Inspection·July 3, 2025

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and Resident's responsible party/family member. The form reflected the Habilitation Coordinator recommended the following services for Resident #4: Habilitation Coordination, Independent Living Skills, Behavioral Enhancement Services, Physical Therapy, Occupational Therapy, Speech Therapy, and Durable Medical Equipment. The form also reflected that Habilitation Coordination, Independent Living Skills, Physical Therapy, Occupational Therapy, Speech Therapy and assessments were accepted, and all other services declined at that time. Review of Resident #4's PASRR Comprehensive Service Plan Form dated 3/12/25 reflected the type of meeting was quarterly IDT. The form reflected in attendance was Resident #4, local mental health authority, Minimum Data Set Nurse, Hospice Social Worker, Director of Rehabilitation, and Resident's responsible party/family member. The plan reflected Resident #4 would continue the following services: Habilitation Coordination, Independent Living Skills, Physical Therapy, Occupational Therapy, Speech Therapy. Review of Resident #4's Habilitative Service Plan/Form 1057 dated 3/12/25 indicated recommended services for Resident #4 were Habilitation Coordination, Independent Living Skills, Physical Therapy, Occupational Therapy and Durable Medical Equipment. Section 6 of the form titled Nursing Facility Specialized Services to be Monitored by the IDT stated to enter all Nursing Facility Specialized Services provided to the individual during the Habilitative Service Plan year. The specialized services listed for Resident #4 were Occupational Therapy with outcome/goal of: Patient will exhibit anatomically correct positioning while sitting in wheelchair with use of adaptive equipment/devices for 2 hours with fair-sitting balance during activities of daily living to reduce pressure and decrease risk of wounds and achieve proper joint alignment. Physical Therapy with outcome/goal of: Patient will maintain mobility with maximum assistance to maintain functional mobility in facility. Speech Therapy, with outcome/goal of: Patient will communicate yes/no responses using non-speech generating augmentative alternative communication system with moderate cueing, patient will communicate basic wants and needs using non-speech generating augmentative alternative communication system with moderate cueing. A review of Resident #4's online Long-Term Care Portal submissions indicated that the facility submitted the NFSS form requesting both Physical Therapy and Occupational Therapy assessments and services on 4/3/25. Both services were initially approved; however, because the authorizations were only valid for one month, the facility was required to resubmit requests to continue services. On 5/11/25, the facility resubmitted the NFSS form for Physical Therapy and was approved. The Occupational assessment and services request was denied. The facility submitted another request for Occupational Therapy assessment and services on 6/2/25, which was again denied. The facility resubmitted a third request for Occupational Therapy on 6/6/25 and was denied. As of 7/1/25, Resident remained in denial status for Occupational Therapy assessment and services. As of 7/1/25, the facility had not submitted an NFSS request for Speech Therapy Assessment or services. In a telephone interview on 7/1/25 at 9:50 a.m. with the PASRR Representative, it was revealed that Resident #4 was identified as PASRR positive and qualified for all services. She stated he had an initial IDT on 12/18/24. She stated that the NFSS forms were due 20 business days after the initial IDT or review meeting. She stated the facility submitted the NFSS for Physical Therapy in April. She stated the facility had to resubmit the NFSS forms because the authorization for services was good for one month only. She stated that the facility then submitted Physical Therapy and Occupational Therapy in May, but Occupational Therapy was denied. She said they resubmitted Occupational Therapy again in June and was denied. She stated Resident #4 was currently in denial status for Occupational Therapy and that the facility had never submitted the NFSS for Speech Therapy. In an interview on 7/1/25 at 11:29 a.m. with the MDS Nurse, she reported she was not responsible for submitting NFSS requests for residents. She stated their rehabilitation therapist was responsible, and she was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 2 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not at the facility. The MDS Nurse stated her responsibility to PASRR was ensuring a PASRR Level I screen (a required assessment for all applicants to Medicaid-certified nursing facilities to determine whether they might have a severe mental illness or intellectual disability) for residents were completed and referred to Level 2 screen (Individuals who test positive at Level I are then evaluated in depth, called Level II PASRR. The results of this evaluation results in determination of need, determination of appropriate setting, and a set of recommendations for services to inform the individual's plan of care). The MDS nurse stated she was familiar with the 20-business day deadline to submit the NFSS request in the portal but that the Director of Rehabilitation oversaw doing those. She reported she attended the IDT meeting for Resident #4 a couple of weeks ago but could not recall the services recommended. She stated the NFSS forms had been submitted except one was denied. She stated she would have to get in touch with the Director of Rehabilitation to see the status of that. In an interview on 7/1/25 at 12:40 p.m. with the Regional Consultant Nurse, she reported she could not recall if she had participated in Resident #4's last IDT meeting. She stated the MDS Nurse handled PASRR, and the Director of Nursing would ultimately oversee the MDS Nurse. She stated she was not aware of what services Resident #4 was receiving. In an interview on 7/1/25 at 10:50 a.m. with the Director of Nursing, she reported Resident #4 was not receiving any specialized services because he was on hospice. She stated she believed he was PASRR Positive and could not remember what services were recommended. She stated she would participate in resident IDT meetings. She stated that the social worker or MDS nurse was responsible for submitting NFSS requests. She stated the MDS nurse was overseen by the Corporate Nurse. After checking records, the Director of Nursing stated Resident #4 had been receiving physical therapy since 5/7/25 and had been waiting approval for occupational therapy. In an interview on 7/2/25 at 10:45 a.m. with the Director of Rehabilitation, she stated she had overseen submitting the NFSS for PASRR positive residents. She stated she participated in Resident #4's IDT meeting on 6/18/25 over the phone. She stated Resident #4's NFSS was requested and approved and was good until 7/20/25. She stated they were in the process of resubmitting the NFSS for Occupational Therapy. She stated that Speech Therapy was never recommended for Resident #4; a NFSS had not been submitted. Review of an email dated 7/2/25 at 4:14 p.m. from the Regional Director of Nursing stated: Our admission Criteria policy also includes multiple references to the IDT and its use in care/decision making. As far as PASRR- we do not have a policy strictly for that program- but our admission Criteria policy (attached) covers the program under section 9: 9. All new admissions and readmissions are screened for mental disorders (MD), intellectual disabilities (ID) or related disorders (RD) per the Medicaid Pre-admission Screening and Resident Review (PASARR) process.a. The facility conducts a Level I PASARR screen for all potential admissions, regardless of payer source, to determine if the individual meets the criteria for a MD, ID or RD.b. If the level I screen indicates that the individual may meet the criteria for a MD, ID, or RD, he or she is referred to the state PASARR representative for the Level II (evaluation and determination) screening process.(1) The admitting nurse notifies the social services department when a resident is identified as having a possible (or evident) MD, ID or RD.(2) The social worker is responsible for making referrals to the appropriate state-designated authority.c. Upon completion of the Level II evaluation, the State PASARR representative determines if the individual has a physical or mental condition, what specialized or rehabilitative services he or she needs, and whether placement in the facility is appropriate.d. The State PASARR representative provides a copy of the report to the facility.e. The interdisciplinary team determines whether the facility is capable of meeting the needs and services of the potential resident that are outlined in the evaluation.f. Once a decision is made, the State PASARR representative, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 3 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0644 potential resident and his or her representative are notified. 