Health inspection·June 19, 2025

F 0552 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #45's Physician Order dated 02/10/25 revealed, Quetiapine 50 mg- give 1 tablet 2 times a day for behaviors. Order was discontinued on 04/18/25 at 01:05 PM. Record review of Resident #45's EMR revealed, no signed consent form for the use of the antipsychotic, Quetiapine. Residents Affected - Some An observation and interview on 04/15/25 at 10:07 AM revealed, Resident #45 well dressed, well-groomed in no immediate distress in bed. The resident said he did not remember when asked questions by the surveyor. In interview on 04/23/25 at 09:29 AM, RN G said she was a Temp Nurse that worked 3 times a week during the time Resident #45 admitted to the facility, but she no longer worked there. She said prior to administering antipsychotic or psychotropic medications, staff must get either signed or verbal consent from the RP. RN G said the resident or RP were notified of the side effects of antipsychotics such as involuntary movement, mood changes, obsessive behaviors or stiff tongue. She stated she didn't remember Resident #45, but most likely she did not get written consent from the RP because residents who admit to the locked unit typically did not have family members or RPs present at admission. In an interview on 04/23/25 at 07:30 AM, the DON said when a resident admitted to the facility, the admitting nurse has to call the MD/NP to reconcile medications and consent must be given the RP prior to administering any psychotropic/antipsychotic medications. She said the use of psychotropic medications in residents with dementia could be considered a chemical restraint and could be more harmful than helpful, so it was required to receive consent prior to administration. In an interview on 04/24/25 at 09:09 AM, the DON said Resident #45 did not have a psychotropic consent form on file and there were no records to support that the resident's RP was ever notified or gave consent to the administration of Quetiapine. The DON said the facility's policy was to educate the resident or their RP on the potential side effects of psychotropic medications and receive their consent prior to administration. She said failure to receive consent for psychotropic/antipsychotic risk could leave residents/family unaware of the use of the medication, the associated risk with its use, and unaware of potential side effects. In an interview on 04/24/25 at 02:44 PM, RP #1 said she was Resident #45's RP and the facility never informed her or requested consent to administer any kind of antipsychotic to the resident from his admission on [DATE] to 04/23/25. She said she never received education from the facility about the potential side effects of treatment with the antipsychotic Quetiapine before it was administered to Resident #45 but on 04/23/25 the facility attempted to send her the consent form, but she had not received it yet. RP #1 said even though she never gave consent for Resident #45 to be administered an antipsychotic, she had no issues with it because the resident's behaviors were not controlled in the past. She said her [family member] also suffered from psychosis like Resident #45 and also received Quetiapine, so she was familiar with the medication. RP #1 said prior to the use of Quetiapine Resident #45 was aggressive so she supported the administration of Quetiapine, and she would have given consent if she was notified on 02/10/25 when the resident admitted to the facility. An observation and interview on 05/01/25 at 09:55 AM revealed, Resident #45 sitting in wheelchair at a table located in the locked unit TV room. The resident said he felt lightheaded, drowsy and unsteady on his feet, and he fell last night. The resident did not have any observed involuntary movements or ticks. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 2 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0552 Resident #42 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #42's Face Sheet dated 04/24/25 revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses which included: moderate dementia with other behavioral disturbances, mood disorder, depressive features, delusional disorders and late onset Alzheimer's Disease. Residents Affected - Some Record review of Resident #42's MDS dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score on 03 out of 15, no hallucinations or delusions, active diagnoses of anxiety disorder and Non-Alzheimer's Dementia. no presence of any behavioral symptoms such as physical (hitting, kicking, pushing), verbal (threatening, screaming, or cursing at others) and no other behavioral symptoms not directed toward others. Record review of Resident #42's undated Care Plan revealed, focus initiated on 03/26/25- episodes of inappropriate behaviors and at risk for further episode and injuries due to pacing up and down hall, repeating the same things over and over, refusing to eat or drink for long periods of time, refusing medications and ADL care at times; Intervention- observe for early warning signs of behavior- approach in a calm manner, call by name, remove from unwanted stimuli. Focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; interventionmedication as ordered. Focus initiated 03/26/25- history and risk of episodes of depression, adverse reactions and depression driven behaviors; intervention- give medications per order, provide psych consult per order. Focus initiated 03/26/25- psychotropic medications and is at risk for adverse reactions and behaviors; interventions- monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes, monitor for anxiety driven behaviors, monitor for insomnia. Record review of Resident #42's Order Summary dated 04/24/25 revealed, Quetiapine 50 mg- give 1 tablet by mouth two times a day for anxiety. Record review of Resident #42's EMR revealed, no documented consent for the administration of antipsychotic medication. No documented completion of the pharmacist recommendations made on 03/25/25. In an interview on 05/06/25 at 08:57 AM, RP #4 said she was aware the resident was receiving antipsychotic medications, but she was never provided any form of educations about the medications or signed a consent. She said the only forms she signed were his admissions documents. Resident #52 Record review of Resident #52's Face Sheet dated 04/24/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: schizophrenia ( mental disorder characterized by a breakdown in thought process, making it difficult to distinguish between reality and fantasy), and anxiety disorder. Record review of Resident # 52's Significant change in status MDS dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score of 05 out of 15. Active diagnosis of anxiety disorder and schizophrenia, no presence of any behavioral symptoms such as physical (hitting, kicking, pushing), verbal (threatening, screaming, or cursing at others) and no other behavioral symptoms not directed toward others. Antipsychotics were received on a daily basis; no gradual dose reduction was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 3 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0552 attempted and there was no physician documentation indicating a GDR was clinically contraindicated. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #52's undated Care Plan revealed, focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; interventionmedication as ordered. Focus initiated 01/07/25- psychotropic medications and is at risk for adverse reactions and behaviors; interventions- monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes. Residents Affected - Some Record review of Resident #52's Order Summary dated 04/24/25 revealed, the resident had active orders for the following antipsychotic: Invega Sustenna IM- inject 234 mg into the muscle one time a day on the 25th of every month for antipsychotics. Quetiapine 100 mg- 1 tablet by mouth in the afternoon for psychosis; Quetiapine 200 mg - 1 tablet by mouth twice daily for schizophrenia. Record review of Resident #42's EMR revealed, no documented consent for the administration of antipsychotic medication. Resident #11 Record review of Resident #11's Face Sheet dated 05/06/25 revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnosis which included: dementia with other behavioral disturbance, schizophrenia, anxiety disorder and psychosis not due to substance or known condition. Record review of Resident #11's Quarterly MDS dated [DATE] revealed, moderately impaired cognition as indicated by a BIMS score of 09 out of 15, no evidence of acute change in mental status, no inattention, disorganized thinking and no physical/verbal or other behavioral symptoms. Record review of Resident #11's undated Care Plan revealed, Focus- taking psychotropic medications and is at risk for adverse reactions and behaviors; interventions- check for effectiveness of psychotropic medications, monitor for psychosis driven behaviors such as aggressiveness, combativeness- report any noted to MD for further orders and observe and record any displayed behavior or mood problems. Record review of Resident #11's Order Summary Report dated 05/06/25 revealed; Olanzapine 20 mg by moth at bedtime for psychotic disorder. Quetiapine 200 mg by mouth three times a day for schizophrenia. Record review of Resident #11's EMR revealed, no documented consent for the administration of antipsychotic medication. In an interview on 05/09/25 at 10:30 AM, Resident #11 said he was on Aspirin and antibiotics. He said he did not need consent for antipsychotic medications because he was not psychotic. Resident #11 became withdrawn after he asked about antipsychotic medications, he folded his arms across his chest, looked away and started muttering under his breath. Resident #54 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 4 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0552 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #54's Face Sheet dated 04/24/25 revealed, a [AGE] year-old male who admitted on [DATE] with diagnosis which included: difficulty swallowing, malnutrition, iron deficiency anemia ( condition where the body doesn't have enough iron), mood disorder, anxiety disorder and autistic disorder ( a developmental condition with challenges in social communication, restricted interests, and repetitive behavior). Residents Affected - Some Record review of Resident # 54's Significant change in status MDS dated [DATE] revealed, severely impaired cognitive skills for daily decision making and no presence of any behavioral symptoms such as physical (hitting, kicking, pushing), verbal (threatening, screaming, or cursing at others) and no other behavioral symptoms not directed toward others. Antipsychotics were received on a daily basis; no gradual dose reduction was attempted and there was no physician documentation indicating a GDR was clinically contraindicated. Record review of Resident #54's undated Care Plan revealed, focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; interventionmedication as ordered. Focus- history and risk of episodes of depression, adverse reactions and depression driven behaviors; intervention- give medications per order, provide psych consult per order. Focus- psychotropic medications and is at risk for adverse reactions and behaviors; interventions- monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes (period with abnormally high or irritable mood and persistently increase goal directed activity or energy lasting at least 1 week). Record review of Resident #54's Order Summary Report dated 04/24/25 revealed: Quetiapine 150 mg- 1 tablet by mouth at bedtime for agitation; med to be given crushed, Quetiapine 25 mg- 1 tablet by mouth two times a day for restlessness/agitation med to be given crushed. Record review of Resident #54's EMR revealed, no documented consent for the administration of antipsychotic medication. On 05/09/25 at 09:44 AM, an attempt was made to contact Resident 54's RP. A voicemail was left Resident #159 Record review of Resident #159's Face Sheet dated 04/24/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: epilepsy ( a brain disorder that has reoccurring sudden seizures and abnormal electrical discharges in the brain), unspecified dementia without behavioral disturbance/psychotic disturbance/mood disturbance, schizoaffective disorder( mental illness or both schizophrenia and mood disorder such as bipolar disorder or depression), bipolar disorder, depression, and anxiety disorder. The Resident discharged on 04/29/25. Record review of Resident #159's MDS dated [DATE] revealed, she returned to the facility on [DATE] after a short-term hospital stay. Record review of Resident #159's undated Care Plan revealed, focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; interventionmedication as ordered. Focus- diagnosis of schizophrenia and is at risk for manic episodes and increased behaviors; interventions- administer medications as ordered, psych consultation as needed, monitor for increased agitation, anger, verbal, and physical aggression. risk of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 5 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0552 Level of Harm - Minimal harm or potential for actual harm episodes of depression, adverse reactions and depression driven behaviors; intervention- give medications per order, provide psych consult per order. Focus- psychotropic medications and is at risk for adverse reactions and behaviors; interventions- monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes. Residents Affected - Some Record review of Resident #159's Order Summary Report dated 04/24/25 revealed, antipsychotic Olanzapine- give 5 mg via G-tube ( a surgically placed feeding tube inserted into the stomach through the abdomen) every 12 hours for psychosis. Record review of Resident #42's EMR revealed, no documented consent form for the administration of antipsychotic medication. In an interview on 05/09/25 at 12:01 PM, RP #2 said he was the RP for Resident #159 and was aware the resident was receiving antipsychotic medications. He said when the resident admitted to the facility in 12/2024, the facility did not educate him on the side effects of the use of antipsychotic medications nor did he sign a consent form for the administration of antipsychotic medications. RP #2 said in late April the facility called him and he gave verbal consent for the administration of antipsychotic medications to Resident #159, but he did not have any concerns about the resident's care. Resident #160 Record review of Resident #160's Face Sheet dated 04/24/25, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses with included: anxiety disorder and difficulty swallowing. Record review of Resident #160's Entry MDS dated [DATE] revealed, resident admitted from a short-term general hospital. Record review of Resident #160's undated Care Plan revealed, no focus area addressing use of an antipsychotic or any mental health disorders. Record review of Resident #160's Order Summary Report dated 04/24/25 revealed, Quetiapine 50 mg- 1 tablet at bedtime for antipsychotics. Record review of Resident #160's EMR revealed, no documented consent for the administration of antipsychotic medication. In an interview on 05/01/25 at 11:46 AM, RP #4 said Resident #160 discharged from the facility on 04/29/25. He said her didn't know details about the resident's medications but to his knowledge Resident #160 should not have received an antipsychotic medication and did not have any mental disorders outside of anxiety . RP #4 said he never signed any consents for the administration of antipsychotic medications, and he did not receive any form of education on the side effects of antipsychotic medications. In an interview on 04/23/25 at 07:30 AM, the DON said when a resident admitted to the facility the admitting nurse calls the MD/NP to reconcile medications and consent must be given the RP prior to administering any psychotropic/antipsychotic medications. She said the use of psychotropic medications in residents with dementia could be considered a chemical restraint and could be more harmful than helpful, so it is required to receive consent prior to administration. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 6 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 04/24/25 at 09:09 AM, the DON said Resident #45 did not have a psychotropic consent form on file and there were no records to support that the resident's RP was ever notified or gave consent to the administration of Quetiapine. The DON said the facility's policy was to educate the resident or their RP on the potential side effects of psychotropic medications and receive their consent prior to administration. She said failure to receive consent for psychotropic/antipsychotic risk could leave residents/family unaware of the use of the medication, the associated risk with its use and unaware of potential side effects. The DON said there were no psychotropic /antipsychotic consent forms on record for Residents #42, Residents #45, Residents #52, Residents #54, Residents #159 and Residents #160. Record review of the facility policy titled Antipsychotic Medication Use revised 12/2016 revealed, Antipsychotic medications may be considered for residents with dementia but only after medical, physical, functional, psychological, emotional psychiatric, social, and environmental causes of behavioral symptoms have been identified and addressed. Antipsychotic medications will be prescribed at lowest possible dosage for the shortest period of time and are subject to gradual dose reduction and re-review. 1. Residents will only receive antipsychotic medications when necessary to treat specific conditions which they are indicated and effective.5- Residents who are admitted from the community or transferred from a hospital and who are already receiving antipsychotic medications will be evaluated for the appropriateness and indications for use. The IDT will: a- complete a PASRR screening (Preadmission screening for mentally ill and intellectually disabled individuals), if appropriate or b- reevaluate the use of antipsychotic medication at time of admission or within 2 weeks (at the initial MDS assessment) to consider whether or not the medication could be reduced, tapered, or discontinued. C- based on assessing the resident's symptoms and overall situation, the physician will determine whether to continue, adjust, or stop existing antipsychotic medication. 6- Diagnosis of a specific condition for which antipsychotic medications are necessary to treat will be based on a comprehensive assessment of the resident. 8- Diagnoses alone do not warrant the use of antipsychotic medication. In addition to the above criteria, antipsychotic medications will generally only be considered if the following conditions are also met: a- the behavioral symptoms present a danger to the resident or others; AND; 1- the symptoms are identified as being due to mania or psychosis; 2- behavioral interventions have been attempted and included in the plan of care, except in an emergency. 12- All antipsychotic medications will be used within the dosage guideline listed in F757, or clinical justification will be documented for dosages the exceed the listed guidelines for more than 48 hours. 18- The physician shall respond appropriately by changing or stopping problematic doses or medications, or clearly documenting (based on assessing the situation) why the benefits of the medication outweigh the risks or suspected or confirmed adverse consequences. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 7 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observations, interviews, and record reviews, the facility failed to ensure residents had the right to a safe, clean, comfortable, and homelike environment including but not limited to receiving treatment and supports for daily living safely for 1 out of 1 laundry rooms reviewed for . The facility failed to ensure the resident's laundry was washed and returned. There were 4 big barrels of dirty clothes in the laundry room that were not able to get washed and returned to the residents. This deficient practice could place residents at risk of missing clothes, and not having clean clothes to wear which could lead to a decreased quality of life. Findings included: In an interview on 04/15/25 at 09:47 AM Resident #28 said he was having problems getting clean laundry, the facility did not return his clothes. In an interview and observation on 4/17/25 at 10:30am with the Laundry Tech, there were 4 big barrels of dirty clothes in the laundry room, that belonged to the residents. The barrels of dirty clothes were piled so high the clothes were spilling over on to the floor. The Laundry Tech said he prioritized the bed linens and towels first, then he started on the resident's clothes. He said he never got done with all of the resident's laundry because there was too much. He said he had received complaints about residents not getting their clothes back or missing clothes because he had not gotten to them yet. The Laundry Tech said they only had 1 washer and 1 dryer, so it took time and backed up the laundry. He said the amount of clothing left to wash was actually better than it had been in the past. In an interview on 4/17/25 at 10:45am with the Housekeeping Supervisor, she said there should not have been that many dirty clothes to be done, and she was shocked to see that many barrels of dirty clothes. She said there was no way all of the resident's clothes were getting done. She said she was going to ensure that the dirty clothes got caught up and that the Laundry Tech was going to be busy. She also said she thought the facility was going to buy another washer and dryer, which would help. She was not sure if the Laundry Tech was not good with time management or what the issue was, but she said she was going to get to the bottom of it. In an interview on 4/18/25 at 8:15am with the Interim ADM, she said she was aware of the 4 barrels of overflowing dirty laundry and said the Laundry Tech told her they were residents' clothes that were missing names. The ADM said even if that was the case, the dirty clothes still needed to be done. She said she did not know why the laundry was not getting done and felt all the laundry should still be able to get processed. She said the laundry was worked 20hrs a day and that was more than enough time to get all the laundry done. She said she did not know if the Laundry Tech was bad with time management or what was going on, but she planned to find out. She said having so much dirty laundry and not finishing it caused the resident's to not get their laundry back. Record review of the Grievance Logs revealed the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 8 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0584 - Level of Harm - Minimal harm or potential for actual harm October 2024: 1 instance of missing clothes - Residents Affected - Many December 2024: 1 laundry complaint January 2025: 3 instances of missing clothes March 2025: 1 instance of missing clothes April 2025: 1 instance of missing clothes Record review of the facility's policy on Sorting of Linen in the Laundry Room (review date 4/17/25) read in part: .Soiled linen is received in designated carts that are leak-resistant and labeled. Bags must not be overfilled and must be securely closed . Record review of the facility's policy on Resident Rights (Revised December 2016) read in part: Employees shall treat all residents with kindness, respect, and dignity. Federal and state laws guarantee certain basic rights to all resident of this facility. These rights include the resident's right to: a dignified existence, be treated with respect, kindness, and dignity, be free from abuse neglect, and misappropriation .have the facility respond to his or her grievances .retain and use personal possessions to the maximum extent that space and safety permit . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 9 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure assessments accurately reflected the resident's status for 5 of 8 residents (Resident #18, Resident #30, Resident #33, Resident #45 and Resident #52) reviewed for accuracy of assessments . Residents Affected - Some - The facility failed to accurately assess Resident #30's behaviors which included calling 911 on a frequent basis, yelling, screaming, and cursing out staff which escalated until the resident attempted suicide and had to be physically restrained by police officers when she attempted to pull their firearm. - The facility failed to accurately assess Resident #52's behaviors which included yelling, screaming, and cursing out staff which escalated until the resident made threats of suicide and was forcefully removed from the facility by EMS under physical restraints. - The facility failed to accurately assess Resident #18's continuous behaviors that included: pulling on and out her G-tube (a surgically placed feeding tube inserted into the stomach through the abdomen) in the resident's MDS. - The facility failed to accurately assess Resident #33 behaviors that included: pulling on and out her G-tube (a surgically placed feeding tube inserted into the stomach through the abdomen) in the resident's MDS. - The facility failed to accurately assess Resident #45's behaviors in his admission MDS. These failures could place residents at risk of a compromised plan of care. Findings Included: Resident #30 Record review of Resident #30's Face Sheet dated 05/02/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included:, Schizoaffective disorder (a mental health condition that combines symptoms of schizophrenia and a mood disorder, such as depression or bipolar disorder), bipolar disorder (mental health condition characterized by extreme mood swings, ranging from periods of intense happiness or irritability (mania or hypomania) to periods of deep sadness or despair) with sever psychotic features (hallucinations (seeing or hearing things that aren't real), delusions (false beliefs), and disorganized thinking. Record review of the Resident #30's Quarterly MDS revealed, intact cognition as indicated by a BIMS score of 14 and use of antipsychotic medications during last 7 days. There were no evidence of an acute change in mental status, and no behaviors present. She had no potential indicators of psychosis such as hallucinations or delusions. Record review of Resident #30's undated Care Plan revealed the following focus areas: *focus- history of being resistant to care at times and is at risk for injury. An intervention was to approach in a calm manner, talk while giving care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 10 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some *Focus- taking psychotropic medications and was at risk of adverse reactions and (depression, anxiety, and/or psychosis driven behaviors. Interventions were to monitor for psychosis driven behaviors such as aggressiveness, combativeness, manic episodes, observe and record any displayed behaviors or mood problems. Record review of Resident #30's Order Summary Report that included all orders since admission on [DATE] and printed 05/02/25 at 01:50 PM revealed, Resident #30 had no behavior monitoring and intervention orders. Record review of Resident #30's previous facility Progress Notes dated 12/26/24 at 02:21 PM revealed, Resident says she is hearing things and people talking about her. She is under mental distress. She is wanting to go to the psych hospital. Resident stated she no longer wanted to be here. Record review of Resident #30's Progress Notes from 12/31/24 to 05/02/25 revealed the following: *01/01/25- EMS arrived at facility stating they received phone call from facility. This nurse was notified by CMA that this resident called EMS. Resident states that she is not feeling well and wants to go to the Hospital. Resident did not notify this nurse that she was not feeling well prior. Resident called EMS instead. EMS assessed resident. No abnormal findings. EMS spoke with resident about receiving care in facility before calling 911. Resident continues to state that she wants to go to the hospital. *01/02/25- Resident called 911 for pain pill when her pain was just due to be given to her, every effort to advise her to take her pain pill yield no result as she wants to go to hospital, NP made aware, administrator made aware, resident insisted on going to hospital, picked up in stable condition. *01/12/25-On rounds at 7:04am resident did not complain of any discomfort, distress, or concerns, noted vaping in the room, was educated by this nurse that vaping is not proper and not allowed in the room, resident did not listen, but continue vaping. At about 7:54am, 911 ambulance arrived facility stated resident called them, complained of pain to lower back, sediment in urine, and brown urine output. Resident has UA result and labs pending ,this explained to resident Norco 5-325mg offered, resident refused, and still insisted going with 911 to the hospital, transferred by 911 to hospital ,per resident request. Resident is self-RP.NP notified. *01/22/25- SW informed nurse that resident was seen by Psych services today and was told that resident may be going through a manic episode. Resident is currently in bed with NAD. Given PRN pain medication. resident has no plan to harm herself stated she is just little down today. MD informed stated to monitor for now and call her for any changes. *01/24/25- Resident informed SW that she called 911 due to pain on her lower back. Education provided on pain management such as other ways to manage pain without medications such as deep breathing, exercise , music therapy and others , resident verbalized understanding but still want to get stronger medication . NP notified . patient has been medicated with Norco Tablet 5-325 MG every 4 hours as needed , last one was at 1034am. Sn will continue to monitor. *01/31/25- Resident signed herself out after requesting (2) cigarettes. Resident was then (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 11 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 transported to the ER by ambulance. Family notified. DON Notified. Level of Harm - Minimal harm or potential for actual harm *02/01/25 at 08:01 AM- Resident requested cigarette, received her cigarette, signed out to go smoke out front where she then called 911 and requested transport. Resident would not specify where she wanted to be transported to. 911 arrived around 07:10 AM and took resident on a stretcher to the ER. Residents Affected - Some *02/01/25 at 03:15 PM- Resident returned from the hospital . Resident still appears anxious upon return and immediately returned to nurses' station to sign out with (4) cigarettes as of 03:25AM resident is signed out of the facility. *02/13/25 at 10:49 PM- Resident called 911 by herself twice this evening at 7:30pm and 9:40pm stating that she wants to go to the hospital because she is having spasms. Charge nurse informed her that he can notify her doctor and see if she can be given some new orders, but she refused. EMS arrived the first time and resident refused to go to [local] hospital where they intended to transport her to. The second time the EMS arrived and took resident to Hospital at 10:00pm. *02/24/25- Note Text : At 21:30 hrs, resident called EMS via 911, requesting to be taken to the emergency room due to spasm and pain. Resident had already received her scheduled pain medication (Norco) at 20:00 hrs (08:00 PM). Resident had not complained to Charge Nurse about being in pain prior to her calling 911, and charge nurse was not aware that she had called EMS 911 until the emergency personnel showed up in the unit. Resident was taken to the emergency room as she requested by the EMS technicians at 21:40 hrs.(09:40 PM) *03/02/25- Resident complains of hearing voices making fun of her, she said had been going on for a while now, she stated that she did not complain initially because she thought they might go away, but they getting louder, depriving her sleep. This morning observed resident in her sleep saying stop stop stop. Resident also have diagnosis of schizophrenia and mild sleep disorder.NP notified, order receive to consult psych. Order carry out. *03/08-25- Resident called EMS via 911, and they took her to hospital at 18:45 hours (06:45 PM)or complaint of pain. Resident's emergency contact (father)' and facility DON notified. *03/19/25- Resident came to Charge nurse and requested for her nightly medication to be administered to her, which was done. After taking her medications, she informed the Charge Nurse that she had called 911 so she can be taken to the hospital due to pain. Charge Nurse advised resident to give her pain pill (Norco) which she just took, time to become effective but she refused, insisting to go to the hospital. Charge nurse noted ant acute distress on resident both in her speech and behavior. Resident then wheeled herself in her wheelchair to the reception area awaiting the arrival of EMS ambulance. Upon arrival to the facility, the EMS personnel spoke briefly with resident and loaded her on their stretcher without asking the charge nurse any questions or informing him where they were taking resident to. When charge nurse inquired from them where they were taking resident to, they simply told him the hospital name and continued on. Facility Director of Nursing was notified. *03/22/25 T at 5:53 AM- Behavioral Note-Resident removed her brief after ADL change claimed is too big despite the brief been her size and the large size that could be used for her. *03/22/25 at 10:09 AM- : Resident was observed alert and oriented with behavior, screamed , yelled, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 12 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some took clothes off. Attempted to talked to resident several times with no effect. NP. was notified order given Alprazolam 0.5mh twice a day for fourteen days for anxiety. *04/13/25 at 1:39 AM signed by LVN H- Patient called 911 at 11:00pm and had been disturbing other patients from sleeping. The two EMS that came refused to take her to hospital stated she has no good reason to go to hospital. Patient received all her pain med and other prescribed med, throwing stuff on the floor including her phone. Patient is threatening to kill herself. Nurse notified the physician, DON, and Administrator. *04/13/25 signed by SW- SW informed per staff that this resident had verbalized wanting to kill herself. SW visited with this resident, and she verbalized I tied something around my neck but, I could still breathe. I want my Xanax back. I want my Xanax back. I am going to get my Xanax back. SW attempted to contact resident's family member, , unable to reach and voicemail full. Resident began to yell and scream as she exited the office. Staff was present to maintain visual of her per SW request while 911 contacted with a request for the Mental Health Response team. Upon 911 arriving Officer was provided with the aforementioned information. He spoke with resident, and she informed him that she wanted to kill herself. He called for assistance and another officer arrived whom also spoke with resident and then SW observed resident began to hit the officers resulting in them restraining her until approximately 4 more officers arrived. SW was informed per that she was being transported to Hospital and that the District Attorney would be contacted but they were doubtful any criminal charges would be filed against her. SW informed the DON and LNFA and was able to contact her family member and informed him. He verbalized understanding. Care Plan updated to reflect. *05/01/25- Resident called EMS and requested to be taken back to the hospital for evaluation. Resident indicated to EMS personnel that she feels nauseated, dehydrated, and is not getting enough pain medications. Resident had not complained to Charge Nurse about any of these concerns tonight. Resident had received her nightly medications as ordered, including her PRN Norco pain medication. Charge Nurse offered to call resident's PCP to see if there may be any new orders, but she refused, stating her preference to go to the hospital. Upon resident's insistence to go to the hospital, EMS personnel took her to hospital. Record review of a 30-day lookback of Resident #30's Behavior Monitoring and Interventions dated 05/09/25 revealed, no documented behaviors observed prior to 05/09/25. Further review revealed on 05/09/25 at 10:30 AM, Resident #30 was screaming and expressed frustration and angers at others. An observation an interview on 05/02/25 at 01:12 PM revealed, Resident #30 sitting in a wheelchair at the nursing station. There were other residents around her and no nursing staff within 15 feet on both sides of the nursing station. The resident said she just returned to the facility from the hospital, and she felt better. Resident #30 said the voices got too loud so she hit herself in the face and tied a pillowcase around her neck to harm herself to stop the voices, but she could still breathe. As Resident #30 talked to the surveyors she swayed left to right & back and forth in her wheelchair. Resident #30 said she did not notify any staff of the voices prior to trying to harm herself but when she went to the hospital, they fixed her medications, so she did not hear the voices anymore and she did not want to harm herself. In an interview on 05/02/25 at 12:33 PM, the SW said Resident #30 was young and had obsessive drug seeking behaviors r/t to complaints of significant pain. She said the resident would call the police 1-2 times a week and had been hospitalized at least 6-7 times since admission. The SW said Resident #30 always yelled at staff and yelled to go to the hospital. The SW said in April she was notified (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 13 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some that Resident #30 wanted to hurt herself. She said she first talked to the resident on the phone and then again when she arrived at the facility. The SW said Resident # 30 told her she tried to hurt herself by tying something around her neck, but she could still breathe, the resident became loud and said she was going to hurt herself, so she called 911 for a mental health response team. She said when the police arrived Resident #30 wheeled herself away from them down the hallway as they spoke to her and when both police officers approached her, Resident #30 started to scream and fought the police. The SW said Resident #30 attacked the police, the police tried to restrain her, the police drew then their guns and pointed them at the resident and Resident #30 was eventually handcuffed. She said Resident #30 was a risk to other patients because of her unpredict ableness. In an interview on 05/02/25 at 01:05 PM, MA C said Resident #30's normal behaviors included verbal aggression/yelling towards staff and other residents. She said the resident propels herself around the facility in her wheelchair cursing and yelling. She said the resident was not on any increased behavioral monitoring, not on 1-on-1 monitoring and was not safe to be in a room with others. In an interview on 05/02/25 at 01:21 PM, LVN J said Resident #30's regular behaviors included yelling and screaming at others. She said Resident #30's former roommate, Resident #22, scared of her because of her yelling and screaming. In an interview on 05/02/25 at 01:27 PM, Resident #22 said her former roommate scared her with yelling and screaming. She said Resident #30 yelled and screamed at night, startling her. In an interview on 05/02/25 Anonymous A said Resident #30's regular behaviors included yelling/screaming and calling Anonymous A out of her name. Anonymous A staff said Resident #30's behaviors were towards anyone including residents and staff. Anonymous A said in one incident Resident #30 screamed and came down the hallway in her wheelchair with no clothes on. Anonymous A said last April, the social worker called the authorities because of Resident #30's behaviors and when they arrived, Anonymous A saw the resident attempt to pull the police officer's firearm. Anonymous A said Resident #30 liked to yell, scream and throw stuff at people and it makes Anonymous A antsy. In an interview on 05/02/25 at 02:37 PM, CNA T said in April she saw the police go towards the SWs office and then Resident #30 came down the hallway in her wheelchair. She said at first the police were talking to Resident #30, when she started yelling and screaming so the police tried to restrain the resident at which point Resident #30 attempted to pull the police officers firearm. CNA T said prior to the incident in April, Resident #30's regular behaviors included rolling around the facility in her wheelchair yelling/screaming/cursing at other residents and staff. In an interview on 05/02/25 at 2:46 PM, LVN T said April she observed Resident #30 come out of SWs office screaming f*** you and the SW called 911 mental health. She said when the police talked to Resident #30, she said she was not suicidal but had attempted suicide the night before. LVN T said Resident #30 rolled away from the police, started fighting the police and when they attempted to restrain the resident grabbed their handcuffs and she heard the police say, let go of the gun. She said the SW thought they were going to shoot Resident #30, so she told her to get out of the way for safety. LVN T said more police arrived and then the ambulance took the resident away. LVN T said Resident #30's behaviors included hollering/yelling at people, calling people out of their name, calling black people the n word, and she did all of this sometimes while going down the hall but the incident in April was the first time it had escalated to this point. LVN T said Resident #30, propelled herself freely in the facility down the halls, always yelling at others. