Health inspection·September 12, 2025

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete she refused to disclose it due to concerns of how Resident #1 was transferred to the ER on [DATE]. An interview with the BOM on 08/26/25 at 1:33 PM, revealed she was responsible for completing the admission documentation for new admissions. The BOM stated when a resident admitted to the facility, We start admission documentation that day. I have to be here. Most important docs are consent to treat and social security. The BOM stated the next step was to ensure there was a POA on file, especially if the resident was not cognitively intact, as well as advanced directives which were included in the admission packet. The BOM stated she was not present the evening Resident #1 admitted to the facility, but had been working earlier that day. When she came to work the following day 08/21/25, she saw that Resident #1 had been sent out to the hospital, so she called his RP to get his social security number and needed the RP to sign his Consent to Treat form. The BOM stated, We still needed it because we still cared for him briefly while he was here, so it is a CYA [cover your ass]. [RP] finally answered me this morning and said no to giving his social until [RP] got what she needed on why he was discharged . The BOM stated Resident #1's RP had come in a week prior to admission to tour the facility but claimed the RP did not come the night he admitted . The BOM said a lot of the required forms at the time of admission could be done electronically, so the person did not have to be at the facility face to face to complete them. The BOM stated by the end of the first week she liked to have all her required admission documentation in place. She stated, I have nothing on him [Resident #1]. I know that is bad, but I did try to get it in my defense. She [Resident #1's RP] could have signed them electronically the day he came in, but I feel like I didn't know he was coming, it was not set in stone. The BOM stated she could not provide any evidence that the facility notified the resident and his RP of the required admission documentation and disclosures. Review of the facility's Introduction statement in their admission Packet undated reflected, State and federal regulations require nursing homes to have written policies covering the rights of residents.The nursing home's staff must implement these policies and explain them to you.This booklet describes your rights and the responsibilities nursing homes have for ensuring those rights. The admission Packet also included 10 forms that were listed as requiring receipt and acknowledgement by the resident or the RP/POA to include:1. Consent to Treat2. Assignment of Benefits3. Schedule of Charges for Ancillary Services4. Information about Medicare and Medicaid Eligibility5. Medicaid Estate Recovery Program6. Resident Rights Under Federal Law7. Ombudsman Services and Contact Information8. Family Council Information9. Policy for Criminal History Check for Employees10. Drug Testing Policy11. Advanced Directive Education and Advanced Care Planning Information12. Privacy Act. Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure when there is a transfer or discharge of resident under any of the circumstances specified in paragraphs (c)(1)(i)(A) through (F) of this section, the facility must ensure that the transfer or discharge appropriate information is communicated to the receiving health care institution; and the facility failed to provide and document sufficient preparation and orientation in a form and manner the resident could understand for one (Resident #1) of five residents reviewed for hospital transfers. 1. The facility sent Resident #1, who they indicated was having a behavioral emergency (pulling on his g-tube, ostomy and catheter) and was in danger of dislodging them, in a private non-medical transport vehicle and left him without facility staff or a family member to supervise him while in the ER waiting area.2. The facility failed to notify and coordinate with Resident #1's RP prior to sending him out to the ER, which did not allow the RP to select the preferred hospital of her choice or be there in time to supervise him and interpret for hospital staff. 3. The facility failed to provide the hospital ER with any clinical information prior to Resident #1's arrival on [DATE], including what his medical emergency was. 4. The facility did not notify and update the MD/NP that EMS refused to transport Resident #1 to the ER because they felt he was not having a medical emergency after the NP gave a verbal order to send him out. On [DATE] an Immediate Jeopardy (IJ) was identified. While the IJ was removed on [DATE], the facility remained out of compliance at a severity level of no actual harm and a scope of isolated due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal. Findings included:Record review of Resident #1's face sheet, dated [DATE], reflected he was a 71?year?old male admitted on [DATE]. Active diagnoses included nontraumatic intracerebral hemorrhage (bleeding within the brainstem), anxiety disorder (mental health condition causing