Inspection·September 15, 2023

F 0641 Level of Harm - Minimal harm or potential for actual harm Assessment can identify gum disease that can contribute to or cause systemic diseases and conditions, endocarditis, and poor control of diabetes. Assessing dental status can help identify residents who may be at risk for aspiration malnutrition, pneumonia, endocarditis, and poor control of diabetes. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 2 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to develop and implement care plans for necessary treatments and conditions for one of four residents (Resident #142) reviewed for Comprehensive Care Plans. The facility failed to develop and implement a comprehensive person-centered care plan to meet care areas triggered (cognitive loss, Visual function, adl assistance, urinary incontinence, falls, nutritional status, pressure area risk, psychotropic drug use and code status). This failure could place residents at risk of not receiving care that is relevant to their condition(s) which could lead to complications in resident health and quality of life and care. The findings include: Record review of Resident #142's face sheet dated 09/14/23 revealed resident was a 48 -year-old female with an admission date of 07/04/2023. Diagnoses included: diabetes (a medical condition in which there is too much sugar in the blood); hemiplegia (muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles); pain disorder; cardiomegaly (enlarged heart); dysphagia (difficulty swallowing); abnormal gait, and lack of coordination. Record review of Resident #142's admission MDS, dated [DATE] documented Resident #142 had a BIMS score of 11 (moderately cognitively impaired). Resident #142 was able to understand others and make her needs understood. The MDS documented Resident #142 utilized a wheelchair, required extensive assistance with one person assist for personal hygiene and two-person assistance with transfers and bed mobility, she was always incontinent of bowel and bladder, she experienced pain during the 5 day look back period and was on a scheduled pain management regimen, was at risk for pressure ulcers, took an antidepressant and a diuretic, and was a full code. The MDS was signed as completed on 07/07/2023. The CAA was (and care plan decisions) were dated as complete on 07/07/2023. Record review of Resident #142's Care plan revealed that the following care areas which were triggered in the CAA were not addressed in the care plan until: Cognitive Loss - 7/27/23 Visual Function - 7/27/23 ADL Assistance - 09/09/2023 Urinary Incontinence - 09/09/2023 Falls - 06/06/23 Nutritional Status - 08/21/23 Pressure Ulcer Risk - 09/09/2023 Psychotropic Drug Use - 09/09/2023 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 3 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0656 Code Status - 07/27/2023 Level of Harm - Minimal harm or potential for actual harm In an interview on 09/14/2023 at 10:22 AM, MDS Coordinator A and B said the care plan should have been completed within 7 days of the completion of the comprehensive assessment and within 21 days of admission. They stated they should looked at the CAT (care area triggers) when the MDS was completed and ensure those area were on the resident's care plan They stated it was an oversight that this care plan was not done in a timely manner. They stated this failure could place the resident at risk for staff not recognizing the resident's care needs. Residents Affected - Few In an interview on 09/14/2023 at 1:30 PM, the DON said that it was the responsibility of the MDS Coordinator, social worker, and the nurses to ensure the resident's care needs were documented in the care plan in a timely manner when captured in the comprehensive assessment. Record review of the Facility policy titled Care Plans and CAAS dated 05/16/2016, revealed the following [in part]: The purpose of this guide is to ensure that an interdisciplinary care plan is used in addressing the CAT'S (care area triggers) generated by the MDS assessment in order to thoroughly address the care area assessments and ultimately achieve a comprehensive care plan for each resident FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 4 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to include resident or the resident's representative in the IDT (Interdisciplinary team) in the comprehensive care planning within 7 days after completion of the comprehensive assessment for 1 of 3 residents (Resident #7) reviewed for care plan timing/revision. The facility failed to ensure Resident #7's care plan was reviewed by the IDT (Interdisciplinary team), which failed to include the resident or the resident's representative after the Comprehensive MDS assessment. This failure placed the residents at risk for not having individual needs identified and care and services provided to meet their needs and promote quality of care, feelings of well-being and quality of life. The findings included: Review of Resident #7's face sheet, dated 09/15/2023, revealed a [AGE] year-old female, with an admission date of 10/03/2005 and a re-admission date of 08/13/2023. Diagnoses included: Metabolic encephalopathy (brain dysfunction is disturbed due to disease in the body), Type 2 Diabetes Mellitus (chronic condition the affects the way the body produces blood sugar), and hypotension (low blood pressure). Review Resident #7's MDS assessment history revealed an annual assessment dated [DATE]. Section C revealed a BIMS score of 15, which means the resident is cognitively intact. Review of Resident #7's comprehensive care plan revealed it was last Reviewed/Revised on 04/27/2023 by the MDS Coordinator. There was no documented evidence that a care plan meeting was conducted for this care plan. Record review of Resident #7's progress notes revealed there was not a care plan meeting completed in April or May 2023. The care plan meeting was completed quarterly with the following dates of: 09/26/2023, 06/27/2023, 03/28/2023. Interview with Resident #7 on 09/12/2023 at 10:40 AM revealed the following: She revaled she had not been invited to careplan meetings and would like to dicuss some of the issues she is having with her needs. She revealed if she was invited, she would attend. She revealed that she makes decisions for her care. Interview with the RN MDS Coordinator on 09/14/2023 at 2:00 PM revealed the following: She revealed that they do not go off of the MDS schedule, they do them Quarterly. She revealed that the Social Worker completed the care planning process by contacting the family for the comprehensive care plan meeting. Interview with the Social Worker on 09/14/2023 at 3:23 PM, revealed that every 3 months they have a care plan meeting, this includes annual assessments. She said she does not know what type of