Inspection·March 25, 2025

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some difficult to breathe) with acute exacerbation (sudden and severe worsening of respiratory symptoms in COPD patients), unspecified cirrhosis of liver (a type of chronic, progressive liver disease where healthy liver cells are replaced by scar tissue), acute cholecystitis (inflammation of the gallbladder, typically caused by a blockage of the cystic duct), dependence on renal dialysis (treatment that cleans the blood when kidneys are unable to do so), and shortness of breath. Resident #1 was his own responsible party. Record review of Resident #1's quarterly MDS dated [DATE] revealed he had a BIMS score of 13 (cognitively intact); Resident #1 exhibited behaviors related to rejection of care; Resident #1 used a manual wheelchair for mobility; Resident #1 was independent with eating, oral hygiene, toileting hygiene, dressing, personal hygiene, and transfers and required supervision or touching assistance for showers/bathing; Resident #1 was always continent of bowel and bladder; and Resident #1 was prescribed anticoagulant and antipsychotic medication. Record review of Resident #1's care plan, revised on 05/25/2025 revealed the following care areas: * Resident has impaired visual function and is at risk for falls, injury, and a decline in functional ability. Goals included: Resident will maintain optimal quality of life and not experience a decline in ADL functional abilities, or an injury related to vision loss. Interventions included: Arrange consultation with eye care practitioner. Assist to ensure glasses are labeled and within reach. * Resistant to Care: Resident is resistant to care and at risk for injury, a decline in functional abilities, and not having his needs met. [He] refuses to take his scheduled medications and refuses to go to his scheduled dialysis days. Goal included: Resident will not be a danger to self or others. Interventions included: If refusals continue, notify MD and family, document in resident records. Give a clear explanation of complications of not having his dialysis. Encourage as much participation as possible. Provide resident with opportunities to make decisions about his treatment. * Falls: Patient is a fall risk due to weakness of both lower extremities. Resident has the potential for falls related to unsteadiness on feet, abnormalities of gait and mobility, unspecified lack of coordination, and generalized weakness. Fall: 01/04/2025, 02/01/2025. Goal included: Resident will not sustain a fall related injury by utilizing fall precautions. Interventions included: Encourage resident not to transfer without assistance. Anticipate and meet the resident's needs. Educate the resident about safety reminders and what to do if a fall occurs. Encourage socialization and activity attendance as tolerated. * Therapeutic Leave: Resident is cognitively able to sign out of the facility and make their own informed decisions while they are out. On 04/10/2025 while on therapeutic leave, resident made the decision to consume alcoholic beverages. Goals included: The resident will follow facility policy for out on pass. The resident will be safe and comfortable while out on pass. Interventions included: Educate the resident/family/caregivers about the potential risks associated with signing out on pass. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 2 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Educate resident/family/caregivers on the facility's policy for therapeutic leave/out on pass. Resident is reminded of his health issues and treatment regimens and the recommendations to avoid the use of alcoholic beverages. Further review of Resident #1's care plan revealed no care areas, goals, or interventions to address his substance abuse concerns. Residents Affected - Some Record review of Resident #1's, Elopement/Wandering Risk Assessment dated 05/24/2025, completed by LVN A revealed, A. Preliminary Data. 1. Is the resident physically able to leave the facility on their own? Yes. Continue assessment. B. Evaluation. Cognition: 1. Is the resident disoriented to place or intermittently confused? Yes . Further review of the assessment revealed Resident #1 scored a 1, which indicated low/no elopement risk. Record review of Resident #1's nursing progress notes for April 2025 and May 2025 revealed: * On 04/02/2025, at 4:10 p.m., SW B wrote, Resident was educated with Administrator, ADON, DON, and SW on the policies for Therapeutic Leave and the expectations for the resident when he is on Therapeutic Leave. Resident verbalized understanding. * On 04/11/2025, at 12:10 a.m., RN E wrote, Resident came back on pass to the facility with alcohol intoxication, vitals and assessment done. All within normal baseline. NP notified. New order to transfer resident to the hospital for further evaluation but resident refused. Resident was monitored through the shift, comfort care provided to resident satisfaction. * On 04/11/2025, at 11:50 a.m., ADON F wrote, Late Entry: 04/10/2025 at 11:00 p.m. Upon resident's return to the facility, resident arrived propelling himself in his motorized wheelchair. Resident had a slurred speech, he was drooling, smiling, and laughing, slow to respond to questions, and lethargic. Resident said he was tired and wanted to lay down and go to sleep and was assisted back to his room and was unable to stand to assist with his transfer to his bed, so he was transferred to bed with two people assist. In speaking with the resident, he said that he had ingested alcohol, specifically three 40 oz bottles of [brand name of beer] and he would not say if he had ingested any other substances or drinks. Upon assessment by unit nurse, there was no evidence of trauma or physical injuries noted, no indications of any falls or any other incidents at the time of his return. * On 04/12/2025, at 7:17 p.m., LVN A wrote, Police officer called facility and said resident vomited and may have been drinking with his friend and they have called 911 for him to go to the ER and have him evaluated. They then came to the facility, and I gave him a face sheet and medication lists. I accompanied the officer to EMS parked on the street near the facility and found the patient inside the ambulance being attended to by two paramedics with patient leaning to his left side. I placed a call to the Administrator and ADON. Resident apparently signed out at about 12 noon and left the facility with another resident. They apparently went to a nearby store and purchased drinks. He drank (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 3 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some until he vomited on himself and became very weak. I asked the paramedics where they were taking him, and they informed me that they were taking him to [a local hospital] ER. NP and RP notified. * On 04/14/2025, at 4:38 p.m., ADON F wrote, Resident was found to be in possession of a cigarette lighter. The resident was educated by the Administrator on the smoking policy and the lighter was placed in the smoker's box for the resident to have access to only when on smoke breaks. The Administrator educated the resident on use of another resident's electric wheelchair and encouraged to use his own, the resident verbalized understanding. * On 04/15/2025, at 2:11 p.m., RN H wrote, Resident signed himself out and came back vomiting. Happened a couple of times. NP notified. Lab work ordered. New order to transfer to ER for further evaluation. * On 04/16/2025, at 5:23 p.m., ADON G wrote, Final lab results received on the drug and alcohol screening, labs placed in NP binder for review . resident remains in the hospital at this time. * On 04/23/2025, at 9:46 p.m., RN E wrote, Resident, who went out on pass, returned to the facility alert but disoriented, drooling from alcohol intoxication also had multiple emesis (vomiting). Resident vitals and assessment done all vital signs were within normal baseline. NP contacted via telehealth/virtual service. New order for Ondansetron 4 MG 1 tablet PO q 6hours as needed . * On 05/01/2025, at 11:59 a.m., the SW wrote, The Social Worker and the Administrator witnessed [Resident #1] taking a power wheelchair without the permission of the resident who owns the power wheelchair. Resident was educated that he cannot take the belongings of other residents while they are out of the facility. Resident was also educated on the importance of not using someone else's wheelchair and the risks that can occur . * On 05/04/2025, at 4:41 p.m., RN H wrote, Resident exchanged wheelchair with his former roommate and resident was educated that it was not safe to do so, resident verbalized understanding. Record review of Resident #1's physician progress note (this was a telehealth/virtual visit) dated 04/10/2025 at 11:17 p.m. revealed, . Details: Nurse Name: [RN E]. Patient Name: [Resident #1]. Primary Complaint: Altered Mental Status . Per nurse, patient went out on pass and returned to facility lethargic, drooling from mouth and vomited once one hour ago. Per nurse, patient only knows his name, does not know where he is, and does not know the month, year. States at baseline patient is alert and oriented x 3 (a term that describes a patient's level of consciousness and cognitive function. Patient aware of person, place, and time). Per nurse, patient admitted to drinking 3 bottles of [brand (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 4 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some of beer]. Per nurse, patient refused dialysis today and states patient did not go to dialysis yesterday . Patient seen with nurse . Physical Exam: Exam findings per nurse and video observation . Orders: Transfer to ER via 911: AMS/ESRD - missed HD/vomiting/possible alcohol intoxication . Record review of Resident #1's physician progress note (this was a telehealth/virtual visit) dated 04/23/2025 at 10:02 p.m. revealed, . Details: Nurse Name: [RN E]. Patient Name: [Resident #1]. Primary Chief Complaint: GI: Vomiting . Nurse notified clinician that the [AGE] year-old-male patient with history of ESRD on dialysis, Schizophrenia, falls, HTN, DM2, went out of the facility for an hour and came back intoxicated. The nurse stated this is a regular occurrence for him. He did have an episode of vomiting. Denies drinking alcohol. Will monitor him for now . Record review of Resident #1's Lab Results Report collected on 04/11/2025 and reported on 04/16/2025 revealed Resident #1 was positive for THC (Cannabis). Observation and interview with Resident #1 on 05/28/2025, at 2:30 p.m. revealed he was in his bed with his eyes closed. Resident #1 opened his eyes and was able to provide his name. Resident #1 stated he lived in the facility a couple of months and living there was alright. He said he went to dialysis. He said he fell out of his wheelchair about six months ago (he did not say why). Resident #1 did not answer questions related to drinking alcohol or taking drugs while outside the facility on pass. He closed his eyes and appeared to be asleep although he responded to questions unrelated to drinking or smoking. In an interview with a random resident on 05/28/2025, at 1:45 p.m., they stated Resident #1 had a known history of taking his former roommate's motorized wheelchair without permission to sign himself out of the facility and drink at nearby stores. The resident stated Resident #1 frequently drank alcohol until he was intoxicated and smoked marijuana in the community around the facility. The resident said one time, Resident #1 was swerving (change or cause to change direction abruptly) all over the sidewalk on his way back to the facility after drinking and fell out of the motorized wheelchair onto the sidewalk. The resident stated the night nurse had to go and find Resident #1 on the sidewalk. In an interview with the SW on 05/28/2025, at 3:24 p.m., she stated Resident #1 was capable of making his own decisions, but he just did not make the right decisions. She said Resident #1 went out on pass and did things he should not do. She said Resident #1 was vomiting once due to intoxication. She said the facility staff could not tell Resident #1 what he could and could not do outside of the facility, and they could only educate him. She said Resident #1 knew what he was doing. She said Resident #1 was his own RP and he did not have any family. She said to her knowledge, Resident #1 only went out twice and got drunk, but she was not there on weekends. She said she was not sure Resident #1's behaviors were addressed on his care plan, but they should have been so all staff are aware of any interventions. She stated she was not responsible for updating resident care plans. She stated she reviewed chart notes and assessed Resident #1's cognition to see if he could make his own decisions. She said Resident #1's BIMS score was high. She said possible negative outcomes of Resident #1 leaving the facility and getting drunk were that he could die, get injured, and go to the hospital. In an interview with the Administrator on 05/28/2025, at 4:32 p.m., he stated the residents had rights. He said Resident #1's BIMS score was 15, but he did not make proper decisions. He said the facility staff had to make sure they did not infringe on the residents' rights. He said Resident #1 signed himself out and returned intoxicated between five and seven times. He said he had undocumented conversations with Resident #1 about how unsafe it was for him to leave the facility and get drunk. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 5 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety said the conversations were not documented because he did not go into the facility's computer system to write progress notes. He said Resident #1 was still capable of wheeling himself down the road to the store in his own manual wheelchair. He said the residents previously went to the gas station at the end of the street (the residents still had to cross a busy two-lanes road), but the store staff said they could not go there anymore. He said now, the residents go down to a store further down the road. He said he did not know if Resident #1's behaviors were care planned, but they should have been. Residents Affected - Some In an interview with MDS Nurse C on 05/29/2025, at 12:25 p.m., she stated her duties included completing assessments and reviewing/updating resident care plans. She said she was responsible for residents whose last names began with A - K, so she did not update Resident #1's care plan. She said another MDS nurse who worked part-time was responsible for updating Resident #1's care plan. She said the MDS nurses reviewed and updated care plans every three months when they did quarterly MDS assessments. She said she was aware of Resident #1's behaviors related to smoking and drinking, and those behaviors should be a part of his care plan if the incidents happened. She said it was important to address those issues in Resident #1's care plan because if anything happened, they had the information in the care plan to show they were not giving him what he went outside to get (drugs and alcohol). She said negative outcomes of Resident #1's behaviors were possible if the facility did not intervene. She said Resident #1 could have serious health issues if the facility did not intervene. She said a resident's care plan should address all their behaviors. In a telephone interview with Resident #1's physician on 05/30/2025, at 10:00 a.m., he stated he was familiar with Resident #1, and he was aware the resident frequently went out on pass to drink and smoke. He said Resident #1 denied drinking and smoking, but he had a history of noncompliance with dialysis and medications. He said Resident #1 was alert and oriented to be able to sign himself out. He said Resident #1 had recently been admitted to the hospital a lot and once, at the hospital, they found he had taken drugs. He said Resident #1 kept denying, so it was hard to address it. He said the negative outcome of Resident #1's behaviors were that one day, Resident #1 is fine, and then in a couple of days, he signs out and takes something (drugs or alcohol) and something happens that leads him back in the hospital. He said he asks the facility staff to do their best to monitor Resident #1. He said once Resident #1 was off drugs and was perfectly normal, it would be safe for him to be out alone. He stated when Resident #1 was in that state (under the influence of drugs and alcohol), it was not safe for him to be out alone. He said if a resident was alert, oriented, and making the right decisions, you could not tell them they could not go out because that would be restraining them. He said he would imagine it was not safe for Resident #1 to be out like that (under the influence of drugs and alcohol), but he had the right to sign himself out. He said the facility may have to get a contract with Resident #1 to say if he continued with these behaviors, they could not handle his needs because they do not want anything bad to happen. In an interview with the VP of Operations on 05/30/2025, at 10:30 a.m., he stated the Administrator was no longer employed at the facility and Resident #1 called 911 and was transferred to the hospital related to stomach pains on 05/28/2025. In an interview with LVN A on 05/31/2025, at 2:11 p.m., he stated on 04/12/2025, around 1:00 p.m., the police called the facility and said Resident #1 had fallen out of his wheelchair and was vomiting at the church next to the facility. He said the police went to the facility and then he (LVN A) followed them to see Resident #1. He said he thought the police saw Resident #1 on the ground and called 911. He said when he arrived at the scene, he saw Resident #1 inside the ambulance. He said Resident #1 said he had gone to the store. He said Resident #1 went to the hospital and returned to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 6 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some facility about two days later. LVN A said he heard the motorized chair Resident #1 fell out of belonged to his friend. In a telephone interview with MDS Nurse D on 06/02/2025, at 11:19 a.m., she stated she was responsible for updating care plans for residents whose last names began with J-Z. She said she made sure MDS assessments were done and care plans were updated. She said she got the information to update care plans by reading progress notes, reading physician's orders, talking to staff, and she observed and talked to the residents. She said she observed Resident #1 around the facility, and he was mostly independent. She even though she read through Resident #1's progress notes, she was not aware of his drinking or drug use. She said she knew he signed himself out of the facility because she saw him in the group when they went out. MDS Nurse D then said she heard Resident #1 smoked weed (marijuana). She said smoking marijuana would be something they needed to add to his care plan. She said it was her understanding that the ADON updated anything that was acute (not long-term issues). She said she only worked 20 hours per week, so she was not at the facility most days. She said she was aware of Resident #1's smoking, but not his drinking. She said she only looked at progress notes when it was time to update the MDS assessments. She said she never saw any notes about Resident #1's drinking alcohol. She said she did not have an answer for why she