Inspection·October 3, 2023

F 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some immunodeficiency. Interventions included to administer medications as ordered and monitor/document and report signs and symptoms. Record review of the August 2023 MAR for Resident #1 indicated the Triumeq medication was coded as follows: *on 08/04/23 the date was coded a 6 and indicated the resident was in the hospital documented by the DON, *on the following dates there was a code 9 on the date indicating other see progress note: 08/08/23 documented by LVN A, 08/09/23 documented by LVN A, 08/10:23 documented by agency staff, 08/12/23 documented by LVN A, 08/13/23 documented by LVN A, 08/14/23 documented by LVN A,08/15/23 documented by LVN A, 08/18/23 documented by LVN A, 08/19/23 documented by LVN A, 08/20/23 documented by LVN A and 08/21/23 documented by LVN A. *on 08/22/23, the date was coded a 6 and indicated the resident was in the hospital. Record review of the September 2023 MAR for Resident #1 indicated the Triumeq medication was coded as follows: *on 09/23/23 the date was coded a 1 and indicated the resident was absent from home without meds *on 9/24/23 the date was coded a 3 and indicated the resident was absent from home with meds *on 09/25/23, 9/26/23 documented by LVN E the date was coded a 9 and on 9/28/23 the date was coded a 9 documented by LVN B and indicated other see progress note Record review of the nurses' progress notes for Resident #1 indicated the following: *on 08/04/23 the resident was at the hospital. Resident #1 returned from hospital with a new antibiotic for pneumonia, *on 08/08/23 documented by LVN A, 08/09/23 documented by LVN A, 08/12/23 documented by LVN A, 08/13/23 documented by LVN A, 08/14/23 documented by LVN A, 08/15/23 documented by LVN A, 08/18/23 documented by LVN A, 08/19/23 documented by LVN A, 08/20/23 documented by LVN A and 08/21/23 documented by LVN A the Triumeq was on order, *on 08/10/23 signed by LVN D, the documentation for Triumeq did not indicate the medication was not administered, *on 08/22/23, the documentation indicated the resident was in the hospital. *on 09/01/23, documentation indicated the resident was readmitted from the LTAC hospital. *on 09/22/23 to 09/24/23, the resident was out of the facility with family *on 09/25/23 documented by LVN E, 09/26/23 documented by LVN E and 09/28/23 documented by LVN B, the documentation indicated the medication was not available. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 2 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some There was no documentation on the nurses' progress notes to indicate the physician was notified the Triumeq medication was not available or not administered. Record review of a LTAC hospital Interdisciplinary Notes for Resident #1 dated 08/23/23 indicated, History of Present Illness: The patient is an [AGE] year-old female who resides at a nursing home, who presented to the emergency room on [DATE] and was found to have urinary tract infection and pneumonia. She was prescribed Lovenox (a medication used to thin the blood) and Rocephin (an antibiotic to treat infection) and sent back to the nursing home, where she continued to have functional decline. The patient has had increased weakness and falls since her emergency room visit. The patient was transferred to LTAC on 08/21/2023 for continuation of antibiotic medical management of above symptoms and strengthening. The patient is currently not able to participate in activities of daily living and mobility as she was prior to her emergency room visit. A consult was performed by Physical Medicine and Rehabilitation physician, who determined the patient was suffering from exacerbation of her Parkinson's disease. The patient wants to come to acute inpatient rehabilitation for aggressive physical and occupational therapy. medication. An order dated 8/24/23 indicated Resident #1's Triumeq medication was ordered for administration. The order indicated the resident could use own home supply. There was no documentation to indicate the resident did not have the Triumeq available upon admission to the LTAC. During interview on 09/30 23 at 8:45 a.m., the DON said Resident #1 had gone out to the hospital on 08/0423 and returned the same day a diagnosis of pneumonia. She said when the resident returned, she was placed on skilled services. The Triumeq medication was a high-cost medication and was not covered on the insurance once the resident became skilled. She said as soon as the facility received the request for approval by the administrator, the approval was signed, faxed back and the resident received the medication. She said she was unaware the resident missed any doses of the Triumeq. During an observation, interview and record review on 09/30/23 at 12:51 a.m., LVN A said she was the nurse who worked Hall 300, where Resident #1 resided. During a record review of Resident #1's August 2023 MAR with LVN A, she said Resident #1 was out of her Triumeq medication on 08/08/23, 08/09/23, 08/12/23, 08/13/23, 08/14/23 08/15/23, 08/18/23, 08/19/23, 08/20/23 and 08/21/23 where she documented the code 9. She said the resident had gone to the hospital on 8/4/23 but returned the same day and was diagnosed with pneumonia. She said the resident was weak because of the diagnoses of pneumonia and did continue to get weaker and was sent out to the LTAC for rehabilitation services on 08/22/23. She said it was her responsibility to administer the medications on Hall 300. She said she should have notified the DON and the physician when the Triumeq medication was not available. She said she did not know why she did not notify them, but she did not. She said she remembered Resident #1 was out of the Triumeq but did not remember notifying the pharmacy it was out. Observation of the bottle of Resident #1's Triumeq 30 count in the medication cart indicated the bottle was ¾ full of medication. The bottle was dated 9/28/23. LVN A said it had been refilled on 9/28/23 and only a few pills had been administered out of the bottle. She said she should have notified the pharmacy when there were approximately 10 tablets left. LVN A said the possible negative outcome of not notifying the physician would be the resident's condition could worsen and the physician would not know the resident had missed her medication. During an interview on 9/30 23 at 1:20 p.m., the DON said she was unaware Resident #1 did not have the Triumeq medication for 11 days during August 2023. She said the Triumeq was to treat her diagnosis of HIV. She said she and the physician should have been notified the medication was not available. She said she and the physician required notification, so interventions could be put in place to have the medication available for administration to the resident. She denied the resident could suffer (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 3 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some increased symptoms by not having the medication available and said the medication was to keep the resident's HIV undetectable. During an interview on 09/30/23 at 1:52 p.m., LVN B said she started orientation on Hall 300 on 09/27/23 last week. She said Resident #1's Triumeq was not available on Wednesday 09/27/23 and Thursday 9/28/23. She said she was in training and did medication pass with LVN C. She said she watched LVN C pass medications on Wednesday 09/27/23 and passed the medications herself on Thursday 09/28/23. She said LVN C told her the Triumeq was a medication that required approval from the administrator and it was not available. LVN B said if a medication was not available the physician should be notified. She said she did not notify the physician the medication was not available because she was in training and LVN B had faxed the pharmacy. She said the medication was for Resident #1's HIV. She said the possible negative outcome of not notifying the physician could be the physician would not be aware the resident did not receive the medication and the resident's HIV symptoms could exacerbate. During a confidential interview on 9/30/23 at 2:04 p.m., an individual said the facility did not have Resident #1's Triumeq medication available when the resident went out on pass 9/22/23 to 09/24/23. The individual said the ADON was notified the resident did not have her medication. During an interview on 09/30/23 at 2:22 p.m., the ADON said she was unaware Resident #1 did not have the Triumeq medication with her when she went out on pass 09/22/23 to 09/24/23. She denied staff had informed her the resident's medication was not available. She said Resident #1 should not miss a dose of the Triumeq medication and she was unaware that she did. She said staff should have called the pharmacy if the medication was not available. She said herself, the DON and the physician should be notified. During an interview on 09/30/23 at 2:34 p.m., an attempt was made to call LVN D, who documented a code 9 on the August 2023 MAR on 08/10/23, with no answer and the mailbox was full; unable to leave message for call back. During an interview on 09/30/23 at 2:48 p.m., the DON said she was unaware Resident #1 had not received the Triumeq until 09/28/23, when the administrator approved the medication for the pharmacy to refill it and he sent the approval to her, and she ordered the medication stat. She denied knowing the resident also did not have the medication in August 2023. She said she was unaware and did not notify the physician. During an interview and record review on 09/30/23 at 3:12 p.m., LVN C said she worked two days last week on Hall 300, Wednesday 09/27/23 and Thursday 9/28/23, training LVN B. She said Resident #1's medication Triumeq was not available for administration either day. She said she did mark the MAR on 09/27/23 with a check which indicated she had administered the Triumeq, but she did not administer the medication because it was not available. She said she ordered the medication on 9/21/23 and there were pills left in the bottle but when she came back on 9/27/23 there were none left. During an interview and record review of a pharmacy Long Term Care Reorder Form dated 09/21/23, LVN C said she ordered the Triumeq on 09/21/23 and faxed it to the pharmacy and did not receive the fax back until the next day and noticed it said the Triumeq did not have an active order. The pharmacy Long Term Care Reorder form dated 09/21/23 had the Triumeq order request circled and had a label indicating No active order. Please send new order. She said she faxed an order for the Triumeq back to the pharmacy on 9/22/23 and was off the next few days. LVN C then provided an order dated 09/22/23 that indicated the Triumeq was ordered. Written across the bottom of the order was Please Refill. She said when she returned to work on 09/27/23 the resident was out of the Triumeq medication, so she called the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 4 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some pharmacy and asked them why it was not in the facility. She said the pharmacy told her it was a high-cost medication and was not covered and they had faxed over a high- cost medication approval request to the administrator but did not receive an approval and the medication could not be refilled until it was approved. She said she did not remember if she reported what the pharmacy said. She said she did not notify Resident #1's physician that the resident did not have the medication available for administration. She said the physician should have been notified. She said the physician would not have known the resident was out of her medication and could not intervene to make sure she received it. During an interview on 09/30/23 at 3:45 p.m., LVN E, who worked Hall 300 on 9/25/23 and 9/26/23, said Resident #1's Triumeq medication was not available for administration. She said she did not usually work Hall 300 and was filling in, so she assumed someone had already ordered the medication and notified the physician. She said she did not notify the physician the medication was not available to administer. She said she told the ADON and the ADON told her to call the LTAC and make sure they did not have it. She said she knew LVN C had reordered the medication, but the pharmacy sent back the refill request saying it was a high-cost medication and had to be approved before it could be filled. During an interview on 09/30/23 at 3:48 p.m., the ADON said the facility had sent Resident #1's Triumeq medication with her to the LTAC hospital on [DATE] because the hospital called and said they could not provide the medication. She said when the resident returned on 09/01/23, the facility had to go pick the medication up from the LTAC because the hospital did not send it back with her . She said she was unaware the resident did not have the Triumeq medication for 11 days in August 2023 or the last week of September 2023. She said no one notified her on 09/25/23 or 09/26/23 that Resident #1 did not have the Triumeq medication available for administration. During an interview on 09/30/23 at 4:01 p.m., Pharmacist F said he pulled all of Resident #1's transactions off of the computer and the pharmacy had refilled Resident #1's Triumeq and had a signed receipt for 6/29/23 and 8/19/23, but did not find a signed receipt for July 2023. He said they had also sent 30 Triumeq tablets to the nursing facility on 09/28/23 . He said he had a note the pharmacy had communicated with the facility on 09/22/23 that the medication was a high dollar medication and could not be refilled without approval, but the Administrator , DON and ADON were out of the facility. He said the pharmacy then refaxed and emailed the information again on 9/25/23, 09/26/23, 09/27/23, and 09/28/23. He said the administrator signed the approval and returned it on 9/28/23 