Inspection·September 30, 2022

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some RM [ROOM NUMBER]- Resident #1 urinates in floor, urinates in closet, and drawer. She uses a cleaning solution, deodorizer. She stated that the resident even urinates in the trashcans and in other residents' room. She stated that staff take him to the restroom when first getting up. Resident #55 can become physical at times and when they try and get him to the restroom to prevent him urinating outside the restroom. She stated she wipes the furniture and cleans behind it and she's talked to Maintenance Director about possibly replacing the furniture and they try and keep ahead of things. In an observation and interview on 09/29/22 at 09:30 AM revealed the odor of urine was gone from all five of the resident's rooms. Record review of the Infection Control Checklist dated 2022 and completed quarterly stated that the Cleaning Procedures listed were met for the third quarter. The cleaning procedures were not listed on this document. Record review requested by this survey from the Administrator for the cleaning policy which was undated titled, admission Room-Ready Prep & Guarantee form listsed that Housekeeping cleans: bed frames, headboard and footboard, call light cord and bed control & TCV remote, drawer fronts, closet doors all sides of bedside table, room chair legs and seating, floor & wall protectors, window blinds, window track and sill, exterior of Packaged Terminal Air Conditioner (PTAC) unit, light fixtures, remove any tape on walls, lights, doors, closet door, drawer, inside and out & hardware, bathroom door and walls, bath fixtures and floors, bath emergency pull cord, toilet surfaces and floor edge, overbed tabletop, underneath and base (hair & strings out of wheels), TV screens top and sides, and finally walls. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 2 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide an ongoing program of activities designed to meet the interests and the physical, mental, and psychosocial well-being of 4 of 4 residents reviewed for activities. Residents Affected - Many At the confidential group interview residents stated there were no organized activities most days and never on weekends. This failure could place residents who could attend activities at risk of boredom, depression, and a decreased quality of life. Findings include: Interview 09/28/2022 at 10:00 AM Resident Counsel Meeting. Basically, residents have no activities in the facility. Activities are whatever residents arrange on their own to do. Activities consist of bingo once or twice a week and this only began 2 weeks ago. Before then, the facility was not offering anything for the residents to do. Residents had learned to entertain themselves since there are no activities. Interview 09/29/22 at 10:40 AM SC stated she works Monday thru Friday from 8:30 AM to 5:00 PM and does not work weekends. SC assists RA with activities since the facility does not have an AD at this time. SC stated at 11:00 AM 09/29/22, her and RA are doing Bingo in the dining room. RA usually tries to do activities twice a day. SC was unaware who if anyone did activities on the weekends. Interview 09/29/22 at 11:00 AM RA stated she works Monday thru Friday from 8:00 AM to 5:00 PM and does not work weekends. RA stated she had been covering activities for the last 30 days since the previous AD resigned at that time. RA stated she tried to hold activities twice a day in the dining room. RA stated that there is an activities schedule for September 2022 created by the AD before she resigned. The AD is responsible for creating and following the activities schedule. RA stated in addition to covering activities, RA is responsible for covering central supplies and restorative care with residents. As such, RA stated it is difficult for her to follow the activities schedule. Therefore, she allows residents to determine the activity the enjoy most to ensure participation. RA stated she goes from room to room asking residents their preferred activity. When the majority agree on the activity RA and the other staff again go from room to room informing residents of the time of the activity and encouraging all to participate. RA stated she does not know if the facility holds activities on the weekends. RA stated she goes room to room painting female resident's nails and reading or playing eBooks for the male residents who cannot physically get to the dining room for activities. RA is presently reading a [NAME] to Resident #52. RA stated she does not document her activities interactions with residents and did not have an answer as to why not. She stated at this time she has not offered any other activities to residents that cannot get to the dining area. She stated there are several activities that the residents can do such as bingo, puzzles, coloring books, and painting. RA also offers residents root beer floats, popcorn socials, and the monthly birthday cake to celebrate resident's birthdays each month. RA stated that she did not create the September 2022 activities schedule. RA stated that the are no activities calendars for the coming months. RA stated AD resigned without notice. RA also stated that the AD either destroyed or took all the activities records with her because there were activities documentation prior to AD resigning and once AD left, the activities documents were unlocatable. