Inspection·April 22, 2023

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some food, conversation, television, or books. 4. Provide structured activities: toileting, walking inside and outside, reorientation strategies, including signs, pictures and memory boxes. Record review of Resident #321's Elopement Assessment, dated 4/13/23 written by LVN O, revealed he was at low risk for elopement. Record review of Resident #321's Progress Notes, dated 4/14/23, written by LVN L, read in part, .after dinner, standing near the exit door, stated where is the door to get out, that he [Resident #321] needs to get out, Resident has history of wandering, Resident was redirected . Record review of Resident #321's History and Physical, dated 4/17/23, written by NP, revealed he had a history of agitation with dementia and was at risk for elopement. He was transferred to this facility on 4/13/23 for a secured unit. In an observation and interview on 4/19/23 at 2:18 p.m. in Resident #36's room, revealed Resident #321 walked by the window on the outside of the building, headed toward the front of the building. The State Surveyor immediately alerted the Administrator, Director of Environmental Services, and Maintenance Director, who were present in Resident #36's room. The Director of Environmental Services ran to the window and then left the room quickly. The Director of Environmental Services opened the exterior door near the laundry room with Resident #321 next to her and said look who I found. She escorted Resident #321 back inside the facility and walked him to the memory care unit. In an interview on 4/19/23 at 2:20 p.m. with MA A on the memory care unit, she said she was outside monitoring Resident #321 in the memory care courtyard. She said she did not tell anyone she left the resident outside. She said when she looked back outside Resident #321 was not there, and no other staff were outside. She said the courtyard gate was opened and she was surprised because it was always locked. She said she did not check the gate earlier to ensure it was locked because it was always locked. In an observation on 4/19/23 at 2:23 p.m. the memory care courtyard gate was opened. An additional opened gate near the laundry room was observed. There was a third opened gate at the front of the facility near the dumpster. Beyond the front opened gate was the busy main street where cars were passing by. In an observation and interview on 4/19/23 at 2:25 p.m. with Plant Operations Assistant who was outside of the building between the gate near the laundry room and the gate located near the front of the facility by the dumpster. He said the front gate and housekeeping (laundry) gate were normally unlocked until 4 p.m. He said the gate by memory care was locked and had to be locked at all times. In an interview on 4/19/23 at 2:29 p.m., the Director of Environmental Services said when she left out of the building she found Resident #321 at the housekeeping (laundry) gate. In an interview on 4/19/23 at 2:43 p.m., the Administrator said it was the first time he saw the memory care courtyard gate opened. He said he would put a sign on the door (to indicate the gate needed to be closed at all times). In an interview on 4/19/23 at 3:06 p.m., MA A said she did not know much about Resident #321 because she only administered medication to him. She said she was unsure if he was an elopement risk but that could be a reason why he was in the memory care. She said at the time of the incident she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 2 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some outside with him but went inside to ask someone to take her place while she went to the restroom. She said when she looked back outside, she did not see Resident #321. She said she did not know the memory care courtyard gate was opened because it was always locked. She checked the gate and started to look for him. She said she ran back to the nursing station to alert the nurse the resident was not in the courtyard. She said staff were normally always outside with the residents and said they were trained to always stay with the residents. She said she was not trained on ensuring the gates were locked and was unsure if a code was used to lock the gate. She said the maintenance staff normally checked the gates because memory care staff did not have access to the gates. In an interview on 4/19/23 at 3:15 p.m. CNA LL, who worked in the memory care secured unit, said she was not trained on checking the courtyard gates and said the gates were permanently locked. In an interview on 4/19/23 at 3:19 p.m. CNA Y, who worked in the memory care secured unit, said at the time of the incident Resident #321 was agitated and wanted to go outside. MA A went out to the back courtyard with Resident #321, and then opened the door to go use the restroom. She said since she started working at the facility 5 years ago, the two courtyard gates were always closed. She said she did not know the code to the gates and the residents were free to move around. She said no one knew the gates were opened because they did not open them at all, no one used them, and it was permanently locked. She said they were trained on checking their surroundings and checking the inside doors of the memory care. She said the problem today was maintenance staff did not alert them the gate was open. In an interview on 4/19/23 at 3:58 p.m., the DON said Resident #321 was a new resident with dementia and who was an elopement risk. She said she was informed, MA A was outside with Resident #321 but left him unattended to use the restroom and did not know the gate was opened. She said staff had to be outside to monitor the residents to ensure there were no incidents such as falls or altercations. She said the gates were not normally opened, especially the memory care units because of the yard. She said maintenance staff sometimes checked to ensure the gates were locked but pest control might have been the person to leave the gate opened. She said there was no sign on the gate to instruct people to shut the door behind them. She said if there was no sign, someone could leave it open. She said staff were not trained specifically on monitoring the courtyard gates but were trained to ensure a safe and secure environment. She said the risk of leaving a resident unsupervised with an unlocked gate could result in the resident eloping or sustaining an accident. If not supervised appropriately they could elope or have an incident fall or accident. In an interview on 4/19/23 at 4:16 p.m., the Director of Plant Operations said the memory care courtyard gate had a magnet lock and it required a code to get in and out. He said pest control staff put black boxes for rats outside and left the gate opened. He said there was no sign on the gate to instruct to make sure the gate was locked so no one tried to get out. He said the facility did not monitor the closed gates because no one was supposed to walk out of those gates. In a telephone interview on 4/19/23 at 4:30 p.m., the Pest Control staff said when he was at the facility this morning, he went through the memory care courtyard gate because it was already opened. He said memory care staff normally let him into the secure unit in the building because he did not have the access codes to the gate. In an interview on 4/19/23 at 4:38 p.m., the DON said when she walked outside of the building to assess the situation at the time of the incident (on 4/19/23 at 2:18 p.m.) all gates were opened. