Inspection·July 26, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 6/13/25 reflected the resident required limited assistance by (1) staff tomove between surfaces, the resident did not walk, and resident used a manual wheelchair for locomotion. Resident #2's care plan addressed his psychiatric illness and refusing medications and services, staff were to monitor, encourage him to participate, inform him of the danger to his health if he did not participate, staff were to document his refusals. Resident #2's care plan did not address him rooming with Resident #1, the staff involved with that decision were no longer working at the facility. The plan addressed the facility educating Resident #2 on the dangers of sleeping in the bed with Resident #1. Resident #2's care plan did not address him leaving the facility, nor did it address any drug/alcohol use.Current MDS requested for Resident #1 and Resident #2 on 07/26/25 at 2:11 PM, and reminder sent on 07/28/25 at 5:16 PM. Received MDS for Resident #1 and Resident #2 on 07/29/25 at 5:04 PM the BIMS was blank.On 07/31/25 at 6:10 AM emailed Administrator-B and Director of Clinical Services and informed the MDS' for Resident's #1 and #2 had no BIMS and if the admission MDS could be provided. On 08/06/25 at 12:07 PM an email was sent to Administrator-B, the MDS for Residents #1 and #2 were requested and received, noting that Resident #1 and Resident #2 both had a BIMS of 15. Interview on 07/24/25 at 11:04 AM with Resident #1 revealed she and Resident #2 were roommates. She stated he was her fiance. She stated earlier in the day on 07/22/25, Resident #2 was upset with RN-A and called the police on him. She stated Resident #2 left to get some beer and brought it back to the room to drink. She stated another resident's friend gave Resident #2 drugs and when he came to the room to try to smoke it, she told him he could not smoke it and he got upset and began to beat on her. She stated she was yelling for help, she stated RN-B came into the room and screamed for Resident #2 to stop hitting her. She stated Resident #2 did stop hitting her then EMS arrived and took her to the hospital, and she was there for about two hours then she was brought back to the facility. She stated her injuries were a black right eye, a busted upper lip, bruised to both cheeks, and a large bruise to her left breast. She stated she did not feel safe at the facility because someone else could enter the room and she could not protect herself. She stated she and Resident #2 had not had any physical altercations in the past. She stated he had taken care of her he had never hurt her. When asked if she pushed the call light button, she stated the call light had not worked in four months. She stated she was given a bell to ring when she needed assistance, but they had put the bell on the door. She said she also had a bell in the drawer next to her bed. She stated no one had told her she needed to keep the bell out of the drawer. She stated she was given a bell to ring when she needed assistance, but they had put the bell on the door. She said she also had a bell in the drawer next to her bed. Observation on 07/24/25 at 11:30 AM revealed there were two call light cords plugged into the wall in the room of Residents #1 and #2. Observation of the call light cords revealed both cords on the floor. Further observation of the room revealed a bell hanging on a short rope/string on the back of the door to the room, out of reach of the Residents. Resident #1 was observed in her bed. A telephone interview with RN-A on 07/24/25 at 11:51 AM revealed he had worked the 2-10 shift on 07/22/25 when Resident #2 came to him at 6 PM and asked for his pain medication, Resident #2 was informed his pain medication was due at 7:30 PM. He stated 30 minutes later Resident #2 came to him and said that Resident #1 needed her wound dressing changed. He stated when he went to the room of Resident #1 and Resident #2, he started to do the dressing when Resident #2 yelled at him that he was not taking care of the wound. He stated he was treating Resident #1 for the sacrum area, when Resident #2 had informed him (RN-A) that the dressing needed to be changed. RN-A stated while he was changing dressing, Resident #2 informed him (the nurse) that there was another wound that had developed. He stated he informed Resident #2 that Resident #1 did not have another wound and Resident #2 attempted to touch the area the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 2 of 14 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 07/26/2025 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some nurse was re-dressing, and RN-A pushed his hand away and became upset saying he (RN-A) had put his hands on him and he (Resident #2) was going to call the police. He stated the police did come to the facility and talked to him and Resident #2, then they left. He stated when he was in a room taking care of a resident who had a G-Tube, he heard noises coming from the room of Resident #1 and Resident #2, he stated when he heard the yelling, he was actively caring for another resident. He stated when he finished with the G-Tube resident he went into the hallway, and he saw RN-B with CNAs in the hallway. He stated he did not see Resident #2 hit Resident #1; the incident ended when RN-B called out Resident #2's name. He stated then RN-B went to the nurses station and called 911. He stated prior to the police arrival Resident #2 came after him and attacked him with a pocketknife and cut his hand. He stated he and Resident #1 went to the hospital for medical attention and Resident #2 was treated and taken to jail. He stated the residents were at risk because Resident #1 did not have a way to call for help other than to yell for help. Face to face interview with Maintenace Director on 07/24/25 at 3:15 PM revealed he had been employed since late February. He stated he knew there were some call lights that were not working throughout the building. He stated he would fix the call lights then they would go out again, because the system was old. He stated if the call light was not working the residents would be given a bell to ring for help until the light could be fixed. He stated he was not sure if the call lights were working in Resident #1 and Resident #2's room. He stated when an aide would report the light was not working, he would fix the light on the spot. He stated he did not believe the light situation got to a point that he needed to notify Administrator-A. He stated there was not any room that had to have the call light fixed more than one time. He stated the staff would come to him face to face to report a call light was not working. He stated the staff could always call him on his cell phone to report issues. He stated when the call light was not working it could delay or not allow a resident to receive help. Face to face