Health inspection·July 2, 2025

F 0565 Level of Harm - Minimal harm or potential for actual harm resident representatives to have input in the operation of the facility;b. discussion of concerns and suggestions for improvement;c. consensus building and communication between residents and facility staff; andd. disseminating information and gathering feedback from interested residents.3. The resident council group is provided with space, privacy and support to conduct meetings. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 2 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 (Resident #2 and Resident #24) of 6 residents reviewed for ADLs. Based on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 (Resident #2 and Resident #24) of 6 residents reviewed for ADLs. Residents Affected - Few The facility failed to ensure: - Resident #2 had her fingernails cleaned and trimmed on 6/30/25. - Resident #24 had her fingernails trimmed 6/30/25. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections and a decreased quality of life. Findings included: Record review of Resident #2's Quarterly MDS assessment dated [DATE] reflected Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses included dementia (group of thinking and social symptoms that interferes with daily functioning), and cerebral infarction (a condition that occurs when blood flow to the brain is blocked. The blockage can lead to brain tissue death). Resident #2's BIMS score of 3, which indicated Resident #2' cognition was severely impaired. The MDS assessment indicated Resident #2 required maximal assistance with personal hygiene. Record review of Resident #2's Care Plan revised 05/15/25, reflected the following: Problem: [Resident#2] has an ADL self-care performance deficit . Goal: [Resident #2] will improve current level of function in through the review date . Interventions: . Personal hygiene . The resident requires maximal to total one person with personal hygiene and oral care . In an observation on 06/30/25 at 10:53 AM revealed Resident #2 was lying in her bed. The nails on both hands were approximately 0.3cm in length extending from the tips of her fingers. The nails were discolored tan and had brownish colored residue underside and on the nail beds. The nails on the right index and middle finger were chipped. Resident #2 was unable to answer questions. Record review of Resident #24's Quarterly MDS assessment dated [DATE] reflected Resident #24 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses included hemiplegia (partial paralysis on one side of the body that can affect the arms, legs, and facial muscles), cognitive communication deficit, and Parkinson's disease (a disorder of the central nervous system that affects movement, often including tremors). Resident #24's BIMS score of 12, which indicated Resident #24 was cognitively intact. The MDS assessment indicated Resident #24 required supervision with personal hygiene. Record review of Resident #24's Care Plan dated 06/12/24, reflected the following: Problem: [Resident #24] has an ADL selfcare performance deficit . Goal: [Resident #24] will maintain current level of function . Interventions Toilet use: The resident requires partial assistance of one staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 3 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few participation to use toilet, . Personal hygiene/oral care: I require assistance from staff with hygiene care at times, Level of assistance may vary depending on my condition. In an observation and interview on 06/30/25 at 11:04 AM revealed Resident #24 was sitting on her bed. The nails on both hands were approximately 0.7cm in length extending from the tip of her fingers. The nails were curved and not shaped. Resident #24 stated she did not like her nails that long. Resident # 24 stated staff were busy to do her nails. In an interview on 06/30/25 at 11:14 AM, CNA A stated CNAs and nurses were responsible to clean and cut the residents' nails. CNA A stated did not notice Resident #2's and Resident # 24's nails. She stated she would do it right then. She stated the risk would be infection control and injury. In an Interview on 07/02/25 at 5:51 PM, the DON stated nail care should be completed as needed and every time aides washed the residents' hands. The DON stated nails should be observed daily. The DON stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. Interview with the DON revealed she expected CNAs to offer to cut and clean nails if they were long and dirty. The DON stated the ADONs would do the routine rounds to monitor. The DON stated residents having long and dirty nails could be an infection control issue and skin break down if scratching. - Record review of the facility's policy Fingernails/Toenails Care dated February 2018, reflected the following: . The purposes of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections . Nail care includes daily cleaning and regular trimming. