Health inspection·September 14, 2023

F 0677 Level of Harm - Minimal harm or potential for actual harm In an interview on 9/12/2023 at 8:20 a.m. with Resident #1 she said it would take all day to say what had been going on at the facility with short staffing. She said she had been at the facility for over a month, and she was supposed to have baths on Tuesday's, Thursday's. She said the staff did not come in the room to offer her a shower. She said she was told last Friday 9/8/2023 she would get a bath. She said she had a rash break out on her neck from not getting a shower. Residents Affected - Some In an interview on 9/13/2023 at 12:40pm with Resident #1 she said she had been at the facility for a while. She said she was gone at the hospital for a few days and came back. She said she would be at the facility for another 2 to 3 weeks for physical therapy. She said she would go 5 days without a bath and would have to fight with the staff to get one. She said the CNAs would give her a hard time She said she did get a bath this morning. She said the CNA told her she did not want to give her a shower because she did not want to get wet. She said the CNA came into her room with a book and told her today was not her shower day. She said she has had a total of 2 showers since she had been at the facility. She said when she would ask staff for a shower, they would tell her it was not her day. She said staff would tell her they did not have enough help at the facility and could not give her a shower. Resident #2 Record review of Resident #2's Face Sheet dated 9/14/2023 revealed a [AGE] year-old male admitted to the facility on [DATE] with a diagnosis of Chronic Obstructive Pulmonary Disease (Blocked airflow, difficulty breathing), Atrial Fibrillation (Irregular heart rate), Difficulty Walking. Record review of Resident #2's quarterly MDS dated [DATE] revealed a BIMS score of 14 out of 15 indicating the resident was cognitively intact. Resident #2 required supervision with walking in the corridor, dressing and personal hygiene excluding baths and showers. Bathing was coded as an 8 indicating activity did not occur or family and or non-facility staff provided care 100% of the time for that activity over the entire 7-day period. The MDS further reflected for mobility devices the resident used a walker, wheelchair. Residents functional abilities and goals were to shower and bathe self. 5. Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity. Record review of Resident #2's ADL sheets dated 8/2023 revealed no shower or baths 8/1/2023 through 8/4/2023 and 8/13/2023 to 8/31/2023. On 9/12/2023 at 8:30 a.m. the Surveyor observed Resident #2 with oily hair. On 9/12/2023 at 8:30 a.m. with Resident #2, he said he had lived at the facility for 2 years. He said he is happy with his stay at the facility, but he has not been getting his showers. He said the facility has been shorthanded. He said he has been asking to get a bath and facility staff say they are shorthanded. He said the last time he had a bath was last Friday 9/8/2023. In an interview on 9/13/2023 at 12:30 p.m. with Resident #2, he said he has missed getting baths and showers. He said they could not catch up in one day and said the facility staff told him he would get a shower tomorrow. He said he did get a bath in the month of August 2023 a couple of weeks ago by a new girl who had been at the facility for a few weeks. He said he would have to ask for a shower and was told they did not have enough help. He said they do not have to help him, but they must be in the shower with him in case he falls. He said he would like to have his showers on the days they are scheduled. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 2 of 6 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 09/14/2023 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 0677 Resident #3 Level of Harm - Minimal harm or potential for actual harm Record review of Resident # 3's Face Sheet dated 9/14/2023 revealed a [AGE] year-old female who was admitted to the facility on [DATE] with an admission diagnosis of Hemiplegia and Hemiparesis Following Cerebral Infarction Affecting Left Non-Dominant Side (Left Sided Paralysis), Unspecified Lack of Coordination, Major Depressive Disorder (Sadness), Anxiety Disorder (Inability to Set Aside a Worry). Residents Affected - Some Record review of Resident #3's quarterly MDS revealed a BIMS score of 15 out of 15 indicating the resident was cognitively intact. Resident #3 required 1 person assistance with transfers, dressing, eating, toilet use, and personal hygiene not including baths and showers. The resident required physical help with bathing. Record review of Resident #3's Care Plan dated 7/18/2023 reflected in part .The resident has an ADL Self Care Performance Deficit .The resident will maintain current level of function Personal Hygiene through review date .Bathing requires staff x1 for assistance. Record review of Resident #'3's ADL sheets revealed no shower or bath 8/2/2023 through 8/14/2023 and 8/16/2023 through 9/12/2023. On 9/14/2023 at 3:00 p.m. observation revealed Resident #3 in her wheelchair. Resident #3 was not able to move her left side. Resident #3 had oily, unkept hair. In an interview on 9/14/2023 with Resident #3 at 3:00 p.m. she said she occasionally went without a shower. She said she refused to [NAME] people who had to work an entire hall by themselves so she washed herself at the sink with a washcloth. She said she did not like doing it that way because she would get cold. She said she preferred a shower. She said they would have only one aide. She said she was not getting the time she needed to get a shower from the staff. She said it had been over a week since she had a shower. In an interview on 9/13/2023 at 11:33 a.m. with Nurse Aid A, she said she had worked at the facility for 4 months. She said she was in-serviced on bathing when she first came to the facility to work. She said she would be taking her CNA test soon. She said the facility had a shower sheet the CNAs went by and Resident #1's shower days were Monday, Wednesdays, and Friday. She said the number 8 on the ADL sheet meant the shower did not occur. She said Resident #1 never asked her for a bath, but she might have declined once so she told the charge nurse. She said she had been told by residents the facility was too short staffed to provide showers. She said when residents were not bathed it was neglect and it hurt the residents pride. She said if a residents were not bathed, they could get a skin infection. In an interview on 9/13/2023 at 11:35 a.m. with CNA A, she said she had been a CNA for 17 years. She said she had worked at the facility since 2018. She said the last in-service on bathing and showering was 2 months ago. She said she worked the 300 hall but worked the 100 hall on Sunday. She said some of the CNAs did not give their baths and showers even when they were fully staffed but she had heard the residents saying the facility was too short staffed to provide showers. She said she stayed over to give Resident #2 a shower on Sunday and Resident #2 said she had only been showered twice in a month. She said if residents were not bathed or showered it was neglect and they could have gotten skin breakdown. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 3 of 6 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 09/14/2023 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 0677 Level of Harm - Minimal harm or potential for actual harm In an interview on 9/13/2023 at 1:45 p.m. with LVN B, she said she had been a nurse for 2 years and had worked at the facility for a couple of years. She said the facility had problems with the 2 to 10pm shift because of staffing. She said they did not have enough CNAs to do all the baths. She said she had heard of residents and families complaining and it had been escalated to management. She said there were more aides in the building the last 2 days,9/12/2023 and 9/13/2023. Residents Affected - Some In an interview on 9/14/2023 at 10:45am with the Administrator, she said she had received complaints from residents and staff that the residents were not getting baths and showers. She said they all pitched in, but staff left and they were shorthanded. She said when residents were not bathed or showered, they could have skin issues and it was a dignity issue. She said when residents do not receive good peri care they can get urinary tract infections. In an interview on 9/14/2023 at 1:50 p.m. with LVN C, she said she had worked at the facility for 5 years and had been a nurse for 2 of those years. She said the last time she was in-serviced on ADLs was within the last year. She said residents and staff had been complaining there had been minimal staff all the time. She said sometimes when she had come to work there would only be 1 CNA in the entire building for that day. She said residents did not get baths or showers like they should have. She said they had asked corporate to help them with staffing and they had not done anything to resolve the issue. Record review of Certified Nurse Aide Job Description, no date, reflected in part . Accountable for personal care (i.e., grooming, bathing, catheter care, peri care, and dressing). Record review of facility's policy titled Bath, Tub/Shower dated 2003 reflected in part, Bathing by tub or shower is done to remove soil, dead epithelia cells, microorganisms from the skin and body odor to promote comfort, cleanliness, circulation, and relaxation Goals 1. The resident will experience improved comfort and cleanliness by bathing. 