interview with Administrator-B on 07/24/25 at 3:36 PM, revealed the day was her fourth day working at the facility. She stated she was not aware Resident #1 and Resident #2 did not have a call light in their room. She stated when she found out about the call light, she was trying to move Resident #1 to another room, but she had refused to move. She stated she did not know how long Resident #1 and Resident #2 had been without a call light or any way to communicate to staff the need for assistance. She stated she did not know how the residents were supposed to let staff know they needed assistance. She stated she did not know there was a bell in the room or that the bell was on the back of the door out of reach of the resident. She stated perhaps the resident put the bell on the back of the door herself. When advised the resident was unable to walk and could not get up without help of staff, she replied, the resident could have put the bell on the door when she was in her wheelchair. She stated she would assume the Maintenace director was responsible to ensure the call lights worked in the rooms. She stated the CNAs and nurses would be responsible to ensure the placement of the bell was in reach of the resident. She stated there was a severe risk of injury or a lack of care to the residents' when they did not have access to communication.A telephone interview with CNA-A on 07/25/25 at 12:09 PM reflected Resident #2 had told him he was upset with RN-A and took his anger out on Resident #1. He stated RN-A had disrespected Resident #1. He stated RN-B was with him when they went to the Resident #1 and #2's door. RN-B asked what was going on and why was Resident #2 hitting Resident #1. He stated Resident #1 said he was not hitting Resident #2, but he could see they were the only two people in the room. CNA-A stated he knew to go to the room because he heard Resident #1 screaming from the room. He stated he did not know the call light was out in the room of Resident #1 and Resident #2. He stated Resident #2 would come out of the room to let the nurse know that Resident #1 needed help. He stated after the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 3 of 14 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 07/26/2025 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some incident he was told there was a bell in the room for them to use to let staff know they needed help, but he had never heard it used. He stated when a resident was not able to call for help, they could be at risk of injury. In a telephone interview with RN-B on 07/26/25 at 6:15 PM, reflected she was aware some of the call lights were not working but she was not sure how long the lights had been out. She stated she thought the administrator and Maintenace knew the light was not working but she had not checked with them. She stated the night of the incident between Resident #2 and #1 she was assigned to halls 300 and 500. She stated she was on hall 400 at the time of the incident to get supplies from the supply closet. She stated she heard Resident #1 screaming and went to see what was happening and when she got to the room, she saw Resident #2 hitting Resident #1 in the face. She stated she called the name of Resident #2, and he stopped hitting Resident #1 immediately and started calling her baby. She stated she called 911, Resident #2 came to the nurses station shouting and saying it was RN-A's fault and swung on RN-A and cut his hand with a knife. She stated the police and EMS arrived, and Resident #1 went to the hospital and Resident #2 was arrested. She stated she did not believe if the resident had a call light it would have kept Resident #2 from harming Resident #1.Record review of facility's incident report dated 07/22/25, reflected, [Resident #2's] roommate (Resident #1) screamed for help and when staff responded to the screams for help, [Resident #2] was seen standing over his roommate punching her in the face repeatedly. After his name was called, he (Resident #2) stopped attacking her (Resident #1) and tried to console her. [Resident #2] slit his own throat with a pocketknife and came to the nurses station and began shouting at the male nurse (RN-A) on duty and [he the jumped on top of the counter swung the knife at the nurse and cut the nurse's hand]. 911 was called when the resident (Resident #1) was beating on his roommate (Resident #2), and they were on the phone when he (Resident #2) cut the nurse's (RN-A) hand. The police came and removed the resident (Resident #2) from the building. DON notified via phone of the incident. [No further action taken at this time ].Record review of LE report dated 07/22/25, reflected, On Tuesday July 22nd, 2024, I Officer [#1] was dispatched to [Nursing & Rehab] room [Resident #1 and Resident #2] reference a cutting in progress call at 2359 hours (11:59 pm). Call text stated a residence of the rehab center got in a fight with the nurses and cut himself as well as a nurse with a knife. The complainant did advise both the resident and the nurse have injuries. EMS and Fire were added to the call for medical treatment on both parties. I was equipped with a functioning body worn camera, while wearing a distinct patrol uniform and driving in marked patrol vehicle [#].Upon arrival to the [Nursing & Rehab] center at 0002 hours (12:02 am) on 7/23/2025, I walked inside the main lobby area and was met by the nurse who had been cut by the resident. This nurse was identified as [RN-A]. While I spoke with [RN-A], Officer [#2], Officer [#3], and Sergeant all went to room [Resident #1 and #2] to[ make contact with] the suspect who had cut himself and nurse [RN-A]. As I remained with [RN-A], I could see he was utilizing gauze to tend to his wounds as he was actively bleeding from both his right and left thumbs. [RN-A] informed me that the resident who officers were going to, had cut him with a knife that was on a keychain lanyard. [RN-A] did show me the knife which was a small black knife that attached to a keychain. Officers confiscated the knife as evidence.Officer [#2] later came back to [RN-A] and gathered his statement and what transpired between him and the resident this evening. I took photographs of [RN-A] injuries with my BWC. EMS and Fire arrived on scene and [RN-A] did advise that he wanted to go to the hospital for further treatment on his lacerations. I followed [RN-A] out to the ambulance and later provided him with the report number.Once [RN-A] left in the ambulance, I went back inside the rehab center and to room [Resident 1 & 2]. As I walked into room [Resident 1 & 2], I observed officers on the ground fighting with the suspect. Ofc. [#3] informed me that they went to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 4 of 14 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 07/26/2025 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some place the