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 3 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interview 09/29/22 at 12:21 PM Administrator stated AD's last day with the facility was 08/01/22. Administrator was trying to rehire for the AD position. The facility was not following the Activities Schedule at this time. The activities scheduled notes at the bottom subject to change. There was no activities log since the AD resigned. The facility holds several activities: movies at night., coloring and bingo. Today, 09/29/22, the facility will be having birthday cake and ice cream to celebrate residents born in September. On the weekends, all staff assist in activities for the residents. Coloring pages, activities books and puzzles are left at the nurse's station to be passed out to residents interested in activities. Residents on the 300 hall really enjoy the coloring pages. Up until 09/26/22, MDS worked Saturdays and Sundays and headed activities. MDS now works Monday through Friday and every other weekend. MDS will continue activities on her weekend shifts and CNAs will assist MDS and oversee on the weekends that MDS is not scheduled to work. There is no activities log of residents who participated in activities. The AD was responsible for the resident council meeting minutes and the activities calendar. Administrator stated when AD quit, AD was disgruntled and the resident council meeting minutes, activity calendars, activity log, grievance log and grievances went missing. Administrator stated there is no activities policy. Interview 09/29/22 at 12:37 PM MDS stated she was scheduled on weekends until 09/26/22 when she was promoted to MDS. Since, 09/26/22, MDS stated she works throughout the week with one or two days off and every other weekend. MDS stated when she works the weekend, she is the weekend's supervising charge nurse and does the activities with the residents. She stated the residents enjoy various activities such as ice cream socials, playing old movies on the big tv in the dining room, playing music and dancing/exercising and or moving in their chairs. She stated residents prefer to have bingo every day. She stated residents have expressed that they enjoy bingo the most. She stated if residents could create the activities schedule that is all the residents would prefer to do. MDS stated she also goes room to room visiting with residents who cannot get up and gather for activities. MDS stated she takes those residents newspapers, coloring material and shares her Lego fish tank made by her 9-year-old son. She stated the residents enjoy the bright colors of the Lego fish tank Observation on 09/27/22 at 10:35 AM no football pictures activities in dining room per activities schedule. Television was playing a daytime talk show and 6 residents were sitting by themselves at tables. The resident were not doing any activities and there were no staff present. Observation on 09/27/22 at 11:30 AM no lunch time trivia in the dining room per activities schedule. Television was playing a daytime talk show and 6 residents were sitting by themselves at tables. Observation on 09/27/22 at 02:45 PM no football bingo in dining room per activities schedule. Television was playing a movie and 3 residents were sitting by themselves at tables. Record review of the Activity Calendar for the month of September 2022. Activities scheduled for every day in the month of September 2022 to include Monday through Friday and Saturday and Sunday. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 4 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety in 1 of 1 kitchen reviewed for food procurement in that: Facility failed to maintain proper storage, label and/or date. These failures could place residents at risk of foodborne illnesses and disease. Findings included: Observation of the 1 of 2 refrigerators in facility's kitchen on 09/27/22 at 09:48 AM revealed: Green lid plastic container of raw ground like meat with no labeling and/or date. Observation of the 1 of 2 freezers in facility's kitchen on 09/27/22 at 09:54 AM revealed: Unsealed and unlabeled and/or dated plastic bag of breaded meat like patties (3.5 pieces). Unsealed and unlabeled and/or dated plastic bag of Chicken Tenders (5-lbs). Interview 09/27/22 at 09:48 AM DM stated that the meat in the green lid container is ground beef. DM stated that [NAME] A used the meat on 09/26/22 to prepare meatloaf for lunch. DM stated it was the responsibility of [NAME] A to label and seal the meat before returning it to the refrigerator. DM stated the 3.5 pieces of breaded meat patties were fish. [NAME] B cooked the fish patties 09/26/22 for dinner along with the Chicken Tenders. DM stated that it was [NAME] A and [NAME] B's responsibility to store, secure and label opened foods before returning them to the refrigerators and freezers. DM stated the adverse effects of not labeling food properly are cross contamination and potentially serving expired food that could cause harmful sickness or disease to residents. Interview 09/27/22 at 10:15 AM [NAME] A stated that the green lid container of ground meat is ground beef used for meatloaf and ground beef patties at lunch