Inspection·September 7, 2023

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few toilet use at total dependence with two plus persons physical assist, personal hygiene at total dependence with two plus persons physical assist, bathing at total dependence with two plus persons physical assist, balancing during transition and walking code of 8 which indicated activity did not occur, no impairment in upper and lower extremity, and that Resident #1 believes he or she is capable of increased independence code of 1 which indicated yes. Record review of Resident #1's care plan, undated, revealed a focus that resident (Resident #1) is risk for falls related to weakness, incontinent, a goal of resident (Resident #1) will be free of falls and will not sustain serious injury, and interventions/tasks to anticipate and meet resident (Resident #1) needs, be sure the resident's (Resident #1) call light is within reach and encourage the resident to use it for assistance as needed, educate resident/family/caregiver about safety reminders and what to do if a fall occurred, encourage resident to participate in activities that promote exercise, physical activity for strengthening and improved mobility, keep furniture in locked position, keep needed items in reach, mechanical lift with staff x2 with transfers, physical therapy evaluate and treat as ordered or PRN, review information on past falls and attempt to determine cause of falls possible root causes, removed any potential causes, educate resident/family/caregivers/IDT (Interdisciplinary Team), provide a safe environment, and activities that minimize the potential for falls while providing diversion and distraction. Record review of the facility's incident report, dated 09/06/2023, revealed a fall incident with Resident #1 on 09/04/2023 at 4:00 p.m. Record review of Resident #1's, undated, progress notes in the EHR revealed a medical practitioner note effective date 09/05/2023 at 02:05 (2:00 a.m.), note text: yesterday 9/4/23 resident (Resident #1) was discovered on the floor, she was lying on her left side. Upon assessment on 10-6pm shift, it has been noted that, resident does not respond like she normally does. If someone asked her a question she responds with simple words. Now, if a questioned is asked she just shakes her head or she just stares at you with no response (this is new). Further review of progress notes revealed a transfer notification, 09/05/2023 05:09 (05:09 a.m.), note text: Resident #1 was transferred to a hospital on [DATE] at 04:43 AM related to neuro changes r/t (related) fall 9/4/23. Record review of Resident #1's assessment page in the, undated, EHR revealed the following assessments completed: 09/04/2023 Event Nurses-Note 8hr Fall 09/04/2023 Neuro Assessment 09/04/2023 Neuro Assessment 09/04/2023 Fall-Risk Assessment 09/05/2023 Neuro Assessment 09/05/2023 Fall Nurses Note 8 hr 09/05/2023 SBAR (situation, background, assessment, and recommendation) 09/05/2023 Transfer Form (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #1's Event Nurses-Note 8hr Fall, dated 09/04/2023 at 16:00 (4:00 p.m.), LVN A noted a nursing description of event, resident (Resident #1) was found by staff on the floor laying on her side on the side of her bed, in residents' room, un-witnessed fall discovered on floor, resident received a bruise from fall, located in face, redness noted, resident not in pain, NP notified on 09/04/2023 at 00:00 (12:00 a.m.), interventions prior to fall was low bed, interventions in response to fall was floor mat and low bed, cognition/behavior at time of event was oriented/no problem. Residents Affected - Few Record review of Resident #1's Neuro Assessment, dated 09/04/2023 at 21:56 (9:56 p.m.), LVN A noted vitals: blood pressure at 117/58, pulse 58, and respirations 18, GCS (Glasgow Coma Scale): eyes opening spontaneously, oriented to person, place, and time, obeys commands, pupils reactive to light, and hand grips are equal. Record review of Resident #1's Neuro assessment dated [DATE] at 21:57 (9:57 p.m.), LVN A noted vitals: blood pressure at 108/58, pulse 60, and respirations 18, GCS (Glasgow Coma scale): eyes opening spontaneously, oriented to person, place, and time, obeys commands, pupils reactive to light, and hand grips are equal. Record review of Resident #1's Fall-Risk assessment dated [DATE] at 21:58 (9:58 p.m.), LVN A noted Resident #1 was alert and oriented. Record review of Resident #1's Neuro Assessment, dated 09/05/2023 at 02:02 (2:02 a.m.), revealed vitals: blood pressure at 116/73, pulse 56, and respirations n/a (not applicable), GCS (Glasgow Coma Scale): eyes opening spontaneously, words only intelligible single words, cannot have a conversation, considered as a new observation for Resident #1, obeys commands, pupil reactive to light, hand grips unable to assess due to paralysis, hemiplegia, injury, contractures, notification to NP/MD on 09/05/2023 02:10 (2:10 a.m.), physician/NP comments or orders listed as none at this time. Record review of Resident #1's Event Nurses-Note 8hr Fall, dated 09/05/2023 at 02:11 (2:11 a.m.), revealed left side of cheek was red, notification to NP/MD on 09/05/2023 02:10 (2:10 a.m.), physician/NP comments or orders listed as none at this time. Record review of Resident #1's SBAR (situation, background, assessment, and recommendation), 9/5/2023 04:51 (4:51 a.m.), situation neurological change, description of symptoms or signs revealed baseline as single words able to answer questions if asked, although currently no words just stares and difficult to arose, symptoms first appeared 9/5/2023. Record review of Resident #1's Transfer form, date 09/05/2023 05:09 (5:09 a.m.), LVN B's note reason for transfer was neuro changes r/t (related to) fall 09/04/2023. Record review of Resident #1's progress note, dated 09/05/2023 at 02:05 (02:05 a.m.), revealed LVN B's note text, Yesterday 9/4/23 resident was discovered on the floor, she was lying on her left side. Upon assessment on 10-6pmshift, it has been noted that resident does not respond like she normally does. If someone asked her a question she responds with simple words. Now, if a questioned is asked she just shakes her head or she just stares at you with no response (this is a new). Interview on 09/06/2023 at 10:29 a.m., the NP stated she needed to confirm if she was notified of the incident of Resident #1 on 9/4/2023, that would have been the on-call MD/NP. The NP stated she did not see a notification of the incident; The NP checked the call log used to record notifications (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few and stated she could not confirm if the on-call MD/NP was notified. The NP stated after falls, when there was an injury to the head of any resident, the corporation had its own policy on neurological checks and monitoring that was evidenced based, nurses would monitor the set of criteria, and if there were any changes to the resident. When asked what the timeframes were for monitoring a resident with an unwitnessed fall or a injury to head, the NP could not recall the exact policy on time frames for neurological testing as it all depended on the evidence