Health inspection·July 8, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few attempt to determine underlying cause. Consider location, time of day, persons involved, and situations; Document behavior and potential causes; and praise any indication of [Resident #2's], progress/improvement in behavior. [Resident #2] is risk for falls (Date Initiated: 01/23/25). Interventions included Be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed; and Staff x 2 (two persons) to assist with transfers. [Resident #2] has a pressure ulcer or potential for pressure ulcer development (Date Initiated: 01/23/25). Interventions included Incontinent care after each episode and apply moisture barrier; and Use lifting device, draw sheet, etc., to reduce friction. Review of Resident #2's digital Visual/Bedside Kardex Report, printed on 06/08/25, reflected Safety, Skin Integrity, Bathing, Eating/Nutrition, Toileting, Transferring, Personal Hygiene/Oral Care, Dressing, Mobility, Bladder/Bowel care needs. Resident #2's Bladder/Bowel needs required incontinent care at least Q2H and apply moisture barrier after each episode. Resident #2's Toileting needs reflected Apply barrier cream after every incontinent episode; Check resident every two hours and assist with toileting as needed; Incontinent care after each episode and apply moisture barrier; and Provide peri-care after each incontinent episode. Resident #2's Mobility needs reflected Bed Mobility: requires staff x1 (one person) for assistance; [Resident #2] used a wheelchair. Resident #2's Transferring needs reflected Staff x 2 (two persons) to assist with transfers. During an observation and interview on 06/08/25 at 4:10 PM revealed Resident #2 lying flat on her back in bed. Resident #2's head rested on one pillow, a sheet and blanket covered her up to her chest. LVN I informed Resident #2 that she would perform a head-to-toe skin assessment. Resident #2 acknowledged understanding and agreed. When LVN I pulled the covers back, Resident #2 wore a pink shirt and an adult brief (diaper). Resident #2's adult brief appeared dry when pulled back by LVN I to observe the skin at the groin area. LVN I checked Resident #2's upper body, below the waist, front side of legs and feet. LVN I asked Resident #2 to assist with sliding to the right side of the bed to turn onto her left lateral side to allow LVN I to visualize the back side and complete the skin assessment. LVN I asked Resident #2 to raise her head, bend her (left) knee and push down with her (left) foot while LVN I grasped the slide sheet placed underneath Resident #2 and pulled her closer to the right side of the bed. Resident #2 required assistance of two CNAs (CNA J and CNA H) to roll from lying on back to left side and return to lying on back in bed. Resident #2 had a lighter area at the right back upper side of the thigh and below the crease beneath the buttocks that appeared as a healed area from a previous pressure injury. Resident #2 verbalized discomfort at the body site when LVN I applied pressure. LVN I told Resident #2 that it was old scar tissue. Resident #2 did not present with any impairments in skin integrity or first stages of pressure damage (warmth or redness that did not blanch with applied pressure) over a bony prominence. After the staff left the room Resident #2 agreed to an interview. Resident #2 was alert and oriented to self, time of day, surroundings, and situation. Resident #2 answered questions directly, with good recall of immediate and past events. Resident #2 indicated the staff provided incontinent care about 10 minutes before the investigator entered the room. She said that the staff applied barrier cream to her buttocks. Resident #2 stated her shower days were Tuesday, Thursday, and Saturday. She said the last time she received a shower was on Wednesday (06/04/25). She said that she did not receive a shower on Thursday because she had one on Wednesday (the day before) and staff did not offer a shower on Saturday (06/07/25). Resident #2 reported if she wet herself overnight she often had to wait until the next morning for incontinent care. Resident #2 said that she feared her skin will become raw from sitting in a urine-soaked diaper. Resident #2 said that on 06/03/25 she had to wait in bed until after 11:00 AM for staff to provide incontinent care and remove the urine-soaked diaper. Resident #2 denied other concerns. During (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 2 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few an interview on 06/08/25 at 5:03 PM, LVN I said that she was the Unit Manager. LVN I said that she was not the charge nurse assigned to Resident #2, but leadership asked if (LVN I) would perform the head-to-skin assessment. LVN I said that she did not notice any skin concerns during the assessment. LVN I said that the area (at Resident #2's right back upper side of the thigh and below the crease beneath the buttocks) was old scar tissue. LVN I explained that old scar tissue occurred from a previous completely healed pressure injury. LVN I said that it was common for a resident to complain of pain or discomfort at a healed site. LVN I said the facility, nursing best practice, and as the Unit Manager expectations for a nurse to assess the skin area a resident complained of pain or discomfort, especially at an area where a pressure injury can develop. LVN I said that Resident #2 sat up in her wheelchair for lengthy periods of time during the day and had to be reminded to relieve pressure to her lower area to prevent pressure injuries. LVN I said that Resident #2 had a pressure relieving pad in her wheelchair (observed by investigator). During an observation and interview on 06/09/25 at 6:40 AM, Resident #2 was in bed lying on her back with head propped on a pillow. Resident #2 wore the same pink shirt she had on the day before; a sheet and blanket covered her. Resident #2 awakened when the investigator called her name. Resident #2 said that the night staff did not change her clothes for bed. Resident #2 said that she was currently wet and