Inspection·November 22, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few unit for 10 (ten) years. CNA D said they used hand gestures when they communicated with Resident #2. When they took Resident #2 to the restroom, they pointed to the restroom. When it was time to eat, they gestured eating. Staff had nothing that would help them communicate in Resident #2's language. CNA D said sometimes she thought Resident #2 did understand a little bit of English. When Resident #2 was really upset or hurting, they asked LVN F to talk to her. LVN F spoke Resident #2's language and could communicate with Resident #2 successfully. She thought having more communication in Korean might be more successful for Resident #2, but no one tried that.Interview on 11/21/25 at 9:51 am with LVN F reflected she helped communicate for Resident #2 when they needed something conveyed to her, and the staff could not get her to understand. Staff in the secured unit would come and grab her to communicate with Resident #2, but this was not too often. Resident #2 was pretty directable with hand gestures. When Resident #2 was admitted to the facility, they realized she did not understand English. LVN F had never seen a communication board for Resident #2. LVN F said she was always accessible if they needed her to speak with Resident #2 and always kept her phone on her. The facility should have tried to provide a way to communicate with the residents who speak another language. The possible negative effect of not being able to communicate with a resident who speaks another language would be an unwitnessed fall. Staff could not communicate with Resident #2 to find out what happened or where she might be injured. It was everyone's responsibility to make sure they could communicate with a resident. Staff needed to tell the ADON and DON if there was a communication issue and it needed to be addressed. Interview on 11/21/25 at 10:57 am with the ADON reflected she had been the ADON at the facility for 1 (one) month. She knew Resident #2 spoke Korean, but the staff communicated with her in English. She thought it was effective because there was no other way to communicate with Resident #2. Resident #2 would sometimes randomly say words in English. If a resident who did not speak her language had an unwitnessed accident, she would speak with them in English and do the best she could to communicate with the resident. She thought it was important for effective communication to speak with residents in a way they could understand. If Resident #2 was provided a communication board, it would not hurt. Because of Resident #2's dementia, she was not sure if a communication board would be helpful, but she thought, it is worth the shot to put out the effort to help with the language barrier.Interview on 11/21/25 at 2:59 pm with the RCD reflected the facility should have absolutely have had a communication board that was customized for Resident #2. She said the negative effect of not having a communication board or using a telephone translation application was that Resident #2 could get frustrated and it was not good quality of care. Interview on 11/22/25 at 11:22 am with the Administrator reflected they had a staff member, LVN F, who spoke Korean, and she translated for Resident #2. When LVN F was not at the facility, LVN F gave them permission to call her to interpret for Resident #2. Some of the staff used the language translation application on their phones and some staff used gestures to communicate with Resident #2. She knew gestures were not the most effective. It was the responsible of the Administer to make sure that residents had access to translation or interpretation services. The negative effect of not having a translation service for LEP (limited English proficiency) residents was miscommunications of resident care services were not provided, and residents needs might not be met.Record review of the facility's policy Translation and/or Interpretation of Facility Services dated November 2020 revealed This facility's language access program will ensure that individuals with limited English proficiency (LEP) shall have meaningful access to information and services provided by the facility. Policy Interpretation and Implementation - The coordinator of this facility's language access program is the Social Service Designee or Administrator. Family members and friends shall not be relied upon to provide interpretation services for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455515 If continuation sheet Page 2 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident, unless explicitly requested by the resident. If family or friends are used to interpret, the resident must provide written consent for disclosure of protected health information.When written translation of vital information is unavailable, or impractical (i.e., an infrequently encountered language), the facility shall attempt to provide oral translation of vital documents.Interpreters and translators must be appropriately trained in medical terminology, confidentiality of protected health information, and ethical issues that may arise in communicating health-related information.Written notification of language access rights may be provided by AI (a set of technologies that empowers computers to learn, reason, and perform a variety of advanced tasks in ways that used to require human intelligence) services online for communication via translation. Competent oral translation of vital information that is not available in written translation, and non-vital information shall be provided in a timely manner and at no cost to the resident through the following means (as available to the facility):A staff member who is trained and