Health inspection·February 16, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete for Resident #45 did not address her Dementia. He advised that the resident's medical diagnosis for Dementia should have been care planned. He advised that the risk to Resident #45 not having her Dementia care planned could result in the resident not receiving proper care. Review of the facility's policy on Care Planning/Interdisciplinary Team, dated September 2013, revealed The Care Plan is based on the resident's comprehensive assessment and developed by a Care Planning/Interdisciplinary Team. Event ID: Facility ID: 675136 If continuation sheet Page 2 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0694 Provide for the safe, appropriate administration of IV fluids for a resident when needed. 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 parenteral fluids were administered consistent with professional standards of practice and in accordance with physician orders, the comprehensive person-centered care plan, and the resident's goals and preferences for 1 of 2 residents (Resident #119) reviewed for intravenous care. Residents Affected - Few The facility failed to ensure Resident #119 received intravenous dressing changes to the PICC line at any time during his admission between 02/05/2023 and date of observation 02/14/2023. This deficient practice could place residents at risk of serious illness and/or infection. Findings included: Review of Resident #119's Face Sheet, dated 02/15/23, revealed he was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included stroke resulting in paralysis affecting left side of his body, heart disease, streptococcus infection, and back surgery with disc replacement. Review of Resident #119's admission MDS, dated [DATE] stated he was moderately cognitively impaired with a BIMS score of 10. Functional status was not completed at time of survey. Review of Resident #119's Functional Abilities Assessment completed upon admission, dated 02/05/2023, revealed he required partial/moderate assistance with eating and oral hygiene. Toileting and other ADLs were not documented as not attempted due to environmental limitations. Record review of Resident #119's physician orders revealed Sodium Chloride 0.9% 10 ml flush injections before and after IV admin, Q shift for IV patency, and antibiotic orders of Ceftriaxone 2 gram intravenous twice a day for streptococcus to start 02/05/2023. No physician orders for intravenous line dressing changes were observed. Record review of Resident #119's TAR dated 02/02/2023-02/15/2023 revealed resident received Sodium Chloride 0.9% Ceftriaxone 2 gram intravenously as ordered between 02/06/2023 and 02/15/2023. Record review of Resident #119's Comprehensive Care Plan, dated 02/06/2023 revealed that Resident #119's Problem: Resident is on antibiotics and is at risk for adverse reactions . Infection: strep mitis bacteremia with his goal for infection to be resolved . at the end of antibiotic therapy with no adverse reactions noted' via follow universal precautions to prevent cross contamination and spread of infection, monitor resident for adverse reactions to antibiotic therapy, and give medications per order: IV ceftriaxone. No documentation of maintenance or care of intravenous access dressings was observed. Record review of Resident #119's Health and Physical, dated 02/06/2023, revealed Assessment and Plan . 1. Bacteremia: secondary to Strep Mitis . IV Ceftriaxone for 6 weeks. In an interview and observation with Resident #119 on 02/14/2023 at 11:37 a.m., revealed the resident resting in bed. Resident observed to have a single lumen power PICC intravenous access on the right upper arm. Dressing appeared clean, dry, intact, and the dressing was dated for 11 days ago, 2/3. The resident stated the dressing had not been changed since his admission to the facility. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 3 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0694 denied any pain at catheter insertion site. Level of Harm - Minimal harm or potential for actual harm In an interview and observation with Resident #119 on 02/15/2023 at 10:24 a.m., revealed the resident resting in bed. Resident observed to have a single lumen intravenous access on the right upper arm. Dressing appeared clean, dry, intact and the dressing was dated 02/14/2023 and initialed EM. Resident #119 stated someone changed the dressing yesterday for the first time since admission. Resident denied any pain at catheter insertion site. Residents Affected - Few In an interview with LVN P on 02/15/2023 at 10:27 a.m., she stated she was the nurse for Resident #119 yesterday, 02/14/2023 and for today, 02/15/2023. She stated that DON changed the intravenous line dressing yesterday. She stated that she was not sure of the date on the dressing prior to 02/14/2023. She stated that it was the nurse's responsibility to ensure dressing changes are performed every 7 days per policy for infection control purposes. She stated it was nursing leadership's responsibility to audit and ensure dressing changes are performed. In an interview with the DON on 