/29/23 and was told the medication had been ordered and was enroute. She stated when it hadn't arrived at the end of her shift, she let LVN F know the medication was not there. She confirmed she did not notify the physician the medications were unavailable. An interview on 11/30/23 at 2:09 PM with LVN H revealed he worked the 10:00 PM to 6:00 AM shift and had cared for Resident #36. He stated the day shift had reported her hydrocodone was not available. He stated he discussed the situation with Resident #36 and let her know she had PRN medications available. LVN H stated Resident #36 would sometimes sleep through her dose hydrocodone on his shift and he did not recall her complaining of pain during his shift. He stated lately she had been sleeping better since getting scheduled medications. LVN H stated, if scheduled medications were not available for administration, he would report the information on the 24-hour report, but Resident #36's information had already been documented. He stated if she had been acting like she was in pain or throwing a fit he would have called the physician. When asked about his rating of her pain as 7/10 on her MAR for his shift, LVN H stated, What they say, may or may not be what's happening. He stated he provided other means for relief such as repositioning. LVN H stated medications should be ordered 3-5 days ahead of time to ensure availability. In a telephone interview on 11/30/23 at 5:00 PM, NP J confirmed she worked under a pain management specialist. She stated she had received a request to refill Resident #36's hydrocodone on 11/27/23 and sent the prescription to the pharmacy the same day. She stated, for some reason, the prescription did not go through. NP J stated she knew Resident #36 well and she needed her pain medication. She stated the nurses usually sent the request further ahead of time, two to three days before because the pharmacy takes a few days to fill it. She stated the nurses knew they should order it at least two to three days ahead. NP J stated she did not know when Resident #36 received her last dose but when she was told it was still unavailable, she called the pharmacy right away. She stated she did not know the script never went through. NP J stated Resident #36 had orders for [muscle relaxer] and Tylenol as well and the nurses could have administered those. She stated, if the resident was in severe pain, the nurses could have called her for an E-kit order. Record review of Resident #36's progress notes revealed the most recent nurse's entry was dated 11/13/2023. The following entries were made after surveyor inquiry: 11/29/2023 9:14 AM: [Recorded as Late Entry on 11/30/2023 08:35] This writer spoke with pain management about the resident medication is unavailable, resident rated pain 10/10, contacted pharmacy and was told that medication has been ordered, will continue to monitor for any changes in condition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 46 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Signed by ADON D Level of Harm - Immediate jeopardy to resident health or safety 11/30/2023 8:35 AM: This writer assessed resident this morning, pain medication has not been delivered, resident rated pain 10/10, prn was being given, called the physician and received an onetime dose for Hydrocodone 10-325, also reached out to [NP J] (pain management) but no answer yet, left message, will continue to monitor for any changes of condition. Signed by ADON D. Residents Affected - Some 11/30/23 10:49 AM: Interviewed resident about pain. Resident stated that she is improved somewhat from the administration of muscle relaxer but states her pain is still a 10 in the bilateral [both sides] legs. Informed resident that we had a onetime dose of 10-325 hydrocodone for her. Administered the 10/325 hydrocodone and will re-assess pain. Signed by DON. 11/30/23 11:50 AM: Resident notes with eyes closed, easily aroused, resident denies any pain at this time level 0/10. Signed by ADON E. Record review of resident #36's Controlled Drug Record for her hydrocodone 7.5-325 mg revealed the final entry was dated 11/27/23 and reflected the last dose was signed out on Monday, 11/27/23 at 8:00 PM. Amount Remaining reflected 0. Record review of the facility's Policy and Procedure titled Medication Administration dated 12/2018 revealed the following: POLICY It is the policy of this home that medications will be administered and documented as ordered by the physician and in accordance with state regulations. PROCEDURE 1. Medications are prepared, administered, and recorded only by licensed nursing, certified medication aides, medical, pharmacy, or other personnel authorized by state laws and regulations to administer medications . 8. Medications are administered within 60 minutes of scheduled time, unless otherwise specified by the physician. The resident's MAR is initialed by the person administering a medication, in the space provided under the date, and on the line for that specific medication dose administration .10. If a dose of regularly scheduled medication is withheld or refused, the space provided on the front of the MAR for that dosage administration is initialed and circled. The physician will be notified if medication is routinely refused. Record review of the facility's Policy and Procedure titled Pain Management dated 12/2018 revealed the following: POLICY It is the policy of this home that residents experiencing pain will be assessed and pain management provided to the degree possible to provide comfort and enhance the resident's quality of life. Procedure 1. Each resident's pain will be assessed using the [Pain Assessment] in the clinical software, upon admission, re-admission, the onset or an increase in pain, quarterly and whenever there is a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 47 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some significant change in condition that may cause an increase in pain .5. The home will treat the resident under the premise that pain