Inspection·October 6, 2025

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Regular and is at risk for unplanned weight loss or gain.Goal: Resident will maintain ideal weight and receive proper nutrition daily x 90 days.Intervention: Determine food preferences and provide within dietary limitations. Encourage meal completion and document amount consumed. Monitor weight per facility protocol. Offer substitute, if resident eats less than 50% or dislikes meal and offer supplement if a resident continues to eat less than 50%. Praise resident for eating well. RD assess per facility protocol. Serve diet and snacks as ordered. ST eval and Tx per Physicians orders as condition warrants. The resident has a pureed diet. Record review of nurse's notes dated 8/29/2025 revealed admission assessment done for weight, it was documented as zero (no documented weight). Record review of Resident #1's weight record done at the facility revealed weight done on 9/9/2025 was 138 pounds. Record review of the hospital discharge notes dated 8/29/2025 revealed the last weight prior to discharge was done 8/26/2025 was 154 pounds. In an interview on 9/16/2025 at 4:00pm the MDS Coordinator said she must have gotten the weight from the hospital records. She said she had to close the MDS for billing purpose, and she just use the hospital weight. In an interview on 9/17/2025 at 1:15pm with LVN G she said she was the nurse who admitted Resident #1. She said Resident #1 was very agitated and she was not able to do his weight. She said she asked the person who does the weight to weigh him in the morning. She said she was not aware that the weight was not done. In an interview on 9/17/2025 at 1:20pm the MDS Coordinator said she should weigh the resident or have one of the staff to weigh him to ensure his weight was correctly documented on the MDS. She said when doing her MDS she usually gets her information from different disciplines. She said she also looked at the nurse's notes and the CNA's documentation before completing their section of the MDS. She said moving forward she will ensure that all documentation on the MDS was accurate. Interview on 09/17/2025 at 2:30pm with the DON she said her expectation of the nurses were to do proper assessments that was to include talking with the CNA's, observe the residents and review nurses progress notes so they can capture all the change of the resident. She said she will be in- servicing the staff. Record review of the MDS policy and procedures dated 2024 read in part.Policy:Residents are assessed, using a comprehensive assessment process, to identify care needs and to develop an interdisciplinary care plan. Policy Explanation and Compliance Guidelines: 1.According to federal regulations, the facility conducts initially and periodically a comprehensive, accurate and standardized assessment of each resident's functional capacity, using the RAI specified by the State. 4. Care Plan Team Responsibility for Assessment Completion: Coding of Assessment:I All disciplines shall follow the guidelines in Chapter 3 of the current RAI Manual for coding each assessment.ii. Within 7 days after completing a resident's MDS assessment or tracking record, the facility must encode the MDS data (i.e., enter the information into the facility MDS software). Event ID: Facility ID: 455703 If continuation sheet Page 2 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure each resident received adequate supervision and assistive devices to prevent accidents for 1 of 5 (Resident #1) residents reviewed for accidents and supervision. The facility failed to ensure that CNA B provided the necessary care and supervision to Resident #1 by ensuring CNA B did not sleep when providing 1:1 supervision to Resident #1 who has a history of falls with injury, including a recent subdural hematoma, CT scan done on 9/12/2025 showed the worsening as indicative by the findings as it noted significant interval change developed of hemorrhage since prior examination, there is a mixed density left subdural hematoma overlying the left cerebral convexity measuring up to 1.0 cm in thickness increased in size compared to 8/21/25 when measure 0.7 cm.The noncompliance was identified as Past Non-Compliance. The PNC IJ began on 09/12/2025 and ended on 09/12/2025. The facility corrected the noncompliance before the survey began. This failure could place dependent residents at risk for falls to experiencing serious injury, pain and hospitalization. Record review of Resident #1's face sheet dated 09/17/2025 reflected Resident #1 was a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #1's diagnoses included intracranial injury with loss of consciousness (a brain injury that causes a person to lose awareness of their surroundings and body), traumatic subdural hemorrhage with loss of consciousness status unknown ( a serious medical condition where a collection of blood forms between the brain and the inner layer of the skull (dura mater) causing pressure on the brain and loss of