Health inspection·September 8, 2025

F 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some reviewed on 04/23/2025 revealed CR#2's had a self-care deficit, with interventions including provide prompt assistance, provide encouragement and cueing as needed to performed ADL cares, aid of for toileting care, aid with bathing, and showering. Record review of CR#2's Comprehensive MDS (resident assessment tool) dated 02/07/2025 revealed a BIMS score of 15, indicating intact cognition. Further review revealed that CR#2' was dependent on helper(s) for toileting hygiene. Record review of CR#1's and CR#2's progress notes revealed: On 01/16/2025 at 5:00pm, reflected Nurse V wrote that she was notified by CR#1 and CR#2 that CNA was rough when ADL care was provided. The progress note did not identify the CNA and included additional details. Grievance dated 01/15/2025, reflected CR#2 reported that she would like CNAs to take more time and care when doing patient care. Documentation did not identify a particular CNA. The surveyor was unable to interview CR#1's and CR#2 as residents no longer resided at the facility. The interview on 09/08/2025 @ 11:00am with the Regional Nurse, she stated CNA A was identity during the facility investigation as the CNA assigned to CR#1's and CR#2 on 01/16/2025. Regional Nurse stated CNA A was suspended to ensure CR#1's and CR#2 safety during the facility investigation. Regional Nurse stated that the allegations of abuse and neglect related to CNA A providing rough care during med pass were unfound due to lack of information provided evidence, CNA A's denial of allegations. She stated the facility is required to report allegations of abuse and conduct a thorough internal investigation within 5 days timeframe. If an incident (such as an injury, abuse, or neglect) is not reported in a timely manner, it could delay any necessary investigations or interventions to protect the safety and well-being of residents and could place residents at risk of harm. She stated the facility reported the incident, but the five-day report evidence findings were not submitted to the state agency and retained by the facility's former administrator. She stated that it was uncertain why the investigation findings were not reported and retained. She stated she was recently, on 09/05/2025, made aware of this failure upon the state surveyor's request for documentation. She started an audit was completed and no additional intake reporting failure has been identified since the termination of the former administrator. She stated the facility has implemented an additional step to prevent similar problems in the future. She stated that the facility has crated an internal secure share drives are all reportable investigation and finding are retained by the facility. She stated that the DON and current Administrator have been trained on the process as of 09/06/2025. Attempted interview with the CNA A on 09/07/2025 at 11:53am, left a voicemail requesting a return call. 2. Record review of facility reported intake created on 12/31/2025 via TULIP, with allegations of Resident Abuse, indicated CR #3' family member alleged MA was rough during medication pass. Further review revealed no five-day investigation submission was found. No additional information related to the incident was submitted via the TULIP intake database. Record review of CR#3's Face Sheet dated 09/07/2025 revealed a [AGE] year-old who was originally admitted on [DATE] due to acute respiratory failure with hypoxia (a condition where there's not enough oxygen or too much carbon dioxide in your body) and discharged from the facility on 04/11/2025. Record review of CR#3's care plan last reviewed on 03/17/2025 revealed CR#3's had a self-care deficit, with interventions including aid with personal hygiene/grooming, aid of for toileting/incontinent care, provide total assistance for transfers, bathing, assistance for upper/lower body dressing, and assistance with meals. Record review of CR#3's Comprehensive MDS (resident assessment tool) dated 02/13/2025 revealed a BIMS score of 00, severe cognitive impairment. Further review revealed that CR#3 was dependent on two or more helper(s) to complete daily living activity. Record revie of grievance document, titled Concern Report dated, 12/29/2024 indicated RP reported concern related med pass to CR#3 on Friday, 12/26/2025. Documented resolution indicated staff was re - educated on medication administration. No additional (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455812 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 455812 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at First Colony 4710 Lexington Blvd Missouri City, TX 77459 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some documentation related to allegation details provided. The interview