Inspection·September 22, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few wandering away from the facility. Resident did not want to hear what this nurse was saying but finally was able to get resident back in facility. Record review of LVN A nursing note dated 09/14/2025 at 6:30 p.m. indicated the following: Resident #1 was placed on 15-minute monitoring checks from the dates of 09/13/2025-09/14/2025 starting at 6:00 p.m. Record review of the fifteen-minute monitoring sheet indicated Resident #1's monitoring was initiated on 09/13/2025 at 6:00 a.m. by LVN A. - On the time slot for 10:45 a.m. - 11:45 a.m. there was no staff initials on the line to confirm Resident #1 was being monitored.- On the time slot for 6:00 p.m.- 11:45 a.m. there was a line from 6:00 p.m. to 11:45 a.m. stating no issues. - On the time slot for 7:45 p.m. stated no issues. - On the time slot for 11:00 p.m. stated no issues.- The monitoring sheets were dated for: 09/13/2025- 09/18/2025. Record review of Resident #1's witness statement completed on 09/19/2025, by LVN A indicated This nurse went to do 15 min check on Resident #1 at about 4:45 p.m. and noted resident was not in his room. I started looking around the halls and other staff did as well. Once nobody could find the resident in the building, several staff went outdoors to look for resident, I was walking down towards the (redacted) on 9th avenue by the fields. I looked by the ditches and trees; I did not see him. LVN A wrote in her statement that Resident #1 was walking back from the field where the ground was uneven and had tall grass. Once staff was able to get him back onto facility grounds and inside, he stated why am I here and he needs to go. Resident did state he does not need to be here, nor does he need to be evaluated for any behaviors. During an interview on 09/16/2025 at 4:00 p.m., the DON said Resident #1 had aggressive behaviors present on admission. On 09/13/2025 he chased staff, cussed at them, tried to hit them, and was very aggressive with staff. The DON said she initially planned to send Resident #1 to a behavioral hospital on [DATE] but decided to cancel the transfer because his behaviors calmed down some. The DON said she initiated 15-minute monitoring checks for Resident #1. The DON did not give specific instructions to staff on how to monitor, nor what behaviors to look for in Resident #1. The DON did not designate a staff member to monitor Resident #1 but said she expected nurses to complete the checks. Resident #1 eloped from the facility on 09/14/2025 while the 15-minute monitoring checks were still in place. The DON said she didn't know the exact location of Resident #1 but hoped he's in his room. The DON said the facility does not have wander guards or any keycodes on any of the doors inside the facility. The DON said the residents can go in and out of the facility freely. During interview on 09/17/2025 at 10:01 a.m. LVN A said she last laid eyes on Resident #1 09/14/2025 at 4:45 p.m. and did not locate him till 5:08 p.m. on 09/14/2025. LVN A said Resident #1 was off facility property. It had taken a minimum of 3 staff members to get him back into the building due to his cussing and combativeness. During interview on 09/17/2025 at 10:15 a.m. Resident #1 said he went out of an unlocked facility door because he did not want to be there. Resident #1 said if the door was locked, he would not have been able to get out of the facility. Resident #1 said he doesn't want to be at the facility and should not be there. During interview on 09/17/2025 at 10:53 a.m., LVN B said on 09/13/2025 Resident #1 came out of his room yelling at her and began chasing her down the hall and around the nurse's station. The LVN B was unable to say why or what triggered Resident #1's aggressive behavior episode. The LVN B said he balled his fist up and attempted to hit her and then began yelling at other staff at the nurse's station. LVN B said the DON and the Administrator were notified. She said the DON told her and LVN A to start 15-minute monitoring checks on Resident #1. The LVN B said the DON did not designate a staff member to oversee the 15-minute monitoring checks nor what behaviors they should be looking for while Resident #1 was on the 15-minute monitoring checks. During interview on 09/17/2025 at 11:05 a.m., LVN A said she started looking for Resident #1 on 09/14/2025 at 4:45 pm because the 15- minute monitoring check was due and noticed he was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 2 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few in his room nor in the facility. She said she located Resident #1 off facility grounds near (YMCA- redacted) in an uneven ground field with high grass, and cut trees laid everywhere. During interview on 09/17/2025 at 11:53 a.m., LVN B said Resident #1 would attempt to elope again because he states he should not be here, he did not want to be here and wanted to leave. During interview on 09/17/2025 at 11:58 a.m., LVN A said Resident #1 would attempt to elope again because now he knows the laundry and front door are unlocked and knows how to exit the facility. She said there was no way she can monitor all her assigned residents, give medications, and monitor Resident #1 at the same time. LVN A said when she gave medications on hall 300, she was unable to complete the 15- minute monitor checks on Resident #1 all at the same time. She said she already missed the 12- noon 15-minute monitor check because she was doing medication pass on her second assigned hall (hall-300). LVN A said while she was on her hour lunch break there was not another nurse watching Resident #1. During interview on 09/17/2025 at 12:12 p.m., CNA C said on 09/13/2025 she was not made aware Resident #1 was on 15-mintute monitoring checks. CNA C said she did not see any staff checking on him during her shift on 09/13/2025 from 6 a.m.- 6 p.m. During interview on 09/17/2025 at 12:30 p.m., CNA D said Resident #1 was wandering inside the facility on 09/13/2025. She said once Resident #1 was located by staff he kept saying the city hired him to pick up all the cut down trees in the field. She said she was not made aware Resident #1 was on 15-mintute monitoring checks. During interview on 09/17/2025 at 12:45 p.m., the CNA Supervisor said on 09/13/2025 Resident #1 was very aggressive stating I don't want to f***ing be here. She said Resident #1 had been saying he did not want to be at the facility since admission. She said she reported Resident #1 behaviors to the DON. She said she was not made aware Resident #1 was on 15-mintute monitoring checks. During interview on 09/17/2025 at 2:40 p.m., the DON said Resident #1 was admitted with behaviors and was very confused. The DON said Resident #1's behavior was reported to her on 09/13/2025 approximately 11:30 a.m. The DON said she along with the Administrator made the decision to place Resident #1 on 15-mintue monitor checks. She said the 15-mintue monitor checks were supposed to start approximately