Health inspection·February 9, 2026

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Let each resident or the resident's legal representative access or purchase copies of all the resident's records. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the resident or the resident's representative had the right to access all records pertaining to the resident, including current clinical records, within 24 hours (excluding weekends and holidays) upon oral or written request, and to obtain copies of such records within two working days upon request for 1 of 4 residents (Resident #1) reviewed for resident rights. The facility did not provide Resident #1's MPOA access to Resident #1's urinalysis (UA) lab results in December 2025 when she verbally requested access. This failure could place residents at risk for delayed medical decision-making, lack of informed consent, and potential harm due to the representative's inability to timely review laboratory results and participate in care planning.Findings included: Record review of an admission record dated 02/07/26 indicated Resident #1 was a [AGE] year-old male who initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including Cerebral Infarction due to unspecified occlusion or stenosis of right middle cerebral artery (a stroke affecting the right side of the brain, which can cause left-sided bodily weakness, speech issues, and vision problems), dementia without behavioral disturbance (a diagnosis of dementia where the patient experiences cognitive decline (memory, language, reasoning) without accompanying behavioral issues like aggression, wandering, or psychosis), hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (complete paralysis of the arm, leg, and often the face on one side of the body), cognitive communication deficit (This impairment can lead to difficulty with aspects of cognition such as attention, memory, organization, problem-solving and reasoning, processing speed, language, and executive function. A cognitive communication disorder can affect many aspects of a person's life, in a variety of ways. Activities of daily living that were once manageable and automatic, may be more challenging.) and seizures (sudden, uncontrolled bursts of electrical activity in the brain that cause temporary, involuntary changes in body movement, behavior, sensation, or awareness). Record review of Resident #1's Medical Power of Attorney documents dated 1/6/23, indicated that Resident #1 appointed Family member #1 as his Medical Power of Attorney (Agent) under the laws of the State of Texas. The document grants the Agent (Family Member #1) authority to make healthcare decisions on his behalf if Resident #1 is unable to make decisions independently. Article Three Legal and Administrative [NAME] and Provisions: Section 3.01 Health Insurance Portability and Accountability Act - In addition to the other powers granted by this document, my Agent may serve as my personal representative for all purposes of the Health Insurance Portability and Accountability Act of 1996 and its regulations (HIPAA) immediately upon my signing this document. Pursuant to HIPAA, I specifically authorize my Agent as my personal representative under HIPAA to do any of the following via traditional or electronic means: (i) request, receive , and review any information regarding my physical or mental health, including , without limitation all medical and hospital records and other HIPAA protected health information; (ii) execute on my behalf any Page 1 of 4 455684 455684 02/09/2026 Longview Hill Nursing and Rehabilitation Center 3201 N Fourth St Longview, TX 75605

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few authorization, release, or other documents that may be required in order to obtain this information; and (iii) consent to the disclosure of this information to others and execute valid authorizations for the release of HIPAA protected health information. Record review of Resident #1's undated revised care plan indicated the following:-Problem: [Resident#1] had impaired cognitive function/dementia or impaired thought processes due to Dementia and history of stroke. Initatiated:1/1/24; Revised:1/22/24-Goal: [Resident #1] will be able to communicate basic needs on a daily basis through the review date. Initatied:1/1/24; Target Date:3/27/26-Interventions: *Ask yes/no questions in order to determine [Resident #1] needs.*Communicate with the resident/family/caregivers regarding resident's capabilities and needs. * Discuss concerns about confusion, disease process, NH placement with resident/family/caregivers. Initatied:1/1/24 Record review of the quarterly MDS assessment, dated 12/01/25, indicated Resident #1 had unclear speech, his ability was limited to making concrete requests; usually understood but missed some parts of conversations. He had a BIMS score of 00 out of 15 indicating he had severe cognitive impairment with thinking and memory. He required maximal assistance or was dependent with most ADLs. Record review of Resident #1's medical chart indicated laboratory specimens were collected in December 2025 on 12/05/25, 12/06/25, 12/24/25, and 12/29/25. Record review of an undated letter written by the medical records staff indicated On 12/30/25, I [Medical Records staff], went to [Resident #1's room] to speak with [Family member #1] about a medical records release form. I [Medical records staff] explained to [Family member #1] that the form needed to be filled out and signed. [Medical records staff] would then send it in to corporate, and they would gather the records that she is asking for. [Family member #1] started stating that she had filled this out once before, and what happened with the form that she had already completed. I [Medical records staff] explained that I am unsure since that was before my [Medical records staff] time. [Family member #1] then stated that she was told when she first came to [facility] that all she had to do was ask for [Resident #1's] medical records, and that she would be able to get them from the staff here because she had already filled that form out once before and continued to ask [medical records staff] where that form was. I [medical records staff] again explained that we do not give out medical records without going through corporate first, and they are the ones that handle that. The only thing that I [Medical records staff] do is email the request form and the MPOA to help her get what she wants. [Family member #1] asked when the policy changed from requesting records from [facility], to which I [Medical records staff] informed her that I [medical records staff] started working [at facility] in November of 2024, and this is the only policy I [medical records staff] known of. [Family member #1] took the paper but did not fill it out, stating that she would hold onto it and look over it. As I [medical records staff] was leaving, I [medial records staff] informed her that I would follow up with Admissions and see exactly what form she was talking about. [Family member #1] thanked me [Medical records staff] and I told that shh was welcomed and left, closing the door behind me. The conversation was casual, but she [family member #1] she did seem to be a little on edge for not being able to get what she wanted asap. Record review of a typed letter dated 1/2/26 addressed to Medical records at facility from family member #2 Re: Request for Reason for Denial of Medical Records.On 12/30/25 [Resident #1] spoke to a representative in Medical Records and requested his most recent test results (labs, urinalysis) from a UTI that began on 12/24/25. [Resident #1] was denied with no reason given. Please provide a detailed written explanation as to why [Resident #1] was denied his medical records and instructions for appeal. Kindly send your correspondence vis US mail, email or fax supplied above. Record review of a typed letter dated 1/9/26 from legal department to Family member #2 indicated [Legal department] received her correspondence dated 1/2/26. [Their] office represented [Name of 455684 Page 2 of 4 455684 02/09/2026 Longview Hill Nursing and Rehabilitation Center 3201 N Fourth St Longview, TX 75605