competent in the skill of interpreting;A staff interpreter who is trained and competent in the skill of interpreting;Contracted interpreter service;Voluntary community interpreters who are trained and competent in the skill of interpreting; andTelephone interpretation service.It is understood that providing meaningful access to services provided by this facility requires also that the LEP resident's needs and questions are accurately communicated to the staff. Oral interpretation services therefore include interpretation from the LEP resident's primary language back to EnglishIt is understood that in order to provide meaningful access to services provided by this facility, translation and/or interpretation must be provided in a way that is culturally relevant and appropriate to the LEP individual. Staff shall be trained upon hire and at least annually on how to provide language access services to LEP residents. Event ID: Facility ID: 455515 If continuation sheet Page 3 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to respect a resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive for 1 (Resident #1) of 5 residents reviewed for resident rights.The facility failed to obtain a valid DNR for Resident #1 which resulted, on [DATE], in Resident #1 receiving CPR when she was found unresponsive. This failure could place residents at risk of their rights to refuse or discontinue treatment being disrespected, being resuscitated against their wishes or placed on life support.Findings included:Record review of Resident #1's face sheet, dated [DATE], revealed an eighty-four-year-old female who was admitted to the facility on [DATE]. Her admitting diagnoses included adult failure to thrive (syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol), fracture of the right femur (a break in the thigh bone, which is the longest and strongest bone in the human body), recurrent depressive disorders (the person has a history of at least two depressive episodes (depressed mood or loss of pleasure or interest in activities) for long periods of time).Record review of Resident #1's MDS (clinical assessment to determine resident's strength and needs) Quarterly assessment dated [DATE] revealed a BIMS score of zero indicating severe cognitive issues.Record review of Resident #1's care plan revealed a focus dated [DATE] reflected Resident #1 had an order for Do Not Resuscitate (DNR) with interventions dated [DATE]: 1. All aspects of DNR will be explained to Resident #1 or responsible party.2. In absence of blood pressure, pulse, respiration, CPR will not be initiated.3. Notify MD of change of condition.4. Resident #1 will be maintained at a level of comfort as ordered by physician.5. Social Services to consult with resident and RP regarding their decision to continue DNR.Record review of Resident #1's Out-of-hospital Do-Not-Resuscitate (OOH-DNR) order Texas Department of State Health Services dated [DATE] revealed it was unsigned by a physician. Record review of page 28 of Resident #1's facility admission papers dated [DATE] signed by Resident #1's RP reflected Informed Consent - I have been informed of my rights to make advanced directives for health care decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives such as Directive to Physicians and/or Living Will or Durable Power of Attorney for Health Care. Beig so informed, it is my decision to: I have previously executed a document and will supply copies to the facility for my or my relative's clinical record and physician use. Record review of Resident #1's order dated [DATE] by RN H reflected order summary DNR advance directive status current and verified. Interview on [DATE] 10:47 am with the DON reflected that she was alerted by a CNA (name of CNA unknown) that Resident #1 was unresponsive. A family member of Resident #1 was in the building. The DON said they assumed that Resident #1 was a full code because she did not have a DNR. The DON said the Resident #1 was not on hospice. The DON said she began placing her hands on Resident #1 to do chest compressions, and the family member told her to stop because Resident #1 had a DNR. She said EMS arrived and were informed by the DON that Resident #1 did not have a DNR and they began to attempt to do chest compressions and again the family member told them to stop because Resident #1 had a DNR. She said the family member received a copy of the DNR via his telephone from another family member, but the DNR did not have the signature of a MD. She said EMS received approval from a member of their team to not proceed with compressions. Interview on [DATE] at 3:38 pm with a family member of Resident #1, who was present when she died, reflected the facility did not have the correct DNR because the former nursing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455515 If continuation sheet Page 4 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility did not send it when Resident #1 was transferred to the current facility. The family said the MD's name was printed on the DNR, but it had no MD signature. He said the former nursing facility was to forward all the information about Resident #1 to her current facility. Interview on [DATE] at 10:57 am with the ADON reflected she had been the ADON at the facility for 1 (one) month. The ADON did not know the facility policy regarding resident DNRs. She said she did not know if the facility required residents to have either a DNR or full code established when they came into the facility, she stated she would hope so, but she did not know. She said she did not know who was responsible for making sure that the residents had the correct code status information when they were admitted to the facility, her first thought would be the