available, the NP stated with Resident #1's unwitnessed fall, she should have met the neurological monitoring criteria. The NP stated it was hard to speculate if the fall led to the Resident #1's change of condition. Interview on 09/06/2023 at 11:20 a.m., the ADM stated she had just received information Resident #1 is being transferred to another hospital. The ADM stated she did not know the detailed reason for a transfer, although she attempted to obtain hospital records where Resident #1 was first sent to and to call the family. Interview and observation on 09/06/2023 at 01:14 p.m., the Interim DON stated when a Resident fell, the facility did a standard check on residents ranging from obtaining vitals, assess resident for injuries, pain, skin assessment, and other recommended checks. The Interim DON stated if a resident could be placed back in his or her bed it was done, although after they contacted the MD or NP, and orders were obtained to send the resident to a hospital then they pursued those orders. The Interim DON stated if staff could place a resident back in his or her bed, they continued routine assessments and reported all changes to the MD or NP. The DON stated assessments were important as the process gave staff objective information on the resident, and to monitor a resident's condition. An observation was completed with the Interim DON to demonstrate how assessments were opened and completed to activate the facility's EHR systems UDA (User Defined Assessment) after resident involved incident. The Interim DON revealed the EHR systems risks management option, that documented related information for the resident, the incident, location, date, and time. The Interim DON revealed the EHR systems action plan for falls and UDA, which included the resident's fall nurses note, all details relevant information such as the location of injury, how the resident was found, pain, all pertinent information related to a resident's fall. The Interim DON demonstrated an option for an unwitnessed fall or head injury in the EHR systems automatically triggered a neurological assessment for the resident involved in an unwitnessed fall or a fall with a head injury. Interview during the demonstration, the Interim DON stated the nurses should call the MD or NP on duty and document any notes or additional interventions, and document what to do notes. The Interim DON stated per the facility policy it did not reveal specific timeframes for the completion of neurological checks, the Interim DON stated the facility EHR system would reveal timeframes for neurological assessments, and it would trigger the EHR's POC (point of care) systems to alert nursing for UDAs. The Interim DON stated and demonstrated, there was a timeframe for neurological checks for nursing practice and the EHR system, a neurological check should have been completed 15 minutes after opening the 8 hours fall note. The Interim DON stated at this time she was unable to provide documentation if LVN A documented the neurological assessments within the timeframes. The Interim DON stated if nursing did not properly open and document assessments it would create an inconsistency with timeframe assessments and accuracy on a resident's condition. The Interim DON stated nursing must do required assessments and document all findings, stating if it is not documented, it did not happen . Interview on 09/06/2023 at 02:13 p.m., the ADM stated she contacted Resident #1's family and obtained limited information on Resident #1, the resident had a suspected brain bleed, on the left side of the brain. The ADM revealed she reported the incident to HHSC after finding out about the serious injury. The ADM revealed the facility policy did not reveal specific timeframes for the completion of neurological checks, and the ADM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few was not able to confirm the process or timeframes of doing neurological checks for falls with head injuries or unwitnessed falls. The ADM stated staff were supposed to assess the residents for all incidents and call the MD or NP to inform them of the situation. The ADM stated assessments were needed to obtain current and accurate information on a resident's medical condition, such as pain, swelling, head injuries, and resident vitals. Interview on 09/06/2023 at 04:10 p.m., LVN A stated resident assessments were completed for all resident incidents, this included falls, unwitnessed falls, elopement, skin issues, or any new findings for a resident. LVN A stated after fall incidents with head injury or unwitnessed falls, staff used the EHR system to create an incident report, and neurological assessments would be triggered by the EHR system. LVN A stated neurological assessments were completed every 15 minutes for the first hour initially, and was not entirely clear on the next timeframes, LVN A stated she was aware of the first hour, having a quarterly or 15-minute neurological check. LVN A recalled the incident that involved Resident #1, the resident had an unwitnessed fall, on 9/4/2023, she could not recall the exact timeframe but stated it was during her shift which would be the early morning shift. LVN A stated Resident #1 was on the floor, in her room , laying on left side by the wall in room. LVN A stated Resident #1 had a bruise on the left side of face, LVN A proceeded to do a full body assessment, Resident #1 was not found to be in pain, and Resident #1 was able to state she fell. LVN A stated she completed the incident report a little later, LVN A stated she could not recall the exact time frame the resident was found on the floor, although gave an approximate timeframe between 4:00 p.m. and 5:00 p.m., LVN further stated she opened up the incident report but did not complete maybe around 8:00 p.m. or 9:00 p.m., as there were other duties performed that evening. LVN A stated she did not contact the NP on duty. LVN A stated she believes I did a neuro check; I was checking her already. LVN A stated she listed the neurological check information down on paper. When asked to provide that information, LVN A could not confirm the whereabouts of that information. LVN A stated, this was on me, I did not follow the procedure of documenting the neurological checks, there was a lot going on that day. LVN A stated if nurses did not properly perform neurological assessments, and all assessments, it could place the residents at risk as it is used for early detection. Record review of Resident #1's hospital records, dated 09/05/2023, revealed, encounter date 09/05/2023, history of present illness, patient (Resident #1) is not oriented and barely opens eyes to stimulation. On arrival in ER (emergency room) she (Resident #1) has a CT scan and chest x-ray which did not reveal significant acute abnormality. Hospital exam, general appearance ill appearing, cranial nerve intact, no focal deficits (There are no specific problems with nerve, spinal cord, or brain function). Record review of Resident #1's hospital records, dated 09/05/2023 and signed 05:49 a.m., revealed CAT scan report, preliminary report, Exam was CT head without intravenous contract. Findings: brain no masses, midline shift or intracranial hemorrhage, chronic atrophy, white matter disease, no hydrocephalus, orbits unremarkable, paranasal sinuses and mastoid air cells are clear, no significant facial or scalp tissue swelling evident, no radiopaque foreign body is seen, no acute skull fracture, impression no acute intracranial abnormality. Record review of Resident #1's hospital records, dated 9/6/2023 at 10:02 a.m., revealed CAT scan report, report status is a draft, preliminary report CAT angio head, findings included increased volume of left sylvian fissure subarachnoid hemorrhage. Impression increased left sylvian fissure subarachnoid hemorrhage now measuring up to 2.6 cm (centimeters) in AP dimension, with a width of up to 8 mm (millimeter) and a craniocaudal of 11 mm (millimeter), no high-grade mass effect. Large left frontal parietal scalp contusion and hemorrhage with contrast blush indicating active hemorrhage coronal. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of the facility policy for neurological checks, revised May 2016, revealed neurologic checks, they are a combination of objective observation and measurements done to evaluate neurologic status. The results of the checks assist to determine nervous system damage and/or deterioration. Goals are to identify changes indicating progressive improvement or deterioration in neurologic status, and the resident will be free from injury. Record review of the facility policy for notifying the Physician of Change in Status, revised March 11, 2013, revealed the nurse should not hesitate to contact the physician at any time when an assessment an their professional judgement deem it necessary for immediate medical attention. This facility utilizes the INERACT tool, Change in Condition-When to Notify the MD/NP/PA to review resident condition and guide the nurse when to notify the physician. This tool informs the nurse if the resident condition requires immediate notification of the physician or non-immediate/Report on Next Work day notification of the physician. 1. The nurse will notify the physician immediately with significant change in statis. The nurse will document signs and symptoms of significant change, time/date of call to physician, and interventions that were implemented in the resident's clinical record. 2. Before the physician is contacted, the nurse will gather and organize resident information. Applicable information will include current medications, vital signs, signs and symptoms initiating call, current laboratory information, and interventions that have currently been implemented. 3. The nurse may collect several non-emergent items and place one telephone call during the shift in order to avoid multiple calls to a physician with non-emergent questions. The nurse is responsible, however, for responding to a change of condition in a timely and effective manner. The nurse will document the time of the call to the physician in the clinical record. 4. If the physician does not return the call within a reasonable amount of time, the nurse will attempt to contact the physician a second time. If the situation is an emergency, and the physician does not call back within a reasonable amount of time, the nurse will contact the Medical Director or the nearest ambulance service for assistance. The nurse will document all attempts to contact the physician in the resident's clinical record. 5. The resident's family member or legal guardian should be notified of significant change in resident's status unless the resident as specified otherwise. 6. The nurse will monitor and reassess the resident's status and response to intervention. Physicians (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 should develop a working diagnosis and guide nursing staff in what to monitor, and when to notify the physician if the resident's condition does not improve. Level of Harm - Immediate jeopardy to resident health or safety 7. Residents Affected - Few The nurse will document all attempts to contact the physician, all attempts to notify the family and/or legal representative, the physician's response, the physician's orders and the resident's status and respond to interventions. 8. If the resident remains in the facility and a significant change has occurred, update the car plan accordingly. 9. Faxes should be following up by the end of the business day. 10. If a resident is transferred to the hospital, complete a transfer form. Send a copy of the most recent H & P, progress note, advance directives, MAR, diagnosis list, and pertinent lab and x-ray reports to the hospital. Document actions in the resident's clinical records. 11. Abnormal lab, x-ray and other diagnostic reports require physician notification. This was determined to be an Immediate Jeopardy (IJ) on 09/06/2023 at 05:28 p.m. The ADM was notified. The ADM was provided with the IJ template on 09/06/2023 at 05:57 p.m. The following plan of Removal submitted by the facility was accepted on 09/07/2023 at 06:00 p.m.: PLAN OF REMOVAL September,6, 2023 IJ Component: F684 Quality of Care Facility failed to initiate neurological checks on CR#1 after resident sustained a head injury. Seven residents with falls could have been affected by the deficient practice. Immediate Actions: As of 9/5/23 resident CR#1 was transferred to the hospital for evaluation. LVN-A was provided 1 on 1 education by Administrator on 9/6/23 and will be re-in serviced prior to next scheduled shift, regarding Event Notification; Abuse and Neglect; and Change of Condition, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 neuro checks and how to notify DON/Physician/RP and oncoming nurses. Level of Harm - Immediate jeopardy to resident health or safety Facility Plan to ensure compliance: Residents Affected - Few Abuse & Neglect policy was reviewed by the Compliance Nurse, Administrator, DON, and ADON and in-serviced on 9/06/23. No changes were made to the policy. The Compliance Nurse in-serviced the DON and ADONs. The Compliance Nurse, DON, ADONs inserviced all staff including clinical, administrative, dietary, housekeeping, laundry, therapy, maintenance, and activities. to ensure compliance for this policy and procedure. All staff not present on 9/06/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. Inservices: Compliance Nurse in-serviced Administrator, DON, and ADON's on Event note completion and Neuro check policy 9/06/23. The Compliance Nurse, DON, and the ADONs in-serviced Charge Nurses on neuro checks (neuro checks are to be initiated if a resident hits their head or had an un-witnessed fall) and Event note completion. Return demonstration with PCC was included in the in-services. In-services will be completed by the DON/Designee monthly for the next 3 months, then as needed thereafter. All staff not present on 9/06/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. Notifying Physician on change in status policy that includes falls with head injury or other serious injury was reviewed & in-serviced on 9/06/23, the Compliance Nurse in-serviced DON and ADONs. The Compliance Nurse, DON, and ADON in-serviced Charge Nurses to ensure