Health inspection·December 17, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bipolar disorder (mental health condition causing extreme mood swings), anxiety disorder, depression, and hypertension (elevated blood pressure). The MDS reflected the mood symptom of little interest or pleasure in doing things. The MDS reflected physical behavioral symptoms directed towards others (e.g., hitting, kicking pushing, scratching, grabbing, abusing others sexually) and verbal behavioral symptoms directed towards others (e.g., threatening others, screaming at others, cursing at others). A BIMS score of 10 indicated moderate cognitive impairment.Review of Resident #4's Care Plan dated 9/18/25 with problem start date 7/13/25 reflected Resident #4 was independent with transfers, ambulation, bed mobility, dressing, and toileting. Care Plan with problem start date of 6/14/25 reflected Resident #4 had behavioral symptoms with multiple episodes of agitation and aggression towards other residents between June 2025 and December 2025. The following behavior related care plan interventions and revisions were noted: Nutritional Status: Get impatient and agitated when waiting for meals:09/18/25 Resident #4 will get his tray first and brought to his room as it comes out to avoid any agitation09/18/25 Resident #4 is to be served his coffee and tray first at each meal09/18/25 Offer alternative meal if patient dislikes the meal given Mood State: Blocks the door to his room due to he doesn't want to be bothered at night:08/08/25 Resident #4 likes to sleep throughout the night being undisturbed, his rights will be respected Impaired Decision-Making r/t Alzheimer's:7/13/25 Determine if decisions made by Resident #4 endanger him or others. Intervene if necessary7/13/25 Encourage to verbalize feelings, concerns, and fears. Clarify misconceptions7/13/25 Give objective feedback when inappropriate decisions are made. Discuss future options to improved decision making skills7/13/25 Respect his rights to make decisions7/13/25 Support and reassure him in new situations At Risk for Adverse Consequences r/t Receiving Antipsychotic Medications:7/13/25 Assess if his behavioral symptoms present a danger to him/others. Intervene as needed.7/13/25 Monitor his behavior and response to medication. Behavioral Symptoms: He is having behavior symptoms of aggression and agitation:12/03/25 Resident #4 was placed on 1:1 and sent to the hospital for evaluation7/31/25 Monitor on Q15 minute checks for aggression7/30/25 Create a safe environment by calming Resident #4 down through active listening and non-threatening body language7/30/25 Staff will maintain an open body posture and avoid sudden movements7/24/25 Encourage Resident #4 to listen to music to calm him when he has behaviors6/30/25 Give any medications ordered by physician and assess for adverse reactions to medication and efficacy of medication therapy.6/30/25 Intervention such as redirection will be used when Resident #4 is experiencing behaviors.6/30/25 Nursing will report any behavior issues to physician6/30/25 Schedule care plan meeting with Resident #4 and family or RP if indicated to address any interventions that can be implemented to help achieve happiness for the resident6/30/25 Social services will refer for psychiatric consult to evaluate for medication or behavior therapy that is needed to manage disruptive behaviors6/30/25 Staff will use individualized non medication interventions first before using medication for behaviors6/14/25 Maintain a safe distance from the patient during episodes of aggression to prevent physical harm. Review of Resident #4's physician orders with start dates 5/22/25 reflected that he was ordered the following psychotropic medications: Abilify, Prozac.Review of Resident #4's physician order dated 6/20/25 reflected Resident #4 was to be monitored for aggression towards staff and other residents every shift.Review of Resident #4's Medication Administration Record dated 11/03/25 to 12/03/25 reflected that Resident #4's behaviors including aggression, itching, picking at skin, restlessness (agitation), hitting, increase in complaints, biting, kicking, spitting, cussing, racial slurs, elopement, staling, delusions, hallucinations, psychosis, aggression, and refusing care were routinely monitored each shift.Review of facility incident/accident log dated 10/1/25 to 12/17/25 reflected Resident #4 was involved in two Aggressive/Combative Behaviors, one on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455748 If continuation sheet Page 2 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Hall 2021 Shoaf Dr Irving, TX 75061 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 11/13/25 and one on 12/3/25. Review of Resident #4's Behavior and Mood Events notes from 6/25/25 to 12/17/25 reflected that Resident #4 had a cluster of behaviors in July 2025 followed by approximately three months without incident. Resident #4 then experienced two incidents in November of 2025 followed by approximately 3 weeks without incidents: 12/3/25 Punched another Resident (Resident #3) in cheek.Facility actions: Resident was redirected but left the area on his own accord. Resident #4 was moved to another room in another hallway away from Resident #3 while awaiting psychiatric evaluation. A mental health warrant was obtained and the police transferred him to the hospital within a few hours. The hospital declined to accept his return to the facility and assisted the hospital to find him a group home. 11/13/25 Punched CNA in right cheek; attempted to pour coffee on CNA.Facility actions: Resident #4 was redirected and escorted back to his room He was placed on 1:1 observation and the police were notified. 11/03/25 Threw coffee into another resident's face; attempted to throw a chair at the same resident (Resident #2).Facility actions: Staff intervened immediately and placed themselves in-between the two residents sparing the amount of coffee contacting Resident #2. The residents were redirected and separated. The police were notified, and Resident #4 was placed on 1:1 observation. Transfer to the hospital for evaluation was arranged but Resident #4 refused. The care plan was updated to reflect that Resident #4 would be provided with coffee/snacks first/separate. 