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 14 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 05/02/25 at 2:57 PM, the ADON said Resident #30 can be extremely aggressive. She said the resident goes in and out of the hospital and calls 911 when she wants her pain medications, and the provider was aware of her behaviors. The ADON said she heard the resident was aggressive especially during night shift. She said everyone was aware of Resident #30's behaviors including social services, and it was documented in the resident's chart. The ADON said while she does not think Resident #30 was a threat to herself or others, she possibly made other residents feel scared. Resident #52 Record review of Resident #52's Face Sheet dated 04/24/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: schizophrenia ( mental disorder characterized by a breakdown in thought process, making it difficult to distinguish between reality and fantasy), and anxiety disorder. Record review of Resident # 52's Significant change in status MDS dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score of 05 out of 15. Resident #52 had active diagnoses of anxiety disorder and schizophrenia. She was assessed as having no presence of any behavioral symptoms such as physical (hitting, kicking, pushing), verbal (threatening, screaming, or cursing at others) and no other behavioral symptoms not directed toward others. Antipsychotics were received daily; no gradual dose reduction was attempted and there was no physician documentation indicating a GDR was clinically contraindicated . Record review of Resident #52's undated Care Plan revealed the following focus areas: *focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury. An intervention was to take medication as ordered. *Focus initiated 01/07/25- psychotropic medications and is at risk for adverse reactions and behaviors. Interventions were to monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes. Further review revealed there was no focus areas addressing suicidal behavior or suicide threats. Record review of Resident #52's Progress Notes from 01/06/25 to 05/06/25 revealed the following: *01/19/25 at 04:53 PM signed by RN G- Resident has been very rude to RT she does not like her to enter room to give care to her roommate. She yells/curse and shout. Education given to resident that her room needs assistance and staff will provide assistance without bothering her, but resident stated now . Resident also continue to ask staff for cups thorough the shift. Education given to resident that she is currently NPO and cannot consume anything by mouth at this time for her safety. Education did not work. She continue to ask anyone walking pass her room *02/01/25 at 09:46 PM signed by RN G- Resident is currently crying and screaming she would like to go the hospital due to pain in her left legs . Resident was given all of her scheduled medication and Tylenol PRN. She also received her pain cream diclofenac cream applied to her ankle. Resident also propels herself around the facility not crying screaming she became very aggressive with staff. Screaming cursing and grabbing of laptop and other staff equipment she is not able to be redirected. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 15 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some *02/08/25 at 05:42 PM signed by RN G- Resident throw a cup at writer on this shift then later came and apologize. she also snatched the phone causing the cords to come undone and later apologize for that she stated she was in a bad mood due to her family member #1 and family member #2not answering the phone. She was educated not to throw things at staff or at all. She stated okay. *02/08/25 a6 06:56 PM signed by RN G- Resident still present with behaviors she snatched all of the cords and laptop and phone off the nurse station. She Started hitting another nurse on duty throwing stuff and cruising. Resident shouting, she will kill herself. 911 called at this time social worker present. *02/08/25 at 07:19 PM signed by the SW- This resident became physically aggressive with nursing staff by hitting, kicking, grabbing, and attempting to bite them. She then began to yell and scream I'm going to kill myself. I am going to kill myself. Attempts to verbally redirect unsuccessful. SW contacted her r/p, and she informed SW that she was having one of her episodes and in the past, she was sent to a Behavioral Hospital. SW contacted Behavioral hospital intake department via and was informed that they have no available beds till Monday. Recommended that she be sent to ER for assessment due to her aggression. *02/08/25 at 07:25 PM signed by the SW- Resident was able to talk with her r/p and also to one of her male friends. They were able to get her to calm down and she again began to apologize for her behavior. She denied current suicidal and or homicidal ideations. She reports I am sorry for the way I acted. No further related behaviors or verbalizations noted. *02/10/25 at 03:02 PM signed by the ADON- resident pounding on door and being aggressive with staff. NP discussion with resident. RP called and informed of current medication list for medication list. RP states that resident does have behaviors and needs to be on certain medications. RP informed and NP aware. crisis center to be contacted. *02/20/25 at 09:35 AM signed by LVN T- Resident has been having behaviors. Resident was hitting staff. Resident has been yelling at staff. Resident was banging on the door as we was trying to provide care on another patient in another room. Resident was redirected and still continued to have behaviors. *02/21/25 at 08:25 AM signed by the ADON- resident does not continue to grab laptop from nurse and grab the phone wanting to call 911. redirection of wanting to take resident for activity. Resident yelling and going in another resident's room when emergency response team is here. resident trying to grab student nurses scrub tops. Psych on site to eval and treat. *02/21/25 at 10:46 AM signed by LVN T- Resident behaviors started around 8 am after receiving her medications. As nurse was handling a 911 emergency. resident was banging on the pt door. resident was yelling in the hallway. She was rolling her wheelchair into other staff. Staff was trying to redirect pt. continue to be aggressive, she started hitting RT, she also start hitting the nurse and the student and student's teacher. Residents continue to follow nurse around yelling to call 911. Resident kept taking everything off the nurse desk. psych N.P started resident on more medication. Resident was giver her PRN and, but the behaviors continues for about 40 minutes after. Resident eventually went to her room and got in bed after 2 hours of behavior. psych N.P started resident on more medication. for her behaviors (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 16 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm *02/25/25 at 08:00 AM signed by LVN T- Resident had a behavior right after receiving morning medication. Resident started to holler that she wanted to go the hospital. Resident kept trying to push the med cart. Resident was trying to take everything off the med cart. Nurse was not able to pass medication due to resident behavior Resident was redirected and resident still insisted to try to take nurse laptop if the nurse did no call 911. After 20 minutes resident eventually settled down and went to lay in bed. Residents Affected - Some *03/01/25 at 11:52 AM signed by ADON- resident continues to be aggressive and hitting staff and banging on walls. resident also continued to try and get meal trays, resident redirected by staff. *03/01/25 at 12:15 PM signed by the SW- SW informed that resident had become aggressive with staff and broke laptop. Upon SW arrival she is no longer exhibiting aggressive behaviors and apologized. SW encouraged her to color and or draw pictures. She reports wanting to return to her group home. She was informed that the owner of the home, RP, is currently out of town and upon her return to [city] she would be able to come to assess her and hopefully she will be able to discharge back to the community and resume her normal activities. No current behaviors noted. *03/08/25 at 10:23 AM signed by RN F- Resident been aggressive towards staffs, runs the writer foot over with wheelchair while trying to give other resident medication. Also approaches CNA with the wheelchair trying to run her over with opening other resident doors while staffs is given care to other residents. The writer tried to redirect; resident refused to follow instruction. *03/08/25 at 01:50 PM signed by the SW- Resident being aggressive against, grabbing on computer and telephone cord in attempts to destroy property attempts to verbally redirect unsuccessful. A review of chart indicates that her behavior has been increasingly aggressive. *03/15/25 at 11:00 AM signed by LVN T- Resident start having behavior. Resident kept trying to call 911 saying that her leg is bothering her. Resident started kicking the nurses cart trying to get in. I reached out to the doctor and the N.P ordered new order for ibuprofen. After receiving medication and she talked to social work. Resident calmed down and went to relax in bed. *05/01/25 at 04:59 PM- resident sitting up in W/C at this time, propelling herself in the hallway. Resident began forcefully driving wheelchair into room C14 where CNA was actively providing care to another resident. resident screaming at CNA, stating You N*****, I want you to change me resident immediately redirected and informed that once care was completed with the resident that CNA would be available to provide incontinent care. resident then screamed out and stated you b**** to writer and then wheeled up the hall where writer was preparing medication in room C3 and began forcefully driving wheelchair into medication cart and resident's room door. staffing coordinator came to unit and provided incontinent care to resident. writer made resident's provider aware of behaviors. will continue to observe. *05/03/25 at 07:20 AM signed by the ADON- This ADON observe resident upset stating that she wants to get out and started sliding herself on the floor A/B hall. several staff members assisted as resident tried to push the med cart into the back glass exit door. this ADON de-escalate situation> assist x 2 to wheelchair. resident social services called and no response> voice mail left for sw to come to facility for resident evaluation. RP called and not able to leave VM. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 17 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some *05/03/25 at 07: 28 AM Signed by the ADON- resident with staffing coordinator to monitor post de-escalation> res resident continued to grab and hit staff member> 911 emergency services was called. this resident as she was crawling on the floor was assisted back to the chair as she tried to bite staff member on the left arm. Immediate removal of staff member for further treatment. staff member was bit noticeable bite mark on skin. resident placed on 1-1 by admin and this ADON assist containment by PD/Ems. *05/03/25 at 07:35 AM signed by the ADON- resident yelled in hallway and stated that she wanted to kill herself. PD stated that she was going with ambulance to the hospital. resident started yelling and tried to hit officer. Hand cuffs to softly placed on resident as this ADON assisted in the process. resident transferred from wheelchair to stretcher. resident became aggressive as EMS staff placed gauze restraint on lower extremities. resident transferred to hospital, administrator present during this process and witnessed behaviors. resident exited facility and no signs of resp distress resident verbal and wanted her purse. In an interview on 05/01/25 at 01:55 PM, the Psychiatric NO said Resident #52 was received antipsychotic medications and today she is so much better and cooperated with her care. She said previously Resident #52 was beating up staff and on one occasion she observed her as she intentionally knocked down a fire extinguisher located at the nursing station. The Psychiatric NP said Resident #52 just didn't want to be here, but her behaviors were so extreme and these behaviors had been present for a couple of months. She said in the previous month, Resident #52, was still following nurses around and beating them up. In an interview on 05/06/25 at 11:02 AM, the DON said the day prior to the incident on 05/03/25 Resident #52 yelled at staff and called them names, but she was easily redirected by the Staffing Coordinator and apologized. She said the next morning, Resident #52 took a cart and tried to push it through the door while she yelled. The DON said she called the mental health team, and the resident was restrained and removed from the facility but not before she bit the Staffing Coordinator. In an observation and interview on 05/06/25 at 12:07 PM, the Staffing Coordinator said when she arrived on 05/03/25 Resident #52 was rolling herself down the hall towards the back door. She said the resident yelled, screamed that she wanted to get out of the facility, so she tried to redirect her to change her clothes. The Staffing Coordinator said when the med aide tried to help Resident #52, swung at her and the med aid. She said the ADON then tried to redirect her, the Resident #52 said she did not want anyone to touch her, screamed, said she wanted to go home and cried. The Staffing Coordinator said the resident slid out of her chair onto the floor, started to crawl, and when the Interim Administrator asked her what was wrong the resident said she wanted to kill herself. She said the resident was placed on 1-on-1 while 911 was called, and when the EMS arrived the resident kicked, screamed, and bit her. She said the bite was hard enough to break skin and she bled. A healing scab indicated by scabs and hyperpigmentation were observed on the Staffing Coordinators arm from where Resident #52 bit her. In an interview on 05/06/25 at 12:21 PM, the admission Director said Resident #52 had increasing behaviors. She said she heard her screaming at staff on a few occasions in April and would close her office door due to the noise. She said she did not report the incidents she observed because Resident #52's behaviors were already a known issue. She said on 05/03/25 Resident #52 came in with her wheelchair, the ADON was holding her, and Resident #52 was going off trying to throw herself on the floor. The admission [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 18 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, and record review the facility failed to develop and implement a baseline care plan for each resident that included the instructions needed to provide effective and person-centered care of the resident that meet professional standards of quality care within 48 hours of a resident's admission for 3 of 12 residents (Resident #58, Resident #109, and Resident #112) reviewed for baseline care plan. - The facility failed to ensure baseline care plans werewithin 48 hours of admission that addressed services that were to be provided to Resident #58, Resident #109, and Resident #112 This failure could place newly admitted residents at risk of not having their individual, medical, functional, and psychosocial needs identified, and services provided with could cause a physical or psychosocial decline in health. Findings included: Resident#109: Record review of Resident #109's undated face sheet revealed she was a [AGE] year-old female admitted on [DATE] with diagnoses of closed fracture of the right femur (broken thigh bone on the right side), sepsis (infection throughout body), cerebral infarction (stroke), type 2 diabetes mellitus (body does not produce insulin or resists it), dysphagia (trouble swallowing), dementia (decline in cognitive function, affecting memory, thinking, and reasoning), Parkinson's (progressive neurological disorder that affects movement), acute kidney failure (kidneys stop working), and hydronephrosis (buildup of urine in the kidney). Record review of Resident #109's admission MDS assessment revealed it had not been completed yet. Record review of Resident #109's Baseline Care Plan dated 4/15/25 revealed only 1 focus regarding activities the resident enjoyed. The baseline care plan did not address her code status, special diet, EBP, PICC line (IV that goes deeper and further up the arm), antibiotics, wounds, or a foley (tube to drain the bladder). Record review of Resident #109's Physician Orders revealed the following orders from MD F: - PICC line placement. Notify MD of any abnormal findings and of any s/s of complications, every shift for 7 days. Ordered on 4/11/25. - Meropenem 500mg IV every 8hr for wound infection for 7 days. Ordered on 4/11/25. - Regular Diet, pureed texture, honey/moderately thick consistency. Ordered on 4/12/25. - Cleanse DTI (pressure injury where damage occurs to underlying soft tissues, before skin shows visible signs of injury) to right knee, apply skin prep, cover and secure with absorbent dressing, as needed. Ordered on 4/12/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 19 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few - Cleanse DTI to R knee, apply skin prep, cover and secure with absorbent dressing, every day shift. Ordered on 4/12/25. - Cleanse unstageable to sacrum (tailbone) with NS/wound cleanser, pat dry with gauze, apply medihoney and calcium alginate (promotes wound healing), cover and secure with absorbent dressing, as needed. Ordered on 4/12/25. - Cleanse unstageable to sacrum with NS/wound cleanser, pat dry with gauze, apply medihoney and calcium alginate, cover and secure with absorbent dressing, every day shift. Ordered on 4/12/25. - Provide Foley catheter care, every shift. Ordered on 4/12/25. In an observation of Resident #109 on 4/17/25 at 9:10am, she had a sign on her door stating she was on EBP. There was an IV pole next to her bed with a bag of Merrem (antibiotic) that was finished. She also had a foley bag clipped to the bed, draining clear urine. Resident #112: Record review of Resident #112's undated face sheet revealed she was a [AGE] year-old female admitted on [DATE] with diagnoses of chronic respiratory failure with hypoxia (not enough oxygen in the blood), sepsis (infection throughout body), pneumonia (infection in lungs), type 2 diabetes mellitus (body does not produce insulin or resists it), cerebral infarction (stroke), epileptic spasms with status epilepticus (seizures), anoxic brain damage (brain damage from lack of oxygen), ESRD (kidneys stop filtering urine), dysphagia (trouble swallowing), tracheostomy status (hole in throat where a tube goes through), gastrostomy status (hole in stomach for a tube to go through), dependence on ventilator (a machine to expand the lungs and give oxygen), and dependence on renal dialysis (a machine to filter the blood). Record review of Resident #112's admission MDS assessment revealed it had not been completed yet. Record review of Resident #112's Baseline Care Plan on 04/17/25 revealed it had not been completed yet. Record review of Resident #112's Physician Orders revealed the following orders from MD F: - May have Shiley #6, every shift. Ordered on 4/11/25. - Vent Settings Mode (AC) tidal volume (350) Rate (10) PEEP (6) FiO2 (31%), every shift. Ordered on 4/11/25. - Monitor IV site for signs and symptoms of infection or infiltration. Notify MD/NP for abnormalities, every shift. Ordered on 4/11/25. - In house hemodialysis Monday-Wednesday-Friday, everyday shift, every Monday, Wednesday, Friday. Ordered on 4/14/25. - Enteral Feed Order: every shift for hydration/nutrition flush tube every hour with 25ml H2O while formula is running. Total fluid - 1278 ml daily. Ordered 4/15/25. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 20 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few - Enteral Feed Order: every shift for nutrition related to gastrostomy status, Nepro 38 ml/hr. x 22hrs continuously. Run until 836 ml is administered. (1505 calories). Ordered 4/15/25. Resident #58: Record review of Resident #58's undated face sheet revealed he was an [AGE] year-old male admitted on [DATE] with diagnoses including Tracheostomy Status (a surgical procedure where a hole is created in the front of the neck, directly into the airway, to allow air to flow into the lungs), Dependence On Ventilator, Acute Embolism and Thrombosis of Left Femoral Vein, Chronic Obstructive Pulmonary Disease, Schizophrenia, Bipolar Disorder, Pleural Effusion (buildup of excessive fluid in the area between the lungs and the chest wall), Seizures, Gastrostomy Status (Tube Feeding), Need For Assistance With Personal Care, Cardiogenic Shock (a life-threatening condition that occurs when the heart is unable to pump enough blood to meet the body's needs), Metabolic Encephalopathy (a brain dysfunction resulting from underlying metabolic or systemic issues, affecting the brain's function and leading to changes in mental status), Severe Protein-Calorie Malnutrition, Pressure Ulcer, Contracture Of Muscle, Multiple Sites. Record review of Resident #58's MDS assessment dated [DATE] revealed the resident was receiving intravenous antibiotics and continuous oxygen. The Brief Interview of Mental Status (BIMS) score of 0 revealed he was severely cognitively impaired. Resident #58 was coded to be always incontinent of bladder and bowel. Record review of Resident #58's medical record revealed there was no baseline care plan. During an interview on 4/17/25 at 1:45 pm with LVN T, she said they did not do any assessments on paper and all care plans and assessments should be in the EMR. She said RNs were responsible for completing the baseline care plans, and she could not say why any resident would not have one. During an interview on 4/21/25 at 2:03pm with the MDS nurse, stated, if missing, baseline care plans could be located in previous PCC records. She said she would try and access the old PCC and see if the documents were there. In an interview on 04/22/25 at 02:58 PM- the MDS Nurse said baseline care plans were only located in the EMR. During an interview on 4/17/25 at 2:20 pm, the DON said that all Residents should have a baseline care plan completed within 48 hours of admission. DON searched the EMR for the baseline care plan for Resident #58 and was not able to find it. She could not explain why the resident did not have a baseline care plan. On 4/22/25 2:06pm, MDS LVN reported they were unable to find the resident's baseline care plans. She stated she was not sure if the data was lost, or they were not completed. Record review of the facility policy entitled; Care Plans-Baseline dated revised December 2016 read in part . Policy Statement: A baseline plan of care to meet the resident's immediate needs shall be developed for each resident within forty-eight (48) hours of admission.Policy Interpretation and Implementation, item #3, The baseline care plan will be used until the staff can conduct the comprehensive assessment and develop an interdisciplinary person-centered comprehensive care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 21 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a residents' mental, nursing and mental and psychosocial needs that were identified in the comprehensive assessment for 7 of 10 Residents (Resident #18, Resident #28, Resident #30, Resident #33 , Resident #52, Resident #113 & Resident #114 ) reviewed for care plans. - The facility failed to develop and implement a care plan that addressed Resident #18's behaviors of pulling on and pulling out her G-tube which resulted in the resident pulling out her G-tube in 11/12/24, 03/28/25 and 04/15/25 which required hospitalization to place a new tube. - The facility failed to develop and implement a care plan that addressed Resident #33's behaviors of pulling out his G-tube which resulted in the resident pulling out his G-tube on 02/04/25, 02/12/25, 02/23/25 and 04/15/25 which required hospitalization to place a new tube. - The facility failed to develop and implement a plan of care that addressed Resident #30's escalating behaviors which resulted in a suicide attempt on 04/13/25 and the resident attempting to draw a police officer's firearm when she had to be forcefully restrained and removed from the facility. - The facility failed to develop and implement a care plan that addressed interventions that would be in place when Resident #30 returned to the facility on [DATE] following her suicide attempt. - The facility failed to develop and implement a plan of care that addressed Resident #52's escalating behaviors which resulted in suicide threats and an incident on 05/03/25 when the resident had to be forcefully restrained and removed from the facility. - The facility failed to address inappropriate sexual behaviors in the care plan for Resident #113. - The facility failed to address physical, verbal aggressive behaviors in the care plan for Resident #114 prior to the resident-to-resident altercation on 3/23/25. An IJ was Identified on 04/17/25 . The template was provided to the facility on [DATE] at 12:33 PM. While the IJ was removed on 04/22/25 the facility remained out of compliance at a scope of pattern and a severity level of no actual harm that was not immediate due to the to the facility's need to evaluate the effectiveness of the corrective systems. A second IJ was identified on 05/05/25. The template was provided to the facility on [DATE] at 04:00 PM. While the IJ was removed on 05/08/25 the facility remained out of compliance at a scope of pattern and a severity level of no actual harm that was not immediate due to the to the facility's need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk of not having their needs met, escalating behaviors, mental breakdowns, dislodged g-tube, hospitalization, pain, and injury. Non-IJ Findings (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 22 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety - The facility failed to implement interventions in Resident #28's care plan addressing nail care, leaving the resident with his left thumb fingernail greater than 1/3rd inch, with thick skin. Findings Included: Resident #18 Residents Affected - Some Record review of Resident #18's Face Sheet dated 04/15/25 revealed, a [AGE] year-old female who admitted to the facility 01/14/21 with diagnoses which included: dysphagia (difficulty swallowing), high blood pressure, contracture of the right hand/ left hand and left food. Dementia with other behavioral disturbance and anxiety disorder. Record review of Resident #18's Quarterly MDS dated [DATE] revealed, severely impaired cognitive skills for daily decision making, upper and lower extremity functional limitations in range of motion, dependent on staff for all aspects of self-care( eating, oral hygiene, toileting hygiene, shower/bathing, dressing), dependent on staff for all aspects of mobility, no physical/verbal behavioral symptoms directed towards others and no behavioral symptoms not directed towards others. Record review of Resident #18's Care Plan printed 04/15/25 revealed, focus- requires the use of feeding tube and is at risk of aspiration(accidental inhalation of food/fluids into the airway), weight loss and dehydration. Feeding tube is related to dysphagia; intervention- administer tube feeding and water flushes as ordered, monitor/document/report to the physician as needed for the following complications related to tube feedings . tube dislodged. Focus initiated 12/29/22- inappropriate behaviors: resident has episodes of inappropriate behaviors of an causing her oxygen tubing from constantly falling off her face onto the floor. Interventions- monitor and chart behaviors every shift and report progress to MD. Focus- history of spitting and crying out at times according to staff and chart review ; intervention- referred to mental health services as needed. Focus initiated 02/07/21- resident has impaired communication, family member reports he is the only one that can get resident to verbally communicate; intervention- will assist with translation when needed, staff will monitor for facial grimaces and body language. , focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; intervention- medication as ordered, redirect resident from source of anxiety. Resident #18's care plan did not include the resident pulling on or pulling out her G-tube. Further review indicated EBP was not included as an intervention. Record review of Resident #18's Progress Notes from to 04/15/25 revealed: 11/12/24 at 11:56 PM- CNA informed nurse during care that resident had pulled her G Tube from her abdomen. Nurse went to assess resident and she was found with tube laying on her abdomen without any s/s of pain or distress. DON and Attending notified 11/13/24 at 01:03 AM- EMS arrived to transport resident to hospital 03/27/25 at 05:32 PM- Resident #18 pulled her feeding tube and IV pole fell on her head. The resident had no bumps and bruises, and the NP was notified 03/28/25 at 09:40 AM- From incident yesterday evening pole fell on resident head right eye and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 23 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 forehead bruises was noted this morning, resident is Level of Harm - Immediate jeopardy to resident health or safety already on neuro checks. NP was notified A.DON as well resident medication was administered. Residents Affected - Some An observation and interview on 04/15/25 at 09:50 AM revealed, Resident #18 in bed with contracted feet and hands. The resident had a bruise with a scab and dry blood on her forehead, with her bed low to the ground and fall mat on the left side of the bed. The resident had a firm grip on her G-tube tubing, pulling it tightly and her abdomen was observed to rise as she tugged on the tubing. The surveyor immediately exited the room to notify facility staff. When the surveyor returned to the room with MA A the resident was no longer pulling on her tube but continued to pull her legs up and move her hands. MA A said the resident returned to the facility that morning from the hospital. The resident had large tan bandage strips loosely placed on top of the site where her G-tube entered her abdomen, there was no abdominal binder or other assistive device preventing Resident #18 from pulling out her G-tube. 04/15/25 at 05:47 PM- Patient pulled her G-tube out. Nurse sent patient to hospital for replacement An observation and interview with LVN J on 04/15/25 at 11:15 AM revealed, Resident #18 squirming/fidgety/restless in bed, with her legs pulled up. There was tube feeding residue, not previously seen, on the resident's sheets and incontinent brief. LVN J said Resident #18 readmitted to the facility in the morning she pulled out her G-tube. She said the resident did not have an order for an abdominal binder, and a binder was not used to protect Resident #30 from dislodging her G-tube. LVN J said, she can have an abdominal binder. In an interview on 04/15/25 at 11:23 AM, the NP said she started following Resident #18 6 weeks ago. She said the residents restless, fidgety, and squirming behavior is what she considered her baseline. The NP said she originally thought the resident's behaviors were due to a UTI so Resident #30 was treated with a course of antibiotics, but the behaviors remained when the medication was completed so she now believed she needed psych services. The NP said residents with excessive restlessness and continuous activity were at risk of pulling out their G-tube, so they should have an abdominal binder covering the tube which would prevent them from easily pulling out the tube. The NP said the resident did not have an order for an abdominal binder because she had not received any reports that the resident consistently pulled on her G-tube. She said the failure to have an abdominal binder on a G-tube resident with excessive movement and restlessness placed the resident at risk for the G-tube dislodgement, danger if the IV pole holding the feed falls leading to injuries. In an interview on 04/15/25 at 12:27 PM, MA B said Resident #18 always moved around and was restless. She said the resident had never had an abdominal binder put she probably could. In an interview on 04/15/25 at 12:30 PM, MA A said he had worked at the facility for 8 years and Resident #18's normal behaviors included: agitation and trying to pull out her G-tube. He said the resident did not have an abdominal binder, so he put a sheet on top her G-tube to prevent her from pulling on it. In an interview on 04/15/25 at 12:35 PM, the DON said Resident #18 was non-verbal. She said the resident had always been grabby and fidgety and received psych services. In an interview on 04/15/25 at 12:38 PM, LVN J said Resident #18 just returned from the facility after she pulled out her G-tube and the IV pole fell and hit her head. She said she received an order (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 24 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 for an abdominal binder from the NP and was waiting for central supply to deliver the binder. Level of Harm - Immediate jeopardy to resident health or safety An observation on 04/16/25 at 07:47 AM revealed, Resident #18 in bed, with no abdominal binder in place. The resident was restless and taking off her clothing. Residents Affected - Some In an interview on 04/16/25 at 07:48 AM, MA A said there was an order for an abdominal binder for Resident #18, but she did not have one on because it had not arrived at the facility. In an interview on 041/16/25 at 07:50 AM, LVN J said Resident #18 did not have an abdominal binder on. She put in an order for an abdominal binder for Resident #18 yesterday, but it had not arrived. In an interview on 04/16/25 at 11:27 AM, LVN H said Resident #18 was one of her residents. She said even though the resident was bedbound, she did not stay in one place, moved her arms and legs around a lot, and was very fidgety. LVN H said she worked with Resident #52 for the past two years and off-course she pulls out her G-tube but the staff could not restrict her. She said she previously notified nursing management of the resident pulling on and out her g-tube, but no changes were made. She said on 04/15/25 at around 4 AM when she checked on the resident, she saw that Resident #18's G-tube was dislodged and the IV pole was on the floor. In an interview on 04/16/25 at 08:27 AM, the DON said she started her position in February and Resident #18 always had behaviors that included pulling on her G-tube. She said in March the resident pulled on her tubing which caused the IV pole holding her feed to fall and hit her in the head leading to an injury. After the incident, the resident had neuro checks in place to confirm she didn't have a change in condition and the IV pole was moved to the other side of the bed. The DON said Resident #18's behaviors were discussed in an IDT meeting, and it was decided a GDR was contraindicated and the only thing in place after the incident in March was the NP ordering labs. In an interview on 04/16/25 at 02:18 PM, RN A said Resident #18 was always fidgety and liked to play and pull on her G-tube. She said Resident #18 did not have an abdominal binder on the night 04/15/25, and she was never educated or informed about any interventions that should be in place to protect Resident #18. RN A said due to resident's movement and preference to pull on her G-tube she had communicated her concerns with nursing management and thought the resident needed an abdominal binder, but nothing was done. In an interview on 04/16/25 at 03:48 PM, the DON said an abdominal binder was ordered from their vendor, but it had not arrived yet, so the staff were monitoring Resident #18's behaviors. She said Resident #18's abdominal binder was expected to arrive on 04/17/25. Resident #33 Record review of Resident #33's Face Sheet dated 04/17/25 revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses which included: chronic respiratory failure, asthma, bipolar disorder, severe with psychotic features, paraplegia (paralysis of legs and lower injury), Gastrostomy and Tracheostomy (opening in neck to access the windpipe). Record review of Resident #33's Quarterly MDS dated [DATE] revealed, severely impaired cognitive skills for daily decision making. The resident had no behavioral symptoms present including physical or verbal behavioral symptoms towards others and no other behavioral symptoms towards others (hitting or scratching self, pacing, rummaging or disruptive sounds) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 25 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #33's undated Care Plan printed 04/17/25 revealed, Focus- risk of aspiration r/t feeding tube in place; intervention- report N/V, absent bowel sounds to MD and RP. Focus- history of depression and is at risk of episodes of depression, adverse reactions and depression driven behaviors; intervention- monitor for impeding episodes of depression- document any noted in clinical record, prove psych consult per order. Record review of Resident #33's Progress Notes from 01/16/25 to 04/17/25 revealed, Resident #33 pulled out or pulled on his G-tube on the following days: 02/04/25- Residents G-tube was dislodged 02/12/25- Residents G-tube was dislodged and he was sent out to the Hospital 02/23/25- Resident pulled out his G-tube and was sent out to the hospital ER for G-tube placement. 