Health inspection·August 14, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete on the hall assigned to her. Resident #40 Review of Resident #40's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with muscle weakness and lack of coordination. Review of Resident #40's Quarterly MDS Assessment, dated 07/02/2024, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated that the resident required maximal assistance for toileting hygiene, shower, dressing, and transfer. Review of Resident #40's Comprehensive Care Plan, dated 06/15/2025, reflected the resident was at risk for falls and one of the interventions was to be sure the resident's call light was within reach. Observation and interview on 08/12/2025 at 9:02 AM revealed Resident #40 was in his bed with eyes closed. It was observed that the resident's call light was on the floor, between his bed and his roommate's. Observation and interview on 08/12/2025 at 9:17 AM, the RCN stated call lights should be with the residents in case they needed the staff. She went inside Resident #40's room and pulled the call light from the floor and placed it beside the resident's hand. She said she would start an in-service about call light. She said the staff should make sure that the call lights were with the residents before they leave the room. In an interview on 08/14/2025 at 7:02 AM, the ADON stated call light should be with the residents at all times when the residents where inside the room, whether the resident was in their bed or in their wheelchair, because the call light was the only way they could reach out to the staff if they were in distress or just needed water. She said the call light were for all residents, whether independent or dependent. She said an independent resident might be having a heart attack and could not call anybody because the call light was not with the resident. She said she was one of the responsible in checking if the call lights were with the residents. She said an in-service had been going around and that she would coordinate with the DON to randomly check if the call lights were with the residents. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated the staff should make sure that the call lights were with the residents before they leave the room. some staff could have clipped the call light when they were doing care, but they have to place it with the resident after the care was done. She said for some residents, the call light was their sense of protection that if something happened to them, they would be able to call the staff for help. She said without the call light the residents might feel helpless. She said everybody was responsible in making sure the call lights were with the residents, whether the resident was independent or not. She said she would collaborate with the DON about the issue regarding call lights. In an interview on 08/14/2025 at 10:13 AM, the DON stated call lights were safety measures wherein the residents could call the staff if they needed something or needed to do something that needed assistance. She said residents might try to go to the bathroom by themselves because she had no way to call the staff that might result to a fall and injuries. The DON said all the staff were responsible for the call lights, including her. The DON said the expectation was for the staff to scan the resident's room when they do their rounds and ensure the call lights were within reach of the residents before they leave the room. The DON said s an in-service was already initiated but she would monitor the staffs' compliance about call lights. Record review of the facility's policy Resident Rights Social Services Manual 2003, no revision date revealed, We believe each resident has a right . communication with and access to persons and services inside and outside our facility. Policy specific to call light being within reach of the residents requested on 08/13/2025 at 1:05 PM via email and verbally requested on 08/14/2025 at 7:42 AM. The RCN stated the facility did not have a policy specific for call light. Event ID: Facility ID: 675292 If continuation sheet Page 2 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 observations, interviews, and record review, the facility failed to ensure the resident's right to personal privacy and confidentiality of his or her personal and medical records for two (Resident #40 and Resident #44) of eight residents reviewed for privacy and confidentiality. 1. The facility failed to ensure the ADON closed, locked, or minimized her laptop's monitor while preparing Resident #40's medication via g-tube (gastrostomy feeding tube: a tube that is surgically inserted through the skin of the belly and into the stomach) on 08/13/2025. 2. The facility failed to ensure LVN A closed the door while performing ADL on Resident #44 on 08/12/2025. These failures could place the residents at risk of not having their personal privacy maintained during ADLs and their medical information exposed to unauthorized individuals. Findings included: 1. Review of Resident #40's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with dysphagia (difficulty in swallowing). Review of Resident #40's Quarterly MDS Assessment, dated 07/02/2024, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated that the resident had a feeding tube (medical device that helps deliver nutrition and medication directly to the person's stomach). Review of Resident #40's Comprehensive Care Plan, dated 06/15/2025, reflected the resident required tube feeding and one of the interventions was to administer medications as ordered. Record review of Resident #40's Physician Order, dated 11/09/2023, reflected Dilantin Infatabs Tablet Chewable 50 MG (Phenytoin) Give 3 tablet via GTubetwo times a day related to EPILEPSY (a medical condition characterized by recurring seizures) . HOLD FEEDING 1 HOUR BEFORE AND 1 HOUR AFTER GIVING. Record review of Resident #40's Physician Order, dated 02/28/2025, reflected Fluoxetine HCl Capsule 10 MG Give 4 capsule via G-Tube one time a day for depression (persistent feeling of sadness or loss of interest). Record review of Resident #40's Physician Order, dated 08/14/2024, reflected Gemfibrozil Oral Tablet 600 MG (Gemfibrozil) Give 600 mg via peg tube (a flexible feeding tube inserted directly to the stomach) two times a day for Elevated cholesterol. Record review of Resident #40's Physician Order, dated 03/13/2024, reflected Valproic Acid Oral Solution 250 MG/5ML (Valproate Sodium) Give 2.5 ml via Gtube one time a day related to EPILEPSY, UNSPECIFIED, NOT INTRACTABLE, WITH STATUS EPILEPTICUS. Record review of Resident #40's Physician Order, dated 02/05/2025, reflected Vitamin C Tablet (Ascorbic Acid) Give 500 mg via Gtube two times a day for Supplement. Record review of Resident #40's Physician Order, dated 07/25/2025, reflected Xarelto Oral Tablet 20 MG (Rivaroxaban) Give 1 tablet by mouth one time a dayrelated to PERSONAL HISTORY OF OTHER VENOUS THROMBOSIS (formation of blood clots) AND EMBOLISM (blockage in the blood vessel that originated from somewhere and traveled to other parts of the body). Observation on 08/13/2025 at 8:57 AM revealed the ADON was about to administer Resident #40's medication via g-tube. She went inside the resident's room to sanitize the overbed table. She left her laptop, that was on top of her cart, open and the displayed the resident's name, status, location, gender, date of birth , age, name of physician, latest vital signs, allergies, code status, that the resident was on gtube, name of the NP, and several physician orders. The screen of the computer was facing the hallway. In an interview on 08/13/2025 at 8:59 AM, the ADON stated she should have locked her computer when she went inside Resident #40's room to clean the resident's table. She said it was a HIPAA violation because the resident's personal and medical information were exposed. She said the said information should be secured and confidential. 2. Record review of Resident #44's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with obesity (excessive accumulation of body fats). Record review of Resident #44's Quarterly MDS Assessment, dated 07/23/2025, reflected Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 3 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the resident was cognitively intact with a BIMS score of 15. The Quarterly MDS Assessment indicated that the resident needed assistance rolling to left and right. Record review of Resident #44's Comprehensive Care Plan, dated 06/15/2025, reflected the resident had an ADL self-care performance deficit and one of the interventions was to assist with bed mobility. Observation and interview on 08/12/2025 at 11:11 AM, LVN A stated Resident #44 wanted to have a bowel movement. She said she would turn the resident to her side because the resident preferred to be on her side every time she had a bowel movement. She turned the resident without pulling the privacy curtain or closing the door and the assistance being given to the resident could be seen from the hallway. In an interview on 08/12/2025 at 11:38 AM, LVN A stated she was not aware that the door was open when she repositioned Resident #44. She said she should have pulled the privacy curtain and closed the door to make sure privacy was provided when giving assistance to the resident. She said the resident might be embarrassed that people would see her condition that she needed assistance to turn to her side. In an interview on 08/12/2025 at 11:58 AM, Resident #44 stated it would be nice if her door was closed so nobody would see if staff was helping her with her limitation. In an interview on 08/13/2025 at 7:38 AM, SNA F she was engrossed with what she could learn and did not notice that the door was open when Resident #44 was turned. She said the door should be close to provide privacy. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated the staff must make sure that the residents were provided privacy when providing care to prevent awkwardness and that the medical information of the residents were secured and protected to prevent improper use of their information. She said the expectation was for the staff to be mindful about privacy when providing care and confidentiality of the residents' medical records. She said she would collaborate with the DON and the ADON to do an in-service about privacy and confidentiality. In an interview on 08/14/2025 at 10:13 AM, the DON stated the door should be closed when repositioning the residents to provide privacy. She said ADLs, such as repositioning the residents, should be done with the door closed or the privacy curtain pulled. She said privacy should be provided during care to avoid embarrassment. She said some residents could not communicate and even though they were feeling embarrassed, they could not verbalize it. The DON stated all the medical information of all the residents should be protected and not be visible for everybody to see because those were confidential information. She said it was a HIPAA violation when unauthorized individuals would see the medical information of the residents. She said all the staff, including her, were expected to provide full privacy during care and to secure all confidential information of the residents. The DON said she would start an in-service about privacy during care and confidentiality of the residents' information. Record review of the facility's policy, Resident Rights Social Services Manual 2003, no revision date revealed, 8. Each resident is treated with . including privacy in treatment and in care . 22. Each resident is ensured confidential treatment of all information . Event ID: Facility ID: 675292 If continuation sheet Page 4 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure the timeliness of each resident's person-centered, comprehensive care plan, and to ensure that the comprehensive care plan is reviewed and revised by an interdisciplinary team for six (Residents #2 #9, #10, #12, #29, and #44) of eight residents reviewed for care plan revision. The facility failed to complete a quarterly care plan for Residents #2, #9, #10, 312, #29, and #44. This failure could place the residents at risk of care and needs not being met. Findings included: Resident #2 Record review of Resident #2's Face Sheet, dated 08/12/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. Record review of Resident #2's Comprehensive Care Plan on 08/12/2025 reflected the quarterly care plan completed after 12/11/2024 was dated 06/15/2025. There should have been care plan dated 03/2025. Resident #9 Record review of Resident #9's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. Record review of Resident #9's Comprehensive Care Plan on 08/12/2025 reflected the quarterly care plan completed after 11/26/2024 was dated 06/15/2025. There should have been a care plan dated 02/2025. Resident #10 Record review of Resident #10's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. Record review of Resident #10's Comprehensive Care Plan on 08/13/2025 reflected the quarterly care plan completed after 11/26/2024 was dated 06/10/2025. There should have been a care plan dated 02/2025. Resident #12 Record review of Resident #12's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. Record review of Resident #12's Comprehensive Care Plan on 08/13/2025 reflected the quarterly care plan completed after 11/26/2024 was dated 06/15/2025. There should have been a care plan dated 02/2025. Resident #29 Record review of Resident #29's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. Record review of Resident #29's Comprehensive Care Plan on 08/13/2025 reflected the quarterly care plan completed after 12/11/2024 was dated 06/15/2025. There should have been a care plan dated 03/2025. Resident #44 Record review of Resident #44's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. Record review of Resident #44's Comprehensive Care Plan on 08/13/2025 reflected the quarterly care plan completed after 01/23/2024 was dated 06/15/2025. There should have been a care plan dated 04/2025. Observation and interview on 08/13/2025 at 12:02 PM, the MDS Coordinator stated it was her responsibility to update the care plans. She said the care plans should be updated if there was a change in condition, the resident came back from the hospital, or if the resident had a fall. She said care plans were done upon admission and quarterly afterwards. She logged on to her computer and saw that Residents #2 #9, #10, #12, #29, and #44's care plans were updated but had gaps and missing some quarterly care plans. She said it was an oversight on her part that some of the resident's care plans had a gap. She said the care plans should be updated to reflect the current conditions of the residents so applicable interventions could be applied. She said she would audit all the care plans to make sure they were updated. In an interview on 08/14/2025 at 7:02 AM, the ADON stated she was familiar with the care plans. She said the care plans were done during admission and were being updated quarterly. She said the care plans should be update if there was an acute change, new wound, resident now needed a blood thinner. She said the care needed to be in place so the staff would know if there were new interventions that needed to be done and to monitor the resident's response to the new interventions. She said if the care plans were not updated, it could mess up the monitoring side of the interventions. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated all the residents should be care planned accordingly and timely to make (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 5 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete sure all the current care and needs of the residents were provided. She said the MDS Nurse was the primary responsible for making and updating the care plans, but she and the nurse managers were equally responsible in making sure that the care plans were up to date. She said without the care plan, there would not be continuity of care and the residents' health issues would not be addressed. She also said she would coordinate with the DON and the MDS Nurse to make sure the care plans were current. In an interview on 08/14/2025 at 10:13 AM, the DON stated every resident needed a thorough and updated care plan to ensure the residents receive proper care and in accordance with their current needs. She said the care plans should be reviewed because the needs of the resident's change, and they need to be congruent with these needs to provide quality care. She said, aside from acute changes, the care plans should be done quarterly to monitor if there were new interventions or to assess if the goals were not being met. She said if the care plans were not updated, the current needs of the residents might not be met. She said she would coordinate with the MDS to audit the care plans of the residents and to make sure, moving forward, that there the care plans would not have gaps on their quarterly. Record review of the facility's policy, Comprehensive Care Planning Nursing Policy & Procedure Manual, no revision date, revealed, The facility will develop and implement a comprehensive person-centered care plan for each resident . Comprehensive Care Plans . The resident's care plan will be reviewed after each Admission, Quarterly, Annual and/or Significant Change MDS assessment, and revised based on changing goals, preferences and needs of the resident and in response to current interventions. Event ID: Facility ID: 675292 If continuation sheet Page 6 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 one (Resident #44) of four residents reviewed for quality of care. The facility failed to ensure that LVN A did not use one gauze to clean Resident #44's scattered wounds, non-pressure