Health inspection·December 11, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few arms and on the left side of her forehead above her left eye and her dentures were broken. Both stated they asked the facility about the bruises and were told the bruise on her right arm was from a blood draw and then they were told about the incident with the nurse hitting the resident with the door. They stated they were told no one knew about the broken dentures. Both stated they were never notified about the resident receiving lab work or about the incident with the door or her broken dentures and felt they should have been contacted. In an interview with LVN K on 12/09/25 at 03:45 p.m., she normally worked double weekends and was on duty the weekend of 11/22/25 and did the admission on Resident #2. She stated the resident would wander throughout the unit and had wandered into a few other residents' room. She stated she was making round on 11/24/25 around 10:00 p.m. and knocked on Resident #2's door and then opened it. She stated the resident was standing behind the door and when she opened the door and contacted the resident. She stated the resident said ouch but stated she did not fall. She stated she assessed the resident and did not notice any bruises, cuts or injury and the resident denied any pain. She stated she should have documented the incident and put on the report but stated she just failed to do so. She stated she was going to tell the family when they came in the next day but stated she did not see them. She stated she had also noticed Resident #2 was taking her upper denture in and out and had wrapped it up in a napkin one day. She stated they placed the denture in a cup and would put them back in for her to eat but had not noticed they were broken. She stated the day the Speech Therapist came to evaluate her on 11/24/25 the Speech Therapist had brought the dentures to her and told her they were broken. She stated she placed the dentures in a cup and locked them in the medication cart. She stated she reported to ADON F about the broken dentures. She stated when the Resident's family came to pick Resident #2 up on 11/26/25 she was asked by ADON F about the bruise on her forehead and that was when she told him about the door incident. She stated she filled out an incident report which was what triggered the late entry in the progress notes about the incident. She stated she knew she was supposed to document any incident so they could observe for any delayed injury. She stated the resident did not appear to be injured in any way, but since she is on blood thinners it would not be unusual for a bruise to occur a few days later. She stated she also had a bruise on her right arm due to the routine lab draw that was ordered upon her admission. She stated that was their standing protocol for base line labs upon admission. In an interview with ADON F on 12/10/25 at 08:35 a.m., he stated he was notified by the Administrator about Resident #2's concerns when they came in on 11/26/25 to take her home. He stated he went and assessed the resident and noted a slight discoloration on her left eye lid but did not see anything on her arms or legs. He stated he immediately started asking the staff if she had fallen and was told by LVN K about the incident with the door on 11/24/25. He stated she should have completed an incident report and notified the family and the MD at the time of the incident. He stated it was nursing judgement on notifying immediately or could it wait until the next day if it was something that had occurred in the night. He stated since there was no apparent injury it would have been acceptable to notify them both the next day but stated it should have been documented at the time of the incident. He stated he was made aware of the dentures the same day he was told about the door incident. He stated the family should have been called when they first noticed the broken dentures. In an interview with Resident #2's MD on 12/11/25 at 09:06 a.m., he stated his expectation was to be notified of any incident that required monitoring or follow up. He stated hitting the resident with a door would need to be monitored for delayed injuries. He stated he had heard about the incident but was not certain if he was notified at the time of the incident or after it was brought to the facility's attention. He stated he does order routine labs on all new admission to obtain a base line but stated since she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 2 of 17 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 12/11/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete a respite only resident the labs should not have been ordered. He stated it was simply oversight when they put in the orders. In an interview with the DON on 12/11/25 at 11:00 a.m., it was revealed the staff was always to complete an incident report, notify family, physician and Administration so any incident could be evaluated to determine if it was a reportable event and to ensure timely monitoring and follow-up. He stated this was not typical of the staff failing to document and report an incident. He stated they had spoken to the Nurse, who admitted that she had failed to complete the necessary documentation and notifications. He stated she had been counseled. He stated this failure could result in delayed injury of resident with an unknown cause and it was their protocol to document all incidents and report as required. Record review of the facility's policy titled, Notifying the Physician of change in Status, dated March 2013, reflected, The nurse should not hesitate to contact the physician at any time when an assessment and their professional judgment deem it necessary.The facility utilized the INTERACT tool, Change in Condition-When to notify the MD/NP/PA to review resident conditions and guide the nurse when to notify the physician. This tool informs the nurse if the resident condition requires immediate notification of the physician or non-immediate/Report on Next Work day notification of the physician.The resident's family member or legal guardian should be notified of significant change in resident's status unless the resident has specified otherwise.The nurse will monitor and reassess the resident's status and response to interventions.The nurse will document all attempts to contact the physician, all attempts to notify the family and/or legal representative. Event ID: Facility ID: 455895 If continuation sheet Page 3 of 17 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 12/11/2025 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 1 of 7 residents (Resident #3). The facility failed to ensure Resident #3's room was free from hazards. This deficient practice could place residents at risk of living in an unsafe environment which could lead to falls and injuries.Findings include: Record review of Resident #3's Face Sheet, dated 12/09/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included muscle weakness and difficulty walking. Record review of Resident #3's Quarterly MDS assessment, dated 9/01/25, reflected a BIMS score of 15, an intact cognitive response. For ADL care, it reflected the resident required substantial assistance. Record review of Resident #3's Comprehensive Care Plan, dated 12/09/2025, reflected the resident was a risk for