Health inspection·August 16, 2025

F 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few started on 04/29/2024, revised by ADON on 05/22/2025 reflected: [Resident #8] is at risk for skin impairment, age related, impaired mobility. The Approaches listed for the problem area reflected, PT/OT to evaluate for rehab potential. Edited: 05/22/2025 Edited by: ADON. Problem area dated 02/20/2024, Revised 07/25/2025 and Edited by Activity Director, reflected: [Resident #8] also enjoys going outside to feed the cat. In the related Approach area, it reflected, Staff will encourage, assist, or plan out of door activities for fresh air weather permitting. Edited: 05/22/2025 Edited by: ADON and Staff will encourage or assist involvement in social groups of interest such as bible study, current events, trivia. Problem area dated 2/26/2024, edited by ADON on 5/22/2025, reflected Category: Cognitive Loss/Dementia [Resident #8] appears to have recall deficit as evidenced by: Periods of paranoia, making false accusations then denies making them, lack of acceptance or understanding of safety issue related to her living environment, Poor decision making. Goal for this problem area reflected a long-term goal target date of 8/22/2025, reflected [Resident #8] will understand helpful reminders, will have needs met by staff as identified or anticipated, will have minimal negative emotional distress related to cognitive issues. As evidenced by documentation in the medical record. Edited: 5/22/2025 Edited By: ADON. Related approaches dated 5/22/2025 reflected, Continue to assess periodically for changes in cognition; adjust approaches to offer more assistance as needed. Review of Resident #8's Progress Notes in Paper Chart since 5/9/2025 -8/4/2025, reflected there were no notes indicating the resident was out of bed, nor are there any notes indicating refusals to get out of bed. There are no notes indicating a refusal of Physical or Occupational therapy during this time frame. Review of Physician Assessment for Resident #8 dated 7/12/2025 signed by Medical Director reflected fatigue, WC mobility, and weakness were chosen to describe Resident #8's general condition and extremities. There were handwritten notes reflecting, Pt. refuses BP meds and noncompliance with medications. There were no further notes regarding mobility or refusals of care. Review of Resident #8's most recent Occupational Therapy Discharge Summary prior to start of survey, for dates of service from 11/15/2024 to 11/18/2024, reflected, Discharge Recommendations: DC to this LTC facility under care of nursing. Restorative Program Established/Trained= Not indicated at this time Functional Maintenance Program Established/Trained=Not indicated at this time. Document was signed by OT F. Review of Resident #8's Summary of Occupational Therapy Daily skilled services signed by OT F dated 11/18/24 reflected, Pt (patient) declined to get out of bed, but finally agreed to work in the bed with therapy. Therapist went to pt's room x3 (three times) in order to get pt to participate. Once pt finally did agree to do therapy she was actually very cooperative and did everything requested of her. Pt education on the importance of movement/getting out of bed due to having pneumonia. Review of Physical Therapy Summary of Daily Skilled Services dated 11/18/2024 and signed by PT H, reflected, Patient requiring encouragement in order to participate proceeding to perform LE/UE (Lower Extremity/Upper Extremity) therex (therapeutic exercise) in all tolerable planes working on str (strength), endurance/ROM (range of motion) w cuing and breaks taken throughout session PRN (as needed).Review of Resident #8's Occupational Therapy Evaluation and Plan of Treatment dated 8/14/2025 and signed by OT G reflected, Personal Hygiene= Substantial/maximal assistance and Transfers section reflected, Recommended use of [mechanical] lift for all transfers. In the section labelled Reason for Therapy there is a note reflecting the following: Reason for Skilled Services: Patient requires skilled OT (occupational therapy) services to assess safety and Independence with ADLs (activities of daily living), develop and instruct on compensatory strategies, develop and instruct in exercise program, increase safety awareness, facilitate sitting tolerance and postural control, provision of pain management techniques, provision of modalities and strengthening, increase functional activity tolerance, and develop and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few instruct on adaptation techniques in order to enhance patient's quality of life by improving ability to return to prior level of skill performance. Review of Summary of Daily Skilled Services dated 8/14/2025 signed by OT G, the Response to Tx (treatment) section reflected Response to Session Interventions: actively participates with skilled interventions. Interview with Resident #8 on 8/12/25 at 9:41AM she stated I don't know when the last time I got up. Last time there were two people. Maybe seven days ago. She stated that she could not remember doing any therapy in the facility. She stated that she walked in the facility using a cane and now could no longer get out of bed. Observation of two person transfer on 8/13/2025 at 2:30PM with CNA A and CNA B revealed Resident #8 was lying in bed attempting to sit up. CNA A and CNA B watched Resident #8 attempt to sit up and did not offer assistance. Resident #8 stated that she was not able to sit up or stand on her own. She stated that she needed help. CNA A and CNA B did not assist after requests from resident. After 15 minutes of attempting to sit from a lying position, she refused to attempt any longer and requested to go stay in bed. She stated, I used to be able to sit and stand, but I can't anymore. No gait belt was observed in the room or in possession of the CNAs for the transfer and they were later found to be unable to properly apply a gait belt. In an interview with LVN D on 8/13/2025 at 2:47PM reflected that Resident #8 was known to be a two-person transfer. He stated that for a normal two-person transfer, if a person was struggling to sit up, the staff would assist the resident to a sitting position. In an interview with LVN C on 8/14/25 at 6:10AM she stated she had worked at the facility full time since September or October of 2024. She stated that she currently worked primarily night shifts but worked days and nights previously. She stated that Resident #8 was almost a mechanical lift now. She stated she knows Resident #8 was able to stand in May, but now she cannot. She stated she was transferring mostly by herself from the bed to the wheelchair and back at the beginning of the year with little assistance from staff. She stated that she could recall last seeing her transfer in March with little assistance from staff. She stated the last time she saw her transfer was around May with assist of two staff, where they had to physically assist her to sit up, which was not normal previously. She stated that she told dayshift at that time that the resident had shown a decline. She could not recall the date. She stated the resident refuses to get up at times. She stated that Resident #8 used to get up to feed the cats. She stated that refusals should be documented in the chart. She stated that residents have the right to refuse, but that staff should be building a relationship with the resident and try to find out the source of the refusals. She stated that residents should receive ongoing education and encouragement from staff with refusals of care. She stated that not getting out of bed can result in a decline in mobility. She stated that improper transfers can result in injuries.In an interview with CNA A on 8/14/25 at 8:45AM, she stated in the transfer with Resident #8 on 8/13/25 she should have assisted her to sit up. She denied having a gait belt for the transfer. She stated she does not use a gait belt on anyone in the facility during transfers. She stated she did not assist the resident with the transfer on 8/13/2025 because she was nervous. She stated it has been more than 3 months and less than 6 months since she's seen Resident #8 up out of bed. She stated the resident refuses to get out of bed a lot. She stated she does inform the nurse. She stated that the level of struggle she saw on 8/13/2025 from Resident #8 attempting to sit up for a transfer was new. She stated in the past, Resident #8 could help more. She stated the resident refuses a lot to get out of bed. She stated she does inform the nurse when the resident refuses. She stated that not providing assistance with transfers for residents that require assistance, can lead to residents feeling discouraged. She stated that if residents do not get out of bed they can lose their strength and ability to get out of bed. In an interview with CNA B on 8/14/2025 at 9:28AM, she said she worked at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facility for about a month. She said she had assisted Resident #8 out of bed with two people approximately two weeks ago. She stated she has seen the resident up, probably twice since she started working at the facility. She stated that she let her take her time to do some and then assisted when her when she needed it. She stated at that time she was not able to stand for the transfer. She stated they did get her in the wheelchair with two people. She stated each person stood on one side of the resident. She stated they then put their arm under her arm, and with the other hand, held on to the resident's pants. She stated that Resident #8 was able to sit up on her own two weeks prior during the transfer. She stated the resident refuses at times. She stated that not providing assistance with transfers for those residents that need it, can lead to resident' potentially giving up and possibly not wanting to try to get up. She stated that if residents do not get out of bed when they are able, they might lose their ability to get out of bed. In an interview with ADON on 8/14/2025 at 7:07AM, she stated that Resident #8 was a two-person transfer. She stated that she frequently refuses therapy. She stated there are no therapy notes for 2025. She stated she would print the last three therapy assessments for review by surveyor. She stated that there was no documentation of refusals of therapy in resident records for nursing in the last 3 months or therapy services documentation in 2025. She stated the Care Plan for the resident included being resistive to care at times, but