agitation), colostomy status (surgical opening in the colon for stool elimination), urinary retention with catheter use (inability to empty bladder requiring a tube), and gastrostomy status (feeding tube placed into the stomach). Resident #1 had a family member [RP] listed as his representative.Record review of Resident #1's admission care plan, dated [DATE], reflected focus areas included risk for line dislodgement, infection, aspiration, weight loss, and dehydration. The care plan did not address any behavioral concerns. Record review of Resident #1's facility admission orders reflected he was not discharged from the hospital with any routine or PRN psychotropic medications, including anxiety medication. Additionally there were no transfer orders to send Resident #1 to the ER on [DATE]. Record review of Resident #1's admission nursing note written by RN F on [DATE] at 11:11PM reflected the resident was confused and anxious, attempted to pull at his tubes, and required one?to?one supervision to prevent device removal.Record review of a follow up skilled nursing note on [DATE] at 3:57 AM reflected Resident #1's vitals were all within normal limits and he was in no pain. The skilled nursing note stated, .The resident is disoriented.The resident is unable to speak.Other Observations: Resident new admit day 1/3 alert and confused very agitated, anxious pulling tubes abdominal binder in place to secure g-tube, foley and colostomy. Awake all night resident on one and one. Total care with adl.Record review of Resident #1's nursing progress note, dated [DATE] at 12:31 PM by the DON, reflected, This writer received call from primary nurse that resident was attempting to remove urinary catheter peg tube and ostomy device. We were unable to successfully redirect the resident and he required ongoing higher-level care. Primary nurse was instructed by MD to send resident to ER for evaluation due to unable to keep resident safe in current building due to pulling lines and aggressive behavior. The DON further wrote, Action: 911 was called by primary nurse, upon their arrival this writer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few spoke with [name redacted] from [Fire Station] who advised this writer that paramedics would not be taking this resident to the hospital as per them he appeared to be medically stable and that the safety aspect of his care would need to be addressed with the [city Police Department or private transportation. This writer then requested nursing staff to arrange private transport via [private transport company] car. Related to RP notification, the DON wrote, Response: [RP] was notified of transfer and requested that resident be sent ‘anywhere but [previous hospital]' Resident was transported via [private transport company] to [different nearby hospital]. Information was relayed by this nurse to triage nurse at [nearby hospital], as well as to [ER MD] for continuity of care.An interview with Resident #1's RP on [DATE] at 11:45 AM revealed the entire discharge from the hospital, admission to the facility and discharge the next morning to the ER was a really bad experience. She stated Resident #1 was transferred to the ER without clinical documentation and without a staff escort. The RP reported that upon arrival, the resident's ostomy was leaking and he was agitated. The RP further stated the ER staff were upset because the resident was by himself, the ER did not receive information about the resident's diagnoses or reason for transfer and were unable to communicate with the resident who did not speak English. The ER staff asked the RP who transported Resident #1 to the ER and the RP assumed he was sent out 911. The ER nurses indicated to the RP that Resident #1 appeared to be brought in a wheelchair in a normal vehicle, no paperwork, no reports, no nothing. They told her Resident #1 was then transferred to a hospital wheelchair by the person who drove him there, taken to the front desk, and told the resident was there. The RP stated she found out Resident #1 was transported through a private company which was upsetting to her. The RP stated, They know this is not right, what they did with [Resident #1]! What if they had taken him and put him in the street? Who was this person transporting him? A medical person? No one stayed with [Resident #1] when they took him to the ER! The ER nurses told the RP that he was brought in through what looked like a ride share company. The RP stated, That is not a proper way to bring someone.I was like who are these people? They just dumped him? How would we know where he was? The facility was not responding, the (ER) staff heard me trying to talk to the facility about sending any reports. An interview with the DON on [DATE] at 10:45 AM revealed the facility initially attempted to send Resident #1 via EMS, but EMS declined transport, determining the situation was not a medical emergency. The DON stated staff then arranged private non?medical transport. The DON confirmed only a medication list was sent with Resident #1 and verbal report was given to a different hospital prior to rerouting the transport. The DON acknowledged