uncomfortable. She said that she did not receive incontinence care since last night . more like early this morning around 1:00 AM. Resident #2 said no one came back to provide incontinent care before the change of shift (06/09/25, 6:45 AM - 7:00 AM). Resident #2 said she told the staff that she was itching when they came in around 1:00 AM and the nurse administered medicine (PRN for itching). Resident #2 said the medication for itching made her fall into a deep sleep. Resident #2 said that she pressed her call button once overnight (06/08/25 - 06/09/25) and staff must have come in the room after she fell back to sleep and turned the call light off and never asked what she needed (Resident #2 looked over at the wall where a red light illuminated when the call button was pushed, and it was not lit). Resident #2 said that staff often came in after she fell asleep and turned the call light off without asking why (Resident #2) pressed the call button. During a continued interview and observation of Resident #2 on 06/09/25 at 7:31 AM, the investigator asked Resident #2 to press her call button. Resident #2 had a hand contracture carrot (therapeutic device, shaped like a carrot, used to treat hand contractures) in her right hand. Resident #2 reached over her right shoulder with her left hand to reach the call button and pressed it. The panel on the wall where a red light illuminated when the call button was pushed, turned on. The investigator stepped out the room to ensure the call light system over door light located above Resident #2's door in the corridor was functioning. The light illuminated a white color. At 7:33 AM, CNA L entered the room, turned off the call light, and asked how she could assist Resident #2. Resident #2 informed she was wet. CNA L acknowledged and said she would be back. At 7:43 AM, CNA L returned with CNA K and supplies to provide incontinence care to Resident #2. CNA L stated Resident #2 required two staff for assistance with incontinence care. Observation of incontinence care revealed Resident #2's brief had a visible wetness indicator stripe on the front center of the brief. When CNA L pulled the brief back the inside was heavily soiled with a pale-yellow urine and the borders of the brief were wet. CNA L had to gently pull the wet brief from Resident #2's skin that stuck due to wetness. There was a wet area on the sheet underneath Resident #2 when turned to the left lateral side. There was no redness, rash, or signs of skin breakdown at Resident #2's perineal area, buttocks, or upper inner thighs. CNA L noted the soiled sheet and said she needed to change the linen on the bed. CNA L and CNA K completed incontinence care, assisted Resident #2 to a comfortable position in bed and placed call button within reach. Resident #2 did not present behavior that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 3 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated rejection of care. During an interview on 06/09/25 at 8:00 AM, CNA L indicated that she worked the 7AM - 3PM shift. CNA L said that she reviewed the resident's Kardex located in the chart to know the resident's level of function and care needs. CNA L said that Resident #2 was a one-person assist with ADLs but required two staff to assist with transfers. CNA L asked CNA K to assist with care because she did not always provide direct care to Resident #2 and was not sure about (Resident #2's) level of functioning. CNA L said that staff should check if needed and provide incontinence care at least every two hours or sooner. CNA L stated checking and changing residents who were incontinent every two hours kept residents comfortable and prevent skin breakdown. During an interview on 06/09/25 at 3:44 PM, the DON stated that Resident #2 was a 1 - 2 person assist. The DON said that it depended on who provided care if 1 or 2 people needed to assist. The DON said that Resident #2 could not fully assist with repositioning and turning during care. Resident #2 needed one-person staff assistance with incontinence care and two persons for transfers. The DON said that nurses should communicate resident needs to the CNAs and ensure the CNAs performed care. The DON said that Resident #2 could be changed into a dry brief and would be wet again. When asked the facility protocol and expectations for incontinence care, the DON replied that it was the facility's goal to maintain or improve a resident's current level of functioning and was unaware Resident #2 did not receive toileting services overnight as directed. The DON said the risks to residents if staff did not perform incontinence care timely, at least every two hours, was skin breakdown and impacted a resident's sense of dignity. The DON said that Resident #2 would refuse showers, and it was care planned to follow up with Resident #2 if refused and provide a bed bath. The DON said that she expected staff to conduct rounds every two hours to assist residents to the restroom or perform incontinence care or more often if a resident was a heavy wetter. The investigator requested a policy on Incontinence Care that outlined incontinence care frequency, care planning, and daily care (reflected on the visual/bedside Kardex). On 06/09/25 and 06/10/25, the investigator requested an Incontinence Care policy to identify how often staff should check a resident for wetness if incontinent, care planning, and daily care. The DON stated that regional leadership informed her that there was not a specific policy that outlined the details requested regarding incontinence care. The investigator acknowledged understanding. The DON provided a policy titled Perineal Care that outlined the procedure when perineal care was provided. Record review of the facility's policy titled Perineal Care created 04/25/2022, effective 05/11/2022, revealed the following: An incontinent resident of urine and/or bowl should be identified, assessed, and provided appropriate treatment and services to restore as much normal bladder/bowel function as possible. Skin problems associated with incontinence and moisture can