Health inspection·December 27, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few aware of the discharge she would have assisted in finding safe placement for Resident # 1. The SW stated she did not assist with the immediate discharge and she did not have any knowledge of. During an interview on 12/27/2024 at 6:00 p.m., the OM stated he did not contact the local ombudsman of the immediate discharge. The OM did not give a reason to why the local ombudsman was not contacted. The OM stated he thought he could issue a 30 days discharge immediately when it was behavior related. The OM stated he know to follow the provider letter when issuing 30 day discharges. Review of long-term care regulation provider letter dated 12/29/2022 reflected If a NF initiates a resident discharge, the facility must provide written notification of the discharge-in a language and manner the resident can understand-to the resident, the resident representative (if applicable), and a representative of the Long-Term Care Ombudsman Program, at least 30 days before the intended discharge date . A NF is required to provide a resident with enough preparation regarding his or her discharge so that it may be safe and orderly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 2 of 5 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0624 Prepare residents for a safe transfer or discharge from the nursing home. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to provide and document sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility for one (1) of one resident reviewed for transfer and discharge rights. (Resident #1) Residents Affected - Few The facility failed to make arrangements for a safe discharge for Resident #1. This failure could place residents at risk for not receiving care and services to meet their needs upon discharge. Findings included: A record review of Resident #1's face sheet undated reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1's diagnosesis were Alzheimer's disease (type of dementia that affects memory, thinking, and behavior), dementia (memory loss), and major depressive disorder (loss of interest in activities). A record review of Resident #1's Quarterly MDS assessment, dated 09/26/2024, reflected the resident had a BIMS score of 3, which indicated severe cognitive impairment. Review of Resident #1's 30-day discharge letter dated 12/10/2024, revealed Resident #1 was given the 30-day discharge letter on the same date (12/10/2024) she was discharged to the hospital. Review of Resident #1's Discharge Planning and Summary date 12/10/2024, revealed Resident #1 was sent to the hospital for behaviors. Attempted an interview on 12/27/2024 at 10:49 a.m. left message for the local ombudsman to return call. During an interview on 12/27/2024 at 12:45 p.m., the FM stated she or the RP never received a call that the resident was being transferred out of the facility and was not able to return. The FM stated on 12/10/2024 at 2:00 p.m., The OM had left a voice message stating Resident #1 was sent out to the hospital for behaviors. The FM stated Resident # 1 had dementia and was not able to understand. The FM stated Resident # 1 was admitted to the hospital 12/10/2024 and was released on 12/13/2024. The FM stated the OM stated Resident #1 was not allowed back at the facility due to her behaviors. The FM stated that Resident # 1 was safe and was admitted to another nursing facility on 12/13/2024. The FM stated that it was very unacceptable to not notify the family and let them know Resident # 1 was not able to return to the facility after being sent out to the hospital. During an interview on 12/27/2024 at 4:56 p.m., The SW stated that Resident # 1 had a history of behaviors but she did not know Resident # 1 was being discharged on 12/10/2024 to the hospital. The SW stated if she had been made aware of Resident #1 being discharged , she would have assisted with finding a safe place for Resident #1. The SW stated the OM was responsible for distributing the 30-day notice and notifying Resident # 1 and her RP. The SW stated it was expected to give a 30-day notice to make the family aware of Resident #1 being discharged . The SW stated not providing a 30-day's notice does not give time to find the resident placement. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 3 of 5 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 12/27/2024 at 5:20 p.m., The BOM stated she was notified on 12/10/2024 through teams 'application that Resident #1 was going to be discharged to the hospital. The BOM stated she was aware Resident #1 was not returning to the facility due to behaviors. The BOM stated a 30-day discharge was given prior to Resident # 1 leaving for the hospital. During an interview on 12/27/2024 at 5:45 p.m., The DON stated that Resident # 1 did not have a medical emergency but was sent out to the hospital for behaviors. The DON stated Resident # 1 was issued an immediate discharge on [DATE] the same day she had left for the hospital. The DON stated Resident # 1's behaviors were a risk to residents and she was not able to return to the facility. During an interview on 12/27/2024 at 6:00 p.m., The OM stated that Resident #1 was sent out to the hospital for behaviors and no medical emergency. The OM stated Resident # 1 was given a 30-day notice when she left for the hospital on [DATE]. The OM stated Resident # 1 was not allowed to come back due to her behaviors. The OM stated it was expected to give a 30-days' notice and he had followed the provider letter. The OM stated he thought he could use an immediate discharge when there is a behavior with a resident, and you want to be able to keep all residents safe. The OM stated he tried to reach the RP by phone but was unable to reach the RP, and he left a message to advise Resident #1 had been sent out to the hospital. The OM stated when a 30-day's notice was not given you would not have time to find safe placement for a resident. Review of long-term care regulation provider letter dated 12/29/2022 reflected If a NF initiates a resident discharge, the facility must provide written notification of the discharge-in a language and manner the resident can understand-to the resident, the resident representative (if applicable), and a representative of the Long-Term Care Ombudsman Program, at least 30 days before the intended discharge date . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 4 of 5 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 455486 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ennis Care Center 1200 S Hall St Ennis, TX 75119 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure the comprehensive care plan described the services that were to be furnished to attain or maintain the residents' highest practicable physical, mental, and psychosocial well-being for 1 of 5 residents (Resident #1) reviewed for comprehensive care plans. The facility failed to ensure Resident #1's comprehensive care reflected Resident #1's resolved at risk for elopement goal of the date initiated, revised, and target. Resident # 1's goal was left blank on the comprehensive care plan. This deficient practice could place residents at risk for not reaching their goals due to inaccurate care plans. Findings included: A record review of Resident #1 's face sheet undated reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1's diagnosesis were Alzheimer's disease (type of dementia that affects memory, thinking, and behavior), dementia (memory loss), and major depressive disorder (loss of interest in activities). A record review of Resident #1's Quarterly MDS assessment, dated 09/26/2024, reflected the resident had a BIMS score of 3, which indicated severe cognitive impairment. A record review of Resident #1's care plan, dated 12/27/2024, did not reflect the resolved at risk for elopement related to or the goal. Resident #1's goal did not reflect the date initiated, revised, or target date of when the at risk for elopement was resolved. During an interview on 12/27/2024 at 12:45 p.m., the FM stated Resident # 1 was discharged from the facility 12/10/2024 when she was sent out to the hospital. Resident # 1 was discharged from the hospital on [DATE] to another nursing facility the same day she was released from the hospital. During an interview with the DON on 12/27/2024 at 5:45pm, The DON stated that she was responsible for making sure the care plan was accurate. The DON stated there may had been a glitch that she was not aware of with the PCC . The DON stated the goals dates automatically update when updates are made to the care plan and when they are resolved . The DON stated the goals on the care plan should include the date initiated, revised, and target date. The DON stated when the care plans are not accurate the resident's needs and goals are not met. During an interview with the OM on 12/27/2024 at 6:00 pm, The OM stated that it was the DON's responsibility to make sure the care plans are accurate. The OM stated it was expected for the care plan focus , goals, and interventions to be updated when there was a change to the care plan. The OM stated when the care plans are not updated the need of the resident would not be met. A record review of the facility's Care Plans, Comprehensive Person-Centered policy, revised 2022, reflected A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455486 If continuation sheet Page 5 of 5