Health inspection·October 13, 2023

F 0600 Cognitive Pattens - Resident #1 had a BIMS of 5, which suggested severe cognitive impairment. Level of Harm - Minimal harm or potential for actual harm Functional Status regarding bed mobility and how the resident moved to and from lying position, turned side to side, and positioned body while in bed. Resident #1 required extensive assistance, Resident #1 was involved in activity, staff provided weight-bearing support and one-person physical assist. Residents Affected - Some Mobility Devices - Resident #1 used a wheelchair. Record review of Resident #1's Care Plan, focus dated 03/29/23, reflected she had impaired cognitive function/dementia or impaired thought. Care plan goal, dated 03/29/23, reflected Resident #1 would attempt to make routine daily decisions with cues/supervision. Care plan intervention, dated 03/29/23, reflected when communicating with Resident #1, staff would identify themselves at each interaction and face her when speaking and make eye contact with Resident #1. Staff would reduce any distractions- close door. Resident #1 understood consistent, simple, directive sentences and staff were to provide Resident #1 with the necessary cues and to stop and return if Resident #1 was agitated. Staff were to provide cues, reorient and supervise Resident #1 as needed. Staff were to encourage Resident #1 to make routine and daily decisions and coach through the process when decisions were not forthcoming and used task segmentation to support short term memory deficits and break tasks into one step at a time. Record review of Resident #1's Care Plan, focus dated 03/20/23, reflected Resident #1 was at risk for falls. Care plan goal, dated 03/29/23, was Resident #1 would have decreased risk for serious injury or hospitalization as a result of falling, through the next assessment review period. Care plan intervention, dated 03/29/23, was to keep environment clear of unnecessary objects. Record review of Resident #1's Care Plan, focus dated 04/20/23 , reflected Resident #1 was on hospice due to a terminal diagnosis of Alzheimer's Disease and was at a risk for decline in mental, physical condition. Care plan goal, dated 04/20/23, reflected all of Resident #1's needs would be met with dignity and respect over the next 90 days. Care plan intervention, dated 04/20/23, reflected staff to assess resident for verbal and non-verbal signs and symptoms of pain and implement appropriate interventions and notify MD and hospice if interventions were not effective, staff were to encourage and allow resident to verbalize her needs and concerns, staff were to use active listening and address needs and concerns as able. Observation of video A , undated, revealed Resident #1 seated on her bed with her legs on the right side of the bed. Resident #1's bed was closest to the door. Resident #1 was dressed in a shirt, no pants, and an adult brief. The door to Resident #1's room was completely open, and another unknown resident was in a wheelchair directly outside and directly facing the open door of Resident#1's room. CNA A stood in front of Resident #1. Resident #1 held the elongated side of a blue rectangular fall mat and CNA A was holding the shorter side of the rectangular fall mat closest to the resident. Resident #1 attempted to pull the floor mat towards her, and CNA A held the floor matt and attempted to take it away from Resident #1. CNA A said, [Resident #1] let it go in a loud voice. CNA A made a gesture with her right arm in an upwards movement toward the direction of Resident #1's chest and Resident #1's hold on the floor mat was broken. Resident #1 fell backwards diagonally onto the bed. Resident #1 struggled to pull herself up in her bed using the bed rail Resident #1 said several times, I don't need this and other unintelligible statements expressed in an agitated manner. CNA said nothing else to Resident #1, used the bottom of her foot to straighten Resident #1's floor mat, exited the room, and turned the unknown resident's wheelchair away from his view into Resident #1's room and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455670 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 455670 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgecrest Retirement and Healthcare Community 1900 W State Hwy 6 Waco, TX 76712 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 0600 pushed him down the hallway. Resident #1 continued to repeat, I don't need this while CNA walked away. Level of Harm - Minimal harm or potential for actual harm Observation of video B, undated, revealed Resident #1 in her room on the floor with her back to the door and wearing a two-piece pajama set. CNA A stood at Resident #1's feet, CNA B stood at Resident #1's head, and CNA C stood at Resident #1's left side. All CNAs were bent over Resident #1 about to lift Resident #1. One of the CNA's (it was unclear which CNA) said, stop that [Resident #1's]. CNA A placed her hands under Resident #1's knees. CNA B placed her hands under Resident #1's arms, and CNA C initially placed her left hand under Resident's left knee but moved it to Resident's left arm where CNA C's right hand was on the upper portion of Resident's left arm. CNA C lifted Resident #1 up pulling Resident #1's left arm. Resident #1 was lifted awkwardly to her bed and placed on her bed in a diagonal position toward the end of her bed. During the move, Resident's pajama top was pulled upward to expose her left breast. When the CNAs put Resident #1 on the bed Resident #1 said, two times, oh, my arm! All three CNAs stepped away from Resident #1's bed and look down at the Resident #1. No CNA asked about her arm. The resident asked, someone pull me up [in the bed]. CNA A stated, you know how to pull yourself up in that bed now. Resident #1 rolled to her left side and used her right arm to grab the headboard and pulled herself up in the bed. The video ended with CNA C pulling up the resident's blanket that was at the end of Resident #1's bed. Residents Affected - Some Observation of video C, undated, revealed the resident seated on the floor