range from irritation to increased risk of skin breakdown. Moisture may make the skin more susceptible to damage from friction and shear during repositioning. Purpose - This procedure aims to maintain the resident dignity and self-worth and reduce embarrassment by providing cleanliness and comfort to the resident, preventing infections and skin irritation, and observing the resident's skin condition. Event ID: Facility ID: 455895 If continuation sheet Page 4 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and records review the facility failed to ensure each resident received adequate supervision and transferred in a safe manner to prevent an accident for one (Resident #1) of four residents reviewed for accidents and hazards, in that: The facility failed to provide Resident #1 with adequate supervision and assistance with transfers to prevent an accident. On 05/14/25, Resident #1 had an unexpected or unintentional incident, which resulted in an injury to her left knee when transferred by two CNAs from the bed to a dialysis chair. On 05/19/25, the facility sent Resident #1 to the hospital after an x-ray of the bilateral (both) knees, dated 05/16/25 , revealed a possible acute nondisplaced fracture (the bone did not move when the fracture occurred) . follow-up x-rays or CT scan is recommended. On 05/19/25, Resident #1 had surgery to her left distal femur (lower part of thighbone, located just above the knee joint) to repair the fracture. An IJ was identified on 06/20/2025 at 1:30PM. The IJ template was provided to the facility on at 1:30 PM. While the IJ was removed on 06/20/2025 at 9:45PM, the facility remained out of compliance at a scope of Isolated and severity level of no actual harm with a potential for more than minimal harm due to the facility's need to complete in-service training and evaluate the effectiveness of the corrective systems. This failure placed residents at considerable risk of significant injury, harm, and/or impairment. Findings included: Record review of Resident #1's 5-day MDS Assessment, dated 05/29/25 reflected an [AGE] year-old female who admitted to the facility on [DATE]. Resident #1 had an admission history and diagnoses of CHF ([congestive heart failure] a chronic condition where the heart is unable to pump blood effectively, leading to a buildup of fluid in the lungs and legs); seizure disorder; CKD dependent on dialysis; and age-related physical debility. A BIMS score of 11 suggested Resident #1 had a moderate cognitive decline. Resident #1 had no behavioral symptoms or rejection of care behavior during the MDS review period. Resident #1 was dependent of staff assistance with ADLs and was frequently incontinent of bladder and always incontinent of bowel. Resident #1 was at risk for pressure ulcers/injuries. Record review of Resident #1s comprehensive care plan, printed 06/09/25, reflected the following: [Resident #1] has surgical site to the left knee and left thigh (Date Initiated: 05/23/25). Interventions included Observe for s/s of infection and Observe for s/s of pain during treatment and medicate PRN per physician's orders. [Resident #1] has an ADL Self Care Performance Deficit (Date Initiated: 03/31/25). Interventions included Bed mobility: requires staff x1 for assistance; Encourage the resident to use bell to call for assistance; and Transfer: require a Mechanical Lift as a Mechanical Aid and 2 staff members to assist in transfers (Date Initiated: 05/20/25 by DON); [Resident #1] has a history of making false accusations/fabrications on staff, refusal of care, and refusal of medications (Date Initiated: 03/31/25; Revision on: 05/27/25). Interventions included Educate [Resident #1/RP/CG] of causative factors and measures to prevent false accusations; and Monitor/document/report and Psych Services to eval and treat as needed. Record review of Resident #1's active physician orders reflected:- Order date 03/28/25: Acetaminophen Oral Tablet 325 mg. Give 2 tablets by mouth three times a day for Pain. Give 2 tablets to equal 650 mg, not to exceed 3000 mg a day. [Discontinued 05/19/25] - Order date 03/28/25: Resident to have pain consult with pain management NP to assess for pain medication needs and /or modifications. [Discontinued 05/19/25] - Order date 03/28/25: DIALYSIS DAYS MONDAY-WED-FRI [Discontinued 05/19/25] - Order date 03/28/25: NO BP/BLOOD DRAW OR FINGER STICK TO RIGHT ARM [Discontinued 05/19/25] - Order date 03/31/25: Anticoagulant Monitoring: monitor for signs and symptoms of adverse reaction: . rash . tissue necrosis . hemorrhage . purple toe syndrome, Increased fracture risk with long term use. Every shift. [Discontinued 05/19/25] Order date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 5 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 05/16/25: Xray of left Femur 2V (two views), Bilateral (both sides) Hip 2V, and Left Tibia & Fibula (the bones that make up the lower leg) 2V. - Order date 05/15/25: Tylenol Extra Strength Oral Tablet 500 mg. Give 2 tablets orally every 8 hours as needed for Pain. Two tablets to equal 1000 mg. - Order date 05/22/25: Norco tablet 5-325 mg. Give 1 tablet by mouth every 6 hours as needed for Pain. - Order date 05/23/25: Cleanse left knee surgical site with wound cleanser, pat dry apply Betadine then cover with protective dressing change every Tuesday - Thursday and as needed. Every day shift every Tuesday, Thursday for wound care. - Order date 05/23/25: Cleanse left thigh surgical site with wound cleanser, pat dry apply Betadine then cover with protective dressing change every Tuesday - Thursday and as needed. Every day shift every Tuesday, Thursday for wound care. - Order date 05/23/25: PT to eval and treat. - Order date 05/23/25: PT to eval and treat as indicated. PT Clarification: Patient to receive skilled PT services 3x/week for 60 days. Order date 05/27/25: [Provider Name] may provide psychiatric services. - Order date 05/23/25: Acetaminophen Oral Tablet 325 mg. Give 2 tablets by mouth three times a day for Pain. Give 2 tablets to equal 650 mg, not to exceed 3000 mg a day. - Order date 