Health inspection·September 10, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few with a 30-day discharge notice due to alleged drug use, but denied using drugs. The document also noted that he provided inconsistent information and had difficulty articulating or focusing. Under Risk Factors the note included Sexual Acting Out: None. Review of Resident #1's progress notes reflected the following:- A note on 09/05/25 at 11:30 PM by LVN C reflected Resident was in A hall knocking at a female resident's room (female resident not identified). Resident was informed that the female resident was asleep. This resident was insisting that the female resident needs to come out, but the female resident told this writer with the A hall nurse and a female CNA that she does not want to be disturbed. When this resident was told what the female resident said, he did not want to move away from the hallway to his hall. He then came to the front lobby and sad [sic] he was waiting for a female visitor. Resident was informed that visitation time ends at 8 pm. He then said, I am a [AGE] year-old man, I can go out whenever I want. He then went to the patio. - A note on 09/06/25 at 12:35 PM by LVN B reflected Resident in room door closed, staff member open door togive lunch tray to resident strong drug order [sic] in room. DON and Ad min [sic] notified - A note on 09/06/25 at 2:59 AM by LVN C reflected (.) Resident noncompliant to instructions. Earlier on the shift, resident was knocking at the female residents rooms (identities of female residents unknown) and refused being redirected to his room. - A note on 09/06/25 at 10:26 PM by LVN C reflected, Resident outside (female resident #13's) knocking at the door. Resident redirected back to his room but non-compliant with instructions, refused to go and started talking to a female resident (identity unknown) inquiring her room number. - A note on 09/07/25 at 4:30 AM by RN A reflected This writer and another nurse were at A hall nurses' stationand saw resident trying to get into (male resident's room). We redirected him to go to his room and stop going into other residents' rooms because they are still sleeping. - A note on 09/07/25 at 7:00 AM by LVN B, reflected Resident refused to answer question on how resident (#2) was in the room. Resident refused skin observation - A note on 09/07/25 at 7:07 AM by LVN B reflected Notified DON and ADMIN (Administrator's name) for possible sexual abuse from resident - A note on 09/07/25 at 11:45 AM by the DON reflected This nurse spoke with (name of worker) from (name of group home) which is part of a home community based service for adult mental health, a placement agency; she will come out tomorrow to evaluate him for placement. Resident currently on 1 :1 observation, will continue until placement is found. - A note on 09/07/25 at 12:44 PM by the DON reflected the PCP and Psych Nurse were made aware of the incident. Review of Resident #2's admission Record, dated 09/07/25 reflected she was a [AGE] year-old female, with diagnoses of Alzheimer's disease, dementia in other disease (dementia caused by another health condition), stroke, major depressive disorder, and presence of a cerebrospinal fluid drainage device (stent for draining excess fluid from around the brain). A family member (Resident #2's POA) was her responsible party. Review of Resident #2's MDS, dated [DATE], reflected she was only sometimes able to be understood, and to understand others. She had a BIMS score of three, indicating severely impaired cognition. Resident #2 had fluctuating inattention and disorganized thinking, and the staff mood assessment reflected she had little interest or pleasure in doing things and felt tired from two to six days of a fourteen-day lookback period, and that she had trouble concentrating every day or nearly every day. She exhibited no behavioral symptoms during the assessment period. Review of Resident #2's care plans reflected the following:- 08/19/22 has difficulty making decisions- 03/15/23 Intrudes on other residents' privacy with a goal of not intruding on resident privacy during the quarter, and interventions (all dated 03/15/23) of monitoring and documenting behavior, placing her in an area where frequent observation is possible, and redirecting her when wandering into other resident rooms.- 07/01/23 h/o physically aggressive behavior with staff and other residents, which included 07/01/23 - was physically aggressive with a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 2 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Immediate jeopardy to resident health or safety Residents Affected - Few staff and resident and on 08/17/25 - physically aggressive with another resident, who hit her and caused her to fall- 01/14/24 displays socially inappropriate/ disruptive of taking items not belonging to her, and when confronted curses, calls people names, and refuses to listen, due to her cognitive diagnosis- 07/12/24 refuses to shower or change clothing for 2-3 days and goes home with family member to shower- 08/12/24 has periods of forgetfulness The care plans did not include any care plan for sexual behavior, or drug use. Review of Resident #2's psych services note, dated 08/13/25, reflected the staff reported signs of cognitive impairment (confusion, word-finding difficulties and difficulties with ADLs) but no behavioral concerns. Resident #2 had no history of alcohol or drug use. Resident #2's thought process was impoverished (resident was unable to think well, leading to minimal speech, lack of detail in conversations, and difficulty sustaining topics), flat (unexpressive) affect, poor eye contact, no risk of aggression, poor attention span, fair judgment, and severely impaired long and short term memory. The document reflected the resident had been in several group homes prior to her admission, but wandered away. Review of Resident #2's progress notes reflected the following: - A note on 09/07/25 at 4:40 AM by RN A Resident resting in bed, door open and lights on. No c/o pain and nos/s of acute distress noted. ADLs provided, safety precautions maintained, will continue to monitor. - A note on 09/07/25 at 6:45 AM by LVN B Resident not in room, this writer went to check blood sugar, resident not in room. This writer then being [sic] to search the B hall area, outside patio, dining area and was unable to find resident - A note on 09/07/25 at 6:55 AM by LVN B Resident notified by over head page to staff missing resident location, (Resident #2's name and room location). Staff member went room to room. Resident was found by (LVN C) in (Resident #1's room number). - A note on 09/07/25 at 7:01 AM by LVN B Resident was in (Resident #1's room number) wear and [sic] black top with no underwear facing the wall and the back toward the door. her under [sic] and pants in the bed with her. This writer assist with sup. (supervisor ADON) to room gait unsteady she was confused and could not walk. This writer went to get wheelchair and resident