Inspection·October 29, 2023

F 0600 channel for feces to leave the body). Level of Harm - Minimal harm or potential for actual harm Review of Resident #2's MDS assessment dated [DATE] indicated Resident #1 had a BIMS score of 10 and was cognitively able to understand and be understood by others and had moderately impaired cognition. He required extensive 2-person assistance with toileting, dressing and bed mobility. He was always incontinent to bladder and had a colostomy for bowel. Residents Affected - Some Review of Resident #1's Comprehensive care plan dated last updated 10/03/23 indicated Resident #2 required a mechanical lift (Hoyer) for transfers and assistance of 2-staff for bathing, bed mobility and toileting. There was no indication of behavioral issues of verbal aggression toward staff of other residents. 3. Review of Resident #3's face sheet dated 10/29/23 indicated Resident #1 was a [AGE] year-old male initially admitted on [DATE], readmitted on [DATE] and discharged on 09/09/23. Resident #3 had a primary diagnosis of Pseudarthrosis after fusion or Arthrodesis. (A condition where the bones do not connect back together after spinal surgery) and diagnoses of contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints), Muscle weakness and atrophy, morbid obesity (extremely overweight), schizoaffective disorder, depressive type, (A mental disorder characterized by abnormal thought processes and an unstable mood), and diabetes. Review of Resident #3's MDS assessment dated [DATE] indicated Resident #3 had a BIMS score of 14 and was cognitively able to understand and be understood by others and was cognitively intact. Resident #3 exhibited verbal behavior symptoms directed toward others which may include threating others, screaming at others, or cursing at others. Resident #3 required extensive 2-person assistance in bed mobility, toileting, and dressing. Resident #3's functional status showed total dependence with most ADLs. Resident #3 was occasionally incontinent to bladder and always continent to bowel. Review of Resident #3's Comprehensive care plan dated 09/12/23 indicated Resident #3 had a potential of demonstrating verbal abusive behaviors toward others, poor coping skills and poor impulse control. Nursing staff were to analyze circumstances and triggers for behaviors and document. Assess and anticipate resident's needs for food, thirst, toileting needs, comfort level body positing and pain. Staff were to assess resident's understanding of the situation, allow time for the resident to express and feelings toward the situation. Give the resident as many choices as possible about care and activities. During an interview on 10/29/23 at 8:30 a.m. Resident #1 said he was in his room on 09/05/23 when CNA A came into his room without knocking and said, You're a nasty motherfucker that can't do for yourself Resident said he did not know why she said that to him, and it had never happened before. Resident #1 said he reported it to the new administrator the next day (09/06/23) when she arrived at work. Resident #1 said he had not seen CNA at the facility since that day. Resident #1 said he felt safe and was not afraid. During an interview on 10/29/23 at 8:20 a.m., Resident #2 said CNA A told him You can't even wipe your own ass, I don't need you, you need me. Resident #2 said he reported it to the previous administrator, but nothing was done. Resident #2 said CNA B refused to come into his room. Resident #2 said he had never had an issue with CNA C, but he had heard her tell another resident to Shut the Hell up. He said he was at Resident #1's room and heard CNA A call Resident #1 a Snatch ass nigger. Resident #2 said he currently feels safe at the facility because the new administrator and DON had gotten (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 2 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 ride of them. Resident #2 said he had no problems with other staff and had no unmet needs at this time. Level of Harm - Minimal harm or potential for actual harm During a telephone interview on 10/29/23 at 8:56, Resident #3 said he was discharged to another facility in Dallas in September. Resident #3 said when he was at the facility, he had problems with CNA B. Resident #3 said CNA B refused to provide care and would stand outside his door after 5:00 p.m. after the administrator and other administrative staff had gone home for the evening and make smart remarks and taunt him. Resident #3 said one day he asked for the nurse and CNA A told him, I am the nurse, I am all you get. Resident #3 said CNA A said to him You can't get up and wipe your own stank ass, you need me. When he said he was going to report her, CNA A said, Call your bitch ass sister, I don't care. Resident #3 said he also had words with CNA C and CNA C told him You are not going to do anything; you can't even wipe your own ass. He