Health inspection·August 28, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some medication. Provide close supervision and safety checks every fifteen minutes for 72 hours. Psych tele-visit scheduled and performed. Head to toe assessment for injuries. Medication review. Date initiated 7/29/2025.Tele-visit with psych NP with medication review. New order for Risperdal started. Referral to crisis care team with onsite assessment of resident for placement. Date initiated 8/26/2025.Focus: The resident requires antidepressant medication (Zoloft and Trazodone) for diagnosis of depression.Interventions: Monitor/document/report to MD prn ongoing s/sx of depression unaltered by antidepressant meds: Sad, irritable, anger, never satisfied, crying, shame, worthlessness, guilt, suicidal ideations, neg. mood/comments, slowed movement , agitation, disrupted sleep, fatigue, lethargy, does not enjoy usual activities, changes in cognition, changes in weight/appetite, fear of being alone or with others, unrealistic fears, attention seeking, concern with body functions, anxiety, constant. Date Initiated: 12/6/2024.Focus: The resident uses anti-anxiety medications LORAZEPAM r/t anxiety disorder.Interventions: Give anti-anxiety medications ordered by physician. Monitor/document side effects and effectiveness. ANTIANXIETY SIDE EFFECTS: Drowsiness, lack of energy, Clumsiness, slow reflexes, Slurred speech, Confusion and disorientation, Depression, Dizziness, lightheadedness, Impaired thinking and judgment, Memory loss, forgetfulness, Nausea, stomach upset, Blurred or double vision. PARADOXICAL SIDE EFFECTS: Mania, Hostility, and rage, Aggressive or impulsive behavior, Hallucinations. Monitor/record occurrence of target behavior symptoms: pacing, wandering inappropriate response to verbal communication and document per facility protocol. Date Initiated: 12/11/2024.Focus: The resident is non-compliant with medication administration related to paranoia and delusions.Interventions: Praise resident for a cooperative attitude towards her acceptance of meds. Talk to resident to determine reasons for refusal of care. Date initiated 7/29/2025.A record review of Resident #62's PCC orders initiated 8/20/2025 thru 8/26/2025 did not reflect a current order for anti-psychotic medication. Active prescriptions reflected Trazodone (for major depressive disorder), and Buspirone and Vistaril (for generalized anxiety). There were previous orders dated 5/31/2025 for Risperdal Consta Intramuscular Suspension Reconstituted ER 25mg; inject 25 mg intramuscularly one time a day every 14 days related to Catatonic Schizophrenia and Risperidone Oral Tablet Disintegrating 1 MG, give one tablet by mouth two times a day related to Catatonic Schizophrenia. A record review of Resident #62's discharge instructions dated 8/20/2025 from the behavior health hospital admission from 8/8/2025 thru 8/20/2025, reflected the following: Continue the following medications: Risperdal 2 MG (1 tablet) by mouth, twice a day for schizoaffective disorder. Risperdal 0.5 MG (1 tablet) by mouth, twice a day for schizoaffective disorderA record review of Resident #10's face sheet dated 8/28/2025 revealed a [AGE] year-old female admitted to the facility on [DATE]. Diagnoses included Alzheimer's Disease (process that causes the brain cells to die and the brain to shrink), Schizoaffective Disorder, Bipolar Type (mental disorder that includes delusions, hallucinations, disorganized thinking), anxiety disorder (overwhelming fear and anxiety), and Major Depressive Disorder, severe with psychotic symptoms (persistent depressive episodes).A record review of Resident #10's MDS dated [DATE] reflected a BIMS of 5, which indicated cognition was severely impaired. Section E0200. Behavioral Symptom - reflected a score of 0 (zero) which indicated Behavior Not Exhibited, for A. Physical behavioral symptoms directed toward others (e.g., hitting, kicking, pushing, scratching, grabbing, abusing others sexually.Section E0900. Wandering - reflected a score of 2 (two) which indicated this behavior occurred 4-6 days each week. A record review of Resident #10's Care Plan dated 8/22/2025 reflected the following: Focus: The resident is an elopement risk/wanderer, exit seeking.Intervention: Distract resident from wandering by offering pleasant diversions, structured activities, food, conversation, television, books. Focus: Resident involved in resident-to-resident altercation. Dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 2 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 7/28/2025.Interventions: Separate residents immediately in the event of resident-to-resident