was taken to her room - A note on 09/07/25 at 7:01 AM by LVN B Resident in room very unsteady bp 122/76 heart rate 112 temp 96.8.Resident refused head to toe assessment from this writer. No signs of bleeding or bruising to arms or legs andface. - A note on 09/07/25 at 7:01 AM by LVN B This writer stay with resident and staff until EMT arrived. Residentasked several times what's happening to me. This writer told help is on the way. Resident in bed some what alert calm no signs or symptom of pain - A note on 09/07/25 at 7:07 AM by LVN B Notified PCP - A note on 09/07/25 at 7:07 AM by LVN B Notified DON and Admin of situation - A note on 09/07/25 at 7:10 AM by LVN B Notified the police and requested EMT - A note on 09/07/25 at 7:15 AM by LVN B Police on the scene. This writer inform the police that resident wasin another resident room undress and resident has Alzheimer's and Dementia confusion sometime can't make decisionon her on [sic]. - A note on 09/07/25 at 7:17 AM by LVN B EMT on the scene to take resident to hospital for evaluation. Resident refused to go. - A note on 09/07/25 at 7:27 AM by LVN B Notified (Resident #2's family member's name) of the situation and (Resident #2's family member's name) (Resident #2's (Resident #2's family member's name) spoke to resident and resident was sent to (name of hospital). - A note on 09/07/25 at 8:26 AM by LVN B sent to ER - A note on 09/07/25 at 9:00 AM by LVN B (Resident #2's family membe4) and (Resident #2's POA) arrived asking what happened and how did I let this happen. This writer explained the event between 6:45 and 7:00 am. (Resident #2's family member) crying asking why did you let this happen. This writer listen to family member and assured her that Admin (Administrator's name) and DON (DON's name) was working on the situation as we speak - A note on 09/07/25 at 9:30 AM by ADON This nurse was at A-hall nurse's station after huddle (a meeting at shift change, for communication) this morning, when I heard overhead page by B-hall charge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 3 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Immediate jeopardy to resident health or safety Residents Affected - Few nurse that she cannot locate one of her residents and she need help to look for her. Other staff members started looking, while this nurse headstraight [sic] to Shall [sic]. Charge nurse reported to this nurse that (Resident #2) was observed lying in bed in room (Resident #1's room number). This nurse entered room (Resident #1's room number) and saw the male resident in room (Resident #1's room number) sitting across his bed facing the door and (Resident #2) was lying on the bed facing the wall and her back to the door. I asked the male resident what's going on? Why is she lying on your bed? He did not respond. He just looked down. I saw his pants and underwear were down to his thighs, and he tried pulling his pants up to cover his pubic area from being exposed. I turned to (Resident #2) and asked her what are you doing on the male resident's bed?. She replied, nothing. I asked her to get out of bed and let me take her back to her room. She tried to get up but couldn't. I noticed when she moved that she didn't have any underwear or pants on. She had a blouse, and sweater on. She also appeared weak and unstable. I asked the male resident to transfer to his w/c x3 while I try to get the female resident out of the bed, but he didn't move. I pulled the bed away from the wall, with both residents sitting on it, then I assisted the female resident to get out of bed and hold her hand while leading her to her room . She stopped and leaned against the wall outside the door because she was staggering. We finally made it to her room with my assistance. Male resident finally got out of bed to his w/c. Charge nurse had notified the DON, Administrator, and police. DON came into the building to start investigation. Marketing director also notified and came into the building to assist. This nurse took resident's vital signs: BP=122/76, P=112, Resp=28-30. Temp=96.8. She denied pain/discomfort from her vagina. She refused to have this nurse do a complete assessment of virginal [sic] area, stating I'm ok, I don't need that. Ambulance with EMT arrived and took over. Police also arrived and spoke with the male resident, charge nurse, and this nurse. Resident was transferred to [name] hosp for further eval and treatment if indicated. - A note on 09/07/25 at 12:56 PM by LVN B Notified resident [sic] of possible abuse by another resident - A note on 09/07/25 at 7:37 PM by LVN B Resident return from hospital alert bruising to rt eye swollen [sic] to top lip. voiced no to pain, gait unsteady some confusion noted - A note on 09/08/25 at 6:47 AM by LVN C Resident's upper lip remains swollen, denies pain or discomfort. - A note on 09/08/25 at 7:21 AM by LVN I resident awake and alert sitting on side of bed at this time. (.) Resident denies any pain/discomfort at this time. Upper lip remains slightly swollen, no c/o pain or discomfort. No signs ofdifficulty swallowing or chewing. Resident eating snack in room at this time. (.) - A note on 09/08/25 at 9:32 AM by the ADON This nurse saw resident being escorted by cna to smoke patio. CNA was holding her arm to assist her while ambulating from her room on B-hall to smoke patio. CNA reported to this nurse that resident is unstable on her feet on that's why she's holding on [NAME] [sic] arm while walking. Noted upper lip swollen. Resident denied pain at this time. Resident unable to verbalized what happen to her upper lip d/t dx of dementia/alzheimers. Charge nurse notified. DON aware. - A note on 09/08/25 at 10:22 AM by LVN I vitals assessed by this writer at 9:53am. 108/77 p97, 98% RA, 97.1 . Resident c/o pain to upper lip at this time. No order [sic] pain. Requested prn pain med at this time. - A note on 09/08/25 at 11:35 AM by LVN I resident oof to hospital with EMT per (Resident #2's family member) phone call to EMT for resident to get CT Scan. Resident sent with face sheet and med list. (Medical Director's name) and admin staff notified - A note on 09/08/25 at 5:43 PM by Agency LVN K the writer of this note made aware that resident was going to pend [sic] the night at her family home - A note on 09/08/25 at 6:00 PM by Agency LVN K Resident during the AM shift for a hospital appointment at (5:00 PM) family member came to the facility and informed the writer of this note that resident was going to pend [sic] the night at home. Evening and HS meds prepped and given to (Resident #2's family (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 4 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Immediate jeopardy to resident health or safety Residents Affected - Few member). - A note on 09/09/25 at 11:35 AM by LVN I resident returned back to facility with (Resident #2's family member) and (Resident #2's family member CC) . (Nurse Practitioner's name) in facility and will assess resident per (Resident #2's family