Health inspection·April 10, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete have been completed when the new diagnosis of major depressive disorder was given. She stated it was the responsibility of the MDS Coordinators to review PASRRs. She stated she had been employed for 8 years, she stated Resident #13's PASRR was missed. She stated there was no harm to the resident. The MDS Coordinator stated they did not have a PASRR policy, they followed state regulation. Interview on 04/10/25 at 1:50 PM with the Interim DON revealed the MDS Coordinators were responsible for updating the PASRR assessments and submitting them timely and complete new ones when a new diagnosis was given. The Interim DON stated by not reviewing resident PASRR. Event ID: Facility ID: 455626 If continuation sheet Page 2 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents who were unable to carry out activities of daily living received necessary services to maintain good grooming, and personal hygiene for 1 of 25 residents (Resident #1) reviewed for ADL care. Residents Affected - Few The facility failed to ensure Resident #1's fingernails was clean and cut. This failure could place residents at risk for poor hygiene, dignity issues, and decreased quality of life. Findings included: Record review of Resident #1's Optional State MDS Assessment, dated 03/20/25, reflected the resident was a an [AGE] year-old female admitted on [DATE]. The MDS also reflected the resident had a BIMS score of 11 indicating moderate cognitive impairment. The MDS also reflected diagnoses of Asthma, COPD (chronic obstructive pulmonary disease), or chronic lung disease (a group of lung diseases that block airflow and make it difficult to breathe). Record review of Resident #1's Care Plan, undated, reflected: Focus: Resident exhibits ADL Self Care Performance Deficit, r/t decrease in mobility. Goal: Resident will maintain current level of function through the review date. Interventions: Bathing/Showering: The resident limited assistance from staff for bathing. Bed Mobility: The resident is able to reposition self in bed with limited assist from CNA staff. Dressing: The resident requires extensive assistance by (1) staff to dress. Eating: The resident is able to feed self meals; tray set up required from staff. Personal hygiene: The resident requires limited assistance with personal hygiene. Toilet use: The resident requires extensive assistance by (1) staff for toileting. Transfer: The resident uses limited assistance with transfers. Observation and interview on 04/08/25 at 1:44 PM revealed Resident #1 sitting in her wheelchair in her room's doorway observing staff and residents passing in the hallway. Resident #1's fingernails were unclean and needed to be trimmed. Resident #1 stated that staff had not offered to trim her nails when she was showered nor at any other time that she could recall. Resident #1 said she would like them trimmed. Observation and interview on 04/10/25 at 9:02 AM revealed Resident #1 sitting in her wheelchair in her room. Resident's nails were unclean and needed to be trimmed. Resident #1 stated she had been showered, but staff did not offer to trim her nails. Resident #1 said she would like her nails trimmed. Interview on 04/10/25 at 9:52 AM with CNA C revealed she was Resident #1's aide for the day shift. CNA C stated she had not offered to trim Resident #1's nails. CNA C said the aides did not trim residents' fingernails in case residents were diabetic. CNA C revealed aides should alert their nurse if a resident's nails needed to be trimmed. CNA C stated if a resident's were too long, they could cut themselves or scratch another resident. CNA C said she would report it to the ADON if a nurse failed to speak with the resident about the importance of nail care and notify the correct individuals. Interview on 04/10/25 at 9:59 AM with RN D revealed CNAs should trim residents' nails unless the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 3 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident was a diabetic. RN D stated the aides should notify the nurse if the resident refused nail care so the nurse could educate the resident on the importance of their nails being trimmed. RN D revealed the nurse should offer to trim the resident's nails up to three times on their shift. RN D stated if the resident refused for an entire day, the nurse should contact the family for assistance. RN D revealed untrimmed nails could lead to infection and spreading of an infection. RN D said the nurse should report the resident's nail care refusal to the ADON and DON. Interview on 04/10/25 at 11:19 AM with ADON E revealed nail care should be offered during showers by CNAs or as soon as they saw a resident's nails were too long. ADON E also said nurses should