Inspection·August 18, 2025

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few with Resident #1's family member on 08/15/25 at 10:50 am, she stated that when she entered his room at 11am, he was laying on the floor facedown with his trach still connected to his throat. LVN A was immediately alerted, and staff came inside the room and began assessments. She stated that she informed that staff amongst admission that Resident #1 could move and prior to him coming to the facility, he had done physical therapy at other facilities. EMS was called and he was transported to the hospital at 1:30 pm due to swelling above his left eyebrow. In an interview with CNA A on 8/15/25 at 11:53 am, she explained that she had worked with Resident #1 on 8/13/25 around 9:30 am to shower him. She stated that day, he was moving a lot. He would constantly move his legs up and down and he moved his head a lot. Resident #1 slept on an air mattress and before she left his room after his shower, she lowered his bed to the lowest position. She recalled that there was not a fall mat next to his bed because he was a new admit and she guessed nursing staff did not see a need for it at the time. In an interview with the Unit Manager on 8/15/25 at 12:16 pm, she stated that Resident #1 was nonverbal, but he could follow people with his eyes. She explained that he was able to move his arms and legs and described them as jerk like reactions. She stated that since Resident #1 was admitted , he had begun to move a lot more and his mother had also noticed his increase in movement. On that day of the fall, she was called to his room (time unknown) by LVN A and noticed that he was face down on the ground. There was no blood, and he was able to move his head. Initially there was no swelling, but after a few hours swelling began to appear on his left side. The Unit Manager recalled that the NP was in the building, but she could not recall if she assessed him immediately after the fall. The Unit Manager stated that the protocol after an unwitnessed depended on if it was a fall with an injury; then they would be sent out immediately. If there was an unwitnessed fall without injury, the facility's fall protocol was to notify the physician of NP and get an order to send them out. The surveyor asked that since Resident #1 had a history of head injuries, previously suffered from a stroke, and was found face down from an unwitnessed fall, would he be qualified to be sent out? Unit Manager took a long pause and said she was thinking and stated that he had no visible injuries, but he was a special situation and if the NP was in the building, she would have grabbed her to come see. In an interview with the DON on 8/15/25 at 12:35 pm, she stated that she did not know when the NP assessed Resident #1, but she was informed by LVN A when he fell, and she was informed when the swelling appeared. She stated that when LVN A noticed the swelling around 1-1:30 pm during neuro-checks and he was sent out afterwards. When the DON and Surveyor reviewed his orders, the DON confirmed that Resident #1 was on Aspirin, which was a blood thinner and the harm in not seeking emergency medical services post fall could be hemorrhaging or bleeding. She stated that no fall preventions were in place because Resident #1 was not able to move, and she believed he may have fell on the floor due to increased alertness. In an interview with the NP on 8/15/25 at 1:30 pm, she stated that LVN A sent her a text message on 8/13/25 at 11:40 am but she did not see the message. She could not give a definite time, but she stated that she entered the facility sometime between 12 pm and 2 pm to complete rounds. While she was there, LVN A sent her a second text message at 12:44 pm and informed her that Resident #1 had some swelling on his head post fall, and she went in to assess him. The NP found a little induration on the left side of his temple and stated that because he was on blood thinners, she ordered him to be sent out because she was concerned about internal bleeding. She stated that if someone had a fall where they hit their head, whether witnessed or unwitnessed, it would be best practice to send them out for a CT scan. This was especially significant for Resident #1 because he had a suspected head injury and was on blood thinners at the time. NP also noted that when she assessed Resident #1 that day, he was notably more alert, was able to shake his head, and seemed to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 If continuation sheet Page 2 of 8 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 08/18/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few understand her in conversation. Observation on 8/15/25 at 2:57 pm in the hospital, Resident #1 was sitting in bed at a 90-degree angle and his eyes were bright and alert. He seemed to have a smile on his face and followed the surveyor around the room as she spoke to him. He was nonverbal but attempted to make grunts and groans in response to conversation. In an interview with the HSW (Hospital Social Worker) on 8/15/25 at 2:59 pm, she explained that Resident #1 was admitted for a fall on 8/13/25. She stated that his admitting diagnoses were interval acute bleeding to the left side of the head, and he had new chronic appearing left frontal sub [NAME] hematoma Internal bleeding to the side. HSW stated that in addition to that, he was currently being treated for sepsis and pneumonia, which was present upon admittance. Record review of the facility's policy titled Fall Management revised July 2024 displayed that:1. The charge nurse will notify the Physician/Physician extender of the fall, provide assessment findings and medication review, and receive orders as indicated.2. If the resident's condition warrants, the charge nurse will arrange for appropriate emergency services or hospital transfer in collaboration with the Physician/Physician Extender. The ADM and DON were notified on 8/15/25 at 7:10 pm that an IJ had been identified and an IJ template was provided. The following POR was approved on 8/16/25 at 12:30 pm: Plan of Removal: F580 Notification of ChangesAugust 16, 2025Immediate action:The facility failed to consult with the resident's physician when there was a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or conditions or clinical conditions. Resident #1 was transferred on 8/13/2025 to the ER and remains in the hospital. Action: LVN A was immediately re-educated by the DON on 8/15/25 on the facility's fall protocol and notification procedures, including the requirement to make direct verbal communication with the provider NP/physician for all significant changes, and event escalation if the NP/Physician does not respond.Responsible: Director of Nursing Completion: August 16, 2025 The Administrator and Director of Nursing notified the Medical Director of the IJ F-0580.Responsible: Administrator/Director of NursingCompletion: August 16, 2025 Action: Ad Hoc QAPI conducted on 8/15/25 with Medical Director, Administrator, DON, & Unit Managers regarding IJ F0580 and F684.Responsible: Administrator/Director of NursingCompletion: August 16, 2025 Action: All license staff will be re-educated by the DON/Designee on the following: facility fall protocol to include immediate provider notification following all unwitnessed falls, regardless of visible injury. All license staff will be educated prior to the start of their next shift. Staff will not provide direct resident care until training/education has been completed. Staff should follow facility protocol and provide verbal communication to the provider.Escalation Protocol for Provider Notification:In the event of an unwitnessed fall and any other changes of condition from resident's baseline:1. Notify the Nurse Practitioner (NP) immediately.2. If the NP does not respond, contact the attending physician.3. If the attending physician does not respond, contact the Medical Director.4. If the Medical Director does not respond, contact the Administrator.Responsible: Director of Nursing/DesigneeCompletion: August 16,2025 Action: Administrator reviewed on 8/15/25 the facility falls policy and changes of conditions notification policy and no changes were needed. Responsible: AdministratorCompletion: August 16, 2025 The Surveyor monitored the POR on 8/16/25 as followed: Review of an in-service titled QAPI 8/15/25: Notification of Change and Quality of Care documented that all nursing staff had been educated on physician escalation notification, all unwitnessed or witnessed falls with a strike to head should be sent out immediately, and the physician or extending physician should be notified immediately. Attendees including the ADM, DON, and Unit Managers. Review of the in-services dated 8/15/25 titled Education Change of Condition, Physician Escalation Protocol for Provider Notification, and Fall management displayed that all nursing staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 If continuation sheet Page 3 of 8 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 08/18/2025 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete were educated. During interviews on 8/16/25 from 2:00 pm - 4:45 pm, nurses from the 6am-6pm and 6pm-6am shift were asked to review what was covered during their in-services. All staff stated that if a resident was experiencing a change in condition, the protocol would be to first assess the resident and if there was a deviation from their baseline, their NP or MD should be notified immediately. If the resident has interventions in place, nurses were to follow them or follow the orders given by the NP/MD. If the NP/MD is not available, 911 should be called so that the resident can receive a higher level of care. It was verbalized that the chain in notification would be that the NP would be notified first and if there was no answer, an attempt would be made to the MD, and the immediate scalation would be to call 911 and the ADM. All nurses should continue providing care until EMS arrives. Review of the Facility's QAPI Agenda, dated 8/15/25, reflected that the MD had reviewed and agreed with the plan. MD was interviewed and stated that a QAPI was held and the team developed a plan to address the issues of the IJs. LVN A was interviewed on 8/16/25 at 2:40 pm. She stated that she was in-serviced on fall management and escalation provider protocol. She said that if a resident has a fall, she was to contact the NP and MD, and if they didn't answer, she must call the administrator or EMS right away. The ADM and DON were notified on 8/16/25 6:05 pm that the IJ had been removed. While the IJ was removed, the facility remained at a level of no actual harm at a scope of isolated that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 455714 If continuation sheet Page 4 of 8 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 08/18/2025 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure based on the comprehensive assessment of a resident, that resident received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 1 (Resident #1) of 5 residents reviewed for quality of care. The facility failed to contact 911 after Resident#1 was found laying face down on the floor after an unwitnessed fall on 8/13/25 at 11am. Resident was transported to hospital at 1:30pm, after an induration began to form above his left brow. An IJ was identified on 8/15/25 at 6:05 pm. The IJ template was provided to the facility on 8/15/25 at 7:10 pm. While the IJ was removed on 8/16/25, the facility remained out of compliance at a scope of isolated and severity level of no actual harm with potential for more than minimal harm that is not IJ, due to the need for the facility to evaluate the effectiveness of the corrective action. This failure could place residents at risk for a delay in treatment or diagnosis, a decline in the resident's condition and/or additional injury, paralysis or death.Findings included:Record review of Resident#1's face sheet revealed a fifty-six-year-old man who was admitted to the skilled nursing facility on [DATE]. His admitting diagnoses were hemiplegia and hemiparesis following cerebral infraction affecting the right dominant side (paralysis and weakness on one side of the body), paraplegia, cerebral aneurysm (blood vessel in the brain), a cerebral infraction (stroke), and the use of a tracheostomy. Record review of Resident #1's care plan disclosed that he utilized a feeding tube for meals and required supplemental oxygen. Record review of progress note dated 8/13/25 at 1:30 pm by LVN A documented unwitnessed fall, resident on floor next to bed in prone position with head turned to the left side. Bilateral arms straight and bilateral legs straight. Small swelling to left upper temporal noted upon assessment. Resident assisted back to bed x4. Vital signs obtained BP:123/87 pulse:89 res:20 temp:96.8. Neurological checks initiated per protocol. Physician and family notified. Resident mother stated resident tends to move a lot and he will try to get out of bed and this is not a new action for him. Precautions have been put in place. Two bedside mats or placed next to resident bed. Bed will continue to be lowered to ground call light within reach. In an interview with LVN A on 08/14/25 at 3:38 pm, she stated that Resident #1's mother alerted her that he was on the floor around 11am. She stated that she found him laying with his arms to his side and he did not have any signs of pain. The NP was notified and she began neuro checks. After a few checks, she noticed a raised area forming above his brow and she alerted the NP who was also in the building at that time. The NP ordered Resident #1 to be sent out for further evaluation. LVN A explained that no fall protocols were put into place because he had not moved much since his admission, and they were not aware that he was able to move on his own. In an interview with Resident #1's family member on 08/15/25 at 10:50 am, she stated that when she entered his room at 11am, he was laying on the floor facedown with his trach still connected to his throat. LVN A was immediately alerted and staff came inside the room and began assessments. She stated that she informed that staff amongst admission that Resident #1 could move and prior to him coming to the facility, he had done physical therapy at other facilities. EMS was called and he was transported to the hospital at 1:30 pm due to swelling above his left eyebrow. In an interview with CNA A on 8/15/25 at 11:53 am, she explained that she had worked with Resident #1 on 8/13/25 around 9:30 am to shower him. She stated that day, he was moving a lot. He would constantly move his legs up and down and he moved his head a lot. Resident #1 slept on an air mattress and before she left his room after his shower, she lowered his bed to the lowest position. She recalled that there was not a fall mat next to his bed because he was a new admit and she guessed nursing staff did not see Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 If continuation sheet Page 5 of 8 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 08/18/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few a need for it at the time. In an interview with the Unit Manager on 8/15/25 at 12:16 pm, she stated that Resident #1 was nonverbal but he could follow people with his eyes. She explained that he was able to move his arms and legs and described them as jerk like reactions. She stated that since Resident #1 was admitted , he had begun to move a lot more and his mother had also noticed his increase in movement. On that day of the fall, she was called to his room (time unknown) by LVN A and noticed that he was face down on the ground. There was no blood and he was able to move his head. Initially there was no swelling, but after a few hours swelling began to appear on his left side. The Unit Manager recalled that the NP was in the building, but she could not