at 11:30a.m. She said the corporate nurse agreed to place him on 15-mintue monitor checks. The DON said she expected the nurses to do 15-mintue monitor checks, know where Resident #1 was at, and report to her any changes. The DON said she was responsible for following up on the 15-mintue monitor checks to ensure they are completed accurately. She said a high elopement risk was someone saying they want to leave the facility and start having exit seeking behaviors. She said a low elopement risk was someone wandering around the facility but not exit seeking. The DON said LVN A notified the Physician about Resident #1s behavior on 09/13/2025. The DON was unable to provide documentation of the physician being notified because the nurse did not document her calling. The DON said they do not have an assigned staff member to sit at the receptionist desk. During interview on 09/17/2025 at 4:05 p.m., the Administrator said Resident #1 had no payor source and stated, who's going to pay for a 1:1 sitter? During observation on 09/17/2025 at 11:15 a.m. Resident #1 was in his room sitting on the bed. Resident #1 had no wander guard on. The facility does not have nor use the wander guard system. During an observation on 09/17/2025 at 11:18 a.m. indicated the facility was located on a busy commercial 4 lane road with a speed limit of 45 mph. LVN A walked outside of facility and showed surveyor where Resident #1 was found when he eloped. LVN A showed surveyor location approximately 50 feet off facility premises in a tall grassy area with rocks, uneven ground, and cut trees. During an observation on 09/17/2025 at 11:20 a.m. LVN B showed surveyor an exit door on hall 200 was not locked and had no keycode or alarming sound on door. She said Resident #1 could also go out of the entrance door of the facility. LVN B said both doors lead to were Resident #1 was located off facility premise. Record review of website www.wunderground.com (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 3 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few accessed 09/17/2025 indicated the outside temperature at the time of the elopement 09/14/2025 was approximately 96 degrees.Record review of an Elopement Policy with revision date of March 2019, indicated, Policy: The facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents. 1. If identified as at risk for wandering, elopement, or other safety issues, the resident's care plan will include strategies and interventions to maintain the resident's safety. 3. If a resident is missing, initiate the elopement/missing resident emergency procedure:1. Determine if the resident is out on an authorized leave or pass;2. If the resident was not authorized to leave, initiate a search of the building(s) and premises; and3. If the resident is not located, notify the administrator and the director of nursing services, the resident's legal representative, the attending physician, law enforcement officials, and (as necessary) volunteer agencies (i.e., emergency management, rescue squads, etc.). 4. When the resident returns to the facility, the director of nursing services or charge nurse shall:1. examine the resident for injuries;2. contact the attending physician and report findings and conditions of the resident;3. notify the resident's legal representative (sponsor);4. notify search teams that the resident has been located; 5. complete and file an incident report; and document relevant information in the resident's medical record. The Administrator and DON were notified on 09/17/2025 at 4:10 p.m., that a noncompliance Immediate Jeopardy situation had been identified due to the above failures and were given a copy of the Immediate Jeopardy template and a Plan of Removal (POR) was requested. The facility's POR for the Immediate Jeopardy was accepted on 09/18/2025 at 6:34 a.m. and reflected the following: 1.Measures Put into Place/System Changes to remove the immediacy, and what date these actions occurred:Action: Resident #1 placed on 1:1 monitoring to be in place until Interdisciplinary team determines that monitoring can be decreased or alternate placement is found in a secure environment. The 1:1 will be 24 hours per day. Resident #1 will be within direct visual observation to ensure safety and immediate response. The person doing the 1:1 monitoring will only have that responsibility. Currently staff are signing up for 2-hour intervals and will not require a meal break. Staff will be required to document the 1:1 on the monitoring form.Person(s) Responsible: Director of Nursing, and/or Designee.Date: By 09/17/2025. Action: Facility audit of all residents to ensure a wander risk assessment was completed within the last quarter. Any resident who has not had a wandering assessment completed will have an updated one completed by 9/17/2025. Person(s) Responsible: Director of Nursing, and/or Designee Date: By 09/17/2025. Action: Ad-Hoc QAPI was conducted on 9/17/2025 with the Medical Director present by telephone. Person(s) Responsible: Administrator and Director of Nursing.Date: 09/17/2025. Action: Referrals to be sent for alternate placement.Person(s) Responsible: Director of Nursing or Assistant Director of Nursing.Date: 09/17/2025. Action: Education provided to the Director of Nursing on 9/17/25 related to interventions when a resident at risk for elopement expresses desires to elope, or an actual elopement occurs. Person(s) Responsible: Regional Nurse.Date: 09/17/2025. Action: Education to be initiated with all staff related to monitoring and safety of residents as well as appropriate steps to take when a resident expresses desire to leave or an actual elopement occurs. This training for all staff will be validated by completion of a post-training test, to be dated and signed by each staff member. Person(s) Responsible: Director of Nursing, and or/ Designee.Date:09/17/2025. Action: Residents requiring 1:1 monitoring or 15-minute checks will be relayed to staff on the daily assignment sheet.Person(s) Responsible: Updated by Nursing Management.Date: 09/17/2025. Action: Staff will be re-educated on the elopement policy and elopement drills will be performed by policy.Date: OngoingPerson(s) Responsible: Director of Nursing, and or/ Designee. Action: Education to be completed with all nursing staff working. Staff who did not receive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 4 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 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.Person(s) Responsible: Director of Nursing, and or/ Designee.Date:09/17/2025. Action: Door chimes will be installed on the laundry door and front door to alert staff when someone is coming in or going out. The staff will re-direct any resident that has been deemed at risk for elopement.Date: To be completed by 09/18/2025 at 12:00 p.m. The facility's verification of the POR was as follows: During observation 09/17/2025 at 4:30 p.m. Resident #1 was placed on 1:1 monitoring with assigned staff. Resident #1 had a staff member outside of his room. During observation on 09/18/2025 at 10:00 a.m. door chimes were on the laundry door and front door. Door chimes sounded every time it was opened. Record review on 09/18/2025 of wander risk audit dated 09/17/2025 indicated a facility audit was conducted on all residents ensuring a wander risk assessment had been completed within the last quarter. Record review of the QAPI sign-in roster dated 09/17/2025 indicated an in-person attendance at the meeting from the Administrator, Assistant director of nursing, regional nurse, DON, and attendance by telephone from the Physician. Record review on 09/18/2025 at 10:00 a.m. of the DON training indicated the DON was trained 9/17/2025 on What is Elopement and Wandering and Elopements policy revised date: March 2019 and took a Elopement in Long- Term Care Quiz on 09/17/2025, by the Regional nurse. The Regional nurse educated the DON on the interventions when a resident at risk for elopement expresses desires to elope, or an actual elopement occurs. Record review on 09/18/2025 at 11:15 a.m. of an Employee In- service Record indicated 20 CNAs, 8 nurses (DON & ADON) included), 7 housekeepers, 2 dietary, 2 cooks, 2 admission staff, and 2 transport staff were educated on the elopement binder, residents at high risk for elopement, (interventions when a resident is exit seeking or attempting to elope.) communication of residents that are requiring 1:1 or 15 minute monitoring (will be indicated on the daily assignment sheet.) Record review on 09/18/2025 at 12:10 p.m. of A Mock elopement drill sign-in sheet and elopement drill observer checklist dated 09/18/2025 indicated 7 CNA's, 6 housekeepers, 1 transport staff, 5 nurses (DON & ADON included) 1 admissions staff, Administrator, and the MDS Coordinator participated in a mock elopement drill with Regional nurse, as the drill observer. Record review on 09/18/2025 2:00 p.m. of facility staff schedules dated 09/18/2025 indicated new rotate staff were all educated on the elopement policy, the elopement binder, and which residents are at high risk for elopement. All staff and took a post test on elopement. Record review of elopement assessments completed on 09/18/2025 reflected 75 assessments were completed. In an interview with the Maintenance Director on 09/18/2025 at 2:13 p.m. indicated he had received an in-service regarding elopement and learned how to identify exit seeking behaviors, look for missing residents, and redirecting exit seeking residents. took a post test on elopement. He said he added chimes to the laundry door and front door so everyone would know whose going in and out of the facility. In an interview with the Administrator on 09/18/2025 at 3:00 p.m., he stated he performed an education in-service with all department heads regarding elopement. He said he would follow up with the DON to ensure compliance with their elopement policy. In an interview with the Administrator on 09/18/2025 at 3:30 p.m., he said all residents who had positive elopement screenings had re-evaluations of their care plans. Staff interviews conducted on 09/18/2025 from 12:00 p.m. to 2:30 p.m., representing staff from (6:00 a.m.- 6:00 p.m.) and (6:00 p.m.- 6:00 a.m.) included: Administrator, DON,ADON, LVN A, LVN C, LVN D, LVN E, LVN F, LVN G, LVN H, LVN I, CNA Supervisor, OT #1, PT #1, LVN F, LVN G, LVN H, LVN J, LVN K, LVN L, LVN P, LVN O, Housekeeper AA, Housekeeper BB, Housekeeper CC, Housekeeper DD, Housekeeper EE, Housekeeper Supervisor, [NAME] FF, [NAME] GG, [NAME] HH, [NAME] LL, Dietary aide, Dietary Supervisor, Business Office Manager, Admissions Director, Activities Director, Maintenance Director, Transportation Director. All staff were able to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 5 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete identify what Elopement is, who to report any residents displaying exit seeking behaviors and steps for staff to take to de-escalate resident behaviors. Staff indicated they were to be aware of resident behaviors, monitor for exit seeking behaviors. Staff were able to state elopement risk factors, elopement prevention strategies, required staff response if an elopement occurs, and keys points to remember. All staff were able to identify the responsibilities for supervision and monitoring residents with any exit seeking behaviors. During these interviews, staff stated they had received in-service training about the facility's elopement policies and procedures, including the charge nurse's responsibility and ensure they checked the elopement binder to know who's at risk for elopement. The staff stated they felt confident in identifying exit seeking behaviors. Record review of the 1:1 monitoring document dated 09/17/2025 indicated the documentation was not completed accurately. The 1:1 monitoring document reflected the following:On the time slot for 10:45 a.m. - 11:45 a.m. there was no staff initials on the line to confirm Resident #1 was being monitored.- On the time slot for 6:00 p.m.- 11:45 a.m. there was a line from 6:00 p.m. to 11:45 a.m. stating no issues. - On the time slot for 7:45 p.m. stated no issues. - On the time slot for 11:00 p.m. stated no issues. During an interview on 09/17/2025 at 2:00 p.m. the DON said it was her responsibility to ensure the 1:1 monitoring sheet was being filled out accurately. Resident #1 was transferred to another facility 09/18/2025 at 5:15 p.m. An IJ was identified on 09/14/2025. The IJ template was provided to the facility on [DATE] at 4:10 p.m. While the IJ was removed on 09/19/2025, the facility remained out of compliance at a scope of isolated and a severity level of potential for more than minimal harm because all staff had not been trained on Elopement. Event ID: Facility ID: 675172 If continuation sheet Page 6 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0755 Level of Harm - Immediate jeopardy to resident health or safety 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 interview and record review, the facility failed to provide pharmaceutical services (the process of receiving and interpreting prescriber's orders and to provide procedures that assure the accurate acquiring, receiving, dispensing, and administration of all drugs) to meet the needs of each resident for one (Resident #2) of four residents reviewed for pharmaceutical services.The facility failed to ensure Resident #2's hospital discharged medication regimen was accurately reviewed and implemented. Resident #2 was readmitted to the hospital with respiratory failure and COPD. The noncompliance was identified as past noncompliance (PNC). The IJ began on 02/07/2025 and ended on 02/10/2025. The facility had corrected the noncompliance before the state's investigation began.This failure could place residents at risk for not receiving medications as ordered by their physician or per manufacturer's directions. Findings included:Record review of Resident #2's PPS MDS assessment dated [DATE] indicated Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of hypertension (high blood pressure), COPD (a group of lung diseases that block airflow and make it difficult to breathe). The MDS also indicated a BIMS score of 14 (suggested no cognitive impairment).Record review of Resident #2's baseline care plan dated 02/07/2025 indicated Resident #2 used oxygen continuously due to COPD. Record review of Resident #2's hospital H&P dated 02/04/2025 (prior to facility admission) indicated Resident #2 was admitted to the hospital on [DATE] for complaints of a 2-3-week history of gradual worsening shortness of breath, cough, and wheezing. Resident #2 was hypoxic (an inadequate supply of oxygen o the body's tissues) and was placed on BIPAP (a non-invasive ventilation therapy that uses 2 different levels of air pressure to assist breathing). Record review of Resident #2's hospital Discharge summary dated [DATE] indicated 3 new medications upon discharge: -budesonide 0.5 mg/2 ml (breathing treatment) per nebulizer twice daily;-prednisone 20 mg(anti-inflammatory) by mouth before breakfast; and-levalbuterol HCL 0.63mg/3 ml (breathing treatment) every 6 hours via nebulizer. Additionally, Resident #2 was to continue previous home medications:-omeprazole 20 (reduces stomach acid) mg daily;-Levothyroxine 100 mcg (used to treat underactive thyroid) daily;-Memantine 10 mg (used to treat moderate to severe Alzheimer's) daily;-hydrochlorothiazide 12.5 mg (used to treat high blood pressure and fluid retention) daily;-Magnesium oxide 400 mg (supplement used to regulate muscle and nerve function) daily;-Duloxetine 30 mg (used to treat mood disorders and chronic pain) twice daily;-Ibuprofen 600 mg (anti0inflammatory) twice daily as needed;-losartan 25 mg (for blood pressure) daily; -atorvastatin 40 mg (used to reduce cholesterol levels) every evening; and -tramadol 50 mg (for pain) four times daily. Record review of Resident #2's admission orders and MAR dated 02/07/2025 indicated the facility ordered and administered 11 medications that were not Resident #2's discharge medications with multiple doses to Resident #2 from 02/07/25-02/10/25. Resident #2 was administered the following: *Amiodarone 200 mg 5 doses (blood pressure) -Plavix 75 mg 3 doses (blood thinner), -Eliquis 5 mg 5 doses (blood thinner), -Lexapro 5 mg 3 doses (anti-depressant), -Lasix 40 mg 3 doses (diuretic), -Metolazone 5 mg 3 doses (diuretic), - Gemtesa 75 mg 3 doses (for bladder spasms), -Valsartan 320 mg 3 doses (blood pressure) ,-Levothyroxine 137 mcg 2 doses(for thyroid - receives 100 mcg at home), -Docusate 100 mg 2 doses (stool softener) and,-Melatonin 5 mg 2 doses (helps sleep).Record review of Resident #2's nurses notes written by LVN P indicated Resident #2 experienced shortness of breath and anxiety within 72 hours of admission to facility, resulting in decreasing oxygen saturation levels and Resident #2 being transferred to hospital for evaluation. She was admitted to the hospital on [DATE] with an exacerbation of COPD and anxiety. Record review of a Medication Error form completed by the corporate nurse and dated 02/10/2025 for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 7 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0755 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident #2 indicated the following: . Family brought to the facilities attention that the medications that [Resident #2] was receiving at the facility did not match their understanding of what medications the resident should be on. Upon investigation, it was discovered that the 2 pages (pages 33 and 34) of the hospital paperwork containing the discharge medications that the family brought to the facility with the resident had a different resident's name on them. This resulted in [Resident #2] being placed on the wrong medications from 2/7 through 2/10. During an interview on 09/17/2025 at 09:30 a.m., the regional nurse said Resident #2's family member came to the facility and had asked if Resident #2 had been given her breathing treatment over the weekend. The corporate nurse said upon review of Resident #2's medical record, she had noticed the diagnoses, and the medication list did not look right. Upon further reviewing, the corporate nurse said out of the 60+ pages, she found that the medication list provided by the discharging hospital had a different person's medication list and discovered the facility had inadvertently missed and had written the wrong medications for Resident #2. In addition, the 3 new medications upon discharge from hospital had been overlooked and were omitted. She said the staff nurses were in-serviced on medication errors, ensuring correct residents were listed on their discharge papers, verifying correctness of orders, etc. She said they did an audit of all admission within the 30 days prior and there were no new identifiable errors. She said they did QAPI and monitored all new admissions for 3 months with no errors. During a phone interview on 09/19/2025 at 10:45 a.m., Physician H, who was the attending physician for Resident #2's most recent hospital visit, said it was difficult to say if Resident #2 having received the wrong medications would have contributed to her hospital stay. He said it was very important for facilities to provide accurate medication lists when transferring residents to the hospital. During an interview on 09/19/2025 at 10:50 a.m., LVN E reported she completed Resident #2's admission Assessment, but denied transcription of the medication orders that were included in the discharge paperwork from the hospital. LVN E said she had noticed Resident #2 crying at times, and felt it was due to being a new admission to the facility. During a phone interview on 09/19/2025 at 11:00 a.m., NP J said he was employed as Physician K's NP (who was also the facility Medical Director). He said he had not seen Resident #2 while she was in the facility, and he recalled receiving a call from nursing staff saying Resident #2 was having shortness of breath. He said he gave orders to send to ER for evaluation. NP J said in his opinion, Resident #2's shortness of breath could have been contributed to having been administered the wrong medications, and added the error should have been caught on admission. He said he and physician attend monthly QA meetings at facility and he vaguely recalled the entire incident. During an interview on 09/19/2025 at 11:50 a.m., the DON said the admitting nurse was responsible for reconciling the medications with the physician, and the ADON was to ensure the medications were accurately transcribed. The DON said she was not employed at the facility at the time of this incident. She was hired one month later. The DON said the facility had a Standards of Care meeting weekly at which time new admissions, wounds, change in conditions were discussed and acted upon. The DON said this failure could negatively affect the residents as the wrong medications could cause harm, allergic reactions, or adverse reactions. She said her