Health inspection·October 5, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #35's Care Plans Target date: 11/05/23 ADL Self Care performance deficit related to dementia. Interview and observation on 10/05/23 at 11:30 am, Resident #35's hair was in two ponytails and twisted to the ends and she stated she would like to get her hair done. Residents Affected - Few Interview 10/04/23 at 4:40 pm, CNA B stated she never saw a beautician doing the resident's hair since she worked here nine months ago. Interview 10/04/23 4:51 pm, CNA C stated the last time she saw a beautician here was 5 months ago. She stated if the residents hair was not combed the other residents could possibly laugh at them and they could feel embarrassed. Interview on 10/04/23 at 5:09 pm, SW D stated the facility did not have a beautician and had not seen a beautician come in to do the resident's hair since she started working here 3 months ago. She stated she spoke to the Administrator about getting the resident's hair done by a beautician and the Administrator told her the family members did the resident's hair in the beauty shop room. She stated the CNA's, and the Nurses were responsible for ensuring the residents hair was done and if a resident requested to get a perm or other service, she would ask their Responsible party if it was okay and then talk to the BOM to see what funding they had. She stated she spoke to Resident #13 today about getting a perm and she said she wanted one. She stated she was not sure what could happen to a resident if their hair was not done honestly .it could look like they were not being taken care of. She stated she was not sure but thought she would be responsible for arranging the resident's beautician appointments. Interview on 10/05/23 at 9:22 am, Transporter/Barber stated she was a licensed barber and at times she cut the residents hair while they currently looked for another beautician because the last one had not been here in a while. She stated she could not remember the last time she saw a beautician at this facility, since working here a year. She stated she did not do perms or curl the resident's hair but cut the male residents hair at times if the request was known. Interview on 10/05/23 at 9:46 am, the BOM stated the current Beautician used to come out monthly and the last time she did the resident's hair was around Memorial Day (May 2023). She stated the female residents did not always get their hair done because it was their choice to get their hair done or not. She stated the last time Resident #13 saw the beautician was May 2023 when she got her hair braided. She stated at times she noticed the resident's hair messed up and notified the nurses. She stated Resident #13 and #35 had their hair done by the beautician in the past and also saw them out in activities with their hair not done. She stated Resident #13's family member did her hair but did not come out to do it all the time. She stated was not sure who was responsible for ensuring the beautician was scheduled but she made sure the residents had the money in their accounts to get their hair done or asked their family's to pay. Interview o 10/05/23 at 10:35 am, SW D stated she was responsible for getting the beauty shop list created and beautician scheduled. She stated since working here for the past 3 months she had not contacted the beautician because no one ask to get their hair done . She stated she did not have the beautician's contact information to schedule the resident's hair appointment but would get it from the Administrator. Interview on 10/05/23 at 10:35 am, the Administrator stated she noticed Resident #13 wore her hair (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few combed straight back and had not thought to get the beautician because the resident or family did not make a request to get her hair done . She stated the facility had a contracted cosmetologist/barber, but she was not sure when the beautician was last out to do the resident's hair. She stated if the resident's ADL care was not done timely it could make them feel bad or unkept and ungroomed. Interview on 10/05/23 at 11:00 am, the BOM said SW D was responsible for getting the resident seen by the beautician. Interview on 10/05/23 at 11:48 am, the Administrator stated SW D would be responsible for arranging the beauty shop appointments and getting a list of residents to get their hair done. Interview on 10/05/23 at 3:23 pm, the Activity Director stated Resident #13's family member did her hair at times. She stated she braided Resident #13's hair about 3 weeks ago and the beautician braided it was either June 2023 or July 2023. Record review of the facility's Social Service dated 2002 and revised October 2010 revealed, Policy Statement: Our facility provides medically related social services to assure that each resident can attain or maintain his/her highest practical physical, mental, or psychological well-being .Policy interpretation and implementation: .f. assistance in meeting the social and emotional needs of residents . