Health inspection·June 2, 2023

F 0695 Level of Harm - Minimal harm or potential for actual harm result of excess protein in your urine with unspecified morphologic (the science of the form and structure of organisms) changes. Record review of Resident #20's Quarterly MDS dated [DATE] reflected she had a BIMS score of 12 indicating intact cognition. Residents Affected - Some Record review of Resident #20's physician's orders dated 02/12/2023 revealed Resident #20's O2 filter to be assessed for placement and cleanliness every week on Sunday and PRN and change O2 tubing/water/every week on Sunday and PRN. Record review of Resident #200's 06/01/2023 face Sheet reflected she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of chronic combined systolic (congestive) and diastolic (congestive) heart failure, mild cognitive impairment, and cerebral infarction. Record review of Resident #200's Quarterly MDS dated [DATE] reflected she had a BIMS score of 3 indicating severe impairment. Record review of Resident #200's physician's orders dated 05/23/2023 revealed Resident #200's O2 filter to be assessed for placement and cleanliness every week on Sunday and PRN and change O2 tubing/water/every week on Sunday and PRN. Record review of Resident #202's 06/01/2023 face Sheet reflected she was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of Abdominal pain, Nausea with vomiting, Hypokalemia ( Low potassium level in blood), Rectal abscess, Generalized Anxiety disorder, Hypertension (High Blood pressure), Parkinson's disease, Seasonal allergy, Hyperlipidemia ( High level of fat in Blood), Kidney failure, Dementia, Psychotic disturbance, Mood disturbance, Restless legs syndrome and Tobacco use . Record review of Resident #202's Quarterly MDS dated [DATE] reflected a BIMS score of 99 out of 15 indicating the resident was unable to complete the interview. Record review of Resident #202's physician's orders dated 05/22/2023 revealed Resident #200's O2 filter to be assessed for placement and cleanliness every week on Sunday and PRN and change O2 tubing/water/every week on Sunday and PRN. Observation on 05/31/2023 at 10:25 AM revealed Resident #10's 02 humidifier had the date 05/22 written on the outside of the humidifier. There were no dates on the O2 tubing. Observation on 05/31/2023 at 10:00 AM revealed Resident #20's 02 humidifier had the date 05/22 written on the outside of the humidifier. There were no dates on the O2 tubing. Observation on 05/31/2023 at 10:45 AM revealed Resident #200's 02 humidifier had the date 05/23 written on the outside of the humidifier. There were no dates on the O2 tubing. Observation on 05/31/2023 at 10:57 AM revealed no dates written on Resident #202's 02 humidifier or tubing. Interview on 05/29/2023 at 3:30 PM with the DON revealed every seven days residents' 02 nebulizer and tubing should be changed and the date of change should be written on the nebulizer and tubing. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 2 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Because staff did not date the nebulizer and tubing there was no information reflecting the last time it had been changed or if it has ever been changed. If there was a date on the nebulizer that was past seven days, then the physician's order was not followed. The DON revealed that there was an order in the MAR for the nebulizer and tubing to be changed and the MAR gave staff directions when to change the nebulizer and the tubing (O2 filter to be assessed for placement and cleanliness every week on Sunday and PRN and change O2 tubing/water/every week on Sunday and PRN). DON revealed that if the nebulizer and the tubing were not changed or not changed according to the physician's order, the resident could get an infection. Review of Equipment Change Schedule dated 08/2016 reflected nasal cannula - change every seven (7) days and as needed basis or per State regulations. Humidifier - change with circuit (detects proper activity from the sensor) every seven (7) days and prn. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 3 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 - 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 pain management is provided to resident who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 4 residents (Resident #24) reviewed for pain management. Residents Affected - Few The facility failed to administer pain medication to Resident #24 on 06/02/23, resulting in prolonged pain for the resident. This failure could result in worsening of pain and injury to residents. The findings were as follows: Review of the face sheet for Resident #24 dated 06/02/23 reflected a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Transient Cerebral Ischemic Attack (stroke), Hypertension (High blood pressure), Weakness, Pain