conscious), epidural hemorrhage with loss of consciousness status unknown (bleeding between the skull and outer lining of the brain followed by loss of consciousness), personal history of other disease of the respiratory system (condition that affect the lungs and airways making it difficult to breath), initial encounter, contusion and laceration of left cerebrum with loss of conscious of 30 minutes or less (severe traumatic brain injury involving a physical tear of the tissue in the left largest part of the brain associated with temporary or prolong loss of awareness), acute cystitis with hematuria (inflammation of the bladder lining caused by bacteria and blood in the urine), pain (physical discomfort ranging from mild to severe), lack of coordination (pattern walking or moving on foot), hypertension (high blood pressure), hyponatremia, (low levels of sodium in the blood), seizure (uncontrolled jerking, loss of consciousness and blank stares), moderate protein calorie malnutrition (a condition that occurs when a person does not consume enough protein and calories to meet their body needs), dysphagia (difficulty swallowing), hypo-osmolality (a condition where the concentration of solutes such as sodium, potassium and glucose is lower than normal), atelectasis (complete collapse of the lung or a section of a lung), paralytic gait (abnormal walk resulting from paralysis or weakness of the leg), muscle weakness (decrease strength in the muscle) and other symbolic dysfunction (language impairments caused by an underlying medical condition). Record review of Resident #1's admission MDS dated [DATE] revealed the following: C1000: Cognitive Skills for Decision Making Resident #1 was coded as severely impaired for cognition indicating he was cognitively unaware. Section G0130: Functional Abilities For eating Resident#1 was coded as needing supervision. For oral hygiene, toileting hygiene, shower/bathe, upper/lower body dressing, putting on and taking off shoes and personal hygiene he was coded as needing substantial or maximal assistance. Section J: Health Condition J- 1700 coded Resident #1 as having falls in the last 2-6 months. J- 1800 coded Resident #1 as having 1 fall since admission. J- 1900 coded Resident #1 as having no injuries from the fall at the facility. J- 2100 coded Resident #1 as having recent major surgery. J- 2688 coded Resident #1 as having major neurological surgery. Record review of Resident #1's care plan dated 9/1/2025 revealed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 3 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Cognition Focus: Resident has impaired cognition or thought process Goal: To improve cognition level through the next review date. Intervention: Administered medications as ordered. Communicating with residents Use resident preferred name, identify self at each interaction. Face resident when speaking and making eye contact. Activities of Daily Living Focus:The resident has ADL care performance deficit.Goal:The resident will maintain or improve current level of functioning in bed mobility, transfer, dressing, eating, toilet use and personal hygiene.Intervention:For bed mobility and transfer the resident need 1 staff for assistance. For eating he needs supervision. For personal hygiene, bathing/showering and dressing he needs 1 staff assistance. Praise resident for all efforts. Focus : Falls Resident #1 had actual fall and remains at risk for injury d/t falls r/t cognitive impairment and noncompliance with callingfor assistance. Resident risk for injury will be minimized through IDT intervention through next review dateGoal Anticipate and meet the resident's needs.Intervention Be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed. Educate the resident/family/caregivers about safety reminders and what to do if a fall occurs. Encourage the resident to participate in activities that promote exercise, physical activity for strengthening and improved mobility such as therapy Ensure that the resident is wearing appropriate footwear when ambulating or mobilizing in W/C. fall mats bilateral Keep furniture in a locked position. Keep needed items, water, etc., in reach. Pt evaluate and treat as ordered or PRN. Resident #1 has actual falls and remains at risk of injury due to falls, cognitive impairment and non-compliance of calling for assistancePer negotiation related to fall risk arrangement bed removed and mattress placed on the floor.Resident wears helmet every shift while up in wheelchair as tolerated.Revision of information on past falls in an attempt to determine causes of falls. Record review of Resident 1's hospital discharge report dated 8/28/2025 revealed diagnoses including traumatic brain injury (brain dysfunction caused by an outside force usually a violent blow to the head) temporal hemorrhagic contusion (brain bruise with bleeding in the temporal lobe of the brain). The brain has a small left temporal contusion (bruise on the left side of the brain's temporal lobe, cause by the brain