Health inspection·November 7, 2023

F 0551 the complaint/grievance was not resolved because family was still upset. Level of Harm - Minimal harm or potential for actual harm During an attempted interview on 11/03/2023 at 11:03 a.m. revealed Resident #1 was not able to answer interview questions due to impaired cognitive status. Residents Affected - Few During an interview on 11/03/2023 at 1:42 a.m. CNA A stated Resident #1 had a handlebar or biker mustache and someone had shaved the bottom handles off. She stated she did not know when it occurred or who shaved the mustache. CNA A stated the family had provided an electric razor and facial hair trimmer for the resident. She stated she did not know if a staff member used the hair trimmer or if the Beautician had cut his hair and cut off the mustache. CNA A stated to visit the Beautician the resident wound need money in their account (trust fund) and then the CNA staff would ask the nurse to call the family and get them on the list to the Beautician. CNA A stated most residents had ongoing permission to get a haircut. She stated she did not know if Resident #1 had permission. CNA A stated they then notify the Activity Director to put the resident on the list to see the Beautician. During an interview on 11/06/2023 at 12:29 p.m., Resident #1's RP stated Resident #1's head had been shaved at the facility on two occasions. She stated one time was in approximately May/June 2023 and the second occasion was in August or last 2023. The RP stated she would not describe the hair cut as a buzz cut but it was close. She stated Resident #1 was left with maybe ½ inch of hair on his head. She stated when she saw it, she was mortified. She stated she notified the Administrator in person. The RP stated the Administrator apologized. The RP stated Resident #1 had a mustache that extended down both sides of his mouth for over 25 years. The RP stated she had some personal health issues which prevented her from coming to the facility for approximately two months. She stated she called the facility and requested a picture of Resident #1. The RP stated a staff member (unknown) sent her a picture on 10/23/2023 of Resident #1 and she noticed the handlebars from his mustache had been cut off. The RP stated she was upset because the mustache was his told the Administrator she did not authorize it. The RP stated the Administrator apologized but had no other response. During an interview on 11/06/2023 at 2:35 p.m., the SW stated she participated in a meeting along with the Administrator and DON with Resident #1's RP at her request. The SW stated her concerns included the Resident #1's mustache was shaved. The SW stated they acknowledged her complaint and told her they would look into it. The SW stated it was mostly the DON and the Administrator that addressed Resident #1's RP. The SW stated she keeps the grievance binder but passed the investigation of the mustache off to the DON since it was a nursing concern. She stated she did not know what had occurred after and the department who the complaint goes to resolves the complaint and brings her back the form. During an interview on 11/03/2023 at 3:02 p.m., the Activity Director stated she was in charge of the list of resident haircuts. She stated the residents will let her know when they need a haircut. She stated in the memory care unit, she asks the nurses if anyone needs a haircut and looks for residents who need one. The Activity Director stated the residents must pay for the haircuts. The Activity Director stated the Beautician shaved Resident #1's head bald in July 2023 (7/17/2023), which surprised her. She stated normally the Beautician would ask first before cutting the hair and she (Activity Director) would normally pull up a picture of the resident from when the resident was first admitted . The Activity Director stated she just came in one day and saw Resident #1 walking around bald. She stated the Beautician also cut off Resident #1's handlebar mustache. The Activity Director stated she had been having some issues with the Beautician because she just wants to do what she wants to do. The Activity Director stated she does not have to notify the family before getting a haircut, shave, or Beautician services. The Activity Director stated she was unable to locate the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 2 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0551 Beautician's employment file or contract. Level of Harm - Minimal harm or potential for actual harm During an interview on 11/06/2023 at 10:04 a.m., the Activity Director stated she wanted to clarify that Resident #1's head was not shaved completely bald but was cut very very short. The Activity Director stated Resident #1's family had not complained about his haircut. The Activity Director stated the facility does not consult with family before the Beautician provided services even though the residents had severe dementia. Residents Affected - Few During an interview on 11/06/2023 at 4:14 p.m., the SW stated she did not schedule or have anything to do with Beautician Services. She stated the Activity Director was responsible. During an interview on 11/07/2023 at 10:56 a.m., the Beautician stated she had been working at the facility for approximately a year and a half. She stated does not remember Resident #1. She stated after she reviewed her notes, she documented she shaved the resident but does not remember any details. The Beautician stated the Activity Director gave her a list of residents with a list of services. She stated the Activity Director usually told her what services to provide. She stated she did what the staff asked her to do. The Beautician stated if the resident was unable to tell her what they wanted, then the Activity Director would tell her what to do. The Beautician stated she does not usually cut men's hair short, or at least not short short. She stated she could not remember if she gave Resident #1 a buzz cut or a short haircut. She stated she was not able to remember if she cut his mustache. The Beautician stated it was important for the residents and the families to be happy with the services that she provided. She stated she did not have any contact with family members. During an interview on 11/07/2023 at 11:47 p.m., the Administrator stated the Activity Director usually communicated with the families about Beautician services. During an interview on 11/07/2023 at 12:03 p.m., the Administrator stated she first became aware the RP was upset about Resident #1's haircut and mustache cut at the end of October 2023. The Administrator stated she investigated the incident. The Administrator stated everyone at the facility knows Resident #1 has a Hulk Hogan mustache. The Administrator stated Resident #1 still had a mustache but not the handlebars. She stated no one admitted to doing it. She stated on 11/01/2023 she became aware that the