02/15/2023 at 12:16 p.m., she stated she changed the intravenous line dressing yesterday [02/14/2023] for Resident #119. She stated the dressing was labeled 02/03 which she stated it must be from the hospital, since he was admitted [DATE]. She stated that the facility policy was for the IV dressing to be changed every 7 days. She stated it was her expectations for the nurses to ensure dressing changes were completed per policy. She stated the intravenous line dressing was not changed, as there was not a physician order. She stated that she did not see any physician orders for IV dressing changes in the computer for Resident #119. She stated that Resident #119 was admitted on a weekend and the weekend supervisor, RN H, was responsible for putting in the physician orders. She stated that her ADON was expected to perform audits to ensure physician orders were properly put in for new admissions. She stated it was important that the facility have a physician order for any care provided. She stated that if intravenous line dressing changes were not performed per policy, infection can occur, which can lead to sepsis. In an interview with RN H on 02/15/2023 at 12:44 p.m. ,revealed she was the weekend supervisor when Resident #119 was admitted . She stated she helped put the physician orders in the EMR but did not recall the date on the dressing nor if the resident had an intravenous line. She stated she did not perform the admission assessment of the resident. She stated that the ADON was responsible for audits for new admits on Monday to ensure physician orders were properly inputted into the EMR. In an interview with ADON C on 02/15/2023 at 1:13 p.m., revealed her expectations were for the resident's bedside nurse to ensure intravenous dressing changes were performed. She stated she was responsible for ensuring the bedside nurses were completing the dressing changes. She also stated she was responsible for auditing the EMR for new admits on Monday to ensure accuracy. She stated there was not an order currently in the EMR for Resident #119 for intravenous line dressing changes and it was an oversight on me. She stated if intravenous dressing changes were not performed every 7 days, it can lead to sepsis and all kinds of things. In an interview with the Administrator on 02/16/2023 at 1:13 p.m., he declined to comment on this as it was clinically related. Review of facility policy, . Dressing Changes, rev. 04/2016, revealed Purpose: The purpose of this procedure is to prevent catheter-related infections . General guidelines: 1. Change . dressing . every 5-7 days after insertion . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 4 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0694 Level of Harm - Minimal harm or potential for actual harm Review of facility policy, Infection Control Program, undated, revealed Standard: There will be an active, facility-wide Infection Control Program with effective measures to identify, control, and prevent infections acquired or brought into the facility from the community or other health care facilities. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 5 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 that a resident who needs respiratory care is provided with such care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for 1 of 2 residents (Resident #8) reviewed for respiratory care. Residents Affected - Few The facility failed to ensure Resident #8 had oxygen concentrator filters free of sediment and debris. These failures could place residents at risk of not receiving proper delivery of oxygen, cross contamination, respiratory compromise and/or infection and residents not having their respiratory needs met. Findings Included: Review of Resident #8's Face Sheet, dated 02/15/23, revealed he was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included chronic obstructive lung disease, respiratory failure, obstructive sleep apnea, pneumonia, morbid obesity, type 2 diabetes, swelling of extremities, mood disorder, obsessive-compulsive disorder, schizoaffective and anxiety disorder. Review of Resident #8's Quarterly MDS, dated [DATE] stated he was cognitively intact with a BIMS score of 15. He required extensive assistance of two staff with bed mobility, toileting, and extensive assistance of one staff with personal hygiene. Record review of Resident #8's physician orders revealed: oxygen at 2-3 LPM via nasal cannula continuous for dyspnea/low 02 sats with a date to start 11/10/2022. Record review of Resident #8's Comprehensive Care Plan, dated 02/08/2022 revealed that Resident #8 required oxygen therapy R/T low O2 sats with a goal that included resident will not exhibit signs of hypoxia . via express the importance of keeping n/c in place to maintain a satisfactory O2 sat, administer oxygen at 2-3 LPM via N/C . In an observation of Resident #8 on 02/14/2023 at 11:30 a.m., revealed him resting in bed with his oxygen concentrator turned on to 3 LPM. Resident #8's oxygen concentrator filter was observed to have significant brown, black, and grey debris sediment accumulation present. In an observation and interview