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: 675112 If continuation sheet Page 4 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 - Minimal harm or potential for actual harm Residents Affected - Few 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 interview, and record review the facility failed to develop and implement a comprehensive person-centered care plan that includes measurable objectives and time frames to meet a resident's medical and nursing needs and describes the services to be furnished to attain or maintain the residents highest practicable physical, mental, and psychosocial well-being for 1 of 5 (Resident #4) residents reviewed for care plans. The facility failed to implement Resident #4's comprehensive person-centered care planned interventions for speech and occupational therapies. Failure to implement the care plan as written could place residents at risk for unmet needs, avoidable decline, injury, or harm, as their individualized support measures are not being followed to ensure safety, health, and well-being.The findings included: Review of Resident #4's annual Minimum Data Set, dated [DATE] reflected the [AGE] year-old male resident was admitted to the facility on [DATE] with diagnoses which included cerebral palsy (a condition caused by damage to the developing brain that affects a person's ability to control their muscles, problems with movement, coordination) kidney failure (kidneys are no longer able to properly filter waste and extra fluid from the blood), contracture (a muscle, tendon, or joint becomes permanently stiff or tight), and dysphagia (trouble swallowing). Review of Resident #4's annual Minimum Data Set assessment dated [DATE] reflected he had no speech, rarely/never made himself-understood, and sometimes was able to understand others. His Brief Interview for Mental Status was not completed. He was totally dependent on two staff for dressing, transferring, bathing and toilet use. He was totally dependent on staff for locomotion, eating, and personal hygiene. He was not ambulatory and had functional limitations in range of motion for upper extremity and lower extremity on both sides. He was indicated as always incontinent of bowel and bladder. He had a physical therapy start date of 03/29/25 with an end date of 04/21/25 with no minutes of treatment recorded during that duration. Record review of Resident #4's Comprehensive Care Plan initiated on 4/11/2018 and revised on 5/27/25 reflected Resident #4 focus area indicated Resident #4 had been identified as PASRR positive status (when a resident is found to need specialized services or supports due to a serious mental health illness, intellectual disability, developmental disability, or related condition through the PASRR screening process) related to an intellectual disability, and Cerebral Palsy. His interventions indicated his family/local mental health authority had agreed to the following PASRR services: Habilitative Physical and Occupational therapy services, Habilitation coordination, and independent living skills. A focus area stated Resident #4 had ADL self-care performance deficit and limited physical mobility. The intervention/Tasks listed Physical Therapy, Occupational Therapy, and Speech Therapy evaluations and treat as indicated. In an interview on 7/1/25 at 10:50 a.m. with the Director of Nursing, she reported Resident #4 was not receiving any specialized services because he was on hospice. After checking records, the Director of Nursing stated Resident #4 had been receiving physical therapy since 5/7/25 and had been waiting approval for occupational therapy. In an interview on 7/2/25 at 10:45 a.m. with the Director of Rehabilitation, she stated they were in the process of resubmitting approval for Occupational Therapy. She stated that Speech Therapy was never recommended for Resident #4. After reviewing records, she stated she believed Resident #4's family did not want speech therapy. She agreed that the refusal of service was not documented in the residents Electronic Health Record. Review of the facility's Care Plan, Comprehensive Person Centered Policy, dated December 2016 stated in part, The Interdisciplinary Team (IDT), in conjunction with the resident and his/her family or legal representative, develops and implements a comprehensive, person-centered care plan for each resident. An explanation will be included in a resident's medical record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 5 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 if the participation of the resident and his/her resident representative for developing the resident's care plan is determined to not be practicable. 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: 675112 If continuation sheet Page 6 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who was unable to carry out activities of daily living, received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 1 of 2 residents (Residents #1) reviewed for ADL care. The facility failed to ensure Residents #1 was repositioned every 2 hours on 06/04/25, resulting in moisture associated damage to Resident #1's right and left buttocks. This failure could place residents at risk of not receiving services or care, decreased quality of life, and decreased self-esteem.Findings included: Review of Resident #1's Annual MDS Assessment, dated 04/08/25, reflected the resident was a [AGE] year-old male admitted to the facility on [DATE]. His cognitive skills for daily decision making were severely impaired. The resident had a supra-pubic catheter (catheter inserted into the bladder to drain urine) a colostomy (bag attached to the abdomen to collect bowel movement that excretes from the stoma), and a tracheostomy (a hole that surgeons make through the front of the neck and into the windpipe, also known as the trachea. Surgeons place a tracheostomy tube into the hole to keep it open for breathing). His diagnoses included stroke, kidney failure, diabetes, and quadriplegia (inability to move arms and legs). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. The resident did not have any skin conditions listed. Review of Resident #1's Care Plans reflected:Revised 07/01/24 - Resident had an activities of daily living deficit.Facility interventions: The resident was totally dependent on staff for repositioning and turning in bed.12/02/24 - Risk for Impaired Skin IntegrityFacility interventions: Evaluate skin integrity Review of Resident #1's Care Plan, last revised 05/20/25 reflected the following focus, goal, and interventions were in place: - Focus: Resident #1 has potential/actual impairment to skin integrity to bilateral buttocks gran 100% tx per MD ORDER 05/03/23. Goal: Resident #1 Skin will remain intact 03/04/25. Interventions: . Involve/educate resident and/or family/designee Monitor for s/s of infection Monitor pain and administer pain medications/treatments as ordered and/or per pain problem- Focus: . Left buttocks clean area with NS. Pat dry with 4x4. Apply house barrier cream twice daily and PRN if soiled until resolved. 0.8 x 0.7 x 0.1cm Right buttocks Left buttocks clean area with NS. Pat dry with 4x4. Apply house barrier cream twice daily and PRN if soiled until resolved. 2.8 x 0.8 x not measurable in CM 06/05/25.Goal: Wound Will Be Free of Signs or Symptoms of Infection Wound Will Show Signs of Improvement 06/05/25.Interventions: Follow facility policies/protocols for the prevention/treatment of skin breakdown Inform the resident/family/caregivers of any new area of skin breakdown Notify provider if no signs of improvement on current wound regimen Provide wound care per treatment order- Focus: Resident #1 has an ADL Self Care Performance Deficit r/t Quadriplegia on Restorative LOW AIRLOSS MATTRESS/CHECK FORFUNCTION EVERY SHIFT 05/03/23, revised 05/23/25. Review of Resident #1's BRADEN - Scale for Predicting Pressure Sore Risk was completed on 05/04/25 and indicated Resident #1 was at a high risk for developing pressure sores. An observation and interview on 06/04/25 at 1:45 PM with Resident #1 revealed CNA A was getting ready to perform incontinence care. The resident was awake, alert, and non-verbal. The resident had a supra-pubic catheter and a colostomy. CNA A washed her hands and put on gloves. The resident was not wearing a brief. CNA A cleaned the penis and scrotal area. The resident was rolled to his left side. His buttocks and the back of his thighs were dark red/purple. He had draining wounds on his buttocks that had drained onto the sheets down to the mattress. There was a moderate amount of tan and black drainage. CNA A cleaned the wounds and buttocks. There were 2 open areas, one on each buttock. An interview on 06/04/25 at 2:05 PM with the WCN revealed she was not aware of the wounds on Resident #1, and no one had notified her Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 7 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 - Actual harm Residents Affected - Few about the wounds. She said she started a skin sweep (skin assessment of residents) in the building to look for skin issues but had not assessed Resident #1. The WCN said staff were supposed to notify her about the wounds. The WCN measured the wounds:Left 1st toe 0.5 cm x 0.2 cm Right 1st toe 0.6 cm x 0.5 cm Right buttock 1.5 cm x 2.0 cm Left buttock 2.5 cm x 3.0 cm An interview on 06/04/25 at 2:10 PM with CNA B revealed she was assigned to Resident #1 for the 6:00 AM - 2:00 PM shift on 06/04/25. She said the last time she repositioned the resident was between 8:00 AM - 9:00 AM and she saw the wounds on his buttocks. She said she did not tell the nurse about the wounds, because the nurse already knew about the wounds. CNA B said she was supposed to reposition residents every two hours, but she got busy and was not able to reposition the resident after 8:00 AM - 9:00 AM. CNA B said she could ask for help, but another CNA was already helping her. CNA B said if a resident was not repositioned every two hours, then they could develop wounds. In an observation 0n 07/02/2025 at 08:21AM with the Wound Care Doctor of Resident #1 revealed moisture related skin breakdown with some excoriation observed to the resident's sacrum and buttocks. Excoriation area measured by the wound doctor to left buttock 0.6 x 0.7 x N/A and right buttock 1.8 x 0.8x N/A.No open areas noted. A pressure relieving mattress was observed. Resident #1's Nurse's Notes for June 2025 reflected the following:06/04/25: Called to resident room . 