on 09/26/22. She stated she forgot to label the meat container because she was distracted with maintenance installing the new stove between 10:00 AM and 03:00 PM. [NAME] A stated the meat container should have been labeled and dated before placing back in the refrigerator. She has been trained on proper food storage and foods opened must be dated and labeled before returning to storage. The risk of not labeling and storing food properly are cross contamination and serving residents expired food. This risk could cause residents to become ill. [NAME] B has not been on shift in a few days. If he returns, he will be asked to contact this Surveyor. Interview 09/30/22 at 12:50 PM Administrator stated she was unaware of the unsealed and unlabeled food storage in the kitchen. Administrator stated that it was the responsibility of all the dietary staff to store and label opened foods after usage. Failure to properly store and label food could result in resident's receiving expired food that may be harmful to the residents. Interview attempt 09/28/22 at 11:35 AM. [NAME] B's telephone number disconnected. Record Review of Nutrition Orientation & Competency Policies and Procedures revision date 02/01/2019 revealed Food Storage: If food is not stored properly, chances are that it will spoil quickly. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 5 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Remember these pointers for storage: Label and date new food items removed from their original containers. Tightly reseal open packages . Keep all containers of food tightly covered. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 6 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to adequately equip residents' rooms to allow residents to call for staff assistance through a communication system which relays the call directly to a staff member or to a centralized staff work area for 11 of 11 rooms, reviewed for communication system, in that: Residents Affected - Some Residents did not have a functional call light or communication system in their rooms. This failure could affect residents and could result in a diminished quality of life, and injury due to not being able to call for assistance. Findings included: Interview and observation with Resident #44 on 09/27/2022 at 09:40 A.M. There was no call light present in the room. The resident stated when she needs help, she calls out for help. She stated that staff check on her every 20 mins or so and she had no complaints or issues. There was no call light in the resident's room. Interview on 09/27/2022 at 10:29 A.M. with RN 2 stated that most times they make rounds every hour, the residents don't have call lights because of safety nets, to prevent injury to themselves. Some of them chew on it and that's not safe. When asked who is chewing on the cords she stated that was an assumption. She stated some residents tear up paper towels and try to eat them. We do whatever we can and we also don't want them to hang themselves. To monitor the residents, if between rounds if staff don't see a resident in the dining room they go and look for them and check on that resident. There is always someone around to hear or see if a resident needs help and they call on us if they need help. Interview on 09/29/2022 at 1:28 P.M. with Maintenance Director stated the call lights in all of them are down for safety reasons. The call lights have not worked in the since he's been here they have not worked. He started in 2020 and the unit has been that way since 2017. He stated that the call lights in the rooms are tied into the ones in the bathrooms. Interventions that are used in place of the call lights are the nurse and CNA are present at all times and they walk the floors every 15-20 mins. If residents are not in the dining room they walk the floor and check on residents, if they're in the restroom they check on them there. Interview on 09/29/2022 at 2:04 P.M. with Administrator stated that Maintenance Director said the call lights have not worked since 2017 and that staff constantly walk the halls to monitor the residents. Interview on 09/29/2022 at 2:09 P.M. the Specialist who stated that she spoke with the Maintenance Director who stated that the call lights are not present for safety reasons that the residents would get entangled with the cords and also why there are no curtains and only blinds on the windows. The CNAs and the RN are always in the unit and don't leave until someone else replaces them. She stated that there is no official specific written policy for the secured unit regarding not having call lights in place. Interview on 09/29/2022 at 2:35 P.M., In place of call lights, the facility has staff do frequent (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 7 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some rounds. RN 2 stated they do not have a log of when rounds have been done. In the mornings there are 2 CNAs, the afternoon there is 1 CNA, 1 RN, and at night 1CNA, 1 LVN in the hall. She stated that if the CNA is doing something with a resident, then she will be watching the residents. Tues for example, the ADON came in to replace the CNA. She stated that she takes lunch in the office in the hall. Interview on 09/29/2022 at 2:44 P.M., with CNA C, In place of call lights, the