falls. In an observation on 12/09/25 at 11:40 AM, Resident #3 had a large extension cord running across the floor from her television on the wall to the outlet next to the side of her bed. The television did have an outlet on the same wall. Resident #3 had another extension cord connected to two fans located next to a wall in the room. The bed adjuster sitting on top of the resident's bed had exposed wires. In an interview and observation on 12/09/25 at 1:00 PM, the Maintenance Supervisor observed the extension cords connected in Resident #3's room and stated she should not have the extension cords because the resident could trip and fall from them. He stated he did not know who placed the extension cords in the resident's room. He stated the resident should have had American Power Conversion cords to connect the devices, instead of the extension cords. He stated he was going to get the APC cords for the resident's room. He also observed the exposed wires for the bed adjuster and stated it was a low shock but should not be exposed. In an interview on 12/10/25 at 9:42 AM, the Administrator was advised of Resident #1's room having the extension cords and exposed wires in the room. He stated he was not aware of this. He stated it was a team effort, and everyone should be paying attention to this, including maintenance. He stated the main risk to the resident was a fire could start and the resident could fall. Record review of the facility's policy on Resident Rights, undated, revealed The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this policy. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident. Event ID: Facility ID: 455895 If continuation sheet Page 4 of 17 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 12/11/2025 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 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 of 4 residents (Resident #5) reviewed for ADL care provided to dependent residents. The facility failed to ensure Resident #5 received any of her scheduled showers based on records reviewed for November and December 2025. This failure could place residents at risk of not receiving necessary services to maintain good personal hygiene, skin integrity, or decreased self- esteem.Findings Included: Record review of Resident #5's Face Sheet, dated 12/09/25, reflected she was an [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included Cerebral Infarction impacting left dominant side (stroke) and reduced mobility. Record review of Resident #5's Quarterly MDS assessment, dated 9/16/25, reflected a BIMS score of 14, an intact cognitive response. For ADL care, it reflected the resident required total assistance. Record review of Resident #5's Comprehensive Care Plan, dated 12/02/2025, reflected the resident was at risk for impairment of skin integrity and an intervention included keeping her skin clean and dry. In an interview on 12/09/25 at 12:05 PM, Resident #5 stated she did not receive her three scheduled showers a week and would be lucky if she got a bed bath. She stated she had not had a shower in over 5 weeks, prior to the shower she had received on 12/08/25. She stated she had to complain to leadership about not getting a shower and she was able to get one on 12/08/25. She stated she wanted her showers but was told by staff they did not have time. She stated the CNAs also told her the shower bed was broken. Record review of Resident #5's shower sheets for the month of November and December 2025 reflected the following:11/03/25: No indication of whether a bed bath or shower was provided.11/07/25: Refused11/19/25: Bed Bath12/04/25: Bed Bath12/05/25: Bed Bath12/08/25: Shower In an interview on 12/09/25 at 2:00 PM, LVN B was advised of Resident #5, only having shower/bath sheets for the dates previously stated. She stated CNAs rotated to different halls daily and the resident hall did not have a dedicated CNA. She stated the CNAs scheduled to work the A-hall, should check the shower schedule to see what residents were scheduled for showers for that day. She stated CNAs were supposed to turn in shower sheets at the end of their shift and the nurse assigned to the hall should check with the resident to confirm they had received their shower, and if they had refused, they were to attempt to persuade the resident to take one and contact the RP if they still refused. She stated if the resident did not receive their scheduled showers, they could have skin break down and stink. In an interview on 12/10/25 at 9:03 AM, LVN C stated he covered the hall of Resident #5. He stated the resident should receive a shower or bed bath at least three times a week. He stated sometimes the resident may refuse. He stated the resident should still have a shower sheet stating the resident refused and he attempts to talk them into getting a shower. He was advised of Resident #5 not receiving her scheduled showers and he stated the resident should receive her showers from the 3:00 PM to 11:00 PM shift. He stated he did not review the shower sheets to ensure the resident was not getting showers. He stated this was the ADON's responsibility. He stated the risk of the resident not receiving showers could result in skin breakdown and infections. In an interview on 12/10/25 at 9:48 AM, ADON E stated she managed the hall of Resident #5. She stated the resident should receive showers three times a week. She was advised of the shower sheets reviewed for November and December 2025, and the dates indicated a shower or bed bad was given. She stated the CNAs checked the shower scheduled to see who should receive the shower that day. The Nurses should check the shower sheets to ensure the resident was provided their shower. She stated she checked the shower sheet book weekly to see if showers were being given and she Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 5 of 17 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 12/11/2025 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 collected all of the shower sheets monthly. She stated she had not collected November's shower sheet yet to see if residents were getting her shower, so she was not aware of this. She stated the resident had not mentioned to her that she was not getting her showers. She stated the risk of residents not getting their shower was they could get sick, get an infection, and develop wounds. She stated all CNAs completed showers, and it was based on whoever CNA was assigned to the Hall during their shower schedule. Record review of the facility's policy on Bath, Tub/Shower, undated, revealed Bathing by tub bath or shower is done to remove soil, dead epithelial cells, microorganisms from the skin, and body odor to promote comfort, cleanliness, circulation, and relaxation. The resident will receive assistance with bathing according to their resident centered plan of care. Event ID: Facility ID: 455895 If continuation sheet Page 6 of 17 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 12/11/2025 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, interview, and record review the facility failed to ensure the resident environment remained as free of accident hazards as possible and failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 of 2 residents (Resident #1) reviewed for accidents and hazards. The facility failed to ensure adequate supervision