Health inspection·August 18, 2023

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few extensive assistance by 2 staff for dressing toilet use and transfers. The resident was transferred by Hoyer lift. Record review of a Social Services note dated 7/13/23 indicated Resident #1 preferred to stay in bed, but occasionally went to the dining room and participated in activities. Written by the social worker. Record review of the Provider Investigation report dated 3/11/22 indicated Resident #2 crawled to Resident #1's bed and was trying to hit him with a remote. He was verbally aggressive towards Resident #1 and threatening to kill him. Resident #1 was hollering for staff. The staff intervened and Resident #2 was removed and taken to the emergency room for evaluation. Record review of a general in service dated 2/23/23 (prior to the incident) indicated an in-service on abuse and neglect. The sign in sheet indicated LVN A and LVN E attended. Record review of the Provider Investigation Report dated 2/27/23 indicated during an investigation the facility was made aware of an additional concern related to LVN A and LVN E. During the investigation of LVN E's treatment of residents, there was an incident that arose regarding LVN A. The allegations regarding LVN A were substantiated. The police were notified, life satisfaction rounds were conducted with residents, and staff questionaries to identify if this happened elsewhere. The LVN A and LVN E were terminated. The report contained a statement dated 2/24/23 written by CNA B that indicated Resident #1 pulled his light a few times. This annoyed LVN A and LVN E to the point they wanted him out of bed. Around 12:00 a.m. CNA B and CNA D got Resident #1 up and they would not let us put him down until closer to 7 :00 a.m. While he was up, they kept telling him to shut up. The nurses laughed at him along with torturing him with past events of a former roommate beating Resident #1 up for talking. They proceeded to say, if you don't shut up Resident #2 was going to come and get you again. The Report contained a statement dated 3/1/23 by Resident #1 written by the Administrator. The statement indicated CNA D took him to the front lobby on Friday night 2/24/23 as punishment from the nurses for hollering. He said LVN A did not like it when he hollered. He said LVN A said, You remember that guy that beat you up? Well, I am gone bring him out here if you don't stop hollering. A statement dated 2/27/28 written by CNA D indicated on the 11 to 7 shift on 2/24/23 Resident #1 was on his call light quite a bit. About 12:00 a.m. LVN A said to get him up. He was not yelling when they got him up but yelled the rest of the night. The aide said she did not hear everything, but the nurses were hollering back to him from the nurses' station. She said they said something about an old roommate that had beat him up. The statement said CNA D and CNA B put Resident #1 to bed about 6:30 a.m. the aide said she returned to work at 3:00 p.m. on 2/26/23 and was told the resident slept all day and did not eat. She said he did not wake up to pull his light until 9:00 p.m. A statement with no date written by LVN A indicted Resident #1 was sitting in the front dining room and frequently yelled out nurse. This nurse told him to quiet down because there were 3 or 4 other residents close to him. At the desk myself and LVN E was talking about the time his former roommate hit him with a remote due to his constant loud yelling. During an interview on 8/8/23 at 10:25 a.m. with Resident #1 and the Administrator, Resident #1 said he was doing fine now. He said remembered the incident that occurred a few months ago when two aides were told to get him up and put him in his chair around 11:00 p.m. or so, it was after the night shift came in. He said they got him up and he did not really want to get up. He said when he was asked to be put to bed, they would not put him to bed until morning. He said he could not put himself to bed, so he just had to sit there all night. Resident #1 said LVN A did that as punishment because she knew he did not like to stay up long. Resident #1 said LVN A threatened him with his former (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 2 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few roommate beating him up if he did not stop hollering. The resident said he was upset by the incident and began to cry. After leaving the room, the Administrator said he did not know what upset Resident #1 more, the incident with LVN A up all night or the threat of Resident #2 beating him up. The Administrator said due to Resident #1 being upset he did not want to dig too deeply into his feelings, but it was obvious he was still upset by the whole thing. During a telephone interview on 8/2/23 at 11:50 a.m., CNA B said she heard LVN A talking to Resident #1 on 2/24/23. She said she heard LVN A threaten Resident #1 with someone beating him up. CNA B said LVN A told her and CNA D to get Resident #1 up and would not let them put him to bed all night. She said he did not like to stay up long. According to her, Resident #1 wanted to lay back down. CNA B said when they told LVN A he wanted to lay down, LVN A told them not to put Resident #1 back to bed until daylight. She said Resident #1 was dependent on staff and could not put his self-back to bed. CNA B said she did not report the incident but had been in-serviced on reporting abuse after the incident happened. During an interview on 8/2/23 at 1:14 p.m., CNA C said she worked at the facility for 4 years. She said Resident #1 liked attention and would holler for help. She said she heard about them getting him up and keeping him up all night. She said when Resident #1 got up, after about 10 minutes, he wanted to lay back down. She said Resident #1 liked to stay in the bed. CNA C said if they kept him up all night, it would have been punishment for him. She said Resident #1 told her, LVN A made him get up and stay up all night because he was hollering, as a punishment. She said Resident #1 was dependent on staff and could not put his self-back to bed. During a telephone interview on 8/8/23 at 1:55 p.m., CNA D said Resident #1 yelled down the hall quite often. He was not yelling down the hallway on the night of 2/24/23She said when they arrived at work at 11:00 p.m. that night Resident #1 was pulling the call light quite a bit. They had only been at work a short time and he had pulled the light about 5 times. LVN A said if Resident #1 pulled the call light again she wanted her and CNA B to get him up. CNA D said he pulled the light again and LVN A told them to get him up. Resident #1 said he did not want to get up. She said they told LVN A he did not want to get up and LVN A told them to get him up anyway. CNA D said after about 2 hours Resident #1 wanted to go to bed. She said LVN A said do not put him to bed. CNA D said after about another hour and a half he asked again and LVN A said no. She said Resident #1 was dependent on staff and could not put himself self-back to bed. She said LVN A told them not put him to bed until day light. CNA D said Resident #1 was sliding out of his chair. She said Resident #1 was in a high-backed wheelchair and kept sliding down and they had to pull him up. CNA D said she did not hear all the comments that night between LVN A and LVN E. She said she heard parts of the conversation about a former roommate beating Resident #1 up and they were laughing. CNA D said she was sure Resident #1 could hear them. He was sitting in the entry way area not too far from the nurse's station. They were talking loudly, and she heard them from a couple of rooms down the hallway. She said she was doing what she was instructed to do by her nurse. She said she did not think too much of it at the time, but it was abuse. She did not report the incident but had been counseled and in-serviced since the incident. During an interview on 8/2/23 at 11:29 a.m., the Administrator said he was investigating another abuse allegation regarding LVN E and discovered LVN A was abusive to Resident #1. The Administrator said on the night of 2/24/23, LVN A had told aides to get Resident # 1 out of bed due to his hollering out and to keep him up. He said LVN A also threatened Resident #1 by telling him a former roommate was going to beat him up. The Administrator said when he spoke to Resident #1, and Resident #1 said he felt like he was being punished. The Administrator said he did not know the exact date he found (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 3 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few out about the incident, the staff did not come and report the abuse. When he was asked about LVN E, then CNA B and CNA D started to talk about the incident with Resident #1. He said it may be a day or two later when he found about the abuse to Resident #1. The Administrator said he started the investigation into LVN E on the morning of 2/25/23 because it was reported that morning. The two aides worked mostly nights and weekends. He said when he was informed what had happened to Resident #1, LVN A was suspended immediately. He said he terminated LVN E not because he could prove that she had abused a resident but because there were so many negative statements about her behavior all together on 3/4/23. He terminated LVN A because the abuse was substantiated on 3/4/23. He referred both their license, in serviced