05/23/25: Resident to have pain consult with pain management NP to assess for pain medication needs and /or modifications. Record review of Resident #1's May 2025 MAR did not reflect a nurse initial that indicated Tylenol Extra Strength Oral Tablet 500 mg. Give 2 tablets orally every 8 hours as needed for Pain. Two tablets to equal 1000 mg were administered to Resident #1 on 05/15/25 for pain as needed. The MAR revealed that Resident #1 received Acetaminophen Oral Tablet 325 mg. Give 2 tablets by mouth three times a day (9AM, 1PM, 5PM) for Pain as ordered; except on Mondays at 9:00 AM when Resident #1 was at dialysis. On 05/14/25, Resident #1 did not receive the Acetaminophen dose on Wednesday, 05/14/25 at 9:00 AM or 1:00 PM. A comment was not entered in the comment section to explain why the doses were not administered. Record review of Resident #1's admission Fall Risk assessment dated [DATE], completed by ADON B, reflected a score of 12 that suggested Resident #1 was a High Risk for falls. Record review of Resident #1's progress notes indicated the following:- 05/15/25 at 9:20 PM, RN E documented [Resident #1] complained of pain to the left leg when turned/repositioned. pain started today. Assessed resident for injury. No injury noted. Resident moaned when left leg is moved. notified NP. Received order for x-ray, 1000 mg Tylenol . Administered Tylenol . - 05/16/25 at 8:12 AM, RN E documented X-ray results for left tibia/fibula, right femur received and relayed to NP. All results were negative. No new orders received. - LATE ENTRY (entered on 05/20/25 at 5:34 PM) effective date 05/16/25 at 4:28 PM, ADON B entered an Event Note: Level of pain 7 out of 10; Resident c/o (complained of) pain. X-ray of left femur (thigh), bilateral (both) hips, and left tibia and fibula (the two bones that make up the lower leg). - 05/17/25 at 2:33 PM, RN F documented New order STAT of x-ray of bilateral knees. [Resident #1] complained of pain to knee. - 05/19/25 at 12:00 AM (midnight), RN F documented Received bilateral knees x-ray result with impression that there is possible acute nondisplaced fracture of the distal left femur and relayed it to NP (on call for PCP), new order received to transfer to hospital for evaluation and treatment. Non-emergency transportation called. Night nurse to follow up. Limited movement initiated and maintained to left leg. - 05/19/25 at 1:25 AM, RN P documented [Resident #1] was transferred to hospital by [non-emergency transportation] for abnormal x-ray result. - LATE ENTRY (entered on 05/27/25 at 3:03 PM) effective date 05/20/25 at 5:17 PM, DON entered Received report at 1:31 PM from [hospital] that [Resident #1] has a nondisplaced fracture of distal femur and would be having surgery to repair. Record review of Incident Report #805, dated 05/15 /25 3:46 PM, completed by RN E indicated the incident occurred in the Resident's Room Incident description: Resident complained of pain in left lower leg when turned/repositioned. Resident description: Resident stated that the pain started today. When asked if she fell, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 6 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few she stated No. When asked if anyone hurt her she said No. When asked what happened her reply was that she didn't know her knee just started hurting. Immediate Action Taken: Assessed resident for injury. No injury noted. Resident moaned when left leg is moved. No s/sx of distress noted. Notified NP. Received order for x-ray bilateral hips, left femur, tibia, fibula. 1000 mg Tylenol every 8 hours PRN. Administered Tylenol 1000 mg to relieve pain. Level of Pain: 5. Record review of Resident #1's x-ray results dated 05/15/25 at 8:16 PM reflected examination of the left tibia/fibula, right femur, and bilateral hips had no evidence of an acute fracture. The reading physician (physician responsible for reading x-ray results and report impression of findings) read the results on 05/15/25 at 9:30 PM. Record review of Resident #1's x-ray results dated 05/16/25 at 1:46 PM reflected examination of bilateral knees that revealed a possible acute nondisplaced fracture of the distal left femur seen. The reading physician (physician responsible for reading x-ray results and report impression of findings) read the results on 05/16/25 at 3:25 PM. Record review of Resident #1's hospital visit summary (05/19/25 - 05/22/25) revealed Resident #1 admitted on [DATE] at 1:33 AM. The admission diagnosis reflected femur fracture. The admitting physician documented that [Resident #1] chief complaint was severe left leg pain. The admitting physician's history and physical summary indicated [Resident #1] . landed on her left knee 5 days ago. She had left knee x-ray done 2 days ago that showed possible knee fracture and acute nondisplaced fracture of left distal femur. [Resident #1] has persistent and worsening left lower extremity pain prompting them to send her to our ED for further evaluation. CT left lower extremity showed nondisplaced distal femoral fracture [Final Result time 05/19/25 at 2:22 AM]. Orthopedic surgery was consulted with plan to proceed with surgery at this morning [05/19/25]. Record review of a facility submitted SRI dated 05/20/25 and a 5-day PIR (Provider Incident Report)dated 05/27/25 reflected the internal investigation was UNFOUNDED. The 5-day PIR included written and signed witness statements from RN F, Resident #1 signed by ADON A, and TT C. The facility conducted In-services dated 05/20/25 on ANE, Resident Rights, and Change of Condition Notification. Record review of a written statement dated 05/19/25, RN F wrote On 05/14/25, [Resident #1] went to dialysis, came back and did not tell (RN F) about having pain. At 3:30 PM, the assigned CNA (CNA G) informed (RN F) and RN E at the nurse's station that [Resident #1] was complaining about pain to her left (knee) leg. RN E and (RN F) quickly went to see (Resident #1), assessed her. [Resident #1] said that she had pain to her left (knee) leg. RN E had already assumed his afternoon shift and he acknowledged to call the