Beautician had done it. She stated she did not if anyone authorized it the grooming, just that he looked disheveled. The Administrator stated she did not know if RP was called, or it was missed. The Administrator stated she had not provided a staff in-service after learning of the incident. She stated she did not think they would ever make Resident #1's RP happy. During an interview on 11/07/2023 at 12:24 p.m., the DON stated the CNA staff was responsible for shaving on shower days. She stated the Beautician provided a closer shave than the CNAs were able to provide. The DON stated a resident or family could request Beautician services. She stated staff could also request it if hair was getting longer. She stated staff would bring it up to the Activity Director to see if they have funding in their trust fund account. The DON stated the Activity Director was responsible for Beautician services. She stated the nursing staff does not get consent from family. She stated that would be the responsibility of the person taking the resident to the Beautician which in this case is the Activity Director. The DON stated she would expect the Activity Director to get consent. The DON stated if the family was not specific with the request for a haircut the facility would go with a standard gentleman haircut. The DON stated Resident #1 was not able to give instructions on services and could not tell how he wanted his hair or mustache cut. The DON stated the Beautician cut off the mustache handlebars. The DON stated it was a shock to her that the family was upset because she did not notice the handlebars were missing and she was not made aware of a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 3 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0551 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete grievance until October 2023. The DON stated it was important to get consent for Beautician services in order to honor the resident's wishes or the families wishes if the resident was not able to take care of themselves. Record Review of a facility policy, titled Resident Rights last revised December 2016 revealed: Team members shall treat all residents with kindness, respect and dignity. 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: g. exercise his or her rights as a resident of the facility .k. appoint a legal representative of his or her choice .p. be informed of and participate in his or her care planning and treatment. Event ID: Facility ID: 455533 If continuation sheet Page 4 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Honor the resident's right to manage his or her financial affairs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to manage the resident's funds for 3 of 4 resident (Residents #1, #3, and #4) reviewed for protection and management of personal funds, Residents Affected - Some 1. The facility failed to manage the transfer of the Resident #1's Trust Fund in a way that prevented the Beautician from overcharging for services. 2. The facility failed to manage the transfer of the Resident #3's Trust Fund in a way that prevented the Beautician from overcharging for services. 3. The facility failed to manage the transfer of the Resident #4's Trust Fund in a way that prevented the Beautician from overcharging for services. This failure could place resident at risk of not being over charged for services and losing money. The findings included: 1. Record review of Resident #1's face sheet dated 11/03/2023 revealed an admission date of 2/07/2023 with diagnoses which included: dementia, generalized muscle weakness and hypertension (high blood pressure). Record review of Resident #1's Care Plan dated 2/07/2023 and last revised on 2/15/2023 revealed had an impaired cognitive function/dementia or impaired thought processes related to dementia with interventions which included cue, reorient, and supervise as needed. Record review of a Beauty Shop Visit Log dated 7/17/2023 and documented on by both the Beautician and the Activity Director revealed Resident #1 was documented as having received a haircut for $15 and a shave for $15 for a total of $30 signed off by the Activity Director. (Facility rate was $10 for haircut, $5 for mustache trim as documented in blank beautician contract and signed by the Beautician after surveyor intervention.} Record review of a Petty Cash Account withdrawal record dated 7/17/2023 revealed $30 was removed from Resident #1's trust fund and paid to the Beautician. Record review of a check #001229 issued to the Beautician on 7/18/2023 revealed a total of $260 was paid to the beautician which included a $30 from Resident #1 . The check detailed the amount deducted from each resident account. Record review of Resident #1's quarterly MDS dated [DATE] revealed a BIMS score of 99 which indicated a score could not be obtained due to a severe cognitive impairment. Record review of Resident #1's quarterly MDS dated [DATE] revealed the resident had both short-term and long-term memory problems and his daily decision making was severely impaired with diagnoses of progressive neurological conditions. Record review of a facility Complaint/Grievance Report dated 10/26/2023 revealed Resident #1's RP made a verbal complaint that someone shaved off the resident's mustache and gave him a haircut (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 5 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some without asking the RP. The RP indicated she did not want Resident #1's mustache to be shaved and would like to be notified of any changes. The Administrator documented on the form on 10/30/2023 that no team member was coming forward on who cut Resident #1's mustache or who cut his hair without approval. The plan to resolve the complaint/grievance was documented as: when mustache/hair is overgrown she (RP) will be notified and provide direction. Family wishes will be followed. The document indicated the complaint/grievance was not resolved because family was still upset. During an attempted interview on 11/03/2023 at 11:03 a.m. revealed Resident #1 was not able to answer interview questions due to impaired cognitive status. During an interview on 11/03/2023 at 1:42 a.m. CNA A stated to visit the Beautician the resident wound need money in their account (trust fund) and then the CNA staff would ask the nurse to call the family and get them on the list to the Beautician. CNA A stated most residents had ongoing permission to get a haircut. She stated she did not know if Resident #1 had permission. CNA A stated they then notify the Activity Director to put the resident on the list to see the Beautician. During an interview on 11/06/2023 at 12:29 p.m., Resident #1's RP stated Resident #1's head had been shaved at the facility on two occasions and his handlebar mustache had been cut off without her consent. The RP stated she had some personal health issues which prevented her from coming to the facility for approximately two months. She stated she called the facility and requested a picture of Resident #1. The RP stated a staff member (unknown) sent her a picture on 10/23/2023 of Resident #1 and she noticed the handlebars from his mustache had been cut off. The RP stated she was upset because the mustache was his told the Administrator she did not authorize it. The RP stated the Administrator apologized but had no other response. The RP stated she never authorized barber or beautician services and would provide the resident a haircut or trim if needed. During an interview on 11/06/2023 at 2:49 p.m., Resident #1's RP stated again she was never told Resident #1 was going to have a haircut or mustache trim in July 2023. She stated she never authorized any Beautician services and was very upset. She stated she had always cut his hair and mustache and the facility was aware of it. The RP stated she never received notification of hairdresser services or prices. 