and it was refilled. Pharmacist F was asked why the facility would have possibly not had the Triumeq medication available in August 2023 and he said there was a refill request for the Triumeq from the facility on 07/05/23 but the medication had already been filled on 6/29/23 and it was too soon. He said there were no other communications found between the pharmacy and the facility regarding Resident #1's Triumeq medication requesting a refill for July 2023 and he did not have a signed receipt for July 2023. During an interview on 10/02/23 at 10:09 a.m., the Administrator said he did not receive an approval request from the pharmacy until 09/28/23 and he immediately sent it back that day with his approval to be filled stat and Resident #1 received the medication the same day. He said he checked his emails daily and did not receive an approval request from the pharmacy until 09/28/23. He said on 09/28/23 he explained to the family member of Resident #1 the Triumeq was not covered because the resident was on skilled services, and it required his approval. He said he was not aware the resident did not receive her medication in August 2023 or the last week of September 2023. He said the resident should receive her medication as ordered. He said he notified his medical director, and the medical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 5 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 director told him there would be no negative outcome of missing the Triumeq medication. Level of Harm - Immediate jeopardy to resident health or safety During an interview and record review on 10/02/23 at 10:10 a.m., the DON provided a document, which she said was the July 2023 receipt for Resident #1's Triumeq. The top of the document had the words on order and Triumeq tablet cut in half indicating the page had been snipped. A pharmacy notes column indicated dispensed 7/26 updated to insurance-BA, 7/25 emailed facility-RR, 7/19 High $ emailed. There was no signature on the document. The DON said she did not have a signed receipt for the Triumeq for July 2023. Residents Affected - Some During an interview on 10/02/23 at 11:15 a.m., the NP said she nor Resident #1's physician was notified the resident did not receive the doses of Triumeq in August 2023 and September 2023. She said the resident had to have the Triumeq medication or it would exacerbate her HIV if she did not receive it. She said it was herself that would need to be notified and she did not receive a call and the records did not indicate the facility called the office to report the resident had missed the Triumeq doses. She said the facility had her personal cell phone number to call her. She said the records indicated the office was notified on 08/21/23 of lab work for Resident #1 and the office was notified when the resident fell, but there were no notifications about the resident missing her Triumeq doses. The NP said her notes indicated a family member called and wanted her to go to hospital on 8/21/23 and a family member called the office on 09/28/23 to report the resident did not receive her Triumeq medication last week from 9/22/23 to 9/28/23. She said her nurse called the ADON on 09/28/23 and spoke with her about Resident #1 not receiving the medication. During an interview on 10/02/23 at 11:20 a.m., the ADON said no one from Resident #1's physician's office notified her that the resident's Triumeq medication was not available, and she was not aware of it. During an interview on 10/02/23 at 1:02 p.m., the DON said she realized the emails from the pharmacy, requesting approval for Resident #1's medications on 09/25/23, 09/26/23, 09/27/23 and 09/28/23, were going to the other box and not the in box of her emails. She said she had just looked and the emails from the pharmacy were in the other box, and she had not checked the other box for incoming emails. During an interview on 10/03/23 at 3:08 p.m., the MD said the ADM had called him either Saturday 9/30/23 or Sunday 10/01/23 and notified him Resident #1 did not receive her Triumeq medication. He said he had not previously been notified. He said it was his understanding that Resident #1 only missed 3 days of the Triumeq medication and that would not be a problem, but he did not understand the resident missed multiple doses in August 2023. He said approximately 15 doses could potentially cause a problem for the resident. Record review of https://www.drugs.com/triumeq.html, last updated June 9, 2022, accessed on 10/03/23 indicated: Triumeq contains a combination of abacavir, dolutegravir, and lamivudine. Abacavir, dolutegravir, and lamivudine are antiviral medications that prevents human immunodeficiency virus (HIV) from multiplying in your body. Triumeq is used to treat human immunodeficiency virus (HIV), the virus that can cause acquired immunodeficiency syndrome (AIDS). Take Triumeq exactly as prescribed by your doctor. Use all HIV medications as directed and read all medication guides you receive. Do not change your dose or stop using a medicine without your doctor's advice. Every person with HIV should remain under the care of a doctor. Usual Adult Dose for HIV Infection: 1 tablet orally once a day. Use: For the treatment of HIV-1 infection. Get your prescription refilled before you run out of medicine completely. If you miss several doses, you may have a dangerous or even fatal allergic reaction (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 6 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 once you start taking this medication again. Level of Harm - Immediate jeopardy to resident health or safety Record review of an Adverse Consequences and Medication Errors policy revised April 2014 indicated . Adverse consequences shall be reported to the Attending Physician and Pharmacist, and to federal agencies as appropriate. Residents Affected - Some Record review of an Adverse Consequences and Medication Errors policy revised April 2014 indicated . Adverse consequences shall be reported to the Attending Physician and Pharmacist, and to federal agencies as appropriate. An Immediate Jeopardy (IJ) situation was identified on 10/02/23. The IJ template was provided to the Administrator on 10/02/23 at 4:30 p.m and the POR was requested. The facility's POR dated 10/02/23 and accepted on 10/03/23 at 3:00 p.m. indicated: [Resident #1] medication was ordered and received by the facility on 9/28/2023. Primary care physician notified of the identified missed doses of medication on 10/2/23. The Medical Director also notified. There were not consequences associated or directly correlated with missed doses of the resident's medication. A viral load test has been ordered STAT for the resident. A facility audit to be completed by the Director of Nursing/Designee by 10/2/2023 of all residents with missed doses of medication in the past 7 days to assure that the medication was not held due to unavailability. For any