that no staff accompanied the resident and that the ER nurse contacted her and was upset and expressed concern that Resident #1 arrived unsupervised, non?English speaking, and without medical documentation. The DON stated she also spoke with the ER physician who was also asking questions about why the resident was sent to the ER and why there was no information on him. The DON stated that when Resident #1 was brought into the ER, he was left in the ER by med transport as that is protocol. The DON stated that if Resident #1 had been brought in via 911, then he would have been taken back immediately to an ER bed and evaluated.An interview with LVN A on [DATE] at 1:04 PM revealed she was the 6a-2p nurse and arrived to work the morning of [DATE] around 5:45 AM and was told by the overnight nurse during report the staff was having problems with Resident #1, he did not sleep at all and was pulling at everything coming out of him, his foley, colostomy and g-tube. LVN A stated the overnight nurse was not the normal nurse who worked, it was a PRN nurse. When LVN A went to see Resident #1 during her first rounds, he had disconnected his g-tube tubing. LVN A stated Resident #1 did not speak English and the facility did not have a interpreting services. LVN A stated and he was not letting her reconnect his g-tube and he did not know what was going on cognitively. LVN A stated the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facility did have a supply of abdominal binders available to use for residents in that situation and she could have placed one on him quickly to prevent him from accessing the gtube but did not. LVN A also stated Resident #1 had no routine or PRN meds to administer to help him relax. LVN A stated the facility did have PRN anxiety medications available for behavioral emergencies in an e-Kit [facility's emergency medication supply], but she did not contact the MD or NP to ask about those as a possible intervention. LVN A stated, I called the staffing person and said there was someone watching him over night but I can't stay with him, I didn't know he was an issue til I got here, so DON called me and said he was danger to himself, so send him out.and to send him back where he came from. LVN A stated when the EMTs arrived, they took Resident #1's vitals and even though he was still pulling at everything, they said it was not a medical emergency and would not take him. When LVN A spoke with the DON again, she told LVN A to have their transport services take Resident #1 back to the hospital. LVN A stated there was a driver the facility used who did medical appointments and hospital transfers, but she was out in the field busy, so non-medical transport was set up instead. LVN A stated she did notify Resident #1's RP after he was picked up by the private transport company of his transfer to the ER. She said the RP told her Resident #1 could not go back to the hospital he had just come from the day before, But he was already in route. LVN A then contacted the DON who called the private transport person enroute to tell him to take the resident to the closer ER by the facility. LVN A stated she contacted the RP back to let them know, but the RP was not happy with the local ER because it was too far for her to get too. LVN A stated, [The RP] never told me where [they] wanted him to go. I was already frustrated and two hours behind schedule and called [the RP] twice and then I sent [the RP] to the DON and I don't know anything after that. LVN A stated that the facility could send residents anywhere the family wanted and did respect family requests. LVN A stated she did not call the facility's MD or NP G but did let NP G know after the transfer to the ER was done. She said NP G was housed onsite at the facility every weekday but was not at the facility when the decision was made to send Resident #1 to the ER. Regarding clinicals and transfer documentation, LVN A stated Resident #1 did not have anything to send and only sent his face sheet and list of medications. LVN A stated, I was going to send the whole packet from the hospital but I thought no, we may need it when he comes back. It would not have helped the receiving hospital. It was just a list of meds and stuff. LVN A stated she called and gave report to the previous hospital Resident #1 was originally going to be taken back to, before it was changed to the local ER. LVN A stated, And then I don't know what happened after that because I passed it to the DON. LVN A stated the importance of giving the receiving hospital ER a report was to let them know why the resident was being sent out, his diagnoses, what was going on with him at the moment. LVN A stated she never followed up and contacted the local ER to give them a report on why he was sent there because she thought the DON did. LVN A stated she did not think anyone stayed with Resident #1 once he arrived at the ER. She said with non-medical transport, the driver would usually drop the resident off at the ER and let them the ER front desk know the resident was there. LVN A said she did not think Resident #1 was safe to be at the ER by himself because she thought him