subject under arrest for aggravated assault and he resisted arrest. I observed Ofc. [#2] controlling the subjects legs and Ofc. [#3] controlling the subjects upper body. I asked Ofc. [#3] and Ofc. [#2] if they needed leg restraints to assist with taking the subject into custody. Ofc. [#3] did confirm to utilize leg restraints to which I then ran out to my patrol vehicle to gather the restraints. Once I gathered the leg restraints, I ran back to room [Resident #1 and #2] and assisted Ofc. [#2] with placing them on the subject. Once the subject was in leg restraints and handcuffs, Officers escorted the subject to my patrol vehicle where he was placed in the back seat.Ofc. [#2] informed me that the subject also cut his throat with the knife he used against [RN-A] and was needing to be medically cleared before being transported to the jail. Due to the subject needing medical clearance, I transported him to [Local] Hospital where he was further treated for his injuries. Once at [Local] Hospital, Ofc. [#2] completed a full search incident to arrest on the subject. In Ofc. [#2] search, she located a black circular container inside the subjects pant pockets. I retrieved this container from Ofc. [#2]as she finished searching the subject. I looked inside the container and observed multiple pills inside of it as a well as a [crystal like] substance that appeared to be methamphetamine based on my training and experience. I later called the Poison Control number and was able to identify some of the pills inside of the container. ID [#199] from the Texas Poison Control Center assisted me in identify the pills. 6 yellow circular pills with the lettering of 0.5 was later identified as Clonazepam (can cause paranoid or suicidal ideation and impair memory, judgment, and coordination.) is a benzodiazepine medication (depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures). The second pill was a white circular pill with the lettering of 5.03. This was identified as Tizanidine (it can treat muscle spasms). ID [#199] informed me that this pill is a prescribed muscle relaxer. The third pill was unable to be identified due to no insignia or lettering on it. There were 2 of these pills which were half black and half red capsules. These pills were sent off for further testing. Lastly, I later tested the [crystal like] substance using a presumptive field test kit. The test kit did show to be positive for methamphetamine as it turned dark purple in color. I later booked in and weighed all the pills and methamphetamine into the North Station property room as seized property. The total weight for all pills were as follows: Tizanidine 0.5 grams, Clonazepam 1.0 grams, and the red and black pills weighed 1.7 grams. The total weight of the methamphetamine weighed 0.01 grams. On Tuesday 07-22-25, at approximately 2359 hours (11:59 p.m.), I, Officer [#2], was dispatched to a Cutting in Progress call at [Nursing & Rehab). The call text stated that the complainant advised residents go into a fight. The suspect is cursing in the background and cut both his neck and the nurse. Upon arrival, at approximately 0002 hours (00:02 a.m.), officers [entered into] the facility, and I saw a B/M who appeared to have a few lacerations to both his left and right hands. He later identified himself as [RN-A], and he is a nurse at the location. I was told that the suspect was back in his girlfriend's room and no longer had the knife but had cut himself in the neck with the knife. When I got back to the room and [made contact with] the suspect, he was very animated and irate. I also noticed that he had several lacerations to his neck which he told me were self-inflicted. He was identified to me as [Resident #2] When I tried to ask [Resident #2] what had happened, he would not tell me anything except that it was the nurse's fault, referring to [RN-A], and that he was the reason this happened. Also in the room with [Resident #2] was his girlfriend who was laying in the bed and later identified herself as [Resident #1]. Since [Resident #2] was being uncooperative and not telling me the story of what happened, I went to the front desk where [RN-A] was to ask him what had occurred. [RN-A] told me that the whole situation started at around 1800 hours (6:00 p.m.) this evening and police had been called out at that time (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 5 of 14 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 07/26/2025 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some too. [RN-A] said that he was changing the dressing on [Resident #1's] wounds when [Resident #2] kept touching the open wound with his bare hands. Since this was not sanitary, [RN-A] advised [Resident #2] to stop and then pushed his hand away. This made [Resident #2] extremely upset and [Resident #2] called the police to try and report an assault. When officers came out, they did not find that any offense occurred and cleared the scene. Still upset about this incident earlier, [Resident #2] ended up coming after [RN-A] with a small knife while he was standing at the nurse's station. [Resident #2] did this after having an altercation with [Resident #1] and then cutting his own neck with the knife. [RN-A] stated that he did want to press charges for the Aggravated Assault and was transported by ambulance to [Local] Hospital. Officer [#1] took pictures of [RN-A's] injuries with his body worn camera. There were two other hospital personnel that stated they were also at the nurse's station with [RN-A] and witnessed the incident. The first nurse identified herself to me as [LVN-A] stated that [Resident #2] came out of his girlfriend's room extremely irate and cussing. He approached [RN-A] and began trying to slice at his face with the knife that was in his hand. [RN-A] ended up putting his hands up to block the blade from striking his face which is how he got the lacerations to his hands. The second nurse identified herself to me as [not listed on employee roster] confirmed the statements from [LVN-A] and added that [Resident #2] was telling [RN-A] that he was going to kill him as he was slashing the knife towards him. I [Ofc. #2] was then informed that there was an additional nurse who had witnessed the beginning of the incident, so I went to talk to her at this time. This nurse identified herself to me as [RN-B]. [RN-B] told me that she heard [Resident #1] screaming so she went to go see what was going on. That's when she witnessed [Resident #2], who was standing beside her bed, punching her repeatedly in the face as she was laying in bed. [RN-B] told me that she began to yell at [Resident #2] to try and get him to stop and he eventually stopped. Once [RN-B] walked away, that is when [Resident #2] grabbed the knife that was attached to his key chain and began slicing his neck before going to the nurse's station, threatening and cutting [RN-A]. When I