Health inspection·July 16, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few the allegation of abuse had been confirmed. The facility immediately suspended the alleged perpetrator once the allegation was made. The facility notified the family, physician, and ombudsman. The facility immediately sent Resident #1 out to the hospital to receive treatment which revealed no abnormalities of the intercranial space. The facility called and filed a report with the local police. The facility's social worker conducted safe surveys with all Interviewalbe residents with no negative outcomes. The facility terminated the alleged perpetrator. The facility conducted in-service with staff on abuse/neglect. Record review of CNA B's written statement dated 03/30/25 reflected, Resident #1 walked up to CNA A while she was sitting down eating a sandwich. [Resident #1] Was asking to call her son on the phone. CNA A told her that the phones were not working. [Resident #1] stated the was BS I know that they are working. CNA A stood up, got in [Resident #1's] face nose to nose and told [Resident #1] to get out of her face and she shoved her. [Resident #1] fell and hit her head on the floor. Record review of CNA A's written statement dated 03/30/25 reflected, I [CNA A] came to work on Sunday March 30th, 2025. I was sitting at table taking my daily meds I take every day after I get to work and eating a half of a sandwich before I get going. At that time, I was approached by [Resident #1] asking she could use the phone like she does every day, but today she was really aggressive and being really bossy and not trying to listen to our answers. She was yelling y'all are damn liars. I was just trying to calm her down and explain to her she can, we gotta [sic] clean up trays and all that and we will. I turned around in my chair she was standing at nurse desk. I get up and stood in front of her trying again to explain we will she got up on me put her face in my face and I said please give me my space. [Resident #1] was still talking and yelling at [Resident #2] She turned toward [Resident #2] and somehow, she lost her footing and I watched her leg cross over and she fell that fast. CNA B was sitting right there with us and witnessed it all. She immediately said I pushed her. I did not. I've been a CNA for 33 years. I would never hurt myself or anyone else. My job is to protect this resident. Record review of CNA A's clock in and out for pay period 03/23/25-04/05/25 reflected on 03/30/25 she had clocked in at 06:05 p.m. and clocked out 07:57 p.m. There were no other time entry's after 03/30/25 and she was listed as terminated. Record review of the Incident report for Resident #1 completed on 03/30/25 at 6:25 p.m. by LVN C reflected, Called to Memory care unit by CNA [B] stating resident was in the floor. Upon entering main room of memory care unit resident was observed to be sitting in the floor to the right of the nurse's station, with her legs straight out. She was noted to be wearing socks and tennis shoes with rubber soles. There is a large hematoma noted to the right forehead with no break in the skin. No loss of consciousness. Resident states she fell due to being pushed down by someone while pointing at CNA [A].VS obtained with assessment. No AMS noted. BP 140/51, P-89, R-20, T 97.9. DON of facility, MD and [family member] notified. Transferred to [hospital] ER via EMS for eval per MD recommendation. DON of facility notified administrator. Written statements obtained from both CNAs on memory care unit. Record review of Resident #1's hospital record dated 03/30/25 reflected an admission date of 03/30/25 at 7:29 p.m. and discharge back to the facility on [DATE] at 10:18 p.m. Resident #1 had a CT scan performed which revealed no intracranial hemorrhage (brain bleed). There was noted a small right frontal scalp hematoma (collection of blood underneath the skin of the forehead and scalp, often the resulting from trauma), No skull fracture. No acute intracranial abnormalities (any deviation from the typical structure or function of the brain or its surrounding structure). The discharge diagnosis was head injury and contusion (bruise) of scalp. Record review of the Police reported completed on 03/31/25 by Officer D, reflected he had attempted to interview Resident #1 who was not able to recall the events from the previous night, only that she had sustained an injury to her head. In addition, he spoke with Resident #1's family (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 2 of 8 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few member who indicated he wished to press charges against CNA A. He interviewed CNA B, and her statement was consistent with the written statement she had made on 03/30/25. Officer D then made contact with CNA A which reflected, .contact was then made with [CNA A] via phone to gather her statement of what occurred the previous evening. [CNA A] advised that on the evening of March 30th, 2025, upon arrival to work the patients were sitting at their tables eating dinner. [CNA A] stated she takes a lot of medications that requires she eat food with, so with the patients busy, she decided to take her medication (did not state what medication) and sit down behind the nurse's desk to eat her food. [CNA A] had mentioned that there were four groups of women always wanted to use the phone to call family and causing issues and Resident #1 was the ringleader. [CNA A] had mentioned that the entire weekend [Resident #1] had been acting very aggressive, hitting people, and doing all kinds of crazy stuff. On this evening [CNA A] stated the [Resident #1] had come up to the desk asking to use the phone. [CNA A] stated that she informed [Resident #1] that once they get everyone settled that she would get the phone number from her nurse so she could make the call. Due to [Resident #1] being forgetful, [CNA A] stated that she had come up to the desk multiple times asking the same question. On roughly the fourth time, [CNA A] stated that [Resident #1] became agitated as she approached the nurse's desk with a large purse on her shoulder as she was followed by another patient only identified as [Resident #2]. [CNA A] stated, I then stood up to go wash my hands or do something. When she stood up, she stated that [Resident #1] was right there, but there was a taller desk in between the two of them. [CNA A] stated that [Resident #1] then leaned over the desk and began screaming in her face, calling her a damn liar and that she was holding them captive. [CNA A] stated that [Resident #1] then began turning back and forth between her and [Resident #2] stating they're not gonna let us out, [CNA A] stated as [Resident #1] turned back towards her, she observed her leg/foot twist and that is what caused her to fall to the ground and strike her head on the floor. [CNA A] stated that she tried to catch [Resident #1] as she was falling, but it happened to fast. [CNA A] stated she immediately got the nurse [LVN C]. [CNA A] had stated I've been an aid for 30 plus years, I don't do something like that. Those people are really aggressive. [CNA A] was advised that due to what had been informed to be up to this point and having a witness statement regarding the incident that the charge of Injury to a Child, Elderly Individual, or Disabled individual (PC 22.049f0) was going to be filed at large against her. She advised she understood. Record review of Resident #1's Psychiatric Subsequent Assessment note completed on 03/31/25 by NP F reflected, .Patient seen today for a new problem.Asked by facility DON to see patient via video telehealth for a recent altercation. Patient seen via telehealth with DON assisting. Pt is able to identify herself by her name and date of birth . Patient denies depressive and/or anxiety symptoms. Pt states I was pushed the other day however overall, I am okay. I know that it was not a resident who did it. It was an employee. I don't' know why they did that. I am not scare [sic] to be here and I feel very staff [sic] here. No overt psychosis detected.Mental Status examination.Short term memory: severely impaired.Long term memory.severely impaired. Observation of Resident #1 on 07/15/25 at 8:55 a.m. revealed her in her room in bed sleeping. In an interview with LVN E on 07/15/25 at 9:10 a.m. she stated she worked the 6 a.m. 6 p.m. shift on 04/01/25 following the incident with Resident #1 on 03/30/25. She stated the resident had a pretty good bruise and knot on her forehead which had also progressed to a black eye to her right eye. She stated the resident told her she had been pushed but was unable to identify who pushed her. She stated Resident #1 frequently request to use the phone and thinks her car is out in the parking lot and wants to call the police and report it stolen. She stated she was usually easily redirected, but at times can get very agitated. She stated they just keep reassuring her and re-directing and offering her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 3 of 8 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few another activity. Call placed to CNA A on 07/15/25 at 11:10 a.m. Message was left with a request for a return call. In an observation and interview with Resident #1 on 07/15/25 at 11:15 a.m. resident was observed ambulating in the hallway. Resident was asked if we could go to her room to talk, and resident stated yes. Resident #1 stated she was doing wonderful today. Resident was unable to recall any of the events that had occurred on 03/30/25 and stated she felt safe here and liked it here very much. Return call received from CNA A on 07/15/25 at 12:43 p.m. CNA A stated she had just come on duty on 03/30/25 for her 6 p.m. to 6 a.m. shift. She stated it was her 3rd day of her rotation. She stated it was a rough day. She stated Resident #1 had been aggressive all weekend. She stated she and the other residents all rushed the desk wanting to use the phone. She stated they usually kick in right after supper. She stated she was sitting behind the station eating her sandwich and taking her medications which was her usual routine when she came on duty. She stated Resident #1 kept coming up to the desk and asking to use the phone and she kept telling her to back up. She stated there was a resident behind Resident #1. She stated she stood up and Resident #1 was in her face, and she stated she told her again to back up and get out of her face. She stated Resident #1 went to turn around and got her feet tangled up and fell. She stated as soon as she fell, she yelled that I had pushed her. She stated she thinks in the resident's mind she thinks she pushed her. CNA A denied pushing the resident and denied putting her hands on the resident. CNA A stated CNA B went and got LVN C who came and assessed the resident and sent her to the hospital. She stated she was removed from the unit and asked to write a statement and was then sent home. She stated she tried to call the DON but was not able to reach her. She stated she had been terminated. She stated she was interviewed by the police and was told she would be getting a letter but stated she had not received anything yet. In an interview with Officer D on 07/15/25 at 1:05 p.m. he stated he did come to the facility on [DATE] to complete the report. He stated he spoke with the DON and met with Resident #1 and her family member. He stated Resident #1's family member wanted to press charges