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 3 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some In an interview on 4/19/23 at 4:39 p.m., the Administrator said Resident #321 admitted to the facility the other day (4/13/23) because he was wandering. He said no one was aware the side courtyard gate was opened, and no one was assigned to ensure the gates were locked and closed. He said there were a few things that could have happened to cause the gate to be left open, which included pest control staff and the fire alarm test. He said the fire alarm was tested earlier (with a life safety code surveyor and maintenance staff) but it did not resonate with him (Administrator) to go and check the gate. He said staff normally watched the gates during a fire alarm test but an announcement was made in the facility that it was a test. He said the gate was normally locked because it was a means for the secure unit residents to freely move around in the courtyard. He said all three gates (memory care, laundry, and front gate) should have never been left opened at the same time. He said he expected staff to supervise residents in the memory care courtyard and ensure they were ok if the resident was outside for an extended period of around 5 - 10 minutes. He said he did not expect staff to sit outside with the residents. He said there was a potential for Resident #321 to have gotten out of the facility. In an interview on 4/19/23 at 4:45 p.m., a copy of the facility's policies were requested from the Administrator on supervision of memory care residents and fire alarm tests. These policies were not provided prior to exit. In an observation and interview on 4/20/23 at 11:44 a.m. revealed Resident #321 was in his room looking out of the window. He said he did not remember if he went outside yesterday and he did not try to leave the facility. He said he was in the facility too long and did not want to be there anymore. In a telephone interview on 4/20/23 at 12:07 p.m., the Director of Environmental Services said on the day of the incident, 4/19/23, she found Resident #321 by the opened outside laundry gate headed toward the street. She said the front gate was cracked opened. 2. Record review of Resident #80's face sheet revealed a [AGE] year-old male who was readmitted to the facility on [DATE]. He had diagnoses which included quadriplegia (a form of paralysis that affects all four limbs), lack of coordination, and contracture of muscle (A permanent tightening of the muscles, tendons, skin, and surrounding tissues that causes the joints to shorten and stiffen). Record review of Resident #80's quarterly MDS assessment, dated 4/19/23, revealed a BIMS score of 13 out of 15, which indicated intact cognition. He was totally dependent on two staff for transfers and toilet use. He required extensive assistance of one staff for bed mobility, dressing, and personal hygiene. Record review of Resident #80's care plan, revised on 1/8/23, revealed he was a smoker. He required a protective apron and assistance while smoking. Interventions included: Resident utilizes the assistance of nursing staff to assist in smoking and holding cigarette, Resident will participate in supervised smoke breaks. Record review of Resident #80's safe smoking assessment dated [DATE] written by RN A revealed he required direct supervision while smoking. He could not independently light smoking materials safely, he could not extinguish smoking materials or dispose of ashes or other tobacco-related residue appropriately, and he could not use his hands to self-smoke. 3. Record review of Resident #34's face sheet revealed a [AGE] year-old female who was readmitted to the facility on [DATE]. She had diagnoses which included alcohol dependence with alcohol-induced (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 4 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some persisting dementia (a group of symptoms that affects memory, thinking and interferes with daily life), symptoms and signs involving cognitive functions following cerebral infarction (stroke), need for assistance with personal care, and intracranial injury (a head injury causing damage to the brain by external force or mechanism. It causes long term complications or deatha) with loss of consciousness. Record review of Resident #34's quarterly MDS assessment, dated 2/21/23, revealed a BIMS score of 15 out of 15, which indicated intact cognition. She was independent with ADLs. Record review of Resident #34's, undated, care plan revealed she was a smoker. Her interventions included: resident will participate in supervised smoke breaks. Record review of Resident #34's Safe Smoking Assessment, dated 4/29/22, written by LVN Y, revealed she required direct supervision while smoking. The assessment indicated the resident shook or had tremors while smoking and indicated the resident had a past accident/incident with smoking materials. 4. Record review of Resident #43's face sheet revealed a [AGE] year-old male who was admitted to the facility on [DATE]. He had diagnoses which included cerebral infarction (stroke), lack of coordination, weakness, need for assistance with personal care, and nicotine dependence. Record review of Resident #43's quarterly MDS assessment, dated 1/18/23, revealed a BIMS score of 13 out of 15, which indicated intact cognition. He required limited to extensive assistance with ADL care. Record review of Resident #43's care plan, revised on 1/26/23, revealed he enjoyed smoking. His interventions were to participate in supervised smoke breaks. Record review of Resident #43's Safe Smoking Assessment, dated 4/6/23, written by RN A, revealed he required direct supervision while smoking. The assessment indicated the resident had finger dexterity problems. 5. Record review of Resident #53's face sheet revealed a [AGE] year-old male who was readmitted to the facility on [DATE]. He had diagnoses which included dementia (a group of symptoms that affects memory, thinking and interferes with daily life), muscle weakness, lack of coordination, and hypertension (high blood pressure). Record review of Resident #53's quarterly MDS assessment, dated 2/20/23, revealed a BIMS score of 15 out of 15, which indicated intact cognition. He was independent with toilet use, eating, and transfers. He required limited assistance with bed mobility, dressing and personal hygiene. Record review of Resident #53's care plan revised on 1/8/23 revealed he was a smoker. His interventions were to participate in supervised smoke breaks. Record review of Resident #53's Safe Smoking Assessment, dated 3/10/23, written by RN A, revealed the resident required direct supervision while smoking. In an observation and interview on 4/18/23 at 10:41 a.m. revealed Residents #80, #34, #43 and #53 were observed smoking unsupervised outside in the courtyard. There were no facility staff present in the courtyard with the residents or in the common area located inside of the building where the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 5 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some smoking area could be seen. Resident #80 was wearing a protective smoking apron and had a cigarette in his mouth. Resident #80 said there were no staff out in the courtyard with them now. Resident #53 said a staff member normally supervised them, but a lady filled in today and told the residents she had to go back to work on the floor. In an