recall if she assessed him immediately after the fall. The Unit Manager stated that the protocol after an unwitnessed depended on if it was a fall with an injury; then they would be sent out immediately. If there was an unwitnessed fall without injury, the facility's fall protocol was to notify the physician of NP and get an order to send them out. The surveyor asked that since Resident #1 had a history of head injuries, previously suffered from a stroke, and was found face down from an unwitnessed fall, would he be qualified to be sent out? Unit Manager took a long pause and said she was thinking and stated that he had no visible injuries but he was a special situation and if the NP was in the building, she would have grabbed her to come see. In an interview with the DON on 8/15/25 at 12:35 pm, she stated that she did not know when the NP assessed Resident #1, but she was informed by LVN A when he fell and she was informed when the swelling appeared. She stated that when LVN A noticed the swelling around 1-1:30 pm during neuro-checks and he was sent out afterwards. When the DON and Surveyor reviewed his orders, the DON confirmed that Resident #1 was on Aspirin, which was a blood thinner and the harm in not seeking emergency medical services post fall could be hemorrhaging or bleeding. She stated that no fall preventions were in place because Resident #1 was not able to move and she believed he may have fell on the floor due to increased alertness. In an interview with the NP on 8/15/25 at 1:30 pm, she stated that LVN A sent her a text message on 8/13/25 at 11:40 am but she did not see the message. She could not give a definite time but she stated that she entered the facility sometime between 12 pm and 2 pm to complete rounds. While she was there, LVN A sent her a second text message at 12:44 pm and informed her that Resident #1 had some swelling on his head post fall and she went in to assess him. The NP found a little induration on the left side of his temple and stated that because he was on blood thinners, she ordered him to be sent out because she was concerned about internal bleeding. She stated that if someone had a fall where they hit their head, whether witnessed or unwitnessed, it would be best practice to send them out for a CT scan. This was especially significant for Resident #1 because he had a suspected head injury and was on blood thinners at the time. NP also noted that when she assessed Resident #1 that day, he was notably more alert, was able to shake his head, and seemed to understand her in conversation. Observation on 8/15/25 at 2:57 pm in the hospital, Resident #1 was sitting in bed at a 90-degree angle and his eyes were bright and alert. He seemed to have a smile on his face and followed the surveyor around the room as she spoke to him. He was nonverbal but attempted to make grunts and groans in response to conversation. In an interview with the HSW (Hospital Social Worker) on 8/15/25 at 2:59 pm, she explained that Resident #1 was admitted for a fall on 8/13/25. She stated that his admitting diagnoses were interval acute bleeding to the left side of the head, and he had new chronic appearing left frontal sub [NAME] hematoma Internal bleeding to the side. HSW stated that in addition to that, he was currently being treated for sepsis and pneumonia, which was present upon admittance. Record review of the facility's policy titled Fall Management revised July 2024 displayed that:1. The charge nurse will notify the Physician/Physician extender of the fall, provide assessment findings and medication review, and receive orders as indicated.2. If (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 If continuation sheet Page 6 of 8 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 08/18/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the resident's condition warrants, the charge nurse will arrange for appropriate emergency services or hospital transfer in collaboration with the Physician/Physician Extender. The ADM and DON were notified on 8/15/25 at 7:10 pm that an IJ had been identified and an IJ template was provided. The following POR was approved on 8/16/25 at 12:30 pm:Plan of Removal: F684 Quality of CareDate: August 16, 2025 Immediate Action:According to the IJ Template, F684 Quality of Care, The facility failed to ensure residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-center care plan, and the residents' choices, in that: The facility failed to contact 911 after Resident#1 was found face down on the floor after an unwitnessed fall on 8/13/2025. Resident #1 was transferred on 8/13/2025 to the ER and remains in the hospital. Action: LVN A Was immediately re-educated by the DON on 8/15/25 on the facility's fall protocol and notification procedures, including the requirement to make direct verbal communication with the provider NP/physician for all significant changes.Responsible: Director of Nursing Completion: August 16, 2025 Action: August 15, 2025 Regional MDS Nurse and Director of Nursing audited all falls within the past 30 days to determine all care plans have appropriate interventions were in place. All care plans were confirmed to be up to date.Responsible: Regional MDS Nurse and Director of Nursing Completion Date: August 16, 2025 August 15, 2025 - All licensed nursing