Health inspection·November 25, 2025

F 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 10/11/25 incontinent care was documented as provided once at 11:16am. The CNA noted she required full staff performance of task. In a telephone interview on 10/16/25 at 12:56pm, Resident #1's family member stated she visited the facility in the evening around 7:00pm on 10/11/25. She said when she arrived, Resident #1 her hair, gown and bed were soaked with urine, and her room was permeated with a pneumonia odor. She said she changed Resident #1's brief herself and told the nursing staff. She could not remember their names. In an interview on 10/29/25 at 2:28pm, CNA A said he was not assigned to work on Resident #1's hallway during the month of October 2025. The surveyor attempted to contact RN A on 10/29/25 at 2:03pm without success. The surveyor attempted to contact CNA B on 10/29/25 at 2:31pm without success. Resident #2 Record review of Resident #2's admission record generated on 10/29/25 revealed he was admitted to the facility on [DATE] and had diagnoses of hemiplegia (paralysis of one side of the body) and hemiparesis (one-sided weakness) following nontraumatic intracerebral hemorrhage (bleeding within the brain that occurs without a head injury) affecting left non-dominant side, epilepsy (a chronic neurological disorder characterized by recurrent seizures, which are sudden, uncontrolled electrical discharges in the brain), morbid obesity, contracture (a condition of shortening or hardening of muscles, tendons or other tissue, often leading to restricted joint mobility) to right elbow and left wrist. He was [AGE] years old. Record review of Resident #2's admission MDS assessment dated [DATE] revealed he had a BIMS of 15 indicating no cognitive impairment and was dependent on staff for transferring from the bed to a chair. He used a manual wheelchair. Record review of Resident #2's care plan dated 8/21/25 revealed a focus area of ADL self-care performance deficit related to hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting left non-dominant side. The goal was for the resident to maintain current level of function in activities of daily living. Interventions included, Adjust ADL assistance per level of need at time of care. Evel of assistance may vary.the resident requires extensive assistance by 2 staff to move between surfaces as necessary. Record review of Resident #2's nurse progress note dated 8/22/25 at 6:10am revealed Resident #2 could not bear weight and required a 2-person assist using a mechanical lift for transfers. Record review of the nursing staffing assignments dated 10/25/25 revealed during the 6am-2pm shift, there were four CNAs scheduled to work with three aides who signed their name indicating they were present, including CNA C. According to the assignments, CNA C was assigned to work on Resident #2's hallway. A handwritten note revealed an RN was on floor as CNA. During the 2pm-10pm shift, there were 2 CNAs scheduled to work, and both signed their name indicating they were present, including CNA B. A handwritten note revealed an RN was on the floor as CNA. There were two LVNs scheduled to work a double shift between 6am-10pm. Record review of Resident #2's ADL-Transferring documentation revealed on 10/25/25, the task was not documented as completed. In an interview on 10/29/25 at 4:09pm, Resident #2 stated the facility was short-staffed at times. He said there were days when there was a delay in getting him out of bed. He said this past weekend on Saturday, 10/25/25, he did not get up for 24 hours because they did not have enough staff to get him out of bed. He said he used a mechanical lift with the assistance of 2 staff. In an interview on 10/29/25 at 11:00am, CNA C said the CNAs were required to operate the mechanical lift with two staff when transferring a resident. She said Resident #2 liked to get out of bed around 11am. She said it was hard to request help from another CNA because they were completing their rounds. She said she tried to assist Resident #2 to transfer out of bed before she left at 2pm. She said the staffing ratios affected the residents' preferences. She further stated it had to affect the residents mentally because they wanted to get up but could not do it themselves. Resident #4Record review of Resident #4's admission record generated on 10/29/25 revealed he was admitted to the facility on [DATE] and had diagnoses of hemiplegia and (continued on next page) 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 11/25/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete hemiparesis following nontraumatic intracerebral hemorrhage affecting left non-dominant side and cirrhosis of liver (a chronic condition where healthy liver tissues is replaced by scar tissue, leading to impaired liver function). He was [AGE] years old. Record review of Resident #4's quarterly MDS assessment dated [DATE] revealed he had a BIMS of 14, indicating no cognitive impairment. He was frequently incontinent of urine and bowel, was dependent on staff for transfers and required substantial/maximal assistance with toileting hygiene. In an interview on 10/16/25 at 11:55am, Resident #4 said during the evening shift, the staff were lazy. He said they waited more than 2 hours for assistance and had to be wet and nasty until they come help with incontinent care. He said took his brief off and threw it on the floor so he his skin did not break down. In an interview on 10/28/25 at 9:44pm, RN B said the staffing ratios for the facility could be better. She