Health inspection·November 22, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 11/21/2023 at 2:37 pm, CNA B stated she had been a CNA for 3 years. She stated all catheter bags should have a privacy cover so a resident want be ashamed if others can see their urine. During an interview on 11/21/2023 at 2:40 pm, CNA C stated she had been a CNA for 36 years. She stated foley catheter bags should be kept in a privacy cover to protect the residents dignity and prevent embarrassment. During an interview on 11/21/2023 at 2:50 pm, CNA D stated she had been a CNA for 20 years and was the CNA assigned to Resident #1. She stated Resident #1's catheter should have been in a cover this morning and there was a cover present, but she forgot to put it back in the bag. She stated if a catheter bag was exposed it could cause embarrassment. During an interview on 11/21/2023 at 3:00 pm, LVN E stated she had been an LVN 11 years and worked on Resident #1's hall in the evenings. She stated all catheters should be covered for dignity purposes and Resident #1 had a cover on his bed and was not sure why his catheter bag was not placed in it. She stated an exposed catheter bag could cause embarrassment. During an interview on 11/22/2023 at 9:36 am, LVN F stated she had been Resident #1's nurse since he had been admitted . She stated foley catheter bags should always have a privacy cover. She said Resident #1 had a privacy bag and was not sure why his catheter bag was not covered. She said the resident could be embarrassed if their catheter bag was exposed. During an interview on 11/22/2023 at 11:40 am, the DON stated she had been the DON for over one year. She stated regarding foley catheter bags, all nursing staff were responsible for ensuring the bag was covered for privacy. She stated catheter bag privacy was monitored by the nursing staff. The resident could have issues with dignity if their urine bag was exposed. She stated going forward she would ensure residents with foleys have a privacy cover and put in place a new monitoring system. During an interview on 11/22/2023 at 12:10 pm, the administrator stated foley bag privacy was the responsibility of the nurses and aides and should always be covered for privacy and dignity. She stated she expected the nursing staff to monitor and ensure the bag was always covered. Record review of facility policy titled Quality of Life-Dignity dated October 4, 2022, indicated, .11. Demeaning practices and standards of care that compromise dignity are prohibited. Staff shall promote dignity and assist residents as needed by: a. helping the resident keep urinary catheter bags contained and private . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455673 If continuation sheet Page 2 of 7 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 455673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkwood IN the Pines 902 Hill Street Lufkin, TX 75904 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 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure the right to reside and receive services in the facility with reasonable accommodation of resident needs and preferences except when to do so would endanger the health or safety of the resident or other residents for 3 of 7 residents (Residents #1, #2, and #3) reviewed for call lights. Residents Affected - Some The facility failed to ensure Residents #1, #2, and #3's call light was accessible and in reach. Resident #1's call light was attached to the privacy curtain at the foot of the bed, Resident #2's call light was hanging on the floor at the end of the bed, and Resident #3's call light was wrapped around the assist bar and hanging off the side of the bed. These failures could affect residents who used their call light or desire to use the call light and place them at risk of not being able to notify staff of their needs. Findings: Record review of the face sheet dated 11/21/2023 indicated Resident #1 admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of dysphagia (difficulty swallowing), urinary tract infection (infection of the bladder), cerebral infarction (impaired blood to brain causing damage), and malnutrition (lack of sufficient nutrients in the body). Record review of the admission MDS dated [DATE] indicated Resident #1 had a BIMS of 08 indicating moderately impaired cognition and required extensive assistance with ADL's. Record review of the comprehensive care plan dated 11/07/23 indicated Resident #1 had a risk for falls and be sure the resident's call light was within reach and encourage the resident to use it. Record review of the face sheet dated 11/21/2023 indicated Resident #2 admitted [DATE] with diagnoses of cerebrovascular disease (blood flow affected to the brain), and malnutrition (lack of sufficient nutrients in the body). Record review of the quarterly MDS dated [DATE] indicated Resident #2 had a BIMS of 08 indicating moderately impaired cognition and was total care for all ADL's. Record review of the comprehensive care plan dated 09/25/2023 indicated Resident #2 required assistance with ADL's and to encourage to use bell to call for assistance. Record review of the face sheet dated 11/21/2023 indicated Resident #3 admitted [DATE] with diagnoses of anemia (low blood count), malnutrition (lack of sufficient nutrients in the body), and dysphagia (difficulty swallowing). Record review of the quarterly MDS dated [DATE] indicated Resident #3 had a BIMS of 12 indicating intact cognition and required maximal assistance with ADL's. Record review of the comprehensive care plan dated 10/19/2023 indicated Resident #3 had an actual fall with no injury and to encourage resident to use call light for assistance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455673 If continuation sheet Page 3 of 7 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 