did not include refusals of therapy. She stated she was not sure if the physical or occupational therapist spoke directly to the resident regarding her therapy opportunities and the risks of not participating in rehabilitative services. She stated that the Resident #8 refused therapy to her after her most recent hospitalization at the end of May, but that she did not document the refusal. In an interview with OT G on 8/14/2025 at 11:40AM, she stated that she worked with a different company than the previous therapists at the facility. She stated she started in the facility as a PRN (As needed) Occupational Therapist when the new company took over at the beginning of the month. She stated that she met Resident #8 on the morning of 8/14/2025. She stated that she reviewed her records. She stated that after speaking with Resident #8, she is going to recommend a mechanical lift for her transfers. She stated she has never seen it documented who has a gait belt in the facility, but if you are standing and moving them, they should have a gait belt on unless they are independent transfers or a mechanical lift is used for transfer. She stated that during transfers staff can hurt the resident's shoulders, cause shearing, or staff could drop them without a gait belt or with improper use of gait belt. She was not sure if Resident #8 was a mechanical lift prior to this assessment but stated that if a resident was screened previously as partial assist and then they are later screened as requiring a mechanical lift, that it would be considered a change in condition for the resident. In an interview with RNC on 8/14/2025 at 12:04 PM, she stated that she had been in the facility for 8 days, since the change of ownership. She stated that she was functioning as the Director of Nursing prior to the DON taking on her role at the facility. She stated that there was not a DON prior to the change of ownership, which would make the ADON responsible for supplies and resident care prior to 8/5/2025. She stated that the current owners use a different therapy company than was used previously by the facility. She stated that all residents who were not independent or mechanical lift transfers should have a gait belt on for transfers. She stated that if a resident was reaching and trying to sit up during a transfer that she would assist them with sitting position. She stated that if a resident made an effort to transfer, she would assist them with the rest of the transfer. She stated that Resident #8 should be assessed quarterly by therapy services. She stated that if there are any signs of decline, residents should be evaluated by therapy and treated per their recommendations. She stated that their responsibility as a facility is to maintain or improve status of residents, unless the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few situation can be helped. She stated that if a resident screens as needing a mechanical lift, when their previous recommendation was for partial assistance with transfers, that it would indicate a change in condition. She stated that if we are not assisting a resident to get out of bed, they can decline. She stated that residents do have the right to refuse care. She stated that she expected staff to encourage residents to get out of bed, to educate them regarding the consequences of not getting out of bed, to get family involved if applicable, and to perform passive range of motion if they continue to refuse to help prevent a decline in mobility. She stated that staff should try to find the source of why the resident is refusing care and address their underlying concerns. In an interview with Resident #8 on 8/14/2025 at 1:05PM she stated that she feels unhopeful when she attempts to transfer. She stated that she trusts one male staff member to transfer her. Resident observed lying in bed during the interview. In a phone interview with facility NP on 8/15/2025 at 12:04PM, she stated that she does not know of any degenerative conditions for Resident #8 that would make a decline in mobility unavoidable. She stated that the resident has some conditions which could cause pain, but that the resident nor the facility has reported an increase in pain. She stated that Resident #8 cannot transfer or stand without assistance from staff. She stated that to her knowledge, the resident could stand briefly to be assisted to the wheelchair. She stated that a new order for a mechanical lift would constitute a change in condition regarding the mobility status for Resident #8. She stated that she knows the resident to refuse care and transfers at times. She stated that she last observed the resident get up with staff assistance of 3-4 staff, gait belt, and walker on 5/23/25 when she ordered a urine culture for the resident. She stated that the extra staff present during the transfer where there to assist with collecting the urine sample. She stated that she knows Resident #8 to be a 2-person transfer. She stated that she saw a note from the morning stating that Resident #8 is now a mechanical lift transfer. She stated that when a resident is refusing to get out of bed, they should be evaluated to see if there is a change in condition. She stated that when a resident is refusing, the facility needs to ensure they are doing what they can and that it isn't just easier for staff not to get her up. She stated that not getting out of bed could contribute to a decline in mobility. She stated that not using a gait belt or using gait belts in properly could result in a fall or injuries to the resident. She stated it was a fundamental skill for a CNA and anyone who transfers residents to know how to use a gait belt. She stated she could not recall any injuries with transfers that would have warranted a gait belt. In an interview with ADON on 8/15/2025 at 1:50PM, she stated she could not believe she did not notice that Resident #8 had not been out of bed. She stated she was not aware that Resident had a change in mobility prior to the OT assessment on 8/14/2025. She stated that she could not recall seeing Resident #8 out of bed in the last few weeks. She stated that she was responsible for monitoring resident care and ensuring appropriate care was provided to Resident #8 at the time of the decline. She stated she was responsible for updating care plans at this time also. She stated that gait belt should be included in the care plan for residents that require a gait belt with transfers. She stated that she informed the physician and psychiatry about Resident #8's refusals of care in the past. She stated that she doesn't know exactly why the resident would refuse to get up recently. She stated that in the past she has given reasons like that she does not want to be forced to do things and that she does not want to put on a show for anyone. She did not recall when she stated this, but stated it was not directly related to a recent occurrence. She stated that Resident #8 does not have any family to her knowledge. She stated that Resident #8 is her own responsible party. She stated that staff try to encourage her to get out of bed with things that she likes. She stated that the facility tried to put her on skilled services when she got back from a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few hospital stay on 6/29/2025, but the resident refused at that time. She stated she does not have any documentation in the resident records to state that she was evaluated and subsequently refused offer of therapy. Observation of Resident #8 on 8/15/2025 at 1:56PM revealed the resident sleeping in her bed. In a follow up interview with RNC on 8/15/2025 at 2:54PM she stated that there was no evidence that an IDT meet was done related to her refusals of care. In a follow up interview with ADON on 8/15/2025 at 2:54PM she stated that there was no QAPI meeting in which Resident #8's refusals of care were discussed. In an interview with the ADMIN on 8/15/25 at 3:43 PM, he stated that he wanted everyone in the building to thrive. He stated everyone who wants to be up out of bed, should be allowed or assisted as needed to get up. He stated that therapy has a role in assisting with mobility needs of the residents. He stated all refusals should be documented. He stated the impact of not getting a resident out of bed could result in weakness. He stated that he would defer to nursing for specifics in the causes of a decline in mobility. He stated refusals for care and therapy should be care planned. He stated that after a few times of refusing, staff should notify the doctor or the NP. He stated that the facility does have to honor a resident's right to refuse. He stated it is the facility's obligation to talk to them and try to find out why they are refusing. He stated they usually have multiple staff attempt to talk to a resident about refusals of care. He stated that psychiatry services can occasionally assist with refusals of care. He stated that he was responsible for ordering the supplies for this facility. He stated there is a supply list at the nurses' station where staff can add needed supplies. He stated he made orders every Tuesday based on the list. He stated he was not aware there was a lack of gait belts available for resident use. He stated he was not aware that gait belts were not being used with residents. He stated that not using a gait belt could cause a fall or injuries, including discomfort to the residents. He stated his expectation was that residents who need gait belts should have them. Review of facility policy on Safe Resident Handling/Transfers (no date) reflected, All residents require safe handling when transferred to prevent or minimize the risk for injury to themselves and the employees that assist them.Staff will be educated on the use of safe handling/transfer practices to include use of mechanical lift devices upon hire, annually and as the need arises or changes in equipment occur.Staff members are expected to maintain compliance with safe handling/transfer practices. Failure to maintain compliance may lead to disciplinary action up to and including termination of employment.Review of Facility ADL policy (no date) stated: The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident's abilities in ADLs do not deteriorate unless deterioration is unavoidable. Care and services will be provided for the following activities of daily living: Bathing, dressing, grooming and oral care; Transfer and ambulation; Toileting; Eating to include meals and snacks; and Using speech, language