observation and interview on 4/18/23 at 10:50 a.m. revealed CNA V opened the door to the courtyard where the residents were smoking and asked Resident #80 if he was ok. CNA V said the facility had designated smoking assignments and said he thought the laundry aide was supposed to supervise the residents. CNA V left the area. In an observation and interview on 4/18/23 at 10:53 a.m., the DON and State Surveyor entered the smoking area in the courtyard. The residents were no longer smoking. Resident #53 told the DON a staff member had to leave them outside smoking by themselves. The DON said she did not see any staff outside with the residents. She said the staff member should have stayed with the residents to finish watching them smoke. In an interview on 4/18/23 at 11:12 a.m., the laundry aide said she was the staff who took the residents out for their smoke break on 4/18/23 at 10:30 a.m. She said she gave the residents the cigarettes and left because she was behind on the laundry. She said the residents were still smoking when she left. She said she reported it to her manager, the Director of Environmental Services. She said the residents needed supervision per policy. She said Resident #80 had no use of his arms and she had to ensure he did not injure himself. She said she was previously instructed to light the cigarettes and stay with the residents if it was not busy. If she was busy, she was instructed to light the cigarettes and leave the residents. In an observation and interview on 4/20/23 at 1:07 p.m., Resident #80 said when he smoked, the cigarette sat in his mouth the whole time and he blew out like normal. Resident #80 said he could not raise a cigarette to his mouth. He said on 4/18/23 Resident #34 removed the cigarette from his mouth when he was done smoking. He said Resident #34 normally placed his smoking apron on and removed it but said staff would also put his apron on. He said earlier this year (unknown date) while smoking his cigarette fell on his neck and down his shirt and burned a hole in the shirt. He said he was wearing a smoking apron at that time. There was no record of this incident in the resident's medical record. Resident #80 said staff normally supervised their smoke breaks. In an interview on 4/20/23 at 1:54 p.m., Resident #34 said she normally assisted Resident #80 with the smoking apron because he was paralyzed. She said she would also light Resident #80's cigarette and discard it when he finished because he could not take it out on his own. She said staff normally supervised their smoke breaks. In an interview on 4/21/23 at 9:58 a.m., the Director of Environmental Services said the laundry aide did not notify her she needed to leave the residents to return to work. She said the laundry aide was trained on smoking procedures and knew she was supposed to stay with the residents the entire time. She said Resident #80 had to wear a smoking vest and needed someone to place the cigarette in his mouth and remove it. In an interview on 4/21/23 at 10:51 a.m., Resident #80 said he did not report the previous smoking incident (from early 2023) to staff. In an interview on 4/21/23 at 11:51 a.m., the DON said during resident smoke breaks she expected (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 6 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 staff to stay and supervise the residents until they were finished with everything for safety reasons. She said Resident #80 required total assistance with smoking and staff had to light and remove his cigarette. She said staff should assist and remove Resident #80's apron, not residents. She said residents should not put the apron on Resident #80 because they may not know how to put it on appropriately. She said the Administrator was responsible for the smoking program and ensured staff were following facility policy. She said she was not aware of the prior smoking incident (from early 2023) with Resident #80. Residents Affected - Some In an interview on 4/21/23 at 11:02 a.m., the Administrator said the laundry aide left the residents smoking unsupervised (on 4/18/23) at the 10:30 a.m. smoke break because she was busy. He said staff should not leave the residents unsupervised while smoking and the residents could be at risk for burns. He said Resident #80 should be protected from burns because he wore a smoking apron. He said Resident #80 manipulated the cigarette with his mouth and if he were to drop an ash, it was designed to fall on the apron. He said Resident #80 could not use his hands and did not know how he would remove the cigarette if staff were not present. He said he was not aware of the previous smoking incident, which involved Resident #80, where the cigarette fell and burned his shirt. He said staff were supposed to put the apron on Resident #80. He said residents should not light the cigarettes or assist other residents with the apron to ensure it was properly placed. The Administrator said all staff were in serviced on the smoking policy and what to do while supervising residents on smoke breaks 6 months ago. The Administrator said staff were aware of the resident's smoking needs by the care plan and from the residents who could verbalize their smoking needs. He said no one monitored the smoke breaks to ensure proper supervision. Record review of the facility's Smoking policy, dated 3/1/17, read in part, .accommodate residents who desire to smoke . by taking reasonable precautions, providing a safe environment for them . Procedure . 8. IDT will develop an individualized plan for safe storage, use of smoking materials, assistance and required supervision for resident who smoke This was determined to be an Immediate Jeopardy (IJ) on 4/20/2023 at 4:18 p.m. The Administrator was notified. The Administrator was provided with the IJ template on 04/20/2023 at 4:18 p.m. The following Plan of Removal (POR) submitted by the facility was accepted on 4/22/2023 at 11:35 p.m. and the POR revealed: April 22, 2023 Plan of Removal F Tag 689 Accident Hazards The following actions have taken place immediately to remove the deficient practice. 1. The resident that was outside was immediately placed back in the secure unit on 4.19.2023, family guardian and physician notified by nurse on 4.19.23 no new orders given. The medication Aide was counseled 1:1 by Director of Nurses, and suspension for failure to follow facility policy on monitoring residents. 4.19.23 Resident was reassessed for elopement on 4.19.23 by the charge nurse. The care plan was updated to show that the attempted to elope on 4.21.23 by MDS coordinator. The staff that was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 7 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some suspended will have to complete 1 Sheet on elopement and attend the mandatory in-service on Elopement, Monitoring, Supervision, and Fire Drills by the Administrator prior to returning to work. Scheduled for 4.24.23. 