nurse, but she did not know which nurse, she would have to look at the policy. She said it was very important to have the residents correct and complete code status because it was a matter of life and death.Interview on [DATE] at 11:32 am with LVN F reflected the charge nurse upon a residents' admission was responsible for checking the residents' code status. LVN F said the resident code status was documented in PCC (an electronic health record designed for long-term care providers, including nursing homes and senior living communities). She said she thought the admission coordinator and the social worker were responsible for making sure that the residents' code status was accurate, correct, with a completed copy in the residents' file. She said the negative effect of not knowing the residents' code status was you would not know what the resident wanted if they were unresponsive and could be violating their wishes if it was incorrect. Interview on [DATE] at 12:10 pm via phone with LVN G reflected she no longer worked at the facility. LVN G believed that the DON was responsible for making sure that the code status for residents was requested and accurate. LVN G said Hospice was also responsible. She said the negative effect of not having a clear DNR for the residents was it would go against resident rights if staff did the opposite of what the resident wanted; either to be resuscitated or not resuscitated if they coded. Interview on [DATE] at 12:58 pm with the SWD reflected she looked over the DNRs for accuracy then uploaded them into the residents' electronic file. She said sometimes the DNRs were incomplete and did not have a signature and she had to wait to upload it. She said the DON was responsible for making sure it was in the facility. She said if staff did not know a residents' code status, the resident was considered a full code and resuscitation efforts would be attempted. She said if a resident had a DNR, and resuscitation efforts were attempted, staff might go against the residents' rights and that was, a big mess up.Interview on [DATE] at 2:59 pm with the RCD reflected the nurse on admission entered in the eMAR either the residents' full code or DNR code. The admitting nurse could have asked the family what the code was when the resident admitted . She said the DON and the social worker were supposed to follow up and confirm that the facility had the correct paperwork for the code status entered by the admitting nurse. She did not know how this was missing. She said it was a big deal because the resident could have been brought back or placed on life support against her wishes. She said it was the responsibility of the social worker and the DON to confirm code status and obtain complete paperwork. She said the DON personally uploaded the DNRs into the resident's record to make sure they were there. Interview on [DATE] at 3:44 pm with the RDO reflected when a resident was referred to their facility from another facility, they had to have the DNR in hand prior to admitting the resident. The RDO did not know what happened that they did not have a completed signed DNR on hand for Resident #1. She said the nurse should not have placed the DNR order unless there was a complete signed DNR on hand. She said it should have been followed up on chart audits by the DON or the ADON. She said the negative outcome was that the resident received CPR (emergency life-saving procedure that is done when someone's breathing or heartbeat has stopped) and it was against the wishes of the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455515 If continuation sheet Page 5 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete resident. It was a resident rights issue.Interview on [DATE] at 4:58 pm with the Administrator reflected nurse managers and the DON had the responsibility of checking the admission orders within the first 24 hours of a resident's admission to make sure all documents and the admission was complete. She said there was a process that began with the charge nurse when the resident was admitted , to the admissions coordinator and the DON. She said the worst-case scenario if there was kink in the process of confirming if a resident had a DNR, was the resident could be resuscitated against their wishes, and when the resident's ultimate wishes were not respected, it was a violation of resident rights.Interview on [DATE] at 6:02 pm with the DON reflected when the charge nurse admitted a resident, the nurse needed a hard copy of the DNR that was signed and executed, and if there was not a fully executed hard copy DNR, the resident was automatically a full code. She said she did not know what happened regarding Resident #1's DNR. The DON said RN H admitted Resident #1 and RN H would have had to have had the DNR in her hand to enter the DNR order for Resident #1. The DON said she never saw a DNR for Resident #1. She said it caused Resident #1's family emotional distress when staff was going to provided Resident #1 CPR. She said a family member threatened bodily harm to the staff if they did not cease CPR because Resident #1 was a DNR.Record review of the facility's policy Do Not Resuscitate Order dated [DATE] revealed Policy Statement - our facility will not use cardiopulmonary resuscitation and related emergency measures to maintain life functions on a resident when there is a Do Not Resuscitate Order in effect. Policy Interpretation and Implementation - Do not resuscitate orders must be signed by the resident's attending physician on the physician's order sheet maintained in the resident's medical record. A Do Not Resuscitate (DNR) order form must be completed and signed by the attending physician and resident (or resident's legal surrogate, as permitted