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 4 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for one (Resident #22) of one resident reviewed for catheter care.Based on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for one (Resident #22) of one resident reviewed for catheter care. The facility failed to ensure Resident #22 had a physician's order for a Foley catheter on 06/30/25. This failure could place residents at risk for the development and/or worsening of urinary tract infections. Findings included: 1.Record review of Resident #22's quarterly MDS assessment, dated 06/11/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Her BIMs score was 11 indicating her cognitive status was moderately impaired. Her diagnoses included Parkinson's disease (a disorder of the central nervous system that affects movement, often including tremors), dementia (group of thinking and social symptoms that interferes with daily functioning), and cognitive communication deficit. The resident required maximal assist for toileting hygiene. MDS assessment reflected resident did not have an indwelling Foley Catheter. Review of Resident #22's care plans dated 6/30/25 reflected she did not have a care plan for an indwelling Foley catheter or care of the Foley. Record review of Resident #'22's physician's orders dated 6/30/25 and medical diagnosis revealed that the resident did not have a diagnosis or order for a Foley catheter. An observation and interview on 06/30/25 at 10:29 AM of Resident #22 revealed the resident had a Foley catheter that was off the floor and covered with a bag. Resident #22 stated she could not urinate last week and that was why she had the catheter. In an interview with LVN D on 07/01/25 at 03:21 PM stated 2 days ago resident did not urinate for the day and the hospice nurse was in the facility. LVN D stated the hospice nurse asked her to insert a Foley catheter. LVN D stated she should not insert or replace a Foley catheter without a physician order. She stated the Foley catheter was supposed to have an order for insertion, an order for daily care, an order for the size, and an order for change. In an interview with the DON 07/02/25 at 05:51 AM she stated a nurse was not allowed to insert or replace a Foley catheter without a doctor's order. She stated a Foley catheter order came in a form of a group of orders which included an order for the size of the catheter, an order for insertion, an order for monitoring the output of urine, an order to change periodically and as needed. The DON stated the catheter should be care planned to guide the resident care of the foley catheter. The DON stated she would educate nurses on catheter orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 5 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0690 Level of Harm - Minimal harm or potential for actual harm Review of the facility policy, Urinary Tract Infection (Catheter - Associated revised September 2017, reflected: . Insert catheters only for indications deemed appropriate for urinary catheter insertion, and as ordered . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 6 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Based on observation, interview, and record review, the facility failed to have sufficient nursing staff to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, for three of four quarters for 2025 (Quarters 1, 2, and 3) reviewed for sufficient nursing staff.Based on observation, interview, and record review, the facility failed to have sufficient nursing staff to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, for three of four quarters for 2025 (Quarters 1, 2, and 3) reviewed for sufficient nursing staff. The facility did not have sufficient staff according to the PBJ report for fiscal year 2024, Quarter 3 (04/01/24-06/30/24), and fiscal year 2025 Quarter 1 (10/31/24-12/31/24), and Quarter 2 (01/01/25-03/31/25). This failure could place residents at risk of diminished quality of life and quality of care. Findings included: Record review of the CMS PBJ report for fiscal year 2024 Quarter 3 (04/01/24-06/30/24) indicated: the facility failed to have Licensed Nursing Coverage 24 hours a day on: 04/19 (Friday); 04/22 (Monday); 04/23 (Tuesday); 04/25 (Thursday); 04/26 (Friday); 05/06 (Monday); 05/19 (Sunday); 05/27 (Monday) . Record review of time sheets for LVN hours reflected the following:04/19 (Friday): 14.38 LVN hours04/22 (Monday): no hours to provide04/23 (Tuesday): 10.58 hrs 04/25 (Thursday): 12.42 hrs04/26 (Friday): 8.02 hrs05/06 (Monday): 12.72 hrs05/19 (Sunday): 14.43 hrs05/27 (Monday): 23.07 hrs Record review of the CMS PBJ report for fiscal year 2025 Quarter 1 (10/31/24-12/31/24) indicated: the facility triggered for one star staffing, excessively