expectations were for nursing staff to make sure the correct resident's names and date of birth were on all paperwork from the hospital or physician offices. During an interview on 09/19/2025 at 12:20 p.m., the regional nurse said the staff had failed to transcribe and administer Resident #2's breathing treatments as prescribed upon discharge from hospital on [DATE]. She said staff failed to verify the names on Resident #2's discharge papers from the hospital. She said the admitting nurse was responsible for transcribing physician orders, and the ADON was responsible to ensure correctness. If a resident was admitted over the weekend, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 8 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0755 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete orders were to be checked on the next workday. During a joint interview on 09/19/2025 at 12:55 p.m., LVN F said she had been employed at facility since April 2025. LVN F said she had been trained in admissions. She said anytime she would be expecting admission, she would request all discharge records prior to transfer. She said she would verify the resident's name, date of birth , and medications. She said upon arrival at the facility, a verification was made by asking residents their name and date of birth , or by looking at hospital bracelets, or verify if the family was present. LVN G agreed with LVN F comments and added when notifying physician of admission and verification of medications, she would also ensure the resident orders were complete as in route, frequency, rationale, and duration. LVN F said anytime medications were questioned, the physicians were quick to respond to calls made by nursing staff. LVN G said when notifying physician to verify medications, they name every medication to the physician. Review of facility policy titled Reconciliation of Medications on Admission, with a revision date of July 2017, indicated The purpose of this procedure is to ensure medication safety by accurately accounting for the resident's medications, routes, and dosages upon admission or readmission to the facility. Medication reconciliation helps to ensure that medications, routes and dosages have been accurately communicated to the Attending Physician and care team. Review the list carefully to determine if there are discrepancies/conflicts.The facility took the following actions to correct the noncompliance prior to the investigation:-Record review of an Employee In-service Record dated 02/10/2025 indicated the facility in-serviced the staff on verifying all information on new admissions as correct and with the correct residents' information. The in-service was conducted by LVN F with an audience of licensed staff. Seventeen licensed staff were in-serviced. - During an interview on 09/19/2025 at 11:50 a.m., the DON said nursing administration implemented for the ADON to perform daily medication checks with orders for newly ordered medications and new admissions during the morning meetings. -Record review of an audit of new admissions indicated the facility monitored 16 new admissions from 01/21/2025 through 02/10/2025 for accuracy 5 times/week for 4 weeks with no negative outcome. -During interviews throughout the investigation from 02/16/2025 at 08:30 a.m. through 02/22/2025 at 5:15 p.m., the licensed staff were aware to verify new medications or new admission residents' medications by calling the physician to verify. (ADON, LVN A, LVN B, LVN E, LVN F, LVN G, LVN H, LVN J, and LVN K) -Record review of 19 new resident admission's clinical record from 09/21/2025 -09/22/2025, revealed the Order Summary, discharge paperwork from recent hospital visits, MAR, history and physicals, etc. indicated no errors in transcribing orders or orders being overlooked. (Resident #s 2, 4, 5, 6, 7, 8, 9,10,11,12,13,14,15,16,17,18, 19, 20, and 21) The noncompliance was identified as past noncompliance (PNC). The IJ began on 02/07/2025 and ended on 02/10/2025. The facility had corrected the noncompliance before the state's investigation began. Event ID: Facility ID: 675172 If continuation sheet Page 9 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 interview and record review, the facility failed to ensure residents were free of significant medication errors for 1 of 19 residents reviewed for significant medication errors. (Resident #2)The facility must ensure that its residents are free of any significant medication errors. Resident #2 received multiple doses of medications that were not prescribed to her to include 2 blood thinners and blood pressure medications. Also, Resident #2 did not receive prescribed breathing treatments and anti-inflammatory medications and was re-hospitalized with COPD.The noncompliance was identified as past noncompliance (PNC). The IJ began on 02/07/2025 and ended on 02/10/2025. The facility had corrected the noncompliance before the state's investigation began.This failure could place residents at risk for not receiving medications as ordered by their physician or per manufacturer's directions. Findings included:Record review of Resident #2's PPS MDS assessment dated [DATE] indicated Resident #2 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of hypertension (high blood pressure), COPD (a group of lung diseases that block airflow and make it difficult to breathe). The MDS also indicated a BIMS score of 14 (suggested no cognitive impairment).Record review of Resident #2's baseline care plan dated 02/07/2025 indicated Resident #2 used oxygen continuously due to COPD.Record review of Resident #2's hospital H&P dated 02/04/2025 (prior to facility admission) indicated Resident #2 was admitted to the hospital on [DATE] for complaints of a 2-3-week history of gradual worsening shortness of breath, cough, and wheezing. Resident #2 was hypoxic (an inadequate supply of oxygen o the body's tissues) and was placed on BIPAP (a non-invasive ventilation therapy that uses 2 different levels of air pressure to assist breathing). Record review of Resident #2's hospital Discharge summary dated [DATE] indicated 3 new medications upon discharge: -budesonide 0.5 mg/2 ml (breathing treatment) per nebulizer twice daily;-prednisone 20 mg(anti-inflammatory) by mouth before breakfast; and-levalbuterol HCL 0.63mg/3 ml (breathing treatment) every 6 hours via nebulizer.Additionally, Resident #2 was to continue previous home medications:-omeprazole 20 (reduces stomach acid) mg daily;-Levothyroxine 100 mcg (used to treat underactive thyroid) daily;-Memantine 10 mg (used to treat moderate to severe Alzheimer's) daily;-hydrochlorothiazide 12.5 mg (used to treat high blood pressure and fluid retention) daily;-Magnesium oxide 400 mg (supplement used to regulate muscle and nerve function) daily;-Duloxetine 30 mg (used to treat mood disorders and chronic pain) twice daily;-Ibuprofen 600 mg (anti0inflammatory) twice daily as needed;-losartan 25 mg (for blood pressure) daily;-atorvastatin 40 mg (used to reduce cholesterol