hitting the inside of the [NAME] during a traumatic head injury), and left laceration and hematoma to the frontal scalp (tear in the skin on the left side and hematoma is a collection of blood that pools under the skin to left right frontal scalp). Stubble areas (areas of a man's face typically on the jaw line) slightly decreased attenuation peripherally in the left temporal region, represent small hemorrhagic contusion ((a type of brain injury that occurs when blood vessels in the brain are damaged leading to bleeding in the brain). No other intracranial abnormalities. No subdural (a pool of blood between the brain and its outer covering) or epidural hematoma (bleeding between the skull and outer lining of the brain followed by loss of consciousness), or vascular hemorrhage (the escape of blood from the circulatory system).Repeat CTB1. Significant interval change developed of hemorrhage since prior examination.2. 5.6 x3.0x4.o hematoma (collection of blood that pools outside the blood vessels) has developed in the left lobe.3. Left cerebral convexity subdural hematoma (collection of blood on the surface of the left side of the brain) 8mmin maximal thickness had developed and they are thin subdural hematomas along the tentorium falx.4. Narrowing left lateral ventricle due to extrinsic compression.5. 5mm of right ward subfalcine herniation (a condition where part of the brain tissue protrudes (herniates) under the faix cerebri, a sickle-shaped fold of dura mater (protective covering of the brain) that separates the two cerebral hemispheres). Record review of Resident #1 nurses' notes written by LVN B dated 9/12/2025 at 03:56 am revealed: At 03:56 am the Sitter came to the nursing station stating that the resident (Resident #1) wanted to use the restroom and when she was about to transfer him from bed to the wheelchair, instead of sitting on the chair, he gently sat on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 4 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few floor, the nurse when went to the room on getting there resident was observed sitting on the floor, no injury noted.At 4:12 am Resident #1's BP-132/79. T-97.8. P -68. R-18. BS-N/A. Resident had a fall. Location: Resident Room. Fall information: Assisted, Missed seat of chair, Cognition / Behavior at Time of Event: Cognitive Impairment, . Resident wanted to be transferred from bed to wheelchair, but instead of sitting in his wheelchair. he gently sat on the floormat. no injury no pain. Initial Treatment/New Orders: N/A Resident Statement: It was witness by his sitter Name of MD/NP notified:At 6:30am MD/NP, RP notified: Interventions in place prior to fall: 1 on 1 supervision, Interventions initiated in response to fall: 1:1 supervision.At 8:54am Head to toe assessment done by DON for Resident #1, no apparent injury noted. Vital signs 118/74 84 18 97.6 97% RA. Resident transfer to the hospital for post fall via EMS transportation. Record review of the facility investigation report dated 9/12/2025 revealed at 09:43am nurse's notes documented Resident #1 was transferred to a hospital on 9/12/2025 related to Post fall. This is intended to serve as notice of an emergency transfer. This notice was provided to Resident Representative. Record review of the hospital report dated 9/12/2025 at 8:52 am from Emergency Medicine revealed the following: Report from the facility revealed that Resident #1 got up and fell, hit his head LOC/C spine tenderness. Hx of Craniotomy- has a sitter at the facility.Progress notes dated 9/9/2025-9/12/2025The resident presents to the neurosurgery clinic for evaluation TS/P left decompressive hemicraniectomy for subdural/epidural hematoma (an emergency procedure to remove a blood clot and relieve dangerous pressure on the brain) evaluation. The patient has been in a nursing and rehab facility and has been progressing well. The caregiver at the facility said he was still very spontaneous, trying to get up at all times and he requires 1:1 monitoring. He was able to verbalize better than he was on admit.Resident readmitted back to facility from hospital. CT brain scan done at the hospital stated there is a mixed density left subdural hematoma overly the left cerebral convexity measuring up to 1.0cm. Resident continues 1:1 sitter, fall and safety precaution maintained. Bed in lowest position and call light within reach. RP aware of resident arrival to facility. Record review of the CT scan of the Head without contrast clinical indication done on 9/12/2025:Brain:There is a mixed density left subdural hematoma overlying the left cerebral convexity measuring up to 1.0 cm in thickness increased in size compare to 8/21/25 when measure 0.7 cm. Previously noted pneumocephalus has resolved.There are scattered areas of hypoattenuation within the intracranial white matter. While nonspecific, this is most suggestive of mild chronic microvascular ischemic disease. Redemonstrated encephalomalacia and gliosis in the left anterior temporal lobe. No definite new intraparenchymal