against CNA A. He stated he completed his investigation and handed it off to the District Attorney's office who will have the final say on what, if any charges were filed. In an interview with the DON on 07/15/25 at 1:10 p.m. stated she received a call from LVN C after the incident on 03/30/25 and was told about the fall and the allegation that Resident #1 had been pushed by CNA A. She stated she told LVN C to remove CNA A immediately from the unit, have her write her statement and then leave. She stated she then called the Administrator. She stated they also contacted the ADON who lives very close to the facility, to come and begin the investigation. She stated they started the Abuse and Neglect in-services that night and then on 03/31/25 they also in-serviced on Resident Rights, Dementia care, and recognizing and dealing with signs of burn out. She stated they sent the resident out to the hospital for evaluation, contacted the MD, family, police and reported the incident to the State. She stated they had NP F from Psychiatric services evaluate Resident #1 the next day and they monitored her for any changes in physical or emotional distress. She stated after they completed their investigation, they felt there was enough evidence to terminate CNA A. She stated she was very surprised at CNA A's action. She stated she had never had any complaints about her care toward the residents. She stated they try and keep consistent staff in the memory care, so they are familiar with the residents and familiar with what works with the resident for behavior management. She stated any time they place a new employee in the unit they go over each resident and review with them the interventions they had in place for re-direction. She stated asking for the phone and asking for her keys was Resident #1's normal behavior. She stated CNA A should have handed her the phone instead of putting her off, which only escalated the resident's behaviors. In an interview with LVN C on 07/15/25 at 4:19 p.m. she stated she had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 4 of 8 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few just come onto her 6 p.m. to 6 a.m. shift on 03/30/25. She stated she was responsible for hall 600 and hall 500 which is the locked unit. She stated she was still getting report from the off going nurse on hall 600 when she got a call from CNA B telling her she needed to come quick to the unit. She stated when she arrived on the unit, CNA B was on the floor by Resident #1 and CNA A was standing behind the resident. She stated CNA B was nervous. She stated CNA B was whispering to her that CNA A had pushed Resident #1. She stated Resident #1 was pointing to CNA A stating she had pushed her, and CNA A was stating she had not pushed her. She stated she evaluated the resident who had a large knot on her forehead. She stated she notified the MD who requested to send the resident out to the hospital for evaluation. She stated after she sent the resident out, she notified the DON about the situation. She stated the DON told her to send CNA A home after she completed her statement and to get a written statement from CNA B. She stated she took CNA A off the unit to the other nurse's station to complete her statement and then she went home. She stated she notified Resident #1's family member of the fall and her transport to the hospital. She stated she had worked with CNA A for several months and had not ever had any issues with her performance. She stated she could get a little overwhelmed at times, but stated she was very thorough with her work. She stated Resident #1 would often get close to you, but stated she thought it was because she was hard of hearing. She stated it was not unusual for her to want to use the phone, often stating she needed to call the police because someone had stolen her car. She stated they would re-direct her with activities or agree with her and she would often forget what she was wanting. She stated the facility started in-services on abuse and neglect that evening and the next day they had in-services on resident rights, dementia care and how to recognize burnout. In an interview on 07/15/25 at 4:36 p.m. with Resident #1's Family member, he said he had no concerns regarding the care of Resident #1. He stated the facility contacted him regarding the incident in March 2025 and that they had terminated the CNA. He stated when he saw Resident #1 the next day, she still had a big goose egg on her forehead and a black eye. He stated he regularly visited with Resident #1 and had not observed any change in behavior. He stated she still seemed to like it at the facility. He stated he does not hold the facility responsible for the actions of the CNA A, but stated he did hold her responsible and had told the police he wanted to press charges. He stated she had no business taking care of the elderly. In an interview with CNA B on 07/15/25 at 5:15 p.m. she stated she and CNA A had just come onto shift for their 6 p.m. to 6 a.m. shift on the memory care unit on 03/30/25. She stated the residents were finishing up with their supper. She stated the nurse's station sits in the middle of the large common/dining area and is L-shaped with the opening to the right side of the station. She stated behind the nurse's station was a small table against the wall. She stated she was sitting on the outside of the station at the L reviewing the assignment book and CNA A was sitting at the small table behind the nurse's station eating a sandwich. She stated Resident #1 had walked up behind CNA A requesting to use the phone and CNA A had told her the phone was not working. She stated Resident #1, again asked to use the phone. She