in right shoulder, Need for assistance with personal care, Unspecified abnormalities of gait and mobility, Unspecified mononeuropathy (nerve damage that are not of brain and spinal cord) of left upper limb, Nicotine dependence, Insomnia due to medical condition, Anxiety disorder, and Major Depressive Disorder, Record Review of Resident #24's quarterly MDS assessment dated [DATE] revealed Resident #24 had a BIMS score of 13 indicating Resident #24 was cognitively intact. Resident #24's ICD code for Pain in Right Shoulder was M25.511 Review of the care plan for Resident #24 dated 09/05/22 reflected the following: I am at risk for pain related to TIA, CAD. Administer pain meds as ordered by physician. Assess for pain on admission and as needed thereafter. Notify physician of concerns or if pain persists. Review of the physician orders for Resident #24 reflected the following: Acetaminophen-Codeine #3 Tablet: 300-30 MG (Acetaminophen-Codeine). Give 1 tablet by mouth two times a day related to pain in right shoulder. (Order Date was 07/28/22 at 17:01and the Facility Time Code was 6a-10a; 6p-10p). Gabapentin Oral Capsule 300 MG (Gabapentin). Give 1 capsule by mouth two times a day for nerve pain hold for sedation. (Order Date was 05/15/23 at 13:34 and the Facility Time Code was 6a-10a; 6p-10p). tiZANidine HCl Tablet 4 MG: Give 1 tablet by mouth every 8 hours for Muscle spasms, back pain. (Order Date was 02/22/22 at 10:05 and the Facility Time Code was 0700, 1500, 2300). HYDROcodone-Acetaminophen Tablet 5-325 MG. Give 1 tablet by mouth every 8 hours as needed for chronic pain. (Order Date was 12/15/2022 at 11:45 and the Facility Time Code was PRN every 8 hours). Tylenol Tablet 325 MG (Acetaminophen). Give 2 tablet by mouth every 6 hours as needed for Pain - Mild APAP NTE. 3gm/24 hours *reassess pain level one hour after medication administration*do not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 4 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 exceed 3000mg (3gm) per day. (Order Date was 04/12/23 at 17:56 and the Facility Time Code was PRN every 6 hours). Level of Harm - Actual harm Residents Affected - Few Observation and interview on 06/02/23 at 9:00AM revealed Resident #24 sitting at the edge of his bed. He was restless, shivering, wincing, pursing his brow, and sweating. Every now and then he grimaced and sucked air through his teeth. Resident #24 stated he was in severe pain since he woke up at 6: 00AM. Resident #24 stated his left shoulder and leg were hurting badly. He reported a staff responded to his call light in the morning and told him that the nurse who administer medications would arrive soon. When the investigator asked what time, he had talked to the staff, he stated it was a while ago. When the investigator asked about his pain level on a 0-10 scale where 10 was the highest, he said it was 8. Review on 06/02/23 at 9:30AM of the June 2023 MAR of Resident #24 (who resided in Hall 300) reflected that none of his morning medications were administered. This included scheduled pain medications, pain medications scheduled on liberalized medication pass time (a period instead of a specific time) and PRN pain medications. During an interview on 06/02/23 at 10:00AM, LVN B stated she was called in to work and towards the final stage of administering medications to the residents in Hall 300. When the investigator asked about the morning medication schedule, LVN B stated she had time to finish it until 11AM and there were only two more residents left for administering medication. Review on 06/02/23 at 1:23PM of the June 2023 MAR for Resident #24 reflected: There was no assessment of pain at the time of the administration of medication administration at 9:37AM. Review of Nursing MAR indicated the assessment of pain scheduled at 6:00 AM to 6:00PM and it was not done. Acetaminophen-Codeine #3 Tablet: 300-30 MG was scheduled on liberalized time. The morning medication was scheduled to administer between 6AM and 10AM and it was administered by LVN B to Resident #24 at 9:37AM. Gabapentin Oral Capsule 300 MG (Gabapentin) was scheduled on a liberalized time. The morning medication was scheduled to administer between 6AM and 10AM and it was administered by LVN B to Resident #24 at 9:37AM. tiZANidine HCl Tablet 4 MG was scheduled to administer at 7AM and it was administered by LVN B to Resident #24 at 9:37AM. HYDROcodone-Acetaminophen Tablet 5-325 MG was a PRN medication, to be given every 8 hours as needed and it was administered to the Resident #24 at 3:30AM as well as 11:30AM. Tylenol Tablet 325 MG (Acetaminophen) was a PRN medication, to be given every 6 hours as needed and it was not administered on 06/02/23. During an interview with the DON on 06/02/23 at 1:45PM, the DON stated liberalized medication pass time