2. Record review of Resident #3's face sheet dated 11/06/2023 revealed an admission date of 8/09/2022 with a readmission date of 9/26/2022 with diagnoses which included: dementia, chronic atrial fibrillation (irregular heart rate), and major depressive disorder. Record review of a facility Beauty Shop Visit Log dated 7/17/2023 revealed Resident #3 received a haircut for $15 signed off by the resident's last name. (Facility rate was $10 for haircut as documented in the blank Beautician contract that was signed after Surveyor intervention) Record review of a Petty Cash Account withdrawal record dated 7/17/2023 revealed $15 was removed from Resident #1's trust fund and paid to the Beautician. Record review of a check #001229 issued to the Beautician on 7/18/2023 revealed a total of $260 was paid to the beautician which included a $15 from Resident #3. The check had an illegible signature and detailed the amount of money withdrawn from each residents trust fund account. Record review of Resident #3's quarterly MDS dated [DATE] revealed a BIMS score of 00 which indicated a severe cognitive impairment. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 6 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #3's Care Plan dated 9/26/2022 and last revies on 10/07/2022 revealed the resident required limited assistance of one staff person with personal hygiene. Record review of a Beauty Shop Visit log dated 10/09/2023 and documented on by both the Beautician and Activity Director revealed Resident #3 received a haircut and was charged $15. Resident #1 had signed her first name. (Facility rate was $10 for haircut) Record review of a Withdrawal Record dated 10/16/2023 revealed $15 was removed from Resident #3's trust fund and paid to the Beautician. Record review of a check issued to the Beautician revealed she was paid a total of $160 and included $15 from Resident #3 . During an interview on 11/06/2023 at 3:08 p.m. Resident #3's RP stated Resident #3 enjoyed going to the Beauty Shop. She stated the facility had ongoing consent for Resident #3 to get beauty services. The RP stated the resident had a little account (trust fund) at the facility that she puts money into, and the facility takes out money to pay for the services. The RP stated she does not know how much is going to be changed in advance and had not been given a price for services. During an attempted interview on 11/06/2023 at 4:05 p.m. Resident #3 was unable to answer interview questions due to cognitive status. During an interview on 11/06/2023 at 4:09 p.m., LVN B stated she was the charge nurse for Resident #3. LVN B stated the SW schedules visits to the Beautician. She stated the nurses call the families and request services. She stated Resident #3's family requested beautician services for Resident #3 which includes a cut and curl at least one time a month. LVN B stated Resident #3 would not be able to remember if she went to the beautician due to her cognitive status and relied on her family for decision making. 3. Record review of Resident #4's face sheet dated 11/06/2023 revealed an admission date of 8/21/2013 with diagnoses which included: Alzheimer's disease, cognitive communication deficit (difficulty with verbal communication) and primary generalizes arthritis. Record review of a facility Beauty Shop Visit Log dated 7/17/2023 and documented on by both the Beautician and Activity Director revealed Resident #3 received hair dye and style for $40 with an illegible signature signing off the services. (Facility rate was $30.00) Record review of a Petty Cash Account withdrawal record dated 7/17/2023 revealed $40 was removed from Resident #1's trust fund and paid to the Beautician. Record review of a check #001229 issued to the Beautician on 7/18/2023 revealed a total of $260 was paid to the beautician which included a $40 from Resident #4 . Record review of Resident #4's Care Plan dated 9/10/2018 and last revised 3/12/2019 revealed the resident had an ADL self-care deficit and required extensive assistance with personal hygiene. Record review of a Beauty Shop Log dated 9/11/2023 revealed Resident #4 received color/style for $40 and a haircut for $15 for a total of $55 signed off by an illegible signature. (Facility rate was #30 for color/style and $10 for haircut for a total of $40) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 7 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Level of Harm - Minimal harm or potential for actual harm Record review of a Beauty Shop Log dated 10/09/2023 and documented on by both the Beautician and the Activity Director revealed Resident #4 received a shampoo and style for $25 signed off by Resident #4. Record review of a Withdrawal Record dated 10/16/2023 revealed $25 was removed from Resident #3's trust fund and paid to the Beautician. Residents Affected - Some Record review of a check issued to the Beautician revealed she was paid a total of $160 and included $25 from Resident #4 . Record review of Resident #4's annual MDS dated [DATE] revealed the resident had a BIMS score of 4 which indicated a severe cognitive impairment. During an interview on 11/06/2023 at 3:57 p.m., Resident #4's RP stated she was the court appointed legal guardian for Resident #4. She stated the facility does not call or request permission for Beautician services. She stated as long as Resident #4 had funds in her trust fund it was fine. The RP stated she gets a bill after the Beautician services have already taken place. She stated she had never been given information on how much the services cost. The RP stated Resident #4 was unable to make decisions for herself. During an attempted interview on 11/06/2023 at 4:00 p.m., Resident #4 was unable to answer interview questions due to cognitive status. During an interview on 11/06/2023 at 4:09 p.m., LVN B stated she was the charge nurse for Resident #4. LVN B stated Resident #4 had visited with the