Inspection·May 5, 2023

F 0842 Level of Harm - Minimal harm or potential for actual harm years, 2 months. She stated that she was familiar with Resident #1 who would pee on the floor next to the toilet rather than in the toilet. She stated she would be better able to describe the resident's condition if she had access to his chart. She stated that a new company took over the facility as of 02/01/23 and since then the staff do not have access to old resident records. Residents Affected - Some Interview on 05/03/23 at 10:31 AM, LVN A stated she began employment with the facility on 11/04/22 and she works various shifts and days. She stated that she was the unit charge nurse over the facility's [NAME] Unit. She stated that Resident #1 was on the [NAME] unit for a week or 2 (specific dates unknown) before he was moved to the East Unit under LVN B's supervision. She stated she does not remember the resident's diagnosis. She stated the resident was of the Asian culture and spoke a little English. She stated that she recalled that the resident was ambulatory and had a lot of urination issues. She stated that the resident would pee all over the floor and go into the closet in his room and pee. She stated at some point, the resident had a roommate who was not happy with the resident's urination behavior. She stated she was unable to recall the resident's diagnosis, admission, or discharge date , and/or condition without looking at the resident's chart. She stated that LVN B was more familiar with the resident's condition. She stated the staff no longer have access to resident records who discharged or transferred since the facility transferred client profile management (CPM) companies on 02/01/23. Interview on 05/04/23 at 03:24 PM, Administrator stated that Resident #1 was impaired. She stated that Resident #1's family made the decision to move him to another facility closer to their home. She stated that the facility changed CPM systems as of 02/01/23. She stated when the previous CPM company was discontinued, they took the resident files with them. Interview on 05/04/23 at 11:05 AM, Resident #1's family stated that the facility transferred the resident to a sister facility. She stated that she was told by the Administrator that the facility transferred ownership and the previous owners took all resident records that were no longer residing in the facility. She stated that because there were no records for the resident, they were unable to provide a list of inventory personal items the resident had prior to discharge. Interview on 05/04/23 at 11:23 AM, RN stated that the owners of the building took over ownership of the facility's resident management and care on 02/01/23. She stated that when the previous owners relinquished control, they also discontinued access to resident files that were no longer residing in the facility when the change of ownership occurred. She stated that Resident #1 resided at the facility, but she does not recall his diagnosis. She stated she did recall that the resident had an urination issue where he would urinate almost anywhere in the facility. She stated that the family made a decision to transfer the resident to another facility that would be better equipped to treat his urination behaviors. Interview on 05/03/23 at 09:49 AM, DON stated she began employment in late December 2022 and was not familiar with Resident #1 but would check if the facility had any information on the resident. Interview on 05/04/23 at 03:24 PM, Administrator stated the Resident #1's family made the decision to discharge him to a facility closer to their home. She stated the facility does not have access to any resident records for resident's who discharged prior to 2/01/23 and the resident discharged prior to that date. Record Review of email dated 03/02/23 at 01:49 PM, revealed that the Administrator communicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 2 of 5 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 455703 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Healthcare and Rehabilitation Center of Ka 1525 Tull Dr Katy, TX 77449 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with Ombudsman. As you know, we are now managed by another company and do not have access to any discharged records . Record Review of Nursing Policy and Procedure Manual 2003: Admission/readmission: Procedure 15. Compile a new clinical record and document pertinent admission information. Place completed nursing assessment forms, vital sings, admission weight/height and other pertinent date in the assigned area of the clinical record. 17. Complete the nursing admission assessment forms (head to toe assessment) within eight hours of resident admission and place on the clinical record. Initiate an interdisciplinary plan of care for the resident and place a copy on the clinical record. Record Review of Resident #2's admission Record dated 05/03/23 revealed that resident was a [AGE] year-old male initially admitted to the facility on [DATE] with his latest admission on [DATE] and discharged on 02/06/23. Resident's principal diagnosis were pressure ulcer of right heel, unspecified and secondary diagnosis of cellulitis of right lower limb, quadriplegia, unspecified, difficulty in walking, not elsewhere classified, seborrhea capitis, rash and other nonspecific skin eruption, sepsis, unspecified organism, chronic viral hepatitis C, major depressive disorder, recurrent, unspecified, polyneuropathy, unspecified, and legal blindness, as defined in USA. Record Review on 05/04/23 at 01:19 PM, revealed the facility's ECP system did not have nursing progress notes relating to Resident #2's 02/21/22 abuse allegation and no physician or facility discharge summary for the resident. Interview on 05-03-23 at 10:14 AM, DON stated the previous company that owned the facility discontinued their services and took the physical and electronic resident files of any resident who discharged prior to 02/01/23. She stated that the facility does not