pulling at his three lines would still be an issue. She said normally for a resident that was not alert and oriented, the resident would have family go with them to the ER or a staff would be with the resident until family could meet them there. LVN A said the risk of Resident #1 being alone in the ER waiting room area was that he could have pulled one of his lines out and caused damage.An interview with Staff C on [DATE] at 1:47 PM revealed she was a CNA and the facility van driver and was working the day Resident #1 was sent out to the ER. She said the resident was trying to pull out his gtube and she was trying to stop him and when the paramedics came (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few in, he calmed down. They took his vitals and said it was a non-emergency unless he pulled out his g-tube, then they could take him. Staff C stated LVN A asked for her to help with transportation, so Staff C contacted the non-emergency private transport company. She stated the typical medical transport company was too busy that day to transport Resident #1 to the ER. Staff C stated, I needed someone and he needed to go to the hospital, he was irritable, trying to pull the g-tube and he was going back to the hospital he came from. Staff C stated she and LVN A let the DON know transport was secured, got Resident #1's face sheet, got him dressed, caressed his arm and told him no one was going to harm him and she was there to assist while using her phone translator to translate into his native language, and he told her thank you back in his language. She stated she got a sheet and tucked it around his torso and he seemed to relax. Staff C stated, They saw him being fidgety but it was not an emergency for him. She stated for non-emergency transportation to the ER, a family member had to be present if the resident had a cognitive impairment and for skilled residents, the family would meet the staff at the hospital. Staff C stated with someone like Resident #1, with him being feisty, a family member would need to be present for him because of the translation barrier. She said if she took a resident to the hospital and it was a resident she knew could not be left alone and family was not present, by all means, I stay at the appointment. Staff C stated because Resident #1 did not speak English, was pulling at his g-tube and agitated, he would need someone to be with him for supervision. Staff C stated normally the charge nurse of the resident would let her know if she needed to stay with a resident at the hospital or not, but with Resident #1, she was not the driver that day, she only assisted with finding transportation. An interview with CNA D on [DATE] at 2:09 PM revealed she was present when Resident #1 was sent to the ER. She stated he was restless, fighting to push his pants off, and trying to pull out his g-tube, . She said he was saying something in another language she could not understand. She said she did incontinent care and placed a brief on him. CNA D stated there were other residents in the facility that sometimes pulled at their tubes and when they did, there was a rubber belt the facility had that could be fixed on the resident and zipped to hold the tubing in place covered and it was very hard to get into and pull off. She stated Resident #1 did not have an abdominal binder on when she saw him on [DATE]. An interview with Receptionist E on [DATE] at 3:01 PM revealed sometime during the early morning of [DATE], an unidentified nurse , told her they were sending out Resident #1. She did not ask any questions but was there to tell the EMT where to go. She said he ended up not going out 911 and did not know why, but she saw him taken out by a non-medical transport. Receptionist E stated once Resident #1 left the facility, his RP called asking why the RP was not notified or why the hospital had not contacted her yet. Receptionist E stated the RP was mad and called back again right before the shift was over saying she needed someone from higher up at the facility to email her the resident's clinicals for the ER to have for review. Receptionist E stated the RP told her the facility was going to be reported to State by the RP as well as the hospital who was filing a complaint against the facility. An interview with RN F on [DATE] at 3:27 PM reflected she was the admitting nurse at the facility on [DATE] and was told Resident #1 was admitting on her shift. He arrived on a stretcher with his RP present. RN F stated she did her nursing assessment and remembered Resident #1 was trying to pull at his tubes and not being still. She asked his RP to stay at the facility because she felt the resident needed to be watched. RN F stated the facility did not know Resident #1 had that behavior as it was not in the report from the discharging hospital. She said she knew Resident #1 was coming with an open surgical incision with a g-tube and catheter. RN F stated Resident #1 had an ace wrap on his abdomen from the hospital, not an abdominal binder, and it was not being effective. RN F said when a CNA came to sit with Resident #1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 