Inspection·November 2, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm and no staff member assisted her to eat. Resident #62 was able to reach her corn bread that was sitting close to her on the bed tray. Resident #62 was not able to push her tray close to her. Observation on 11/1/2023 at 12:30p.m., revealed the Resident #62 took her foot attempting to push the tray out of her way. There was no CNA or staff member present to assist Resident #62. Residents Affected - Few During an interview on 11/1/2023 at 12:13p.m. with CNA D said she Resident #62 is usually fed during her meals because she is supposed to have assistance with feeding, but sometimes she will not allow it to happen. She said she did not ask Resident #62 if she would like to feed herself because Resident #62 grabbed the spoon, and she believed she wanted to eat on her own. During an interview on 11/1/2023 at 12:00p.m. with the DOR said she saw Resident #62 for SOC (start of care) because she was pocketing food. She said a family member brought it to the nursing staff's attention that Resident #62 was pocketing food. She said they have had morning meetings and care plan meetings with Resident 62's family member. She said a family member brought food to the resident and sometimes it was a matter of if the resident was going to eat the food. She said staff should be feeding her in the room or the dining room. She said the speech therapist put in the percentage of how much Resident #62 ate. She said she was not sure of the time frame from when the resident had a one on one to assist here with feeding. She Resident #62 was on a mechanical soft diet and thin liquids. During a follow-up interview on 11/1/2023 at 12:35p.m. CNA D said she documented the meals how much the residents eat. She said if Resident #62 ate everything she will document 100 percent. She said if it was most of her food but not all of it, she will document 75 percent. She said it depends on the amount of food the Resident #62 ate. During a follow-up interview on 11/1/2023 with the DOR at 1:30p.m., said to make changes regarding Resident #62 meals, they can probably have a morning meeting, update the care plan to make sure someone was consistently helping Resident #62 whether it was in the dining room or her bedroom. She said they would work on educating staff and have in-services completed. During an interview on 11/2/2023 at 4:26p.m. CNA E, said she has assisted Resident #62 in eating and sometimes her family member assisted her with eating. She said usually she stayed with Resident #62 to watch her eat. She said she ate regular diets. She said sometimes Resident #62 received milkshakes or magic cups. She said the milkshake did not come with every meal. She said sometimes it did not have the shake or the magic cup, but you can go to the kitchen and ask. She said Resident #62 would eat by herself. She said she would sit her up and she fed herself. She said Resident #62 would eat in her chair, in the room or sometimes she would eat on her bed. She said she received in-service on feeding when she first became a CNA. Record Review of an in-service training report dated 11/1/2023 revealed, Employee: CNA D. Topic: Melas, trays, assistance with feeding. The contents or summary session: When a resident requires assistance with feedings, you do not leave the tray in the room. You do not put tray in the room until you are ready to assist that resident with feeding. Explain what you are about to do, make sure residents are properly positioned with head of bed. Record Review of an in-service training report dated 11/1/2023 revealed, Employe: Nurses, CNAs, CMAs. Topic Meals, trays, assistance with feeding. Contents or summary: You are to put a tray in the room with a resident requiring assistance with feeding until you are ready to assist them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 2 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 Record Review of the facility's policy for care plan was not available. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 3 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure a post-discharge plan of care was developed with the participation of the resident and, with the resident's consent, the resident representative(s), which will assist the resident to adjust to his or her new living environment and the post-discharge plan of care must indicate where the individual plans to reside, any arrangements that have been made for the resident's follow up care and any post-discharge medical and non-medical services for 1 of 4 residents (CR # 1) reviewed for an effective discharge process. The facility failed to complete a discharge summary prior to and after CR#1's discharge. This failure could place residents at risk for incorrect, incomplete, or misleading information recorded regarding discharged residents and failures in the continuity of care for residents. Findings include: Record review of the undated admission sheet for CR # 1 revealed a [AGE] year-old female who was admitted to the facility on [DATE], readmitted on [DATE] and discharged on 10/18/23. Her diagnoses included type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), stage 4 pressure ulcer (an injury to skin and underlying tissue resulting from prolonged pressure on the skin , staged 1-4 