by state law) and placed in the front of the resident's medical record. Do not resuscitate (DNR) orders will remain in effect until the resident (or legal surrogate) provides the facility with a signed and dated request to end the DNR order. Verbal orders to cease the DNR will be permitted when two (2) staff members witness such request. Both witnesses must have heard the request and both individuals must document such information on the physician's order sheet. The attending physician must be informed of the resident's request to cease the DNR order. The interdisciplinary care planning team will review advance directives with the resident during quarterly care planning sessions to determine if the resident wishes to make changes in such directives. The resident's attending physician will clarify and present any relevant medical issues and decisions to the resident or legal representative as the resident's condition changes in an effort to clarify and adhere to the resident's wishes. Event ID: Facility ID: 455515 If continuation sheet Page 6 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record reviews, and interviews, the facility failed to maintain acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance, unless the resident's clinical condition demonstrates that this is not possible or resident preferences indicate otherwise for one (Resident #1) of 7 (seven) residents reviewed for weight loss.The facility failed to follow its procedures and provide effective interventions to prevent weight loss in Resident #1, who had a 10.39% weight loss between 10/09/25 and 11/03/25. Resident #1 was not weighed when she was admitted to the facility on [DATE]. Resident #1 was not weighed weekly x 4 weeks after her admission to the facility. Nutritional supplements were recommended by the RD on 10/15/25. They were ordered 11/14/25. Resident #1 died on [DATE].This failure could place residents at risk of dehydration, malnutrition, functional decline and death.Findings included:Record review of Resident #1's face sheet, dated 11/20/25, revealed an eighty-four-year-old female who was admitted to the facility on [DATE]. Her admitting diagnoses included adult failure to thrive (syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol), fracture of the right femur (a break in the thigh bone, which is the longest and strongest bone in the human body), recurrent depressive disorders (the person has a history of at least two depressive episodes (depressed mood or loss of pleasure or interest in activities) for long periods of time).Record review of Resident #1's MDS (clinical assessment to determine resident's strength and needs) Quarterly assessment dated [DATE] revealed a BIMS score of zero indicating severe cognitive issues. Record review of Resident #1's care plan revealed a focus dated 10/20/25 of Resident #1 refused to eat/resisted feeding with interventions dated 10/20/25 of 1. Administer medications as ordered. Monitor/document for side effects and effectiveness.2. Resident #1 needed encouragement/support to be independent with eating. Allow Resident #1 to feed self if desired, regardless of skill.3. Empower Resident #1 by allowing choices in mealtime, menu selection, dining location.4. Invite Resident #1 to food-related activities and offer food, beverages of choice to encourage intake. Record review of Resident #1's facility weights reflected two weight records 10/09/25 scale mechanical lift value 129.0 pounds and 11/03/25 scale mechanical lift value 115.6 pounds representing a weight loss of 10.39 percent in 25 days. Record review of Resident #1's progress notes dated 10/15/25 reflected Resident #1 refused meals. RD recommended providing supplemental support house supplement 2.0 120 ml QID in between meals; update related to food preferences to provide meals and snacks of choice. Record review of Resident #1's order dated 11/14/25 reflected diet supplement of house supplement order type medication aide supplement four times a day for house supplement 2.0 (a nutrient-dense supplement for managing weight loss, malnutrition) four times a day. Resident #1's November 2025 MAR for House Supplement four times a day for house supplement 2.0 four times a day reflected no refusals of supplement by Resident #1.Interview on 11/20/25 at 10:47 am with the DON reflected Resident #1 died on [DATE], and she was not on hospice care. The DON said Resident #1 died from failure to thrive. She said the RA did the facility weights and if the RA was not there, CNA B did resident weights. The DON said it was the responsibility of the ADON to make sure that the weights were taken. The DON said Resident #1 should have been weighed on 10/03/25 when she was admitted to the facility. The DON did not see documentation that Resident #1 refused to be weighed during Resident #1's time at the facility. She said the facility did not follow its policy for weighing residents. The DON said the possible negative effects of not weighing residents according to facility policy was that staff could not tell if residents had a significant amount of weight loss. She said when the RD entered the facility on Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455515 If continuation sheet Page 7 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 10/15/24, it would have been important to have given the RD the correct weight information for a resident who was not eating. The DON said the facility should have been on top of the weights. The DON said the RD recommended a supplement, but the supplement was not ordered until 11/14/25. She was not sure why it took so long for the order to be placed. She said Resident #1's supplement was not received timely and Resident #1's weight loss was not appropriately