with the Housekeeping Supervisor on 02/14/2023 at 11:41 a.m., she was observed bent over inspecting Resident #8's oxygen concentrator filters. She removed the filters from the device and stated they were dirty. She stated she was responsible for cleaning resident oxygen concentrator filters once per week but must have missed it the last time. She stated if resident oxygen concentrator filters become dirty, it clogs up [the concentrator] and they won't run, and then dust gets into resident lungs. In an interview with ADON C on 02/16/2023 at 11:08 a.m., she stated that she expected the nurses to take a look at the machine and double check it, but it was housekeeping's responsibility to clean the filters once a week. She stated she was not sure if there was a specific policy on oxygen concentrator filters. She stated that if the oxygen concentrator filters are dirty, it was an infection (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 6 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0695 control issue. Level of Harm - Minimal harm or potential for actual harm In an interview with the DON on 02/16/2023 at 11:13 a.m., she stated she expected the nurses to check the entire concentrator when they check the [oxygen] tubing, when the tubing gets changed out once weekly. She stated it was housekeeping responsibility to ensure the oxygen concentrator filters were clean. She stated she was not sure if there was a specific policy on oxygen concentrator filters. She stated if the oxygen concentrator filters are dirty, a fire can occur and the air the resident is inhaling would not be clean which would be an infection control issue. Residents Affected - Few In an interview with the Administrator on 02/16/2023 at 1:13 p.m., he stated his expectation was for oxygen concentrator filters be cleaned weekly by the housekeeping staff. He expected the filters to be free of sediment and dust. Stated if this was not performed, he stated he assumed it could affect the way the concentrator runs. Review of facility policy, Oxygen Therapy, undated, revealed Policy: 1. To provide quality nursing care by implementing oxygen therapy . per physician's order and implemented by a licensed nurse. Objectives: 1. To administer oxygen under conditions in which insufficient oxygen is carried by the blood to the tissues . Procedure: 10. Discard masks, cannulas, and tubing . when it has become soiled. Change cannulas and humidifier bottles weekly. Review of facility policy, Infection Control Program, undated, , revealed Standard: There will be an active, facility-wide Infection Control Program with effective measures to identify, control, and prevent infections acquired or brought into the facility from the community or other health care facilities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 7 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, and interviews the facility failed to ensure medications were secure and inaccessible to unauthorized staff and residents for one (400 Hall medication cart) of two medication carts. The facility failed to ensure medications were secure on the 400 Hall medication cart. These failures placed the residents at risk for drug diversion, drug overdose, and accidental administration of medications to the wrong resident. Findings included: In an observation on 02/14/2023 at 9:18 a.m., an unidentified white and blue capsule was observed in a plastic medication cup on top of the medication cart on the 400 hall. LVN Q was observed placing carbonated beverages in a refrigerator in room [ROOM NUMBER], outside of the view of the 400 Hall medication cart. At 9:19 a.m., LVN Q exited room [ROOM NUMBER] with cardboard boxes in her hands, and then disposed of the boxes. In an interview with LVN Q on 02/14/2023 at 9:40 a.m., she stated that Resident #9's roommate hollered and she left the medication on the cart to go check on her. She stated she did not mean to leave it, and that it was not best practice. She stated that someone could walk by and take the medication. In an interview with ADON C on 02/16/2023 at 9:48 a.m., she stated that medications should never be left out unattended. She stated that anyone could take it and an adverse medication reaction could occur. In an interview with the DON on 02/16/2023 at 11:13 a.m., she stated that medications should never be left out unattended. She stated she does not have a specific policy on that but she re-iterated that it was best practice for medications to never be left unattended. She stated that anyone could take the medication, be consumed, and could have adverse reactions. In an interview with the Administrator on 02/16/2023 at 1:12 p.m., he stated his expectations were for medications to never be left unattended. He stated that if medications were left unattended, someone could take them. He declined to comment any further. The facility was given opportunities to provide additional documentation on medication storage prior to exit on 02/16/2023. No additional information, policies, procedures were provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 8 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm F-812 Residents Affected - Some Based on observation, interview, and record review, the facility failed to store, prepare, and serve food in accordance with professional standards for food safety in 1 of 1 kitchens reviewed. 