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 observation, interview, and record review the facility failed to ensure residents who were unable to carry out activities of daily living received necessary services to maintain personal hygiene for three ( #2, #16, #71) of 8 residents reviewed for ADL care. Residents Affected - Some The facility failed to ensure Residents' (#2, #16, #71) hair was cut and combed, faces shaved, and fingernails clipped. These failures could place residents at risk of infections and skin tears resulting in pain, discomfort and decrease their dignity which could lead to a decreased psycho-social well-being and feeling of self worth. Findings included: A)Record review of Resident #2's Significant Change MDS assessment dated [DATE] revealed a [AGE] year old male who admitted [DATE] and had a BIMS Score of 03 (Severe Cognitive deficit) .with diagnosis of hypertension, Gastroesophageal Reflux (Stomach acid) , Renal insufficiency (kidney failure), arthritis (joint inflammation), aphasia (language deficit), cerebrovascular accident (stroke), hemiplegia (one side paralysis), seizure disorder (electricity burst in brain), malnutrition (nutrient deficit), depression (mood disorder), vascular dementia (memory loss). And total dependence one person assist for personal hygiene by CNA. Record review of Resident #2's Care Plan revealed communication problem related to expressive aphasia (anticipate and meet needs), cognitive function and impaired thought processes related to CVA, terminal prognosis hospice (Adjust provision of ADL's to compensate for resident's changing abilities and ADL Self-care performance deficit related to hemiplegia, stroke: Personal hygiene/oral care: the resident requires (x1) staff participation with personal hygiene and oral care by CNA) Observation and interview on 10/03/23 at 10:38 am, Resident #2 was lying in bed and his hair was 2 inches long the edges were different lengths, his nails were ¼ inch long from the nail bed and he gestured nodding his head yes, he would like to get his nails cut. Observation and interview on 10/04/23 at 9:02 am of Resident #2 revealed his nails were ¼ inch long from the nail bed on both hands. He gestured by nodding his head yes , he would like to get his nails clipped and was not sure when they were last clipped. Record review of Resident #2's Shower Sheets were requested from ADON on 10/04/23 at 9:43 am and was not provided. B) Record review of Resident #16's admission MDS assessment dated [DATE] revealed a [AGE] year old male who admitted on [DATE] with a BIMS score of 07 (Severe cognitive deficit) .with diagnoses of Anemia, Atrial Fibrillation (irregular heart beat), Hypertension (high blood pressure), Peripheral Vascular Disease (circulatory disorder), Renal insufficiency (kidney failure), Pneumonia (lung infection), diabetes mellitus (high blood sugar), hyperlipidemia (high cholesterol) and non-Alzheimer's Dementia (memory impairment) and required extensive one person assist for personal hygiene by CNA. Record review of Resident #16's Care plan revealed he required pain management (chronic) pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 - Some related to diabetic neuropathy (diabetic nerve damage) and PVD .ADL Self-care performance deficit related to Dementia, impaired balance, ADL self-care performance deficit (Personal hygiene/oral care: the resident requires extensive (x1) staff participation by CNA. Observation and interview of Resident #16 on 10/03/23 /23 at 11:17 am, Resident #16's hair was 2 inches long and fingernails were ½ inch long from the nail bed and had a ¼ inch beard and long uneven mustache. He stated he was last shaved last week and needed to be shaved again and needed his fingernails clipped. He stated CNA C was supposed to shave his face as soon as she got some free time. He stated getting bed baths as he preferred three times weekly but did not get shaved on a regular basis. He stated he had some hair clippers in the closet and said if he could get someone here to cut his hair would be nice, maybe CNA C could do it. He stated he felt better after being shaved, haircut and nails clipped. He stated the staff told him they would groom him when they could get to him and said he felt they always put him off. He stated he spoke to the SW about needing to be groomed and she said okay she would see about it and added his family member cut his hair about three weeks ago. Observation and interview of Resident #16 on 10/05/23 at 9:15 am, Resident #16's hair was 2 inches long and his nails were ½ long from his nail bed and four of the nails were broken, he stated he was not sure when his fingernails had last been clipped. Record review of Resident #16's Shower Sheets revealed he was showered on 09/20/23, 09/22/23 and bed bath on 09/25/23, 09/27/23, 09/29/23, 10/02/23 and 10/04/23. C) Record review of Resident #71's Quarterly MDS assessment dated [DATE] revealed a [AGE] year old male who admitted [DATE] with a BIMS score of 07 (severe cognitive deficit), did not resist care, with diagnoses hypertension, Alzheimer's Disease (cognitive impairment), Cerebrovascular Accident (stroke), muscle wasting, muscle weakness, lack of coordination .Personal hygiene/oral care: the resident requires extensive (x1) staff participation by CNA. Record review of Resident #71's Care Plan on 10/05/23 revealed terminal prognosis (work cooperatively with the hospice team to ensure the resident's .physical needs are met by LVN .ADL self-care performance deficit related to Alzheimer's). Personal/oral care: the resident requires extensive (x1) person staff participation by CNA. Observation and interview on 10/03/23 at 11:50 am, Resident #71 hair was 2 inches long and uneven and his nails were ½ inch long from the nail bed and he said he would like to get them clipped. Observation and interview on 10/04/23 at 9:20 am, Resident #71 hair was not combed and appeared uneven, and his nails were approximately ½ inch long from the nail bed. He stated he needed his nails clipped and if someone would give him some nail clippers he would clip them himself. He stated his family member cut his hair and was not sure when it was last cut. Record review of Resident #71's Shower Sheet revealed he was showered by his hospice aide on 09/22/23, 09/25/23, 09/27/23, 09/29/23, 10/02/23 and 10/04/23. Interview on 10/04/23 at 9:25 am, LVN A stated after the residents showered their nails were cleaned and clipped if needed and said the nurses and CNA's were responsible for the resident's ADL Care. She stated Resident #71's nails did appear to be long. She stated the residents' hair should be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 - Some washed every shower and said she told the CNA's to please remember to shave and wash their hair and clip their nails. She stated they used shower sheets to reflect what care was provided to the residents. She stated if a resident's nails were not clipped on a regular basis the resident could be a danger to themselves by tearing off and scratching their skin or by having physical contact with another resident. She stated unclipped nails was a source for germs to accumulate, increasing infection. She explained to Resident #71 that he would not be able to clip his own nails and told him she would get his CNA to clip them. Interview 10/04/23 at 4:40 pm, CNA B stated Resident #71 was showered on a regular basis and assigned to care for him recently and said she sometimes noticed he was not shaved, and his nails were long. She stated a week ago she noticed his nails were long and she reported it to his hospice nurse and thought they had been clipped but was not for sure if that had been done. She stated she never saw a beautician doing the resident's hair since she worked here nine months ago. She stated every time a resident showered there were supposed to get shaved, and if they noticed the resident's nails were long she clipped them unless the resident was a diabetic then the nurse would clip them. She stated if the resident's nails were not done they could get an infection under their nails from food and nasty stuff under their nails. She stated they could scratch skin and get an infection. She stated if residents were not shaved regularly, they could get an infection on their face. Interview 10/04/23 4:51 pm, CNA C stated the last time she saw a beautician here was 5 months ago. She stated on the Resident's shower days their hair was washed, bed linen changed, teeth brushed, and nails were done as needed. She stated she noticed Resident #2's nails were long for a couple of weeks and had not cut his nails because he leaned and was unsteady and had not spoken to anyone about assisting her because she got busy and forgot. She stated residents with long nails could scratch themselves or someone else and dirt could get off in their nails. She stated she provided care to Resident #71 in the past and had not noticed his nails or hair needed to be cut. She stated if they residents hair was not combed the other residents could possibly laugh at them and they could feel embarrassed. She stated she never combed his hair but a month ago she clipped his nails, because he asked her to clip them. She stated the nurses were responsible for ensuring the CNA's did ADL care appropriately. Interview on 10/04/23 at 5:09 pm, SW D stated the facility did not have a beautician and had not seen a beautician come in to do the resident's hair since she started working here 3 months ago. She stated she spoke to the Administrator about getting the resident's hair done by a beautician and the Administrator told her the family members did the resident's hair in the beauty shop room. She stated the CNA's, and the Nurses were responsible for ensuring the residents hair was done and if a resident requested to get a perm or other service, she would ask their Responsible party if it was okay and then talk to the BOM to see what funding they had. She stated she was not sure what could happen to a resident if their hair was not done honestly .it could look like they were not being taken care of. She stated she was not sure but thought she would be responsible for arranging the resident's beautician appointments. Interview on 10/05/23 at 9:22 am, Transporter/Barber stated she was a licensed barber and at times she cut the residents hair while they currently looked for another beautician because the last one had not been here in a while. She stated she could not remember the last time she saw a beautician at this facility, since working here a year. She stated she did not do perms or curl