and put measures in place to prevent Resident #1 who was at risk for eloping from the facility. On 09/29/25, Resident #1 eloped out of the facility and was found in a nearby hospital about 12 hours later. Resident #1 retuned back to the facility and continued on one-to-one supervision. The noncompliance was identified as Past Non-compliance (PNC). The Immediate jeopardy (IJ) began on 09/29/25 and ended on 09/30/25. The facility had corrected the noncompliance before the survey began. These failures could place residents at risk of potential accidents, injuries, harm, or death.Findings include: Review of Resident #1's quarterly MDS assessment dated [DATE] reflected Resident #1 was a [AGE] year-old male with an initial admission date of 8/18/2025. Resident #1 had a BIMS of 5 indicating he was severely cognitively impaired. He required partial assistance with walking and ADLs. His pertinent diagnoses included non-Alzheimer's dementia (forms of cognitive decline not caused by Alzheimer's disease), anxiety, hypertensive heart disease (refers to heart problems from long-term high blood pressure ), osteoarthritis ( a degenerative joint disease especially in hands, hips, knees, and spine), and psychotic disorder (a mental health condition causing a break from reality, characterized by symptoms like hallucinations and delusions, accompanied by disorganized thinking, speech, and behavior), Intervertebral disc degeneration (breakdown of discs that separate the bones of the spine). Resident #1's height was 72 inches and weight was 283 pounds. Record review of Resident #1's comprehensive care plan with revised date of 8/20/25 reflected, Focus: [Resident #1] is at risk for elopement as evidenced by: Lack of safety awareness and cognition impairment. Goal: [Resident #1] Will remain safe within facility unless accompanied by staff or other authorized person through review date. Intervention: [Resident #1] Assess/record/report to MD risk factors for potential elopement such as: Wandering, Repeated requests to leave facility, statements such as I am leaving I am going home, attempts to leave facility, elopement attempts from previous facility, home, or hospital will not leave facility unattended through the review date. Distract [Resident #1] from elopement attempts by offering pleasant diversions, structured activities, food, conversation, television, books . Record review of Resident #1's comprehensive care plan with initiation date of 09/29/25 and revised date of 10/28/25 reflected, Focus: Actual elopement: [Resident #1] left the facility unattended. Goal: To find [Resident #1] without harm and return him to the facility. Intervention: [Resident #1] Will remain safe in the facility, with no further elopements or elopement attempts, unless accompanied by staff or other authorized person through review date.Assess/record/report to MD risk factors for potential elopement such as: [Resident #1's] elopement or attempted elopement, Wandering, Repeated requests to leave facility, statements such as I am leaving I am going home, attempts to leave facility, elopement attempts from previous facility, home, or hospital. Staff to provide 1 on 1 Supervision, until discharge from facility. Record review of Resident #1's initial elopement risk assessment dated [DATE] reflected, [Resident #1] was placed on secured unit. [Resident #1] exhibits wandering behavior and is frequently exit-seeking. Resident identified as high risk for elopement. Safety measures in place and staff will continue close monitoring . Record review of Resident #1's progress notes by RN A dated 09/29/25 at 7:20 AM reflected At 11PM shift rounds, [Resident #1] was in his room. [At] 12.58 AM, [Resident #1] sat at the TV room. Rounds and checks were done. [At] 04:37 AM, [Resident #1] refused blood draw. At (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 7 of 17 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 12/11/2025 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 06:30 AM, nurse saw [Resident #1] sitting in the TV room, Nurse went to administer medication to a resident, and on coming back, [Resident #1] was not on his seat. Rooms were searched. Code orange ([NAME]) was called MD, ADON, Administrator notified. At 0655 AM, [Resident #1's] responsible party was notified that resident left the building without letting anyone know. Police were notified. Record review of Resident #1's progress notes by the Administrator dated 9/29/25 at 8:49 PM reflected, Notified Responsible Party that [Resident #1] is in the hospital and being evaluated. Medical director (MD) and Nurse Practitioner (NP) notified. Record review of Resident #1's progress notes by LVN K dated 9/30/25 at 1:47 AM reflected, [Resident#1] returned to the facility from the hospital in stable condition via ambulance. Upon arrival, resident was alert and oriented to baseline. Vital signs were obtained and remained within normal limits . No signs or symptoms of distress, discomfort, or pain noted. Resident was assisted to his/her room safely by the Emergency Medical Technician (EMT) and the nurse on duty. All discharge instructions and hospital documentation were received, reviewed, and placed in the medical chart. Medications were reconciled and orders updated as indicated. Responsible party and attending physician were notified of resident's return. Ongoing monitoring and plan of care continue. One-on-One monitoring/head count has been initiated. Bilateral dressings present to the posterior lower legs. Record review of Resident #1's Hospital notes dated 9/29/25 - 9/30/25 revealed [Resident #1] was found screaming for help while lying on an embankment by EMS (Emergency Medical Service) and transported to the nearby hospital. Resident # 1 sustained bilateral superficial abrasions to his lower extremities, right hip and shoulder pain, and a compression fracture of the lumbar region of his spine. Record review of the Provider Investigation Report (PIR) dated 10/6/2025 reflected, Assessment: Once the [Resident #1] was located, he was transported to the hospital for evaluation and treatment as needed. The resident returned to the facility with a hospital report indicating that everything was stable and no concerns were identified.Upon review of the hospital records the X-ray results indicated a compression fracture in the lumbar region.Provider response: When resident was nowhere to be located staff-initiated code orange missing resident. A head count of all resident was completed and accounted all residents except the missing resident. A thorough search was conducted inside of the facility and outside, staff extended their search throughout the community and informed law enforcement, Responsible party/family and Physician. Staff in service. The Administrator arrived at 7:40 AM, initiated an investigation, and confirmed all doors, windows, and alarms were functioning. At 8:00 AM, Maintenance repaired a damaged window. At 8:30 AM, staff searched the resident's listed address while the Marketer contacted local hospitals and continued follow-ups every 30 minutes; police also arrived on-site.Search efforts continued throughout the afternoon. and Maintenance securing all windows with new locks at 2:00 PM. The administrator re-tested all security systems at 3:10 PM, confirming no issues. Throughout the day, the Administrator remained