Health inspection·September 5, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm initiate small amounts of pureed textured snacks (not to exceed >1/2 a meal tray for pleasure with SLP supervision or trained caregiver.G-tube placement on 07/28/25. During an interview on 09/03/25 at 1:00 p.m., the DON said the MDS nurse, or she was responsible for updating care plans. During an interview at 2:30 p.m., the Regional Nurse Consultant said they do not have a care plan policy, and that they follow the RAI manual. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675254 If continuation sheet Page 2 of 4 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 675254 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Galveston 3702 Cove View Blvd Galveston, TX 77554 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. 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 maintain an effective pest control program so that the facility is free of pests and rodents for 2 (Resident #2 and Resident #3) of 4 residents reviewed for physical environment. - Resident #2 was in her bedroom sitting in her wheelchair when roaches were observed by Nurse A crawling on her floor, bed, and wheelchair. -A small live roach was observed on the floor of Resident #3's bedroom floor near the doorway. This failure could place residents at risk of experiencing emotional and physical distress. The findings included: Record review of Resident #2's admission Record, dated 09/05/25, revealed an [AGE] year-old female who was admitted to the facility on [DATE]. Her diagnoses included cerebral palsy (a neurological disorder that affects body movement and muscle coordination, typically caused by abnormal brain development or damage), congenital malformation (birth defect) of ear causing impairment of hearing, and mood disorder due to known physiological condition. Record review of Resident #2's Quarterly MDS Assessment, dated 07/16/25, revealed a BIMS score of 99, indicating the resident was unable to complete the interview. Further review revealed resident required supervision or touching assistance with sit to stand and chair/bed-to-chair transfer, and no assistance from a helper with eating. Record review of Resident #2's care plan report, undated, revealed the resident had cerebral palsy affecting cognition, speech, and physical mobility. Further review revealed she had a customized manual wheelchair that was to be kept clean. Resident was dependent on staff etc. for meeting emotional, intellectual, physical, and social needs r/t cognitive deficits and impaired communication. Resident required assistance supervision by staff to eat, transfer, and bed mobility. Resident has a communication problem r/t hearing deficit, noted with unclear speech, sometimes able to understand and be understood verbal communication. Record review of Resident #2's progress notes, dated 08/28/25 at 6:30 a.m., read in part .while repositioning the resident in her chair I notice bugs crawling on the chair.removed the resident from the room and moved her to [room number] so that the room could be cleaned.informed the DON and administrator of the move. Observation and attempted interview on 09/02/25 at 2:17 p.m. made with Resident #2 revealed she was lying in bed watching television. The bedroom floor, bed, and wheelchair were clean and there were no signs of roaches. This Investigator attempted to interview resident but was unable to understand her due to resident's impaired speech. Observation on 09/02/25 at 1:03 p.m., revealed a small live roach on the floor of Resident #3's bedroom floor near the doorway. During an observation and interview on 09/02/25 at 1:03 p.m., Resident #3 was lying in bed. Resident said he was doing good and had not seen any roaches in the facility. Observation and interview on 09/02/25 at 1:05 p.m. with housekeeping staff revealed she identified the bug in Resident #3's bedroom floor by his bedroom door as being a roach. She said they have been spraying for roaches, but they keep coming back. She said she believed the last time the exterminator came out and sprayed was about a week or so ago. During an interview on 09/05/25 at 8:07 a.m., Nurse A said she could not recall the day it happened, but said sometime last week, 08/24/25-08/30/25, when she was working the 10:00 a.m. to 6:00 p.m. shift, she said one night when she went to change Resident #2's brief, she saw roaches crawling on the resident's bedroom floor and on her bed. She said the resident at this time was sitting in her wheelchair on top of a blanket. She said she and another CNA lifted the resident up and she saw roaches on the blanket the resident was sitting on. She said she removed the blanket and saw more roaches on the resident's wheelchair. She said they lifted the resident out of her wheelchair, moved her to another room, cleaned her up, and put her to bed. She said she made a nurses note, texted the Administrator and DON, and told them they needed to discard the wheelchair and get a new one. She said Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675254 If continuation sheet Page 3 of 4 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 675254 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Galveston 3702 Cove View Blvd Galveston, TX 77554 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 0925 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete they both texted her back and said they would take care of it in the morning. She said the DON said she would order a new wheelchair. She said the following night, she went back to the room, and it appeared to have been clean and treated. She said weeks prior to this incident (could not recall date), she saw 4 to 6 roaches in the resident's room. She said she reported it to the DON around her first week of employment, June 18th, and she said the DON said they would have maintenance take care of it. She said the resident would refuse to let staff take her dinner tray out of her room. During an interview on 09/05/25 at 12:48 p.m., the DON said a nurse notified her that there were roaches in Resident #2's room. She said the roaches were reportedly on her wheelchair. She said she asked staff to clean her up and to give her a bed bath. She said they moved the resident to the room next door. She said there were a lot of issues with Resident #2, and she had spoken to the Doctor and NP of psychiatry, because they were having issues with the resident getting very upset and yelling if they took her food items out of her room, specifically her meal tray. She said she notified the Administrator and Director of Maintenance and told them pest control needed to come out. She said she believed pest control came out the following day. She said the NP with psychiatry visited Resident #2 and adjusted her medications and also talked to her guardian. She said Nurse B may have told her that there had been a few roaches in the resident's room prior to this incident, but not to the extent that was reported that evening. She said she did not know what date the roaches were found on the resident's wheelchair. She said the wheelchair was power washed, her old cushion was thrown away, a new cushion was bought, and she believed maintenance tossed the bed mattress. She said Resident #2 was in a new room. During an interview on 09/05/25 at 3:02 p.m., the Director of Maintenance stated he treated Resident #2's room on several occasions. He said her mattress was also replaced about a month ago. He said he did not recall the dates, but just about every time he treated her room, he saw German roaches. He said he would pull out the end table, pull out the outlet, and would see between 10 to 20 roaches each time. He said he would treat the room with roach spray because it killed on contact. He said he did not personally treat the room last week, 08/24/25-08/30/25. He said last week, 08/24/25-08/30/25 (did not know the exact date), they moved the resident to a different room and let the exterminator treat the room. He said pest control had not been effective in Resident #2's originally assigned room. He said every time he went in her room, he found food. He said pest control came out 08/29/25 and treated the room. He said he would see food crumbs on the floor and on her bed. He said pest control came out monthly, and when they called them to come out to do other stuff. He said he also requested the exterminator to exterminate Resident #2's room on 08/20/25. He said having roaches in a bedroom could affect a resident's ability to sleep, their health, and cause discomfort. Record review of pest control invoice, dated 04/16/25, revealed location in/out was treated for roach prevention. Record review of pest control invoice, dated 05/21/25, revealed Residents #2's room was one of several other locations treated for roach prevention. Record review of pest control invoice, dated 06/18/25, revealed interior/exterior was treated for prevention of roaches, ants, and spiders. Record review of email from pest control, dated 07/16/25, revealed treatment was performed on 07/16/25. Record review of store invoice, dated 07/25/25, revealed one-9 oz can of roach spray was purchased on 07/25/25. Record review of pest control invoice, dated 08/20/25, revealed in/out location was treated for roach prevention. Record review of pest control invoice, dated 08/29/25, revealed Resident #2's room was one of several other locations treated for roach prevention. Event ID: Facility ID: 675254 If continuation sheet Page 4 of 4