with 4 being the most extensive), hypotension (low blood pressure) pressure ulcer of the sacral region stage 2 (injury to the skin and underlying tissue located in or around the large heavy bone at the base of spine and buttock), pain (an unpleasant sensory sensation that can range from mild, localized discomfort to agony and has both physical and emotional components) and adult failure to thrive (a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments). Record review of CR#1's EMR on 10/31/23 at 10:00 AM under the census heading revealed CR #1 discharged on 10/18/23. There was no discharge order. Record review of CR#1's EMR on 10/31/23 at 10:02 am revealed there was no discharge summary. Record review of CR#1's EMR on 10/31/23 at 10:03 am revealed in there was no discharge note on 10/18/23, indicating what time CR#1 left the facility, how CR #1 left the facility, the location CR#1 discharged to, or the condition CR #1 was in when she left the facility. Record review of CR#1's EMR on 10/31/23 at 10:04 am revealed the discharge Minimum Data Set (MDS) dated [DATE] revealed it was coded as a Discharge-return anticipated. Record review of CR#1's EMR revealed social worker note dated: 10/18/2023 at 3:08 SW spoke to staff member with Facility B. Stated that CR#1 contacted them about a possible transfer. Spoke with CR#'1's family member who confirmed they want to see if facility will accept and transfer her. SW notified medical records to send clinicals for review. Record review of CR#1's EMR revealed nurses progress note dated 10/19/2023 at 5:50pm CR#1's family member here to pick up CR#1's belongings. Author: LVN C-LVN. (e-Signed). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 4 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0661 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 11/2/23 at 3:08pm with CR#1's family member who said that they communicated with Former Administrator that CR#1 was discharging from the facility after care complaints. CR#1's family member said that CR#1 went to the hospital on [DATE] for a central line removal and they had the hospital case managers request CR#1's paperwork to forward to another facility and that CR#1 was accepted and admitted to the other facility from the hospital. CR#1's family member said they never received any discharge paperwork from the facility and never heard back from anyone at the facility about CR#1's discharge. The family member said they went to the facility the next day, to collect CR#1's belongings and no facility member said anything to him or had him sign anything and no one asked what happened to CR#1 or where she went. Interview with the MDS Coordinator who said they did not know why CR#1 had no discharge summary and did not know who was responsible for completing a discharge summary. Interview with SW on 11/1/23 at 11:30 am the SW said that she knew CR#1 was going to the hospital for a procedure but did not know when or exactly what time the resident left the facility. The SW said she did receive a call from another facility requesting medical records for transfer and she believed CR#1 transferred to that other facility. She said the IDT meets daily and discusses admissions and discharges. The SW said she was unsure if or when CR#1 was discussed but believed the IDT had discussed it. The SW said she did not know who was responsible for the discharge summary. Interview and record review on 11/1/23 at 11:32am with the DON she said there should have been a nursing progress note on 10/18/23 when CR#1 left the facility. She said there was no discharge summary because CR#1 left the facility to go to the hospital to have her Central Line (Central venous catheter used by doctors to give medicines, fluids, blood and or nutrition) removed. The DON said that the IDT meets daily in the morning to discuss resident changes, including admissions and discharges. She said that the nurses should have documented where CR#1 went and if she was not returning to the facility. She said she was working at the facility as the DON on 10/18/23 when CR#1 was discharged . She said that there was a note dated in September that referenced CR#1's 10/18/23 discharge to the hospital. Record review in CR#1's EMR: 10/9/2023 1:09 Nurses Note. Note Text: This writer followed up with the radiology dept at Hospital A regarding an appt for the resident to get her central line removed. Appt is on 10/18/23 at 1pm. Transport is set up with Transportation Company A with a pickup time at 1245PM. The DON said she did not know why the nurses did not write a discharge note or any note regarding CR#1's discharge to the hospital or why CR#1 did not return. Telephone interview with Regional Director of Reimbursement Services on 11/1/23 at 11:48 AM she said that any resident who was discharged from the facility, should have a discharge note indicating when the resident discharged and where the resident discharged to. Interview with DON on 11/1/23 at 5:00pm she said that CR#1 should have had a discharge note and discharge summary and that she did not know why they had not been completed. The DON said that she had only been working at the facility for a few weeks and did know who was previously assigned as being responsible for the completion of the discharge summary. She said the charge nurses were responsible for completing the discharge progress notes and discharge summary. There was no discharge summary for CR#1 provided prior to survey exit. Record review of facility provided policy and procedure dated as revised December 2016 and titled: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 5 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0661 Level of Harm - Minimal harm or potential for actual harm Transfer or Discharge, Preparing a Resident for read in part: Residents will be prepared in advance for transfer. 