2. Wander Guards of the 8 residents were reevaluated by the Maintenance Director to ensure they are working properly on 4.20.23. They were all functioning properly. The 8 residents were taken to the front door and the alarm went off to indicate the wander alarm device was functioning properly. The resident that attempted to elope did not have a wander guard on and there is no wander guard system in the secure unit. The residents on the secure unit will have supervised out times in the single access courtyard in the secure area that staff will be assigned by charge nurse daily. If the staff member has to leave for some reason, the staff member will call the receptionist and have them to send some to relieve them. 3. The clinical staff on-site will be in-serviced on monitoring the gate closure during and after a fire alarm has been activated or in the event of a power failure by the Administrator. During environmental rounds the Administrator and the Director of Maintenance will ensure the gates are functioning and intact weekly. The in-service will show that after the alarm sound they are to physically go and shake the gate to ensure that it is closed, and the locking mechanism is activated. Prior to training the gate was checked by Maintenance Director and Total Fire and Safety and a sensor was replaced on the door 4.20.23. A pre and posttest, for all Nursing staff will complete training. Those not being able to attend the training will not be allowed to work until training is completed. Completed by 4.22.23. 4. Staff will be trained on the monitoring of the residents in the secure unit and smoking areas. Residents that are outside or in the building will not be left alone or unsupervised. This training is conducted by the Administrator on 4.21.23. System change is that there will be scheduled times that the residents will be able to go into the courtyard and supervision will be mandatory, Completed 4.21.23. 5. All Licensed Staff will be in-serviced with return demonstration on the measure to ensure that the gate will be locked before and after the fire alarm sounds by the Administrator. The staff members that are not at work will be required to take the training from the Maintenance Director prior to coming back to work. Completed by 4.21.23 6. An elopement assessment will be completed on all residents in the secure unit and the 5 residents with wander guards in place and the elopement binder updated. Completed by the Director of Nurses and Nursing Management by 4.21.23. 7. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 8 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some Signage was posted by the Maintenance Director above the one keypad to make sure contract personnel close the gate if used. The Maintenance Director and the Administrator will ensure that the signage remains intact during the weekly environmental round. Completed by 4.20.23 8. All staff will be in-serviced by the Administrator on the current company policy for Elopement, Fire Drills, and simulations, and Memory Care Education Announcement, by the Administrator: Code PINK, which signals that an Elopement Drill Procedure is in progress. 1. An immediate and thorough search of the center and surrounding grounds. Including but not limited to a search of the area outside the nearest exit to the patient's/resident's room or the exit where he/she was last seen, and the entire unit where the patient/resident resides or was last seen, the remainder of the facility (all rooms, closets - including storage areas - and bathrooms) and grounds, extending beyond the fence line. 2. The entire search process of the facility and grounds, from the time the patient/resident is missing. 3. If the search fails to locate the missing patient/resident within (30) thirty minutes from the time the patient/resident is found to be missing, then the Administrator and/or designee places a mock telephone call to the appropriate community agencies (Police, Local Health Department), Administration, the patient's/resident's legal representative and attending physician. 4. The search is continued. Two staff members search the surrounding streets by car for a two (2) mile radius around the facility. By Administrator completed by 4/20/2023. 9. All Facility doors will be checked by Maintenance Director to ensure that the exit magnets are functioning properly. The Maintenance Director and the Administrator will check the doors weekly during environmental rounds and report and negative findings to the QAA. Completed by 4.20.23 10. Risk of elopement assessments, care plans and interventions reviewed and or revised for all residents at risk of wandering or elopement by Director of Nurses and Assistant Director of Nurses. Completed by Director of Nurses and Nursing Administration by 4.22.23 11. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 9 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Some Resident #80 When made aware that the residents were outside smoking unsupervised another housekeeping staff member went to supervise the residents on 4.18.23. Resident was assessed by Licensed Nurse on 4.21.23 to see if there were any injuries or burns none were noted. The family and Nurse Practitioner were notified in regards to the resident being left unsupervised during smoke break by Administrator on 4.21.23 no new orders were given by NP. The staff that left the residents unattended was given a written 1:1 counseling on 4.18.23 on the smoking policy and not leaving the residents unattended during smoke breaks. Completed 4.18.23. The residents smoking items will be stored in a tackle box on the A nursing unit. The policy was reviewed by the IDT on 4.18.2023 and found not updates needed. The facility has always mandated that a resident smoking items be keep or maintained by the staff at the facility. 12. All Staff were in-serviced on smoking and residents being left unsupervised on 4.18.23, 4.19.23, 4.20.23, 4.21.23 by the Administrator. A copy of the smoking times and a copy of the policy was placed in the smoking area by the Maintenance Director on 4.21.23. The resident smoking assessments were completed by Social Services Completed on 4.21.23 and no changes to current smoking arrangements for identified residents. 13. Change is the facility will hire a smoking hospitality aide immediately and train them on the policy and smoking of the residents. We will use current schedule of departments to smoke the residents until the smoking aide is hired and trained. We will hire 2 persons to fulfill this role so that it will provide 7 days a week coverage. Residents that smoke on the secure unit will be escorted to the smoke area and monitored by the assigned staff from the secure unit on 4.20.23. The assigned staff will take the residents back once they have completed the smoke break. If the staff member has to leave for some reason, the staff member will call the receptionist and have them to send someone to relieve them. 14. A meeting is scheduled for 4.22.23 with the residents by the Administrator and Activities Director and they were informed that at no time should they place any smoke apron on one another, light another's cigarette, or extinguish another resident's cigarette. Completed 4.22.23. 