Inspection·February 4, 2026

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some antipsychotic, antianxiety, antidepressant, antibiotic and anticonvulsant medications. Record review of Resident #1's care plan, initiated 12/29/23 and last revised 01/12/26, reflected the following areas focus areas: 1) Signs of disorganized thinking and auditory hallucinations (initiated: 03/09/24), 2) Has a female resident that he looked at as his companion (initiated: 03/27/24). Interventions included to administer medications as ordered, allow ample time to answer questions, introduce changes slowly and monitoring by nursing every hour for his whereabouts. Resident #1 also was care planned as having a history of behaviors, refused medication at times, had a history of aggressive behavior towards other residents when he is made fun of. Care planned dates of aggression incidents were 09/16/25 when he hit another resident thinking he was making fun of him and on 01/12/26 when he pushed another resident. Additional interventions included not to argue with Resident #1 and Assist [Resident #1] to selection of appropriate coping mechanisms, ensure that other residents are safe when [Resident #1] exhibits aggressive behaviors, Illicit help from family members when [Resident #1] has aggressive behaviors, Monitor and document [Resident #1's] behaviors, Notify PCP.Refer to psych services when exhibiting behaviors, Social services to evaluate and visit with [Resident #1], Talk to him in a calm voice when behavior is disruptive.Record review of Resident #1's Physician Order Summary reflected he was prescribed the following psychotropic medications: -Lorazepam 1mg three times a day for anxiety disorder (start date: 03/13/25) -Lexapro 10 mg once a day for depression (start date 04/30/24) -Lithium Carbonate 300 mg twice a day for bipolar disorder (start date 03/14/24)-Risperdal 2 mg once in the evening for schizophrenia (start date 09/24/25)-Divalproex Sodium 250 mg twice a day for schizophrenia (start date 09/24/25)-Mirtazapine 15 mg in the evening for mood/appetite (start date 04/29/24)Record review of Resident #1's December 2025 and January 2026 MAR reflected he was administered his psychotropic medications as ordered, however, he had periodic medication refusals throughout the two months as documented by the nurses and medication aides on the MAR. Record review of Resident #1's psychological services progress note, by LPC, dated 12/11/25, reflected he had no current risk factors, which included self-injury, sexual acting out, homicidal and aggressive behavior. His appearance was neat, judgement within normal limits and he was alert and oriented to person/place/time/day/year. His attention was average and he had restless psychomotor symptoms (connection between mental states and physical movement, manifesting as either extreme agitation or severe slowing). He had tangential speech and a sad, labile, anxious and stressed affect. His mood was worried and depressed and his speech was impoverished. Short-term therapy goals were for Resident #1 to verbalize feelings about his current situation during sessions, identify and discuss at least two positive coping skills, reduce frequency of behavioral disturbances by 50% for four weeks and he will report two positive social interactions daily that improve his mood. Resident #1's response to intervention per the clinician's notes was, Engaged and interactive in session. Met in day area, where he is isolating; acknowledged insight into mood changes when isolating. Praised pt for recognizing patterns and symptoms of avoidance/disengaging. Encouraged his progress with new awareness. Record review of a 30-day Discharge Notice for Resident #1, dated 12/12/25, reflected he was formally notified that he would be discharged from the facility on 01/10/26 due to 1) The safety of other individuals is endangered, 2)The health of other individuals in the Health Care Center is endangered, and 3) Your needs cannot be met by the Health Care Center.Record review of Resident #1's Psychiatric Subsequent Assessment, dated 01/07/26, by PMHNP reflected he was being seen for medication management. The assessment reflected, Collateral Information: According to staff, the resident refuses medications at times, exhibits sx of paranoia, auditory hallucinations and anxiety. Resident is currently on hourly checks due to behavioral concerns. An increase of 0.5mg added of Risperdal daily was added with a start (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 2 of 8 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 02/04/2026 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some date of 01/12/26 with no other changes recommended. The plan was continue with care and reassess in two weeks for a follow-up visit. A follow up visit by the PMHNP on 01/14/26 reflected Resident #1 was seen for a medication management visit. The assessment reflected, Collateral Information: According to staff, the residents [sic] an improvement in sx of anxiety, agitation and psychosis. Resident recently pushed a fellow