compliance for this policy & procedure. Return demonstration with PCC was included in the in-services. In-services will be completed by the DON/Designee monthly for the next 3 months, then as needed thereafter. All staff not present on 9/06/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. The Regional Compliance Nurse visited the facility 9/06/23 to review resident falls in PCC. Inservicing was provided by the Compliance Nurse with the Administrator, DON, and ADON on Abuse & Neglect, Neuro checks, Notifying Physician on change in status, and process of reporting changes to oncoming shift nurses. The Administrator, Compliance Nurse, DON, and ADON provided all facility staff in-servicing on Abuse and Neglect. The Compliance Nurse, DON, and ADON inserviced the Charge Nurses on neuro checks and notifying the MD for a change in condition and reporting changes to the oncoming shifts. Inservicing began on 9/6/23. All staff not present on 9/6/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. Audits completed: Falls for the last 30 days were audited by the Regional Compliance Nurse and DON on 9/6/23. No additional issues were noted. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Inservicing: Notifying oncoming Nurse in charge on any resident injury or change in condition that include falls during the change of shift report process. The Compliance Nurse in-serviced DON and ADON on 9/6/23. The DON/ADON in-service Charge Nurses to ensure compliance for this policy & procedure. The DON/Designee will continue in-servicing monthly for the next 3 months, then as needed thereafter. All staff were in-serviced by the compliance nurse, DON, and ADON on notifying the DON for any resident change in condition on 9/6/23. All staff not present on 9/6/23 will in-serviced prior to the start of the next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. The Medical Director was notified by the Administrator on 9/06/23 at 6:20pm on the immediate jeopardy citation. An AD HOC QAPI meeting was held on 9/06/23 by the Interdisciplinary Team to discuss the Immediate Jeopardies and review the Plan of Removal. Monitoring: The DON / designee will monitor Real Time clinical software and/or the PCC Dashboard for clinical alerts for any resident change of condition including falls, head injuries, other serious injuries, or changes of condition 7 days per week to ensure physician/NP were notified. All charge nurses will be responsible for notifying the MD on the weekends. DON/ADON/Designee will provide oversight. Monitoring began 9/06/23 and will continue x 4 weeks and weekly thereafter. The DON and/or designee will monitor fall events 7 days a week to ensure neuro checks and assessments were initiated for all falls. Monitoring began 9/06/23 and will continue x 4 weeks or until the administrator determines substantial compliance has been achieved and maintained. This plan will be reviewed monthly at QAPI for the next three months. The State Survey Team monitored the Plan of Removal on 09/07/2023 and included the following: Observation on 09/07/2023 at 10:39 a.m., reflected corporate staff in facility monitoring the POR process initiated by the facility. Interview on 09/07/2023 at 03:03 p.m., LVN A stated she was provided 1-on1 education by Administrator, LVN A stated she was in serviced regarding Event Notification; Abuse and Neglect; and Change of Condition, neuro checks and how to notify DON/Physician/RP and oncoming nurses. Interview on 09/07/2023, the Interim DON and ADON stated they were in-service and reviewed by corporate nurse, on 09/06/2023 on Abuse and Neglect, Event note completion and Neuro check policy, Notifying Physician on change in status policy that included falls with head injury or other serious injury. Interview on 09/07/2023 from 12:33 p.m. to 02:20 p.m., charge nurses from all shifts, stated they were in-serviced by Interim DON and ADON on 09/06/2023 and 09/07/2023 on Abuse and Neglect, Event note completion and Neuro check policy, Notifying Physician on change in status policy that included falls with head injury or other serious injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Interview on 09/07/2023, the Interim DON stated continued monitoring on Real Time clinical software and fall events 7 days a week to ensure neuro checks and assessments were initiated for all falls. Interview on 09/07/2023 from 12:19 p.m. to 02:20 p.m., AIT (administrator in training), rehabilitation director, and two CNAs stated in-service, knowledge and reporting on Abuse and Neglect. Record review on 09/07/2023, revealed in-service initiated on 09/06/2023 on training of notification of change of conditions to DON, Fall prevention, Abuse & Neglect, Neuro checks, Shift change=nurse provides oncoming shift nurse with information to provide care to residents, and Event note completion. Record review on 09/07/2023, revealed Neuro Checks-Relias course, when a resident hits their head during a fall or the fall is unwitnessed, neuro checks will need to be completed at the time of the fall then according to the schedule below: every 15 minutes x 4, then every 30 minutes x2, then every 1 hour x2, then every 2 hours x 2, then every 8 hours x 8 Record review on 09/07/2023, revealed QAPI meeting held 9/7/23. The ADM was informed the Immediate Jeopardy was removed on 09/07/2023 at 08:00 p.m. The facility remained out of compliance at a severity level of actual harm with potential for more than minimal harm that is not immediate jeopardy with a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure based on the comprehensive assessment of a resident, the resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for one (Resident #1) of 7 Residents reviewed for quality of care. Residents Affected - Few The facility nurses failed to ensure nurses conducted neurological exams after Resident #1 sustained a fall with head injury on 09/04/2023 at 4:00 p.m., 10 of 12 neuro checks were not conducted. The first documented neuro exam was not until approximately 6 hours after the incident, 09/04/2023 at 9:56 pm. The next neuro exam was not until 09/05/2023 at 2:05 am at which time a change in condition was identified. The resident was not sent to the hospital until 09/05/2023 at 4:43 am. The 04:00 am Neuro check was not done. Resident #1 was subsequently diagnosed with a left sylvian fissure subarachnoid hemorrhage (bleeding). An Immediate Jeopardy (IJ) situation was identified on 09/06/2023. While the IJ was removed on 09/07/2023, the facility remained out of compliance at a scope of isolated with actual harm, due to the facility's need to evaluate the effectiveness of the corrective systems. This failure could place residents at risk of not receiving the highest practicable care through resident assessments by recognizing and addressing the physical, mental, and neurological dysfunctions such as altered state of consciousness, cognitive decline, confusion, memory loss, changes in behavior in an effective and timely manner to prevent residents from further harm, injury, or death. Findings include: Record review of Resident #1's face sheet, dated 09/06/2023, revealed a [AGE] year-old-female