02/25/25- Resident was found pulling on G-tube around 9 am. Resident was cleaned up and abdominal binder was applied. 04/15/25- Residents G-tube became dislodged and he was sent out to the hospital ER of G-tube placement. In an interview on 04/16/25 at 09:18 AM, the MDS Nurse said she had been in her current position for 8 to 9 years but worked in the facility for 19 years. In an interview on 04/16/25 at 11:40 AM, the MDS Nurse said she was responsible for completing resident care plans. She said the care plan functioned as a plan of how to care for a resident. The MDS nurse said everything needed to care for a resident should be included, day to day tasks/care, wound status, behaviors, diagnosis, code status, and weight management. She said if a resident had behaviors, those behaviors should be included in their care plan with specific details that include the type of behaviors and should include goals and interventions. The MDS Nurse said incorrect care plans posed no risks to residents because nobody looks at the care plan except state. She said staff do not look at resident care plans to determine how to care for residents but received care information from reports, documentation, and verbal communications. The MDS nurse said she did not know about Resident #18's continuous behaviors of pulling at and on her G-tube and she only knew that the resident had once pulled on her IV pole causing it to fall and injury her. She said based on the behaviors she knows Resident #18 displayed, the resident's care plan should have had a focus area addressing them. In an interview on 04/17/25 at 12:50 PM, the DON said she took the role at the facility in February. She said the purpose of the care plan is to provide guidance for patient care and resident needs. The DON said she was responsible for the accuracy and completion of the care plan, but the MDS nurse is the person who actually completes the care plan. She said each resident's care plan should address their: diet, code status, diagnoses, treatments received and behaviors. The DON said the care plan triggers everything the nurses did for the residents and let them know what interventions to implement. She said inaccuracies in the care plan can result in missed treatments or interventions and in Resident #18's case it led to the resident pulling out her G-tube, injury, and hospitalization to replace her G-tube. The DON said she was not aware of Resident #18's behaviors of pulling on and out her G-tube, and she was not aware those behaviors were not in the resident's care plan, but it should have been . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 26 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety An IJ was Identified on 04/17/2025 . The template was provided to the Administrator on 04/17/25 at 12:33 PM. The following Plan of Removal submitted by the facility was accepted on 04/18/2025 at 07:52 PM. Plan of Removal

F656 Residents Affected - Some On 4/17/2025 at 12;33 PM, the surveyor provided an Immediate Jeopardy (IJ) template notification stating the Regulatory Services had determined the facility failed to develop and implement a comprehensive care plan. The facility failed to develop and implement a comprehensive care plan that addressed Redients#18's behaviors of pulling her G-tube which resulted in injury after the IV pose fell and hit resident in the head and her G-tube being dislodged on 2 occasions. 1. Immediate Action: oThe Director of Nursing immediately reassessed Resident #18 to validate the resident's G-tube was in place, patent, and medication/nutrition was being administered per provider orders. An abdominal binder ordered on 4/15/2025 after displacement was received 4/17/2025 and applied per provider orders. No other concerns were identified. Resident #18 tolerated the application of device well and exhibits no distress. Resident #18 injury to forehead is resolving without complications. oThe MDS Coordinator revised the care plan to include interventions related to the incident occurring on 3/27/2025 where Resident #18 pulled feeding tube causing the IV pole to fall on her head. Interventions included changing the positioning of the IV pole to reduce ability to pull feeding tube and IV pole. Occupational Therapy evaluation was ordered and completed. New occupational therapy plan of care for Resident #18 includes, range of motion, joint proprioception, to decrease restlessness with bilateral upper extremities. oThe MDS Coordinator updated and revised Resident#18 care plan to include provider orders for G-tube, any current/historical behaviors including agitation, fidgeting, and attempts to remove or dislodge the G-tube. Care plan revisions include interventions to prevent/reduce displacement of G-tube and requirement of documenting provider notification of any changes in behavior specifically related risk of G-tube displacement. Start Date: 4/17/2025 Completion Date: 4/17/2025 Responsible: Administrator Plan of Removal

F656 Immediate Action: oThe Director of Nursing/Designee conducted a review of all facility residents and determined 13 residents were currently receiving nutritional feeding through a G-tube/Peg Tubes. All 13 residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 27 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some were immediately assessed to validate tubes were secure and patent. Further assessment included a 7 day look back record review to determine that there are no new changes in behavior, increased agitation, or fidgeting related to potential risk of G-tube/Peg Tube displacement. oThe Director of Nursing determined that 4 of the 13 residents receiving nutritional supplements via G-tubes/Peg Tubes, including Resident #18, would potentially benefit from the use of an abdominal binder. The abdominal binders were previously ordered from the supply vendor and received, provider orders were obtained, and all abdominal binders have been applied to applicable residents and applicable residents are tolerating well with reduced risk of displacement. oThe MDS Coordinator completed updates/revisions for the 13 resident care plans that included noting any current or historical behaviors (7 day look back) related to potential displacement of G-Tube/Peg tube and validated that if behaviors were identified, interventions included actions to take to reduce risk of displacement and documentation of provider notification. New orders for abdominal binders and monitoring for 4 of the 13 residents, have been added to care plan interventions to assist in potential displacement of G-Tubes/Peg Tubes as applicable. oThe MDS Coordinator/designee completed an audit to validate that all 13 residents who receive nutritional feeding through tube have updated care plans. Start Date: 4/17/2025 Completion Date: 4/17/2025 Responsible: Administrator Plan of Removal

F656 Immediate Actions: oThe QAPI Committee reviewed the policies and procedures regarding Care Plans, Comprehensive Person-Centered, to validate accuracy of the policy. oThe Director of Nursing/Designee provided training to all nursing staff who provide care to residents who receive nutritional feeding via a tube prior to providing direct patient care. oIf resident is exhibiting restlessness, agitation, or changes in behaviors related to obstruction/removal of a G-tube will be documented in the resident record which pulls to the 24 hour report and the Provider/Director of Nursing are to be promptly notified and increased supervision is implemented to maintain tube replacement and patency until root cause of increased restlessness, agitation, changes in behavior are determined. oCompleted a return determination with nursing staff on proper placement of G-tube and securing abdominal [NAME] to validate skill set. oThe Administrator provided training to the MDS Coordinator regarding the requirement to collaborate with the Interdisciplinary Team (IDT) to update and revise the resident care plans timely with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 28 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety resident changes in condition including behaviors that might put the resident at risk for displacement of G-tubes/Peg Tubes, compliance with provider orders. Start Date: 4/17/2025 Completion Date: 4/17/2025 Residents Affected - Some Responsible: Administrator Plan of Removal

F656 Immediate Actions: oThe Director of Nursing/Designee will monitor residents with G-Tubes/Peg Tubes including those that require supportive devices such as abdominal binders that reduce the risk of tube displacement q shift and as needed to validate correct placement and patency of tubes for residents who currently have provider orders. If concerns are identified, immediate corrective action will be implemented, provider notified, and applicable staff re-educated. oThe Director of Nursing/Designee will monitor changes in behavior including increased agitation and restlessness daily to promptly determine a root cause and ensure appropriate interventions have been implemented timely on the care plan to reduce potential negative outcomes, including displacement of G-Tube/Peg Tube. oAn ad-hoc QAPI meeting was held, and the facility medical director was notified of the deficient practice and plan of removal. The Plan of Correction will be reviewed monthly during the QAPI meeting for the next 3 months and as needed until a lesser frequency is deemed appropriate. Meeting minutes will be taken and maintained for 12 months. Start Date: 4/17/2025 Completion Date: 4/17/2025 Responsible: Administrator Monitoring of the POR . An observation on 04/19/25 at 12:25 revealed, Resident #18 in bed with an abdominal binder on. An observation on 04/19/25 at 12:29 PM revealed, Resident #33 with an abdominal binder on. In an interview on 04/19/25 at 01:01 PM, MA B said she received training on G-tube safety on 04/16/25. She said the training addressed how to address active/agitated residents with G-tube, ensuring interventions like abdominal binders are in place, ensuring the resident is safe and administering medications as ordered if necessary. MA B said the training reinforced that G-tube residents with increased agitation could be at risk of dislodgement and the IV pole falling on them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 29 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety In an interview on 04/20/25 at 06:45 AM, LVN H said she was trained on 04/17/25 about G-tube safety. She said Resident #18 moved around a lot and had a tendency to pull on and out her G-tube, so she had asked for a binder to be used on the resident in the past, but no action was taken. In an interview on 04/20/25 at 08:55 AM, MA A said he had not received any training on G-tubes, Care Plans or Accidents/Supervision. Residents Affected - Some An observation on 04/20/25 at 08:57 AM revealed, Resident #22 in bed with an abdominal binder in place. An observation on 04/20/25 at 09:05 AM revealed , Resident #18 in bed with an abdominal binder in place. The resident was calm, in no immediate distress and did not have concerning body movement In an interview on 04/20/25 at 09:00 AM, CNA K said she received training on G-tube safety in the previous week. She said if a resident with a G-tube was agitated they were expected to report it to the nurse and ensure an abdominal binder was on if there was an order. In an interview on 04/20/25 at 09:05 AM, LVN J could not answer what in-services she received and had to be prompted by the surveyor. She said she received training on G-tubes and care plans on 04/17/25 and 04/20/25. LVN J said when a resident on a G-tube had behaviors nurses were expected to document the incident in the chart, and report it to management, while CNAs document behaviors in the POC and report it to their nurse. She said when residents with G-tubes become agitated, they are at risk of dislodgment so nursing staff should initiate interventions like an abdominal binder if there is an order for one and notifications should be sent out. In an interview on 04/20/25 at 09:07 AM, the ADON said she completed training with staff on 04/17/25 regarding G-tube Placement, Behaviors and Abdominal binders. She said staff were educated that residents who are agitated, fidgety, constantly moving/irritated should be documents on having behaviors in the POC or the progress notes. The ADON said staff were trained that these residents are at risk of dislodgement and can also pull-down equipment. She said the training addressed reporting and documenting behaviors that increase risk of G-tube dislodgement, sending notifications and interventions that should be in place. The ADON said she also did training on resident care plans and how documentations played into the development of care plans, where to find a resident's care plan and how to review the interventions in place. She said this training was provided to CNAs, CMAs, Nurses, RTs, and anyone who provided care to residents, In an interview on 04/20/25 at 01:10 PM, the MDS Nurse said she received a 1-on-1 training from the Interim Administrator regarding care plan timing & accidents, incidents on 04/17/25 and training regarding G-tubes on 04/18/25. She said the training reinforced that she should know about resident behaviors such as pulling on and pulling out their G-tube and make sure there is the appropriate documentation. The MDS Nurse said behaviors should be tracked, orders should be in place for a binder, the binder must actually be used/in place on the resident and such orders must be in the resident's plan of care. The MDS nurse said even though the MDS is only a 7 day look back the behaviors should be documented in the resident's plan of care. The MDS nurse said she was educated that all behaviors should be documented in the care plan even if it were the resident's baseline behaviors because agitated residents are at risk of pulling out their G-tube which could result in rupture, injury, trauma, infection, and hospitalization. In an interview on 04/22/25 at 04:56 AM, RN A said she received training on G-tube safety the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 30 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some previous week and on 04/21/25. She said the training focused on preventing G-tube dislodgement with the use of a binder. RN A said when a resident with a g-tube is agitated or has increased movement, nursing staff are expected to assess the resident, and if needed, apply an abdominal binder or get an order for an abdominal binder. She said resident behaviors are to be documented in the resident's chart and interventions such as repositioning, medications administered as ordered, and notification sent to the MD/NP because increased behaviors/movement can place residents at risk of dislodgement, bleeding, bloating and infection. RN A said documenting any incidents that occur is important because it plays into the resident's care plan. In an interview on 04/22/25 at 05:01 PM, RN E said he received training on G-tube safety on 04/21/25. He said if a resident with a G-tube had behaviors such as fidgeting and pulling on the tube they should not be ignored, they should be assessed and interventions such as abdominal binders or PRN meds should be in place. RN E said if a resident even if these behaviors are continuous staff should document it whenever they see it because it plays into the care plan. In an interview on 04/22/25 at 05:05 AM, CNA X said he did not receive any training on G-tubes, care plans or behaviors in residents with behaviors but if a resident is observed pulling on their G-tube staff should ensure interventions like abdominal binders are in place, notify their nurse and document the behaviors in the POC to prevent dislodgement. In an interview on 04/22/25 at 05:09, RT A said he had not received in-person training on G-tube safety but had received a text message on some trainings and asked if he could pull it up. RT A was not able to verbalize independently what the training he received was but read from his text that residents with increased agitation were at risk of dislodgement or injury so the nurse should be notified and the behaviors document. An observation on 04/22/25 at 05:20 AM revealed, Resident #18 in bed, with no abdominal binder on. In an interview on 04/22/25 at 05:25 AM, CNA A said she received training regarding G-tube safety on 04/20/25. She said when a resident with a G-tube was agitated or fidgety she is expected to observe them and document it in the POC. CNA A said Resident #18 did not have an abdominal binder on because it was only required when the resident was agitated which she was not at this time . In an interview on 04/22/25 at 05:29 AM LVN B said he received training on G-tube safety on 04/21/25. He said residents with G-tubes that experienced behaviors were at risk for dislodgement, so they must notify the MD to receive an order for an abdominal binder or use one if order was in place. LVN B said Resident #18 did not have an abdominal binder in place because she only required one when she was agitated. In an interview on 04/22/25 at 08:50 AM, LVN D said she received training on G-tube safety on 04/21/25. She said residents with G-tubes that are fidgety are considered as having behaviors and that should be documented. In an interview on 04/22/25 at 09:18 AM, MA C said she had not received any training on G-tube safety. In an interview on 04/22/25 at 01:55 PM, MA C said she received training that day regarding residents with G-tubes displaying behaviors, communication & notifications of behaviors and the application of abdominal binders as ordered. She said if a resident with a G-tube was agitated they were at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 31 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some risk of G-tube dislodgement so interventions should be in place as ordered, nurse notified, and observations document ed in the residents POC. MA C said residents with behaviors like Resident #18 should have binders in place at all times except when care is provided. An observation on 04/22/25 at 02:00 PM revealed, Resident #22 sleeping in bed with her [family member] by her bedside. The said the resident currently had an abdominal binder on and had extra ones in her nightstand. In an interview on 04/22/25 at 02:18 PM with the Interim Administrator and the DON, the Administrator said the facility performed an audit and identified 5 residents with a history of behaviors associated with pulling out their Gtube. She said those resident's care plans have been updated, every FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 32 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure that, for a resident who is unable to carry out activities of daily living, provide the necessary services to maintain grooming and personal care for 2 of 8 residents (Resident #28 and Resident #109) reviewed for ADL care. Residents Affected - Some -The facility failed to provide nail care to Resident #28, leaving the nail on his left thumb long, dirty, thick, and discolored. The facility failed to ensure Resident #109 was provided personal grooming (long fingernails and brown substance under the fingernails) and oral hygiene (bad breath) by facility staff. This failure could place residents at risk of social embarrassment, isolation, infection, injury, pain, deterioration of health and a diminished quality of life. Findings included: Resident #28 Record review of Resident #28's Care Plan dated 04/15/25 revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses which included: p acute respiratory failure with hypoxia (inadequate gas exchange by the respiratory system), dependence on supplemental oxygen, Hemiplegia (one sided paralysis), Hemiparesis (paralysis to one side of body), stroke, chronic obstructive pulmonary disease (a lung condition caused by damage to the airway), anemia (reduced number of red blood cells), depression, functional quadriplegia (inability to completely move), congestive heart failure (is a condition where the heart is unable to pump enough blood to meet the body's needs), hypertension (elevated blood pressure) and anxiety. Resident #6 was his own RP. Record review of Resident # 28's Quarterly MDS (minimum data set, resident assessment, and care screening) dated 02/11/2025 revealed a BIMS score of 14 indicating he was cognitively intact. He had lower extremity impairment on both sides of the body that interfered with daily function. He was coded for no impairment to the upper extremity. He required total dependence on staff for lower body dressing and substantial maximum assist for upper body dressing and personal hygiene. He was always incontinent of urine and bowel. Record review of Resident #28's undated care plan revealed focus: ADL self-care performance deficit related to impaired balance/coordination; intervention: personal hygiene- extensive assistance with 1-2 staff. Provide shower, shave, oral care, hair care and nail care per schedule and when needed. Focusdeficit of sitting balance related to weakness and disease process; interventions- staff with apply hand roll daily. Focus- risk of skin break down increased pain from contractures to bilateral feet, elbows, and fingers; interventions- provide small hand roll to left hand. Record review of Resident #28's order summary report as of 04/15/25 revealed, there were no physician orders for fingernail care. Record review of Resident #28's progress notes for date range: 02/14/2025 to 04/15/2025 and uploaded on 04/15/2025 at 07:04 PM, revealed no documentation of nail care or refusal of nail care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 33 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #28's ADL report for March 2025 printed 4/15/25 revealed, no documentation of nail care. An observation on 04/15/25 at 09:47 AM, revealed Resident #28 in bed with left contracted hand with a long-left thumbnail that was approximately 1/3 of an inch long. The nail was thick, yellow, and curved to the left. Resident #28 did not have a hand roll between his fingers on this contracted hand. Resident #28 said he wanted his fingernails cut and did not remember when his nails were cut. An observation and interview on 04/16/25 at 07:35 AM, Resident #28 in bed with fingernails cut and a hand roll in place on his left contracted hand. He said therapy staff came by yesterday and provided him a hand roll and the MDS nurse cut his fingernail yesterday. He said management also looked at his toes and will set up something with a podiatrist to cut his toenails. In an interview on 04/16/25 at 09:18 AM, the MDS nurse said she cut Resident #28's fingernails yesterday. She said he had 1 finger that needed to be trimmed and it had thick skin under it. She confirmed the surveyor's visual demonstration that Resident #28's fingernail was over 1 cm (1/3rd of an inch) prior to being trimmed, and he did not bleed when she cut his nail. The MDS nurse said CNAs and nurses are responsible for trimming fingernails and it was not her responsibility but as a nurse she could complete it, so she did. The MDS Nurse said she could see why Resident #28's left thumbnail had not been trimmed because of the buildup of skin, so it caused him pain. The MDS Nurse said failure to cute fingernails in residents with contractures could cause the nails to get imbedded in their skin leading to infection and pain. In an interview on 04/22/25 at 12:24 PM, the DON said there was no reason for Resident #28's fingernails to not have been cut and his hand roll to not be in place. She said CNAs and Nurses can cut fingernails and ADL care should be done every day and as needed. She said nail care is important because long nails can get snagged and in residents with contractures, they could become imbedded in the skin, cause skin breakdown and Infections. The DON said failure to have a hand roll in place could result in worsening of contractures and fingernails being imbedded in the skin. In an interview on 04/22/25 at 12:27 PM, the DON said ADL care included oral care and nail care. She said CNAs cut nails of non-diabetic patients and thick nails are cut by the nurse. She said dirty and long nails place residents at risk of infection, sores, and wounds. Resident #109 Record review of Resident #109's face sheet dated 04/16/25 revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included fracture of the right thigh, blood infection, local infection of the skin, stroke, heart disease, diabetes, malnutrition, dementia, difficulty with swallowing, contractures, Parkinson's disease (a nervous system disorder) and need for assistance with personal care. Record review of Resident #109's admission MDS dated [DATE] indicated the assessment was in progress. Resident #109's BIMS score was blank. Section GG - Functional Abilities was blank. Resident #109 had no behaviors, and she was always incontinent of bowel and bladder. Record review of Resident #109's active orders as of 04/16/25 indicated orders for an unstageable wound to the sacrum and orders for a deep tissue injury to the right knee starting 4/12/25. An order for Meropenem 500m(antibiotic) IV every 8 hours for a wound infection starting on 4/12/25 and ending (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 34 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 on 4/19/25. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #109's undated care plan did not address need for assistance with personal care or any ADL care. Residents Affected - Some In an observation and interview on 4/15/25 at 10:00 AM, Resident #109 was in bed, she had contractures to her wrists, her body was stiff, and she spoke softly. She stated she had a wound to her bottom from the prior facility she was at and that she had a broken leg. She had long fingernails with dark brown substance under the fingernails. She was holding a sausage patty in her left hand attempting to feed self. In an observation and interview on 4/16/25 at 9:30 AM, Resident #109 stated she would like her fingernails trimmed and cleaned as they need it, they were dirty. She stated she is diabetic, and nurses must be the ones to cut them. Her teeth were filmy, with food particles and she had bad breath. She stated here teeth felt gritty and gross. She stated they were her own teeth, and she didn't have a toothbrush. In an interview on 4/16/25 at 1:00 PM, CNA AC, stated she performed oral care for Resident #109 and used oral swabs and mouthwash. She stated she did not check her fingernails today and said if they needed trimming, she would notify the nurse since she is a diabetic. In an interview on 4/16/25 at 3:00 PM, RN D stated the nurses were responsible to trim nails if diabetic and would refer to Podiatrist if a consult is needed. She stated the risks for long dirty nails was infection if the resident scratches a wound. She stated normally the CNAs would report the need for nurse attention. In an interview on 4/16/25 at 3:05 PM, RN F stated she would trim nails if the resident was diabetic and the risk for long and dirty nails would be scratching the skin and potential for wounds. She stated CNA AC did notify her about Resident #109. She also stated she knew about Resident #109's long fingernails and had seen them on 4/15/25. She stated she was going to trim the nails at that time but could not find the clippers and the state was in the building. In an observation and interview on 4/20/25 at 9:00 AM, Resident #109's teeth were filmy, with food particles and she had bad breath. She stated why is there resistance regarding oral care. Observed her fingernails were clipped but still had brown matter in and around the fingernails to both hands. She stated yes, the fingernails still need to be cleaned a little more. In an interview on 4/22/25 at 12:27 PM, the DON stated the CNAs can cut fingernails unless if the resident is non-diabetic and CNAs can provide oral care. She stated she would expect oral care daily and as needed. She stated the facility had toothbrushes and swabs for use on residents with tracheostomies. The DON stated the nurses were responsible to trim diabetic nails. The DON stated residents totally dependent on grooming, should have clean mouths to help reduce plaque buildup. She stated poor oral care could lead to infection, broken teeth, bad breath, pain, and it would make them feel bad. She stated the resident should have clean nails to help reduce nails snagging on items. She stated dirty nails could lead to infection and more risk for further sores and wounds. Record review of the facility policy Activities of Daily Living (ADL), Supporting revised 03/2018 revealed, 1Residents will be provided with care, treatment and services to ensure that their activities of daily living do not diminish unless the circumstances of their clinical conditions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 35 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete demonstrate diminishing ADLs are unavoidable. 2- appropriate care and services will be provided for residents who are unable to carry out ADLs independently, with the consent of the resident and in accordance with plan of care, including appropriate support and assistance with: a- hygiene (bathing, dressing, grooming, and oral care). Record review of the facility policy and procedure for Mouth Care, revised in February 2018 read in part: .the purpose of this procedure are to keep the resident's lips and oral tissues moist, to cleanse and freshen the resident's mouth and to prevent oral infection . Event ID: Facility ID: 675078 If continuation sheet Page 36 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews the facility failed to ensure personnel provide basic life support, including CPR, to a resident requiring such emergency care prior to the arrival of emergency medical personnel and subject to related physician orders and the resident's advance directives for 1 of 5 ( Resident #161) residents and 2 out of 2 Crash Carts in that: - RN D failed to use the AED when providing CPR to Resident #161 when he was found unresponsive on [DATE]. - The facility failed to ensure the facility had pads for use with the AED in case a resident was in need of CPR. - The facility failed to ensure the facility crash carts had oxygen available. An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 02:12 PM. While the IJ was removed on [DATE] the facility remained out of compliance at a scope of pattern and severity level of no actual harm with a potential for more than minimal harm that is not immediate jeopardy due to facility's need to evaluate the plan of removal. This facility failure could place residents at risk of experiencing worsening of condition, severe injury, brain damage, hospitalization, and death. Findings include: Record review of the facility list of Residents with full code status provided on [DATE] at 02:00 PM revealed, 46 out of 50 residents in the facility were full code, which signified that they requested to receive all possible medical interventions to save their lives in the event of cardiac or respiratory arrest. Resident #161 Record review of Resident #161's Face Sheet dated [DATE] at 04:45 PM revealed, the resident admitted to the facility on [DATE] with diagnosis which included: respiratory failure, mild protein-calorie malnutrition, epilepsy (brain disorder characterized by unprovoked seizures), heart failure, low blood pressure, inability to sleep and the presence of a prosthetic heart valve. The resident had advanced directives of Full Code CPR when he discharged to the hospital on [DATE]. Record review of Resident #161's Discharge MDS dated [DATE] revealed, the resident had an unplanned discharge to a short-term general hospital. He received continuous oxygen and tracheostomy (a surgical procedure where a hole is created in the neck, directly into the windpipe to allow air to enter the lungs) care, had no acute mental status change and had severely impaired cognitive skills for daily decision making. Record review of Resident #161's undated care plan revealed, focus: advance directive choice of FULL CODE status; interventions- staff will initiate CPR and notify EMS for transport to a hospital. The full code status for Resident #161 was initiated on the resident's care plan on 05/27.25. Focus(continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 37 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some episodes of inappropriate behaviors and risk of injury due to self-dislodgement of trach; interventionsobserve for early warning signs of behavior; date initiated [DATE]. Focus- resident has a tracheostomy; intervention- provide tracheostomy care per order. Record review of Resident #161's Progress Note dated [DATE] at 06:15 PM signed by RN D revealed, approximately 05:30 PM , SN went to check blood pressure and noticed resident unresponsive with no pulse , Code blue activated, and resident placed on floor CPR started immediately for 3 minutes resident become responsive , placed on non-breather mask with 15 liters. blood pressure 165/101, heart rate 105 , oxygen 98% , temperature 99.2, blood sugar 131. 