on 09/08/2025 @ 11:00am with the Regional Nurse, she stated MA L was identity during the facility investigation and the MA assigned to CR # 3 on 12/26/2024 @ 9:00am. Regional Nurse stated MA L was suspended to ensure CR #3's safety during the facility investigation. Regional Nurse stated that the allegations of abuse and neglect related to MA L providing rough care during med pass were unfound due to lack of information provided by the RP and MA L denial of rough incident. The surveyor was unable to interview CR #3; no longer resided at the facility. Attempted interview with the RP on 09/05/2025 at 11:53am, left a voicemail requesting a return call. Record review of MA L file revealed MA L was suspended on 12/26/2024 no documentation of date of return. Attempted interview with the MA L on 09/05/2025 at 1:58pm, left a voicemail. Record review of documentation provided revealed Medication Administration in- service was provided on 02/01/2025, no evidence of training provided on the date or surround dates of the incident. 3. Record review of facility reported intake created on 03/01/2025 via TULIP, with allegations of Resident Neglect, indicated CR #3' RP alleged CNA R was not providing the essential level of care on 02/25/2025. Further review revealed no five-day investigation submission was found. No additional information related to the incident was submitted via the TULIP intake database. Record review of training documentation revealed Abuse and neglect training was provided on 02/28/2025. Record review of CR # 3 clinical documentation, Skin Observation dated 02/27/2025, indicated not finding. Attempted interview with the former Administrator on 09/06/2025 at 10:16am; surveyor left a voicemail requested a return call. During interview on 09/07/2025 @ 4:48pm with CAN R, CAN R stated she could recall the alleged incident, she stated that CR # 3 often presented with aggressive behaviors towards staff. CAN R denial neglecting the CR # 3 when she previously provided patient care. She stated she was not sure of the details related to the incident. She stated she was suspended after the report was made and was later informed that the allegations were unfound. She stated abuse and neglect training was provided following the incident. She stated additional training regarding patient care and abuse was provided by the facility monthly. She stated that when care is provided to current residents who may present with behaviors, she used the support of the unit nurse or staff to aid in redirecting the resident. 4.Record review of facility reported intake created on 02/12/2025 via TULIP, indicated Resident #4 hitting Resident #5 across. Further review revealed no five-day investigation submission was found. No additional information related to the incident was submitted via the TULIP intake database. Record review of Resident #4's Face Sheet dated 09/07/2025 revealed a [AGE] year-old who was originally admitted on [DATE] due to skin infection. Record review of Resident #4's care plan last reviewed on 07/07/2025 revealed Resident #4's focus areas: Behaviors related to physical aggression, documented occurrence of 02/11/2025 with interventions including, monitor and chart behaviors as they occur and report progress/declines to provider, provide psych consult, re-evaluated, and admission to behavioral hospital as ordered.Psychotropic medications related to behavior management with interventions including, administer psychotropic medications as ordered by physician; monitor for side effects and effectiveness every shift; discuss with medical provider/family regarding ongoing need for use of medication; monitor/document/report as needed for any adverse reactions of psychotropic medications. Record review of Resident #4's Comprehensive MDS (resident assessment tool) dated 07/02/2025 revealed a BIMS score of 13, indicating intact cognition. Further review revealed that Resident #4 was able to function with a helper provided verbal cues and/or touching. Record review of Resident #5's Face Sheet dated 09/07/2025 revealed a [AGE] year-old who was originally admitted on [DATE] with schizophrenia. Record review of Resident #5's care plan last reviewed on 08/08/2025 revealed Resident #5's focus areas: Behaviors: occurrence date 02/11/2025- roommate hitting him, at risk for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455812 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 455812 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at First Colony 4710 Lexington Blvd Missouri City, TX 77459 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some further increased episodes and injury with interventions Resident #5's was moved to another location for safety, occurrence was reported to abuse coordinator; skin and pain assessment completed and reported to medical providers, DON