did not address Resident #1's smoking in his care plan. She said the ADON was at the facility more than she was and they should have updated Resident #1's care plan to address his drinking. She said in her opinion, anybody could update the care plan. She said it was important to address Resident #1's behaviors related to smoking and drinking because it was pertinent information and they needed to act on things like that to keep the resident safe. She said the nursing facility was not a place to get drunk and do drugs. She said the IDT needed to get together, call a care plan meeting, talk, and update things to make sure all Resident #1's behaviors were on his care plan. In an interview with ADON F and ADON G on 06/02/2025, at 11:45 a.m., ADON G said MDS Nurse D was not in the building a lot, so she should review progress notes daily to ensure care plans were updated appropriately. ADON F said they handled (updated care plans) regarding things that were acute, but Resident #1's drinking and drug use were not acute because he had those behaviors a while. ADON G said it was important to address those behaviors in the care plan so all staff know what is going on. ADON G said a negative outcome of not having the behaviors care planned would be that the behaviors continued and but the resident's safety at risk. Record review of the facility's policy, titled, Comprehensive care Plans revised on 09/04/2024 revealed, Policy: It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. Definitions: Person-centered care means to focus on the resident as the locus of control and support the resident in making their own choices and having control over their daily lives. 1. The care planning process will include an assessment of the resident's strengths and needs, and will incorporate the resident's personal and cultural preferences in developing goals of care . 2. The comprehensive care plan will be developed within 7 days after the completion of the comprehensive MDS assessment . Other factors identified by the interdisciplinary team, or in accordance with the resident's preferences, will also be addressed in the plan of care. The facility's rationale for deciding whether to proceed with care planning will be evidenced in the clinical record. 3. The comprehensive care plan will describe, at minimum, the following: a. The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. B. Any services that would otherwise be furnished, but are not provided due to the resident's exercise of his or her right to refuse treatment (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 7 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety . d. The resident's goals for admission, desired outcomes, and preferences for future discharge . 5. The comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive and quarterly MDS assessment. 6. The comprehensive care plan will include measurable objectives and timeframes to meet the resident's needs as identified in the resident's comprehensive assessment. The objectives will be utilized to monitor the resident's progress. Alternative interventions will be documented, as needed . Residents Affected - Some Record review of the facility's policy, titled, Behavior Management revised on 04/15/2014 revealed, Policy: The purpose of the policy is to optimize the quality of life and function of patients that experience behavioral symptoms that require person centered approaches to meet the health, physical, psychosocial, and behavioral health needs. Fundamental Information: Individualized, person-centered approaches may help reduce potentially distressing or harmful behaviors and promote improved functional abilities and quality of life for dementia patients. Fundamental principles of care for a patient with behaviors include an interdisciplinary approach that focus on the individualized needs of the patient . Procedure. Determine whether there is a medical, physical, functional, physiological, emotional, psychiatric, social, or emotional cause of the behaviors . Considerations: Person-Centered Care - evaluate if the environment is supportive and promotes comfort toward understanding, preventing, relieving, and recognizes individual needs and preferences . Evaluations are completed on new or worsening behaviors . Identify the frequency, intensity, duration, severity, and impact of behaviors, as well as the location, surroundings, or situation. Identify interventions or approaches to prevent, modify, relieve, or address the behaviors or distress. Patient behaviors or distress are documented as it occurs and the effectiveness of interventions. Individualized Care Plan Approaches - individualized approaches are used as a first line intervention (except in a documented emergency situation or if clinically contraindicated) . Consistent interventions are used that focuses on a patient's individual needs . Monitor and follow-up care plan is done by the interdisciplinary team who reviews the patient's progress towards goals. Summarize effectiveness of non-pharmacological and pharmacological interventions (quarterly and as indicated), for target behaviors and/or psychological symptoms and changes in a resident's level of distress or emergence of adverse consequences. Adjust interventions as needed and identified when care objectives are not met . An IJ was identified on 05/29/2025 at 1:20 p.m. The IJ template was provided to the Administrator on 05/29/2025 at 1:20 p.m. and a Plan of Removal was requested. The following Plan of Removal submitted by the facility was accepted on 05/31/2025 at 10:42 a.m. Issue Cited: Care Plans Failure to develop and implement a comprehensive person-centered care plan 5/30/25 1. Immediate Action Taken On 5-29-25 resident #1 is currently in hospital with diagnosis of gastroenteritis (inflammation of the lining of the stomach and intestines) and ESRD. 2. Identification of Residents Affected or Likely to be Affected: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 8 of 26 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 03/25/2025 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 0656 Level of Harm - Immediate jeopardy to resident health or safety A. On 5/29/25 by 3pm DON/designee identified 11 residents who sign out of the facility independently, had charts reviewed and determined by their capabilities according to their functional ability assessment (MDS section GG), and make their own choices and decisions according to their BIMs, they were reviewed for any behaviors, none were found, and care plan interventions are in place. 2. Residents Affected - Some Actions to Prevent Occurrence/Recurrence: A. On 5/30/25 by 10:00 am the RNC reviewed the policy on Comprehensive Care Plans with no changes made. B. On 5/29/25 by 7:30pm DON/designee reviewed the care plans for those 11 residents identified as independently capable of signing out of the facility and making their own choices and decisions. None were found to have unsafe behaviors. Care plans were reviewed, and no updates were needed. If and when Resident #1 returns from hospital the care plan will be reviewed and updated with any unsafe behavior and the CNAs and Nurses will be in-serviced to the updated care plan at that time by DON/designee. C. On 5/30/25 by 9am the Regional Nurse Consultant in-serviced the IDT on updating comprehensive care plans to include measurable objectives, timeframes, and interventions for those residents identified as independently signing themselves out of the facility with a focus on unsafe behaviors, goals, and interventions while out of facility. The Administrator/ or designee and DON/ or designee were in-serviced by the RNC beforehand. D. DON/designee will monitor comprehensive care plans for all residents identified as capable of signing themselves out of the facility independently for any unsafe behaviors present and report findings to IDT in morning meeting and revise care plans as needed. E. All findings will be discussed during QAPI monthly and plan of care will be revised as needed. F. On 5/29/25 the facility's Administrator/ or designee notified the Medical Director regarding the Immediate Jeopardy the facility received related to Failure to Develop and Implement a Comprehensive Person-Centered Care Plan and reviewed plan to sustain compliance. Monitoring of the plan of removal included the following: Record review of a facility document, titled, In-Service - Program Attendance Record dated 05/30/2025 revealed the IDT team (DON, Activity Director, ADON F, ADON G, MDS Nurse C, Treatment Nurse, , and a representative from the rehabilitation department) was educated by the RNC on comprehensive care plans, including measurable goals and individualized interventions. Record review of the facility's, Comprehensive Care Plans policy revealed it was reviewed by the RNC on 05/29/2025. Record review of the facility's plan of removal documentation revealed the MDS assessments and care plans for all eleven residents identified as independently capable of signing out of the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 9 of 26 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 03/25/2025 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 0656 and making their own choices and decisions were reviewed by the DON. Level of Harm - Immediate jeopardy to resident health or safety Interviews were conducted with staff on 05/31/2025 from 10:45 a.m. until 3:00 p.m. from all shifts (nurses and CNAs worked 12-hour shifts) including the VP of Operations, RNC, DON, ADON F, ADON G, LVN A (day shift), MDS Nurse C, RN P (day shift), CNA Q (day shift), RN R (night shift), Receptionist[TRUNCATED] Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 10 of 26 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 