7/30/25 Attempting to flip table over onto residents in dining hall but staff intervened and prevented.Facility actions: Resident #4 was separated from the other residents and placed on Q15 minute checks for aggression. His care plan was updated to reflect the behavior and interventions included that staff will maintain an open posture and avoid any sudden movements and to create a safe environment by calming Resident #4 down through active listening and non-threatening language. 7/29/25 Attempted to hit two residents with a vase in the dining room, but staff intervened and prevented.Facility actions: Residents were separated, and Resident #4 went to his room where he agreed to eat. He was placed on Q15 minute monitoring from 7/29/25-8/8/25. A psychiatric evaluation was ordered. His care plan was updated on 7/30/35 as noted above. 7/29/25 Barricaded himself in his room by putting the table by the door.Facility actions: Resident was placed on Q15 minute monitoring. His care plan was updated to reflect this behavior and included that Resident #4 was independent with his activities of daily living and did not need assistance. On 8/08/25 an intervention was added that Resident #4 liked to sleep through the night being undisturbed and his rights would be respected. 7/28/25 Verbal altercation with another resident and attempting to walk around/reach and slap another resident. Staff redirected.Facility actions: Resident #4 was redirected to his room where his lunch was delivered, and he was placed on Q15 minute monitoring. 7/17/25 Shoved an LVN in the hallway into the wall stating for her to get out of his way.Facility actions: Resident on Q1 hour monitoring. 6/25/25 Barricaded himself in his room with a table against the door.Facility actions: Resident was placed on Q15 minute monitoring from 6/25/25 to 6/27/25. Review of Resident #4's progress note dated 6/14/25 reflected that he was transferred and admitted to the hospital on [DATE] due to his aggressive behavior.Review of Resident #4's progress notes reflected on 7/31/25 referrals were faxed to 3 separate behavioral health hospitals and another nursing facility.Review of Resident #4's progress notes reflected on 8/05/25 he was seen by psychiatric services with no new orders received. No further details were included.Review of psychiatric services Neurobehavioral Status Exam on 10/31/25 reflected Resident #4 had refused assessment in July 2025 and during three different assessments (dates unknown). The exam reflected recommendations for continued sobriety and supplemental Thiamine for Alcohol-Induced-Dementia.Review of Resident #4's progress note dated 11/3/25 reflected he refused transfer to the hospital for evaluation.Review of Resident #4's progress note dated 11/12/25 reflected orders were received to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455748 If continuation sheet Page 3 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Hall 2021 Shoaf Dr Irving, TX 75061 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some send Resident #4 to the hospital, but he refused to go and was placed on one-to-one monitoring.Review of Resident #4's progress notes from admission on [DATE] to transfer on 12/03/25 reflected that he was often on 15-minute monitoring and was intermittently placed on one-to-observations during periods of increased agitation/aggression.Review of Resident #4's progress notes dated from admission on [DATE] to transfer on 12/03/25 reflected that he consistently refused his medications for months despite continued attempted teaching by staff and repeated offers of ordered medications.Review of Resident #4's Medication Administration Record from 11/03/25 to 12/03/25 reflected Resident #4 consistently refused all of his medications. In an interview on 12/17/25 at 09:50 am, the ADM stated that on the 12/03/25 during activities Resident #4 had become upset because he had placed his shoes against the wall and Resident #3 had picked them up. Resident #4 then hit Resident #3 in the left jaw with his fist. The ADM stated that Resident #4 was very quick and very independent, and that the activity assistant was dealing with another resident when it occurred. She stated that Resident #3 was not injured. The ADM stated that Resident #4 was moved to another room, placed on one-to-one observation, and that a mental health warrant was obtained, and he was transferred to the hospital by the Sheriff's department within a couple of hours. She reported that the hospital medically cleared him and attempted to return Resident #4 to the facility within a few hours, but that the facility then assisted the hospital to find alternative placement for Resident #4. ADM reported that prior to this incident she had been speaking with a judge to obtain eviction orders as Resident #4 was refusing to leave the facility for discharge. She stated he was too independent to be in a nursing home. The ADM stated that Resident #4 had thrown coffee on Resident #2 in the dining room on 11/3/25 and that staff immediately intervened, and Resident #2 had not sustained any injuries. In an interview on 12/17/25 at 10:00 am the Executive Assistant reported that the facility had been trying to discharge Resident #4 because the facility could not handle his behaviors but that he had refused to leave the facility despite being accepted by multiple group homes. She stated that anytime the facility sent him to the hospital, the hospital would send him back in two hours saying he was fine when he really needed help. She stated that Resident #4 had thirteen incidents since his admission including barricading himself in his room, chasing staff, hitting staffing, and hitting other residents. She stated the facility placed him on every fifteen-minute monitoring or on one to one as needed following incidents. She stated the facility made multiple attempts to get him psychiatric care but that he refused all his medications, and he chased psychiatric services out of his room. She reported that Resident #4 had bipolar disorder but refused offered medications for months. She stated the facility catered to his needs in further attempts to mitigate behaviors and doubled his food portions and gave him a heavy snack load