was acceptable as long as it would not affect the residents. The DON said the facility policy of liberalized medication pass time allowed nurses to administer medications within one hour before or after the scheduled time. She explained that if the liberalized medication pass time was 6AM to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 5 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 - Actual harm Residents Affected - Few 10AM, the nurses could administer medications anytime between 5AM and 11AM and if the medication was scheduled specifically at 7AM, the nurses were allowed to give that medication anytime in between 6AM and 8AM. The DON added; however, pain medications must be administered as soon as possible irrespective of liberalized or regular time schedule. The DON stated she was not sure if any pain medication that could be on a liberalized medication pass time schedule. When asked about not administering Resident #24's scheduled pain medications until after 9:35AM, the DON stated leaving a resident in enormous pain and suffering for such a long time was not acceptable. During a telephone interview with the NP on 06/02/23 at 2:00PM, the NP stated liberalized medication pass time was not appropriate for all medication regimens. She stated medication like blood pressure medications, it was appropriate if administer same time every day. When asked about Acetaminophen-Codeine and Gabapentin, NP said, if they were prescribed twice a day the expectation was, giving them every 12 hours of interval. When asked about Resident# 24's pain medication Acetaminophen-Codeine was ordered on liberalized medication pass time, after checking the EHR, she stated it was done by previous physician and no one brought this issue to her attention for correction. She said Resident #24's Acetaminophen-Codeine should not be scheduled on liberalized medication pass time. The NP added, whether it was on liberalized medication pass time or not, it was not appropriate to keep a resident waiting with severe pain for receiving their pain medication. During a telephone interview with the MD on 06/02/23 at 2:45PM, when the investigator asked about liberalized medication pass time policy for pain medication, MD stated he did not want to answer to hypothetical questions. When the investigator asked specifically about the liberal time schedule for the Acetaminophen-Codeine of Resident #24, the MD stated he was new to the facility; started his job last week of April,23 and preferred not to commend about it until studying the situation well. During an interview on 06/02/23 at 3:00PM, when the investigator asked about the purpose of the liberalized medication pass time policy, the ADM stated it was for creating a home like environment where the residents had more freedom to choose the medication time and thus minimizes the feeling of institutionalization. When asked about the appropriateness of pain medications on a liberalized medication pass time schedule, the ADM stated she was not the right person to answer that question as she was not a clinical expertise and requested to discuss with MD, NP, or DON. When investigator asked about the facility expectation of pain management, ADM stated minimizing the suffering of any resident from pain was her priority. Review of the in-service since January 2023 reflected on 01/06/23 the facility conducted an in service on the topic Medication Error. Review of the facility policy titled Pain-Clinical protocol dated March,2018 reflected the following: 1. The physician and staff will identify individuals who have pain or who are at risk for having pain . . The ·staff and physician will evaluate how pain is affecting mood, activities of daily living, sleep, and the resident's quality of life, as well as how pain may be contributing to complications such as gait disturbances, social isolation, and falls . .With input from the resident to the extent possible, the physician and staff will establish goal of pain treatment; for example, freedom from pain with minimal medication side effects, le s (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 6 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 frequent hcad,1ehcs. or improved functioning, mood, and sleep . Level of Harm - Actual harm .1. Residents Affected - Few The staff will reassess the individual's pain and related consequences at regular intervals, at least each shift for acute pain or significant changes in levels of chronic pain and at least weekly in stable chronic pam. a. Review should include frequency, duration and intensity of pain, ability to perform activities of daily living (AD Ls), sleep pattern, mood, behavior, and participation in activities. Review of the facility policy titled Administering pain medication dated March,2020 reflected the following: .1. The pain management program is based on a facility-wide commitment to appropriate assessment and treatment of pain, based on professional standards of practice, the comprehensive care plan, and the resident's choices related to pam management. 