beautician on occasion for a color and cut. LVN B stated Resident #4 was not able to tell staff what services she wanted done or voice what she would want due to cognitive status. LVN B stated Resident #4 had a guardian that made decisions for the resident. During an interview on 11/03/2023 at 3:02 p.m., the Activity Director stated she was in charge of the list of resident haircuts. She stated the residents will let her know when they need a haircut. She stated in the memory care unit, she asks the nurses if anyone needs a haircut and looks for residents who need one. The Activity Director stated the residents must pay for the haircuts. The Activity Director stated the Beautician shaved Resident #1's head bald in July 2023 (7/17/2023), which surprised her. She stated normally the Beautician would ask first before cutting the hair and she (Activity Director) would normally pull up a picture of the resident from when the resident was first admitted . She stated the Beautician also cut off Resident #1's handlebar mustache. The Activity Director stated she had been having some issues with the Beautician because she just wants to do what she wants to do which included changing prices for services. The Activity Director stated she does not have to notify the family before getting a haircut, shave, or Beautician services. The Activity Director stated she was unable to locate the Beautician's employment file and did not know if the Beautician signed a contract for services. The Activity Director stated she did not notify the RP's/family's of price increase for salon services and did not know if the prices were know prior to services provided. She stated she had the resident sign off on the services if they were able to sign their name. She stated if the resident was unable to sign their name she would sign off on the services after receiving the prices. The Activity Director stated even residents with dementia had rights and had their own opinions. During an interview on 11/06/2023 at 9:57 a.m., the HR Director stated she did not have a file for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 8 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the Beautician. She stated she was new to the facility of about 2 months. She stated she did not work for the facility when the Beautician first came to the facility and did not have a hire date for her. The HR Director stated the Beautician was paid from money from resident trust fund accounts in order to be paid. During an interview on 11/06/2023 at 10:04 a.m., the Activity Director stated she was not able to provide a list of residents who had services provided by the Beautician. She stated she used to keep a list, but it became too time consuming. She stated she had a price list in her own personal binder of prices the Beautician provided to her. She stated the Beautician wrote down the services provided, and her price and she (the Activity Director) signs off on the prices before giving the list to the BOM (Business Office Manager) so the Beautician could be paid. The Activity Director stated the facility does not consult with family before the Beautician provided services even though the residents had severe dementia. She stated she did not notify the families when the Beautician had pay increases. She stated there was not normally a pay increase except that the Beautician wanted to charge $16 dollars for a haircut. The Activity Director stated she told the Beautician that some families count not afford that, so she negotiated down to $10 a cut. During an observation/interview of the Beauty Salon with the Activity Director on 11/03/2023 at 3:25 p.m., revealed the Beauty Salon was located inside the locked memory care unit. There were no prices posted either outside or inside of the Beauty Salon. The Activity Director stated she used to have a list of prices outside of the salon but the residents in the memory care unit torn the sign down due to their dementia. During an interview on 11/06/2023 at 4:14 p.m., the SW stated she did not schedule or have anything to do with Beautician Services. She stated the Activity Director was responsible. During an interview on 11/06/2023 at 4:20 p.m., the Activity Director stated she obtained the list of prices to charge the residents from the Beautician. She stated she was not aware the facility was supposed to have a contract. She stated she was told by a previous Administrator to just take care of it (beautician services). She stated she had worked for the facility for 9 years and had never received training on what she information she was supposed to get. During an interview on 11/06/2023 at 4:27 p.m., the HR Director stated she did not audit the Beautician's records because she did not know the Beautician's name. She stated she did not know who was working to upkeep the records. During an interview on 11/07/2023 at 10:56 a.m., the Beautician stated she had been working at the facility for approximately a year and a half. The Beautician stated she had not signed a contract when she was hired by the Activity Director. She stated she was given a price list by the Activity Director that the previous Beautician was charging. She stated she went up higher on her prices after working at the facility for approximately 6 months due to the cost of supplies. The Beautician stated she told the Activity Director and another staff (unknown) and discussed the price increase. She stated she told them she needed to charge more. The Beautician stated the facility told her some of the residents were not able to pay what she was asking, so they negotiated and agreed on the prices. She stated the prices agreement was not in writing and there was no written agreement. She stated she just told them her prices and gave them a list. The Beautician stated she kept a list of residents with services provided and her cost which she turned in to the Activity Director on each date of service. The Beautician stated she had never spoken with the facility Administrator. She stated she did not remember residents by name or what services were provided. The Beautician stated the Activity (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 9 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Level of Harm - Minimal harm or potential for actual harm Director gave her a list of residents with a list of services. She stated the Activity Director usually told her what services to provide. She stated she did what the staff asked her to do. The Beautician stated if the resident was unable to tell her what they wanted, then the Activity Director would tell her what to do. The Beautician stated it was important for the residents and the families to be happy with the services that she provided. She stated she did not have any contact with family members. Residents Affected - Some During an interview on 11/07/2023 at 11:19 a.m., the BOM stated she did not have a hire