said the CNAs reported he was trying to run them over with his motorized wheelchair and that is why he was asked to go to another facility. Resident #3 said he was not able to read or write, but he had made numerous written statements complaining about CNA A, CNA B and CNA C, but the statements got lost somewhere and nothing was ever done. He said he is happy the new administrator fired the CNAs. Residents Affected - Some During an interview on 10/29/23 at, 11:47 a.m. CNA C said she quit her job when the administrator told her on 09/06/23 she was suspended pending investigation of an allegation of verbal abuse of Resident #3. CNA said she had a verbal altercation with Resident #3 when he was making verbal treats to her saying he was going to Get her and her family and I knew where you lived. CNA C said she became upset with Resident #3 and said to him, You are not going to do anything, you can't even wipe your own ass. CNA C she had training on Resident Rights and Abuse and Neglect. On 10/29/23 at 11:40 a.m. an attempt was made to contact CNA A and CNA B by phone. A recorded message indicated the numbers had been changed or disconnected. There were no other phone numbers available for CNA A or CNA B. During an interview on 10/29/23 at 12:36 p.m., LVN A said she had witnessed CNA A and CNA B yell at Residents and called Resident #3 a Son of a bitch and a lazy fat motherfucker. LVN A said she had reported incidents to the former DON, but nothing was ever done about it. LVN A said CNA A and CNA B would stand at Resident #3's door and make remarks to him. They would tell him You think you are going to get us fired, but we are not going anywhere'. LVN A said CNA A, CNA B, and CNA C would ignore Resident #1, Resident #2, and Resident #3's call light and refuse to provide care. LVN A said she had reported incidents to the former DON, but nothing was ever done about it. LVN A said she went to the human resource manager and asked about the written statement she turned in to the former DON and the forms could not be found. LVN A said Resident #3 was not able to read or write, so someone would help him write out the statement. LVN A said those statements could not be found. LVN A said the former administrator and DON Just swept it under the rug. LVN said once the new administrator started, and the verbal abuse was reported all three CNAs were terminated. LVN A said she had received in-service training since the new administrator started in September, and she feels comfortable reporting abuse and neglect and feels the new administrator will not allow staff to verbally abuse residents as in the past. During an interview on 10/29/23 at 12:36 p.m., LVN B said she had witnessed CNA A and CNA B curse at Residents and called Resident #3 a Son of a bitch and a lazy fat motherfucker. LVN B said CNA A, would ignore Residents call light and refuse to provide care. LVN B said she had reported incidents to the former DON, but nothing was ever done about it. LVN B said she had reported CNA A and CNA B several time for verbal abuse and refusing to provide care, before the new administrator started on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 3 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 09/04/23, but nothing was ever done. LVN A said the former administrator and DON just ignored it. LVN A said once the new administrator started, and the verbal abuse was reported all three CNAs were terminated. LVN B said she had not witnessed any abuse of residents since CNA A, CNA B and CNA C had been terminated. LVN B said staff received in-service on reporting abuse after the new administrator started and she would feel comfortable reporting abuse to the new administrator and felt like she could report incidents without fear of retaliation. During an interview on 10/29/23 at 8:45 a.m., LVN D said she was the assistant director of nursing and had overseen making the schedule for the CNAs. LVN said she was not aware of any verbal abuse of residents until Resident #1 made the allegation of verbal abuse by CNA A on 09/06/23 to the administrator. LVN D said she did not witness the incident but heard the Resident #3 attempted to run down staff with his motorized wheelchair. LVN D said because of his behavior, Resident #3 was immediately discharged to another facility, because he was found to be a danger to other residents. LVN D said she had been told not to assign CNA B to the same hallway as Resident #3, because they did not get along. LVN D said all allegations of abuse and neglect are reported to the Administrator, who is responsible for monitoring and assuring resident's safety. During an interview on 10/29/23 at 8:50 a.m., CNA D said she had worked at the facility for about a year. CNA D said Resident #3 was her a family member. CNA D said she normally works the 6:00 a.m. to 2:00 p.m. shift and did not work the same shift as