2. Pain management is defined as the process of alleviating the resident's pain based on his or her clinical condition and established treatment goals . .6. Administer pain medications as ordered. If there are signs or symptoms of serious adverse consequences related to narcotic (opioid) analgesics (including somnolence, delirium, respiratory depression), notify the practitioner prior to administering Review of the facility policy titled Liberalized Medication Pass Times dated March,2017 reflected the following: It is the policy of the company to administer medications to residents in a safe manner that coincides with their daily activities and normal schedule. Residents will be administered their medications using liberalized medication pass times to promote a home like environment and meet the residents needs effectively. Each resident's medication time preference will be modified in accordance with his or her daily schedule. Administration window will be one hour prior to scheduled dose and one hour post scheduled dose. Medication Pass Guidelines: The following schedule will be followed when administering medications. ORDER TIME BEGINE SCHEDULE (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 7 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 END SCHEDULE Level of Harm - Actual harm Morning Medication Residents Affected - Few Pass 0600 1000 Mid-Morning Medication Pass 1000 1400 Mid-Day/Evening Medication Pass 1400 1800 HS Med Pass 1800 2200 *Any physician orders for specific medication times will supersede facility policy for liberalized medication pass times. * FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 8 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on 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 of 4 residents reviewed for Pain Management. (Resident #24) The facility failed to provide Resident #24 pain medication Hydrocodone-Acetaminophen Tablet 5-325 MG and Gabapentin Oral Capsule 300 MG as ordered. This failure placed the resident at risk of increased pain, poor sleep patterns, increased anxiety and depression, and decreased sense of wellbeing. Findings included: Review of the face sheet for Resident #24 dated 07/28/23 reflected a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Transient Cerebral Ischemic Attack (stroke), Hypertension (High blood pressure), Weakness, Pain in right shoulder, Need for assistance with personal care, Unspecified abnormalities of gait and mobility, Unspecified mononeuropathy (nerve damage that are not of brain and spinal cord) of left upper limb, Nicotine dependence, Insomnia due to medical condition, Anxiety disorder, and Major Depressive Disorder, Record Review of Resident #24's quarterly MDS assessment dated [DATE] revealed Resident #24 had a BIMS score of 12 indicating Resident #24 was cognitively intact. Review of the physician orders for Resident #24 reflected the following: Hydrocodone-Acetaminophen Tablet 5-325 MG. Give 1 tablet by mouth every 4 times a day for pain. (Order Date was 06/16/2022 at 16:00). Gabapentin Oral Capsule 300 MG (Gabapentin). Give 1 capsule by mouth two times a day for nerve pain hold for sedation. (Order Date was 06/02/23 at 18:00). Record review of the July 2023 MAR for Resident #24 (who resided in Hall 300) reflected blanks (no documentation) on the following scheduled medications on 07/04/23 hydrocode-Acetaminophen oral tablet 5-325 MG scheduled at 0600 as well as no pain assessment and Gabapentin Oral Capsule 300 MG (Gabapentin) scheduled at 6a 1. Record review of the controlled drug Administration Record Tablet dated 07/28/23 indicated Resident #24 for hydrocodone-Acetaminophen oral table 5-325 MG reflected there was not documentation for 07/04/23 at 0600. Record review of Resident #24's Progress note dated 7/03/23 at 23:59 PM (11:59) written by a Nurse reflected Pt transferred back from [NAME] hospital. No new medication orders. Pt continues to grimace but denies pain. Alert and verbally responsive. Pt want to get out of bed right away. Encourage to stay in bed to get some help. During an interview on 07/28/23 at 2:20 PM, the DON stated that she called LVN C to ask if she gave (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 9 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the medication to the resident. The DON stated LVN C told her that resident refused the medication due to being sedated after being readmitted from the ER and that LVN C told LVN D about resident refusing the medication and thought LVN D would follow up and document that