Health inspection·July 2, 2025

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some breakfast that were as hard as a baseball. During this conversation, Resident #3 interjected and stated that he had been taking pictures of the food they had been receiving during meals. Record review of the pictures shared by Resident #3 detailed the following:1. For dinner on 06/26/25 at 5:40pm, residents received a roll, creamed peas, a white tortilla with a small piece of lettuce, a possible piece of meat, and a heavy serving of a white sauce drenched across that tortilla. The food was hard to identify and did not look attractive. 2. For breakfast on 06/23/25 at 7:43 am, he received oatmeal that was shaped in a dome as if it was scooped out with an ice cream scooper and a Cinnabon with frosting. 3. For dinner on 06/22/25 at 5:51pm, he received one piece of what appeared to be a fried chicken strip, a roll, a very small scoop of peas, and a scoop of a red vegetable that could not be identified by Resident #3 or the investigator. In an interview on 06/27/25 at 2:36 pm, the DM stated that she had been working at the facility for 2 years and she started off as a cook. She explained that food was served first in the dining room and came to the halls after all the residents had received a plate. She admitted that she had received complaints regarding the food being cold and portion sizes from Resident #1, Resident #2, and Resident #3. She stated that when the trays came, the staff would let them sit on the hall and delayed passing them out immediately. The DM explained that she had spoken to the DON and nurses about the hall trays and suggested to get additional help from other staff to get trays out faster and to get more residents into the dining room for a hot plate. The interview was cut short due to the DM having prior engagements. In an observation on 07/02/25 at 9:45 am in the kitchen, a pack of ground beef sat in the sink while hot water ran over the meat and a gulf of hot steam came off of the meat. [NAME] A came over and turned the water off and took the meat out of the sink with his bare hands and placed it on a silver tray. The menu for 07/02/25 displayed that lunch for that day would consist of smothered chopped steak, hash brown casserole, green beans, garlic cheese biscuit, banana pudding desert, and a beverage. On a bulletin board, DA A and [NAME] A displayed up to date food service certifications. In an interview on 07/02/25 at 10:03 am, [NAME] A stated that he had worked as a cook in the kitchen for almost 2 months and his schedule was 6am-6pm daily. He explained that when he took the meat out of the sink, he seasoned it and spread it flat the silver pan. He stated that since they were serving smothered steak, the DM told him it would be better to cook that way. He stated that he had a received a few complaints regarding the food and said the criticism was centered around the way the food looked and was presented. He explained that the resident's wanted it a little neater on the plate. He stated that he had tried some of the meals that were prepared by him but he did not like them, but the things he did like he would eat. In an interview on 07/02/25 at 10:24 am, Resident #4 stated she would sometimes try food from the kitchen but it was not her favorite. She stated that the oatmeal came unsweetened and she would have to ask for extra sugar to put on it just so she would be able to eat it. She explained that the food tasted flat, lacked flavor, and was not served hot during meals. Resident #4 explained she stopped asking staff to do things for her because she felt that would put her down. She recalled that one staff (unknown) told her before you know it, you will be a diabetic and she responded before I know it, I will be malnourished because the food has no taste whatsoever. In an interview on 07/02/25 at 11:28 am, the AD stated that in a recent Resident Council meeting, he received complaints that the trays being served on the halls were cold and the food was not good. The AD said he explained to the residents that the DM had no control over the menu and they were pushed out by corporate. He stated that the biggest concern with the resident's was the food not being appealing to. The AD stated that he also told residents to let the aides know any issues with their food and document while he informed the nurses and management. In an observation on 07/02/25 at 11:43 am in the kitchen, three grilled (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675229 If continuation sheet Page 2 of 7 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 675229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Manor Nursing and Rehabilitation 99 Rigby Owen Rd Conroe, TX 77304 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete cheese sandwiches were sitting on the counter. Of the 3, the top slice of bread on one the sandwiches was almost completely brunt. In an interview on 07/02/25 at 12:34 pm, Resident #1 was in his room and had just received his tray from one of the aides off the hall. He stated that his food was cold and the investigator checked the food on his lunch tray using a thermometer. The temperatures were 128 degrees F for the hashbrown casserole, 146 degrees F for the chopped steak, and 118 degrees F for the string beans. The suggested holding temperature should be heated to at least 135 degrees F. On 07/02/25 at 1:30 pm, the investigator began to taste the test tray provided by [NAME] A. The string beans were fine and had been seasoned and cooked properly. The chopped steak was unappealing to the eye and looked like a slab of mashed ground beef covered in gravy. The hashbrown casserole was bland and gummy. In an interview on 07/02/25 at 3pm with the DM, she explained that she trained all staff verbally and [NAME] A trained with her for 4 days but she could not locate any training information when asked. The DM stated she had been