CNA A, CNA B or CNA C, who works the 2:00 p.m. to 10:00 p.m. shift. CNA D said Resident #3 told her that CNA B had been rude to him. CNA D said Resident #3 was his own responsible party and she did not know he was being transferred to another facility in Dallas until the day he was leaving. CNA D said the facility Resident #3 was sent to in Dallas was closer to a family member and he was okay with moving and wanted to go to the new facility. CNA D said she had not witnessed any abuse or neglect and if so, would report it to the Administrator who is the Abuse Coordinator. CNA D said she had received training on reporting abuse and neglect since the new administrator started in September. CNA D said she had not witnessed any abuse or neglect since the new administrator had started. During an interview on 10/29/23 at 9:05 a.m., the Administrator said she was the abuse coordinator. She said she stated working at the facility on 09/04/23. She said on 09/06/23 Resident #1 reported to her that on the evening of 09/05/23 that CNA A walked into his room without knocking and stared curing and calling him names. Administrator said CNA A was not working when the incident was reported, but she called CNA A and advised her she was suspended pending investigation. Administrator said CNA A never admitted nor denied the allegation of verbal abuse toward Resident #1. Administrator said when she started interviewing staff during her investigation, she discovered there had been many instances where staff had verbally abused residents. Administrator said she suspended CNA A, CNA B and CNA C for verbal abuse of residents. Administrator said after her investigation all three nurse aides were terminated and not eligible for rehire. Administrator said the issue was addressed in the next QAPI meeting and all staff received training on recognizing and reporting abuse or neglect. Administrator said she was not aware of and did not know about any missing written statements prior to starting as the administrator on 09/04/23. Administrator said the written statement are nowhere to be found. The administrator said she and the DON are responsible for monitoring residents are safe. Administrator said she is responsible for reporting in incidents of abuse or neglect to the state. During an interview on 10/28/23 at 8:05 a.m. the DON said she had been DON since 07/30/23. The DON said the first time she became aware of any abuse was on 09/06/23 when Resident #1 reported to the Administrator that the day before CNA A cursed at him in his room. The DON said prior to this incident, she had not known of any abuse to residents. The DON said staff are required to report any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 4 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some allegation of abuse to her or the administrator who is the abuse coordinator. The DON said she was not aware of any staff being verbally abusive to residents prior to the allegation made by Resident #1 on 09/06/23. DON said the allegation of verbal abuse was substantiated and all three CNAs were terminated. The DON said all staff were trained on identifying and reporting abuse or neglect. The DON said she was not aware of any other incidents of abuse. The DON said there was a history of verbal abuse by the 3 CNAs prior to 09/05/23, but the previous DON and ADM did not address it to her knowledge. The DON said she and the administrator are responsible for monitoring to ensure the residents are treated with respect and dignity and the Administrator, as the abuse coordinator is responsible for reporting any allegations of abuse to the state. Review of a facility incident report dated 09/06/23, indicated on 09/05/23, Resident #1 reported to the Administrator that CNA A had walked into his room without knocking and said, You're a messy motherfucker that can't do for yourself and I'm through fucking with all you motherfuckers. Then CNA A left the room. Resident #2 was in the room and collaborated the incident. CNA A was suspended pending the results of an investigation. During the investigation it was found that there were 3 CNAs (CNA A, CNA B and CNA C) who were found to taunting, curing, and refusing to provide care to 3 residents (Residents #1, #2 and #3) CNA B and CNA C were also suspended on 09/06/23. After the investigation was completed by the Administrator, the allegation of verbal abuse was substantiated and, CNA A, CNA B, and CNA C were terminated for verbal abuse or a resident. Review of employee records indicated: On 05/08/23 CNA A received coaching by the DON on being a team player and refusing to go into certain resident's rooms. A Nurse Aide cannot refuse to provide care and services to residents. CNA A was suspended pending investigation into the allegation of verbal abuse. Records also indicated CNA A was terminated on 09/14/23 for verbal abuse of a resident. On 