altercation. Provide increased supervision for the aggressor. Assess resident for injuries and emotional needs. Schedule Psychiatric NP tele-visit to assess for residual emotional trauma.Focus: Resident has a mood problem r/t Disease Process Alzheimer's dementia. Interventions:Monitor/record/report to MD prn risk for harming others: increased anger, labile mood, or agitation, feels threatened by others or thoughts of harming someone, possession of weapons or objects that could be used as weapons. Focus: Resident is an elopement risk/wanderer exit seeking behavior. Interventions: Assess for fall risk. Assess for secure unit.Distract resident from wandering by offering pleasant diversions, structured activities, food, conversation, television, book.Provide structured activities: toileting, walking inside and outside, reorientation strategies including signs, pictures, and memory boxes. Focus: Resident involved in resident-to-resident altercation. Interventions: Separate residents immediately in the event of a resident-to-resident altercation.Provide increased supervision to the aggressor. Assess resident for injuries or emotional needs. Schedule Psychiatric NP tele-visit to assess for residual emotional trauma. A record review of Resident #52's face sheet dated 8/27/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses include Senile Degeneration of Brain (progressive deterioration of brain tissue), Dementia (symptoms that affect memory, thinking and social ability) and anxiety disorder (overly fearful or anxious). A record review of Resident #52's MDS dated [DATE] reflected a BIMS score of 3, which indicates cognition was severely impaired. Section E09.00. Wandering - Presence and Frequency. Has the resident wandered? The resident scored 0. Behavior not exhibited. A record review of Resident #52's Care Plan dated 7/11/2025 reflected the following: Focus: Resident has had aggressive behavior towards others. Interventions: 1:1 supervision for 72 hours Administer PRN anxiety medication for agitation. Identify trigger if possible and remove trigger. Medication review by Psychiatric NP - increased Depakote sprinkles to TID Psychiatric NP visit/evaluation Redirect and provide activities.Redirect resident during periods of agitation or aggression. Offer fluids/food in separate location within the secured unit. Assess for physical needs (bathroom privileges, comfort/pain).Provide activities for distraction. Separate residents during agitation. A record review of Resident #32's face sheet dated 8/27/2025 reflected a [AGE] year-old female admitted on [DATE]. Her diagnoses included Alzheimer's (common dementia where the brain shrinks) Major Depressive Disorder (depression, loss of self-esteem or low interest), and Lack of Coordination (unorganized movements and actions). A record review of Resident #32's MDS dated [DATE] reflected a BIMS of 4, indicated cognition is severely impaired. Section E0900. Wandering - Presence & Frequency, Has the resident wandered? Resident #32 scored a 2. Behavior of this type occurred 4-6 days, but less than daily. A record review of Resident #32's Care Plan dated 6/9/2025 reflected the following: Focus: The resident has a Skin Tear to right wrist from striking staff member while being redirected out of others' rooms. Interventions: Identify potential causative factors and eliminate/resolve when possible. Focus: Resident was involved in an altercation with another resident. Interventions: Administer PRN anxiety meds if resident is agitated and/or verbally instigating. Check for any physical needs - toileting, pain. Medication review by Psychiatric NP, initiated Vistaril BID Notify Psychiatric NP for med review r/t agitation/altercation. Nurse to assess for injuries and emotional trauma. Provide activities for distraction. Provide fluids and/or snack activity.Psychiatric NP visit to perform med review and evaluate for emotional adverse effects of altercations. A record review of the facility incident investigation dated 7/28/2025 reflected Resident #62 pushed Resident #10 who was attempted to enter the resident's room without permission. The other resident sustained no injury. Resident #62 was placed on 72 hour 1:1 monitoring, and no behaviors were exhibited during this (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 3 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some period. A record review of the facility incident investigation dated 8/7/2025 reflected Resident #62 and Resident #52 were engaged in a pushing match. Resident #52 fell on the floor, hit her head, was sent to ER and CT scan revealed no injury. Resident #62 was