addressed. The DON said she knew the responsibility for weights and monitoring the ordering of supplements, fell on her. The DON said they did not know Resident #1 had that amount of weight loss, and had she known, she would have tried to get more supplements and spoken with the family to see if they would have been interested in hospice. The DON said she would have done a lot of things differently. She said the lack of addressing the weight loss could have led to Resident #1's failure to thrive and ultimately her death. Interview on 11/20/25 at 10:47 am with the RD reflected she saw Resident #1 on 10/15/25 and Resident #1 was not flagging for a significant weight loss. The RD said she saw Resident #1 on 11/11/25 for a significant weight loss. The RD said that Resident #1's weight loss would have given her a better picture of what was happening with Resident #1's nutrition. The RD said Resident #1 should have been weighed when she entered the facility. For some reason there was a gap in Resident #1's weights, and she did not know why. The RD said if the intervention she made 10/15/25 for supplements had been implemented, it might have made a difference, but she could not say for sure. The RD said she notified the DON that her recommendation made on 10/15/25 for Resident #1 to have a supplement was not ordered, the DON corrected it right away. The first weight The RD received for Resident #1 was 11/11/25. The RD stated had she known about Resident #1's weight loss, she might have added an intervention. Interview on 11/20/25 at 12:51 pm with the NP reflected Resident #1 came from another skilled nursing facility and the family wanted to hold off on hospice. The NP said she was aware that Resident #1 refused to eat. The NP said she did prescribe Resident #1 an appetite stimulate, but Resident #1 refused the medication. The NP said she ordered labs for Resident #1, and they all came back fine but Resident #1 refused food. The NP said she did not feel nutritional stimulants would have helped Resident #1, but she would have liked to have had more weights. The NP stated she had phone calls from the DON that consistently discussed Resident #1's refusal to eat. Interview on 11/21/25 at 10:57 am with the ADON reflected she had been the ADON at the facility for 1 (one) month. The ADON said CNA B, who was also responsible for transportation, was responsible for doing weights and the RA was also responsible for weights. She stated she would have to look at the weight policy before she was able to state the facility's policy for when residents should be weighed. She said maybe she was responsible for making sure residents were weighed according to facility policy, but she was unsure because she was still learning her role. She stated it was important to weigh residents and track their weight to see if they had lost weight because weight could affect everything. She stated weight can affect resident wound care, and their overall nutrition. If a resident lost weight, the facility should notify the family and the dietician to incorporate a change to the residents' diet, find out what the resident liked to eat, and encourage them to eat. In her experience, she had not been the person who was having to get resident weights. She would guess residents would be weighed on either a weekly or a monthly basis. She just knew the basics without referring to the policy. She did not do what she was supposed to do when the RD recommended supplements for Resident #1. She now knows the process of getting a RD recommended supplement ordered for a resident. If they did not check weights, residents could get malnourished and lose weight and a significant amount of weight loss could be determinantal. Even if a resident was refusing meals, weight should still be tracked so they can implement supplements accordingly. She said the possible negative effect of not implementing supplements for a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455515 If continuation sheet Page 8 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident who was not eating would be possible loss of weight. She did not know why Resident #1 died. Interview on 11/21/25 at 11:32 am with LVN F reflected it was important to weight residents to see if they were gaining or losing weight because the resident might have failure to thrive and may need a supplement. Residents should be weighed upon admission, then once a week, for 2 weeks, then 1 time a month if things were going well. The possible negative effect of not weighing a resident, who was not eating, was that you would not know the amount of weight lost, and it could be a significant change. If there was significant weight loss, the facility could bring in the RD and notify the NP or the MD, and they could add an order for supplements. If an order for a supplement was not entered for approximately a month, the resident could continue to lose weight. Interview on 11/21/25 at 12:01 pm with RA reflected she did the monthly weights for the residents. Some residents had weekly weights, but she did weights for the residents who had monthly weights. She did not know who did the resident weekly weights. She began working as the RA on 11/01/25. She did not enter the weights in the EMR. She was given a list of residents to weight, and she wrote their weight on a paper list and gave it to the DON. She did not know who entered the weights into the EMR. If a resident refused to be weighed, she told the nurse. Interview on 11/21/25 at 12:40 pm with CNA B reflected she did the weekly weights. No one asked her to do weights on Resident #1. She knew residents were weighed upon admission and every Monday for the next four weeks if they were under 100 pounds. It was important to take