Health inspection·February 5, 2026

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to protect the resident's right to be free from types of abuse: mental abuse/verbal abuse/physical abuse/sexual abuse/deprivation of goods and services by facility staff for 1 resident (Resident #5) out of 10 residents reviewed for abuse and neglect. The facility failed to ensure Resident #5 was free from abuse when CNA-C spanked him twice on his bottom while he was lying on the floor on 3/13/2025. This failure could place residents at risk of being physically or emotionally abused.Record Review of Resident #5's face sheet revealed he was an [AGE] year-old male and was admitted on [DATE] and readmitted [DATE]. His diagnoses included: Alzheimer's Disease (a progressive disease that destroys memory and other important mental functions), Difficulty in Walking, Major Depressive Disorder (characterized by a persistent, intense, and low mood, along with a loss of interest in activities), Repeated falls, Abnormalities of Gait and Mobility, Adjustment Disorder (stress-related mental health condition which causes emotional or behavioral symptoms that are disproportionate to the stressor) and Cognitive Communication Deficit (impairment in communication caused by underlying disruptions in cognitive processes).Record Review of Resident #5's Quarterly MDS dated [DATE] revealed he was unable to complete a cognitive assessment which gave him no score for BIMS, which meant he was severely cognitively impaired. Resident #5's MDS revealed he rarely/never made himself understood or understood others. The MDS revealed Resident #5 had short- and long-term memory problems. Resident #5's MDS revealed he was dependent for toileting, shower hygiene and needed substantial assistance with dressing.Record Review of Resident #5's Care Plan dated 7/7/25 revealed the following care areas:*Impaired cognition and was at risk for further decline in cognition and functional abilities.*Behavior problems as evidenced by him urinating in dresser drawers, closets, trash cans, sinks, corners, and common areas.*Behaviors of pushing on exit or egress doors and was difficult to redirect*Behavior of continuing to remove personal clothing when dressed by staff.*Behavior of sitting on the floor as a refusal mechanism.*Resistant to care as he would refuse to shower.Further review revealed the facility's intervention for these behaviors was to Approach resident in a calm manner, call by name, speak slowly, and maintain eye contact. Talk while providing care, allow time for a response and do no rush. Interview on 2/3/26 at 10:11 a.m. Resident #5 stated he thought the facility was pretty good. He stated he was comfortable with the temperature in his room, had no falls, got his brief changed as often as he needed and had no concerns with the facility or staff.Interview on 2/3/26 at 11:15 a.m. LVN-A stated they did abuse/neglect trainings often with the last time being about two weeks ago. He stated Resident #5 had been there for three or four years. His family had five cameras in his room. LVN-A stated the family complained all the time. He stated if he saw any abuse, he would report it to the Admin and complete an incident report. A telephone interview on 2/3/26 at 4:33 p.m. the NP stated Resident #5 was her patient and she did not have any concerns for him. She had talked to Resident #5's FM in the past Page 1 of 3 455731 455731 02/05/2026 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few but not recently. The FM would catch her in the hallway but never expressed any concerns to her about the facility.Interview on 2/3/26 at 4:40 p.m. with the DON, stated Resident #5's FM always had concerns with a particular nurse that worked on the weekend. The DON stated the FM was concerned about how long he was in the bathroom or how long a break he took. The DON stated the FM had complained about another resident being half dressed all day. She tried to explain that behaviors for dementia residents looked different for each person.Interview on 2/3/26 at 5:00 p.m. with the Admin, stated Resident #5's FM did complain to her about several things. The Admin stated the FM did not care for a weekend nurse at all. The FM had stated the weekend nurse took too long on bathroom and on meal breaks. The Admin stated the FM complained about a resident walking around half clothed. The Admin stated Resident #5's FM had concerns he was missing clothes, he was cold and had a wet bed.Notified on 2/4/26 at 10:12 a.m. of an Addendum Video intake had received from FM on 2/3/26 at 5:25 p.m. with Resident #5 and CNA-B.Observation on 2/4/26 at 10:12 a.m. of a video with no date or time stamp revealed:CNA-B came into the room where Resident #5 laid on the floor next to his bed on his left side. CNA-B asked, Why you do this again, huh? She tells him to Get up and slapped him on his right buttock once with her hand. CNA-B asked, why you did this and slapped him on the right buttock with her hand again. Resident #5 said Oh shit, lady. CNA-B said why you did this two more time and said Come on. No, you are not supposed to do this, come on, sit up. Come on. Resident #5 said I can't. CNA-B said Yes, you can. Why you come on the floor in the first place? Resident #5 said Oh shit. CNA-B said Oh shit, why you say oh shit? Give me your hand. So, this place is better than a bed? Resident #5 said Yes ma'am. CNA-B said