resident without any apparent provocation and is currently on 1:1 monitoring. An increase of 0.5mg added of Risperdal daily had been added on 01/12/26. No other changes were recommended. The PMHNP documented she would revisit with Resident #1 to re-assess. Record review of Resident #1's social worker progress notes from 12/01/25 through 02/04/26 reflected the facility issued a 30-day discharge notice due to behavioral concerns on . The ombudsman was notified the same day via email and fax. The RP was informed and the appeal process was explained and a copy of the discharge notice was sent to the RP. On 12/16/25, the SW documented continued communication with the RP and efforts to secure alternate placement, including exploration of nursing home and group home options. On 01/12/26, the SW documented Resident #1 continued to refuse medications, became and exhibited screaming and yelling behaviors. EMS responded and Resident #1 was subsequently approved for a transfer to a behavioral hospital via an Order of Protective Custody (OPC), with a court appearance on 01/14/26 which was approved and the RP notified regarding the transfer. The SW progress notes, dated 01/21/26 through 02/06/26, reflected ongoing communication between the facility, the behavioral hospital and an external placement coordinator regarding discharge planning to a group home. Subsequent entries reflected confusion regarding discharge timing, coordination with the behavioral hospital and whether the group home was prepared to receive the resident at the time of discharge. Notes further reflected at one point, Resident #1 was discharged from the hospital without a clear confirmation that placement arrangements were finalized. On 02/02/26, a SW progress note reflected, I received a call from the patient's [RP], who reported that both the state and the ombudsman have been contacted due to concerns of abandonment. I clarified to her that, to my knowledge, the patient was in the process of transitioning to a group home, and that I had been working closely with the group home in this regard. The [family member] stated that she is no longer able to provide care for the patient and insisted that we need to take responsibility for him. I expressed concern to her regarding the patient's recent behavior, specifically the risk associated with the patient having physically assaulted another individual. I informed her that, given the current circumstances, the risk to other patients here is considered high.Record review of Resident #1's nursing progress notes from 12/01/26 through 02/04/26 reflected periodic behavioral concerns including medication refusals, yelling, wandering into other residents' rooms, verbal altercations and two documented physical incidents. On 12/26/25, Resident #1 was documented as deliberately bumping into the maintenance director with his shoulder and was placed on 1:1 observation. On 01/12/26, Resident #1 pushed another resident and was again placed on 1:1 monitoring. The PMHNP was notified after the incident on 01/12/26 and his dose of Seroquel (antipsychotic) was increased to 0.5 mg added in the morning. Resident #1 was subsequently transferred for inpatient psychiatric evaluation on 01/14/26. The nursing progress notes did not reflect the evaluation of increased anti-psychotic medication's effectiveness on Resident #1's behaviors or that identified behavioral interventions had been exhausted or determined ineffective.Review of TULIP database reflected no facility reported incidents related to Resident #1 and resident to resident abuse for the 01/12/26 incident pf physical aggression.An interview with Resident #1's RP on 02/04/26 at 10:05 AM revealed Resident #1 was currently at the behavioral hospital and had been there since 01/14/26. The RP stated the facility's SW would not accept Resident #1 back because he got into an altercation with another patient at the behavioral hospital, but that was before he got his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 3 of 8 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 02/04/2026 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some medication in him. The RP stated the behavioral hospital confirmed he hit a patient but did not jump on him (meaning he did not physically attack him). The RP stated she did not know why Resident #2 was sent to the behavioral hospital and only found out when someone from the hospital called her. She stated the facility did not tell her they were sending him there but stated her voice mail had been full. The RP stated she did not know what Resident #1 had done that warranted him having to be sent out but was told the resident was hearing things and needed to be evaluated. She stated while at the facility, there had been times when Resident #1 did not want to take his medication and she felt maybe he had become immune to his medications and was acting out. The RP stated she did not know anything about a group home placement. She stated, All I know is [nursing facility] referred him; you have to talk to [nursing facility] about