15. At smoking times, the Administrator and Department heads will be making rounds in the smoking area daily starting 4.19.23 to ensure that the residents are supervised by departmental staff during the assigned smoking times. Any deficiency will be corrected by the department manager staying and to monitor and disciplinary actions up to termination for the assigned staff member leaving the residents unsupervised. Plan to Ensure Compliance Medical Director confirmed receipt of IJ on 4.20.23 1. An Ad hoc QAPI was completed by the IDT on 4.19.23. The QAPI included smoking and monitoring (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 10 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 compliance by staff. Level of Harm - Immediate jeopardy to resident health or safety 2. Wander guard system will be checked daily by Maintenance Director to start 4.20.23. Smoking monitoring compliance[TRUNCATED] Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 11 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0695 Provide safe and appropriate respiratory care for a resident when 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 that a resident who needed respiratory care, which included tracheostomy care and tracheal suctioning, was provided such care consistent with professional standards of practice, the comprehensive person-centered care plan, the resident's goals and preferences for 1 of 2 residents (Resident #65) reviewed for oxygen therapy. Residents Affected - Few The facility failed to ensure Resident #65's oxygen was set according to physician orders. This failure could place residents at risk of respiratory distress. The findings were: Record review of Resident #65's face sheet revealed a [AGE] year-old male who was admitted to the facility on [DATE] and readmitted on [DATE]. He had diagnoses which included chronic respiratory failure (long-term condition that happens when your lungs cannot get enough oxygen into your blood), cerebral infarction (stroke), and seizures. Record review of Resident #65's quarterly MDS assessment, dated 2/18/23, revealed a staff assessment for mental status was completed and indicated his cognitive skills for daily decision making were severely impaired. The resident was on oxygen therapy. Record review of Resident #65's care plan, dated 1/24/23, revealed the resident was on oxygen therapy related to respiratory illness. Interventions included oxygen settings: O2 via nasal cannula. Record review of Resident #65's Order Summary Report for April 2023, revealed an order for oxygen at 4 L via trach collar (trach collar is a medical device used to secure a trach tube in its position) every shift, order date 7/19/22. Record review of Resident #65's Licensed Nurse Medication Administration Record for April 2023 revealed his O2 saturation (measure of how much oxygen is traveling through your body in your red blood cells) was 98 % on 4/18/23, 4/19/23, and 4/20/23. (Oxygen saturation level in healthy patients is considered normal between 97 percent and 99 percent). In an observation on 4/18/23 at 11:37 a.m. revealed Resident #65's oxygen was between 9 and 10 L. The resident was lying in bed asleep with the oxygen tube in place. In an observation on 4/19/23 at 10:43 a.m. revealed Resident #65's oxygen was on 5 L. The resident was lying in bed asleep with the oxygen tube in place. In an observation on 4/20/23 at 9:15 a.m. revealed Resident #65's oxygen was between 5 and 6 L. The resident was lying in bed asleep with the oxygen tube in place. In an observation and interview on 4/20/23 at 11:26 a.m. revealed LVN Z looked at Resident #65's oxygen machine and said the oxygen was around 5 L. LVN Z said Resident #65 should be on 4 L of oxygen per physician's order. She said the level on the oxygen machine would sometimes move and pop up. She said she would need to get a new machine if that occurred. She said at every shift, the nurse was responsible for verifying the O2 level. She said the oxygen helped Resident #65 breathe and dry out (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 12 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0695 his mucus. She said if the level was on 5 L it could make him more restless and dry the mucous up more. Level of Harm - Minimal harm or potential for actual harm In an interview on 4/21/23 at 11:29 a.m., the DON said the O2 level on the machine did not normally jump up but they would replace the concentrator for Resident #65. She said she expected nurses to check O2 levels every shift and have the O2 level at the prescribed MD order because they must follow the MD order. She said if the O2 level needed to increase, the resident would need to be evaluated and receive a new order. She said if the O2 level was set higher than prescribed Resident #65 could accumulate more carbon dioxide. She said Resident #65's lung capacity was assessed at the prescribed level. Residents Affected - Few Record review of the facility's Oxygen Therapy policy, dated 4/2021, read in part, . it is the policy of this community to ensure all oxygen administration is conducted in a safe manner . Procedure: 1. Verify there is an order for oxygen administration to include: . b. flow rate . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 13 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0759 Ensure medication error rates are not 5 percent or greater. 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 medication error rate was not five percent (%) or greater. The facility had a medication error rate of 6% based on 2 errors out of 31 opportunities, which involved 2 of 7 residents (Residents #36 and #32) reviewed for medication errors. Residents Affected - Few 1. MA CC failed to apply Resident #36's lidocaine patch to the knee and foot, according to physician orders and applied a Lidocaine patch to Resident #36's shoulder only. 2. LVN Z failed to administer Reglan to Resident #32 according to physician orders and administered 12 mL instead of 10 mL. These failures could place residents at risk of not receiving the intended therapeutic benefits of prescribed medications. Findings include: 1. Record review of Resident #36's face sheet revealed a [AGE] year-old female who was readmitted to the facility on [DATE]. She had diagnoses which included chronic pain, rheumatoid arthritis (a chronic inflammatory disease that affects the joints. This results in painful joints, swelling and stiffness in the joints), cerebral infarction (stroke), and hypertension (elevated blood pressure). Record review of Resident #36's quarterly MDS assessment, dated 1/13/23, revealed a BIMS score of 15 out of 15, which indicated intact cognition. She required extensive assistance to total dependence on 1-2 staff for ADL care. Record review of Resident #36's, undated, care plan revealed she had joint pain (personal history of shoulder pain and knee pain), and arthritis. Her interventions were to administer pain medications as ordered. Record review of Resident #36's Order Summary Report for April 2023 revealed an order for Lidoderm external patch 5% (Lidocaine) apply to left, shoulder, knee, foot topically one time a day for pain .order date 3/8/23. In an observation on 4/19/23 at 8:56 a.m. MA CC applied one Lidocaine patch 5% to Resident #36's left shoulder. In an interview on 4/19/23 at 10:55 a.m., Resident #36 said MA CC did not apply a Lidocaine patch to her knee today. She said her knee always hurt and the patch helped very little. She said staff normally applied the Lidocaine patch to her left shoulder and sometimes applied it to her left knee and left foot. In an observation on 4/19/23 at 1:26 p.m. with a CNA (unknown name) revealed there was no Lidocaine patch on Resident #36's left knee or left foot. In an observation and interview on 4/19/23 at 1:37 p.m., MA CC said she applied the Lidoderm patch to Resident #36's left shoulder only because she was under the notion the order was for one patch as it was previously. She said she checked the eMAR and the label on the Lidocaine box for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 14 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few directions to make sure it was given correctly. She said she was not sure what the order was this morning when she applied the patch. Observation