1.The facility failed to ensure food located in the facility only kitchen refrigerator, dry food pantry, and prep areas were labeled and dated. 2.The facility failed to ensure that the dishing machine operating at the appropriate temperature for sanitation of the dishes. 3.The facility failed to ensure that staff covered used head and beard covering while conducting dietary duties. 4. The Faility failed to ensure dietary staff doffed used gloves when leaving the kitchen and donned new gloves when re-entereing the kitchen 5. The facility failed to ensure that the stove burners were clean and free of build up from oil, crumbs, waisted The facility failed to ensure the container for the tea covered and free of air borne substances. These failures could place residents at risk to bacteria, and other infectious illness. Findings include: During the initial tour of the facility's only kitchen revealed the DM wear a hat with the back of his head uncovered exposing short hair. He not wearing a beard covering at the time of entrance. DM later doffed a beard restraint, however it did not cover the full beard. In an observation of the kitchen's refrigerator on 02/14/2023 at 10:00 A M. revealed the following food items undated 2 boxes filled with green leafy lettuce. 1 box of whole pineapples 1 box of cantaloupe (5) 1 box of honey dew melon (5) 3 half-filled pitchers of beverages (lemonade, tea, cranberry juice) stored on a serving tray undated. 2 boxes of margarine (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 9 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 Observation of the facility kitchen on 02/14/2023 at 10:05 A M. revealed , Dietary aide left the serving scoop in the bowl of pineapples to conduct another task. Dietary aide observed walking down the hall with disposable gloves on, opening kitchen door and returning to task, left the kitchen with gloves on, walked down the hall touched door handle of and returned to task in kitchen. Kitchen burners were observed with a build up from grime, oil, crumbs, food particles. 5 gallon iced tea dispenser not covered or sealed from environment. An observation of DW/CK on 02/14/2023 at 9:28 AM revealed the task of dishes being cleaned in the dish washer. The DW/CK not wearing a hair net, and the sides of his beards were exposed on the sides. An observation on 02/14/2023 at 9:32 A.M. revealed a dishwasher temperature of 115.1 The dishwasher temperature after the second cycle revealed a temperature of 117.6. The dishwasher temperature after the third cycle revealed a temperature of 122. In an interview with the DM on 02/14/2023 at 9:34 AM revealed that the machine was a low temp sanitation machine that reached 120 sanitation temp for clean sanitized dishes. DM will have the MD to come assess the operations of the machine. DM stated that the machine serviced in January 2023. An observation on 02/15/2023 at 11:37 a.m. of the dry storage room revealed the following items were stored undated: Large Square Clear Containers containing equal, Splenda, mayo, grape jelly, ketchup salt, pepper, crackers, ranch dressing, oatmeal pies, food coloring (egg color) and green Observation of food prep area for seasoning revealed the following were undated. 16 oz. containers of basil leaves, curry powder, ground cinnamon, ground thyme leaves, mild chili powder, paprika, rubbed sage. In an interview with DW/CK 02/14/2023 at 9:25 A M., he was responsible for cleaning dishes, food Prep he does do the cooking. DW/CK stated that normally he will run the dishwashing machine 3 times before the temp registers. He stated that failing to wash the dishes at the appropriate temp could lead to cross contamination, germs and bacteria. He stated that they have received training on beard that they should cover the full beard to prevent hair from getting in the dishes. The dish machine should be on 120 to properly sanitize. He does watch the aide for sanitation. He stated that there a communication gap. Communication for diet changes and they do not receive timely communication. He stated that another DA' cleans daily. He stated that the expectation of his aides were know their job and do their job. Kitchen garbage cans should be covered to prevent cross contamination, but I don't see why? He stated that he does not understand why the seasoning has to be dated. He stated that seasonings doesn't go bad. He stated that the seasoning does not check the expiration date on the seasoning. sanitation for garbage can to keep a top on it. In an interview with DA-B on 02/16/2023 at 8:28AM revealed that all staff should wash hands in the kitchen with the change of every task, and wear hair nets while working in the kitchen to prevent the hair from falling in the food and surfaces. DA-B said gloves should be worn when preparing food. DA stated that practicing good handwashing prevents infection and illness for residents. DA-B stated