stated when CNA A jumped up suddenly from her chair, was what caused her to look up. She stated CNA A turned around and put herself in Resident #1' face, nose to nose and screamed for her to back up and get out of her face and she stated all of sudden CNA A pushed the resident with both her hands open palmed. She stated Resident #1 stumbled backwards and tried to break her fall but could not and fell backwards outside of the nurse's station. She stated there was not another resident behind her. She stated CNA A did not try to catch the resident, but instead just put her hands down to her side. She stated she immediately jumped to run around the station to check on the resident. She stated she did not see her hit her head, but stated she heard the thump, which was very loud. She stated she took a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 5 of 8 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few very hard fall. She stated when she got to the resident, she could see the knot on her forehead. She stated she reached in her pocket to get her phone to call for the nurse. She stated she retrieved her phone, and CNA A reached down and grabbed her arm, which caused her phone to fly across the floor. She stated CNA A asked her what she was doing, and she stated she was calling the nurse, look at her head. She stated when CNA A grabbed her arm, Resident #1 flipped out yelling keep her away from me, she pushed me. She stated she retrieved her phone, called the nurse and stayed on the floor with the resident until LVN C got to the unit. She stated she informed LVN C about what she had witnessed. She stated LVN C assessed the resident and called 911. She stated she was asked to write a statement of what she witnessed, and CNA A was told to write her statement. She stated they removed CNA A from the unit immediately. She stated the ADON came to the facility shortly after the incident and she showed her what had happened. She stated the Administrator was on the phone listening to her describe what had occurred. She stated later that evening, maybe around 10:00 p.m. she received a call from CNA A. She stated she wanted her to write her statement that she witnessed the resident get her feet tangled up and that CNA A had tried to catch her. She stated she told CNA A, but you did not try and catch her, She stated CNA A wanted her to make sure she put in her statement the resident tripped over her feet and she wanted her to send her a screenshot of her statement. She stated she told CNA A OK so she could get her off the phone. She stated once she hung up, she immediately blocked her number. She stated she did not send her a screen shot of her statement. She stated she had no doubt CNA A pushed Resident #1 down. She stated she was interviewed by the police and told them the same thing. She stated she had worked with CNA A for a long time and never witnessed her being abusive toward any of the residents but stated she could be a bit explosive with staff at times. She stated the facility in-serviced them on Abuse and neglect that evening and the next day they were in-serviced on resident rights, dementia care and burn out. She stated she did not hesitate in reporting what she saw. In an interview with the ADON on 07/16/25 at 8:55 a.m. she stated the DON had called her on 03/30/25 after the incident with Resident #1. She stated she only lived about 10 minutes away from the facility, so she arrived probably around 8:00 p.m. She stated CNA A had already left the building. She stated CNA B was very distraught over the incident. She stated she did re-enact the incident with her and was very certain she saw CNA A push Resident #1. She stated she spoke with Resident #1 who was also adamant that she did not fall, but instead was pushed. She stated the resident could not name the person who pushed her. She stated she started in servicing the staff on Abuse and Neglect that evening and then onto to the next day. She stated they also in serviced on dementia care, resident rights, and signs of burnout and how to prevent it. She stated they do abuse and neglect inservices monthly or more frequently if an incident occurs. She stated she had not received any complaints or concerns about CNA A's performance before this incident. In an interview on 07/16/25 at 10:47 a.m. with the Social Worker she stated she was responsible for the safe surveys conducted after the incident with Resident #1. She stated none of the residents had abuse concerns. She stated she was familiar with Resident #1, and did not observe any psychosocial impacts such as change in emotional patterns or behavior since the incident. The Social Worker stated that the facility in-serviced on abuse routinely, was able to name types of abuse and who the abuse coordinator was including reporting requirements. In an interview with the Administrator on 07/16/25 at 11:15 a.m. he stated he was the abuse coordinator, and staff were in-serviced on abuse and neglect monthly and sometimes more often. He stated he was notified by the DON on 03/30/25 of the incident involving Resident #1. He stated they suspended CNA A immediately. He stated Resident #1 was assessed and sent to the hospital for further evaluation. He stated she was returned to the facility later the same day. He stated they (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 6 of 8 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few immediately began in services on Abuse and neglect, Resident rights, dementia care and signs and symptoms of burn out. He stated he reported the incident to the State within 2 hours. He stated the family was notified as well as the MD. He stated they completed their investigation and determined abuse