working with [NAME] A for two months and felt that he did well initially but had slacked off. She expressed that he had also completed his food handler's certification course when hired, but he would always say that he didn't remember what was covered. She explained that she would often have to redirect [NAME] A on kitchen protocols involving portion sizes, puree's, and using salt, but she felt that he did not follow instructions. Another issue she had with [NAME] A was that he would cook the biscuits too fast and not allow them to brown. Lastly, she expressed that her biggest issues were found the days he worked in the kitchen. The DM was showed the picture of the grilled cheese sandwich from the lunch service and she responded that she had told [NAME] A several times not to serve burnt food. With all of the information presented, the DM said that the kitchen practices performed by her staff could put residents at risk for cross contamination. The DM also informed the investigator that she had recently hired a new cook and she was going to shorten [NAME] A's hours until she was able to remove him from her kitchen because she needed someone who followed direction and was consistent with meal quality. On 07/02/25 at 3:15 pm, a request was made to the DM to attain any training and in-services completed by the DM to [NAME] A. The DM stated she could not remember where she put them and none could be located before the investigator exited the facility. In an interview on 07/02/25 at 4:22 pm with the ADM, he was informed of the errors identified during the lunch meal service. He shook his head and stated that he spoke with corporate and the facility was in the process of ordering new covers for the tray cart that would help keep the food warmer for the residents who chose to eat meals outside of the dining room. Record review of the facility's grievance logs from April 2025-July 2025 displayed no grievances regarding food had been documented. Record review of the facility's policy titled Food Handling revised June 1, 2019, documented that the facility's policy was to ensure that all food served by the facility is of good quality and safe for consumption, all food will be handled according to the state and US Food Codes and HACCP guidelines. Event ID: Facility ID: 675229 If continuation sheet Page 3 of 7 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 675229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Manor Nursing and Rehabilitation 99 Rigby Owen Rd Conroe, TX 77304 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 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 for 1 of 1 kitchen reviewed for sanitation in that: 1. [NAME] A placed a 10lb pack of ground beef in the sink underneath running hot water to defrost for lunch service. 2. Intern A failed to secure her waist length hair in a hair net. 3. [NAME] A failed to use gloves when handling the ground beef for lunch service. 4. During a food temperature check, [NAME] A placed the thermometer in each item of food without properly sanitizing the thermometer between checks. 5. [NAME] A failed to wash hands before utilizing gloves. 6. [NAME] A touched the top of the trashcan with his gloved hands and proceeded to prepare a test tray for the investigator. 7. For lunch service, Resident #1 received food that fell below safe temperatures for hot foods during his lunch service on 07/02/25. The temperatures of the hashbrowns were 128 degrees F and string beans were 118 degrees F. These failures could place residents at risk of foodborne illnesses. The findings included:Record review of Resident #1' s face sheet revealed a [AGE] year-old man who was admitted to the facility on [DATE]. His admitting diagnoses were Hemiplegia and hemiparesis (loss of strength and weakness to a side of the body) and vascular dementia. In an observation on 07/02/25 at 9:45 am in the kitchen, a pack of ground beef sat in the sink and while hot water ran over the meat and a gulf of steam came off of the water. [NAME] A came over and turned the water off and took the meat out of the sink with his bare hands and placed it on a silver tray. There was a handwashing sink a few feet away from where the meat was being thawed, however, [NAME] A did not wash his hands prior to grabbing the meat. Intern A had long orange hair that hung to her waist that was not covered with a hair net. [NAME] A could be observed minutes later mixing the ground beef with his bare hands in a silver pan. The menu for 07/02/25 displayed that lunch for that day would consist of smothered chopped steak, hash brown casserole, green beans, garlic cheese biscuit, banana pudding desert, and a beverage. On a bulletin board, DA A and [NAME] A displayed up to date food service certifications. In an interview on 07/02/25 at 9:59 am, Intern A stated she had been interning in the kitchen as a dietary aide for 4.5 weeks and her last day would be July 11th. Some of her job duties included wrapping silverware for meal services, filling tea cups, clean up, and occasionally serving food in the dining room. In an interview on 07/02/25 at 10:03 am, [NAME] A stated that he had worked as a cook in the kitchen for almost 2 months and his schedule was 6am-6pm daily. He explained that when he took the meat out of the sink, he seasoned it and spread it flat in the silver pan. He stated that since they were serving smothered steak, the DM told him it would be better to cook that way. [NAME] A stated that he didn't normally unthaw meat using hot water but it was taking a long time to thaw out. He stated his normal practice was to place it in a pan of room temp water. When asked what the health concerns were of running partially frozen ground beef under hot water to unthaw and he explained that it depended on the time frame, and [NAME] A had only ran the hot water of the ground beef for 10 minutes. He explained that he worked yesterday (07/01/25), but he forgot to take meat