who was admitted to the facility on [DATE] with diagnoses which included cerebral infarction (stroke), metabolic encephalopathy (brain disruption), heart failure, obesity, and hypertension. Record review of Resident #1's MDS, dated [DATE], revealed a BIMS of 05, which indicated a severe cognitive impairment. Further review of Resident #1's MDS, Hearing, Speech, and Vision, revealed a Speech Clarity code of 0 revealed clear speech-distinct intelligible words, Makes Self Understood code of 1 revealed Usually understood-difficulty communicating some words or finished thoughts but able if prompted or given time. Further review of Resident #1's MDS, Health Conditions, revealed Fall history code of 0, which indicated Resident #1 did not have a fall in the last month, last 2 to 6 months, or fracture related to fall in the 6 months prior to admission. Further review of Resident #1's MDS, Functional status, revealed bed mobility at total dependence with two plus persons physical assist, transfer at activity did not occur, walk in room at activity did not occur, walk in corridor at activity did not occur, locomotion on unit at activity did not occur, dressing at total dependence with two plus persons physical assist, eating at limited assistance with one person physical assist, toilet use at total dependence with two plus persons physical assist, personal hygiene at total dependence with two plus persons physical assist, bathing at total dependence with two plus persons physical assist, balancing during transition and walking code of 8 which indicated activity did not occur, no impairment in upper and lower extremity, and that Resident #1 believes he or she is capable of increased independence code of 1 which indicated yes. Record review of Resident #1's care plan, undated, revealed a focus that resident (Resident #1) is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few risk for falls related to weakness, incontinent, a goal of resident (Resident #1) will be free of falls and will not sustain serious injury, and interventions/tasks to anticipate and meet resident (Resident #1) needs, be sure the resident's (Resident #1) call light is within reach and encourage the resident to use it for assistance as needed, educate resident/family/caregiver about safety reminders and what to do if a fall occurred, encourage resident to participate in activities that promote exercise, physical activity for strengthening and improved mobility, keep furniture in locked position, keep needed items in reach, mechanical lift with staff x2 with transfers, physical therapy evaluate and treat as ordered or PRN, review information on past falls and attempt to determine cause of falls possible root causes, removed any potential causes, educate resident/family/caregivers/IDT (Interdisciplinary Team), provide a safe environment, and activities that minimize the potential for falls while providing diversion and distraction. Record review of the facility's incident report, dated 09/06/2023, revealed a fall incident with Resident #1 on 09/04/2023 at 4:00 p.m. Record review of Resident #1's, undated, progress notes in the EHR revealed a medical practitioner note effective date 09/05/2023 at 02:05 (2:00 a.m.), note text: yesterday 9/4/23 resident (Resident #1) was discovered on the floor, she was lying on her left side. Upon assessment on 10-6pm shift, it has been noted that, resident does not respond like she normally does. If someone asked her a question she responds with simple words. Now, if a questioned is asked she just shakes her head or she just stares at you with no response (this is new). Further review of progress notes revealed a transfer notification, 09/05/2023 05:09 (05:09 a.m.), note text: Resident #1 was transferred to a hospital on [DATE] at 04:43 AM related to neuro changes r/t (related) fall 9/4/23. Record review of Resident #1's assessment page in the, undated, EHR revealed the following assessments completed: 09/04/2023 Event Nurses-Note 8hr Fall 09/04/2023 Neuro Assessment 09/04/2023 Neuro Assessment 09/04/2023 Fall-Risk Assessment 09/05/2023 Neuro Assessment 09/05/2023 Fall Nurses Note 8 hr 09/05/2023 SBAR (situation, background, assessment, and recommendation) 09/05/2023 Transfer Form Record review of Resident #1's Event Nurses-Note 8hr Fall, dated 09/04/2023 at 16:00 (4:00 p.m.), LVN A noted a nursing description of event, resident (Resident #1) was found by staff on the floor laying on her side on the side of her bed, in residents' room, un-witnessed fall discovered on floor, resident received a bruise from fall, located in face, redness noted, resident not in pain, NP notified on 09/04/2023 at 00:00 (12:00 a.m.), interventions prior to fall was low bed, interventions in response to fall was floor mat and low bed, cognition/behavior at time of event was oriented/no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 problem. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #1's Neuro Assessment, dated 09/04/2023 at 21:56 (9:56 p.m.), LVN A noted vitals: blood pressure at 117/58, pulse 58, and respirations 18, GCS (Glasgow Coma Scale): eyes opening spontaneously, oriented to person, place, and time, obeys commands, pupils reactive to light, and hand grips are equal. Residents Affected - Few Record review of Resident #1's Neuro assessment dated [DATE] at 21:57 (9:57 p.m.), LVN A noted vitals: blood pressure at 108/58, pulse 60, and respirations 18, GCS (Glasgow Coma scale): eyes opening spontaneously, oriented to person, place, and time, obeys commands, pupils reactive to light, and hand grips are equal. Record review of Resident #1's Fall-Risk assessment dated [DATE] at 21:58 (9:58 p.m.), LVN A noted Resident #1 was alert and oriented. Record review of Resident #1's Neuro Assessment, dated 09/05/2023 at 02:02 (2:02 a.m.), revealed vitals: blood pressure at 116/73, pulse 56, and respirations n/a (not applicable), GCS (Glasgow Coma Scale): eyes opening spontaneously, words only intelligible single words, cannot have a conversation, considered as a new observation for Resident #1, obeys commands, pupil reactive to light, hand grips unable to assess due to paralysis, hemiplegia, injury, contractures, notification to NP/MD on 09/05/2023 02:10 (2:10 a.m.), physician/NP comments or orders listed as none at this time. Record review of Resident #1's Event Nurses-Note 8hr Fall, dated 09/05/2023 at 02:11 (2:11 a.m.), revealed left side of cheek was red, notification to NP/MD on 09/05/2023 02:10 (2:10 a.m.), physician/NP comments or orders listed as none at this time. Record review of Resident #1's SBAR (situation, background, assessment, and recommendation), 9/5/2023 04:51 (4:51 a.m.), situation neurological change, description of symptoms or signs revealed baseline as single words able to answer questions if asked, although currently no words just stares and difficult to arose, symptoms first appeared 9/5/2023. Record review of Resident #1's Transfer form, date 09/05/2023 05:09 (5:09 a.m.), LVN B's note reason for transfer was neuro changes r/t (related to) fall 09/04/2023. Record review of Resident #1's progress note, dated 09/05/2023 at 02:05 (02:05 a.m.), revealed