Inspection·October 30, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few assistance for ADL care and at the time of this assessment, CR #1 was not at risk for elopement. Record review of CR #1's Progress Note dated 03/13/2025 written by MD stated, resident unable to obtain due to cognitive impairment/dementia/inability to cooperate. Psychiatric alert and oriented x1. A discussion was assisted with SW L with the resident stated, patient surrogate decision maker was family, and the patient does not have the capacity to make decisions for himself at this time and needs assistance with decisions. With the diagnosis of mood disorder with psychosis, consult behavioral health services, patient to remain in secured unit and monitor for any agitation or aggression. Record review of the facility's undated self-report read in part, .Incident Details: Date/Time you first learned of incident: Reported to Administrator . patient (CR #1) went through the window from the secure unit. Approxiametly (sic) at 5:30 - 5:45 pm. Police have been called . Date/Time the incident occurred: approximately Sunday March 23rd approximately 5:30 5:45. Record review of Reporting to HHSC Complaint and Incident Intake dated 03/23/2025 at 7:33pm by ADMN stated, at this time, CR #1 eloped from the secure unit, via e-mail. Record review of Reporting to HHSC Complaint and Incident Intake dated 03/23/2025 at8L27 pm by ADMN stated, at this time, CR #1 is found safe, approximately 8:20pm near his home. Follow up with Ombudsman and family has been done, via e-mail. Record review of CR #1's Nurses Note dated 03/23/2025 at 10:55pm written by LVN W stated the on-call supervisor was contacted and dispatch was notified of Resident #9 eloping from the facility. Record review of CR #1's Social Service Note dated 03/23/2025 written by SW L stated resident has eloped from the facility and police were notified. The family was contacted, and SW L received an address for where CR #1 lived prior to being admitted to the previous facility. Record review of CR #1's Alert Note dated 03/23/2025 written by SW L stated resident was spotted at his old address by a neighbor who provided the resident with $40.00 and a bike. Staff were unable to locate the residents by this time. Record review of Secured Unit schedule for 03/23/2025 revealed, 1 LVN, 2 CNA's, and 1 CMA were assigned for 2pm-10pm. Record review of CR #1's Social Service Note dated 03/24/2025 written by SW L went to the residence of CR #1 and spoke face to face regarding the signature of an AMA. CR #1 was asked if he wanted to return to the facility and he stated he did not want to come back. During the time of speaking with CR #1, the Ombudsman was called where CR #1 stated again he did not want to return to the facility. The administrator was also contacted via telephone with the DON on the line CR #1 also stated that he did not wish to return to the facility and signed the AMA at that time. CR #1 was not assessed prior to the SW L leaving the premises nor was he screened for BIMS. Record review of corrective actions' facility implemented beginning on 03/24/2025.The facility had CR #1 sign an AMA form to be discharged from the facility to home. Increased staffing on the secured unit by 1 CNA for monitoring. Staff were re-educated on elopement prevention with in-services on 03/24/2025 and 03/27/2025. The window and screen was were replaced by Maintenance and screws were placed in the windowpane to prevent future elopements. Record review of facility in-service on 03/24/2025 for elopement brief outline of contents: If an employee observes a resident leaving the premises he/she should; 1. Attempt to prevent the resident from leaving. 2. Seek help from staff nearby. 3. Inform another member to inform the Charge Nurse, Administrator, Social Worker, and ADON's. Conducted by LVN S and signed by staff. Record review of Secured Unit schedule for 03/24/2025 revealed, 2 LVN's, 2 CNA's, and 1 CMA were assigned for 2pm-10pm. Record review of in-service on 03/27/2025 for elopement brief outline of contents: If an employee or family member sees or reports a resident leaving or attempting to leave the premises, he/she should attempt to prevent the resident from leaving in a courteous manner, notify nursing staff, administrator, director of nursing, and social worker immediately. Do not leave the resident alone. Notify Medical Director and Responsible Party. Complete the following: incident report, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675231 If continuation sheet Page 2 of 6 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 675231 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Jacinto Rehab LP 1405 Holland Houston, TX 77029 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few wandering assessment, call police for case #, and 15-minute monitoring for 72 hours. Conducted by LVN S and signed by all nursing staff. During an interview with the ADMN on 10/14/2025 at 10:56am, she stated CR #1 had a history of elopements from the window while in secured unit. The ADMN stated the resident wanted to go see the mother of his kids and the next day he eloped. She stated the resident signed an AMA form after eloping because he did not want to return to the facility. The ADMN did state they were not present when the residents eloped, so they were only informed of what took