resident weights to see if they were losing or gaining weight. Residents might need to have an adjustment to their diet. You cannot tell if they need a food change if you do not take their weights. She said it was the responsibility of her and the DON to make sure weights were done. The facility had a change in management, and she was not sure if things had changed.Interview on 11/21/25 at 2:59 pm with the RCD reflected the facility policy on weights for residents was for residents to be weighed on admission and then once a week for the next 4 (four) weeks. She said the facility did not follow the policy, The policy was in place to make sure residents were not losing weight and to make sure residents' weight were stable. If they have this information the facility can intervene before residents lose too much weight. She said absolutely the interventions for the supplements recommended by the RD should have been put in place sooner. She said it was a system failure and the facility did not follow its policy with getting weights on admission and putting appropriate interventions in place when a weight trigger was noticed. The ADON was responsible for the dietary recommendations and did not follow through and notify the NP when the supplements were recommended by the RD. When the DON found out that the dietary recommendations were not put in place, the DON had the orders placed for the supplements. The ADON was responsible for doing the weights and she was aware she was responsible because she herself trained the ADON on the facility weight policy at the end of September. The DON thought the ADON was doing the weights. The failure was did not following the weight policy and a failure to delegate. Interview on 11/21/25 at 3:44 pm with the RDO reflected the weight policy was in place to monitor for weight loss, and weight gain and to provide the necessary interventions prior to weight becoming an issue. it was the responsibility of the ADON to make sure Resident #1's supplement was ordered on 10/15/25. She did not know why it did not get ordered on 10/15/25. Because the supplement was not ordered, Resident #1 did not receive timely supplement for nutritional support.Interview on 11/21/25 at 4:58 pm with the Administrator reflected the issues with not following facility weight and nutrition policy, not weighing Resident #1, and Resident #1 not receiving the recommended RD supplements when they were first recommended, was a system and communication failure. There was a communication breakdown between the RD and the facility nursing staff. The DON was responsible for the weights, and Resident #1's supplements should have been started earlier. It was the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455515 If continuation sheet Page 9 of 10 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 455515 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copperas Cove Nursing & Rehabilitation 607 W Ave B Copperas Cove, TX 76522 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete responsibility of the ADON to look at the RD recommendations and communicate the recommendation to the physician. It would have been Resident #1's right to refuse the supplement, but it was the facility's responsibility to offer the supplements. Record review of the facility's undated Weight Assessment and Intervention policy revealed Policy Statement - The nursing staff and the Dietitian will cooperate to prevent, monitor, & intervene for undesirable weight loss for our residents. Policy Interpretation and Implementation The nursing staff will measure resident weights on admission and weekly x 4 weeks. If no weight concerns are noted at this point, weights will be measured monthly thereafter. Significant weight loss will continue to be weighed weekly. All residents will be weighed monthly by the 10th. Weights will be recorded in Weight Record chart in the individual's medical record. The dietician will also review the Weight Record by the 30th of the month to follow individual weight trends over time. Negative trends will be assessed and addressed by the Dietitian whether or not the definition of Significant Weight Change is met. Significant Weight Changes are defined as: more or less than 5 percent within 30 days, more or less than 7.5 percent in 3 months; and more or less than I0 percent within 6 months. If a weight loss meets the definition of Significant, the Dietitian should discuss with the Interdisciplinary Team if a Significant Change MDS is necessary. Care Plan interventions will consider Severity of change, medical diagnosis (e.g., condition, prognosis, and stability); activities of daily living status, medications, psychological status, family input, resident preferences, and input from direct care givers. All team members will provide relevant information from their discipline to provide an interdisciplinary approach. Interventions for undesirable weight loss should focus first on food (example extra food, snacks, calorie-dense food), liquid nutritional supplements, per facility formulary may be considered if resident caloric intake remains inadequate to stabilize or increase weight. Interdisciplinary Team members should consider possible interventions relevant to their discipline. The physician my order tests. Appetite stimulants, or medications as appropriate. A weight loss regimen should not be initiated for a cognitively capable resident without his/her approval and involvement. The Dietitian will discuss the weight issue with the resident and/or family. If a resident declines to participate in a weight loss goal, the Dietitian will document the resident's wishes, and those wishes will be respected. Event ID: Facility ID: 455515 If continuation sheet Page 10 of 10