1:1, his RP left for the night. She stated the purpose of the 1:1 was to prevent the resident from rolling out of bed and to make sure he did not pull his tubes. RN F stated there was one time during her 2-10pm shift where the 1:1 CNA reported he disconnected his g-tube, which was just a connection issue. RN F said besides that one time, the 1:1 CNA did not report any other concerns to her during her shift. An interview with NP G on [DATE] at 10:14 AM revealed Resident #1 admitted after she left on [DATE] and was gone the next morning before she arrived the facility, so she never saw him. She stated she heard he was very volatile, aggressive, and punched someone the day before at the hospital. NP G stated the morning of [DATE], [LVN A ] updated me because she came into this scene and let me know it was too much, so we sent him back out. NP G said she gave a verbal order to LVN A for the ER transfer. NP G stated she got the impression from staff that Resident #1 was out of control due to agitation and confusion but she did not have a baseline to go from. NP G stated she assumed Resident #1 was sent to the ER via ambulance. She stated she did not know the EMTs assessed him and determined he did not have a medical emergency. She stated, I was not aware of that. I would not think it is safe to transport him via non-emergency because if he is actively agitated, the EMTs can handle it. That's what I thought he was doing, going out via ambulance. NP G stated if she knew the EMTs deemed him not in a medical emergency state, she would have ordered PRN medications at the facility to help address the behaviors. She stated she did not see his clinicals so she did not know if he had a qualifying diagnosis to justify their use. NP G stated giving a report to the ER when sending them a resident was important so they could know what to expect, try to prepare, and have anticipated interventions in place if they were having issues related to cardiac distress, behavioral emergency, and so forth. A follow up interview with the DON on [DATE] at 10:48 AM revealed she was notified by the facility staffing coordinator on [DATE] that LVN A felt Resident #1 was being antsy and aggressive. The DON stated she did not know until after the fact that Resident #1 had been given Haldol by the discharging hospital during his stay due to him punching a hospital staff. She said that was not sent with his hospital clinicals prior to admission. The DON stated, They didn't relay any of that information to us. They didn't tell anybody; they just were like here he's yours now. The DON said she had not observed him herself, so her decision was based on what she was told secondhand. The DON said she contacted NP G who told her to send him out to the hospital. The DON stated 911 was called but when they came out, the EMT did not feel like Resident #1 was having a medical emergency so they would not transport him to the hospital. The DON stated she did not contact NP G after EMT refused the transport to update her that the order to send out via 911 could not be done. The DON stated the information was relayed to NP G after the resident was sent out via a private transport company. The DON stated she did not consider discussing PRN medication options with the staff or NP because it could not be given to keep him subdued from pulling at his lines and it walks that fine line of are you chemically restraining a patient? The DON said with other residents in the facility with lines and pulled on them, the staff had rapport so they could more easily calm them down. The morning Resident #1 had the behaviors, [DATE], the DON stated she did not talk with his RP until after he was sent out in the private transport vehicle. The DON said she was under the impression that the RP had already been notified but did not know who did the notification. The DON said regarding sending Resident #1 to the ER via a private transport company, We felt like it was our only option.I couldn't put him in my car and take him so that was really our only recourse to get him where he needed to be. The DON said they knew the driver stayed with Resident #1 in the ER until he was checked in and gave the hospital all the information they needed before he left, Which was basically his med list. The DON said the facility did not have to supervise Resident #1 when he was taken to the ER and checked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few in. She stated, Technically once they leave the building they have been discharged or transferred.We ensure that they get to a place where they are safe, which we did, through a third party transport company and so at that point the hospital assumed responsibility for him once he was checked in [at the front desk]. The DON further stated she could not bill for Resident #1 so she could not send a facility staff member to sit with him since the facility would not get paid for it. An interview with the ADM on [DATE] at 11:35 AM revealed she wondered how the overnight CNA was able to manage Resident #1's behaviors during his first night of admission to the facility, And then all of a sudden it becomes this huge