staff, and took the incident to QIPP. He said he completed the in-service and had the staff to take a test to ensure their knowledge of what was considered abuse, and when to report abuse. They were told if a resident did not want to get up then do not force them. If the nurse insisted, to contact him to determine what needed to be done on 3/4/23. During an interview on 8/18/23 at 2:10 p.m. CNA C said she worked at the facility for 4 years. She said they had in services all the time about abuse and neglect. Abuse was making a resident do something against their will. She said Resident #1 did not like to get up and the staff do not make him get up. CNA C said occasionally they can talk him into getting up, but Resident #1 did not like to stay up long. She said he had been like that ever since she had been at the facility. CNA C said the facility bought him a fancy wheelchair, give pain meds, but he still did not like to get up. She said if a nurse told her to get him up and he did not want to get up, She would call the abuse coordinator. CNA C said they should make him get up, they must honor the resident wishes. She said putting Resident # 1 in his chair and making him stay there could be a restraint. CNA C said Resident #1 could not get out of the chair without assistance. She said they were serviced on reporting and not doing things against resident wishes. Record review of the facility corrective actions prior to the initiation of the survey revealed: Record review of a QIPP worksheet dated 3/14/23 indicated the identified concern was two nurses involved in the mistreatment of residents. The alleged perpetrator was suspended pending investigation on 2/25/23. Systemic Actions were the corporate nurse and facility administrative staff completed a thorough investigation on abuse neglect, mistreatment, involuntary seclusion on 3/4/23. In-services were completed on 3/4/23 to include detailed discussion on abuse triggers, abuse scenarios as well as what to do when you encounter a situation where you feel the resident is being mistreated. Monitoring was initiated and complete on 6/9/23. LVN A and LVN E were both suspended on 2/26/23 and both were terminated on 3/4/23. Record review of an in service dated 3/4/23 indicated the Administrator presented the topic Abuse, Neglect, Mistreatment, and Involuntary Seclusion. The in-service sign in sheet had 51 signatures to include CNA B and CNA D. Record review of a time sheet for LVN A indicated she worked full shifts on 2/24/23 and 2/25/23- from 11p to 7a. The time sheet indicated that her last day at work was 2/25/23 at 7:18 a.m. Record review of a time sheet for LVN E indicated she worked full a shift on 2/24/23 from 11p- 7a. The time sheet indicated that her last day at work was 2/24/35 at 7:17 a.m. Interviews were conducted LVNs on 8/2/23 between 10:43 a.m. and 4:41 p.m. about the training they received in regard to abuse, restraints and seclusion: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 4 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0600 At 10:43 a.m. LVN H Level of Harm - Immediate jeopardy to resident health or safety At 11:02 a.m. LVN I Residents Affected - Few At 8/2/23 at 4:41 p.m. LVN J At 8/2/23 at 3:58 p.m. LVN G The LVNs said she had received an in service on abuse with a focus on seclusion. They informed to always honor the residents' rights and wishes. If a resident did not want to get up, do not make them got up, and do not force them to stay up in a chair. The nurses said they knew better than to make a resident do things against their will, and if they did that was abuse. They would not intentionally place a resident alone, in a room or a chair, if they were dependent on staff to meet their needs they would take care of the residents needs. They said they had received in services many times on abuse and neglect and was familiar with what constituted abuse, who to report to and to report immediately. Record review of the Abuse Prohibition Policy last revised March 2023 indicated the intent of this protocol was intended to assist in the prevention of abuse, neglect, and misappropriation of property. Each resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion, and financial abuse. The policy indicated the facility will prohibit neglect, mental or physical abuse, including involuntary seclusion and misappropriation of property or finances of residents. The definition of abuse means the willful infliction of injury, withholding or misappropriation or property or money, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or anguish. Any employee who becomes aware of an allegation of abuse, neglect, or misappropriation of resident property, shall report the incident to the Abuse Coordinator immediately. Failure to do so will result in disciplinary action, up to and including termination. Training of all new and current employees will receive training and reinforcement on all aspects of abuse probation program. Training will include prohibiting and preventing all forms of abuse, identifying what constitutes all forms of abuse, recognizing signs and symptoms of all abuse, and reporting all forms of abuse. Prevention of abuse included facility staff will immediately correct, intervene in reports, or identified situation in which abuse/neglect is at risk for occurring. Protection indicated all residents will be immediately protected from harm. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 5 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free from physical restrains for 1 of 5 residents (Resident #1) reviewed for restraints in that: Residents Affected - Few Resident #1 was gotten out of bed against his wishes, made to sit up all night in his wheelchair on 2/24/23 by the orders of LVN A. Resident #1 wanted to lay back down but was not allowed to do so and he was totally dependent on staff for assistance. Resident #1 said he was being punished for hollering out. The noncompliance was identified as PNC. The IJ began on 2/24/23 and ended on 3/4/23. The facility corrected the noncompliance before the survey began. This failure could place residents at risk for being restrained against their will. Findings included: Record review of Resident #1's face sheet dated 8/8/23 indicated he was a [AGE] year-old male who admitted to the facility on [DATE]. Some of his diagnoses were Hemiplegia (Paralysis on one side of the body) following a stroke, mild cognitive impairment, abnormal posture, anxiety disorder, and schizoaffective disorder bipolar type. Record review of Resident #1's quarterly MDS assessment dated [DATE] indicated his cognitive status was moderately impaired. His bed mobility was extensive assistance with two people. Resident #1 required the assistance of two people for transfers. Record review of Resident #1's care plan initiated on 10/22/21 with a focused area of behaviors related to frequently yelling out instead of using the call light, attention seeking, as evidence by asking to have pillow fluffed multiple times within minutes of doing so. A history of climbing out of bed and screaming when up in chair wanting to go back to bed within less than 30 minutes of being up. Some of the interventions were to be supportive of all needs and requests to maintain comfort. Encourage him to sit up for as long as possible. If multiple requests were made to go back, please put him back to bed. Maintain a calm, restful safe environment. A focused area of ADL self-care performance deficit related to left sided hemiplegia. Resident #1 required extensive assistance of two staff for positioning and tuning in bed for proper body alignment as necessary. The resident had limited range of motion of the left upper extremity, hand, and lower extremity. Resident #1 required extensive assistance by 2 staff for dressing toilet use and transfers. The resident was transferred by Hoyer lift. Record review of a Social Services note dated 7/13/23 indicated Resident #1 preferred to stay in bed, but occasionally went to the dining room and participated in activities. Written by the social worker. Record review of the Provider Investigation report dated 3/11/22 indicated Resident #2 crawled to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 6 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0604 Level of Harm - Immediate jeopardy to resident health or safety Resident #1's bed and was trying to hit him with a remote. He was verbally aggressive towards Resident #1 and threatening to kill him. Resident #1 was hollering for staff. The staff intervened and Resident #2 was removed and taken to the emergency room for evaluation. Record review of a general in service dated 2/23/23 (prior to the incident) indicated an in-service on abuse and neglect. The sign in sheet indicated LVN A and LVN E attended. Residents Affected - Few Record review of the Provider Investigation Report dated 2/27/23 indicated during an investigation the facility was made aware of an additional concern related to LVN A and LVN E. During the investigation of LVN E's treatment of residents, there was an incident that arose regarding LVN A. The allegations regarding LVN A were substantiated. The police were notified, life satisfaction rounds were conducted with residents, and staff questionaries to identify if this happened elsewhere. The LVN A and LVN E were terminated. The report contained a statement dated 2/24/23 written by CNA B that indicated