medication identified as not given due to not available, the MD will be notified, and pharmacy will be contacted if the medication continues to not be available in the facility. If trends established, then we will QAPI the trend and in-service staff on root cause to prevent in the future. No other issues have been identified. In-services initiated by DON/Designee on 9/30/23 with licensed nursing staff present in facility related to timely reordering of medications within one week of running out, contacting pharmacy when medication is not in facility, notification of MD and DON. All other licensed staff will be in-serviced prior to working the next shift. The regional nurse consultant in serviced the DON and Administrator on checking all email folders for notifications of high-cost medications or refills from the pharmacy. Ad Hoc QAPI meeting completed with IDT and Medical Director on 10/2/2023. Facilities Plan to ensure compliance quickly: Facility interventions were implemented to remove immediate jeopardy: Audit to be completed 10/2/23 by DON/Designee to identify any residents that did not receive medications due to availability, pharmacy was contacted, and MD notified. This audit included the med cart, med room and MARS. There were no other residents identified that missed doses due to medication unavailability. We did identify new admits on the weekend were at a risk due to pharmacy hours of operation and ordering cut off time at 6PM. These orders will be sent to the local pharmacy and then delivered to the facility. Education was completed with the administrative nursing team by the Regional Nurse Consultant related to supervision to prevent missed medication administrations on 9/30/23. This includes checking (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 7 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 all eFax's, and fax machines at the nurse's station. Level of Harm - Immediate jeopardy to resident health or safety In-services initiated by DON/Designee on 9/30/23 with licensed nursing staff present in facility related to timely reordering of medications within one week of running out, contacting pharmacy when medication is not in facility, notification of MD and DON. Staff will be responsible for contacting the MD/PCP for any missed doses. The DON and or designee will follow up in the morning clinical meeting to ensure compliance. LVN A has been given disciplinary action and trained one on one by the DON. Residents Affected - Some This training to Licensed Nurses will be validated by completion of a post-training test, to be dated and signed by each nurse. *Education to be completed with all nursing staff working by 10/3/2023 at 2 PM either in person or via phone call. Staff who did not receive the training will receive this training prior to their next shift and will not be allowed to provide direct resident care until they have completed the training. On 10/03/23 the surveyor confirmed the facility implemented their plan of removal sufficiently to remove the Immediate Jeopardy (IJ) by: During observation on 09/30/23 at 12:51 p.m., Resident #1's Triumeq medication was dated 09/28/23 and available in the Hall 300 nurses' medication cart. During interviews on 10/03/23 from 3:18 p.m. to 3:28 p.m., Resident #1's NP and the MD said they were notified of Resident #1's missed doses of Triumeq. Record review of the audit tool completed by the DON indicated residents were identified that did not have their medications available. The medications were unavailable for 9 residents and the physicians were notified on 09/30/23, 10/02/23 and 10/03/23. No new orders were implemented. Record review of signed in-services to LVNs indicated the LVNs were trained on documenting missed doses of medications, who to notify, and notification of the physician with posttests taken and dated 10/02/23 and 10/03/23. Record review of in-services dated 09/30/23 to 10/03/23 indicated the LVNs were trained on supervision to prevent missed medication administration. Record review of the Regional Nurse Consultant's in-service to the DON and ADM dated 10/03/23 indicated the DON and ADM were trained to check all email folders for notifications of high cost medications or refills from the pharmacy. Record review of a counseling note dated 10/03/23 indicated LVN A was counseled on documentation, notification, and medications not being available. During an interview on 10/03/23 at 3:53 p.m., the DON was able to verbalize how to check emails for pharmacy notifications. During interviews on 10/03/23 from 4:20 p.m. to 5:20 p.m., three day shift LVNs, 3 evening shift LVNs and 2 night shift LVNs were able to verbalize the appropriate interventions to put in place to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 8 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete ensure the medications were available, refilled timely, weekend admits received their medications, the physician and DON were notified timely if medications were not available for administration and when to notify the pharmacy. On 10/03/23 at 5:40 p.m., the Administrator was informed the IJ was removed; however; the facility remained out of compliance at a severity level of no actual harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 675172 If continuation sheet Page 9 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Ensure that residents are free from significant medication errors. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure residents were free of significant medication errors for 1 of 4 residents reviewed for significant medication errors. (Resident #1) Residents Affected - Some The facility failed to ensure Resident #1's HIV ([human immunodeficiency virus] a virus that attacks the human immune system) medication was available for administration in August 2023 for 11 doses and September 2023 for 3 doses. Resident #1 had a diagnosis of HIV. An Immediate Jeopardy (IJ) situation was identified on 10/02/23 at 4:24 p.m. While the IJ was removed on 10/03/23 at 5:40 p.m., the facility remained out of compliance at a severity level of no actual harm that is not immediate jeopardy at a scope of a pattern due to the facility's need to evaluate the effectiveness of the corrective systems. This failure could place residents at risk of harm, impairment, or death from not receiving a significant medication. Findings included: Record review of physician orders dated 10/02/23 indicated Resident #1 was an [AGE] year-old female re-admitted on [DATE]. Her diagnoses included HIV, diabetes (a disease in which the body's ability to produce or respond to the insulin hormone is impaired resulting in abnormal metabolism) and pneumonia (lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid). The orders indicated the resident was to receive Triumeq (antiviral medications that prevents human immunodeficiency virus (HIV) from multiplying in your body) 600-50-300 mg one tablet