Health inspection·April 18, 2023

F 0550 assisted instead of the word feeder. The Administrator stated the failure was a dignity issue. Level of Harm - Minimal harm or potential for actual harm Record review of the facility's policy titled Resident Rights revised on 11/28/2016, indicated Respect and dignity - The resident has a right to be treated with respect and dignity Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 2 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure medical records were maintained in accordance with accepted professional standards and practices on each resident and accurately documented for 3 of 15 residents (Resident's #6, #7, and #16) reviewed for accuracy of medical records. 1. The facility did not ensure Resident #16's OOH-DNR was signed at the bottom by the witnesses. 2. The facility did not ensure Resident #6's signed her OOH-DNR. 3. The facility failed to ensure Resident #7's OOH-DNR had a license number, printed name, and date for the physician's statement. These failures could place residents at risk of not receiving care and services to meet their needs. The findings included: 1. Record review of Resident #16's face sheet, dated [DATE], revealed Resident #16 was an [AGE] year-old male who re-admitted to the facility on [DATE] with diagnoses of paroxysmal atrial fibrillation (when your heartbeat returns to normal within 7 days, on its own or with treatment) and unspecified dementia without behavioral disturbance (group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life). Record review of the MDS assessment, dated [DATE], revealed Resident #16 had clear speech and was understood by staff. The MDS revealed Resident #16 was able to understand others. The MDS revealed Resident #16 had a BIMS score of 12, which indicated moderately impaired cognition. Record review of the comprehensive care plan, revised on [DATE], revealed Resident #16 had an order for DNR. Record review of the order summary report, dated [DATE], revealed Resident #16 had an order, which started on [DATE], for DNR. Record review of the OOH-DNR form, dated [DATE] revealed it was missing witness signature 1 and missing witness signature 2 at the bottom of the form. During an interview on [DATE] at 3:39 PM, the DON stated she initiated the DNR and was responsible for ensuring it was completed. The DON stated she was unaware Resident #16's DNR was missing witness signatures. The DON stated the facility had been without a social worker for the past 3 months and nursing was assisting with the completion of the DNR process. The DON stated it was overlooked during her routine audit process. The DON stated it was important that all DNRs be accurately documented and completed to ensure the resident's and family's wishes were honored. The DON stated not ensuring a DNR was completed could result in interventions not wished upon by the resident or family. During an interview on [DATE] at 4:41 PM, the Administrator stated DNRs should have been filled out completely. The Administrator stated she expected whoever was initiating the DNR to ensure it was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 3 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some filled out. The Administrator stated it was important to ensure DNRs were filled out for accuracy and to abide by residents wishes. 2. Record review of Resident #6's order summary report, dated [DATE], indicated Resident #6 was an [AGE] year-old female, admitted to the facility on [DATE] with diagnoses which included dementia (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life), type 2 diabetes mellitus (high blood sugar), and essential hypertension (high blood pressure). Further review of the order summary report, dated [DATE], indicated an active physician's order for code status: DNR with an order date [DATE]. Record review of the annual MDS dated [DATE], indicated Resident #6 understood others and made herself understood. The assessment indicated Resident #6 was cognitively intact with a BIMS score of 14. Record review of Resident #6's care plan, with an initiated date of [DATE], indicated Resident #6 had an order for DNR. The care plan interventions included all aspects of DNR will be explained to Resident #6 or responsible party, and in absence of blood pressure, pulse, respiration, CPR will not be initiated. Record review of the OOH-DNR form dated [DATE] revealed a missing signature by Resident #6. During an interview on [DATE] at 10:12 a.m., the DON stated she initiated the DNR and was responsible for ensuring it was completed. The DON stated she was unaware prior to surveyor intervention Resident #6's DNR was missing her signature. The DON stated the facility had been without a social worker for the past 3 months and nursing was assisting with the completion of the DNR process. The DON stated monthly audits were completed looking for accuracy of OOH DNR paperwork. The DON stated it was overlooked during her routine process. The DON stated it was important that all DNRs be accurately documented and completed to ensure the resident's and family's wishes were honored. The DON stated not ensuring a DNR was completed could result in interventions not wished upon by the resident or family. During an interview on [DATE] at 2:06 p.m., the Administrator stated she expected Resident #6 DNR to be completed. The Administrator stated the DON was responsible for ensuring Resident #6's DNR was accurately and documented since the facility has not had a social worker in the past several months. The Administrator stated due to open positions the facility had to divide duties amongst the department heads. The Administrator stated a potential negative outcome of an invalid DNR would be her wishes not being respected. 3. Record review of Resident #7's face sheet, dated [DATE], revealed a [AGE] year-old female admitted to the facility on [DATE], with diagnoses which included dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life), essential primary hypertension (high blood pressure), and atrial fibrillation (rapid, irregular heart rate). Record review of the Comprehensive MDS assessment dated [DATE] revealed, Resident #7 made self-understood and understood others. Resident #7's BIMS score was 9, which indicated her cognition was moderately impaired. Record review of Resident #7's care plan last revised [DATE] revealed, resident had an order for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 4 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0578 DNR (Do Not Resuscitate). Level of Harm - Minimal harm or potential for actual harm Record review of the order summary report dated [DATE] revealed, Resident #7 had a physician's order for DNR (Do Not Resuscitate) with an order date of [DATE]. Residents Affected - Some Record review of Resident #7's OOH-DNR revealed under the section for the physician's statement there was no date for the physician signature and no license number and no printed name for the physician. During an interview on [DATE] at 2:00 PM, the DON stated the social worker was responsible for making sure all the blanks on the DNR were filled out, but she had been overseeing the DNRs because the current Social Worker was new to her position. The DON stated she was doing audits on the DNR to ensure they were filled out completely. The DON stated for Resident #7 she must have missed auditing the DNR and that was why there were blanks not filled out. The DON stated it was important the DNRs were filled out completely so the residents code status would be honored. During an interview on [DATE] at 3:35 PM, the Administrator stated traditionally the social worker or whoever initiated the DNR should make sure it was complete. The Administrator stated due to the Social Worker being new to her position the DON was currently the one responsible for making sure the DNRs were completed correctly. The Administrator stated the DNR not being filled out correctly and leaving blanks could make the DNR invalid. Record review of the facility's policy titled, Do Not Resuscitate Order, last revised [DATE], revealed . All validly executed DNR orders will be honored by the facility. Social services will assist all interested family members and residents will information, education, and execution of the DNR form. For completion of the form, see attached instructions for out of hospital DNR from the TAHC . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 5 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review the facility failed to respect the right to personal privacy for 1 of 1 nurses' station reviewed for privacy. Residents Affected - Few The facility failed to ensure RN L communicated with the hospice company in a private and confidential manner. This failure could place residents at risk of diminished quality of life, loss of dignity and self-worth. The findings included: During an observation on 04/16/2023 at 9:57 AM, RN L was sitting at the nurses' station attempting to speak with the hospice company. RN L had her telephone on speaker phone and RN L spoke loudly regarding the status of two hospice residents. The surveyor was standing down the hallway near room [ROOM NUMBER], approximately 40 feet from the nurses' station, and was able to overhear the phone conversation. Several residents and staff members walked by the nurses' station during the conversation. RN L stated I just wanted to give you and update on [Resident #8], her time is getting close, and her family is all here. Her respirations are down to 10 and her blood pressure is 108/56, which is lower than it was this morning. [Resident #8] is extremely pale with no output and her time is getting close. The same thing with [Resident #26]. I think [Resident #8] is going faster than [Resident #26] but we are having to medicate every two hours to keep her comfortable. [Resident #26]'s family is with her also. I was just giving you an update. During an interview on 04/18/2023 at 3:39 PM, the DON stated RN L should not have spoken with the hospice company on speaker phone. The DON stated she expected the nursing staff to ensure privacy and confidentiality while relaying a resident's health information. The DON stated it was important to protect the resident's health information. During an interview on 04/18/2023 at 3:39 PM, RN L stated she remembered speaking to the hospice company on 02/16/2023 but was unaware she was overheard. RN L stated she was hard of hearing and talked louder. RN L stated she should not have had the telephone on speaker phone and should have ensured privacy while speaking about residents at the nurses' station. RN L stated it was important because it was a privacy issue. During an interview on 04/18/2023 at 4:41 PM, the Administrator stated she expected health information to have been kept private. The Administrator stated RN L should not have been speaking to the hospice company on speaker phone at the nurses' station. The Administrator stated privacy and confidentiality was monitored by all staff and training was provided annually. The Administrator stated it was a privacy issue. Record review of the Confidentiality policy, undated, did not address privacy during telephone communication. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 6 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to complete a comprehensive resident-centered assessment of each resident's cognitive, medical, and functional capacity in a timely manner for 4 of 15 residents (Resident's #297, #147, #4, and #7) reviewed for comprehensive assessment and timing. 1. The facility did not ensure Resident #297's admission MDS assessment was completed within 14 days of admission. 2. The facility failed to complete Resident #147's admission MDS assessment with 14 days of admission. 3. The facility failed to complete an admission MDS assessment after Resident #4 was discharged returned not anticipated and readmitted to the facility. 4. The facility failed to complete Resident #7's admission MDS assessment within 14 days of admission. These failures could place residents at risk of not having their needs identified and met. Findings included: 1. Record review of Resident #297's order summary report, dated 04/18/2023, indicated Resident #297 was a [AGE] year-old female, originally admitted to the facility on [DATE] with a diagnosis included type 2 diabetes with hyperglycemia (high blood sugar), bipolar (a disorder associated with episodes of mood swings ranging from depression lows to manic highs), and Parkinson's (brain disorder that causes unintended or uncontrollable movements). Record review of Resident #297's electronic medical records indicated the admission MDS assessment was in process, meaning it had not been electronically transmitted to CMS. During an interview on 04/18/2023 at 10:52 a.m., the MDS Coordinator stated she was responsible for completing all the MDS assessments. The MDS Coordinator stated all data for the admission MDS assessment should be collected by day 14, and the admission MDS assessment should be completed within 14 days of admission. The MDS Coordinator stated Resident #297's admission MDS should have been completed by 04/11/2023. The MDS Coordinator stated she tried to complete the MDS assessments by day 14 but stated it was not always possible. The MDS Coordinator stated she was aware that Resident #297's admission MDS had not been completed. The MDS Coordinator stated the importance of ensuring MDS assessments were completed timely was to ensure residents care were articulated and they were given the proper care based on their assessments. During an interview on 04/18/2023 at 11:20 a.m., the Regional Reimbursement Nurse stated the admission MDS assessment should be completed within 14 days of admission. The Regional Reimbursement Nurse stated Resident #297's admission MDS should have been completed by 04/11/2023. The Regional Reimbursement Nurse stated she was responsible for monitoring the MDS Coordinator to ensure the assessments were completed timely. The Regional Reimbursement Nurse stated she monitored to ensure timely completion by reviewing the in progress and the schedule list in PCC (healthcare software provider) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 7 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some weekly. The Regional Reimbursement Nurse stated if there were late assessments the MDS nurse was advised to complete in a timely manner. The Regional Reimbursement Nurse stated she was unaware the MDS assessment was not completed. The Regional Reimbursement Nurse stated the importance of ensuring MDS assessments were completed timely was to set the care plans and to ensure the baseline care was carried out for the resident. The Regional Reimbursement Nurse stated the facility had a system in place to assure assessments are conducted in accordance with the specified timeframes for each resident by following the RAI manual. During an interview on 04/18/2023 at 2:06 p.m., the Administrator stated she expected all MDS assessments to be completed on time. The Administrator stated the MDS Coordinator was responsible for making sure the MDS assessments were completed on time. The Administrator stated the Regional Reimbursement Nurse was responsible for monitoring the MDS Coordinator to ensure the assessments were completed timely. The Administrator stated it was important to complete the MDS assessments on time because it could affect the resident's quality of care. 2. Record review of Resident #147's face sheet dated 4/16/23 revealed she was a [AGE] year-old, female, and admitted to the facility on [DATE] with diagnoses of cerebral infarction (disruption of blood flow to the brain and parts of the brain to die off, also known as a stroke), hemiplegia and hemiparesis (weakness or inability to move one side of the body), diabetes (disease too much sugar in the blood), and hypertension (high blood pressure). Record review of Resident #147's admission MDS dated [DATE] revealed the MDS Coordinator verified the assessment was completed and signed 4/14/23. The MDS Coordinator signed it on 4/15/23 indicating sections A, B, E, G, GG, H, I, J, K, L, M, N, O, P, and Q were completed. The MDS Coordinator completed section V (Care Area Assessment Summary) and signed it on 4/16/23. The MDS assessment should have been completed on 4/14/23. The MDS assessment was 2 days late. During an interview on 4/18/23 at 9:02 AM the MDS Coordinator said she had been the MDS Coordinator at the facility for a year. The MDS Coordinator said the MDS should be completed within 14 days of the ARD. The MDS Coordinator said she probably changed Resident #147's completion date because it was due on 4/14/23 and she had completed it late. The MDS Coordinator said she was behind on the MDS's, and she knew there were some late MDS's. The MDS Coordinator said the Regional MDS Coordinator, and the Administrator had done an in-service with her last week on completing the MDS's within the required timelines per the RAI Manual. The MDS Coordinator said if the MDS assessment was not completed timely, it would not show an accurate assessment of the resident and the facility could miss out on revenue. During an interview on 4/18/23 at 11:31 AM the Administrator said she would expect the MDS assessments to be completed timely. The Administrator said when the MDS assessment was not completed timely, it would not show an accurate assessment of the resident and it affects the facility financially. 3. Record review of Resident #4's face sheet, dated 04/18/2023, revealed an [AGE] year-old male initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses which included heart failure (the heart muscle does not pump blood as well as it should to meet the body's needs for blood and oxygen), localized edema (fluid trapped in the body's tissues), and chronic kidney disease, stage 3 (kidneys have mild to moderate damage and they are less able to filter waste and fluid out of the blood). Record review of Resident #4's MDS assessments in the electronic health record revealed a Discharge (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 8 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assessment, discharge return not anticipated, with an ARD of 01/12/2023, followed by an entry tracking record with an ARD of 01/16/2023, followed by a Quarterly assessment with an ARD of 03/31/2023. Resident #4 had no admission assessment. 4. Record review of Resident #7's face sheet, dated 04/18/2023, revealed a [AGE] year-old female admitted to the facility on [DATE], with diagnoses which included dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life), essential primary hypertension (high blood pressure), and atrial fibrillation (rapid, irregular heart rate). Record review of Resident #7's comprehensive MDS assessment with an ARD of 03/04/2023 indicated in Section A0310 it was an admission assessment (required by day 14). The MDS assessment for Resident #7 indicated in Section A1600 an entry date of 02/19/2023. The MDS assessment in Section Z0500B was signed completed on 03/06/2023, indicating the MDS assessment for Resident #7 was completed 1 day late. During an interview on 4/18/2023 at 9:31 AM, the MDS Coordinator stated she was responsible for completing all the MDS assessments. The MDS Coordinator stated an admission assessment should be completed within 14 days of admission. The MDS Coordinator stated she had not completed Resident #7's admission assessment within 14 days because she was behind and was trying to catch up. The MDS Coordinator stated if a resident discharged return not anticipated she was supposed to complete an admission assessment when the resident readmitted to the facility. The MDS Coordinator stated she had done a Quarterly assessment for Resident #4 because she had not realized she discharged him return not anticipated. The MDS Coordinator said, I do not know how I missed that. The MDS Coordinator stated the Regional MDS Nurse monitored her completion of the MDS assessments. The MDS Coordinator stated the Regional MDS Nurse was aware she had completed the admission assessments late, and she had been in-serviced last week on timely completion of the MDS assessments. The MDS Coordinator stated not completing the admission assessment and not completing it timely could result in incorrect documentation, loss of revenue for the residents to have their needs met, and the residents care would not be specific to them. During an attempted phone interview on 04/18/2023 at 3:19 PM, the Regional MDS Nurse did not answer the phone. During an interview on 4/18/2023 at 3:31 PM, the Administrator stated the MDS Coordinator was responsible for completing all the MDS assessments. The Administrator stated the Regional MDS Nurse monitored the MDS Coordinator. The Administrator stated she expected the MDS Coordinator to complete all MDS assessments according to the RAI manual. The Administrator stated not completing the admission assessment and not completing it timely could affect the information the facility staff have to form the plan of care for the residents. Record review of the Long-Term Care Facility Resident Assessment Instrument 3.0 User's Manual Version 1.17.1 updated October 2019 indicated, .Completion of an OBRA admission assessment must occur in any of the following admission situations . when the resident has been in this facility previously and was discharged return not anticipated .For the admission assessment, the MDS Completion Date (Z0500B) must be no later than 13 days after the Entry Date (A1600). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 9 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0640 Encode each resident’s assessment data and transmit these data to the State within 7 days of assessment. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure an encoded, accurate, and complete MDS discharge assessment was electronically completed and transmitted to the CMS System within 14 days after completion for 1 of 1 resident (Resident #11) reviewed for discharge MDS assessments. Residents Affected - Many The facility did not ensure Resident #11's discharge MDS assessment was completed and transmitted within 14 days of completion. This deficient practice could place residents at risk of not having records completed and submitted in a timely manner as required. Findings include: Record review of Resident #11's order summary report, dated 04/18/2023, indicated Resident #11 was a [AGE] year-old female, originally admitted to the facility on [DATE] with a diagnosis which included bipolar (a disorder associated with episodes of mood swings ranging from depression lows to manic highs), essential hypertension (high blood pressure), and atrial fibrillation (irregular, often rapid heart rate). Record review of a progress note dated 03/10/2023 indicated Resident #11 was discharged to another facility. Record review of Resident #11's electronic medical records indicated no documented evidence of a discharge MDS assessment completed or transmitted. During an interview on 04/18/2023 at 10:52 a.m., the MDS Coordinator stated she was responsible for completing all the MDS assessments. The MDS Coordinator stated the discharge assessments should be transmitted 14 days after completion. The MDS Coordinator stated Resident #11's discharge assessment should have been transmitted by 03/23/2023. The MDS Coordinator stated she relied on PCC (healthcare software provider) to notify her when an assessment was due for discharge. The MDS Coordinator stated she was unaware Resident #11's discharge assessment had not been completed. The MDS Coordinator stated the importance of ensuring MDS assessments were completed timely was to ensure that proper documentation was collected prior to discharge. During an interview on 04/18/2023 at 11:20 a.m., the Regional Reimbursement Nurse stated the discharge MDS assessments should be transmitted within 14 days. The Regional Reimbursement Nurse stated Resident #11's discharge assessment should have been transmitted by 03/23/2023. The Regional Reimbursement Nurse stated she was responsible for monitoring the MDS Coordinator to ensure the assessments are completed timely. The Regional Reimbursement Nurse stated she monitor by reviewing the in progress and the schedule list in PCC weekly. The Regional Reimbursement Nurse stated if a discharge assessment was not completed, the MDS nurse was advised to complete. The Regional Reimbursement Nurse stated she was unaware the discharge MDS assessment was not completed. The Regional Reimbursement Nurse stated the facility had a system in place to assure assessments are conducted in accordance with the specified timeframes for each resident by following the RAI manual. The Regional Reimbursement Nurse stated this failure did not affect the resident. The Regional Reimbursement Nurse stated the discharge assessment was a tracking form for CMS. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 10 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0640 Level of Harm - Potential for minimal harm Residents Affected - Many During an interview on 04/18/2023 at 2:06 p.m., the Administrator stated she expected the discharge assessments to be completed on time. The Administrator stated the MDS Coordinator was responsible for making the MDS assessments were completed on time. The Administrator stated the Regional Reimbursement Nurse was responsible for monitoring the MDS Coordinator to ensure the assessments were completed timely. The Administrator stated this failure did not affect the resident. The Administrator stated the discharge assessment was a tracking form for CMS. Record review of the undated facility's policy titled, Minimum Data Set (MDS) Policy for MDS assessment Data Accuracy indicated, . the purpose of the MDS policy is to ensure each resident receives an accurate assessment by qualified staff to address the needs of the resident who are familiar with his/her physical, mental, and psychosocial well-being . Procedures 4. Every MDS Coordinator will receive training for each section of the MDS to ensure competence in completing the MDS 3.0 assessment . Record Review of the CMS RAI Version 3.0 Manual, dated October 2019, indicated, in Chapter 2, page 2-37 09. Discharge Assessment-Return Not Anticipated (A0310F), Must be completed (item Z0500B) within 14 days after the discharge date (A2000 + 14 calendar days). The RAI Manual further revealed the discharge assessment-return not anticipated must be submitted within 14 days after the MDS completion date (Z0500B +14 calendar days) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 11 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment for 1 of 15 residents (Resident #4) reviewed for care plans. The facility failed to develop and implement a care plan for Resident #4's edema (swelling) to both legs. This failure could place residents at risk of not having individual needs met and a decreased quality of life. Findings included: Record review of Resident #4's face sheet, dated 04/18/2023, revealed an [AGE] year-old male initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses which included heart failure (the heart muscle does not pump blood as well as it should to meet the body's needs for blood and oxygen), localized edema (fluid trapped in the body's tissues), and chronic kidney disease, stage 3 (kidneys have mild to moderate damage and they are less able to filter waste and fluid out of the blood). Record review of the MDS assessment dated [DATE] revealed Resident #4 was able to make self-understood and understood others. The MDS assessment revealed Resident #4 had a BIMS score of 15, which indicated his cognition was intact. The MDS assessment revealed Resident #4 required extensive assistance with bed mobility, transfers, toilet use, and limited assistance with dressing and personal hygiene. The MDS assessment revealed Resident #4 received a diuretic (medication used to rid the body of excess fluid) 7 days in the 7 day look back period. Record review of the care plan last revised on 04/06/2023 revealed Resident #4 had no care plan for edema. Record review of Resident #4's order summary report with a date range of 04/01/2023-04/30/2023 revealed Furosemide (medication used to treat fluid retention and swelling) tablet 40 MG Give 1 tablet by mouth one time a day for edema with a start date of 04/06/2023. During an observation on 04/16/2023 at 9:58 AM, Resident #4 had swelling to both legs. During an observation on 04/16/2023 at 2:51 PM, Resident #4 had swelling to both legs. During an observation on 04/17/2023 at 3:05 PM, Resident #4 had swelling to both legs. During an interview on 04/18/2023 at 9:35 AM, the MDS Coordinator stated the IDT team was responsible for the care plan, but she ensured that it was complete. The MDS Coordinator stated she was aware that Resident #4 had swelling to both legs. The MDS Coordinator stated he should have had interventions in his care plan to address his edema especially because he had diagnoses of heart failure, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 12 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few chronic kidney disease, and he was on diuretics. The MDS Coordinator stated she made a mistake and did not care plan it. The MDS Coordinator stated it was important for Resident #4's edema to be care planned to make sure it was not worsening, and that he was not having shortness of breath or any respiratory distress. During an interview on 4/18/2023 at 1:47 PM, the DON stated the MDS Coordinator was responsible for ensuring everything for the resident's care was included in the care plans. The DON stated Resident #4 should have had a care plan for edema. The DON stated she did not know why it was not in the care plan. The DON stated it was important for Resident #4's edema to be included in his care plan because it could lead to other cardiac issues and altered health conditions. During an interview on 4/18/2023 at 3:34 PM, the Administrator stated the DON and the MDS Coordinator were responsible for completing the care plans. The Administrator stated she expected them to include in the care plan edema and anything unusual or special for the resident's care. The Administrator stated it was important for Resident #4's edema to be included in the care plan so the staff could monitor the condition adequately. Record review of the facility's undated policy titled, Comprehensive Care Planning, revealed, The facility will develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan will describe the following the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being . Each resident will have a person-centered comprehensive care plan developed and implemented to meet his other preferences and goals, and address the resident's medical, physical, mental and psychosocial needs . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 13 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 ensure that residents receive treatment and care in accordance with professional standards of practice for 1 of 15 (Resident #4) residents reviewed for quality of care. Residents Affected - Few The facility failed to provide wound care for Resident #4 per the physician's orders. This failure could place residents of risk for not receiving appropriate care and treatment. Findings included: Record review of Resident #4's face sheet, dated 04/18/2023, revealed an [AGE] year-old male initially admitted to the facility on [DATE] and readmitted to the facility on [DATE] with diagnoses which included heart failure (the heart muscle does not pump blood as well as it should to meet the body's needs for blood and oxygen), localized edema (fluid trapped in the body's tissues), and chronic kidney disease, stage 3 (kidneys have mild to moderate damage and they are less able to filter waste and fluid out of the blood). Record review of the MDS assessment dated [DATE] revealed Resident #4 was able to make self-understood and understood others. The MDS assessment revealed Resident #4 had a BIMS score of 15, which indicated his cognition was intact. The MDS assessment revealed Resident #4 required extensive assistance with bed mobility, transfers, toilet use, and limited assistance with dressing and personal hygiene. The MDS assessment did not indicate the presence of venous ulcers. Record review of the care plan last revised on 04/06/2023 revealed he had venous stasis ulcers (wounds on your skin that develop because of problems with blood circulation) to bilateral (both) lower extremities. Resident #4's care plan did not include the treatment to be provided for the venous stasis ulcers. Record review of Resident #4's order summary report with a date range of 04/01/2023-04/30/2023 revealed unna boots (special gauze bandage used for the treatment of venous stasis ulcers and other venous insufficiencies of the legs) to bilateral lower extremities for venous ulcers change every 3 days/as needed for soilage/slippage and every 72 hours for 21 days with a start date of 04/06/2023. Record review of the Wound Administration Record for the month of April 2023 revealed Resident #4 had an order for unna boots to bilateral lower extremities for venous ulcers and to change every 3 days/as needed for soilage/slippage and every 72 hours for 21 days with a discontinued date of 04/16/2023, the last time this treatment was documented as completed was on 04/13/2023. Resident #4 had another order for venous wounds to his right lower extremity cleanse with normal saline apply collagen and cover with foam dressing daily and as needed for soilage with a discontinued date of 04/17/2023, no initials for the month of April 2023. There was another order for Resident #4 for his venous wound to his right lower extremity cleanse with normal saline apply collagen and cover with foam dressing daily and as needed for soilage to start on 04/18/2023. Record review of Resident #4's Progress Notes from 04/10/2023-04/17/2023, did not address Resident #4's venous ulcer to his right leg, any wound care provided, or any changes in his wound care orders. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 14 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0684 Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 04/16/2023 at 9:58 AM, Resident #4 had 2 tan-colored square dressings on the front of his right leg dated 04/14/2023, the signature was not legible, and he did not have unna boots on his legs. Resident #4 stated the dressings were applied by the hospital when he went for his shoulder surgery on 04/14/2023. Resident #4 stated he had returned from the hospital the next day (4/15/2023) in the morning. Residents Affected - Few During an observation on 04/16/2023 at 2:51 PM, Resident #4 had 2 tan-colored square dressings on the front of his right leg dated 04/14/2023, and he did not have unna boots on his legs. During an observation on 04/17/2023 at 3:05 PM, Resident #4 had 1 tan-colored square dressing dated 04/17/2023. Resident #4 stated the dressing was applied that morning by the nurse (unable to specify which nurse). During an interview on 04/18/2023 at 11:30 AM, the ADON stated she monitored the wound care, but the charge nurses were responsible for performing the wound care. The ADON stated Resident #4 had a venous ulcer to his right leg, and the order had changed from unna boots to foam collagen dressings on Sunday (04/16/2023) by Resident #4's doctor. The ADON stated the 2 tan-colored dressings dated 4/14/2023 were probably placed by the hospital on [DATE]. Resident #4 went to have surgery on his right shoulder on 04/14/2023 and returned the morning of 04/15/2023. The ADON stated the dressings should have been removed on 04/15/2023 when he returned from the hospital and wound care provided per the physician's orders. The ADON stated she did not know why this had not been done. The ADON stated LVN N was the charge nurse prior to Resident #4 going to the hospital and LVN O was the charge nurse when he returned to the facility on [DATE]. The ADON stated wound care not being provided per physician's orders did not help the healing process and it could cause an infection. During an interview on 4/18/2023 at 1:47 PM, the DON stated the charge nurses were responsible for providing wound care per the physician's orders. The DON stated the charge nurse on Saturday (04/15/2023) should have removed the dressings and provided wound care. The DON stated not providing wound care per physician's orders could result in an infection and the wound declining. During an attempted phone interview on 4/18/23 at 2:55 PM, LVN O did not answer the phone. During an interview on 4/18/2023 at 3:34 PM, the Administrator stated the charge nurse was responsible for changing the dressing and she expected the nurses to provide wound care per the physician's orders. The Administrator stated not providing wound care per the physician's orders could cause an infection. During a phone interview on 04/18/2023 at 4:39 PM, LVN N stated he was the charge nurse on Friday (04/14/2023) for Resident #4. LVN N stated Resident #4's unna boots were removed to give him a shower as part of the prep for his surgery. LVN N stated after the shower he did not reapply the unna boots. LVN N stated Resident #4 left the building before he could provide wound care. LVN N stated he should have provided wound care per the physician's orders. LVN N stated not providing wound care could lead to a wound infection, sepsis (an infection of the blood stream), and further wound decline. Record review of the facility's undated policy titled, Skin Integrity, did not address the management of venous ulcers. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 15 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 ensure that respiratory care was provided consistent with professional standards of practice for 1 of 16 residents reviewed for respiratory care. (Resident #42). Residents Affected - Few The facility failed to properly store Resident #42's respiratory equipment. The facility failed to change Resident #42's HHN equipment weekly per policy. These failures could place residents at risk of respiratory infections. Findings included: 1. Record review of Resident #42's face sheet dated 4/16/23 revealed he was a [AGE] year-old male, who admitted to the facility on [DATE]. Resident #42 had diagnoses of emphysema (lung disease that damages lung tissue and causes difficulty or discomfort in breathing) and cerebral infarction (caused from disruption of blood flow to the brain due problems with the blood vessels that supply the brain, also known as a stroke). Record review of Resident #42's quarterly MDS dated [DATE] revealed he had a BIMS of 13, which indicated he was cognitively intact. Resident #42 required supervision for most ADLs . Record review of Resident #42's Order Summary Report dated 4/16/23 revealed he received Ipratropium-Albuterol Solution 0.5-2.5 mg in 3 ml inhaled orally (by mouth) every four hours as needed for shortness of breath by HHN. There was not an order specific to changing the HHN, tubing, or storage bag. Record review of Resident #42's TARs dated 12/01/22-4/16/23 revealed he had received 2 documented breathing treatments of Ipratropium-Albuterol Solution by HHN on 1/23/23 and 2/07/23 by a nurse. During an observation and interview on 4/16/23 at 10:08 AM Resident #42 said he self-administered his HHN for breathing treatments once or twice a week. Resident #42's HHN with a mouthpiece was laid on top of his bedside table and it was not dated or stored in a bag. During an observation on 4/16/23 at 3:53 PM revealed Resident #42's HHN continued to be laid on top of his bedside side table and it was not dated or stored in a bag. During an observation on 4/17/23 at 09:06 AM revealed Resident #42's HHN continued to be laid on top of his bedside side table and it was not dated or stored in a bag. During an observation and interview on 4/17/23 at 4:00 PM Resident #42 said he self-administered his HHN breathing treatments once or twice a week. Resident #42 said his HHN had not been changed since he started taking breathing treatments in November 2022. He said he had always laid the HHN on the top of his bedside table and he had not been provided a storage bag to keep his HHN in. During an interview on 4/17/23 at 4:15 PM LVN C said she had worked at the facility for a year and a half and usually worked the 2 PM-10 PM shift. LVN C said she was also working a split shift on two days a week and worked a few hours in the morning and then came back to work the evening shift. LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 16 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few C said she was the Charge Nurse for all the residents. LVN C said residents' HHNs should be changed weekly, usually done on the Sunday night shift. LVN C said the HHNs should be