3. Open area to left buttocks with 2.5c. x 3.0cm outer slight discoloration and inner 1.5cm x 2.0cm x 0.2cm with scant amount of serous drainage noted. 4. open area to right buttocks outer slight discoloration area noted 1.5cm x 2.0cm with inner open area noted to be 1.3cm x 1.6cm x 0.2cmC06/04/25: Notified wound care physician Dr. [Name] and Primary contact [Name] of patient status change and areas to left and right buttocks and left and right great toe. Resident #1's Physician's Orders for June 2025 reflected the following: o Right buttock clean area with NS. Pat Dry with 4x4. Apply collagen and anasept mixture and cover bordered gauze qd and PRN if soiled until resolved. o Right buttock clean area with NS. Pat Dry with 4x4. Apply collagen and anasept mixture and cover bordered gauze qd and PRN if soiled until resolved. o Left buttocks clean area with NS. Pat dry with 4x4. Apply barrier cream twice daily. Start date 06/18/25. o Right buttocks clean area with NS. Pat dry with 4x4. Apply barrier cream twice daily. Start date 06/18/25.In an interview on 07/02/25 at 9:25AM, the DON stated Resident #1 was totally bed-bound. On 07/02/25 between 9:25AM and 9:35AM, interviews with Resident #1 assigned Charge Nurses and CNAs revealed they were aware of the interventions in place for Resident #1 to maintain skin integrity and prevent any new skin issues. It was reported that Resident #1 was completely bed-bound. In an interview on 07/02/25 at 8:56AM, the Wound Care Physician confirmed he had been providing treatment for both Resident #1. Wound Care Physician stated he felt very confident in the fact that Resident #1 did not have pressure ulcers. He stated Resident #1 had moisture-associated skin damage to his buttocks. He stated both areas were being treated and were improving. The Wound Care Physician stated these types of wounds/skin damage were very common in individuals with similar comorbidities as Resident #1; he did not feel as though any of these wounds/skin damage were caused by a lack of care and/or negligence. He stated he did not feel as though there was likely anything the facility could have done to prevent these wounds/skin damage from occurring. He said they likely occurred in a short amount of time before being first noticed by the surveyor/facility, and they could have occurred during a transfer, due to friction, etc. On 07/02/25 at 10:00AM, Resident #1's physician confirmed he had been providing care for both residents. Regarding Resident #1, the physician stated he was totally bed-bound. He stated he did not think there was anything the facility could have done differently to prevent the wounds/skin damage that Resident #1 had obtained (which were likely obtained due to his comorbidities). The physician stated the facility had been consistently putting interventions in place for residents to maintain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 8 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete their skin integrity/prevent new skin issues; he had no concerns regarding the facility or the treatment provided related to wounds. Record review of the facility policy, Repositioning, revised May 2013, reflected:1. Repositioning is a common, effective intervention for preventing skin breakdown, promoting circulation, and providing pressure relief.2. Evaluation of a resident's skin integrity after pressure has been reduced or redistributed should guide the development and implementation of repositioning plans. Such plans should be addressed in the comprehensive plan of care consistent with the resident's needs and goals.3. Repositioning is critical for a resident who is immobile or dependent upon staff for repositioning.4. The care plan for a resident at risk of friction or shearing during repositioning may require the use oflifting (sic)[offloading] devices for repositioning.5. Positioning the resident on an existing pressure ulcer should be avoided since it puts additional pressure on tissue that is already compromised and may impede healing . Review of the facility's policy titled Activities of Daily Living (ADL), Supporting last revised March 2018, reflected: Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). Residents who are unable to carry out activities of daily living independently will receive the services necessary tomaintain good nutrition, grooming, and personal and oral hygiene. 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 the plan of care. 6. Interventions to improve or minimize a resident?s functional abilities will be in accordance with the resident's assessed needs, preferences, stated goals and recognized standards of practice. 7. The resident's response to interventions will be monitored, evaluated and revised as appropriate. Event ID: Facility ID: 675112 If continuation sheet Page 9 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0679 Provide activities to meet all resident's needs. 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 provide activities based on the comprehensive assessment and care plan, designed to meet the interests of and support the physical, mental and psychosocial well-being of one resident (Resident #4) out of five who were reviewed for activities. The facility failed to consistently provide encouragement and assistance to participate in facility provided activities for Resident #4. This failure could place residents at risk for social isolation, depression, and a decline in psychosocial well-being.Findings included: Review of Resident #4's annual Minimum Data Set, dated [DATE] reflected the [AGE] year-old male resident was admitted to the facility on [DATE] with diagnoses which included cerebral palsy (a condition caused by damage to the developing brain that affects a person's ability to control their muscles, problems with movement, coordination) kidney failure (kidneys are no longer able to properly filter waste and extra fluid from the blood), contracture (a muscle, tendon, or joint becomes permanently stiff or tight), and dysphagia (trouble swallowing). Review of Resident #4's annual Minimum Data Set assessment dated [DATE] reflected he had no speech, rarely/never made himself-understood, and sometimes was able to understand others. His Brief Interview for Mental Status was not completed. He was totally dependent on two staff for dressing, transferring, bathing and toilet use. He was totally dependent on staff for locomotion, eating, and personal hygiene. He was not ambulatory and had functional limitations in range of motion for upper extremity and lower extremity on both sides. He was indicated as always incontinent of bowel and bladder. He had a physical therapy start date of 03/29/25 with an end date of 04/21/25 with no minutes of treatment recorded during that duration. Review of Resident #4's Care Plan, initiated on 4/11/2018 and revised on 5/27/25 reflected Resident #4 would have 1:1 activity to Resident #4's likes/abilities. Activity Director to individualize activities for Resident #4 and work on getting Resident #4 to socialize with others in a group setting. The goal stated that Resident #4 would continue to participate in activities of choice to his likes/abilities through the next review date and to provide 1:1 assistance as needed to participate in activities. The Care Plan also stated that Resident #4 would have involvement related to music, therapy, and fitness each week at an unspecified number of times a week. The tasks/interventions stated Resident #4 needed a variety of activity types and locations to maintain interests. The tasks/interventions stated that Resident #4 would need assistance/escort to activity functions. The Care Plan included a Focus that stated Resident #4 was high risk for decreased quality of life related to little interest in activities. The goal stated that Resident #4 would maintain his highest practical quality of life as evidenced by attending activities of choice. The intervention/task stated that the facility would encourage Resident #4 to attend group activities as it appeared Resident #4 enjoyed singing and sports where he could participate passively. The facility would assist to/monitor individual/small group activities which included restorative exercise, watching TV, staff talking and laughing with him. Review of Resident #4's Individual Profile - Nursing Facility, dated 6/18/25 under section 4 titled These are my preferences and what is important to me reflected in part It is important for me to maintain a sense of pride and dignity.Please don't leave me in bed all day, I want to be dressed and out of bed in my chair.I love to be taken to musicals or listening to sing a longs and CD's.Sometimes the social workers pull me into their office and turn up the music where I can bounce to the tunes.I can watch TV up until dinner time.I especially like to watch all the action in sport programs.