placed on 72 hour 1:1 monitoring by the facility, evaluated by the NP, and referred and admitted to psychiatric facility, A record review of the facility incident investigation dated 8/25/2025 reflected Resident #62 and Resident #32. Resident #32 fell on the floor, hit her head, was sent to ER and CT scan revealed no injury. Resident #62 was placed on 1:1 monitoring by the facility. PRN medications were given for anxiety, consideration of readmission to behavioral health hospital (resident refused) and consult with the appointed guardian.An observation and interview on 8/26/2025 at 10:35 AM revealed Resident #62 lying on her bed, in her room. Clothing and hygiene were clean and appropriate. Resident interacted with surveyors by responding to assessment questions without hesitation. She stated she was doing okay. There were no visible marks or bruises.An observation and interview on 8/26/2025 at 10:40 AM revealed Resident #32 sitting in wheelchair, pulled up to a table in the main living area. Clothing and hygiene were clean and appropriate. There were no visible marks or bruises. Resident #32 said she does not remember falling or being shoved.During an interview on 8/26/2025 at 11:10AM the DON said Resident #62 was placed on immediate 1:1 monitoring beginning 8/25/2025 at 6:00 PM and would remain on monitoring until alternate placement could be identified for Resident #62. The DON stated the 1:1 monitoring checklist/form was blank from 8/25/2025 at 6:00 PM thru 8/26/2025 at 6:00 AM because the facility did not have the correct forms at the time the 1:1 monitoring was started. She said until about two weeks ago, Resident #62 (the aggressor) did not have a history of physical aggression, and she went to a behavioral health hospital on 8/8/2025 for delusional behaviors after she started refusing her injectable antipsychotic medication. She said, Regarding the incident last night, staff got them separated. We scheduled and conducted a tele-visit and medication review with NP and the preventions/interventions are for medication reviews and management. We are seeking a re-admission to the behavioral health hospital. A psych tele-visit has been planned.A record review of the facility's policy titled Abuse/Neglect, revision date 10/04/22 reflected the following: 1. Abuse: Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain, or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Resident-to-resident altercations will be reviewed as potential abuse not assumed as abuse. Resident-to-resident altercations must include any willful action that results in physical injury, mental anguish, or pain. 2. Adverse event: An adverse event in an untoward, undesirable, and usually unanticipated event that causes death or serious injury; or the risk thereof.Procedure: C. Prevention: The facility will provide residents, families, and staff an environment free from abuse and neglect.4. The facility will be responsible to identify, correct, and intervene in situations of possible abuse/neglect. F. Protection: The facility will take necessary measures to protect residents and employees from harm during and following an abuse, neglect, and exploitation, mistreatment of residents or misappropriation of resident property investigation.On 8/26/25 at 6:45 PM, an IJ was identified. The facility was notified of the IJ and provided the IJ Template 8/26/25 at 08:09 PM. Plan of Removal Version 4 was accepted/approved on 8/27/2025 at 5:39 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 4 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some PM and Version 5 was accepted/approved on 8/28/2025 at 5:45 PM. Immediate Jeopardy Plan of Removal The center Leaderships (Administrator and Director of Nursing) were notified on 8/26/2025 @7:45pm that an Immediate Jeopardy had been issued to the center related to F600 Abuse. Resident #32 attempted to go into Resident #62 room and Resident #62 pushed Resident #32 to the floor. Resident #32 was sent to the hospital on 8/25/2025 after being pushed by resident #62. The Hospital Physician/Staff assessed resident #10 on 8/25/2025 with no signs/symptoms of injury. She returned to the center with no new orders and has resumed her usual activities. Resident #62 being on 1:1 offers protection from abuse for Resident #32 and the other residents residing in the secure unit. The Director of Nursing and Assistant Director of Nursing conducted assessments/evaluations on the residents residing in the secure unit on 8/27/2025, no signs/symptoms of abuse were noted, since none of them can be interviewed. The assessments were documented in the resident electronic medical