doctor and (RN F) left for home. RN F signed and dated (05/19/25) the statement. Record review of an undated written statement, ADON A wrote [Resident #1] stated that her leg started to hurt last Wednesday when 1 male and 1 female picked her up under her arms to put her in the chair for dialysis. She said her leg dropped and she told them it hurt. She went to dialysis and when she came back the nurse gave her pain medicine. Resident #1 and ADON A signed the statement. ADON A wrote Writer next to her name. Record review of an undated written statement, TT C wrote On Wednesday, 14th May 2025, (TT C) was called to assist to transport [Resident #1] to dialysis den (facility area where in house dialysis is given)for her dialysis schedule. (TT C) and a female aid transferred her from bed in the transport chair without moaning or groaning or complaint of pain, neither did any of her body part was dropped or rub against any hard surface. She was successfully and comfortably transported to dialysis den. TT C signed the statement. During an interview and record review on 06/08/25 at 1:44 PM, the NFA stated that he assisted the former administrator with completing self-reports before her last day worked for the facility. The NFA said that he was not the administrator over the facility at the time of the incident. The NFA said that he called in the self-report on 05/20/25 and completed the 5-day provider investigation report (PIR) on 05/27/25. Record review of the 5-day (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 7 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few PIR reflected . An x-ray was ordered; no confirmed injuries were found initially, but the resident was sent to the hospital for further evaluation. The hospital determined the resident had a non-displaced distal femur fracture and will undergo surgery. The NFA said that he was unaware that the x-rays that resulted no confirmed injuries were of the hips, the right thigh, and the left lower leg. The NFA said that he did not know that there was a second set of x-rays done STAT on 05/16/25 of Resident #1's knees and the findings determined the possible non-displaced fracture and that was why Resident #1 was sent to the hospital but not until 05/19/25. The NFA said that he reported the investigation the way the DON informed him. During observation and interview on 06/08/25 at 3:42 PM, Resident #1 was lying in a left lateral position in bed. Resident #1 was oriented to self, situation, and time of day (with prompts). Resident #1 with fair recall of immediate and past events. Resident #1 stated two (unidentified) staff dropped her on her (left) knee when transferred from bed to dialysis chair prior to going to dialysis. Resident #1 said that the staff transferred her from the bed by lifting her under her arms to the dialysis chair. Resident #1 said she told the staff that they hit her knee on the floor and her knee hurt. Resident #1 said that the nurse administered pain medicine when she returned from dialysis. Resident #1 said that the male staff pushed her to dialysis in the dialysis chair. Resident #1 said she had to go to the hospital and had surgery to her knee. Resident #1 said that she still had stitches in her knee and had an appointment to follow up with the surgeon to remove the stitches. There were no fall mats noted on the bedside floor or in the room. Resident #1 denied she had a fall and restated that staff dropped her on her (left) knee during a transfer. During an interview and record review on 06/09/25 at 2:06 PM, the DON said that she learned about the x-ray results of Resident #1's knees that indicated a possible acute fracture during the morning meeting on 05/19/25. The DON said that there were previous x-ray results that were negative. The DON said that she told the staff to send Resident #1 to the hospital by non-emergency transport to get a second opinion of the x-ray results and she immediately implemented an internal investigation. The DON said that Resident #1 never told staff how she hurt her knee. The DON said that staff did not report a fall and Resident #1 never told staff that she fell or that someone hurt her. The DON said that Resident #1 was wheelchair bound and needed staff assistance to transfer. Record review of the 5-day PIR reflected [Resident #1] initially reported left leg pain during repositioning by staff. When asked what happened, [Resident #1] was unsure and denied any fall. With further questioning, she mentioned a fall at dialysis. When asked the dialysis staff they denied any fall. [Resident #1] stated she had been dropped in her room, but staff involved in her care denied any fall. When asked her again [Resident #1] changed her story and said there was no fall in the room and that it might have occurred while being transferred to a chair at dialysis. She eventually retracted this as well stating she had not fallen but her leg dropped a little . The DON said that she sent ADON A to the hospital to interview Resident #1 (on 05/19/25) after the hospital informed Resident #1 would have surgery to repair the fracture of the left knee. The DON said that ADON A reported that Resident #1 said that two staff members dropped her knee to the floor when transferred from the bed to the dialysis chair. The DON said that Resident #1 just had surgery and was still under the influence of anesthesia and had ADON A return to the hospital the next day (05/20/25) to interview Resident #1 again and [Resident #1] told a different story. Continued record review of the undated written statement signed by Resident #1, written and signed by ADON A, reflected . 