low weekend staffing, and failed to have Licensed Nursing Coverage 24 hours a day on: 11/17 (Sunday); 11/28 (Thursday), 12/01 (Sunday); 12/07 (Saturday); 12/08 (Sunday); 12/25 (Wednesday). Record review of LVN hours timesheets reflected the following:11/17 (Sunday): no hours11/28 (Thursday): 23.26 hrs12/01 (Sunday): 15.18 hrs12/07 (Saturday): 16.12 hrs12/08 (Sunday): 15.93 hrs12/25 (Wednesday): 22.95 hrs Record review of the CMS PBJ report for fiscal year 2025 Quarter 2 (01/01/25-03/31/25) indicated: the facility triggered for one star staffing, excessively low weekend staffing, and failed to have Licensed Nursing Coverage 24 hours a day on: 01/01 (Wednesday); 01/04 (Saturday); 01/05 (Sunday); 01/11 (Saturday); 01/19 (Sunday); 02/01 (Saturday); 02/02 (Sunday); 02/08 (Saturday); 02/17 (Monday); 03/02 (Sunday). Record review of LVN hours timesheets reflected the following:01/01 (Wednesday): 24 hour coverage 01/04 (Saturday): 16.10 hrs 01/05 (Sunday): 24 hour coverage 01/11 (Saturday): 14.90 hrs 01/19 (Sunday): 15 hrs02/01 (Saturday): 15.15 hrs 02/02 (Sunday): no hours 02/08 (Saturday): 8.27 hrs02/17 (Monday): 8.63 hrs03/02 (Sunday): 9.65 hrs In an interview on 07/02/25 at 4:35 PM with the Administrator she stated she had worked at the facility for about a year and she and the DON were responsible for scheduling LVN coverage. She stated the DON was hired on May 26, 2025. She stated it was important to have a LVN coverage 24 hours a day to ensure residents received care. She stated staff call-outs happened more often than she wanted, and staff were supposed to find coverage if they were not able to come to work. She stated that the facility used agency nursing to supplement and there was never a time where a licensed nurse was not on site. In an interview on 07/02/25 at 5:47 PM with the DON she stated she was responsible for scheduling LVN coverage, and her hire date was May 26, 2025. She the facility had placed ads on different platforms, staff were hired and then they did not show up for work or just do not return. She stated she expected staff to follow the schedule and find coverage if they were not able to come in to work. She stated when an LVN or aide did not show up for their shift, she covered it and worked on the floor. She stated it was important to have 24/7 LVN coverage to ensure residents received medication and care. Record review of the facility's policy titled Staffing, Sufficient (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 7 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0725 and Competent Nursing, dated 2001, reflected: .Licensed nurses and certified nursing assistants are available 24 hours a day, seven (7) days a week to provide competent resident care services Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 8 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interviews and record reviews, the facility failed to utilize the services of an RN for 8 consecutive hours 7 days a week for 28 days out of 365 days reviewed.Based on interviews and record reviews, the facility failed to utilize the services of an RN for 8 consecutive hours 7 days a week for 28 days out of 365 days reviewed. The facility failed to have an RN for 8 consecutive hours 7 days a week for 28 days out of 365 days reviewed from April 1, 2024 through March 31, 2025. These failures could place all residents at risk for their clinical needs not being met. Findings included: Record review of the CMS PBJ report for fiscal year 2024 Quarter 3 (04/01/24-06/30/24) reflected no RN hours for the following dates: 05/04 (Saturday); 05/05 (Sunday); 05/11 (Saturday); 05/12 (Sunday); 05/18 (Saturday); 05/19 (Sunday); 05/25 (Saturday); 05/26 (Sunday); 06/01 (Saturday); 06/02 (Sunday); 06/08 (Saturday); 06/09 (Sunday); 06/15 (Saturday); 06/16 (Sunday) . Record review of the CMS PBJ report for fiscal year 2025 Quarter 1 (10/1/24-12/31/24) reflected no RN hours for the following dates: 10/06 (Sunday); 11/02 (S); 11/03 (Sunday); 11/17 (Sunday); 12/07 (Saturday) Record review of the CMS PBJ report fiscal year 2025 Quarter 2 (01/01/25-03/31/25) indicated: the facility triggered for one star staffing, excessively low weekend staffing, and no RN hours on: 01/04 (Saturday), 01/05 (Sunday), 01/11 (Saturday), 02/01 (Saturday), 02/02 (Sunday), 02/08 (Saturday), 02/09 (Sunday), 02/15 (Saturday), 02/1 (Sunday), 03/02 (Sunday). In an email to the Administrator, dated 07/01/25 at 10:53 AM RN hours were requested for the following dates: 01/04 (Saturday), 01/05 (Sunday), 01/11 (Saturday), 02/01 (Saturday), 02/02 (Sunday), 02/08 (Saturday), 02/09 (Sunday), 02/15 (Saturday), 02/16 (Sunday), 03/02 (Sunday). In a reply email, dated 07/01/25 at 11:36 AM, the Administrator replied: No RN hours recorded for the specified dates. In an email to the Administrator, dated 07/01/25 at 2:35 PM RN hours were requested for the