Health inspection·August 12, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete incontinent bowel. Resident #2 was triggered for cognition, incontinence, pressure sore, activities, dehydration, falls, psychosocial well-being, communication and nutrition. Record review of Resident #2's care plan, initiated 6/06/2025, revealed the care plan did not address cognition, activities and nutrition. In an interview on 8/12/2025 at 2:18 PM, the DON said they did not have a MDS Coordinator. She said the corporate nurse was helping them and was doing a 100% audit to ensure all triggered areas on the MDS were captured on the care plan. She said they were going to try and ensure all triggered areas on the MDS were captured on the care plans to ensure residents care needs were addressed. Record review of the policy and procedures, dated March 2022, Care Plans, Comprehensive Person-Centered read in part .Policy Statement A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. Policy Interpretation and Implementation1. The interdisciplinary team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. Event ID: Facility ID: 455714 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 455714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm Northwest 17600 Cali Dr Houston, TX 77090 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 (CR#1) residents reviewed for accidents and supervision. 1. The facility failed to ensure CR#1 received adequate supervision and assistance devices to prevent accidents resulting in CR#1 sliding out of bed to the floor sustaining a cut to the right eye and left thalamic bleed (a type of intracerebral hemorrhage) without intraventricular (inside the brain's ventricles) involvement. 2. CNA A failed to ensure two-person assistance was used to provide care to CR #1, who required total assistance with all ADLs, and resulted in CR#1 sliding out of bed to the floor. The noncompliance was identified as PNC. The IJ began on 08/11/2025 and ended on 08/12/2025. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk of experiencing serious injury, pain, hospitalization and death. Findings include: Record review of CR#1's face sheet, dated 08/08/2025, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. He was diagnosed with type 2 diabetes mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy), dysphagia (difficulty swallowing), respiratory failure (when the lungs cant properly exchange gases causing abnormal level of carbon dioxide or oxygen in the blood), cerebral infarction (brain tissue dies due to lack of blood supply), unspecified hypoxia (low oxygen in the blood), and hypertension (high blood pressure), Constipation (difficultly passing stool) vitamin deficiency (too little of one or more of the essential vitamins in the body), gastroesophageal reflux disease (a digestive disease in which the stomach acid or bile irritates the food pipe lining), feeding tube (a device that delivers liquid nutrition directly to the stomach or small intestine through a tube), anticoagulant therapy (treatment that prevents or reduces blood clotting), tracheostomy (a surgical procedure that creates an opening in the wind pipe to help with breathing) and need assistance with personal care. Record review of CR#1's baseline care plan, dated 8/5/2024, revealed he was assessed as dependent on staff for all areas of ADL's. Record review of CR#1's revised care plan, dated 8/5/2025, revealed the following areas of concern: Focus: ADL Self Care Deficits: CR#1's has ADL selfcare deficits and is at risk for further decline in ADL functioning and injury AEB decline physical function.Goal: CR#1 will be well dressed, groomed, clean, dignity will be maintained and will have no further decline in ADL functioning or injury the next 90 daysIntervention: Anticipate needs - provide prompt assistance. Encourage independent function as able Encourage resident to ask for assistance for ADL care as neededEnsure call light is within reach and answer in a timely mannerKeep daily preferred routine unchangedProvide (Total) assistance of (2 of support persons) for transfersProvide (Total) assistance of (1 of support persons) for bathingProvide (Total) assistance of (1 of support persons) for bed mobilityProvide (Total) assistance of (1 of support persons) for eating via peg tubeProvide (Total) assistance of (1 of support persons) for personal hygiene/groomingProvide (Total) assistance of (1 of support persons) for toileting/incontinent careProvide (Total) assistance of (1 of support persons) for upper/lower body dressingFocus: Bowel Incontinence: CR#1 has bowel incontinence related to:Goal: CR#1 will have no alterations in skin integrity related to incontinence or brief use through the review dateIntervention: Monitor for signs of discomfort or agitation that may indicate the need for toiletingPerform routine rounding to include incontinence care and brief changes. Record review of CR#1's nurses notes, dated 8/6/2025, revealed CR#1 had a change in condition: - Fall 8/06/2025 at 5:00 AMLocation of the Fall: Resident's room classification of the Fall: witnessed with Head Injury:What was the resident doing prior to the Fall:Resident AAOx1, nonverbal. Vital Signs Post Fall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 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 455714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm Northwest 17600 Cali Dr Houston, TX 77090 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 Event: Blood Pressure-122/68, Pulse-72.Resident was sent to the hospital. Record review of CR#1's, undated, hospital records revealed he was admitted to a local hospital on [DATE] with a cut to the right eye, swollen shoulder and was later diagnosed with left thalamic bleed without intraventricular involvement. Observation on 8/08/2025 at 12:00 PM of CR#1 at the hospital revealed CR#1 was in bed. He appeared to be asleep, he did not respond when his name was called. He was clean and without odor, he was observed with a raise to the right-side front of his head, he had swelling to the right shoulder. There were no other visible injuries. In an interview on 8/8/2025 at 12:05 PM, the hospital RN said the resident was admitted to the facility on [DATE] from the nursing