It's not. Get up. Come on. CNA-B took his hand. Resident #5 said something unintelligible, and CNA-B walked out of view and the video ended.Interview on 2/4/26 at 10:23 a.m. Resident #5's FM stated the video was from 3/13/25. She stated she had lots of text and videos she sent to the Admin and former ADON but normally, they did not reply.Interview on 2/4/26 at 2:45 p.m. Resident #5's FM stated she had not seen CNA-B anymore and she was not sure how long it had been since she had seen her. She was not sure if she texted the video to both ADON and the ADMIN. She did not talk to either one of them personally about the video. She stated she figured they had got it and were not going to do anything about it.Interview on 2/4/26 at 2:55 p.m. the DON stated abuse could be physical, psychological, verbal, or monetary. She stated neglect would be not doing care as needed. The DON stated abuse was active and purposeful while neglect was something one should be aware of regarding care. She stated hitting a resident on the bottom would not be alright.Interview and observation on 2/4/26 at 3:03 p.m. the Admin stated abuse was verbal towards a resident or anyone taking something from a resident. She stated it would never be alright to hit a resident. She stated CNA-B stopped working at the facility not long after she started in November 2024. She stated if she remembered correctly, they had CNA-B scheduled and she did not show up. The Admin stated she never saw a video of anything from the FM. She stated she was not sure if she had given her personal cell phone number or the Admin number back in March 2025. She stated their corporate office had turned off the Admin phone and required her to use her personal phone around August 2025. The Admin stated she was not even sure she had business cards back in March 2025. Observed Admin's business card to have a sticky note number covering another phone number. The Admin stated the number on the business card was the Admin phone number and the sticky note number was her personal number. The Admin viewed the video of Resident #5 and CNA-B and stated that it should not have happened. She stated if she had seen the video, she would have suspended CNA-B and investigated the incident. The Admin stated Resident #5's FM never talked to her about the video or abuse.Interview and observation on 2/4/26 at 3:34 p.m. Resident #5's FM stated she texted 5 videos to the Admin on 3/14/25. She texted a screenshot to 455731 Page 2 of 3 455731 02/05/2026 Advanced Health & Rehab Center of Garland 1201 Colonel Drive Garland, TX 75043

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few surveyor showing it was sent 3/14/25 at 8:54 a.m. with 5 videos attached and no text message. The FM stated she sent the videos to the number for the Admin's personal number.An attempted telephone interview on 2/4/26 at 3:56 p.m. with CNA-B, the phone went straight to voicemail. A message was left requesting a return phone call. No return call was received.Interview and observation on 2/4/26 at 4:15 p.m. the Admin showed she only had one text from Resident #5's FM on 1/26/26. She stated as far as she knew, she did not get any text messages from the FM in March 2025. She stated she did regularly delete messages as it was her personal phone, and she had paid for extra money for memory due to the amount of text messages she received.Interview on 2/5/26 at 9:56 a.m. with the Admin stated she called in an incident report last night for the 3/13/25 video of Resident #5 and CNA-B. She talked with Resident #5's FM last night. The Admin stated she was going to meet with the FM once a week as it appeared she was telling different staff complaints, and it was not being relayed to her. She had started doing abuse and neglect training with staff also.Interview on 2/5/26 at 10:19 a.m. with Resident #5's FM stated she talked with the Admin last night. She stated if she saw staff members of the facility, she would talk to them. She stated she could not remember what was on the 5 videos now. Resident #5's FM stated she talked to staff if she saw them in Resident #5's area.Interview on 2/5/26 at 10:45 a.m. CNA-C stated they did abuse/neglect training every month and yesterday was the last time she did the training. Abuse would be leaving a resident in a chair. Neglect would be if staff did not answer a call light within 2 minutes or if staff did not do something for a resident that needed to be done for them. She stated it was never acceptable to hit a resident. CNA-C stated a resident being hit by staff could indirectly affect the resident mentally.Record Review of the facility's Policy and Procedures for Abuse, Neglect and Exploitation dated 10/24/22, revealed under Abuse means the willful infliction of injury.intimidation or punishment with resulting physical harm, pain, or mental anguish.It includes verbal abuse.physical abuse, and mental abuse. Under Willful means the individual must have acted deliberately, not that individual must have intended to inflict injury or harm.Physical Abuse includes but is not limited to, hitting, slapping. Under Policy Explanation and Compliance Guidelines: 1. The facility provides resident protection that include: a) Prevention/prohibit resident abuse. Under III. Prevention of Abuse, Neglect and Exploitation, The facility will make every effort to prevent and prohibit all types of abuse. 455731 Page 3 of 3