[Resident #4] likes to be out of room on a daily basis.[Resident] #4 enjoys people watch in the hallways or in the lobby of the nursing facility.It is important for [Resident #4] to be around other people. The plan went on to list activities Resident #4 enjoyed: [Resident #4] likes Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 10 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some listening to music, instrument sounds, spending time outside, instrumentals, and being around others. Review of Resident #4's Individual Profile - Nursing Facility, dated 6/18/25 under section Communication stated Resident #4 did not communicate verbally, he would follow people with his eyes and watch what was going on, at times he would say ya, most of the time when someone would ask him a question he would not respond, he would show emotion in body language, make gestures and point or look toward things, and yell out. Review of Resident #4's Habilitative Service Plan, dated 6/18/25 reflected that Resident #4 wanted to listen to music, attend musicals when the facility offered them, TV/movies, music videos, music therapy, music exercise group, and go outside. Review of Resident #4's most recent Activity Evaluation, dated 6/24/24, reflected that Resident #4 required reminders/cues, extensive verbal cuing, and could not comprehend instructions. The evaluation indicated that Resident #4 used a wheelchair with max assist. The evaluation also indicated Resident #4 had a cooperative and cheerful attitude, needed assistance to and from activities, enjoyed 1 on 1 in room, bible study, and watching TV. Review of Resident #4's Progress Notes dated 4/5/25 at 4:30PM entered by Nutrition/Dietary stated in part .patient continues to want to be in his chair more sitting out.Even though patient is nonverbal he cries when he has to return to bed. Review of Resident #4's Progress Notes dated 5/18/25 at 10:19PM stated in part .[Resident] has been sitting up during the day for activities. Review of Resident #4's Progress Notes revealed no further notes that reflected Resident #4 participating in activities since 5/18/25 as indicated by the note entered for that day. Review of the most recent Activities Quarterly Note dated 2/9/24 at 1:01PM stated, Staff will continue to provide Resident #4 with 1:1 visit. Resident also enjoyed sitting in the TV room watching. Staff will continue to provide various activities. Review of the facility's activity calendar, dated July 2025, reflected the following scheduled activities for: 07/01/25 9:00AM - Coffee & Convo10:00AM - Daily Devotional 10:30AM - Nail Time & Chit Chat1:30PM - Arts N Craft3:00PM - In room visits6:00PM - Nightly Cinema Review of the facility's activity calendar, dated July 2025, reflected the following scheduled activities for: 07/02/25 9:00AM - Coffee & Convo10:00AM - Words for Life10:30AM - Fitness for Life1:00PM - Popcorn Social1:30PM Bingo6:00PM - Nightly Cinema Review of the facility's activity calendar, dated July 2025, reflected the following scheduled activities for: 07/06/25 (Sunday) Activity of Your ChoiceReadingWriting - DrawingWord SearchesChurch Service on TV at 11amFamily Visits During interview and observation with Resident #4 on 7/1/25 at 10:09AM, he was observed to be lying in his bed. Resident #4 was non-verbal but made eye contact at times when spoken to. He was not able to answer questions by gesturing or nodding. Resident #4 was observed in a hospital gown. The TV was not on and no music was playing. During an observation of Resident #4 on 7/1/25 at 1:45PM, Resident #4 was observed to be lying in his bed in the same hospital gown. The TV was not on and no music playing. Resident was not participating in the scheduled activity of Arts N Crafts at 1:30PM. During an observation of Resident #4 on 7/1/25 at 3:00PM, Resident #4 was with his hospice nurse being bathed. During an observation of Resident #4 on 7/2/25 at 3:00PM, Resident #4 was observed to be lying in bed in hospital gown. His TV was on showing a reality court show. During an interview of Resident #4's family member/legal representative on 7/1/25 at 4:45PM, he stated Resident #4's hospice nurse was supposed to be getting him out of bed every day to change clothes. He stated Resident #4 liked watching sports and action shows. He stated the former social worker at the facility would take Resident #4 into her office and play music. He stated Resident #4 would also attend church services at the facility and enjoyed being in the halls around other people. During an interview with LVN J on 7/1/25 at 1:20PM, he stated Resident #4 communicated by facial expressions and he would smile to show emotion. He stated Resident #4 did not participate in activities. He stated Resident #4 received a haircut last week. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 11 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview with the Activity Director on 7/2/25 at 10:30AM, she reported she would meet one-on-one with Resident #4 twice a week to provide daily devotional which she would do with every resident or bring a music box. She reported she would record these interactions in her activity logbook. She stated Resident #4 liked to watch TV, he would listen to the daily devotional, and enjoyed music when she would bring a radio. The Activity Director stated she had spoken to Resident #4's family about what he was interested in. She stated she was told that he liked music, church, and TV. She stated at times she would leave the radio in Resident #4's room over the weekend. She stated the nurses or aides would turn his TV on. She stated she had never gotten Resident #4 out of bed to participate in activities. She stated before an activity on Monday's, Wednesday's and Friday's, she would go into Resident #4's room and ask him if he wanted to participate. She stated Resident #4 would not show any interest. She stated she knew he was not interested by him having a blank stare on his face. The Activity Director reported she believed that Resident #4 had been out of his bed twice for activities since she began employment there in March 2025. She stated she was unaware that Resident #4 enjoyed being around people and people watching because no one told her. To determine what residents liked to do, she stated she would talk to the family members. When asked about church services, she stated they no longer had someone come to the facility to facilitate church service. She stated the residents would watch services on TV. The Activity Director was asked to provide her one-on-one activity logbook, and it was never provided. She stated she could not locate her book. She stated she was out on leave last week so she is not sure who moved it. When asked who covered activities while she was on leave, she stated no one did. During an interview with Director of Nursing on 7/2/25 at 10:50AM, she stated Resident #4 would communicate by making sounds and if annoyed he would scream. She stated staff would anticipate his needs. She stated he couldn't nod for yes or no. Review of the Facility's Quality of Life - Resident Self Determination and Participation Policy dated December 2016 stated in part: Our Facility respects and promotes the right of each resident to exercise his or her autonomy regarding what the resident considers to be important facets of his or her life.Each resident is allowed to choose activities, schedules, and health care that are consistent with his or her interest, values, assessments and plans of care including: (a) daily routine, such as sleeping and waking, exercise and bathing schedules; (b) personal care needs, such as bathing methods, grooming styles, and dress; (e) Activities, hobbies and interests; and (f) Religious affiliations and worship preferences. In order to facilitate resident choices, the administration and staff: (a) inform the residents and family members of the residents' right to self-determination and participation in preferred activities; (b) Gather information about the residents' personal preferences on initial assessment and periodically thereafter, and document these preferences in the medical record; (d) Document and communicate any medical conditions or limitations that may inhibit or interfere with participation in preferred activities. Residents are encouraged to make choices about aspects of their lives in the facility, including: (b) organizing and participating in resident groups; (c) interacting with other residents, family and members of the community. Residents are provided assistance as needed to engage in their preferred activities on a routine bases. Event ID: Facility ID: 675112 If continuation sheet Page 12 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the resident's choices for 2 (Residents #1 and #2) of 5 residents reviewed for quality of care. 1. The facility failed to ensure Resident #1 did not develop wounds on his toes and moisture associated skin damage on his buttocks. 