have a discharge summary on Resident #2. She stated that RN, LVN A and LVN B have been working for the facility for some time and maybe familiar with Resident #2 and any other residents who discharged prior to 02/01/23. Interview on 05-03-23 at 10:28 AM, LVN B stated that Resident #2 was transferred to another nursing facility. She stated she was familiar with the resident, but without reviewing his medical chart she could not provide any information on the resident's patient care. Interview on 05-03-23 at 10:31 AM, LVN A stated she was familiar with Resident #2. She stated he had a lot of aggression issues. She stated that the resident was a big intimidating man. She stated that he was discharged to a sister facility due to his aggression issues. She stated that this surveyor should review his progress notes to get a better understanding of the type of resident he was. Interview on 05/04/23 at 11:23 AM, RN stated that Resident #2 had aggression issues and was discharged to a facility better equipped to handle his behaviors. She stated she does not have a discharge summary for the resident. Interview on 05/04/23 at 03:24 PM, Administrator stated that Resident #2 had a lot of behavioral issues and was discharged due to his aggression towards staff. She stated that she does not have access to a lot of resident files since the new company took over. She stated that she does not have access to anything not located in the current CPM system. Record Review of Resident #2's Care Plan dated 01/17/23 revealed the reason the care plan was closed as: discharged . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 3 of 5 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 455703 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Healthcare and Rehabilitation Center of Ka 1525 Tull Dr Katy, TX 77449 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 0842 Level of Harm - Minimal harm or potential for actual harm Record Review on 05-03-23 at 10:12 AM, of the facility's ECP system revealed that the facility did not have Resident #3's assessments, comprehensive plan of care and services provided, the results of any preadmission screening and resident review evaluations and determinations conducted by the State, Physician's, nurse's, and other licensed professional's progress notes; and/or laboratory, radiology and other diagnostic service reports. Residents Affected - Some Interview on 05/03/23 at 09:49 AM, DON stated she not familiar with Resident #3, but would check to see if the facility had any patient records for him. Interview on 05/03/23 at 02:46 PM, DON stated that there was no patient information she could locate on Resident #3. Interview on 05/04/23 at 11:23 AM, RN stated that Resident #3 discharged , but she does not recall the date or reasoning. She stated his stay may have been very short. She stated that the facility did not have any chart records for Resident #3 since the new CPM company took over 02/01/23. Record review on 05-03-23 at 09:58 AM, of the facility's ECP system revealed that the facility did not have Resident #4's assessments, comprehensive plan of care and services provided, the results of any preadmission screening and resident review evaluations and determinations conducted by the State, Physician's, nurse's, and other licensed professional's progress notes; and/or laboratory, radiology and other diagnostic service reports. Interview on 05-03-23 at 10:28 AM, LVN B stated that she was not familiar with Resident #4's diagnosis or care services as her room was on the opposite side of the hall. She stated that the facility does not have access to the resident's records since the resident discharged . She stated that LVN A would be more familiar with the resident. Interview on 05-03-23 at 10:31 AM, LVN A stated that she was not familiar with Resident #4. Interview on 05/03/23 at 01:05 PM, DON stated that the facility did not have any records for Resident #4. Interview on 05/04/23 at 11:23 AM, RN stated that the facility no longer has access to Resident #4's records and is not familiar with the resident's diagnosis or care services. Record review of Grievance log dated March 2023 and April 2023 did not reflect any grievances for Resident's #1, #2, #3 or #4. Record Review Discharge Planning Process Policy last revised date 11/28/16 revealed, Discharge Summary must include: 3. The post discharge plan of care must indicate; E) The Final discharge summary will be filed in the resident's medical records. The final discharge summary will be available for release to authorized individuals and agencies, with the consent of the resident or the resident's legal representative. Record review Nursing Policy and Procedure Manual: Abuse/Neglect last revised date of 03/2918, revealed F. Investigation: 7. The facility will report and cooperate with any and all investigations concerning reports of abuse, neglect, exploitation, mistreatment of residents, misappropriation of resident property and injuries of unknown source by the company's employees as set forth in state law (including to the state survey and certification agency). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 4 of 5 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 455703 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oakmont Healthcare and Rehabilitation Center of Ka 1525 Tull Dr Katy, TX 77449 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of Nursing Facility: Resident Rights policy dated November 2021 revealed: Information You have the right to: Receive a written statement or admission agreement describing the services provided by the facility and the related changes. Receive a copy of the statement of Resident Rights and to be informed of revisions. Record review of Fall Risk Mini Manual: Preventive Strategies to Reduce Fall Risks policy last revised date 10/05/16 revealed: Education: Orient residents to bedroom, unit, activities, and routines. Document education. Event ID: Facility ID: 455703 If continuation sheet Page 5 of 5