emergency the next morning? She stated going forward, for late night admissions, the staff needed to be more informed on what the resident's care needs were , ensure the hospital clinicals were reviewed prior to admission, and make sure interventions were in place. An interview with the private transport company, Driver H, on [DATE] at 11:47 AM revealed he remembered transporting Resident #1 by himself to the ER on [DATE]. He stated he initially started driving Resident #1 to one hospital further away but was re-routed by the facility to a closer hospital. He said when he arrived at the ER, the staff at the ER desk said to leave him there so he transferred him to a hospital wheelchair. Driver H said while in the ER waiting area, Resident #1 was trying to escape and could walk. He stated the ER staff were trying to talk to Resident #1 but he did not speak any English and they were trying to figure out what language he spoke so they could use their translator. Driver H stated he gave the ER staff the resident's face sheet, which was the only document he was given by the facility. He stated he left the hospital at that point so he did not know what else happened. A follow up interview with the ADM on [DATE] at 4:00 PM revealed the facility did not send a facility staff to supervise Resident #1 because the transport company had a driver that stayed with him. The ADM stated the only reason Resident #1 had been a 1:1 the night before was to make sure he didn't pull anything out. She stated, He [Resident #1] didn't need a 1:1 because driver of the van was with him. While he was here in the room, there was no one in the room so that is why we put an aide in. IF he had pulled out lines, the drivers are CPR trained and he was told if he needed to call 911, he could, by our nursing staff. The ADM stated the transport company said they could handle it and the company will know based on their own assessment from what we tell them, but they also observe the resident when they arrive to make sure they are appropriate [for transport]. The ADM stated, So they felt confident they could do it, we felt confident they could do it. She said the facility's responsibility for resident's supervision ended when once they were checked in at the hospital. We make sure they are there and give report and one there, they are the hospital's concern. The ADM said she felt once the DON realized that the EMTs were not going to transport Resident #1 due to him not having an emergency, maybe she felt it was not that serious of an issue and could send him out non-emergent. The ADM said she felt like the level of emergency changed when the EMTs saw Resident #1. She stated, It was not like he was in respiratory distress or about to die, so the rest of us were thinking okay, if not emergency, then next best thing. The ADM continued to state that the facility trusted the transport company to make sure the residents got from point A to point B. The ADM said she herself, talked to Driver H and he told her he stayed with Resident #1 at the ER for about 15-20 minutes until the ER staff took him to a room and she said the transport staff would never leave a patient there. The ADM stated Driver H did not tell her Resident #2 had tried to get up, rather that he sat there with him the whole time. A follow up interview with the DON on [DATE] at 4:20 PM revealed the reason Resident #1 was sent to the ER without staff supervision was because his family/RP was meeting him at the hospital. The DON did not feel that sending a staff member would have been helpful to intervene if Resident #1 had pulled at his lines during transport because that staff would be buckled (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few in in front or behind, and not able to intervene if there was an emergency and the van was moving. The DON stated again that a resident was no longer the facility's responsibility once they left the facility when they were sent out to a higher level of care. The DON said she did not know if [Company Name] did medical transports, but there were not normally used for emergency transportations. The DON stated a staff member would accompany a resident to the ER on ly if that resident did not have a family member meeting them at the hospital. She said Resident #1 did have his family member/RP in route to meet him at the ER. Review of the facility's contract with the transport company dated, reflected in part, .l. Services Provided. (Company Name) provide patients of the Facility with nonemergency transportation services to or from locations designated by the Facility (the Services). The vehicles used by (Company Name) in the delivery of the Services shall be staffed by at least two (2) persons who are licensed or certified by law to render emergency medical care for Stretcher and Basic Life Support vehicles and at least (I) person/driver for Wheelchair Ramp and Sedan vehicles. (Company Name) shall make the Services available twenty-four (24) hours per day, seven (7) days per week, The Services do not include, and this Agreement does not affect, the delivery by (Company Name) of emergency medical transportation