LVN B's note text, Yesterday 9/4/23 resident was discovered on the floor, she was lying on her left side. Upon assessment on 10-6pmshift, it has been noted that resident does not respond like she normally does. If someone asked her a question she responds with simple words. Now, if a questioned is asked she just shakes her head or she just stares at you with no response (this is a new). Interview on 09/06/2023 at 10:29 a.m., the NP stated she needed to confirm if she was notified of the incident of Resident #1 on 9/4/2023, that would have been the on-call MD/NP. The NP stated she did not see a notification of the incident; The NP checked the call log used to record notifications and stated she could not confirm if the on-call MD/NP was notified. The NP stated after falls, when there was an injury to the head of any resident, the corporation had its own policy on neurological checks and monitoring that was evidenced based, nurses would monitor the set of criteria, and if there were any changes to the resident. When asked what the timeframes were for monitoring a resident with an unwitnessed fall or a injury to head, the NP could not recall the exact policy on time frames for neurological testing as it all depended on the evidence available, the NP stated with Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety #1's unwitnessed fall, she should have met the neurological monitoring criteria. The NP stated it was hard to speculate if the fall led to the Resident #1's change of condition. Interview on 09/06/2023 at 11:20 a.m., the ADM stated she had just received information Resident #1 is being transferred to another hospital. The ADM stated she did not know the detailed reason for a transfer, although she attempted to obtain hospital records where Resident #1 was first sent to and to call the family. Residents Affected - Few Interview and observation on 09/06/2023 at 01:14 p.m., the Interim DON stated when a Resident fell, the facility did a standard check on residents ranging from obtaining vitals, assess resident for injuries, pain, skin assessment, and other recommended checks. The Interim DON stated if a resident could be placed back in his or her bed it was done, although after they contacted the MD or NP, and orders were obtained to send the resident to a hospital then they pursued those orders. The Interim DON stated if staff could place a resident back in his or her bed, they continued routine assessments and reported all changes to the MD or NP. The DON stated assessments were important as the process gave staff objective information on the resident, and to monitor a resident's condition. An observation was completed with the Interim DON to demonstrate how assessments were opened and completed to activate the facility's EHR systems UDA (User Defined Assessment) after resident involved incident. The Interim DON revealed the EHR systems risks management option, that documented related information for the resident, the incident, location, date, and time. The Interim DON revealed the EHR systems action plan for falls and UDA, which included the resident's fall nurses note, all details relevant information such as the location of injury, how the resident was found, pain, all pertinent information related to a resident's fall. The Interim DON demonstrated an option for an unwitnessed fall or head injury in the EHR systems automatically triggered a neurological assessment for the resident involved in an unwitnessed fall or a fall with a head injury. Interview during the demonstration, the Interim DON stated the nurses should call the MD or NP on duty and document any notes or additional interventions, and document what to do notes. The Interim DON stated per the facility policy it did not reveal specific timeframes for the completion of neurological checks, the Interim DON stated the facility EHR system would reveal timeframes for neurological assessments, and it would trigger the EHR's POC (point of care) systems to alert nursing for UDAs. The Interim DON stated and demonstrated, there was a timeframe for neurological checks for nursing practice and the EHR system, a neurological check should have been completed 15 minutes after opening the 8 hours fall note. The Interim DON stated at this time she was unable to provide documentation if LVN A documented the neurological assessments within the timeframes. The Interim DON stated if nursing did not properly open and document assessments it would create an inconsistency with timeframe assessments and accuracy on a resident's condition. The Interim DON stated nursing must do required assessments and document all findings, stating if it is not documented, it did not happen . Interview on 09/06/2023 at 02:13 p.m., the ADM stated she contacted Resident #1's family and obtained limited information on Resident #1, the resident had a suspected brain bleed, on the left side of the brain. The ADM revealed she reported the incident to HHSC after finding out about the serious injury. The ADM revealed the facility policy did not reveal specific timeframes for the completion of neurological checks, and the ADM was not able to confirm the process or timeframes of doing neurological checks for falls with head injuries or unwitnessed falls. The ADM stated staff were supposed to assess the residents for all incidents and call the MD or NP to inform them of the situation. The ADM stated assessments were needed to obtain current and accurate information on a resident's medical condition, such as pain, swelling, head injuries, and resident vitals. Interview on 09/06/2023 at 04:10 p.m., LVN A stated resident assessments were completed for all (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few resident incidents, this included falls, unwitnessed falls, elopement, skin issues, or any new findings for a resident. LVN A stated after fall incidents with head injury or unwitnessed falls, staff used the EHR system to create an incident report, and neurological assessments would be triggered by the EHR system. LVN A stated neurological assessments were completed every 15 minutes for the first hour initially, and was not entirely clear on the next timeframes, LVN A stated she was aware of the first hour, having a quarterly or 15-minute neurological check. LVN A recalled the incident that involved Resident #1, the resident had an unwitnessed fall, on 9/4/2023, she could not recall the exact timeframe but stated it was during her shift which would be the early morning shift. LVN A stated Resident #1 was on the floor, in her room , laying on left side by the wall in room. LVN A stated Resident #1 had a bruise on the left side of face, LVN A proceeded to do a full body assessment, Resident #1 was not found to be in pain, and Resident #1 was able to state she fell. LVN A stated she completed the incident report a little later, LVN A stated she could not recall the exact time frame the resident was found on the floor, although gave an approximate timeframe between 4:00 p.m. and 5:00 p.m., LVN further stated she opened up the incident report but did not complete maybe around 8:00 p.m. or 9:00 p.m., as there were other