that. The nursing home makes the decisions for [Resident #1] and they get paid to take care of him. She did not know that the behavioral hospital had tried to arrange transportation to take Resident #1 to a group home. She said she thought the behavioral hospital tried to take Resident #1 back to the facility and they refused him. The RP stated she could not take care of Resident #1 as she worked full time. She stated she felt like the facility had abandoned him by dropping him off at a behavioral hospital and telling him he was not allowed to come back. She stated Resident #1 was not cognitively able to agree to anything and she herself did not sign any documentation agreeing to any transfers or discharged . She stated she did not know anything about the facility's acquisition of an Order of Protective Custody for Resident #1. An interview with the SW on 02/03/26 at 12:50 PM revealed she had been employed at the facility for about two months and Resident #1 was already living at the facility when she started and was not initially identified as a concern. According to the SW, the resident did not immediately stand out to her, but concerns developed approximately a month later as she began interacting with him more directly. She described her early interactions with Resident #1 as troubling and stated she felt afraid of him from the beginning of those encounters. The SW stated Resident #1's demeanor alone felt threatening, even in the absence of overt verbal aggression. She stated he did not need to speak or act out physically to cause concern and said his presence, posture and eye contact was intimidating. She stated he spent much of his time in bed and was often withdrawn but when he became active, staff were immediately aware. The SW stated Resident #1 began walking the halls and entering other residents' rooms, sometimes standing over them while they were in bed. She stated this behavior caused fear among residents and staff and concerns were raised about the safety of other residents, particularly those who were vulnerable or cognitively impaired. The SW stated staff reported feeling uneasy and residents expressed fear when Resident #1 was mobile and roaming the halls. She stated the behaviors escalated to the point that 911 was called. She reported Resident #1 initially agreed to go to the hospital, but once outside the facility with EMS, he refused transport and EMS did not take him. The SW described the concerns prompting the call to 911 as behavioral rather than medical. Following these events, the SW stated she was instructed to seek alternate placement for Resident #1 due to the ongoing behaviors and safety concerns. She stated she made extensive efforts to secure a placement for him, contacting at least 15 nursing facilities, all of which declined and consistently indicated to her Resident #1's behaviors and refusal to take medications as reasons for denial. The SW stated she also attempted to pursue group home placement and worked with a group home contact. The SW said she kept Resident #1's RP informed throughout the process. The SW stated the RP acknowledged she could not care for the Resident #1 herself and did not mind the SW looking for alternate placements. The SW stated after discussions with the ADM, a 30-day discharge notice was issued on 12/12/25 while placement efforts continued. She reported due to escalating behaviors, an Order of Protective Custody (OPC) was obtained (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 4 of 8 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 02/04/2026 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and Resident #1 was transferred to a behavioral health facility. Following the transfer, the SW stated there were significant communication problems with the behavioral hospital. She stated she attempted repeatedly to contact hospital staff for updates regarding Resident #1's condition, medications and discharge planning but did not receive return calls. She said she was initially told Resident #1 was stable but later informed that he had allegedly assaulted another resident described as an elderly male. She stated details of the incident were unclear. The SW also stated she received conflicting information regarding whether Resident #1 had been transferred to a group home, returned to the behavioral hospital or discharged to his family member. She described the situation as confusing and difficult to track. The SW reported Resident #1's RP later contacted her and accused the facility of abandoning the resident and believed the facility should accept Resident #1 back. The SW stated the final decision not to accept Resident #1 back was made by the ADM. The SW stated there were ongoing safety concerns with Resident #1's behaviors, refusal to take medications and there was a lack of clinical documentation from the behavioral hospital regarding medication changes and condition at discharge or readiness to return. She stated no discharge paperwork or medication information was received from the behavioral hospital. An interview with ADON