member's) request. Will continue with plan of care. Hospital records for Resident #2 were not reviewed. An observation on 09/07/25 at 12:22 PM revealed that Resident #2 was not in her room but a name plate with her first initial and last name was on the door. An interview and observation on 09/07/25 at 12:24 PM revealed Resident #1 outside his room, wheeling back and forth a short distance, and turning around in a circle and ranting. The ADON was standing next to his door, watching him. Resident #1 agreed to speak privately with the surveyor in his room, and the ADON said she would be right outside the door. Resident #1's speech was hard to understand at times, somewhat slurred, and he jumped from one unfinished sentence to another at times. He was speaking without stopping unless the surveyor interrupted him to ask questions. He said they (the facility staff) were talking this stuff about him, for no reason, and they didn't know anything. He said she (Resident #2) had autism and he didn't know that but they were friends and he talked to her all the time and she made decisions as well as him. He said she thinks good thoughts. When the surveyor asked the name of the lady he was talking about, he gave an incorrect first name starting with the same initial as Resident #2's, and the correct last name. He said They are saying a whole lot of whatever it is. They don't know that me and her have whole, decent conversations. He said he had not talked to her about sex, but he went into her room and told her he was going to his room, and she said she was coming over to get weed. When asked if he normally kept drugs in his room, he said no but when the surveyor asked about Resident #2 saying she was coming over to get marijuana, he said that he just kept a little weed in his room. He said that when they were in his room she I'm ready and he said no because them people are going to come in here but she pulled her clothes off. He said the door to his room just opened, he could not lock it, and people came in all the time. He said they both fit in his (twin) bed, and they watched TV first, then she wanted to have sex. He repeated that she was his friend, and just a friend, and that they (facility staff) know better than I am fixin' to rape. He said it was just like 10 minutes and he didn't even finish and he repeated this, and that the staff were makin' a big deal about it, and that they did not understand, repeatedly throughout this conversation. He said Resident #2's shoe was on the floor, and his money fell in her shoe. When the surveyor tried to talk about the allegation again, he continued to talk about the money, which was over $300, but when asked what kind of decisions he had ever seen Resident #2 make, he denied that she had any problem making her mind up about anything including sex or anything else. He said she was able to say yes or no and that she was happy while they were together, not upset. He said someone came in and saw them sitting there, and looked all over and got upset. He said a nurse came in and he was sitting upright in the bed. He then backtracked to how Resident #2 was his friend, and said she said naw then she said yes. When the surveyor asked if she said no to sex before she said yes, he said no, she never said no and that she wanted to get together with him. He said that when they were looking at the TV she told him to put on this song she liked, and he started looking for a song on his phone, and humming. He said when she said that he wasn't even thinkin' like that but he did it because she wanted to. He talked more about his money, the amount, and that she (pointed at the door) took the money and counted it and he wanted his money back. Several times during this interview the surveyor had to ask him to re-state things, and when he did, his speech was noticeably more clear and easy to understand. In his demeanor he seemed to be more emotional about his money and did not express any concern for Resident #2. Constantly throughout the interview he put his hands on his head and shook his head, while he denied there was any problem with his actions toward (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 5 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #2. An interview on 09/07/25 at 12:36 PM with the ADON revealed she was the person designated to watch Resident #2 at this time. She said there was some question about who the money belonged to, because it was found in another resident's room, and it was being held until they were certain of who it belonged to. The resident was inside his room and loudly said they knew it was his money and he wanted it back. A telephone interview on 09/07/25 at 12:44 PM with Resident #2's Family Member said the facility called at about 7:30 that morning (09/07/25) to tell her they needed the resident to go to the hospital, and she would not go, because she did not understand why. She talked to Resident #2 so she would go, and when she was at the facility she saw the man who did it. She said there was nothing wrong with him, except his was in a wheelchair, and he said the night nurse knew they had been doing it (he and Resident #2 having sexual contact) for a while, and told them it was OK. During the conversation, Resident #2's family member was crying and said that earlier another man had jumped on Resident #2 and hit her on the head. She said the resident had a stent in her head and they sent her to the hospital because she was worried that the man might have done something to her stent. She said Resident #2 had dementia and she was very concerned, because she thought the staff were supposed to protect Resident #2, and check her at least every two hours, and she wanted to know how nobody noticed she was in a man's room. She said her dementia was getting worse, and she was not able to decide to go to a man's bed. She said she did not believe there was any way Resident #2 would be thinking to look for that (sex) and she would not be looking for drugs. She was worried the facility would lie about it and say Resident #2 meant to be in the man's room. She did not know how the resident was doing, because she was still at the hospital. Once she was released her family meant to take her home for a while. A telephone interview on 09/07/25 at 12:59 PM with Resident #2's POA said he had been told that Resident #2 had been found in a man's room with no clothes on, around 6:50-7:00AM that morning, and she appeared to have no recollection that anything happened. He said she did not seem agitated or upset because she was completely unaware of what happened. He said he was at the hospital during this conversation and they were waiting for them to do a rape kit on the resident. He said she had never talked about being involved with a man at the facility and no staff had ever told them she showed any interest in that, and he would not expect her to, because she could not remember anything from one minute to the next. Resident #2's POA said they were feeling very bad