later spoke to [Resident #1], she confirmed what [RN-B] told me, and I also observed that her face was red and swollen in several spots. I took a picture of [Resident #1's] injuries with my body worn camera. She told me that her and [Resident #2] had gotten in an argument over him trying to bring methamphetamine in the room. [Resident #1] stated that she told [Resident #2] not to bring it in because she is on probation. He then got irate and began punching her in the face several times. She was later transported to [Local hospital] by ambulance for treatment. At this time, I went back to the room where [Resident #2] was being checked out by EMS and placed him under arrest for Aggravated Assault w/Deadly Weapon. Once [Resident #2] was in handcuffs, he began becoming extremely combative. We had him sitting down in chair, but he began trying to get up and at one point got up and attempted to head butt me in the face. This is when Officer [#3], who had hold of his right arm, took him to the ground and secured his upper body while I secured his legs with body weight as taught by the training academy. [Resident #2] began kicking and resisting while still on the ground and was fighting to get out of the grasp of officers. Officer [#1] went to retrieve leg restraints so that we could better secure him and get him out to the patrol vehicle since he was refusing transport by ambulance. While waiting on the leg restraints, Officer [#3] and I continued to hold body weight on him to keep him from assaulting officers. Once Officer [#1] came back with the leg restraints, they were placed on [Resident #2]'s legs and secured. EMS provided a body tarp so that officers could more easily transport [Resident #2] to the vehicle. He was rolled onto the body tarp and picked up by me, Officer [#3], Officer [#1], and Sgt. While we were attempting to carry him on the tarp, he became physically combative again and began kicking at officers. [Resident #2] kicked me with his left foot in the right side (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 6 of 14 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 07/26/2025 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some of my jaw causing pain. Due to him kicking, we opted to take him off the body tarp and carry him ourselves so that we could secure his legs and keep him from kicking officers. Once [Resident #2] was off the tarp, Officer [#3] and Officer [#1] both grabbed one of his arms, and Sgt. and I got his feet, and we began carrying out to the patrol vehicle outside. [Resident #2] continued to resist by squirming and shrimping up his body in attempts to get officers to drop him. We had to put him down once more and attempt to carry him right side up and were finally able to get him into the back of Officer [#1]'s patrol vehicle for transport to [Local Hospital] for treatment. Once on scene at [Local Hospital], [Resident #2] was removed from the back of the patrol vehicle and taken into the hospital by nursing staff to be treated. Before being placed on the gurney, he was searched incident to arrest where officers located a small black, circular tin containing a small number of unknown pills. This item and its contents were seized for further examination. At one point while in the hospital with officers, [Resident #2] became irate again due to finding out that he was going to be charged with Aggravated Assault. At this time, he only had one hand handcuffed to the bed. When officers entered the room to handcuff the other hand to the bed, [Resident #2] began resisting and would not willingly give his hand to officers. He then pushed himself off the hospital bed and onto the floor while his left hand was still handcuffed to the railing. Nursing staff and hospital security came into assist getting him back into the bed and secured. Once he was medically cleared, he was released from the hospital. I then transported him to the [local] City Jail where he was released to the care, custody, and control of jail staff. Officer [#1] called [local] Texas Poison Control and identified two out of three of the unknown pills. He weighed them, took pictures with his body worn camera, and booked them into the [local] Station Property Room. Please see his supplement to this report regarding his identification of and booking of the substances. Officer [#1] informed me that there was 0.01g of Methamphetamine, .5g of Tizanidine, a dangerous drug, 1g of Clonazepam, and an unknown substance in a red and black capsule that weighed 1.76g. In total [Resident #2] was charged with several charges. First, Assault Family Household W/Previous Conviction for intentionally and knowingly causing bodily injury to [Resident #1] by punching her multiple times in the face. Second, Aggravated Assault W/Deadly Weapon for exhibiting a knife during the commission of an assault and cutting [RN-A] multiple times on the hands with the knife. Third, Assault on Peace Officer for intentionally and knowingly causing pain to a person he knows is a peace officer for kicking me in the jaw while officers were attempting to take him from the location into the patrol vehicle. Fourth, Resist Arrest Search Transport for intentionally obstructing a peace officer from effecting transportation by using force for kicking, squirming, and attempting to get out of the grasp of officers as we were trying to escort him into the patrol vehicle. Lastly, he was charged with the drug offenses Possession of Dangerous Drug, Poss of CS PG 3<28g, and Poss of CS PG 11 <1g for having in his care, custody, and control the Clonazepam, Tizanidine, and Methamphetamine. I seized the small knife that was used in the commission of the Aggravated Assault offense and booked it into the [Local] Station Property Room. It was booked in as item one and placed in the drop box. Hospital staff advised that the Agg Assault would have been captured on surveillance footage and will be able to retrieve it upon the request of detectives if needed. A completed Family Violence Packet was also turned into Jail Central.'Review of facility's Resident-to-Resident Altercations policy dated December 2016 reflected, 2. If two residents are involved in an altercation, staff will: a. Separate the residents, and institute measures to calm the situation; b. Identify what happened, including what might have led to aggressive conduct on the part of one or more of the individuals involved in the altercation;Review of facility's Abuse and Neglect-Clinical Protocol, dated March 2018 reflected, 2. Neglect, as defined at 483.5, means (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 7 of 14 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 07/26/2025 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress. 1. The staff, with the physician's input as needed, will investigate alleged abuse and neglect to clarify what happened and identify possible