following dates:05/04 (Saturday); 05/05 (Sunday); 05/11 (Saturday); 05/12 (Sunday); 05/18 (Saturday); 05/19 (Sunday); 05/25 (Saturday); 05/26 (Sunday); 06/01 (Saturday); 06/02 (Sunday); 06/08 (Saturday); 06/09 (Sunday); 06/15 (Saturday); 06/16 (Sunday); 10/06 (Sunday); 11/02 (S); 11/03 (Sunday); 11/17 (Sunday); 12/07 (Saturday). In a reply email, dated 07/01/25 at 2:52 PM, the Administrator replied: NO RN hours for the dates requested to report. In an interview on 07/02/25 at 4:35 PM with the Administrator she stated the DON covered the RN hours on the weekdays and she was not able to provide time sheets for RN hours because the DON was salaried and recently started in May 2025. She stated RN coverage had been spotty on the weekends, the facility had gone through 2 different RNs for double weekends. She stated there was an RN who worked from February to June of 2024 and had a lot of call outs. She stated that the facility advertised the positions on different platforms. She stated there were no residents who had missed services or treatment because an RN was not onsite. She stated that staff contacted her, the DON, the physician or nurse practitioner depending on the situation. She stated the corporation also had RNs at other facilities she could call with any questions. She stated it was important to have a RN coverage 8 hours a day to ensure residents received care. She stated RN coverage was important because RNs were trained more extensively and were a resource for LVNs . In an interview on 07/02/25 at 5:47 PM with the DON she stated she was responsible for scheduling RN coverage and currently covered the required 8 hours for the facility and over the weekend was at the facility on Saturdays and was always available via phone. She stated they were interviewing a candidate for an RN weekend supervisor at the end of the week. She stated it was important to have a RN coverage because they were more skilled than an LVN and were able to assess patients differently. Record review of the facility's policy titled Staffing, Sufficient and Competent Nursing, dated 2001, reflected: .3. A registered nurse provides services at least eight (8) consecutive hours every 24 hours, seven (7) days a week. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 9 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0727 RNs may be scheduled more than eight (8) hours depending on the acuity needs of the resident. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 10 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident for 2 (Women's Hall Medication Cart and Men's Hall Medication Cart) of 3 carts reviewed for pharmacy services. The facility failed to ensure:- the Men's Hall Medication Cart did not have 1 insulin pen for Resident #22 with an expired open date and 1 insulin pen for Resident #10 with an expired open date. - LVN E responsible for Women's Hall Medication Cart, counted controlled drugs every shift change. These failures could affect residents resulting in diminished effectiveness, and not receiving the therapeutic benefits of the medications and could place residents at risk of not having the medication available due to possible drug diversion. Findings Included: - Record review and observation on [DATE] at 11:22 AM of the Men's Hall Medication Cart, with LVN B revealed the pen of insulin Novolog 100 unit/ml for Resident #22 with an open date of [DATE]. Observation of the pen reflected it was used. And instruction on the pen reflected to discard after 28 days of use. The pen of insulin Lantus 100 unit/ml for Resident #10 with an open date of [DATE]. Observation of the pen reflected it was used. And instruction on the pen reflected to discard after 28 days of use. Interview on [DATE] at 12:53 PM, LVN B stated nurses were responsible to check the medication carts and the insulin pens for the open dates before giving insulin. She stated the nurse supposed to label the pen with the open date when first opened it. LVN B stated the purpose of putting an open date was for expiration purposes because the insulin was only good for 28 days. She stated after 28 days the insulin would be ineffective. - Record review and observation on [DATE] at 11:28 AM of Women's Hall Medication Cart, with LVN B revealed missing signatures for On duty for [DATE] (2:00 PM to 10:00 PM shift) and [DATE] (10:00 PM to 6:00 AM shift) of the narcotic count sheet. Interview on [DATE] at 3:57 PM, LVN E stated she should have signed the narcotic sheet after counting the narcotics, on [DATE] and on [DATE] at the beginning and at the end of the shift. She stated she got busy with a resident asking for medication and did not go back to sign the count sheet. She stated she knew that she supposed to sign immediately after the count was done. She stated the risk would be potential for drug diversion. Interview on [DATE] at 5:51 PM, the