03/25/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure the resident received adequate supervision and assistance devices to prevent accidents as was possible for 1 (Resident #1) of 5 residents reviewed for accidents and supervision. -The facility failed to ensure a system was in place to adequately supervise Resident #1 when he left the faciity on [DATE] and did not return. The facility failed to notify law enforcement or conduct a thorough search for Resident #1. As of 03/21/25, the facility did not know Resident #1's whereabouts. An immediate Jeopardy (IJ) was identified on 03/21/25. The IJ Template was provided to the facility on [DATE] at 2:09 p.m. While the IJ was removed on 03/23/25, the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with potential for more than minimal harm due to the facility continuing to monitor the implementation and effectiveness of their Plan of Removal (POR). This failure placed residents at risk for harm, significant injury, or death. The findings included: Record review of Resident #1's admission Record, dated 03/21/25, revealed a [AGE] year-old male who was admitted to the facility on [DATE]. His diagnosis included candidiasis (fungal infection caused by overgrowth of a type of yeast), cellulitis (serious bacterial infection of the skin), depression (mood disorder that causes a persistent feeling of sadness and loss of interest), cognitive communication deficit (one or more cognitive processes involved in communication), and unsteadiness on feet. Record review of Resident #1's physician order's revealed he was taking the following medications: potassium chloride for on Lasix, furosemide for edema, metoprolol succinate for essential (primary) hypertension, melatonin for insomnia, aripiprazole for schizoaffective, atorvastatin calcium for high LDL, ergocalciferol for supplement, trazodone for insomnia, and sertraline HCL related to depression unspecified. Resident's medications were due. Record review of Resident #1's MDS Assessment, dated 02/26/25, revealed a BIMS score of 13, indicating cognition was intact. Further review revealed the resident did not exhibit wandering behavior. The resident was independent (completes activity by himself with no assistance from a helper) with self-care, except shower/bathe self (required supervision or touching assistance) and mobility functional abilities. Record review of Resident #1's Care Plan Report, undated, revealed resident was in the facility for long-term care placement as a result of a continued need for the services of skilled nursing staff as evidenced by an inability to provide self-care and discharge planning is not needed. Resident was not care planned for leaving out on pass. Record review of Resident #1's Elopement/Wandering Risk Assessment, dated 03/15/25, reflected Category: Elopement Risk-Low, no plan of care needed .Score: 1.0. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 11 of 26 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 03/25/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #1's progress notes, entered by ADON B and dated 03/19/25 at 16:20 [4:20 p.m.], revealed Resident left facility out on pass. Record review of Resident #1's progress notes, entered by Nurse A and dated 03/20/25 at 6:42 [a.m.], revealed Resident did not return from off pass. Observation on 03/21/25 at 7:28 a.m. revealed the facility's Sign out Book was on the counter at the Nurse's Station. The Release of Responsibility for Leave of Absence form for Resident #1 was blank. During a telephone interview on 03/21/25 at 9:15 a.m., Nurse A said she was told by Nurse B that Resident #1 went out on pass on 03/19/25. She said she did not see him for her entire shift, 6:00 p.m. to 6:00 a.m., on the 19th. She said she documented in the resident's progress notes that he did not return. She said usually, residents sign out before they go out on pass, and were supposed to sign back in with the date and time. She said Nurse B did not give her any additional information. She said it could be the nurse's responsibility to make sure the resident signed out or any staff who the resident was under and said she was not sure but thinks the receptionist too. During an interview on 03/21/25 at 9:44 a.m., the DON said ADON A and B both reported to her that Resident #1 went out on pass on Wednesday, 3/19, in the afternoon around 4:00 p.m. She said to her knowledge, the resident did not tell anyone he was leaving or where he was going. She said the ADONs did not say when they expected Resident #1 to return. She said she did not know where Resident #1 was currently. She said the resident did not sign out. She said residents should sign out, but she did not believe they were required to say where they were going or who they were leaving with. She said she has been told the resident used a ride service himself to and from the facility in the past. She said the resident had a BIMS score of 13/14, was his own RP, and has family emergency contacts. She said she did not consider Resident #1 leaving the building an emergency at the time. She said residents were allowed to be on pass for 72 hours. She said the resident did not have a telephone. During an interview on 03/21/25 at 9:58 a.m., ADON A, said Resident #1 went out on pass on Wednesday, 3/19/25, and she believed ADON B told her. She said she did not know where the resident went. She said she did not know where the resident was now. She said she would have to check to see if the resident signed out. She said if residents go out on pass, they can stay out for 72 hours, residents let them know where they were going, when they plan to return, and sign back in when they return. She said Resident #1's medications did not go with him as far as she was aware. She said the resident had a high BIMS score, she believed it was a 13 or 14 and was cognitively intact. During an interview on 03/21/25 at 10:11 a.m., ADON B said the Staffing Coordinator/CNA reported to him, the DON, and ADON A that Resident #1 went out on pass. He said she did not say where he was going. He said he did not ask any additional questions. He said he did not know if he signed out. He said he did not know where Resident #1 was currently. He said he did not know if he had any of his medications with him. He said he did not know when Resident #1 was expected to return. He said residents can stay out on pass for up to 72 hours. During an interview on 03/21/25 at 10:51 a.m., the Receptionist said she worked Wednesday the 19th and saw Resident #1 leave the facility. She said the resident asked her if he could go outside and she said she thought he meant to sit outside. She said she asked the Staffing Coordinator/CNA if he was allowed to go outside and she said yes, he was okay and so she let him go outside. She said after she let Resident #1 go outside, she received a telephone call and walked to the hall and told the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 12 of 26 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 03/25/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some nurse she had a call. She said when she returned, she sat down, and the Staffing Coordinator/CNA asked her where the resident was, and she said he should be sitting outside. She said the Staffing Coordinator/CNA said he was not out there and asked if he signed the book, and she said no he did not. She said the Staffing Coordinator/CNA told her everyone needed to sign out. She said the Staffing Coordinator/CNA told ADON B and he went to go find the resident on foot, and that was when ADON B was told by another resident that he saw Resident #1 get into a car. She said Resident #1 did not tell her he was going to leave the facility. During an interview on 03/21/25 at 11:01 a.m., the Staffing Coordinator/CNA said she saw Resident #1 go outside and went on the porch and sat in a rocking chair. She said when she went back by, she saw him down the walkway and he got into a white vehicle. She said she notified the ADONs and the DON. She said they said he was out on pass. She said early that morning, 3/19/25, before 7:00 a.m., Resident #1 mentioned wanting to go to another facility and she told him to talk to the social worker. She said she did not know where the resident was now. During an interview on 03/21/25 at 11:11 a.m., the Administrator said he was out on PTO on the 19th and the 20th. He said he was notified that Resident #1 got into a white vehicle and forgot to sign out by the ADONs at approximately 4-5 o'clock, could not recall the day, but wanted to say it was Wednesday, 3/19/25. He said no one knew where he was. He said initially when Resident #1 first left, they tried to find the white SUV to get him to sign out, but they were unsuccessful. He said he would have to review what their Therapeutic Leave policy stated. He said there had not been any other attempts to find him because they knew he left out on pass. He said even if residents leave and forget to sign out, they try to call them or try to see in what general direction they went and try to redirect them to go back and sign out. He said ultimately, Resident #1 had a high enough BIMS score, and the facility did not want to infringe upon his rights. During an interview on 03/21/25 at 12:44 p.m., the DON said she just called the phone number listed for Resident #1 on his face sheet and a family member answered. She said the family member told her she was happy they called her because she had some concerns about a group home he was at previously. She said the resident's sister believed the Owner/Manager of the group home sent someone to pick him up. She said the family member told her the resident made his own decisions. During an interview on 