dated and stored in a bag. LVN C said it would be an infection control issue if the HHN was not stored properly. LVN C said she was not aware Resident #42's HHN was laid on top of his bedside table and was not dated or stored in a bag. During an interview on 4/17/23 at 4:23 PM the ADON said she had worked at the facility for 5 years. The ADON said HHN equipment should be changed when it became visibly soiled or if it was contaminated, such as if it was dropped on the floor. She said HHNs should be dated and stored in a bag to keep it clean for reuse. The ADON said if the HHN was not stored in a bag and was just laid on top of a dresser, there was no way of knowing if the HHN had been contaminated. The ADON said if the HHN was not changed and was left uncovered, germs could develop, and it could be harmful for the resident. The ADON said she was not aware Resident #42's HHN was laid on top of his bedside table and it was not dated or stored in a bag. The ADON said Resident #42's HHN should have been dated and stored in a bag for infection control reasons. During an interview on 4/18/23 at 8:51 AM RN B said she had worked at the facility for 3 years and usually worked the 6 AM-2 PM shift. RN B said HHNs should be changed weekly. RN B said there was usually an order in the resident's chart to change the HHN and it would be documented on the TAR. RN B said the HHN should be dated and stored in a bag when not in use. RN B said she had not seen Resident #42's HHN laid on his bedside table and was not dated or stored in a bag. RN B said Resident #42's HHN should be stored in a bag to keep it clean and for infection control. During an interview on 4/18/23 at 11:20 AM the DON said HHN equipment should be changed weekly, dated, and stored in a bag. The DON said HHNs should be stored in a bag for infection control purposes. The DON said if the HHN was not changed weekly, it could lead to bacterial growth, and the resident could develop a respiratory infection and have a negative outcome. The DON said there was not a system in place to ensure the order to change the HHN weekly was on the resident's chart and TAR to ensure the HHN equipment was being changed weekly. The DON said she was not aware Resident #42's HHN was laid on his bedside table, not dated, and not stored in a bag until surveyor informed the facility on 4/17/23. During an interview on 4/18/23 at 11:31 AM the Administrator said HHNs should be stored in a bag, and she was not sure of the timeframe that the HHNs were to be changed. The Administrator said she would expect the residents' HHN equipment to be changed per the facility's policy and stored properly. The Administrator said if the HHN equipment was not changed or stored properly, it could lead to the resident developing a bacterial infection and affect the resident's overall health. Review of the facility's respiratory policy titled Respiratory Equipment/Supply Disinfecting/Cleaning with a revision date of June 1, 2006, indicated the . purpose was to remove microorganisms from the surfaces of equipment . schedule for supply changes . nebulizers/aerosols/humidifiers every 7 days and as needed for soiling . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 17 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to ensure all drugs were stored in a locked compartment and only accessible by authorized personnel for 1 of 16 residents (Resident #42) reviewed for medication storage. 1. The facility failed to keep medication being administered under the direct observation of the person administering medications. Resident #42 had 3 packages (each contained 1 dose vial) of Ipratropium-Albuterol Solution 0.5-2.5 mg in 3 ml (used to open airways to make breathing easier) on top of his bedside table. These failures could place residents at risk for health complications and not receiving the intended therapeutic benefit of their medication. Findings included: 1. Record review of Resident #42's face sheet dated 4/16/23 revealed he was a [AGE] year-old male, who admitted to the facility on [DATE]. Resident #42 had diagnoses of emphysema (lung disease that damages lung tissue and causes difficulty or discomfort in breathing) and cerebral infarction (caused from disruption of blood flow to the brain due problems with the blood vessels that supply the brain, also known as a stroke). Record review of Resident #42's quarterly MDS dated [DATE] revealed he had a BIMS of 13, which indicated he was cognitively intact. Resident #42 required supervision for most ADLs . Record review of Resident #42's Order Summary Report dated 4/16/23 revealed he received Ipratropium-Albuterol Solution 0.5-2.5 mg in 3 ml inhaled orally (by mouth) every four hours as needed for shortness of breath by HHN (delivers medication through a fine mist to the airways). There was not an order indicating the resident could self-administer Ipratropium-Albuterol Solution 0.5-2.5 mg in 3 ml inhaled orally by HHN. Record review of Resident #42's undated care plan revealed there was nothing care planned for self-administration of medication or keeping medications in his room. During an observation and interview on 4/16/23 at 10:08 AM Resident #42 said he self-administered his HHN breathing treatments once or twice a week. Resident #42 had 3 packages (each package contained 1 vial of medication) of Ipratropium-Albuterol Solution 0.5-2.5 mg in 3 ml on top of his bedside table. During an observation on 4/16/23 at 3:53 PM revealed Resident #42 continued to have 3 packages of Ipratropium-Albuterol Solution on top of his bedside table. During an observation on 4/17/23 at 09:06 AM revealed Resident #42 continued to have 3 packages of Ipratropium-Albuterol Solution on top of his bedside table. During an interview on 4/17/23 at 10:50 AM the DON said residents were allowed to keep medications, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 18 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few such as eye drops, at their bedside, but only if the resident had passed the safe medication assessment. She said she was not sure if the facility had any residents that were approved to self-administer their medications and she would need to refer to her reports . The DON said she would be responsible for assessing the residents for safe self-administration. During an interview on 4/17/23 at 11:11 AM the DON reported the facility did not currently have any residents that were self-administering medications. During an observation and interview on 4/17/23 at 4:00 PM Resident #42 said he self-administered his HHN breathing treatments once or twice a week. Resident #42 continued to have 3 packages of Ipratropium-Albuterol Solution on top of his bedside table. Resident #42 said he kept the packages of Ipratropium-Albuterol Solution at his bedside and only used it when he felt he needed it. He said he usually used the HHN with Ipratropium-Albuterol Solution once a week and the last time he used it was about a week ago. Resident #42 said when he was running low of Ipratropium-Albuterol Solution, he would ambulate to the nurses' station and tell the nurse he needed some more. He said the nurse would give him the Ipratropium-Albuterol Solution, but he did not know their names that had given him the medication. Resident #42 said he had not been instructed on how to self-administer the breathing treatments. Resident #42 said it was easy to unscrew the HHN, open the vial and squeeze the medication into it, then turn the machine on, and then breathe it normally by the mouthpiece. Resident #42 said he did not tell the nurse prior to self-administering his breathing treatments and the nurse did not assess him before and after self-administering the breathing treatment. During an interview on 4/17/23 at 4:15 PM LVN C said she had worked at the facility for a year and a half and usually worked the 2 PM-10 PM shift. She said she was also working a split shift on two days a week and worked a few hours in the morning and then came back to work the evening shift. LVN C said she was the Charge Nurse for all the residents when she was on duty. She said the nurse was responsible for administering the residents' breathing treatment medications by HHN and performing a respiratory assessment before and after the treatment. LVN C said she did not have any residents that administered their own medications. LVN C said if a resident wanted to be able to administer their own medications, the resident would have to be evaluated by the DON for safety. LVN C said Resident #42 did not use his HHN breathing treatments very often. LVN C said she was not aware Resident #42 had Ipratropium-Albuterol Solution packages on his bedside table and was self-administering the medication. LVN C said it would be a safety issue for him to have the Ipratropium-Albuterol Solution at his bedside. LVN C said Resident #42 had not asked her for Ipratropium-Albuterol Solution to keep at bedside and she had not given Resident #42 Ipratropium-Albuterol Solution to keep at bedside. During an interview on 4/17/23 at 4:23 PM the ADON said she had worked at the facility for 5 years. The ADON said residents were not allowed to have medications at their bedside. The ADON said the nurses were responsible for administering breathing treatments by HHN and the nurse should be performing a respiratory assessment before and after the breathing treatment to assess the resident for any adverse (not desirable) reactions from the medication. The ADON said she was not aware Resident #42 had 3 packages of Ipratropium-Albuterol Solution on his bedside table. The ADON said Resident #42 should not have medication at his bedside for his HHN and she would have to investigate on how he received them. During an interview on 4/18/23 at 8:51 AM RN B said she had worked at the facility for 3 years and usually worked the 6 AM-2 PM shift. RN B said residents can have some medications at bedside, but only after the resident had been assessed and deemed safe to self-administer the medication. RN B said she was not aware Resident #42 had 3 packages of Ipratropium-Albuterol Solution for his HHN at his (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 19 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few