455673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkwood IN the Pines 902 Hill Street Lufkin, TX 75904 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an observation and interview on 11/21/2023 at 9:50 am Resident #1's call light was attached to the privacy curtain at the foot of the bed. Resident #1 unable to voice use of call light. During an observation and interview on 11/21/2023 at 10:27 am Resident #3's call light was wrapped around assist rail and was hanging from the side of the bed. Resident #3 attempted to reach and unwrap the call light but was unsuccessful. She stated the call light was always wrapped around her assist rail and often could not reach it if she needed to call for help. During an observation and interview on 11/21/2023 at 10:56 am Resident #2's call light was hanging on the floor at the foot of the bed. Resident #2 stated she yells when she needs help. During an observation on 11/21/2023 at 11:02 am Resident #1's call light remained attached to the privacy curtain at the foot of the bed. During an observation on 11/22/2023 at 8:14 am Resident #3's call light was wrapped around assist rail hanging off side of bed and out of reach. During an interview on 11/21/2023 at 11:08 am, CNA A stated she had been a CNA for one year. She stated she was assigned to the hall for Resident #1 and Resident #2. She stated Resident #2 does call for help and Resident #1 yells for help when he needs something. She stated she was not aware their call lights were not in reach and call lights should be in reach so the resident could get help. She stated if a resident could not call for help care could be delayed. During an interview on 11/21/2023 at 2:37 pm, CNA B stated she had been a CNA for 3 years. She stated call lights should be in reach so a resident could call for help if they needed and all staff were responsible for making sure the light was in reach but mainly the CNA since they were the ones providing the most care. During an interview on 11/21/2023 at 2:40 pm, CNA C stated she had been a CNA for 36 years. She stated all call lights should be in reach so a resident can call for help. She stated if the call light was not in reach, delay in care could occur or injuries could happen like falls. During an interview on 11/21/2023 at 2:50 pm, CNA D stated she had been a CNA for 20 years and was the CNA assigned to Resident #1. She stated Resident #1 could use his call light and the call light should always be in reach. She stated she was not sure how she forgot to put the call light back in reach this morning. She stated if a resident could not call for help, they could fall or could have a delay in care needs. During an interview on 11/21/2023 at 3:00 pm, LVN E stated she had been an LVN 11 years and worked on Resident #1's hall in the evenings. She stated call lights should always be in reach and not wrapped around the rail so the resident could call for help and care would not be delayed. During an interview on 11/22/2023 at 9:36 am, LVN F stated she had been Resident #1's nurse since he had been admitted . She stated resident call lights should always be in reach and placement should be checked by all staff throughout the day and night. She stated if a call light was not in reach the resident could not get the help they needed. During an interview on 11/22/2023 at 11:40 am, the DON stated she had been the DON for over one year. She stated regarding call lights, they have angel rounds that include management team inspecting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455673 If continuation sheet Page 4 of 7 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 455673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkwood IN the Pines 902 Hill Street Lufkin, TX 75904 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some rooms and the nursing staff were to make sure the light was always in reach. She stated if a call light was not in reach, the resident could not notify staff for help. She stated going forward she would retrain all staff and monitor call light positioning and ensure they were in reach. During an interview on 11/22/2023 at 12:10 pm, the administrator stated call lights should always be in reach and it was everyone's responsibility to check the call light when they were in the resident room. She stated if the light was not reachable, the resident may not get the help they need. She stated her expectation going forward was to make sure all residents call light was in reach. Record review of the facility policy titled Resident Call Light System dated 6/2023 indicated, .The purpose of this procedure is to respond to the resident's request and needs. 4. Ensure that the call light is easily reachable by the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455673 If continuation sheet Page 5 of 7 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 455673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkwood IN the Pines 902 Hill Street Lufkin, TX 75904 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide the necessary services to maintain personal hygiene for 1 of 7 residents (Resident #1) reviewed for ADL's. Residents Affected - Few The facility failed to ensure Resident #1's face, mouth and nails were kept clean. This failure could place residents who required assistance from staff for ADLs at risk of not receiving care and services to meet their needs which could result in poor care, risk for skin breakdown, feelings of poor self-esteem, lack of dignity and health. Findings: Record review of the face sheet dated 11/21/2023 indicated Resident #1 admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of dysphagia (difficulty swallowing), urinary tract infection (infection of the bladder), cerebral infarction (impaired blood to brain causing damage), and malnutrition (lack of sufficient nutrients in the body). Record review of the admission