03/21/25 at 1:01 p.m., the Administrator and DON said they just got off the phone with the Owner/Manager of the group home and was told Resident #1 was with her. They said the Owner/Manager told them the resident called her Tuesday, 3/18/25, night and said he wanted to go back and so she sent an Uber to pick him up. They said they asked to speak with the resident but was told she was driving and would have him call them when she got to where she was going. During an interview on 03/25/25 at 10:54 a.m., the Owner/Manager of the group home said Resident #1 was no longer at her personal care home and believed he went to another home. Record review of the facility's Therapeutic Leave policy, revised 07/14/2023, read in part .Compliance Guidelines .13. The resident or resident representative will sign a release form indicating the date and time the resident is leaving, location, (including address if going to a specific residence) of where resident is going, a telephone number where resident can be reached .17. If the resident has not returned from therapeutic leave as expected, the facility will attempt to contact the resident and resident representative and document attempts in the medical record . Record review of the facility's Missing Resident Policy, revised 08/15/23, read in part (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 13 of 26 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 03/25/2025 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 0689 .Definitions .Elopement occurs when a resident leaves the premises or a safe area without authorization (an order for discharge or leave of absence) and/or any necessary supervision to do so . Level of Harm - Immediate jeopardy to resident health or safety The Administrator was notified on 03/21/25 at 2:09 p.m. that an IJ was identified due to the above failures and the IJ template was provided. Residents Affected - Some The following Plan of Removal (POR) was accepted on 03/22/25 at 2:55 p.m.: Plan of Removal Tag Cited: F-689 Issue Cited: Free of Accidents/Hazards/Supervision Failure to ensure residents receive adequate supervision to prevent elopement 1.Immediate Action Taken On 3/21/25 @ 4:35pm DON/designee located and visited Resident #1 at the Personal Care Home in a nearby city. Resident #1 had a safe discharged to the Personal Care home on 3/21/25 with the assistance of the Personal Care Home manager and the Administrator delivered all medications. DON evaluated resident #1 at the Personal Care Home to ensure his safety and well-being. The Administrator was responsible for the facility's decision not to call the resident/RP/police. Administrator and DON were in-service by Regional Nurse Consultant on 3/21/25 by 6:00pm on the Missing Resident Policy, which was reviewed on 3/21/25 at 11:41am with no changes made, along with notifying the police/RP/physician and the state agency when resident is not located in the facility or on facility grounds. The nearby hospital should not be contacted. Don/designee will have the 1:1 training with the receptionist on Therapeutic Leave policy and to notify charge nurse of residents that have not returned from leave that day when the receptionist shift is over and the Missing Resident Policy by 3/22/25 at 10 am. Residents therapeutic leave sign out book will be located at receptionist desk on 3/21/25 by 7:30pm, for her/him to know who is leaving. The Charge nurses will be responsible for tracking of the residents leaving after 5:30pm. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 14 of 26 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 03/25/2025 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 0689 Don/designee will educate charge nurses on 3/21/25 by 8pm on giving a follow-up call to resident/RP that did not return Level of Harm - Immediate jeopardy to resident health or safety from therapeutic leave for the day and document in progress notes. Any charge nurse not present will not be allowed to Residents Affected - Some work their next shift until receiving the education. 2. Identification of Residents Affected or Likely to be Affected: A. On 3/21/25 by 11 pm DON/designee will have 100% of resident's Elopement Risk Assessment completed to identify all elopement risk residents. No new resident identified. B. On 3/21/25 by 11pm DON/designee will identify all the residents with the physical ability to have therapeutic leave. 59 residents were identified. 3. Actions to Prevent Occurrence/Recurrence: A. DON/designee will In-service all staff on the Missing Person Policy on 3/21/25 by 7pm. Any staff not present will not be allowed to work their next shift until they have the training. B. DON/designee will In-service all staff on the Therapeutic Leave Policy on 3/21/25 by 7pm. Any staff not present will not be allowed to work their next shift until they have the training. On 3/21/25 at 8:08am the Regional Nurse Consultant emailed the Therapeutic Policy after reviewing, no changes were made. C. Missing Person Drill will be completed and documented with all staff on 3/21/25 by 7pm. Any staff not present will not be allowed to work their next shift until they have the drill. D. The Elopement binder will be updated with any newly identified residents on 3/21/25 by 7pm. E. All the residents identified as Elopement Risk will have their care plans updated by DON/designee on 3/21/25 by 11 pm. F. All residents identified with physical ability for Therapeutic Leave will have their care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 15 of 26 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 03/25/2025 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 0689 plan updated by DON/designee on 3/21/25 by 11 pm. Level of Harm - Immediate jeopardy to resident health or safety G. DON/designee will educate and be completed by 3/22/25 by 4pm, Residents Affected - Some identified with the physical ability for therapeutic leave. residents/responsible party on the Therapeutic Leave Policy for those residents H. Administrator will have an ad hoc meeting with the Medical Director on IJ findings and actions taken will be completed on 3/21/25 by 7:45pm. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: ________________. On 03/22/25-03/23/25, the state surveyor monitoring confirmed the facility implemented their plan or removal (POR) to sufficiently remove the IJ by: Observation on 03/23/25 at 7:15 a.m. revealed the sign out book was located at the nurse's station. Record review on 03/23/25 revealed, the Regional Nurse Consultant in-serviced the Administrator and the DON on the Missing Person policy on 03/21/25. Record review on 03/23/25 revealed, the Receptionist received 1:1 training on 03/22/25 on the Therapeutic Leave policy and when to notify the charge nurse of residents who have not returned from leave that day when the shift was over. Record review on 03/23/25 of in-service sign in sheet revealed charge nurses were educated on 03/21/25 on follow-up calling the resident/RP who have not returned from Therapeutic Leave and documenting it in the progress notes. Record review on 03/23/25 revealed an Elopement Risk assessment was completed for 100% of the residents on 03/21/25 and no new residents were identified. Record review on 03/23/25 revealed residents with the physical ability to have therapeutic leave was completed on 03/21/25 and 59 residents were identified. Record review of in-service trainings dated 03/21/25 and 03/24/25 revealed 44 staff were in-serviced on the Missing Person and Therapeutic policy. Record review on 03/23/25 of the facility's Elopement binder revealed it was updated. Record review on 03/23/25 of resident Care Plans revealed those who were identified with physical ability for Therapeutic Leave was updated. Record review on 03/23/25 of Therapeutic Leave documentation revealed contact/attempted contact was made with residents/responsible party for those identified with the physical ability for Therapeutic Leave was completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 16 of 26 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 03/25/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Ad hoc sign in sheet on 03/23/23 revealed meeting was completed with the Medical Director on the IJ findings on 03/21/25. Interviews were conducted from 03/22/25 to 03/23/25 with staff from all shifts and all interviewees verbalized an understanding on the Therapeutic Leave and Missing Person policies. Interviewed staff included the Administrator, ADON A, ADON B, Receptionist A, Receptionist B, Nurse C, Nurse D, Nurse E, CNA A, CNA B, CNA C, and CNA D. The Administrator was notified the Immediate Jeopardy was removed on 03/23/2025 at 2:16 p.m. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that was not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 17 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure each resident received the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care, encompassing the resident's whole emotional and mental well-being, which includes, but is not limited to, the prevention and treatment of mental and substance use disorders for 1 of 12 residents (Resident #1) reviewed for behavioral services. The facility failed to ensure Resident #1 received adequate behavioral health care services to prevent and treat substance abuse disorder when Resident #1 frequently signed himself out of the facility to go to nearby stores and consume alcohol, resulting in intoxication, vomiting, and lethargy to the point of falling out of his wheelchair. Resident #1 was also known by staff to sign himself out and smoke marijuana in the community surrounding the facility, resulting in a positive laboratory finding for THC. An IJ was identified on 05/29/2025. The IJ template was provided to the facility on [DATE] at 1:20 p.m. While the IJ was removed on 06/01/2025, the facility remained out of compliance at a scope of pattern with severity level at potential for more than minimal harm that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. This failure could place residents who require behavioral health services at risk not receiving having their needs met and, deterioration of health Findings include: Record review of Resident #1's face sheet dated 05/28/2025 revealed he was a [AGE] year-old male who was initially admitted to the facility on [DATE]. He was diagnosed with end-stage renal disease (the final stage of chronic kidney disease where the kidneys can no longer filter waste and excess fluid from the body), schizoaffective disorder (a chronic mental illness that combines systems of both schizophrenia and mood disorder), gastro-esophageal reflux (a chronic condition where stomach contents regularly flow back up into the esophagus), history of falling, difficulty walking, diabetes mellitus type II (chronic disease where the body either does not produce enough insulin or cannot properly use the insulin it produces) with hypoglycemia (when blood glucose levels drop too low), essential hypertension (persistently high blood pressure with no identifiable cause), chronic ischemic heart disease (long-term condition where the heart's blood supply is reduced due to a mismatch between oxygen supply and demand), chronic obstructive pulmonary disease (chronic lung disease that makes it difficult to breathe) with acute exacerbation (sudden and severe worsening of respiratory symptoms in COPD patients), unspecified cirrhosis of liver (a type of chronic, progressive liver disease where healthy liver cells are replaced by scar tissue), acute cholecystitis (inflammation of the gallbladder, typically caused by a blockage of the cystic duct), dependence on renal dialysis (treatment that cleans the blood when kidneys are unable to do so), and shortness of breath. Resident #1 was his own responsible party. Record review of Resident #1's quarterly MDS dated [DATE] revealed he had a BIMS score of 13 (cognitively intact); Resident #1 exhibited behaviors related to rejection of care; Resident #1 used a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 18 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety manual wheelchair for mobility; Resident #1 was independent with eating, oral hygiene, toileting hygiene, dressing, personal hygiene, and transfers and required supervision or touching assistance for showers/bathing; Resident #1 was always continent of bowel and bladder; and Resident #1 was prescribed anticoagulant and antipsychotic medication. Record review of resident #1's care plan, revised on 05/25/2025 revealed the following care areas: Residents Affected - Some * Behavioral Problem: Resident has a behavior problem as evidenced by: displaying verbal and sexually inappropriate behavior by exposing his private area to female residents and female staff. Goal included: Resident's inappropriate behavior will not result in harm or injury to self or others. Interventions included: Educate resident on the privacy issues associated with his behavior. Encourage as much as possible to detour injury. Intervene as necessary to protect the rights and safety of others. Remove resident to an alternate location when needed to protect the rights and safety of other. Resident will be receiving psychiatric visits with [Psychiatric Provider] to monitor his behaviors per physician orders. * Therapeutic Leave: Resident is cognitively able to sign out of the facility and make their own informed decisions while they are out. On 04/10/2025 while on therapeutic leave, resident made the decision to consume alcoholic beverages. Goals included: The resident will follow facility policy for out on pass. The resident will be safe and comfortable while out on pass. Interventions included: Educate the resident/family/caregivers about the potential risks associated with signing out on pass. Educate resident/family/caregivers on the facility's policy for therapeutic leave/out on pass. Resident is reminded of his health issues and treatment regimens and the recommendations to avoid the use of alcoholic beverages. Further review of Resident #1's care plan revealed no care areas, goals, or interventions to address his substance abuse concerns. Record review of Resident #1's nursing progress notes for April 2025 and May 2025 revealed: * On 04/02/2025, at 4:10 p.m., SW B wrote, Resident was educated with Administrator, ADON, DON, and SW on the policies for Therapeutic Leave and the expectations for the resident when he is on Therapeutic Leave. Resident verbalized understanding. * On 04/11/2025, at 12:10 a.m., RN E wrote, Resident came back on pass to the facility with alcohol intoxication, vitals and assessment done. All within normal baseline. NP notified. New order to transfer resident to the hospital for further evaluation but resident refused. Resident was monitored through the shift, comfort care provided to resident satisfaction. * (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 19 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some On 04/11/2025, at 11:50 a.m., ADON F wrote, Late Entry: 04/10/2025 at 11:00 p.m. Upon resident's return to the facility, resident arrived propelling himself in his motorized wheelchair. Resident had a slurred speech, he was drooling, smiling, and laughing, slow to respond to questions, and lethargic. Resident said he was tired and wanted to lay down and go to sleep and was assisted back to his room and was unable to stand to assist with his transfer to his bed, so he was transferred to bed with two people assist. In speaking with the resident, he said that he had ingested alcohol, specifically three 40 oz bottles of [brand name of beer] and he would not say if he had ingested any other substances or drinks. Upon assessment by unit nurse, there was no evidence of trauma or physical injuries noted, no indications of any falls or any other incidents at the time of his return. * On 04/12/2025, at 7:17 p.m., LVN A wrote, Police officer called facility and said resident vomited and may have been drinking with his friend and they have called 911 for him to go to the ER and have him evaluated. They then came to the facility, and I gave him a face sheet and medication lists. I accompanied the officer to EMS parked on the street near the facility and found the patient inside the ambulance being attended to by two paramedics with patient leaning to his left side. I placed a call to the Administrator and ADON. Resident apparently signed out at about 12 noon and left the facility with another resident. They apparently went to a nearby store and purchased drinks. He drank until he vomited on himself and became very weak. I asked the paramedics where they were taking him, and they informed me that they were taking him to [a local hospital] ER. NP and RP notified. * On 04/14/2025, at 4:38 p.m., ADON F wrote, Resident was found to be in possession of a cigarette lighter. The resident was educated by the Administrator on the smoking policy and the lighter was placed in the smoker's box for the resident to have access to only when on smoke breaks. The Administrator educated the resident on use of another resident's electric wheelchair and encouraged to use his own, the resident verbalized understanding. * On 04/15/2025, at 2:11 p.m., RN H wrote, Resident signed himself out and came back vomiting. Happened a couple of times. NP notified. Lab work ordered. New order to transfer to ER for further evaluation. * On 04/16/2025, at 5:23 p.m., ADON G wrote, Final lab results received on the drug and alcohol screening, labs placed in NP binder for review . resident remains in the hospital at this time. * On 04/23/2025, at 9:46 p.m., RN E wrote, Resident, who went out on pass, returned to the facility alert but disoriented, drooling from alcohol intoxication also had multiple emesis (vomiting). Resident vitals and assessment done all vital signs were within normal baseline. NP contacted via telehealth/virtual service. New order for Ondansetron 4 MG 1 tablet PO q 6hours as needed . * (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 20 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety On 05/01/2025, at 11:59 a.m., the SW wrote, The Social Worker and the Administrator witnessed [Resident #1] taking a power wheelchair without the permission of the resident who owns the power wheelchair. Resident was educated that he cannot take the belongings of other residents while they are out of the facility. Resident was also educated on the importance of not using someone else's wheelchair and the risks that can occur . Residents Affected - Some * On 05/04/2025, at 4:41 p.m., RN H wrote, Resident exchanged wheelchair with his former roommate and resident was educated that it was not safe to do so, resident verbalized understanding. Record review of Resident #1's physician progress note (this was a telehealth/virtual visit) dated 04/10/2025 at 11:17 p.m. revealed, . Details: Nurse Name: [RN E]. Patient Name: [Resident #1]. Primary Complaint: Altered Mental Status . Per nurse, patient went out on pass and returned to facility lethargic, drooling from mouth and vomited once one hour ago. Per nurse, patient only knows his name, does not know where he is, and does not know the month, year. States at baseline patient is alert and oriented x 3 (a term that describes a patient's level of consciousness and cognitive function. Patient aware of person, place, and time). Per nurse, patient admitted to drinking 3 bottles of [brand of beer]. Per nurse, patient refused dialysis