in contact with police, and ADONs updated elopement risk assessments and care plans for all residents, ensuring accuracy and compliance with policy. At 6:15 PM, Hospital confirmed the resident had arrived and was undergoing evaluation, with labs and X-rays completed. By 8:00 PM, the hospital reported all findings were stable and the resident was cleared for discharge. On 9/30/25 at 1:40 AM, the resident returned safely to the facility, where one-to-one monitoring was initiated and continued until further notice. Provider action taken post Investigation: in service staff: Abuse and Neglect, Elopement protocol and elopement prevention. Elopement assessment on all residents. Skin assessment and Pain assessment completed when resident returned back. One-on-one with resident when returned back to the facility until further notice. Monitoring checks in the Secure Unit. Reenforce windows in the secure unit. Record review of Progress notes for Resident #1 from 09/30/25 through 12/11/25 reflected the resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 8 of 17 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 12/11/2025 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 remained on every 15-minute checks. Record review of facility's incident Log from 9/30/25 to 11/30/2025 revealed Resident #1 had attempted elopement on 10/18/25. In an observation on 12/09/25 at 9:11 AM of the secured unit revealed the entrance door to the unit was locked. It had a doorbell. Signage on the entry door revealed high elopement risk -please make sure the door is closed and locked behind you. A staff member, came from the secured unit, and opened the door by keying in the door code, let the surveyor inside the secured unit, and made sure the door was closed behind us. In an interview and observation on 12/9/25 at 9:31 AM, the Maintenance supervisor, within the secured unit, revealed that there were 3 exit doors to the facility from the secured unit. All exit doors were secured, and alarmed. Observed room [ROOM NUMBER], was diagonally opposite and the closest room to the TV area in the secured unit. There was no resident in room [ROOM NUMBER] at the time of observation. Observed that the window in room [ROOM NUMBER] had a hole on the bottom track where the initial bolt was in place. The window in room [ROOM NUMBER] chimed as soon as the maintenance supervisor opened the window. The window only opened about 6 inches. The window was reinforced with bolt and additional clamp that acted as a stopper to prevent the window from opening fully, both on the top and bottom frame. The height of the windowsill from the base of the window to the ground was about 37 inches. The maintenance supervisor stated that after investigation it was revealed that Resident #1 eloped by jumping out form the window of room [ROOM NUMBER] in the secured unit. He stated that when he reported to work on 09/28/25, around 8 AM, and headed to the secured unit, he saw that the window in room [ROOM NUMBER] was off track and opened. The mesh outside the window was broken as well. He stated that the bolt that acts as a [NAME] was bolted out and the window was half open. He stated that this could have happened because Resident #1 applied so much force that it likely caused the mechanical device (Stopper) to be pressed down and put the window off track. He stated that the window opened outside to the facility premises that led to a double lane street of a residential area. He stated that he repaired the broken window in room [ROOM NUMBER] soon after. He stated that all windows and doors in the secured unit were checked daily. He stated that all windows in the secured unit were reinforced with additional bolsters on top and bottom window frames as well as alarms was placed on all windows the same day of elopement, 9/29/25. He added he had received in services on elopement protocol and elopement prevention as well as abuse and neglect. He was able to verbalize forms of abuse and the reporting requirements. In an observation on 12/9/25 between 9:45 AM 9:50 AM, in the secured unit revealed windows in room [ROOM NUMBER], room [ROOM NUMBER] and room [ROOM NUMBER] had stopping devices on both the top and bottom of the window frame. The windows opened about 6 inches and alarmed. The windows in all three rooms chimed as soon as the surveyor opened them. Facility staff quickly came to the rooms as soon as they heard the alarm on all three instances. In an observation and interview on 12/9/25 at 9:53 AM, Resident #1 was observed to be sleeping in his room. There was a sitter at his bedside. He later woke up and stated that he did not remember anything about the elopement incident. He stated he was doing well. Observed wheelchair in his room , to which he stated , its used for seating purposes only. He added he was able to walk independently. In an interview on 12/9/25 at 10:00 AM, CNA I revealed she had been working in the facility for more than two years. She stated that she worked in the secured unit as a CNA on 09/29/25 on the 7AM - 3 PM shift. She stated that when she reported to work on 9/29/25, she was alerted about code orange (code for elopement). She stated that she joined other staff to find Resident #1 looking from room to room in the secured unit. She stated that all doors and windows in the secured unit were secured and alarmed. She added that she had received in-services on elopement protocol and elopement prevention as well as abuse and neglect. She was able to verbalize forms of abuse and the reporting requirements. She stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 9 of 17 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 12/11/2025 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 Resident #1 continued to be on one-to-one supervision since he came back to the facility after elopement. In an interview on 12/9/25 at 10:06 AM, CNA G revealed she had been working in the facility for 20+ years. She stated that she worked in the secured unit as a CNA on 09/29/25, 7AM - 3 PM shift. She stated Resident # 1 was very strong and can be confused at times. When she came to work on 9/29/25, she was alerted about code orange (code for elopement). She stated that she joined other staff to find Resident #1 looking room to room and in the facility. She stated that she heard later that Resident #1 broke the window in room [ROOM NUMBER] and eloped. She stated that all doors and windows in the secured unit are now secured and alarmed. She added that she had received in services on elopement protocol and elopement prevention as well as abuse and neglect. She was able to verbalize forms of abuse and the reporting requirements. She stated that Resident #1 continued to be on one-to-one supervision since he came back to the facility after elopement. In an interview on 12/9/25 at 10:23 AM, Med Tech H revealed he worked on the secured unit as medication aide. He stated that he was familiar with Resident #1's care needs. He stated Resident #1 did not have any exit seeking behaviors in the past except for the elopement incident in September 2025. He stated in the secured unit, all doors and windows are locked and secured at all times. He stated window alarms were put in after the elopement incident. He stated he had received in services on elopement protocol and elopement prevention as well as