911 was called and transferred resident to hospital . MD notified . RP and caregiver also notified of the CIC and transfer. Record review of Resident #161's Change in Condition Evaluation dated [DATE] at 06:26 PM revealed, the residents change of condition was abnormal vital signs and unresponsiveness that started in the afternoon. Resident #161 was unresponsive, code blue activated, resident sent to ER via ambulance. Record review of Resident #161's Hospital Record revealed, he admitted to the ED with altered mental status. Resident #161 admitted from a nursing facility in which the staff states he was in cardiac arrest and did 1 round of CPR. The fire department stated the resident had pulses and breathing on scene, with eyes open with a gaze and he was unresponsive to pain. According to EMS, they were called to the patient's nursing home due to cardiopulmonary arrest. They state that staff at the facility had told him that they found the patient unresponsive without a pulse. It is unclear what time this was or when the patient was last seen normal. According to EMS, staff had performed chest compressions for 3 minutes and had ventilated the patient with the BVM (a manual technique to deliver positive pressure ventilation to a patient who is not breathing or is not breathing adequately). No medications or defibrillation/cardioversion was performed. When EMS arrived, patient was awake and confused. In an interview on [DATE] at 09:25 AM, RN D said on [DATE] Resident #161 was found unresponsive without a pulse in his room. She said facility staff immediately started CPR on the resident and after 1 round of CPR (30 compressions to 2 breaths) the resident came back (responsive and with a pulse). RN D said when a resident is found unresponsive nursing staff are expected to check the residents pulse and activate code blue and the crash cart is brought to the resident. She said when the cart arrives, the staff are to apply the AED and then follow the prompts. RN D said she last received training on AED use with the previous management company at the end of 2024. She said she did not use the AED on Resident #161 because he came back pretty fast (after 1-2 minutes of CPR). RN D said the AED was supposed to be applied after 1 round of CPR was completed. In observation on [DATE] at 09:26 AM with RN D, inventory of the A & B hall crash cart revealed, the contents of the crash cart were unsecured. There were no pads for the AED, the oxygen tank was empty and there were 2 sealed syringes with needles in one of the drawers. The cart was signed off as being fully stocked from [DATE] to [DATE] by different staff on Crash Cart Check List was signed off . RN D said the crash cart had not had any pads for the AED for an unknown period in time , she opened the valve on the oxygen tank and confirmed the oxygen tank was empty. In an interview on [DATE] at 09:30 AM, the DON said Resident #161 was found unresponsive so facility staff-initiated CPR, 911 was called but he was responsive when the EMS arrived. She said when a resident who is full code is unresponsive nursing staff must initiate CPR while someone calls 911. She said once CPR is started staff are expected to grab the crash cart and immediately apply the AED and follow the prompts and there should be no delay in the use of the AED. The DON said if a resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 38 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety did not have a pulse the AED should have been used. She said she was notified that there were no AED pads during the previous week, and she attempted to order them, but she was unsuccessful due to the facility's new vendor, so she sent the order form to the medical director. The DON said failure to have AED pads would result in staff being unable to defibrillate a resident, but the resident would not die because they could still perform CPR without it. The DON would not answer what the risk to residents was if the facility crash cart did not have oxygen. Residents Affected - Some An observation and interview on [DATE] at 09:38 am revealed, the Station C & D of the crash cart was unlocked. There were no AED on the station C & D Hall Crash Cart and there was no oxygen tank. LVN J said the crash cart had an AED but did not know where to find it, she checked the cart and the supply closet, but the AED could not be located. An observation on [DATE] at 10:11 AM revealed, an empty box that read AED/defibrillator located in the front hallway on the way to the station A & B hall after the door to the DONs office. In an interview on [DATE] at 10:30 AM, the DON said she did not know exactly how long the facility had been without AED pads, but she notified the Medical Director on [DATE]. She said the facility's supplier sent her a form to order the AED pads, so she forwarded it to the Medical Director, but she had not received a response from the Medical Director or the supplier. The DON said going forward she would order the AED pads herself from an online marketplace. She said she did not have record of the last reorder for the AED pads as it was with the older management company (new management of the facility started on [DATE]) and she did not have any records available. In an interview on [DATE] at 01:27 PM, the Administrator said the nursing designee is responsible for ensuring the crash carts were stocked. He said he was unaware that the facility did not have pads for the AEDs, but he saw an email he was copied on regarding AED pads, but he did not know what the difficulty was. The Administrator said the facility only had 1 AED in the building and failure to have a functional AED in the facility could place residents at risk of a delay in care up to death. He said he was not aware that the oxygen tanks on the crash carts were empty or absent and failure to have oxygen on the crash cart could place resident at risk for a delay in care and negative outcomes. The Administrator said he was not aware that nursing staff were not checking the contents of the crash cart correctly and he did not know how long the facility had gone without AED pads. He said as the administrator he expected the crash carts to be fully stocked, timely restocked after use, and locked to maintain the integrity of the contents and for patient safety. In an interview on [DATE] at 01:45 PM, RN D said she only knew about the lack of AED pads and no back up AED this morning when the state surveyor brought it up. She said when Resident #161 coded and they performed CPR they brought the entire crash cart to the residents room, but she did not get to connect the AED and did not look inside. RN D checked the facility EMR system and said the last time the AED was used was on [DATE] and the night shift was responsible for checking the crash cart/AED. RN D said lack of supplies for the AED or lack of a back up AED placed residents at risk of a bad situation but the EMTs always have their own AEDs so facility staff would have continued with CPR until they arrived. In an interview on [DATE] at 02:38 PM, the Medical Director said she expected nursing staff to know how to perform CPR including when to use the AED. When asked the expectation for AED use the Medical Director said she could not answer because it was a hypothetical question. When asked what expectations she had for nursing staff regarding CPR the medical director said she would not answer because it was a hypothetical situation. The Medical Director said the AED should be used when a resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 39 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some had pulseless electrical activity and a fibrillation pattern, but she would not answer how the staff would be able to determine if the resident was in these states without first attaching the AED because it was a hypothetical situation. She said the Medical Director, DON and Central Supply were responsible for ensuring that the facility crash carts were fully stocked and she was unaware that the facility did not have pads for the AED or that the O2 tanks on the crash carts were empty. The Medical Director said she received an email on [DATE] from the DON regarding the ordering of the AED pads but she did not read it until recently. She said as the Medical Director she meets with facility administration every week when she comes in and she also had a QAPI meeting last week but they did not discuss the facility's need of AED pads. When asked the risk to residents if the facility did not have functional AEDs or O2 on the crash cart, the Medical Director said she couldn't say because it was a hypothetical situation. Record review of RN D's BLS Provider Certificate dated [DATE] revealed, RN D BLS training expired on 10/2026. Record review of the facility policy titled Automatic External Defibrillator, Use and Care of revised 03/2015 revealed, personnel have completed training on the initiation of CPR and BLS, including defibrillation, for victims of sudden cardiac arrest. arrest. 1- During a sudden cardiac arrest event, follow guidelines outlined in the procedure for CPR and BLS. 2- if an individual is found unresponsive and not breathing normally, a staff member who is trained in CPR/BLS shall initiate CPR unless- the resident has a DNR order that prohibits CPR or external defibrillation exist for that individual or there are obvious signs of irreversible death. 3- The AED will be used to try and restore normal cardiac rhythm when arrythmia is strongly suspected. 4- In general, SCA should be suspected if; the victim's symptoms appeared very suddenly; he or she is unresponsive; and his or her breathing has stopped. 5- If an individual is found unconscious and SCA is suspected, begin AED protocol. Initial Assessment and Safety Precautions: 1- Call or direct someone to call 911; 2- Apply PPE; 3- Assess the victim- if unresponsive, retrieve (or direct someone to retrieve) the AED from its location and bring to the victim. Open airway and look, listen, feel for breathing. If breathing is absent, deliver 2 rescue breaths. If signs of circulation are absent, begin CPR until the AED is available Devise Setup: remove device from case. remove the film [NAME] from pads, turn on the device and follow the prompts Defibrillation . The AED will analyze the heart rhythm and indicate whether a shock is needed. Storing the AED- 1- replace used accessories, including pads; 2- check and inspect device. Maintaining the AED: keep spare battery and adhesive pads in the case as instructed. 3- document checks, maintenance steps and date performed on maintenance log and store log with the device. Record review of the facility policy titled Emergency Procedure- Cardiopulmonary Resuscitation and Basic Life Support revised 10/2024 revealed, personnel have completed training on the initiation of CPR and BLS, including defibrillation, for victims of sudden cardiac arrest. General Guidelines: 1- if an individual is found unresponsive and not breathing normally, a staff member who is trained in CPR/BLS shall initiate CPR unless- the resident has a DNR order that prohibits CPR or external defibrillation exist for that individual or there are obvious signs of irreversible death. Preparation for CPR: 1- obtain and/or maintain certification in BLS/CPR that adheres to the AHA guidelines for all clinical staff members, including non-licensed personnel . 4- maintain equipment and supplies necessary for CPR/BLS in the facility at all times. AHA guidelines for CPR and ECC: 10 staff are trained to follow current AHA guidelines and recommendation for sequence of resuscitation including: Recognition or cardiac arrest; initiation of resuscitation; opening the airway; metrics for high-quality CPR; ventilation and compression-to-ventilation ratio; defibrillation . An IJ was Identified on [DATE]. The Administrator was notified of the IJ, and the template was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 40 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety provided to the facility on [DATE] at 02:12 PM. The following Plan of Removal submitted by the facility was accepted on [DATE] at 02:13 PM. [DATE], F678 Introduction: Residents Affected - Some On [DATE], at 2:12pm, an Immediate Jeopardy was identified due to: The facility failed to use an AED when Resident #161 coded on [DATE]. The facility failed to have a functional crash cart. The station A&B crash cart did not have pads for the AED and the oxygen tank was empty. Nurse Station C&D did not have an AED or oxygen tank available. As a result of the IJ the facility has implemented the following: 1. All current residents could be at risk of having a change of condition and have the potential to be impacted by this deficient practice. 2. The facility completed an ad-hoc QAPI, on [DATE], at 3:30pm, F678 was reviewed as it pertained to the incident resulting in the IJ and reviewed the its CPR Policy, AED policy and Code procedures. 3. All residents' code status (Full Code/DNR) confirmed and verified in the electronic health record (EHR). Completed [DATE]. 2025 by DON/ADON. 4. All residents' oxygen orders were confirmed and verified in the electronic health record (EHR). All residents use oxygen concentrators, residents who are on concentrators will have their concentrators plugged into outlets that are powered by the facility generator. Oxygen tanks will be used should a concentrator fail, for resident transportation on facility bus, and for use during emergent situations, such as a resident code. Facility is able to contact the supplier for additional tanks as needed. Completed [DATE]. 2025 by DON/ADON. 5. An audit was conducted on the crash carts, identified missing equipment replaced, or reordered, as necessary. If the crash cart is used, the on-duty nurse will restock the cart as soon as possible (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 41 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some after it use, no later than the end of the current shift. The restocking will be verified by the second nurse on duty in the facility. The cart will be audited by the DON/ADON/Designee no later than 24 hours after its use and restocking. Completed [DATE]. 2025 by DON/ADON 6. The audit sheet will serve as the guide and system for checking and re-stocking the crash cart. DON/ADON will in-service the RNs and LVNs on the use of the audit sheet to re-stock the crash cart. This training will be completed on [DATE]. 7. On [DATE], replacement pads for the AEDs were obtained and placed on the crash carts. 8. An audit is being conducted by DON/ADON/Designee of RN and LVN CPR training and certifications. Audit will be completed [DATE]. Any staff member found not current will be removed from the schedule and will be required to update their certification prior to being placed back on the schedule. The facility will make Annual training available. Initial annual training will be offered to all staff by [DATE]. 9. All nursing staff; RN, LVN, CMA, and CNA's in-service on the facilities resident code policy and procedures. All staff must complete this training prior to the start of their next shift. All staff will sign off on the training. Training will be completed [DATE]. 10. Facility will complete daily audits for 14 days to ensure that Staff can locate and interpret code status, That emergency equipment, (i.e., .crash cart, AED is accessible and functional. 11. Random resident code drills will be conducted at least once on all shifts during the next 30 days. These codes will be performed by DON/ADON. Staff members will be retrained on any deficiencies observed during the drills. 12. The Administrator, DON/ADON will monitor this plan of removal and correction daily during morning meeting for the next 30 days. Monitoring of the POR (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 42 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety In an observation and Interview on [DATE] at 05:50 AM, LVN R said he had not received an in-service regarding CPR and the use of the AED recently. His BLS/CPR card was observed to have an expiration date of 05/2025. An observation on [DATE] at 05:56 AM revealed, the ADON asking nursing staff to sign in-service documentation. Review of the document signed was training addressing crash cart audits . Residents Affected - Some In an interview on [DATE] at 08:56 AM, RN F said she did not have CPR/BLS certification, and she last received an in-service on CPR/BLS last week. She said a resident's code status is documented in the EMR and it is also on the 24-hour report. RN F said her training emphasized when a resident was found unresponsive nursing staff must check on them, check vitals, listen for breathing and if there is none, call help and start CPR. She said the AED was located on the crash cart and it should be used while doing chest compressions which should start once the resident was found unresponsive. In an interview on [DATE] at 09:14 AM, RN D said she was last CPR/BLS certified in 10/2024 and she was current until 10/2026. She said the last inservice she received was with the previous company and a residents code status was found on their profile. She said her training on running a code emphasized, yelling for help, bringing the crash cart to the resident, assigning duties to each person including calling 911 and starting CPR on a resident immediately if there is no pulse. RN D said there is an AED on the crash cart, and it should be used if the resident still does not have a pulse after 1 round of CPR is completed. In an interview on [DATE] at 09:40 AM, MA A said she completed her BLS certification on [DATE] and it expires in 2026. She said she received an in-services about CPR 2 weeks ago and the AED was located on the A Hall on the wall. MA C said the AED is used when they do compressions to restart the resident and when a code is called staff bring the AED and the crash cart into the residents room. In an interview on [DATE] at 09:55 AM, LVN O said she was last certified in BLS a few days ago and does not remember the last time she received an in-service from the facility about CPR/BLS. She said a resident's code status can be found on their profile and she had no training to run a code. LVN O said if she saw an unresponsive resident she would check their code status, then go grab the crash cart and activate the response team to ask for help. She said nursing staff with help, and they will start CPR, check if the resident is breathing or not and if not, the resident is placed on the floor and 2 nursing giving CPR while they call 911. LVN O corrected herself and said she would never leave the resident and she said the AED is used when they shock the resident after giving 15 breaths. In an interview on [DATE] at 10:15 AM, the Wound Care Nurse said she was last BLS certified in 10/2024. She said she had not received an in-service on CPR/BLS, and she had only worked in the facility for 3 weeks. The Wound Care Nurse said she was showed the location of the AED and crash carts, and she knew where to find the residents code status on the EMR. She said if a resident were found unresponsive, she would check for breathing ensuring there was no obstruction, check carotid pulse and immediately start CPR. The Wound Care Nurse said when the AED is applied it would tell her when to do CPR and the pads must be put on immediately when CPR starts. In an interview on [DATE] at 11:08 AM, MA D said she was last BLS certified when she was hired in 10/2024 and the last time, she received an in-service was a month ago, but she could not remember. She said a resident code status is located in the EMR she said as a MA she does not do assessments so she will call for the nurse of a CNA. MA D said the AED was located at the nurses station ad she was not involved in using the AED so she would just help the nurses with whatever they need. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 43 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some In an interview on [DATE] at 11:20 AM, CNA H said she was last BLS certified in 01/2025. She said if a resident was unresponsive, she would run to the nurses station to get the crash cart, then continue doing compressions while someone calls 911. She said she would follow the nurses instructions to perform CPR. In an interview on [DATE] at 11:36 AM, RT D said her BLS certification will expire in 08/2025. She said she last received an in-service on BLS/CPR a few months ago before the facility management company changed. RT D said a residents code status can be found in PCC and if a resident was not responsive, she would check their pulse, run to get help, ask the nurse to call a code blue, get the crash cart and go to the resident. She clarified that she would call the code and someone else would bring the crash cart so she would not leave the resident. RT D said the nurses will check on the resident and place the AED pads on the resident, start chest compressions and have the bag set up. She said there was an AED on the crash cart by the nursing station. In an interview on [DATE] at 12:19 PM, RN A said she was last BLS certified in 11/2024 and she received an in-service addressing CPR approximately 3 weeks ago. She said the AED was part of the crash cart and after the resident is connected to the AED the device would tell them what to do. RN A said the AED pads should be applied as soon as the crash cart arrived. In an interview on [DATE] at 03:48 PM. LVN R said he was last BLS certified on 09/2023 and his last in-service on CPR was yesterday ([DATE]). He said if a resident is found unresponsive, with full code status, code blue will be called, and the nurses will help start CPR. LVN R said the AED is located in the crash cart by the nursing station and it should be used when a resident is unresponsive and after it arrives. In an interview on [DATE] at 05:48 PM, the DON stated they had IJ because in the documentation it did not show that the nurses used the AED for the resident. After interviewing the nurse and finding out what happened he did not need the AED because he got 3 min of CPR. They got the AED, opened the pads but did not need to apply them . They in serviced the nursing staff on documentation following the incident. In an interview on [DATE] at 06:15 PM, the ADON stated that there was an IJ in AED because the AED was used prior, and pads were not ordered between there. Things that are missing, there are always 2 sets. The time frame from the time they replaced the AED pads. She stated if they did CPR that is a true code. She stated the resident had hypoxia because they did not get potassium. The IJ was because it was an AED issue that was not used. They need to analyze heart rate is with the defibrillator. There was teaching and orientation done. There was no pads and any CPR patient they use the AED because it tells them what they need. It was a failure on the nurse In an interview on [DATE] at 06:30 PM, the Administrator said the facility had an IJ in CPR because the facility failed to ensure the proper items were available for use and in stock. The facility failed to follow up on audits to verify for completeness. Going forward the facility will ensure the audits were done appropriately with all the supplies were ready and available on the crash carts. Record review completed on [DATE] revealed: - The facility held an ad-hoc QAPI meeting with the Administrator, DON, ADON and medical director on [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 44 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some - The Administrator, DON and ADON were in-serviced by the CNO on CIC, follow-up, staff reporting of incidents and CIC and notifying the medical director and or designated on call provider. The document was dated [DATE] and the training was completed over phone and email. - The facility provided training to staff on CPR- Crash Cart/AED un an unspecified date. - The facility provided training to staff on CPR- Crash Cart/AED on [DATE]. - The facility completed a CPR training audit on an unspecified dated and the following discrepancies were noted: LVN R was documented as expiration date 09/25 when the observed BLS card was 05/2025. - The facility audited the crash cart on [DATE] and [DATE] and all items where in working order. - The facility completed an audit of the number of O2 tanks in the building on [DATE] through [DATE]. - The facility ordered a new AED and Pads on [DATE]. The supplies were shipped to an address located in a different city from the facility and the AED pads purchased were replacement adult training pads for training only. The facility was informed that the immediacy was removed on [DATE] at 06:40 PM. The facility remained out of compliance at a scope of pattern and severity level of no actual harm that is not immediate jeopardy, due to the facility's need to evaluate the effectiveness of the corrective systems. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 45 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that residents received care and services in accordance with professional standards of practice for 3 of 9 residents (Resident #161, Resident #162 and Resident #163) reviewed for quality of care. Residents Affected - Some - LVN T failed to enter orders for potassium to treat Resident #161's critically low potassium of 2.7 correctly which resulted in Resident #161 receiving his first dose of potassium over 12 hours after the lab notified LVN T of the critical lab result and Resident #162 receiving 2 doses of Potassium in error. - RN E failed to notify Resident #163's physician of his critically high BUN of 93 correctly by sending a picture to the incorrect provider after hours instead of notifying the on-call physician and failed to conduct a CIC evaluation for the resident. These failures could place residents at risk of delay in care, worsening of health conditions, adverse reactions, hospitalization, and death. An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 04:36 PM. While the IJ was removed on [DATE] the facility remained out of compliance at a scope of pattern and severity level of no actual harm with a potential for more than minimal harm that is not immediate jeopardy due to facility's need to evaluate the plan of removal. Findings include: Resident #161 Record review of Resident #161's Face Sheet dated [DATE] at 04:45 PM revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnosis which included: respiratory failure, mild protein-calorie malnutrition, epilepsy (brain disorder characterized by unprovoked seizures), heart failure, low blood pressure, inability to sleep and the presence of a prosthetic heart valve . The resident had advanced directives of Full Code CPR when he discharged to the hospital on [DATE] at 06:01 PM. Record review of Resident #161's Discharge MDS dated [DATE] revealed, the resident had an unplanned discharge to a short-term general hospital. He received continuous oxygen and tracheostomy (a surgical procedure where a hole is created in the neck, directly into the windpipe to allow air to enter the lungs )care, had no acute mental status change and had severely impaired cognitive skills for daily decision making. Record review of Resident #161's undated care plan revealed, focus: advance directive choice of FULL CODE status; interventions- staff will initiate CPR and notify EMS for transport to a hospital. The full code status for Resident #161 was initiated on the resident's care plan on 05/27.25. Focus- episodes of inappropriate behaviors and risk of injury due to self-dislodgement of trach; interventions- observe for early warning signs of behavior; date initiated [DATE]. Focus- resident has a tracheostomy; intervention- provide tracheostomy care per order. Focus- Potential for seizure activity, injury related to seizure activity and epilepsy; Goal- maintain lab values WNL through therapeutic range per MD order and be free of seizure activity through next review date; Interventions- administer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 46 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 medications as ordered. Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #161's Lab Result Results dated [DATE] at 04:41 PM revealed, the facility collected a blood sample for a complete blood count, lipid panel and comprehensive metabolic panel on [DATE] at 05:55 AM; the sample was received by the lab on [DATE] at 10:26 AM; the lab reported the results on [DATE] at 04:41 PM. Resident #161's Potassium was tested to be 2.7 mmol/L and flagged as a critically low since the normal range for potassium was 3.6-5.5 mmol/L. The results were verified, called to and red back by [LVN T] on [DATE] at 04:37 PM regarding the residents potassium. Residents Affected - Some Record review of Resident #161's Progress Notes dated [DATE] at 06:34 AM signed by RN D revealed, Critical lab potassium noted 2.7 and reported to the MD . New order received to give stat potassium chloride 40mEq , then another at night and give 40 mEq for the next 3 days. RP called ; phone went to Voice mail, administered the medication as ordered . Resident vital signs are wnl, nurse will continue to monitor . Record review of Resident #161's Change in Condition Evaluation dated [DATE] at 03:06 PM signed by RN D revealed it was a follow up CIC evaluation. The residents change of condition was critical potassium level of 2.7 that stated in the afternoon on [DATE]. There was no repeat lab ordered, treatment was in place for 3 days and the physician was notified on [DATE] at. 06:34 AM. Abnormal chemistry values of K less than 3.0 at 2.7 from [DATE]. Record review of Resident #161's Progress Note dated [DATE] at 06:15 PM signed by RN D revealed, approximately 05:30 PM , SN went to check blood pressure and noticed resident unresponsive with no pulse , Code blue activated, and resident placed on floor CPR started immediately for 3 minutes resident become responsive , placed on non-breather mask with 15 liters. blood pressure 165/101, heart rate 105 , oxygen 98% , temperature 99.2, blood sugar 131. 911 was called and transferred resident to hospital . MD notified . RP and caregiver also notified of the CIC and transfer. Record review of Resident #161's Change in Condition Evaluation dated [DATE] at 06:26 PM revealed, the residents change of condition was abnormal vital signs and unresponsiveness that started in the afternoon. Resident #161 was unresponsive, code blue activated, resident sent to ER via ambulance. Record review of the facility Unreviewed Laboratory records on [DATE] at 01:33 PM revealed, Resident #161 had critical lab result that were reported to the facility on [DATE] at 04:41 PM. Record review of the Resident #131's Lab Results in his EMR dated [DATE] at 02:02 PM revealed, his critical lab results were reported on [DATE] at 04:41 PM but the review status read To Be Reviewed. Record review of Resident #161's Order Summary Report dated [DATE] at 02:06 PM revealed: - Potassium 20 mEq- Give 40 mEq by mouth one time only for critical potassium 2.7 for 1 Day - Potassium 20 mEq- give 40 mEq by mouth one time only for low potassium level 2.7 for 1 day. - Potassium 20 mEq- give 40 mEq by mouth one time only for low potassium level 2.7 for 3 days. Record review of Resident #161's Hospital Record printed [DATE] at 03:48 PM revealed, Resident #161's Potassium level upon admission to the hospital was abnormal. His potassium level was 3.1 mEq/L with a reference range of 3.4-4.5. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 47 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of Resident #161's May MAR dated [DATE] revealed, RN D administered only 1 dose of Potassium 40 mEq to Resident #161 on [DATE] at 07:19 AM (over 12 hours after the critical lab value was reported). Record review of Resident #161's Hospital Record revealed, he admitted to the ED with altered mental status. Resident #161 admitted from a nursing facility in which the staff states he was in cardiac arrest and did 1 round of CPR. The fire department stated the resident had pulses and breathing on scene, with eyes open with a gaze and he was unresponsive to pain. According to EMS, they were called to the patient's nursing home due to cardiopulmonary arrest. They state that staff at the facility had told him that they found the patient unresponsive without a pulse. It is unclear what time this was or when the patient was last seen normal. According to EMS, staff had performed chest compressions for 3 minutes and had ventilated the patient with the BVM (a manual technique to deliver positive pressure ventilation to a patient who is not breathing or is not breathing adequately). No medications or defibrillation/cardioversion was performed. When EMS arrived, patient was awake and confused. In an anonymous interview on [DATE], They said Resident #161 coded in the facility in May due to a delay in treatment of a critical lab because the lab was called in under an incorrect resident who received Resident #161's critical treatment in error resulting in Resident #161 receiving delayed treatment for his critical lab value. The anonymous person said this was not the only critical lab missed but this particular incident bothered them. In an interview on [DATE] at 02:45 PM, the Hospital Nurse A said Resident #161 was not in his room because he was undergoing a procedure in a different building. She said the resident initially admitted to the facility because he was unresponsive and had admitting diagnosis of heart valve replacement and cardiac issues. Hospital Nurse B said the resident was unresponsive with no pulse in the facility but once he was conscious, he had seizure like activity. In an interview on [DATE] at 09:36 AM, RN D said when she came in on her morning shift on [DATE] the nurse who gave her a verbal report said Resident #162 had a critically low potassium, so he was administered potassium. She said in her experience when a resident had a critically low result the MD ordered a retest, but the reporting nurse said no such report was received, so she reviewed Resident #162's medical record and determined that the resident did not have a critical lab result for potassium but Resident #161 did. She said after further investigation she learned that both LVN T and RN A administered 40 mEq to Resident #162. RN D said she immediately called the doctor and received orders for Potassium for Resident #161 which she administered, and she notified the DON who asked for a STAT lab for Resident #161 and Resident #162. RN D said throughout the day Resident #161 was not his usual self, he was very lethargic, had slightly elevated BP, decreased O2 stats, was not trying to get out of bed and was spacing out. She said Resident #161 only ate a little bit of his lunch and around 04:00 PM when staff went to check on him, he was found unresponsive. RN D said she and her trainee nurse, RN H, immediately initiated CPR, Resident #161 recovered and was then sent out to the hospital which he remains. She said a resident potassium level was important because potassium controlled how the heart contracts. RN D said if a resident had low potassium they could go into cardiac arrest, and while she cannot say that is exactly why Resident #161 was found unresponsive the chance was high that the critically low potassium caused the resident to code. In an interview on [DATE] at 09:25 AM, RN D said on [DATE] Resident #161 was found unresponsive without a pulse in his room. She said facility staff immediately started CPR on the resident and after 1 round of CPR (30 compressions to 2 breaths) the resident came back (responsive and with a pulse). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 48 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Level of Harm - Immediate jeopardy to resident health or safety RN D said when a resident is found unresponsive nursing staff are expected to check the residents pulse and activate code blue and the crash cart is brought to the resident. She said when the cart arrives, the staff are to apply the AED and then follow the prompts. RN D said she last received training on AED use with the previous management company at the end of 2024. She said she did not use the AED on Resident #161 because he came back pretty fast (after 1-2 minutes of CPR). RN D said the AED was supposed to be applied after 1 round of CPR was completed. Residents Affected - Some Resident #162 Record review of Resident #162's Face Sheet dated [DATE] at 01:58 PM revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnosis which included: traumatic brain hemorrhage , respiratory failure, type 2 diabetes, brain injury, anxiety disorder, g-tube, and dependence on a ventilator. Record review of Resident #162's Admissions MDS dated [DATE] revealed, active diagnoses included: coronary artery disease, anemia, a CVA, TIA or stroke and traumatic brain injury. Record review of Resident #162's undated Care Plan revealed, Focus- risk of aspiration due to feeding tube and episodes of inappropriate behaviors of rolling himself from the bed to floor mat pulling out his feeding tube. Record review of Resident #162 Change in Condition Evaluation dated [DATE] at 05:00 PM signed by LVN T revealed, change of condition was critical potassium level of 2.7 that started on [DATE] in the afternoon. LVN T received a call from the clinical laboratory with a critical potassium value of 2.7 and she reported the result to the Medical Director. LVNT received new orders to give 40 mEq of potassium now, another dose at night and then daily for 3 days. LVN T entered the orders into the EMR and administered the initial dose of potassium 40 mEq. Abnormal results- potassium level 2.7. Record review of Resident #162's Progress Note dated [DATE] at 06:57 AM signed by LVN T revealed, LVN T received a call from the clinical laboratory with a critical potassium value of 2.7 and she reported the result to the Medical Director. LVN T received new orders to give 40 mEq of potassium now, another dose at night and then daily for 3 days. LVN T entered the orders into the EMR and administered the initial dose of potassium 40 mEq. Record review of Resident #162's Lab Results Report dated [DATE] at 04:00 PM revealed, the result was reviewed by NP B on [DATE] at 11:11 PM. A blood sample for BMP testing was collected on [DATE] at 02:20 PM and Resident #162's potassium level was 4.5 mmol/L with a reference range of 3.5-5.2 [NAME]/L. Record review of Resident #162 Order Summary Report dated [DATE] revealed: - Potassium give 40 mEq via G-tube one time only for critical potassium level for 1 day. - Potassium give 40 mEq via G-tube at bedtime for critical potassium level - Potassium give 40 mEq via G-tube one time a day for critical potassium level for 3 days. Record review of Resident #162 May [DATE] dated [DATE] at 01:59 PM revealed, Resident #162 received Potassium 40 mEq on: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 49 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 - [DATE] at 06:33 PM administered by LVN T. Level of Harm - Immediate jeopardy to resident health or safety - [DATE] at 09:00 PM administered by RN A. Record review of Resident #162's Clinical Results on [DATE] at 02:01 PM revealed, Resident #162 had no labs were collected on [DATE] and no results for critical potassium were reported on [DATE]. Residents Affected - Some In an interview on [DATE] at 03:50 PM, RN A said she did not administer Potassium 40 mEq to Resident #162. In an interview on [DATE] at 07:28 PM, LVN T said she was not aware she made a med error with Resident #161 and Resident #162. She said when nurses received a critical lab result, they are expected to notify the NP in order to receive new orders for treatment. LVN T said she would report the CIC to the RP, enter the new orders into the EMR and notify the ADON. She said critically low potassium could place residents at risk for a cardiac event and all critical lab result should have immediate interventions in place because the resident could experience an adverse event, or the resident could die. After LVN T looked through the EMR she confirmed that she was documented as receiving the critical lab call from the lab on [DATE], she entered the order for potassium into Resident #162's chart and she administered potassium to Resident #162. LVN T said she did not remember a med error incident on [DATE] as that was her first day working over here, no one ever talked to her about the incident, and she never received any re-training or in-service related to this incident. In an interview on [DATE] at 05:06 PM, the DON said there was a medication error when Resident #161's labs were attributed to Resident #162 and the wrong resident was treated for critically low potassium. She said the facility investigation revealed LVN T made the med error. The DON said when a resident has a critical lab value nursing staff must follow the critical labs pathway, notify the MD/NP, and follow through as ordered. She said low potassium can impact heart muscle contraction, leading to cardiac arrest if response is delayed. An observation on [DATE] at 06:15 PM revealed, Resident #162 in bed in no immediate distress. He was connected to a ventilator and received continuous enteral feeding via a G-tube. In an interview on [DATE] at 11:42 AM, NP A said she was unaware that Resident #161 coded in May nor was she aware that Resident #162 received potassium in error. She said when the facility is notified of critical labs, nursing staff are expected to call them into the MD/NP as soon as possible but sometimes she did not receive a call but instead found out about resident abnormal labs during chart review. NP A said critically low potassium can present as elevated heart rate, lethargy, seizures, and result in cardiac arrest. In an interview on [DATE] at 10:53 AM, the DON said she completed an investigation into the incident, discussed the incident with LVN T and completed an incident report. She said she did not remember if she in-serviced nursing staff in regards to medication errors and handling critical labs. The DON said she did not remember if any interventions were put into place after [DATE] to ensure the medication error incident would not occur again. In an interview on [DATE] at 12:04 PM, the Medical Director said she does not remember if LVN T associated the critical lab with the wrong resident when she was notified of the incident. She just remembered she was notified that potassium was given to the incorrect patient, so she gave orders for labs, but she could not say which resident received potassium in error or which resident was supposed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 50 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Level of Harm - Immediate jeopardy to resident health or safety to receive the medication. The Medical Director said she was sure she discussed the medication error with the facility administration, but she did not know what interventions were put into place following the incident. The Medical Director would not say what a delay in care of critically low potassium would place residents at risk of as she would not attest to hypothetical situation. She said she would like notification and treatment immediately when a resident had a critical lab, but she could not say what the expected time was because it was a hypothetical situation. Residents Affected - Some In an interview on [DATE] at 06:28 PM, NP B said she worked with the facility contracted medical practice. She said when nursing staff received notification of a critical lab, they are expected to notify the provider and initiate treatment immediately. NP B said critical potassium could present differently in residents, but the resident could be confused, have flaccid muscles (muscles that are weak and lacking firmness) and/or cardiac arrest. She said a relay in treatment of critically low potassium with oral potassium could result in arrythmia and cardiac arrest so treatment should be immediate within minutes. NP B said administration of potassium over 12 hours after staff were notified of a critically low potassium level would not be acceptable because of all the symptoms previously discussed. Resident #163 Record review of Resident #163's Face Sheet dated [DATE] at 08:20 AM revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnosis which included: blood infection, acute kidney failure, heart failure, irregular heartbeat, and dependence on ventilator. Record review of Resident #163's admission MDS dated [DATE] revealed, severely impaired cognitive skills for daily decision making, total dependence for all ADLs, an indwelling catheter, history of stroke and respiratory failure. He received oxygen therapy, suctioning, tracheostomy care, and a non-invasive machinal ventilator. Record review of Resident #163's Lab Results Report dated [DATE] at 12:33 AM revealed, a sample for a comprehensive metabolic panel was collected on [DATE] at 07:30 PM, the sample was received by the lab at 11:27 PM and the results were verified, called to and read back by [RN E] on [DATE] at 12:25 AM. Resident #163's lab reported a critically high BUN of 93 mg/dL with a reference range of 3-23. Record review of a text sent on [DATE] at 01:01 AM revealed, pictures of Resident #163's Critical BUN of 93 were sent to NP C who was not listed on Resident #163's Face Sheet. Record review of Resident #163's Progress Notes printed [DATE] at 08:32 AM revealed, - on [DATE] Resident #163's lab results from [DATE] came back with a critical BUN of 91, the NP was notified, and a STAT redraw for the CMP was ordered. - [DATE] at 03:04 PM signed by RN E, Resident had his 8 hourly Amoxicillin 500mg at 2200, other medications were administered , well tolerated. Result of the CMP is ready, doctor notified. Indwelling catheter is in place, draining well. No SOB or any adverse reaction observed during the shift. Vital signs are wnl. Record review of Resident #163's EMR on [DATE] at 08:30 AM revealed, no CIC evaluation was completed for Resident #163's elevated BUN, no new orders from the provider after notification of the critical Lab. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 51 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Level of Harm - Immediate jeopardy to resident health or safety An observation on [DATE] at 08:05 AM revealed, Resident #163 in bed in no immediate distress. The resident was connected to a ventilator and continuous enteral feeding. In an interview on [DATE] at 08:09 AM, RN H said she was the 6 AM- 6 PM nurse for Resident #163. She said when she received report from RN E, she was not notified of any critical lab results reported by the lab early this morning. Residents Affected - Some In an interview on [DATE] at 08:11 AM, RN E said the lab called lab results to her early this morning for an elevated BUN of 93 for Resident #163. She said immediately after she received the results, she took a picture and sent the results to NP A, but NP A just responded, thank you, without any additional orders. RN E said when the facility received critical lab report they must immediately notify the doctor by phone and if they do not respond they send a picture. She said the facility had an on-call doctor, but they will not pick up calls, so staff take pictures and send them to the resident's provider. RN E said she notified RN H when she gave report this morning, but she had not notified the RP yet because it was too early. She said immediate notification of critical BUN levels was very important and a failure to get an immediate response from a provide could result in a delay in treatment. An observation and interview on [DATE] at 08:32 AM revealed, the DON sitting in her office as she reviewed the facility 24-hour report and took notes on residents. The DON said Resident #163 had a critical BUN on [DATE] and the provider ordered a retest, but she was unaware the results came back early yesterday morning because she had not been notified and the facility had not had their morning meeting. She said when a staff member received a critical lab result, they must call the residents provider or the on-call physician if the lab report is released after hours. The DON said nursing staff should document the lab results, who they notified and what the new orders are. She said sending text pictures of lab results was not their facility policy because it is a violation of patient confidentiality. The DON said failure to properly notify a provider of a resident's critical lab result can place a resident at risk of delay in care and untreated health conditions. Record review of the facility document Laboratory Notification Parameters with no revision date revealed, Test/Procedure: K(potassium) any value outside reference range should be reported immediately. BUN > 60 mg/dl should be reported immediately. An IJ was Identified on [DATE]. The Administrator was notified of the IJ, and the template was provided to the facility on [DATE] at 04:36 PM. The following Plan of Removal submitted by the facility was accepted on [DATE] at 03:39 PM. [DATE]

F684 Introduction: On [DATE], at 4:36pm, an Immediate Jeopardy was identified due to a critically low potassium of 2.7 by reporting it under an incorrect resident, resulting in a delay in treatment. All current residents could be at risk of having a change of condition and have the potential to be impacted by this deficient practice. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 52 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 As a result of the IJ the facility has implemented the following. Level of Harm - Immediate jeopardy to resident health or safety 1. Residents Affected - Some Administrator, DON and ADON were in-serviced by Chief Nursing Officer on the following Healthcare regarding resident changes in condition, follow-up, staff reporting of incidents and changes in condition and notifying the medical director and or designated on call provider Admin, DON and ADON in-serviced on the need for increased staff education and monitoring including new hires and agency staff. All verbalized understanding. In service completed on [DATE]. The facility nurse receiving the results will ensure that the correct resident and medical provider have been identified, a second nursing staff member will double-check that the correct results have been attached to the correct resident. Facility will contact the correct physician and communicate the results, and obtain orders. RNs and LVNs were trained on this process on [DATE]. Additional training is in process and will be completed [DATE]. Staff will not be allowed to work if they do not complete the training. 2. Facility reviewed polices and procedures prior to in-services. Polices reviewed include medication pass, change in condition, clinical lab protocol. No changes were made to policies, as a result of the initial review. 3. Administrator, DON and ADON completed the following: a. The facility DON and ADON on [DATE] at 5:00pm implemented the following: All on duty nurses staff were in-serviced on the following by DON and ADON. i. MD notification of change in condition, including change in mental status/alertness to include critical labs, ii. Notification of DON/ Administrator of any change in condition. iii. Resident follow-up monitoring iv. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 53 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Monitoring residents for change in conditions. Level of Harm - Immediate jeopardy to resident health or safety b. Residents Affected - Some i. Signs/Symptoms of Resident change of condition to include but not limited to: mental status, ii. critical lab values iii. changes in breathing iv. unarousable while sleeping, v. changes to pupils vi. inability to/or refusing to eat, drink or take medications. vii. Documentation 4. Facility also conducted additional in-services on the following topics: a Abuse, neglect, and exploitation. b Documentation c. Medication administration and medication error training, d. Physician notification. Staff will verify that the correct provider is being notified as per the resident chart. Staff will make phone notifications and will not use other methods of communication such as text or email. Facility will continue to in-service as needed. Initial trainings will be completed by [DATE]. All staff must complete the trainings prior to working their next scheduled shift. 5. All other nurses will be in-serviced prior to starting their next scheduled shift. The DON, ADON or designee will in-service the nursing staff. 6. Administrator, DON and or Designee will review all residents who have had a lab draw in the past 7 days, [DATE] forward/ An audit will be conducted on residents with a lab draw change in condition to ensure compliance with the policy. The audit was completed by the ADON and completed [DATE]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 54 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 7. An Audit was conducted on [DATE]. for residents having a current change in condition, residents who were identified as having a change of condition in the past 14 days were reviewed. Level of Harm - Immediate jeopardy to resident health or safety a. The facility Identified no other residents with change of condition due to critical labs during the review period. Residents Affected - Some b. The facility reviews all labs and results from [DATE] to [DATE]. 8. Administrator, DON/ADON will monitor this plan of removal and correction daily during morning meeting for the next 30 days. 9. The facility completed an ad-hoc QAPI, on [DATE], regarding the incident resulting in the IJ. QAPI Committee will add residents with change of condition to the agenda and will review data for 8 weeks. Additionally, any change of conditions will be reviewed in morning meeting. Monitoring of POR In an interview on [DATE] at 08:56 AM, RN F said she received training on ANE, CIC and physician notification on Monday [DATE]. She said a change in condition was anything that new with a resident that they did not have before like: high temperature, respiratory distress, no bowel movement for 2 days and blood sugar above normal. RN F said when a resident had a CIC nursing staff should notify the doctor, document, and follow whatever orders they received from the DON. She said she also received training on critical labs which addressed notifying the MD immediately. RN F said providers can be notified via text of critical labs but if they do not respond in 2 to 5 minutes, she would call them, and an on-call physician is available after hours. RN F said once the orders from the physician were received and implemented, nursing staff must follow the resident to ensure there are no further acute changes. She said she had access to the automated dispensing system and when a resident readmitted to the facility, staff would take pictures of the medication list and send it to the MD for approval. She said when a medication is unavailable nursing staff must check the automated system or get the medication expedited from the pharmacy. RN F said if a medication was unavailable, she must notify the MD, who will give orders for action to take. She said the training also address attaching labs to the correct medical record by linking the lab to the progress note. In an interview on [DATE] at 09:14 AM, RN D revealed she received training on ANE, CIC, physician notification last week and she was the staff who trained new nurses. She said when a resident had a CIC nursing staff are expected to check their vitals, notify the doctors, and await new orders like medication changes or labs. RN D said the lab calls to notify the facility of critical labs. She said she had to go into the facility lab system and looked through everyone's labs to figure out was ordered and what happened. RN F said the facility needs to do better, but when she saw a critical lab, she is expected to notify the MD and the family of the CIC as well. RN F said after hours providers should be notified of critical labs through the on-call system and documentation should include what the lab result was, and interventions in place. RN F said she received training on med errors and readmission/admission medication reconciliation on [DATE]. She said when a resident arrived at the facility, nursing staff send the admissions orders to the physician immediately, who approved the orders after review. RN F said if a medication was not available, the medication can be retrieved from the automated dispensing system if available and the physician must be notified if the medication was unavailable. In an interview on [DATE] at 09:40 AM, MA A said she was trained on ANE, CIC, and physician (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 55 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete notification last week and this week. She said if a patient experienced a change of condition, she must notify the nurse. MA A said she was trained on medication administration, medication errors and admission/readmission medication reconciliation on [DATE] and the pharmacy and nurse must be notified if medications were unavailable for newly admitted residents. In an interview on [DATE] at 09:55 AM, LVN O said she was trained on ANE, CIC, and physician notification on [DATE] and a CIC was any type of change in a resident. She said if a resident experienced a CIC the DON, family and MD must be notified, and the change documented in the EMR. LVN O said the lab called the facility immediately after a critical lab and nursing start are expected to notify the MD immediately to receive orders for treatment. She said if a lab resulted after hours nursing staff were expected to send notification to the on-call physician, and implement any orders received immediately. LVN Event ID: Facility ID: 675078 If continuation sheet Page 56 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to use the services of a registered nurse for at least eight consecutive hours a day, 7 days a week for 6 of 7 months (October 2024, November 2024, December 2024, January 2025, February 2025, March 2025) reviewed for nursing services. The facility failed to ensure a registered nurse worked on 2 out of 31 days in October of 2024. The facility failed to ensure a registered nurse worked on 4 out of 30 days in November of 2024. The facility failed to ensure a registered nurse worked on 9 out of 31 days in December of 2024. The facility failed to ensure a registered nurse worked on 4 out of 31 days in January of 2025. The facility failed to ensure a registered nurse worked on 2 out of 28 days in February of 2025. The facility failed to ensure a registered nurse worked on 3 out of 31 days in March of 2025. These failures could place residents at risk by leaving staff without supervisory coverage for RN specific nursing activities and for coordination of events such as an emergency care and disasters. Findings included: Record review of the CMS PBJ Staffing Data Report for FY Quarter 1 2025 (October 1- December 31) with run date 05/01/25 revealed, the facility did not have a registered nurse scheduled on the following days in 2024: 10/12 (SA); 10/13 (SU), 11/09 (SA); 11/23 (SA); 11/24 (SU); 11/28 (TH); 11/30 (SA), 12/01 (SU); 12/07 (SA); 12/08 (SU); 12/14 (SA); 12/15 (SU); 12/21 (SA); 12/22 (SU); 12/28, (SA); 12/29 (SU) Record review of the facility provided payroll records dated 05/03/25 revealed, no RN worked on the following Saturdays & Sundays: October 2024: 12th & 13th. November 2024: 9th, 23rd, 24th, 30th December 2024: 1st, 7th, 8th, 14th, 15th, 21st, 22nd, 28th and 29th January 2025: 4th, 11th, 12th and 18th February 2025: 2nd and 16th March 2025: 1st, 2nd and 30th In an interview on 04/21/25 at 11:50 AM, the Interim Administrator said she started her position as Administrator in April of 2025. She said the facility is expected to maintain 8 hours of continuous RN coverage in order to ensure that there is staff present with the skills necessary to provide patient care. She said failure to have an RN on duty could place residents at risk of not being able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 57 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0727 receive treatment at the facility which could result in hospitalization. Level of Harm - Minimal harm or potential for actual harm In an interview on 04/22/25 at 08:47 AM, the Staffing Coordinator said she was responsible for the facility nursing staffing, she had been for the past month, and she did not know who was responsible for it prior to her. She said she sends messages to the nurses and they in return sign up for shifts. When asked how she ensured the facility had the required minimum of 8 hours consecutive hours, the Staffing Coordinator said she could not make staff work outside of their hours and would not elaborate further. Residents Affected - Many In an interview on 04/22/25 at 12:24 PM, the DON said the Staffing Coordinator is responsible for ensuring the facility has 8 hours of consecutive RN coverage in a day and if she had problems getting those hours she would be notified. She said when scheduling, the facility must have 8 hours of RN staffing everyday including weekends and she was counted towards the RN coverage during the week. The DON said she just started her employment in the facility on 02/17/25 and she was never notified that the facility did not have the required 8 hours of coverage. She said failure to have RN coverage could place residents at risk of not receiving necessary care. Record review of the facility policy titled Departmental Supervision, Nursing revised 08/2022 revealed, the nursing services department shall be under the direct supervision of a registered or licensed practical/vocational nurse at all times. 2- A registered nurse provides services at least eight (8) consecutive hours every 24 hours, seven (7) days a week. RNs may be scheduled more than eight (8) hours depending on the acuity needs of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 58 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0732 Post nurse staffing information every day. Level of Harm - Potential for minimal harm Based on observation, interview, and record review, the facility failed to ensure that the daily staffing was posted and readily accessible for review for 1 of 1 facility reviewed for required postings. Residents Affected - Some - The facility failed to post the daily nursing staffing information on 04/15/25, 04/19/25 & 04/20/25. - The facility failed to include the facility name and census of the daily nursing staffing information post on 04/16/25, 04/17/25, 04/18/25 & 04/21/25. This failure could affect residents, facility visitors, vendors, and emergency personnel by placing them at risk of not having access to information regarding daily nursing staffing in a timely manner. Findings Include: An observation on 04/15/25 at 11:38 AM revealed, the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk that read Today's Date 04-14-25. The posting did not have the name of the facility or the census. An observation on 04/16/25 at 08:00 AM revealed, the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk that read Today's Date 04-16-25. The posting did not have the name of the facility or the census. An observation on 04/17/25 at 08:30 AM revealed, the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk that read Today's Date 04-17-25. The posting indicated license nurses (RN & LVNs) and the CMAs had shifts that ran from 6AM to 6PM and 6 PM to 6AM, while CNA shifts were from 6AM to 3PM, 2PM to 10PM and 10PM to 6AM. The posting did not have the name of the facility or the census. An observation on 04/18/25 at 10:00 AM revealed, the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk that read Today's Date 04-18-25. The posting indicated license nurses (RN & LVNs) and the CMAs had shifts that ran from 6AM to 6PM and 6 PM to 6AM, while CNA shifts were from 6AM to 3PM, 2PM to 10PM and 10PM to 6AM . The posting did not have the name of the facility or the census. An observation on 04/19/25 at 12:31 PM revealed, the display container that housed the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk was empty. An observation on 04/20/25 at 08:51 AM revealed, the display container that housed the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk was empty. An observation on 04/21/25 at 11:51 AM revealed, the facility Daily Staffing posting on the top of a pony wall located behind the receptionist desk that read Today's Date 04-21-25. The posting indicated license nurses (RN & LVNs) and the CMAs had shifts that ran from 6AM to 6PM and 6 PM to 6AM, while CNA shifts were from 6AM to 3PM, 2PM to 10PM and 10PM to 6AM . The posting did not have the name of the facility or the census. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 59 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0732 Level of Harm - Potential for minimal harm Residents Affected - Some In an interview on 04/20/25 at 11:55 AM, the Staffing Coordinator said she was responsible for the daily staffing posting, but she did not know who was responsible for it over the weekend or on days she did not work. She said the posting must be posted in an obvious place that can be seen by anyone who enters the facility, it included the number of staff for the day and the number of hours worked by each type of nursing staff. The Staffing Coordinated said the posting included the facility name and the census on the day it was posted but she did not know why the information displayed in the lobby did not have that information. She said failure to provide an up to date and accurate daily staffing posting could leave family, residents, and staff unaware of the staff present or the level of care that can be provided. In an interview on 04/22/25 at 03:06 PM, the Interim Administrator said the Staffing Coordinator is responsible for the daily nursing staffing posting, but she did not know who was responsible for updating the posting on the weekend . She said the posting should include the facility name, date, census, and the nursing breakdown which included RNs, MAs, LVNs and & CNAs but she did not know why it was not accurately posted or updated. The Interim Administrator said nurses worked 12-hour shifts and aides worked 8-hour shifts. She said failure to display accurate nursing staff posting could result in the resident's and their family members being unaware of the staffing pattern or who was available for them to speak to. Record review of the facility policy Posting Direct Care Daily Staffing Numbers revised 07/2016 revealed, our facility will post on a daily basis for each shift, the number of nursing personnel responsible for providing direct care to residents. 1- within two hours of the beginning of each shift, the number of licensed nurses (RNs, LPNs, and LVNs) and the number of unlicensed nursing personnel (CNAs) directly responsible for resident care will be posted in a prominent location *accessible to residents and visitors) and in a clear and readable format. 3- Staffing information shall be recorded on the Nursing Staff Directly Responsible for Resident Care form for each shift. The information on the form shall include: a. The name of the Facility; b. The date for which the information is posted; c. The resident census at the beginning of the shift for which the information was posted. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 60 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure a resident who displayed or was diagnosed with a mental disorder or psychosocial adjustment disorder received appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being for 3 of 8 residents (Resident # 30, Resident #42 Resident #52) reviewed for treatment and services for mental and psychosocial concerns. - The facility failed to provide appropriate treatment and services to prevent and correct Resident #30's escalating behaviors which resulted in a suicide attempt on 04/13/25 and the resident attempting to draw a police officer's firearm when she had to be forcefully restrained and removed from the facility. - The facility failed to provide appropriate treatment and services to prevent and correct Resident #52's escalating behaviors which resulted in suicide threats and an incident on 05/03/25 when the resident had to be forcefully restrained and removed from the facility. - The facility failed to provide treatment and services to correct Resident #42's continuous behaviors of pacing up and down the secure unit, banging on the doors, getting in residents and staff faces, touching their shoulder while asking if his RP was dead. An IJ was identified on 05/03/25. The template was provided to the facility on [DATE] at 01:58 PM. While the IJ was removed on 05/08/25 the facility remained out of compliance at a scope of pattern and a severity level of no actual harm that was not immediate due to the to the facility's need to evaluate the effectiveness of the corrective systems. The IJ was called again on 06/07/25. The template was provided to the facility on [DATE] at 07:03 AM. While the IJ was removed on 06/19/25 the facility remained out of compliance at a scope of pattern and a severity level of no actual harm that was not immediate due to the to the facility's need to evaluate the effectiveness of the corrective systems. These failures could place residents at risk of minor and major injuries, suicide threats, attempted suicide, hospitalization, and death. Resident #30 Record review of Resident #30's Face Sheet dated 05/02/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: spinal cord injury, anemia, nicotine dependence, Schizoaffective disorder (a mental health condition that combines symptoms of schizophrenia and a mood disorder, such as depression or bipolar disorder), bipolar disorder (mental health condition characterized by extreme mood swings, ranging from periods of intense happiness or irritability (mania or hypomania) to periods of deep sadness or despair) with sever psychotic features (hallucinations (seeing or hearing things that aren't real), delusions (false beliefs), and disorganized thinking) and paraplegia( paralysis of the legs and lower body, typically caused by a spinal cord injury). Record review of Resident #30's previous facility Progress Notes dated 12/26/24 at 02:21 PM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 61 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some revealed, Resident says she is hearing things and people talking about her. She is under mental distress. She is wanting to go to the psych hospital. Resident stated she no longer wanted to be here. Record review of the Resident #30's Quarterly MDS revealed, intact cognition as indicated by a BIMS score of 14 and use of antipsychotic medications during last 7 days. There were no evidence of an acute change in mental status, and no behaviors present. She had no potential indicators of psychosis such as hallucinations or delusions. Record review of Resident #30's undated Care Plan revealed, focus- history of being resistant to care at times and is at risk for injury; intervention- approach in a calm manner, talk while giving care. Focus- taking psychotropic medications and is at risk of adverse reactions and (depression, anxiety, and/or psychosis driven behaviors; interventions- monitor for psychosis driven behaviors such as aggressiveness, combativeness, manic episodes, observe and record any displayed behaviors or mood problems. FocusResident #30 verbalized suicidal ideations and became physically aggressive with police related to her diagnosis of bipolar and or anxiety, date initiated 04/13/25; interventions- provide medications as ordered, resident will be assisted with discharge planning as when needed, resident will be referred to inpatient geri psych placement as when needed, call 911 with request for the mental health team as/when needed. Record review of Resident #30's Progress Notes from 12/31/24 to 05/02/25 revealed : 01/01/25- EMS arrived at facility stating they received phone call from facility. This nurse was notified by CMA that this resident called EMS. Resident states that she is not feeling well and wants to go to the Hospital. Resident did not notify this nurse that she was not feeling well prior. Resident called EMS instead. EMS assessed resident. No abnormal findings. EMS spoke with resident about receiving care in facility before calling 911. Resident continues to state that she wants to go to the hospital. 01/02/25- Resident called 911 for pain pill when her pain was just due to be given to her, every effort to advise her to take her pain pill yield no result as she wants to go to hospital, NP made aware, administrator made aware, resident insisted on going to hospital, picked up in stable condition. 01/12/25- Note Text : On rounds at 7:04am resident did not complain of any discomfort, distress, or concerns, noted vaping in the room, was educated by this nurse that vaping is not proper and not allowed in the room, resident did not listen, but continue vaping. At about 7:54am, 911 ambulance arrived facility stated resident called them, complained of pain to lower back, sediment in urine, and brown urine output. Resident has UA result and labs pending ,this explained to resident Norco 5-325mg offered, resident refused, and still insisted going with 911 to the hospital, transferred by 911 to hospital ,per resident request. Resident is self-RP.NP notified. 01/22/25- SW informed nurse that resident was seen by Psych services today and was told that resident may be going through a manic episode. Resident is currently in bed with NAD. Given PRN pain medication. resident has no plan to harm herself stayed she is just little down today. MD informed stated to monitor for now and call her for any changes. 01/24/25- Resident informed SN that she called 911 due to pain on her lower back. Education provided on pain management such as other ways to manage pain without medications such as deep breathing, exercise , music therapy and others , resident verbalized understanding but still want to get (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 62 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some stronger medication . NP notified . patient has been medicated with Norco Tablet 5-325 MG every 4 hours as needed, last one was at 1034am. Sn will continue to monitor. 01/31/25- Resident signed herself out after requesting (2) cigarettes. Resident was then transported to the ER by ambulance. Family notified. DON Notified. 02/01/25 at 08:01 AM- Resident requested cigarette, received her cigarette, signed out to go smoke out front where she then called 911 and requested transport. Resident would not specify where she wanted to be transported to. 911 arrived around 0710 and took resident on a stretcher to the ER. 02/01/25 at 03:15 PM- Resident returned from the hospital . Resident still appears anxious upon return and immediately returned to nurses' station to sign out with (4) cigarettes as of 0325 resident is signed out of the facility. 02/13/25 at 10:49 PM- Resident called 911 by herself twice this evening at 7:30pm and 9:40pm stating that she wants to go to the hospital because she is having spasms. Charge nurse informed her that he can notify her doctor and see if she can be given some new orders, but she refused. EMS arrived the first time and resident refused to go to the hospital they intended to transport her to. The second time the EMS arrived and took resident to Hospital at 10:00pm. 02/24/25- Note Text: At 21:30 hrs (09:30 PM), resident called the EMS via 911, requesting to be taken to the emergency room due to spasm and pain. Resident had already received her scheduled pain medication (Norco) at 20:00 hrs. Resident had not complained to Charge Nurse about being in pain prior to her calling 911, and charge nurse was not aware that she had called EMS 911 until the emergency personnel showed up in the unit. Resident was taken to the emergency room as she requested by the EMS technicians at 21:40 hrs. 03/02/25- Resident complains of hearing voices making fun of her, she said had been going on for a while now, she stated that she did not complain initially because she thought they might go away, but they getting louder, depriving her sleep. This morning observed resident in her sleep saying, stop stop stop. Resident also have diagnosis of schizophrenia and mild sleep disorder.NP notified, order received to consult psych. Order carry out. 03/08-25- Resident called EMS via 911, and they took her to the hospital at 18:45 hours for complaint of pain. Resident's emergency contact (family member)' and facility DON notified. 03/19/25- Resident came to Charge nurse and requested for her nightly medication to be administered to her, which was done. After taking her medications, she informed the Charge Nurse that she had called 911 so she can be taken to the hospital due to pain. Charge Nurse advised resident to give her pain pill (Norco) which she just took, time to become effective but she refused, insisting to go to the hospital. Charge nurse noted ant acute distress on resident both in her speech and behavior. Resident then wheeled herself in her wheelchair to the reception area awaiting the arrival of EMS ambulance. Upon arrival to the facility, the EMS personnel spoke briefly with resident and loaded her on their stretcher without asking the charge nurse any questions or informing him where they were taking resident to. When charge nurse inquired from them where they were taking resident to, they simply told him the hospital name and continued on. Facility Director of Nursing was notified. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 63 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety 03/22/25 T 05:53 AM- Behavioral Note-Resident removed her brief after ADL change claimed is too big despite the brief been her size and the large size that could be used for her. 03/22/25 at 10:09 AM- : Resident was observed alert and oriented with behavior, screamed , yelled, took clothes off. Attempted to talked to resident several times with no effect. NP. was notified order given Alprazolam 0.5mh twice a day for fourteen days for anxiety. Residents Affected - Some 04/13/25 at 01:39 AM signed by LVN H- Patient called 911 at 11:00pm and had been disturbing other patients from sleeping. The two EMS that came refused to take her to hospital stated she has no good reason to go to hospital. Patient received all her pain med and other prescribed med, throwing stuff on the floor including her phone. Patient is threatening to kill herself. Nurse notified the physician, DON, and Administrator. 