causes.Record review of facility Call Lights: Accessibility and Timely Response dated 10/2022 reflected, 1. All staff will be educated on the proper use of the resident call system, including how the system works and ensuring resident access to the call light.2. All residents will be educated on how to call for help by using the resident call system.6. The call system will be accessible to residents while in their bed or other sleeping accommodations within the resident's room.5. Staff will ensure the call light is within reach of resident and secured, as needed.An IJ was identified on 07/24/25. The IJ template was provided to Administrator-B and Regional Nursing Director on 07/24/25 at 5:20 PM and a Plan of Removal was requested. The POR was accepted on 07/25/25 at 5:47PM.The POR reflected the following: Plan of Removal For F6001. Immediate Corrective Actions Taken Date/Time of IJ Notification: 7/24/25 @5:20 PM Resident Safety: Resident #1 was immediately assessed by bedside staff nurse for injuries and provided appropriate medical care; completed on 7/23/25. Resident #1 was relocated to a private room to ensure safety and prevent further incidents and call light was verified as operational; completed on 7/24/25. Roommate Removal: The male roommate involved in the assault was removed from the facility by law enforcement after evaluation by EMS on 7/23/25. BOM and Social worker provided Notice of immediate discharge to male resident via certified mail to [Local][NAME] County Jail mailed on 7/25/2025. Communication System: All residents' rooms were audited by Maintenance Super to ensure functioning call lights or alternative communication devices were present and accessible; completed 7/25/2025. Temporary communication devices (bells) were installed within reach of residents identified with malfunctioning call system until permanent solutions were in place; completed 7/25/25. Education of each resident with an alternative device (bell) was completed at time of placement by maintenance and will be documented in the EHR by DON; completed 7/25/25.________________________________________2. Systemic Corrective Measures Facility-Wide Audit: A full audit of all resident rooms was completed on 7/25/25 to verify the presence and accessibility of communication systems. Maintenance logs were reviewed by maintenance supervisor to identify any prior reports of malfunctioning call lights. An outside Vendor, was contacted to repair malfunctioning call lights/system on 7/25/25. Init[TRUNCATED] Event ID: Facility ID: 675112 If continuation sheet Page 8 of 14 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 07/26/2025 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure the facility was adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for four residents (Resident #1, Resident #2, Resident #6, and Resident #7) of 83 residents reviewed for resident call system in that: The facility failed to ensure the call lights in Resident #1's and Resident #2's shared room were in working order. Resident #1 was not able to use her call light to call for help when she was physically assaulted by her roommate, Resident #2. On 07/25/25 at 11:20 AM an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 07/26/25 the facility remained out of compliance at a scope of isolated and a severity level of potential for more than minimal harm that was not immediate jeopardy due to the facility's need to monitor the implementation and the effectiveness of their Plan of Removal. The facility failed to ensure call lights were flashing outside Resident #6's and Resident #7's rooms to ensure staff knew the Residents needed assistance. This failure could place residents at risk of being unable to obtain assistance for activities of daily living or in the event of an emergency.Based on observations, interviews and record review, the facility failed to ensure the facility was adequately equipped to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for four residents (Resident #1, Resident #2, Resident #6, and Resident #7) of 83 residents reviewed for resident call system in that: The facility failed to ensure the call lights in Resident #1's and Resident #2's shared room were in working order. Resident #1 was not able to use her call light to call for help when she was physically assaulted by her roommate, Resident #2.xOn 07/25/25 at 11:20 AM an Immediate Jeopardy (IJ) was identified. While the IJ was removed on 07/26/25 the facility remained out of compliance at a scope of isolated and a severity level of potential for more than minimal harm that was not immediate jeopardy due to the facility's need to monitor the implementation and the effectiveness of their Plan of Removal. The facility failed to ensure call lights were flashing outside Resident #6's and Resident #7's rooms to ensure staff knew the Residents needed assistance . This failure could place residents at risk of being unable to obtain assistance for activities of daily living or in the event of an emergency.Findings included:Record review of Resident #1's admission record, dated 07/24/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included, cognitive communication deficit (communication disorder stemming from cognitive impairments that affect a person's ability to communicate effectively), bipolar disorder (associated with episode of mood swings ranging from depressive lows to manic highs), calculus of kidney(small, hard deposit that forms in the kidneys and is often painful when passed), morbid (severe) obesity (a disorder that involves having too much body fat, which increases the risk of health problems), and paraplegia (condition characterized by the loss or impairment of motor and sensory functions in the lower half of the body).Record review of Resident #1's care plan dated 6/13/25 reflected the resident had limited physical mobility, does not walk, used manual wheelchair for locomotion, is totally dependent on staff for repositioning and turning in bed, and totally dependent on (2) staff for transferring. Record review of Resident #2's admission record, dated 07/24/25, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #2 had diagnoses which included, a diffuse traumatic brain injury (widespread damage to the brain's white matter), major depressive disorder (persistently depressed mood or loss of interest in activities, causing significant impairment in daily life activities), epilepsy (a disorder in which nerve cell activity in the brain Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 9 of 14 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 07/26/2025 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 0919 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some is disturbed causing seizures), chronic pain syndrome (persistent pain that last weeks to years by be caused by inflammation or dysfunctional nerves), bipolar disorder (associated with episode of mood swings ranging from depressive lows to manic highs), and antisocial personality disorder (a mental health disorder characterized by disregard for other people).Record review of Resident #2's care plan dated 6/13/25 reflected the resident requires limited assistance by (1) staff to move between surfaces, the resident does not walk, and resident uses manual wheelchair for locomotion.Record review of Resident #6's admission record, dated 7/24/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #6 had diagnoses which included, Depression (the elevation or lowering of a person's mood), Anxiety (intense, excessive, and persistent worry and fear about everyday situations), Cognitive Communication Deficit (difficulties in communication arising from impairments), Type 2 Diabetes (long-term condition in which the body has trouble controlling blood sugar and using it for energy), and Parkinsonism (clinical syndrome characterized by tremor).Record review of Resident #7's admission record, dated 7/24/25, reflected a [AGE] year-old male who admitted to the facility on [DATE]. Resident #7 had diagnoses which included cerebral infarction (a medical condition where brain tissue dies due to a lack of blood supply), Crohn's disease (a chronic inflammatory bowel disease that affects the lining of the digestive tract), Schizophrenia ( a disorder that affects a person's ability to think, feel, and behave clearly), type 2 diabetes (a long-term condition in which the body has trouble controlling blood sugar and using it for energy). Current MDS requested for Resident #1, Resident #2, Resident #6, and Resident #7 on 07/26/25 at 2:11 PM, and reminder sent on 07/28/25 at 5:16 PM. Received MDS for Resident #1 and Resident #2 on 07/29/25 at 5:04 PM the BIMS was blank.On 07/31/25 at 6:10 AM emailed Administrator-B and Director of Clinical Services and informed the MDS' for Resident's #1 and #2 had no BIMS and if the admission MDS could be provided. On 08/06/25 at 12:07 PM an email was sent to Administrator-B, the MDS for Residents #1, #2, #6, and #7 were requested but not received.Interview on 07/24/25 at 11:04 AM with Resident #1 revealed she and Resident #2 were roommates. She stated he was her fiance. She stated another resident's friend gave Resident #2 drugs and when he came to the room to try to smoke it, she told him he could not smoke it and got upset and began to beat on her. She stated she was yelling for help, she stated RN-B came into the room and screamed for Resident #2 to stop hitting her. She stated Resident #2 did stop hitting her then EMS arrived and took her to the hospital, and she was there for about two hours then she was brought back to the facility. She stated her injuries were a black right eye, a busted upper lip, bruises to both cheeks, and a large bruise to her left breast. She stated she did not feel safe at the facility because someone else could come in the room and she could not protect herself. She stated they had not had any physical altercations in the past. She stated he had taken care of her he had never hurt her. When asked if she pushed the call light button, she stated the call light had not worked in four months. She stated she was given a bell to ring when she needed assistance, but they had put the bell on the door. She stated no one had told her she needed to keep the bell out of the drawer. Observation on 07/24/25 at 11:30 AM revealed there were two call light cords plugged into the wall in the room of Residents #1 and #2. Observation of the call light cords revealed both cords on the floor. Further observation of the room revealed a bell hanging on a short rope/string on the back of the door to the room, out of reach of the resident. Resident #1 was observed in her bed. Face to face interview with Maintence Director on 07/24/25 at 3:15 PM revealed he had been employed since late February. He stated he knew there were some call lights that were not working throughout the building. He stated he would fix the call lights then they would go out again, because the system was old. He stated if the call light was not working the residents would be given a bell to ring (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 10 of 14 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 07/26/2025 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 0919 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some for help until the light could be fixed. He stated he was not sure if the call lights were working in Resident #1's and Resident #2's room. He stated when an aide would report the light was not working, he would fix the light on the spot. He stated he did not believe the light situation got to a point that he needed to notify Administrator - A. He stated there was not any room that had to have the call light fixed more than one time. He stated the staff would come to him face to face to report a call light was not working. He stated the staff could always call him on his cell phone to report issues. He stated when the call light was not working it could delay or not allow a resident to receive help. Face to face interview with Administrator-B on 07/24/25 at 3:36 PM, revealed the day was her fourth day working at the facility. She stated she was not aware Resident #1 and Resident #2 did not have a call light in their room. She stated when she found out about the call light, she was trying to move Resident #1 to another room, but she had refused to move. She stated she did not know how long Resident #1 and Resident #2 had been without a call light or any way to communicate to staff the need for assistance. She stated she did not know how the residents were supposed to let staff know they needed assistance. She stated she would assume the maintence director was responsible to ensure the call light worked in the rooms. She stated the CNAs, and nurses would be responsible to ensure the placement of the bell was in reach of the resident. She stated there was a severe risk of injury or a lack of care to the resident's when they did not have access to communication.Observation and interview on 07/25/25 with Resident #6 at 12:54 PM, revealed when asked to push her call light, the light did not flash above her door. Staff were observed walking throughout the hall, but no one came to Resident #6's room until they were notified in person by the investigator the resident had pushed the call light. Observation and interview with Resident #7 on 07/25/25 at 1:05 PM, revealed Resident #7 was asked to push his call light and the light did not flash above his door. Resident #7 stated he thought the light was working properly. Staff were observed walking throughout the hall, but no one came to Resident #7's room until they were notified in person by the investigator the resident had pushed the call light. In an interview with the Regional Director of Clinical