1 male and 1 female picked her up under her arms to put her in the chair for dialysis. She said her leg dropped and she told them it hurt. She went to dialysis . The DON said that ADON A obtained the statement from Resident #1 at the hospital on [DATE], but Resident #1 changed her story. When asked if staff should pick a resident up under her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 8 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few arms to transfer, the DON replied, absolutely not. The DON demonstrated how the staff transferred Resident #1 from the bed to the dialysis chair. The DON said that TT C and CNA D clasped each other's arms like a bridge underneath Resident #1's legs and to support Resident #1's back, lifted her up off the bed and placed in the dialysis chair. The DON said that TT C was very tall, and CNA D was short. The DON said that the only thing she can figure that happened was CNA D may have bumped Resident #1's leg on the floor because the transfer was uneven, but it could not cause a fracture. The DON said that she consulted with the PCP (also the Medical Director) and he told her that he reviewed some old medical records and found that Resident #1 had brittle bones from osteoarthritis. Record review of Resident #1's admission record and admission MDS did not reflect an admission history or diagnosis of osteoarthritis. The diagnosis of Unilateral osteoarthritis resulting from hip dysplasia, right hip, entered during stay and the onset date reflected 05/15/25. The DON said that TT C was a CNA but was employed as the van driver. She could not think of the name of the female CNA (CNA D), but a statement was provided with the 5-day PIR. The investigator verified there was not a statement by a female CNA. During an interview on 06/10/2025 2:13 PM, the DOR said that she was familiar with Resident #1 who received physical therapy services effective 05/23/25. The investigator explained to the DOR the transfer technique used for Resident #1 the DON described and demonstrated. The DOR replied that she never heard of a 2-person transfer technique by clasping arms together to lift someone in a seated position. The DOR said that the therapy department educated staff on supervision with assisted devices and transfers whenever a resident received physical therapy services to ensure understanding on how to assist the resident. The DOR said the only transfer techniques are 1- and 2-person transfer with a gait belt and a mechanical lift. During an interview on 06/10/25 at 2:30 PM, RN F said that he worked 7A - 3P during the week. RN F said that he was familiar with Resident #1 as he was always her assigned nurse. RN F said that Resident #1 was weight-bearing during transfer. RN F said that Resident #1 required a gait belt for transfer and could stand from a seated position on the bed and step then pivot to sit in a wheelchair or dialysis chair. RN F stated that a CNA would bring the dialysis chair from the dialysis den (a room where residents go to receive dialysis by a third-party dialysis provider) to the resident's room, transfer the resident to the dialysis chair, and then push the resident to the dialysis den in the dialysis chair. RN F said that he assisted Resident #1 to bed when she returned from dialysis (Wednesday, 05/14/25) and she did not complain of pain to the left knee. RN F said that Resident #1 usually received dialysis in the morning and returned to her room shortly before or sometimes after his shift ended. RN F said on 05/15/25, CNA G approached the nurses' station and reported Resident #1 complained of pain of her left leg. RN F said that it was shift change and he had given hand-off report to RN E. RN F said that he accompanied RN E to Resident #1's room and observed RN E assess Resident #1. RN F said that RN E said that he would notify the doctor and RN F left. RN F said that he received hand-off report on 05/16/25 that Resident #1 had x-rays done for complaint of pain. RN F said on 05/16/25, he reviewed the x-rays and saw that they were of the right and left hips, the left lower leg, and the right thigh. RN F said that he called the x-ray company and asked where the results for Resident #1's left knee were. RN F said that the x-ray representative said that the results were of the areas ordered. RN F said that he was sure that Resident #1 complained of knee pain, obtained an order for a STAT x-ray of Resident #1's right and left knees and notified the x-ray company. RN F said that the x-ray company came out on 05/16/25 to do the x-rays. RN F said on 05/17/25 the facility did not receive Resident #1's x-ray results before the end of his shift at 3:00 PM. RN F said that he worked on Sunday, 05/19/25 from 7:00 AM to 11:00 PM. RN F said that he checked for Resident #1's x-ray results that morning and the facility still had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 9 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few not received the x-ray results. RN F said that he followed up with the x-ray company. RN F said that he checked the x-ray company site for the results at the end of his shift, 05/19/25 at 11:00 PM, and the results were posted in the portal. RN F said he saw that Resident #1 had a fracture, called the PCP to obtain an order to send Resident #1 to the hospital for further evaluation. RN F said that he contacted the non-emergency transport company and gave hand-off report to the on-coming nurse (RN P). During an interview on 06/10/25 at 2:51 PM, the Medical Director said that the DON notified him that she initiated an internal investigation of an unknown injury for Resident #1. The Medical Director said that the DON inquired how could [Resident #1] sustain a fracture if the staff denied there was a fall. The Medical Director said that he reviewed Resident #1 past medical history and discovered that she received injections to increase bone formation for osteoporosis back in 2014. The Medical Director said that he provided the health information to the facility to determine factors that could cause the injury if Resident #1 did not fall. The Medical Director emphasized that Resident #1's past health history was not his viewpoint or his determination for the fracture. The Medical Director said that Resident #1's osteoporosis was stable and was not of concern to her left lower extremity. The Medical Director said that it would require force to sustain the non-displaced fracture to Resident #1's distal femur. The Medical Director stated it was probable when asked by the