duties performed that evening. LVN A stated she did not contact the NP on duty. LVN A stated she believes I did a neuro check; I was checking her already. LVN A stated she listed the neurological check information down on paper. When asked to provide that information, LVN A could not confirm the whereabouts of that information. LVN A stated, this was on me, I did not follow the procedure of documenting the neurological checks, there was a lot going on that day. LVN A stated if nurses did not properly perform neurological assessments, and all assessments, it could place the residents at risk as it is used for early detection. Record review of Resident #1's hospital records, dated 09/05/2023, revealed, encounter date 09/05/2023, history of present illness, patient (Resident #1) is not oriented and barely opens eyes to stimulation. On arrival in ER (emergency room) she (Resident #1) has a CT scan and chest x-ray which did not reveal significant acute abnormality. Hospital exam, general appearance ill appearing, cranial nerve intact, no focal deficits (There are no specific problems with nerve, spinal cord, or brain function). Record review of Resident #1's hospital records, dated 09/05/2023 and signed 05:49 a.m., revealed CAT scan report, preliminary report, Exam was CT head without intravenous contract. Findings: brain no masses, midline shift or intracranial hemorrhage, chronic atrophy, white matter disease, no hydrocephalus, orbits unremarkable, paranasal sinuses and mastoid air cells are clear, no significant facial or scalp tissue swelling evident, no radiopaque foreign body is seen, no acute skull fracture, impression no acute intracranial abnormality. Record review of Resident #1's hospital records, dated 9/6/2023 at 10:02 a.m., revealed CAT scan report, report status is a draft, preliminary report CAT angio head, findings included increased volume of left sylvian fissure subarachnoid hemorrhage. Impression increased left sylvian fissure subarachnoid hemorrhage now measuring up to 2.6 cm (centimeters) in AP dimension, with a width of up to 8 mm (millimeter) and a craniocaudal of 11 mm (millimeter), no high-grade mass effect. Large left frontal parietal scalp contusion and hemorrhage with contrast blush indicating active hemorrhage coronal. Record review of the facility policy for neurological checks, revised May 2016, revealed neurologic checks, they are a combination of objective observation and measurements done to evaluate neurologic status. The results of the checks assist to determine nervous system damage and/or deterioration. Goals are to identify changes indicating progressive improvement or deterioration in neurologic status, and the resident will be free from injury. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review of the facility policy for notifying the Physician of Change in Status, revised March 11, 2013, revealed the nurse should not hesitate to contact the physician at any time when an assessment and their professional judgement deem it necessary for immediate medical attention. This facility utilizes the INERACT tool, Change in Condition-When to Notify the MD/NP/PA to review resident condition and guide the nurse when to notify the physician. This tool informs the nurse if the resident condition requires immediate notification of the physician or non-immediate/Report on Next Work day notification of the physician. 1. The nurse will notify the physician immediately with significant change in status. The nurse will document signs and symptoms of significant change, time/date of call to physician, and interventions that were implemented in the resident's clinical record. 2. Before the physician is contacted, the nurse will gather and organize resident information. Applicable information will include current medications, vital signs, signs and symptoms initiating call, current laboratory information, and interventions that have currently been implemented. 3. The nurse may collect several non-emergent items and place one telephone call during the shift in order to avoid multiple calls to a physician with non-emergent questions. The nurse is responsible, however, for responding to a change of condition in a timely and effective manner. The nurse will document the time of the call to the physician in the clinical record. 4. If the physician does not return the call within a reasonable amount of time, the nurse will attempt to contact the physician a second time. If the situation is an emergency, and the physician does not call back within a reasonable amount of time, the nurse will contact the Medical Director or the nearest ambulance service for assistance. The nurse will document all attempts to contact the physician in the resident's clinical record. 5. The resident's family member or legal guardian should be notified of significant change in resident's status unless the resident as specified otherwise. 6. The nurse will monitor and reassess the resident's status and response to intervention. Physicians should develop a working diagnosis and guide nursing staff in what to monitor, and when to notify the physician if the resident's condition does not improve. 7. The nurse will document all attempts to contact the physician, all attempts to notify the family (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety and/or legal representative, the physician's response, the physician's orders and the resident's status and respond to interventions. 8. If the resident remains in the facility and a significant change has occurred, update the car plan accordingly. Residents Affected - Few 9. Faxes should be following up by the end of the business day. 10. If a resident is transferred to the hospital, complete a transfer form. Send a copy of the most recent H & P, progress note, advance directives, MAR, diagnosis list, and pertinent lab and x-ray reports to the hospital. Document actions in the resident's clinical records. 11. Abnormal lab, x-ray and other diagnostic reports require physician notification. This was determined to be an Immediate Jeopardy (IJ) on 09/06/2023 at 05:28 p.m. The ADM was notified. The ADM was provided with the IJ template on 09/06/2023 at 05:57 p.m. The following plan of Removal submitted by the facility was accepted on 09/07/2023 at 06:00 p.m.: PLAN OF REMOVAL September,6, 2023 IJ Component: F684 Quality of Care Facility failed to initiate neurological checks on CR#1 after resident sustained a head injury. Seven residents with falls could have been affected by the deficient practice. Immediate Actions: As of 9/5/23 resident CR#1 was transferred to the hospital for evaluation. LVN-A was provided 1 on 1 education by Administrator on 9/6/23 and will be re-in serviced prior to next scheduled shift, regarding Event Notification; Abuse and Neglect; and Change of Condition, neuro checks and how to notify DON/Physician/RP and oncoming nurses. Facility Plan to ensure compliance: Inservices: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Abuse & Neglect policy was reviewed by the Compliance Nurse, Administrator, DON, and ADON and in-serviced on 9/06/23. No changes were made to the policy. The Compliance