out of the freezer. In an interview on 07/02/25 at 11:14 am, LPN A stated that when the trays came out to the halls for meal services, she tried to push them out immediately. In the past she had gotten complaints of the food being cold, one of the resident's being Resident #1. She explained that when the food was cold, she would take the plate and reheat it in the microwave. In an interview on 07/02/25 at 11:28 am, the AD stated that in a recent Resident Council meeting, he received complaints that the trays being served on the halls were cold. The AD said he explained to the residents that the residents who sat in the dining room were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675229 If continuation sheet Page 4 of 7 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 675229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Manor Nursing and Rehabilitation 99 Rigby Owen Rd Conroe, TX 77304 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 severed first and then trays were pushed out to the halls. He gave them the suggestion to eat their meals in the dining room and the residents understood but they refused to budge, which they have the right to. The AD stated that he also told residents to let the aides know their food was cold and document while he informed the nurses and management. In an observation on 07/02/25 at 11:43 am in the kitchen, the investigator requested temperature checks for the lunch service. [NAME] A grabbed the thermometer out of a basket and walked to the steam table. The temperatures were 200.7 degrees F for the chopped steak, 196.3 degrees F for the hashbrowns, and 174.4 degrees F for the green beans (range should be over 165 degrees F for hot food). During the temperature checks, [NAME] A took the thermometer from the chopped steak, to green beans, to hashbrowns and did not wipe or sanitize the thermometer between food items. Back in the kitchen, [NAME] A wiped the thermometer off with a paper towel and placed it back into the basket. The investigator requested a test tray to sample and [NAME] A grabbed the plate with his hands, but the investigator stopped him and requested he put gloves on prior to serving and told him that she noticed that he had not been wearing gloves. [NAME] A stated that he was supposed to wear gloves while cooking and he normally did. He grabbed a pair of gloves from a corner on the counter and mumbled that they were too small when his left hand burst through the plastic. With the right glove still on his hand, he walked to the trash can, opened the trash can lid with his right gloved hand, tossed the ripped glove inside with his left hand, returned the trash can's top with his right gloved hands, walked back to the box of gloves, and grabbed another glove to put back on his left hand. [NAME] A then returned to the plate to begin serving, however the investigator stopped him. The investigator explained that how he touched the trash can and plate with his gloves was a method of cross contamination. [NAME] A explained that his hands burst through the glove because they were a size medium and he normally wore a size large. When he wore gloves, his hands would burst through the gloves so it was almost like no point. He stated that the kitchen was required to keep the trashcan covered, but he understood how touching the lid with his glove and beginning to plate would be hazardous. When asked why he did not wear gloves when he handled the ground beef form earlier, he stated that he did not know they had gloves so he didn't put any on. On the counter wear the thermometer was held was a box of size large gloves. When asked about his training, he stated that he had completed his food handler's certification course and showed the investigator where it was placed on a bulletin board. In an observation and interview on 07/02/25 at 12pm, the DM entered the kitchen to oversee the lunch service. Intern A hair was still pulled back in a ponytail and no hair net was present. Intern A grabbed a pair of the large gloves, put them on, and began to rub her gloved hands on her mouth and face. The DM noticed that Intern A did not have a hair net on, and in structed her to get a hair net 3 times. After each request. Interne A replied what, huh, WHAT?, I don't know how. The DM grabbed a hair net and took her to the side to help place the net on her head. The DM told her to remove her gloves and walked her over to the kitchen and showed her how to properly wash her hands and gave her new gloves to place on her hands. When intern A was asked why she did not wear a hair net earlier, she explained that she did not normally wear a hair net and although she saw others doing it, no one had ever let her know it needed to be done. In an interview on 07/02/25 at 12:34 pm, Resident #1 stated that his food was cold. The investigator checked the food on his lunch tray using a thermometer. The temperatures were 128 degrees F for the hashbrown casserole, 146 degrees F for the chopped steak, and 118 degrees F for the string beans. In an interview on 07/02/25 at 3 pm with the DM, she stated that Intern A was not employed with the facility, but was a high school student with a work force staffing agency. She said Intern A had worked with the kitchen for less than a month and did not realize that she was not easy to direct. When informed that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675229 If continuation sheet Page 5 of 7 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 675229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Manor Nursing and Rehabilitation 99 Rigby Owen Rd Conroe, TX 77304 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 [NAME] A ran hot water to thaw the meat from today's lunch, she stated that she had gotten on him about that in the past and he was supposed to use cold water because hot water could cook the meat. She expressed that he should have known that from his food handler's