hemorrhage. No midline shift. Postsurgical change from a left cerebral craniectomy and or no fracture status post-surgical fixation involving portion of the left sphenoid bone. Observation on 9/16/2025 at 7:20am revealed Resident #1 was in bed, he was clean and groomed with no offensive odor. No visible marks, bruises, redness or swelling noted. Resident #1's bed was noted to be in a low position and floor mat on both sides of the bed. A sitter was noted to be in the room. The resident was alert but confused. The resident was noted to be very agitated trying to get up off the bed and turning in all directions on the bed. In an interview on 9/16/2025 at 7:30 am with the CNA C she said she was the sitter, and it was her first time sitting with Resident #1. She said the resident was always trying to get up. She said the night sitter told her he gets really agitated and will try to get up. An attempt was made to interview the Resident#1 on 9/16/2025 at 7:35 a.m. revealed the resident to answer simple questions. He answered no when he was asked if he was in pain and yes when asked if he had fallen. The resident was unable to explain what he was doing when he fell. In an interview on 9/16/2025 at 7:45 am the Administrator said the resident was a 1:1 due to his unsteady gait, agitation and trying to get up all the time. She said along with the DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 5 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few they decided to have him on 1:1 supervision because of the head injury he had from a fall prior to admission to the facility. She said they did not want him to fall and reopen the wound and that was why they initiated the 1:1 supervision. She said the resident had a fall on 9/12/2025 and they assessed him, and the family was called. She said the family later called back after viewing their video stating the resident did not fall out of his chair, they told them he fell face down on the floor and the CNA was sleeping. She said they immediately reassessed the resident and he was sent to the hospital for evaluation as this was now an unwitnessed fall. She said on assessment the resident had no visible injuries. She said he was evaluated at the hospital and the resident was sent back from the hospital to the facility the same day with no new orders. She said the CNA was suspended pending investigation and will be terminated based on company policy. In an interview on 9/16/2025 at 11:05 am with RN A she said she worked with Resident #1, and he was alert but does not follow command. She said he was nonverbal and would point to the restroom. She said he will get up and gets very agitated at times turning from side to side on his bed and will attempt to get out of bed. She said he has unsteady gait and will fall. She said he has a 1:1 sitter who was provided by the facility. In an interview on 9/16/2025 at 3:15pm with CNA E she said they have in-service training every month. She said she never worked with Resident #1, but she heard of him, and that he has a 1:1 sitter. She said she was in-in-service on abuse, neglect, monitoring 1:1 and falls. Staff said 1:1 means you must always have your eyes on the resident. In an interview on 9/16/2025 at 3:33pm with LVN G she said she was the nurse for Resident #1. She said she assisted the Sitter with taking him to the bathroom at times. She said the resident can get very agitated at times and try to get out of bed. She said he was 1:1 supervision and had to always be in eyesight. She said sometimes he was difficult to redirect. In an interview on 9/16/2025 at 3:45pm with CNA F she said she worked with Resident #1 the first day he was admitted . She said he was very restless and could feed himself. She said they were in-serviced on abuse/neglect, call lights, customer service, mechanical lift training, 1:1 training and fall prevention. Staff were able to verbalize understanding of in-services. In an interview on 9/16/2025 at 5:00pm the DON said Resident#1's 1:1 supervision was initiated by the facility, because of his agitation, unsteady gait and the resident trying to get up all the time. She said she was notified on 9/12/2025 by LVN B that the resident had fallen, and the responsible party was notified. She said LVN B told her the CNA that was providing 1:1 supervision to Resident #1 told her she was taking the resident to the bathroom, and he sat on the floor. She said, when the RP was notified, the RP said she was going to look at her camera. After the family reviewed the video, they called the facility and told them, the resident did not fall out of the chair, he was standing and fell on his face to the floor. She said when she heard the report she immediately went and reassessed the resident. She said on assessment of Resident #1 she did not see any marks, bruises, redness or swelling on the resident's face or body. She said the resident was sent to the hospital via 911 for evaluation due to a previous fall that resulted in head injuries before