Health inspection·July 8, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few after being hit in the mouth which caused a deep cut on his upper lip. The wound was cleaned and closed with stitches both inside and outside the lip, to help it heal well. Observation and interview on 07/08/25 at 1:57 PM with Resident #2 revealed he was sitting in a wheelchair in his room writing on a piece of paper with a black sharpie . Resident #2 said he was not in pain, laceration to top lip healed. He did not recall the incident, and stated that everyone was good to him and he just wanted to write his sister a letter. Record review of Resident #1's MDS Assessment, dated 05/15/25, reflected the Resident #1 was a [AGE] year-old male who originally admitted to the facility on [DATE]. He had a BIMS score of 09, indicating moderate cognitive impairment. His MDS indicated he had no behaviors. His diagnoses included Traumatic Brain Injury (TBI), Anxiety Disorder, and Non-Alzheimer's Dementia. Record review of Resident #1's care plan, revised 06/21/25, reflected the following: Focus: 6/21/25- [Resident #1] Potential to demonstrate physical behaviors r/t Anger, Dementia 6/21/25 resident to resident incident: Interventions [Resident#1] should remain on 1:1 observation and recommended for him to be transferred to [local hospital] ER for further psych evaluation. Record review of Resident #1's Progress Notes reflected the following: 06/21/25 4:30 AM - This nurse was notified by the nurse staff on the floor to come [Resident#2] room and check on the resident with urgency. Rushed to the resident's room and observed [Resident#2] sitting on the wheelchair with visible bleeding from his mouth on his upper lip. The [CNA A] stated that she observed [Resident#2] being hit by the [Resident#1] and separated them and supported [Resident#2] back to his room [Resident #1] sent back to his room and placed on one-on-one monitoring. On assessment no visible injuries noted. [Resident#1] is alert and oriented x3 verbalizes needs. Denies pain/discomfort. V/S 145/89. P 76, R 18, temperature 97.6, oxy sat 97% RA. Administrator notified, NP E notified, DON notified. The resident is self-representative. [Resident#1 contact] called, and a message was left. This entry was written by RN C. Record review of clinical note by the psychologist dated 06/21/2025 at 1:33PM by the psychologist reflected that [Resident#1] was seen after a reported altercation with another resident. Law enforcements were notified, and report filed with state per regulations. [Resident#1] presented as quite angry throughout session. When therapist entered the room, he asked Did you hear about what happened with the nut job this morning? [Resident#1] He expressed agitation about patient in question and reported that patient had been bothering him. [Resident#1] elaborated that patient he felt targeted by patient and that the patient had been going into his room and bothering him. [Resident#1] was unable to elaborate specifically the other resident was doing that was causing such concern to him. [Resident#1] did complain about him wandering around the facility and bothering everybody. When therapist attempted to challenge [Resident#1]'s thoughts about the patients' cognitive impairments, [Resident#1] was adamant that the resident in question was quite aware of his actions, and he further blamed facility staff for letting him get away with it. [Resident#1] reported that he was aware that the patient reportedly lost a tooth and [Resident#1]'s response was good. [Resident#1] continued to fixate about the patient in question. [Resident#1] denied being remorseful about his actions and indicated that he would not change what he did if faced with a similar situation. [Resident#1] also generalized his anger from the patient in question to anybody who bothered him or came in his room. Therapist attempted to intervene and encourage [Resident#1] to use calming strategies to improve his outcomes given the relationship between anger and negative physiological reactions including increases in high blood pressure, muscle tension etc. [Resident#1] presented as resistant to therapist attempts to reframe and redirect his attention to other activities or calming strategies. [Resident#1] reported that he did not care if he was removed from the facility. [Resident#1] further presented as quite incredulous at the prospect of law enforcement intervention other consequences of his actions as he (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675111 If continuation sheet Page 2 of 6 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 675111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Gardens Rehabilitation and Healthcare 2135 N Denton Dr Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Actual harm Residents Affected - Few feels justified in his actions. This entry was written by the psychologist. Record review of Psychiatric Subsequent assessment dated [DATE] at reflected Patient is a [AGE] year-old White/Caucasian