related wound to her left posterior (towards the back) thigh on 08/12/2025. This failure could place the residents with scattered wounds at risk for worsening of existing wounds and infection. Findings included: Record review of Resident #44's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with non-pressure chronic ulcer of left thigh with fat layer exposed. Record review of Resident #44's Quarterly MDS Assessment, dated 07/23/2025, reflected the resident was cognitively intact (resident capable of normal cognition and needed little support) with a BIMS score of 15. The Quarterly MDS Assessment indicated that the resident had a non-pressure chronic ulcer of left thigh. Record review of Resident #44's Comprehensive Care Plan, dated 06/15/2025, reflected the resident had two lymphedemic wounds to left posterior thigh and one of the interventions was to administer wound care treatment as ordered. Record review of Resident #44's Physician Order, dated 07/24/2025, reflected WOUND CARE: Cleanse area to the Left, posterior thigh with ns and pat dry. Apply Triad Paste one time a day for Wound healing AND as needed for wound healing. Can add adhesive dressing when in Wheelchair only. Observation and interview on 08/12/2025 at 11:22 AM, LVN A stated she would go ahead and do Resident #44's wound care on the resident's left thigh since the resident was already on a side-lying position. LVN A prepared the normal saline, gauzes, and the triad paste. She said the wound was left without a dressing to air dry. She said she would only put a dressing if the resident would be transferred to her wheelchair. It was observed that the resident had scattered wounds to her left thigh. She took a couple of gauze, poured normal saline on it, and started cleaning the wound. She started cleaning the top wound and proceeded to clean the other wounds. She did not change the gauze and used the same gauze that she used on the first wound to clean the other wounds. LVN A then took some gauze and dried the wounds. She used the same gauze to dry up the wounds. In an interview on 08/12/2025 at 11:38 AM, LVN A stated the right procedure in cleaning the wound was to clean the wound from inside to outside. She said she should have discarded the gauze that she used to clean one of Resident #44's wound and took another one to clean and dry the next wound, and so on and so forth. She said it seemed like the germs that gauze accumulated from the first wound were introduced to the other wound. She said she would be mindful the next time she would do a wound care not to use soiled gauze to clean the same wound or if the resident had other wounds. In an interview on 08/14/2025 at 7:02 AM, the ADON stated using the gauze used to clean the adjacent wounds of the resident was not the proper procedure in cleaning the wound. She said the best practice was to clean the wound from the cleanest to the dirtiest and then discard the gauze after one stroke. She said a new gauze should be used again to clean the same wound. She said the procedure was also applicable if the resident had scattered wounds on the same area. She said the gauze used to clean one wound could not be used to clean the other wounds because the bacteria from the first wound cleaned could be introduced to the other wounds. She said the expectation was to keep the bacteria out and not introduce them to the other wounds. She said the wrong procedure done could cause aggravation of the wounds and possible infection of the other wounds. She said she would coordinate with the DON to do an in-service for all the staff doing wound care about the propre procedures in doing wound care. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated not changing the gauze after each use was not ok. She Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 7 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete said, if she visualized what happened was, the bacteria was not removed and were only transferred to the other wounds. She said this could result to infection or the wound not healing. She said she would coordinate with the DON and ADON to address the issue immediately. In an interview on 08/14/2025 at 10:13 AM, the DON stated she was made aware by the ADON about the issue during wound care. She said she already initiated an in-service about wound care and wound do a one-on-one with LVN A. She said she the wound should be cleaned from the least contaminated area; the gauze should be discarded after every stroke. She said using the same gauze could only introduce the bacteria, if there were, into the wound. Using the same gauze to clean the other wounds could result to introduction of the bacteria from the first wound to the other wounds that could result to cross contamination and probable infection. She said the expectation was for the staff doing wound care would do the right procedure. Policy specific to not using the same gauze in cleaning the wounds requested on 08/13/2025 at 1:05 PM via email and verbally requested on 08/14/2025 at 7:42 AM. The RCN stated the facility did not have a policy specific for wound care technique. Event ID: Facility ID: 675292 If continuation sheet Page 8 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview, and record review the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infection and to restore continence to the extent possible for one of (Resident #44) two residents reviewed for catheter care. The facility failed to ensure that LVN A placed Resident #44's catheter bag (collects urine from the urinary bladder) below the bladder on 08/12/2025. This failure could place residents with catheter at risk for urinary tract infection. Findings included: Record review of Resident #44's Face Sheet, dated 08/13/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with neuromuscular dysfunction of the bladder (the muscles and nerves that control the bladder do not work properly due to illness). Record review of Resident #44's Quarterly MDS Assessment, dated 07/23/2025, reflected the resident was cognitively intact with a BIMS score of 15. The Quarterly MDS Assessment indicated that the resident had an indwelling catheter (a thin, flexible tube inserted in the bladder to allow the urine to flow in the catheter bag). Record review of Resident #44's Comprehensive Care Plan, dated 06/15/2025, reflected the resident had a Foley catheter and one of the interventions was to position the catheter bag and tubing below the level of the bladder. Observation and interview on 08/12/2025 at 11:11 AM, LVN A stated Resident #44 wanted to have a bowel movement. She said she would turn the resident to her side because the resident preferred to be on her side every time she had a bowel movement. It was observed that the resident had an indwelling catheter. LVN A turned the resident but before she turned the resident, she unhooked the resident's catheter and placed it on top of the resident's bed. It was observed that the catheter bag was at the same level of the resident's bladder and urine from the catheter bag travelled back to the catheter's tubing. Observation on 08/12/2025 at 11:22 AM revealed LVN A proceeded with wound care after Resident #44 tried to have a bowel movement since the resident was already on her side. It was observed that the catheter bag was still on top of the bed, at the same level of the bladder and urine was still observed on the tubing. In an interview on 08/12/2025 at 11:38 AM, LVN A stated she placed Resident #44's catheter bag on top of the bed so it would not be pulled that could cause injury to the resident. She said she should have pulled the bed and hang the catheter on the other side to prevent backflow of the urine that could cause urinary retention and UTI. In an interview on 08/12/2025 at 11:58 AM, Resident #44 stated some staff would pull her bed to transfer her catheter when she needed to be turned. She said some staff did not and would just put the catheter bag on top of her bed. In an interview on 08/14/2025 at 7:02 AM, the ADON stated the catheter bag should always be below the bladder to prevent backflow of the urine to the bladder. She said what should have done was to pull the bed to transfer the catheter bag or turn the resident to where the catheter bag was hooked. She said the expectation was for the catheter bag be below the bladder to allow the urine to drain by gravity and prevent backflow that could potentially introduce bacteria to the bladder that could lead to infection. She said she would coordinate with the DON to do an in-service about catheter care. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated the expectation was for the catheter bag be below the bladder to prevent infection. She said she would collaborate with the ADON and the DON to make sure the said issue would be addressed. In an interview on 08/14/2025 at 10:13 AM, the DON stated the catheter bag should always be below the bladder to prevent backflow of the urine to the bladder that could result to urinary retention or infection. She said the Resident #44's bed should have been pulled to place the catheter on the other side. She said the expectation was for the staff would make sure that the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 9 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0690 Level of Harm - Minimal harm or potential for actual harm catheter bag was below the bladder and make adjustments if needed, like pull the bed or turn the resident to where the catheter was hooked. She said she would initiate an in-service about catheter care and would do a one-on-one with LVN A. Record review of the facility's policy Catheter Care Nursing Policy and Procedure Manual 2003 revised February 13, 2007, revealed, 15. Keep drainage bag below level of bladder when cleaning the urethral area. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 10 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident who was fed by enteral means received the appropriate treatment and services to restore, if possible, oral eating skills and to prevent complications of enteral feeding including but not limited to aspiration pneumonia, diarrhea, vomiting, dehydration, metabolic abnormalities, and nasal-pharyngeal ulcers for one of three residents (Resident #40) reviewed for feeding tube (a way of providing nutrition directly to the stomach). The facility failed to ensure Resident #44 had an order to flush the g-tube before and after medication administration on 08/13/2025. This failure could place residents at risk for infection and development of obstruction of the g-tube. Findings include: Record review of Resident #40's face sheet, dated 08/13/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with dysphagia (difficulty in swallowing). Record review of Resident #40's Quarterly MDS Assessment, dated 07/02/2024, reflected the resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated the resident had a feeding tube. Record review of Resident #40's Comprehensive Care Plan, dated 06/15/2025, reflected the resident required tube feeding and one of the interventions was to administer medications as ordered. Record review of Resident #40's Physician Order, dated 12/21/2020, reflected every shift Flush with at least 5mls of water between each medication. Record review of Resident #40's Physician Order, dated 11/09/2023, reflected Dilantin Infatabs Tablet Chewable 50 MG (Phenytoin) Give 3 tablet via GTube two times a day related to Epilepsy. Hold Feeding 1 Hour Before and 1 Hour After Giving. Record review of Resident #40 ‘s Physician Order on 8/13/2025 reflected no order for flushing the g-tube before and after medication administration. Observation on 08/13/2025 at 8:57 AM revealed the ADON was about to administer Resident #40's medication via g-tube. The ADON flushed the resident's g-tube with 30 ml of water and proceeded to administer the medications one-by-one, flushing in between medications with 5 ml water. After she was done administering the medications, she flushed the g-tube with 30 ml of water. Observation and interview on 08/13/2025 at 9:20 AM, the ADON stated g-tubes should be flushed before and after medication administration to maintain its patency, to make sure all the medications went through, and nothing was left in the tube. She said, Resident #44 had Dilantin that was why the feeding was stopped one hour before medication administration and to resume one hour after. When asked if the resident had an order for flushing the g-tube before and after medication administration, the ADON checked her computer for the order and said there was no order for the flushing before and after medication administration. She said she knew what to do but there should be an order for the flushing. She said this should have been caught earlier by whoever was administering the resident's medications, so an order was put in place. She said there should be an order for everything done for the resident to ensure continuity of care. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated there should be an order for everything done for the residents to make sure all the staff were in sync with the residents' care. She said some staff would know the right procedure in administering medications to residents with a g-tube. She said but what about those new nurses that would follow religiously the order reflected in the residents' profile. She said she would collaborate with the ADON and the DON to make sure there were appropriate orders for g-tube. In an interview on 08/14/2025 at 10:13 AM, the DON stated the gtube should be flushed before and after medication administration to prevent clogging and to ensure delivery of the medications. She said since the feeding formula was stopped for an hour before the medications were administered, the formula inside the tube could thicken and cause blockages. She (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 11 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete said even though the staff did the right procedure and knew that the g-tube needed flushing before and after administering medications via g-tube, there should still be an order for flushing before and after and how much should be used for flushing. She said, new nurses might not be familiar with how to administer medications via g-tube and end up not flushing the g-tube before and after, and then they would wonder why the g-tube was clogged. She said the expectation was for the nurses to check if the orders for g-tubes were complete. She said she would check the orders of the residents with g-tube to make sure they were completed. Record review of the facility's policy Gastrostomy Tube Care Nursing Policy & Procedure Manual 2003, revised February 13, 2007, reflected Procedure . 6. Flush the tube with 30-60 ml water to clear the formula . Special Considerations . order from the physician. Record review of the facility's policy Physician's Orders Medical Records Manual 2015, with no revision date, reflected Purpose: To monitor and ensure the accuracy and completeness of the medication orders, treatment orders . 2. The nurse will enter the order into PCC for the resident. Event ID: Facility ID: 675292 If continuation sheet Page 12 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 a resident who needed respiratory care, including tracheostomy care and tracheal suctioning, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for two of twelve residents (Resident #29 and Resident #31) reviewed for respiratory care.1. The facility failed to ensure Resident #29 's nasal cannula (flexible tube used to deliver oxygen to the nose through two prongs) was stored properly when not in use on 08/13/2025. 2. The facility failed to ensure there was a sign outside Resident #29's room that reflected oxygen was in use. 3. The facility failed to ensure Resident #31's breathing mask was stored properly when not in use on 08/12/2025. These failures could place residents at risk for respiratory infection and not having their respiratory needs met. Findings include: 1. Record review of Resident #29's face sheet, dated 08/13/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of Resident #29's Quarterly MDS Assessment, dated 06/30/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 07. The Quarterly MDS Assessment indicated the resident had chronic obstructive pulmonary disease and was on oxygen therapy. Record review of Resident #29's Comprehensive Care Plan, dated 06/15/2025, reflected the resident had chronic obstructive pulmonary disease and one of the interventions was give oxygen therapy as ordered. Record review of Resident #29's Physician's Order, dated 07/14/2025, reflected Resident may have Oxygen 2-4 LPM as needed to keep above 92%. Observation on 08/13/2025 at 8:10 AM revealed Resident #29 was not inside the room. It was observed that an oxygen concentrator was at the bedside with a nasal cannula connected to it. The nasal cannula was inside the trash can and was not bagged. it was also observed that there was no Oxygen in Use sign outside the resident's room. Observation and interview with LVN C on 08/13/2025 at 8:13 AM, LVN C stated the nasal cannula should be inside the bag to prevent cross contamination and respiratory infection. She went inside Resident #29's room and saw the nasal cannula that was inside the trash can. She disconnected the nasal cannula and threw it on the trash can. She went out of the room, went to the storage room, and took a plastic bag and a new nasal cannula. She said the resident needed assistance during transfer. She said whoever transferred the resident should have made sure the nasal cannula was stored properly or called her attention that the nasal cannula was in the trash can, so she could change it. She also said she would get signage for oxygen use so