today and states patient did not go to dialysis yesterday . Patient seen with nurse . Physical Exam: Exam findings per nurse and video observation . Orders: Transfer to ER via 911: AMS/ESRD missed HD/vomiting/possible alcohol intoxication . Record review of Resident #1's physician progress note (this was a telehealth/virtual visit) dated 04/23/2025 at 10:02 p.m. revealed, . Details: Nurse Name: [RN E]. Patient Name: [Resident #1]. Primary Chief Complaint: GI: Vomiting . Nurse notified clinician that the [AGE] year-old-male patient with history of ESRD on dialysis, Schizophrenia, falls, HTN, DM2, went out of the facility for an hour and came back intoxicated. The nurse stated this is a regular occurrence for him. He did have an episode of vomiting. Denies drinking alcohol. Will monitor him for now . Record review of Resident #1's Lab Results Report collected on 04/11/2025 and reported on 04/16/2025 revealed Resident #1 was positive for THC (Cannabis). Record review of Resident #1's, Psychiatric Subsequent Assessment dated 04/24/2025 revealed, . History of Presenting Illness: Last visit was on 03/24/2025 . Collateral Information: On 04/24/2025, I attended a multidisciplinary care conference meeting with the DON, ADON, MDS, administrator, medical records, and SW. The case was discussed in detail, and it was concluded; 1. Patient was sent to the hospital due to after the staff found him at the store unable to move. Patient was under the influence of alcohol. 2. Patient does not follow his dialysis schedule . Record review of Resident #1's, Clinical Treatment Plan Review (Plan of Care) completed by the psychiatric provider and dated 04/29/2025 revealed, . History of Presenting Illness: . Patient was referred to psychological services for: Agitation, Irritability, Memory Loss, Short Term Memory Problems, Long Term Memory Problems, Noncompliance, Resistance to ADL/Medications, Sexually Inappropriate Behavior, Attention Seeking Behavior, Medication Evaluation, Other: Resident is refusing dialysis. In addition, he was touching himself in his genitals in an inappropriate way . Family/Social History: . Patient endorsed history of drug/alcohol abuse . Summary of Progress: Patient has been less active with therapy during this treatment cycle due to a new interpersonal relationship and frequent trips outside the facility . Treatment Plan: Treatment is expected to result in an improvement in condition or prevention of decline that would otherwise be expected. Treatment is expected to help improve (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 21 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some patient's emotional, cognitive, social, behavioral functioning symptomatology. Psychotherapy in addition to psychotropic medication is the treatment of choice for this patient . Further review of Resident #1's Clinical Treatment Plan Review (Plan of Care) revealed no mention of a plan to address Resident #1's substance abuse concerns. Record review of Resident #1's, Psychiatric Subsequent Assessment dated 05/01/2025 revealed, . History of Presenting Illness: Last visit was on 04/24/2025 . Further review of Resident #1's, Psychiatric Subsequent Assessment revealed no documentation to show his substance abuse issues were addressed. Record review of Resident #1's, Psychiatric Subsequent Assessment dated 05/28/2025 revealed, . History of Presenting Illness: This is a post hospital follow up. After my last visit the patient was admitted into the hospital due to AMS, and general weakness. Psych meds were not changed. My last visit was on 05/01/2025 . Collateral Information: On 05/28/2025, I attended a multidisciplinary care conference meeting with the ADON, MDS, Medical records, DON, and SW. The case was discussed in detail, and it was concluded: 1. Patient has returned back from the hospital. Patient was drinking and using drugs while out on pass . Observation and interview with Resident #1 on 05/28/2025, at 2:30 p.m. revealed he was in his bed with his eyes closed. Resident #1 opened his eyes and was able to provide his name. Resident #1 stated he lived in the facility a couple of months and living there was alright. He said he went to dialysis. He said he fell out of his wheelchair about six months ago (he did not say why). Resident #1 did not answer questions related to drinking alcohol or taking drugs while outside the facility on pass. He closed his eyes and appeared to be asleep although he responded to questions unrelated to drinking or smoking. In an interview with the SW on 05/28/2025, at 3:24 p.m., she stated Resident #1 was capable of making his own decisions, but he just did not make the right decisions. She said Resident #1 went out on pass and did things he should not do. She said Resident #1 received psychiatric services to see why he refuses dialysis so much. She said she was not sure if Resident #1's substance abuse issues were discussed during his psychiatric sessions. She said Resident #1 was vomiting once due to intoxication. She said the facility staff could not tell Resident #1 what he could and could not do outside of the facility, and they could only educate him. She said Resident #1 knew what he was doing. She said Resident #1 was his own RP and he did not have any family. She said to her knowledge, Resident #1 only went out twice and got drunk, but she was not there on weekends. She said Resident #1's behavior of going out and getting drunk had decreased and he went out a lot less. She said Resident #1 had been sleeping a lot more recently and he had several hospitalizations. She said she spoke to Resident #1 about the risks of him going out drunk. She said possible negative outcomes of Resident #1 leaving the facility and getting drunk were that he could die, get injured, and go to the hospital. In an interview with the Activity Director on 05/28/2025, at 3:45 p.m., she stated Resident #1 was known to take his former roommate's motorized wheelchair. She stated Resident #1 had been caught smoking weed (marijuana) and drinking beer. She said a group of residents were at a nearby store drinking and the store workers called the police. She said the police went to the facility and told them they had to keep the residents from going there, but once they sign out, the residents go their own way. She said the residents needed more things to do inside the facility. She said she left the facility at 5:00 p.m. daily and she had only observed Resident #1 return to the facility intoxicated a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 22 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some couple of times. She said Resident #1 was in the hospital about a week or so and yesterday (05/27/2025) or Monday (05/26/2025), he was sick and throwing up. She said Resident #1 refused dialysis a lot. She said Resident #1 used another resident's motorized wheelchair to go to the store because he could not physically wheel himself out to store in his manual wheelchair. She said Resident #1 kept taking his former roommate's wheelchair, so they moved Resident #1 to another room. She said she had no knowledge of Resident #1 falling out of a wheelchair but about 7-8 months ago, she observed him outside with his manual wheelchair stuck and leaning off a curb. She said she pulled over and pushed his wheelchair all the way back to the facility. She said Resident #1 was leaning over in his wheelchair and he kept saying he was sick. She said she did not know of he was intoxicated at that time. She said the residents had to pass a busy road and cross the road to get to the store. She said it was not safe for the residents to travel that way, but they had their rights. She said the Administrator told the staff that the residents had their rights. In an interview with the Administrator on 05/28/2025, at 4:32 p.m., he stated the residents had rights. He said Resident #1's BIMS score was 15, but he did not make proper decisions. He said the facility staff had to make sure they did not infringe on the residents' rights. He said Resident #1 signed himself out and returned intoxicated between five and seven times. He said he had undocumented conversations with Resident #1 about how unsafe it was for him to leave the facility and get drunk. He said the conversations were not documented because he did not go into the facility's computer system to write progress notes. He stated Resident #1 received psychiatric services, but he sometimes refused to talk or participate during his sessions. He said he was not sure if Resident #1's smoking and drinking were addressed during the sessions. He said addressing Resident #1's smoking and drinking in his psychiatric sessions would be helpful to reinforce what the facility staff try to educate him on related to those behaviors. In a telephone interview with Resident #1's physician on 05/30/2025, at 10:00 a.m., he stated he was familiar with Resident #1, and he was aware the resident frequently went out on pass to drink and smoke. He said Resident #1 denied drinking and smoking, but he had a history of noncompliance with dialysis and medications. He said Resident #1 had recently been admitted to the hospital a lot and once, at the hospital, they found he had taken drugs. He said Resident #1 kept denying, so it was hard to address it. He said the negative outcome of Resident #1's behaviors were that one day, Resident #1 is fine, and then in a couple of days, he signs out and takes something (drugs or alcohol) and something happens that leads him back in the hospital. In an interview with LVN A on 05/31/2025, at 2:11 p.m., he stated on 04/12/2025, around 1:00 p.m., the police called the facility and said Resident #1 had fallen out of his wheelchair and was vomiting at the church