home due to a fall. She said he had swelling to the right shoulder, a cut to the right eye and a raise to the right front of the head but she did not know if the raise to the front of the head was because of the fall or an old injury. She said the family mentioned an injury to the left hand, but she did not see any injury to the left hand on her assessment. In an interview on 8/8/2025 at 12:45 PM, the DON said LVN B called and told her CR#1 slid off the bed to the ground when CNA A provided care to him, 911 was called and they sent him to the hospital. She said during the investigation CNA A told her she provided care to CR#1 and did not ask for help and the resident slid out of bed to the floor and sustained a cut to the right eye. Further interview revealed the resident was new and the staff were not sure of his mobility status. The DON revealed if a resident had a tracheostomy, sacral pressure sore or total care, they needed 2 persons for transfers and incontinent care. She said CNA A's decision to provide care to CR#1 by herself instead of asking for help resulted in CR#1 having a fall with injuries and was hospitalized . She said CNA A was in-serviced on getting assistance when providing care for residents who were total care. She said in-service began the same day with Nursing staff, ensuring them, there should be two persons assist when providing care to residents who were new and mobility not known, tracheostomy, sacral pressure sore and total care with ADLs. In an interview on 08/08/2025 at 1:17 PM with CNA A, she stated she was providing her last incontinent care to CR#1 at around 5:00 AM and everyone was busy, and she decided to do it by herself. She said she turned CR#1 to his side, and he slid off the bed to the floor. She said she did not ask for help. She said when the resident fell to the floor, she called the nurse for help and he came immediately and assessed the resident, called 911 and the doctor, the DON and the family, and the resident was sent to the hospital. She said she worked with CR#1 earlier in her shift and she knew the resident was two-person assist because she was assisted by the nurse. She said she knew CR#1 was total care with ADLs, but she thought she could do it by herself since everyone was busy. She said she did not know he would slide off the mattress. She said she was immediately trained on transfer and two-person assistance with bed mobility and incontinent care. She said she would never attempt to transfer or provide incontinent care to any resident who was total care. In an interview with CNA T on 8/8/2025 at 2:05 PM, she said she worked the 6-2 AM shift. She said she was in-serviced on abuse neglect, transferring and having two staff assisting when providing incontinent care to residents who were total care with ADL and could not assist the staff, infection control and dignity. In an interview with CNA F on 8/8/2025 at 3:39 PM, she said she worked at the facility for 4 years. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care with residents who were total care with ADL and could not assist the staff. In an interview with LVN A on 8/8/2025 at 3:58 PM, she said she worked at the facility for 4 years. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care to residents who were total care with ADL and could not assist the staff for repositioning. In an interview with LVN C on 8/8/2025 at 4:37 PM, she said she worked the 2-10 shift. She said she was in-serviced on turning and reposition of residents, abuse neglect, transferring and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 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 455714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm Northwest 17600 Cali Dr Houston, TX 77090 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 have two staff to provide care to residents who were total care with ADL and could not assist the staff In an interview with MA/CNA J on 8/8/2025 at 4:47 PM, she said she worked at the facility for the last 2 months and she worked the 6 -2 PM shifts. She said she was in-serviced on abuse neglect, privacy, transferring with 2 persons when using the Hoyer lift and have two staff to provide incontinent care with residents who were total care with ADL and could not assist the staff. In a telephone interview on 08/08/2025 at 4:57 PM with LVN B, he said he worked the 10:00 PM - 6:00 AM shift on 8/6/2025 when the incident with CR#1 took place. He said he worked with CNA A that night and assisted her in changing CR#1 during the night. He said the CNA did not call him to assist her during her 5:00 AM rounds. He said when the CNA called for him the resident was on the floor. He said he immediately called 911, the doctor, the DON and the family and the resident was sent to the hospital. He said the resident had a cut to the right eye and he did not see any other visible injury. In an interview with MA B on 8/8/2025 at 5:00 PM, she said she worked at the facility for 2 years. She said she was in-serviced on abuse neglect, fall precaution, two staff with transferring and have two staff to provide care with residents who were total care with ADL and could not assist the staff with repositioning, and infection control. In an interview with LVN E on 8/8/2025 at 5:08 PM, she said she worked the 2:00 PM-10:00 PM shift. She said she was in-serviced on abuse neglect, two persons assist with transferring and providing care to residents who were total care with ADLs. She said she also was in-serviced on infection control and dignity. In a follow-up interview with the DON on 08/11/2025 at 11:41 AM, she stated CR #1's care plan should have been updated to reflect two staff were required for bed mobility/incontinent care. She stated CR #1 was very new to the facility and they were still assessing him, so the revision was missed. She said the MDS was going to do an audit and all persons who were total care they should be two person assist for bed mobility and they were going to update the MDS and care plans. In an interview with CNA N on 8/11/2025 at 4:17 PM, she said she worked the 2-10 PM shift. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care for residents who were total care with ADLs and could not assist the staff, resident rights, infection control and falls. She said if she was not sure if the resident was a two person assist, she would ask the nurse, look at the computer or call for help. In an interview with CNA O on 8/11/2025 at 4:20 PM, she said she worked the 2-10 PM shift. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care for residents who were total care with ADLs and could not assist the staff, infection control, and resident rights. In an interview with CNA P on 8/11/2025 at 4:25 PM, she said she worked the 2-10 PM shift. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care for residents who were total care with ADLs and could not assist the staff. In an interview with LVN G on 8/11/2025 at 4:45 PM, she said she worked the 2-10 PM shift. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care for residents who were total care with ADLs and could not assist the staff. In an interview with MA K on 8/11/2025 at 4:49 PM, she said she worked the 2-10 PM shift. She said she was in-serviced on abuse neglect, transferring and have two staff to provide care for residents who were total care with ADLs and could not assist the staff. In an interview on 8/11/2025 at 4:55 PM with the Administrator regarding the PNC IJ she said it came about because the CNA did not ask for help to provide care to CR#1 and he fell and sustained injuries to his face and head. She said the aide was in-service and all staff were in-service on transfers and using two people when providing incontinent care and transferring residents. In a follow-up interview with the DON on 08/12/2025 at 11:30 AM, she said CR #1's care plan should have been updated to reflect two staff were required for bed mobility/incontinent care. She stated CR #1 was very new to the facility and they were still assessing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 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 455714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm Northwest 17600 Cali Dr Houston, TX 77090 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 FORM CMS-2567 (02/99) Previous Versions Obsolete him, so the revision was missed. In an interview with LVN K on 8/12/2025 at 2:43 PM, he said he worked the 10:00 PM-6:00 AM shift. He said she was in-serviced on abuse neglect, transferring and have two staff to provide care for residents who were total care with ADLs and could not assist the staff and infection control. In an interview with LVN D on 8/12/2025 at 3:14 PM, she said she worked the 2:00 PM-10:00 PM shift. She said she was in-serviced on abuse neglect, two persons assist with transferring and providing care to residents who were total care with ADLs. She said she also was in-serviced on infection control and dignity. In an interview with LVN H on 8/12/2025 at 3:45 PM, she said she worked the 2 PM-10 PM shift. She said she was in-serviced on abuse neglect, transferring and always to have two staff to provide care for residents who were total care with ADLs and could not assist the staff. Record review of staff training record revealed they were trained on incontinent, transfer and ensure two staff assisted when incontinent care was being done. Record review of the facility's, undated, policy and procedure on Incident and Accident read in part .Introduction:Ensuring resident safety management, incident response, in a nursing facility requires a structured approach to risk management, incident response and regulatory compliance. Incident vs Accident* Incident: Unexpected or unusual event within the facility that potentially affects resident safety, well-being, or quality of care.* Accident: An unplanned and unforeseen event resulting in harm, injury, or damage to a resident, staff member, visitor or property.Types of incidents and Accidents:Falls: Any unintentional descent to the floor, including assisted falls.Fractures or bodily injury: Any incident resulting in injury requiring medical attention. Record review of the facility's in-services revealed CNA A (received written disciplinary warning and 1:1 education) and nursing staff were educated on 08/06/2025, 08/07/2025 and 8/8/2025 regarding two-person assistance for residents who were total care or if staff were unsure of their mobility status related to incontinent care. Record review of In-Service, dated 08/06/2025, revealed CNA A (CNA A received 1:1 education) and all other nursing staff were educated by the DON regarding demonstrating accessing and utilizing the Kardex on PCC (the facility's computer system). Record review of in-Service, dated 08/06/2025, 08/07/2025 and 08/08/2025 revealed all staff were educated by the DON and Administrator regarding Abuse and Neglect, transferring of resident and 2 person to provide incontinent care for resident. Record review of the facility's Ad hoc Qapi dated 8/7/2025 revealed:Findings: Certified Nursing Assistant performed incontinent care on a resident that required a two-person bed mobility.1.The resident does not currently reside at the facility. He is currently at the local hospital.2. Certified Nursing Assistance was provided one and one education of the Kardex and before providing care to review the Kardex and use appropriate supervision and assistance.3. 100 percent audit was completed by nurse management to ensure all resident Kardex had the mobility and transfer status present.4. Administrator provided educational in-service on incident accident/accident policies and procedures and abuse/neglect and exploitation.5. DON/designee provided education on the Kardex. Kardex Competency skills training check off completed for Certified Nursing Assistant, and nurses. 6. All training and education will be provided before the next shift including PRN staff. All information was reviewed with the Administrator, DON, Unit Manager, Medical Director, during the Ad hoc QAPI meeting on 8/7/2025 to review all findings.7. During the morning clinical meeting, accidents and incident will be review daily and at-risk meetings for trends with IDT team members brought to monthly QAPI. The noncompliance was identified as PNC. The IJ began on 08/11/2025 and ended on 08/12/2025. The facility had corrected the noncompliance before the survey began. Event ID: Facility ID: 455714 If continuation sheet Page 6 of 6