abuse and neglect. He was able to verbalize forms of abuse and the reporting requirements. He stated that he was not aware of any other residents that were at elevated risk of elopement. ,Attempted phone interview on 12/9/25 at 10:51 AM, with RN A left voice message for RN A to call back the surveyor. Attempted phone interview on 12/19/25 at 11:50 AM with ADON F, was not in the facility and not available for interview. In an interview on 12/9/25 at 2:35 PM, CNA N revealed she worked as a CNA on the secured unit on 09/28/25 on 11 PM to 7 AM shift. She stated she was in the secured unit when Resident #1 eloped from the facility. Stated she had seen Resident #1 around 5 AM on 9/29/25 sitting in the TV room with other residents while making her round. She stated Resident #1 was a very strong resident. He was able to walk independently and only used his wheelchair for sitting purpose. She stated that Resident #1 used to wander within the secured unit upon admission but did not show any signs of elopement. She stated that Resident #1 needed moderate assistance with ADLs. She added around 6:30 AM, she was getting ready to take other residents to dining room for breakfast, when she heard RN A asking about Resident #1 whereabouts. She stated she looked into Resident #1's room and could not find him. She stated they started looking for Resident #1 from room to room, including bathrooms and closets within the secured area. She stated that RN A called, code Orange (code for elopement) since they could not locate Resident #1. She stated that it was busy hour in the secured area, since staff busy with assisting residents with breakfast / providing ADL care and did not hear any noise from room [ROOM NUMBER]. She stated that she was provided training and in-services on abuse, neglect and elopement protocols. She was able to verbalize forms of abuse and the reporting requirements. She stated that Resident #1 was on One-on-One monitoring after he was back in the facility until this time. In an interview with LVN K on 12/9/25 at 3:11 PM, revealed she was the Charge Nurse on the secured unit working 11PM - 7 AM Shift, when Resident #1 returned from the hospital on 9/30/25. She stated that she assessed Resident #1, he looked confused and thanked the paramedics for getting him back. She stated he complained of his legs hurting, there were bilateral dressings present to the posterior lower legs. She stated that Resident #1 was being treated for venous ulcer on right posterior leg previously in the facility. Resident #1 was administered his PRN pain medication. She stated she mostly worked on weekends in the facility. Resident #1 did not show any signs of eloping in the past. She stated that Resident #1 was started on one-on-one monitoring as soon as he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 10 of 17 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 12/11/2025 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 came back to the facility. In an interview on 12/9/25 at 3:23 PM, CNA O revealed he worked as a CNA on the secured unit on 09/28/25 on 11 PM to 7 AM shift. He stated she was in the secured unit when Resident #1 eloped from the facility. He stated that he had seen Resident #1 sitting in the TV room, near the nurse's station, around 6:00 AM on 09/29/25. He stated that resident #1 is a tall man and very strong. He stated that he walked independently. He added between about 6:30 AM on 09/29/25, RN A started looking for Resident #1. She asked CNA N to look for Resident #1 in his room since she could not see him at the TV room anymore. He stated CNA N could not find Resident #1 in his room. He stated soon after the code Orange (code for elopement) was called, Staff members from the facility started searching for Resident #1 room to room throughout the facility and outside the facility. He stated that he noted Window of room [ROOM NUMBER] was open and broken during his search and notified RN A. He stated that Resident #1 was on One-on-One monitoring after he was back in the facility until this time. He stated that she was provided training and in-services on abuse, neglect and elopement prevention and protocols. He was able to verbalize forms of abuse and the reporting requirements. In an interview on 12/9/25 at 4:05 AM, the Administrator revealed Resident #1 did not have any prior elopement attempts from the facility. He added that he was at risk of wandering and hence was on secured unit from the time of admission to the facility. He stated that Resident #1 ambulated independently. He stated that between 6:30-7:00 AM on 09/29/25, Staff working in the secured unit noted that Resident #1 was missing. They immediately called Code Orange for elopement and started elopement procedure. He stated that ADON F immediately notified him about the incident, around 7:30 AM on 09/29/25 and he was in the facility by 7:40 AM. As soon as he arrived , he confirmed all doors, windows, and alarms were functioning. He noted that the window in room [ROOM NUMBER] was open and mesh broken, he stated that the maintenance supervisor repaired the broken window the same day. He stated that Resident #1 eloped from the window in room [ROOM NUMBER], closest to the TV room. He added that Resident #1 is a big guy, weighing close to 300 pounds, post investigation it was concluded that Resident #1 applied force on the sliding window and jammed it enough that it got out of track and opened the window. Resident #1 eloped by jumping out of the window. He stated that the bushes outside the window were broken and footprints were seen on the ground closer to the window. He stated that there were no cameras in the inside or outside of the facility. He added Police report was made and law enforcement officer soon arrived in the facility. He stated that search efforts continued throughout the afternoon. Maintenance supervisor added new locking and alarming devices on all windows in the secured unit on the same day of elopement. He stated that he assisted with search and was in touch with the law enforcement officers regarding the investigation. He added Resident #1 was found by EMS in the nearby area and taken to the hospital around on 09/29/25 around 6:15 PM. He added Resident #1 underwent evaluation, with lab work and X-rays in the hospital, they reported all findings were stable and [Resident#1] was cleared for discharge with arrival to the facility on 9/30/25 at 1:40 AM. Resident #1 was started on one-to-one monitoring upon his arrival to the facility and was in place until now. He stated that the acting DON read in the hospital records that Resident #1 had sustained compression fracture of the lumbar region of his spine per the hospital documentation. He stated that the physician was notified about the same. The Administration stated that he had interventions in place after the incident. He stated all windows and doors were reinforced in the secured unit. Maintenance Supervisor added additional stopping device on both top and bottom window frame and alarming device for all windows in the secured unit. Door and Window monitoring checks in the secured unit were continued daily. All residents in the facility were reassessed for elopement risk and no new residents were found with elevated risk. All staff were re-inserviced on elopement protocol and