Services on 07/26/25 at 2:15 PM, she stated she was not aware that the resident's (Resident #1 and Resident #2) call light was not working, she stated Resident #1 informed her and wrote a statement that the bell provided to her was in the drawer next to her bed. She stated the maintence director would have been responsible to ensure the call lights were working. She stated it would be the responsibility of the nursing staff to let the maintence director know when the lights are not working. She and the maintence director checked the lights in the rooms of Resident's #6 and #7 and the notification was going to the board at the nurses station, but the light was not lighting up outside the door. She stated Resident #1 was moved to a room with a working call light and Resident #2 was taken to jail and given a discharge notice. She stated if a resident's call light was not working it could delay their care.In a telephone interview with RN-B on 07/26/25 at 6:15 PM, reflected she was aware some of the call lights were not working but she was not sure how long the lights had been out. She stated she thought the administrator and maintence knew the lights were not working but she had not checked with them. She stated when a resident's call light did not work, it could cause the resident to not receive proper care.Record review of Call Light and Communication Device dated/revised 7/25/25, reflected All staff are responsible for responding promptly to resident call lights and communication devices. The facility shall maintain functional systems for resident communication and implement escalation procedures when systems fail, or response times are inadequate.Procedure1. Resident Education Upon admission and as needed, residents will be educated on: The purpose and use of the call light system. The importance of [keeping the call light within reach at all times]. How to request assistance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 11 of 14 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 07/26/2025 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 0919 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some using the call light or other communication devices.2. Call Light Accessibility Staff must ensure the call light is: Within easy reach of the resident [at all times]. Positioned appropriately after any care, repositioning, or transfer. Available in both the bedside and restroom areas.3. Response Expectations All call lights must be answered promptly, ideally within 5 minutes. If the responding staff member is not the assigned caregiver, they must: Address the need if within their scope. Notify the appropriate caregiver immediately if not.4. Escalation ProtocolIf a call light is not answered within 10 minutes or a communication device is non-functional:5. Backup MeasuresIn the event of call light system failure or during power outages: Place manual bells or battery-operated call devices at: Each resident's bedside. Each resident-accessible restroom. Implement Q15-minute visual safety rounds to assess resident needs. Document each round in the designated log.An IJ was identified on 07/25/25. The IJ template was provided to Administrator-B and Regional Nursing Director on 07/25/25 at 11:20 AM and a Plan of Removal was requested. The POR was accepted on 07/25/25 at 5:47PM.The POR reflected the following:Plan of Removal For F9191. Immediate Corrective Actions Taken Date/Time of IJ Notification: 7/25/25 @11:20 AM Resident Safety: Resident #1 was immediately assessed by bedside staff nurse for injuries and provided appropriate medical care; completed on 7/23/25. Resident #1 was relocated to a private room to ensure safety and prevent further incidents and call light was verified as operational; completed on 7/24/25. Roommate Removal: The male roommate involved in the assault was removed from the facility by law enforcement after evaluation by EMS on 7/23/25. BOM and Social worker provided Notice of immediate discharge to male resident via certified mail to [NAME] County Jail mailed on 7/25/2025. Communication System: All residents' rooms were audited by Maintenance Super to ensure functioning call lights or alternative communication devices were present and accessible; completed 7/25/2025. Temporary communication devices (bells) were installed within reach of residents identified with malfunctioning call system until permanent solutions were in place; completed 7/25/25. Education of each resident with an alternative device (bell) was completed at time of placement by maintenance and will be documented in the EHR by DON; completed 7/25/25.2. Systemic Corrective Measures Facility-Wide Audit: A full audit of all resident rooms was completed on 7/25/25 to verify the presence and accessibility of communication systems. Maintenance logs were reviewed by maintenance supervisor to identify any prior reports of malfunctioning call lights. An outside Vendor, Summit Fire and Security was contacted to repair malfunctioning call lights/system on 7/25/25. Initial visit will occur on Monday 7/28/25. Staff Training: All staff will receive re-education on: Resident rights to a safe environment (F600). Proper placement and testing of communication devices (F919). Immediate reporting and escalation procedures for malfunctioning equipment. Started on 7/23/25; ongoing until all staff educated; no staff will be allowed to work their next shift until completed; education by ADON/DON; PRNs via phone if needed. Included education:- Call lights must be in reach and operational. If found to be inoperable then must immediately notify the administrator, DON and Maintenance Supervisor.- Implement an alternate call system; including Q15 min checks until provided.- Maintenance will provide manual bell and education to resident for use until malfunctioning issue is resolved. - Must take manual bell to restroom with resident and place in reach, if toileting is needed and then ensure it is returned to bedside and in reach once done in restroom. Monitoring and Oversight: A designated staff member (e.g., DON or Maintenance Supervisor) will conduct daily rounds for 14 days to ensure compliance; started 7/25/25. Random weekly audits by DON will continue for 4 weeks. Results will be reviewed in QAPI by administrator/DON for 3 months starting with adhoc on July 30th.3. Prevention of Recurrence Resident Interviews: All residents were interviewed to ensure they feel safe and have access to communication systems; started Safe surveys by social worker started on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 12 of 14 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 07/26/2025 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 0919 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 7/23/25. Ongoing Staff Education: Monthly in-services on abuse prevention, neglect, and emergency response. Next all-staff in-service scheduled for Friday August 8th, 2025. 