levels) every evening; and-tramadol 50 mg (for pain) four times daily. Record review of Resident #2's admission orders and MAR dated 02/07/2025 indicated the facility ordered and administered 11 medications that were not Resident #2's discharge medications with multiple doses to Resident #2 from 02/07/25-02/10/25. Resident #2 was administered the following: *Amiodarone 200 mg 5 doses (blood pressure) -Plavix 75 mg 3 doses (blood thinner),-Eliquis 5 mg 5 doses (blood thinner),-Lexapro 5 mg 3 doses (anti-depressant),-Lasix 40 mg 3 doses (diuretic), -Metolazone 5 mg 3 doses (diuretic),- Gemtesa 75 mg 3 doses (for bladder spasms),-Valsartan 320 mg 3 doses (blood pressure) ,-Levothyroxine 137 mcg 2 doses(for thyroid - receives 100 mcg at home),-Docusate 100 mg 2 doses (stool softener) and,-Melatonin 5 mg 2 doses (helps sleep).Record review of Resident #2's nurses notes written by LVN P indicated Resident #2 experienced shortness of breath and anxiety within 72 hours of admission to facility, resulting in decreasing oxygen saturation levels and Resident #2 being transferred to hospital for evaluation. She was admitted to the hospital on [DATE] with an exacerbation of COPD and anxiety. Record review of a Medication Error form completed by the corporate nurse and dated 02/10/2025 for Resident #2 indicated the following: . Family brought to the facilities attention that the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 10 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 - Few medications that [Resident #2] was receiving at the facility did not match their understanding of what medications the resident should be on. Upon investigation, it was discovered that the 2 pages (pages 33 and 34) of the hospital paperwork containing the discharge medications that the family brought to the facility with the resident had a different resident's name on them. This resulted in [Resident #2] being placed on the wrong medications from 2/7 through 2/10. During an interview on 09/17/2025 at 09:30 a.m., the regional nurse said Resident #2's family member came to the facility and had asked if Resident #2 had been given her breathing treatment over the weekend. The corporate nurse said upon review of Resident #2's medical record, she had noticed the diagnoses, and the medication list did not look right. Upon further reviewing, the corporate nurse said out of the 60+ pages, she found that the medication list provided by the discharging hospital had a different person's medication list and discovered the facility had inadvertently missed and had written the wrong medications for Resident #2. In addition, the 3 new medications upon discharge from hospital had been overlooked and were omitted. She said the staff nurses were in-serviced on medication errors, ensuring correct residents were listed on their discharge papers, verifying correctness of orders, etc. She said they did an audit of all admission within the 30 days prior and there were no new identifiable errors. She said they did QAPI and monitored all new admissions for 3 months with no errors. During a phone interview on 09/19/2025 at 10:45 a.m., Physician H, who was the attending physician for Resident #2's most recent hospital visit, said it was difficult to say if Resident #2 having received the wrong medications would have contributed to her hospital stay. He said it was very important for facilities to provide accurate medication lists when transferring residents to the hospital.During an interview on 09/19/2025 at 10:50 a.m., LVN E reported she completed Resident #2's admission Assessment, but denied transcription of the medication orders that were included in the discharge paperwork from the hospital. LVN E said she had noticed Resident #2 crying at times, and felt it was due to being a new admission to the facility. During a phone interview on 09/19/2025 at 11:00 a.m., NP J said he was employed as Physician K's NP (who was also the facility Medical Director). He said he had not seen Resident #2 while she was in the facility, and he recalled receiving a call from nursing staff saying Resident #2 was having shortness of breath. He said he gave orders to send to ER for evaluation. NP J said in his opinion, Resident #2's shortness of breath could have been contributed to having been administered the wrong medications, and added the error should have been caught on admission. He said he and physician attend monthly QA meetings at facility and he vaguely recalled the entire incident.During an interview on 09/19/2025 at 11:50 a.m., the DON said the admitting nurse was responsible for reconciling the medications with the physician, and the ADON was to ensure the medications were accurately transcribed. The DON said she was not employed at the facility at the time of this incident. She was hired one month later. The DON said the facility had a Standards of Care meeting weekly at which time new admissions, wounds, change in conditions were discussed and acted upon. The DON said this failure could negatively affect the residents as the wrong medications could cause harm, allergic reactions, or adverse reactions. She said her expectations were for nursing staff to make sure the correct resident's names and date of birth were on all paperwork from the hospital or physician offices.During an interview on 09/19/2025 at 12:20 p.m., the regional nurse said the staff had failed to transcribe and administer Resident #2's breathing treatments as prescribed upon discharge from hospital on [DATE]. She said staff failed to verify the names on Resident #2's discharge papers from the hospital. She said the admitting nurse was responsible for transcribing physician orders, and the ADON was responsible to ensure correctness. If a resident was admitted over the weekend, the orders were to be checked on the next workday. During a joint interview on 09/19/2025 at 12:55 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 11 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete p.m., LVN F said she had been employed at facility since April 2025. LVN F said she had been trained in admissions. She said anytime she would be expecting admission, she would request all discharge records prior to transfer. She said she would verify the resident's name, date of birth , and medications. She said upon arrival at the facility, a verification was made by asking residents their name and date of birth , or by looking at hospital bracelets, or verify if the family was present. LVN G agreed with LVN F comments and added when notifying physician of admission and verification of medications, she would also ensure the resident orders were complete as in route, frequency, rationale, and duration. LVN F said anytime medications were questioned, the physicians were quick to respond to calls made by nursing staff. LVN G said when notifying physician to verify medications, they name every medication to the physician.Review of facility policy titled Reconciliation of Medications on Admission, with