A on 02/03/26 at 2:06 PM revealed Resident #1 had behavioral issues related to mental illness such as paranoia, verbal outbursts, misinterpreting conversations as being about him, standing in residents' doorways and causing fear among some of the residents. ADON A stated she was aware of reports that Resident #1 attempted to strike another resident, though she did not personally witness any physical contact. ADON A stated the facility managed residents with serious mental illness through psychology and psychiatry services, including regular visits and medication management. She reported one-to-one supervision was implemented when a resident exhibited aggression or posed a safety risk. ADON A stated she was not involved in discussions regarding Resident #1's transfer to a behavioral hospital, the Order of Protective Custody or decisions regarding readmission or discharge. She stated those decisions were primarily handled by the DON and ADM and her involvement was limited. An interview with LVN D on 02/03/26 at 2:35 PM revealed she was familiar with Resident #1's baseline behavioral patterns and described him as cyclical with long periods of stability followed by periodic behaviors but occurring months apart. According to LVN D, early indicators of behavioral decline for Resident #1 included refusal of medications and increased verbal fixation on perceived accusations related to his sexual orientation. LVN D reported during these cycles, Resident #1 appeared to experience auditory hallucinations, often triggered by male voices, leading to defensive verbal outbursts. She stated while she could not speak for other shifts, she was personally able to redirect him and consistently get him to take his medication by giving one on one time and patience. LVN D stated she had not personally observed Resident #1 physically strike other residents or hit walls but was aware of reports he had attempted to hit another resident. She recalled personally observing him shoulder-bump a maintenance staff member without clear provocation. LVN D stated while Resident #1 was generally redirectable during her shift, she heard reports he stood in residents' doorways on other shifts, which caused fear among residents. LVN D if staff were unfamiliar with Resident #1 and did not understand his behaviors and de-escalation techniques that worked for him and his triggers, they might feel hesitant to intervene during those episodes. LVN D stated, If staff are afraid to step in, that's when things can escalate. She stated patience was the only thing that worked for him. LVN D stated she was not involved in management-level decisions regarding Resident #1's transfer, Order of Protective Custody or readmission decisions and was unaware of the criteria used to determine whether a resident could return to the facility. She stated those decisions were handled by management staff.An interview with CNA C on 02/04/26 at 11:30 AM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 5 of 8 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 02/04/2026 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some revealed Resident #1 was generally quiet and tended to remain in his room for much of the day. She stated for the majority of the time, Resident #1 was not highly social and did not regularly interact with other residents. When he did leave his room, it was typically to request coffee or to shower. She stated Resident #1 exhibited intermittent behavioral issues that were not constant or daily but occurred approximately once or twice per week. She described his primary behavioral concern as verbal outbursts related to paranoia, particularly believing that others were calling him derogatory names. CNA C stated these beliefs appeared to be internal to the resident and were not typically triggered by other residents or staff. CNA C stated when Resident #1 became agitated, he would sometimes verbalize his beliefs loudly, stating others were calling him names, even when staff attempted to reassure him no such comments had been made. She stated Resident #1 often could not be redirected once he became fixed on these beliefs. CNA C stated she had not heard of or seen Resident #1 entering other residents' rooms, standing over residents or intentionally frightening other residents during her shifts. She was not aware of any residents reporting fear of Resident #1 and indicated most concerns among staff related to unpredictability rather than ongoing aggression. She stated Resident #1 sometimes refused medications, particularly during periods of agitation. She stated certain staff members were more successful than others in encouraging compliance and de-escalation was commonly used. These strategies included offering coffee and redirecting Resident #1 or involving staff members with whom he was more familiar. CNA D stated that approaches to managing Resident #1's behaviors were not always consistent among facility staff and responses to him varied depending on the situation and staff working at the time. CNA D stated frontline staff were not always