elopement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 11 of 17 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 12/11/2025 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 prevention as well as abuse and neglect. He stated that Resident #1 continues on one-on-one until now. He added that Resident #1 had another elopement attempt on 10/18/25 and the facility was able to successfully provide interventions. The Administrator stated Resident #1's Responsible Party lived out of state and was making arrangements to move Resident #1 closer to her. In second interview on 12/9/25 at 4:12 PM, LVN K stated she was the charge nurse on the secured unit on 10/18/25. She stated that after Resident #1 came back from the hospital after the elopement incident on 09/29/25, he spent most of his time in the room. On 10/18/25, Resident #1 was up and stated he did not want anyone to come near him. He had one-on-one aide that continued watching him from outside his room. She stated that Resident #1 paced through the halls within the secured unit, he went to the exit door one time, however, did not push the door. She stated Resident #1 did not try opening any windows on her shift. LVN K stated she was able to calm down Resident #1 and redirect him back to his room after some time. She stated that she was provided training and in-services on abuse, neglect and re-inserviced on elopement prevention and protocols. She was able to verbalize forms of abuse and the reporting requirements. In an observation on 12/09/25 at 4:35 PM, Resident #1 was sitting outside his room near the TV area. He was engaged in a conversation with one-to-one sitter, who was next to him. An attempt was made to interview on 12/10/25 at 8:05AM, Resident #1 Responsible party. Left voice message to return the writer's call. Call was not retuned until exit from the facility. In a phone interview on 12/10/25 at 8:08 AM, RN A revealed she worked as a charge nurse in the secured unit on 9/28/25 11PM - 7AM shift on the day of the incident. She stated she last saw Resident #1 around 6:30 AM on 9/29/5 in the TV area that was close to the nurse's station. Resident #1 did not show any signs of elopement; he was calm all through the night and sat at the TV area for a long time. She was in the process of administering meds and getting other residents ready for breakfast. She noted that she went to administer medication for one of the other residents and after coming back to the nurses station, did not see Resident #1 in the TV area. She asked CNA N to check Resident #1's room and started checking other rooms in the meantime. Around 7 AM on 09/29/25, she called ADON F to report Resident #1 was missing and started code Orange (elopement code). After some time, a staff noted room [ROOM NUMBER]'s window was broken, and the bushes near the window had some indentations. She stated that police came and she provided all the information regarding elopement. She stated she did not hear any noises from room [ROOM NUMBER] that morning because it was very busy during that time. Residents were pushed in wheelchairs to be taken to the dining room for breakfast, some residents needed their morning medications and some others needed to be changed. She stated that Resident #1 was wearing long pants and shoes. She stated that resident had swelling on both lower extremities and was provided wound care by wound nurse. She stated that window alarms were not present prior to the elopement incident. She stated that maintenance comes in very frequently to check on all windows/ doors for secured units. She added that there were no concerns with any windows or doors prior to elopement that needed attention. She stated that Resident #1 continued on One-on-One monitoring at this time. She stated that she was provided training and in-services on abuse, neglect and re-inserviced on elopement prevention and elopement protocols. She was able to verbalize forms of abuse and the reporting requirements. In an interview on 12/10/25 at 8:52 AM, ADON F, revealed that he was the ADON of the secured unit. He stated Resident #1 was in secured unit on initial admission to the facility, with cognitive deficit and confusion. He added Resident #1 was very strong, weighing close to 300 pounds and 6 feet tall. He stated that Resident #1 was ambulatory, he presented with edema on his lower legs and some wounds on his posterior legs on admission. He stated he was alerted by RN A regarding Resident #1 missing while he was driving to the facility around 7:00 AM on 9/29/25. He stated that once he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 12 of 17 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 12/11/2025 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 reached the facility, RN A had called code orange and the staff was already looking for the resident, when he joined in search. He stated he asked staff to search outside of the facility in the nearby vicinity. He stated that through their investigations, it was revealed that Resident #1 had eloped form the window in room [ROOM NUMBER] in the secured unit. He stated that he observed the metal bolt (placed in the bottom window frame to prevent the window from opening all the way) was sheared and one side of the sliding window was open all the way. He stated there were no alarms on the window before the elopement incident. He stated that the bush outside the window had some indentations. He stated Resident #1 was found in the hospital and X-rays revealed Resident #1 had compression fracture of the lumbar region and some superficial bruise on his lower posterior legs. He stated that after Resident #1 returned back on 9/30/25, he stayed in bed for a few days. He was treated for pain per physician order. ADON F stated, we did and continue to do everything to keep him [Resident #1] safe, his strength was underestimated. He stated all facility staff were re-inserviced on elopement protocol and elopement prevention as well as abuse and neglect. He was able to verbalize forms of abuse and the reporting requirements. He stated that Resident #1 continues on one-on-one until now. In an observation on 12/10/25 at 9:52 AM, Resident #1 was seen sitting on his bed in his room. The sitter (CNA P) was outside the room with direct sight on the resident. In an observation on 12/10/25 at 9:55 AM, with CNA P revealed Resident #1 ate breakfast in the morning of the interview. She stated that Resident #1 was watching something on the TV in his room and soon got agitated. She stated he turned the bedside table upside down. CNA P was able to redirect the resident and continued her one on one with him. She stated that she was not assigned to work on the secured unit on 9/29/25. She stated that when she came to work on 9/29/25, she was alerted about Code Orange (code for elopement) in the secured unit. She stated she was provided training and in-services on abuse, neglect, and elopement prevention and protocols. She was able to verbalize forms of abuse and the reporting requirements. In an interview on 12/10/25 at 9:39 AM, the DON revealed he was the Regional Compliance RN and was acting as the DON for the facility. He stated that he was notified about the elopement incidence for Resident #1 on the same day. He stated he helped with the search for Resident #1. He stated that after reviewing hospital records on 9/30/25, Resident #1 had sustained compression fracture of the lumbar region of his spine per the hospital documentation. He stated that the physician was notified about the same. The DON stated that he provided in services to the Administrator on Elopement prevention / Elopement protocols as well as Abuse and Neglect. He stated all facility staff have been re-inserviced on Abuse, Neglect and Elopement protocols and preventions. He stated that all residents in the facility were reassessed for elopement risk and no new residents were found with elevated risk. He stated that Resident #1 continues on one-on-one until now. Interview on 12/10/25 at 10:03AM, the Wound Nurse revealed Resident #1 had superficial scrapping on the posterior left side and noted no additional wounds after the elopement incident. She stated that they were already treating Resident#1 for venous ulcer on right posterior leg. She also added that Resident #1 was not compliant with his wound care and would not keep wound dressing on his feet at times. She stated that Resident #1 did not complain of any pain. She stated she was provided training and in-services on abuse, neglect, and elopement prevention and protocols. She was able to verbalize forms of abuse and the reporting requirements. Interview on 12/10/25 at 10:28 AM, the Medical Doctor revealed he was aware Resident #1 had sustained a compression fracture after the elopement incident. He stated that it was common in residents who were elderly. He added that Resident #1 had history of Intervertebral disc degeneration and the compression fractures often heal naturally. Interview on 12/9/25 at 10:31 AM, LVN L revealed he had worked in the facility for last 4 months. He stated that he worked on 9/29/25 and 9/30/25 in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 13 of 17 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 12/11/2025 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 the secured unit, 7AM - 3PM shift. He stated that on 9/29/25, when he arrived at work, he was informed about after Resident #1's elopement and code Orange (code for elopement) was called. He stated he helped the staff with the search for some time until the administrator took over and went back to assist other residents in the secured unit. He stated that on 9/30/25 on 7 AM - 3 PM Shift, Resident #1 did not complain of any pain and was calm. He stated Resident #1 was very strong and needed moderate assistance with ADLS. He stated he was aware of Resident #1's care needs and did not display any elopement behavior in the past prior to the elopement incident. He added that he was not aware of any other resident in the secured unit that was at an elevated risk of elopement. He stated that Residents in the secured unit should be checked upon every 2 hours. He stated that he was provided training and re-inserviced on abuse, neglect and elopement prevention and protocols. He was able to verbalize forms of abuse and the reporting requirements. He stated that Resident #1 continues on one-on-one until now. He added Resident #1 had not tried opening any windows or doors after the elopement incident. Record review of facility's policy titled Elopement Prevention undated reflected, .Physical Plant .Function of the alarm system will be verified each week and documented in a maintenance log, Keypad exit magnetic locks. Secured Unit Or a combination of the above.All other exits not considered fire exits will be locked when not occupied by staff members. All exit devices will be maintained by the manufactures recommendations and function of each door device will be verified weekly and a log maintained.Staff Training Staff will receive training during their orientation process and then annually regarding: Elopement prevention, Operation of all exit devices and Actions to take if elopement occurs. Review of facility's policy titled Elopement Response undated reflected, Policy Statement : Nursing personnel must report and investigate all reports of missing residents. Event ID: Facility ID: 455895 If continuation sheet Page 14 of 17 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 12/11/2025 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Arrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to obtain from hospice the hospice election form, hospice plan care, and physician certification and recertification of the terminal illness specific to the patient and failed to designate a member of the facility's interdisciplinary team who was responsible for working with hospice representatives to coordinate care to the resident for one of three (Resident #2) residents reviewed for hospice services. The facility failed to coordinate care between the facility and Hospice Agency J for Resident #2 at the time of her Respite stay from 11/22/25 through 11/26/25 which resulted in her not receiving her Hospice aide services from 11/24/25 through 11/26/25. These failures could place residents on hospice at risk of not having services coordinated between service providers.Findings included:Record review of Resident #2's Face Sheet dated 12/12/25 reflected an [AGE] year-old female with an admission date of 11/22/25. Her diagnoses included Alzheimer's disease. Record review of Resident #2's Hospice Agency J Face sheet/staff assignments dated 10/17/25 reflected, Hospice Aide 5 visits weekly, Record review of Resident #2's admission Nurses notes dated 11/22/25 and completed by LVN K, reflected the resident was ambulatory without assistive device, required minimal assistance with dressing, was able to toilet herself, required a secured unit, was alert to person but had short term memory impairments and difficulty in decision making when faced with new tasks or situations and had wandering behaviors. Resident was on anticoagulant (blood thinner) medication. Review of Resident #2's base line care plan initiated on 11/23/25 reflected, [Resident #2] has a terminal prognosis and/or is receiving hospice services.Interventions.work cooperatively with hospice team to ensure the resident's. physical and social needs are met. Record review of Resident #2's Physician order Summary dated 12/10/25 reflected, .Resident receives care from Hospice Agency J. with a start date of 11/24/25. In an interview on 12/09/25 at 3:00 p.m. with Resident #2's Representative they stated the resident was receiving hospice services at home and a brief respite request had been made to provide a break for Resident #2's Family member. They stated Hospice Agency J arranged with the facility for the resident to be admitted on [DATE] for a five day stay. The stated they did not think the resident had received a shower during her stay at the facility. In an interview with LVN K on 12/09/25 at 03:45 p.m., she normally worked double weekends and was on duty on the weekend of 11/22/25 and did the admission on Resident #2.In an interview with LVN K on 12/09/25 at 03:45 p.m., she normally worked double weekends and was on duty on the weekend of 11/22/25 and did the admission on Resident #2. She stated this was the first respite admission she had completed. She stated ADON F had sent her a message about the upcoming admission and stated she had received the Hospice faces sheet but stated she had not noticed the staff assignments. She stated she did her admission assessments and stated one of the family members