about the facility after another man assaulted her by hitting her, twice, for no reason and he wanted to find a better place for her because of that. He said the other assaults had been in the last couple of months, he thought. He said that on top of that, now this has happened and they (her family) were very, very upset. An interview on 09/07/25 at 2:10 PM with LVN B revealed the staff were having huddle at about 6:30 or 6:40 and she noticed Resident #2's door was open and she was not in there. She said she made a round to look for her, and she was not in any of her normal places. She said she went from room to room on her hall and checked the rooms again, in case they had missed each other in passing. When she was not able to find Resident #2 she asked another nurse if they had seen her, and did a page overhead to call for help. RN A and LVN C found Resident #2 in Resident #1's room and told her. The ADON was also searching and she went into Resident #2's room with her. She said Resident #2 was in the bed, facing the wall, and her underwear and pants were off, and her shirt was pulled part-way up her back. She said the ADON asked Resident #1 to pull his clothes up and get in the wheelchair so they could get Resident #2 off the bed. LVN B said she called the Administrator and the DON because this was abuse, and she called 911 for police and EMTs. She said Resident #2 seemed loopy and could not get out of the bed, so they helped her to a chair. She said normally Resident #2 was able to walk very well, and she walked all the time, but she was having trouble walking. She said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 6 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #2 was hugging herself and shaking when the ADON got her back into her own bed, and the ADON stayed with her. She said the DON stayed on her cell phone with her while she called the police, and that Resident #1 would not allow them into his room or talk to them. The police came and spoke with Resident #1, then with her, and she gave them her version of what happened. LVN B said Resident #2 was not able to make decisions about things like that for herself, but she was very passive, and easily influenced, and if she needed her to be somewhere she just said Come on (Resident #2's name), let's go and she would go right along with her. She did not believe Resident #2 would ever be seeking out drugs or sex, and she had never shown any idea of those things, in the time she had known her. She had never had any sort of sexually related behaviors. She said Resident #1 had a history of going on pass and doing drugs and Resident #2 never left the building except with her family, and never went out to the tree to be with other residents. She mostly just kept to herself. She said that Resident #1 was a sick person and on the night of 09/06/25 he was hanging his entire torso out his window, and smoking something that made his room and the hall smell terrible. When she told him to stop, he swore at her. She said he did that a lot, and was very threatening. She reported it to the Administrator and the night staff. The Administrator told her to call the police. She had been told that Resident #1 had earlier gone into a men's room, looking for a female friend and when RN A and LVN C told him no, it was a men's room, he said it was her (identity of her unknown) room. RN A and LVN C redirected him back to his room after that, and they watched him go all the way to his room. She reiterated that she felt Resident #1 was a sick person and that something was very wrong with him, and he was very perverted. She said when she notified Resident #2's family member, because she was able to get her to do things, she talked to her and got her to go to the hospital. Later Resident #2's family member and Resident #2's POA came to the facility and they had Resident #1's phone with them, and wanted to know where Resident #2's phone and wallet was. Resident #1 was there and told Resident #2's POA Give me my phone and the POA asked Resident #1 how Resident #2 even had his phone. Resident #1's response when Resident #2's POA asked him if he did that (sex) to Resident #1 was it lasted maybe 10 minutes and it's not a big deal and everyone is making a big deal about it. LVN B said Resident #1 said they (he and Resident #2) went in the room and it didn't last long and that everyone was acting like they didn't know what a man and woman being together was. She said Resident #2's POA called the police and her family member was in tears. She said she explained to Resident #1 that Resident #2 was not mentally equal to him, and he responded that she was older than him, and she explained it was not about age, it was about her mind. She said she did not know why someone did not go watch Resident #1 after he tried to go into rooms in the middle of the night. She said she had been so stressed over Resident #1's behavior that she had to take some time off. She said Resident #1 had talked about a lot of things that made her uncomfortable, and been very threatening toward her. She had asked him to turn his loud music down once, and close his door, because it was night, and people were sleeping, and he said he was going to get somebody's cousin to fuck her up. She said she talked to the Administrator about it, but he just said they could call the police but they probably would not do anything. She told the DON she did not feel safe there, and took some time off. She said they moved her to a different nurses station, but it did not help. She said Resident #2's only real behavior problem was that she was a little bit of a klepto and would go into rooms and pick up other people's things, and she collected the water pitchers, and things like that. The only time she ever heard of her going into a man's room was because she wanted to take something she saw, not because it was a man's room. She said the resident probably had no idea whose room it even was. She said Resident #2 probably did not even know Resident #1's name. She said she felt like Resident #1 was really (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 7 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete bad, and the Administrative staff should have taken him more seriously before this. An interview on 09/07/25 at 4:58 PM with the Hospital SANE revealed she had just seen Resident #2, and examined her for possible sexual assault. She said the resident could not remember what happened or answer any questions about it, so the information she got came mostly from her family. She said she did a full head-to-toe assessment, taking pictures of anything she found, and swabbed her for DNA. She said the only injury she found was some redness on her face , which her family said was not normal for her, but that lack of injury did not necessarily mean lack of assault. She said Resident #2 did not remember at all what happened, and did not seem particularly upset. An interview on 09/07/25 at 6:38 PM with RN A revealed Resident #1 was trying to go into a man's room on the night of 09/06/25, and he and the other nurse (LVN C) told him to stop trying to go into rooms because it was late and people wanted to rest. He said he was aware of Resident #1 and another resident who had recently been discharged having a consensual sexual relationship, and he had reported it to the DON and Administrator. He said both residents were fully alert and oriented and able to consent. He said he was not aware of Resident #1 trying to have sex with any other resident. He said they were near the nurses station at the front door (at the opposite of a hall from Resident #1 and Resident #2's rooms) at the time, and watched Resident #1 go all the way down the hall, and into his room. He said it was about 4:00 AM on 09/07/25 when that happened. He said around 4:45 AM Resident #2 was in bed, with the light on, which was normal for her. He said at that time, Resident #1 was in his room, sitting in his wheelchair, watching TV. He said Resident #2 had never had any sexual behaviors, or shown any interest in drugs, that he was aware of. He said they had done training on abuse and neglect, including sexual abuse, and what consent meant, and he did not know if Resident #2 would be able to give consent, but Resident #1 was able to consent. He said Resident #2 could remember bits and pieces of things that happened years ago, but was not able to remember recent things because her short-term memory was very poor. He said he did not think someone with poor short-term memory would be able to give informed consent, which meant a person was able to understand the implications of their decisions. An interview on 09/07/25 at 7:03 PM with LVN C revealed he was working at the station by the front door, on admitting a resident, when he heard the call on the intercom that there was a missing resident, so he went to the other nurses station. He said he checked in Resident #2's room, and she was not there so he went room to room and found Res[TRUNCATED] Event ID: Facility ID: 455881 If continuation sheet Page 8 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 that an allegation of abuse was reported immediately but not later than 2 hours after the allegation was made if the events that caused the allegation involved abuse to Health and Human Services for one (Resident #3) of twelve residents reviewed for abuse and neglect. The facility failed to report an allegation by Resident #3 (a discharged resident) that Resident #1 put drugs in a beer he gave her on 08/31/25 or 09/01/25. This failure could place residents at risk of being abused and lack of oversight by a state agency. Findings included: Review of Resident #1's admission Record, dated 09/08/25, reflected he was a [AGE] year-old male, admitted on [DATE], with diagnoses of paraplegia (loss of voluntary movement and sensation in the lower half of the body), depression, anxiety, cerebral infarction (stroke), and traumatic brain injury (sudden injury to the brain usually caused by a blow or jolt to the head.) Resident #1 was his own responsible party. Review of Resident #1's MDS, dated [DATE], reflected Resident #1 was able to understand others, and be understood by others, and had a BIMS score of 14, indicating he was cognitively intact. He exhibited no signs of delirium or psychosis, and was not depressed, but did sometimes felt socially isolated. He had no behaviors during the assessment period. Resident #1 used a wheelchair for locomotion, and needed little assistance with his ADLs. Resident #1 required partial to moderate (helper does less than half the effort) assistance with toileting, showering, and lower body dressing. He required only supervision or touching assistance with personal hygiene and upper body dressing. Resident #1 was able to move himself around in bed, and sit and lie down with no assistance. Review of Resident #1's Careplans reflected the following care plans:07/24/25 for impaired comprehension related to his history of traumatic brain injury- 08/22/25 for potential for disruption of continuity of care related to signing himself out of the facility to gather off the facility property with other residents to smoke and socialize-08/25/25 for a psychosocial well-being problem related to a history of drug and alcohol use Review of Resident #1's psychological services note, dated 09/05/25 reflected he was seen for hallucinations and delusions. The document noted that Resident #1 told the counselor that he had been served with a 30-day discharge notice due to alleged drug use, but denied using drugs. The document also noted that he provided inconsistent information and had difficulty articulating or focusing. Review of a note on 08/31/25 at 1:10 AM by RN A reflected At about 12am, this writer and another nurse were doing nurse's rounds and observed that resident was in his room with another female resident with door slightly opened. Resident stated that we are just watching a movie. Shortly after, his door was closed and this writer and another nurse went to check on patient. When we knocked on patient's door, he answered and stated that i am enjoying myself. We observed both residents lying in bed having sex. We provided privacy. (Medical Director), Administrator and DON notified. Review of Resident #3's admission Record, dated 09/10/25 , reflected the resident was a [AGE] year-old female with diagnoses of bipolar disorder, anxiety disorder, COPD (a condition which makes it difficult to breathe) and post-traumatic stress disorder. Review of Resident #3's MDS assessment, dated 09/01/25, reflected Resident #3 was usually understood, and usually able to understand others. She had diagnoses of depression, mild cognitive impairment, and personal history of suicidal behavior. She had a BIMS score of 11, which indicated moderate cognitive impairment. During the assessment period she showed no signs of delirium, psychosis, or behavioral problems. She had one-sided impairment of her upper extremity, and was able to use her wheelchair with only supervision or touching assistance. Review of Resident #3's careplans reflected the following:- 03/15/25 a history of suicidal ideation (thoughts of killing oneself)- 03/15/25 impaired cognitive function(continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 9 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 03/17/25 impaired comprehension- 05/12/25 a history of verbal aggression with staff, residents and transport drivers, and socially in appropriate/ disruptive behavior, sexually inappropriate behavior, cursing, and throwing things.