is present whenever the resident says that it is .10. The physician will order appropriate pain medication intervention both routine and PRN to address the individual's pain. 11. Residents with unrelieved pain will be evaluated by the nurse and the physician notified. Pain interventions will be adjusted accordingly and may include non-pharmacological measures. Record review of the facility's Policy and Procedure titled Medication-Unusual Occurrences dated 12/2017 revealed the following: Policy: It is the policy of this home to administer medications within the Standards of Practice and in compliance with Regulatory Guidelines. Definitions: Medication Error: A medication error occurs when a medication is administered in any manner that is inconsistent with the physician's order for that medication. Medication errors include, but are not limited to, administering the wrong medication, administering at the wrong time, administering the wrong dosage strength, administering by the wrong route of administration, and/or administering to the wrong resident . Procedure: 1. Unusual occurrences may be medication errors and/or adverse drug reactions. Medication errors and adverse drug reactions shall be immediately reported to the resident's physician and the Director of Nursing .4. Licensed nurses who observe such unusual occurrences are to: a. Take whatever immediate action is necessary to protect the resident's safety and welfare. b. Report the incident immediately to the Director of Nursing. C. Make the appropriate records and notifications required above The Administrator and Regional Operations Manager were notified on 11/30/23 at 12:51 PM that Immediate Jeopardy and Substandard Quality of Care had been identified in the area of Significant Medication Errors. The IJ Template was provided to the Administrator and DON on 11/30/23 06/08/2023 at 1:12 PM and they were informed the POR was due to HHSC by 2:30 PM on 11/30/23. The following Plan of Removal submitted by the facility was accepted on 12/1/23 at 2:48 PM and reflected: 11/30/2023 Plan of Removal - F-760 Medication Error- Immediate Action Taken Resident Specific The facility failed to ensure Resident #36 received her physician-ordered pain medication, Hydrocodone 7.5 milligrams (mg), every 6 hours due to the facility failing to re-order the medication after the last dose was administered on Monday, 11/27 /23, at 7:00 PM. As of 11/30/23, the resident has missed a total of 9 doses. The resident reports having pain at a level of 10 out of 10 on the pain scale. Physician was notified/Medical director on 11/30/2023. Residents was immediately assessed for pain by the DON resident stated her pain was a 10/10 Alternative medication Norco 10/325mg one time dose Resident was reassessed in 1 hour by charge nurse after alternate medication was administered resident was asleep. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 48 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Medication Error form completed. Level of Harm - Immediate jeopardy to resident health or safety Pharmacy called by the DON awaiting medication to arrive. Residents Affected - Some Residents will be monitored for pain daily all negative findings will be giving to the DON/ designee. System Changes 100% Audit will be completed of all resident's pain risk to ensure all at risk residents have been identified. Audit was initiated on 11/30/2023 and will be completed on 12/1/2023 by Nurse managers. DON/designee will monitor medication available report daily to ensure all medications are given as ordered to address any possible significant medication errors. System initiated on 11/30/2023. Education Regional Nurse Consultant, RNC educated DON/ADON/MDS if a resident is out of pain medication to notify the MD and DON immediately on 11/30/23. DON/Designee will educate Nurses CMA's if a resident is out of pain medication to notify the MD and DON immediately. Initiated on 11/30/2023 and will continue until all nurse / CMA's have been educated prior to working the floor. DON/Designee will educate staff on when to re-order medications. Initiated on 11/30/2023 and will continue until all nurse / CMA's have been educated prior to working the floor. DON/Designee will in-service on the availability of medication in the E-kit and calling the physician for any medications not available for an alternative dose or alternate medication that is available in the E-kit not following these instructions will result in disciplinary action. Initiated on 11/30/2023 and will continue until all nurse/CMA's have been educated prior to working the floor. Monitoring DON/Designee will randomly interview resident daily. Initiated on 12/1/2023 and 12/31/2023 end [sic] Residents will have a pain risk observation completed quarterly. Administrator and RNC will review each task overseen by DON / Designee weekly beginning 12/1/23 and will end 12/31/2023 to ensure tasks are completed. At that time further review will be conducted through the QAPI process. Monitoring of the facility's Plan of Removal included the following: Interview with the DON on 12/1/23 at 3:00 PM revealed in-service training was initiated on 11/30/23 and was still in progress. The training topics included identification of signs and symptoms of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 49 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some pain, how and when to re-order medications, and proper documentation of pain medication administration. In-service content and sign-in sheets were requested for review. Interviews were conducted on 12/1/23 from 3:40 PM to 4:05 PM with direct care nurses including ADON E, 1 GVN, 1 RN and 2 LVNs. The staff indicated they had been in-serviced on pain management including assessments, medication administration and documentation. The staff stated they would contact the attending physician and DON immediately if any medications were unavailable and check the E-kit for availability. The staff stated medications should be re-ordered one week in advance