certification course, but he would always say that he didn't remember. [NAME] A had also been written up recently regarding wearing improper footwear in the kitchen. She explained that the proper technique was to wear gloves when handling meat and she had often told him that if he was not sure, then he should ask her but she felt that he did not follow instructions. She explained that she trained all staff verbally and he trained with her for 4 days but she could not locate any training information when asked. The DM stated she had been working with [NAME] A for two months and felt that he did well initially, but he slacked off. With all the information presented, DM said that kitchen practices preformed by her staff could put residents at risk for cross contamination, especially using hot water to unthaw the meat and not wearing gloves. The DM also informed the investigator that she had recently hired a new cook and she was going to shorten [NAME] A's hours until she was able to remove him from her kitchen. She explained that since she had been getting complaints, she had started to pop up on weekends to monitor the kitchen staff and she also would assist at meal servings to monitor portion sizes and presentation. She wanted kitchen staff who were able to work without supervision and could train others when she was not there so that she could complete her duties. In an interview on 07/02/25 at 4:22 pm with the ADM, he was informed of the errors identified during the lunch meal service. He shook his head with a grimace and stated that he spoke with corporate and that the facility was in the process of ordering covers for the tray cart that would help keep the food warmer for the residents who chose to eat meals outside of the dining room. Record review of the facility's policy titled Employee Sanitation dated 2018, documented that:1. Employee Cleanliness Requirementsa. All employees must wear clean outer clothing.b. Hairnets, headbands, caps, beard coverings or other effective hair restraints mustbe worn to keep hair from food and food-contact surfaces2. Hand washinga. Employees must wash their hands and exposed portions of their arms atdesignated hand washing facilities at the following times:i. After touching bare human body parts other than clean hands andclean, exposed portions of armsii. After using the toilet roomiii. After coughing, sneezing, using a handkerchief or disposable tissue,using tobacco, eating, or drinkingiv. Immediately before engaging in food preparation including workingwith exposed food, clean equipment and utensils, and unwrappedsingle-service and single-use articlesv. During food preparation, as often as necessary to remove soil andcontamination and prevent cross contamination when changing tasksvi. When switching between working with raw foods and working withready-to-eat foodsvii. After engaging in other activities that contaminate the hands.3. Use of Glovesa. Gloves are not a substitute for thorough and frequent hand washing. Whenusing gloves, always wash hands before touching or putting on new gloves.b. Do not use latex or corn starch powder, which can transfer protein allergensfrom latex to person consuming foodc. Use single use gloves for one task.d. Change gloves:i. Between each food preparation task.ii. After touching items, utensils or equipment not related to task.iii. After touching hair, face or any other source of contaminationiv. When leaving food preparation area for any reason.v. When damaged, soiled or when interrupted.vi. Every hour for all tasks taking longer than one hour.e. Do not store gloves in pockets or aprons. Record review of the facility's policy titled Food Handling revised June 1, 2019, documented that:1. Thawing Foodsa. Thaw meat, poultry and fish in a refrigerator at 41 F or less.b. Foods may also be thawed using the following procedures:i. Completely submerged under running water at a temperature of 70 F or below with sufficient water velocity to agitate and float off loosened food particles into the overflow:1. For a period of time that does not allow thawed portions of ready-to-eat food to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675229 If continuation sheet Page 6 of 7 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 675229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Manor Nursing and Rehabilitation 99 Rigby Owen Rd Conroe, TX 77304 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 FORM CMS-2567 (02/99) Previous Versions Obsolete rise above 41 F; or2. For a period of time that does not allow thawed portions of a raw animal food requiring cooking to be above 41 F for more than four hours including the time the food is exposed to the running water and the time needed for preparation for cookingii. In a microwave oven using the defrost mode and immediately transferred to conventional cooking equipment with no interruption in the processiii. As part of the cooking process3. Hot Food Temperaturesa. Do not remove meats and other raw foods from refrigerator until ready to cook.b. [NAME] comminuted meat (such as hamburger) products thoroughly to heat all parts of the meat to a minimum temperature of 155 F for at least 15 seconds.c. [NAME] raw animal products such as eggs, fish, lamb, pork or beef, except roast beef, and foods containing these raw ingredients to an internal temperature of 145 F or above for at least 15 seconds.d. [NAME] poultry, stuffed fish or meat, stuffed pasta or stuffing containing fish, meat or poultry to 165 F or above for 15 seconds.e. When cooking raw animal foods in a microwave oven:i. Rotate or stir throughout or midway during cooking to compensate for uneven distribution of heatii. Cover to retain surface moistureiii. Heat to a temperature of at least 165 F throughout all parts of the foodiv. Allow to stand covered for two minutes after cooking to obtain temperature equilibrium. Event ID: Facility ID: 675229 If continuation sheet Page 7 of 7