04/13/25 signed by SW- SW informed per staff that this resident had verbalized wanting to kill herself. SW visited with this resident, and she verbalized I tied something around my neck but, I could still breathe. I want my Xanax back. I want my Xanax back. I am going to get my Xanax back. SW attempted to contact resident's [family member], , unable to reach and voicemail full. Resident began to yell and scream as she exited the office. Staff was present to maintain visual of her per SW request while 911 contacted with a request for the Mental Health Response team. Upon 911 arriving officer was provided with the aforementioned information. He spoke with resident, and she informed him that she wanted to kill herself. He called for assistance and another officer arrived whom also spoke with resident and then SW observed resident began to hit the officers resulting in them restraining her until approximately 4 more officers arrived. SW was informed per that she was being transported to Hospital and that the District Attorney would be contacted but they were doubtful any criminal charges would be filed against her. SW informed the DON and LNFA and was able to contact her [family member] and informed him. He verbalized understanding. Care Plan updated to reflect. Record review of Resident #30's Hospital Progress note dated 04/22/25 at 01:22 PM revealed, Resident #30 continued to throw tantrums and screamed, covering her face with her pillow. The resident was requesting IV pain medication. Record review of Resident #30's Hospital Progress note dated 04/23/25 at 12:01 PM revealed, Resident #30 continued to throw tantrums and requested IV pain medication despite being notified that she was on oral pain medication. Record review of Resident #30's Hospital Progress note dated 04/24/25 at 11:52 AM revealed, Resident #30 called 911 from her hospital room and pretend to sleep when the MD entered her room. Record review of Resident #30's Hospital Psychiatric Consultation note dated 04/24/25 at 12:00 AM, revealed Resident #30 had bipolar disorder with discrete periods of mania and discreet periods of depression. She had poor impulse control and a history of PTSD and had attempted fake suicide in the past on multiple occasions by either choking herself or overdosing on medications. Resident #30 had a history of ideas of persecution, thinking that people were going to hurt her or that something negative was going to happen to her. Resident #30 had a history of auditory hallucinations commanding her to wrap a cord around her neck or to overdose on Seroquel. In the past Resident #30 contemplated starting a fire in her apartment following the command of the voices she heard, and she wished she had a weapon to hurt hospital or nursing staff. Resident #30 was admitted to a behavioral hospital in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 64 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some February of 2021 and in November of 2023 she was admitted to the hospital after typing a collar on her neck to kill herself. Record review of Resident #30's Progress Notes on 05/01/25 at 02:48 AM revealed, Note Text : Resident called EMS and requested to be taken back to the hospital for evaluation. Resident indicated to EMS personnel that she feels nauseated, dehydrated, and is not getting enough pain medications. Resident had not complained to Charge Nurse about any of these concerns tonight. Resident had received her nightly medications as ordered, including her PRN Norco pain medication. Charge Nurse offered to call resident's PCP to see if there may be any new orders, but she refused, stating her preference to go to the hospital. Upon resident's insistence to go to the hospital, EMS personnel took her to hospital. Record review of Resident #30's Order Summary Report that included all orders since admission on [DATE] and printed 05/02/25 at 01:50 PM revealed, Resident #30 had no behavior monitoring and behavior intervention orders. Record review of a 30-day lookback of Resident #30's Behavior Monitoring and Interventions dated 05/09/25 revealed, no documented behaviors observed prior to 05/09/25. On 05/09/25 at 10:30 AM Resident #30 was screaming and expressed frustration and angers at others. An observation an interview on 05/02/25 at 01:12 PM revealed, Resident #30 sitting in a wheelchair at the nursing station. There were other residents around her and no nursing staff within 15 feet on both sides of the nursing station. The resident said she just returned to the facility from the hospital, and she felt better now. Resident #30 said the voices got too loud so she hit herself in the face and tied a pillowcase around her neck to harm herself to stop the voices, but she could still breathe. As Resident #30 talked to the surveyors she swayed left to right & back and forth in her wheelchair. Resident #30 said she did not notify any staff of the voices prior to trying to harm herself but when she went to the hospital, they fixed her meds, so she did not hear the voices anymore and she did not want to harm herself. In an interview on 05/02/25 at 12:33 PM, the SW said Resident #30 was young and had obsessive drug seeking behaviors r/t to complaints of significant pain. She said the resident would call the police 1-2 times a week and had been hospitalized at least 6-7 times since admission. The SW said Resident #30 always yelled at staff and yelled to go to the hospital. The SW said in April she was notified that Resident #30 wanted to hurt herself. She said she first talked to the resident on the phone and then again when she arrived at the facility. The SW said Resident # 30 told her she tried to hurt herself by tying something around her neck, but she could still breathe, the resident became loud and said she was going to hurt herself, so she called 911 for a mental health response team. She said when the police arrived Resident #30 wheeled herself away from them down the hallway as they spoke to her and when both police officers approached her, Resident #30 started to scream and fought the police. The SW said Resident #30 attacked the police, the police tried to restrain her, the police drew then their guns and pointed them at the resident and Resident #30 was eventually handcuffed. She said Resident #30 was a risk to other patients because of her unpredict ableness. In an interview on 05/02/25 at 01:05 PM, MA C said Resident #30's normal behaviors included verbal aggression/yelling towards staff and other residents. She said the resident propels herself around the facility in her wheelchair cursing and yelling. She said the resident was not on any increased behavioral monitoring, not on 1-on-1 monitoring and was not safe to be in a room with others. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 65 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety In an interview on 05/02/25 at 01:21 PM, LVN J said Resident #30's regular behaviors included yelling and screaming at others. She said Resident #30's former roommate, Resident #22, was scared of her because of her yelling and screaming In an interview on 05/02/25 at 01:27 PM, Resident #22 said she was scared by her former roommates yelling and screaming, She said Resident #30 yelled and screamed at night, startling her. Residents Affected - Some In an interview on 05/02/25, Anonymous A said Resident #30's regular behaviors included yelling/screaming and calling Anonymous A out of her name. Anonymous A staff said Resident #30's behaviors were towards anyone including residents and staff. Anonymous A said in one incident Resident #30 was screaming and she came down the hallway in her wheelchair with no clothes on. Anonymous A said last April, the social worker called the authorities because of Resident #30's behaviors and when they arrived, Anonymous A saw the resident attempt to pull the police officer's firearm. Anonymous A said Resident #30 liked to yell, scream and throw stuff at people and it makes Anonymous A antsy. In an interview on 05/02/25 at 01:36 PM, the MDS Nurse said she did not know Resident #30 had a history of attempted suicide or aggressive behaviors. She said the resident was always nice, but she liked to go to the ER on a weekly basis since arriving in the facility. The MDS nurse had she known of the resident's behaviors she would have included it in her care plan. In an interview on 05/02/25 at 02:04 PM, the Psychiatric NP said Resident #30 had a lot of anxiety and would call 911 often. She said the resident seemed hyper-manic and had racing thoughts. The Psychiatric NP said no one notified her that the resident was aggressive, she was unaware that the resident yelled at others, but she could believe Resident #30 rolled down the hall naked because the resident was always inappropriately dressed in her room. The Psychiatric Nurse said the resident had never shown any signs of suicidal ideation, or that she heard voices, but Resident #30 expressed anxiety and depression. She said she was unaware of Resident #30's previous history of suicide attempts, and she would have to review the hospital notes because based on what was discussed the resident's behaviors were more severe. The Psychiatric NP said Resident #30 should have a lot more monitoring by the staff and she did not know why the resident never communicated any of these issues with her. She said she had not read Resident #30's readmission clinicals from 04/30/25 but she assumes the resident is safe since she was discharged . The Psychiatric NP said based on Resident #30's behaviors she was not a safe person, and she expected the resident to have frequent assessments, close monitoring, increased therapy visits and should be encouraged to verbalize her feelings. She said Resident #30 needed additional monitoring to make sure nothing occurs. In an interview on 05/02/25 at 02:22 PM, the DON said prior to readmission she or her designee are supposed to receive and review the resident's hospital clinicals, but she did not, she said she thought the admitting nurse did. The DON said to her knowledge Resident #30 was not having behaviors in the hospital and since her return there had been no medication changes. She said since the resident returned to the facility there have been no interventions in place beyond the standard shift monitoring and based on her documented history of behaviors Resident #30 was not safe to be in a room with Resident #18 who was unable to communicate. In an interview on 05/02/25 at 02:27 PM, the Administrator said she did not know about Resident #30's aggressive behaviors or significant history of suicide, all she knew was that the resident would go to the hospital often. She said now that she knew the contents of the hospital psych consult notes and the resident's history of attempted suicide, the resident should be placed on 1on1 monitoring for at least 72 hours, because she was a resident safety risk having her unsupervised and ambulating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 66 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 in her wheelchair around the facility. Level of Harm - Immediate jeopardy to resident health or safety In an interview on 05/02/25 at 02:37 PM, CNA T said in April she saw the police go towards the SWs office and then Resident #30 came down the hallway in her wheelchair. She said at first the police were talking to Resident #30, when she started yelling and screaming so the police tried to restrain the resident at which point Resident #30 attempted to pull the police officers firearm. CNA T said prior to the incident in April, Resident #30's regular behaviors included rolling around the facility in her wheelchair yelling/screaming/cursing at other residents and staff. Residents Affected - Some In an interview on 05/02/25 at 02:46 PM, LVN T said she was the nurse scheduled when Resident #30 arrived at the facility, but she was on break, so the resident was already in the room when she returned. She said upon readmission Resident #30 had been roaming the facility unattended asking for cigarettes and pain medications. LVN T said in April she observed Resident #30 come out of SWs office screaming fuck you and the SW called 911 mental health. She said when the police talked to Resident #30, she said she was not suicidal but had attempted suicide the night before. LVN T said Resident #30 rolled away from the police, started fighting the police and when they attempted to restrain the resident grabbed their handcuffs and she heard the police say, let go of the gun. She said the SW thought they were going to shoot Resident #30, so she told her to get out of the way for safety. LVN T said more police arrived and then the ambulance took the resident away. LVN T said Resident #30's behaviors included hollering/yelling at people, calling people out of their name, calling Black people the n word, and she did all of this sometimes while going down the hall but the incident in April was the first time it had escalated to this point. LVN T said Resident #30, propelled herself freely in the facility down the halls, always yelling at others. She said when the resident returned on 04/30/25 , she did not receive the discharge clinicals that listed Resident #30's extensive suicide history, and the resident was not ordered or placed on 1on1 observation or suicide watch. In an interview on 05/02/25 at 02:57 PM, the ADON said Resident #30 can be extremely aggressive. She said the resident goes in and out of the hospital and calls 911 when she wants her pain medications, and the provider is aware of her behaviors. The ADON said she heard the resident was aggressive especially during night shift. She said everyone was aware of Resident #30's behaviors including social services, and it was documented in the resident's chart. The ADON said while she does not think Resident #30 is a threat to herself or others, she possibly made other residents feel scared. The ADON said when a resident has made threats of or attempted suicide interventions like 1on1 monitoring should be in place when they readmitted to the facility, but she did not know if Resident #30 had any others for this. The ADON said the IDT/Managers/Administration had not discussed interventions needed to ensure Resident #30's safety but management should absolutely have had that conversation. In an interview on 05//02/25 at 03;41 PM, the DON said she did not know Resident #30 had a history of attempted fake suicide, suicide attempts by tying a cord around her neck, auditory hallucinations telling her to harm herself by tying something around her neck or overdose on medications, wished to have a weapon to harm hospital and nursing staff or attempted suicide in November 2023. The DON said did not read the hospital discharge record sent to the facility prior to the resident readmitting that had the psychiatric consult notes describing all of Resident #30's previous behavioral issues and she honestly does not know why she did not. The DON said now that she knows Resident #30 had this history of behaviors the resident should have been somewhere more appropriate and based on the new information the facility had not provided Resident #30 adequate care. She said prior to today (05/02/25) Resident #30's behaviors placed the safety of herself and other residents in jeopardy. In an interview on 05/03/25 at 01:37 PM, the DON said since the surveyor alerted the facility of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 67 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #30's extensive history of fake suicide attempts, actual suicide attempts, auditory hallucinations, desire to harm others the resident was placed on 1on1 observation. She said the resident has had a sitter at all times, had not had any new behaviors and was doing well today. An observation and interview on 05/03/25 at 01:38 PM revealed, Resident #30 sitting in her wheelchair, writing in a notebook with headphones on. Resident #30 said she now had a sitter with her and has had no behaviors. She said she no longer heard voices since they put her on her proper meds in the hospital, but the doctor will take her off the medication in 10 days, and that is what keeps her calm. She said her Xanax helps her anxiety and bipolar and she was not drug seeking. Resident #30 said she was collating a list of songs for her online music store. In an interview on 05/03/25 at 01:42 PM, the DON said since Resident #30 had behaviors, received antidepressants and antipsychotic medications she should have had behavior monitoring orders. The DON said behavior monitoring orders are important for residents with behaviors in order to monitor for side effects or changes, and failure to have behavior monitoring orders would result in missed behaviors or change of condition. The DON looked through the resident's chart and said nope Resident #30 had no orders from her admission up until her suicide attempt on 04/13/25, and there were no orders entered when she returned to the facility on [DATE]. The DON said the lack of behavior monitoring played a part in the missed behavior monitoring and the missed residents change of condition. Resident #52 Record review of Resident #52's Face Sheet dated 04/24/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: schizophrenia ( mental disorder characterized by a breakdown in thought process, making it difficult to distinguish between reality and fantasy), and anxiety disorder. Record review of Resident # 52's Significant change in status MDS dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score of 05 out of 15. Active diagnosis of anxiety disorder and schizophrenia, no presence of any behavioral symptoms such as physical (hitting, kicking, pushing), verbal (threatening, screaming, or cursing at others) and no other behavioral symptoms not directed toward others. Antipsychotics were received on a daily basis; no gradual dose reduction was attempted and there was no physician documentation indicating a GDR was clinically contraindicated. Record review of Resident #52's undated Care Plan revealed, focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; interventionmedication as ordered. Focus initiated 01/07/25- psychotropic medications and is at risk for adverse reactions and behaviors; interventions- monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes. There was no focus areas addressing suicidal behavior or suicide threats. Record review of Resident #52's Progress Notes from 01/06/25 to 05/06/25 revealed: 01/19/25 at 04:53 PM signed by RN G- Resident has been very rude to RT she does not like her to enter room to give care to her roommate. She yells/curse and shout. Education given to resident that her room needs assistance and staff will provide assistance without bothering her, but resident stated now. Resident also continue to ask staff for cups thorough the shift. Education given to resident that she is currently NPO and cannot consume anything by mouth at this time for her safety. Education (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 68 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0742 did not work. She continue to ask anyone walking pass her room. Level of Harm - Immediate jeopardy to resident health or safety 02/01/25 at 09:46 PM signed by RN G- Resident is currently crying and screaming she would like to go the hospital due to pain in her left legs. Resident was given all of her scheduled medication and Tylenol PRN. She also received her pain cream diclofenac cream applied to her ankle. Resident also propels Residents Affected - Some herself around the facility not crying screaming she became very aggressive with staff. Screaming cursing and grabbing of laptop and other staff equipment she is not able to be redirected. 02/08/25 at 05:42 PM signed by RN G- Resident throw a cup a writer on this shift then later came and apologize. she also snatched the phone causing the cords to come undone and later apologize for that she stated she was in a bad mood due to her mother and boyfriend not answering the phone. She was educated not to throw things at staff or at all. She stated okay. 02/08/25 a6 06:56 PM signed by RN G- Resident still present with behaviors she snatched all of the cords and laptop and phone off the nurse station. She Started hitting another nurse on duty throwing stuff and cruising. Resident shouting, she will kill herself. 911 called at this time social worker present. 02/08/25 at 07:19 PM signed by the SW- This resident became physically aggressive with nursing staff by hitting, kicking, grabbing, and attempting to bite them. She then began to yell and scream I'm going to kill myself. I am going to kill myself. Attempts to verbally redirect unsuccessful. SW contacted her r/p, and she informed SW that she was having one of her episodes and in the past, she was sent to a Behavioral Hospital. SW contacted Behavioral hospital intake Dept via and was informed that they have no available beds till Monday. Recommended that she be sent to ER for assessment due to her aggression. 02/08/25 at 07:25 PM signed by the SW- Note Text : Resident was able to talk with her r/p and also to one of her male friends. They were able to get her to calm down and she again began to apologize for her behavior. She denied [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 69 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing, and administrating of all drugs and biologicals, to meet the needs of each resident for 2 of 2 Med Rooms ( A&B Med Room and C&D Med Room) reviewed for pharmacy services. -The facility failed to ensure the A & B Hall Med Room did not contain expired IV Antibiotics -The facility failed to ensure the C & D Hall Med Room did not contain expired IV Antibiotics and expired insulin. This failure could place residents at risk of not receiving the therapeutic benefit of medications and/or adverse reactions to medications. Findings Included: A&B Med Room In observation and interview on 04/16/25 at 12:15 PM, inventory of the A & B Hall Med Room with RN D revealed expired medications in varied size boxes/bins stacked on the side of the room higher than 5 feet tall, not in use/discontinued medications on the counters and expired IV medications in the refrigerator mixed in with current medications: - 4 bags of expired IV antibiotic Daptomycin for Resident #200 labeled with the expiration date of 03/27/25 in the fridge. RN D said the ADON, and all nursing staff are expected to check the medication room daily for expired medications as used. She said when IV antibiotics expire, they can become ineffective or contaminated so they must be discarded. RN D said the use of expired antibiotics could place residents at risk of side effects or infection. C& D Med Room In observation and interview on 04/16/25 at 12:38 PM, inventory of the C & D Med Room Med Room with LVN J revealed: - An open, in-use, and expired vial of Lantus Insulin for Resident #52 with open date of 03/14/25 in the refrigerator. The pharmacy label read Once opened refrigerated or not product must be used within 28 days. Date Opened 03/14/25. - 1 bags of expired IV antibiotic Daptomycin for CR #1 with expiration date of 01/24/25. - 2 bags of expired IV antibiotic Daptomycin for CR #1 with expiration date of 02/06/25. - 4 bags of expired IV antibiotic Daptomycin for CR #1 with expiration date of 02/14/25. LVN J said nursing staff are expected to check the med rooms daily as used for expired medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 70 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some She said injectable medications expired they could become less effective or contaminated and use could place residents at risk of infection and side effects. LVN J said CR #1 discharged from the facility. In an interview on 04/20/25 at 09:07 AM, the ADON said nursing staff are expected to check the med rooms daily as used for expired medications. She said when injectable medications expired, they could become contaminated and lose their efficacy. Record review of the facility policy titled Storage of Medications revised 04/2007 revealed, 4- The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 71 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews the facility failed to ensure residents were free of significant medication error for 3 of 7 residents (Resident #31, Resident #161, and Resident #162) reviewed for significant medication errors. Residents Affected - Some - The facility failed to administer Potassium 40 mEq immediately to Resident #161 after he had a critical potassium lab value of 2.7. - The facility failed to ensure Resident #162 was not administered Potassium 40 mEq in error. -The facility failed to administer Resident #31's seizure medications (Lacosamide and Clonazepam) and IV antibiotic (Meropenem) after he readmitted to the facility from a short-term hospital stay even though the medication was in the facility. This failure could place residents at risk of side effects of medications, worsening of health conditions, increased chance of seizures, cardiovascular arrest, brain damage and death. An IJ was identified on [DATE]. The IJ template was provided to the facility on [DATE] at 04:36 PM. While the IJ was removed on [DATE] at 06:40 PM. The facility remained out of compliance at a scope of pattern and severity level of no actual harm with a potential for more than minimal harm that is not immediate jeopardy due to facility's need to evaluate the plan of removal. Findings include: Resident #161 Record review of Resident #161's Face Sheet dated [DATE] at 04:45 PM revealed, a [AGE] year-old male who admitted to the facility on [DATE] with diagnosis which included: respiratory failure, mild protein-calorie malnutrition, epilepsy, heart failure, low blood pressure, inability to sleep and the presence of a prosthetic heart valve. The resident had advanced directives of Full Code CPR when he discharged to the hospital on [DATE] at 06:01 PM. Record review of Resident #161's Discharge MDS dated [DATE] revealed, the resident had an unplanned discharge to a short-term general hospital. He received continuous oxygen and tracheostomy (a surgical procedure where a hole is created in the neck, directly into the windpipe to allow air to enter the lungs care, had no acute mental status change and had severely impaired cognitive skills for daily decision making. Record review of Resident #161's undated care plan revealed, focus: advance directive choice of FULL CODE status; interventions- staff will initiate CPR and notify EMS for transport to a hospital. The full code status for Resident #161 was initiated on the resident's care plan on 05/27.25. Focus- episodes of inappropriate behaviors and risk of injury due to self-dislodgement of trach; interventions- observe for early warning signs of behavior; date initiated [DATE]. Focus- resident has a tracheostomy; intervention- provide tracheostomy care per order. Focus- Potential for seizure activity, injury related to seizure activity and epilepsy; Goal- maintain lab values WNL through therapeutic range per MD order and be free of seizure activity through next review date; Interventions- administer medications as ordered. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 72 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #161's Lab Result dated [DATE] at 04:41 PM revealed, the facility collected a blood sample for a complete blood count, lipid panel and comprehensive metabolic panel on [DATE] at 05:55 AM; the sample was received by the lab on [DATE] at 10:26 AM; the lab reported the results on [DATE] at 04:41 PM. Resident #161's Potassium was tested to be 2.7 mmol/L and flagged as a critically low since the normal range for potassium was 3.6-5.5 mmol/L. The results were verified, called to and red back by [LVN T] on [DATE] at 04:37 PM regarding the residents potassium. Residents Affected - Some Record review of Resident #161's Progress Notes dated [DATE] at 06:34 AM signed by RN D revealed, Critical lab potassium noted 2.7 and reported to the MD. New order received to give stat potassium chloride 40mEq , then another at night and give 40 mEq for the next 3 days. RP called ; phone went to Voice mail, administered the medication as ordered . Resident vital signs are WNL, nurse will continue to monitor. Record review of Resident #161's Progress Note dated [DATE] at 06:15 PM signed by RN D revealed, approximately 05:30 PM , SN went to check blood pressure and noticed resident unresponsive with no pulse , Code blue activated, and resident placed on floor CPR started immediately for 3 minutes resident become responsive , placed on non-breather mask with 15 liters. blood pressure 165/101, heart rate 105 , oxygen 98% , temperature 99.2, blood sugar 131. 911 was called and transferred resident to hospital . MD notified . RP and caregiver also notified of the CIC and transfer. Record review of Resident #161's Change in Condition Evaluation dated [DATE] at 06:06 PM signed by RN D revealed it was a follow up CIC evaluation. The residents change of condition was critical potassium level of 2.7 that stated in the afternoon on [DATE]. There was no repeat lab ordered, treatment was in place for 3 days and the physician was notified on [DATE] at. 06:34 AM. Abnormal chemistry values of K less than 3.0 at 2.7 from [DATE]. Record review of Resident #161's Change in Condition Evaluation dated [DATE] at 06:26 PM revealed, the residents change of condition was abnormal vital signs and unresponsiveness that started in the afternoon. Resident #161 was unresponsive, code blue activated, resident sent to ER via ambulance. Record review of the facility Unreviewed Laboratory records on [DATE] at 01:33 PM revealed, Resident #161 had critical lab result that were reported to the facility on [DATE] at 04:41 PM. Record review of the Resident #161's Lab Results in his EMR dated [DATE] at 02:02 PM revealed, his critical lab results were reported on [DATE] at 04:41 PM but the review status read To Be Reviewed. Record review of Resident #161's Order Summary Report dated [DATE] at 02:06 PM revealed: - Potassium 20 mEq- Give 40 mEq by mouth one time only for critical potassium 2.7 for 1 Day - Potassium 20 mEq- give 40 mEq by mouth one time only for low potassium level 2.7 for 1 day. - Potassium 20 mEq- give 40 mEq by mouth one time only for low potassium level 2.7 for 3 days. Record review of Resident #161's Hospital Record printed [DATE] at 03:48 PM revealed, Resident #161's Potassium level upon admission to the hospital was abnormal. His potassium level was 3.1 mEq/L with a reference range of 3.4-4.5. Record review of Resident #161's [DATE] MAR dated [DATE] revealed, RN D administered only 1 dose of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 73 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Potassium 40 mEq to Resident #161 on [DATE] at 07:19 AM (over 12 hours after the critical lab value was reported). Record review of Resident #161's Hospital Record revealed, he admitted to the ED with altered mental status. Resident #161 admitted from a nursing facility in which the staff states he was in cardiac arrest and did 1 round of CPR. The fire department stated the resident had pulses and breathing on scene, with eyes open with a gaze and he was unresponsive to pain. According to EMS, they were called to the patient's nursing home due to cardiopulmonary arrest. They state that staff at the facility had told him that they found the patient unresponsive without a pulse. It is unclear what time this was or when the patient was last seen normal. According to EMS, staff had performed chest compressions for 3 minutes and had ventilated the patient with the BVM (a manual technique to deliver positive pressure ventilation to a patient who is not breathing or is not breathing adequately). No medications or defibrillation/cardioversion was performed. When EMS arrived, patient was awake and confused. In an anonymous interview on [DATE], They said Resident #161 coded in the facility in May due to a delay in treatment of a critical lab because the lab was called in under an incorrect resident who received Resident #161's critical treatment in error resulting in Resident #161 receiving delayed treatment for his critical lab value. The anonymous person said this was not the only critical lab missed but this particular incident bothered them. In an interview on [DATE] at 02:45 PM, Hospital Nurse A said Resident #161 was not in his room because he was undergoing a procedure in a different building. She said the resident initially admitted to the facility because he was unresponsive and had admitting diagnosis of heart valve replacement and cardiac issues. Hospital Nurse B said the resident was unresponsive with no pulse in the facility but once he was conscious he had seizure like activity. In an interview on [DATE] at 09:36 AM, RN D said when she came in on her morning shift on [DATE] the nurse who gave her a verbal report said Resident #162 had a critically low potassium, so he was administered potassium. She said in her experience when a resident had a critically low result the MD ordered a retest, but the reporting nurse said no such report was received, so she reviewed Resident #162's medical record and determined that the resident did not have a critical lab result for potassium but Resident #161 did. She said after further investigation she learned that both LVN T and RN A administered 40 mEq to Resident #162. RN D said she immediately called the doctor and received orders for Potassium for Resident #161 which she administered, and she notified the DON who asked for a STAT lab for Resident #161 and Resident #162. RN D said throughout the day Resident #161 was not his usual self, he was very lethargic, had slightly elevated BP, decreased O2 stats, was not trying to get out of bed and was spacing out. She said Resident #161 only ate a little bit of his lunch and around 04:00 PM when staff went to check on him, he was found unresponsive. RN D said she and her trainee nurse, RN H, immediately initiated CPR, Resident #161 recovered and was then sent out to the hospital which he remains. She said a resident potassium level was important because potassium controlled how the heart contracts. RN D said if a resident had low potassium they could go into cardiac arrest, and while she cannot say that is exactly why Resident #161 was found unresponsive the chance was high that the critically low potassium caused the resident to code. In an interview on [DATE] at 09:25 AM, RN D said on [DATE] Resident #161 was found unresponsive without a pulse in his room. She said facility staff immediately started CPR on the resident and after 1 round of CPR (30 compressions to 2 breaths) the resident came back (responsive and with a pulse). RN D said when a resident is found unresponsive nursing staff are expected to check the residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 74 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Level of Harm - Immediate jeopardy to resident health or safety pulse and activate code blue and the crash cart is brought to the resident. She said when the cart arrives, the staff are to apply the AED and then follow the prompts. RN D said she last received training on AED use with the previous management company at the end of 2024. She said she did not use the AED on Resident #161 because he came back pretty fast (after 1-2 minutes of CPR). RN D said the AED was supposed to be applied after 1 round of CPR was completed. Residents Affected - Some Resident #162 Record review of Resident #162's Face Sheet dated [DATE] at 01:58 PM revealed, a [AGE] year-old man who admitted to the facility on [DATE] with diagnosis which included: traumatic brain hemorrhage, respiratory failure, type 2 diabetes, brain injury, anxiety disorder, g-tube and dependence on a ventilator. Record review of Resident #162's Admissions MDS dated [DATE] revealed, active diagnoses included: coronary artery disease, anemia, a CVA, TIA or stroke and traumatic brain injury. Record review of Resident #162's undated Care Plan revealed, Focus- risk of aspiration due to feeding tube and episodes of inappropriate behaviors of rolling himself from the bed to floor mat pulling out his feeding tube. Record review of Resident #162 Change in Condition Evaluation dated [DATE] at 05:00 PM signed by LVN T revealed, change of condition was critical potassium level of 2.7 that started on [DATE] in the afternoon. LVN T received a call from the clinical laboratory with a critical potassium value of 2.7 and she reported the result to the Medical Director. LVNT received new orders to give 40 mEq of potassium now, another dose at night and then daily for 3 days. LVNT entered the orders into the EMR and administered the initial dose of potassium 40 mEq. Abnormal results- potassium level 2.7. Record review of Resident #162's Progress Note dated [DATE] at 06:57 AM signed by LVN T revealed, LVN T received a call from the clinical laboratory with a critical potassium value of 2.7 and she reported the result to the Medical Director. LVNT received new orders to give 40 mEq of potassium now, another dose at night and then daily for 3 days. LVNT entered the orders into the EMR and administered the initial dose of potassium 40 mEq. Record review of Resident #162's Lab Results Report dated [DATE] at 04:00 PM revealed, the result was reviewed by NP B on [DATE] at 11:11 PM. A blood sample for BMP testing was collected on [DATE] at 02:20 PM and Resident #162's potassium level was 4.5 mmol/L with a reference range of 3.5-5.2 [NAME]/L. Record review of Resident #162 Order Summary Report dated [DATE] revealed: - Potassium give 40 mEq via G-tube one time only for critical potassium level for 1 day. - Potassium give 40 mEq via G-tube at bedtime for critical potassium level - Potassium give 40 mEq via G-tube one time a day