or other functional communication systems.Policy Explanation and Compliance Guidelines: Conditions which may demonstrate unavoidable decline in ADLs include: Natural progression of the resident's disease state with known functional decline. Deterioration of the resident's physical condition associated with the onset of an acute physical or mental disability while receiving care to restore or maintain functional abilities. Refusal of care and treatment by the resident or his/her representative to maintain functional abilities after efforts by the facility to inform and educate about the benefits/risks of the proposed care and treatment; counsel and/or offer alternatives to the resident or representative.The facility will maintain individual objectives of the care plan and periodic review and evaluation. The ADMIN was notified of Immediate Jeopardy on 08/15/2025 at 4:35 PM and the need for a Plan of Removal. The Plan of Removal was accepted on 08/16/2025 at 11:18 AM and was as follows: On 8/12/2025 a recertification survey was initiated at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few facility. On 08/15/2025 the surveyor provided an Immediate Jeopardy (IJ) Template for SNF notification that the Regulatory Services has determined that the condition at the facility constitutes an immediate threat to resident health and safety. Notification of the Immediate Jeopardy states as follows: F-676 - Activities of Daily Living (F676 The facility failed to ensure provide the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. This includes the facility ensuring that: S483.24(a)(1) A resident is given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living to include mobility and transfers. Mobility Decline) 1. Immediate Actions Taken for Those Residents IdentifiedAction: Resident #8 immediately evaluated by nursing staff. Care plan updated to reflect current mobility status, interventions to maintain or improve function, and therapy recommendations. Resident requires a mechanical lift. Order placed in Point Click Care (PCC) for mechanical lift transfers. Physical Therapy referral placed in PCC for evaluation and treatment. Person(s) Responsible: Director of Nursing (DON), Assistant Director of Nursing, and Regional Nurse Consultant, and/or DesigneeDate: 08/15/2025 by noon Action: Facility-wide audit of all residents with transfer needs conducted to ensure correct transfer methods are documented, appropriate equipment is available at point of care, and no additional residents have experienced an undocumented decline. If equipment is not available, the DON/Designee will initiate an urgent order through the facility's contracted vendor, provide interim safe transfer methods, and ensure staff are trained on the temporary intervention until the equipment is in place. Any identified changes were addressed immediately through therapy referral and care plan updates. No changes identified.Person(s) Responsible: Director of Nursing (DON), Assistant Director of Nursing, and Regional Nurse Consultant, and/or DesigneeDate: 08/15/2025 by noon Action: All licensed nurses, CNAs, and therapy staff educated on Safe Resident Handling/Transfers policy, proper gait belt use, and immediate reporting of mobility declines to the DON and/or ADON. Competency validation with return demonstration completed prior to resident care. Staff members will be educated prior to working their next shift. Staff who are not present will receive education via the telephone and complete the competency with return demonstration prior to working their next shift. All new hires and agency staff will receive education and competency evaluation with return demonstration prior to providing resident care. Person(s) Responsible: Director of Nursing (DON), Assistant Director of Nursing, and Regional Nurse Consultant, and/or Designee Date: 08/17/2025 by noon 2. How the Facility Identified Other Possibly Affected Residents: Action: 100% audit of all residents requiring assistance with transfers conducted to ensure accuracy of transfer status, care plans, and availability of required equipment. No other residents identified.Person(s) Responsible: Director of Nursing (DON), Assistant Director of Nursing, and Regional Nurse Consultant, and/or Designee Date: 08/15/2025 3. Measures Put into Place/System Changes to remove the immediacy, and what date these actions occurred: Action: Policy on Safe Resident Handling/Transfers reviewed with no changes made. Staff members will be educated on policy prior to working their next shift. Staff who are not present will receive education via the telephone and will sign the in-service sheet prior to working their next shift. All new hires and agency staff will receive education prior to providing resident care.Person(s) Responsible: VP of Clinical Operations, Director of Nursing (DON), Assistant Director of Nursing, and Regional Nurse Consultant, and/or DesigneeDate: 08/15/2025 policy reviewed08/17/2025 by noon for education of all staffAction: Change in Condition Protocol reviewed with no changes made. Staff members will be educated on policy prior to working their next shift. Staff who are not present will receive education via the telephone and will sign the in-service sheet prior to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0676 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete working their next shift. All new hires and agency staff will receive education prior to providing resident care.Person(s) Responsible: VP of Clinical Operations, Director of Nursing (DON), Assistant Director of Nursing, and Regional Nurse Consultant, and/or DesigneeDate: 08/15/2025 policy reviewed08/17/2025 by noon for education of all staff 4. How the Corrective Actions Will be Monitored/Ensure Comprehension, by whom and for how long: Action: All licensed nurses, CNAs, and therapy staff received immediate education on Safe Resident Handling/Transfers policy, including proper use of gait belts and mechanical lifts, and the requirement to report any resident mobility changes to nursing leadership. Staff completed a competency validation with return demonstration prior to providing further resident care. Staff not on-site were educated via telephone and completed competency validation prior to their next scheduled shift. All agency and new hire staff will receive the same education and competency validation prior to resident care assignment. Person(s) Responsible: DON, ADON, and/or DesigneeDate: 08/17/2025 by noon for education of all staffAction: DON/designee will conduct a minimum of 5 random transfer observations per shift for 4 weeks to ensure: proper transfer method is being used per care plan and gait belts/mechanical lifts are available and used appropriately. Results documented on Transfer Audit Log; noncompliance addressed immediately with re-education.Person(s) Responsible: DON, ADON, and/or DesigneeDate: Ongoing x 60 days Action: Interdisciplinary team will review all audit results in QAPI weekly for 8 weeks, then monthly for 4 months. Any identified trends will result in additional training.Person(s) Responsible: Administrator, DON, Rehab DirectorDate: Ongoing QAPI-Action: Medical Director notified of the deficient practice/IJ and Plan of Removal.Person(s) Responsible: DON, Administrator, and/or DesigneeDate: 08/14/2025 Monitoring facility's plan of removal was completed on 8/16/2025 as follows: Review of Resident #8's Occupational Therapy Evaluation and Plan of Treatment dated 8/14/2025 and signed by OT G, reflected that Resident #8 was evaluated on 8/14/2025 by nursing staff and occupational therapist. Resident #8's Care plan was updated on 8/14/2025 to reflect mechanical lift transfer and related care. Resident #8's Physician orders updated on 8/15/2025 to reflect mechanical lift transfer. There is a physician order for PT/OT (physical therapy/occupational therapy) to Evaluate and Treat dated 8/15/2025. In an interview with RNC on 08/16/2025 at 1:00PM, she stated that Resident #8 was transferred to hospital on 8/15/2025 at 8:08AM for sore throat and cough. She was not available for interview at that time. In an interview with ADON on 8/16/2025 at 1:53PM, she stated that the Facility-wide 100% audit of all residents with transfer [ Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure 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 two of eight residents (Resident #2 and Resident #7) reviewed for ADL care. The facility failed to ensure Resident # 2 and Resident #7's nails were cleaned and did not have any rough edges on 08/12/2025. This failure could place residents at risk of not receiving services or care, diminished quality of life, and decreased self-esteem. Findings included: Record review of Resident #2's face sheet , dated 08/13/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE] with diagnoses which included unspecified dementia ,unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety ( a group of diseases and illnesses that affect your thinking, memory, and reasoning without behaviors), blindness right eye , low vision left eye ( lack of vision it interferes with daily activities), and muscle weakness ( decreased ability to move, lift, or hold objects). Record review of Resident #2's Annual MDS, dated [DATE], reflected the resident had a BIMS score of 5, which indicated his cognition was severely impaired. Resident #2 required supervision or touching assistance with the following: personal hygiene, showers, upper and lower body dressing and, toileting hygiene. Record review of Resident# 2's Comprehensive Care Plan, revised on 05/08/2025, reflected Resident #2 ‘s ability to maintain personal hygiene has deteriorated. Intervention: Resident #2 required assistance with ADLs. Record review of Resident #2's nurses notes and there was not any refusal of nail care documented from 08/01/2025 thru 08/12/2025. Observation and interview on 08/12/2025 at 11:01 AM, revealed Resident #2 was in his room lying in bed. He had a blackish/ brownish substance underneath the middle and ring fingernails on his right hand. Resident # 2's middle fingernail on his right hand was uneven around the edges. Resident #2 was not interviewable. Record review of Resident #7's face sheet, dated 08/13/2025, reflected a [AGE] year-old- male who was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included unspecified lack of coordination (the inability to smoothly and precisely control bodily movements), dementia in other diseases classified elsewhere, without behavioral disturbance, psychotic, mood