Resident #1 pulled his light a few times. This annoyed LVN A and LVN E to the point they wanted him out of bed. Around 12:00 a.m. CNA B and CNA D got Resident #1 up and they would not let us put him down until closer to 7 :00 a.m. While he was up, they kept telling him to shut up. The nurses laughed at him along with torturing him with past events of a former roommate beating Resident #1 up for talking. They proceeded to say, if you don't shut up Resident #2 was going to come and get you again. The Report contained a statement dated 3/1/23 by Resident #1 written by the Administrator. The statement indicated CNA D took him to the front lobby on Friday night 2/24/23 as punishment from the nurses for hollering. He said LVN A did not like it when he hollered. He said LVN A said, You remember that guy that beat you up? Well, I am gone bring him out here if you don't stop hollering. A statement dated 2/27/28 written by CNA D indicated on the 11 to 7 shift on 2/24/23 Resident #1 was on his call light quite a bit. About 12:00 a.m. LVN A said to get him up. He was not yelling when they got him up but yelled the rest of the night. The aide said she did not hear everything, but the nurses were hollering back to him from the nurses' station. She said they said something about an old roommate that had beat him up. The statement said CNA D and CNA B put Resident #1 to bed about 6:30 a.m. the aide said she returned to work at 3:00 p.m. on 2/26/23 and was told the resident slept all day and did not eat. She said he did not wake up to pull his light until 9:00 p.m. A statement with no date written by LVN A indicted Resident #1 was sitting in the front dining room and frequently yelled out nurse. This nurse told him to quiet down because there were 3 or 4 other residents close to him. At the desk myself and LVN E was talking about the time his former roommate hit him with a remote due to his constant loud yelling. During an interview on 8/8/23 at 10:25 a.m. with Resident #1 and the Administrator, Resident #1 said he remembered the incident that occurred a few months ago when two aides were told to get him up and put him in his chair around 11:00 p.m. or so, it was after the night shift came in. He said they got him up and he did not really want to get up. He said when he was asked to be put to bed, they would not put him to bed until morning. He said he could not put himself to bed, so he just had to sit there all night. Resident #1 said LVN A did that as punishment because she knew he did not like to stay up long. Resident #1 said LVN A threatened him with his former roommate beating him up if he did not stop hollering. The resident said he was upset by the incident and began to cry. After leaving the room, the Administrator said he did not know what upset Resident #1 more, the incident with LVN A up all night or the threat of Resident #2 beating him up. The Administrator said due to Resident #1 being upset he did not want to dig too deeply into his feelings, but it was obvious he was still upset by the whole thing. During a telephone interview on 8/2/23 at 11:50 a.m., CNA B said she heard LVN A talking to Resident #1 on 2/24/23. She said she heard LVN A threaten Resident #1 with someone beating him up. CNA B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 7 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0604 Level of Harm - Immediate jeopardy to resident health or safety said LVN A told her and CNA D to get Resident #1 up and would not let them put him to bed all night. She said he did not like to stay up long. According to her, Resident #1 wanted to lay back down. CNA B said when they told LVN A he wanted to lay down, LVN A told them not to put Resident #1 back to bed until daylight. She said Resident #1 was dependent on staff and could not put his self-back to bed. CNA B said she did not report the incident but had been in-serviced on reporting abuse after the incident happened. She said if anything like that happened again, she would let the Administrator know immediately. Residents Affected - Few During an interview on 8/2/23 at 1:14 p.m., CNA C said she worked at the facility for 4 years. She said Resident #1 liked attention and would holler for help. She said she heard about them getting him up and keeping him up all night. She said when Resident #1 got up, after about 10 minutes, he wanted to lay back down. She said Resident #1 liked to stay in the bed. CNA C said if they kept him up all night, it would have been punishment for him. She said Resident #1 told her, LVN A made him get up and stay up all night because he was hollering, as a punishment. She said Resident #1 was dependent on staff and could not put his self-back to bed. During a telephone interview on 8/8/23 at 1:55 p.m., CNA D said Resident #1 yelled down the hall quite often. He was not yelling down the hallway on the night of 2/24/23She said when they arrived at work at 11:00 p.m. that night Resident #1 was pulling the call light quite a bit. They had only been at work a short time and he had pulled the light about 5 times. LVN A said if Resident #1 pulled the call light again she wanted her and CNA B to get him up. CNA D said he pulled the light again and LVN A told them to get him up. Resident #1 said he did not want to get up. She said they told LVN A he did not want to get up and LVN A told them to get him up anyway. CNA D said after about 2 hours Resident #1 wanted to go to bed. She said LVN A said do not put him to bed. CNA D said after about another hour and a half he asked again and LVN A said no. She said Resident #1 was dependent on staff and could not put himself self-back to bed. She said LVN A told them not put him to bed until day light. CNA D said Resident #1 was sliding out of his chair. She said Resident #1 was in a high-backed wheelchair and kept sliding down and they had to pull him up. CNA D said she did not hear all the comments that night between LVN A and LVN E. She said she heard parts of the conversation about a former roommate beating Resident #1 up and they were laughing. CNA D said she was sure Resident #1 could hear them. He was sitting in the entry way area not too far from the nurse's station. They were talking loudly, and she heard them from a couple of rooms down the hallway. She said she was doing what she was instructed to do by her nurse. She said she did not think too much of it at the time, but it was abuse. She did not report the incident but had been counseled and in-serviced since the incident. She said if anything like that happened again, she would let the Administrator know immediately. During an interview on 8/2/23 at 11:29 a.m., the Administrator said he was investigating another abuse allegation regarding LVN E and discovered LVN A was abusive to Resident #1. The Administrator said on the night of 2/24/23, LVN A had told aides to get Resident # 1 out of bed due to his hollering out and to keep him up. He said LVN A also threatened Resident #1 by telling him a former roommate was going to beat him up. The Administrator said when he spoke to Resident #1, and Resident #1 said he felt like he was being punished. The Administrator said he did not know the exact date he found out about the incident, the staff did not come and report the abuse. When he was asked about LVN E, then CNA B and CNA D started to talk about the incident with Resident #1. He said it may be a day or two later when he found about the abuse to Resident #1. The Administrator said he started the investigation into LVN E on the morning of 2/25/23 because it was reported that morning. The two aides worked mostly nights and weekends. He said when he was informed what had happened to Resident #1, LVN A was suspended immediately. He said he terminated LVN E not because he could prove that she had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 8 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0604 Level of Harm - Immediate jeopardy to resident health or safety abused a resident but because there were so many negative statements about her behavior all together on 3/4/23. He terminated LVN A because the abuse was substantiated on 3/4/23. He referred both their license, in serviced staff, and took the incident to QIPP. He said he completed the in-service and had the staff to take a test to ensure their knowledge of what was considered abuse, and when to report abuse. They were told if a resident did not want to get up then do not force them. If the nurse insisted, to contact him to determine what needed to be done on 3/4/23. Residents Affected - Few During an interview on 8/18/23 at 1:50 p.m. the Activity Director said they had in services all the time on abuse and neglect. She said just today, there was an Inservice that came up on her computer about abuse and neglect and when to report. She said they were to report any suspicion of abuse immediately to the Administrator. The Activity Director said if the Administrator was not there, they call him. She said they were not allowed to use restraints in the facility. She said restraints could be chemical, locking someone in a chair, or side rails. She said Resident #1 did not like to get up a lot. If someone put him in a chair and would not lay him down, it was a restraint because he could not lay down by himself. During an interview on 8/18/23 at 2:10 p.m. CNA C said she worked at the facility for 4 years. She said they had in services all the time