of the last dose. In an interview on 12/1/23 at 4:20 PM, ADON D stated she had received in-service training from the Regional Nurse Consultant. She stated medications should be re-ordered a week ahead of the last dose available. ADON D acknowledged the failure to administer scheduled medications was a medication error. She described the risks of medications errors as increased blood pressure for a resident who didn't receive their blood pressure medications and stated residents who did not receive their ordered pain medications as at risk suffering more from pain. She stated the resident's physician and DON should be notified of any medication errors. In an interview on 12/1/23 at 4:18 PM, the DON revealed she had been in-serviced by the Regional Nurse Consultant and was still in progress in-servicing all staff. She stated medications should be ordered approximately a week in advance. The DON stated all nurses should be assessing residents for pain every shift and as needed. She explained residents should also be assessed around the administration of pain medications and treatments. She stated she was also in-servicing CNAs regarding pain assessments as well. She had instructed them to report any signs of pain to the charge nurse and to come to her if they felt the resident's pain was not managed. She stated she had begun auditing pain assessments and will continue to monitor to ensure completion. The DON stated, if medications were not available, the nurses should check the E-kit for availability. She stated she printed the inventory and placed it with the E-kit machine so that nurses could more quickly check availability. If the medication was not available, the nurse should contact the physician and the DON to obtain an order. The DON stated any medication errors were to be reported immediately to the physician and herself and monitor the resident. She stated she was responsible for investigating and documenting the errors. The DON stated all staff currently working had received their in-service training. All staff not yet trained will receive in-service prior to beginning their next shift. During an interview on 12/1/23 at 4:50 PM, the Regional Director of Operations stated he felt all the problems identified came down to communication. He stated medication issues should start with the nurse and move up the chain. He stated he had periodically attended the facility stand-up meeting and planned to attend more regularly and monitor the situation. The Regional Director of Operations s[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 50 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Potential for minimal harm Based on interviews and record review, the facility failed to have a policy regarding use and storage of foods brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption for 1 of 1 facility, in that: Residents Affected - Many The facility did not have a policy regarding use and storage of food brought to residents by family and other visitors to ensure safe and sanitary storage, handling, and consumption. This failure could place residents at the facility who received food from outside sources at risk for foodborne illnesses. The findings were: Record review of an email received on 11/29/2023 at 1:24 PM from the ADM stated, The facility does not have a policy on foods brought in by visitors. Interview on 11/29/2023 at 2:20 PM with the Dietary Manager, requested the facility's policy for foods brought into the facility by visitors. The Dietary Manager was advised that the ADM stated that the facility did not have a policy. The Dietary Manager stated that that he has been at the facility for 2 months and he was unsure if the facility had the requested policy. The DM stated that he would speak with his Dietician and his Corporate Office to try to obtain more information. Interview on 11/30/2023 at 10:50 AM with the ADON stated she was unaware that the facility had a policy for food brought into the facility from visitors. The ADON stated she was unaware that the facility provided any form of education or training to the residents and/or visitors regarding brought into the community from outside sources. The ADON stated she has observed several residents bring outside food into the facility. Record Review of an email sent by the ADM on 11/30/2023 at 4:45 PM included an attachment with a Policy Outside Food and Special Events dated 12/05/2019. The policy indicated residents have the right to participate in events and consume foods brought into the community from outside sources. The community will provide the resident and family education on the basics of food safety and the use and storage of food to ensure safe consumption. If the resident chooses to consume a food or beverage that is not within the guidelines of the physician's order, education will be provided, and the food will be served in the safest manner possible that can be agreed upon by the resident. Interview on 11/30/2023 at 5:00 PM with the ADM stated that there should be some documentation in relation to the training and would provide the documentation. The facility failed to provide documentation of the education to by residents, families, and visitors regarding outside food being brought into the facility prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 51 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 5 residents (Resident #68) observed for infection control. Residents Affected - Some 1. The facility failed to ensure clean linen closets were kept sanitary. 