place via telephone by the DON. Once it was verified CR #1 was no longer at the facility or surrounding areas, the incident was reported to HHSC and followed through with an investigation to locate CR #1. The ADMN stated the reason for the resident being in the secured unit was based off family and what information was provided at admission. She stated the reason are based off the residents diagnosis or if the family's input. The ADMN stated she did not recall specifically why the resident was placed into the secured unit but does know it was for a reason, and it would be based on their BIMS score. During an interview with DON on 10/14/2025 at 12:06pm, she stated she was contacted by nursing staff the resident eloped, and a perimeter search would need to be started, and she also contacted the family. After speaking with the family, she was told the resident was at his previous home and contacted his RP who provided him with $40.00 and a bike. The resident was not found the night he eloped from the facility, but the social worker did go to the previous home of the resident the next morning. The ombudsman called and stated the resident was able to sign himself out by using the AMA form. The DON was unsure of how the resident eloped from the facility and stated she was unsure because it was so long ago and could not remember. The secured unit does not have an alarm on the windows, or any other windows at the facility. The DON stated the next day, she does remember the window had to be replaced and they were informed by someone from the state they are able to put nails on the windows, but the window could not be raised greater than 3 inches, so that's what they did to every window at the facility. The DON stated this was the first time a resident had eloped out of the window from the secured unit. The resident did not give any indication of exit seeking behaviors before he eloped and appeared to be a very pleasant guy, quiet. The DON stated the reason why the resident was put into secured unit was due to him attempting an elopement at a previous facility and it was recommended for the resident to remain in the secured unit, as that was where he was at in previous facility. The DON stated the resident could not sign himself out due to him being in the secured unit, but he was evaluated on 02/17/2025, where it revealed the resident was a high-risk wanderer, which was why he remained in secured unit. The DON stated it would be considered a restraint for the resident to be placed on the secured unit based on his BIMS solely, but because had had an history, it was not considered a restraint. The resident's family member also wanted him to stay in the secured unit because the family knew he was at high risk for wandering. The DON stated she did not know how the resident was able to elope from the facility and get to his previous home. The facility had since done elopement in-services to educate staff on what to do in case of an elopement. In the case of an elopement, staff are to checking any and all closed doors, anywhere a resident could be hiding, immediate location of the facility and surrounding areas, teams are broken out and the perimeter is searched until the resident is found. If the resident is not found within 15-30 minutes Law Enforcement will need to be contacted. The facility hired a third CNA to the secured unit for greater monitoring and to prevent elopement. The DON stated the risk of the resident eloping was being killed because the facility was on a main highway. The resident could have also been hurt because the facility was also in a dark crime area. The DON was not present when the resident was found, therefore he was never accessed for possible injury. In an interview with CR #1's family member on 10/14/2025 at 12:35pm (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675231 If continuation sheet Page 3 of 6 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 675231 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Jacinto Rehab LP 1405 Holland Houston, TX 77029 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few stated the reason the resident was in the secured unit was he left out of the window at a prior facility was successful, although he was found shortly. The family member stated the resident was living on his own before going to the hospital, and it was recommended that he did not live alone. The family member stated they did keep the lights and water on, should the resident ever return. The family member stated the resident could not be in a nursing home and not be secured because he would try to leave. The day the resident eloped; it was unsure of how the resident got back to his previous address but stated that it was within 9 miles of the facility. Observation of facility windows on 10/14/2025 at 1:15ppm with LVN P for the following rooms: room [ROOM NUMBER] measured at opening no more than 2.5 inches on the right and 3.5 inches on the left (secured unit). room [ROOM NUMBER] measured at opening no more than 5 inches to the left and unable to measure the window to the right due to a resident in bed (secured unit). room [ROOM NUMBER] measured at opening no more than approximated 6 inches. room [ROOM NUMBER] measured at opening 5.5 inches. LVN P stated in case of emergency or fire, in the secured unit there are 5 emergency exits that can be