the resident's hair but cut the male residents hair at times if the request was known. She stated the nursing staff used shower sheets to document the resident's ADL services such shaving, podiatry, skin and nail care. She stated if the resident's ADL's were not done it could affect their self-esteem by lowering it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 - Some Interview on 10/05/23 at 9:46 am, the BOM stated the current Beautician used to come out monthly and the last time she did the resident's hair was around Memorial Day (May 2023). She stated the female residents did not always get their hair done because it was their choice to get their hair done or not. She stated was not sure who was responsible for ensuring the beautician was scheduled but she made sure the residents had the money in their accounts to get their hair done or asked their family's to pay. She stated basic ADL care should also be done and had spoken to the DON and Administrator about the residents hair not being done and they would say okay they would look into it. Interview on 10/05/23 at 10:35 am, SW D stated she noticed yesterday Resident #71's hair looked a little fluffy, it was 2 inches all around his head and scruffy around his face. She stated Resident #71 said he wanted to get his hair cut and it was done this morning. She stated she was responsible for getting the beauty shop list created and beautician scheduled. She stated since working here for the past 3 months she had not contacted the beautician because no one asked to get their hair done. She stated she did not have the beautician's contact information to schedule the resident's hair appointment but would get it from the Administrator. Interview on 10/05/23 at 10:35 am, the Administrator stated the residents were showered 3 times weekly and the nursing staff were responsible to ensure their hair was washed, nails checked and shaved. She stated when the resident were showered the CNA's were to provide ADL Care. She stated if a resident was getting hospice services, the caregiver took care of all the resident's ADL care and if they did not, her staff was responsible for cutting the resident's nails and shaving them. She stated she was not sure when the beautician was last out to do the resident's hair, She stated Resident #16 had stubble on his face and she went to the nurse or CNA to address. She stated if the resident's ADL care was not done timely it could make them feel bad or unkept and ungroomed and their nails could get dirty if too long. She stated her expectation for ADL care was for everyone to be well groomed and for ADL care to be ever Q shift and as often as necessary. She stated she saw Resident #71's nails needed to be clipped and stated she would start looking at the residents nails when she made her rounds. Interview on 10/05/23 at 11:00 am, the BOM said SW D was responsible for getting the resident seen by beautician. Interview on 10/05/23 at 11:48 am, the Administrator stated SW D would be responsible for arranging the beauty shop appointments and getting a list of residents to get their hair done. She stated ADL care fell under nursing services and the DON and ADON was responsible for ensuring the residents ADL care was done. Interview on 10/05/23 at 3:04 pm, the ADON stated the charge nurse and herself followed up with the residents and if they were hospice patient's, the nurse or herself contacted hospice if they noticed their ADLs were not being done. She stated they stepped in also to provide their hospice resident's ADL care also. She stated she had not noticed any of the resident's had long nails, facial hair and hair undone and the felt the nursing staff did a good job with the residents ADL care. She stated they had enough staff to care for the resident, but had they not had any request to get her hair done by. She stated Resident #16 had not requested to get ADL care and Resident #2 never requested he needed his nails clipped and Resident #71 they offered to clip his nails and he said no. She stated they had enough staff to care for the residents, but the residents had not requested to get their hair done by the beautician. She stated when the residents were showered or bathed their hair was washed, nails cleaned and clipped, and they were shaved and skin moisturized. She stated if ADL care was not done she was not sure how it could affect the residents then said it could make them feel unkept (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 and not clean. Level of Harm - Minimal harm or potential for actual harm Interview on 10/05/23 at 3:23 pm, the Activity Director stated Resident #16 had long nails, but he said he did not want his nails clipped. She stated she noticed Resident #71's fingernails long one day ago (Wednesday 10/04/23). She stated she notice Resident #71's fingernails were long about 2 weeks ago, and he said no to getting them clipped. She stated 2 weeks ago she trimmed Resident #2's fingers nails and was not sure if they were long or not. She stated if the resident's fingernails were long they should be getting their nails and hair done by the CNA's when they get showered and was not sure why the CNA's were not doing the ADL care right. She