of the pharmacy label on the Lidocaine box for Resident #36 revealed: apply to left shoulder, knee, foot topically, dated 4/8/23. MA CC reviewed the physicians order and said the directions were to apply the patch to the shoulder, knee and foot. MA CC said the Lidocaine patch was used for arthritis and said if they were not applied to her knee and foot the resident could be in pain. She said the DON and the ADON conducted the in-service to ensure staff administered the right medication and verified with the computer for accuracy. In an interview on 4/21/23 at 11:36 a.m., the DON said Resident #36 was supposed to have three patches applied to her left side. She said Lidocaine was a local patch and if it was not applied to the knee or the foot, it would not work there. She said it could affect the resident because it was a pain patch. She said the physicians order instructed MA CC on how many patches to apply and where to put them. 2. Record review of Resident #32's face sheet revealed a [AGE] year-old female who was readmitted to the facility on [DATE]. Her diagnosis included gastro-esophageal reflux disease (a chronic digestive disease where the liquid content of the stomach refluxes into the esophagus, the tube connecting the mouth and stomach), pneumonitis (mainly refers to inflammation of lung tissue due to non-infectious causes, which results in cough without mucus or phlegm, shortness of breath and fatigue) due to inhalation of food and vomit, acute embolism (blockage in the arterial (oxygen rich blood which flows from the heart to rest of the body) or venous (which carry deoxygenated blood from the organs to the heart) blood flow due to a blood clot), and thrombosis (the formation or presence of a blood clot in a blood vessel) of unspecified vein and dementia. Record review of Resident #32's quarterly MDS assessment, dated 3/8/23, revealed a BIMS score of 11 out of 15, which indicated moderate cognitive impairment. She required extensive assistance of two staff for ADL care. Record review of Resident #32's, undated, care plan revealed she had GERD and was at risk for abdominal pain and discomfort. Interventions were to give medications as ordered. Record review of Resident #32's Order Summary Report for April 2023 revealed an order for Metoclopramide solution 5 mg / 5 mL give 10 mg by mouth every 6 hours for GERD, order date 3/27/23. In an observation and interview on 4/18/23 at 12:57 p.m. revealed LVN Z prepared and administered 12.5 mL of Metoclopramide 5 mg/mL to Resident #32 by g-tube instead of 10 mL as prescribed by the physician. LVN Z said there was 10 mL of Metoclopramide and said she knew it was 10 mL because she referred to the line. The amount of red Metoclopramide liquid that LVN Z prepared was observed and was noticeably above the 10 mL line at eye level. In an observation and interview on 4/18/23 at 1:25 p.m., LVN Z said she referred to the MD order to determine how much Metoclopramide to administer. The State Surveyor showed LVN Z the picture of the Metoclopramide liquid (which was taken by the State Surveyor) that was prepared for Resident #32 by LVN Z on 4/18/23 at 12:57 p.m. LVN Z said again the liquid was at 10 mL. She said Resident #32 was prescribed Reglan (Metoclopramide) for gas and acid reflux. In an observation and interview on 4/21/23 at 11:36 a.m. the State Surveyor showed the DON, the same picture that was shown to LVN Z on 4/18/23 at 1:25 p.m. of the Metoclopramide liquid that was prepared for Resident #32 by LVN Z on 4/18/23 at 12:57 p.m. The DON said the Metoclopramide liquid was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 15 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete above the 10 mL line. She said staff were expected to prepare the liquid and verify it at eye level. She said Reglan was used for acid reflux and was a medication error if more liquid was given. Record review of the facility's Oral Medication Administration policy, dated 9/2018, read in part, .medications will be administered in a safe and effective manner . Procedures: . 2. Review and confirm medication orders for each individual resident on the MAR prior to administering medications to each resident . 4. For liquid medications . b. pour the correct amount of medication directly into a graduated/calibrated medication sup or measuring device or use an oral syringe to pull up the correct amount. Measure the volume on a flat surface at eye level and read the volume from the bottom of the meniscus (curve) Event ID: Facility ID: 675000 If continuation sheet Page 16 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure the commercial oven, stove and wall were not soiled with any gummy/greasy substances. 2. The facility failed to ensure the deep fryer was not full of odiferous grease. 3. The facility failed to ensure 7 full-size sheet pans did not have baked-on brown substances. These deficient practices could place residents at-risk by contributing to foodborne illness, poor intake, and/or weight loss. Finding include: Observation on 04/18/23 at 8:35 a.m. revealed the deep fryer was full of odiferous grease and had floating crumbs and debris on the surface. The commercial stove and oven were soiled with crumbs and dust on top and the wall behind it was soiled with a gummy substance. Observation on 04/19/23 at 2:39 p.m. revealed the deep fryer was full of odiferous grease and had floating crumbs and debris on the surface. The commercial stove and oven were soiled with crumbs and dust on top and the wall behind it was soiled with a gummy substance. Further observation revealed a clean rack of dishes had 7 full-size sheet pan with baked-on brown substances. Observation and interview on 04/19/23 3:01p.m., the Dietary Manager stated the commercial stove and oven were soiled with crumbs and dust was on top and the wall behind it was soiled with a gummy substance. She stated the deep fryer contained oil that was murky and soiled with crumbs and debris. When asked who was responsible for ensuring the walls were cleaned and who was responsible for changing the oil in the [NAME]. Why was it important for these items to be cleaned. How could the residents be affected by this failure. The Dietary Manager said frying oil was replaced by the cooks with fresh oil every Sunday because the facility served fish fry every Fridays. She said there were 3 cooks who worked at the kitchen. She said the AM cook made and served breakfast and made lunch. The PM cook served the lunch and made dinner. She said each cook was supposed to clean the stove after each meal. She said, this looks weeks worth of mess not just todays. She said there were some burn stains, but grease could easily be cleaned. She said, the could not get the baking tray to scrub and the would need new ones. The Dietary Manager stated she told the Administrator the kitchen needed new pans. She said she told the Administrator when she started working in the facility 3 and half months ago. Observation and interview on 04/19/23 at 3:30 p.m. with the Dietary Manager and [NAME] A. when asked how often they cleaned. Why were these items not cleaned. Why was there build up. [NAME] A said each cook needed to clean the stove after cooking the meal because build up could catch on fire. In an interview on 4/20/2023 at 10:20 a.m. with [NAME] B, she said she was the AM cook and stayed until 1:30 p.m. She said, sometimes they needed help because they had so many things and it's easy to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 17 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 - Many fall behind and everything was on the line to be served and had to go out to the residents. She said the cook who came for lunch and dinner was supposed to wash their own dishes, everybody was responsible for cleaning the stove. [NAME] B stated Sometimes we are just too busy to clean the stove and it is all of our responsibility. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2017, U.S. Department of H&HS, revealed 4-602.13 Nonfood-Contact Surfaces, Nonfood-Contact Surfaces of equipment shall be cleaned at a frequency necessary to preclude accumulation of soil residues. Record review of the Food Code, U.S. Public Health Service, U.S. FDA, 2017, U.S. Department of H&HS, revealed 6-501.12 Cleaning, Frequency and Restrictions, (A) Physical facilities shall be cleaned as often as necessary to keep them clean. Record review of the facility's Food Safety policy (effective date: 01/2018) read in part: .Policy: All food purchased will be wholesome, manufactured, processed, and prepared in compliance with all State, Federal, and local laws and regulations. Food will be handled in a safe and sanitary method to prevent contamination and food-borne illness . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 18 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 observation, interview and record review the facility failed to ensure there was a communication process, which included how the communication would be documented between the LTC facility and the hospice provider, to ensure that the needs of the resident were addressed and met 24 hours per day for 1 of 2 residents (Resident #64) reviewed for hospice services. -The facility failed to ensure there was hospice communication documentation for Resident #64 in her medical record or hospice communication binder. This deficient practice could place residents at risk of treatments and services not being coordinated. Findings include: Record review of the admission sheet for Resident #64 revealed a [AGE] year-old female who was admitted to the facility on [DATE] and re-admitted on [DATE]. She had diagnoses which included Alzheimer's disease (a progressive disease that destroys memory and other important mental functions) cognitive communication deficit (an impairment in organization/ thought organization, sequencing, attention, memory, planning, problem-solving, and safety awareness) and dysphagia (Difficulty swallowing foods or liquids, arising from the throat or esophagus, ranging from mild difficulty to complete and painful blockage). Record review of Resident #64's Quarterly MDS, dated [DATE], revealed the BIMS score was 00. The staff assessment for mental status was conducted, the resident was unable to complete interview. Resident #64 had a short term memory problem, long term memory problem, and cognitive skills for daily decision making was severely impaired and she never/rarely made decision. She required total dependence from one-person physical assist for personal hygiene, toilet and transfer. The resident was always incontinent of bowel and bladder. Record review of Resident #64's physician order, dated 02/27/23, revealed Resident admitted to [Hospice company name] with terminal DX: Alzheimer's Disease under the care of Dr. [AA] with n/o to continue all current treatments and medications. Record review of Resident #64's Care plan, initiated 04/01/2019 and revised on 04/19/2023, revealed the following: Focus: [Resident #64] admitted to [Hospice company] with terminal DX: Alzheimer's Disease Goal: The resident's dignity and autonomy will be maintained at highest level through the review date Interventions: Consult with physician and Social Services to have Hospice care for resident in the facility. Work cooperatively with hospice team to ensure the resident's spiritual, emotional, intellectual, physical and social needs are met. Record review of Resident #64's Visitor Sign-in sheet revealed hospice staff visited her on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 19 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 following days: 02/23/23, 02/24/23, 02/27/23, 03/06/23, 03/07/23 and 04/04/23. Level of Harm - Minimal harm or potential for actual harm Record Review of Resident #64's medical file revealed there was no documentation of any coordination of care or any communication with hospice company. Residents Affected - Few Observation and attempted interview with Resident #64 on 4/18/23 at 9:40 a.m., revealed the resident was resting on an air mattress. The resident did not respond to the questions asked about her stay at the facility. In an interview and record review with LVN Z on 4/19/23 at 1: 37 p.m., she said she was the nurse for Resident #64. She said Resident #64 was receiving hospice services. She said she was not sure exactly what days the hospice came but she knew they came weekly. She said when the hospice aides came, they gave the resident a bed bath and the nurse would do assessments. She said the hospice staff always announced when they were there and asked the nurse if there were any concerns or anything they should be aware of or if they needed meds refilled. LVN Z said hospice staff communicated with the facility by always logging in their binder when they were there. She said they told them verbally what they did, and they also documented in their binders. When asked when was the last time the hospice came and what they did when they were there, she said, I need to check the binder. She reviewed the binder for Resident #64 with the State Surveyor and said, Looks like they were last here on today 04/04/23. LVN Z checked the hospice binder and said she could not find the documentation which stated what Hospice did while they were there. She checked the binder and said, there is no RN initial assessment or the weekly assessment. LVN Z stated she did not know who was responsible for ensuring hospice was documenting in the binder. In an interview and record review on 4/19/23 at 2:02 p.m., with the DON reviewed Resident #64's hospice binder and said the hospice nurse came once a week and the hospice aides were supposed to come 3 times a week. When asked who was responsible for ensuring hospice notes were documented and the residents had a hospice plan of care. The DON said, she would get with hospice company to see what the plan was and to request current notes for the binder. She said it was important to have the current hospice plan of care for the resident if there were any changes to keep the facility informed and for communication purpose. In an interview and record review on 4/20/23 at 12:02 p.m., with the Administrator and the DON, the DON said the Administrator contacted the hospice company yesterday (04/19/23) to send hospice documentation. The Administrator said the hospice company said the facility should have another hospice binder with all the communications/ documentation regarding Resident #64. The DON said, We told the hospice company we were unable to locate such folder. Record review of facility's Hospice Program (Revised July 2017) read in part: .10. In general, it is the responsibility of the facility to meet the resident's personal care and nursing needs in coordination with the hospice representative, and ensure that the level of care provided is appropriately based on the individual resident's needs. These include: d. communicating with the hospice provider (and documenting such communication) to ensure that the needs of the residents are addressed and met 24 hours per day. Obtaining the following information from the hospice: (1) The most recent hospice plan of care specific to each resident; (2) Hospice election form; (3) physician certification and recertification of the terminal illness specific to each resident; (4) Names and contact information for hospice personnel involved in hospice care of each resident; (5) Instructions on how to access the hospice's 24-hour-on-call system; (6) Hospice medication information specific to each resident; and (7) Hospice physician and attending physician (if any) orders specific to each resident. 13. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 20 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 Coordinated care pan for residents receiving hospice services will include the most recent hospice plan of care as well as the care and services provided by our facility (including the responsible provider and discipline assigned to specific tasks) in order to maintain the resident's highest practicable physical, mental and psychosocial well-being Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 21 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0880 Provide and implement an infection prevention and control program. 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 establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for 1 of 4 residents (Resident #9) reviewed for infection control. Residents Affected - Few CNA A failed to properly change gloves and wash or sanitize her hands when moving from a dirty area to a clean area when incontinent care was provided to Resident #9. This failure could place residents at risk for cross contamination, infections, delay in treatment and hospitalization. Findings include: Record review of the admission sheet for Resident # 9 revealed a [AGE] year-old male who was admitted to the facility on [DATE] and re-admitted on [DATE]. He had diagnoses which included quadriplegia (refers to paralysis from the neck down, including the trunk, legs and arms), covid-19 (is an infectious disease caused by the SARS-CoV-2 virus) and hypertension (A condition in which the force of the blood against the artery walls is too high). Record review of Resident #9's Quarterly MDS assessment, dated 09/09/2023, revealed a BIMS score of 13 out of 15, which indicated intact cognition. He required extensive assistance from one-person physical assist for dressing, toilet use, and personal hygiene. He was always incontinent of bowel and bladder. Record review of Resident # 9's care plan, initiated 5/8/2019 and revised on 8/31/2021, revealed the following: Focus: [Resident #9] is incontinent of: [ x]Bowel [ x] Bladder Goal: Resident will remain clean, dry, and odor free with no occurrence of skin breakdown throughout the review date. Intervention: 1. Monitor for incontinence Q2H/PRN, change promptly and apply protective skin barrier. 2. Monitor for s/s of skin break down and report abnormal findings to MD/RP. 3. Assess for causes of incontinence. 4. Labs as ordered by MD. 5. Encourage fluid intake within dietary limits. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 22 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0880 6. Monitor for s/s of infection and notify MD/RP promptly. Level of Harm - Minimal harm or potential for actual harm Observation on 04/18/23 at 10:38 a.m., revealed CNA A and CNA B provided Resident #9 with incontinence care. CNA A completed perineal care and wearing the same soiled gloves, touched the resident's clean brief, shirt, pants, sock, shoes and transferred the resident using sit to stand lift (A sit to stand lift is a medical device that assists individuals with limited mobility in standing up from a seated position) from bed to wheelchair. Residents Affected - Few In an interview on 04/18/23 at 10:45 a.m. with CNA A, she said she should have performed hand hygiene in between going from dirty to clean as it placed risk for cross contamination. She said she had been in-serviced on hand washing/infection control last month but could not recall the exact date. She said she forgot to change gloves and sanitize her hands. She said all staff had skills check off to include peri care on a female manikin sometime last month. She said she could not recall the exact day. In an interview on 04/18/23 at 10:45a.m. with CNA B, she said she did good assisting CNA A with turning and repositing the resident. She said CNA A performed care and transferred the resident with the same gloves. She said CNA A should have changed her gloves before placing clean brief on the resident. This placed the resident at risk for infection. In an interview on 4/19/23 at 2:02 p.m. with the DON, she said she expected staff to provide appropriate care to residents based on their needs. She said the CNA should have either washed or sanitized her hands after touching a dirty area prior to moving to a clean area when performing incontinent care. She said staff were provided training on infection control and hand hygiene monthly and as needed. She said staff were monitored to ensure they followed infection control precautions by the Unit Mangers/ADON spot checking during care. She said the potential risk to residents due to this failure was cross contamination. In an interview on 04/20/23 at 12:05 p.m. with the ADON, she said she did daily infection surveillance to include hand washing and sanitizing. She said she spot checked CNAs daily to make sure they washed hands properly, sanitized their hands after touching a dirty area prior to moving to a clean area and cleaning the resident properly in the right director to prevent cross contamination. She said she did not recall the last time she spot checked CNA A and CNA B. Record review of the facility's Skill/Procedure: Peri/Incontinent Care, Male (without catheter) (original 6/13) read in part: .5. Remove soiled clothing or brief. Place soiled brief/clothing in plastic bag. 6. Remove gloves, clean hands (may use gel), apply new gloves Record review of the facility's Hand Hygiene policy (effective 8/4/2021) read in part: .Policy: Hand hygiene is used to prevent the spread of pathogens in healthcare settings. Hand hygiene is a general term that describes hand washing using soap and water or the use of an alcohol-based hand rub (ABHR) to destroy harmful pathogens, such as bacteria or viruses, on the hands Record review of the facility's Infection Control policy (effective 6/8/2021) read in part: .Policy: This communities' infection control policies and practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to help prevent and manage transmission of diseases and infections Record review of the facility's Hand Hygiene policy (effective: 8/4/2021) read in part: .Policy: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 23 of 24 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 675000 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Beechnut 12777 Beechnut St Houston, TX 77072 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 0880 Level of Harm - Minimal harm or potential for actual harm Hand hygiene is used to prevent the spread of pathogens in healthcare settings. Hand hygiene is a general term that describes hand washing using soap and water or the use of an alcohol-based hand rub (ABHR) to destroy harmful pathogens, such as bacteria or viruses, on the hands Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675000 If continuation sheet Page 24 of 24