3. Nursing services is responsible for: a. Obtaining orders for discharge or transfer . b. Preparing the discharge summary .d. Providing the resident or representative (sponsor) with required documents (i.e., Discharge Summary and Plan). h. Completing discharge note in the medical record. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 6 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the resident maintained acceptable nutritional status, such as usual body weight or desirable body weight, unless the resident clinical condition demonstrated this was not possible, for 1 of 6 residents (Resident #62) reviewed for nutritional status, in that; Residents Affected - Some Resident #62 who admitted to the facility with poor nutrition was not provided prompt intervention to prevent severe weight loss of -16.85 pounds in 6 months. This failure could affect all residents in the facility with weight loss at increased risk of weight loss. Findings included: Record review of Resident #62's admission sheet revealed she was an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included muscle weakness, unspecified abnormalities of gait and mobility (a change to your walking pattern), depression, dementia (a group of thinking and social symptoms that interferes with daily functioning), and type 2 diabetes. Record review of Resident #62's quarterly MDS assessment dated [DATE] revealed she had a BIMS score 06 indicating severely impaired. Record review of Resident #62's Care Plan dated under focus revealed weight loss as evidence by 10.0 % change over 180 days. Resident #62 is refusing eat at times 8/10/2022, current weight is 125. Weight loss noted while in the hospital. 8/3/22 119.5 lbs., 9/2/2022 118.3 lbs. -5.36%/30dyas, 10/19/2022-readmit weight of 114.0 lbs., 1/9/2022 113.2 1bs., 4/10/2023 99.2 lbs., 5/8/2023 106.2 lbs., 7/21/2023 92.2 lbs. 7.5 % change comparison weight 5/8/2023 106.2 lbs., 9/9/203-9 lbs. Goal: Resident will stay within 3-5 1lbs of baseline weight over the 90 days. Resident will be encouraged to eat 50%-100% of her meals over the next 90 days. Target date 1/25/2024. Interventions: Assess resident for food preferences, serve resident food preferences. Record review of Resident #62's comprehensive care plan date 5/1/2023, did not address any plan of care for her nutrition regarding supplements until 4/10/23 and the weight loss and poor diet was first noticed on 8/10/2022. Appetite stimulant was not added until 6/5/2023. Record Review of Resident #62's Diet Type Report revealed, her diet type was carb controlled/no added salt, diet texture was mechanical soft, and her fluid consistency was regular. Dietary - Supplements was a health shake, administer one (1) health shake two (2) times a day with lunch and dinner. Record Review of Resident #62's Monthly Weight Report revealed, in April 99.7 Lbs., May 106.2 Lbs., June 89.0 Lbs., July 92.5 Lbs., August 90.0 Lbs., September 90.5 Lbs., and October 86.2 Lbs . Record Review for Weight Variance Report for September 2023 revealed, 30 days (+0.56%), 90 days (+1.69%) and 180 days 15.66%. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 7 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record Review for Weight Variance Report for October 2023 revealed, 30 days (4.75%), 90 days ((6.81%), and 180 days 13.54%. Observation on 11/1/2023 at 12:10p.m., revealed CNA D bringing Resident #62 her tray. She adjusted Resident #62's bed. CNA D asked Resident #62 how she wanted her bed positioned but she did not respond. CNA D placed bed tray over Resident #62 with food on a plate. Resident #62 grabbed the cup off the tray and drank it. She did not touch the food. The food was not in reach of Resident #62, and she was lying flat on her back. Observation and on 11/1/2023 at 12:15p.m., revealed the Resident #62 lying low. Her tray was out of reach and there was no one assisting her to eat. Resident #62 was able to reach her cornbread that was sitting close to her on the bed tray. Resident #62 was not able to push her tray close to her. The health shake was not present on the tray. Observation on 11/1/2023 at 12:30p.m., revealed the Resident #62 taking her foot attempting to push the tray out of her way. There was no CNA present to assist Resident #62. During an interview on 11/1/2023 at 12:13p.m. with CNA D said she usually fed Resident #62 because she was supposed to have assistance with feeding, but sometimes she will not allow it to happen. She said she did not ask Resident #62 if she would like to feed herself because Resident #62 grabbed the spoon, and she believed she wanted to eat on her own. During an interview on 11/1/2023 at 12:00p.m. with the DOR said she saw Resident #62 for SOC (start of care) because she was pocketing food. She said a family member brought