stated she had not asked nursing why and would try to clip their nails. Residents Affected - Some Interview on 10/05/23 at 4:23 pm, the DON stated she was responsible for insuring the residents received adequate ADL Care. She stated ADL Care started with the CNA's and for hospice residents her nursing staff was supposed to notify the hospice provider if ADL care was lacking. She stated the department heads visited the resident's daily to ensure there ADL Care needs were met they. She stated all of the residents were getting appropriate ADL care including Residents #2, #16, #71. Record review of the facility's ADL Care undated revealed, Policy Statement: Residents will provide with care, treatment and services as appropriate to maintain and improve their ability to carry out activities of daily living (ADLs) .Residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for one of one kitchen reviewed for food storage and kitchen sanitation. 1. The facility failed to adequately clean the kitchen which resulted in an accumulation of food and dirt on the equipment surfaces and appliances. 2. The facility failed to clean the kitchen and floors thoroughly and replace the dish racks that were old, discolored, chipped and appeared unclean. These failures could place residents at risk for ingesting cross contaminated food, which could result in food-borne illnesses, health decline and serious illness. Findings Included: Observation on 10/03/23 beginning at 9:30 am revealed the metal door around the handle of the walk-in refrigerator was black with what appeared to be 1 foot of dirt buildup and the plastic curtain was missing approximately 3 strips and one strip that was torn and about to tear completely. There was 2 small boxes on the floor by the exit door of the kitchen and the flooring around the exit door had accumulated blackish dirt in the corners and one white glue pest trap appeared brownish, jagged and frayed. The mop bucket had several areas of blackish dirt buildup around it and cloth like debris on it. A red three shelf serving cart appeared to have dirt buildup and crumbs on it, which had 8 serving spoons on the top of it. The shelf under the steam table had several brownish and blackish rust spots with approximately 12 baking pans on it. The dishwasher door had a large brownish rust stain approximately 3x4 inches in length, the dish racks appeared worn, with blackish and yellowish dirt buildup. The top of the dishwasher had debris particles on it and the drain next to the dishwasher appeared to have several layers of blackish built up of dirt. The floors had several areas of blackish dirt build up along the base boards by the 2 boxes on the floor, the exit door, around the dish washer and stove. The floor drain by the dishwasher appeared clogged with several layers of accumulated dirt and the table and legs of the dishwasher appeared to have blackish and brownish rust stains on it. And the garbage disposal underneath the dishwasher had several layers of brownish debris, grime and brownish stain spots on it. Interview on 10/03/23 at 10:00 am, the Dietary Director stated when cleaning the red serving cart, they were not able to get everything to come off of it, she stated everyone was responsible for cleaning the kitchen and equipment daily. She stated they mopped daily and in between meals and the night shift did the last cleaning for the day of sweeping, mopping and deep cleaning. She stated the two small boxes of lids and juice cups, sitting on the floor next to a metal rack by the exit door, she got from storage a few days ago and had not had a chance to stock them yet. She stated the yellow mop bucket in the utility room did appear dirty with brown stains and mop debris on it and was not sure when the last time it was cleaned. She stated she would have to ask the cook because he probably took it outside to clean it with soap and water. She stated the dishwasher was cleaned daily and was not able to explain why there was a 5 inch x 3 inch brownish rust stain on the dishwasher door and why the rack holding the 2 large cleaning solutions had brownish rust all over it. She stated she was not sure why the walk in refrigerator door had accumulated layers of dirt by the door handle and were about to replace the plastic curtains. She stated she was not sure why the dishwasher racks were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some cracked and discolored with yellow and blackish stains. She stated she was not sure why the corner of the dishwasher counter had accumulated layers of blackish dirt with what appeared to be glue. She stated she was not sure why the floors and floor drains had not been cleaned yet or why the shelves under the counter tops had brownish rust on them. Interview on 10/05/23 at 1:20 pm, [NAME] F stated it was kind of hard to get the dietary staff to do their jobs and this facility was an old place and stated the bottom shelf where the pots and pans were cleaned, were old. He stated they cleaned the kitchen Monday thru Thursday and went by a schedule by initialing what they cleaned and said they tried to clean the kitchen on a daily basis . He stated they kept the kitchen cleaned as best as they could. He stated he