Male admitted to the facility on [DATE] for Long Term Care. On 6/22, pt punched another resident. The other resident sustained a laceration on his lip which required ER transfer. Pt states he was tired of the other resident bothering him and constantly entering his room. PCP added Xanax PRN and buspirone. Pt was also sent to the ER for evaluation. Returned to facility with no new orders. Pt is now calm. Pt is not expressing remorse but states he does not want to harm anyone. Pt lacks understanding of the other resident's behaviors. Pt believed the other resident was bothering him intentionally. Currently calm and remorseful that he hit the other resident. No SI, HI, or delusions at this time. No significant mood changes. This entry was entered by NP F Record review of hospital records dated 6/21/2025 at 20:27 Department of behavioral Health, Social work progress note reflected that Resident #1 was psych cleared stating that the aggression was not due a psychiatric issue and that resident #1 was a volunteer patient, and he wanted to leave and return back to the nursing home and he cannot he held against his will. An interview on 07/08/2025 at 10:09 AM with Resident #1 revealed that around 4:00 AM, Resident #2 was yelling and making noise outside Resident #1's room that woke Resident #1 up. Resident #1 stated that he got up and went to the nurse station to complain about Resident #2 waking him up. Resident #1 stated that Resident #2 liked to spit all the time, and it looked like Resident #2 was spiting at Resident #1. Resident #1 stated that he was upset so he punched Resident #2 in the mouth, and he was going to do it again, but the staff separated them and took Resident #2 away. Resident #1 stated that Resident #2 was always in places where he was not supposed to be, and that Resident #2 spit all over the place. Resident #1 stated that it was not his responsibility to worry about Resident #2's medical problems because it was obvious that Resident #2 had issues. Resident #1 stated that he did not look for trouble; he minded his own business and had no problem with other residents. He stated that he felt safe, but did not like anyone coming to make noise at his door at night and waking him up. An interview on 7.08.2025 at 11:18AM with CNA A revealed that while doing rounds on the 300 hall Resident#2 requested for a pen and paper. She gave him the paper and pen, but he wanted a sharpie marker that she did not have at the time. CNA A stated finished her rounds on the 300 hall. She stated she passed by Resident#2's room, and Resident#2 was in his room. She stated he told her he was writing a letter to his sister. CNA A stated she went to hall 200 ;where she was assigned two rooms. She stated that after providing care to the residents on 200 hall, she saw Resident #1 wheeling himself to the nurse station, he appeared upset and was using curse words. She asked him what was wrong, he stated that he was upset because Resident#2 was making noise and woke him up. She stated that then she saw Resident#2 at the nurse's station next to the trash can, with his cup that he spits in. CNA A stated that Resident #1 punched Resident #2 in the face, and she got in between Resident#1 and Resident#2 to separate them. CNA A stated she turned Resident #2 around and stood between them. She stated Resident #1 was threatening to hit Resident #2 again. She re-directed Resident #1 to go to his room. CNA A stated took Resident #2 back to his room, she then notified LVN B who went and assessed Resident #2. CNA A stated that LVN B notified the supervisor RN C, DON and Administrator, and they sent Resident #2 to the hospital. CNA A stated that the laceration on Residengt#2 looked like it needed stiches, so the nurses sent Resident #2 to the ER. She stated that she had been in-serviced on abuse and neglect, and had received training and resident-to-resident altercation. She stated that if she witnessed resident to resident, she would separate the residents to ensure they were safe, then report to the charge nurse, abuse coordinator, and DON. An interview on 07.08.2025 at 11:42 AM with Resident #2's FM revealed that Resident #2 was her brother who had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675111 If continuation sheet Page 3 of 6 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 675111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Gardens Rehabilitation and Healthcare 2135 N Denton Dr Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Actual harm Residents Affected - Few autism with developmental delays and was always writing her a letter. She stated that he also produced a lot of saliva and spat in a cup, but never spat on anyone. She stated that she got a call from LVN B at 5 am that Resident #2 was attacked by another resident and had been sent to the ER. She stated that she went to the emergency room, and she was met by the police. She stated that Resident #2 had a huge laceration and got sutures to close it up. She stated that the