facility has staff do frequent rounds. she does rounds every shift. Every 8 hours she does rounds. She checks on the residents, talks with other CNAs and inform them of what's been happening. If she is dealing with a resident, then when she finishes with the current resident then moves on to the other resident. When she takes a break, the nurse watches the residents. Interview on 09/29/2022 at 2:48 P.M., with Resident #44 stated that staff are constantly walking up and down the hall, or every 15-20 minutes. She was asked what she would do if she needed assistance or help. The resident stated stated that if she needed help with something she would call out for staff. She also stated that sometimes visitors are here to help and they would get staff's attention. Observation on 09/29/2022 at 2:55 P.M., of Specialist, Maintenance director, and the Administrator. They attempted to plug in call light cords into the wall to test the call lights in room [ROOM NUMBER]. An alarm sounded somewhere, but neither the light on the wall in the resident's room or the light outside above the resident's room lit up. Interview on 09/30/2022 at 11:22 A.M., with the MDS Nurse. She stated regarding delays in resident care that there are none that she's aware of. She has not seen or heard of residents receiving delayed care due to the lack of call lights. They make such frequent rounds. Even when there are falls we find them quickly. They recently starting today, 09/30/2022 started doing rounds every 10-20 minutes. She stated we didn't have a set time when doing rounds before, but there was always someone walking around keeping an eye on residents. She was asked if it was just her just her working how would she handle multiple residents needing assistance. She stated there are always at least 2 staff. There has never been only one staff in the unit. She stated she was MDS before, but she became weekend nurse recently. Only issue was when a staff couldn't remember a password and they were banging on the door, but in a pattern and she knew it was staff. No resident has had delayed care. If she needed additional help she would call for staff on their cell phone. She has each other's phone numbers. If needed, they could also open the fire door and ask for assistance. She would just yell out that she needed help after opening the secured door. During our interview she was observed to have done a round check on the residents. Interview on 09/30/2022 at 11:25 A.M. with CNA A stated she's been working here since June, she usually works 100 Hall, but she does rotate working other halls. She has not seen or heard of residents receiving delayed care due to the lack of call lights. She was asked if there were no other staff in the hall she stated and if she's dealing with a patient and the other staff is resident busy, before she handles her resident then she would get additional assistance from another hall, a CNA, or a nurse. She stated that if both staff were in emergency situations with residents, she would stop what she's doing, ensure the resident is ok temporarily, and get additional assistance. If it's an emergency, she would cover them, lock the wheelchair if applicable, and she would walk out and get the help. She was asked what she would do when there is only one staff is in the hall she stated that since she's been here, she's never worked alone, there has always been other staff working in 300, it's another CNA and a nurse. Interview on 09/30/2022 at 11:37 A.M. with CNA B when asked how often a resident has been delayed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 8 of 9 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 675214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/30/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Solidago Health and Rehabilitation 1720 N Logan St Texas City, TX 77590 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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some care because of a staff did not know that a person needed care. She has not seen or heard of residents receiving delayed care due to the lack of call lights. She stated she is going to handle the resident she is with first, and then call out for help. If there is only the nurse and the aid back here. She would triage the current resident and see about the other resident that needs assistance. She was asked what she would do when there is no other staff in the hall She stated she has never been worked alone. There are always 2 staff, a CNA and a nurse. She was asked what to do to get help. She stated she would verbally call out or blows her (personal) whistle, or she would call someone from the office to the outside. She would evaluate the situation with the current resident before leaving to make the call first. Interview on 09/30/2022 at 11:45 A.M. with Specialist, stated that the facility has implemented rounds checks in the 300 hall for staff and created a log book where staff will log each time their rounds were completed due to the lack of call lights in the hall. Staff know to call out for help via through the fire door, using their cell phones, or having another staff temporarily leave the hall to get additional assistance. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675214 If continuation sheet Page 9 of 9