MDS dated [DATE] indicated Resident #1 had a BIMS of 08 indicating moderately impaired cognition and required extensive assistance with all ADL's. Record review of the comprehensive care plan dated 10/23/2023 indicated Resident #1 had an ADL deficit and required extensive assistance of one person for personal hygiene and oral care. During an observation and interview on 11/21/2023 at 9:50 am, CNA D was leaving Resident #1's room and family present visiting. Resident #1 was lying in bed to his left side and observed with a white crusty substance on his lips, a thick brown substance running out of his left nostril and into his mouth and had a thick black substance underneath nail, on his left hand. Family member stated his mouth, face and nails are dirty most times they visit. During an observation on 11/21/2023 at 11:02 am, Resident #1 had a white crusty substance on his lips, a thick brown substance running out of his left nostril and into his mouth and had a thick black substance underneath nail on his left hand. During an observation on 11/21/2023 at 4:48 pm Resident #1's face and mouth had been cleaned however nails on the left hand had a thick black substance under them. During an interview on 11/21/2023 at 11:08 am, CNA A stated personal care should be provided every 2 hours for dependent residents. She stated oral care should be done every 2 hours when they provide care because Resident #1 does not get anything by mouth. She stated she had not done oral care on Resident #1 because he was assigned to another CNA. She stated if care was not provided it could cause sores and infection. During an interview on 11/21/2023 at 2:37 pm, CNA B stated she had been a CNA for 3 years. She stated a resident that was dependent for ADL care should be checked on at least every 2 hours to prevent skin breakdown. She stated nails should be cleaned on bath days by the CNA and if left dirty could cause an infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455673 If continuation sheet Page 6 of 7 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 455673 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkwood IN the Pines 902 Hill Street Lufkin, TX 75904 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 During an interview on 11/21/2023 at 2:40 pm, CNA C stated she had been a CNA for 36 years. She stated dependent residents should receive care either incontinent care, positioning, and oral care at least every 2 hours and nails should be cleaned when a resident gets a bath or as needed. She stated if care was not provided every 2 hours skin breakdown and infections could occur and if nails were left dirty it can cause an infection. Residents Affected - Few During an interview on 11/21/2023 at 2:50 pm, CNA D stated she had been a CNA for 20 years and was the CNA assigned to Resident #1. She stated Resident #1 was dependent on staff for all his ADL's. She said Resident #1 had a bath this morning and his nails should have been cleaned. She stated dirty nails could cause infections. She stated a resident with a feeding tube should get oral care every 2 hours but no less than one time a shift. She stated she missed providing oral care to Resident #1 when she made rounds this morning. She stated oral care prevents infections, mouth sores, and pain. During an interview on 11/21/2023 at 3:00 pm, LVN E stated she had been an LVN 11 years and worked on Resident #1's hall in the evenings. She stated dependent residents should be checked, changed, and repositioned every 2 hours by the CNA to prevent skin breakdown and it was the nurses responsibility to see that care was provided. She stated feeding tube residents that were dependent should receive oral care at least one time a shift and as needed. She stated dependent resident faces should be cleaned as well as their nails every day and as needed to prevent infections and skin breakdown. During an interview on 11/22/2023 at 9:36 am, LVN F stated she had been Resident #1's nurse since he had been admitted . She stated residents with a feeding tube receive oral care from the nurse once a shift and then as needed by the nurse aide. She stated nails were to be kept clean and trimmed by the nurse and the nurse aides. She stated the charge nurse was responsible for overseeing that residents ADL care was provided to protect them from infections and skin breakdown. During an interview on 11/22/2023 at 11:40 am, the DON stated she had been the DON for over one year. She stated regarding residents that require total care and feeding tube residents, the nurses were to do oral care every shift and the nurse aides should be providing oral care and nail care when providing routine care. She stated if a resident does not receive ADL care it could lead to infections. She stated she expected the nursing staff to provide all personal care with rounds and would begin retraining staff. During an interview on 11/22/2023 at 12:10 pm the administrator stated ADL care was the responsibility of the DON. She stated the DON was to oversee that the care was being provided by the nurses and aides. She stated she expected all residents receive full ADL care with rounds and would monitor to see that it was done. Record review of the facility policy titled Assisting the Nurse in Examining and Assessing the Resident dated 9/2010 indicated, .grooming and dressing - as provided with personal care needs you should: assistance with bathing, hair and nail care, mouth care . Record review of the facility policy titled Mouth Care dated 10/2010 indicated, .documentation by CNA of mouth care during routine care and as needed . Record review of the facility policy titled Care of Fingernails/Toenails dated 10/2010 indicated, .1. Nail care includes daily cleaning and regular trimming . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455673 If continuation sheet Page 7 of 7