staff and visitors would know that oxygen was being used to prevent accidental fire. She was one of the responsible in making sure that there was a sign outside the resident's room. In an interview on 08/13/2025 at 1:32 PM revealed Resident #29 only shrugged his shoulders when asked who removed his nasal cannula earlier that day. 2. Record review of Resident #31's face sheet, dated 08/13/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with chronic obstructive pulmonary disease. Record review of Resident #31's Quarterly MDS Assessment, dated 06/09/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 05. The Quarterly MDS Assessment indicated the resident had chronic obstructive pulmonary disease and was on oxygen therapy. Record review of Resident #31's Comprehensive Care Plan, dated 07/29/2025, reflected the resident had chronic obstructive pulmonary disease and one of the interventions was give aerosol (substance released in fine mist) or bronchodilators (medication that caused widening of the air passages) as ordered. Record review of Resident #31's Physician's Order, dated 08/01/2025, reflected Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 13 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 FORM CMS-2567 (02/99) Previous Versions Obsolete (Ipratropium-Albuterol) 1 dose inhale orally every 6 hours as needed for SOB. Observation and interview on 08/12/2025 at 9:06 AM revealed Resident #31 was in her bed, awake. It was observed the nebulization machine was on top of the resident's side table with a breathing mask connected to it. The breathing mask was not bagged and was on the floor. The resident said nurses would give it to her and would come back to take it off. When asked when was the last time she had the breathing treatment and if she knew her mask was on the floor, the resident did not reply. Observation and interview on 08/12/2025 at 9:17 AM, the RCN stated if the resident was not using the breathing mask, it should be inside a clean plastic bag to ensure cleanliness for the next use. She said, if she was correct, the order for Resident #31's breathing treatment was as needed. She went inside the resident's room and saw the breathing mask on the floor. She disconnected the breathing mask and threw it in the trash can. She said the breathing mask should be bagged properly or disconnected and just connect a new one if needed. She said the nurse administering the breathing treatment was the one responsible in bagging the breathing mask. She said not bagging the breathing mask could lead to respiratory infection. She said she would start an in-service about bagging the breathing mask. In an interview on 08/14/2025 at 7:02 AM, the ADON stated the breathing mask should be stored properly to prevent cross contamination and respiratory infections. She said whoever administered the breathing treatment was responsible for cleaning it and storing it in a plastic bag. She said whoever transferred any resident with a nasal cannula should put it inside a plastic bag, so it would be clean for the next use. She said the expectation was for the staff to bag the nasal cannula and the breathing mask to when not in use. She said another expectation was for the staff to check if there was an Oxygen in Use sign outside the door of residents that were using oxygen. She said the sign for oxygen use was to remind the staff and visitors to be careful not to cause any ignition that could cause fire. She said she would coordinate with the DON to do an in-service about the issue about respiratory care and oxygen administration. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated the expectation was for the staff to bag the nasal cannula and the breathing mask when not in use to prevent respiratory issues. She said she would coordinate with the DON and the ADON on how to deal with the issue because they were vigilant in reminding the staff to make sure the nasal cannula and the breathing masks should be bagged when not in use. In an interview on 08/14/2025 at 10:13 AM, the DON stated the staff were responsible in making sure the nasal cannula and the breathing masks were bagged when not in use to prevent respiratory infection. She said it was her responsibility to check if the staff were compliant. She said an in-service was already initiated on 08/12/2025. She said, moving forward, she would still randomly monitor the staff if they were bagging them when not in use. Record review of the facility's policy Oxygen Administration Nursing Policy & Procedure Manual 2003, revised February 13, 2007, reflected Goals . 1. The resident will maintain oxygenation with safe and effective delivery of prescribed oxygen . Procedure . 11. Place NO SMOKING signs in area when oxygen is administered and stored. In an interview on 08/14/2025 at 7:42 AM, the RCN stated the facility did not have a policy specific for bagging the nasal cannula and the breathing mask when not in use. Policy specific to bagging the nasal cannula and breathing mask requested on 08/13/2025 at 1:05 PM via email but was not provided prior to exit. Event ID: Facility ID: 675292 If continuation sheet Page 14 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to provide pharmaceutical services, including procedures that assured the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals that met the needs of each resident for one of eight residents (Resident #30) reviewed for pharmaceutical services. The facility failed to ensure vials of solutions used for breathing treatment were not left inside Resident #30's room for the resident to administer by himself on 08/12/2025. This failure could place residents at risk of not receiving medications as ordered by the physician, potential overdose, and adverse effects. Findings include: Record review of Resident #30's face sheet, dated 08/13/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of Resident #30's Comprehensive MDS Assessment, dated 06/30/2025, reflected the resident had a moderated impairment (resident may need additional support and monitoring) in cognition with a BIMS score of 11. The Comprehensive MDS Assessment indicated the resident had generalized weakness. Record review of Resident #30's Comprehensive Care Plan, dated 05/28/2025, reflected the resident had shortness of breath and one of the interventions was to administer medications as ordered. Record review of Resident #30's Physician's Order, dated 04/26/2025, reflected Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 1 vial inhale orally every 4 hours for SOB or Wheezing via nebulizer **While awake, do not administer if res sleeping. Record review of Resident #30's Assessment Notes on 07/01/2025 reflected no assessment for self-administration of medications, no clear instructions for self-administrations, and no assessment the resident was competent to manage their own medications. Observation and interview on 08/12/2025 at 12:18 AM revealed Resident #30 was in his wheelchair, awake. A nebulizer machine was observed on top of the resident's side table and beside the nebulize machine were four plastic vials of solutions used for breathing treatment. The plastic vials were not opened and still had the solutions inside. Resident #30 said he was the one administering his breathing treatment. He said the nurse would leave several vials with him so he could do the breathing treatment if he needed to. He said he did not call or tell the nurse he did a breathing treatment. In an interview on 08/12/2025 at 12:28 PM, LVN B stated she was the one administering Resident #30's breathing treatment. She said she was not aware the resident was doing it by himself. She said she saw the solutions for breathing treatment when he gave the resident's morning medications but forgot to grab them on her way out. She said the solutions should not be left inside the room because they were medications. she said the resident might use them every hour and no one would know until adverse reactions such as palpitations, chest pain, or headache. In an interview on 08/13/2025 at 7:16 AM, Resident #30 said the nurses gave his breathing treatment on evening of 08/12/2025. He said but before that date, he would usually do his breathing treatment. In an interview on 08/14/2025 at 7:02 AM, the ADON stated medications should not be left with a resident to administer unsupervised. She said the staff administering the breathing treatment should stay with the resident until the resident was done with it. She said the resident might not take them, someone else might, or the resident might administer it not as ordered. She said if the resident did not have an assessment that he could administer the medications by himself, the staff should do it, and medications should not be left inside the room. She said the medication should be in the cart because the nurses were the one who was supposed to administer it. She said she would coordinate with the DON to do an in-service about not leaving the medications with the residents. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 15 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete medications should be left inside the room because the resident might overmedicate. She said the expectation was for the staff not to leave any medication inside the room for the resident to administer by himself. She said she would coordinate with the DON and the ADON to do an in-service about not leaving the medications with the resident. In an interview on 08/14/2025 at 10:13 AM, the DON stated staff should never leave the solutions at the bedside for the resident to administer unsupervised. She said the staff must ensure the resident had the breathing treatment as scheduled. She said the residents could overdose as manifested by increased heart rate and chest pain. She said if the resident was the one administering the breathing treatment, there should be proper assessment that the resident was capable to do so. If the resident was capable, the solutions should still not be on top of the side table were other confused residents could assess it and consume it. The DON said she would do an in-service not leaving any medication inside the residents' room. Record review of the facility's policy, Medication Administration Procedures Pharmacy Policy & Procedure Manual 2003, revised 10/25/17. reflected, 1. All medications are administered by licensed medical or nursing personnel. Event ID: Facility ID: 675292 If continuation sheet Page 16 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 - Some 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 observation, interview and record review the facility failed to, in accordance with State and Federal laws, store all drugs and biologicals in locked compartments under proper temperature controls, and permitted only authorized personnel to have access to the keys for four of sixteen residents (Resident #2, #11, #30, and #42) reviewed for medication storage. 1. The facility failed to ensure Resident #2's zinc oxide (medicated cream used to prevent skin irritation) was not left inside the resident's room on 08/12/2025. 2. The facility failed to ensure Resident #11's zinc oxide was not left inside the resident's room on 08/12/2025. 3. The facility failed to ensure Resident #42's zinc oxide was not left inside the resident's room on 08/12/2025. 4. The facility failed to ensure Resident #30's vials of solutions used for breathing treatment were not left inside the resident's room on 08/12/2025. These failures could place residents at risk of misuse of medications that could lead to overdosing or underdosing. Findings include: 1. Record review of Resident #2's face sheet, dated 08/12/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with dementia (a condition characterized by loss of memory and ability to reason). Record review of Resident #2's Comprehensive MDS Assessment, dated 06/26/2025, reflected the resident had a severe impairment in cognition with a BIMS score of 03. The Comprehensive MDS Assessment indicated the resident had dementia and was at risk of developing pressure ulcers/injuries. Record review of Resident #2's Comprehensive Care Plan, dated 06/28/2025, reflected the resident had incontinence and one of the interventions was to apply barrier cream after each episode. Record review of Resident #2' Physician Order, dated 05/30/2024, reflected May apply barrier cream as needed every shift. 2. Record review of Resident #11's Face Sheet, dated 08/12/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with Alzheimer's disease (a disorder that primarily affects memory). Record review of Resident #11's Quarterly MDS Assessment, dated 04/01/2025, reflected the resident had severe impairment in cognition with a BIMS score of 03. The Quarterly MDS Assessment indicated the resident had Alzheimer's Disease and was at risk of developing pressure ulcers/injuries. Record review of Resident #11's Care Plan, dated 06/15/2025, reflected the resident had potential for pressure ulcer related to incontinence and one of the interventions was to apply barrier cream per physician order. Record review of Resident #11's Physician Order, dated 12/01/2020, reflected May apply barrier cream as needed. Observation on 08/12/2025 at 8:57 AM revealed there were two tubes of zinc oxide inside Resident #2 and Resident #11's room. The zinc oxide was located beside the sink inside the room. Observation and interview on 08/13/2025 at 7:01 AM revealed the tubes of zinc oxide were still inside Resident #2 and Resident #11's room. The ADON went inside the rooms after being notified that there were zinc oxides on the said rooms and took the tubes of zinc oxide and said it should be inside the room, or it should be placed where the residents could not access them. She said it should be inside the cart. She said confused residents might could mistake it as toothpaste and place it in their mouth. She said the expectation was for the staff to make sure no zinc oxide was placed where the residents could access them. She said she would coordinate with the DON to do an in-service about medication storage. 3. Record review of Resident #42's face sheet, dated 08/13/2025, reflected an [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with dementia (a condition characterized by loss of memory and ability to reason). Record review of Resident #42's Quarterly MDS Assessment, dated 06/27/2025, reflected the resident had severe impairment in cognition with a BIMS score of 04. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 17 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete The Quarterly MDS Assessment indicated the resident had dementia and was at risk of developing pressure ulcers/injuries. Record review of Resident #42's Care Plan, dated 06/01/2025, reflected the resident reflected the resident had potential for pressure ulcer related to incontinence and one of the interventions was to apply barrier cream per the physician order. Record review of Resident #42's Physician Order, dated 12/08/2024, reflected May apply barrier cream as needed every shift. Observation on 08/12/2025 at 9:00 AM revealed Resident #42 was in his bed with eyes closed. It was observed that a tube of zinc oxide was on top of his side table. Observation and interview on 08/12/2025 at 9:16 AM, LVN A stated zinc oxide was a form of medication because to was used to prevent any pressure injury to the skin. She said it should not be inside the room, as confused residents might consume it. She said the cream should be stored in the cart and just put some in a cup for use or place it somewhere not accessible. She said she would go to Resident #42's room to get the zinc oxide. She said she would also check the other rooms. 4. Record review of Resident #30's face sheet, dated 08/13/2025, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. The resident was diagnosed with chronic obstructive pulmonary disease (a chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of Resident #30's Comprehensive MDS Assessment, dated 06/30/2025, reflected the resident had a moderated impairment (resident may need additional support and monitoring) in cognition with a BIMS score of 11. The Comprehensive MDS Assessment indicated the resident had generalized weakness. Record review of Resident #30's Comprehensive Care Plan, dated 05/28/2025, reflected the resident had shortness of breath and one of the interventions was to administer medications as ordered. Record review of Resident #30's Physician's Order, dated 04/26/2025, reflected Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML 1 vial inhale orally every 4 hours for SOB or Wheezing via nebulizer **While awake, do not administer if res sleeping. In an interview on 08/12/2025 at 12:28 PM, LVN B stated she was the one administering Resident #30's breathing treatment. She said she saw the solutions for breathing treatment when he gave the resident's morning medications but forgot to grab them on her way out. She said the solutions should not be left inside the room because they were medications. she said the resident might use them every hour and no one would know until adverse reactions such as palpitations, chest pain, or headache. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated the expectation was for the staff to be mindful with all the tubes of zinc oxide were not inside the residents' rooms where they could assess them and consume them. She said she would coordinate with the DON and the ADON about storing the tubes of zinc oxide. In an interview on 08/14/2025 at 10:13 AM, the DON stated medications should not be stored inside the resident's room. She said zinc oxide was a form of medications that could be harmful when ingested. She said some residents might be allergic to it and was able to get hold of the zinc oxide because the tubes were in plain view. She said the expectations were for the staff to always scan the residents' rooms to make sure they were not leaving the tubes of zinc oxide inside the room, putting them where the resident could not access them, or just put them in the cart. She said she would do an in-service about storing the zinc oxide accordingly. Record review of the facility's policy, Medication Administration Procedures Pharmacy Policy & Procedure Manual 2003, revised 10/25/17, revealed, 8. After the medication administration process is completed, the medication cart must be completely locked and stored in a locked medication room or otherwise secured. Event ID: Facility ID: 675292 If continuation sheet Page 18 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen for food and nutrition services.1. The facility failed to seal, label and date refrigerator and freezer food items.2. Dietary staff failed to dispose of expired foods items in the pantry and refrigerator.These deficient practices could place residents at risk for cross-contamination and foodborne illness.Findings include: Observation on 08/12/2025 from 9:10 AM to 9:45 AM in the facility's kitchen revealed: -Two Sandwiches wrapped in plastic, located in the refrigerator with no label or expiration date. - One Gallon size bag of Cheddar Cheese, located in the refrigerator, dated 07/31/25 with a use by date of 08/07/25.- One Plastic Bin containing assorted unpackaged sliced cheese, located in the refrigerator, dated 07/24 with a use by date of 07/30/25. - One Flat of Mushrooms kept in a cardboard box on the middle shelf in one of the refrigerators, labeled 07/10/25 but not labeled with a use by date. The mushrooms had a dried-out appearance. - One Block Cream Cheese in the refrigerator Manufacture use by date of 07/18/2025, marked in sharpie 07/24/25. - One Large Freezer bag which contained 3 separate Smoked Sandwich meat, in the freezer which had visible freezer burn. - One 2lb Smoked Turkey Breast, in the freezer which had visible freezer burn. - One 2lb Smoked Turkey Breast, in the freezer that had visible freezer burn. - One Gallon size freezer bag, in the freezer with four fish fillets that had visible freezer burn. - One Freezer bag in the freezer labeled Chix Pieces, dated 07/18/25. with a use by date of 07/22/25. - Three 2 Gallon size Freezer bags which contained chicken thighs in the freezer, which had visible freezer burn. - One Clear bag which contained a Pie crust, dated of 07/17/25, and a use by date of 07/22/25. - One Gallon size bag which contained (five) individual biscuits in the bread pantry, dated 08/01/25, with a use by date of 08/08/25. One Loaf of bread in the bread pantry which had visible Green/Black mold. - Four Loaves of bread in the bread pantry, dated 07/31/25, with a use by date of 08/08/25. - Three Loaves of bread in the bread pantry, dated 07/17/25, with a use by date of 07/30/25. _One loaf of bread in the bread pantry, dated 07/03/25, with a use by date of 07/18/25. During an interview on 08/14/2025 at 10:15 AM, the DM stated she had been the DM for about 4 months, and prior to that was the cook at the facility for a year. The DM stated she was the person overall responsible for ensuring the kitchen met guidelines for food storage and kitchen sanitization. The DM acknowledged the surveyor observations. The DM stated she was responsible for kitchen sanitation and proper storage of food products and the deficient practices were oversights. She stated the risk of all the concerns observed in the kitchen could result in residents getting sick. The DM stated the risk of the concerns not being addressed could result in food-borne illnesses .DM stated if food items were not dated when opened then they will not be able to know how long it will last. Items stored in the refrigerator must be dated upon receipt, unless they contain a manufacturer use by, sell by, best by date, or a date delivered. DM stated the fridge and freezer should be checked daily for spoiled foods. During an interview on 08/14/2025 at 12:39 PM, the ADMIN stated she oversaw all departments, and ensured residents were taken care of. The ADMIN said the policy or procedure for storing food was, everything needed to be dated, and if opened it needed to have an open date and an expiration date. She said the risk to residents, if the policy was not followed was, they could get sick from food borne illnesses. She said the worst thing that could happen was, residents got sick and ended up in the hospital or worse. The ADMIN stated she expected staff to ensure they followed policies and procedures of the facility kitchen policy, to protect residents and to deliver good care.Record review of the facility's Dietary Services Policy & Procedure Manual, dated 2012, indicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 19 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete .6. When items are received from the vendor, they should be first examined for expiration date, and if an expiration date is present, it is beneficial to mark it by circling it, so it is readily visible and noticeable. As the quality may deteriorate after the date passes, the dietary manager should closely inspect any products that are past the best by date to determine if they are still good quality. If in doubt, discard the product. If any stamped date is unclear, contact the food vendor for clarification. If an item does not have a date designated by the manufacturer as an expiration date, then the item should be dated as to when it is received, and shelf-stable items will be stored in a first in, first out manner, to be used within one year . Any product with a stamped expiration date will be discarded once that date passes. 8. On perishable foods, microorganisms such as molds, yeasts, and bacteria can multiply and cause food to spoil. Spoiled foods will develop an off odor, flavor, or texture due to naturally occurring spoilage bacteria. If a food has developed such spoilage characteristics, it should not be eaten. food spoilage is observed prior to the best by date, the product will be discarded. If a frozen food does not have an expiration date or a dated shipping label it will be dated when received or is removed from original packaging. Record review of the U.S. Food and Drug Administration (FDA ) Code (2022) revealed, Packaged Food shall be labeled as specified in law, including 21 CFR 101 Food Labeling, 9 CFR 317 Labeling, Marking Devices, and Containers, and 9 CFR 381 Subpart N Labeling and Containers, and as specified under S 3-202.18. Food shall be protected from contamination that may result from a factor or source not specified under Subparts 3-301 - 3-306. Event ID: Facility ID: 675292 If continuation sheet Page 20 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based observation, interview and record review the facility failed to establish and 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 two of fifteen residents (Resident #6 and Resident #44) reviewed for infection control. 1. The facility failed to ensure CNA D and CNA E changed their gloves during Resident #6's incontinent care on 08/13/2025. 2. The facility failed to ensure LVN A did not put Resident #44's catheter bag on top of the bed's linen. 3. The facility failed to ensure LVN performed hand hygiene and wore a gown while turning Resident #44 on 08/12/2025. 4. The facility failed the ensure CNA E did not touch the new linens after touching the catheter when changing Resident #44's beddings on 08/12/2025. These failures could place residents at risk of cross-contamination and development of infections. Findings include: 1. Record review of Resident #6's face sheet, dated 08/13/2025, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. The resident was diagnosed with chronic kidney disease (a condition where the kidneys were damaged and cannot filter the blood). Record review of Resident #6's Comprehensive MDS Assessment, dated 05/30/2025, reflected the resident had severe impairment in cognition with a BIMS score of 02. The Comprehensive MDS Assessment indicated the resident was always incontinent for bladder and bowel. Record review of Resident #6's Comprehensive Care Plan, dated 04/27/2025, reflected the resident had incontinence, one of the interventions was provide pericare after each incontinent episode. Observation on 08/13/2025 at 1:42 PM revealed CNA D and CNA E were about to provide incontinent care to Resident #6. Both CNAs washed their hands and put on a pair of gloves. CNA E pulled the resident's bed and went to the resident's left side. CNA D went to the resident's right side. Both CNAs unfastened the soiled brief and tucked it between the resident's legs. CNA E proceeded in cleaning the resident's perineal area (area between the legs) using the front to back technique. After cleaning the perineal area, the resident was assisted to roll to her side