trim diabetic residents' nails. ADON E revealed if residents refused nail care, the CNAs should notify their nurse. ADON E then stated the nurse should educate the residents who refused nail care on the importance of nail care. ADON E said the nurse should contact the resident's family if the resident continued to refuse nail care. ADON E then stated the nurse should notify the DON if the resident continued to refuse nail care, so the DON could contact the physician to determine if interventions such as medication changes were necessary. ADON E revealed residents with untrimmed nails were at risk for infection and harm to other residents and staff as well as themselves. Interview on 04/10/25 at 1:48 PM with the Interim DON revealed she expected the CNAs to offer nail care during showers. The Interim DON stated if the resident refused nail care by the CNA during an entire shift, she expected the CNA from the next shift to attempt nail care. If the resident still refused nail care, the Interim DON stated the nurse should educate the resident on the importance of nail care as a part of hygiene. The Interim DON said if a resident's nails were untrimmed, it could lead to injury and infection. Record review of the facility's current Care of Fingernails/Toenails policy, dated February 2018, reflected the following: Policy Statement: The nursing services department shall be responsible for identifying and performing nail care as needed and unless otherwise permitted. General Guidelines: 1. Nail care includes cleaning and trimming as tolerated by the resident. 2. Unless otherwise permitted, do not trim the nails of diabetic residents or residents with circulatory impairments. 3. Stop and report to the nurse supervisor if there is evidence of ingrown nails, infections, pain, or if nails are too hard or too thick to cut with ease. Reporting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 4 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 1. Level of Harm - Minimal harm or potential for actual harm Notify the supervisor if the resident refuses the care. 2. Residents Affected - Few Report other information in accordance with facility policy and professional standards of practice FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 5 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure any drug regimen irregularities reported by the Pharmacist Consultant were acted upon, for 1 of 5 residents (Resident #40) whose drug regimens were reviewed. The facility's Pharmacy Consultant recommended the facility include a diagnosis to the medication order to support therapy for Quetiapine on 10/13/24 and 11/13/24 for Resident #40. This failure could place residents receiving medications at risk for adverse consequences and could cause a decline in their physical, mental, and psychosocial condition. Findings included: Record review of Resident #40's admission Record, dated 04/10/25, reflected she was an [AGE] year-old female who admitted to the facility on [DATE]. Record review of Resident #40's Quarterly MDS Assessment, dated 03/24/25, reflected she had a BIMS score of 12 indicating no cognitive impairment. Her active diagnoses included cerebrovascular accident/transient ischemic attack/stroke, non-alzheimer's dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems), anxiety disorder (refers to a group of specific psychiatric disorders characterized by extreme fear or worry), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). For the medication review, it was noted Resident #40 received antipsychotics on a routine basis. Record review of Resident #40's care plan, revised 01/24/25, reflected the following: Focus: [Resident #40] uses psychotropic medications -Resident takes Seroquel .Goal: [Resident #40] will reduce the use of psychotropic medication through the review date .Interventions: Administer PSYCHOTROPIC [sic] medications as ordered by physician. Record review of Resident #40's Order Summary Report, dated 04/10/25, reflected the following: - Seroquel Oral Tablet 25 MG (Quetiapine Fumarate), Give 1 tablet by mouth two times a day for ANTIPSYCHOTICS/ANTIMANIC AGENTS, Take one tablet by mouth in the morning. Record review of Resident #40's April 2025 MAR reflected she received Seroquel every day as ordered. Record review of Resident #40's Consultant Pharmacist/Physician Communication Report, dated 10/13/24, reflected: Dear [Physician A], This resident was admitted on an antipsychotic, Quetiapine. Please ensure approved psych diagnosis has been documented to support continued use .Physician/Prescriber Response 'acute on [illegible] psychosis'. The report was signed by Physician A on 10/17/24. Record review of Resident #40's Medication Regimen Record review Report, dated 11/13/24, reflected: Resident has an order for the following medication. I recommend including a diagnosis to the medication order to support therapy. Quetiapine. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 6 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and interview on 04/08/25 at 12:00 PM revealed Resident #40 was in her room with a family member. Resident #40 said she was doing okay today. Interview on 04/10/25 at 3:27 PM with LVN B revealed she was caring for Resident #40. LVN B said she reviewed Resident #40's Seroquel order and saw a diagnosis was missing. LVN B said there should be a diagnosis listed with the medication which would come from the doctor. Interview on 04/10/25 at 3:50 PM with the Interim DON revealed normally the Charge Nurse would put an order for an antipsychotic medication into a resident's chart with the indications for use and a nurse manager, such as herself, would add the diagnosis. The Interim DON said Resident #40 should have a diagnosis associated with her antipsychotic medication and staff should have caught that. The Interim DON said the nurse managers would have been responsible for ensuring the diagnosis was included with the order. The Interim DON said the purpose of this was to ensure the resident was not receiving unnecessary medications. The Interim DON said the nurse managers should have been monitoring residents' medication orders. The Interim DON said the nurse managers should have identified the issue and were trained to look for those things and correct them. The Interim DON said the concern with the missing diagnosis was that it was not right and needed to be fixed. Record review of the facility's Medication Utilization and Prescribing- Clinical Protocol policy, dated 2001, reflected the following: 1. When a medication is prescribed in response to an identified problem, condition, or risk, the physician and staff will identify the indications (condition or problem for which it is being given, or what the medication is supposed to do or prevent), considering the resident's age, condition, risks, health status, and existing medication regimen. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 7 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to ensure residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs for 1 of 5 residents (Resident #40) reviewed for unnecessary medications. The facility failed to ensure Resident #40 had an appropriate diagnosis for her prescribed Seroquel (used to treat depression). This failure could place residents at risk of possible psychotropic medication side effects, adverse consequences, decreased quality of life, and dependence on unnecessary medications. Findings included: Record review of Resident #40's admission Record, dated 04/10/25, reflected the resident was an [AGE] year-old female who admitted to the facility on [DATE]. Record review of Resident #40's Quarterly MDS Assessment, dated 03/24/25, reflected she had a BIMS score of 12 indicating no cognitive impairment. Her active diagnoses included cerebrovascular accident/transient ischemic attack/stroke, non-alzheimer's dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems), anxiety disorder (refers to a group of specific psychiatric disorders characterized by extreme fear or worry), and depression (a mood disorder that causes a persistent feeling of sadness and loss of interest). For the medication review, it was noted Resident #40 received antipsychotics on a routine basis. Record review of Resident #40's care plan, revised 01/24/25, reflected the following: Focus: [Resident #40] uses psychotropic medications -Resident takes Seroquel .Goal: [Resident #40] will reduce the use of psychotropic medication through the review date .Interventions: Administer PSYCHOTROPIC [sic] medications as ordered by physician. Record review of Resident #40's Order Summary Report, dated 04/10/25, reflected the following : - Seroquel Oral Tablet 25 MG (Quetiapine Fumarate), Give 1 tablet by mouth two times a day for ANTIPSYCHOTICS/ANTIMANIC AGENTS [sic], Take one tablet by mouth in the morning Record review of Resident #40's April 2025 MAR reflected she received Seroquel every day as ordered. Record review of Resident #40's Consultant Pharmacist/Physician Communication Report, dated 10/13/24, reflected: Dear [Physician A], This resident was admitted on an antipsychotic, Quetiapine. Please ensure approved psych diagnosis has been documented to support continued use .Physician/Prescriber Response 'acute on [illegible] psychosis'. The report was signed by Physician A on 10/17/24. Record review of Resident #40's Medication Regimen Record review Report, dated 11/13/24, reflected: Resident has an order for the following medication. I recommend including a diagnosis to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 8 