was present during the assessment. She stated the family member stated the resident might be hesitant about allowing them to assist her a lot with changing her clothes and showering but stated she told them if they laid her clothes out the resident could dress herself. She stated a nurse from Hospice came on the day of admission and left her a phone number to call if they needed anything and stated she saw one other person from the Hospice agency come later in the week but was not sure if she was a nurse or caregiver. In an interview with ADON F on 12/10/25 at 8:35 a.m., he stated he had received a message on 11/21/25 that they were receiving Resident #2 on 11/22/25 for respite services for 5 days. He stated he had let LVN K know about the new admission. He stated at that time he was not aware of what services the Hospice agency would provide. He stated when he came in Monday he found out they were missing some documents and had reached out to the hospice agency but stated he did (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 15 of 17 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 12/11/2025 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 0849 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete not ask about the hospice aide. He stated this was a new hospice agency they had not worked with before and it was the first respite case he had handled, so he was not sure what was being provided. He stated regardless they still scheduled the resident for showers and provided what care she would allow them to do. In an interview with CNA G on 12/10/25 at 9:05 a.m., she stated Resident #2 was here for 4 or 5 days. She stated she was very independent and required limited assistance. She stated she was scheduled for showers on Monday, Wednesday and Fridays but stated they had offered and she declined. She stated they had assisted her with changing her clothes. She stated she knew she was on hospice services but stated she was not aware of when the Hospice aide was coming. She stated she saw one caregiver come one day but was not sure if she was the hospice aide. She stated they usually know when the hospice aides are coming and how often they are coming. In an interview with Hospice Agency J's Social Worker on 12/10/25 at 11:37 a.m., she stated she assisted with setting up the respite services for Resident #2. She stated they scheduled a nurse to come out on the day of admission to ensure the resident was settled in and the facility had what they needed. She stated the resident's hospice plan of care should have continued at the facility which included sending the hospice aide 5 days a week. She stated it appeared this did not happen. She stated they would look into what happened on their end but stated the facility did not reach out and let them know the aide was not coming.In an interview with Hospice Agency J's Case manager for Resident #2 on 12/10/25 at 1:15 p.m., she stated their Social Worker had set the respite services up for Resident #2. She stated it was all at the very last minute. She stated she did not see Resident #2 the week she was at the facility but stated the after-hours nurse saw her on admission and another nurse saw her on 11/25/25. She stated the hospice aide should have come Monday through Wednesday and was not sure what happened. In an interview with the DON on 12/11/25 at 11:00 a.m., he stated they have long standing relationships with the hospice agency they have contracted with, and everyone knows the routine. He stated the Hospice Nurse's and aides all communicate with the staff when they have arrived and what their schedules will be. He stated this was a new Hospice agency and they all dropped the ball, and not all of those pieces were in place prior to the resident's admission. He stated that going forward each unit's ADON will be responsible for coordinating with the hospice agency to ensure they have the Hospice agency's care plan and schedule and then communicate and coordinate with the facility staff. He stated the facility was ultimately responsible for the resident, but they had to communicate effectively between the two. He stated ultimately the facility's comprehensive care plan, and the hospice care plan should be combined into one comprehensive care plan to best serve the resident. He stated communication was key between the facility, the hospice and the family to ensure the residents' needs were met. Record review of the facility's policy titled, Hospice Services, dated February 2007, reflected, .The nursing facility and hospice provider must ensure that a coordinated plan of care reflects the participation of the hospice, nursing facility, the resident, and legal representative to the extent possible. Event ID: Facility ID: 455895 If continuation sheet Page 16 of 17 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 12/11/2025 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 0914 Provide bedrooms that don't allow residents to see each other when privacy is needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure the resident had the right to be treated with respect and dignity for 1 of 4 residents (Resident #4) reviewed for dignity. The facility failed to ensure Resident #4 had a privacy curtain. This deficient practice could place the resident at risk of not feeling as if they were being treated with dignity and respect while being fed.Findings include:Record review of Resident #4's Face Sheet, dated 12/09/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included major depressive disorder and anxiety. Record review of Resident #4's Quarterly MDS assessment, dated 11/19/25, reflected a BIMS score of 8, a moderate impairment. For ADL care, it reflected the resident required supervision or touching assistance. Record review of Resident #4's Comprehensive Care Plan, dated 12/02/2025, reflected the resident had an impaired cognitive impairment and an intervention included providing the resident a homelike environment. In an interview and observation on 12/09/25 at 12:10 PM, Resident #4 stated she had been in the room for 4 weeks and she did not have a privacy curtain since residing in the room. She stated she needed to change her clothes but had to go into the bathroom because she was concerned about someone walking in on her. The resident was observed to not have a privacy curtain. In an interview on 12/09/25 at 12:30 PM, LVN B stated Resident #4 did not have a privacy curtain and she was supposed to have one for her privacy. She stated she just started working the A-hall and was not sure why the resident did not have a privacy curtain. In an interview on 12/10/25 at 9:48 AM, ADON E and the Administrator was told about Resident #4 not having a privacy curtain in her room, and they stated they were not aware of this. ADON E stated laundry may have removed the curtain to have it cleaned. ADON E stated the resident's roommate had a privacy curtain, this did not help Resident #4 for when anyone came into the room and she was trying the change. They both stated the resident needed a privacy curtain for her privacy and dignity. Record review of the facility's policy on Resident Rights, undated, revealed The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this policy. A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455895 If continuation sheet Page 17 of 17