- 05/21/25 puts herself in dangerous situations, and rolling walker inside and outside, and wandering into unsafe situations re: cognitive status- 05/21/25 After discovering (Resident #3) was sexually [sic] she disclosed her triggers were men, and aggressive people. She also said that constant stares triggers her. An 08/31/25 note added to this careplan that on that date she was observed by a nurse having sexual relations with another resident. - 08/21/25 potential for disrupting continuity of care due to signing out and sitting outside socializing with other residents.08/25/25 history of alcohol and drug used, and goes out on pass regularly. A note added to this careplan on 09/01/25 reflected the resident called 911 and requested to go to the hospital as a result of another resident putting drugs in her beer when they were outside. Review of Resident #3's progress notes reflected the following: - A note on 08/31/25 at 3:10 AM by LVN C This resident was in room (Resident #1's room number) saying that she waswatching a movie with the resident who stays in room (Resident #1's room number). Shortly after, the door closed and when this writer and another nurse went there and knocked at the door, the two residents were in bed having sex. Then the resident who lives in room (Resident #1's room number) said, I am enjoying myself'. The residents were accorded [sic] privacy. (Medical Director's name), administrator and DoN notified. - A nurses note on 08/31/25 at 11:50 PM, writer unknown, reflected Resident returns from hospital for chest pain of uncertain cause. Patient is in stable condition BP: 118/76, HR: 65, SATS: 96% on room air, Temp: 98.1, no c/o pain and no s/s of acute distress (Medical Director's name) notified, will continue to monitor. - A note on 09/01/25 at 3:10 AM by RN A At about 2:00am, this writer and the nurse on C. hall knocked on resident's door. She stated go away (Resident #1) is here. The door was barricaded with their wheelchairs and trash can. (Medical Director's name), DON, and Administrator notified. Male resident finally cameout [sic] of her (Resident #3's room number) at about 2:30am. - A note on 09/01/25 at 6:29 AM, writer unknown, reflected CNA answered this resident's call light at this time andresident asked for a refill of Ice and stated to CNA I have the ambulance coming. The CNA notified this nurse and at that time a police officer walked into the facility. The officer stated So l'mhere [sic] for a (Resident #3's name). The officer went to speak with resident in her room. This nurse notified the Administrator and DON. The officer came outof the room stating to this nurse So she is saying the resident in room (Resident #1's room number) gave her a steel reserve last night and it didn't taste like normal beer. She said it tasted like some other chemicals were in it as wellmaking her chest hurt. The Administrator and DON notified of this information at this time. 0637am At this time (name of ambulance company) personnel walked into facility setting resident up for transport. (.) A note on 09/01/25 at 1:18 PM by LVN E This nurse called (name of hospital) ER and spoke to (name of hospital nurse) who stated All of the patient's labs were normal, so she was given tramadol and ASA , and discharged back to (name of facility). - A note on 09/02/25 at 12:29 AM by LVN D resident remains awake up in w/c sitting in room. states I filed a police report against male in (Resident #1's room number) for putting drugs in my drink the hospital did a urine screen and said i could get my records for the police tomorrow. im pressing charges and i want him arrested resident stated it all happened over the weekend i felt funny after I drank the drink but the hospital said i was ok and sent me back denies pain or distress at this time denies sob or discomfort im fine now this was yesterday nad [sic] noted tolerating snacks and po fluids well prn for pain effective. cont poc - A note on 09/08/25 at 7:00 AM by LVN E This former resident called at this time stating Y'all think it's a joke I'm filing a lawsuit against y'all nursing home. I was drugged by (Resident #1's name) and every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 10 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 since I been feeling like I was dying. I been in the hospital ever since I discharged . Tell the administrator and DON to give me a call please. The administrator and DON notified of this information. Review of change in condition documentation for Resident #3, dated 08/31/25 at 4:01 PM, reflected the resident had sharp musculoskeletal pain at a level 5 and tightness in her chest, with no shortness of breath, which started on the afternoon of 08/31/25, but resident was otherwise normal. Her blood pressure was 147/92, pulse 97, respirations 20, temperature 98.1, oxygen 96% on room air. It was noted that the symptoms stayed the same since the change in condition occurred. Resident #3 was sent to the ER. An interview on 09/09/25 at 1:17 PM with the ADON revealed she was aware that Resident #1 and Resident #3 had a consensual sexual relationship, and the staff had notified her that they observed them in bed having sex. She said she was also aware of the allegation that Resident #1 drugged her, and she was sent to the hospital for stomach pain and her body did not feel right since he put something in her drink. She did not know any more details, and was not aware of whether it had been reported to the state or not. She said whenever a staff member reported something to her that should also be reported to the DON and Administrator, she asked them if they reported it to the DON and Administrator, and the answer they gave was always Yes. An interview on 09/09/25 at 4:01 PM with the DON revealed she was aware that Resident #3 had made an allegation that Resident #1 put something in her drink. She said Resident #3 went to the hospital, and came back shortly after. She said her nurse called the hospital to find out results, and was told that they found nothing, and everything was clear, so they sent her back with some tramadol (a narcotic pain reliever.) She thinks that she and the Administrator did not report it, because there were no drugs in her system, and it did not happen. She said that Resident #3 called her on 09/08/25, and she could tell by the way she sounded that she was recording the call, and she said that they put her out and she was mad about Resident #1. The DON said she reminded Resident #3 that she wanted the discharge and they tested her at the hospital and she had no drugs in her system, and the resident hung up on her. An interview on 09/12/25 (post-exit) at 9:53 AM with the Administrator revealed he heard about Resident #3 making an allegation that Resident #1 drugged her third party . He did not say who told him, or when he heard about it. He said he heard that it happened off-site, when both residents had signed out of the facility. He did not know if it was under the tree where the residents hung out, or somewhere else. He did not report it, because it happened off-site, and there was no proof. He said that whether he reported something that happened off-site would depend on the situation. He gave an example of an incident from a previous building he worked in, where a resident returned and said that their family member had left them in the car by themselves. He said something like that, they would probably look at