2. The facility failed to ensure Resident #1 and Resident #2 were repositioned every two hours on 6/4/25. This failure could place residents at risk for a delay in treatment or diagnosis, a decline in the resident's condition, harm and/or the need for hospitalization and prolonged treatment.Findings included:1. Review of Resident #1's Annual MDS Assessment, dated 04/08/25, reflected the resident was a [AGE] year-old male admitted to the facility on [DATE]. His cognitive skills for daily decision making were severely impaired. The resident had a supra-pubic catheter (catheter inserted into the bladder to drain urine) a colostomy (bag attached to the abdomen to collect bowel movement that excretes from the stoma), and a tracheostomy (a hole that surgeons make through the front of the neck and into the windpipe, also known as the trachea. Surgeons place a tracheostomy tube into the hole to keep it open for breathing). His diagnoses included stroke, kidney failure, diabetes, and quadriplegia (inability to move arms and legs). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. The resident did not have any skin conditions listed. Review of Resident #1's Care Plans reflected:Revised 07/01/24 - Resident had an activities of daily living deficit.Facility interventions: The resident was totally dependent on staff for repositioning and turning in bed.12/02/24 - Risk for Impaired Skin IntegrityFacility interventions: Evaluate skin integrity. Review of Resident #1's Care Plan, last revised 05/20/25 reflected the following focus, goal, and interventions were in place:- Focus: Resident #1 has potential/actual impairment to skin integrity to bilateral buttocks gran 100% tx per MD ORDER 05/03/23. Goal: Resident #1 Skin will remain intact 03/04/25. Interventions: Elevate heels off the bed Involve/educate resident and/or family/designee Monitor for s/s of infection Monitor pain and administer pain medications/treatments as ordered and/or per pain problem- Focus: Wound Management Apply betadine toes qd shift and monitor for sign/symptoms of infection. Apply qd until resolved. right 1st toe 0.75 x 0.5 x nm in cm. Left buttocks clean area with NS. Pat dry with 4x4. Apply house barrier cream twice daily and PRN if soiled until resolved. 0.8 x 0.7 x 0.1cm Right buttocks Left buttocks clean area with NS. Pat dry with 4x4. Apply house barrier cream twice daily and PRN if soiled until resolved. 2.8 x 0.8 x not measurable in CM 06/05/25.Goal: Wound Will Be Free of Signs or Symptoms of Infection Wound Will Show Signs of Improvement 06/05/25.Interventions: Follow facility policies/protocols for the prevention/treatment of skin breakdown Inform the resident/family/caregivers of any new area of skin breakdown Notify provider if no signs of improvement on current wound regimen Provide wound care per treatment order- Focus: Resident #1 has an ADL Self Care Performance Deficit r/t Quadriplegia on Restorative (having the ability to restore health, strength, or a feeling of well-being.) LOW AIRLOSS MATTRESS/CHECK FOR FUNCTION EVERY SHIFT 05/03/23, revised 05/23/25. Review of Resident #1's BRADEN - Scale for Predicting Pressure Sore Risk completed on 05/04/25 indicated Resident #1 was at a high risk for developing pressure sores. An observation and interview on 06/04/25 at 1:45 PM with Resident #1 revealed CNA A was getting ready to perform incontinence care. The resident was awake, alert, and non-verbal. The resident had a supra-pubic catheter and a colostomy. CNA A washed her hands and put on gloves. The resident was not wearing a brief (for an unknown reason) CNA A cleaned the penis and scrotal area. The resident was rolled to his left side. His buttocks and the back of his thighs Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 13 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0686 Level of Harm - Actual harm Residents Affected - Few were dark red/purple. He had draining wounds on his buttocks that had drained onto the sheets down to the mattress. There was a moderate amount of tan and black drainage. CNA A cleaned the wounds and buttocks. There were 2 open areas, one on each buttock. CNA A said she did not know why there was not a dressing on the wounds. CNA A finished cleaning the buttocks and grabbed a clean brief and placed it under the resident. The resident also had a wound on the tip of both his first toes. The wounds were scabbed and very small. An interview on 06/04/25 at 2:05 PM with the WCN revealed she was not aware of the wounds on Resident #1, and no one had notified her about the wounds. She said she started a skin sweep (skin assessment of residents) in the building to look for skin issues but had not assessed Resident #1. The WCN said staff were supposed to notify her about the wounds. The WCN measured the wounds:Left 1st toe 0.5 cm x 0.2 cm - Stage IIRight 1st toe 0.6 cm x 0.5 cm - Stage IIRight buttock 1.5 cm x 2.0 cm - Stage IILeft buttock 2.5 cm x 3.0 cm - Stage II An interview on 06/04/25 at 2:10 PM with CNA B revealed she was assigned to Resident #1 for the 6:00 AM - 2:00 PM shift on 06/04/25. She said the last time she repositioned the resident was between 8:00 AM - 9:00 AM and she saw the wounds on his buttocks. She said she did not tell the nurse about the wounds, because the nurse already knew about the wounds. The WCN was in the room and told CNA B that she was never made aware of the wounds. CNA B said the resident's wounds were not draining when she repositioned him. CNA B said she was supposed to reposition residents every two hours, but she got busy and was not able to reposition the resident after 8:00 AM - 9:00 AM. CNA B said she could ask for help, but another CNA was already helping her. CNA B said if a resident was not repositioned every two hours, then they could develop wounds. In an interview on 06/05/25 at 11:50 AM LVN C said he was assigned to Resident #1 on 06/04/25. He said he did not know about the wounds and did not do a skin assessment. In an observation on 07/02/2025 at 08:21AM with the Wound Care Doctor of Resident #1 revealed a dark scab was noted to left big toe and a smaller scab to tip of right big toe with no redness noted to the surrounding skin. Moisture related skin breakdown with some excoriation (a raw irritated lesion (as of the skin or a mucosal surface) was observed to the resident's sacrum (a triangular bone in the lower back formed from fused vertebrae and situated between the two hipbones of the pelvis) and buttocks (either of the two round fleshy parts that form the lower rear area of a human trunk.). Excoriation area measured by the wound doctor to the left buttock was 0.6 x 0.7 x N/A and right buttock was 1.8 x 0.8x N/A. No open areas were noted. A pressure relieving mattress was observed. Review of Resident #1's Nurse's Notes for June 2025 reflected the following:06/04/25: Called to resident room. Noted 1. left great toe intact scab measuring 0.5cm x0.2cm with no redness or drainage noted. No increased warmth noted to touch. 2.Right great toe noted intact scabbed area 0.6cm x 0.5cm with no drainage/no redness/ and no increased warmth to the touch. 3. Open area to left buttocks with 2.5c. x 3.0cm outer slight discoloration and inner 1.5cm x 2.0cm x 0.2cm with scant amount of serous drainage (thin, watery fluid, often clear or pale yellow, that occurs during the normal healing process of a wound) noted. 4. open area to right buttocks outer slight discoloration area noted 1.5cm x 2.0cm with inner open area noted to be 1.3cm x 1.6cm x 0.2cm06/04/25: Notified wound care physician and Primary contact of patient status change and areas to left and right buttocks and left and right great toe. Review of Resident #1's Physician's Orders for June 2025 reflected the following:o Apply skin prep to toes qd shift and monitor for sign/symptom of infection. Apply qd until resolved left great toe, everyday shift for wound care. Start Date is 06.05.25 End Date is blank.o Apply skin prep to toes qd shift and monitor for sign/symptom of infection. Apply qd until resolved right great toe, everyday shift for wound care. Start Date is 06.05.25 End Date is blank.o Right buttock clean area with NS. Pat Dry with 4x4. Apply collagen and anasept mixture and cover bordered gauze qd and PRN if soiled until (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 14 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0686 Level of Harm - Actual harm Residents Affected - Few resolved.o Left buttock clean area with NS. Pat Dry with 4x4. Apply collagen and anasept mixture and cover bordered gauze qd and PRN if soiled until resolved. o Apply betadine to toes qd shift and monitor for sign/symptoms of infection. Apply qd until resolved. Right great toe. Start date 06/26/25.o Apply betadine to toes qd shift and monitor for sign/symptoms of infection. Apply qd until resolved. left great toe. Start date 06/26/25.o Left buttocks clean area with NS. Pat dry with 4x4. Apply barrier cream twice daily. Start date 06/18/25. Right buttocks clean area with NS. Pat dry with 4x4. Apply barrier cream twice daily. Start date 06/18/25. An interview on 06/04/25 at 3:15 PM with the DON revealed she did not know Resident #1 had wounds. She said if a CNA saw a wound on a resident, then they were supposed to notify the nurse. The DON said staff were supposed to reposition residents every two hours. 2. Review of Resident #2's Annual MDS Assessment, dated 04/24/25, reflected the resident was a [AGE] year-old female admitted to the facility on [DATE]. Her cognitive skills for daily decision making were severely impaired. The resident had a Foley catheter (catheter to drain urine from the bladder) and was always incontinent of bowel movement. Her diagnoses included stroke, diabetes, and non-Alzheimer's disease (form of dementia). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. Review of Resident #2's Care Plans reflected:Revised 08/02/24 - Resident had an activities of daily living performance deficit related to contracture to upper/lower extremities, non-verbal, history of stroke and total assist with all ADLs.Facility interventions included:Bed mobility: the resident required total assist by one staff.There was not a care plan for repositioning. Review of Resident #2's care plan, undated, reflected:Focus: The resident has Peripheral artery disease with non-healing ulcer of left 1st toe 3/11/2024 angiogram outpatient surgery procedure- 1. left superficial; femoral artery atherectomy, angioplasty 2. left posterior tibial artery atherectomy, angioplasty 3. left anterior tibial artery atherectomy, angioplasty NP will f/u with in 1-2 weeks Plavix n/o vascular NP do follow ups and schedule appt as needed 03/12/25, revised 04/16/25.Goal: [Resident #2] will remain free of complications related to PVD through review date. [Resident #2's] extremities will be free from pain, pallor, rubor, coldness, edema and skin lesions. 03/12/25.Interventions: Give medications for improved blood flow or anticoagulants as ordered Monitor the extremities for s/sx of injury, infection or ulcers. Monitor/document/report to MD PRN any s/sx of complications of extremities: coldness of extremity, pallor, rubor, cyanosis and pain. Monitor/document/report to MD PRN any s/sx of skin problems related to PVD: Redness, Edema, Blistering, Itching, Burning, Bruises, Cuts, other skin lesions. An observation on 06/04/25 at 1:20 PM of incontinence care for Resident #2 by CNA B and CNA D revealed both CNAs washed their hands and put on gloves. CNA D cleaned the peri-area and the buttocks. CNA D placed a clean brief under the resident and began straightening her sheets. The resident did not have any wounds. The staff repositioned the resident. An interview on 06/04/25 at 1:30 PM with CNA D revealed the last time Resident #2 was repositioned was at the time of the incontinence care. An interview on 06/04/25 at 1:35 PM with CNA B revealed the last time Resident #2 was repositioned was at the time of the incontinence care. An interview on 06/04/25 at 2:20 PM with a family member of Resident #2 revealed the resident was supposed to be repositioned every two hours. The family member had a camera in the room and said the resident was repositioned at 9:54 AM and 1:20 PM on 06/04/25. An interview on 06/04/25 at 3:05 PM with CNA B revealed she was assigned to Resident #2 on 06/04/25 for the 6:00 AM - 2:00 PM shift. She said she was not able to reposition Resident #2 every two hours because she was very busy. She said she did not reposition Resident #1 and Resident #2 every two hours and those were the only two residents who did not get repositioned. She said she was too busy to reposition them and the risk to the residents was wound development. Observation on 07/02/25 at 8:21 AM of Resident #2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 15 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0686 Level of Harm - Actual harm Residents Affected - Few revealed a healed scab to the right second and fourth toe. There were no open areas or signs/symptoms of infection. A pressure relieving mattress was observed. Review of Resident #2's Nurse's Notes for the month of June 2025 reflected she had a history of wounds to her toes (likely vascular related), dating back to 07/2024:06/16/25: Resident observed with small, reopened sore on the 4th toe, assessment completed, mild bleeding, no indication of pain. Site cleaned with NS, dry dressing applied. Notify wound care nurse for wound care consult. RP family member in the room.06/16/25: Resident observed with small, reopened sore on the 4th toe, assessment completed, mild bleeding, no indication of pain. Site cleaned with NS, dry dressing applied. Notify wound care nurse for wound care consult. NP and DON made aware. RP family member in the room.06/18/25: Wound care rounds made with wound care physician. New order change dressing to M-W-F. Notified facility DON and will notify the POA at this time.06/18/25: Spoke with POA via phone and updated on new toe wound treatment schedule. Resident #2's Physician's Orders reflected the following:- Resident to have pressure off loading boots on while in bed. Every Shift. Start date 01/15/25.Clean right 2nd toe with NS and pat dry. Apply skin prep qd until resolved. Every day shift for wound care. Start date 06/26/25.- Wound care consult. One time a day every Wed for Wound care. Start date 06/18/25.Weekly skin assessment every Monday 6-2 shift. Every day shift every Mon for skin assessment. Start date 07/15/24. In an interview on 07/02/25 at 8:56AM, the Wound Care Physician confirmed he had been providing treatment for both Resident #1 and Resident #2. Regarding Resident #1, the Wound Care Physician stated he felt very confident in the fact that Resident #1 did not have pressure ulcers. He stated Resident #1 had an arterial wound to his toe, as well as moisture-associated skin damage to his buttocks. He stated both areas were being treated and were improving. The Wound Care Physician stated these types of wounds/skin damage were very common in individuals with similar comorbidities as Resident #1; he did not feel as though any of these wounds/skin damage were caused by a lack of care and/or negligence. He stated he did not feel as though there was likely anything the facility could have done to prevent these wounds/skin damage from occurring. He said they likely occurred in a short amount of time before being first noticed by the surveyor/facility, and they could have occurred during a transfer, due to friction, etc. Regarding Resident #2, the Wound Care Physician stated he felt very confident in the fact that Resident #2 did not have pressure ulcers, either. He stated Resident #2 had a recently resolved superficial wound to her toe. The Wound Care Physician said Resident #2 had a history of superficial/vascular wounds to her toes; she had a history of hitting her toes on the side of the bed. He stated this was not too concerning, as the areas resolved rather quickly. He stated she had been seen by a vascular specialist and no treatment was recommended. He stated he had not ordered a cradle to help keep her feet free from the bed linens, as he did not see a need at the current time. In an interview on 07/02/25 at 9:25AM, the DON stated Resident #1 was totally bed-bound and Resident #2 got out of bed for four hours every Tuesday, Thursday, and Saturday per her family's request. When Resident #2 was out of bed, she still received positioning adjustments and incontinence care at least every 2 hours. Resident #2 also had heel protectors that were worn when she was out of bed. On 07/02/25 between 9:25AM and 9:35AM, interviews with Resident #1 and Resident #2's assigned Charge Nurses and CNAs revealed they were aware of the interventions in place for both Resident #1 and Resident #2 to maintain skin integrity and prevent any new skin issues. It was reported that Resident #1 was completely bed-bound, and Resident #2 got out of bed for four hours every Tuesday, Thursday, and Saturday per her family's request. On 07/02/25 at 10:00AM, Resident #1 and Resident #2's physician confirmed he had been providing care for both residents. Regarding Resident #1, the physician stated he was totally bed-bound. He stated he did not think there was anything the facility could have done differently to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 16 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0686 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete prevent the wounds/skin damage that Resident #1 had obtained (which were likely obtained due to his comorbidities). Regarding Resident #2, he stated he did not think the facility could have done anything differently to prevent the wound to her toe (which was likely caused by trauma, per the wound care physician). The physician stated the facility had been consistently putting interventions in place for residents to maintain their skin integrity/prevent new skin issues; he had no concerns regarding the facility, or the treatment provided related to wounds. Record review of the facility policy, Repositioning, revised May 2013, reflected:1. Repositioning is a common, effective intervention for preventing skin breakdown, promoting circulation, and providing pressure relief.2. Evaluation of a resident's skin integrity after pressure has been reduced or redistributed should guide the development and implementation of repositioning plans. Such plans should be addressed in the comprehensive plan of care consistent with the resident's needs and goals.3. Repositioning is critical for a resident who is immobile or dependent upon staff for repositioning.4. The care plan for a resident at risk of friction or shearing during repositioning may require the use of lifting (sic)[offloading] devices for repositioning.5. Positioning the resident on an existing pressure ulcer should be avoided since it puts additional pressure on tissue that is already compromised and may impede healing . Event ID: Facility ID: 675112 If continuation sheet Page 17 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident who was incontinent of bladder received appropriate treatment and services to prevent urinary tract infections for 1 (Resident #2) of 2 residents reviewed for catheter care. The facility failed to ensure Resident #2 received her Foley catheter change as ordered every month when RN E documented that he changed the Foley catheter on 05/13/25, but he only changed the bag and did not change the catheter. These failures could place residents at risk of cross-contamination and development of infections.Findings included: 1. Review of Resident #2's Annual MDS Assessment, dated 04/24/25, reflected the resident was a [AGE] year-old female admitted to the facility on [DATE]. Her cognitive skills for daily decision making were severely impaired. The resident had a Foley catheter (tube to drain urine from the bladder) and was always incontinent of bowel movement. Her diagnoses included stroke, diabetes, non-Alzheimer's disease (form of dementia), neurogenic bladder (refers to what happens when an injury or disease interrupts the electrical signals between your nervous system and bladder function) and obstructive uropathy (blockage that prevents urine from flowing naturally through the urinary system). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. Review of Resident #2's Physician Orders for June 2025 reflected the following:04/13/25 Foley catheter to be changed monthly and as needed for malfunction every day shift starting on the 13th of every month. Review of Resident #2's Care Plans reflected the following:Revised 10/29/24 - Resident had and indwelling foley catheter that had to be changed monthly and as needed for malfunction . An observation on 06/04/25 at 1:20 PM of incontinence care for Resident #2 by CNA B and CNA D revealed both CNAs washed their hands and put on gloves. CNA D cleaned the peri-area and Foley catheter. CNA D placed a clean brief under the resident and began straightening her sheets . Interviews on 06/04/25 at 12:45 PM and 06/04/25 at 2:20 PM with the family member of Resident #2 revealed the resident was in the hospital in March 2025 and had her Foley catheter changed. She said the Foley catheter had not been changed since March 2025. The family member said she had a camera in her room and never saw staff change the Foley catheter. The family member said she was told by the DON that the Foley catheter was changed in May. She said she spoke with RN E (staff who signed the MAR that he had changed the catheter) who said he did not change the catheter on 05/13/25, just the bag. An interview on 06/05/25 at 11:20 AM with RN E revealed he documented that he changed the Foley catheter on 05/13/25, but he only changed the bag because it was leaking . RN E said he did not change the catheter because it was not dirty. RN E said not changing the Foley catheter could lead to clogging and infection. An interview on 06/05/25 at 11:30 AM with the DON revealed she would have to check the order to see how often the catheter was supposed to be changed for Resident #2. The DON said she did not know the Foley catheter was not changed on 05/13/25. The DON said the family member of Resident #2 asked if it had been changed , but she said she could not tell if had or had not been changed. The DON said failure to change a Foley catheter could lead to infection. Record review of the facility policy, Catheter Care Policy, dated 06/03/25, reflected: PurposeTo provide guidelines for the appropriate management, care, and monitoring of urinary catheters to reduce the risk of complications such as urinary tract infections (UTIs), catheter-associated pain, and to ensure that the catheter remains necessary for the patient's care . Event ID: Facility ID: 675112 If continuation sheet Page 18 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 - Immediate jeopardy to resident health or safety Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for one (Resident #3) of three residents reviewed for pharmacy services. The facility failed to administer all physician ordered doses of Rifaximin (medication to treat liver failure) to Resident #3 between 01/09/25 - 01/20/25. The failure could place residents at risk for exacerbation of health conditions, worsening of conditions, and physical/emotional discomfort.An Immediate Jeopardy ( IJ) was identified on 06/05/25. Findings demonstrate that the Immediate Jeopardy began on 01/09/25 and was removed on 01/20/25. The noncompliance continued at a Pattern of Potential for More than Minimal harm that is not Immediate jeopardy.Findings included: Record review of Resident #3's quarterly MDS assessment dated [DATE], reflected she was a [AGE] year-old female who admitted on [DATE]. She had a BIMS score of 13, which indicated she was cognitively intact. The resident's diagnoses included a diagnosis of liver cirrhosis (permanent scarring of the liver) and hepatic encephalopathy (happens when your liver is not filtering toxins as it should. These toxins build up in your blood and affect your brain, causing confusion, disorientation, and other changes.)Record review of Resident #3's January 2025 Physician Orders reflected the following:Start Date 01/09/25 Rifaximin Oral Tablet 550 milligrams two times a day for Hepatic Encephalopathy.Record review of Resident #3's January 2025 Medication Administration Record reflected she had not received Rifaximin on the following dates:01/09/25 4:00 PM - Medication not available from pharmacy - MA H01/10/25 4:00 PM - Medication not available from pharmacy - MA H01/12/25 8:00 AM and 4:00 PM - Medication not available from pharmacy - MA F01/13/25 4:00 PM - Medication not available from pharmacy - MA H01/14/25 8:00 AM and 4:00 PM - Medication not available from pharmacy - MA G01/16/25 4:00 PM - Medication not available from pharmacy - MA H01/17/25 4:00 PM - Medication not available from pharmacy - MA H01/18/25 8:00 AM and 4:00 PM - Medication not available from pharmacy MA F01/19/25 8:00 AM and 4:00 PM - Medication not available from pharmacy - MA F01/20/25 8:00 AM MA G and 4:00 PM - Medication not available from pharmacy - MA H Record review of Resident #3's Hospital Records, dated 01/23/25, reflected:The patient was a 60-year -old female with history of cirrhosis came to emergency room after family member had concern for medical management at nursing home. Per family member, patient was newly admitted to this nursing home. She got a call from the nursing home that the patient was found on floor but was doing ok. The family member went to check on the patient and noticed that she had not been getting any meds for three weeks and the patient was confused. An interview on 06/04/25 at 9:45 AM with the family member for Resident #3 revealed the resident was in the hospital and while she was at the facility in January 2025, she missed doses of her medication. The resident admitted to the hospital on [DATE] and discharged on 01/27/25. The resident was sent to a different hospital on [DATE].An interview on 06/05/25 at 10:30 with RN I revealed she did not remember issues with the Rifaximin order for Resident #3 in January 2025. She said if a medication was not available, then the staff would contact the pharmacy to deliver it. RN I said the physician had to be notified if a medication was not available to give to anyone.n interview on 06/05/25 at 10:35 AM with MA F revealed she did not remember passing medication to Resident #3 in January 2025. She said if she documented that she was waiting on the medication from the pharmacy, then she would have told the nurse. She said she only worked weekend shifts. Interviews were attempted on 06/05/2025 with the Medication Aides who were scheduled:MA H on 06/05/25 at 11:15 AM did not return call of the Surveyor.MA G on 06/05/25 at 11:45 AM when MA G hung up the phone on the Surveyor.An interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 19 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 06/04/25 at 2:30 PM with the Physician who was no longer employed with the facility stated he did not remember Resident #3 and was no longer employed at the facility. He said if he had been notified that the Rifaximin was not available, then he would have ordered a different medicine for the resident. The physician said if the resident did not receive the medication it could result in altered mental status. An interview on 06/04/25 at 11:40 AM with the DON revealed she did not work at the facility in January 2025.Record review of the only facility's policy received and was titled, Documentation of Medication Administration, revised April 2007, reflected the following:Policy StatementThe facility shall maintain a medication administration record to document all medications administered.Policy Interpretation and Implementation1. A Nurse or Certified Medication Aide (where applicable) shall document all medications administered to each resident on the resident's medication administration record (MAR).2. Administration of medication must be documented immediately after (never before) it is given.3. Documentation must include, as a minimum:a. Name and strength of the drug;b. Dosage;c. Method of administration (e.g., oral, injection (and site), etc.);d. Date and time of administration;e. Reason(s) why a medication was withheld, not administered, or refused (as applicable);f. Signature and title of the person administering the medication; andg. Resident response to the medication, if applicable (e.g., PRN, pain medication, etc.). The facility initiated the following interventions prior to surveyor entry on 05/31/25.Record review revealed Resident #3 was discharged from the facility 05/30/25. Review of Resident #1 and Resident #2's MARs revealed that they did not have any issues with their medications being unavailable.Interviews with staff (ADON, 1 RN, 1 LVN, Regional DON, Interim DON and 1 MA) on 06/04/25 from 11:10 AM - 06/05/25 to 1:30 PM revealed that staff were knowledgeable on the procedure to follow if a medication was not available. An Immediate Jeopardy (IJ) was identified on 06/05/25. Findings demonstrate that the Immediate Jeopardy began on 01/09/25 and was removed on 01/20/25. The noncompliance continued at a Pattern of Potential for More than Minimal harm that is not Immediate Jeopardy. Event ID: Facility ID: 675112 If continuation sheet Page 20 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 observations, interviews, and record reviews the facility failed to establish and 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 two (Resident #1 and Resident #2) of five residents, reviewed for infection control. 