staffAction: Director of Nursing will educate all nursing staff on Fall Management, and Changes of Condition Policies and Procedures before the start of their next shift. The DON will educate all licensed nursing staff to ensure all residents receive appropriate and immediate care after an unwitnessed fall. The charge nurse will notify the Physician/Physician extender of the fall, provide assessment findings and medication review, and receive orders as indicated. The Director of Nursing to train on the proper protocols to take once a resident has a fall and if there is a delay in physician response. In the event of a witnessed or unwitnessed fall of a resident anticoagulants staff will immediately send out to ER 911. No staff will be able to work until they are educated and trained. Responsible: Director of Nursing Completion Date: August 16, 2025 Action: Ad Hoc QAPI conducted on 8/15/25 with Medical Director, Administrator, DON, & Unit Managers regarding IJ F0580 and F684.Responsible: Administrator/Director of NursingCompletion: August 16, 2025 August 15, 2025 - Facility Medical Director NotifiedAction Taken: The Medical Director was notified and provided the following protocol for unwitnessed falls:If the resident is not coherent and cannot reliably state whether they hit their head: Send to ER via 911 immediately.If the resident is coherent and reliably states, they did not hit their head:Proceed with: Appropriate assessments Neurological checks Vital signs monitoringIf any change in condition occurs later: Send to ER via 911.Head Injury Protocol for Residents on AnticoagulantsIn the event of a witness or unwitnessed fall, if the resident: Strikes their head, and Is currently on anticoagulant therapyStaff must: Call 911 immediately and send the resident to the emergency room (ER) for evaluation.The staff have received education on witnessed/unwitnessed falls of residents on anticoagulants that strike their head. The medical director protocol was not added to the policy instead we will keep the information included in our current fall management policy that states The charge nurse will notify the Physician/Physician extender of the fall, provide assessment findings and medication review including anticoagulants, and receive orders as indicated.Responsible: Administrator/Director of NursingCompletion Date: August 16, 2025 August 15, 2025 - Daily Fall Review and Care Plan UpdatingAction: The IDT Team will review all falls daily during the clinical morning meeting. The MDS Coordinator/Designee will update the care plan as needed. Designee/DON will monitor falls during weekends and after hours electronically in Point Click Care system and communicate with present licensed nursing staff.Responsible: DON/DesigneeCompletion Date: August 16, 2025 The Surveyor monitored the POR on 8/16/25 as followed: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455714 If continuation sheet Page 7 of 8 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 08/18/2025 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Review of an in-service titled QAPI 8/15/25: Notification of Change and Quality of Care documented that all nursing staff had been educated on physician escalation notification, all unwitnessed or witnessed falls with a strike to head should be sent out immediately, and the physician or extending physician should be notified immediately. Attendees including the ADM, DON, and Unit Managers. Review of the in-services dated 8/15/25 titled Education Change of Condition, Physician Escalation Protocol for Provider Notification, and Fall Management displayed that all nursing staff were educated. During interviews on 8/16/25 from 2:00 pm - 4:45 pm, nurses from the 6am-6pm and 6pm-6am shift were asked to review what was covered during their in-services. All staff stated that if a resident was experiencing a change in condition, the protocol would be to first assess the resident and if there was a deviation from their baseline, their NP or MD should be notified immediately. If the resident has interventions in place, nurses were to follow them or follow the orders given by the NP/MD. If the NP/MD is not available, 911 should be called so that the resident can receive a higher level of care. It was verbalized that the chain in notification would be that the NP would be notified first and if there was no answer, an attempt would be made to the MD, and the immediate scalation would be to call 911 and the ADM. All nurses should continue providing care until EMS arrives. Review of the Facility's QAPI Agenda, dated 8/15/25, reflected that the MD had reviewed and agreed with the plan. MD was interviewed and stated that a QAPI was held and the team developed a plan to address the issues of the IJs. LVN A was interviewed on 8/16/25 at 2:40 pm. She stated that she was in-serviced on fall management and escalation provider protocol. She said that if a resident has a fall, she was to contact the NP and MD, and if they didn't answer, she must call the administrator or EMS right away. The ADM and DON were notified on 8/16/25 6:05 pm that the IJ had been removed. While the IJ was removed, the facility remained at a level of no actual harm at a scope of isolated that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 455714 If continuation sheet Page 8 of 8