record. The Director of Nursing and Assistant Director of Nursing reviewed incident reports for the last 6 months on 8/27/2025 to validate incidents that occurred have appropriate interventions in place.Resident #62 was assessed by the Director of Nursing on 8/26/2025 with no signs/symptoms of injury/abuse/neglect. Her discharge orders were reviewed by the Director of Nursing on 8/26/2025 as a discrepancy was identified by a surveyor. Resident #62 had discharge orders for an antipsychotic medication from behavioral hospital on 8/20/2025 that were not implemented (Risperdal 2.5mg by mouth twice a day). The discrepancy was corrected by the Director of Nursing on 8/26/2025 and a medication error report was completed on 8/26/2025 by the Director of Nursing. The responsible party, Administrator, and Medical Director were made aware of the medication error. The center attending Nurse Practitioner assessed the resident on 8/26/2025 and made some antipsychotic medication changes that were implemented. Resident #62 remains on 1:1 monitoring, and this will continue until Resident #62 is discharged from the center or the interdisciplinary team determines discontinuation of the 1:1 monitoring is appropriate. The criteria includes discussion/consultation with the Medical Director, Attending Nurse Practitioner, and Psychiatric Nurse Practitioner. Review of resident behaviors for noted decreases in anxiety, agitation as confirmation of current medication effectiveness. The 1:1 monitoring will be provided by various nursing team members (licensed nurses, certified nursing assistants, certified medication aides, or hospitality aides). The center social worker contacted state hospital on 8/26/2025 and their Crises Care Team came to the center on 8/26/2025 and did an assessment on Resident #62. She is now on the waiting list to admit to state hospital and the center must fax requested documents every 3 days until resident #62 is accepted into the state hospital. The Director of Nursing will be responsible for that. The Psychiatric Nurse Practitioner will continue to provide onsite visits with the resident at least every two weeks until she discharges to state hospital. The attending Nurse Practitioner adjusted Resident #62 Risperdal order on 8/27/2025. The Director of Nursing contacted The Medical Director on 8/26/2025 and had no concerns related to this event and indicated that due to the resident's history and co-morbidities the medication error did not contribute to any behaviors.The Director of Nursing re-educated all staff (full-time, PRN) 8/27/2025 on interventions for Resident #62 including her being on 1:1, giving her opportunity to share her needs/wants, give her space as she is protective of her room/space, and to re-direct other residents away from her room. Those not present will receive the re-education prior to the start of their next shift.The Director of Nursing re-educated all staff (full-time, PRN) on addressing and responding to Resident #62 behavioral needs on 8/27/2025. Those not present will receive this re-education prior to the start of their next shift.The Director of Nursing and Assistant Director of Nursing did an audit of new admissions/re-admissions on 8/26/2025 with no negative findings. The audit consisted of new admissions/re-admissions since 8/1/2025. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 5 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some This was conducted to ensure medication orders were implemented.The Director of Nursing re-educated the Assistant Director of Nursing on the admission/readmission audit process on 8/26/2025. The Director of Nursing re-educated the licensed nurses on the admission/re-admission process related to medication orders on 8/26/2025 (full-time and part-time staff). Those not present will receive this re-education prior to the start of their next shift by the Director of Nursing.The Administrator, Director of Nursing, and Medical Director conducted an AD HOC Quality Assurance Meeting on 8/27/2025 to review the Immediate Jeopardy event.The Administrator/Director of Nursing will conduct random chart audits of readmissions weekly for four weeks to validate those returning from the hospital have their correct orders/order changes implemented. The Administrator/Designee will conduct random interviews/interactions with Resident #62 to validate behaviors are being managed. Negative findings will be addressed at the time of discovery and presented to the center Quality Assurance Program. Plan of Removal Monitoring Included:An observation of and interview on 8/28/2025 at 11:45am Resident #62 was in her room with CNA-A, who