every day for antiviral. Record review of a quarterly MDS dated [DATE] indicated Resident #1 was usually able to make herself understood, usually understood others, had moderately impaired cognitive skills and required supervision and set up for transfers and ambulation. She utilized a walker for mobility and had no impairment to upper and lower extremities. Record review of a care plan dated 08/21/23 indicated Resident #1 was at risk for infections related to HIV. The goal indicated the resident would not display any complications related to immunodeficiency. Interventions included to administer medications as ordered and monitor/document and report signs and symptoms. Record review of the August 2023 MAR for Resident #1 indicated the Triumeq medication was coded as follows: *on 08/04/23 the date was coded a 6 and indicated the resident was in the hospital documented by the DON, *on the following dates there was a code 9 on the date indicating other see progress note: 08/08/23 documented by LVN A, 08/09/23 documented by LVN A, 08/10:23 docuemnted by agency staff, 08/12/23 documented by LVN A , 08/13/23 documented by LVN A , 08/14/23 documented by LVN A,08/15/23 documented by LVN A, 08/18/23 documented by LVN A, 08/19/23 documented by LVN A , 08/20/23 documented (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 10 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 by LVN A and 08/21/23 documented by LVN A. Level of Harm - Immediate jeopardy to resident health or safety *on 08/22/23, the date was coded a 6 and indicated the resident was in the hospital documented by LVN G Record review of the September 2023 MAR for Resident #1 indicated the Triumeq medication was coded as follows: Residents Affected - Some *on 09/23/23 the date was coded a 1 and indicated the resident was absent from home without meds., *on 9/24/23 the date was coded a 3 and indicated the resident was absent from home with meds, *on 09/25/23, 9/26/23 documented by LVN E the date was coded a 9 and on 9/28/23 the date was coded a 9 and documented by LVN B and indicated other see progress note. Record review of the nurses' progress notes for Resident #1 indicated the following: *on 08/04/23 the resident was at the hospital. Resident #1 returned from hospital with a new antibiotic for pneumonia, *on 08/08/23 documented by LVN A, 08/09/23 documented by LVN A, 08/12/23 documented by LVN A, 08/13/23 documented by LVN A, 08/14/23 documented by LVN A, 08/15/23 documented by LVN A, 08/18/23 documented by LVN A, 08/19/23 documented by LVN A, 08/20/23 documented by LVN A and 08/21/23 documented by LVN A the Triumeq was on order, *on 08/10/23 signed by LVN D, the documentation for Triumeq did not indicate the medication was not administered, *on 08/22/23, the documentation indicated the resident was in the hospital. *on 09/01/23, documentation indicated the resident was readmitted from the LTAC hospital. *on 09/22/23 to 09/24/23, the resident was out of the facility with family *on 09/25/23 documented by LVN E, 09/26/23 documented by LVN E and 09/28/23 documented by LVN B, the documentation indicated the medication was not available. There was no documentation on the nurses' progress notes to indicate the physician was notified the Triumeq medication was not available or not administered. Record review of a LTAC hospital Interdisciplinary Notes dated 08/23/23 indicated History of Present Ilness: The patient is an [AGE] year-old female who resides at a nursing home, who presented to the emergency room on [DATE] and was found to have urinary tract infection and pneumonia. She was prescribed Lovenox (a medication used to thin the blood) and Rocephin (an antibiotic medication used to treat infection) and sent back to the nursing home, where she continued to have functional decline. The patient has had increased weakness and falls since her emergency room visit. The patient was transferred to [LTAC] on 08/21/2023 for continuation of antibiotic medical management of above symptoms and strengthening. The patient is currently not able to participate in activities of daily living and mobility as she was prior to her emergency room visit. A consult was performed by Physical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 11 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Medicine and Rehabilitation physician, who determined the patient was suffering from exacerbation of her Parkinson's disease. The patient wants to come to acute inpatient rehabilitation for aggressive physical and occupational therapy.medication. A LTAC order dated 8/24/23 indicated Resident #1's Triumeq medication was ordered for administration. The order indicated the resident could use own home supply. There was no documentation to indicate the resident did not have the Triumeq available upon admission to the LTAC. During interview on 09/30 23 at 8:45 a.m., the DON said Resident #1 was sent out to the hospital on 08/0423 and returned the same day a diagnosis of pneumonia. She said when the resident returned, she was placed on skilled services. The Triumeq medication was a high-cost medication and was not covered on the insurance once the resident became skilled. She said as soon as the facility received the request for approval for the Triumeq by the administrator, the approval was signed, faxed back and the resident received the medication. She said she was unaware the resident missed doses of the Triumeq. During an observation, interview, and record review on 09/30/23 at 12:51 a.m., LVN A said she was the nurse who worked Hall 300, where Resident #1 resided. During record review of Resident #1's August 2023 MAR with LVN A, she said Resident #1 was out of her Triumeq medication on 08/08/23, 08/09/23, 08/12/23, 08/13/23, 08/14/23 08/15/23, 08/18/23, 08/19/23, 08/20/23 and 08/21/23 where she documented the code 9. She said the resident had gone out to hospital on 8/4/23 but returned the same day and was diagnosed with pneumonia. She said the resident was weak because the diagnoses of pneumonia and did continue to get weaker and was sent out to the LTAC for rehabilitation services on 08/22/23. She said it was her responsibility to administer the medications on Hall 300. She said she should have notified the DON and the physician, when the Triumeq medication was not available. She said she did not know why she did not notify them, but she did not. She said she remembered Resident #1 was out of the Triumeq but did not remember notifying the pharmacy it was out. Observation of the bottle of Resident #1's Triumeq 30 count in the medication cart indicated the bottle was ¾ full of medication. The bottle was dated 9/28/23. LVN A said it had been refilled on 9/28/23 and only a few tablets had been administered out ot the bottle. She said she should have notified the pharmacy when there were approximately 10 tablets left. LVN A said the possible negative outcome of Resident #1 not receiving her medication