Health inspection·March 16, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few The outgoing Nurse reported to this Nurse that Resident did not go to dialysis yesterday. No char [sic] time reservation was made for the Resident for today and no transportation arrangement was made for the Resident, however, this Nurse called Dialysis Center and they said that the only chair time they have is at 3:20 pm today. This Nurse reserved the open 3:20 PM available today. I was not able to find any transportation to take Resident to Dialysis. I called the facility driver and she said that she has no transportation scheduled for today, Called. [Transportation service#1] and [Transportation service#2] transportation and both said that they are fully booked for today (they have no drivers). This Nurse notified both the Unit Manager and the Administrator about the dialysis issue. The Admin [Administrator] called this Nurse and asked about transportation and Nurse explained to her that I was not able to secure transportation, Nurse Manager asked for the phone numbers of the transportation co [company] that I called earlier and those Numbers were provided to her but no further response was received. Record review of Resident #1's clinical file revealed no progress note dated 03/07/25 which detailed why the resident did not attended dialysis on that (Friday ). Attempted on 03/12/25 at 9:30 AM to interview Resident#1 at hospital. Resident was not interviewable at that time. Interview on 03/14/25 at 2:55 PM, RN B stated Resident#1 refused dialysis and the Administrator, Director of Nursing, Assistant Director of Nursing and Medical Doctor were notified. Interview on 03/14/25 at 4:20 PM, the Assistant Director of Nursing stated she was currently over scheduling transportation and verifying dialysis treatment schedules. The Assistant Director of Nursing stated when a resident missed a dialysis appointment the Administrator, Director of Nursing and Medical Doctor were notified immediately. The Assistant Director stated she delegated a nurse to reschedule the appointment. Interview, over the phone, on 03/14/25 at 5:05 PM, the durable power of attorney for healthcare, stated she was not notified of Resident#1 missing their dialysis treatment. Interview, over the phone, on 03/14/25 at 6:16 PM with the Nurse Practitioner revealed the facility notified her and let her know the resident returned to the facility without receiving dialysis treatment because of an incontinent accident on the way to dialysis. The Nurse Practitioner stated he had not refused dialysis care in the past. Interview, over the phone, on 03/16/25 at 12:38 PM, LVN A stated when he came on to his shift the outgoing nurse informed him Resident#1 missed his dialysis appointment on Friday. LVN A called the dialysis center and was informed Resident#1 did not have a reserved chair time but, the dialysis center was able to get him in at 3:20 PM. LVN A called both transportation services and they were fully booked. LVN A then notified the Administrator, Director of Nursing and Assistant Director of Nursing. LVN A stated he was busy and did not call the family member about Resident#1 missing dialysis. LVN A stated it is important to notify family to keep everyone updated with resident's care. Follow-up interview, over the phone, on 03/17/25 at 9:50 AM with the Administrator, Director of Nursing and Assistant Director of Nursing stated it was important for the responsible party and family members to be called when a resident had a refusal or change of condition for the resident care. Resident could experience a decline, but the resident has the right to refuse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 If continuation sheet Page 2 of 3 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043 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 - Minimal harm or potential for actual harm Residents Affected - Few Record review of the facility's Patient Refusal of Care policy, dated 04/25/2014, reflected The resident has the right to refuse treatment as defined as care provided for purposes of maintaining/ restoring health, improving functional level, or relieving symptoms. In the case of a resident who is incapable of making decisions, the representative would make any decisions that have to be made, but the resident should still be told what is happening to him or her. In the case of a competent individual, the facility must still contact the resident's physician and notify interested family members, if known 4. Notify the patient ' s physician and family about refusal of care, service and treatment FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 If continuation sheet Page 3 of 3