used to ensure residents are out of the facility safely. The only risk would be if the residents could possibly catch fire if in proximity and the windows not being able to open entirely. During an interview with MD on 10/14/2025 at 2:38pm stated she was notified by the DON of the resident eloping from the window. MD stated if the resident has exit seeking behaviors it has been an understanding the resident should be in a secure unit and use clinical judgment, not based on the BIMS score. The MD stated if there was a risk of elopement, the recommendation was for the resident to be in the secured unit. She stated with a diagnosis of dementia, if the residents scored well on the BIM's, ADL wise the resident may not be able to care for themselves. The MD stated they can contradict each other but if the resident was in the secured unit he was not competent enough to sign himself out. The MD recalled the resident being able to make decisions but could not recall the specifics of decision making. The MD was not aware of CR #1 signing the AMA form, as she stated that would not have been necessary because the resident had already left the facility. The MD stated she was under the impression the family wanted the resident to be back home but did not question their reasoning or who was to care for the resident. The MD stated she was also informed the resident did not want to return to the facility. The risk of elopement was ultimate and could cause harm to the resident or injury, which would be the worst-case scenario. During an interview with LVN W on 10/14/2025 at 4:08pm, she stated she was present the day CR#1 eloped from the facility. She stated the resident was acting normal all day with no signs of wandering/elopement and as trays were being passed out, that was when it was noticed the resident escaped from the window. There were no witnesses to the resident leaving the facility. The resident pushed the window screen out and she was unsure if the resident being injured as he eloped. Record review on 10/15/2025 of In-Service Education on 09/24/2025 for Virtual Dementia Tour with a brief outline of; examine his or her current perception of dementia, experience the virtual dementia tour environment while attempting to complete five activities of daily living such as dressing, eating, or setting a dinner table, compare pre and post virtual tour perceptions during a post tour debriefing session, and propose a strategy for how to effectively interact with individuals with dementia. This in-service was facilitated by RD M and signed by 38 facility staff members. Record review on 10/15/2025 of policy for Discharging a Resident without a Physician's Approval (revised October 2022) .3. If a resident wishes to be discharged to a setting that does not appear to meet his or her post-discharge needs, or appears unsafe, the facility will treat this situation similarly to refusal of care, and will:a. discuss with the resident, (and/or his or her representative, if applicable) and document the implications and/or risks of being discharged to a location that is not equipped to meet his/her needs and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675231 If continuation sheet Page 4 of 6 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 675231 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Jacinto Rehab LP 1405 Holland Houston, TX 77029 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete attempt to ascertain why the resident is choosing that location;b. document that other, more suitable, options of locations that are equipped to meet the needs of the resident were presented and discussed;c. document that despite being offered other options that could meet the resident's needs, the resident refused those other more appropriate settings; andd. determine if a referral to Adult Protective Services or other state entity charged with investigating abuse and neglect is necessary. The referral should be made at the time of discharge. Record review on 10/15/2025 of policy for Wandering and Elopements (Revised March 2019).The facility will identify residents who are at risk of unsafe wandering and strive to prevent harm while maintaining the least restrictive environment for residents.If identified as at risk for wandering, elopement, or other safety issues, the resident's care plan will include strategies and interventions to maintain the resident's safetyIf an employee observes a resident leaving the premises, he/she should:Attempt to prevent the resident from leaving in a courteous manner;- Get help from other staff members in the immediate vicinity, if necessary; and- Instruct another staff member to inform the Charge Nurse or Director of Nursing Services that a resident is attempting to leave or has left the premises.If a resident is missing, initiate the elopement/missing resident emergency procedure:1. Determine if the resident is out on an authorized leave or pass;- If the resident was not authorized to leave, initiate a search of the building(s) and premises; and- If the resident is not located, notify the Administrator and the Director of Nursing Services, the resident's legal representative, the Attending Physician, law enforcement officials, and (as necessary) volunteer agencies (i.e., Emergency Management, Rescue Squads, etc.).When the resident returns to the facility, the