DON stated the insulin flex pens and vial, once opened, needed to be dated because each insulin pen and vial had a specific day's shelf life and if not thrown out by that time the insulin could lose its effectiveness. The DON stated the pharmacy consultant checked the carts monthly and she stated she would do random checks of the medication carts for monitoring. The DON stated she expected nurses to sign the narcotic count sheet at the beginning and at the end of their shift after they completed count with the incoming and off-going nurse. The DON stated if the staff was not signing the narcotic count sheets, she was unable to prove they were counting. The DON stated it was important to ensure a drug diversion did not occur. The DON stated she would randomly check the carts for monitoring. On [DATE] at 4:15 PM requested facility's policy to the Administrator, not provided. Based on observation, interview, and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs of each resident for 2 (Women's Hall Medication Cart and Men's Hall Medication Cart) of 3 carts reviewed for pharmacy services. The facility failed to ensure:- the Men's Hall Medication Cart did not have 1 insulin pen for Resident #22 with an expired open date and 1 insulin pen for Resident #10 with an expired open date. - LVN E responsible for Women's Hall Medication Cart, counted controlled drugs every shift change. These failures could affect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 11 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete residents resulting in diminished effectiveness, and not receiving the therapeutic benefits of the medications and could place residents at risk of not having the medication available due to possible drug diversion. Findings Included: - Record review and observation on [DATE] at 11:22 AM of the Men's Hall Medication Cart, with LVN B revealed the pen of insulin Novolog 100 unit/ml for Resident #22 with an open date of [DATE]. Observation of the pen reflected it was used. And instruction on the pen reflected to discard after 28 days of use. The pen of insulin Lantus 100 unit/ml for Resident #10 with an open date of [DATE]. Observation of the pen reflected it was used. And instruction on the pen reflected to discard after 28 days of use. Interview on [DATE] at 12:53 PM, LVN B stated nurses were responsible to check the medication carts and the insulin pens for the open dates before giving insulin. She stated the nurse supposed to label the pen with the open date when first opened it. LVN B stated the purpose of putting an open date was for expiration purposes because the insulin was only good for 28 days. She stated after 28 days the insulin would be ineffective. - Record review and observation on [DATE] at 11:28 AM of Women's Hall Medication Cart, with LVN B revealed missing signatures for On duty for [DATE] (2:00 PM to 10:00 PM shift) and [DATE] (10:00 PM to 6:00 AM shift) of the narcotic count sheet. Interview on [DATE] at 3:57 PM, LVN E stated she should have signed the narcotic sheet after counting the narcotics, on [DATE] and on [DATE] at the beginning and at the end of the shift. She stated she got busy with a resident asking for medication and did not go back to sign the count sheet. She stated she knew that she supposed to sign immediately after the count was done. She stated the risk would be potential for drug diversion. Interview on [DATE] at 5:51 PM, the DON stated the insulin flex pens and vial, once opened, needed to be dated because each insulin pen and vial had a specific day's shelf life and if not thrown out by that time the insulin could lose its effectiveness. The DON stated the pharmacy consultant checked the carts monthly and she stated she would do random checks of the medication carts for monitoring. The DON stated she expected nurses to sign the narcotic count sheet at the beginning and at the end of their shift after they completed count with the incoming and off-going nurse. The DON stated if the staff was not signing the narcotic count sheets, she was unable to prove they were counting. The DON stated it was important to ensure a drug diversion did not occur. The DON stated she would randomly check the carts for monitoring. On [DATE] at 4:15 PM requested facility's policy to the Administrator, not provided. Event ID: Facility ID: 455563 If continuation sheet Page 12 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen.Based on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen. 1. The facility failed to date 11 bags of broccoli stored in the original packages in the freezer. This failure could place residents who at risk for food-borne illness and food contamination. Findings included: Observation in facility's kitchen on 06/30/25 at 09:30 AM revealed 11 bags of frozen broccoli in the original packages in the walk-in freezer were not dated. In