was providing 1:1 monitoring. Resident #62 stood by pleasantly, while CNA-A made her bed. Resident #62 spoke with the Surveyor and stated she wanted assistance being placed in a different facility. During an interview on 8/28/2025 at 11:15 AM, the DON stated she in-serviced all staff providing 1:1 monitoring for Resident #62. She stated overnight staff were in-serviced via telephone on 8/27/2025 at 2:30 AM, and they signed documents left at the facility. She stated the in-service included resident-to-resident altercation preventions and how to manage residents who required 1:1 monitoring/supervision.During an interview on 8/28/2025 at 11:38 AM, LVN-H stated the most recent in-service on ANE covered 1:1 monitoring and de-escalation. She stated methods of prevention for resident-to-resident altercations included providing personal space to Resident #62. She also stated redirection of other residents away from Resident #62's room. She stated 1:1 monitoring for Resident #62 meant always being with her, everywhere she went.During an interview on 8/28/2025 at 11:43 AM LVN-G stated she was in-serviced on 1:1 monitoring and ANE. She stated de-escalation for Resident #62 included giving her space while redirecting other residents. She stated additional tactics were offering Resident #62 activities and checking on her personal needs, i.e., hunger or thirst. She stated abuse was physical, mental, sexual and/or verbal, and was to be reported immediately to the abuse coordinator.During an interview on 8/28/2025 at 11:45 AM CNA-A stated she was in-serviced on signs of Resident #62's agitation. She stated signs of agitation included Resident #62 walking fast with her head down. She stated staff walked with Resident #62, but did not force anything on her (direction or location). She stated she was in-serviced on ANE, and added it was either physical, mental, or sexual. She denied witnessing it, and added she would make a report to the Administrator or would call HHSC.During an interview on 8/28/2025 at 11:50 AM CNA-B stated she received in-services on how to manage 1:1 resident monitoring. She stated staff were to always stay with Resident #62. She stated withdrawal was a sign of Resident #62's agitation and/or aggression. She stated medication refusal was also a sign of upcoming agitation. She stated actions to keep residents safe from abuse meant paying close attention to and redirecting them. She stated activities helped all residents to remain calm.During an interview on 8/28/2025 at 12:04 PM SC/MA stated she was in-serviced on signs of aggression for Resident #62. She stated signs included facial expressions, movement, isolation, speedy walking. She stated prevention of resident-to-resident altercations included separation, offering activities, providing personal space, and redirection. During an interview on 8/28/2025 at 12:09 PM CNA-C stated she was in-serviced on ANE, 1:1 monitoring and Resident #62's behaviors. She stated when Resident #62, or any resident, became agitated, she has asked them what was needed to calm them. She stated if the resident did not respond, she would leave the resident alone for a few minutes, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 6 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some then return. She stated if the resident escalated, she would back off and get a nurse for assistance. She stated resident-to-resident altercations required resident separation and additional staff assistance. She stated she was also in serviced on ANE and to whom to make a report.During an interview on 8/28/2025 at 12:12 PM CNA-D stated she received an in-service on ANE, proper procedures for resident-to-resident altercations and de-escalation. She stated resident-to-resident altercations were managed by separation, and added she would remove the resident who was less aggressive. She stated she paid close attention to resident behaviors, specifically an agitated resident, and she would move the other residents away from the area ahead of an incident. She stated all aides should know residents, and added if any resident seemed off behaviorally, staff intervened beforehand. During an interview on 8/28/2025 at 12:15 PM CNA-E stated he was in-serviced on Resident #62. He stated in-service training included respecting her space and redirecting other residents away from her room. He stated during resident-to-resident altercations, the residents were separated. He stated he would find an activity to offer the agitated resident, like walking or watching television. He stated Resident #62's trigger was her room; of which she was very territorial. During a