Nurse in-serviced the DON and ADONs. The Compliance Nurse, DON, ADONs inserviced all staff including clinical, administrative, dietary, housekeeping, laundry, therapy, maintenance, and activities. to ensure compliance for this policy and procedure. All staff not present on 9/06/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. Residents Affected - Few Compliance Nurse in-serviced Administrator, DON, and ADON's on Event note completion and Neuro check policy 9/06/23. The Compliance Nurse, DON, and the ADONs in-serviced Charge Nurses on neuro checks (neuro checks are to be initiated if a resident hits their head or had an un-witnessed fall) and Event note completion. Return demonstration with PCC was included in the in-services. In-services will be completed by the DON/Designee monthly for the next 3 months, then as needed thereafter. All staff not present on 9/06/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. Notifying Physician on change in status policy that includes falls with head injury or other serious injury was reviewed & in-serviced on 9/06/23, the Compliance Nurse in-serviced DON and ADONs. The Compliance Nurse, DON, and ADON in-serviced Charge Nurses to ensure compliance for this policy & procedure. Return demonstration with PCC was included in the in-services. In-services will be completed by the DON/Designee monthly for the next 3 months, then as needed thereafter. All staff not present on 9/06/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. The Regional Compliance Nurse visited the facility 9/06/23 to review resident falls in PCC. Inservicing was provided by the Compliance Nurse with the Administrator, DON, and ADON on Abuse & Neglect, Neuro checks, Notifying Physician on change in status, and process of reporting changes to oncoming shift nurses. The Administrator, Compliance Nurse, DON, and ADON provided all facility staff in-servicing on Abuse and Neglect. The Compliance Nurse, DON, and ADON inserviced the Charge Nurses on neuro checks and notifying the MD for a change in condition and reporting changes to the oncoming shifts. Inservicing began on 9/6/23. All staff not present on 9/6/23 will be in-serviced prior to start of their next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. Audits completed: Falls for the last 30 days were audited by the Regional Compliance Nurse and DON on 9/6/23. No additional issues were noted. Inservicing: Notifying oncoming Nurse in charge on any resident injury or change in condition that include falls during the change of shift report process. The Compliance Nurse in-serviced DON and ADON on 9/6/23. The DON/ADON in-service Charge Nurses to ensure compliance for this policy & procedure. The DON/Designee will continue in-servicing monthly for the next 3 months, then as needed thereafter. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few All staff were in-serviced by the compliance nurse, DON, and ADON on notifying the DON for any resident change in condition on 9/6/23. All staff not present on 9/6/23 will in-serviced prior to the start of the next shift. Newly hired, PRN, and agency staff will be in-serviced by the DON or ADON prior to start of their scheduled shift. The Medical Director was notified by the Administrator on 9/06/23 at 6:20pm on the immediate jeopardy citation. An AD HOC QAPI meeting was held on 9/06/23 by the Interdisciplinary Team to discuss the Immediate Jeopardies and review the Plan of Removal. Monitoring: The DON / designee will monitor Real Time clinical software and/or the PCC Dashboard for clinical alerts for any resident change of condition including falls, head injuries, other serious injuries, or changes of condition 7 days per week to ensure physician/NP were notified. All charge nurses will be responsible for notifying the MD on the weekends. DON/ADON/Designee will provide oversight. Monitoring began 9/06/23 and will continue x 4 weeks and weekly thereafter. The DON and/or designee will monitor fall events 7 days a week to ensure neuro checks and assessments were initiated for all falls. Monitoring began 9/06/23 and will continue x 4 weeks or until the administrator determines substantial compliance has been achieved and maintained. This plan will be reviewed monthly at QAPI for the next three months. The State Survey Team monitored the Plan of Removal on 09/07/2023 and included the following: Observation on 09/07/2023 at 10:39 a.m., reflected corporate staff in facility monitoring the POR process initiated by the facility. Interview on 09/07/2023 at 03:03 p.m., LVN A stated she was provided 1-on1 education by Administrator, LVN A stated she was in serviced regarding Event Notification; Abuse and Neglect; and Change of Condition, neuro checks and how to notify DON/Physician/RP and oncoming nurses. Interview on 09/07/2023, the Interim DON and ADON stated they were in-service and reviewed by corporate nurse, on 09/06/2023 on Abuse and Neglect, Event note completion and Neuro check policy, Notifying Physician on change in status policy that included falls with head injury or other serious injury. Interview on 09/07/2023 from 12:33 p.m. to 02:20 p.m., charge nurses from all shifts, stated they were in-serviced by Interim DON and ADON on 09/06/2023 and 09/07/2023 on Abuse and Neglect, Event note completion and Neuro check policy, Notifying Physician on change in status policy that included falls with head injury or other serious injury. Interview on 09/07/2023, the Interim DON stated continued monitoring on Real Time clinical software and fall events 7 days a week to ensure neuro checks and assessments were initiated for all falls. Interview on 09/07/2023 from 12:19 p.m. to 02:20 p.m., AIT (administrator in training), rehabilitation director, and two CNAs stated in-service, knowledge and reporting on Abuse and Neglect. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 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 455589 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fortress Nursing and Rehabilitation 1105 Rock Prairie Rd College Station, TX 77845 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Record review on 09/07/2023, revealed in-service initiated on 09/06/2023 on training of notification of change of conditions to DON, Fall prevention, Abuse & Neglect, Neuro checks, Shift change=nurse provides oncoming shift nurse with information to provide care to residents, and Event note completion. Record review on 09/07/2023, revealed Neuro Checks-Relias course, when a resident hits their head during a fall or the fall is unwitnessed, neuro checks will need to be completed at the time of the fall then according to the schedule below: every 15 minutes x 4, then every 30 minutes x2, then every 1 hour x2, then every 2 hours x 2, then every 8 hours x 8 Record review on 09/07/2023, revealed QAPI meeting held 9/7/23. The ADM was informed the Immediate Jeopardy was removed on 09/07/2023 at 08:00 p.m. The facility remained out of compliance at a severity level of actual harm with potential for more than minimal harm that is not immediate jeopardy with a scope of isolated due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 20 of 20