that when preparing food she checks the dates, to know when they expire and discard when the date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 10 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 expires. Level of Harm - Minimal harm or potential for actual harm In an interview with DA-C on 02/16/23 at 11:22 AM revealed that she trained to h her hands when changing task and before doffing gloves and after doffing gloves to prevent contamination. DA stated that she has left the scoop in the pineapples for a minute. She said that leaving for a long time could cause contamination. DA said that the garbage can should be covered at all times to prevent cross contamination. Residents Affected - Some In an Interview on 02/16/23 at 11:45 AM with DON revealed that she expects dietary staff to practice good food sanitization by washing hands, when changing task. Interview second interview with DM on 02/16/2023 at 1:40 PM, revealed that he expects the staff to wear gloves to prepare the food and handwash and change gloves in between cleaning and preparing. He said it was not appropriate for staff to wear same gloves when leaving and re-entering the kitchen, nor leave food scoops in food as it could cause cross contamination. DM said that he has cleaned the stove and has to be sprayed and stove 3 months ago. He has not had the time with staff shortages to clean. It is important to cover the beard Bread, stove, hair nets, beard restraint. In an interview with [NAME] S. on 2/16/2023 at 3:00 PM, he said the stove cleaned every shift. [NAME] S stated that it difficult to clean with the cooking duties that are required. [NAME] S said the fire (pilot light) on and it too hot to clean. [NAME] S said that no matter when they clean it, it looks the same. [NAME] S said she encourages the staff to h their hands when they change tasks and wear gloves. [NAME] S has not educated the staff on the importance of utensil sanitation and removing bacteria from food. She stated that everything that comes must be dated and discarded in 3 days. [NAME] S. stated that they date the plastic where it can She denies that the food fully warm during her shifts. She stated that some residents have complained of the food being cold from sitting in the hall until the aides serve. Physically and verbally, she stated that it is not appropriate for kitchen staff to wear the gloves when they leave and return to the kitchen. She has dishwashers, and unless there was a problem with the temperature, she does not check. In the event this occur she will contact the DM, and he makes the report. She's been here for six months. The dishwasher should be set to 120 degrees Fahrenheit. In an interview with Administrator 02/16/2023 said he expects the food to be dated upon delivery and expiration dates routinely checked. It is important for dietary staff to date food to prevent food from being used for residents that was old. He stated that the stove has been cleaned. He has contracted outside resources that trained dietary staff and the chef. 1.The Food Services Manager will be responsible for scheduling staff for regular cleaning of kitchen and dining areas. Food service staff will be trained to maintain cleanliness throughout their work areas during all tasks, and to clean after each task before proceeding to the next assignment. 2.Dishwashing machines must be operated using the following specifications: High-Temperature Dishwasher (Heat Sanitization) 1.Wash temperature (150°- 165°F) for at least forty-five (45) seconds; 2.Rinse temperature (165°- 180°F for at least twelve (12) seconds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 11 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 Low-Temperature Dishwasher (Chemical Sanitization) Level of Harm - Minimal harm or potential for actual harm 1.Wash temperature (120°F); 2.Final rinse with 50 parts per million (ppm) hypochlorite (chlorine) for at least 10 seconds. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 12 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 observation, interview, and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (Resident #9) of five residents observed for infection control. Residents Affected - Few 1. The facility failed to ensure LVN Q performed hand hygiene before and after administration of ophthalmic medications for Resident #9 on 02/14/2023. This failure placed residents at risk of cross-contamination and infections. Findings Included: Review of Resident #9's Quarterly MDS, dated [DATE] stated she was severely cognitively impaired with a BIMS score of 05. Resident #9 was totally dependent on one staff member for bed mobility, toileting, and personal hygiene. Record review of Resident #9's physician orders revealed Macrobid (nitrofurantoin monohyd/m-cryst) 50 mg capsule twice a day for urinary tract infection to start 10/20/2022. Additionally, Resident #119 had an order for Artificial Tears . ophthalmic (eye) . 