4. Verification of Compliance Documentation: Audit logs, training rosters, and maintenance reports will be maintained and available for review. Follow-Up: The Administrator and Director of Nursing will verify completion of all corrective actions.Monitoring of the facility plan of removal was as follows: Record review at 9:00 AM on 07/26/25 of facility POR training with staff dated 7/23/25 thru 7/26/25, reflected, the training consisted of ensuring the call light was within reach and operational, if call light was found to be inoperable then DON and Maintenance Supervisor should be notified immediately, and an alternate call system should be implemented including Q15 min. checks until provided. The maintenance staff would provide a manual bell and the resident would be educated to use the bell until the malfunctioned issue was resolved. Staff should remind the resident to take the manual bell with them when toileting and it should be kept until they had returned to their bed.Observation of Resident #1's current room on 07/26/25 revealed she had a working call light. Resident #1 was not in the building at the time of this observation. Interview with CNA-C on 07/26/25 at 10:00 AM reflected she had received training on how to work the call light system, she stated she had not been received training that she needed to check the rooms on hall 200 Q shift when she started her shift on 07/26/25.Interview with CNA-D on 07/26/25 at 10:10 AM reflected she was trained on the call lights, she stated she was told to check rooms every 15 minutes on hall 200 because the residents were not cognitive enough to know how and wen to use the call lights. Interview with CNA-E on 07/26/25 at 11:34 AM, reflected she received training on answering the call lights, when a residents call light was out, she should notify the charge nurse and maintence, provide the resident with a bell and do 15-minute checks on the resident. Additional interview with Interview with CNA-C on 07/26/25 at 11:50 AM, reflected she had been trained to check all rooms on 200 hall every 15-minutes because they may not understand how to use the light, and residents on other halls if a light was not working she would notify the charge nurse and maintence and provide a bell for the resident to notify her when they need help. Interview with LVN-C on 07/26/25 at 12:10 PM reflected, she had received an in-service training on answering the call light, if the light was not working she should check the rooms every 15-minutes and give the resident a bell and notify maintence.Interview with LVN-D on 07/26/25 at 12:23 PM reflected, she had been trained on what to do if the call light was not working, she needed to notify the administrator, the DON, and the maintence director, do 15-minute checks on the resident and provide the resident with a bell and make sure the bell is within reach and not in a drawer. Interview with CNA-G on 07/26/25 at 12:33 PM reflected, she had been trained to make sure the call lights were working and in reach, if the light was not working she must notify the administrator, DON, and maintence, give the resident a bell and make sure it is within reach and when the resident went to the bathroom to make sure the bell was with them if she stepped out of the room, if the resident cannot use the bell to make 15-minute checks in the room. Interview with CNA-H on 07/26/25 at 12:41 PM reflected, she had been trained to provide a bell to the resident if the call light was not working, she should notify the administrator and maintence, the call light should be in reach of the resident, if the light did not work to give the resident a bell and do 15 minute checks to make sure the resident was okay, and make sure the resident had to bell with them if in the bathroom. Interview with CNA-I on 07/26/25 at 12:48 PM reflected, she had been trained to make sure the call light was in reach, if the light was not working to get the resident a bell, notify the administrator and maintence to fix the light, if the resident has a bell make sure the bell is accessible to the resident and not in a drawer, if the resident went to the bathroom to make sure they had the bell. Interview with CNA-J on 07/26/25 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675112 If continuation sheet Page 13 of 14 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 07/26/2025 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 0919 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 12:55 PM, reflected she received training that if a call light was not working, she should contact maintence, give the resident a bell and make sure it stayed within reach, and if the resident went to the bathroom wait for them or provide a bell, do 15-minute checks. Interview with LVN-E on 07/26/25 at 1:12 PM, reflected she had been in-serviced on call lights, if they were not working she should notify the administrator, DON and maintence, she should check on the resident every 15-minutes, give the resident a bell and educate the resident to always keep the bell with them. Interview with CNA-K on 07/26/25 at 1:18 PM, reflected he had received training on the call light, that it should be answered by everyone, if the light was not working to report it to the nurse who would give a bell for resident to use, the resident should be checked every 15-minutes until the light is fixed. Interview with LPN-F on 07/26/25 at 1:24 PM, reflected she had received training on the call lights that if she noticed the light was not working, she should give the resident a bell and notify the administrator, the resident should be checked every 15-minutes to ensure safety, if they went to the bathroom to take the bell. Interview with MA-G on 07/26/25 at 1:32 PM, reflected she had received in-service on call lights, if the light was not working, she should notify the DON, administrator, and maintence, give the resident a bell, if the resident cannot use the bell to do 15-minute checks until the light was fixed. Observation of Hall 200 on 07/26/25 from 1:45 PM to 2:15 PM revealed CNA's C and D had walked in rooms in 15-minute intervals. Telephone call from RN-B on 07/26/25 at 6:15 PM, reflected she had received additional training on making sure the call light was within reach of the resident, if the light was not working to provide a bell within reach and notify the nurse and maintence. Review of the facility abuse, and neglect in-service dated 07/23/25-07/26/25 reflected all facility staff had been in-serviced prior to shift on abuse and neglect. An Immediate Jeopardy (IJ) was identified on 07/25/25 at 11:20 AM. While the IJ was removed on 07/26/25 at 2:35 PM the facility remained out of compliance at a scope of isolated and a severity level of actual harm that is not immediate jeopardy. Event ID: Facility ID: 675112 If continuation sheet Page 14 of 14