date for the Beautician, but the first check issued to her was 2/04/2023. The BOM stated the old rate for a haircut was $10 but the rate was increased to $15 because the Beautician was bringing her own supplies and disinfecting. The BOM stated with the previous Administrator the rate was $10 for a haircut and it was typed up on a piece of paper. She stated she did not know where the other prices except the haircut came from because she only negotiated the price of the haircut. The BOM stated she did not review a contract for the Beautician and would not have gone over one because she assumed it was the Activity Directors responsibility. The BOM stated she could not remember if the new prices were discussed because they did not include the Administrator in the in the conversation. The BOM stated she raised the prices because she felt it was fair. The BOM stated she protected resident trust funds from over charges by verifying the pricing on the paper provided by the Beautician. She stated if she saw something that looked out of the norm, she would question it. The BOM stated the facility usually looked for residents who needed a haircut and the Activity Director organized the list. She stated just because a resident had a trust fund did not automatically mean they got Beautician services. She stated the Administrator pays for some of the resident haircuts for residents without a trust fund. The BOM stated her responsibility of the trust funds were to manage them and ensure money is accounted for and reconciled. The BOM stated her supervisor was the Administrator. She stated the Administrator reviews checks issued and reviews trust fund reconciliation. The BOM stated the reconciliations are then uploaded to corporate office. The BOM stated it was important to be accurate with trust fund withdraws because it was her job to manage it and it was a resident right. She stated she could also be audited, and accuracy was important. During an interview on 11/07/2023 at 11:47 a.m., the Administrator stated she had not been able to locate the Beauticians file or contract. She stated the Beautician would be treated as a typical team member for hire except she would sign a contract for services. The Administrator stated the Beautician was already working for the facility when she began working at the facility in October 2021. The Administrator stated acknowledgement that the contract for services was signed by the Beautician on Sunday, 11/05/2023 after surveyor intervention. The Administrator stated she assumed one had been signed prior, they had just not been able to locate it. The Administrator stated the contract had the correct charges the Beautician should have charged. The Administrator stated it was her responsibility to review the charges by the Beautician and the checks issued to her. She stated she did not notice the prices were different. The Administrator stated when she saw the contract after surveyor intervention then she knew the prices were different. The Administrator stated she was not going to change the contract for the prices. She stated the prices in the contract were to be used going forward. The Administrator stated the Activity Director communicated with families if they want a haircut and they will ask how much. The Activity Director will tell them how much. The Administrator stated or the families will call and say a resident needs a haircut and they will not ask about prices, so the Beautician was using her prices. The Administrator stated she recently found out the Beautician keeps trying to change the prices and the Activity Director has already spoken with her about it. The Administrator stated the Beautician needed to understand she can't change prices because she wants to. The Administrator stated it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 10 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0567 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some proper decency, so the residents are not taken advantage of, especially when they have dementia to ensure accuracy with trust fund payments. Record review of an email from the Administrator to Surveyor dated 11/03/2023 revealed the facility was unable to locate the Beautician's file. The Administrator stated she had attached a copy of information that should have been included in the file. This information included a contract for the Beautician titled Beauty Shop Services Agreement that included prices for services. Record review of a facility contract for Beautician Services that was blank and not signed revealed: the facility will provide a resident trust fund billing sheet. Licensed Cosmetologist will complete the form with resident's name, date and type of services, charges due and obtain the residents signature for the charges. ***NOTE, if the resident is not able to sign on their own behave (sic)(behalf) there must be two signatures other than the licensed cosmetologists verifying the services were provided and resident agrees to charges. C. Allowable Charges: The Facility reserves the right to cap service rates in the facility beauty shop. Current allowable charges for Beauty Shop Services: Shampoo and set $10.00 Hair cut $10.00 Color $30 includes shampoo and set Trim nose, ear, brow $5.00 Any increase in the above rates must be approved in writing by the facility Administrator. Rate increases require a 30-day notice to residents and responsible parties prior to new rates taking effect. Notification of rate increases will be the sole responsibility of the licensed cosmetologist. Record Review of a facility policy, titled Resident Rights last revised December 2016 revealed: Team members shall treat all residents with kindness, respect, and dignity. 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: g. exercise his or her rights as a resident of the facility .h. be supported by the facility in exercising his or her rights. k. appoint a legal representative of his or her choice .r. manage his or her personal funds, or have the facility manage his or her funds. Record review of a facility policy, titled Management of Residents' Personal Funds last revised March 2021 revealed: The resident is informed in advance of any charges imposed to his or her personal funds. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 11 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to implement written policies and procedures to prohibit and prevent abuse and neglect for 1 of 3 staff reviewed for develop/implement abuse policies, Residents Affected - Few The facility failed to have proof of EMR prior to hire and annually for the Beautician. This failure could place residents at risk of abuse, neglect, and exploitation due to staff not properly screened for employability. The findings included: Record review of the Beautician's EMR dated 11/03/2023 at 4:10 p.m., (after surveyor intervention) revealed the Beautician was not unemployable and she was not listed on the EMR registry . During an interview on 11/03/2023 at 3:02 p.m., the Activity Director stated she was in charge of resident haircuts and kept a file with records for the Beautician. The Activity Director stated she was unable to locate the file for the Beautician and thought maybe the HR Director had the documents. The Activity Director stated it had gone back and forth with HR on who wants the files and when they want her to hold them. She stated she did not know what the final outcome was or who was responsible. During an interview on 11/06/2023 at 9:57 a.m., the HR Director stated she did not have a file for the Beautician. She stated she was new to the facility of about 2 months. She stated she did not work for the facility when the Beautician first came to the facility and did not have a hire date for her. The HR Director stated she was able to find a logbook for 2022 which showed a criminal background check was run for the Beautician in February 2022. The HR Director stated the Beautician was not a CNA, was not a regular staff member and did not work in the facility as anything other than as the hairdresser. The HR Director stated an EMR was supposed to have been run prior to hire. During an interview on 11/06/2023 at 4: 20 p.m., the Activity Director stated she was not aware of the requirements for hiring the Beautician. She stated she was just told by the previous Administrator to take care of it. She stated she had never received training on what she was supposed to get or what information she was supposed to get prior to hire. The Activity Director stated she knew she was supposed to get a background check. During an interview on 11/07/2023 at 10:56 a.m., the Beautician stated she first started working at the facility approximately one and a half years ago. She stated she went to the facility approximately one time a month unless the facility contacts her about needed services. She stated she got the job because she left her contact information with the facility and asked if the needed beauty services. She stated she was then called in for an interview with the Activity Director. The Beautician stated she provided the Activity Director with her beautician license, COVID vaccine records and other personal information. She stated she did not fill out any forms. During an interview on 11/07/2023 at 11:19 p.m., the BOM stated she did not know the Beauticians date of hire. She stated the first check issued to the Beautician was dated 2/04/2022. During an interview on 11/07/2023 at 11:47 a.m., the Administrator stated she had not been able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 12 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few locate a personnel file for the Beautician. The Administrator stated the facility process for a contract staff included an application, and background checks. She stated it was the same process for a regular team member. She stated they were treated the same as if they worked for the facility except they signed a contract for services. The Administrator stated she thought the Beautician started at the facility around October 2021. The Administrator stated the HR Director would have been responsible for running the EMR. The Administrator stated there was a filing cabinet in the HR office with a section for these files and the HR Director should have reviewed the files. The Administrator stated the HR Director should have run the EMR prior to hire. The Administrator stated the EMR was important to ensure the staff had not done anything bad . Record review of an untitled facility policy dated July 2020 revealed: The Company reserves the right to bar employment of candidates who have adverse records .who are listed on the appropriate state or license Misconduct Registry .Links to all Website that must be checked prior to hire and/or annually included https://emr.dads.state.tx.us/DadsEMRWeb/emrRegistrySearch.jsp. Record review of a facility policy, titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program last revised April 2021 revealed: Policy Interpretation and Implementation: 4. Conduct employee background checks and not knowingly employ or otherwise engage any individual who has: a. been found guilty of abuse, neglect, exploitation, misappropriation of property, or mistreatment by a court of law b. had a filing entered into the state nurse aide registry . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 13 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that include measurable objectives and time frames to meet residents' mental, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment and to ensure that the comprehensive care plan described the services that were to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including the right to refuse treatment for 1 of 8 residents (Resident #1) reviewed for care plans, in that: The facility failed to ensure Resident #1's care plan indicated his and his families wishes for DNR (Do Not Resuscitate) status. These failures could place residents at risk of not receiving inappropriate care. The findings include: Record review of Resident #1's face sheet dated [DATE] revealed an admission date of [DATE] with diagnoses which included: dementia, generalized muscle weakness and hypertension (high blood pressure). Record review of Resident #1's physician orders dated [DATE] revealed Code Status: DNR. Record review of Resident #1's OOH (Out of Hospital) DNR form revealed the document was signed by the physician on [DATE]. Record review of Resident #1's Care Plan initiated on [DATE] and had not been revised revealed Resident #1 had chosen to be Full Code status with interventions to include ensure residents wishes are followed as desired, please initiate CPR in the event of unresponsiveness and active 9-1-1 and signed full code order in chart (medical record). Record review of Resident #1's quarterly MDS dated [DATE] revealed a BIMS score of 99 which indicated a score could not be obtained due to a severe cognitive impairment. During an attempted interview on [DATE] at 11:03 a.m. revealed Resident #1 was not able to answer interview questions due to impaired cognitive status. During an interview on [DATE] at 10:42 a.m., the MDS Coordinator stated Resident #1 care plan indicated the resident was full code status. The MDS Coordinator stated Resident #1 had an OOH DNR filed on his medical record and a physician order for DNR status. She stated Resident #1's care plan should have been updated to reflect a DNR status. The MDS Coordinator stated MDS staff should review and update the care plan after each MDS review. She stated the last MDS review for Resident #1 occurred on [DATE]. The MDS Coordinator stated other staff nursing staff members and the SW had access to the care plan and could update a resident code status and revise the care plan at the time the change occurred. The MDS Coordinator stated it was important for Resident #1's care plan to be accurate so that in the event of an emergency event, the nursing staff could refer to the care plan to see if the resident was full code or DNR status. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 14 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 During an interview on [DATE] at 12:41 p.m., the DON stated the MDS Coordinator was responsible for care plan revisions. She stated the MDS Coordinator had informed her (after surveyor intervention) Resident #1's care plan reflected an incorrect code status. The DON stated an accurate care plan was important because it determines what plan of care the facility was giving to the resident. The DON stated in the event of an emergency, an inaccurate care plan could confuse the nurse. Residents Affected - Few Record review of a facility policy, titled Care Plan, Comprehensive Person-Centered last revised [DATE] revealed: 2. The comprehensive, person-centered care plan is developed within seven (7) days of the completion of the required MDS assessment .7. The comprehensive, person-centered care plan: b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including 1. Services that would otherwise be provided for the above but are not provided due to the resident exercising his or her rights .11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 15 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0772 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Have an agreement with an approved laboratory to obtain services, if on-site laboratory services aren't provided. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide laboratory services to meet the needs of the resident, for 1 of 4 residents (Residents # 1) reviewed for laboratory services, The facility failed to obtain a 14-panel drug screen for Resident #1 as ordered by a NP. This failure could place residents at risk for delays in treatment. The findings included: Record review of Resident #1's face sheet dated 11/03/2023 revealed an admission date of 2/07/2023 with diagnoses which included: dementia, generalized muscle weakness and hypertension (high blood pressure). Record review of Resident #1's Care Plan dated 2/07/2023 and last revised on 2/15/2023 revealed had an impaired cognitive function/dementia or impaired thought processes related to dementia with interventions which included cue, reorient, and supervise as needed. Record review of Resident #1's quarterly MDS dated [DATE] revealed a BIMS score of 99 which indicated a score could not be obtained due to a severe cognitive impairment. Record review of Resident #1's progress notes revealed: -11/02/2023: NP in to evaluate Resident #1 .new order to obtain .drug screen 14 panel due to AMS (altered mental status ). Record review of Resident #1's consolidated physician orders for November 2023 revealed the 14-panel drug screen was not showing up as an order . Record review of Resident #1's laboratory services indicated a request was documented in the PCC laboratory portal dated 11/03/2023 at 9:05 a.m. revealed an oral drug screen had been placed for an oral fluid drug screen. The specimen information revealed there was no documentation for time/date of collection or the techs initials. which meant the specimen had not been collected as viewed on 11/06/2023 with the DON. Record review of Resident #1's progress note dated 11/06/2023 revealed the lab technician came to the building to collect sample for ordered drug panel oral fluid. The lab tech assumed they were to collect a urine same, did not confirm with nurse and exited the building. Laboratory called to have tech come back to collect for the ordered oral drug screen. The laboratory representative stated she would contact the representative for the facility for them to send another technician out. NP informed; no new orders given. Documented by ADON. During an attempted interview on 11/03/2023 at 11:03 a.m. revealed Resident #1 was not able to answer interview questions due to impaired cognitive status. During an interview on 11/06/2023 at 1:52 p.m., the DON stated Resident #1's order for a 14-panel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 16 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0772 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few drug screen was not showing up as a physician order because the facility recently integrated laboratory into PCC. She stated to view the order it could only be viewed as a laboratory request. The DON stated the ADON notified the lab via telephone on 11/03/2023 about the requested toxicology screen for Resident #1. The DON stated the laboratory stated they did not do 14-panel drug screens. The DON stated she notified the NP that lab was not able to complete the 14-panel drug screen and did not receive any new orders. The DON stated she ordered a oral swab basic toxicology screen instead. She stated the basic drug screen was different than the 14-panel drug screen, but the lab did not have the ability to complete the 14-panel one. The DON stated the 14-panel drug screen should have been collected last week but lab had not come to collect the specimen and she did not know why. During an interview on 11/06/2023 at 1:58 p.m., the NP stated she ordered a 14-panel drug screen for Resident #1 at the family's request. She stated a nurse (unknown) notified her of a change in status and that the family was concerned. The nurse also reported that the resident was now fine and was not showing any change of condition. The NP stated she came to the facility and assessed Resident #1 in person . The NP stated Resident #1 was fine. The NP stated she spoke to the nurse who reported the family had concerns but after a full neurological assessment the NP stated the resident was at baseline and not having any residual neurological changes. The NP stated there were no neurological changes whatsoever. The NP stated the resident was walking and acting normally and intact neurologically. The NP stated she agreed to do a toxicology screen to make the family happy. The NP stated in long-term care toxicology screens are difficult to obtain but she would expect it to be done in 2-3 days or for someone to notify her. The NP stated the DON notified her on Friday (11/03/23) or Saturday (11/04/2023) that the 14-panel toxicology screen would take a little longer, but she did not recall the DON stating a 14-panel could not be drawn. The NP stated if the toxicology screen took longer, it could affect the results depending on the half-life of the drug taken. The NP stated the 14-panel toxicology screen should be drawn via blood. During an interview on 11/06/2023 at 2:10 p.m., the ADON stated she contacted the laboratory on Friday (11/03/2023) about the order for the 14-panel drug toxicology screen. She stated the lab rep told her they didn't have one. She stated the lab said they had a