05/09/23, CNA B received a coaching by the DON on being a team player and refusing to go into certain resident's rooms. Nurse Aide can not refuse to provide care and services to residents. On 06/19/23 CNA B received a suspension for failing to give a resident a meal tray because she was outside smoking. On 06/21/23 CNA B received Inservice training from the DON on Resident Rights and customer service. CNA B was suspended on 09/06/23 pending investigation into allegations of verbal abuse and refusing to provide care to residents. On 09/14/23 CNA B was terminated for verbal abuse of a resident. On 09/06/23 CNA C was suspended pending investigation into the allegation of verbal abuse. Records also indicated CNA C was terminated on 09/14/23 for verbal abuse of a resident. Review of in-service records dated 09/02/23 through 09/12/23 indicated staff received training on Resident Rights, Verbal Abuse, HIPAA regulations, and Profanity toward Residents. Review of QAPI minutes dated 10/09/23 indicated QAPI team reviewed allegations of verbal abuse to several residents, Staff were suspended and terminated. Resident was discharged for aggressive behavior and discharged to another facility. Ombudsman notified and agreed with the immediate discharge of resident. Review of facility policy dated 03/29/18 indicated The resident has the right to be free from abuse .The facility will provide and ensure the promotion and protection of resident rights .3. Verbal abuse: Any use of oral, written, or gestured language that willfully includes disparaging and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 5 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 derogatory terms to residents. Level of Harm - Minimal harm or potential for actual harm The noncompliance was identified as PNC. The noncompliance began on 09/05/23 and ended on 09/14/23. The facility had corrected the noncompliance before the survey began. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 6 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to implement policy to ensure the rights of residents to be free from abuse for 3 of 14 residents reviewed for abuse. (Residents #1, #2, and #3) Residents Affected - Some The facility failed to keep Residents #1, #2, and #3 free from verbal abuse by Nurse Aides CNA A, CNA B, and CNA C. The failure could place residents at risk for abuse, humiliation, intimidation, fear, shame, agitation, and decreased quality of life. The noncompliance was identified as PNC. The noncompliance began on 09/05/23 and ended on 09/14/23. The facility had corrected the noncompliance before the survey began. Findings included: Review of facility policy dated 03/29/18 indicated The resident has the right to be free from abuse .The facility will provide and ensure the promotion and protection of resident rights .3. Verbal abuse: Any use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to residents. 1. Review of Resident #1's face sheet dated 10/29/23 indicated Resident #1 was a [AGE] year-old male admitted on [DATE] with diagnoses of Hypertension, (High blood Pressure), bipolar disorder (a serious mental illness that causes unusual shifts in mood, ranging from extreme highs to lows), Muscle wasting and atrophy (Decrease of muscle mass and strength), and Seizures (Sudden, uncontrolled electrical disturbance in the brain which can cause changes in behavior, movements, feelings, and consciousness). Review of Resident #1's MDS assessment dated [DATE] indicated Resident #1 had a BIMS score of 12 and was cognitively able to understand and be understood by others and was cognitively intact. He required one-person physical assistance with dressing. Resident #1 was always continent to bowl and bladder. Review of Resident #1's Comprehensive care plan dated 02/10/23 indicated Resident #1 can verbalize/communicate required assistance. There was no indication of a history of physical or verbal behaviors toward staff or other residents. 2. Review of Resident #2's face sheet dated 10/29/23 indicated Resident #1 was a [AGE] year-old male admitted on [DATE] with diagnoses of Paraplegia (impairment in motor or sensory function of the lower extremities), Dementia without behavioral disturbance, Chronic kidney disease, Stage 3, (moderate to severe loss of kidney function), Anxiety (an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events), and Colostomy status (a surgical procedure that creates an opening in the large intestine which provides an alternative channel for feces to leave the body). Review of Resident #2's MDS assessment dated [DATE] indicated Resident #1 had a BIMS score of 10 and was cognitively able to understand and be understood by others and had moderately impaired cognition. He required extensive 2-person assistance with toileting, dressing and bed mobility. He was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 7 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 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 0607 always incontinent to bladder and had a colostomy for bowel. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's Comprehensive care plan dated last updated 10/03/23 indicated Resident #2 required a mechanical lift (Hoyer) for transfers and assistance of 2-staff for bathing, bed mobility and toileting. There was no indication of behavioral issues of verbal aggression toward staff of other residents. Residents Affected - Some 3. Review of Resident #3's face sheet dated 10/29/23 indicated Resident #1 was a [AGE] year-old male initially admitted on [DATE], readmitted on [DATE] and discharged on 09/09/23. Resident #3 had a primary diagnosis of Pseudarthrosis after fusion or Arthrodesis. (A condition where the bones do not connect back together after spinal surgery) and diagnoses of contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints), Muscle weakness and atrophy, morbid obesity (extremely overweight), schizoaffective disorder, depressive type, (A mental disorder characterized by abnormal thought processes and an unstable mood), and diabetes. During an interview on 10/29/23 at 8:30 a.m. Resident #1 said he was in his room on 09/05/23 when CNA A came into his room without knocking and said, You're a nasty motherfucker that can't do for yourself Resident said he did not know why she said that to him, and it had never happened before. Resident #1 said he reported it to the new administrator the next day (09/06/23) when she arrived at work. Resident #1 said he had not seen CNA A, CNA B or CNA C at the facility since he reported CNA A to the administrator. Resident #1 said he felt safe and was not afraid. During an interview on 10/29/23 at 8:20 a.m., Resident #2 said CNA A told him You can't even wipe your own ass, I don't need you, you need me. Resident #2 said he reported it to the previous administrator, but nothing was done. Resident #2 said CNA B refused to come into his room. Resident #2 said he had never had an issue with CNA C, but he had heard her tell another resident to Shut the Hell up. He said he was at Resident #1's room and heard CNA A call Resident #1 a Snatch ass nigger. Resident #2 said he currently feels safe at the facility because the new administrator and DON had gotten rid of them. Resident #2 said he had no problems with other staff and had no unmet needs at this time. During a telephone interview on 10/29/23 at 8:56 a.m., Resident #3 said he was discharged to another facility in Dallas in September. Resident #3 said when he was at the facility, he had problems with CNA B. Resident #3 said CNA B refused to provide care and would stand outside his door after 5:00 p.m. after the administrator and other administrative staff had gone home for the evening and make smart remarks and taunt him. Resident #3 said one day he asked for the nurse and CNA A told him, I am the nurse, I am all you get. Resident #3 said CNA A said to him You can't get up and wipe your own stank ass, you need me. When he said he was going to report her, CNA A said, Call your bitch ass sister, I don't care. Resident #3 said he also had words with CNA C and CNA C told him You are not going to do anything; you can't even wipe your own ass. He said the CNAs reported he was trying to run them over with his motorized wheelchair and that is why he was asked to go to another facility. Resident #3 said he was not able to read or write, but he had made numerous written statements complaining about CNA A, CNA B and CNA C, but the statements got lost somewhere and nothing was ever done. He said he is happy the new administrator fired the CNAs. During an interview on 10/29/23 at, 11:47 a.m. CNA C said she quit her job when the administrator told her on 09/06/23 she was suspended pending investigation of an allegation of verbal abuse of Resident #3. CNA said she had a verbal altercation with Resident #3 when he was making verbal threats to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 8 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some her saying he was going to Get her and her family and I knew where you lived. CNA C said she became upset with Resident #3 and said to him, You are not going to do anything, you can't even wipe your own ass. On 10/29/23 at 11:40 a.m. an attempt was made to contact CNA A and CNA B by phone. A recorded message indicated the numbers had been changed or disconnected. There were no other phone numbers available for CNA A or CNA B. During an interview on 10/29/23 at 12:36 p.m., LVN A said she had witnessed CNA A and CNA B yell at Residents and called Resident #3 a Son of a bitch and a lazy fat motherfucker. LVN A said she had reported incidents to the former DON, but nothing was ever done about it. LVN A said CNA A and CNA B would stand at Resident #3's door and make remarks to him. They