a revision date of July 2017, indicated The purpose of this procedure is to ensure medication safety by accurately accounting for the resident's medications, routes, and dosages upon admission or readmission to the facility. Medication reconciliation helps to ensure that medications, routes and dosages have been accurately communicated to the Attending Physician and care team. Review the list carefully to determine if there are discrepancies/conflicts.The facility took the following actions to correct the noncompliance prior to the investigation:-Record review of an Employee In-service Record dated 02/10/2025 indicated the facility in-serviced the staff on verifying all information on new admissions as correct and with the correct residents' information. The in-service was conducted by LVN F with an audience of licensed staff. Seventeen licensed staff were in-serviced. - During an interview on 09/19/2025 at 11:50 a.m., the DON said nursing administration implemented for the ADON to perform daily medication checks with orders for newly ordered medications and new admissions during the morning meetings. -Record review of an audit of new admissions indicated the facility monitored 16 new admissions from 01/21/2025 through 02/10/2025 for accuracy 5 times/week for 4 weeks with no negative outcome. -During interviews throughout the investigation from 02/16/2025 at 08:30 a.m. through 02/22/2025 at 5:15 p.m., the licensed staff were aware to verify new medications or new admission residents' medications by calling the physician to verify. (ADON, LVN A, LVN B, LVN E, LVN F, LVN G, LVN H, LVN J, and LVN K) -Record review of 19 new resident admission's clinical record from 09/21/2025 -09/22/2025, revealed the Order Summary, discharge paperwork from recent hospital visits, MAR, history and physicals, etc. indicated no errors in transcribing orders or orders being overlooked. (Resident #s 2, 4, 5, 6, 7, 8, 9,10,11,12,13,14,15,16,17,18, 19, 20, and 21) The noncompliance was identified as past noncompliance (PNC). The IJ began on 02/07/2025 and ended on 02/10/2025. The facility had corrected the noncompliance before the state's investigation began. Event ID: Facility ID: 675172 If continuation sheet Page 12 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure all drugs and biological were stored in accordance with currently accepted professional principles for 1 of 3 medication carts (300 hall) reviewed for storage of medication and biologicals.The facility failed to ensure 4 tablets of Ondansetron 8mg (medication used for nausea and vomiting) expired 10/31/24, had been expired for 322 days, were removed from use. The facility failed to ensure 5 tablets of Clonidine 0.1mg (medication used for high blood pressure) expired 07/31/24, had been expired for 414 days, were removed from use.These failures could place residents at risk of adverse reactions to medications, misappropriation of medications, and not receiving therapeutic effects of medication.Findings included:Observation on 09/18/25 at 10:45 a.m. of the facility 300 Hall medication storage cart indicated in the second draw the following:- an individual medication card with 4 untouched tablets of Ondansetron 8mg with an expiration date of 10/31/24 and fill date of 11/06/23, the medication had been expired for 322 days and had not been removed from use in the medication cart. - an individual medication card with 5 tablets of Clonidine 0.1mg (medication used for high blood pressure) expired 07/31/24 and fill date 08/11/23, had been expired for 414 days, were removed from use.During an interview on 09/18/25 at 10:45 a.m. LVN A said the Ondansetron 8mg medication had been expired since 10/31/24 and she said 4 out of 10 tablets were left and 5 out of 30 tablets of Clonidine 0.1mg were left and had expired 07/31/24. LVN A said she was new and had started working with the facility about 3-4 days ago and this was her first day working by herself. LVN A said she was responsible for administering medication out of the 300-hall medication cart but had not given any of the expired Ondansetron or Clonidine. LVN A said she had been trained by the facility on medication storage, making sure meds are not expired before giving medication and keeping the cart stocked, free of expired medications and spills. LVN A said if residents were administered expired medications it could lead to medication poisoning or sickness. LVN A said she would remove the expired medications from the cart.During an interview on 09/18/25 at 1:10 p.m., the DON said there should be no expired medications inside the medication room or inside the medication carts. The DON said the Nurse working on the medication cart checked the medication cart every time they work on the medication cart. The DON said nurses are to check for expired medications and discharged residents' medication to be removed for disposal. The DON said she was responsible in ensuring that the nurses were checking the medication carts for removal and disposal of expired medications and she said was not sure how it got over looked. The DON said if the medication were not given for months then they could expire and be overlooked on the medication cart. She said the effects of expired medications could range from reduced effectiveness to unfavorable side effects.Record Review of the facility pharmacy monthly medication review for storage dates 7/2025 to 9/2025 indicated no evidence of expired medications on the medication carts needing removal.Record review of the facility undated policy titled Medication Storage reflected in part:. Policy: It is the policy of this facility to ensure all medications housed on our premises will be stored in the pharmacy and or medication rooms according to the manufacturer's recommendations and sufficient to ensure proper sanitation, temperature, light, ventilation, moisture control, segregation and security.5. Staff should observe proper storage and labeling requirements for all medications and vaccines during the performance of their daily task and should demonstrate safety in regards to the medication's integrity such duties should include but are not limited to: c. Remove any expired medications from active stock and discard medications according to facility policy. Event ID: Facility ID: 675172 If continuation sheet Page 13 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infection control for 3 of 4 residents (Resident #3, Resident #4, Resident #5), and 2 of 2 therapists, (PT #1 and OT #2.) The facility failed ensure PT #1 and OT #1 used hygiene and wipe down therapy equipment between Resident's use. These failures could place residents at risk of cross-contamination and development of infections. Findings included: During observation on 09/21/2025 at 4:20 p.m. indicated while in the Physical therapy room, PT#1 touched 3 residents (Resident #3, Resident #4, Resident #5), gait belt, 2 walkers, and 3 residents (Resident #3, Resident #4, Resident #5) wheelchairs while wearing the same pair