reporting. He said if the resident had spoken to him directly, he would have talked to his advisors and found out whether it needed to be reported. He said he attempted to talk to her about it, and she swore at him, flipped him off, and told him he was no kind of manager and come the third (of September) she would be gone, and that was going to be it. He did not document that he attempted to speak with her. He said some days she would be pleasant and speak to him, but most of the time she made it well known that one of her big triggers was talking to men in authority, and she did not like talking to them. He said the police came, and wanted to talk to someone named (name not belonging to any residents or staff at the facility) , and he told them there was nobody there by that name. He said somehow it was determined it was Resident #3, and they went out under the tree and spoke to her, and left. The police did not ask him anything, or speak with him about anything, so he did not know what the conversation was about. He said he was not notified of her call on 09/08/25. Review of the policy Abuse Prevention Program, revised December 2016, reflected Policy Interpretation and Implementation: As (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 11 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 part of the resident abuse prevention, the administration will: (.) 7. (.) and report any allegations of abuse within timeframes as required by federal requirements;(.) Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 12 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Some 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 observation, interviews and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs and describes the services that are to be furnished in order attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being for five (Residents #1, #8, #9, #11, and #12) of eight residents reviewed for care plans related to sexual activity with other residents. The facility failed to create care plans addressing known sexual relationships between residents for Residents #1, #8, #9, #11, and #12. This failure could affect residents by placing them at risk for not receiving care and services to meet their needs. Findings included: Review of Resident #1's admission Record, dated 09/08/25, reflected he was a [AGE] year-old male, admitted on [DATE], with diagnoses of paraplegia (loss of voluntary movement and sensation in the lower half of the body), depression, anxiety, cerebral infarction (stroke), and traumatic brain injury (sudden injury to the brain usually caused by a blow or jolt to the head.) Resident #1 was his own responsible party. Review of Resident #1's MDS, dated [DATE], reflected Resident #1 was able to understand others, and be understood by others, and had a BIMS score of 14, indicating he was cognitively intact. He exhibited no signs of delirium or psychosis, and was not depressed, but did sometimes feel socially isolated. He had no behaviors during the assessment period. Resident #1 used a wheelchair for locomotion, and needed little assistance with his ADLs. Resident #1 required partial to moderate (helper does less than half the effort) assistance with toileting, showering, and lower body dressing. He required only supervision or touching assistance with personal hygiene and upper body dressing. Resident #1 was able to move himself around in bed, and sit and lie down with no assistance. Review of Resident #1's Careplans reflected the following care plans:- 09/07/25 for sexually inappropriate behavior with another resident.- The care plans did not include any other care plan related to sexual behavior or relationships. Review of Resident #8's admission Record, dated 09/10/25, reflected the resident was a [AGE] year-old male admitted on [DATE], with diagnoses of epilepsy, depression, and mild cognitive impairment. Resident #8's family member was listed as his responsible party. Review of Resident #8's quarterly MDS assessment, dated 09/01/25, reflected the resident had a BIMS score of 11, which indicated moderate cognitive impairment. He was usually understood by others, and usually understood others. Resident #8 exhibited no signs of delirium or psychosis during the assessment period, and had no behavioral problems. Review of Resident #8's care plans, dated 09/03/25, reflected the following:- Resident was at risk for altered status due to a traumatic life experience, due to being raped as a young child.- Resident was a registered sex offender and must be supervised when he goes out on pass in a child safety zone.- The care plans did not include any other care plan related to sexual behavior or relationships. Review of Resident #9's admission Record, dated 09/10/25, reflected the resident was a [AGE] year-old male admitted on [DATE], with diagnoses of schizoaffective disorder (a mental health condition having symptoms of schizophrenia and a mood disorder), major depressive disorder, and generalized anxiety disorder. Resident #9 was listed as his own Responsible Party. Review of Resident #9's quarterly MDS assessment, dated 08/29/25, reflected the resident had a BIMS score of 10, which indicated moderate cognitive impairment. Resident #9 was usually understood by others, and usually able to understand others. Resident #9 had fluctuating inattention and disorganized thinking during the assessment period, and no behavioral problems. Review of Resident #9's care plan, dated 09/04/25, reflected the following:- Resident has a history of frequently accusing other male residents that he is (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 13 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Some fixated on and (who he doesn't like) of raping his female companion, even though his female companion clearly states that I never told him that. That has never happened to me.- (Resident #9) experiences disorganized thinking due to Schizophrenia. He frequently makes false accusations againstothers. If he does not get his way he becomes angry and curses at others. He tries to manipulate staff into getting hisway. He recently has begun to say that people are beating the crap out of my girlfriend.