1. The facility failed to ensure CNA A performed hand hygiene during incontinence care for Resident #1 on 06/04/25.2. The facility failed to ensure CNA B and CNA D performed hand hygiene during incontinence care for Resident #2 on 06/04/25. This failure placed residents at risk for cross contamination and infections.Findings included: 1.Review of Resident #1's Annual MDS Assessment, dated 04/08/25, reflected the resident was a [AGE] year-old male admitted to the facility on [DATE]. His cognitive skills for daily decision making were severely impaired. The resident had a supra-pubic catheter (catheter inserted into the bladder to drain urine) a colostomy (bag attached to the abdomen to collect bowel movement that excretes from the stoma), and a tracheostomy (a hole that surgeons make through the front of the neck and into the windpipe, also known as the trachea. Surgeons place a tracheostomy tube into the hole to keep it open for breathing). His diagnoses included stroke, kidney failure, diabetes, and quadriplegia (inability to move arms and legs). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. Review of Resident #1's Care Plans reflected the following: Revised 01/20/25 - Resident had an activities of daily living deficit.Facility interventions: maximal assistance of one staff for all ADLs. An observation and interview on 06/04/25 at 1:45 PM with Resident #1 revealed CNA A was getting ready to perform incontinence care. The resident was awake, alert, and non-verbal. He had a tracheostomy with a tracheostomy collar (collar to deliver oxygen to the tracheostomy). The resident had a supra-pubic catheter and a colostomy. CNA A washed her hands and put on gloves. The resident was not wearing a brief . CNA A cleaned the penis and scrotal area. The resident was rolled to his left side. His buttocks and the back of his thighs were dark red/purple. He had draining wounds on his buttocks that had drained onto the sheets down to the mattress. There was a moderate amount of tan and black drainage. CNA A cleaned the wounds and buttocks. There were 2 open areas, one on each buttock. CNA A said she did not know why there was not a dressing on the wounds . CNA A finished cleaning the buttocks and grabbed a clean brief and placed it under the resident. CNA A did not change gloves or perform hand hygiene. CNA A said she should have changed gloves and performed hand hygiene after cleansing the resident and before putting on a new brief. CNA A said she did not do it this time, but she should have. She said she did not do it because she was nervous. CNA A said the risk to the residents was contamination. 2. Review of Resident #2's Annual MDS Assessment, dated 04/24/25, reflected the resident was a [AGE] year-old female admitted to the facility on [DATE]. Her cognitive skills for daily decision making were severely impaired. The resident had a Foley catheter (tube that drains urine from the bladder) and was always incontinent of bowel movement. Her diagnoses included stroke, diabetes, and non-Alzheimer's disease (form of dementia). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. Review of Resident #2's Care Plans reflected the following: Revised 08/02/24 - Resident had an activities of daily living performance deficit related to contracture to upper/lower extremities, non-verbal, history of stroke and total assist with all ADL's.Facility interventions included:Bed mobility: the resident required total assist by one staff. An observation on 06/04/25 at 1:20 PM of incontinence care for Resident #2 by CNA B and CNA D revealed both CNAs washed their hands and put on gloves. CNA D cleaned the peri-area and changed her gloves but did not perform hand hygiene. CNA D cleaned the Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 21 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 FORM CMS-2567 (02/99) Previous Versions Obsolete buttocks and changed gloves but did not perform hand hygiene. CNA B changed her gloves but did not perform hand hygiene . CNA D placed a clean brief under the resident and began straightening her sheets. The resident did not have any wounds. An interview on 06/04/25 at 1:30 with CNA D who stated she only performed hand hygiene before care and after care but had been trained to perform hand hygiene during the care. She said she did not know why she did not perform hand hygiene for Resident #2, and the risk to the resident was contamination. An interview on 06/04/25 at 1:35 PM with CNA B who stated she had been trained to perform hand hygiene after changing gloves and did not know why she did not for Resident #2. An interview on 06/04/25 at 3:15 PM with the DON who stated she was the Infection Preventionist. The DON said staff were supposed to change their gloves during incontinence care and perform hand hygiene when changing gloves. Record review of the facility policy, In-Service Education: Hand Hygiene & Personal Protective Equipment (PPE) Compliance, not dated, reflected:Hand Hygiene ExpectationsPerform hand hygiene using soap and water or alcohol-based hand rub (ABHR) before and after resident contact.After contact with blood, body fluids, or contaminated surfaces.After touching objects in the resident's environment.Before performing aseptic tasks (e.g., catheter insertion, dressing changes).After removing PPE (gloves, gowns, masks).Use soap and water when hands are visibly soiled or when caring for residents with C. difficile or norovirus.Offer residents hand hygiene after toileting and before meals.Personal Protective Equipment (PPE) RequirementsGloves must be worn for contact with blood, body fluids, mucous membranes, or non-intact skin, and changed between tasks . Event ID: Facility ID: 675112 If continuation sheet Page 22 of 23 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675112 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Rehabilitation and Nursing of Arlington 1112 Gibbins Rd Arlington, TX 76011 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 effective pest control program so that the facility was free of pests and rodents for one, Resident #1, of five residents reviewed for environmental concerns. The facility failed to ensure Resident #1's room was free of gnats on 06/04/25 which were landing on a cloth near his tracheostomy collar. This failure could place residents at risk of having pests in their rooms and insect bites.Findings included: Review of Resident #1's Annual MDS Assessment, dated 04/08/25, reflected the resident was a [AGE] year-old male admitted to the facility on [DATE]. His cognitive skills for daily decision making were severely impaired. The resident had a supra-pubic catheter (catheter inserted into the bladder to drain urine) a colostomy (bag attached to the abdomen to collect bowel movement that excretes from the stoma), and a tracheostomy (a hole that surgeons make through the front of the neck and into the windpipe, also known as the trachea. Surgeons place a tracheostomy tube into the hole to keep it open for breathing). His diagnoses included stroke, kidney failure, diabetes, and quadriplegia (inability to move arms and legs). The resident was dependent on staff for rolling on back to left and right side and return to lying on back on the bed. Review of Resident #1's Care Plans reflected the following: Revised 01/20/25 - Resident had an activities of daily living deficit.Facility interventions: maximal assistance of one staff for all ADLs. An observation and interview on 06/04/25 at 1:45 PM with Resident #1 revealed CNA A was getting ready to perform incontinence care. The resident was awake, alert, and non-verbal. He had a tracheostomy with a tracheostomy collar (collar to deliver oxygen to the tracheostomy). The resident also had a cloth with mucus drainage that was lying on his chest. Gnats were flying around the tracheostomy collar and nebulizer tubing. A cluster of gnats was observed on the cloth and flying around the room. CNA A and LVN C said she did not know why there were gnats in the room and CNA A stated she would notify maintenance. An interview on 06/04/25 at 3:15 PM with the DON who stated she was not aware that Resident #1 had gnats in his room. An interview on 06/05/25 at 11:55 am with the Maintenance Director revealed he was notified on 06/04/25 about the gnats and he cleaned the room of the gnats by washing down the walls and surfaces. He said no one had reported Resident #1 had gnats in his room. Record review of the facility policy, Pest Control, not dated, reflected:Policy StatementOur facility shall maintain an effective pest control program . Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 23 of 23