would be the resident's HIV could worsen. During an interview on 9/30/23 at 1:20 p.m., the DON said she was unaware Resident #1 did not have the Triumeq medication for 11 days during August 2023. She said the Triumeq was to treat her diagnosis of HIV. She said she and the physician should have been notified the medication was not available. She said she expected the nurses to make sure the residents' medications were available for administration. She denied the resident could suffer increased symptoms by not having the medication available and said the medication was to keep the resident's HIV undetectable. During an interview on 09/30/23 at 1:52 p.m., LVN B said she started orientation on Hall 300 on 09/27/23 last week. She said Resident #1's Triumeq was not available on Wednesday 09/27/23 and Thursday 9/28/23. She said she was in training and did medication pass with LVN C. She said she watched LVN C pass medications on Wednesday 09/27/23 and passed the medications herself on Thursday 09/28/23. She said LVN C told her the Triumeq was a medication that required approval and it was not available. LVN B said if a medication was not available, the physician should be notified. She said she did not notify the physician the medication was not available because she was in training and LVN B had faxed the pharmacy. She said the medication was for Resident #1's HIV. She said the possible negative outcome if the resident did not receive the medication, would be the resident's HIV symptoms could exacerbate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 12 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During a confidential interview on 9/30/23 at 2:04 p.m., an individual said the facility did not have Resident #1's Triumeq medication available when the resident went out on pass 9/22/23 to 09/24/23. The individual said the ADON was notified the resident did not have her medication. During an interview on 09/30/23 at 2:22 p.m., the ADON said she was unaware Resident #1 did not have the Triumeq medication with her when she went out on pass 09/22/23 to 09/24/23. She denied staff had informed her the resident's medication was not available. She said Resident #1 should not miss a dose of the Triumeq medication because her HIV could worsen, and she was unaware that she missed doses. During an interview on 09/30/23 at 2:34 p.m., an attempted was made to call LVN D, who documented a code 9 on the August 2023 MAR on 08/10/23, with no answer and the mailbox was full; unable to leave message for call back. During an interview on 09/30/23 at 2:48 p.m., the DON said she was unaware Resident #1 had not received the Triumeq until 09/28/23, when the administrator approved the medication for the pharmacy to refill it and he sent the approval to her, and she ordered the medication stat. She denied knowing the resident also did not have the medication in August 2023. She said she was unaware and did not notify the physician. During an interview and record review on 09/30/23 at 3:12 p.m., LVN C said she worked two days last week on Hall 300, Wednesday 09/27/23 and Thursday 9/28/23, training LVN B. She said Resident #1's medication Triumeq was not available for administration either day. She said she did mark the MAR on 09/27/23 with a check which indicated she had administered the Triumeq, but she did not administer the medication because it was not available. She said she ordered the medication on 9/21/23 and there were pills left in the bottle but when she came back on 9/27/23 there were none left. During an interview and record review of a pharmacy Long Term Care Reorder Form dated 09/21/23, LVN C said she ordered the Triumeq on 09/21/23 and faxed it to the pharmacy and did not receive the fax back until the next day and noticed it said the Triumeq did not have an active order. The pharmacy Long Term Care Reorder form dated 09/21/23 had the Triumeq order request circled and had a label indicating No active order. Please send new order. She said she faxed an order for the Triumeq back to the pharmacy on 9/22/23 and was off the next few days. LVN C then provided an order dated 09/22/23 that indicated the Triumeq was ordered. Written across the bottom of the order was Please Refill. She said when she returned to work on 09/27/23 the resident was out of the Triumeq medication, so she called the pharmacy and asked them why it was not in the facility. She said the pharmacy told her it was a high-cost medication and was not covered and they had faxed over a high cost medication approval request to the administrator but did not receive an approval and the medication could not be refilled until it was approved. She said she did not remember if she reported what the pharmacy said. She said she did not notify Resident #1's physician that the resident did not have the medication available for administration. She said the physician should have been notified. She said the possible negative outcome of the resident not receiving her HIV medication could be the resident's HIV symptoms could worsen. During an interview on 09/30/23 at 3:45 p.m., LVN E, who worked Hall 300 on 9/25/23 and 9/26/23, said Resident #1's Triumeq medication was not available for administration. She said she did not usually work Hall 300 and was filling in, so she assumed someone had already ordered the medication and notified the physician. She said she did not notify the physician the medication was not available to administer. She said she told the ADON and the ADON told her to call the LTAC hospital and make sure they did not have it. She said she knew LVN C had reordered the medication, but the pharmacy sent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 13 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some back the refill request saying it was a high-cost medication and had to be approved before it could be filled. She said the resident's condition could get worse if she did not receive her medication as ordered. During an interview on 09/30/23 at 3:48 p.m., the ADON said the facility had sent Resident #1's Triumeq medication with her to the LTAC on 08/22/23 because the hospital called and said they could not provide the medication. She said when the resident returned on 09/01/23, the facility had to go pick the medication up from the LTAC because the hospital did not send it back with her. She said she was unaware the resident did not have the Triumeq medication for 11 days in August 2023 or the last week of September 2023. She said no one notified her on 09/25/23 or 09/26/23 that Resident #1 did not have the Triumeq medication available for administration. During an interview on 09/30/23 at 4:01 p.m., Pharmacist F said he pulled all of Resident #1's transactions offthe computer and the pharmacy had filled Resident #1's Triumeq and had a signed receipt for 6/29/23 and 8/19/23 but did not find a signed receipt for July 2023. He said they had also sent 30 