1 drop in each eye . for dry eye syndrome . to start 10/11/2022. In observation of LVN Q on 02/14/2023 at 9:30 a.m., she was observed on the 400 hallway at her medication cart looking at the computer. LVN Q touched the computer mouse and keyboard with ungloved hands. At 9:32 a.m., LVN Q entered room [ROOM NUMBER] with medications in her ungloved hands and placed the medications on Resident #9's bedside table. LVN Q failed to perform hand hygiene upon entering resident room and prior to providing direct care. LVN Q raised Resident #9's head of bed by touching the control panel attached to the bed. LVN Q then obtained Resident #9's hearing aids and placed them in the resident's ears. LVN Q failed to perform hand hygiene prior to touching the resident's control panel and hearing aids. LVN Q then administered Resident #9's oral medications. At 9:36 a.m., LVN Q obtained Artificial Tears box, opened box, and opened medication. Then, LVN Q raised Resident #9's right eyelid with her left thumb and administered one drop of medication into Resident #9's right eye. LVN Q then raised Resident #9's left eyelid with her left thumb and administered one drop of medication into Resident's left eye. LVN Q failed to perform hand hygiene before administering Resident #9's eye medication. LVN Q then assisted Resident #9 to rotate on her left side and applied a lidocaine patch to her upper right back area. LVN Q failed to perform hand hygiene after administering eye medications and prior to the application of a lidocaine patch. Review of facility policy, Hand Washing, 2001, revealed Policy: 1. All personnel are required to wash their hands before and after each direct contact for which hand washing is indicated by accepted professional practice . 2. Before and after resident contact 3. After contact with a source of microorganisms ( . bodily fluids, mucous membranes .) Review of facility policy, Passing Medications, undated, received 02/16/2023, Eye Medications: When administering eye medication, the hands should always be washed both before and after the medication is applied . Hand Washing During Medication Pass: 3. Hands should be washed before and after giving eye medications. During this process hands are very close to the resident's mucous membranes which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 13 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 may be both a source and recipient of microorganisms as the eye medication is instilled. Level of Harm - Minimal harm or potential for actual harm Review of facility policy, Infection Control Program, undated, received 02/16/2023, revealed Standard: There will be an active, facility-wide Infection Control Program with effective measures to identify, control, and prevent infections acquired or brought into the facility from the community or other health care facilities. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 14 of 15 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 675136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Denton Rehabilitation and Nursing Center 3345 Medpark Dr. Denton, TX 76210 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure resident bedrooms measured at least 80 square feet per resident in multiple resident bedrooms for 57 (Rooms 101, 103, 104, 111, 112, 113, 114, 115, 201, 202, 205, 206, 207, 208, 209, 210, 302, 303, 304, 305, 306, 307, 309, 310, 311, 312, 313, 314, 601, 602, 604, 605, 606, 607, 609, 610, 611, 612, 701, 703, 704, 706, 707, 708, 709, 710, 801, 803, 804, 806, 807, 809, 811, 812, 813, 814, 815) of 101 resident bedrooms. The facility failed to ensure the following multiple resident bedrooms measured at least 80 square feet per resident: Rooms 101, 103, 104, 111, 112, 113, 114, 115, 201, 202, 204, 205, 206, 207, 208, 209, 210, 302, 303, 304, 305, 306, 307, 309, 310, 311, 312, 313, 314, 601, 602, 604, 605, 606, 607, 609, 610, 611, 612, 701, 703, 704, 706, 707, 708, 709, 710, 801, 803, 804, 806, 807, 809, 811, 812, 813, 814 and 815. This failure could at place residents at risk of not having adequate space for their personal belongings. Findings included: During entrance conference with the Administrator on 02/14/2023 at 9:25 a.m., he was asked to provide a list of multiple resident bedrooms with less square footage than 80 square feet per resident. The Administrator stated there had not been any room size changes since the most recent annual survey. The Administrator provided a list of bedrooms with less square footage than required on 02/15/2023, which reflected the following rooms did not have at least 80 square feet per resident, which would require a room-size waiver: Rooms 101, 103, 104, 111, 112, 113, 114, 115, 201, 202, 204, 205, 206, 207, 208, 209, 210, 302, 303, 304, 305, 306, 307, 309, 310, 311, 312, 313, 314, 601, 602, 604, 605, 606, 607, 609, 610, 611, 612, 701, 703, 704, 706, 707, 708, 709, 710, 801, 803, 804, 806, 807, 809, 811, 812, 813, 814 and 815. Review of the waiver issued to the facility on [DATE] indicated that the following waiver was approved and would remain in effect unless conditions are found to exist that would cause reconsideration or rescission. The waiver is subject to re-evaluation at the time of each subsequent standard survey. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675136 If continuation sheet Page 15 of 15