and anxiety ( a group of diseases and illnesses that affect your thinking, memory, and reasoning without behaviors), and muscle weakness (decreased ability to move, lift, or hold objects). Record review of Resident #7's Annual MDS, dated [DATE], reflected the resident rarely/never understood. He had poor short- and long-term memory recall. His decision-making ability was severely impaired. Resident #7 required supervision and touching assistance with the following: personal hygiene, lower/ upper body dressing and, oral hygiene. He required partial to moderate assistance- (Helper does less than half the effort) with the following: Showers and toileting. Record review of Resident #7's Comprehensive Care Plan, dated 06/16/2025, reflected Resident # 7 was at risk for deterioration in ADLs (bed mobility, transfers, personal hygiene, dressing, eating, walking and locomotion). Provide assistance for ADLs as needed. Record review of Resident #7's nurses notes and there was not any refusal of nail care documented from 08/01/2025 thru 08/12/2025. Observation and interview on 08/12/2025 at 10:15 AM, revealed Resident #7 was in his room lying in bed. He had a blackish/ brownish substance underneath the middle ring and fore fingernails on his right hand. Resident #2's ring and middle fingernail on her right hand were uneven around the edges. He was not interviewable. In an interview on 08/13/2025 at 2:31 PM, LVN D stated the nurses were responsible for residents with diagnosis of diabetes with nail care such as trimming, cleaning, filing. He stated the CNAs were responsible for all other residents' nail care. LVN D stated if a resident had brownish/blackish Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete substance underneath their nails and if a resident swallowed the substance there was a possibility a resident may become ill, such as stomach problems nausea and vomiting. He stated she would need to ask staff questions for the reason nail care was not completed on Resident #2 and Resident #7. LVN D stated no one reported to him that Resident #2 or Resident #7 refused nail care. He stated anytime a resident refused care it was documented in the nurses' notes. In an interview on 08/13/2025 at 2:45 PM, CNA H stated the CNA s were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes (a disease occurs when blood sugar is too high). She stated the nurses were responsible for all the residents' nails with a diagnosis of diabetes. CNA H stated the residents' nails were usually cleaned on Sundays, their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as vomiting and diarrhea. CNA H stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident # 2 and Resident #7, and they did not refuse nail care. In an interview on 08/13/2025 at 2:58 PM, CNA I stated the CNAs were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes. She stated the nurses were responsible for all the residents' nails with a diagnosis of diabetes. CNA, I stated the residents' nails were usually cleaned on Sundays, their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as nausea and diarrhea. CNA I stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident # 2 and Resident # 7, and they did not refuse nail care. CNA I stated she did not know the last time these residents' nails were trimmed or cleaned she would need to check the medical records. In an interview on 07/31/25 at 10:20 AM, the ADON stated if a resident ingested the blackish substance on their fingers or underneath their fingernails, there was a possibility the substance may be some type of bacteria, however it would be difficult to determine if the blackish/ brownish substance was bacteria. She stated it was a possibility a resident may become ill with stomach issues such as vomiting and nausea if they ingested the blackish/ brownish substance. She stated the CNAs were responsible for all residents' nails such as cleaning, trimming, and filing except for the residents with diabetes. She stated for any resident with a diagnosis of diabetes the nurse was responsible for these residents' fingernails. The ADON stated the nurse supervisor was responsible for monitoring CNAs giving ADL care which included nail care, and the ADON and DON was responsible for monitoring the nurse supervisors. Record review of the facility's Policy on Nail Care, not dated, reflected The purpose of this procedure is to provide guidelines for the provision of care to a resident's nails for good grooming and health. Routine cleaning and inspection of nails will be provided during ADL care on an ongoing basis. Routine nail care, to include trimming and filing, will be provided on a regular schedule. Nail care will be provided between scheduled occasions as the need arises. Nails should be kept smooth to avoid skin injury. Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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, based on the comprehensive assessment and care plan and the preferences of each resident, an ongoing activities program to support residents in their choice of activities, both facility sponsored group and individual activities, and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for one of five residents ( Resident # 3) reviewed for activities. The facility failed to provide Resident #3 in room activities on the dates of 07/03/2025 thru 08/11/2025. This failure could place residents at risk for boredom, depression, and a diminished quality of life. Findings included: Record review of Resident# 3's face sheet, dated 08/14/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #3 had diagnoses which included depression, unspecified ( a mood disorder that causes a persistent feeling of sadness and loss of interest), generalized anxiety disorder ( a mental health disorder that produces fear, worry, and a constant feeling of being overwhelmed), and unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety ( a condition where individuals experience cognitive decline consistent memory loss, impaired thinking, etc. without behaviors). Record review of Resident#3's Annual MDS Assessment, dated 10/02/2024, reflected Resident #3 had a BIMS score of 0, which indicated her cognition was severely impaired. Resident #3 was not capable of responding to questions of her activity preferences. Record review of Resident #3's Quarterly MDS Assessment, dated 05/31/2025, reflected Resident #3 was rarely/never understood. The staff completed Resident #3 cognitive assessment. Resident #3 decision making ability was severely impaired (never/rarely make decisions). She had poor short- and long-term memory recall. Record review of Resident #3's Comprehensive Care Plan reflected (problem created on 08/15/2022) Resident #3 was dependent on staff for meeting emotional, intellectual, physical, and social needed related to Alzheimer's (a brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks). Resident #3 care plan (revised on 08/13/2025) reflected Resident required personalized engagement to support psychosocial wellbeing. Resident #3 will participate in at least one 1:1 activity of choice a minimum of two times per week to enhance social interaction and emotional wellness. Monitor for changes in engagement levels and adjust the type of timing of 1:1 activities as needed. Record Review of the Activity In Room Participation record for the months of July 2025 and August 2025 reflected Resident #3 did not receive in room visits from 07/03/2025 thru 08/11/2025. Observation and interview on 08/12/2025 at 10:05 AM Resident was in her room lying in bed. Resident # 3's television was not on and there was not any stimulation in resident's room. Resident #3 was not interviewable. Interview on 08/14/2025 at 8:30 AM, the Activity Director stated Resident #3 did not receive in room activities from 07/03/2025 thru 08/11/2025. The Activity Director stated she was expected to ensure all residents received activities based on their preferences and their physical abilities. She stated if residents were not coming out of their room, the residents were to be provided in room activities. The Activity Director stated she provided in room activities at least twice a week. She stated there was not an excuse why Resident #3 did not receive in room visits. The Activity Director stated if a resident was not receiving activities on a consistent basis there was a potential a resident may become bored, depressed, or have a decline in their quality of life. Interview on 08/14/2025 at 10:45 AM, the Administrator stated he expected in room activities be provided to the residents needing these types of activities. He stated if a resident was not receiving in room activities there was a possibility a resident may become depressed, bored and isolated. Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete He stated the Activity Director was responsible for all activities in the facility. He stated the Administrator would be responsible for monitoring the Activity Director. Record review of the facility's Activity Policy, dated not dated, reflected It is the policy of this facility to provide an ongoing program to support residents in their choice of activities based on their comprehensive assessment, care plan, and preferences. Facility-sponsored group, individual, and independent activities will be designed to meet the interests of each resident, as well as support their physical, mental, and psychosocial well-being. Activities will encourage both independence and interaction within the community. Activities may be conducted in different ways: one-to-one programs, person appropriate- activities relevant to the specific needs, interests, culture, background, etc. for the resident. Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews the facility failed to ensure that resident environment remained as free from accident hazards as is possible, by not providing adequate supervision and assistance devices to prevent accidents for 4 of 11 residents (Resident #18, Resident #23, Resident #5, and Resident #3) reviewed for safe transfers. 1. The facility failed to ensure two staff members transferred Resident #18 via mechanical lift which resulted in Resident #18 suffering a skin tear due to being transferred by one staff member on 6/04/2025. 2. The facility failed to ensure CNA A and CNA B knew how to competently use transfer assistive device (gait belt) when performing a transfer from recliner to wheelchair for Resident #5 on 8/13/2025. 