and Administrator. Psychotropic medications, with interventions including, administer antipsychotic medications as ordered by physician; monitor for side effects and effectiveness; Monitor for episodes of psychotic/psychosis driven behaviors such as Visual/Auditory hallucinations, delusions, thought insertion/withdrawal, increased physical/verbal aggression; and provide psych consult as ordered. Record review of Resident #5's Comprehensive MDS (resident assessment tool) dated 07/02/2025 revealed a BIMS score of 14, indicating intact cognition. Further review revealed that Resident #5 was able to function with helper provided setup or clean up assistance. Record review of nursing clinical documentation dated 02/11/2025 at 11:30am, revealed a head-to-toe assessment was completed on Resident #4 following the incident, no injury identified. Record review of nursing clinical documentation dated 02/11/2025 at 11:31am, revealed a head-to-toe assessment was completed on Resident #4 following the incident, no injury identified. Record of progress notes revealed: Resident #4 was transferred to a behavioral hospital on [DATE], following the incident. Resident #5 was immediately moved to a different room on 02/11/2025. Nursing assessment completed without finding of injury, and social worker consult. During interviews on 09/08/2025 @ 5:18pm with Resident #4, he stated he feels safe at the facility. Residents denied he had experienced or witnessed abuse at the facility. Resident #5 could not recall the incident. During interviews on 09/08/2025 @ 5:42pm with Resident #5, he stated he feels safe at the facility. Residents denied he had experienced or witnessed abuse at the facility. Resident #5 could not recall the incident. 5.Record review of facility reported intake created on 01/15/2025 via TULIP, indicated facility reported allegation of abuse and neglect reported by insurance provider regarding CR#6, including a new-onset rectal bleeding noted on 9/17/24 (reported to be absent on 9/16/24) with concern of possible sexual assault, absence of a dressing on the dialysis catheter, and unsanitary conditions in the room with mold and mildew. Further review revealed no five-day investigation submission was found. No additional information related to the incident was submitted via the TULIP intake database.Record review of CR#6's Face Sheet dated 09/07/2025 revealed a [AGE] year-old who was originally admitted on [DATE] with primary diagnosis of sepsis (a serious condition in which the body responds improperly to an infection) and chronic kidney disease (occurs when a disease or condition impairs kidney function) and discharged from the facility on 09/23/2024. Record review of CR#6's care plan last reviewed on 09/14/2024 revealed CR#6's bowel incontinence, with interventions including apply a house moisture barrier cream after each episode of incontinence; encourage the resident to maintain mobility and participate in activities that promote regular bowel movements; monitor for signs of discomfort or agitation that may indicate the need for toileting; perform routine rounding to include incontinence care and brief changes; and remind and assist the resident to use the toilet regularly as indicated/able. No additional information related to self-care deficit was identified in care plan. Record review of CR#6 Comprehensive MDS (resident assessment tool) dated 04/29/2024 revealed a BIMS score of 06, indicating severe cognitive impairment. Further review revealed that CR#6's was totally dependent on helper(s) for toileting hygiene. The surveyor unable to interview CR#6 as resident no longer reside at the facility. During an interview on 09/05/2025 at 2:18pm, the SW stated she's worked in his role as the SW at the facility for many years. The SW explained her role as part of a comprehensive abuse investigation was to assess the safety and psychosocial well-being of the resident identified in the investigation and other residents. She stated when an abuse allegation is made, involving a staff member, it's critical to determine whether the abuse was isolated or systemic. She stated other residents may have been (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455812 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 455812 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at First Colony 4710 Lexington Blvd Missouri City, TX 77459 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some affected or were at similar risk. She stated when notified of an abuse incident it was her responsibility to identify at-risk residents. She stated she would start by reviewing other residents under the care of the alleged abuser (same hall/unit). Thereafter, she would conduct safety care rounds by meeting with each identified resident privately to assess. She explained in the individual