police gave her a police report number, but no charges were filed. She stated that the Administrator told her that the facility would ensure that Resident #2 was safe and would not have interactions with Resident #1. The FM stated that she had found a group home for Resident #2 that would cater to his needs and as adult with autism. She stated that she had a meeting scheduled with a local behavioral clinic, the group home provider, and the social worker to begin the transitioning Resident #2 to the group home. Attempted on 07.08.2025 at 12:24 PM to interview RN C via telephone. There was no answer voicemail left with call back number. Attempted on 07.08.2025 at 12:30 PM to interview LVN B via telephone. There was no answer voicemail left with call back number. Interview on 07.08.2025 at 1:30PM with the DON revealed that she was notified by the Administrator and LVN B that Resident #2 and Resident#1 had an altercation. Resident#2 was wheeling himself around looking and calling for the nurse to get him a sharpie. Resident#1 was upset that he was woken up by Resident#2's noise. Resident#2 had a behavior that made him spit in a cup and Resident#1 thought he was spitting at him. CNA A was coming from providing care and was headed to the nurse station she saw Resident#1 wheeling himself towards Resident#2, then punched Resident#2 in the face. CNA A separated the residents then she called the LVN B. RN C assessed and evaluated Resident#2 and Resident#1; Resident#2 had laceration to his upper lip. they notified the NP, and got new orders to send Resident#2 to the ER. Resident#2 returned to the facility the same day with sutures to his top lip. DON stated that immediately after the incident, Resident#1 and Resident#2 were placed on one-on-one monitoring. Psyche evaluated Resident#2 and gave orders to discontinue one on one monitoring because he was not a risk to himself or any other resident. The DON stated that the psych NP gave orders to send Resident#1 to Hospital for evaluation for inpatient psyche services. Resident#1 was evaluated at and sent back to the facility because per the hospital evaluation, Resident#1 was not exhibiting any aggressive behavior. The DON stated that psych and the physician gave orders to continue one on one on Resident#1 until he got him to inpatient psych. The DON stated that the facility had sent referrals to inpatient psych hospitals, but he did not qualify him for inpatient psych services. The facility continued one on one monitoring on Resident#1 for three days then psyche discontinued the one-on-one monitoring stating he had calm down, and he was not exhibiting any aggressive behavior. The DON stated that Resident#1 had not exhibited aggression towards other residents that was an isolated issue with Resident#2. An interview on 07.08.2025 at 1:43 PM with NP E revealed that he was notified by LVN B that Resident#1 punched Resident#2 in the face causing Resident #2 to have a laceration to his upper lip. NP E stated that he gave orders to send Resident#2 to the ER for sutures. Resident#2 returned to the facility the same day. NP E stated that Resident#1 had previously mentioned that Resident#2 spat all the time but never mentioned wanting to hurt him. NP E stated that Resident#2 continuously spat in a cup, a behavior that was caused by his developmental issues. He stated that Resident#1 was calm most of the time, and that Resident#1 told NP E that he was annoyed with the noise by Resident #2, at 4 o'clock in the morning and that was what ticked him off. NP E stated that it was possible that another altercation could happen again if the two residents came across each other. He stated that Resident#2's family had been looking for a group home and even before this happened. He stated he that he told the DON that one of the residents had to move out. He stated that he gave a referral for the psych team to evaluate and treat . An (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675111 If continuation sheet Page 4 of 6 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 675111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Gardens Rehabilitation and Healthcare 2135 N Denton Dr Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Actual harm Residents Affected - Few interview on 07.08.2025 at 3:48 pm with Social Worker revealed that she was not at the facility when the incident happened. She stated that she was notified in the morning meeting that Resident#2 was wheeling himself around following the nurse looking for a sharpie so he could write. Resident#1 woke up, and he tried telling Resident#2 to be quiet. then Resident#1 punched Resident#2 in the face. She stated that Resident#1 and Resident#2's families were notified. The facility made sure Resident#1 and Resident#2 did not have contact with each other by placing them on one-on-one monitoring. She stated that the facility sent out referrals to six inpatient psychiatric hospitals, but he was denied admission due to his medical acuity. The provider