Triumeq tablets on 09/28/23. He said he had a note that the pharmacy had communicated with the facility on 09/22/23 that the medication was a high dollar medication and could not be refilled without approval, but the administrator, DON and ADON were out of the facility. The pharmacy then refaxed and emailed the information again on 9/25/23, 09/26/23, 09/27/23, and 09/28/23. He said the administrator signed the approval and returned it on 9/28/23 and it was refilled. Pharmacist F was asked why the facility would have possibly not had the Triumeq medication available in August 2023 and he said there was a request from the facility on 07/05/23 for a refill but the medication had already been filled on 6/29/23 and it was too soon. He said there were no other communications found between the pharmacy and the facility regarding Resident #1's Triumeq medication requesting a refill for July 2023 and he did not have a signed receipt for July 2023. The During an interview on 10/02/23 at 10:09 a.m., the Administrator said he did not receive an approval request from the pharmacy until 09/28/23 and he immediately sent it back with his approval to be filled stat as soon as he received the request and Resident #1 received the medication the same day. He said he checked his emails daily and did not receive an approval request from the pharmacy until 09/28/23. He said on 09/28/23 he explained to the daughter of Resident #1 the Triumeq was not covered because the resident was on skilled services, and it required his approval. He said he was not aware the resident did not receive her medication in August 2023 or the last week of September 2023. He said the resident should receive her medication as ordered. He said he notified his medical director, and the medical director told him there would be no negative outcome of missing the Triumeq medication. During an interview and record review on 10/02/23 at 10:10 a.m., the DON provided a document, which she said was the July 2023 receipt for Resident #1's Triumeq. The top of the document had the words on order and Triumeq tablet cut in half indicating the page had been snipped. A pharmacy notes column indicated dispensed 7/26 updated to insurance-BA, 7/25 emailed facility-RR, 7/19 High $ emailed. There was no signature on the document and no year indicated on the document. The DON said she did not have a signed receipt for the Triumeq for July 2023. During an interview on 10/02/23 at 10:35 a.m., a phone call was initiated to the MD. The MD did not answer with a voice message left for callback. No call back was returned. During an interview on 10/02/23 at 11:15 a.m., the NP said she nor Resident #1's physician was notified the resident did not receive the doses of Triumeq in August 2023 and September 2023. She said (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 14 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some the resident had to have the Triumeq medication or it would exacerbate her HIV if she did not receive it. She said it was herself that would need to be notified and she did not receive a call and the records did not indicate the facility called the office to report the resident had missed the Triumeq doses. She said the facility had her personal cell phone number to call her. She said the records indicated the office was notified on 08/21/23 of lab work for Resident #1 and the office was notified when the resident fell, but there were no notifications about the resident missing her Triumeq doses. The NP said her notes indicated a family member called and wanted her to go to hospital on 8/21/23 and a family member called the office on 09/28/23 to report the resident did not receive her Triumeq medication last week from 9/22/23 to 9/28/23. She said her nurse called the ADON on 09/28/23 and spoke with her about Resident #1 not receiving the medication. During an interview on 10/02/23 at 11:20 a.m., the ADON said no one from Resident #1's physician's office notified her that the resident's Triumeq medication was not available, and she was not aware of it. During an interview on 10/02/23 at 1:02 p.m., the DON said she realized the emails from the pharmacy, requesting approval for Resident #1's medications on 09/25/23, 09/26/23, 09/27/23 and 09/28/23, were going to the other box and not the in box of her emails. She said she had just looked and the emails from the pharmacy were in the other box and she had not checked the other box for incoming emails. During an interview on 10/03/23 at 3:08 p.m., the MD said the ADM had called him either Saturday 9/30/23 or Sunday 10/01/23 and notified him Resident #1 did not receive her Triumeq medication. He said he had not previously been notified. He said it was his understanding that Resident #1 only missed 3 days of the Triumeq medication and that would not be a problem, but he did not understand the resident missed multiple doses in August 2023. He said approximately 15 doses could potentially cause a problem for the resident. Record review of https://www.drugs.com/triumeq.html, updated June 9, 2022, accessed on 10/03/23 indicated: Triumeq contains a combination of abacavir, dolutegravir, and lamivudine. Abacavir, dolutegravir, and lamivudine are antiviral medications that prevents human immunodeficiency virus (HIV) from multiplying in your body. Triumeq is used to treat human immunodeficiency virus (HIV), the virus that can cause acquired immunodeficiency syndrome (AIDS). Take Triumeq exactly as prescribed by your doctor. Use all HIV medications as directed and read all medication guides you receive. Do not change your dose or stop using a medicine without your doctor's advice. Every person with HIV should remain under the care of a doctor. Usual Adult Dose for HIV Infection: 1 tablet orally once a day. Use: For the treatment of HIV-1 infection. Get your prescription refilled before you run out of medicine completely. If you miss several doses, you may have a dangerous or even fatal allergic reaction once you start taking this medication again. Record review of the Administering Medications policy revised April 2019 indicated: Medications are administered in a safe and timely manner. The Director of Nursing Services supervises and directs all personnel who administer medications and/or have related functions. Medications are administered in accordance with prescribed orders, including any required time frame. Medication errors are documented, reported and reviewed by the QAPI committee. Record review of the Pharmacy Services policy revised April 2019 indicated: Policy Statement: The facility shall accurately and safely provide or obtain pharmaceutical services, including the provision of routine and emergency medications and biologicals, and the services of a licensed consultant (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 15 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Level of Harm - Immediate jeopardy to resident health or safety pharmacist. 