phone interview on 8/28/2025 at 1:30 PM the NP stated Resident #62 had a recent change in condition with three behavioral episodes in the last month. She said the medication changes conducted prior to admission to the behavioral health hospital failed, thus requiring an inpatient stay. She said, The inpatient stay was not long enough. They do not make a pill for behavior. She said, According to my assessment of the care provided at the facility, they did everything they could have done to prevent future behavioral occurrences. She said the interdisciplinary team was currently trying to stabilize Resident #62 with additional medication adjustments. During an interview on 8/28/2025 at 12:18pm CNA-F stated she was in-serviced on 8/25/25 on abuse, resident rights, to whom she would make a report, and resident to resident altercations. She stated she would separate the resident, as altercations were resolved by separation. She stated prevention methods were dependent upon each resident as they had unique needs. She stated 1:1 monitoring with Resident #62 was conducted day and night, and if necessary other residents were redirected away from Resident #62's room. Record review of the medication audit sheets for six residents for admission/re-admission orders compliance. The orders were cross-referenced in the EMR to verify accuracy. Record Review of the assessments/evaluations in the EMR conducted on all residents in the secure unit.Record review of the in-service sheet dated 8/27/2025 and verified via interviews with licensed nurses understanding of medication reconciliation. Record review of the ad hoc QAPI Meeting sign-in sheet dated 8/27/25 reflected signatures of the Medical Director, Administrator, and Director of Nursing. Record review of in-service titled, Resident Specific In-Service - Resident #62, conducted by DON on 8/27/2025 reflected: Please remember these things when caring for Resident #62: 1. Please respect her space, she likes to spend time alone in her room. 2. Please redirect other residents from wandering into her room. 3. Allow her to express herself. 4. Offer activities that interest Resident #62. 5. If she appears anxious or agitated, please try to determine if she needs anything (hungry, thirsty, toileting, discomfort) and report this behavior to the charge nurse. 6. Report ALL refusals to the charge nurse immediately. Thirty-nine staff signatures were included on the in-service.Record review of 1:1 Monitoring Log for Resident #62, dated 8/27/25 and 8/28/25 reflected staff initials in 15-minute intervals to indicate continuous monitoring of Resident #62. Record review of Attestations for 1:1 Monitoring for Resident #62, dated 8/28/2025 and signed by two CNA's verifying they both provided 1:1 monitoring/supervision for Resident #62 during the shifts 6:00 PM - 10:00 PM on 8/25/2025 and 10:00 PM - 6:00 AM on 8/26/2025.Record review of Resident #62's orders in PCC reflected an order dated 8/26/25 for Risperdal Oral Tablet 0.5 MG to be administered 1 tablet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 7 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete by mouth, two times daily for preventative related to major depressive disorder, recurrent severe without psychotic features for three days; Risperdal Oral Tablet 1 MG dated 8/30/25 to be administered 1 tablet by mouth two times a day for Preventative related to major depressive disorder, recurrent severe without psychotic features. On 8/28/2025 at 5:39 PM the ADM, DON, and [NAME] President of Clinical Services were notified the IJ was removed.While the IJ was removed on 08/28/25 at 5:56 PM, the facility remained out of compliance at a scope of pattern and a severity level of pattern due to the facility not providing interventions for Resident #62. Event ID: Facility ID: 675139 If continuation sheet Page 8 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to provide pharmaceutical services including the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals for 1 (Resident #62) of 4 residents reviewed for pharmacy servicesThe facility failed to ensure Resident #62 received Risperdal 2mg by mouth twice daily and Risperdal 0.5mg by mouth twice daily between 8/20/2025 and 8/26/2025. This omission could place residents at risk for exacerbation of psychotic symptoms.The findings included:Record review of Resident #62's electronic medical record on 08/26/2025 revealed a [AGE] year-old female admitted to the facility on [DATE] and re-admitted [DATE]. Diagnoses included Schizophrenia (a chronic mental health condition characterized by a combination of cognitive symptoms that significantly impair