3. The facility failed to ensure that staff used any assistive devices (gait belt) when standing Resident #23 at the bedside resulting in a fall on 6/05/2025. 4. The facility failed to ensure that staff used any transfer assistive devices (gait belt) when transferring Resident #3 between bed and geri-chair. This failure could place residents at risk for serious injury, fracture, or death. Findings included: 1. Review of Resident #18's Face sheet dated 9/18/2020 reflected a [AGE] year-old, male admitted to the facility on [DATE]. Diagnoses included muscle wasting atrophy right and left shoulder (muscles shrinking and becoming weaker), rheumatoid arthritis (a chronic disease where the immune system attacks the joints), abnormalities of gait (abnormal way of walking) , contracture to right and left knee (condition where muscles, tendons, ligaments, or skin shorten and stiffen), and muscle wasting and atrophy of lower leg (muscles shrinking and becoming weaker). Review of Resident #18's Quarterly MDS dated [DATE] reflected a BIMS score of 15 (no cognitive impairment). In Section GG- Functional Abilities section GG0170. Mobility, Resident #18 is coded as dependent on staff for Chair/bed-to-chair transfers and, Not attempted due to medication condition or safety concerns for sit to stand transfer. Review of Resident #18's Paper Care Plan reflected a Problem area stating, Problem Start Date: 06/05/2025 Category: ADLs Functional Status/Rehabilitation Potential Resident presents with mobility limitations and requires [mechanical lift] for transfers Created: 06/05/2025 Created by: [ADON]. Related Goal area reflected, Long Term Goal Target Date: 09/05/2025 Staff will safely transfer resident utilizing a [mechanical lift] Created: 06/05/2025 Created by: [ADON]. Problem initiated for, Category: ADLs Functional Status/Rehabilitation Potential [Resident #18] requires assistance with ADL's d/t impaired mobility and incontinence of bowel and bladder. Edited by: 05/08/2025 Edited by: [ADON] with a related Approach stating, Transfer: Total with 1-2 person assist (utilize a [mechanical lift]) Wheelchair for mobility; gel cushion to wheelchair Edited: 05/08/2025 Edited by: [ADON] Review of orders dated 8/15/2025 for Resident #18 reflected an order dated 08/14/2025 reflecting, [Mechanical Lift] transfer for safety and non-weight bearing status. Review of Facility Incident/Accident Investigation Worksheet dated 6/05/2025 reflected an incident involving Resident #18 on 6/04/2025 at 11:30AM. The section titled, Describe Exactly What Happened reflected, Resident reports during transfer mech (mechanical) lift [with]sling, sling rubbed against arm causing S/T [with] minimal bleeding. No other injuries were found. [Resident] alert and oriented. No swelling or bruising noted. Under the Witness section of the form CNA A is listed as the only witness. The Follow up/steps to prevent reoccurrence and person(s) responsible: section reflected a note stating, Inservice staff proper use of lift +sling during transfer. Signature on form is illegible. Review of Inservice initiated by ADON and dated 6/5/2025 reflected, 2. When using the [mechanical] lift-please make sure sling is positioned appropriately so that it is not causing skin tears. Never use a [mechanical] lift without 2 people. Inservice signed by all staff. Review of Paper Progress Note reflected an entry on 6/4/25 stating, Resident report during transfer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some using mech (mechanical) lift + sling, his arm rubbed against skin causing S/T to rt (right) [lower] forearm, minimal bleeding, area was cleaned [with] wound cleanser. TAO (triple antibiotic ointment) + light dressing applied, no other injuries noted. Review of Skin Assessment for Resident #18 dated 6/4/2025 reflected a note stating, S/T (skin tear) to L (left) upper arm + R (right) lower forearm. The signature is illegible with LVN after the name. Review of staff competencies for [Mechanical] lift/Transfer prior to start of survey on 08/12/2025 reflected 7 total staff, including nurses and nurse aides, had met the Standards of Practice outlined on the form. Review of Employee List provided by facility on 8/12/25 reflected 18 total nurses and nurse aides employed at the facility on that day. 2. Review of Resident #5's Face sheet dated 8/15/2025 reflected a [AGE] year-old, female admitted to the facility on [DATE]. Diagnoses included muscle wasting atrophy right and left shoulder (muscles shrinking and becoming weaker), dementia, unsteadiness on feet, anxiety disorder (intense and excessive worry or fear), and cerebral infarction (a temporary lapse of blood flow to the brain). Review of Resident #5's Quarterly MDS dated [DATE] reflected a BIMS score of 6 (severe cognitive impairment). In Section GG - Functional Abilities, the coding reflected that Resident #5 is dependent on staff to move from sitting to standing position and to transfer from a bed to a chair or wheelchair. Review of Resident #5's Orders dated 8/15/2025 reflected an order dated 8/14/2025 for, [Mechanical Lift] for all transfer due to non-weight bearing status. Review of Resident #5's Care Plan in EMR (electronic medical record) reflected a Focus area stating, I am at risk for falls related to unsteady gait, history of falls, muscle weakness, cognitive impairment, medication side effects, poor vision, or incontinence. Date Initiated: 08/08/2025. The related Interventions/Tasks area reflected, I will be assisted with walking, transfers, or toileting as needed, based on my current ability. Date Initiated: 08/08/2025. Review of Resident #5's Paper Care Plan reflected a Problem area stating, Problem Start Date: 09/12/2024, Category: ADLs Functional Status/Rehabilitation Potential [Resident #5's] ability to ___ (ADL: e.g., transfer, walk in room, walk in corridor, dress, eat, toilet, maintain personal hygiene) has deteriorated R/T advanced age. Edited: 05/29/2025 Edited By: [ADON]. The related Goal area reflected, Long Term Goal Target Date: 08/29/2025 Resident will not further deteriorate in ADL Edited: 05/29/2025 Edited By: [ADON]. The related Approach area reflected, Approach Start Date: 05/29/2025 Follow PT/OT/ST recommendations. Edited: 05/29/2025 Edited By: [ADON] and Approach Start Date: 05/29/2025 Provide assistance for ADL's as indicated Edited: 05/29/2025 Edited By: [ADON]. Observation of two-person transfer of Resident #5 on 08/13/2025 at 03:17 PM with OT G, CNA A, and CNA B revealed Resident #5 sitting in recliner in her room. OTA G had two gait belts in hand. She stated that she would leave the gait belts with the aides and exit the room for the transfer. CNA A and CNA B raised the recliner chair and placed the wheelchair next to the recliner. Both aides stood in front of the resident and each attempted to apply the gait belt to Resident #5. Neither CNA A or CNA B could properly apply the gait belt. CNA A stated, I am going to be honest, I usually do it without a gait belt. It has been a minute since I used a gait belt. We usually do it with two people, one on each side, without a gait belt. Resident #5 requested twice for CNA B to move the belt below her breasts because it was painful. CNA B moved the gait belt slightly lower and continued to try to secure the belt properly. After 15 minutes, Resident #5 declined to continue with the transfer. Resident #5 stated she was tired. CNA B stated, I will go down to therapy and let them train me. In an interview with OT G on 8/13/2025 at 03:37PM, she stated that the facility asked her to train the two CNA's prior to the transfer with Resident #5, but there was not time for her to do it before the surveyor arrived to observe the transfer. She stated that she was a PRN (as needed/temporary) therapist for the facility. She stated that she started on 08/01/2025 when the new company took ownership. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some stated that the new ownership no longer contracted with the previous rehabilitation company used by the facility. She stated that at other facilities it was her experience that staff would be trained on transfers when they were hired at the facility. She stated there was no therapy director or physical therapist at the facility currently. 3. Review of Resident #23's Facesheet dated 8/15/2025 reflected an [AGE] year-old, female admitted to the facility on [DATE]. Diagnoses included dementia, muscle wasting atrophy right and left shoulder (muscles shrinking and becoming weaker), myocardial infarction (lapse of blood flow to the heart), abnormalities of gait and mobility, abnormalities of gait (abnormal way of walking), and history of falling. Review of Resident #23's Annual MDS assessment dated [DATE] reflected a BIMS score of 14 (no cognitive impairment). In Section GG - Functional Abilities, the coding reflected the resident requires, Supervision or touching assistance with all transfer types, indicating staff assisting the resident would provide verbal cues and/or touching/steadying and/or contact guard assistance as needed as the resident completes activity. Review of Resident #23's Orders dated 8/15/2025 reflected no orders related to mobility assistance required or any assistive devices required for transfers. Review of Resident #23's Paper Care Plan reflected a Problem area stating, Problem Start Date: 11/08/2023 Category: Falls [Resident #23] is at risk for falling R/T [] immobility,[X] muscle weakness, [] Diabetes, [X] COPD,[X] chronic pain, [X] anemia, [] dizziness, [X]vision problems, [] hearing problems,[X]incontinence , [X] neuropathy, []dehydration, [] decreased cognition. 6-5-2025- Resident had a fall while attempting to stand without assistance. 