different drug screen for mentally altering drugs. The ADON stated the laboratory did not indicate when they were coming to draw the sample. The ADON stated she put the order in as STAT (urgent) and the laboratory will typically draw same day or next day. The ADON stated she would expect the lab to come gets the sample within a 24 period. The ADON stated the laboratory did indicate the sample would be an oral swab. The ADON stated she did not notify the DON because she did not think it was necessary because the NP just asked for a drug panel. The ADON stated she did not see any change of condition for the resident, and he appeared his normal self, at baseline. The ADON stated an order for the 14-panel drug screen was not viewable because the order went straight to laboratory in PCC. During an interview on 11/07/2023 at 12:31 p.m., the DON stated they had been having a lot of issues with lab regarding the 14-panel toxicology screen. The DON stated a 14-panel toxicology screen was not a lab that the facility normally drew. She stated when inquiring about the lab draw lab had given 3-4 answers. She stated the lab appeared more confused than they were. The DON stated she expected the lab turnaround time to be within the next day for a STAT order. The DON stated the facility called it in STAT because they had a limited time to collect if before certain drugs were out of the system. The DON stated they had not considered seeking an alternate source to get the 14-panel toxicology screen collected. She stated she knew the lab had a contract with a local hospital to get lab draws but they had never used an outside source. Record review of an email from the Administrator to Surveyor dated 11/07/2023 the Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 17 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0772 stated the facility followed state guidelines for lab services and did not have a formal policy. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 18 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ or obtain outside professional resources to provide services in the nursing home when the facility does not employ a qualified professional to furnish a required service. Based on interview and record review, the facility failed to ensure agreements pertaining to services furnished by outside resources specified in writing that the facility assumes responsibility for obtaining services that meet professional standards and principles that apply to professionals providing services in such a facility for 1 of 1 outside resources reviewed The facility did not have a written agreement or contract for the Beautician. This failure could place residents at risk for not having access to outside resources. The findings included: Record review of an email from the Administrator to Surveyor dated 11/03/2023 revealed the facility was unable to locate the Beautician's file. The Administrator stated she had attached a copy of information that should have been included in the file. This information included a contract for the Beautician titled Beauty Shop Services Agreement that included prices for services which was not signed by the Beautician. During an interview on 11/03/2023 at 3:02 p.m., the Activity Director stated she was in charge of the list of resident haircuts. She stated she oversaw hiring the Beautician. The Activity Director stated she was unable to locate the Beautician's employment file and did not know if the Beautician signed a contract for services. She stated there had been some discussion on who should hold on to the Beauticians information and it had gone back and forth with HR. During an interview on 11/06/2023 at 9:57 a.m., the HR Director stated she did not have a file for the Beautician. She stated she did not work for the facility when the Beautician first came to the facility and did not have a hire date for her. During an interview on 11/06/2023 at 4:14 p.m., the SW stated she did not schedule or have anything to do with Beautician Services. She stated the Activity Director was responsible. During an interview on 11/06/2023 at 4:27 p.m., the HR Director stated she did not audit the Beautician's records because she did not know the Beautician's name. During an interview on 11/07/2023 at 10:56 a.m., the Beautician stated she had been working at the facility for approximately a year and a half. She stated she came to the facility approximately one time a month but sometimes more often whenever the facility needed services. She stated she communicated with the Activity Director. The Beautician stated she had not signed a contract when she was hired by the Activity Director. The Beautician stated she had never spoken with the facility Administrator. During an interview on 11/07/2023 at 11:19 a.m., the BOM stated she did not have a hire date for the Beautician, but the first check issued to her was 2/04/2023. The BOM stated she did not review a contract for the Beautician and would not have gone over one because she assumed it was the Activity Directors responsibility. During an interview on 11/07/2023 at 11:47 a.m., the Administrator stated she had not been able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 19 of 20 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 455533 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windcrest Nursing and Rehabilitation 8800 Fourwinds Dr Windcrest, TX 78239 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 0840 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few locate the Beauticians file or contract. She stated the Beautician would be treated as a typical team member for hire except she would sign a contract for services. The Administrator stated the Beautician was already working for the facility when she began working at the facility in October 2021. The Administrator acknowledged that the contract for services was signed by the Beautician on Sunday, 11/05/2023 after surveyor intervention. The Administrator stated she assumed one had been signed prior, they had just not been able to locate it. The Administrator stated the contract had the correct charges the Beautician should have charged. Record review of a hiring policy which was untitled and dated July 2020 revealed there was no information on contracted services. Record review of an email from the Administrator to Surveyor dated 11/07/2023 the Administrator stated the facility did not have a policy for contracted services. She stated they used state guidelines and attached a copy of the Texas Administration Code Title 26 Part I Chapter 554 subchapter T rule 554.1906 which read: b. Agreements pertaining to services furnished by outside resources must specify in writing that the facility assumes responsibility for 1. obtaining services that meet professional standards and principles. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455533 If continuation sheet Page 20 of 20