a person's daily functioning), Major Depressive Disorder recurrent severe Psychotic Features (a severe form of depression where a person experiences symptoms of major depression alongside symptoms of psychosis such as delusions or hallucinations that often align with the depressed mood), Generalized Anxiety Disorder (a mental health condition characterized by excessive, persistent, and uncontrollable worry about everyday events or activities, even with there's little or no clear cause.), Drug Induced Subacute Dyskinesia (a type of involuntary, repetitive muscle movements that develop of a period of weeks to months after taking certain medications), Insomnia and UTI. Review of physician's orders did not reflect a current prescription for anti-psychotic medication. Active prescriptions for psychotropic medications reflected Trazodone (for major depressive disorder), and Buspirone and Vistaril (for generalized anxiety). Record review of Resident #62's MDS, dated [DATE] reflected a BIMS score of 10, which indicated moderate cognitive impairment, with disorganized thinking that comes and goes, and changes in severity.Record review of Resident #62's care plan revised 07/29/2025 and last updated 08/26/25 reflected the following:Problem identification: The resident is noncompliant with medication administration related to paranoia and delusions.Initiated 07/29/2025.Revision 08/14/2025.Goal: Resident's needs will be met during the next 90 days.Interventions: Initiated 07/29/2025: Notify family and physician of behavior/refusal of care, Initiated 07/29/2025 and revised 08/07/2025: Praise resident of a cooperative attitude towards acceptance of meds, Initiated 08/07/2025 and revised 08/14/2025: Report refusal to supervisor, Initiated 08/14/2025: talk to resident to determine reasons for refusal of care.Problem identification: The resident has potential to demonstrate physical behaviors r/t Poor impulse control and paranoia/delusions.Initiated 07/29/2025.Revision 08/14/2025.Goal: The resident will seek out staff when agitation occurs through the review dateInterventions: Initiated 07/29/2025: Assess and address for contributing sensory deficits, modify environment: move resident back to previous room where she resided alone, separate resident immediate in the event of resident-to-resident altercation, encourage resident to accept PRN anxiety medication, provide close supervision and safety checks every fifteen minutes for 72 hours, psych tele-visit scheduled and performed, Head to toe assessment for injuries, medication review Initiated 07/29/2025: Assess and anticipate resident's needs: food thirst, toileting needs, comfort level, body positioning, pain etc. Initiated 08/07/2025: Immediately separate resident and assess both residents, provide one on one continuous monitoring, continue to encourage resident to take medications to control behaviors, Psych tele-visit with NP encouraging resident to take her medications, refer to Behavioral Health Hospital. Modify environment: Move resident back to previous room where she resided alone. Initiated 08/26/2025: Tele-visit with psych NP with medication review, Risperdal started, referral to Crisis Care Team with onsite assessment of resident for placement.Record Review of the discharge orders dated 8/20/2025 that listed the psychotropic medications to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 9 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete continued following discharge from the Behavioral Health Hospital. The list included Risperdal 2mg by mouth twice daily and Risperdal 0.5mg by mouth twice daily and this was not included in the current active orders as of 08/26/2025 or on the MAR for the month of August 2025. Record Review of Resident #62's MAR and active orders for August 2025 and this medication was not included.Record Review of the facility's medication reconciliation policy was requested.During an interview on 8/26/2025 at 10:30 AM the DON stated the facility did not have a medication reconciliation policy. A Record Review of the facility's undated Admissions Checklist reflected the admissions nurses was required to complete Drug Regimen Review ASAP/Medication Reconciliation.On 08/26/2025 at 2:43PM, conducted an interview with the admitting nurse, LVN-G, who described the process of medication reconciliation post discharge from an acute care inpatient setting. She reported that she reviewed the DC orders from the hospital and contacted the NP on call to obtain order the medications as recommended in the DC orders. Upon review of Resident #62's order, LVN-G recognized that she had failed to transcribe an order