about abuse and neglect. Abuse was making a resident do something against their will. She said Resident #1 did not like to get up and the staff do not make him get up. CNA C said occasionally they can talk him into getting up, but Resident #1 did not like to stay up long. She said he had been like that ever since she had been at the facility. CNA C said the facility bought him a fancy wheelchair, give pain meds, but he still did not like to get up. She said if a nurse told her to get him up and he did not want to get up, She would call the abuse coordinator. CNA C said they should make him get up, they must honor the resident wishes. She said putting Resident # 1 in his chair and making him stay there could be a restraint. CNA C said Resident #1 could not get out of the chair without assistance. She said they were serviced on reporting and not doing things against resident wishes. During an interview on 8/18/23 at 2:13 p.m. CNA F said she worked at the facility for 10 years. She said she was aware of what abuse and neglect was, when, and who to report to. CNA F said if a nurse told her to do something to a resident that was not right, she would report her. She said they were in serviced on involuntary seclusion. CNA F said a restraint-could be holding someone against their will and not allowing them to do what they wanted. She said if a resident wanted to lay down and could be a restraint. She said Resident #1 could not lay down himself. CNA F said it was the resident right, to lay down or to get help. Record review of the facility corrective actions prior to the initiation of the survey revealed: Record review of a QIPP worksheet dated 3/14/23 indicated the identified concern was two nurses involved in the mistreatment of residents. The alleged perpetrator was suspended pending investigation on 2/25/23. Systemic Actions were the corporate nurse and facility administrative staff completed a thorough investigation on abuse neglect, mistreatment, involuntary seclusion on 3/4/23. In-services were completed on 3/4/23 to include detailed discussion on abuse triggers, abuse scenarios as well as what to do when you encounter a situation where you feel the resident is being mistreated. Monitoring was initiated and complete on 6/9/23. LVN A and LVN E were both suspended on 2/26/23 and both were terminated on 3/4/23. Record review of an in service dated 3/4/23 indicated the Administrator presented the topic Abuse, Neglect, Mistreatment, and Involuntary Seclusion. The in-service sign in sheet had 51 signatures to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 9 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0604 include CNA B and CNA D. Level of Harm - Immediate jeopardy to resident health or safety Record review of a time sheet for LVN A indicated she worked full shifts on 2/24/23 and 2/25/23- from 11p to 7a. The time sheet indicated that her last day at work was 2/25/23 at 7:18 a.m. Residents Affected - Few Record review of a time sheet for LVN E indicated she worked full a shift on 2/24/23 from 11p- 7a. The time sheet indicated that her last day at work was 2/24/35 at 7:17 a.m. Interviews were conducted LVNs on 8/2/23 between 10:43 a.m. and 4:41 p.m. about the training they received regarding abuse, restraints and seclusion: At 10:43 a.m. LVN H At 11:02 a.m. LVN I At 8/2/23 at 3:58 p.m. LVN G At 8/2/23 at 4:41 p.m. LVN J The LVNs said she had received an in service on abuse with a focus on seclusion. They informed to always honor the residents' rights and wishes. If a resident did not want to get up, do not make them got up, and do not force them to stay up in a chair. The nurses said they knew better than to make a resident do things against their will, and if they did that was abuse. They would not intentionally place a resident alone, in a room or a chair, if they were dependent on staff to meet their needs they would take care of the residents needs. They said they had received in services many times on abuse and neglect and was familiar with what constituted abuse, who to report to and to report immediately. Record review of the facility's Policy on Restraints and Involuntary seclusion last revised October 2022 and reviewed in March 2023. The policy indicated residents have the right to be free from any physical restrains imposed for the purposes of discipline or convenience and when not required to treat the residents' medical conditions. Residents have the right to function at the highest practicable level in the least restrictive environment possible. Restraints will never be used for the discipline or staff convenience. A physical restraint is any manual method, or physical, or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. Discipline is defined as any action taken by the facility for the purpose of punishing or penalizing the resident. Record review of the Abuse Prohibition Policy last revised March 2023 indicated the intent of this protocol was intended to assist in the prevention of abuse, neglect, and misappropriation of property. Each resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion, and financial abuse. The policy indicated the facility will prohibit neglect, mental or physical abuse, including involuntary seclusion and misappropriation of property or finances of residents. The definition of abuse means the willful infliction of injury, withholding or misappropriation or property or money, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or anguish. Any employee who becomes aware of an allegation of abuse, neglect, or misappropriation of resident property, shall report the incident to the Abuse Coordinator immediately. Failure to do so will result in disciplinary action, up to and including termination. Training of all new and current employees will receive training and reinforcement on all aspects of abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 10 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0604 Level of Harm - Immediate jeopardy to resident health or safety probation program. Training will include prohibiting and preventing all forms of abuse, identifying what constitutes all forms of abuse, recognizing signs and symptoms of all abuse, and reporting all forms of abuse. Prevention of abuse included facility staff will immediately correct, intervene in reports, or identified situation in which abuse/neglect is at risk for occurring. Protection indicated all residents will be immediately protected from harm. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 11 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure they implemented the written policies and procedures that prevented abuse and neglect for (Resident #1) in that: Residents Affected - Few Resident #1 was gotten out of bed against his wishes, made to sit up all night on 2/24/23 by the orders of LVN A. Resident #1 was threatened, and emotionally abused on 2/24/23 by LVN A and LVN E. The staff failed to prevent and protect Resdient#1 from continued abuse and involuntary seclusion. Resident #1 said he was being punished for hollering out. The noncompliance was identified as PNC. The IJ began on 2/24/23 and ended on 3/4/23. The facility corrected the noncompliance before the survey began. This failure could place residents at risk for continued abuse, fear, and intimidation. Findings included: Record review of Resident #1's face sheet dated 8/8/23 indicated he was a [AGE] year-old male who admitted to the facility on [DATE]. Some of his diagnoses were Hemiplegia (Paralysis on one side of the body) following a stroke, mild cognitive impairment, abnormal posture, anxiety disorder, and schizoaffective disorder bipolar type. Record review of Resident #1's quarterly MDS assessment dated [DATE] indicated his cognitive status was moderately impaired. His bed mobility was extensive assistance with two people. Resident #1 required the assistance of two people for transfers. Record review of Resident #1's care plan initiated on 10/22/21 with a focused area of behaviors related to frequently yelling out instead of using the call light, attention seeking, as evidence by asking to have pillow fluffed multiple times within minutes of doing so. A history of climbing out of bed and screaming when up in chair wanting to go back to bed within less than 30 minutes of being up. Some of the interventions were to be supportive of all needs and requests to maintain comfort. Encourage him to sit up for as long as possible. If multiple requests were made to go back, please put him back to bed. Maintain a calm, restful safe environment. A focused area of ADL self-care performance deficit related to left sided hemiplegia. Resident #1 required extensive assistance of two staff for positioning and tuning in bed for proper body alignment as necessary. The resident had limited range of motion of the left upper extremity, hand, and lower extremity. Resident #1 required extensive assistance by 2 staff for dressing toilet use and transfers. The resident was transferred by Hoyer lift. Record review of a Social Services note dated 7/13/23 indicated Resident #1 preferred to stay in bed, but occasionally went to the dining room and participated in activities. Written by the social worker. Record review of the Provider Investigation report dated 3/11/22 indicated Resident #2 crawled to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 12 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Resident #1's bed and was trying to hit him with a remote. He was verbally aggressive towards Resident #1 and threatening to kill him. Resident #1 was hollering for staff. The staff intervened and Resident #2 was removed and taken to the emergency room for evaluation. Record review of a general in service dated 2/23/23 (prior to the incident) indicated an in-service on abuse and neglect. The sign in sheet indicated LVN A and LVN E attended. Residents Affected - Few Record review of the Provider Investigation Report dated 2/27/23 indicated during an investigation the facility was made aware of an additional concern related to LVN A and LVN E. During the investigation of LVN E's treatment of residents, there was an incident that arose regarding LVN A. The allegations regarding LVN A were substantiated. The police were notified, life satisfaction rounds were conducted with residents, and staff questionaries to identify if this happened elsewhere. The LVN A and LVN E were terminated. The report contained a statement dated 2/24/23 written by CNA B that indicated Resident #1 pulled his light a few times. This annoyed LVN A and LVN E to the point they wanted him out of bed. Around 12:00 a.m. CNA B and CNA D got Resident #1 up and they would not let us put him down until closer to 7 :00 a.m. While he was up, they kept telling him to shut up. The nurses laughed at him along with torturing him with past events of a former roommate beating Resident #1 up for talking. They proceeded to say, if you don't shut up Resident #2 was going to come and get you again. The Report contained a statement dated 3/1/23 by Resident #1 written by the Administrator. The statement indicated CNA D took him to the front lobby on Friday night 2/24/23 as punishment from the nurses for hollering. He said LVN A did not like it when he hollered. He said LVN A said, You remember that guy that beat you up? Well, I am gone bring him out here if you don't stop hollering. A statement dated 2/27/28 written by CNA D indicated on the 11 to 7 shift on 2/24/23 Resident #1 was on his call light quite a bit. About 12:00 a.m. LVN A said to get him up. He was not yelling when they got him up but yelled the rest of the night. The aide said she did not hear everything, but the nurses were hollering back to him from the nurses' station. She said they said something about an old roommate that had beat him up. The statement said CNA D and CNA B put Resident #1 to bed about 6:30 a.m. the aide said she returned to work at 3:00 p.m. on 2/26/23 and was told the resident slept all day and did not eat. She said he did not wake up to pull his light until 9:00 p.m. A statement with no date written by LVN A indicted Resident #1 was sitting in the front dining room and frequently yelled out nurse. This nurse told him to quiet down because there were 3 or 4 other residents close to him. At the desk myself and LVN E was talking about the time his former roommate hit him with a remote due to his constant loud yelling. During an interview on 8/8/23 at 10:25 a.m. with Resident #1 and the Administrator, Resident #1 said he remembered the incident that occurred a few months ago when two aides were told to get him up and put him in his chair around 11:00 p.m. or so, it was after the night shift came in. He said they got him up and he did not really want to get up. He said when he was asked to be put to bed, they would not put him to bed until morning. He said he could not put himself to bed, so he just had to sit there all night. Resident #1 said LVN A did that as punishment because she knew he did not like to stay up long. Resident #1 said LVN A threatened him with his former roommate beating him up if he did not stop hollering. The resident said he was upset by the incident and began to cry. After leaving the room, the Administrator said he did not know what upset Resident #1 more, the incident with LVN A up all night or the threat of Resident #2 beating him up. The Administrator said due to Resident #1 being upset he did not want to dig too deeply into his feelings, but it was obvious he was still upset by the whole thing. During a telephone interview on 8/2/23 at 11:50 a.m., CNA B said she heard LVN A talking to Resident #1 on 2/24/23. She said she heard LVN A threaten Resident #1 with someone beating him up. CNA B (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 13 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0607 Level of Harm - Immediate jeopardy to resident health or safety said LVN A told her and CNA D to get Resident #1 up and would not let them put him to bed all night. She said he did not like to stay up long. According to her, Resident #1 wanted to lay back down. CNA B said when they told LVN A he wanted to lay down, LVN A told them not to put Resident #1 back to bed until daylight. She said Resident #1 was dependent on staff and could not put his self-back to bed. CNA A said she did not report the incident but had been in-serviced on reporting abuse after the incident happened. She said if anything like that happened again, she would let the Administrator know immediately. Residents Affected - Few During an interview on 8/2/23 at 1:14 p.m., CNA C said she worked at the facility for 4 years. She said Resident #1 liked attention and would holler for help. She said she heard about them getting him up and keeping him up all night. She said when Resident #1 got up, after about 10 minutes, he wanted to lay back down. She said Resident #1 liked to stay in the bed. CNA C said if they kept him up all night, it would have been punishment for him. She said Resident #1 told her, LVN A made him get up and stay up all night because he was hollering, as a punishment. She said Resident #1 was dependent on staff and could not put his self-back to bed. During a telephone interview on 8/8/23 at 1:55 p.m., CNA D said Resident #1 yelled down the hall quite often. He was not yelling down the hallway on the night of 2/24/23She said when they arrived at work at 11:00 p.m. that night Resident #1 was pulling the call light quite a bit. They had only been at work a short time and he had pulled the light about 5 times. LVN A said if Resident #1 pulled the call light again she wanted her and CNA B to get him up. CNA D said he pulled the light again and LVN A told them to get him up. Resident #1 said he did not want to get up. She said they told LVN A he did not want to get up and LVN A told them to get him up anyway. CNA D said after about 2 hours Resident #1 wanted to go to bed. She said LVN A said do not put him to bed. CNA D said after about another hour and a half he asked again and LVN A said no. She said Resident #1 was dependent on staff and could not put himself self-back to bed. She said LVN A told them not put him to bed until day light. CNA D said Resident #1 was sliding out of his chair. She said Resident #1 was in a high-backed wheelchair and kept sliding down and they had to pull him up. CNA D said she did not hear all the comments that night between LVN A and LVN E. She said she heard parts of the conversation about a former roommate beating Resident #1 up and they were laughing. CNA D said she was sure Resident #1 could hear them. He was sitting in the entry way area not too far from the nurse's station. They were talking loudly, and she heard them from a couple of rooms down the hallway. She said she was doing what she was instructed to do by her nurse. She said she did not think too much of it at the time, but it was abuse. She did not report the incident but had been counseled and in-serviced since the incident. She said if anything like that happened again, she would let the Administrator know immediately. During an interview on 8/2/23 at 11:29 a.m., the Administrator said he was investigating another abuse allegation regarding LVN E and discovered LVN A was abusive to Resident #1. The Administrator said on the night of 2/24/23, LVN A had told aides to get Resident # 1 out of bed due to his hollering out and to keep him up. He said LVN A also threatened Resident #1 by telling him a former roommate was going to beat him up. The Administrator said when he spoke to Resident #1, and Resident #1 said he felt like he was being punished. The Administrator said he did not know the exact date he found out about the incident, the staff did not come and report the abuse. When he was asked about LVN E, then CNA B and CNA D started to talk about the incident with Resident #1. He said it may be a day or two later when he found about the abuse to Resident #1. The Administrator said he started the investigation into LVN E on the morning of 2/25/23 because it was reported that morning. The two aides worked mostly nights and weekends. He said when he was informed what had happened to Resident #1, LVN A was suspended immediately. He said he terminated LVN E not because he could prove that she had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 14 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0607 Level of Harm - Immediate jeopardy to resident health or safety abused a resident but because there were so many negative statements about her behavior all together on 3/4/23. He terminated LVN A because the abuse was substantiated on 3/4/23. He referred both their license, in serviced staff, and took the incident to QIPP. He said he completed the in-service and had the staff to take a test to ensure their knowledge of what was considered abuse, and