Health inspection·February 20, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #2's face sheet dated 2/20/2025 revealed a [AGE] year-old male admitted originally on 4/20/2023 and most recent on 12/18/2023 with the following diagnoses: Dementia (memory loss), adjustment insomnia (disruption in sleep), congestive heart failure, hypertension (high blood pressure) and muscle wasting. Record review of Resident #2's annual MDS assessment, dated 2/13/2025, reflected a BIMS score 6 out of 15 which indicated severe cognitive impairment. Section I - Active Diagnoses included Anemia, Congestive heart failure, Dementia, and Muscle Wasting. Record review of Resident #2's care plan revised 5/14/2024 revealed the following in part: Focus Respiratory illness: [Resident #2] is at risk for developing viral respiratory illnesses such as, but not limited to : COVID-19 (contagious disease caused by the coronavirus), Influenza (an infection of the nose, throat and lungs, which are part of the respiratory system) and RSV (a viral infection of the respiratory tract caused by the virus). Goal [Resident #2] will have no adverse effects from developing or being at risk for respiratory viral illnesses through the review date (2/23/2025). Interventions Monitor for signs/symptoms of respiratory illnesses (fever, chills .). Observation on 2/20/2025 at 8:25 a.m. revealed the outside temperature was 38 degrees Fahrenheit. Observation on 2/20/2025 at 8:33 a.m. of Resident #1 and Resident #2's and room revealed: o Folded white sheets and towels were stacked and covered the window seal. o Strong draft of cool air was felt at the bottom seal of the window. o The middle frame of the window was not secured to the plexi glass (plastic glass replacement) which allowed cool air to enter. o Resident #1 and #2's beds were pushed together and were approximately 4 feet away from the window. Interview and observation on 2/20/2025 at 8:35 a.m., Resident #1 said she it was frequently cold in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675085 If continuation sheet Page 2 of 4 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 675085 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Woodwind Lakes 7215 Windfern Rd Houston, TX 77040 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 - Some the room. She said she put on extra clothes to stay warm. Resident #1 had on gloves, nightgown, knitted hat, slippers and a blanket that covered her legs. Resident #1 said she turned on the overhead bed light for warmth. She said she was not sure who placed the blankets on the window seal. She said she was constantly cold in the room. Interview and observation on 2/20/2025 at 8:39 a.m., Resident #2 said he always felt a draft in the room. He said he said he would like it warmer in the room. Resident #2 had on a hoodie, pants and socks. He said he normally dressed like that to stay warm. Interview and observation on 2/20/2025 at 8:45 a.m., LVN A said Resident #1 and #2 have complained about their room feeling cold. LVN A said the facility has provided the residents with extra blankets. She said she was not aware of who placed the blankets on the window seal. She stated it may have been placed there to stop the draft. LVN A placed her hand near the bottom of the window and said she felt the cold draft. She said that could make the room colder. She said Resident #2 had anemia and that could make her colder. She said maintenance was notified through a repair management system. She said previous maintenance had been notified of the drafty windows. Interview and observation on 2/20/2025 at 9:18 a.m. with Maintenance A said Resident #1 and #2's room window needed to be re-calked. He said, the windows were old and needed to be updated. He said he felt the draft of cool air that came through Resident #1's and #2's window and he saw a broken window seam. He said the plexi glass was not sealed properly and was not connected to the window frame. He said air could come in and make the room colder, but he said he could not say how it would affect the residents. She said maintenance was responsible for the window repairs. Interview on 2/20/2025 at 11:30 a.m., Activity Assistant A said she performed ambassador rounds for Resident #1 and #2 today. She said she checked if the room was clean and resident needs were met. She said she was not sure where the draft was coming from, but it could be a draft because the building was old. She said she did not inspect the window in the room. She said was aware that Residents #1 and #2 said their room was cold, but she said residents were purchased blankets recently to aide in keeping them warm. She said she and other staff offer blankets when residents indicated they were cold. Interview on 2/20/2025 at 1:48 p.m. SW said there were two complaints in this month (February 2025) related to cold Resident #1 was cold in the room. She said she made an observation of the room on 2/7/2025 and 2/17/2025 and said the room temperatures were in the range between 71- and 81-degrees Fahrenheit. She said she was not sure of the exact temperature. She said she did not inspect the window in the room. She said she was not able to know how the draft in the room affected the residents and could be answered by nursing. She said Resident #1 was offered one of the comforters the resident had on her bed. She said if the window needed to be repaired the facility would consider a room change for the residents if needed. In a follow up interview on 2/20/2025 at 2:09 p.m. Maintenance Assistant A said he was not aware Residents' #1 and #2 window needed repair until today (2/20/2025). He said he started working for the facility on 1/27/2025. He said he had begun his inspection of the entire building to see what repairs or maintenance related issues needed attention. He said the cold temperatures had prevented him from inspecting all windows. He said he had made adjustments to the thermostats in the secure unit were Resident #1 and #2 resided. He said some of the staff have adjusted the thermostats to their comfort level and may not have been comfortable to the residents. He said he was responsible for window repairs. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675085 If continuation sheet Page 3 of 4 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 675085 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Woodwind Lakes 7215 Windfern Rd Houston, TX 77040 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 - Some Interview on 2/20/2025 at 2:20 p.m., DON said she was not aware there was the window needed repair in Resident #1 and 2's room. She said Residents #1 and #2 had made complaints related to the room was cold. She said extra blankets were offered to the residents. She said the nursing staff made rounds periodically throughout the day. She said the temperatures have been cold outside and we adjust the thermostat. The DON said maintenance was responsible for the repairs to windows and the facility. She said nursing staff were responsible for reporting any repairs resident rooms needed. Record review of facility Grievances dated 2/2025 revealed the following: o 2/7/2025 - Environment for Resident #1 - related to cold temperatures in the room. o 2/17/2025 - Environment for Resident #1 - related to cold temperatures in the room. Record review of facility policy Resident Rights (revised 4/2024) revealed the following in part: The facility protects and promotes the rights of each resident. The facility staff will uphold the resident's dignity and individuality, providing care that fosters their quality of life in a respectful environment. The facility provides a clean, safe, comfortable, and home-like environment. Record review of facility policy Operations Policies and Procedures (revised 6/2019) revealed the following in part: Subject: Environmental: Resident's Room, Resident's Rights Policy: It is the policy of this facility that the Facility provides the resident with an environment that preserves dignity, privacy and contributes to a positive self-image. Resident rooms are designed and equipped for adequate nursing care comfort and privacy of residents . Procedures: . 13) The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675085 If continuation sheet Page 4 of 4