admission to the facility. She said the resident was reassessed at the hospital; a CT scan was done, and the resident was sent back to the facility with no new injuries or orders. She said after the call from the family she called CNA B and interviewed her. CNA B told her, she dozed off and then she heard a boom, and when she got up, she saw the resident on the floor. DON said they decided to send the resident to the hospital for an evaluation based on what the family said and the report from the CNA that she dozed off as it would be an unwitnessed fall. She said she then requested a copy of the video. She said on viewing the video, she saw the resident staggered but it was difficult to determine if he fell on his face to the floor as that part of the video was missing. She said the CNA was suspended pending investigation and will be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 6 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few terminated for sleeping on the job. In an interview on 9/16/2025 at 9:35pm via telephone with LVN B she said she was working the night shift when the sitter (CNA B) came to her and told her she was transferring Resident #1 to his wheelchair to take him to the restroom and the resident sat on the floor, and she was asking her to help put him back in his chair. She said she went to the room to assist the sitter to get the resident off the floor back in his chair. She said when she got to the room the resident was sitting on the floor. She said she assessed the resident and there was no swellings, bruises or redness on his body/face and the resident did not complain of any pain. She said she checked his vitals, and they were okay. She said the RP, MD/NP and DON were notified. She said the resident was 1:1 with a staff, he was on a low bed with fall mats on both sides of the bed. She said she also initiated neuro checks. She said she was not aware that Resident #1 had fallen face down to the floor, that was why he was not sent to the hospital immediately. She said the CNA was suspended pending investigation. In a telephone interview on 9/17/2025 at 8:45 am with CNA B, she said she was the person who was doing 1:1 supervision with Resident #1 when he fell. She said she was unaware that the resident was up when he fell, she said he fell by the closet door. Further interview with at CNA B revealed she was sitting within arm's length from Resident #1's bed. CNA B said she could not prevent the resident from falling because she dozed off and then she heard boom, and the resident was on the floor. She said she called the nurse and asked her to assist her in getting the resident off the floor. She said she did not tell the nurse the truth. She said the resident did not have any swelling, marks or bruises to his body/face. Interview on 9/17/2025 at 2:30pm with CNA D she said she worked with Resident #1, and she gave him a shower. She said he did not complain of any pain. She said she was in-serviced on abuse, neglect, falls and infection control. She said if a resident was at risk at falling, she would ensure the bed was in the lowest position with fall mats on both sides and check him at least every two hours or as needed. She said they were recently in-serviced on abuse/neglect, fall prevention and 1:1 monitoring. The staff demonstrated understanding of training. Interview on 9/17/2025 at 2:45pm with CNA L she said she worked with Resident #1, and he can get restless at times. She said he did not complain of any pain. She said she was in-serviced on abuse, neglect, falls and infection control. She said if a resident was a fall risk, the bed should be in the lowest position with fall mats and staff should check him at least every two hours or as needed. She said if the resident wanted to use the bathroom he would get up and point to the bathroom. She said they were recently in-serviced on abuse/neglect, fall prevention, infection control and 1:1 monitoring. Interview on 10/01/2025 at 3:07 pm the DON said 1:1 monitoring means to always lay eyes on the individual, the staff should be within arm's reach of the individual. She said they did in-services with everyone on what 1:1 monitoring means, no sleeping on the job. She said the CNA who was sitting with the resident at the time of the fall was suspended and then terminated on 9/17/2025. She said she asked the CNA to tell the truth, and she told her she had dozed off when she heard a boom and when she looked the resident was on the floor. She said moving forward if they have 1:1 supervision for residents they were going to initiate frequent breaks, shorter shifts such as 8 hour shifts especially if the staff was not accustomed to 12-hour shift. They will ensure they have their breaks to prevent fatigue. She said the resident was sent out to the hospital because he had a fall with head injuries prior to coming to the facility and the fall was an unwitnessed fall. She said there were no bruises, no facial injuries, trauma or any evidence he fell face to the floor. She said evidence from the video did not show he fell, it showed the resident just staggered but did not show he hit the floor Further interview on 10/01/2025 at 4:37pm with LVN B she said when she went to the room the resident was sitting on the floor. She said he was beside the bed, and the wheelchair was nearby. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 7 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few said there was no swelling or bruises when she assessed him. She said she initiated neuro checks and called the RP, DON and physician. Further interview on 10/01/2025 at 4:45pm with CNA B she said Resident #1was in a sitting position on the floor near the closet when she heard the sound. She said he was not on his face and there were no visible injuries, and he did not complain of pain. In an interview on 10/02/2025 at 8:37am Doctor F said when there were unwitnessed falls the NP or the doctor should be called. She said Resident #1 was sent to the hospital for evaluation due to a previous intercranial head injury that he sustained prior to admission to the facility. She said there was no concern at the time because there was no bleeding, no laceration or complaining of pain. She said when he returned from the hospital, he was pretty much the same. She said he had underlined confusion before the fall, she said when he went to the hospital he was evaluated, and was sent back from the hospital the same day. She said nothing was different with him and no new orders were given. In an interview on 10/02/2025 at 8:56am NP C said he did not see Resident #1 prior to going to the hospital but he saw Resident #1 after his return. He said he did not complain of head pain, soreness, redness or swelling. He said there was no negative outcome from the fall. He said he was sent to the hospital due to an unwitnessed fall and based on his previous fall prior to admission where he had head injuries he was sent out to ensure he had no brain bleed or any other head injuries. He said he was sent back with no injuries or orders. He said the negative outcome from that fall could be damage to the brain, brain bleed, soreness and pain. An interview on 10/6/2025 at 4:21pm LVN K revealed she has been working at the facility for over a year. She said they did a lot of in-services. The most recent in-services done were falls, transfers, 1:1 monitoring, no sleeping on the job and call lights. She said she was not working the day the resident fell; however, she was aware that the resident fell while he was under a 1:1 supervision watch. She said the resident should be on a low bed with mats to both sides of the bed. She said the resident mattress was now on the floor. In an interview on 10/06/2025 at 4:45pm MA N said she worked at the facility for 19 years. She said they did a lot of in-services and the most recent in-services they did was on abuse/neglect, showers, time clock, fall prevention and 1:1 monitoring. She said she worked with Resident #1 when she was on break to relieve the sitter. She said he has improved a lot. She said when he was on 1:1 he would try to get up and would not sleep. She said 1:1 means you cannot take your eyes off the person, and you cannot sleep. She said Resident #1 was no longer on 1:1 because his mattress was on the floor with side mats, and he moved around a lot. She said he was more alert and oriented now. She said therapy was working with him, pointing at him walking with therapy, using a walker. The staff demonstrated understanding of training. In an interview on 10/06/2025 at 4:55pm CNA P said she had been working at the facility for 2 months: Said she was in-serviced on falls and transfer and abuse neglect and 1:1 monitoring. She said when you are doing 1:1 you cannot sleep. She said Resident 1 was very active and you must always keep an eye on him. She said he gets agitated at times and will try to get up. Staff demonstrated understanding of training. In an interview on 10/06/2025 at 5:10pm CNA G said she worked at the facility for about 8 months. She said she was in-serviced on abuse and neglect, dementia, incontinent care, 1:1 monitoring, Fall prevention, and safety risk. She said she was aware of Resident #1's fall. She said, when you are doing 1:1 you can't leave the resident out of sight; you are not supposed to sleep you must always keep him insight. She said he was no longer on 1:1. She said his mattress was on the floor and he had fall mats on both sides of his mattress. Staff demonstrated understanding of training. Record review of the video on 9/17/2025 revealed clippings where the resident staggered and stumble but did not observed him hitting the ground. The next review were staff members in the room and the resident in his wheelchair. Record reviews of facility in-services revealed CNA B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 8 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (received written disciplinary warning and 1:1 education) and nursing staff were educated on 9/12/2025 