assessment it is; she just does one every 3 months; she does not go off of the MDS schedule. She revealed there was not an IDT completed in April 2023 or May 2023, that coincides with the Annual MDS (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 5 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few assessment. She revealed since there was not a comprehensive care plan meeting, they did not include the resident or the resident's representative, she revealed this failure places residents at risk of not having family involved in their care planning process. Review of the facility's policy and procedure for Care Plans and CAAS, (05/16/2016), revealed the following [in part]: Care Plan Updates: * The IDT will review the care plans Annually, Quarterly and as needed to ensure all goals and approaches are appropriate. * The IDT will sign their designated sections of the care plan thereby signifying that they have reviewed their section of each care plan. Care Plan Meetings: * The Social Worker will use the facilities designated form for documentation by IDT of meeting. Form will be filed out in the resident's chart. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 6 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 3(Resident #45) residents reviewed for safe transfers. The facility failed to ensure Resident #45 was transferred with a gait belt. This failure could place residents dependent on staff for assistance with transfers at risk for falls and/or injury. Evidence includes: Record review of Resident 45's face sheet revealed a [AGE] year-old female who was readmitted on [DATE] with diagnoses of history of unsteady gait, muscle wasting and weakness, psychosis (a mental disorder characterized by disconnection with reality) and lack of coordination. Record review of Resident 45's significant change MDS dated [DATE] revealed she required extensive assistance of 2 with transfer, bed mobility and hygiene. Record Review of the video taken on 09/09/23 by the electronic monitoring camera in resident #45's room revealed during the transfer or resident #45 completed by CNA's E and F (without a gait belt) the 2 aides hooked their arm underneath the resident's armpits with the resident facing in the direction of the bed that she was transferred to. The recliner she was transferred from was approximately 5 feet from the bed. The CNA's fell with the resident itno the bed during the transfer. The resident appeared frightened with the manner with which she was transferred. The resident was not injure. Interview with the DON on 9/14/2023 at 10:00 AM revealed she had viewed the video of the transfer (by CNA E and CNA F) with Resident 45's daughter and she agreed that the family member had a reason to be upset. She stated it was her expectation for the staff to use a gait belt with all transfers and transferring a resident using the technique displayed by CNA E and CNA F in the video was not acceptable and could result in injury to the resident and the aides. She stated it was the charge nurses responsibility to monitor the aides on their shift to see that they were doing safe transfers. She stated she was in-servicing the staff on proper transfer techniques and doing proficiency checks. She stated she had suspended the aides pending the investigation of the complaint by Resident #45's family member. She called the aides that did the improper transfer on the video into her office, and they had received training and a disciplinary action. Observation and interview on 09/13/2023 with CNA C and CNA D, CNA C stated Resident #45's care plan had been updated and she was now transferred with a Hoyer lift. She stated a Hoyer lift was always done with 2 people. The CNA's were observed transferring Resident #45 with the Hoyer lift and their technique was correct and safe. Interview on 09/13/2023 at 2:47 pm, Administrator stated it was expected for CNAs to use a gait belt at all times when transferring a resident. The Administrator stated failure to do so could result in a fall. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 7 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0689 Level of Harm - Minimal harm or potential for actual harm Record review of policy Transfers of Residents, dated 05/2012, revealed in part: Use a gait belt around the resident to protect both the resident and you. Position the chair so that the 2 transfer surfaces are at a 45-degree angle. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 8 of 9 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview and record review, the facility failed to ensure the accurate administration of medications for 1 of 4 residents observed for medication administration. (Resident #7) Residents Affected - Few Treatment Nurse left a medication at Resident #7's bedside, unattended. This failure could place residents who received medications administered by the treatment nurse at risk of not receiving the intended therapeutic benefit of their medications and a possible medication error to another resident. Findings included: During an observation and interview on 09/12/2023 at 10:42 AM., Resident #7 was lying in her bed. There was a medication cup with cream next to her bed. She revealed that the medication cup was left there the prior day by the treatment nurse. She revealed that she was supposed to administer the fungal ointment herself but that she had not gotten around to it. SH revealed it was not a medication he could self-administer. The Electronic Treatment Record for Resident #7 dated 09/12/2023 revealed a physician's order for treatment on the left breast fold; by applying the antifungal cream Q-day and PRN for prevention every shift for excoriation/redness. The medication was last administered on 09/11/2023 from 6AM to 6PM. During an interview on 09/12/2023 at 11:00AM., LVN B revealed the following: She said that she had not given the treatments for Resident #7 yet that day. She said that she left the antifungal cream at her bedside yesterday and forgot about it. She revealed that she normally does not leave meds at bedside. She looked at the medication cup and said the antifungal treatment had not even been used. She stated this failure could result in the resident putting it on the wrong part or someone else getting it. Policy and Procedures titled Medications- Treatment dated 02/02/2014 revealed the following: 4.Adminsiter the medication according to the physician's orders. 5. Document initials and/or signature for medications and treatments administered on the MAR and TAR immediately following administration. 7. Circle initials for those medications or treatments that were not administered and document the reason for the non-administration on the MAR and TAR. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455849 If continuation sheet Page 9 of 9