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few facility] and are responsible for reviewing records requested to ensure compliance with applicable federal and state law such as the Health Insurance Portability and Accountability Act (HIPAA). Our [legal department] records currently show [Family member #1] as [Resident #1's] Medical Power of Attorney, and those files are in [Resident #1's] admission packet. Those files are not missing nor has there been a security breach. Regarding [Resident #1s] medical records, pursuant to 45 C.F.R. S 164.524(b)(1), we [legal department] may require requests for medical records in writing. To date, we [legal department] have not received a written request for [Resident #1's] recent test results (labs, UA) from [Family member #1]. [Family member #1] may submit a written request for the requested records. During an attempted interview on 2/7/26 at 4:55 p.m., Resident #1 was unable to respond appropriately to the questions asked. During an interview on 2/7/26 at 6:05 p.m. LVN B, said she was trained that if a resident or the resident's representative requested any information regarding the resident's medical records or chart, she was to provide them with a medical release form to complete and instruct them to submit it to the medical records department. She reported that this instruction applied regardless of whether the individual was requesting a verbal explanation of a test result or a hard copy of the medical records. LVN B stated she was instructed not to provide any information directly. During an interview on 2/9/26 at 4:23 p.m., the Medical Records staff member stated that Resident #1's MPOA verbally requested Resident #1's urinalysis (UA) lab results in December 2025. She reported that she provided the MPOA with a medical release form to complete, explaining that it is facility policy for the form to be completed prior to releasing any records. She stated the completed form would then be forwarded to the company's legal department to process the request. The Medical Records staff member reported that she had not received the completed paperwork and, therefore, had not provided the MPOA with the requested documents in accordance with facility policy. During a telephone interview on 2/9/26 at 5:09pm, the General Counsel from the company's legal department stated he was aware that Resident #1's family had requested information from the resident's medical chart. He reported that because the MPOA had not completed a medical release form in accordance with facility policy and HIPAA provisions, the family was not permitted access to the records. He stated that a written request must be submitted prior to releasing any medical information. He further stated that he received a certified letter from Family Member #2 requesting information and responded in writing to inform her that she was not the MPOA and that a completed authorization form would be required before any records could be released. During an interview on 2/9/26 at 7:00pm with Family member #1 and #2 they said they never received Resident #1's lab results. Family member #1 said she was Resident #1's MPOA and should have access to everything. She said she asked LVN B for the verbal results and was told she was instructed NOT to release it. Family member #2 said she sent a certified letter to corporate requesting an explanation for refusing Resident #1 his labs results. Resident #1's MPOA said she felt she should not have to go on a wild goose chase to hunt down a ghost in medical records that no one has any knowledge of; sign a form for every little thing and wait for corporate approval every time she wanted to see a lab result. Record review of undated Release of Medical and [NAME] Records Policy indicated To protect the integrity of requested medical records and billing records by ensuring that it is:. This Facility has adopted a system-wide policy regarding the release of medical and billing records, adopted and approved by the governing body, effective February 22, 2016, as amended. In order to ensure compliance with this Policy, all requests for medical and billing records must be cleared through the Legal Department prior to the release of any information.The procedure for medical and billing records requests is as follows:1. A fully completed medical, or billing records release authorization form must be submitted either by theResident, if a Resident is able to 455684 Page 3 of 4 455684 02/09/2026 Longview Hill Nursing and Rehabilitation Center 3201 N Fourth St Longview, TX 75605

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few complete such a form, or by the appropriate Authorized Party.If the medical records release request is executed by an Authorized Party, the appropriate appointment paper should be attached for review by the Legal Department. The appropriate documentation may be a durable business power of attorney, a medical power of attorney (if the medical power of attorney allows for the release of medical records and not just for decision making related to care), or an order of the court appointing a person guardian over the person or estate of Resident. 455684 Page 4 of 4