informed in advance of significant changes related to residents with behavioral concerns. She stated she was aware Resident #1 would be moved out of the facility but did not recall being provided advance details regarding the timing or destination. She indicated staff often learned residents had been transferred only after returning to work. CNA D stated she was not present on the day Resident #1 was transferred under an Order of Protective Custody and was not aware it had occurred until she came to work. She stated she did not receive detailed information regarding Resident #1's circumstances or subsequent discharge planning.An interview with the COO and C-RN on 02/03/26 at 3:10 PM revealed inpatient psychiatric hospitalizations were a stabilization attempt, not necessarily a permanent removal. The COO stated even when the behavioral hospital determined a resident was at baseline, that baseline may still be unsafe within the long-term care environment. The COO and C-RN stated decisions not to accept a resident back should involve facility leadership. If the facility determined a resident could not return, they stated the facility would then be responsible for assisting with alternate placement. The COO and C-RN stated their understanding was that group home placement had been arranged for Resident #1 from the behavioral hospital. An interview with the ADM on 02/04/26 at 12:15 PM revealed the concern that led to Resident #1 being issued a discharge notice on 12/12/25 was the ADM had heard some of the female residents had woken up and noticed Resident #2 was standing in their doorways saying he was not gay and to get off him, but he never touched any of them. The ADM stated, He [Resident #1] would say that he would never hit a woman and when I was there, he didn't. But residents became scared because he started changing and pacing the halls, which was normal, but he started saying he was not gay and he was no faggot. The ADM stated he knew Resident #1 had a stay in the penitentiary, so he did not know if maybe that contributed to his behavior. He stated everything with Resident #1 was manageable at first, the facility knew how to deal with him, did the right interventions psyche services. The ADM stated everything was good until Resident #1 started getting more into the staff's faces. The ADM felt it got to the point where he felt Resident #1 was acting more threatening and would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 6 of 8 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 02/04/2026 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some was getting closer to hitting someone. The ADM stated he had been an administrator for over ten years and I know eventually he was going to go over the top and we could not afford another resident-to-resident altercation again, so he had to go to a facility that could suit his needs. So we sent him to [behavioral hospital]. The ADM said he heard from the SW, Resident #1 had assaulted a staff member at the psyche hospital and they changed his medications, but they were not working. The ADM stated, He assaulted someone there and I said I would not let him stay at the facility because he was noncompliant with his meds at the psyche hospital. The ADM further stated, So I said we can't take him back. He didn't get the help he needed. They (behavioral hospital staff) wanted him to come back to the facility, they were telling us the time was up and they couldn't do anything with him. The ADM stated the facility SW talked to Resident #1's RP and found a group home that would accept him. Then the behavioral hospital dropped him off at the group home, but no one was there and neither the facility nor behavioral hospital coordinated with the group home about him coming. The ADM stated he heard the behavioral hospital said they were going to call in a complaint to HHSC because the facility was not taking Resident #1 back. The ADM stated, We said no need because we are actively working with you to get placement. We did everything we were supposed to do. He stated the SW found the group home and he thought Resident #1's RP knew the group home and wanted to be involved in the process, but when the time came for him to discharge from the psyche hospital, the RP did not want to take him there and took him home instead. The ADM stated, I may be confused, but I am pretty sure she said she would take him with her. The ADM stated he was under the impression Resident #1 was at home with his RP and We did not hear anything else about it. The ADM stated the first priority was to make sure residents felt safe and he did not feel the facility was equipped to take care of residents like Resident #1. The ADM stated, When you take a person who at any time could be a danger to any resident or staff member, they are going to cause you issues and headaches from day one and they will hurt someone and I can't afford that. The ADM stated the Order of Protective Custody was obtained by the facility because, We needed him out as soon as possible, any minute he was going to do