an interview on 06/30/25 at 9:30 AM with the Dietary Manager, she stated all food items needed to be labeled with the date received and they must have been missed. She stated she and the cooks were responsible for labeling food when it was delivered. She stated it was important to label food with the date received so they knew when food goes bad. Record review of facility policy titled Food Receiving and Storage, dated October 2017, reflected: Foods shall be received and stored in a manner that complies with safe food handling practices.8. All foods stored in the refrigerator or freezer will be covered, labeled and dated. Event ID: Facility ID: 455563 If continuation sheet Page 13 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on record review and interviews, the facility failed to conduct and document a comprehensive facility-wide assessment for the past year to determine what resources were necessary to care for its residents competently during day-to-day operations and review and update the assessment at least annually for 1 of 1 facility reviewed annual assessment. Based on record review and interviews, the facility failed to conduct and document a comprehensive facility-wide assessment for the past year to determine what resources were necessary to care for its residents competently during day-to-day operations and review and update the assessment at least annually for 1 of 1 facility reviewed annual assessment. The facility did not have a completed Facility Assessment. This deficient practice could affect all residents and contribute to insufficient staffing and a lack of necessary resources to provide necessary care to residents. The findings were: During the entrance conference on 06/30/25 at 9:46 AM the Administrator was provided the Entrance Conference Checklist which instructed the facility to provide the survey team the facility's Facility Assessment within 4 hours of the entrance. In an interview on 07/02/25 at 4:35 PM with the Administrator, she confirmed they did not have a facility assessment. Record review of the facility's census, dated 06/30/25, reflected the census was 25. Record review of the facility's policy titled, Facility Assessment, dated October 2018, reflected: A facility assessment is conducted annually to determine and update our capacity to meet the needs of and competently care for our residents during day-to-day operations. 1. Once a year, and as needed, a designated team conducts a facility-wide assessment to ensure that the resources are available to meet the specific needs of our residents. Event ID: Facility ID: 455563 If continuation sheet Page 14 of 15 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 455563 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denison Nursing and Rehab 601 E Hwy 69 Denison, TX 75021 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to maintain an infection prevention and control program designated to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 2 (Resident #3 and Resident #16) of 3 residents reviewed for infection control. Residents Affected - Some Based on observation, interview and record review, the facility failed to maintain an infection prevention and control program designated to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection for 2 (Resident #3 and Resident #16) of 3 residents reviewed for infection control. The facility failed to ensure LVN B disinfected the blood pressure cuff in between blood pressure checks for Residents #3 and #16. This failure could place residents at-risk of cross contamination which could result in infections or illness. Findings included: Observation on 07/01/25 at 8:59 AM revealed LVN B performing morning medication pass, during which time she checked the blood pressure on Resident #3. LVN B did not sanitize the blood pressure cuff before and after using it on Resident #3 and continued to the next resident without sanitizing the blood pressure cuff. LVN B then checked Resident #16's blood pressure. LVN B did not sanitize the blood pressure cuff before using it on Resident #16. Interview on 07/01/25 at 9:35 AM, LVN B stated reusable equipment, like blood pressure cuffs, should be sanitized before and after use on each resident to keep germs from spreading. She stated she was nervous and forgot to sanitize the blood pressure cuff between residents' use. In an interview with the DON on 07/02/25 at 05:51 PM, She stated her expectation staff to sanitize blood pressure cuff after each use. She stated to ensure staff were knowledgeable in the sanitation of blood pressure cuff the facility would do skills competency checks and she stated she would make daily rounds and watched care and medication administration. On 07/02/25 at 4:15 PM requested facility's policy, not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455563 If continuation sheet Page 15 of 15