it to the nursing staff's attention that Resident #62 was pocketing food. She said they have had morning meetings and care plan meetings with Resident 62's family member. She said a family member brought food to the resident and sometimes it was a matter of if the resident was going to eat the food. She said staff should be feeding her in the room or the dining room. She said the speech therapist put in the percentage of how much Resident #62 ate. She said she was not sure of the time frame from when the resident had a one on one to assist here with feeding. She Resident #62 was on a mechanical soft diet and thin liquids. During a follow-up interview on 11/1/2023 at 12:35p.m. with CNA D said she documented the meals how much the residents eat. She said if Resident #62 eats everything she will document100 percent. She said if it is most of her food but not all of it, she will document 75 percent. She said it depends on the amount of food the Resident #62 eats. During a follow-up interview on 11/1/2023 with the DOR at 1:30p.m., said to make changes regarding Resident #62 meals, they can probably have a morning meeting, update the care plan to make sure someone was consistently helping Resident #62 whether it is in the dining room or her bedroom. She said they would work on educating staff and have in-services completed. During an interview on 11/1/2023 at 3:14p.m., with the dietician, he said he checked for residents weights every 30 days, 90 days, and 180 days to see the weight differential. He said Resident #62's weight for the 180 days in April to October triggered. He said the 30 day was 4.75, the 90 day was 6.81 and the 180 day was 13.5 and it triggered just for that day. He said Resident #62's weight loss had slowed down. He said he ordered a health shake with meals for breakfast, lunch, and dinner. He said he would come to the facility once a week. He said he would make a recommendation if something triggered for him, to the ADON, DON, and the Administrator. He said he does a follow-up to make sure (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 8 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some residents have received what he recommended. He said Resident #62 was getting the health shake BID. He said he does not physically see what was on the Resident #62's tray every day. He said he weighed the resident every month. During an interview on 11/2/2023 at 3:33p.m., with the DON, said 4 weeks ago she put Resident #62 on weight variance. She said she viewed her diagnosis and ordered a stat lab. She said she wanted to increase her medication, but her daughter said no. She said the SBAR was completed on October 23rd. She said Resident #62 was holding food in her mouth. During a follow-up interview on 11/2/2023 at 4:04p.m., the DON, said she would notify the doctor and the doctor will know when Resident #62 has not been receiving supplement. She said she can notify the doctor and inform him Resident #62 doctor supplement might need to be increased. She said she followed up with kitchen to find out why it was not provided. She said also talked to nurses and CNAs. She said the resident could have electrolyte imbalance. She said Resident #62 had compromised health complications, skin breakdown, because the shake has protein in it. She said if residents have issues with weight, she will go by the weight loss list. She said they discuss weight loss in the morning meetings. She said it should be care planned because if they lose weight you have to care plan to show what you are doing for the resident and if it is working. She said when she checked the facility systems Resident #62's weight because it triggered in the system. She said she checks the weight on a weekly basis. She said she started working at the facility on 10/9/23 and ordered a lab and chest x-ray. She said she decided to have a care conversation with Resident #62's family member. She said she told staff to get Resident #62 out of bed because she is high risk for aspiration. She said the nurses are supposed to make sure the interventions are being followed. She said the nurses should be able to notice the decline with the residents. She said no one did anything regarding Resident #62's weight for a while because she was told the resident went to the hospital, and she had COVID. She said she will have to look into it and find out what the policy says regarding weight loss. During an interview on 11/2/2023 at 4:26p.m., with CNA E, said she has assisted Resident #62 in eating and sometimes her sister assisted her with eating. She said usually she stayed with Resident #62 to watch her eat. She said she ate regular diets. She said sometimes Resident #62 received milkshakes or magic cups. She said the milkshake did not come with every meal. She said sometimes it did not have the shake or the magic cup, but you can go to the kitchen and ask. She said Resident #62 would eat by herself. She said she would sit her up and she feed herself. She said the Resident #62 would eat in her chair, in the room or sometimes she would eat on her bed. She said she accepted to in the dining room. She said she received in-service on feeding when she first became a CNA. During an interview on 11/2/2023 at 4:33pm the ADON she said she has been working at the facility since 2010. She said