Inspection·July 18, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm including but not limited to receiving treatment and supports for daily living safely. The facility must provide-A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455861 If continuation sheet Page 2 of 4 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 455861 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Plano Rehabilitation and Nursing Cente 1621 Coit Rd Plano, TX 75075 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure all alleged violations involving abuse, neglect, exploitation, or mistreatment were reported no later than 2 hours if the events that caused the allegation did involve abuse or serious bodily injury to HHS, for 1 of 1 resident (Resident #1) reviewed for abuse, neglect, exploitation, or mistreatment. The facility failed to report to HHS within two hours, when a staff member reported CNA A spoke rudely and pushed Resident #1 down the memory care hallway on 07/05/25. This failure could place residents at risk of abuse or mistreatment. Findings included: Record review of Resident #1's face sheet, dated 07/18/25, reflected a [AGE] year-old female, with an initial admit date of 03/28/25, and a readmit date of 05/16/25. Resident #1 had diagnoses of Frontotemporal Neurocognitive Disorder (brain disease that leads to significant changes in behavior, language abilities, and personality), Dementia (Decline in memory, thinking, and social abilities), Muscle Weakness, Bipolar Disorder (Extreme Mood Swings), Depression (disorder causing feelings of sadness, anger, or loss), Manic Disorder (causes periods of extreme changes in mood or emotions and energy level), Impulse Disorder (Inability to resist strong urges), and Cognitive Communication Deficit (Communication difficulty). Record review of Resident #1's Quarterly MDS Assessment, dated 05/01/25, reflected Resident #1 had a BIMS score of 03, which indicated Resident #1 was severely impaired. In an interview on 07/18/25 at 11:45 AM, the Administrator stated he was informed by a Charge Nurse who worked in memory care, that CNA A allegedly abused a resident on 07/05/25. He stated he was told that CNA A spoke rudely to the resident. He stated he suspended CNA A, who allegedly abused Resident #1, and he stated he started an investigation. The Administrator stated he did not find any evidence of abuse. He stated Resident #1 was assessed and did not have any bruises, marks, or injuries, and he stated Resident #1 did not have an outcry of abuse. The Administrator stated he did not report the allegation to HHS, because it was not an abuse issue but a customer service issue. The Administrator stated CNA A was in-serviced on customer service. The Administrator stated he felt there was no risk of not reporting the allegations, because it was a customer service issue. In a telephone interview on 07/18/25 at 1:23 PM, CNA A stated she worked the 2:00 PM to 10:00 PM shift on 07/05/25. She stated she could hear someone beat on the door while she sat at the nurse's station. CNA A stated she had worked for years at the facility and was very familiar with Resident #1, so when she saw it was Resident #1 who made the noise, she went to calm her. She stated the staff knew to take Resident #1 to the back of memory care, to the sunroom area, where she was not around other residents, and had the opportunity to calm down. CNA A stated Resident #1 stated she wanted a snack and to use the bathroom. CNA stated Resident #1 was calm after she received a snack and had a trip to the bathroom. CNA A stated she never yelled, grabbed, pushed, pulled, or harmed Resident #1. CNA A stated she walked arm in arm with Resident #1 like she did often. CNA A stated she was trained on how to redirect residents in memory care, as well as on abuse and neglect. She stated three types of abuse were verbal, physical, and sexual. She stated she had never abused a resident, never witnessed any abuse at the facility, and would tell the abuse coordinator if she witnessed any type of abuse. In a telephone interview on 07/18/25 at 1:35 PM, the CNA Trainee stated she and the Charge Nurse went to the vending machine, and when they returned CNA B told them she did not like how that girl treated Resident #1. The CNA Trainee stated CNA B told them CNA A was very stern with Resident #1. The CNA Trainee stated CNA B told them CNA A forced Resident #1 down the hallway toward the sunroom. The CNA Trainee stated Resident #1 would yell loudly at times and had psychiatric issues. The CNA Trainee stated Resident #1 had to be redirected often. The CNA Trainee stated she did not witness the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455861 If continuation sheet Page 3 of 4 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 455861 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Landmark of Plano Rehabilitation and Nursing Cente 1621 Coit Rd Plano, TX 75075 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete incident. She stated it happened while she and the Charge Nurse left to go to the vending machine. In a telephone interview on 07/18/25 at 1:45 PM, the Charge Nurse stated she was not in memory care to witness the incident. She stated was gone to the vending machine with the CNA Trainee. The Charge Nurse stated when they returned to the memory care unit CNA B told them she did not like how CNA A talked to Resident #1. The Charge Nurse stated at the time of the complaint, CNA A was in the bathroom with Resident #1. The Charge Nurse stated once they were finished, she asked CNA A to leave for the day. She stated CNA A was suspended, but she was not sure how long it was before she returned to work. She stated CNA B called and told the Administrator about the incident. In an interview on 07/18/25 at 5:18 PM, Resident #1 stated she could not think of any staff who were rude to her, and she stated she felt safe in the facility. Resident #1 stated she could not remember any staff member by name. She stated she could not remember any incidents were someone pulled her by the arm. In an interview on 07/18/25 at 6:18 PM, the DON stated she became aware of the abuse allegations the same day it happened on 07/05/25. She stated the staff had already notified the Administrator of the allegations. She stated CNA A was suspended, and the Administrator did an investigation. She stated she was not aware he did not report the abuse allegations to HHS. The DON stated she felt there was not a risk of the Administrator not contacting HHS, because he did his own investigation and found it to be a customer service concern and not abuse. Record review of the facility's policy, dated 03/29/18, titled, Abuse/Neglect, reflected the following: A. Reporting1. Any person having reasonable cause to believe an elderly or incapacitated adult is suffering from abuse, neglect or exploitation must report this to the DON, administrator, state and/or adult protective services. State law mandates that citizens report all suspected cases of abuse, neglect or financial exploitation of the elderly and incapacitated persons.2. When a suspected abused. neglected. exploited. mistreated or potential victim of misappropriation of property comes to the attention of any employee, that employee will make an immediate verbal report to the Abuse Preventionist or designee. If the discovery occurs outside of normal business hours., the Abuse Preventionist and/or designee will be called.3. Facility employees must report all allegations of abuse. neglect, exploitation, mistreatment of residents, misappropriation of resident property or injury of unknown source to the facility administrator. The facility administrator or designee will report to HHSC all incidents that meet the criteria of Provider Letter 19-17 dated 7/10/19.a. if the allegations involve abuse or result in serious bodily injury, the report is to be made within 2 hours of the allegationb. If the allegation does not involve abuse or serious bodily injury, the report must be made within 24 hours of the allegation. Event ID: Facility ID: 455861 If continuation sheet Page 4 of 4