would tell him You think you are going to get us fired, but we are not going anywhere'. LVN A said CNA A, CNA B, and CNA C would ignore Resident #1, Resident #2, and Resident #3's call light and refuse to provide care. LVN A said she had reported incidents to the former DON, but nothing was ever done about it. LVN A said she went to the human resource manager and asked about the written statement she turned in to the former DON and the forms could not be found. LVN A said Resident #3 was not able to read or write, so someone would help him write out the statement. LVN A said those statements could not be found. LVN A said the former administrator and DON Just swept it under the rug. LVN said once the new administrator started, and the verbal abuse was reported all three CNAs were terminated. LVN A said she had received in-service training since the new administrator started in September, and she feels comfortable reporting abuse and neglect and feels the new administrator will not allow staff to verbally abuse residents as in the past. During an interview on 10/29/23 at 12:36 p.m., LVN B said she had witnessed CNA A and CNA B curse at Residents and called Resident #3 a Son of a bitch and a lazy fat motherfucker. LVN B said CNA A, would ignore Residents call light and refuse to provide care. LVN B said she had reported incidents to the former DON, but nothing was ever done about it. LVN B said she had reported CNA A and CNA B several time for verbal abuse and refusing to provide care, before the new administrator started on 09/04/23, but nothing was ever done. LVN A said the former administrator and DON just ignored it. LVN A said once the new administrator started, and the verbal abuse was reported all three CNAs were terminated. LVN B said she had not witnessed any abuse of residents since CNA A, CNA B and CNA C had been terminated. LVN B said staff received in-service on reporting abuse after the new administrator started and she would feel comfortable reporting abuse to the new administrator and felt like she could report incidents without fear of retaliation. During an interview on 10/29/23 at 8:45 a.m., LVN D said she was the assistant director of nursing and had overseen making the schedule for the CNAs. LVN D said she was not aware of any verbal abuse of residents until Resident #1 made the allegation of verbal abuse by CNA A on 09/06/23 to the administrator. LVN D said she did not witness the incident but heard the Resident #3 attempted to run down staff with his motorized wheelchair. LVN D said because of his behavior, Resident #3 was immediately discharged to another facility, because he was found to be a danger to other residents. LVN D said she had been told not to assign CNA B to the same hallway as Resident #3, because they did not get along. During an interview on 10/29/23 at 8:50 a.m., CNA D said she had worked at the facility for about a year. CNA D said Resident #3 was a family member of Resident #3. CNA D said she normally works the 6:00 a.m. to 2:00 p.m. shift and did not work the same shift as CNA A, CNA B or CNA C, who works the 2:00 p.m. to 10:00 p.m. shift. CNA D said Resident #3 told her that CNA B had been rude to him. CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 9 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some D said Resident #3 was his own responsible party and she did not know he was being transferred to another facility in Dallas until the day he was leaving. CNA D said the facility Resident #3 was sent to in Dallas was closer to family and he was okay with moving and wanted to go to the new facility. CNA D said she had not witnessed any abuse or neglect and if so, would report it to the Administrator who is the Abuse Coordinator. CNA D said she had received training on reporting abuse and neglect since the new administrator started in September. CNA D said she had not witnessed any abuse or neglect since the new administrator had started. During an interview on 10/29/23 at 9:05 a.m., the Administrator said she was the abuse coordinator. She said she stated working at the facility on 09/04/23. She said on 09/06/23 Resident #1 reported to her that on the evening of 09/05/23 that CNA A walked into his room without knocking and stared curing and calling him names. Administrator said CNA A was not working when the incident was reported, but she called CNA A and advised her she was suspended pending investigation. Administrator said CNA A never admitted nor denied the allegation of verbal abuse toward Resident #1. Administrator said when she started interviewing staff during her investigation, she discovered there had been many instances where staff had verbally abused residents. Administrator said she suspended CNA A, CNA B and CNA C for verbal abuse of residents. Administrator said after her investigation all three nurse aides were terminated and not eligible for