for critical potassium level for 3 days. Record review of Resident #162 May [DATE] dated [DATE] at 01:59 PM revealed, Resident #162 received Potassium 40 mEq on: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 75 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 - [DATE] at 06:33 PM administered by LVN T. Level of Harm - Immediate jeopardy to resident health or safety - [DATE] at 09:00 PM administered by RN A. Record review of Resident #162's Clinical Results on [DATE] at 02:01 PM revealed, Resident #162 had no labs were collected on [DATE] and no results for critical potassium were reported on [DATE]. Residents Affected - Some In an interview on [DATE] at 03:50 PM, RN A said she did not administer Potassium 40 mEq to Resident #162. In an interview on [DATE] at 07:28 PM, LVN T said she was not aware she made a med error with Resident #161 and Resident #162. She said when nurses received a critical lab result, they are expected to notify the NP in order to receive new orders for treatment. LVN T said she would report the CIC to the RP, enter the new orders into the EMR and notify the ADON. She said critically low potassium could place residents at risk for a cardiac event and all critical lab result should have immediate interventions in place because the resident could experience an adverse event, or the resident could die. After LVN T looked through the EMR she confirmed that she was documented as receiving the critical lab call from the lab on [DATE], she entered the order for potassium into Resident #162's chart and she administered potassium to Resident #162. LVN T said she did not remember a med error incident on [DATE] as that was her first day working over here, no one ever talked to her about the incident, and she never received any re-training or in-service related to this incident. In an interview on [DATE] at 05:06 PM, the DON said there was a medication error when Resident #161's labs were attributed to Resident #162 and the wrong resident was treated for critically low potassium. She said the facility investigation revealed LVN T made the med error. The DON said when a resident has a critical lab value nursing staff must follow the critical labs pathway, notify the MD/NP, and follow through as ordered. She said low potassium can impact heart muscle contraction, leading to cardiac arrest if response is delayed. In an interview on [DATE] at 11:42 AM, NP A said she was unaware that Resident #161 coded in May nor was she aware that Resident #162 received potassium in error. She said when the facility is notified of critical labs, nursing staff are expected to call them into the MD/NP as soon as possible but sometimes she did not receive a call but instead found out about resident abnormal labs during chart review. NP A said critically low potassium can present as elevated heart rate, lethargy, seizures, and result in cardiac arrest. In an interview on [DATE] at 10:53 AM, the DON said she completed an investigation into the incident, discussed the incident with LVN T and completed an incident report. She said she did not remember if she in-serviced nursing staff in regards to medication errors and handling critical labs. The DON said she did not remember if any interventions were put into place after [DATE] to ensure the medication error incident would not occur again. In an interview on [DATE] at 12:04 PM, the Medical Director said she does not remember if LVN T associated the critical lab with the wrong resident when she was notified of the incident. She just remembered she was notified that potassium was given to the incorrect patient, so she gave orders for labs, but she could not say which resident received potassium in error or which resident was supposed to receive the medication. The Medical Director said she was sure she discussed the medication error with the facility administration, but she did not know what interventions were put into place following the incident. The Medical Director would not say what a delay in care of critically low (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 76 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Level of Harm - Immediate jeopardy to resident health or safety potassium would place residents at risk of as she would not attest to hypothetical situation. She said she would like notification and treatment immediately when a resident had a critical lab, but she could not say what the expected time was because it was a hypothetical situation. An observation on [DATE] at 06:15 PM revealed, Resident #162 in bed in no immediate distress. He was connected to a ventilator and received continuous enteral feeding via a G-tube. Residents Affected - Some In an interview on [DATE] at 06:28 PM, NP B said she worked with the facility contracted medical practice. She said when nursing staff received notification of a critical lab, they are expected to notify the provider and initiate treatment immediately. NP B said critical potassium could present differently in residents, but the resident could be confused, have flaccid muscles (muscles that are weak and lacking firmness) and/or cardiac arrest. She said a relay in treatment of critically low potassium with oral potassium could result in arrythmia and cardiac arrest so treatment should be immediate within minutes. NP B said administration of potassium over 12 hours after staff were notified of a critically low potassium level would not be acceptable because of all the symptoms previously discussed. Resident #31 Record review of Resident #31's Face Sheet dated [DATE] revealed, a [AGE] year-old male who initially admitted to the facility on [DATE] and readmitted on [DATE] after a short-term hospital stay with diagnosis which included: chronic respiratory failure, cardiac arrest, cerebral palsy, anxiety disorder, contracture and epilepsy ( a brain disorder characterized by recurring seizures due to abnormal electrical activity in the brain. Record review of Resident #31's Quarterly MDS dated [DATE] revealed, the resident had no speech, had severely impaired cognitive skills for daily decision making, had Aphasia (inability to speak), cerebral palsy, seizure disorder or epilepsy and traumatic brain injury. Record review of Resident #31's undated care plan revealed, focus- risk for increased episodes of seizure activity and injury due to his diagnosis of epilepsy; interventions- give medications per order. Record review of Resident #31's Progress Note dated [DATE] at 11:25 PM revealed, resident readmitted to the facility at 07:30 PM from a hospital. Medications were reconciled with the NP, and the DON was notified of the resident's arrival. There is no documentation of the resident not receiving his evening dose of medication. Record review and audit of the facility 24-hour Summary dated [DATE] at 08:15 AM revealed, Resident #31 admitted to the facility on [DATE] and exceptions were triggered for his medication order administration on [DATE] for: Clonazepam 0.5 mg at 09:37 PM, Clotrimazole 1% Cream at 09:38 PM, Lacosamide 100 mg at 09:38 PM and Midodrine 2.5 mg at 11:00 PM. Record review of Resident #31's Order Summary Report dated [DATE] revealed, Lacosamide 100 mg- give 100 mg via G-tube every 12 hours related to epilepsy; Clonazepam 0.5 mg- give 0.5 mg via G-tube every 12 hours for seizure management; meropenem IV solution- 500 mg IV every 6 hours for pneumonia. Record review of Resident #31's MAR for June printed [DATE] revealed, on [DATE] Resident #31 did not receive: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 77 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 - Meropenem 500 mg IV solution scheduled for 08:00 PM Level of Harm - Immediate jeopardy to resident health or safety - Lacosamide 100 mg scheduled for 08:00 PM. Residents Affected - Some - Clotrimazole 1% cream to his stoma scheduled for 09:00 PM. - Clonazepam 0.5 mg scheduled for 08:00 PM. - Midodrine 2.5 mg scheduled for 11:00 PM. Record review of Resident #31's MAR for June printed [DATE] revealed, on [DATE] Resident #31 did not receive: Meropenem 500 mg IV solution scheduled for 10:00 AM Record review of the facility provided audit of the 24-hr. report on [DATE] revealed, Resident #31 readmitted on [DATE] and he was to start meropenem antibiotics, there is no mention of the missed doses of medication. Record review of the pharmacy automated dispensing system Content List provided on [DATE] at 12:24 PM revealed the system contained: - Clonazepam 0.5 mg with a minimum quantity of 3 and maximum quantity of 8 - Meropenem 1 g and 500 mg. Record review of the pharmacy provided Transaction Report for the automated dispensing system dated [DATE] revealed, on [DATE] at 07:34 AM RN D retrieved a vial of Meropenem antibiotics for Resident #31. In an interview on [DATE] at12:28 PM, the DON said when a resident readmits to the facility from a hospital stay the admitting nurse performs medication reconciliation, enters the orders in the EMR and the pharmacy delivers the medications. She said if a resident's medication had not arrived from the pharmacy staff can pull the first dose from the automated dispensing system which contained both non-controlled and controlled substances. She said the resident's first dose of medication would be determined by the last dose that was given and documented in their hospital discharge medication list. The DON said Resident #31 readmitted to the facility yesterday ([DATE]) and returned on antibiotics, but when he was transferred to the hospital his narcotics were taken of the nursing cart and locked in her office. She said Resident #31 was diagnosed with pneumonia and ordered Meropenem antibiotics for 3 or 4 days. The DON said even though Resident #31 was discussed in the facility morning clinical meeting, she was unaware that he had not received his seizure and antibiotic medication last night or his antibiotic early this morning until it was mentioned by the surveyor. She said it is important that residents receive their seizure meds on time because it keeps the drug level in a safe range which prevents and controls seizures; and antibiotics frequency must be maintained to keep the concentration of the drug at the right level. The DON said Resident #31's missed doses of seizure and antibiotic medications could place him at risk of seizures, promote bacterial drug resistance and continued growth of bacteria, leaving his pneumonia untreated resulting in difficulty breathing. An observation on [DATE] at 12:45 PM revealed, Resident #31 in bed receiving breathing assistance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 78 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some via a tracheostomy and continuous enteral feeding via a g-tube. The resident was non-interviewable and appeared to be no immediate distress. In an interview on [DATE] at 12:48 PM, RN D said Resident #31 readmitted to the facility last night ([DATE]) with a diagnosis of pneumonia. She said Resident #31 did not receive his medications last night, his Lacosamide or Clonazepam was not administered last night because they were locked in the DONs office and his Meropenem was not administered during the 6PM to 6AM shift because RN A did not have access to the automated dispensing system. She said when she arrived this morning, she retrieve the IV antibiotic from the automated dispensing system and administered it to the resident. RN D said she contacted the DON at 07:12 AM to ask her about Resident #31's seizure meds and the DON said the medications were locked in her office, but she would be in the facility shortly. RN D said the DON arrived at the facility at approximately 08:00 AM and shortly thereafter she administered Resident #31 his Lacosamide and Clonazepam. RN D said failure to administer seizure medications timely is a critical error because it could cause seizures which can result in brain damage. In an interview on [DATE] at 03:50 PM, RN A said she became a full-time nurse at the facility 2 months ago. She said on [DATE] she received report that Resident #31 was readmitting back to the facility, but he arrived late. RN A said she was Resident #31's admitting nurse when he arrived at night on [DATE], she performed his admission assessment, called the doctor to reconcile medications and entered the orders into the chart. She said when Resident #31 arrived he was ordered IV antibiotics four times a day, but the medication had not arrived from the pharmacy. RN A said she checked the medication room for his controlled substances (Lacosamide & Clonazepam), but they were not there, so she administered his other medications and check his blood sugar. She said Resident #31 did not receive his seizure and antibiotic medications because she cannot borrow medications from another patient, and she did not get the IV antibiotics from the automated dispensing system because she does not have a code to access the system. RN A said she never received access to the automated dispensing system because she worked at night and would not answer what the facility's expectations were when resident medications were unavailable, but she did not notify the doctor because the resident was not new to the facility, and she did not contact the DON because it was late late. In an interview on [DATE] at 05:06 PM, the DON said the facility had an automated dispensing system that nursing staff should get first doses of medication prior to resident medication delivery from the pharmacy. She said the automated machine had a list of medications in the machine that are stocked by the pharmacist and when a nurse dispensed medications from the machine a pharmacist restocks it as needed and scheduled. The DON said all nurses and nurse management should have access to the automated dispensing system, but she just learned that RN A did not have access. She said RN A was never trained on how to use the automated system, all nurses working on the floor should have access and it was an oversight that RN A never had access. The DON said on [DATE] Resident #31 did not receive his meropenem or controlled substance seizure medications. Record review of the facility policy titled Reconciliation of Medications on admission revised 07/2017 revealed, General Guidelines 1.Medication reconciliation is the process of comparing pre-discharge medications to post-discharge medications by creating an accurate list of both prescription and over the counter medications that includes the drug name, dosage, frequency, route, and indication for use for the purpose of preventing unintended changes or omissions at transition points in care. 2. Medication reconciliation reduces medication errors and enhances resident safety by ensuring that the medications the resident needs and has been taking continue to be administered without interruption, in the correct dosages and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 79 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some routes, during the admission/transfer process. 3. Medication reconciliation helps to ensure that all medications, routes, and dosages on the list are appropriate for the resident and his/her condition, and do not interact in a negative way with other medications/supplements on the list. 4. Medication reconciliation helps to ensure that medicati9ns, routes and dosages have been accurately communicated to the Attending Physician and care team. An IJ was Identified on [DATE]. The Administrator was notified of the IJ, and the template was provided to the facility on [DATE] at 04:36 PM. The following Plan of Removal submitted by the facility was accepted on [DATE] at 03:39 PM. [DATE] F760 Introduction: On [DATE], at 4:36pm, an Immediate Jeopardy was identified due to a critically low potassium of 2.7 by reporting it under an incorrect resident, resulting in a medication error and delay in treatment. All current residents could be at risk of having a change of condition and have the potential to be impacted by this deficient practice. As a result of the IJ the facility has implemented the following. 1. Administrator, DON and ADON were in-serviced by Chief Nursing Officer on the following Healthcare regarding resident changes in condition, follow-up, staff reporting of incidents and changes in condition and notifying the medical director and or designated on call provider Admin, DON and ADON in-serviced on the need for increased staff education and monitoring including new hires and agency staff. All verbalized understanding. In service completed on [DATE]. The facility nurse receiving the results will ensure that the correct resident and medical provider have been identified, a second nursing staff member will double-check that the correct results have been attached to the correct resident. Facility will contact the correct physician and communicate the results, and obtain orders. RNs and LVNs were trained on this process on [DATE]. Additional training is in process and will be completed [DATE]. Staff will not be allowed to work if they do not complete the training. 2. Facility reviewed policies and procedures prior to in-services. Polices reviewed include medication pass, change in condition, clinical lab protocol. No changes were made to policies, as a result of the initial review. 3. Administrator, DON and ADON completed the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 80 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 a. Level of Harm - Immediate jeopardy to resident health or safety The facility DON and ADON on [DATE] at 5:00pm implemented the following: All on duty nurses staff were in-serviced on the following by DON and ADON. i. Residents Affected - Some MD notification of change in condition, including change in mental status/alertness to include critical labs, ii. Notification of DON/ Administrator of any change in condition. iii. Resident follow-up monitoring iv. Monitoring residents for change in conditions. b. Signs/Symptoms of Resident change of condition to include but not limited to: i. mental status, ii. critical lab values iii. changes in breathing iv. unarousable while sleeping, v. changes to pupils vi. inability to/or refusing to eat, drink or take medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 81 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0760 vii. Level of Harm - Immediate jeopardy to resident health or safety Documentation Residents Affected - Some Facility also conducted additional in-services on Abuse, neglect, and exploitation. 4. a. Abuse, neglect and exploitation. b. Documentation c. Medication administration and medication error training, d. Physician notification. Staff will verify that the correct provider is being notified as per the resident chart. Staff will make phone notifications and will not use other methods of communication such as text or email. Facility will continue to in-service as needed. Initial trainings will be FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 82 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to ensure in accordance with State and Federal laws, all drugs and biologicals were stored in locked compartments under proper temperature controls and permitted only authorized personnel to have access to the keys for 3 of 5 medication carts (Hall A Nursing Cart, Hall A & B Nurse Cart and RT Cart ) reviewed for medication storage . - The facility failed to ensure the Hall A & B Nursing Cart did not contain loose pills. - The facility failed to ensure the Hall A Nurse Cart did not contain open and in-use insulin pens with no open date. - The facility failed to ensure the RT Cart was not left unlocked when unattended. These failures could place residents at risk of adverse reactions to medications, misappropriation of medications, and injury. Findings include: Hall A & B Nursing Cart In an observation and interview on 04/16/25 at 12:07 AM, inventory of the Hall A & B Nurse Cart with RN D revealed 8 loose pills. RN D said nursing staff are expected to check their carts daily as used for inappropriately labeled medication or lose pills. She said all medications are expected to be packaged in the original pharmacy packaging containing all the required pharmacy labels or in the OTC stock bottles to ensure patient safety. She said if mistakenly administered loose pills could place residents at risk of catastrophic side effects since their identification is unknown so they must be crushed and discarded in the sharp's container. Hall A Nurse Cart In an observation and interview on 04/16/25 at 12:24 AM, inventory of the Hall A Nurse Cart with RN F revealed: - An open and in-use HumaLOG Insulin pen for Resident #20 with pharmacy fill date of 02/08/25 and no open date. The pharmacy label read High Alert. Refrigerate until opened. Once opened store at room temperature for 28 days. - An open and in-use Novolin R Insulin pen for Resident #38 with pharmacy fill date of 03/04/25 and no open date. The pharmacy label read: once opened refrigerated or not product must be used within 28 days. - An open and in-use HumaLOG Insulin pen for Resident #109 with pharmacy fill date of 04/12/25 and no open date. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 83 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some RN F said multidose containers should be labeled with the date when opened in order to track the expiration date. She said if a multidose container like insulin did not have an open date, it could be expired. RN F said when insulin expired is can become ineffective and could place residents at risk of uncontrolled blood sugars if administered. In an interview on 04/20/25 at 09:07 AM, the ADON said nursing staff are expected to check their carts daily for loose pills and inappropriately labeled medications. She said all medications should be stored in their original containers. The ADON said multidose containers should be labeled when open with the date in order to track the expiration date and if an insulin pen does not have an open date, it should be considered expired. The ADON said when insulin expires it could have a change in potency so it should be pulled from use and discarded in the sharp's container. She said the use of expired medications or lose pills could place residents at risk of adverse reactions, infection from contamination or uncontrolled health conditions. RT Cart An observation and interview on 04/22/25 at 05:05 AM, revealed 2 unattended and unlocked medication carts (RT Cart) against the wall across from the nursing station between the A & B Halls. The keys to the RT cart was observed on top of the cart but the RT was not in sight. In an observation and interview on 04/16/25 at 05:09 AM, inventory of the RT cart located on Hall A with RT A revealed: Drawer 2- a box of 20% acetylcysteine ( a medication used to thin out mucus), and other respiratory supplies Drawer 3- At least 21 boxes of varied Resident labeled boxes of prescription only inhalation solution including ( Ipratropium and Albuterol, Albuterol, Fluticasone, Budesonide) RT A said his cart should be locked at all times, with the keys on his person to prevent unauthorized access to the contents of his cart. He did not answer as to why he left his keys on top of his cart but said unauthorized access to medications and supplies in the RT cart could place residents at risk of ADRs. In an interview on 04/24/25 at 09:45 AM, the DON said nursing carts are expected to be locked when not in use and the keys should not be left unattended. She said failure to maintain locked med carts could place residents at risk of med errors and adverse reactions. Record review of the facility policy Security of Medication Cart revised 04/2007 revealed, 1- The nurse must secure the medication cart during the medication pass to prevent unauthorized entry. 4- Medication carts must be securely locked at all times when out of the nurse's view. Record review of the facility policy Administering Medications revised 12/2012 revealed, 9- The expiration/beyond use date on the medication label must be checked prior to administering. When opening a multi-dose container, the date opened shall be recorded on the container. Record review of the facility policy Storage of Medications revised 04/2017 revealed, the facility shall store all drugs and biologicals in a safe, secure and orderly manner. 1- drugs and biologicals shall be stored in the packaging, containers, or other dispensing systems in which they are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 84 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some received. 2- the nursing staff shall be responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. 7- Compartments (including, but not limited to, drawers, cabinets, rooms, refrigerators, carts and boxes.) containing drugs and biologicals shall be locked when not in use, and trays or carts used to transport such items shall not be left unattended if open or otherwise potentially available to others. 10- Only persons authorized to prepare and administer medications shall have access to the medication room, including any keys. Record review of the facility policy Labeling of Medication Containers revised 04/2019 revealed, all medications maintained in the facility are properly labeled in accordance with current state and federal guidelines and regulations. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 85 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Administer the facility in a manner that enables it to use its resources effectively and efficiently. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure it was administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being for the entire facility which included: 2 residents who experienced abuse (Resident #113 & Resident #114), 3 residents who experienced problems with services for treatment and services for mental and psychosocial concerns (Resident #30, Resident #42 & Resident #52); 2 resident who experienced repeated G-tube dislodgement (Resident #18 & Resident #33); 2 residents who experience problems with ADL care (Resident #28 & Resident #109), 3 residents who experienced significant medication errors and problems with quality of care (Resident #161, Resident #162, Resident #163); pharmacy services & physical environment reviewed for administration. Residents Affected - Many - Facility administration failed to have an effective system that identified and put interventions in place to address residents with escalating behaviors leaving residents in distress, suffering from suicidal ideation, attempting suicide, fighting police officers and staff, having guns drawn on them by police, attempting to pull police officers guns and being forcefully restrained by police and removed from the facility. - Facility administration failed to have an effective system that identified and put interventions in place to address residents with repetitive behaviors of pulling on and out their gtube that resulted in dislodgment, hospitalization for replacement and head injury from an IV pole falling on their head. - Facility administration failed to have an effective system that identified and put interventions in place to address residents with repetitive verbal aggression, physical aggression, and sexually inappropriate behaviors. - Facility administration failed to have an effective system in place to ensure that critical supplies needed for CPR were maintained and staff were provided CPR to residents per the facility policy. - Facility administration failed to have an effective system that identified: medication errors, delay in care after critical labs were reported incorrectly, delayed administration of medications upon readmission; and failed to put in interventions in place to prevent such occurrences from repeating. - Facility administration failed to have an effective system that ensured plan of corrections from previously cited visits were followed which resulted in residents not receiving proper ADL care, delay in resident laundry services and the facility left unsafe/disrepair with loose floor tiles, unsecure toilets, and sinks. - Facility administration failed to have a system in place to ensure there was a RN on duty to provide care to the residents every day between 10/2024 and 03/2025. - Facility administration failed to maintain vendor services for drug destruction due to non-payment resulting in expired medications building up in the medication rooms and being mixed in with current medications. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 86 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety An IJ was Identified on 05/06/25 was called on 06/03/25 . The template was provided to the facility Administrator on 06/03/25 at 11:51 PM. While the IJ was removed on 06/19/25 the facility remained out of compliance at a scope of widespread and a severity level of no actual harm that was not immediate due to the to the facility's need to evaluate the effectiveness of the corrective systems. Findings included: Residents Affected - Many Resident #30 Record review of Resident #30's Face Sheet dated 05/02/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: spinal cord injury, anemia, nicotine dependence, Schizoaffective disorder (a mental health condition that combines symptoms of schizophrenia and a mood disorder, such as depression or bipolar disorder), bipolar disorder (mental health condition characterized by extreme mood swings, ranging from periods of intense happiness or irritability (mania or hypomania) to periods of deep sadness or despair) with sever psychotic features (hallucinations (seeing or hearing things that aren't real), delusions (false beliefs), and disorganized thinking) and paraplegia( paralysis of the legs and lower body, typically caused by a spinal cord injury). Record review of Resident #30's previous facility Progress Notes dated 12/26/24 at 02:21 PM revealed, Resident says she is hearing things and people talking about her. She is under mental distress. She is wanting to go to the psych hospital. Resident stated she no longer wanted to be here. Record review of the Resident #30's Quarterly MDS revealed, intact cognition as indicated by a BIMS score of 14 and use of antipsychotic medications during last 7 days. There were no evidence of an acute change in mental status, and no behaviors present. She had no potential indicators of psychosis such as hallucinations or delusions. Record review of Resident #30's undated Care Plan revealed, focus- history of being resistant to care at times and is at risk for injury; intervention- approach in a calm manner, talk while giving care. Focus- taking psychotropic medications and is at risk of adverse reactions and (depression, anxiety, and/or psychosis driven behaviors; interventions- monitor for psychosis driven behaviors such as aggressiveness, combativeness, manic episodes, observe and record any displayed behaviors or mood problems. FocusResident #30 verbalized suicidal ideations and became physically aggressive with police related to her diagnosis of bipolar and or anxiety, date initiated 04/13/25; interventions- provide medications as ordered, resident will be assisted with discharge planning as when needed, resident will be referred to inpatient geri psych placement as when needed, call 911 with request for the mental health team as/when needed. Record review of Resident #30's Progress Notes from 12/31/24 to 05/02/25 revealed : 01/01/25- EMS arrived at facility stating they received phone call from facility. This nurse was notified by CMA that this resident called EMS. Resident states that she is not feeling well and wants to go to the Hospital. Resident did not notify this nurse that she was not feeling well prior. Resident called EMS instead. EMS assessed resident. No abnormal findings. EMS spoke with resident about receiving care in facility before calling 911. Resident continues to state that she wants to go to the hospital. 01/02/25- Resident called 911 for pain pill when her pain was just due to be given to her, every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 87 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety effort to advise her to take her pain pill yield no result as she wants to go to hospital, NP made aware, administrator made aware, resident insisted on going to hospital, picked up in stable condition. 01/12/25- Note Text : On rounds at 7:04am resident did not complain of any discomfort, distress, or concerns, noted vaping in the room, was educated by this nurse that vaping is not proper and not allowed in the room, resident did not listen, but continue vaping. At about 7:54am, 911 ambulance Residents Affected - Many arrived facility stated resident called them, complained of pain to lower back, sediment in urine, and brown urine output. Resident has UA result and labs pending ,this explained to resident Norco 5-325mg offered, resident refused, and still insisted going with 911 to the hospital, transferred by 911 to hospital ,per resident request. Resident is self-RP.NP notified. 01/22/25- SW informed nurse that resident was seen by Psych services today and was told that resident may be going through a manic episode. Resident is currently in bed with NAD. Given PRN pain medication. resident has no plan to harm herself stayed she is just little down today. MD informed stated to monitor for now and call her for any changes. 01/24/25- Resident informed SN that she called 911 due to pain on her lower back. Education provided on pain management such as other ways to manage pain without medications such as deep breathing, exercise , music therapy and others , resident verbalized understanding but still want to get stronger medication . NP notified . patient has been medicated with Norco Tablet 5-325 MG every 4 hours as needed, last one was at 1034am. Sn will continue to monitor. 01/31/25- Resident signed herself out after requesting (2) cigarettes. Resident was then transported to the ER by ambulance. Family notified. DON Notified. 02/01/25 at 08:01 AM- Resident requested cigarette, received her cigarette, signed out to go smoke out front where she then called 911 and requested transport. Resident would not specify where she wanted to be transported to. 911 arrived around 0710 and took resident on a stretcher to the ER. 02/01/25 at 03:15 PM- Resident returned from the hospital . Resident still appears anxious upon return and immediately returned to nurses' station to sign out with (4) cigarettes as of 0325 resident is signed out of the facility. 02/13/25 at 10:49 PM- Resident called 911 by herself twice this evening at 7:30pm and 9:40pm stating that she wants to go to the hospital because she is having spasms. Charge nurse informed her that he can notify her doctor and see if she can be given some new orders, but she refused. EMS arrived the first time and resident refused to go to the hospital they intended to transport her to. The second time the EMS arrived and took resident to Hospital at 10:00pm. 02/24/25- Note Text: At 21:30 hrs (09:30 PM), resident called the EMS via 911, requesting to be taken to the emergency room due to spasm and pain. Resident had already received her scheduled pain medication (Norco) at 20:00 hrs. Resident had not complained to Charge Nurse about being in pain prior to her calling 911, and charge nurse was not aware that she had called EMS 911 until the emergency personnel showed up in the unit. Resident was taken to the emergency room as she requested by the EMS technicians at 21:40 hrs. 03/02/25- Resident complains of hearing voices making fun of her, she said had been going on for a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 88 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety while now, she stated that she did not complain initially because she thought they might go away, but they getting louder, depriving her sleep. This morning observed resident in her sleep saying, stop stop stop. Resident also have diagnosis of schizophrenia and mild sleep disorder.NP notified, order received to consult psych. Order carry out. 03/08-25- Resident called EMS via 911, and they took her to the hospital at 18:45 hours for complaint of Residents Affected - Many pain. Resident's emergency contact family member' and facility DON notified. 03/19/25- Resident came to Charge nurse and requested for her nightly medication to be administered to her, which was done. After taking her medications, she informed the Charge Nurse that she had called 911 so she can be taken to the hospital due to pain. Charge Nurse advised resident to give her pain pill (Norco) which she just took, time to become effective but she refused, insisting to go to the hospital. Charge nurse noted ant acute distress on resident both in her speech and behavior. Resident then wheeled herself in her wheelchair to the reception area awaiting the arrival of EMS ambulance. Upon arrival to the facility, the EMS personnel spoke briefly with resident and loaded her on their stretcher without asking the charge nurse any questions or informing him where they were taking resident to. When charge nurse inquired from them where they were taking resident to, they simply told him the hospital name and continued on. Facility Director of Nursing was notified. 03/22/25 T 05:53 AM- Behavioral Note-Resident removed her brief after ADL change claimed is too big despite the brief been her size and the large size that could be used for her. 03/22/25 at 10:09 AM- : Resident was observed alert and oriented with behavior, screamed , yelled, took clothes off. Attempted to talked to resident several times with no effect. NP. was notified order given Alprazolam 0.5mh twice a day for fourteen days for anxiety. 04/13/25 at 01:39 AM signed by LVN H- Patient called 911 at 11:00pm and had been disturbing other patients from sleeping. The two EMS that came refused to take her to hospital stated she has no good reason to go to hospital. Patient received all her pain med and other prescribed med, throwing stuff on the floor including her phone. Patient is threatening to kill herself. Nurse notified the physician, DON, and Administrator. 