regarding 1:1 monitoring for residents who were at risk of falling. CNA B was also suspended pending investigation. Record review revealed in-service dated 9/12/2025 revealed staff were educated on the following topics by the Administrator and the DON regarding Abuse neglect, fall prevention and 1:1 monitoring which included not sleeping on the job, always have the resident in eyesight, and resident rights. Record review of in-services done on 09/16/2025 Additional services on abuse/neglect and 1:1 monitoring was done on 9/16/2025 with the Administrator and the DON. Record review of the facility's undated Fall policy read in part .Preventing falls requires an interdisciplinary program that focuses on modifying the extrinsic factors, correcting intrinsic factors, and educating the resident and family. A Fall Risk Assessment will be completed on admission and after each fall. The MDS 3.0 will also assist in determining a resident who is a fall risk. Procedure 1. On admission, the nurse will complete a fall risk assessment for each resident. 2. If the resident is unable to assist in completion of the tool, or if medical records are unavailable, the nurse may obtain the assistance of a family member or legal representative that is familiar with the resident's current functional status.3. Fall Risk AssessmentThe Fall Risk Assessment Tool will be completed at admission and after each fall occurrence. The assessment should be completed by reviewing the residents' medical history, social history, and current functional status. Information may be obtained by reviewing current medical records, interview with resident/family, or conference with the interdisciplinary team members. The assessment tool should be scored and interventions implemented as indicated.4. Appropriate interventions will be addressed immediately on the interdisciplinary plan of care. Reassessment will occur after each fall.5. Interventions will be resident centered.13. In instances where fall risk measures do not prevent a fall, the resident will be assessed immediately for injury. Vital signs and first aid measures will be completed immediately. The Charge Nurse will notify the attending physician and family member as soon as possible after the resident has been stabilized. 15. The nurse will complete an event fall nurses note after each fall. Falls resulting in serious injury will be reported to the DON and/or Administrator.16. The DON or designee will be responsible for investigating all resident falls to attempt to determine the cause and need for new interventions as required.17. Appropriate education will be provided to all staff members as needed on fall prevention. EnvironmentalEnsure room has adequate lighting (60watts or greater / non-glare bulbs).Be aware of spills / wet floors. Make sure residents have proper eyewear.Remove clutter from floors / hallways.Shoes should fit properly and have non-skid soles, full backs and adequate arch support.Bed height needs to be appropriate height with wheels locked.Follow toilet schedules, utilize hip protectors for those who are at risk.Watch for raised surfaces (i.e. threshold, steps). [NAME] with bright tape or remove if possible. Furniture should not easily tip or slide.Place frequently used items in drawers that do not require the resident to bend or stoop.Beds and chairs should be positioned so that the resident transfers to their stronger side. Position call bells within reach.Respond timely to call bells and resident's request for assistance.Utilize bed low bed if indicated.Resident's room should be tidy and uncluttered with special attention to detail at night.Rehabilitation: Strengthening, Assistive Devices/Footwear, ROM and Gait. Record review of the facility's Adhoc Qapi dated 9/12/2025 revealed:Findings: Certified Nursing Assistant who was 1:1 to prevent fall, fell asleep and the resident got up and fell.1.The resident currently resides at the facility.2. Certified Nursing Assistance was provided one and one education.3. DON provides in-services on 1:1, Abuse neglect, fall prevention, resident rights,4. All training and education will be provided before the next shift. All information was reviewed with the Administrator, DON, ADON, RN and the medical Director during the Adhoc Qapi meeting on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 9 of 10 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 10/06/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety 09/12/2025 to review all findings.The noncompliance was identified as Past Non-Compliance. The PNC IJ began on 09/12/2025 and ended on 09/12/2025. The facility corrected the noncompliance before the survey began, no POC required. On 10/06/2025 at 4:10 p.m., the facility's Interim Administrator, and Regional Nurse were notified of the past noncompliance IJ. A plan of removal was not requested. An IJ template was provided to the Administrator on 10/06/2025 at 4:15 p.m. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455703 If continuation sheet Page 10 of 10