meetings, he would assess for the resident safety, signs of fear or distress, or unreported incidents. When asked if she recalled the identified incidents involving CR #1, CR#2, CR#3, CR#6, and Residents #4, #5, she stated she recalled the incident. She stated she completed safety care rounds related to the incidents. When asked where the information was documented, she stated that safety care round documentation was submitted to the Former Administrator, FS M. When asked if her encounter with the resident was documented in the clinical record, he stated all encounters were documented in social worker's progress notes which is part of the resident clinical record. Attempted interview with the former Administrator on 09/05/2025 at 3:58pm, left a voicemail. Attempted interview with resident family member on 09/07/2025 at 1:05pm, left a voicemail requesting a return call. During an interview on 09/05/2025 at various times, with staff (LVN, K, LVN D, RN C, CMA M, CNA L, CAN J, and CAN R) stated they had been trained in abuses and neglect, repositioning techniques. Staff denied witnessing abuse and/or neglect at the facility. All staff identified the Administrator as the abuse coordinator. Staff stated they feel that there was enough staff support with resident's needs. They stated that sometimes they were short, but staff work together to meet the needs of the resident. During an interview with Administrator and DON on 09/07/2025 at 10:00am, the Administrator she was the facility's abuse coordinator. She stated as the abuse coordinator she must report to HHSC immediately and then start the investigation and complete it within five days of the incident. The Administrator stated that if a staff member were identified in the incident, she would suspend the staff member while continuing the investigation. The Administrator stated, she realized that there was a failure by the previous administration, FS M with the 5-day submission of investigation findings involving CR #1, CR#2, CR#3, CR#6, and Residents #4, and #5. The Administrator stated she gathered all the documentation to review that incidents were initiated but was unable to locate documentation evidence that a thorough investigation was completed, and findings reported to the state. The Administrator stated each intake was reviewed upon surveyor's request for evidence. The Administrator stated supporting documentation was gathered to confirm that each incident was addressed with acknowledgement that it was noted and addressed with education or clinically assessed. The Administrator stated five-day reports for the identified incidents were not submitted to by the pervious Administrator, FS M. The Administrator stated the facility was now required to store all investigations on a shared drive with regional staff to prevent the reoccurrence of the facility not retaining the documentation and evidence for all incident investigations. Record review of TULIP (portal where facilities report incidents to the state) on 09/05/2025 revealed no facility five-day investigation findings were reported for CR #1, CR#2, CR#3, #4, #5 CR#6. Record review of CNA A, CNA R, and MA L's file revealed abuse and neglect training to staff and a follow up incident follow ups were made regarding involving CR #1, CR#2, and CR#3. Record review of training and in-services revealed that the facility had provided the following trainings: 08/04/2025 - Abuse Reporting06/27/2025 - Abuse, Neglect, and Exploitation05/10/2025 - Abuse, Neglect, and Exploitation04/17/2025 - Abuse, Neglect, and Exploitation04/17/2025 - Turing and Reportioning04/07/2025 - Abuse, Neglect, and Exploitation 04/14/2025 - Abuse, Neglect, and Exploitation02/01/2025 - Abuse, Neglect, and Exploitation01/24/2025- Abuse, Neglect, and Exploitation 12/22/2024 - Reporting Abuse and Neglect Timely Record review of the facility's Abuse, Neglect and Exploitation Policy, revised 10/2024 revealed: The Facility will conduct a timely investigation of any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455812 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 455812 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at First Colony 4710 Lexington Blvd Missouri City, TX 77459 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 0610 Level of Harm - Minimal harm or potential for actual harm alleged abuse/neglect, exploitation, mistreatment, injuries of unknown origin, or misappropriation of resident property. The investigation should include gathering evidence, interviewing witnesses, conducting surveys as indicated, reviewing medical records, and examining any relevant documentation.The Facility will submit a summary of its investigation as required by applicable state and federal regulations. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455812 If continuation sheet Page 6 of 6