the dietician comes and weighted the residents monthly. She said it is done weekly when they first enter the facility. She said if someone wants to add a supplement. She said the nurses can request it. She said the DON is over the weight system. She said Nurse can ask doctor if they notice a weight issue with the resident. She said [NAME] does monthly and weekly weights and report it to the DON. She said Resident #62 did not trigger for weight loss back in April. She said Resident #62 was on the health shake April or May twice a day and was recently increased to 3 times a day. She was put on Remeron for appetite simulate. She said supplement may be a change in intake or not taking meals. She said they check the tray card and the nurse check the tray as well. She said they could continue to lose weight if they we're not receiving the supplements. Record Review of the facility's policy titled Nutrition Management revised on 06/2018 read in part . The purpose of this policy is to establish facility guidelines on how and when the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 9 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete obtains and documents residents weights. This policy is also to ensure that residents with significant weight loss or weight gain are rapidly identified to ensure that the resident maintains the highest quality of life and wellness in the facility. Based on a resident's comprehensive assessment, the facility must ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein levels, unless the resident's clinical demonstrates that this is not possible; and receives a therapeutic diet when there is a nutritional problem. It is best practice to use the same scale each time to weight the residents. Ensure the resident is weighed, if possible, during the same time of day. The following percentages of weight loss are considered significant: 5% in 30 days or less, 7.5% in 90 days, and 10% in 180 days. Any resident who experiences a significant weight loss or gain must be placed on the Weight Surveillance program . Event ID: Facility ID: 675079 If continuation sheet Page 10 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store, prepare, and serve food under sanitary conditions in 1 of 1 kitchen: Residents Affected - Many -The facility failed to ensure that the kitchen floors were clean and free of food particles. -The facility failed to ensure that food preparation equipment was clean and free of grease build up. -The facility failed to ensure food items in the refrigerator\freezer were dated, labeled, and appropriately sealed. These failures placed all residents who ate food served by the kitchen at risk of food-borne illness. Findings included: Observation on 10/31/23 from 9:15AM to 9:30AM, revealed the following: *the kitchen floor was dirty with food particles and grease around the cooking area and behind the stove. *One of two cooking stoves had grease built up inside and around outer part of the stove. * one of one commercial can opener in the kitchen revealed had grease and dark looking substance around the cutting blade and the blade holder. * freezer #1 revealed the floor of the freezer had food particles and the door had grease build up. Inside the freezer were open half bag of French fries, a half bag of frozen biscuit, left over hot dog meat in a plastic bag, left over pork sausage. All food items were unlabeled and undated. All food items were identified by the Dietary Manager. * freezer #2 revealed left over hamburger meat, chicken party, and chicken parts all in plastic bags undated and unlabeled. During an interview on 10/31/23 at 10:10Am, the dietary Manager said all food out of their original packet should be labeled and dated with used by date. She said the kitchen should be clean daily after meal preparation and at the end of the day. She said preparing food in an unclean environment can lead to food born illness and violations of food establishment codes. She said she would have an in-service and have the kitchen cleaned. Record review of the facility's policy entitled Food Storage, Food Safety in Display and Service Policy dated 1/20/2018, revised 04/11/2022, read in part- documented: The receiving date is written on the top of all food cases or containers. All food in its original containers, will have the expiration date written on it. All food purchased will be wholesome, manufactured, processed, and prepared in compliance with all State, Federal, and local laws, and regulations. Food will be handled in a safe and sanitary method to prevent contamination and food-borne illness. #9 Opened package or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 11 of 12 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 675079 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/02/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Focused Care at Allenbrook 4109 Allenbrook Dr Baytown, TX 77521 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm leftover food is to be tightly wrapped or covered in airtight, clean containers. It should be labeled, dated with the opened or use by date. Do not keep leftovers in the refrigerator for more than 7 days. The policy did not address kitchen cleaniness Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675079 If continuation sheet Page 12 of 12