Inspection·September 27, 2024

F 0585 Level of Harm - Minimal harm or potential for actual harm physician and responsible party as needed. Discuss the need for continuing long-term care placement with the resident or family as indicated or requested. Encourage and allow the resident or family to discuss feelings and concerns regarding long-term care placement. Discuss with the resident or family the level of care that would be needed to safely return to an assisted living facility, group home, or the community when indicated or Residents Affected - Few requested. Record Review of the facility's Grievance log (June 2024 to September 2024) revealed Resident#1 filed a grievance on 09/03/2024 and 09/04/2024 with the facility that included patient care and medication administration. The resolution date for the grievance was 09/03/2024 and 09/04/2024 and documentation revealed that the resident was verbally informed of their decision regarding the grievance by the DON, SW, Administrator, but no documentation of written notification was given to Resident #1 or Resident #1's representative. In an interview on 09/27/2024 at 9:30a.m., Resident #1 stated that she had filed two grievances with the facility on 09/03/24 and 09/04/24. Resident #1 stated she had made several attempts with the SW and the Administrator to request copies that the grievance was concluded but had not received any documentation. Resident#1 stated she was told by the Administrator that it was the company's policy not to provide written documentation of the decision regarding the grievance. Resident#1 stated she had filed grievances regarding insulin administration and patient care, and it was her right to view the resolution of the grievances. Resident#1 stated she felt ignored not getting written decisions about her grievances. In an interview on 09/27/2024 at 11:46a.m., with the Administrator, he stated the grievance form was an internal document. Resident/family and not even state Surveyor can have access to the grievance form. It's company's policy. Surveyor asked what if the resident/family or Surveyor request to see the documentation of the decision regarding the grievance. The Administrator stated, they can't. In an interview on 09/27/2024 at 1:10p.m., The SW stated Resident#1 had requested written explanation of the findings of the grievance several times. SW stated she did not give Resident #1 a written explanation of the findings of the grievance. SW stated they had a meeting with Resident#1, Regional Administrator, Administer and her as witness of the conversation. The Regional Administrator explained to the resident normally it's not what we practice. Grievance form is more of internal document, so it is not uploaded to the resident's file. It's not a medical record. SW stated the grievances form goes in the grievance file and when state surveyors ask for it, she was to give it in the form of the grievance log. SW said that a possible negative outcome for not giving a resident written notification for a filed grievance would be that a resident may not feel that the grievance was resolved. In an interview on 09/27/2024 at 1:50 p.m., Interim DON stated the Administrator was the facility's abuse coordinator. Interim DON stated the process for grievance was interview staff/resident, investigate, resolve, and provide explanation to the resident if alert and or family. Interim DON stated, I don't think there is anything that would be preventing us from giving a copy. Interim DON stated that a possible negative outcome for not providing written documentation of the resolution would be that the resident would feel a lapse of communication in the facility, that a resident may forget that they were talked to about the grievance and feel that their grievance was not heard. Record Review of facility's Grievance Policy (Revision Date: 11/19/2016, 7/22/2023) reflected in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 2 of 3 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 675046 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosenberg Health & Rehabilitation Center 1419 Mahlman St Rosenberg, TX 77471 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 0585 Level of Harm - Minimal harm or potential for actual harm part: .The Administrator (grievances officer) is responsible for the following: Validates designee follows up with the resident/family regarding resolution or explanation. Ensure that residents either individually or through postings throughout the facility are aware of: The right to file grievances orally, or in writing in the language he/ she understands, Residents Affected - Few The right to file grievances anonymously, The contact information of grievance official Ensure that the grievance officer's information is posted to include: his/her name, business address (mailing and e-mail) and business phone number. A reasonable expected time frame for completing the review of the grievance. The contact information of independent entities with which grievances may be filed. E.g.: The pertinent state agency, Quality improvement Organization, State Survey Agency and State Long Term Care Ombudsman program or protection and advocacy system. Provide a copy of the grievance policy to the resident upon request . The grievance policy did not mention the right to obtain a written decision regarding his or her grievance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 3 of 3