resident refused the medication. During an interview on 07/28/23 at 5:00 PM, Resident #24 stated he remembers going to the ER, but he does not remember refusing his medication when he came back to the facility. He stated he does not know why he would refuse the medication and added that he would not refuse his pain medication. Attempted to call LVN C on 07/28/23 at 5:07 PM no answer left a voicemail. During an interview on 07/28/23 at 5:14 PM, LVN B stated it is not common for Resident #24 to refuse his medications, especially pain medications. She stated they always have to document if the resident received or refused the medication. During a phone interview on 07/28/23 at 5:41 PM, LVN D stated she does not remember if LVN C told her that Resident #24 refused the medication. She stated that around 5:30 AM on 7/04/23 resident was not asleep. She stated that she remembers seeing the resident on his bed resting on his right elbow looking to the hall. She stated that Resident #24 takes all his medications and added he has never refused his medication with her. She stated they should always document if residents received or refused their medication on a progress note and, on the MAR. She stated if a resident refuses the medication, they are supposed to document this specially since it is a narcotic and let the NP know. She stated the nurses are responsible for documenting when a resident refuses the medication in the progress notes and the med aid has to let the nurse know. She stated if there is no documentation that the resident received the medication, they could give the medication again to the resident. During an interview on 07/28/23 at 6:03 PM, the DON stated she expects, regardless of the resident refusing or getting the medication, there to be some type of documentation if it was given or not. She stated if there is no documentation of medication administration the resident could potentially get another dose. She stated that LVN C told her that resident was asleep when she attempted to give the medication. The DON stated that especially because the resident was readmitted from hospital she would check more closely and keep an eye on the resident just to make sure he is ok. During an interview on 07/28/23 at 6:46 PM, ADM stated the expectation is for the nurses to document why the resident refuses the medication. She stated there could be a negative outcome; when there is no documentation of medication administration, the medication could be administered twice by someone else. Review of the in-service reflected on 07/28/23 at 1430 (2:30 pm) the facility conducted an in service on the following: If a resident is sedated, asleep or refuse. Nurse must sign out the medication and indicate the reason for why it was not given. Prior to the end of the shift nurse should double check documentation to ensure all documentation is true and correct and resident does not suffer any ill effect regarding the medication being refused or held. Notify NP if more than one dose of medication is held. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 10 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 CMA should communicate to nurse if any medications were held. Level of Harm - Minimal harm or potential for actual harm Disciplinary action will be taken for missing documentation moving forward. Review of the facility policy titled Administering Medication revised April 2019 reflected the following: Residents Affected - Few 4. Medication are administered in accordance with prescriber orders, including any required time frame. 21. if a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the mediation shall initial and circle the MAR space provided for that drug and dose. 22. The individual administering the medication initials the resident's MAR on the appropriate line after giving each medication and before administering the next ones. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 11 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an infection and prevention control program that included, at a minimum, a system for preventing and controlling infections for 2 of 6 residents reviewed for the usage of Blood Pressure Monitors (Resident #45, Resident #202). Residents Affected - Few The facility failed to ensure LVN A disinfected the blood pressure monitor between Resident#45 and Resident #202. This failure could place the residents at risk for cross contamination and infection. Findings included: Review of Resident #202's face sheet dated 06/01/23reflected the resident was a [AGE] year-old female and was admitted to the facility on [DATE].The diagnoses included Abdominal pain, Nausea with vomiting, Hypokalemia ( Low potassium level in blood), Rectal abscess, Generalized Anxiety disorder, Hypertension (High Blood pressure), Parkinson's