when to report abuse. They were told if a resident did not want to get up then do not force them. If the nurse insisted, to contact him to determine what needed to be done on 3/4/23. Residents Affected - Few During an interview on 8/18/23 at 1:50 p.m. the Activity Director said they had in services all the time on abuse and neglect. She said just today, there was an Inservice that came up on her computer about abuse and neglect and when to report. She said they were to report any suspicion of abuse immediately to the Administrator. The Activity Director said if the Administrator was not there, they call him. She said they were not allowed to use restraints in the facility. She said restraints could be chemical, locking someone in a chair, or side rails. She said Resident #1 did not like to get up a lot. If someone put him in a chair and would not lay him down, it was a restraint because he could not lay down by himself. During an interview on 8/18/23 at 2:10 p.m. CNA C said she worked at the facility for 4 years. She said they had in services all the time about abuse and neglect. Abuse was making a resident do something against their will. She said Resident #1 did not like to get up and the staff do not make him get up. CNA C said occasionally they can talk him into getting up, but Resident #1 did not like to stay up long. She said he had been like that ever since she had been at the facility. CNA C said the facility bought him a fancy wheelchair, give pain meds, but he still did not like to get up. She said if a nurse told her to get him up and he did not want to get up, She would call the abuse coordinator. CNA C said they should make him get up, they must honor the resident wishes. She said putting Resident # 1 in his chair and making him stay there could be a restraint. CNA C said Resident #1 could not get out of the chair without assistance. She said they were serviced on reporting and not doing things against resident wishes. During an interview on 8/18/23 at 2:13 p.m. CNA F said she worked at the facility for 10 years. She said she was aware of what abuse and neglect was, when, and who to report to. CNA F said if a nurse told her to do something to a resident that was not right, she would report her. She said they were in serviced on involuntary seclusion. CNA F said a restraint-could be holding someone against their will and not allowing them to do what they wanted. She said if a resident wanted to lay down and could be a restraint. She said Resident #1 could not lay down himself. CNA F said it was the resident right, to lay down or to get help. Record review of the facility corrective actions prior to the initiation of the survey revealed: Record review of a QIPP worksheet dated 3/14/23 indicated the identified concern was two nurses involved in the mistreatment of residents. The alleged perpetrator was suspended pending investigation on 2/25/23. Systemic Actions were the corporate nurse and facility administrative staff completed a thorough investigation on abuse neglect, mistreatment, involuntary seclusion on 3/4/23. In-services were completed on 3/4/23 to include detailed discussion on abuse triggers, abuse scenarios as well as what to do when you encounter a situation where you feel the resident is being mistreated. Monitoring was initiated and complete on 6/9/23. LVN A and LVN E were both suspended on 2/26/23 and both were terminated on 3/4/23. Record review of an in service dated 3/4/23 indicated the Administrator presented the topic Abuse, Neglect, Mistreatment, and Involuntary Seclusion. The in-service sign in sheet had 51 signatures to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 15 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0607 include CNA B and CNA D. Level of Harm - Immediate jeopardy to resident health or safety Record review of a time sheet for LVN A indicated she worked full shifts on 2/24/23 and 2/25/23- from 11p to 7a. The time sheet indicated that her last day at work was 2/25/23 at 7:18 a.m. Residents Affected - Few Record review of a time sheet for LVN E indicated she worked full a shift on 2/24/23 from 11p- 7a. The time sheet indicated that her last day at work was 2/24/35 at 7:17 a.m. Interviews were conducted LVNs on 8/2/23 between 10:43 a.m. and 4:41 p.m. about the training they received regarding abuse, restraints, and seclusion: At 10:43 a.m. LVN H At 11:02 a.m. LVN I At 8/2/23 at 3:58 p.m. LVN G At 8/2/23 at 4:41 p.m. LVN J The LVNs said she had received an in service on abuse with a focus on seclusion. They informed to always honor the residents' rights and wishes. If a resident did not want to get up, do not make them got up, and do not force them to stay up in a chair. The nurses said they knew better than to make a resident do things against their will, and if they did that was abuse. They would not intentionally place a resident alone, in a room or a chair, if they were dependent on staff to meet their needs they would take care of the residents needs. They said they had received in services many times on abuse and neglect and was familiar with what constituted abuse, who to report to and to report immediately. Record review of the facility's Policy on Restraints and Involuntary seclusion last revised October 2022 and reviewed in March 2023. The policy indicated residents have the right to be free from any physical restrains imposed for the purposes of discipline or convenience and when not required to treat the residents' medical conditions. Residents have the right to function at the highest practicable level in the least restrictive environment possible. Restraints will never be used for the discipline or staff convenience. A physical restraint is any manual method, or physical, or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. Discipline is defined as any action taken by the facility for the purpose of punishing or penalizing the resident. Record review of the Abuse Prohibition Policy last revised March 2023 indicated the intent of this protocol was intended to assist in the prevention of abuse, neglect, and misappropriation of property. Each resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion, and financial abuse. The policy indicated the facility will prohibit neglect, mental or physical abuse, including involuntary seclusion and misappropriation of property or finances of residents. The definition of abuse means the willful infliction of injury, withholding or misappropriation or property or money, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or anguish. Any employee who becomes aware of an allegation of abuse, neglect, or misappropriation of resident property, shall report the incident to the Abuse Coordinator immediately. Failure to do so will result in disciplinary action, up to and including termination. Training of all new and current employees will receive training and reinforcement on all aspects of abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 16 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0607 Level of Harm - Immediate jeopardy to resident health or safety probation program. Training will include prohibiting and preventing all forms of abuse, identifying what constitutes all forms of abuse, recognizing signs and symptoms of all abuse, and reporting all forms of abuse. Prevention of abuse included facility staff will immediately correct, intervene in reports, or identified situation in which abuse/neglect is at risk for occurring. Protection indicated all residents will be immediately protected from harm. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 17 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure they implemented the written policies and procedures that prevented abuse and neglect. (Resident #1) Residents Affected - Few CNA B and CNA D did not report the abuse of Resident #1 to the Administrator. The administrator discovered the abuse while investigation another abuse allegation. The facility failed to ensure the abuse of Resident #1 was reported within 2 hours as required by their policy. The noncompliance was identified as PNC. The IJ began on 2/24/23 and ended on 3/4/23. The facility corrected the noncompliance before the survey began. This failure could place residents at risk for continued abuse, fear, and intimidation. Findings included: Record review of Resident #1's face sheet dated 8/8/23 indicated he was a [AGE] year-old male who admitted to the facility on [DATE]. Some of his diagnoses were Hemiplegia (Paralysis on one side of the body) following a stroke, mild cognitive impairment, abnormal posture, anxiety disorder, and schizoaffective disorder bipolar type. Record review of Resident #1's quarterly MDS assessment dated [DATE] indicated his cognitive status was moderately impaired. His bed mobility was extensive assistance with two people. Resident #1 required the assistance of two people for transfers. Record review of Resident #1's care plan initiated on 10/22/21 with a focused area of behaviors related to frequently yelling out instead of using the call light, attention seeking, as evidence by asking to have pillow fluffed multiple times within minutes of doing so. A history of climbing out of bed and screaming when up in chair wanting to go back to bed within less than 30 minutes of being up. Some of the interventions were to be supportive of all needs and requests to maintain comfort. Encourage him to sit up for as long as