services. The determination of whether a transport is an emergency or nonemergency shall be made by (Company Name) in accordance with the standards and protocols established and approved by the Emergency Physicians Advisory Board.The facility's policy titled, Transfer and Discharge last revised [DATE], reflected, .7. Emergency Transfers/Discharges - initiated by the facility for medical reasons, or for the immediate safety and welfare of a resident: a. Obtain physicians' orders for emergency transfer or discharge, stating the reason the transfer or discharge is necessary on an emergency basis; b. Notify resident and/or resident representative; c. Contact an ambulance service and provider hospital, or facility of resident's choice, when possible, for transportation and admission arrangements; d. Complete and send with the resident (or provide as soon as practicable) a Transfer Form which documents: i. Resident status, including baseline and current mental, behavioral, and functional status and recent vital signs; ii. Current diagnosis, allergies, and reasons for transfer/discharge; iii. Contact information of the practitioner responsible for the care of the resident; iv. Resident representative information including contact information; v. Current medications (including when last received), treatments, most recent relevant lab and/or radiological findings and recent immunizations; vi. Special instructions or precautions for ongoing care to include precautions such as isolation or contact; vii. Special risks such as risk for falls, elopement, bleeding, or pressure injury and/or aspiration precautions; viii. Comprehensive care plan goals, and ix. Any other documentation, as applicable, to ensure a safe and effective transition of care.g. Provide orientation for transfer or discharge to minimize anxiety and to ensure safe and orderly transfer or discharge, in a form and manner that the resident can understand; h. Document assessment findings and other relevant information regarding the transfer in the medical record.This was determined to be an Immediate Jeopardy (IJ) on [DATE]. The ADM was notified. The ADM was provided with the IJ template on [DATE] at 12:02 PM. The following Plan of Removal submitted by the facility was accepted on [DATE] at 3:45 PM and reflected: Immediate Actions Taken (Date: [DATE]):1. None- the resident did not return after discharge.Systemic Changes Implemented:Transport Protocol:1. EMT refusal of transport will trigger an automatic notification to the physician and DON before arranging alternative transport.2. A return to acute check list for non-emergency transport was created to document resident behaviors and medical devices prior to any transfer. 3. The checklist assists staff in decision making to determine if supervision is needed during non-emergency transport for residents who are not alert and oriented and have behaviors. The determination of supervision is not just for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455731 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 455731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2025 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 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete appointments, but for any destinations, including the ER.4. A trained CNA, or Licensed nurse will be assigned to supervise transportation if supervision is deemed necessary from the checklist. The DON or Designee will arrange supervision if needed.5. The supervising staff member will stay with the resident at the ER and check them in with ER personnel.6. If there is a behavioral emergency during transport staff are instructed to pull over to a safe place, stay with the resident and call 911.Education & Training1. Regional Nurse DON/designee will educate DON on emergency transport vs non-emergency transport with posttest. Completion by [DATE]. DON/designee will educate all licensed nurses on emergency transport vs non-emergency transport with posttest. Completion by [DATE]. DON/designee will educate license nurses on the Return to Acute Checklist before calling non-emergency transport. Completion by [DATE]. DON/designee will educate CNAs on recognizing and reporting line-pulling, fidgeting, and self-harm risks immediately to the charge nurse. Completion by [DATE]. Staff unavailable to attend in service on [DATE] will receive personalized education and posttest prior to assuming their duties. Monitoring:1. DON/Designee will audit 100% of all hospital/ER transfers for 30 days to verify:a. Completion of Return to Acute Checklist for non-emergency transport.2. Findings will be reviewed in QA/QI Committee meetings monthly for 3 months, then quarterly thereafterDate Facility Asserts Likelihood for Serious Harm No Longer Exists: [DATE].Monitoring interviews for the Immediate Jeopardy were started on [DATE] at 2:45 PM with nine nursing staff and management across multiple shifts to include: DON, ADM, RN B, ADON I, ADON J, RN K, LVN L, LVN M and LVN N. All staff were able to provide competency of education on the new Resident Transfer Checklis Event ID: Facility ID: 455731 If continuation sheet Page 10 of 10