of her room at the door with her back towards the camera and her right arm extended outside the door. CNA A was in the room when the resident was initially on the floor. CNA B approached resident's room and took the hand of Resident #1's extended arm then released Resident #1's hand and resident fell on her back into her room onto the floor. A sound was heard from the audio as the resident hit the floor and it appeared either her head or her back might have it the bottom railing of a bedside table. No CNA remarked when Resident #1 fell backwards. The resident was restless and continued to make contact with the bottom railing of the bedside table with her head and shoulder. The bedside table was not moved away from the resident. CNA C stepped over the resident and went to straighten the resident's bed. CNA A made the statement, she ain't even fallen and now she want to just lay there. CNA A and CNA C, who walked in after CNA B, told resident to, get up. Beside telling Resident #1 to get up none of the CNAs spoke to Resident #1. The video ended with the CNA A pulling her arm to get her to a seated position. Observation of video D, undated, reflected Resident #1 seated on her bed. CNA A stood at the foot of Resident #1's bed with a cell phone to her ear. CNA A told Resident #1, okay, lay down. Resident #1 began to lay down in the bed and CNA A, with her cell phone to her ear walked to the door to leave Resident #1's room. Resident #1 said, wait, no come here I ain't got [unintelligible] I need you to, I can't and Resident #1 gestures to the end of her bed where her sheet and blankets were in a pile. CNA said, [unintelligible] you know how to put that cover on you [unintelligible] and walked out of the room with her cell phone held in place to her ear with her shoulder. Resident #1 said, I can't, come on and help me CNA A had left the room. Interview with CNA A on 10/12/23 at 12:04 PM regarding video C who revealed Resident #1 was crawling out on the floor and she and CNA B and CNA picked up Resident #1 and put her in the bed. CNA A said she was not sure if Resident #1 fell because Resident #1 normally just slides off the bed. CNA A revealed Resident #1 would, put herself on the floor and crawl out to the hallway. CNA A revealed she did not know if Resident #1 hit her head. CNA A revealed if a resident fell, the staff were supposed to report to the nurse. CNA A said Resident #1 was care planned for falls, but CNA A did not know the meaning of a care planned. CNA A revealed she did know the residents had the right to fall, and she thought everyone should be assessed after a fall. She revealed residents should be assessed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455670 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 455670 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgecrest Retirement and Healthcare Community 1900 W State Hwy 6 Waco, TX 76712 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some after a fall because you couldn't always tell if a resident was injured. She said they called for a nurse, but she did not know if the nurse came to access Resident #1 because she left, her shift was over . Interview with CNA C on 10/12/23 at 12:15 PM regarding video C revealed Resident #1 had, gotten on the floor and she and the other CNAs picked up Resident #1 and put her back in the bed, then left the room and let the nurse know she had gotten onto the floor. CNA C revealed she did not know what the nurse did after. CNA C revealed when they told Resident #1 to sit up that caused her to fall backwards, but CNA C couldn't tell if Resident #1 hit her head or not. CNA C revealed that if Resident #1 did hit her head it was when Resident #1 flopped back. CNA C revealed she was trained in abuse, neglect, and exploitation and it was the facility policy to assess a resident if a resident was on the floor. Interview with the ADON on 10/12/23 at 1:42 PM regarding video C, revealed the CNAs provided, poor customer service in the way the spoke with Resident #1 and poor care as well. The ADON revealed it was not a good scene and they just let her lay there. The ADON revealed in video C, it appeared the CNA was holding Resident #1's hand and just let go and this possibility, caused Resident #1 to fall. The ADON said staff should never walk over a resident who was on the floor. The ADON revealed when CNA A said, she ain't even fallen and now she want to just lay there that was not an appropriate thing to say . The ADON stated the language used was teasing. The ADON said the resident should have been consoled, the CNAs should have made sure Resident #1 was comfortable, and the CNAs should have made sure the environment was safe and clear of hazards. The ADON further revealed if a resident was found on the floor, staff should always get a nurse to assess the resident before the resident was moved. The ADON revealed when a resident was found on the floor a nurse should be called to check the resident's vitals, check the resident for injuries, and see if the resident was bleeding or in pain. While waiting for the nurse to come to assess the resident the staff who found the resident should get the resident comfortable. the ADON stated if her loved one was treated in this manner she would be very upset . Interview with the DON on 10/12/23 at 3:16 PM who revealed when a staff member found a resident on the floor staff needed to get a nurse to assess the resident and the nurse decided what to do, depending on what was found in their assessment. The DON revealed staff should not put the resident back in bed without a nurse assessment. The DON revealed the CNAs or staff needed to make sure the environment was safe. When referencing video C, a CNA should have moved the bedside table environment and it was clear none of the CNAs in video C cleared the area. The DON revealed, when video C was discussed, she would have been concerned about further injury to Resident #1 because of where Resident #1's head and upper body were in reference to the bedside table. The CNAs responsibility was to try and keep the resident calm and