6-8-2025 Fall while at son's home while attempting to toilet self. Edited: 06/10/2025 Edited By: [ADON]. In the related Goal area it stated, Short Term Goal Date: 09/04/2025 [Resident #23] will remain free from injury. Edited: 06/04/2025 Edited By:[ADON]. In the related Approach area it stated, Approach Start Date: 06/06/2025 Assist resident with standing Created: 06/06/2025 Created By: [ADON]. Review of Patient/Resident Incident/Accident Investigation Worksheet reflected a fall without injury for Resident #23 on 06/05/2025 at 11:15AM. In the Describe Exactly What Happened field, it stated, The patient was attempting to stand up for wkly (weekly) skin assessment, lost her balance and was eased down to the floor. No bruising or injuries noted or reported. The statement is signed by RN. In the section for Follow up/steps taken to prevent reoccurrence and person(s) responsible: it stated, Patient can only stand with assistance. Administrative staff signature is illegible. The signature is dated 6/06/2025. Review of Fall Investigation Worksheet for fall on 6/05/2025 for Resident #23 reflected RN as the only witness to the fall. The statement of witness reflected, The patient verbalized she could stand with my assistance for me to complete her wkly skin assessment. She began losing her balance and was eased to the floor by this nurse. For Neuromuscular/Functional section of the form, it indicated Resident #23 has lower extremity weakness. The recommendations field stated, The patient should not attempt to stand up for skin assessment. She can be assessed better in bed. The form was filled out by RN. 4. Review of Resident #3's Face sheet dated 8/14/2025 reflected a [AGE] year-old, female admitted to the facility on [DATE]. Diagnoses included dementia, contracture (shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff) of muscle in lower leg and upper arm, muscle weakness, and pain.Review of Resident #3's Quarterly MDS dated [DATE] reflected that resident was rarely or never understood and BIMS assessment was not able to be conducted to assess cognition. Section GG for Functional Abilities indicated Resident #3 had impairment to both legs, she was totally dependent on staff for all self-care and transfer types, and she is unable to use a wheelchair, walker, or cane. Review of Resident #3's Paper Care Plan reflected a Problem area stating, Problem Start Date: 06/26/2024 [Resident #23's] ability to (ADL: e.g., transfer, walk in room, walk in corridor, dress, eat, toilet, maintain personal hygiene) has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some deteriorated R/T Hospice End of Live Care Edited: 06/02/2025 Edited By: [ADON]. The related Approach area stated, Approach Start Date: 06/02/2025 Provide assistance for all ADL's. Edited: 06/02/2025 Edited By: [ADON], Approach Start Date: 06/02/2025 She uses Geri Chair for positioning Edited: 06/02/2025 Edited By: [ADON], Approach Start Date: 06/02/2025 Transfer extensive assist 1-2 Edited: 06/02/2025 Edited By: [ADON] Review of Resident #3's Orders on 8/15/2025 reflected an order dated 08/14/2025 for, [Mechanical Lift] Transfer due to non-weight bearing status. There are no other orders listed indicating Resident #3's related to mobility status or transfer equipment prior to 8/14/2025. The last weight for Resident #3 visible on the order screen reflected a weight of 102.2 lbs on 8/04/2025. Review of Resident #3's Occupational Therapy Evaluation and Plan of Treatment dated for Start of Care on 1/06/2025 and signed by OT F, reflected a Behaviors section indicating, Patient Behaviors: Confused, yet participative. Range of motion to both arms and legs are listed as impaired. Standing ability and sitting ability are listed as, unable. The documents do not indicate any necessary transfer devices or the number of staff required for transfers. It does not describe an appropriate transfer technique for the resident in the notes. Review of Resident #3's Physical Therapy Evaluation and Plan of Treatment dated for Start of Care on 1/6/2025 and signed by PT H, reflected the range of motion to both arms and legs are listed as impaired. Standing ability and sitting ability are listed as, unable. For the section labelled Transfers, it stated Patient requires assistance, however, will not currently address in treatment plan. In an interview with LVN C on 8/14/2025 at 5:50AM, she stated that there were two aides in the building. She stated that the aides present were both She stated that Resident #3 was a two person transfer but was already up in the Geri-chair for the day. She stated she would inform staff that surveyor wanted to observe two-person transfer. Observation of Resident #3 on 08/14/2025 at 6:00AM reflected Resident #3 lying in Geri-chair, eyes closed, well-groomed with blanket placed over her up to her lower chest. In a follow-up interview with LVN C on 08/14/2025 at 6:10AM, she stated that she transfers Resident #3 required two staff. She stated the resident is not classified as needing a mechanical lift. She stated that when she transfers Resident #3, one person stands in front of the resident and one person is behind the resident. She stated the resident is non-weight-bearing. She stated the person behind the resident would normally hold the chair steady during the transfer. She stated the resident is smaller in size, so the person not holding the chair will raise the head of the bed to sit her up, they would then place their arms under the resident's arms and lift her from the bed over to the chair. She stated the second person doesn't usually touch the resident. She stated that they do not use a gait belt with the transfer for Resident #3. She stated that for a bigger resident, one person would be on each side of the resident. She stated the staff would each then place one of their arms under the resident's arm, then assist them to either stand at the bedside or perform an assisted pivot transfer to a wheelchair. She stated she worked at the facility full-time since September or October of 2024. She stated that there was a gait belt in the breakroom now. She stated that it was not safe for staff to transfer a resident by carrying them under their arms. She stated they did it because of Resident #3's size. She stated Resident #3 was not classified as a mechanical lift transfer. She stated she knew of one resident who needed a gait belt and stated that the resident was able to stand on her own. She stated that she has not seen staff use a gait belt recently. She could not recall a specific date or time she last saw staff use a gait belt. She stated, I'm not there in the room to see the transfers usually. She stated that she usually has two CNA‘s on night shift with her. She stated there was an aide assigned to the secure unit and the second aide was helping with the rest of the residents not on the secure unit. She stated that both aides working with her that night were agency staff. She stated that when the aides (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some are ready to transfer the two person assists and residents requiring mechanical lifts in the mornings, she will usually watch the secure unit while the aides work together to assist with residents care. She stated that she sometimes helps with ADL care. She stated that not using proper transfer equipment can result in a fall and injuries. She stated that gait belt use was a fundamental skill for a CNA. She stated that improper use of a gait belt can cause injuries depending on the placement, including skin tears. LVN C demonstrated proper use of a gate belt. In an interview with CNA E on 08/14/2025 at 6:27AM, she stated that she was employed by an agency to work shifts at the facility. She stated that she picks up shifts at the facility when she can because it is closer to her home. She stated that they do not get people up overnight usually and she was familiar with three residents that were two person transfers. She stated that Resident #3 and Resident #5 were two-person transfers. She stated Resident #3 did not require a mechanical lift. She stated that she is not heavy, but she does require two people to lift her to the chair. She stated that each staff member stands on either side of the resident and puts their arms under one side of the resident's arms and they lift the resident together to the Geri-chair. She stated that they do not use any transfer devices or equipment for the transfer for Resident #3. She stated that Resident #3 cannot assist with standing. She stated that people who cannot stand at all during the transfer usually use a mechanical lift. She stated that she does not know the residents well. She stated that she does not check the care plans or the chart to find out the transfer status of a resident. She stated that she usually asks the facility CNA's or the charge nurse how to transfer a resident. She stated they always have regular staff or a nurse available on the shift. She denied receiving any transfer training from the facility prior to starting there. She stated that she has never been trained to do a two person transfer where she was told to lift a resident who cannot stand from under their shoulder without any transfer equipment. She stated it was not safe to lift a resident for a transfer. She stated that transferring a resident without a gait belt by lifting them under their arms was something she learned to do at work. She stated that she never lifts a resident who cannot stand on their own by herself. She stated that the potential impact to the resident was that it could, hurt her. She stated that Resident #3 is, real fragile. She stated, It is a bad habit. She stated she was knowledgeable about how to use a gait belt. She stated, I only use it when they are able to stand some on their own. She stated that in other facilities gait belts are usually in the resident's rooms in the nightstand or in a basket at the bedside. She stated she believed they would be in the same place in this facility. CNA E was able to demonstrate proper application of a gait belt. She was unable to locate a gait belt in the room for Resident #5. Resident stated that she did not believe there was a belt like that in her room. She stated that gait belt use was a fundamental skill for a CNA. She stated that with improper use of a gait belt, a resident could be hurt or sustain a rib fracture if it was too tight and if it was too loose, the gait belt could hurt a resident under their arms and cause shearing to their skin or be useless in assisting with the transfer. She was unable to recall other staff members using a gait belt with a resident in the facility. She stated, I don't think anyone uses a gait belt for transfers here. In an interview with ADON on 8/14/2025 at 7:07AM, she stated that Resident #5 was a two-person transfer. She stated that Resident #3 was a 1-2-person transfer. She stated that Resident #3 was full weight bearing status to her knowledge. She stated that the last physical therapy discharge note did not state the weight bearing status of Resident #3 or transfer requirements. She stated that there is a note from occupational therapy assessment dated [DATE] to 2/06/2025 stating Resident #3 is unable to stand. The notes state that she requires assistance with transfers but does not indicate how the transfer should be performed. She stated that she would provide the most recent therapy (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some notes from the previous rehabilitation company the facility contracted with. She stated that the care plans should be pretty accurate regarding transfer status. She denied knowledge of any falls with transfers. In an interview with Resident #18 on 8/14/2025 at 6:50AM, he stated that he transfers with a mechanical lift. He stated that he has not had any problems that he can recall. He stated that the staff usually only use one person for the lift transfer. He stated he believed he only needed one person to perform the transfer. In an interview with CNA E on 8/14/2025 at 07:06AM, she stated that a mechanical lift transfer should only be performed with two staff. She stated that Resident #18 was a mechanical lift transfer. She stated that she has never performed a mechanical lift transfer on her own. In a follow up interview with Resident #18 on 8/14/2025 at 8:36AM, he stated that he did recall an incident in early June 2025 where he received a skin tear during a mechanical lift transfer. He stated that he did not remember how many people were operating the mechanical lift during the transfer. In an interview with CNA A on 8/14/2025 at 8:45AM, she stated she had worked at the facility for 14 years. She stated that she did recall the mechanical lift transfer with skin tear incident on 6/04/2025 for Resident #18. She stated that she got him dressed, put the mechanical lift blanket under him, and got him up in the lift. She stated, I was pulling him back in the chair when my nails scraped his elbow. She stated there were no other witnesses to the event. She stated that she performed the mechanical lift transfer with Resident #18 on 6/4/25 by herself. She stated that she should have used two people for the transfer. She stated that she knew that she needed two people. She stated that she could not find the other CNA on staff that day. She stated that she should have asked the nurse to help her and she did not. She stated that she was not trained by facility on mechanical lifts. She stated that the potential risk to patient with a one-person mechanical lift transfer is that a resident could fall out of the lift. She stated that for a normal two-person transfer, she would ensure privacy for the resident. She stated she would normally sit the bed up to help if the resident needed assistance sitting. She stated they did not do that the day before. She stated it was because she was nervous. She stated that she would normally assist a resident to sit if they needed it. She stated she didn't know anyone in the building who needed a gate belt. She stated the gate belt use and transfer skills were an important skill for a CNA to have. She stated the transfers without the proper equipment can put the resident at risk of hurting themselves.In an interview with CNA B on 08/14/2025 at 9:28 AM, she said she worked at the facility for about a month. She stated she had no transfer training or gate belt training on hire. She stated that for a normal two-person transfer, staff stand on either side of the patient. She stated one person near the shoulder. She stated one person should stand near the resident's legs. Then they swing the resident together to set their shoulders up and their feet down and in a sitting position. She stated that if they are unable to sit up on their own, she would assist them. She stated each person would then stand on one side of the resident. She stated the staff would put one of their arms under the resident's arm on each side, and staff would use the other hand to hold onto the resident's pants to assist them to a standing position and either pivot to the destination or walk a few steps and sit down. She stated that she has not used a gait belt on anyone in the facility. She stated she does not know of any residents that need a gait belt in the facility. She stated it's been about four months since she used a gait belt. She stated that she was not able to apply the gait belt on Resident #5 on 8/13/2025 during the observation. She stated that knowledge of how to use a gait belt and perform transfers was an important skill for CNA. She stated that she asks the nurses to know what the ability level and transfer status of the residents in the facility. She stated she does sometimes checks the care plans to find out information about resident information and transfers. She stated that CNA A has worked at the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some facility for a long time and she asked her how to do the transfers for the residents. She stated she would ask the nurse to find out who needs a gait belt after the interview. She stated that improper transfers can cause a fall. She stated that improper use of a gait belt can cause a fall. She stated that the resident can also be injured by improper positioning of a gait belt. She stated that she was trained by the occupational therapist on 8/13/2025. In a follow up interview with OT G on 08/14/2025 at 11:40AM, she stated that she was not sure how many residents were 1 person, 2 person, or mechanical lift transfers in the facility. She stated that she had never seen a list of residents who required gait belts for transfers. She stated that anyone who is not independent or using a mechanical lift for transfers, should have a gait belt on during transfers. She stated that she would use a mechanical lift to transfer a resident who is unable to bear weight on their legs. She stated that Resident #3 is non-weight bearing. She stated that she just met Resident #3 on the morning of 8/14/2025. She would use a mechanical lift to transfer her. She stated that she would not recommend a one person transfer for Resident #3. She stated that she would never lift a resident from under their arms to perform a transfer. She stated that transfer recommendations from therapy staff should be in a therapy evaluation or in the care plan. She stated sometimes care plan updates do not happen immediately after a change. She stated that lifting a resident for a transfer from under their shoulders could result in a shoulder injury. She stated that improper transfers can also result in shearing injuries or falls. She stated that she was not sure how long Resident #3 had been unable to bear weight. She stated she would check the records. She stated staff should never use a mechanical lift with one person only. She stated that the potential risk to resident is injury. She stated her role was to evaluate and assess patients for their occupational performance, functional mobility, and ADL performance. In an interview with RNC on 8/14/2025 at 12:04PM, she stated that she started in the building as the acting Director of Nursing on 8/04/2025. She stated that the new company took over the building on 08/01/2025. She stated that the new Director of Nursing started on 8/11/2025, but she had not been through the training for the position and would not be familiar with the residents or corporate policies at that time. She stated her role was as Clinical Support when the Director of Nursing assumes her role in the facility. She stated that anytime staff transfer a resident they should use a gait belt. She stated she asked the ADMIN to order 30 gait belts on 08/13/2025 when staff were unable to find a gait belt outside of the two utilized by the therapy team. She stated that staff should not have to provide that. She stated that the facility should provide gait belts for residents that need them. She stated it would have been the responsibility of the previous Director of Nursing to ensure that gait belts were available. She stated that in the absence of a DON, the ADON would be responsible for gait belts. She stated she did not have time to do a mock survey or evaluate that part of the facility prior to survey entrance. She stated that staff would not use a gait belt if a resident refused the gait belt, if they were a mechanical lift transfer, or if they transferred independently. She stated that transfers without a gait belt, when one is indicated, put residents at risk for skin tears, bruising, and falls. She stated that improper use of a gait belt can cause injury to a resident. She stated it was a fundamental skill for a CNA to be able to use a gait belt for transfers. She stated she started a competency packet with transfers for the facility staff when she realized there was a problem. She stated that staff should never transfer a resident in a mechanical lift with one person. She stated that the risk to the residents of only having one staff member perform a mechanical lift transfer is injury. She stated that she was not aware of any incidents of staff using a mechanical lift with one person. She stated that she would work with therapy to start trainings for mechanical lift proficiencies with the direct care staff. She stated that for a normal two (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete person transfer without a mechanical lift, staff would raise the head of the bed slightly, and each staff member would support either the shoulders or the legs, as assist the resident to sit. She stated that staff would then apply a gait belt, allow the resident to sit at the bedside for a moment, and ensure that the wheelchair is locked. She stated that staff would then stand to the right and left of the resident and use the gait belt and assist the resident to stand. She stated that she requested OT G to evaluate the transfers of several of the residents. She stated that staff should never lift a resident from under their arms during transfers. She stated that if a resident is non-weight bearing, they should automatically be listed as a mechanical lift transfer for the safety of the resident and the staff. She stated that movement from a partial to moderate assist to a mechanical lift transfer would indicate a decline in status. She stated that it was the responsibility of the facility to improve the status of the residents, but some situations cannot be helped. In an interview with ADON on 8/14/2025 at 2:59PM, she stated that she started at the facility in December of 2025 as MDS Coordinator/ADON. She stated that when the previous DON of the facility left in December, she had been on call for all nursing related concerns or reportables. She stated that she worked on the investigation involving Resident #18 on 6/04/2025. She stated that when she interviewed Resident #18 he stated that the fabric of the sling pulled on his skin causing the skin tear. She stated that staff should always use two people for mechanical lift transfers. She stated that the risk to the resident of only using one staff for a mechanical lift transfer is injury. She stated, You just don't do it without two people. She stated that she was not aware that there was only one person in the mechanical lift transfer on 6/04/2025. She stated that she did not know if she assumed that there were two people present for the transfer or if she [TRUNCA Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute food in accordance with professional standards for food service safety for one of one kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure Dietary Aide K wear a beard guard when standing over clean dishes in the dishwashing room on 08/12/2025. 