2. ADON D failed to complete hand hygiene while providing wound care to Resident #68 These failures could place residents at risk of cross-contamination resulting in infections. Findings included: 1. An observation of the Clean Linen Closet in the Secured Unit, on 11/28/23 at 11:48 AM revealed a pair of white running shoes on the bottom shelf, resting on top of clean linen. In an interview on 11/28/23 at 12:23 PM, CNA B said the clean linen closet should only contain clean linen. She stated she did not know why running shoes were in the closet. She said the laundry staff stocked the closet and all staff were responsible to ensure the closet was kept clean to prevent cross-contamination. In an interview on 11/30/23 at 9:49 AM, the DON stated she expected laundry staff to ensure only clean linens were in the Clean Linen Closets. She said running shoes on the shelf along with clean linens posed a potential risk of cross-contamination. In an interview on 12/1/23 at 2:41 PM, the Housekeeping/Laundry Supervisor stated only clean linens should be kept in the Clean Linen Closets. He said the shoes were likely sent to laundry and returned to the Unit cleaned and placed in the linen closet. He said they should be returned to the resident's room. He said the shoes in the Clean Linen Closet posed a risk of cross contamination. He stated laundry staff stocked clean linen in the closet. He said he had done verbal in-services on handling linens but did not have a record of the time or date. Record review of the facility's undated Laundry and Linen Storage Policy, policy reflected: Clean laundry must be handled in such a way that contamination is avoided during transport and storage. Clean linen should always be stored in a clean, dry designated area, preferably in a purpose-built cupboard. It is the responsibility of the person disposing of the linen to ensure it is segregated properly. 2. Review of Resident #68's face sheet dated 11/30/2023 reflected the resident had the following diagnoses, pressure ulcer of unspecified heel Stage 4, pressure ulcer of right heel Stage 4, chronic kidney disease, Stage 4 (severe), lack of coordination and muscle weakness (generalized). Review of Resident #68's care plan revised on 11/09/2023 reflected, Problem: Resident is at risk for pressure ulcer due to limited mobility 08/29/2023, resident has a stage 4 pressure ulcer on the right lateral ankle due to limited mobility. Resolved on 10/26/23. 10/19/23, [Resident #68] was seen by the podiatrist for in grown toenail, new ABT ordered for treatment. 10/05/23 Resident has stage 4 pressure ulcer on the left lateral ankle, and left medial ankle, stage 4 wound on the left medial (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 52 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 foot. 10/26/23 Level of Harm - Minimal harm or potential for actual harm Observation on 11/29/23 at 11:38 AM with ADON D revealed her completing wound care on Resident #68. ADON D completed hand hygiene and gloved. Resident #68 was in bed and ADON D positioned the resident and took off the resident's boot on the left foot. ADON D then took off the dressings on the left foot which had two wounds to the left media ankle. ADON D then cleaned both wounds at the same time with the same gloves. After cleaning the wounds there was no form of hand hygiene or change of gloves. ADON D proceeded and squeezed some Santyl ointment to gloved finger and applied to the left media ankle wound and then applied the xeroform petrolatum dressing and then dry dressing. With the same gloves, ADON D proceeded to apply the clean dressing to the left medial ankle by applying the collagen sheet and xeroform petrolatum dressing then applied the dry dressing. Residents Affected - Some In an interview on 11/29/23 at 12:05 PM, ADON D stated she was the Infection Preventionist. ADON D stated she was supposed to clean hands before and after care. She stated she did not use the hand sanitizer or wash hands after cleaning the resident's wound because she had changed her gloves, (she was not observed changing gloves during the care). ADON D was made aware she was not observed change gloves. ADON D stated there was no need to complete hand hygiene or wash hand hands after cleaning the resident's wounds so long as she changed gloves. The staff stated the facility policy also did not indicate the staff was supposed to wash hands in-between care or if someone changed gloves. Interview on 11/29/23 at 3:05 PM with ADON D, she stated she talked with the DON and the DON informed her she was supposed to use the hand sanitizer and change gloves during wound care after cleaning the resident's wound to prevent the spread of infection. In an interview on 11/30/23 at 11:33 AM with the DON, she stated she expected ADON D to complete hand hygiene before care, after taking off the dirty dressing and cleaning the wound and when applying the clean dressing. The staff was to complete hand hygiene and change gloves to prevent Infection control. The DON stated the ADON was to change gloves and complete hand hygiene after cleaning the resident's wound. The DON stated in-service on infection control was completed on 11/25/23. The DON stated she completed observation with ADON D on wound care, but she did not have a check-off on wound care. Review of the facility's Hand Washing policy, revised December 2017 reflected: POLICY It is the policy of this home that hand hygiene is the primary means to prevent the spread of infection. Hand hygiene products and supplies (sinks, soap, towels, alcohol-based hand rub) shall be readily available and convenient for staff use to encourage the compliance with hand hygiene. PROCEDURE Washing hands: 1. The use of gloves does not replace proper hand washing. The following equipment and supplies will (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 53 of 54 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 455463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Health and Rehabilitation Center 8383 Meadow Rd Dallas, TX 75231 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 be necessary when performing this procedure: Level of Harm - Minimal harm or potential for actual harm a. Running water; Residents Affected - Some b. Soap (liquid or bar, anti-microbial or non-antimicrobial); c. Paper towels; d. Trash can; e. Lotion; and f. Alcohol-based hand rub containing 60-95% ethanol or isopropanol. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455463 If continuation sheet Page 54 of 54