2. The resident will maintain intact skin integrity. Record review of facility's policy titled, Resident Rights, no date, reflected in part . A facility must treat each resident with respect and dignity and care of each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 4 of 6 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 09/14/2023 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 0812 Level of Harm - Minimal harm or potential for actual harm 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 walk-in refrigerator in that: Residents Affected - Few -The facility stored unlabeled and unsealed foods in the refrigerator. This failure had the potential to place residents at risk of serious complications from foodborne illness as a result of their compromised health status Findings include: Observation and interview on 09/13/2023 at 11:25 AM with [NAME] A revealed containers labeled green tomatoes and ketchup in the refrigerator were opened and unsealed, open to the air. She said the green tomatoes and ketchup should be closed so that nothing like bugs or bacteria got inside. She closed and sealed the lids on the containers and said she would have to throw it away. A bag of what appeared to be coleslaw mix was observed with no label, in the refrigerator. [NAME] A identified the food as coleslaw mix and said the food in the fridge should be dated so staff knew if it was good or bad. She said she would throw away the coleslaw mix as well. She said the policy was that food in the refrigerator should be sealed and labeled. She said risk to residents if food was not sealed or labeled was they could get sick and or die. Interview on 09/14/2023 at 1:51 PM with the Dietary Manager, she said she had worked at the facility since February 2023. She said as the dietary manager she managed the dietary department, new staffing, ordered all supplies, charted the dietary side of things, and cooked, and/or washed dishes when needed. She said if food was cooked and placed in the refrigerator, it should be sealed and dated. She said there were two dates on it, an open date, and the delivery date. She said canned fruit was dated from the date it was opened. She said food was dated to ensure food was not expired. She said the risk to residents if food was not labeled or sealed was it could make residents sick, or they could die. Record review of the Dietary Services Policy & Procedure Manual 2012 dated 2012 reflected in part .Open packages of food are stored in closed containers with tight covers and dated as to when opened Record review of U.S. Food and Drug Administration Food Code dated 2022 reflected in part . 3-305.11 (A) Except as specified in (B) and (C) of this section, FOOD shall be protected from contamination by storing the FOOD: (1) In a clean, dry location; (2) Where it is not exposed to splash, dust, or other contamination . . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 5 of 6 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 09/14/2023 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to dispose of garbage and refuse properly for 1 of 2 waste receptacles reviewed for garbage disposal. Residents Affected - Few -Waste receptacle #1 had its top lid opened when no one was disposing of trash. These failures could place residents at risk for exposure to germs and diseases carried by vermin and rodents. Findings include: Observation and interview on 09/13/2023 at 11:25 AM with the Dietary Manager, revealed that one of the two waste receptacle's' lid was observed opened. The waste receptacle was located on facility property about 15 yards from the building. The closest entrance to the facility was through an external kitchen door. There was no fence surrounding the waste receptacles. There was trash inside the dumpster and no facility staff was disposing of trash at the time the lid was observed open. The Dietary Manager said the lid to the dumpster should be closed to avoid flies and pest getting into the dumpster which could then possibly get into the facility. She said the lid was open because the staff could not reach the lid to close it and that normally staff used a stick to reach the lid to close it. She said the risk to residents was they could get sick because of the flies and pest that could get inside the facility. The maintenance person went outside, and the Dietary Manager asked him if he could close it. The maintenance person walked towards the dumpster, found the stick, and closed the lid on the dumpster. She said the facility had a policy on food storage and refuse disposal. The Dietary Manager said the policy was the dumpster lid should always be closed unless someone was throwing away trash. Interview on 09/14/2023 at 5 PM with the Administrator who said the outdoor trash receptacle applied to the dumpster. Record review of the Dietary Services Policy & Procedure Manual 2012 dated 2012 reflected in part .Trash cans must be covered at all times, except during use . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455589 If continuation sheet Page 6 of 6