- The care plans did not include any plan related to sexual behavior or relationships. Review of Resident #11's face sheet, dated 09/10/25, reflected the resident was a [AGE] year-old male, admitted on [DATE], with diagnoses of diffuse traumatic brain injury with loss of consciousness of unspecified duration (a type of traumatic brain injury that results from blunt injury to the brain which can lead to loss of consciousness), major depressive disorder, and bipolar disorder. Resident #11 was listed as his own Responsible Party. Review of Resident #11's quarterly MDS assessment, dated 07/01/25, reflected the resident had a BIMS score of 11, which indicated moderate cognitive impairment. Resident #11 was usually able to be understood by others, and usually able to understand others. Resident #11 had fluctuating disorganized thinking and no behavioral problems during the assessment period. Review of Resident #11's care plans reflected no care plans related to sexual behavior or relationships. Review of Resident #12's face sheet, dated 09/10/25, reflected the resident was an [AGE] year-old female admitted on [DATE], with diagnoses of chronic kidney disease, mood disorder, and bipolar disorder. She was listed as her own Responsible Party. Review of Resident #12's quarterly MDS assessment, dated 08/07/25, reflected the resident had a BIMS score of 08, which indicated moderate cognitive impairment. Resident #12 was usually able to understand others, and usually able to be understood by others. Resident #12 exhibited no indicators of psychosis or delirium and had no behavioral problems during the assessment period. Review of Resident #12's care plans reflected no care plans related to sexual behavior or relationships. An interview on 09/07/25 at 6:38 PM with RN A revealed Resident #1, and Resident #3 (a resident who was discharged on 09/03/25) had a consensual sexual relationship, and that both of them were alert and oriented, and able to give or refuse consent. An interview on 09/07/25 at 7:03 PM with LVN C revealed he witnessed Resident #1 and Resident #3 in Resident #1's room, having sex, and that he believed they had a consensual relationship. An interview on 09/08/25 at 10:14 AM with Resident #7 revealed she had a boyfriend in the facility who had moved out of town, and now Resident #8 was her boyfriend. She said they were sexually active together, and the nurses talked to them about condoms and how to be safe and all that. An interview and observation on 09/08/25 at 10:20 AM revealed Resident #9 and Resident #10 seated next to each other. Resident #9 said This is my lady, my girlfriend. This alerted Resident #10 to wake up from her apparent nap, and say Yes, this is my boyfriend. An interview on 09/08/25 at 11:10 AM with the DON revealed she was aware of Resident #1 and Resident #3 having a consensual sexual relationship before Resident #3 discharged . She said if residents were both in their right minds, and consenting, the staff provided privacy. She said she thought it was careplanned, and she knew it was for Resident #7, who had a boyfriend who was transferred to another facility, before she was with Resident #8. She said they provided condoms for those residents, and when they had a younger female resident having sex, they talked about sexual health and safety (birth control, diseases, etc.) She said their residents were adults, and did not ask permission to do it, they just decided in the privacy of their rooms to do it, and they did it. She said when staff learned they were sexually involved with each other, and if they were both consenting adults, they offered them condoms, and privacy. An interview on 09/08/25 at 11:25 AM with the Administrator revealed he was aware of Resident #1 and Resident #3 having a sexual relationship. He said it was consensual, and they both had private rooms, and he talked with both of them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 14 of 15 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 455881 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dfw Nursing & Rehab 900 W Leuda St Fort Worth, TX 76104 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete He said he thought the staff talked to residents about consent and safe sex. A telephone interview on 09/09/25 at 9:43 AM with Resident #3 revealed she denied having any relationship with Resident #1, and when asked about the staff witnessing them having sexual contact, she said the staff were lying. When asked if the staff talked to them about consent and safe sex, she said they did not, because they were not having sex. An interview on 09/09/25 at 1:17 PM with the ADON revealed she was aware of some of the residents having sexual relations with each other. She said aside from Resident #1 and Resident #3, they had Residents #9 and #10 who had originally asked to be in a room together, but at some time were moved to separate rooms, but she did not know if they requested that, or it was some other reason. She said Resident #11 actually brought Resident #12 from another facility because she was his girlfriend, and they used to room together, and are still a couple, though they do not room together any more. She said Resident #7 and Resident #8 were a recent couple. She said she heard about it from staff who told her they go out on dates, and sometimes come back drunk. She said Residents #7 and #8 were signing out once for overnight, and she asked when they expected to return, and Resident #8 said in the morning, when the room they had arranged closed. She told them she did not feel it was a good idea for them to be gone overnight, because of his health condition, but he just asked What are you going to do when we get married? She notified his responsible party, and the responsible party said she hoped they did get married so they could take her name off the contact list. She did not know of any official assessment, but she thought the management team was aware of all of the relationships. She thought there were probably care plans in place for them, but she was not sure. An interview on 09/09/25 at 2:45 PM with the MDS Coordinator revealed he had been told to do acute careplans about resident relationships, but it had been a long time ago. He said the ADON and DON did most of the acute careplans about things like sexual activity. He said that even though he had not done careplans for all of them, he had been requested to do a quick BIMS assessment on residents before, as part of an assessment of them to decide if they were competent to make the decision to be in a sexual relationship. An interview on 09/09/25 at 4:01 PM with the DON revealed she had done careplans on residents for relationships before. She said the careplans for relationships, if she knew about them, would probably fall to her, and the Social Worker could also do them, but she never thought to care plan the couples having sex. She said she would have to take a look at the individual careplans, and that the careplans were important because the staff would know how to care for residents, and what the interventions were for helping them reach their goals. Review of the policy Care Planning - Interdisciplinary Team, revised September 2013, reflected Policy StatementOur facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. 2. The care plan is based on the resident's comprehensive assessment and is developed by a Care Planning/Interdisciplinary Team (.) 3. The resident, the resident's family and/or the resident's legal representative/guardian or surrogate are encouraged to participate in the development of and revisions to the resident's care plan. (.) The policy did not directly address acute careplans for issues not covered by the resident's comprehensive assessment. Event ID: Facility ID: 455881 If continuation sheet Page 15 of 15