Investigator if an inappropriate and/or unsafe transfer technique could cause the fracture. On 06/10/25 at 4:30 PM, the DON handed the investigator a copy of an email received from the x-ray company dated 06/10/25 at 4:25 PM and a copy of the staffing schedule dated 05/14/25. The DON said that she remembered who the female aide (CNA D) was and that was her name and phone number written on the schedule. The DON said that CNA D was no longer employed at the facility. The DON said that CNA D called off because she had a family emergency and never returned so the facility had to terminate her. Record review of the email received from the x-ray company revealed that the x-ray order of Resident #1's knees was placed on 05/16/25 at 8:32 AM; the order was confirmed 05/16/25 at 9:32 AM; the x-ray tech performed the x-ray on 05/16/25 at 1:32 PM; and the images were sent to the physician who reads the x-ray results on 05/16/25 at 1:56 PM. The email indicated that the results were not uploaded to the facility because of an error and was manually uploaded to the facility on [DATE] as a significant finding after notified that the results were not received. Record review of the schedule dated 05/14/25 reflected CNA D assignment was on a different hall than Resident #1 resided. The schedule reflected a code next to CNA D's name that indicated she was out due to emergency and did not work that day. During an interview on 06/10/25 at 5:25 PM, TT C said that he was the van driver for the facility and did not interact with residents from day-to-day except to transport to and from appointments. TT C said that he heard his name called out in the hallway (05/14/25) while he was getting a resident from their room to take to an appointment. TT C said a female (did not know who the female was) asked him to assist CNA D to transfer Resident #1 to dialysis. TT C said that he entered Resident #1's room and CNA D was standing beside Resident #1 (on the left side) who was sitting on the edge of the bed. TT C said that Resident #1 had on a (facility provided) gown. TT C said that CNA D placed a gait belt around Resident #1's waist and he grabbed the front and the back of the gait belt to lift Resident #1 up and placed her in the dialysis chair. TT C replied no when asked if he reached under Resident #1's arms to lift her when he assisted CNA D to transfer Resident #1 to the dialysis chair. TT C said that he was not sure if the gait belt slipped up under Resident #1's arms when he lifted her up because the belt was too loose. When asked if Resident #1 stepped or walked to the dialysis chair, TT C said no, we lifted her and placed her in the dialysis chair. When asked if Resident #1's feet raised off the floor when he and CNA D lifted Resident #1 to transfer from the bed to the dialysis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 10 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few chair, TT C said that he did not recall. TT C said that he did not know the female aide (CNA D) or her name. During an interview on 06/10/25 at 5:56 PM, RN E said that he was the charge nurse for Resident #1 on the 3PM - 11PM shift. RN E said that CNA G notified him of Resident #1's leg pain on 05/15/25 during shift change around 3:30 PM. RN E said that Resident #1 was in bed when he entered the room to assess Resident #1. RN E said that he assessed Resident #1 thighs and hips for bruising, swelling, or any signs of trauma from a fall and there were no signs of injury. RN E said whenever he tried to reposition Resident #1 or touch the left leg, she cried out and asked not to move her. RN E said that Resident #1 demonstrated decreased mobility of the left leg and she did not usually complain of pain. RN E said that he asked Resident #1 if she fell or if anyone hurt her and she denied. RN E said he asked staff if anyone saw her fall and staff replied that she was bed all day. RN E said that he asked Resident #1 when did the pain start and she replied today (05/15/25). RN E said that he did not remember if he asked what [Resident #1] was doing when the pain started or asked what could have caused the pain. RN E said that he completed an incident report after he spoke with his supervisor (could not recall exactly who he spoke to) about Resident #1 pain. RN E said that it was decided to complete an incident report because Resident #1's complain of pain was unusual. An outbound call on 06/10/25 at 5:00 PM and at 6:30 PM to CNA D was unanswered. The investigator left a message on the voicemail to return call. CNA D did not return the call before the Investigator exited the facility on 06/10/25 at 8:00 PM. Record review of the facility's Safe Patient Handling/Transfer undated policy reflected in its entirety the following: The facility has a program to promote and assure safe patient handling for both the resident and the employee. The policy includes identification, assessment and interventions to provide a comfortable, safe transfer, repositioning and resident movement.1. Nurses will identify residents in need of transfer, repositioning or movement assistance.2. Nurses will assess the risks associated with lifting, transferring, repositioning or movement assistance.3. nurses will be educated in the identification, assessment and control of risks of injury to resident and nurses during patient handling.4. Resident will be evaluated on admission and as needed for alternative means of lifting.5. Nurses will be educated regarding correct safe handling procedures, to report concerns or the inability to perform resident handling or movement that the nurse believes in good faith will expose a resident or nurse to an unacceptable risk of injury.6. Facility staff will report to supervisor the inability to complete resident lifting, transfer, or repositioning if they feel it will either endanger the resident or cause injury to staff.7. Nursing will request therapy disciplines to evaluate resident ability to assist and amount of assistance needed with lifting, repositioning, transferring or mobility.8. Position a gait belt around the resident's