bedside. RN B said Resident #42 had never asked her for Ipratropium-Albuterol Solution to keep in his room and she had not provided him with any of the medication. During an interview on 4/18/23 at 11:20 AM the DON said the nurses were responsible for administering the breathing treatments by HHNs. The DON said the nurse should be performing a respiratory assessment before and after the breathing treatment to assess for adverse reactions and effectiveness of the breathing treatment. The DON said Ipratropium-Albuterol Solutions for breathing treatments should be kept locked in the medication cart and administered by the nurses. The DON said she was not aware Resident #42 had Ipratropium-Albuterol Solution for his HHN in his room until the surveyor informed the facility on 4/17/23. The DON said they had removed the medication from Resident #42's room, and she would be in-servicing her staff. During an interview on 4/18/23 at 11:31 AM the Administrator said the charge nurse was responsible for administering medications by HHNs, because it was a physician's order. The Administrator said if the nurse was not monitoring the breathing treatments to assess the effectiveness of the medication, it could affect the resident's overall health. The Administrator said Resident #42 should not have had Ipratropium-Albuterol Solution at his bedside. Review of the facility's policy titled Bedside Storage of Medications dated 2003 indicated . bedside medication was permitted for inhaled emergency medications and for residents who were able to self-administer medications upon the written order of the prescriber and when it was deemed appropriate in the judgement of the facility's resident assessment team . written order for bedside storage of medication placed on resident's chart . facility's interdisciplinary team must assess that the resident was capable of safely self-administering the medication . assessment must be documented . bedside medications were stored in a drawer or cabinet that was locked for security . Review of the facility's policy titled Storage of Controlled Substance dated 2003, indicated . all drugs in the nurses' station shall be stored under the following conditions . all medications and other drugs, including treatment items, shall be stored in a locked cabinet or room, inaccessible to patients and visitors . drugs shall be accessible only to authorized personnel . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 20 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. 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 food that was palatable and served at an appetizing temperature for 2 of 15 residents (Resident #4 and Resident #19) and 1 of 1 meal (lunch meal) reviewed for dietary services. Residents Affected - Some The facility failed to provide palatable food served at an appetizing temperature or taste to residents who complained the food was not hot and did not taste good. The facility failed to ensure [NAME] G followed the recipe for pureeing the garlic cheese biscuits for four residents on puree diet. These failures could place residents who ate food from the kitchen at risk of weight loss, altered nutritional status, and diminished quality of life. Findings included: 1. During an observation and interview on 04/17/2023 starting at 12:58 PM, a lunch tray was sampled by the Dietary Manager and five surveyors. The sample tray consisted of Meat loaf, scallop potatoes, green beans, garlic cheese biscuit, and frosted vanilla cake. The meat loaf needed to be warmer temperature; The Dietary Manager stated it could be warmer. The scallop potatoes were crunchy and cold. The Dietary Manage stated the scallop potatoes were not cooked enough. The green beans were bland. The Dietary Manager stated the green beans were bland. During an interview on 04/17/23 at 5:45 PM, Resident # 4 stated he didn't have much of an appetite and the food was never seasoned enough. Resident # 4 stated that the food at lunch today wasn't cold, but it was a long way from hot. Resident # 4 stated he wished they would put his food in the microwave and heat it up more. Resident # 4 stated the kitchen staff told him they can't take the food back into the kitchen after it comes out. Resident # 4 stated the facility would give him a substitute if he asked. During an interview on 04/17/23 at 4:50 PM, Resident # 19 stated she didn't like the food, she said the scalloped potatoes today at lunch were crunchy and chewy, she said she could not eat them. Resident # 19 stated the food here was always cold and didn't have any seasoning. Resident # 19 stated they will give her something else to eat if she didn't want what they served. During an interview on 4/18/23 at 11:08 AM, the Regional Dietician stated she was not aware of any current food complaints. The Regional Dietician stated dietary staff were responsible for ensuring the residents received food that was palatable and the appropriate temperature. The Regional Dietician stated it's the cook responsibility to prepare the meals and ensure that it's the correct temperature, however it's the Dietary Manager responsibility to follow up to ensure the temperatures was correct. The Regional Dietician stated it was important for the residents to receive food that was palatable and the appropriate temperature for their overall wellbeing and nutritional status. The Regional Dietician stated she had a test tray this month because of the new cook and the pork lion was delicious. During an interview on 4/18/23 at 11:45 AM, the Dietary Aide F stated she was not aware of any food complaints. The Dietary Aide F stated when she gets a complaint, she notifies the cook and Dietary (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 21 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 Manager right away. The Dietary Aide F stated the cook was responsible for making sure the food was at the correct temperature before serving. The Dietary Aide F stated the food needs to be hot and taste good so the residents will eat it and not lose weight. During an interview on 4/18/23 at 1:59 PM, the [NAME] G stated she started working on March 1, 2023, at the facility. [NAME] G stated she was not aware of any food complaints. [NAME] G stated the food should taste good for the residents. [NAME] G stated the food normal taste very good, however [NAME] G stated yesterday she was nervous. [NAME] G stated it was her responsibility to make sure the food was at the correct temperature before serving. [NAME] G stated the hot food need to be hot and the salads need to be the temperature it should be, to be safe to eat. During an interview on 04/18/20 at 2:37 PM, the Dietary Manager stated she was not aware of any food complaints. The Dietary Manager stated the residents usually come talk to her if they don't like the food. The Dietary Manager stated she would try to fix the problem and provide an in-service to the staff. The Dietary Manager stated it was the cook's responsibility to make sure the food temperature was correct. The Dietary Manager stated a good cook always taste the food. The Dietary Manager stated she had never had a problem with the food, she cooks a lot of the food too. the Dietary Manager stated it important for the food to be hot and taste good so the residents will eat it, for the nutrition. During an interview on 04/18/2023 at 2:58 PM, the Administrator stated she hadn't received any food complaints in a long time. The Administrator stated it depends on the food complaints, she would speak with the Dietary Manager and dietary staff to get it corrected. The Administrator stated the cook was responsible for the taste and temperature of the food. The Administrator stated she ate in the facilities dining room all the time, and the food was always good. The Administrator stated it can go either way, the food can be to cold and the residents don't eat it or to hot and burns them. If the meat was to cold or under cooked it could cause issues there too, like food borne illness. A request for the facility policy regarding Palatable Food was submitted to the administrator on 4/18/23 at 2:24 PM. A policy was not received prior to exit. 2. During an observation and interview on 04/17/23 starting at 11:21 AM, [NAME] G crumbled garlic cheese biscuits into blender and added gravy to puree the biscuits. [NAME] G stated she doesn't use a recipe to puree biscuits for four residents on a puree diet. Record review of the facility's recipe dated 04/17/23 for pureed garlic cheese biscuit, titled P.[NAME] Biscuit, Cheese Garlic, indicated recipe#: 45057 garlic cheese biscuit 4 each, milk homogenized gallon ¼ cup. During an interview on 4/18/23 at 11:08 AM, the Regional Dietician stated the cook should be using a recipe for pureed food and it was the Dietary Managers responsibility to provide the cook with the recipe. The Regional Dietician stated another cook, or the Dietary Manager should train new cook to use the recipe for puree food. The Regional Dietician stated it was important to follow the recipe, so the residents get the right nutrition. The Regional Dietician stated if they don't follow the recipe, they may not get the right nutrition from that food item depending on how they prepare it. During an interview on 4/18/23 at 1:59 PM, the [NAME] G stated she started working on March 1, 2023, at the facility. [NAME] G stated it was the Dietary Managers responsibility to make sure she was preparing the purees correctly. [NAME] G stated she worked for Seven Oaks six years ago and wasn't (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 22 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 trained because she worked there before. [NAME] G stated it was important to follow the recipe but the last time she worked at Seven Oaks she was told by the Dietary Manager to cook like she would at home. [NAME] G stated she thought she was following the recipe, she used gravy with bread before. [NAME] G stated she didn't know how not following the recipe could affect the residents. During an interview on 04/18/20 at 2:37 PM, the Dietary Manager stated she was responsible for making sure the cook prepares the pureed foods correctly. The Dietary Manager stated she guess the cook