of used gloves. PT#1 did not take used gloves off nor use hand hygiene after working with residents and touching 2 walkers, and 3 residents (Resident #3, Resident #4, Resident #5) wheelchairs. During observation on 09/21/2025 at 4:28 p.m. PT#1 and OT#1 did not use hand hygiene before assisting a Resident #4 to a standing position from his wheelchair. During observation on 09/21/2025 at 4:38 p.m. PT#1 was working with a Resident #4 on the parallel bars. After the resident completed the exercise, PT#1 put Resident #3 on the parallel bars without disinfecting the parallel bars in-between resident use. During observation on 09/21/2025 at 4:45 p.m. OT#1 was physically working between Resident #4 and Resident #5 and did not use hand hygiene in between residents during their exercise. During observation 09/21/2025 at 4:50 p.m. PT#1 washed his hands then dried his hands with paper towels. PT#1 used the same paper towels he dried his hands with to wipe the visible sweat off his forehead then wiped his hands with the same paper towels. PT#1 did not perform hand hygiene before touching Resident #3 and Resident #4 after wiping his visible sweat off his forehead. During observation 09/21/2025 at 4:45 p.m. PT#1 had an open cut with flesh exposed on his index finger approximately 0.5 inches. PT#1 did not have a band-aid covering on his index finger while working with the resident's. During Interview on 09/21/2025 at 4:50 p.m. PT#1 said he was wearing gloves because one of the residents in therapy was very sweaty and he did not want the sweat to get into the open cut on his finger. PT#1 said he should have had his finger covered especially when working with the residents to prevent the risk of cross contamination. PT#1 said he should have used hand hygiene before and after resident contact to prevent infection. PT#1 said he should not have wiped his hands with used paper towels he used to wipe his sweat off with. PT#1 said he disinfected the used equipment only at the end the day not in-between residents. He said the only time he disinfected equipment during the day was if a Resident was in isolation. PT#1 said he was trained on infection control by hospitals but not by the facility nor by the DON. During Interview on 09/21/2025 at 5:05 p.m. OT#1 said he should have used hand hygiene before and after working with the resident. He said not using hand hygiene or disinfecting used equipment can potentially put staff and Residents at risk of passing and contracting infections. OT#1 said he has completed infection control modules from his contracting company but has not completed a skill check-off on infection control for the facility. During an observation and Interview on 09/21/2025 at 5:20 p.m. the DON said she was the infection control preventionist and has not trained the Rehabilitation department on infection control. The DON observed PT#1 open cut on index finger and said the cut should always be covered to prevent cross contamination. She said PT#1 should have discarded his used paper towels and rewashed his hands to prevent his body fluids getting on the residents. The DON said her expectation was for staff to disinfected used equipment in-between residents. During Interview on 09/22/2025 at 11:55 a.m. the Director of Rehabilitation said she had not completed skill check off's, trainings, nor education on infection control/ hand hygiene. She said most of her Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675172 If continuation sheet Page 14 of 15 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675172 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete staff know to disinfect equipment. The Director of Rehabilitation said all equipment including the parallel bars should be disinfected after each use to prevent the spread of germs. She said the DON told her PT#1 should have had his index finger covered to prevent cross contamination. The Director of Rehab said she has not been in-serviced by the facility on infection control but has completed infection control computer modules. She said her expectation was for her staff to disinfect equipment after each use, wash hands before and after working with the residents. During interview 09/22/2025 at 3:38 p.m. indicated the Administrator said his expectation was for therapy to be in-serviced by the DON on infection control before working with Residents. He said he expected therapy to wash their hands before and after working with the residents and clean equipment between usage. Record review of [company] (online education) Certificate of Course Completion dated 04/25/2025 indicated The Director of Rehabilitation completed Infection Control Microlearning: Standard Precautions for Clinical and Nonclinical Staff. The brief course was an annual refresher training course on infection control. Record review of [company] (online education) Certificate of Course Completion dated 04/04/2025 indicated OT#1 completed Infection Control Microlearning: Standard Precautions for Clinical and Nonclinical Staff. The brief course was an annual refresher training course on infection control. Record review of [company] Certificate of Course Completion dated 9/22/2025 indicated PT#1 completed Personalized Learning: Understanding Infection Control. The brief course was an annual refresher training course on infection control. Record review of Infection Control policy dated: July 2019 indicated: Policy Statement: This facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary, and comfortable environment and to prevent and manage transmission of diseases and infections.1. This facility's infection control policies and practices apply equally to all personnel, consultants, contractors, residents, visitors, volunteer workers, and the general public alike, regardless of race, color, creed, national origin, religion, age, sex, handicap, marital or veteran status, or payor source.2. The objectives of our infection control policies and practices are tob. Maintain a safe, sanitary, and comfortable, environment for personnel, residents, visitors, and the general public.f. Provide guidelines for the safe cleaning and reprocessing of reusable resident- care equipment. 3. The Quality Assurance and Performance Improvement Committee, through the Infection Control Committee, shall oversee implementation of infection control policies and practices, and help department heads and managers ensure that they are implemented and followed. 4. All personnel will be trained on infection control policies and practices upon hire and periodically thereafter, including where and how to find and use pertinent procedures and equipment related to infection control. The depth of employee training shall be appropriate to the degree of direct resident contact and job responsibilities. 6. Inquiries concerning our infection control policies and facility practices should be referred to the Infection Preventionist of Director of Nursing Services. Event ID: Facility ID: 675172 If continuation sheet Page 15 of 15