2. The facility failed to ensure Dietary [NAME] M used proper hand hygiene during food preparation on 08/13/2025. These failures could place residents who ate food from the kitchen at risk for foodborne illness.Findings included: 1.Observation on 04/22/2025 at 9:10 AM, Dietary Aide K was not wearing a beard guard when standing in the dishwasher room over clean dishes. His beard growth was approximately 8 inches. Interview on 08/12/2025 at 9:15 AM, Dietary Aide K stated he was expected to wear a beard guard anytime he was in the kitchen area. He stated if hair fell onto plates and the hair transferred to residents' food there was a possibility a resident may become ill with some type of stomach issues (when asked what type of stomach issues he did not respond to the question). He stated germs was located on hair. Dietary Aide K stated he had been in-service on wearing beard guards. He stated it was in February 2025 or March 2025. He did not recall the exact date. 2. Observation on 08/13/25 at 7:25 AM, Dietary [NAME] L was wearing gloves when preparing puree food. She touched the right side of her shirt with her right hand. Dietary [NAME] L touched the bacon without changing her gloves. She picked up the bacon with her right hand and placed the bacon on a baking pan. Interview on 08/13/25 at 12:50 PM, Dietary [NAME] L stated she did not change her gloves after she touched her clothes. She stated she did touch pick up the bacon and place it on pan with her right hand. Dietary [NAME] L stated she did contaminate the bacon. She stated if a resident ate contaminated food there was a possibility the resident may become ill with stomach issues such as vomiting, diarrhea and nausea. She stated she had been in-service on hand hygiene and to change gloves anytime you touch anything contaminated. She stated her clothes would be considered contaminated. She stated she had been in-service on hand hygiene but did not remember the date of the in-service. Interview on 08/14/25 at 8:30 AM Dietary Manager stated hair nets or cap and beard guard on facial hair was present are required for all staff while in the kitchen. Dietary Manager stated it could negatively affect a resident if hair restraints are not worn by a resident receiving food with hair in it. Dietary Manager stated it was her responsibility to ensure beard restraints were worn by the male staff in the kitchen. Dietary Manager did not answer why dietary aide did not properly wear a beard guard while in the kitchen even though he had facial hair. She stated all staff was to wash hands after touching anything no Interview on 08/14/25 at 12:30 PM the Administrator stated his expectation was that beard restraints were to be worn by all staff in the kitchen. The Administrator stated if beard restraints are not worn there was a possibility a hair may fall into food. He stated there was a possibility if a resident ingested a hair the resident may become ill with some type of stomach issues. The Administrator stated he expected gloves to be changed, hands washed anytime staff touch contaminated items. He stated clothes would be considered contaminated. He stated there was a possibility if there was a hair or bacteria in food, a resident may develop a food borne illness. The Administrator stated the Dietary Manger was responsible for all protocols in the kitchen and he was responsible to monitor the Dietary Manager. Record review of the facility's Policy on Dietary Employee Personal Hygiene, not dated, reflected It is the policy of this facility to utilize the following as guidelines for employee personal hygiene to prevent contamination of food by foodservice employees. Gloves are to be worn and changed appropriately to reduce the spread of infection. All dietary staff must wear hair restraints (hairnet, hat and/or beard restraint) to prevent hair from contacting food. Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 observation, interview, and record review 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 and follow accepted national standards for one of five residents reviewed for infection control practices. (Resident #48). The facility failed to ensure that staff wore a gown during medication administration via g-tube (a tube inserted into the stomach) on 08/13/2025 for Resident #27 when the resident was on isolation precautions ordered 08/12/2025. There was no Enhanced Barrier Precaution signage on the door nor PPE (personal protective equipment) inside or outside of Resident 27's room. This failure could place the residents, staff and visitors risk for cross contamination. Findings included: Review of Resident #27's Face sheet dated 8/13/2025 reflected a [AGE] year-old, male admitted on [DATE]. Diagnoses included Cerebral Infarction (a temporary lapse of blood flow to the brain), Neurosyphilis (sexually transmitted infection that affects the brain and spinal cord causing cognitive changes), and Hypertension (high blood pressure). Review of Resident #27's orders reflected an order dated 8/12/2025 for Enhanced Barrier Precautions: Resident requires enhanced barrier precautions. Wear PPE per facility protocol.[BH1] [EM2] Review of Resident #27's Care Plan reflected a Focus Area stating, Resident requires Enhanced Barrier Precautions due to colonization or infection with a multidrug resistant organism (MDRO) or is at high risk per CDC criteria r/t g tube Date Initiated: 08/12/2025. Related Interventions/Tasks reflected, [NAME] gown and gloves before high-contact resident care activities (e.g., dressing, bathing, toileting, device care, wound care), Date Initiated: 08/12/2025, Maintain a supply of gowns and gloves inside or outside the room for ease of access, Date Initiated: 08/12/2025, and Place signage outside of residents room indicating Enhanced Barrier Precautions are in use (do not include specific diagnosis), Date Initiated: 08/12/2025. Observation of medication administration with LVN D on 08/13/2025 at 7:59AM[BH3] [EM4] , revealed LVN D did not wear a gown while administering medications via G-tube for Resident #27. There was no Enhanced Barrier Precaution signage on the door. There was no PPE (personal protective equipment) inside or outside of the room. In an interview with LVN D on 8/13/2025 at 8:30AM, he stated that Resident #27 should be on enhanced barrier precautions. He stated that he should have worn a gown during medication administration with a g-tube. He stated it was the responsibility of nurses and CNAs to initiate EBP for newly admitted residents. He stated that the potential impact to the resident of not wearing a gown with medication administration via g-tube could lead to infections. In an interview with ADON on 8/13/2025 at 8:39AM, she stated her expectation was that staff use gowns and gloves when providing direct care to a resident or handling the medical device for a resident, as indicated by the guidelines for enhance barrier precautions, for those residents who require it. She stated that enhance barrier precautions should be followed with g-tube medication administration. She stated it was the responsibility of nursing staff and nursing administration to implement EBP for a new resident. She stated that she printed the signs and thought they were being posted and PPE was set out by staff. She stated the potential impact to the resident of not following the guidelines is possible exposure to infection for the resident receiving care and potentially spread infection to other residents in the facility. In an interview with RNC on 8/14/2025 at 12:04PM, she stated that the was the current Infection Preventionist for the facility. She stated that she asked the newly hired DON and ADON to put the EBP sign on the door for Resident #27. She stated that she did not go back to check that it was done. She stated that Resident #27 should be on EBP for his g-tube. She stated that the potential impact to the resident of not using a gown and gloves during Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675132 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 675132 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bremond Nursing and Rehabilitation Center 211 N Main Bremond, TX 76629 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete medication administration is the potential for cross contamination. In an interview with NP on 8/15/2025 at 12:04AM, she stated that she expected the facility to follow the guidelines for enhance barrier precautions, when appropriate. She stated the potential impact to the residents of not following the guidelines could be exposure to infection, actual infection, or issues with the device. In an interview with ADMIN on 8/15/2025 at 3:43PM, he stated that residents with g-tubes should be on enhanced barrier precautions. He stated his expectation was that staff follow the guidelines while providing care and giving medications to residents with enhance barrier precautions. Requested facility policy for Medication Administration and Enhanced Barrier precautions via email on 08/13/2025 at 09:45AM. No policy or related policy was provided before exit. Review of the CDC[BH5] guidelines for Enhanced Barrier Precautions in Nursing Homes dated 05/20/2024 reflected, EBP are indicated for residents with any of the following: Wounds and/or indwelling medical devices even if the resident is not known to be infected or colonized with a MDRO.Indwelling medical device examples include central lines, urinary catheters, feeding tubes, and tracheostomies. A peripheral intravenous line (not a peripherally inserted central catheter) is not considered an indwelling medical device for the purpose of EBP. EBP should be used for any residents who meet the above criteria, wherever they reside in the facility. Event ID: Facility ID: 675132 If continuation sheet Page 23 of 23