had occurred at the hands of CNA A. He stated they terminated her. He stated in his conversation with CNA A she did not show any remorse or concern for Resident #1, she just kept repeating how many years she had been a CNA and adamantly denied she had pushed her. He stated they held a QAPI meeting on 04/01/25 and put monitoring into place. He stated they interviewed and tested 3-5 random staff members on abuse and neglect, did skin assessments on 3 residents in the memory care unit, the DON reviewed all the weekly skin assessment, and randomly did 3 safe surveys on Interviewalbe residents weekly for 4 weeks and then monthly until June 2025. He stated in addition they were reviewing grievances daily with a resolution within 72 hours. He stated he also communicated frequently with the families, especially the families on the memory care unit. He stated he felt his staff had acted quickly and appropriately during this unfortunate incident and they had done everything in their power to prevent this from occurring. Interviews on 07/15/25 and 07/16/25 across both 12 hour shifts with various staff members, as well as new staff and agency staff (ADON, CNA B LVN C, LVN E, CNA G, CNA H, Staffing Coordinator, CNA I, Agency CNA J, LVN K, RN L, MA M, Agency CNA N, LVN O, CNA P, LVN Q, CNA R, Social Worker and the DON) revealed the facility had conducted abuse and neglect in-services immediately after the incident on 03/30/25 and on a routine basis. The above-mentioned staff members were able to verbalize abuse and different forms of abuse and neglect including reporting to the Administrator who was the facility's abuse coordinator. In addition, the facility had conducted training on Resident rights, dementia care and signs of burnout on 03/31/25. Staff were knowledgeable in re-direction, offering activities, snacks and residents centered activities to assist in behavior management as well as resident rights for refusal a care. Record review of CNA A's personnel file revealed she was hired on 04/01/24 with a last worked date of 03/30/25 and terminated from employment on 04/01/25. The facility had conducted Texas Department of Public Safety Criminal History verification and Employee Misconduct Registry Employability status checks as required and found no bars to employment. Record Review of abuse and neglect in-services conducted by the facility on 03/30/25 revealed that the facility staff was trained on abuse and neglect, types of abuse, who was the abuse coordinator and when abuse should be reported. Record Review of in-services on Resident rights, Dementia Care and Recognizing Burn out reflected the staff were in-serviced on the facility's protocols on 03/31/25. Record review of the facility policy titled, Abuse and Neglect-Clinical Protocol dated October 2022, reflected, The facility will ensure that each resident has the right to be free from, among other things, physical or mental abuse and corporal punishment. The facility will provide a safe resident environment and protect resident from abuse.Staff to Resident Abuse of any Types.The facility assumes the responsibility upon admission of ensuring safety and well-being of the resident.Education fro all staff will be ensured in how to react and reason appropriately to resident behaviors.Staff are expected to be in control of their behavior and behave professionally.The facility will not accept from an employee to claim his/her action was reflexive or knee-jerk reaction' and was not intended to cause harm.Definition.Abuse.the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.Willful.the individual mush have acted deliberately, not that the individual mush have intended to inflict injury or harm. Record review of the facility's policy titled, Resident Rights, dated October 2022, reflected, Employee's will treat residents with kindness, respect, and dignity.be free from abuse.be supported by the facility in exercising his or her rights. Record review of the facility's policy titled, Dementia(continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675212 If continuation sheet Page 7 of 8 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 675212 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Homestead of Denison 1101 Reba McEntire LN Denison, TX 75020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Clinical Protocol, dated November 2018, reflected, .For the individual with confirmed dementia, the IDT will identify a resident-centered care plan to maximize remaining function and quality of [NAME] with interventions that are resident specific. Record review of the facility's policy titled, Recognizing and Dealing with Signs of Burnout, Frustration and Stress that May lead Abuse, dated December 2022, reflected, The facility will make every effort to prevent abuse.Training will be included on these topics in orientation of new employees and at least annually for education and awareness.Behaviors to avoid being accuse of abuse.Never get caught in a shouting match or shoving contest with a resident or staff that would be considered inappropriate.stay calm-maintain a soothing tone of voice.If necessary ask another person to intervene.Always report an incident to your supervisor.Understand resident with Cognitive deficits or Dementia for episode of action out and why they do this. The noncompliance was identified as PNC. The IJ began on 03/30/25 at 6:40 p.m. and ended on 03/31/25. The facility had corrected the noncompliance before the survey began. CNA A was terminated from employment and Resident #1 had no other incidents or signs of harm. The facility staff were reeducated regarding Abuse and Neglect on 03/30/25. Event ID: Facility ID: 675212 If continuation sheet Page 8 of 8