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 0758 medication order to support therapy. Quetipaine. Level of Harm - Minimal harm or potential for actual harm Observation and interview on 04/08/25 at 12:00 PM with Resident #40 revealed she was in her room with a family member. Resident #40 said she was doing okay today. Residents Affected - Few Interview on 04/10/25 at 3:27 PM with LVN B revealed she was caring for Resident #40. LVN B said she reviewed Resident #40's Seroquel order and saw that a diagnosis was missing. LVN B said there should be a diagnosis listed with the medication which would come from the doctor. Interview on 04/10/25 at 3:50 PM with the Interim DON revealed normally the Charge Nurse would put an order for an antipsychotic medication into a resident's chart with the indications for use and a nurse manager, such as herself, would add the diagnosis. The Interim DON said Resident #40 should have had a diagnosis associated with her antipsychotic medication and staff should have caught that. The Interim DON said she just stepped into her role last week and the previous DON would have been responsible for ensuring the Pharmacist's recommendations were followed up on. The Interim DON said she was now responsible for them going forward, however. The Interim DON said the purpose was to complete or respond to the recommendations based on the regulations and to allow for communication between the pharmacist and the doctor to occur. The Interim DON said the previous DON was the only one following up on the recommendations and there was not anyone going behind her to ensure they were completed. The Interim DON said the previous DON was expected to complete the recommendations herself. Interview on 04/10/25 at 4:15 PM with the Interim DON revealed the facility did not have a policy regarding pharmacy recommendations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 9 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 0805 Level of Harm - Minimal harm or potential for actual harm Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review, the facility failed to ensure food was prepared in a form designed to meet individual needs for 1 of 2 meals (lunch) reviewed for food meeting residents' needs. Residents Affected - Some The facility failed to prepare and serve pureed turkey tetrazzini as a pudding consistency for residents who required pureed diets during the lunch meal on 04/09/25. This deficient practice could place residents at risk of not receiving meals that meet their needs. Findings included: Record review of the lunch menu ticket for 04/09/2025 revealed the menu for the lunch service was Turkey Tetrazzini, Vegetable Medley, Breadstick, Fruit Cup. Observation on 04/09/25 at 11:02 AM revealed the [NAME] prepared turkey tetrazzini with a food processor and then placed it on the steam table. The Dietary Manager did not check the consistency or ensure it was all blended to a pudding smooth consistency. Observation and interview with the Dietary Manager on 04/09/25 beginning at 1:05 PM revealed the test tray included the regular textured menu items and the pureed menu items. The Dietary Manager stated the pureed turkey tetrazzini did not have a smooth, pudding consistency. He also said the turkey tetrazzini had chunks of turkey and noodles throughout the entree. Interview on 04/09/25 at 1:07 PM with the Dietary Manager revealed his expectation was for pureed food to have a smooth, pudding consistency. The Dietary Manager stated the turkey tetrazzini was not the correct consistency. The Dietary Manager stated residents could choke if dietary items were not blended to a smooth pudding texture. Interview on 04/10/25 at 1:44 PM with the Administrator revealed the facility did not have a policy for pureed foods. The Administrator stated the Dietary Manager had completed an in-service with the dietary staff on 04/09/25. The Administrator provided the in-service that included directions on preparing purees. Record review of the Facility In-Service dated 04/09/25 reflected: 1. The desired thickness should be smooth mashed potato or pudding. There should be no large lumps or particles. 2. Do not add water to pureed food. 3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 10 of 11 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 455626 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Guest Care Center 2712 N Hurstview Hurst, TX 76054 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 0805 Add liquid, if needed (ex. reserved liquid, broth, sauces, gravy, milk or juice Level of Harm - Minimal harm or potential for actual harm 4. If needed, gradually add thickener. Ex mashed potato flakes, cream of rice, or commercial thickener) Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455626 If continuation sheet Page 11 of 11