disease, Seasonal allergy, Hyperlipidemia ( High level of fat in Blood), Kidney failure, Dementia, Psychotic disturbance, Mood disturbance, Restless legs syndrome and Tobacco use. Record review of Resident #202's MDS assessment dated [DATE] revealed a BIMS score of 99 out of 15 indicating the resident was unable to complete the interview. Record review of Resident #202's MAR for May and June,2023 reflected: Lisinopril Oral Tablet 10 MG (Lisinopril), Give 1 tablet by mouth one time a day for HTN Hold if BP<110/60. Carvedilol Oral Tablet 3.125 MG (Carvedilol). Give 1 tablet by mouth two times a day for HTN Hold if BP<110/60, HR<60. Review of Resident #45's face sheet dated 06/01/23 reflected the resident was an [AGE] year-old male and was admitted to the facility on [DATE]. The diagnoses included Hypertension, Hyperlipidemia (high fat level in blood), Heart failure, Polyneuropathy (malfunction of multiple peripheral nervous), Myocardial infarction (Heart attack), Acute respiratory failure (breathing impairment) and Acute Pulmonary Edema (accumulation of fluid in lungs). Record review of Resident #45's MDS assessment dated [DATE] revealed a BIMS score of 11 out of 15 indicating the cognition of the resident was moderately impaired. Record review of Resident #45's MAR for May and June,2023 reflected: Metoprolol Tartrate Oral Tablet 25 MG (Metoprolol Tartrate): Give 0.5 tablet by mouth two times a day for HTN Hold for SBP<110 or DBP<60 or HR<60. During an observation on 06/01/23 at 10:00 AM revealed LVN A was administering medications to the residents in Hall 100. LVN A used a wrist blood pressure monitor that was kept in her scrub's pocket, to take blood pressure of Resident #202 and then administered the ordered medications. After that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 12 of 13 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 455503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosewood Heights 5700 E Central Texas Expwy Killeen, TX 76543 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few she moved on to Resident#45 and took blood pressure using the same blood pressure monitor. LVN A did not sanitize the blood pressure monitor before and after using it on Resident#202 and after the completion on Resident#45. During an interview on 06/01/23 at 10:30 AM, LVN A stated she forgot to sanitize the blood pressure monitor before and after she used it on residents. She said sanitizing the monitor was necessary to minimize the spread of transmittable diseases. LVN A stated putting the blood pressure cuff in her scrub's pocket was unsafe to the resident due to the possibility of cross contamination from her scrub. LVN A stated there were in-services on infection control every now and then. However, she did not remember if she received any in-service specific to sanitization of medical equipment. During an interview with the DON on 06/01/23 at 3:00 PM, the DON stated the staff followed the instructions in the facility policy. The DON stated medical equipment should be sanitized before and after and in between the residents to minimize the spread of transmittable diseases. She sated the staff who were non-compliant to the policy were identified by observation and then provide in-services. During an interview with the ADM on 06/01/23 at 3:30PM, she stated staff was required to follow facility policy. When the investigator asked how the facility ensured an effective infection control at the facility, ADM said the facility achieved that through tracking, infection control auditing and clinical meetings. She explained staff were constantly observed and monitored by DON to identify deficiencies in infection control. She stated the identified staff were trained and an in-service was conducted for all the staff members. Record review of the facility's in-services reflected, since 01/01/23, there were no in-services on disinfection of medical Equipment. Record review of the facility's policy Cleaning and Disinfection of Resident-Care Items and Equipment revised in 10/22 reflected: Resident-care equipment, including reusable items and durable medical equipment will be cleaned and disinfected according to current CDC recommendations for disinfection and the OSHA Bloodborne Pathogens Standard . 1 . c. non-critical items are those that come in contact with intact skin but not mucous membranes. (i) Non-critical resident-care items include bedpans, blood pressure cuffs, crutches and computers . .3. Durable medical equipment (DME) must be cleaned and disinfected before reuse by another resident. 4. Reusable resident care equipment will be decontaminated and/or sterilized between residents according to manufacturers' instructions . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455503 If continuation sheet Page 13 of 13