something. The ADM said Resident #1 would not agree to go to a psyche hospital on his own and his RP did not want him to go either and wanted him to stay at the facility. The ADM did not know if the facility obtained updated clinicals for Resident #1 since his admission to the behavioral hospital for evaluation. He stated the facility typically did not send residents for inpatient psychiatric hospitalization that they were not planning on re-admitting. The ADM stated, We will not throw them away or walk away, we will help them find a placement. We are good with that due to the connections we have of knowing people all over. We are not going to make an unsafe discharge. He said Resident #1 needed psychiatric help.because we can't help him if [psyche hospital] cannot settle him down.An interview with the Director of Clinical Services/LCSW from the inpatient psychiatric hospital on [DATE] at 11:47 AM revealed Resident #1 was admitted on [DATE] due to hearing voices and becoming agitated when the voices would call him gay. The DCS stated the facility told her due to Resident #1's aggression at their facility, they had issued him a 30-day discharge notice and on the date of the discharge, they found a group home that would take him but when the group home placement agency came to the inpatient behavioral hospital to take Resident #1 to the group home, it was not in existence. Since Resident #1 was at the inpatient hospital, he became aggressive on 01/16/26 and 01/22/26. He was treated and an attempted discharge was attempted on 01/29/26, which the DCS stated was seven days without incident, which was standard for an inpatient stabilization. The DCS stated Resident #1 had not been violent since 01/22/26, But due to this placement issue, the patient started being inconsistent with his medications as he was upset the nursing home still has all of his belongings and is not allowing him (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455881 If continuation sheet Page 7 of 8 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 02/04/2026 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete back. This has been very triggering for the patient and has caused setbacks in his treatment. As a facility, we would require at least 72 hours of medication compliance prior to discharge to assure stabilization. She stated Resident #1 had been stable and had not had any additional outbursts and a discharge location was still pending. The DCS stated it was her understanding their social worker had spoken with the facility's SW and it was understood the facility would be accepting Resident #1 back until the facility could locate a placement, as his 30-day discharge notice was not up until 02/10/26 per her understanding. The DCS stated, In the case of the nursing home, since the patient was still legally their resident, they should be responsible for locating placement as we (nursing facility) were not a long-term facility and the patient's 30 day was not up. It appears they started this process, sent him to us, then stopped assisting the patient's family member once he was in our (nursing facility) care. Although the group home placement agency stated they were working with [facility SW], [facility SW] informed me on 1/29/2026 that she ‘had not set up a group home for the patient', indicating they did not attempt to locate safe placement for their patient from 1/10/2026 when the 30 day was issued until his admission here on 1/14/2026. The DCS stated the facility told the inpatient behavioral hospital staff they would not accept him back. She said her social worker was in contact with the facility and if she would have known, she would have been attempting to locate placement had she been told he was not accepted back. She said per the group home placement agency, who showed up to the behavioral hospital, on Resident #1's date of discharge, the group home was ready. The DCS stated, Then when we sent the patient there, the group home was a vacant home. The patient was brought back to my facility, [behavioral hospital SW] could not explain why the group home she came to divert the patient to was empty, and [facility SW] reports she didn't set up a group home. The patient's [family member] then called us (She had not responded to any contacts prior to this) and said the group home would be ready Saturday, 1/30, and agreed to pick the patient up. On Saturday, she refused and stated the group home won't be ready until March. The DCS stated similar situations had occurred with the facility where they would send residents and then decline to take them back. She stated there was no discharge planning assistance provided by the nursing home despite issuing 30-day notices. The DCS stated she felt the facility issued a 30-day notice to Resident #1 and did not do any discharge planning for him and sent him to an inpatient behavioral hospital for them to take on responsibility for him. She stated there was currently no clear plan for Resident #1's discharge, but Event ID: Facility ID: 455881 If continuation sheet Page 8 of 8