should use a recipe if they don't know how to do the puree. The Dietary Manager stated whoever the trainer was that day, either herself or another cook could train the cook to use the recipe. The Dietary Manager stated it was important to follow a recipe so it would all taste the same. The Dietary Manager stated she wasn't sure how not following the recipe could affect the residents. The Dietary Manager stated if the puree was to thin it could choke them and if it was to thick it could choke them. During an interview on 04/18/2023 at 2:58 PM, the Administrator stated it was the Dietary Managers responsibility to make sure the cook was preparing the purees correctly. The Administrator stated the cook should follow the recipe when preparing purees. The Administrator stated the Dietary Manager was responsible for training the cook to follow puree recipes. The Administrator stated it is important to follow the recipe because the recipe could have items in it the resident could be allergic to and so it doesn't taste crazy. The Administrator stated not following the recipe cause an allergic reaction or effect the palatability. A request for the facility policy regarding Puree Food was submitted to the administrator on 4/18/23 at 2:24 PM. A policy was not received prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 23 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 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 safety in the facility's only kitchen. Residents Affected - Some The facility failed to ensure: 1.Food items were dated and labeled. 2. Hair restraints were worn appropriately by dietary staff. 3. The deep fryer was free of grease build up. These failures could place residents at risk for foodborne illness. Findings include: During an observation in the freezers and refrigerator on 4/16/23 starting at 9:03 AM, revealed a plastic bag with no label or date that was identified by [NAME] G, as onions and bell peppers, 1 container of Italian sausage undated with thick ice buildup, 1 frozen uncovered opened pitcher of lemonade identified by [NAME] G that was not labeled or dated, 1 box beef chill and bean red burritos opened not secured in freezer, 1 box of onion rings undated without received date or open date, 1 box health vanilla shakes undated without received date or open date, 1 box collard greens undated without received date or open date, 1 bag whipped topping undated without received date or open date. During an observation in the dry storage room on 4/16/23 starting at 9:15 AM, 1 gallon of dill pickle relish undated without a received date, 1 gallon Teriyaki marinade undated without a received date, 1 qt box of Ready Care thickened orange juice undated without a received date, 2 package of 12 hamburger buns undated without a received date, 1 open package of 3 hamburger buns undated without a received date. During an observation in the kitchen on 04/16/23 at 9:30 AM, revealed brown grease with brownish black crumbs floating in grease and buildup around the deep fryer. During an observation in the kitchen on 04/16/23 at 9:40 AM, revealed [NAME] G was not wearing a hair restraint appropriately while preparing the lunch meal. [NAME] G's hair was visible outside of the hairnet in the back approximately four inches. During an observation in the kitchen on 04/17/23 at 11:15 AM, revealed [NAME] G was not wearing a hair restraint appropriately while preparing puree for lunch. [NAME] G's hair was visible outside of the hairnet in the back approximately four inches. During an interview on 4/18/23 at 11:08 AM, the Regional Dietician stated the food should be labeled and dated unless it's on the packaging. The Regional Dietician stated all the kitchen staff was responsible for labeling and dating the food items when the truck comes in. The Regional Dietician stated the Dietary Manager was responsible for ensuring food items were properly labeled and dated. The Regional Dietician stated the refrigerator should be checked daily for unlabeled foods. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 24 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 - Some Regional Dietician stated all food items need to be labeled and dated to ensure food safety and proven food borne illness. During an interview on 4/18/23 at 11:45 AM, the Dietary Aide F stated all the food items should be labeled and dated so they would know what to use first. The Dietary Aide F stated it was the Dietary Managers responsibility to make sure it done correctly. The Dietary Aide F stated the refrigerator and freezer were checked daily. The Dietary Aide F stated it was important label and date the food so they will know what's in each box and it was still in date. The Dietary Aide F stated it was important to label and date the food because it can be very harmful to the residents. During an interview on 4/18/23 at 1:59 PM, [NAME] G stated she tries to cover all her hair with her hairnet, to keep the hair from falling in the food. [NAME] G stated the deep fryer was clean on Friday 4/14/23. [NAME] G stated the food should be labeled and dated before putting up, with the date opened, what it was and expiration date. [NAME] G stated if she put a pot pie in the refrigerator today, it should expire in three days. [NAME] G stated she tries to check the dates daily. [NAME] G stated its everyone's responsibility to check the dates. [NAME] G stated if something was in the refrigerator nine to ten days, and it's given to the resident they can become sick. During an interview on 04/18/20 at 2:37 PM, the Dietary Manager stated all dietary staff should have their hair covered with a hairnet. The Dietary Manager stated the food items should be labeled with date prepared, the date put in the bag, and the used by date. The Dietary Manager stated the date should be put on the outside of all boxes if it hasn't been open. The Dietary Manager stated she expects all food items to be labeled and dates. The Dietary Manager stated it was her responsibility to ensure all food items was labeled and dated correctly. The Dietary Manager stated it was important to label all the food items so they will know what was in the boxes and to prevent food contamination that could cause food borne illness. During an interview on 04/18/2023 at 2:58 PM, the Administrator stated she expects the kitchen staff to wear hairnets correctly. The Administrator stated she believed the dietary staff dated food items from when they open them. The Administrator stated the Dietary Manager was responsible for ensuring food items was correctly labeled and dated. The Administrator stated the Dietary Manager was responsible for ensuring the staff checks the refrigerator daily for outdated items, so they don't serve something that was expired or spoiled. The Administrator stated it was important to label and date items to know how old it was and to prevent food borne illness. Record review of the facility's undated Dress Code Policy revealed dietary staff must wear hairnets while in the dietary department A request for the facility policy regarding Food Labeling and Deep Freezer sanitation was submitted to the administrator on 4/18/23 at 2:24 PM. A policy was not received prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 25 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 6 staff (CNA K) reviewed for infection control. Residents Affected - Few The facility failed to ensure CNA K changed gloves and performed hand hygiene while providing incontinent care to Resident #2. This failure could place residents and staff at risk for cross-contamination and the spread of infection. Findings included: During an observation of incontinent care on 04/16/2023 starting at 3:20 PM, CNA K had finished incontinent care on Resident #15. CNA K took the trash bag containing Resident #15's dirty adult brief and wipes over to Resident #2's bedside and placed it on the floor. CNA K put on gloves. CNA K did not perform hand hygiene prior to putting on gloves. CNA K pulled off Resident #2's covers, unsecured her adult brief and pulled it down from the front. CNA K then wiped Resident #2's front peri area, and with the same gloves on, picked up the wipes container and took more wipes out. CNA K then proceeded to finish cleaning Resident #2's front peri area. CNA K removed his gloves and applied new gloves. CNA K did not perform hand hygiene after removing his gloves. Afterwards, CNA K turned Resident #2 on her side and CNA K then cleaned the resident's back peri area. CNA K picked up the wipes container while wearing the same dirty gloves and took more wipes out to clean the resident's back peri area. CNA K finished cleaning Resident #2's back peri area, he removed the dirty adult brief and placed the dirty adult brief on the floor, next to the trash bag he had placed on the floor when he started. CNA K was stepping on the dirty adult brief with his shoe. CNA K removed the dirty linens, and then picked up the roll of trash bags and used one to put the dirty linen in. CNA K touched the roll of trash bags with his dirty gloves. CNA K then applied the clean adult brief and finished the incontinent care. CNA K did not change gloves or perform hand hygiene prior to applying the clean adult brief. CNA K removed his dirty gloves and took the dirty linen and trash to the bins, and then performed hand hygiene. During an interview on 04/16/2023 at 3:32 PM, CNA K stated he should have performed hand hygiene prior to putting on gloves and after removing his gloves. CNA K stated he should have changed gloves and performed hand hygiene prior to applying the clean adult brief. CNA K stated he should not have placed the dirty adult brief on the floor, and he should not have brought the trash bag containing Resident #15's dirty adult brief and wipes over to Resident #2's bedside. CNA K stated he should have placed the dirty adult brief in a trash bag. CNA K stated he should not have touched the wipes container and the roll of trash bags with his dirty gloves. CNA K stated he carried the roll of trash bags in his pocket and had returned the wipes container to the linen cart to use on other residents. CNA K stated he did not perform hand hygiene, change gloves, touched the roll of trash bags and wipes container, and used the same trash bag because he was nervous. CNA K stated the last time he was trained on incontinent care was 12 years ago. CNA K stated not performing hand hygiene and glove changes when required could result in the spread of germs and viruses and the residents getting a urinary tract infection. CNA K stated touching the wipes container and roll of trash bags with his dirty gloves could result in cross contamination. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 26 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of the competency for perineal care/incontinent care female dated 02/02/2023 revealed CNA K demonstrated competency in providing incontinent care and it was signed by the DON. During an interview on 04/18/2023 at 11:57 AM, the ADON stated when providing incontinent care, the CNAs should perform hand hygiene prior to starting and after changing gloves. The ADON stated gloves should be changed when moving from a dirty area to clean area. The ADON stated CNAs should not lay the adult brief on the floor, should not touch the wipes container or the roll of trash bags with dirty gloves, should not carry the roll of trash bags in their pocket, and should not use the same trash bag for two residents. The ADON stated that should not be done due to cross contamination. The ADON stated the DON and herself were responsible for making sure the CNAs performed proper incontinent care. The ADON stated at least once a week she randomly watched a CNA perform incontinent care. The ADON stated she had not observed any problems with incontinent care. The ADON stated it has been a couple months since she observed CNA K provide incontinent care, but the last time she had observed him there were no issues. The ADON stated it was important to provide proper incontinent care to the residents due to infection control. The ADON stated not providing proper incontinent care could result in the residents getting an infection and having a decline in status. During an interview on 04/18/2023 at 2:06 PM, the DON stated when providing incontinent care, the CNAs should perform hand hygiene prior to starting and after changing gloves. The DON stated the CNAs should change gloves and perform hand hygiene when moving from a dirty area to a clean area. The DON stated the CNAs were supposed to place incontinent supplies in a bag, including placing wipes in a bag to prevent cross contamination. The DON stated the CNAs should not take the wipes container or roll of bags in the resident's room and should not touch the wipes container or the roll of bags with dirty gloves and return it to the linen cart or carry it in their pockets. The DON stated the CNAs should not carry a trash bag with dirty items from one resident to use with the other resident. The DON stated she was responsible for ensuring the CNAs provided proper incontinent care. The DON stated she observed incontinent care randomly once a shift to ensure it was done properly. The DON stated during her observations there were no issues. The DON stated competencies on incontinent care were done on hire, annually, and as needed. The DON stated she had observed and completed CNA K's competency on incontinent care in February (2023), and there had been no issues. The DON stated not providing proper incontinent care and not performing hand hygiene appropriately could cause an infection and it was an infection control issue. During an interview on 04/18/2023 at 3:38 PM, the Administrator stated the DON was responsible for ensuring the CNAs performed proper incontinent care and performed hand hygiene appropriately. The Administrator stated she expected the CNAs to follow the policy for providing incontinent care. The Administrator stated not performing proper incontinent care and not performing hand hygiene appropriately could result in the spread of bacteria, germs, and infection. Record review of the facility's policy titled, Perineal Care, with an effective date of 05/11/2022 revealed, . Start 10) Perform hand hygiene 11) [NAME] gloves and all other PPE per standard precautions . remove an adequate number of pre-moistened cleansing wipes . 21) Gently perform care to the buttocks and anal area, working from front to back without contaminating the perineal area . 24) Doff gloves and PPE 25) Perform hand hygiene 26) Provide resident comfort and safety by re-clothing (if applicable - incontinence pad(s) and briefs), straightening bedding, adjusting the bed and/or side rails, and placing call light within resident's reach . Always perform hand hygiene before and after glove use . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 27 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0921 Level of Harm - Minimal harm or potential for actual harm Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. Based on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable homelike environment for 1 of 4 halls (Hall 2) reviewed for environment. Residents Affected - Few The facility did not ensure the floor and walls, on Hall 2, were cleaned and free of marks or debris. The facility did not ensure the floor, on Hall 2, was repaired. These failures could place the resident at risk for decreased quality of life and infection due to unsanitary conditions. The findings included: During an observation on 04/16/2023 between 9:00 AM - 10:26 AM, there was missing flooring in the hallway entrance to Hall 2. The floors were dirty with numerous crumbs and 4 white, quarter-sized, dried spots throughout the hallway. There was a dead beetle bug at the exit door. There were thick layers of dust in the corners of the hallway. There were black streaks along the painted drywall the length of the hallway, approximately 75 - 100 feet. During an observation on 04/16/2023 between 4:11 PM - 4:22 PM, there was missing flooring in the hallway entrance to Hall 2. The floors were dirty with numerous crumbs and 4 white, quarter-sized, dried spots throughout the hallway. There was a dead beetle bug at the exit door. There were thick layers of dust in the corners of the hallway. There were black streaks along the painted drywall the length of the hallway, approximately 75 - 100 feet. During an observation on 04/17/2023 at 8:42 AM, there was missing flooring in the hallway entrance to Hall 2. The floors were dirty with numerous crumbs and 4 white, quarter-sized, dried spots throughout the hallway. There was a dead beetle bug at the exit door. There were thick layers of dust in the corners of the hallway. There were black streaks along the painted drywall the length of the hallway, approximately 75 100 feet. During an interview on 04/18/2023 at 1:15 PM, Housekeeper M stated she had worked at the facility for approximately 4 weeks. Housekeeper M stated she was the only housekeeper on the schedule besides the Housekeeping Supervisor and she worked Monday through Friday. Housekeeper M stated some days she did not have time to sweep and mop the hallways. Housekeeper M stated she was unsure how often the floors should have been swept and mopped or what the facility policy required. Housekeeper M stated she tried to clean the black streaks off the walls at least once a week and the walls had looked worse. Housekeeper M stated sometimes she did not get to finish cleaning the rooms on her hallway because the facility did not have the manpower and she was the only one scheduled. Housekeeper M stated no one was scheduled for Sunday (04/16/2023) which was why the hallway looked dirty and wasn't cleaned. Housekeeper M stated keeping the hallway floor and walls cleaned was important for the residents' health and to maintain a homelike environment. During an interview on 04/18/2023 at 2:39 PM, the Housekeeping Supervisor stated she had only been in that position for approximately 6 months. The Housekeeping Supervisor stated it was hard to find and keep help for the housekeeping department. The Housekeeping Supervisor stated she had reached (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 28 of 29 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 675271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Seven Oaks Nursing & Rehabilitation 901 Seven Oaks Rd Bonham, TX 75418 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 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few out to corporate office, and nothing had been done yet. The Housekeeping Supervisor stated the floors should have been swept and mopped and the walls should have been cleaned twice a day, every day. The Housekeeping Supervisor stated she was responsible for ensuring the floors were swept and mopped and the walls were cleaned, however she had been working the floor as well because of the lack of staffing. The Housekeeping Supervisor stated cleaning the floors and walls was important to maintain a homelike environment and infection control. During an interview on 04/18/2023 at 4:41 PM, the Administrator stated the hallway's floors and walls should have been cleaned. The Administrator stated housekeeping staff and charge nurses on the weekend were responsible for ensuring the hallways were cleaned. The Administrator stated there was housekeeping staff scheduled during the weekend, but someone had called in on Sunday (04/16/2023). The Administrator stated the hallways should have been cleaned daily. The Administrator stated the Housekeeping Supervisor was responsible for monitoring the cleanliness of the hallways. The Administrator stated it was important to keep the environment clean to maintain a peaceful living environment. The Administrator stated the Maintenance Supervisor had only been in his position for approximately 2 days. The Administrator stated corporate office was aware of the missing flooring and a scheduled date to fix them had not been set. The Administrator stated the missing flooring could have been a fall hazard. Record review of the Resident Rights policy, revised 11/28/16, revealed Safe environment - The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. The policy did not address housekeeping staff, timelines for cleaning, or missing flooring. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675271 If continuation sheet Page 29 of 29