possible. If multiple requests were made to go back, please put him back to bed. Maintain a calm, restful safe environment. A focused area of ADL self-care performance deficit related to left sided hemiplegia. Resident #1 required extensive assistance of two staff for positioning and tuning in bed for proper body alignment as necessary. The resident had limited range of motion of the left upper extremity, hand, and lower extremity. Resident #1 required extensive assistance by 2 staff for dressing toilet use and transfers. The resident was transferred by Hoyer lift. Record review of a Social Services note dated 7/13/23 indicated Resident #1 preferred to stay in bed, but occasionally went to the dining room and participated in activities. Written by the social worker. Record review of the Provider Investigation report dated 3/11/22 indicated Resident #2 crawled to Resident #1's bed and was trying to hit him with a remote. He was verbally aggressive towards Resident #1 and threatening to kill him. Resident #1 was hollering for staff. The staff intervened and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 18 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0609 Resident #2 was removed and taken to the emergency room for evaluation. Level of Harm - Immediate jeopardy to resident health or safety Record review of a general in service dated 2/23/23 (prior to the incident) indicated an in-service on abuse and neglect. The sign in sheet indicated LVN A and LVN E attended. Residents Affected - Few Record review of the Provider Investigation Report dated 2/27/23 indicated during an investigation the facility was made aware of an additional concern related to LVN A and LVN E. During the investigation of LVN E's treatment of residents, there was an incident that arose regarding LVN A. The allegations regarding LVN A were substantiated. The police were notified, life satisfaction rounds were conducted with residents, and staff questionaries to identify if this happened elsewhere. The LVN A and LVN E were terminated. The report contained a statement dated 2/24/23 written by CNA B that indicated Resident #1 pulled his light a few times. This annoyed LVN A and LVN E to the point they wanted him out of bed. Around 12:00 a.m. CNA B and CNA D got Resident #1 up and they would not let us put him down until closer to 7 :00 a.m. While he was up, they kept telling him to shut up. The nurses laughed at him along with torturing him with past events of a former roommate beating Resident #1 up for talking. They proceeded to say, if you don't shut up Resident #2 was going to come and get you again. The Report contained a statement dated 3/1/23 by Resident #1 written by the Administrator. The statement indicated CNA D took him to the front lobby on Friday night 2/24/23 as punishment from the nurses for hollering. He said LVN A did not like it when he hollered. He said LVN A said, You remember that guy that beat you up? Well, I am gone bring him out here if you don't stop hollering. A statement dated 2/27/28 written by CNA D indicated on the 11 to 7 shift on 2/24/23 Resident #1 was on his call light quite a bit. About 12:00 a.m. LVN A said to get him up. He was not yelling when they got him up but yelled the rest of the night. The aide said she did not hear everything, but the nurses were hollering back to him from the nurses' station. She said they said something about an old roommate that had beat him up. The statement said CNA D and CNA B put Resident #1 to bed about 6:30 a.m. the aide said she returned to work at 3:00 p.m. on 2/26/23 and was told the resident slept all day and did not eat. She said he did not wake up to pull his light until 9:00 p.m. A statement with no date written by LVN A indicted Resident #1 was sitting in the front dining room and frequently yelled out nurse. This nurse told him to quiet down because there were 3 or 4 other residents close to him. At the desk myself and LVN E was talking about the time his former roommate hit him with a remote due to his constant loud yelling. During an interview on 8/8/23 at 10:25 a.m. with Resident #1 and the Administrator, Resident #1 said he remembered the incident that occurred a few months ago when two aides were told to get him up and put him in his chair around 11:00 p.m. or so, it was after the night shift came in. He said they got him up and he did not really want to get up. He said when he was asked to be put to bed, they would not put him to bed until morning. He said he could not put himself to bed, so he just had to sit there all night. Resident #1 said LVN A did that as punishment because she knew he did not like to stay up long. Resident #1 said LVN A threatened him with his former roommate beating him up if he did not stop hollering. The resident said he was upset by the incident and began to cry. After leaving the room, the Administrator said he did not know what upset Resident #1 more, the incident with LVN A up all night or the threat of Resident #2 beating him up. The Administrator said due to Resident #1 being upset he did not want to dig too deeply into his feelings, but it was obvious he was still upset by the whole thing. During a telephone interview on 8/2/23 at 11:50 a.m., CNA B said she heard LVN A talking to Resident #1 on 2/24/23. She said she heard LVN A threaten Resident #1 with someone beating him up. CNA B said LVN A told her and CNA D to get Resident #1 up and would not let them put him to bed all night. She said he did not like to stay up long. According to her, Resident #1 wanted to lay back down. CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 19 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few B said when they told LVN A he wanted to lay down, LVN A told them not to put Resident #1 back to bed until daylight. She said Resident #1 was dependent on staff and could not put his self-back to bed. CNA B said she did not report the incident but had been in-serviced on reporting abuse after the incident happened. She said if anything like that happened again she would let the Administrator know immediately. She said if anything like that happened again, she would let the Administrator know immediately. During an interview on 8/2/23 at 1:14 p.m., CNA C said she worked at the facility for 4 years. She said Resident #1 liked attention and would holler for help. She said she heard about them getting him up and keeping him up all night. She said when Resident #1 got up, after about 10 minutes, he wanted to lay back down. She said Resident #1 liked to stay in the bed. CNA C said if they kept him up all night, it would have been punishment for him. She said Resident #1 told her, LVN A made him get up and stay up all night because he was hollering, as a punishment. She said Resident #1 was dependent on staff and could not put his self-back to bed. During a telephone interview on 8/8/23 at 1:55 p.m., CNA D said Resident #1 yelled down the hall quite often. He was not yelling down the hallway on the night of 2/24/23She said when they arrived at work at 11:00 p.m. that night Resident #1 was pulling the call light quite a bit. They had only been at work a short time and he had pulled the light about 5 times. LVN A said if Resident #1 pulled the call light again she wanted her and CNA B to get him up. CNA D said he pulled the light again and LVN A told them to get him up. Resident #1 said he did not want to get up. She said they told LVN A he did not want to get up and LVN A told them to get him up anyway. CNA D said after about 2 hours Resident #1 wanted to go to bed. She said LVN A said do not put him to bed. CNA D said after about another hour and a half he asked again and LVN A said no. She said Resident #1 was dependent on staff and could not put himself self-back to bed. She said LVN A told them not put him to bed until day light. CNA D said Resident #1 was sliding out of his chair. She said Resident #1 was in a high-backed wheelchair and kept sliding down and they had to pull him up. CNA D said she did not hear all the comments that night between LVN A and LVN E. She said she heard parts of the conversation about a former roommate beating Resident #1 up and they were laughing. CNA D said she was sure Resident #1 could hear them. He was sitting in the entry way area not too far from the nurse's station. They were talking loudly, and she heard them from a couple of rooms down the hallway. She said she was doing what she was instructed to do by her nurse. She said she did not think too much of it at the time, but it was abuse. She did not report the incident but had been counseled and in-serviced since the incident. She said if anything like that happened again she would let the Administrator know immediately. She said if anything like that happened again, she would let the Administrator know immediately. During an interview on 8/2/23 at 11:29 a.m., the Administrator said he was investigating another abuse allegation regarding LVN E and discovered LVN A was abusive to Resident #1. The Administrator said on the night of 2/24/23, LVN A had told aides to get Resident # 1 out of bed due to his hollering out and to keep him up. He said LVN A also threatened Resident #1 by telling him a former roommate was going to beat him up. The Administrator said when he spoke to Resident #1, and Resident #1 said he felt like he was being punished. The Administrator said he did not know the exact date he found out about