Director of Nursing Services or Charge Nurse shall:1. Examine the resident for injuries;2. Contact the Attending Physician and report findings and conditions of the resident;3. Notify the resident's legal representative (sponsor);4. Notify search teams that the resident has been located;5. Complete and file an incident report; and6. Document relevant information in the resident's medical record During an interview on 10/30/2025 between 9:17am and 11:13am CNA P, LVN W, CNA C, CNA V, HSK B, AA L, LVN G, LVN, M and CNA H and between 11:56am and 1:48pm CM M, CNA A, CNA W, LVN M, were able to state they were in-services on elopement. Staff stated once it is announced that a resident has eloped from the facility they immediately begin checking all areas in the facility, to include all closed off spaces. If the resident is not found inside the facility, teams are formed to monitor the inside and a thorough search is conducted outside of the facility by a team. If the resident is not located within a perimeter of 5-10 minutes from the facility, Law Enforcement must be contacted, along with ADMN and DON to start an official investigation and file an incident report with State. During an interview with Ombudsman R on 10/30/2025 at 11:26am he stated he was unaware of any resident eloping from the secured unit from a window and he could not provide any information regarding the elopement. Observation of Elopement Drill on 10/30/2025 at 11:28am revealed the announcement of a missing resident over the intercom and to follow elopement procedure to locate the resident safely. Event ID: Facility ID: 675231 If continuation sheet Page 5 of 6 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 675231 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Jacinto Rehab LP 1405 Holland Houston, TX 77029 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure Residents who are incontinent of bowel and bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extend possible for 1 of 5 residents (Resident #1) reviewed for incontinent care. CNA A failed to place the urine collection bag of the indwelling urinary catheter below Resident #1's bladder after transferring from bed to chair.The failure could place residents with indwelling urinary catheters at risk for infection from potential backflow of urine into the bladder. Findings included:Record review of Resident #1's face sheet dated 10/16/25 revealed a [AGE] year old admitted to the facility on [DATE]. Resident #1's diagnoses included chronic kidney disease, and retention of urine.Record review of Resident #1's annual MDS dated [DATE] revealed a BIMS score of 10 out of 15 indicating moderate impaired cognition. Resident #1 was dependent on staff for most ADLs and had an indwelling urinary catheter.Record review of Resident #1's undated care plan included the following: * Resident #1 had renal insufficiency r/t acute kidney disease and acquired absence of kidney. Goal included: The resident will be free from infection through the review date, target date was 11/29/25. Interventions included: monitor for signs and symptoms (s/sx) of acute renal failure. *Resident#1 had a foley catheter d/t obstructive uropathy and urinary retention. Goal: The resident will show no s/sx of urinary infection through the review date. Interventions did not include keep urinary foley bag at a level below the resident's bladder.Record review of Resident #1's active order summary report dated 10/16/25 revealed and order for Cefdinir 300 mg capsules by mouth two times a day for urinary tract infection (UTI) for 7 days. Start date was 10/11/25.Observation on 10/15/25 at 1:35PM, Resident #1 was asleep in a recliner inside the resident's room. The urine collection bag was hooked on the armrest of the recliner which was at a level above Resident #1's bladder. In an interview and observation on 10/15/25 at 1:35 PM, LVN B stated the urine collection bag was higher than Resident #1's bladder and it should not be at or above the bladder d/t risk of infection as the urine could back up into the bladder. LVN B stated Resident #1 was being treated for a UTI. LVN B repositioned the urine collection bag below the level of the bladder.In an interview on 10/15/25 at 1:45PM, CNA A stated she and another CNA transferred Resident #1 from the bed to the recliner at 10:15 AM and said the collection bag should be below the bladder. CNA A stated the risk would be infection. CNA A asked the surveyor if she left the bag in the wrong place. CNA A stated she was rushing to get to another resident after transferring Resident #1.In an interview on 10/15/25 at 1:57 PM, the DON stated urinary collection bags should be below the level of the bladder for drainage and the risks were infection such as UTI. The DON stated Resident #1 gets UTI's frequently due to refusals of care. The DON stated the CNA's were responsible to ensure the urine collection bag was placed properly.Record review of the facility policy for Urinary Catheter Care revised on August 2022 read in part: The purpose of this procedure is to prevent urinary catheter-associated complications, including urinary tract infections.Maintaining Unobstructed Urine Flow.3. Position the drainage bag lower than the bladder at all times to prevent urine from flowing back into the urinary bladder. Event ID: Facility ID: 675231 If continuation sheet Page 6 of 6