rehire. Administrator said the issue was addressed in the next QAPI meeting and all staff received training on recognizing and reporting abuse or neglect. Administrator said she was not aware of and did not know about any missing written statements prior to starting as the administrator on 09/04/23. Administrator said the written statement are nowhere to be found. The administrator said she and the DON are responsible for monitoring residents are safe. Administrator said she is responsible for reporting in incidents of abuse or neglect to the state. During an interview on 10/28/23 at 8:05 a.m. the DON said she had been DON since 07/30/23. The DON said the first time she became aware of any abuse was on 09/06/23 when Resident #1 reported to the Administrator that the day before CNA A cursed at him in his room. The DON said prior to this incident, she had not known of any abuse to residents. The DON said staff are required to report any allegation of abuse to her or the administrator who is the abuse coordinator. The DON said she was not aware of any staff being verbally abusive to residents prior to the allegation made by Resident #1 on 09/06/23. DON said the allegation of verbal abuse was substantiated and all three CNAs were terminated. The DON said all staff were trained on identifying and reporting abuse or neglect. The DON said she was not aware of any other incidents of abuse. The DON said there was a history of verbal abuse by the 3 CNAs prior to 09/05/23, but the previous DON and ADM did not address it to her knowledge. The DON said she and the administrator are responsible for monitoring to ensure the residents are treated with respect and dignity and the Administrator, as the abuse coordinator is responsible for reporting any allegations of abuse to the state. Review of a facility incident report dated 09/06/23 indicated on 09/05/23, Resident #1 reported to the Administrator that CNA A had walked into his room without knocking and said, You're a messy motherfucker that can't do for yourself and I'm through fucking with all you motherfuckers. Then CNA A left the room. Resident #2 was in the room and collaborated the incident. CNA A was suspended pending the results of an investigation. During the investigation it was found that there were 3 CNAs (CNA A, CNA B and CNA C) who were found to taunting, curing, and refusing to provide care to 3 residents (Residents #1, #2 and #3) CNA B and CNA C were also suspended on 09/06/23. After the investigation was completed by the Administrator, the allegation of verbal abuse was substantiated and, CNA A, CNA B, and CNA C were terminated for verbal abuse or a resident. Review of employee records indicated: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 10 of 11 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 675183 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Twin Oaks Health and Rehabilitation Center 1123 N Bolton St Jacksonville, TX 75766 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 05/08/23 CNA A received coaching by the DON on being a team player and refusing to go into certain resident's rooms. A Nurse Aide cannot refuse to provide care and services to residents. CNA A was suspended pending investigation into the allegation of verbal abuse. Records also indicated CNA A was terminated on 09/14/23 for verbal abuse of a resident. On 05/09/23, CNA B received a coaching by the DON on being a team player and refusing to go into certain resident's rooms. Nurse Aide cannot refuse to provide care and services to residents. On 06/19/23 CNA B received a suspension for failing to give a resident a meal tray because she was outside smoking. On 06/21/23 CNA B received Inservice training from the DON on Resident Rights and customer service. CNA B was suspended on 09/06/23 pending investigation into allegations of verbal abuse and refusing to provide care to residents. On 09/14/23 CNA B was terminated for verbal abuse of a resident. On 09/06/23 CNA C was suspended pending investigation into the allegation of verbal abuse. Records also indicated CNA C was terminated on 09/14/23 for verbal abuse of a resident. Review of in-service records dated 09/02/23 through 09/12/23 indicated staff received training on Resident Rights, Verbal Abuse, HIPAA regulations, and Profanity toward Residents. Review of QAPI minutes dated 10/09/23 indicated QAPI team reviewed allegations of verbal abuse to several residents, Staff were suspended and terminated. Resident was discharged for aggressive behavior and discharged to another facility. Ombudsman notified and agreed with the immediate discharge of resident. The noncompliance was identified as PNC. The noncompliance began on 09/05/23 and ended on 09/14/23. The facility had corrected the noncompliance before the survey began. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675183 If continuation sheet Page 11 of 11