the incident, the staff did not come and report the abuse. When he was asked about LVN E, then CNA B and CNA D started to talk about the incident with Resident #1. He said it may be a day or two later when he found about the abuse to Resident #1. The Administrator said he started the investigation into LVN E on the morning of 2/25/23 because it was reported that morning. The two aides worked mostly nights and weekends. He said when he was informed what had happened to Resident #1, LVN A was suspended immediately. He said he terminated LVN E not because he could prove that she had abused a resident but because (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 20 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0609 Level of Harm - Immediate jeopardy to resident health or safety there were so many negative statements about her behavior all together on 3/4/23. He terminated LVN A because the abuse was substantiated on 3/4/23. He referred both their license, in serviced staff, and took the incident to QIPP. He said he completed the in-service and had the staff to take a test to ensure their knowledge of what was considered abuse, and when to report abuse. They were told if a resident did not want to get up then do not force them. If the nurse insisted, to contact him to determine what needed to be done on 3/4/23. Residents Affected - Few During an interview on 8/18/23 at 1:50 p.m. the Activity Director said they had in services all the time on abuse and neglect. She said just today, there was an Inservice that came up on her computer about abuse and neglect and when to report. She said they were to report any suspicion of abuse immediately to the Administrator. The Activity Director said if the Administrator was not there, they call him. She said they were not allowed to use restraints in the facility. She said restraints could be chemical, locking someone in a chair, or side rails. She said Resident #1 did not like to get up a lot. If someone put him in a chair and would not lay him down, it was a restraint because he could not lay down by himself. During an interview on 8/18/23 at 2:10 p.m. CNA C said she worked at the facility for 4 years. She said they had in services all the time about abuse and neglect. Abuse was making a resident do something against their will. She said Resident #1 did not like to get up and the staff do not make him get up. CNA C said occasionally they can talk him into getting up, but Resident #1 did not like to stay up long. She said he had been like that ever since she had been at the facility. CNA C said the facility bought him a fancy wheelchair, give pain meds, but he still did not like to get up. She said if a nurse told her to get him up and he did not want to get up, She would call the abuse coordinator. CNA C said they should make him get up, they must honor the resident wishes. She said putting Resident # 1 in his chair and making him stay there could be a restraint. CNA C said Resident #1 could not get out of the chair without assistance. She said they were serviced on reporting and not doing things against resident wishes. During an interview on 8/18/23 at 2:13 p.m. CNA F said she worked at the facility for 10 years. She said she was aware of what abuse and neglect was, when, and who to report to. CNA F said if a nurse told her to do something to a resident that was not right, she would report her. She said they were in serviced on involuntary seclusion. CNA F said a restraint-could be holding someone against their will and not allowing them to do what they wanted. She said if a resident wanted to lay down and could be a restraint. She said Resident #1 could not lay down himself. CNA F said it was the resident right, to lay down or to get help. Record review of the facility corrective actions prior to the initiation of the survey revealed: Record review of a QIPP worksheet dated 3/14/23 indicated the identified concern was two nurses involved in the mistreatment of residents. The alleged perpetrator was suspended pending investigation on 2/25/23. Systemic Actions were the corporate nurse and facility administrative staff completed a thorough investigation on abuse neglect, mistreatment, involuntary seclusion on 3/4/23. In-services were completed on 3/4/23 to include detailed discussion on abuse triggers, abuse scenarios as well as what to do when you encounter a situation where you feel the resident is being mistreated. Monitoring was initiated and complete on 6/9/23. LVN A and LVN E were both suspended on 2/26/23 and both were terminated on 3/4/23. Record review of an in service dated 3/4/23 indicated the Administrator presented the topic Abuse, Neglect, Mistreatment, and Involuntary Seclusion. The in-service sign in sheet had 51 signatures to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 21 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0609 include CNA B and CNA D. Level of Harm - Immediate jeopardy to resident health or safety Record review of a time sheet for LVN A indicated she worked full shifts on 2/24/23 and 2/25/23- from 11p to 7a. The time sheet indicated that her last day at work was 2/25/23 at 7:18 a.m. Residents Affected - Few Record review of a time sheet for LVN E indicated she worked full a shift on 2/24/23 from 11p- 7a. The time sheet indicated that her last day at work was 2/24/35 at 7:17 a.m. Interviews were conducted LVNs on 8/2/23 between 10:43 a.m. and 4:41 p.m. about the training they received regarding abuse, restraints, and seclusion: At 10:43 a.m. LVN H At 11:02 a.m. LVN I At 8/2/23 at 3:58 p.m. LVN G At 8/2/23 at 4:41 p.m. LVN J The LVNs said she had received an in service on abuse with a focus on seclusion. They informed to always honor the residents' rights and wishes. If a resident did not want to get up, do not make them got up, and do not force them to stay up in a chair. The nurses said they knew better than to make a resident do things against their will, and if they did that was abuse. They would not intentionally place a resident alone, in a room or a chair, if they were dependent on staff to meet their needs they would take care of the residents needs. They said they had received in services many times on abuse and neglect and was familiar with what constituted abuse, who to report to and to report immediately. Record review of the facility's Policy on Restraints and Involuntary seclusion last revised October 2022 and reviewed in March 2023. The policy indicated residents have the right to be free from any physical restrains imposed for the purposes of discipline or convenience and when not required to treat the residents' medical conditions. Residents have the right to function at the highest practicable level in the least restrictive environment possible. Restraints will never be used for the discipline or staff convenience. A physical restraint is any manual method, or physical, or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body. Discipline is defined as any action taken by the facility for the purpose of punishing or penalizing the resident. Record review of the Abuse Prohibition Policy last revised March 2023 indicated the intent of this protocol was intended to assist in the prevention of abuse, neglect, and misappropriation of property. Each resident has the right to be free from abuse, mistreatment, neglect, corporal punishment, involuntary seclusion, and financial abuse. The policy indicated the facility will prohibit neglect, mental or physical abuse, including involuntary seclusion and misappropriation of property or finances of residents. The definition of abuse means the willful infliction of injury, withholding or misappropriation or property or money, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or anguish. Any employee who becomes aware of an allegation of abuse, neglect, or misappropriation of resident property, shall report the incident to the Abuse Coordinator immediately. Failure to do so will result in disciplinary action, up to and including termination. Training of all new and current employees will receive training and reinforcement on all aspects of abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675051 If continuation sheet Page 22 of 23 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 675051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeview Rehabilitation & Healthcare Center 502 East Coke Rd Winnsboro, TX 75494 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete probation program. Training will include prohibiting and preventing all forms of abuse, identifying what constitutes all forms of abuse, recognizing signs and symptoms of all abuse, and reporting all forms of abuse. Prevention of abuse included facility staff will immediately correct, intervene in reports, or identified situation in which abuse/neglect is at risk for occurring. Protection indicated all residents will be immediately protected from harm. The facility will orient new staff to the reporting requirements upon hire and annually notify covered individuals that the obligation is to comply with reporting requirements. Each individual shall report immediately, but not later than 2 hours after forming the suspicion, , if the events that cause suspicion result in serious bodily injury, or not later than 24 hours if the events tat cause the suspicion do not result in serious bodily harm. Event ID: Facility ID: 675051 If continuation sheet Page 23 of 23