04/13/25 signed by SW- SW informed per staff that this resident had verbalized wanting to kill herself. SW visited with this resident, and she verbalized I tied something around my neck but, I could still breathe. I want my Xanax back. I want my Xanax back. I am going to get my Xanax back. SW attempted to contact resident's [family member], , unable to reach and voicemail full. Resident began to yell and scream as she exited the office. Staff was present to maintain visual of her per SW request while 911 contacted with a request for the Mental Health Response team. Upon 911 arriving officer was provided with the aforementioned information. He spoke with resident, and she informed him that she wanted to kill herself. He called for assistance and another officer arrived whom also spoke with resident and then SW observed resident began to hit the officers resulting in them restraining her until approximately 4 more officers arrived. SW was informed per that she was being transported to Hospital and that the District Attorney would be contacted but they were doubtful any criminal charges would be filed against her. SW informed the DON and LNFA and was able to contact her [family member] and informed him. He verbalized understanding. Care Plan updated to reflect. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 89 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many Record review of Resident #30's Hospital Progress note dated 04/22/25 at 01:22 PM revealed, Resident #30 continued to throw tantrums and screamed, covering her face with her pillow. The resident was requesting IV pain medication. Record review of Resident #30's Hospital Progress note dated 04/23/25 at 12:01 PM revealed, Resident #30 continued to throw tantrums and requested IV pain medication despite being notified that she was on oral pain medication. Record review of Resident #30's Hospital Psychiatric Consultation note dated 04/24/25 at 12:00 AM, revealed Resident #30 had bipolar disorder with discrete periods of mania and discreet periods of depression. She had poor impulse control and a history of PTSD and had attempted fake suicide in the past on multiple occasions by either choking herself or overdosing on medications. Resident #30 had a history of ideas of persecution, thinking that people were going to hurt her or that something negative was going to happen to her. Resident #30 had a history of auditory hallucinations commanding her to wrap a cord around her neck or to overdose on Seroquel. In the past Resident #30 contemplated starting a fire in her apartment following the command of the voices she heard, and she wished she had a weapon to hurt hospital or nursing staff. Resident #30 was admitted to a behavioral hospital in February of 2021 and in November of 2023 she was admitted to the hospital after typing a collar on her neck to kill herself. Record review of Resident #30's Hospital Progress note dated 04/24/25 at 11:52 AM revealed, Resident #30 called 911 from her hospital room and pretend to sleep when the MD entered her room. Record review of Resident #30's Progress Notes on 05/01/25 at 02:48 AM revealed, Note Text : Resident called EMS and requested to be taken back to the hospital for evaluation. Resident indicated to EMS personnel that she feels nauseated, dehydrated, and is not getting enough pain medications. Resident had not complained to Charge Nurse about any of these concerns tonight. Resident had received her nightly medications as ordered, including her PRN Norco pain medication. Charge Nurse offered to call resident's PCP to see if there may be any new orders, but she refused, stating her preference to go to the hospital. Upon resident's insistence to go to the hospital, EMS personnel took her to hospital. Record review of Resident #30's Order Summary Report that included all orders since admission on [DATE] and printed 05/02/25 at 01:50 PM revealed, Resident #30 had no behavior monitoring and behavior intervention orders. Record review of a 30-day lookback of Resident #30's Behavior Monitoring and Interventions dated 05/09/25 revealed, no documented behaviors observed prior to 05/09/25. On 05/09/25 at 10:30 AM Resident #30 was screaming and expressed frustration and angers at others. An observation an interview on 05/02/25 at 01:12 PM revealed, Resident #30 sitting in a wheelchair at the nursing station. There were other residents around her and no nursing staff within 15 feet on both sides of the nursing station. The resident said she just returned to the facility from the hospital, and she felt better now. Resident #30 said the voices got too loud so she hit herself in the face and tied a pillowcase around her neck to harm herself to stop the voices, but she could still breathe. As Resident #30 talked to the surveyors she swayed left to right & back and forth in her wheelchair. Resident #30 said she did not notify any staff of the voices prior to trying to harm herself but when she went to the hospital, they fixed her meds, so she did not hear the voices anymore and she did not want to harm herself. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 90 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many In an interview on 05/02/25 at 12:33 PM, the SW said Resident #30 was young and had obsessive drug seeking behaviors r/t to complaints of significant pain. She said the resident would call the police 1-2 times a week and had been hospitalized at least 6-7 times since admission. The SW said Resident #30 always yelled at staff and yelled to go to the hospital. The SW said in April she was notified that Resident #30 wanted to hurt herself. She said she first talked to the resident on the phone and then again when she arrived at the facility. The SW said Resident # 30 told her she tried to hurt herself by tying something around her neck, but she could still breathe, the resident became loud and said she was going to hurt herself, so she called 911 for a mental health response team. She said when the police arrived Resident #30 wheeled herself away from them down the hallway as they spoke to her and when both police officers approached her, Resident #30 started to scream and fought the police. The SW said Resident #30 attacked the police, the police tried to restrain her, the police drew then their guns and pointed them at the resident and Resident #30 was eventually handcuffed. She said Resident #30 was a risk to other patients because of her unpredict ableness. In an interview on 05/02/25 at 01:05 PM, MA C said Resident #30's normal behaviors included verbal aggression/yelling towards staff and other residents. She said the resident propels herself around the facility in her wheelchair cursing and yelling. She said the resident was not on any increased behavioral monitoring, not on 1-on-1 monitoring and was not safe to be in a room with others. In an interview on 05/02/25 at 01:21 PM, LVN J said Resident #30's regular behaviors included yelling and screaming at others. She said Resident #30's former roommate, Resident #22, was scared of her because of her yelling and screaming In an interview on 05/02/25 at 01:27 PM, Resident #22 said she was scared by her former roommates yelling and screaming, She said Resident #30 yelled and screamed at night, startling her. In an interview on 05/02/25 at 01:27 PM, Anonymous A said Resident #30's regular behaviors included yelling/screaming and calling Anonymous A out of her name. Anonymous A staff said Resident #30's behaviors were towards anyone including residents and staff. Anonymous A said in one incident Resident #30 was screaming and she came down the hallway in her wheelchair with no clothes on. Anonymous A said last April, the social worker called the authorities because of Resident #30's behaviors and when they arrived, Anonymous A saw the resident attempt to pull the police officer's firearm. Anonymous A said Resident #30 liked to yell, scream and throw stuff at people and it makes Anonymous A antsy. In an interview on 05/02/25 at 01:36 PM, the MDS Nurse said she did not know Resident #30 had a history of attempted suicide or aggressive behaviors. She said the resident was always nice, but she liked to go to the ER on a weekly basis since arriving in the facility. The MDS nurse had she known of the resident's behaviors she would have included it in her care plan. In an interview on 05/02/25 at 02:04 PM, the Psychiatric NP said Resident #30 had a lot of anxiety and would call 911 often. She said the resident seemed hyper-manic and had racing thoughts. The Psychiatric NP said no one notified her that the resident was aggressive, she was unaware that the resident yelled at others, but she could believe Resident #30 rolled down the hall naked because the resident was always inappropriately dressed in her room. The Psychiatric Nurse said the resident had never shown any signs of suicidal ideation, or that she heard voices, but Resident #30 expressed anxiety and depression. She said she was unaware of Resident #30's previous history of suicide attempts, and she would have to review the hospital notes because based on what was discussed the resident's behaviors were more severe. The Psychiatric NP said Resident #30 should have a lot more monitoring by the staff and she did not know why the resident never communicated any of these issues with her. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 91 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many said she had not read Resident #30's readmission clinicals from 04/3025 but she assumes the resident is safe since she was discharged . The Psychiatric NP said based on Resident #30's behaviors she was not a safe person, and she expected the resident to have frequent assessments, close monitoring, increased therapy visits and should be encouraged to verbalize her feelings. She said Resident #30 needed additional monitoring to make sure nothing occurs. In an interview on 05/02/25 at 02:22 PM, the DON said prior to readmission she or her designee are supposed to receive and review the resident's hospital clinicals, but she did not, she said she thought the admitting nurse did. The DON said to her knowledge Resident #30 was not having behaviors in the hospital and since her return there had been no medication changes. She said since the resident returned to the facility there have been no interventions in place beyond the standard shift monitoring and based on her documented history of behaviors Resident #30 was not safe to be in a room with Resident #18 who was unable to communicate. In an interview on 05/02/25 at 02:27 PM, the Administrator said she did not know about Resident #30's aggressive behaviors or significant history of suicide, all she knew was that the resident would go to the hospital often. She said now that she knew the contents of the hospital psych consult notes and the resident's history of attempted suicide, the resident should be placed on 1on1 monitoring for at least 72 hours, because she was a resident safety risk having her unsupervised and ambulating in her wheelchair around the facility. In an interview on 05/02/25 at 02:37 PM, CNA T said in April she saw the police go towards the SWs office and then Resident #30 came down the hallway in her wheelchair. She said at first the police were talking to Resident #30, when she started yelling and screaming so the police tried to restrain the resident at which point Resident #30 attempted to pull the police officers firearm. CNA T said prior to the incident in April, Resident #30's regular behaviors included rolling around the facility in her wheelchair yelling/screaming/cursing at other residents and staff. In an interview on 05/02/25 at 02:46 PM, LVN T said she was the nurse scheduled when Resident #30 arrived at the facility, but she was on break, so the resident was already in the room when she returned. She said upon readmission Resident #30 had been roaming the facility unattended asking for cigarettes and pain medications. LVN T said in April she observed Resident #30 come out of SWs office screaming fuck you and the SW called 911 mental health. She said when the police talked to Resident #30, she said she was not suicidal but had attempted suicide the night before. LVN T said Resident #30 rolled away from the police, started fighting the police and when they attempted to restrain the resident grabbed their handcuffs and she heard the police say, let go of the gun. She said the SW thought they were going to shoot Resident #30, so she told her to get out of the way for safety. LVN T said more police arrived and then the ambulance took the resident away. LVN T said Resident #30's behaviors included hollering/yelling at people, calling people out of their name, calling Black people the n word, and she did all of this sometimes while going down the hall but the incident in April was the first time it had escalated to this point. LVN T said Resident #30, propelled herself freely in the facility down the halls, always yelling at others. She said when the resident returned on 04/30/25 , she did not receive the discharge clinicals that listed Resident #30's extensive suicide history and the resident was not ordered or placed on 1on1 observation or suicide watch. In an interview on 05/02/25 at 02:57 PM, the ADON said Resident #30 can be extremely aggressive. She said the resident goes in and out of the hospital and calls 911 when she wants her pain medications, and the provider is aware of her behaviors. The ADON said she heard the resident was aggressive especially during night shift. She said everyone was aware of Resident #30's behaviors including (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 92 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety social services, and it was documented in the resident's chart. The ADON said while she does not think Resident #30 is a threat to herself or others, she possibly made other residents feel scared. The ADON said when a resident has made threats of or attempted suicide interventions like 1on1 monitoring should be in place when they readmitted to the facility, but she did not know if Resident #30 had any others for this. The ADON said the IDT/Managers/Administration had not discussed interventions needed to ensure Resident #30's safety but management should absolutely have had that conversation. Residents Affected - Many In an interview on 05//02/25 at 03;41 PM, the DON said she did not know Resident #30 had a history of attempted fake suicide, suicide attempts by tying a cord around her neck, auditory hallucinations telling her to harm herself by tying something around her neck or overdose on medications, wished to have a weapon to harm hospital and nursing staff or attempted suicide in November 2023. The DON said did not read the hospital discharge record sent to the facility prior to the resident readmitting that had the psychiatric consult notes describing all of Resident #30's previous behavioral issues and she honestly does not know why she did not. The DON said now that she knows Resident #30 had this history of behaviors the resident should have been somewhere more appropriate and based on the new information the facility had not provided Resident #30 adequate care. She said prior to today (05/02/25) Resident #30's behaviors placed the safety of herself and other residents in jeopardy. In an interview on 05/03/25 at 01:37 PM, the DON said since the surveyor alerted the facility of Resident #30's extensive history of fake suicide attempts, actual suicide attempts, auditory hallucinations, desire to harm others the resident was placed on 1on1 observation. She said the resident has had a sitter at all times, had not had any new behaviors and was doing well today. An observation and interview on 05/03/25 at 01:38 PM revealed, Resident #30 sitting in her wheelchair, writing in a notebook with headphones on. Resident #30 said she now had a sitter with her and has had no behaviors. She said she no longer heard voices since they put her on her proper meds in the hospital, but the doctor will take her off the medication in 10 days, and that is what keeps her calm. She said her Xanax helps her anxiety and bipolar and she was not drug seeking. Resident #30 said she was collating a list of songs for her online music store. In an interview on 05/03/25 at 01:42 PM, the DON said since Resident #30 had behaviors, received antidepressants and antipsychotic medications she should have had behavior monitoring orders. The DON said behavior monitoring orders are important for residents with behaviors in order to monitor for side effects or changes, and failure to have behavior monitoring orders would result in missed behaviors or change of condition. The DON looked through the resident's chart and said nope Resident #30 had no orders from her admission up until her suicide attempt on 04/13/25, and there were no orders entered when she returned to the facility on [DATE]. The DON said the lack of behavior monitoring played a part in the missed behavior monitoring and the missed residents change of condition. Resident #52 Record review of Resident #52's Face Sheet dated 04/24/25 revealed, a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses which included: schizophrenia ( mental disorder characterized by a breakdown in thought process, making it difficult to distinguish between reality and fantasy), and anxiety disorder. Record review of Resident # 52's Significant change in status MDS dated [DATE] revealed, severely impaired cognition as indicated by a BIMS score of 05 out of 15. Active diagnosis of anxiety disorder and schizophrenia, no presence of any behavioral symptoms such as physical (hitting, kicking, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 93 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0835 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Many pushing), verbal (threatening, screaming, or cursing at others) and no other behavioral symptoms not directed toward others. Antipsychotics were received on a daily basis; no gradual dose reduction was attempted and there was no physician documentation indicating a GDR was clinically contraindicated. Record review of Resident #52's undated Care Plan revealed, focus- signs and symptoms of anxiety like hypersensitivity, paranoid, nervousness and is at risk for further episodes of anxiety and injury; interventionmedication as ordered. Focus initiated 01/07/25- psychotropic medications and is at risk for adverse reactions and behaviors; interventions- monitor for adverse reactions and hypnotic driven behaviors such as tiredness and weakness, monitor for psychosis driven behaviors such as aggressiveness, combativeness, and manic episodes. There was no focus areas addressing suicidal behavior or suicide threats. Record review of Resident #52's Progress Notes from 01/06/25 to 05/06/25 revealed: 01/19/25 at 04:53 PM signed by RN G- Resident has been very rude to RT she does not like her to enter room to give care to her roommate. She yells/curse and shout. Education given to resident that her room needs assistance and staff will provide assistance without bothering her, but resident stated now. Resident also continue to ask staff for cups thorough the shift. Education given to resident that she is currently NPO and cannot consume anything by mouth at this time for her safety. Education did not work. She continue to ask anyone walking pass her room. 02/01/25 at 09:46 PM signed by RN G- Resident is currently crying and screaming she would like to go the hospital due to pain in her left legs. Resident was given all of her scheduled medication and Tylenol PRN. She also received her pain cream diclofenac cream applied to her ankle. Resident also propels herself around the facility not crying screaming she became very aggressive with staff. Screaming cursing and grabbing of laptop and other staff equipment she is not able to be redirected. 02/08/25 at 05:42 PM signed by RN G- Resident throw a cup a writer on this shift then later came and apologize. she also snatched the phone causing the cords to come undone and later apologize for that she sta[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 94 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 5 residents (Resident #18 and #109) and one of one laundry room reviewed for infection control. Residents Affected - Some LVN J failed to wear a PPE (personal protective equipment) gown during administration of medications via Resident #18's indwelling PEG tube (percutaneous endoscopic gastrostomy - an endoscopic medical procedure in which a tube is passed into a patient's stomach allowing nutrition to be received through the stomach when oral intake is contraindicated). CNA F failed to wear a PPE gown during bathing Resident #109 who had a PICC line (peripherally inserted central catheter a flexible tube inserted into a vein in the upper arm, providing access to large central veins near the heart, used for administering IV treatments) and an indwelling urinary foley catheter. The facility failed to ensure dirty laundry was kept in the appropriate bin and not on the floor, there was trash and a bloody piece of gauze in the clean linen bin, and there was not appropriate PPE in the laundry room. These failures could place residents at risk of exposure to infection, decline in health and hospitalization. Findings include: Record review of Resident #18's face sheet dated 04/15/25 revealed a [AGE] year-old female admitted to the facility on [DATE] and originally admitted on [DATE]. Her diagnoses included respiratory failure, malnutrition, dysphagia (swallowing disorder), cerebrovascular disease (condition affecting blood flow to the brain), hypertension (elevated blood pressure), muscle weakness and dementia. Record review of Resident #18's quarterly MDS dated [DATE] revealed she had short term and long-term memory problems. She had severely impaired cognitive skills for daily decision making. She was dependent on staff for all ADLs. She was always incontinent of bowel and bladder. She had open skin lesions. Further review revealed she had a PEG tube for feeding. Record review of Resident #18's order summary report dated 4/15/25 revealed Resident #18 had a skin infection at the feeding tube site and had an order for mupirocin Ointment 2% to be applied topically three times per day. The start date was 11/05/24. Record review of Resident #18's undated care plan revealed she had an open wound to abdomen PEG tube site and was at risk for further skin breakdown, infection formation AEB drainage and odor coming from the PEG site area. Date initiated 02/23/24. Further review revealed EBP was not included in the interventions. Record review of Resident #109's face sheet dated 04/16/25 revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included fracture of the right thigh bone, blood infection, local infection of the skin, stroke, diabetes, malnutrition, dementia, Parkinson's disease (a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 95 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 nervous system disorder), heart disease, pressure ulcer and hypothyroidism (underactive thyroid gland). Level of Harm - Minimal harm or potential for actual harm Record review of Resident #109's admission MDS dated [DATE] was in progress as of 04/24/25. BIMs summary score was blank. Section GG - Functional Abilities was blank. Residents Affected - Some Record review of Resident #109's order summary dated 04/16/25 revealed an order for PICC line monitoring every shift from 4/12/25 to 4/19/25, an order for Meropenem 500mg IV every 8 hours for wound infection from 4/12/25 to 4/19/25 and an order to provide foley catheter care every shift starting 4/12/25. Record review of Resident #109's undated care plan revealed PICC line, or foley catheter was not addressed. In an observation on 04/15/25 at 11:15 AM, Resident #109's room had a sign that read: Enhanced Barrier Precaution. The sign included that providers and staff must wear gloves and gown for high-contact resident care activities. The list of activities included: Bathing/Showering. CNA F prepared to give Resident #109 a bed bath. CNA F sanitized hands and put on clean gloves. CNA F did not put on a gown. Resident #109 was alert, verbal and able to follow commands. Resident #109 had a urinary foley catheter. Resident #109 had a PICC line in her left upper arm. CNA F completed the bed bath, removed gloves, and washed hands. In an interview on 04/15/25 at 1:20 PM, RN H stated any resident with a PEG tube, or on a ventilator was on EBP. RN H stated gloves and gowns must be worn when giving treatments, during wound care and during any close contact with residents. RN H stated the purpose was to try and protect residents and staff from infection. RN H stated she expected the CNAs to follow the instructions on the EBP sign. In an interview on 04/15/25 at 1:30 PM, CNA F stated she was PRN and had worked at the facility for 2 months. CNA F stated the EBP sign outside Resident #109's door was meant to help prevent spread of infection. CNA F stated the sign was to be followed when she looks after the resident during peri care and baths. CNA F stated she missed seeing the EBP sign and did not have an answer when asked why it was important to wear a gown. CNA F stated the last inservice she received on infection control was during orientation. In an interview on 04/15/25 at 1:45 PM, RN F stated she worked the hall with CNA F and she expected CNAs to follow the EBP signs during peri care, bed baths and the purpose was to prevent spread of infection, especially to other residents. RN F stated she expected CNA F to put on gloves and gown for the bed bath for Resident #109. In an interview on 04/15/25 at 1:50 PM, the DON stated any resident with open wounds, tracheostomies, PEG tubes were on EBP and expected any staff performing care such as emptying urinary foley catheter bags and nurse's accessing PEG tubes, should follow the EBP list and gown. The DON stated that basically during close contact with residents, the EBP list should be followed. The DON stated the last infection control inservice was conducted recently by herself and the ADON. The DON stated the purpose of the EBP was to prevent spread of infection, to protect those residents with openings to the skin and those who are immunosuppressed. In an observation on 04/16/25 at 7:05 AM, Resident #18's room had a sign that read: Enhanced (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 96 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Barrier Precaution. The sign included that providers and staff must wear gloves and gown for high-contact resident care activities. The list of activities included: Device care or use of feeding tube. Resident #18 was lying in bed alert and non-verbal. Resident #18's PEG tube was connected to the feeding pump and the head of the bed was raised. LVN J prepared medications outside the room, washed hands and put on clean gloves. LVN J did not put on a gown. Resident #18's PEG tube site was clean, and the dressing was clean, dry, and intact. LVN J paused the feeding pump, disconnected feeding tube from the PEG tube and checked the PEG tube for placement. LVN J administered medications via the PEG tube with no issues. LVN J removed gloves, sanitized hands, and left the bedside. In an interview on 04/16/25 at 7:15 AM, LVN J stated she would follow EBP instructions when providing resident care such as wound care and that the purpose was to prevent cross contamination. LVN J did not have an answer when asked why she did not put on a gown prior to administering medication to Resident #18 who had a PEG tube. LVN J stated she did not remember when the last infection control inservice was but recalled that the ADON conducted it. In an interview on 04/16/25 at 2:48 PM, the DON stated the risks to Resident #109 if nursing staff did not follow EBP signs is cross contamination since Resident #109 had a sacral wound and an IV site. The DON stated if Resident #18 had an infection and the PEG tube should spill stomach contents, it might get on the staff's clothing and the resident. The next residents the nursing staff provided care for would be at risk of infection due to cross contamination. In an observation and interview on 4/17/25 at 10:15 AM, the Laundry Tech, 4 big bins of dirty laundry were observed overflowing with dirty laundry. There was dirty laundry observed on the floor along with trash. There was also trash and a bloody piece of gauze in the clean linen bin. The Laundry Tech said he needed to clean out the bin with the trash and gauze in it. He said if he received linen from a COVID resident he would have to wear a gown, mask, and gloves, but he did not have any in the laundry room and only had an apron and gloves. In an observation and interview on 4/17/25 at 10:45 AM, the new Housekeeping Supervisor, she said she would be the Laundry Tech's Supervisor. She said she saw many things wrong with the laundry room like trash and dirty clothes on the floor. She said she was going to get these issues corrected right away and these issues were an infection control issue. In an interview with the Interim Administrator on 4/18/25 at 8:15 AM, she said there should not have been dirty clothes on the floor or trash and bloody gauze in the clean linen bin. She said these issues are infection control problems. She said the Laundry Tech was being re-trained. Record review of CNA F's Orientation Checklist revealed Universal Precaution and Isolation policies/procedures were completed on 03/11/25. No signatures were on the checklist. Record review of the facility in-service training report dated 4/2/25, revealed it was signed by LVN J and conducted by the ADON. Further review revealed the report was not signed by CNA F. The topic was EBP an approach of targeted gown and glove use during high contact resident care to reduce transmission of Staphylococcus Aureus (a common bacterium that can cause skin infections) and MDROs (multi-drug resistant organisms). Record review of the facility policy for Enhanced Barrier Precautions dated August 2022 read in part: Policy Statement, Enhanced barrier precautions (EBPs) are utilized to prevent the spread of multi-drug resistant organisms (MDROs) to residents .2. EBPs employ targeted gown and glove use during (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 97 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some high contact resident care activities when contact precautions do not otherwise apply. a. Gloves and gown are applied prior to performing the high contact resident care activity .3. Examples of high-contact resident care activities requiring the use of gown and gloves for EBPs include: a. dressing; b. bathing/showering; c. transferring; d. providing hygiene; e. changing linens; f. changing briefs or assisting with toileting; g. device care or use (central line, urinary catheter, feeding tube, tracheostomy/ventilator, etc.); and h. wound care .5. EBPs are indicated (when contact precautions do not otherwise apply) for residents with wounds and/or indwelling medical devices regardless of MDRO colonization. 6. EBPs remain in place for the duration of the resident's stay or until resolution of the wound or discontinuation of the indwelling medical device that places them at increased risk 9. Staff are trained prior to caring for residents on EBPs. 10. Signs are posted in the door or wall outside the resident room indicating the type of precautions and PPE required . Record review of the facility's policy for Personal Protective Equipment - Using Gowns, revised in September 2010, read in part: .Objectives 1. To prevent the spread of infections; 2. To prevent soiling of clothing with infectious material; 3. To prevent splashing or spilling blood or body fluids onto clothing or exposed skin . Record review of the facility's policy and procedure on Sorting of Linen in the Laundry Room (Review Date: 4/17/25) read in part: To ensure that soiled and clean linens are handled and sorted in a manner that prevents cross-contamination, supports infection control protocols, and maintains facility hygiene standards .All laundry personnel must wear appropriate PPE: gloves, gowns, and masks as required .Soiled linen is received in designated carts or bags that are leak-resistant and labeled. Bags must not be overfilled and must be securely closed .Ensure that all laundry hampers, bins, and surfaces are labeled appropriately and cleaned routinely . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 98 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to maintain all mechanical, electrical and patient care equipment in safe operating condition for 1 of 2 (the left dryer) dryers reviewed for safe operating conditions. Residents Affected - Many - The facility failed to clean the lint filter in a timely manner resulting in a thick layer of lint on the filter, around it, and below it. This failure could place residents at risk of injury, hospitalization, or death due to a fire. In an observation and interview on 4/17/25 at 10:30am with the Laundry Tech, he pulled out the lint filter for the dryer. There was a thick layer of lint on the filter, around the filter, and below the filter. He said he checked the filter when he got to work at 6am, again at 10:00am, and then before he left at 5:00pm. He said if there was a buildup of lint it could cause a fire. He also said he thought it should be checked more often. In an interview with the new Housekeeping Supervisor on 4/17/25 at 10:45am, she said she was going to be the new Supervisor over the Laundry Tech. She said there was too much lint on the lint filter, and it needed to be checked more often. In an interview on 4/18/25 at 8:15am with the Interim ADM, she said she expected the lint filter to be checked after every load. She said she did not know where the Laundry Tech got the times for checking the filter from and no one ever told him that. She said a full lint filter could cause a fire. She said he had already been in-serviced and was getting re-trained. A policy on Cleaning Lint Filters was requested but was not received. Record review of the facility's policy and procedure on Sorting of Linen in the Laundry Room (Review Date 4/17/25) read in part: .Report any malfunctioning equipment or safety concerns to the supervisor immediately . In an interview on 4/18/25 at 8:15am with the Interim ADM, she said she expected the lint filter to be checked after every load. She said she did not know where the Laundry Tech got the times for checking the filter from and no one ever told him that. She said a full lint filter could cause a fire. She said he had already been in-serviced and was getting re-trained. A policy on Cleaning Lint Filters was requested but was not received. Record review of the facility's policy and procedure on Sorting of Linen in the Laundry Room (Review Date 4/17/25) read in part: .Report any malfunctioning equipment or safety concerns to the supervisor immediately . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page 99 of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe, functional, sanitary, and comfortable environment for residents, staff, and the public for 2 (Halls C and D) of 4 halls reviewed for environmental concerns. The facility failed to repair loose and damaged floor tiles on Hall C, secure a loose toilet in room [ROOM NUMBER] on Hall C, and secure a loose sink in room [ROOM NUMBER] on Hall D. This deficient practice could place residents at risk of falls, injuries, and decreased quality of life. The findings included: Observation on 4/15/25 at 9:30 a.m. of resident rooms on Hall C revealed the toilet in room [ROOM NUMBER] was not properly secured to prevent it from being unstable. Observation on 4/15/25 at 9:45 a.m. of resident rooms on Hall D revealed the sink in room [ROOM NUMBER] was not properly secured to the wall and was shaky. Observation on 4/15/25 at 10:46 a.m., of the end of Hall C revealed the floor tiles were loose and coming apart. The area impacted was approximately 40 feet by 8 feet. Pieces of broken tile were on the floor. Housekeeping was trying to mop, and small pieces were coming up with the mop. During an interview with the Maintenance Director on 4/15/25 at 9:45 a.m., he stated he fixed the toilets and loose sinks since the new management company took over but has not been able to repair all of them yet. During an interview on 4/17/25 at 2:30 p.m., the Maintenance Director regarding the loose and broken floor tiles on Hall C, he stated they are going to replace the flooring. He revealed that the previous manager had the wrong type of floor installed. The type of tile installed absorbs water which is why it was coming apart. The new management is willing to spend money to get things in the facility fixed. During a record review of the facility policy on Homelike Environment dated 2/2021 revealed residents are to be provided with a safe, clean, comfortable, and homelike environment. Record review of undated Maintenance Service Policy revealed the following: 1. The Maintenance Department is responsible for maintaining the buildings, grounds, and equipment in a safe and operable manner at all times. 2. Functions of maintenance personnel include, but are not limited to: Maintaining the building in compliance with current federal, state, and local laws, regulations, and guidelines. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page100of101 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 675078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodway Nursing & Rehab 2808 Stoneybrook Drive Houston, TX 77063 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 0921 Maintaining the building in good repair and free from hazards. Level of Harm - Minimal harm or potential for actual harm Maintaining the heat/cooling system, plumbing fixtures, wiring, etc., in good working order. Establishing priorities in providing repair service. Residents Affected - Some Maintaining the grounds, sidewalks, parking lots, etc., in good order. Others that may become necessary or appropriate. 10. Maintenance personnel shall follow established safety regulations to ensure the safety and well-being of all concerned. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675078 If continuation sheet Page101of101