was by himself today in the kitchen with one dietary Aide G was new and was not much help because he needed training still. He stated he had to cook and mop and wipe the walls down by the coffee machine today, 10/05/23, and stated they needed another floor scrubber to clean the floors better. He stated their mop bucket should be cleaned and drained daily and was not sure when the last time mop bucket was cleaned. He stated he mainly focused on cooking and had not noticed the walk in fridge door being dirty. He stated boxes were not to be on the floor due to the risk of cross contamination, if mopping and the mop touched the boxes and to prevent pests from getting in them. He stated they tried cleaning the red rolling serving cart yesterday, 10/04/23, and was not sure why it had not been replaced before now because of the stains on it. He stated the dish racks had been here since he had been working here for the past two years. He stated he had not noticed any grime or dirt buildup on the dish racks and added he was waiting on another dietary Aide H to come back to work tomorrow to help clean the kitchen. He stated they currently had four staff (1 cook and 3 dietary aides plus the dietary director). He stated they needed 2 more cooks and 2 more dietary aides and were actively looking for more staff. He stated sometimes they were not able to clean as good as he preferred and tried to get the kitchen cleaned. He stated he was having a hard time cleaning the debris from the top of the garbage disposal. He stated the Dietary Director was responsible for ensuring the kitchen was cleaned and equipment in good condition. Interview 10/04/23 at 11:48 am, the Administrator stated she noticed the kitchen floors and walls were dirty yesterday and she told the dietary staff to put an emphases to cleaning things and go by their cleaning schedule Monday thru Friday. She stated they deep cleaned the kitchen as far as she knew and said the kitchen walls, dish machine and trays, garbage disposal under the counter and the corner of the dishwasher counter needed to be cleaned and was not sure why it had not been done. She stated she was not aware of the mop bucket being dirty, or that the refrigerator door had a large dirt stain on it or that the shelved under the counter tops were rusty. She stated she was not aware of boxes being left on the floor and not having a clean and sanitary kitchen could cause cross contamination risks. She stated the Dietary Manager was responsible for making sure the kitchen was cleaned. Record review of the Facility's September 2023 Kitchen Cleaning schedule Sheet revealed, the Week of: Was blank and there was not any initials of anything cleaned on Saturday, Sunday and Monday. And on Tuesday 17 out of 20 items was initialed cleaned, and Wednesday, Thursday and Friday 18 out of 20 items was initialed cleaned. Record review of the Facility's October 2023 Kitchen Cleaning schedule Sheet revealed, the Week of: Was blank and for Sunday there was 20 out of 20 items initialed cleaned on Monday there was 13 out of 20 items initialed cleaned and there was not any other initials on anything cleaned on Tuesday, Wednesday, Thursday, Friday and Saturday. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility's Sanitization Policy dated 2001 and revised October 2008 revealed, Policy Statement: The food service area shall be maintained in a clean and sanitary manner .Policy interpretation and implementation: 1. All kitchen, kitchen areas and dining areas shall be kept clean, free from litter and rubbish and protected from rodents, roaches, flies and other insects .2. All utensil, counters, shelves and equipment shall be kept clean, maintained in good repair and shall be free from corrosions, open seams, cracks and chipped areas that may affect their use or proper cleaning, seals, hinges and fasteners will be kept in good repair .3. All equipment, food contact surfaces and utensils shall be washed to remove or completely loosen soil by using manual or mechanical means necessary and sanitized using hot water and/or chemical sanitizing solutions .16. Kitchen and dining room surfaces not in contact with food shall be cleaned on a regular schedule and frequently enough to prevent accumulation of grime .17. The Food Services Manager will be responsible for scheduling staff for regular cleaning of kitchen and all tasks, and to clean after each task before proceeding to the next assignment. Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to maintain medical records in accordance with accepted professional standards and practices, on each resident that are- complete; accurately documented; readily accessible; and, systematically organized for 1 of 3 residents (Resident #1). The facility failed to maintain medical records for Resident #1's progress notes from his mental health visit on 8/18/23 that were complete and accurate until 10/05/23. This failure could place residents at risk of not recording a proper account of medical interventions, treatments, and outcomes during a residents' stay. Findings included: Record review of Resident #1's Quarterly MDS assessment dated [DATE] revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with a diagnosis of End Stage Renal Disease (kidney failure), schizophrenia (psychological disorder), post-traumatic stress disorder, and Hypertension (high blood pressure). He had a BIMS of 08 (mild cognitive impairment). Resident #1 required limited to extensive assistance with ADLs. Record review of Resident #1's Physician Order dated 05/26/23. It read psych services to evaluate and treat PRN (as needed) an order for Aripiprazole 5mg 1 tablet by mouth at bedtime related to schizoaffective disorder, and Amitriptyline HCl 25mg 1 tablet at bedtime related to post-traumatic-stress disorder. Record review of Resident #1's MAR dated 10/01/23 revealed she received psychotropic medications on 5 out of 5 days reviewed. Record review of Resident #1's MAR dated 09/01/23 revealed she received psychotropic medications on 28 out of 30 days reviewed. Record review of Resident #1's MAR dated 08/01/23 revealed she received psychotropic medications on 30 out of 30 days reviewed. Record review of Resident #1's care plans dated 06/13/23 revealed a psychotropic medication (aripiprazole) care plan with an intervention of consult with pharmacy, MD to consider dosage reduction when clinically appropriate; monitor/record/report to MD prn side effects and adverse reactions of psychoactive medications. Record review of Resident #1's care plan dated 6/13/23 revealed a psychotropic medication (amitriptyline) care plan with an intervention of monitor/document/report to MD prn ongoing s/sx (signs and symptoms) of depression. Record review of Resident #1's progress notes from 05/26/23 to 10/05/23 revealed there was no MD or psych services provided to Resident to include medication and or behavioral management review was provided. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 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 455994 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desoto Nursing & Rehabilitation Center 1101 N Hampton Rd Desoto, TX 75115 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 10/05/23 at 12:16pm with LVN E revealed that Resident #1's psychotropic medications are evaluated by the psych doctor, but she was unsure if the Resident was seen in the facility or outpatient. She stated if he went outpatient then the after-visit notes should be uploaded to the EMR under the miscellaneous section and there should be a progress note from the date the resident left and returned to the facility. Residents return from appointments with an after-visit summary and if was not brought back with the residents than the facility could miss new orders or future appointment that were scheduled. She stated the DON and Medical Records are the ones who are responsible to make sure the notes are in the chart. Interview on 10/05/23 at 2:01pm with Medical Records revealed there should be an after-visit summary uploaded to the EMR after the residents return from outpatient appointments. He stated there was no pending documents needing uploading for Resident #1 and he requested last after visit summary from outpatient facility to be faxed on 10/05/23. Interview on 10/05/23 at 2:33pm with the ADON revealed that Resident #1 received psych services and medication management outside of facility. She stated that the notes for this visit should be under the miscellaneous tab on the EMR. She stated if the residents came back from appointments without the after visit summary, then the facility would reach out to the outpatient clinic to request the information. The person who would do this would be DON, ADON or Medical Records. She stated if this was not done than it meant there must be no changes to their medications or treatment plan . Interview on 10/05/23 at 3:13pm with Medical Records revealed he received the outpatient after visit summary via fax dated 8/18/23 and stated it was not in the EMR. This could cause the residents to miss getting the proper care due to missing information or follow up. He also stated that it should be in the EMR under the miscellaneous tab. He stated he is responsible to upload the documents and the DON or ADON is responsible to make sure the after-visit summary is reviewed for changes to plan of care and to make sure it was not missing. Record review of Resident #1's Mental Health Outpatient Note dated 8/18/23 revealed Resident was seen by an outside provider, note revealed Resident #1 as not appropriate to attend future appointments without a caregiver and Facilities management of psychotropic medications was unclear. Interview on 10/05/23 at 4:23pm with the DON revealed Resident #1 had been seen by an outpatient psych services provider. She stated they did not have the notes in the EMR because it was difficult to get them from the social workers at the outpatient facility. She stated her expectation is that the Medical Records and nurse managers make sure the notes were received after appointments because it could lead to residents not getting the appropriate care and changes to medications and lead to adverse effects. Request for accuracy or medical records policy from Administrator and DON on 10/05/23 at 4:40pm revealed the facility did not have one. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 455994 If continuation sheet Page 13 of 13