comfortable and not anxious. The DON revealed Resident #1 was restless and the CNAs did not pay attention to the resident at all. Interview with the ADM on 10/13/23 at 11:20 AM revealed, after video C was viewed , the CNAs care was, below minimum expectations and did not show compassion, there was no urgency to care for the resident and the care provided was unacceptable. The ADM said the CNAs, failed to provide a service by not getting a nurse to assess Resident #1 before they transferred the resident to her bed . Record review of the facility Disciplinary/Counseling Report, dated 10/10/23, reflected CNA A was suspended pending investigation. Record review of the facility Disciplinary/Counseling Report, dated 10/11/23, reflected CNA B was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455670 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 455670 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgecrest Retirement and Healthcare Community 1900 W State Hwy 6 Waco, TX 76712 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 0600 suspended pending investigation. Level of Harm - Minimal harm or potential for actual harm Record review of the Disciplinary/Counseling Report, dated 10/11/2 reflected CNA C was suspended pending investigation. Residents Affected - Some Record review of the facility's, undated, policy titled Falls Clinical Protocol Assessment and Recognition, reflected after a fall, the resident will be assessed for unsteadiness, weakness, decline, contributing factors etc . Record review of the facility in-service dated 10/10/23 revealed in the event a resident is observed on the floor or on a floor mat this is a change of plane and is considered a fall, licensed nurse must assess resident prior to moving resident. Record review of the signed statement from CNA A's personnel file, dated 10/26/22. reflected CNA A was given a copy of the facility policy against abuse, neglect and mistreatment of residents which indicated she understood there was no tolerance for poor customer service and/or abuse and she understood her employment was subject to termination for poor customer service and/or abuse. Record review of the signed statement from CNA B's personnel file, undated, reflected CNA B was given a copy of the facility policy against abuse, neglect and mistreatment of residents which indicated she understood there was no tolerance for poor customer service and/or abuse and she understood her employment was subject to termination for poor customer service and/or abuse. Record review of the signed statement from CNA C's personnel file, dated 05/25/23, reflected CNA C was given a copy of the facility policy against abuse, neglect and mistreatment of residents which indicated she understood there was no tolerance for poor customer service and/or abuse and she understood her employment was subject to termination for poor customer service and/or abuse. Record review of the signed, undated, statement from CNA A's personnel file, reflected CNA A pledged to follow the guiding principles of the facility to ensure she performed her job duties at the highest level at all times so the facility could provide outstanding customer service to all residents that were entrusted to the facility. Customer service was the single most important thing the facility did. The facility had an obligation to all those they served to be friendly, helpful, and treat everyone with dignity and respect. Record review of the signed, undated, statement from CNA B's personnel file, reflected CNA A pledged to follow the guiding principles of the facility to ensure that she performed her job duties at the highest level at all times so the facility could provide outstanding customer service to all residents that were entrusted to the facility. Customer service was the single most important thing the facility did. The facility had an obligation to all those they served to be friendly, helpful, and treat everyone with dignity and respect. Record review of the signed, undated, statement from CNA C's personnel file, reflected CNA A pledged to follow the guiding principles of the facility to ensure she performed her job duties at the highest level at all times so the facility could provide outstanding customer service to all residents that were entrusted to the facility. Customer service was the single most important thing the facility did. The facility had an obligation to all those they served to be friendly, helpful, and treat everyone with dignity and respect. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455670 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 455670 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgecrest Retirement and Healthcare Community 1900 W State Hwy 6 Waco, TX 76712 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of training from CNA A's orientation in her personnel file, dated 10/26/22, reflected she was trained that examples of verbal abuse included the use of profane language, sarcasm, swearing, name calling, and teasing and she is an advocate for all the residents in the facility to prevent any abuse or neglect. Record review of training from CNA A's orientation in her personnel file, date unknown, reflected she was trained that examples of verbal abuse included the use of profane language, sarcasm, swearing, name calling, and teasing and she is an advocate for all the residents in the facility to prevent any abuse or neglect. Record review of training from CNA C's orientation in her personnel file, date unknown, reflected she was trained that examples of verbal abuse included the use of profane language, sarcasm, swearing, name calling, and teasing and she is an advocate for all the residents in the facility to prevent any abuse or neglect. Record review of the facility's, undated, customer service basics, reflected when customers asked for something, when possible, do it immediately and if you can't do it immediately, let them know when you will do it and then do what you said you would do. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455670 If continuation sheet Page 6 of 6