multiple times a day. She stated he was given a private room despite not being able to pay for it. She stated the facility had also involved his family in providing input and that the family refused for him to live with him. The Executive Assistant reported she was involved in getting the mental health warrant on the day that Resident #4 hit Resident #3 and that Resident #4 was quickly transferred to the hospital by the Sheriff's department the same day and was later discharged to a group home.In an interview on 12/17/25 at 01:10 pm, the Activity Assistant reported that during an activity on 12/03/25 she heard Resident #4 state, ‘leave my shoes alone and turned and saw Resident #3 reaching for Resident #4's shoes. She stated, It happened so fast and by the time Resident #3 picked up his shoes Resident #4 jumped up and ran around the table, and I was yelling for the nurse or aide loudly. She stated that she was not able to get to the residents before Resident #4 struck Resident #3 in the face with a closed fist. She stated she did not have to separate the residents as Resident #4 then pushed away on his own down the hallway in his wheelchair. She reported the DON came (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455748 If continuation sheet Page 4 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Hall 2021 Shoaf Dr Irving, TX 75061 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to assess the residents. The Activity Assistant reported she had previously had training dealing with difficult behaviors and intervening in altercations between residents, and she was aware of separating the residents and notifying her supervisors. She reported that Resident #3 did not have any injuries from this altercation.In an interview on 12/17/25 at 02:15 pm, Resident #3 was observed as not interviewable. He made brief eye contact before walking away.In an interview on 12/17/25 at 02:17 pm Resident #2 was not interviewable due to confusion.In an interview on 12/17/25 at 10:32 a.m., the Marketing and Admissions Coordinator stated that the facility had been trying to discharge Resident #4 because he was combative and hitting others, but that Resident #4 had been refusing to leave. She stated Resident #4 was a danger to himself and others and that even the staff were afraid of him. She stated the facility had tried to intervene by accommodating his schedules, desires, and preferences, and giving him a private room without charge. She stated she did not know details of Resident #4's aggression but that she was aware that he had been aggressive towards other residents on multiple occasions. She reported that when Resident #4 was going to be returned to the facility from the hospital, they were able to assist the hospital in finding alternative placement for Resident #4.In an interview on 12/27/25 at 12:40 pm, the DON stated she had not witnessed the incident between Resident #4 and Resident #3, but that she had been told that Resident #4 had hit Resident #3 in the cheek with a closed first during activities. She stated that Resident #4 told her that he hit Resident #3 because, I just got upset. She stated Resident #3 was too confused to state any details about the incident. She stated that Resident #4 was placed on one-to-one monitoring and moved to another hall. She stated that Resident #4 had been refusing all his medications, including his psychotropic medications for months. The DON stated that Resident #4 had been refusing to discharge and refusing psychiatric services and would not talk to psychiatric services when they came. She stated the facility gave him a private room, began giving him his snacks first, gave him his trays and coffee away from other residents, provided him showers at his desired times, and accommodated him by not bothering him after 9pm as he requested. She stated Resident #4 was completely independent in his activities of daily living and needed a group home rather than a nursing home but had refused to leave on multiple occasions when they had found him group home placements. She stated he needed psychiatric services and to take his medications, but he continued to refuse these things. She stated the facility would transfer him to the hospital, but the hospital would quickly send him back without doing anything for him. She stated that Resident #4 could remember days later his actions and would state that the people he attacked, deserved it and if he could get to them, he would do it again. She stated he knew the things he was doing. She reported that Resident #4 was transferred to the hospital shortly after attacking Resident #3 and was later discharged to a group home. The DON reported that her staff immediately intervened as expected when residents were in an altercation. She stated she had done an in-service education with staff on recognizing and intervening for early signs of agitation. She stated it was her expectation for aggressive residents to be placed on monitoring and to be placed on interventions to help prevent aggressive behaviors.Review of facility staff in-service education records dated 11/02/25 reflected staff signatures were present for training on identifying and intervening with resident behaviors and review of the facility policy titled, Behavioral Assessment, Intervention and Monitoring.In interviews on 12/17/25, a random sampling of an LVN and a CNA staff reflected staff reported receiving training on caring for residents with dementia and difficult behaviors and were able to discuss appropriate interventions for residents in altercations.The facility policy titled, Abuse, Neglect, Exploitation, and Misappropriate Prevention Program dated 2001 and revised April 2021 stated, Residents have the right to be free from abuse. and implementation included to, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455748 If continuation sheet Page 5 of 6 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 455748 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Hall 2021 Shoaf Dr Irving, TX 75061 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 0600 develop and implement policies and protocols to prevent and identify abuse. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455748 If continuation sheet Page 6 of 6