for Risperdal and, therefore, the resident had not received her antipsychotic medication.On 08/28/25 at 1:30PM conducted a phone interview with the Psychiatric Nurse Practitioner. She stated it is unlikely the lack of this medication caused any untoward effects as Risperdal will stay in the system for approximately 6 days after the last dose. She also stated, they do not make a pill for behavior.On 08/28/2025 at 4:00PM conducted an interview with the DON who stated that an outcome from omitting a medication would depend on the type of medication. It could cause an exacerbation of symptoms. Event ID: Facility ID: 675139 If continuation sheet Page 10 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 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 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen. The facility failed to ensure the food served was fresh and in an edible condition. The facility failed to ensure food was served in a sanitary manner.This failure could place residents at risk of foodborne illness by serving them expired food and food in unsanitary conditions. Findings included: Observation on 8/26/2025 at 8:33 AM of the cooler revealed the following: - Moldy tomatoes were in a box with no date. - Moldy cucumbers were in a box with no date. - Parmesan Cheese dated 3-23-2025 with a use-by date of 5-29-2025. Observation on 8/26/2025 at 8:47 AM of the pantry revealed the following: - Blueberry Muffin Mix dated 6-18-25 and a use by date of 7-08-2025. - Marshmallows with a use-by date of 8-18-2025. Observation on 8/26/2025 at 11:30 AM revealed CK taking temperatures of the food before serving: - While CK was taking the temperature of the gravy, CK dropped the food thermometer into the brown gravy. CK did not discard the gravy. In an interview on 08/28/2025 at 1:35 PM the DA stated that everyone is responsible for checking for out-of-date items in the kitchen. The DA stated that mainly the CK and the DM are the ones who monitor the dates on the food. The DA stated that if he sees an expired item, he will discard the item and notify the DM. The DA stated that when they receive a delivery, he will place the new food items in the back and the older food items in the front. The DA stated that if expired or moldy food is served to residents, they could get sick. In an interview on 08/28/2025 at 1:43 PM the CK stated that everyone working in the kitchen is responsible for checking for expired and old food items. The CK stated that food should be rotated so that older food is used first. The CK noted that when she sees outdated or moldy food, it is to be thrown away. The CK stated she will let the DM know when she sees expired food. The CK stated that if something is dropped in the food, it should not be used and should be thrown out and remade. The CK stated that residents could get sick if served moldy food. In an interview on 08/28/2025 at 1:58 PM the DM stated that everyone working in the kitchen is responsible for checking for expired and moldy food. The DM stated that staff are to let her know when expired or moldy food is found in the kitchen, then it should be thrown away. The DM stated that old food is to be used before the new food. The DM stated that if a thermometer is dropped in food, then the food should be discarded. The DM stated that residents could get sick if they were served food that was expired, moldy, or if a thermometer was dropped in the food. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 11 of 12 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 675139 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Healthcare Residence 1025 W Yeagua Groesbeck, TX 76642 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 Record review of the facility's undated policy titled Food Safety and Sanitation, Copyright 2023 [NAME] & Associates, Inc. reflected the following: Level of Harm - Minimal harm or potential for actual harm 4. Food Storage (see Chapter 3: Food Production and Food Safety for Food Storage) Residents Affected - Some a. Stored food is handled to prevent contamination and growth of pathogenic organisms. · Leftovers are used within 72 hours (or discarded). Note: 2022 Federal Food Code guidelines allow 7 days for food safety with the day of preparation counted as day 1 of the 7 days and then food is discarded. Check local and state regulations and if different from the Federal Food Code, determine which regulation should be followed. · Perishable foods with expiration dates should be used prior to the use by date on the package. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675139 If continuation sheet Page 12 of 12