next to the facility. He said the police went to the facility and then he (LVN A) followed them to see Resident #1. He said he thought the police saw Resident #1 on the ground and called 911. He said when he arrived at the scene, he saw Resident #1 inside the ambulance. He said Resident #1 said he had gone to the store. He said Resident #1 went to the hospital and returned to the facility about two days later. LVN A said he heard the motorized chair Resident #1 fell out of belonged to his friend. He said Resident never admitted to the drinking and always tried to hide it. He said Resident #1 usually returned to the facility late at night, so he (LVN A) was usually gone by that time (LVN worked the day shift, 7:00 a.m. - 7:00 p.m.). He said the negative outcome of Resident #1's behavior was that he was a dialysis patient and it interfered with his kidneys. He said Resident #1 falling out of the chair while intoxicated and going to the ER was a very negative effect. Record review of the facility's policy, titled, Behavior Management revised on 04/15/2014 revealed, Policy: The purpose of the policy is to optimize the quality of life and function of patients that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 23 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some experience behavioral symptoms that require person centered approaches to meet the health, physical, psychosocial, and behavioral health needs. Fundamental Information: Individualized, person-centered approaches may help reduce potentially distressing or harmful behaviors and promote improved functional abilities and quality of life for dementia patients. Fundamental principles of care for a patient with behaviors include an interdisciplinary approach that focus on the individualized needs of the patient . Procedure. Determine whether there is a medical, physical, functional, physiological, emotional, psychiatric, social, or emotional cause of the behaviors . Considerations: Person-Centered Care - evaluate if the environment is supportive and promotes comfort toward understanding, preventing, relieving, and recognizes individual needs and preferences . Evaluations are completed on new or worsening behaviors . Identify the frequency, intensity, duration, severity, and impact of behaviors, as well as the location, surroundings, or situation. Identify interventions or approaches to prevent, modify, relieve, or address the behaviors or distress. Patient behaviors or distress are documented as it occurs and the effectiveness of interventions. Individualized Care Plan Approaches - individualized approaches are used as a first line intervention (except in a documented emergency situation or if clinically contraindicated) . Consistent interventions are used that focuses on a patient's individual needs . Monitor and follow-up care plan is done by the interdisciplinary team who reviews the patient's progress towards goals. Summarize effectiveness of non-pharmacological and pharmacological interventions (quarterly and as indicated), for target behaviors and/or psychological symptoms and changes in a resident's level of distress or emergence of adverse consequences. Adjust interventions as needed and identified when care objectives are not met . An IJ was identified on 05/29/2025 at 1:20 p.m. The IJ template was provided to the Administrator on 05/29/2025 at 1:20 p.m. and a Plan of Removal was requested. The following Plan of Removal submitted by the facility was accepted on 05/31/2025 at 5:20 p.m. Issue Cited: Behavioral Services Failure to provide behavioral services 5/31/25 6. Immediate Action Taken On 5-29-25 resident #1 is currently in hospital for diagnosis of gastroenteritis and ESRD. 2. Identification of Residents Affected or Likely to be Affected: A. On 5/29/25 by 5:15pm DON/designee identified 66 residents are currently on behavioral services. The remaining 32 residents had no noted behaviors on admission or currently to warrant a referral for behavioral services. 3. Actions to Prevent Occurrence/Recurrence: A. On 5/30/25, [Psychiatric Provider] Services begins performing a psych evaluation on those 32 residents identified to establish any behavioral service needs, ongoing. No residents are identified as using drugs/alcohol when leaving the facility. If any of the 32 residents are identified as having (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 24 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some a need for psych behavioral services, then care plans will be updated to reflect the behavior services. If any of the 32 residents are found to need behavioral services then [Psychiatric Provider] will treat in-house, and the care plan will be updated and nursing staff will be educated. None of the 32 residents require behavioral services at this time. B. Resident #1 is in hospital currently and has been on behavioral services but frequently refused visits. If and when resident #1 returns, psych behavioral services will be updated with his alcohol/drug behaviors and will be seen for appropriate service needs. Resident #1 has a history of refusing medical care including medications, dialysis, and psych services. If residents' refusals continue to jeopardize their health and the facility can no longer meet their needs, then the facility may discharge per HHSC guidelines. C. On 5/30/25 at 9:00 am the RNC reviewed the Behavioral Management policy, with no revisions made. D. On 5/30/25 by 12:00 PM the DON/ or designee will in-service nurses on Behavior Management policy, to include monitoring of behaviors each shift, documentation of any unsafe behaviors, notify physician of unsafe behaviors for new orders, and notify DON/ or designee of unsafe behaviors, no nurse will be able to work a shift without the in-service. The RNC in-serviced the Administrator/ or designee and DON/ or designee beforehand. On 5/30/25 by 6pm DON/designee in-serviced CNAs on Behavior Management policy including responding to behaviors and notifying charge nurse, no CNA will be able to work a shift without the in-service. E. DON/designee will review future admissions for the need of psych services and notify physician for an order for behavioral services. F. DON/designee will monitor 24-hour report for unsafe behaviors identified daily in morning stand-up meeting. G. All findings will be discussed during the morning stand-up meeting with IDT team and report to QAPI and update plan of correction as needed. H. On 5/29/25 the facility's Administrator/or designee notified the Medical Director regarding the Immediate Jeopardy the facility received related to Failure to Provide Behavioral Services and reviewed plans to sustain compliance. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: ___5/31/25_________ Monitoring of the plan of removal included the following: Record review of the facility's plan of removal documentation revealed a complete audit of the building was completed by the RNC on 05/29/2025 and 32 residents who did not receive behavioral health services were identified. Further review of the facility's plan of removal documentation revealed psychiatric evaluations were completed on the 32 residents who did not previously receive behavioral health services beginning on 05/30/2025. No substance abuse issues were identified among the 32 residents evaluated. Record review of the Behavior Management policy revealed it was reviewed by the RNC on 05/29/2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 25 of 26 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 03/25/2025 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of a facility document, titled, In-Service - Program Attendance Record dated 05/29/2025 revealed the DON was educated by the RNC on the Behavior Management policy, including monitoring behaviors each shift, documentation of any unsafe behaviors, and notifying the doctor of any unsafe behaviors. Record review of a facility document, titled, In-Service - Program Attendance Record dated 05/30/2025 revealed the facility's nurses were educated by the RNC on the Behavior Management policy, including monitoring behaviors each shift, documentation of any unsafe behaviors, and notifying the doctor and DON of any unsafe behaviors. Record review of a facility document, titled, In-Service - Program Attendance Record dated 05/29/2025 revealed the facility's CNAs were educated by the DON, ADON F and ADON G on the Behavior Management policy, including how to respond to behaviors, redirection, providing a calm environment, and notifying the nurse of unsafe behaviors. Interviews were conducted with staff on 06/01/2025 from 9:30 a.m. until 12:00 p.m. from all shifts (nurses and CNAs worked 12-hour shifts) including the VP of Operations, RNC, DON, ADON F, ADON G, RN H (day shift), Receptionist I, Receptionist J, LVN K (day shift), CNA L (day shift), CNA M (day shift), LVN N (night shift), and CNA O (night shift), to verify the in-services were conducted and to validate the staff understanding of requirements, training material, and expectations. The VP of Operations, RNC, DON, ADON F, ADON G, RN H, Receptionist I, Receptionist J, LVN K, CNA L (day shift), CNA M (day shift), LVN N (night shift), and CNA O were able to explain the importance of identifying and addressing unsafe behaviors (alcohol and drug abuse), notifying the nurses, DON, and physician of unsafe behaviors, documenting behaviors, responding appropriately to residents who exhibit behaviors, and monitoring residents who exhibit behaviors related to alcohol and drug abuse for their entire shift. The RNC was informed the Immediate Jeopardy was removed on 06/01/2025 at 12:09 p.m. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675046 If continuation sheet Page 26 of 26