psych services evaluated Resident#2 and Resident#1. Resident#2 was discharged from one-on-one monitoring the same day. Resident#1 continued one on one monitoring while the facility tried to get him inpatient psych services but was later cleared by practitioners after few days. Resident#1 used to have outbursts, but he has not had any outbursts in a while. Resident#2 had autism with developmental delays, but he did not have behaviors. She stated that she was not aware of any other incident between Resident#1 and any other resident, and no residents had voiced that they did not feel safe. She stated that Resident#2's family had been trying to find him a group home that would be more appropriate for Resident#2's needs. Stated that Resident#2's sister had found him a group home and the behavioral health clinic had started the process to transition him to the group home. She stated that Resident#2 denied any psychosocial injury; all he wanted was to go to a group home. An interview on 07.08.2025 at 4:00pm with the Administrator revealed that LVN B called him early morning on 06/21/2025 and told him that Resident#1 hit Resident#2. He stated that LVN B reported that Resident#2 had gone down the hallway looking for a nurse to give him a sharpie marker. The noise of resident#2 calling for the nurse woke resident#1. Resident#1 got up headed to the nurse's station, Resident#1 asked Resident#2 why he woke him up, and then punched Resident#2 in the face. CNA A witnessed the incident and immediately separated Resident#1 and Resident#2. LVN B took Resident#2 to the room and assessed Resident#2s injuries then called the NP and sent Resident#2 to the ER. Administrator stated Resident#1 confirmed that he punched Resident#2 in the face because he woke him up. The administrator stated that Resident#1 was placed on one-on-one monitoring immediately, and Resident#2 was sent to the ER. The administrator called the police, they came to the facility, and tried to interview Resident#1. then the police went and interviewed Resident#2 but no charges we filed. Resident#1 was on one-on-one from Saturday 6/21/2025 until Wednesday 6/25/25. Resident#1 was seen by psyche on Saturday 06/21/2025 and the following Tuesday 06/24/2025.The Administrator stated that Psych reevaluated Resident#1 on 6/25/2025, and per psyche assessment he was calm with no intentions to hurt anyone psych discontinued One on One monitoring . He stated that prior to the incident on 06/21/2025, Resident#2's FM was already looking for places to move Resident#2 to a group home that specialized in adults with autism. The behavioral clinic suggested s group home setting for Resident#2, but most group homes could not admit Resident#2 because he had a gastronomy tube (a feeding tube inserted through the abdominal wall into the stomach). She found a place and was waiting for paperwork so that she can move him. Since the incident, the facility had sent out referral for in patient psych for Resident#1 to six hospital, and they all declined him due to Resident#1's medical acuity, and because he had dementia; some of their programs did not admit patients with dementia. He stated that the facility educated all the staff to make sure the Resident#1 and Resident#2 did not have contact with each other. Because Resident#1 was legally blind, he thought that Resident#2 was spitting at him. Resident#2 had a medical condition that caused him to over produce saliva. The Administrator stated that after the incident the staff was in serviced on abuse and resident to resident altercation. The Administrator stated that safe surveys conducted and all the residents in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675111 If continuation sheet Page 5 of 6 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 675111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Heritage Gardens Rehabilitation and Healthcare 2135 N Denton Dr Carrollton, TX 75006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the facility stated that the felt safe in the facility. Record review of the facility's incidents/accidents report from 1/25/25 to 06/25/25 reflected there were no other incidents that involved Resident #1 or Resident #2. Record review of the facility's policy, revised April 2025, and titled Abuse: Prevention of and Prohibition Against reflected: 1. Abuse is willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. This includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. 2.If the allegation of abuse, neglect, misappropriation of resident property, or exploitation involves another resident, the Facility will: Separate the residents so they do not interact with each other until circumstances of the reported incident can be determined. If a room change is appropriate, advise the residents and/or resident representatives of reason for the change in writing. Continue to assess, monitor, and intervene as necessary to maximize resident health and safety. Event ID: Facility ID: 675111 If continuation sheet Page 6 of 6