said they used to schedule 3 nurses each shift, but now they scheduled 2 nurses with 4 CNAs. She said they met the residents' needs, but said the residents deserved more attention. Record review of a Resident Council Department Recommendation/Concern dated 10/3/2025 and signed by the ADON, revealed the residents voiced a concern about the night shift staff only changing residents one time right before shift change, and noted sometimes they did not see the CNAs. The ‘Department Response' section stated observations of night shift were conducted and staff were observed making rounds and answering call lights. The ‘Resolution' section stated, staff were reminded of the importance of maintaining skin integrity by ensuring (every 2 hour) rounds for peri-care, turning and repositioning. In an interview on 10/29/25 at 3:52pm, the Administrator said they used the facility's PPD and census to create the facility's nursing staff schedule. He said he made sure the ratio of CNAs to residents was 1:15. He said if they took into account the higher functioning residents then it was feasible. He said according to the facility's star rating, they had more staff than the national average. He said when they received a grievance from resident council, he visited the facility at night a few times to observe. He said he did not observe any issues with the care being provided. In an interview on 10/29/25 at 4:42pm, the ADON said the facility had a weekly scheduling meeting to create the schedule. She said they used the facility census and PPD (a metric used to analyze costs and staffing) to determine how many staff to schedule. She said she attended the weekly scheduling meeting with the CNA Coordinator and DON. She said they did not have a DON at that time. She said she was not sure if the facility looked at resident's acuity when creating the schedule, but that it could be important to look at. In a telephone interview on 10/29/25 at 5:15pm, the CNA Coordinator said they had a weekly scheduling meeting to create the schedule. She said they used the facility census and PPD to determine how many staff to schedule. She said she used what she knew about the residents, including how many brief changes each resident required throughout the day, to create the staff assignments. Record review of the facility assessment, dated 4/30/25, revealed it did not include information regarding the level of staff needed to meet the needs of each resident. Record review of the facility policy for Sufficient and Competent Nursing dated August 2022 read in part, Our facility provides sufficient numbers of nursing staff with the appropriate skills and competency necessary to providing nursing and related care and services for all residents in accordance with resident care plans and the facility assessment.staffing numbers and the skill requirements of direct care staff are determined by the needs of the residents based on each resident's plan of care, the resident assessments and the facility assessment. 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 11/25/2025 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 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on interview and record review the facility failed to ensure the facility assessments were documented and facility-wide assessments determined what resources were necessary to care for residents competently during both day-to-day operations and emergencies for 1 of 1 facility (Facility) reviewed for facility assessment. The facility failed to ensure the facility assessment contained information regarding the level of staff needed to meet the needs of each resident. This failure could place residents at risk of inadequate care or treatment. Findings include: Record review of the facility assessment, dated 4/30/25, revealed it did not include information regarding the level of staff needed to meet the needs of each resident. In an interview on 10/29/25 at 3:52pm, the Administrator said he was unsure if the facility assessment included the level of staff needed. He said they did not use the facility assessment when creating the nursing staff schedule. He said they used the facility's PPD and census. He said he made sure the ratio of CNAs to residents was 1:15. He said if they took into account the higher functioning residents then it was feasible. He said according to the facility's star rating, they had more staff than the national average. Record review of the facility assessment policy (undated) read in part, A facility assessment is conducted annually to determine and update the capacity to meet the needs of and competently care for residents during day-to-day operations (including nights and weekends) and emergencies.the facility assessment is used to inform staffing decisions. staffing needs are considered for each shift, including day, evening and night shifts, and adjusted as necessary based on changes in the resident population. Record review of the facility policy for Sufficient and Competent Nursing dated August 2022 revealed in part, Our facility provides sufficient numbers of nursing staff with the appropriate skills and competency necessary to providing nursing and related care and services for all residents in accordance with resident care plans and the facility assessment.staffing numbers and the skill requirements of direct care staff are determined by the needs of the residents based on each resident's plan of care, the resident assessments and the facility assessment. Event ID: Facility ID: 675254 If continuation sheet Page 4 of 4