waist and clasp it. Make sure it is tight enough that only a slight hand movement will guide the patient, but not so tight that you cannot firmly grasp the belt without making the patient uncomfortable. The NFA was notified of an Immediate Jeopardy (IJ) on 06/20/2025 at 3:00 PM, due to the above failures and the IJ template was provided. The facility's Plan of Removal (POR) was accepted on 06/20/2025 at 7:11PM and included: Plan of Removal for 6/20/25 Problem: F689 Free from Accidents/Hazards The facility failed to provide adequate supervision and assistance to prevent accidents. Interventions: As of 6/10/25, CNA A was in-serviced 1:1 by the DON. All other nursing staff were in-serviced on the same topics by the DON/ADON/Director of Rehab. Completion date will 6/10/25. CNA B is no longer employed with the facility. In-serviced Admin / DON by regional nurse and Area director of operations on gait belt transfers, abuse/neglect, notification of change of condition, and resident rights. Resident #1 was assessed for any additional injuries by DON/ADON on 6/10/25. No additional injuries noted. All other residents that require assistance with transfers were assessed for injuries on 6/10/25 by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 11 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete DON/ADON/Charge nurse. No additional injuries noted. Following the Kardex in Point Click Care for all transfer status and assistance required with return demonstration from staff. Gait belt transfers with return demonstration. Abuse and Neglect (Improper transfers) education Notification of change of condition education Resident Rights education completed 6/10/25 Fall Prevention Policy will be completed 1:1 with CNA A as of 6/10/25 by the Regional Compliance Nurse. This in-service will include reporting to the charge nurse immediately if a resident suffers a fall, has an accident, or is found on the floor. If the charge nurse is not available, staff will report to DON immediately. Staff will not assist a resident off the floor until a charge nurse has been notified and assessed the resident. As of 6/10/25 audits were completed. All residents in the facility received head-to-toe assessment/ pain assessment by the DON/ADON/Tx Nurse for any injuries and/or fractures. No additional issues were found. On 6/10/25, all resident care plans were reviewed and audited for accuracy of transfer status and assistance by DON and ADON and if there is any change of condition- care plans will be updated accordingly. No issues were identified. On 6/10/25, DOR/designee initiated gait belt (1 to 2 person) and mechanical lift training and check offs with return demonstration. All nursing staff will be checked off prior to the start of their next shift. Training and checkoffs will be completed by DON/ADON/and Director of Rehab. The medical director was notified the immediate jeopardy potential by the administrator on 6/10/25. ADHOC QAPI was held with the Medical Director and facility inte Event ID: Facility ID: 455895 If continuation sheet Page 12 of 13 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 455895 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Five Points at Lake Highlands Nursing and Rehab 9009 White Rock Tr Dallas, TX 75238 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on record review, observations and interviews, the facility failed to assure that medications were secure and inaccessible to unauthorized staff and residents, for one (medication cart #1) of two medication carts observed for medication storage. On 06/09/25 at 7:53 AM, MT Q failed to ensure medications were secured or attended to by authorized staff when MT Q did not lock the medication cart (#1) before she walked away. This failure placed residents at risk of a potential for more than minimal harm if a resident accessed and ingested medications or drug diversion. Findings included: During an observation on 06/09/25 at 7:53 AM revealed a medication cart (#1) unlocked, unattended and not under direct observation of authorized staff. The lock was in the out position, and anyone could open the drawers and left the medications accessible. Various multi-dose bottles of OTC medications were organized in the top drawer of the medication cart. Residents' routine and PRN medications and medication blister packs were organized in other drawers of the medication cart. One resident was ambulating back and forth in the hallway during observation. At 7:55 AM, the Investigator observed MT Q walking towards the medication cart from approximately twenty-five feet away. During an interview on 06/09/25 at 7:56 AM, MT Q said she did not normally leave the medication cart I#1) unlocked when she walked away. MT Q stated she was only right there and pointed at a resident room down the hall, it was her fault, and she knew that leaving the medication cart unlocked and walking away should never happen. MT Q said she received training during new hire orientation. MT Q stated a resident could get a hold of medications and have an allergic reaction. During an interview on 06/09/25 at 12:31 PM, the DON who said that it was not acceptable to leave medication carts unlocked and unattended or not within direct line of site and arms reach for resident safety and to prevent drug diversion. The DON said if residents could access the medications, swallow a medication that they are allergic to, could have an adverse reaction. The DON said she would conduct an in-service about medication storage and safety. The DON stated surveillance of medication carts being locked were conducted regularly for quality assurance. Review of the facility's policy Medication Storage Storage of Medication, dated 05/16, reflected:- In order to limit access to prescription medication, only licensed nurses, pharmacy staff, and those lawfully authorized to administer medications are allowed access to medication carts. medication supplies should remain locked when not in use or attended by persons with authorized access. Event ID: Facility ID: 455895 If continuation sheet Page 13 of 13