2. The facility shall contract with a licensed consultant pharmacist to help it obtain and maintain timely and appropriate pharmacy services that support residents' needs, are consistent with current standards of practice, and meet state and federal requirements. Residents have sufficient supply of their prescribed medications and receive medications (routine, emergency or as needed) in a timely manner. Nursing staff communicate prescriber orders to the pharmacy and are responsible for contacting the pharmacy if a resident's medication is not available for administration. Residents Affected - Some An Immediate Jeopardy (IJ) situation was identified on 10/02/23. The IJ template was provided to the Administrator on 10/02/23 at 4:30 p.m. The facility's POR dated 10/02/23 and accepted 10/03/23 at 3:00 p.m. indicated: Resident #1 medication was ordered and received by the facility on 9/28/2023. Primary care physician notified of the identified missed doses of medication on 10/2/23. The Medical Director also notified. There were not consequences associated or directly correlated with missed doses of the resident's medication. A viral load test has been ordered STAT for the resident. A facility audit to be completed by the Director of Nursing/Designee by 10/2/2023 of all residents with missed doses of medication in the past 7 days to assure that the medication was not held due to unavailability. For any medication identified as not given due to not available, the MD will be notified, and pharmacy will be contacted if the medication continues to not be available in the facility. If trends established, then we will QAPI the trend and in-service staff on root cause to prevent in the future. No other issues have been identified. In-services initiated by DON/Designee on 9/30/23 with licensed nursing staff present in facility related to timely reordering of medications within one week of running out, contacting pharmacy when medication is not in facility, notification of MD and DON. All other licensed staff will be in-serviced prior to working the next shift. The regional nurse consultant in serviced the DON and Administrator on checking all email folders for notifications of high-cost medications or refills from the pharmacy. Ad Hoc QAPI meeting completed with IDT and Medical Director on 10/2/2023. Facilities Plan to ensure compliance quickly: Facility interventions were implemented to remove immediate jeopardy: Audit to be completed 10/2/23 by DON/Designee to identify any residents that did not receive medications due to availability, pharmacy was contacted, and MD notified. This audit included the med cart, med room and MARS. There were no other residents identified that missed doses due to medication unavailability. We did identify new admits on the weekend were at a risk due to pharmacy hours of operation and ordering cut off time at 6PM. These orders will be sent to the local pharmacy and then delivered to the facility. Education was completed with the administrative nursing team by the Regional Nurse Consultant related to supervision to prevent missed medication administrations on 9/30/23. This includes checking all eFax's, and fax machines at the nurse's station. In-services initiated by DON/Designee on 9/30/23 with licensed nursing staff present in facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 16 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some related to timely reordering of medications within one week of running out, contacting pharmacy when medication is not in facility, notification of MD and DON. Staff will be responsible for contacting the MD/PCP for any missed doses. The DON and or designee will follow up in the morning clinical meeting to ensure compliance. LVN A has been given disciplinary action and trained one on one by the DON. This training to Licensed Nurses will be validated by completion of a post-training test, to be dated and signed by each nurse. *Education to be completed with all nursing staff working by 10/3/2023 at 2 PM either in person or via phone call. Staff who did not receive the training will receive this training prior to their next shift and will not be allowed to provide direct resident care until they have completed the training. On 10/03/23 the surveyor confirmed the facility implemented their plan of removal sufficiently to remove the Immediate Jeopardy (IJ) by: During observation on 09/30/23 at 12:51 p.m., Resident #1's Triumeq medication was dated 09/28/23 and available in the Hall 300 nurses' medication cart. During interviews on 10/03/23 from 3:18 p.m. to 3:28 p.m., Resident #1's NP and the MD said they were notified of Resident #1's missed doses of Triumeq. Record review of the audit tool completed by the DON indicated residents were identified that did not have their medications available in the last 7 days. The medications were unavailable for 9 residents and the physician was notified on 09/30/23, 10/02/23 and 10/03/23. No new orders were implemented. Record review of signed in-services dated 10/02/23 and 10/03/23 to LVNs indicated the LVNs were trained on documenting missed doses of medications, who to notify, and notification of the physician with posttests taken and dated 10/02/23 and 10/03/23. Record review of in-services dated 09/30/23 to 10/03/23 indicated LVNs were trained on supervision to prevent missed medication administration. Record review of the regional nurse consultant's in-service to the DON and ADM dated 10/03/23 indicated the DON and ADM were trained to check all email folders for notifications of high-cost medications or refills from the pharmacy. Record review of a counseling note dated 10/03/23 indicated LVN A was counseled on documentation, notification, and medications not available. During an interview on 10/03/23 at 3:53 p.m., the DON was able to verbalize how to check emails for pharmacy notifications. During Interviews on 10/03/23 from 4:20 p.m. to 5:20 p.m., three day shift LVNs, 3 evening shift LVNs and 2 night shift LVNs were able to verbalize the appropriate interventions to put in place to ensure the medications were available, refilled timely, weekend admits received their medications, the physician and DON were notified timely if medications were not available for administration and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 17 of 18 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 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Port Arthur 6600 Ninth Ave Port Arthur, TX 77642 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 0760 when to notify the pharmacy. Level of Harm - Immediate jeopardy to resident health or safety On 10/03/23 at 5:40 p.m., the Administrator was informed the IJ was removed; however, the facility remained out of compliance at a severity level of no actual harm that is not immediate jeopardy and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 18 of 18