and CNA E cleaned the resident's bottom. After cleaning the resident's bottom, CNA E rolled, pulled the soiled brief, and threw it in the trash can. CNA D helped in rolling the soiled brief. After throwing the soiled brief, CNA E took the new brief placed it on the resident's side, put it under the resident, and fixed it. CNA D helped in fixing the new brief. Both CNAs did not change their gloves after cleaning the bottom and after touching the new brief. In an interview on 08/13/2025 at 1:58 PM, CNA E stated she already knew she forgot to do something. She said she was not able to change her gloves after she cleaned Resident #6's bottom because her gloves were deemed soiled after touching the soiled linen and after cleaning the resident's bottom. She said her action could result to UTI. She said she would be mindful the next time she would do incontinent care to change gloves as needed and to sanitize in between changing of gloves. In an interview on 08/13/2025 at 2:02 PM, CNA D said she assisted during Resident #6's incontinent care. She said she did touch the soiled brief when it pushed between the legs and when it pulled from the resident. She said, at that point, she should have changed her gloves before touching the new brief because her gloves were already dirty and it could result to cross contamination and infection. She said the resident might get infected because of the dirty brief. 2. Record review of Resident #44's face sheet, dated 08/13/2025, reflected a [AGE] year-old female who admitted to the facility on [DATE]. The resident was diagnosed with neuromuscular dysfunction of the bladder (the muscles and nerves that control the bladder do not work properly due to illness) and obesity. The face sheet indicated the resident was on enhanced barrier precaution due to an open wound and catheter. Record review of Resident #44's Quarterly MDS Assessment, dated 07/23/2025, reflected the resident was cognitively intact Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 21 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 - Some with a BIMS score of 15. The Quarterly MDS Assessment indicated the resident had an indwelling catheter and needed assistance rolling to the left and right. Record review of Resident #44's Comprehensive Care Plan, dated 06/15/2025, reflected the resident was on enhanced barrier precautions and one of the interventions was to wear gloves and gowns during bed mobility. Observation and interview on 08/12/2025 at 11:11 AM, LVN A stated Resident #44 wanted to have a bowel movement. She said she would turn the resident to her side because the resident preferred to be on her side every time she had a bowel movement. It was observed the resident had an indwelling catheter. LVN A put on a pair of gloves but did not do hand hygiene before putting on a pair of gloves. LVN A also did not wear a gown while turning the resident. It was observed there was signage and a PPE cart outside the resident's room. The signage stated the resident was on enhanced barrier precaution. It was also observed when LVN A turned the resident, she placed the catheter bag on top of the bed, adjacent to where the resident's wound would be if the resident was rolled back. In an interview on 08/12/2025 at 11:38 AM, LVN A stated she should have worn a gown when turning Resident #44 because she had a catheter and an open wound. She said turning the resident was a high contact activity. She said EBP was required for doing treatment for residents with a catheter and open wounds to prevent the spread of resistant organisms and to protect the residents from such organisms. She said hand hygiene should be done before and after every care. She said it did not hit her that the catheter bag should not be placed on the top of the bed because the catheter bag was dirty. She said her actions could contribute to cross contamination and the development of infections. 3. Observation on 08/12/2025 at 11:30 PM revealed after LVN A was done with wound care, she told CNA E to change Resident #44's bed linens. CNA E gathered the bed linens she needed, put on a pair of gloves and a gown, and proceeded with changing the linens. She did not do hand hygiene before putting on a pair of gloves. In the process of changing the linen, CNA E unhooked the resident's catheter and placed it on top of the new linen. She then hooked the catheter back to the railings below the resident's bed. She did not change her gloves after touching the catheter and continued touching the new linen. In an interview on 08/12/2025 at 12:08 PM, CNA E stated she should not place the catheter on top of the new linen because the catheter bag was dirty making the new linen was dirty as well. She said the linen should be cleaned because Resident #44 did not want to wear a brief and had wounds at the back of the left thigh. She said dirty linens could cause infection. She said she should have changed her gloves as well after touching the catheter because the catheter bag was always presumed dirty. In an interview on 08/14/2025 at 7:02 AM, the ADON stated the purpose of hand hygiene and changing of gloves was to prevent cross contamination and spread of infection in the facility. She said gloves should be changed after cleaning the resident's bottom and after touching the catheter, hand hygiene should be performed before doing any care, the catheter bags should not be placed on top of the bed. She also said if a resident was on enhanced barrier precaution, the staff should wear a gown. She said all the issues discussed could lead to infection. She said the expectations were for all the staff to be mindful with how they took care of the residents and to be compliant with the policy of infection control. She said she would coordinate with the DON to do in-services regarding infection control. In an interview on 08/14/2025 at 7:42 AM, the Administrator stated after touching something soiled, the staff should change their gloves. She said, she was not a clinician, but she knew that before every care, hand hygiene should be performed. She said the catheter bag was dirty and should not be placed on top of the bed or touch the new linen. She said gowns should be worn for residents who were on EBP. She said the concerns discussed would all contribute to the development of infection. She said she would coordinate with the DON and the ADON about infection control. In an interview on 08/14/2025 at 10:13 AM, the DON (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675292 If continuation sheet Page 22 of 23 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 675292 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cottonwood Nursing and Rehabilitation 2224 N Carroll Blvd Denton, TX 76201 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete stated hand hygiene was the most effective way to prevent cross contamination and spread of infection. She said staff should do hand hygiene before and after any care. She said gloves should be changed after cleaning the resident's bottom and after touching the catheter bag. She said the catheter should never be placed adjacent to any wound. She said if the resident had a catheter or an open wound, wearing a gown was required. She said the issue discussed could all cause probable infection. She said she would do an in-service about infection control and would personally monitor the staff's adherence to the policy and procedure of infection control. Record review of the facility's, undated, policy Enhanced Barrier Precautions, reflected EBP are indicated for residents with any of the following . Wounds and/or indwelling medical devices . Indwelling medical device examples include central lines, urinary catheters . don gloves and gown . turn and reposition or assist with bed mobility. Record review of the facility's policy Perineal Care Female Nursing Policy and Procedure Manual 2003 , revised December 8, 2009, reflected Purpose: To clean the female perineum without contaminating the urethral area . wash hands . H. Wash hands and put on clean gloves for perineal care. Record review of the facility's policy Infection Control Plan: Overview, updated 03/2023, reflected, The facility will establish and maintain an Infection Control Program designed to provide a safe, sanitary . environment and to help prevent the development and transmission of disease and infection . Linens: Personnel will handle . linens so as to prevent the spread of infection . Preventing Spread of Infection . The facility will require staff to wash their hands after each direct resident contact for which hand washing . Gloves are worn . To reduce the likelihood that hands of personnel contaminated with microorganisms . and hands washed after gloves are removed. Record review of the facility's policy Hand Hygiene/Handwashing Infection Prevention and Control Policies and Procedures, revised May 15, 2023, reflected Policy: Hand Hygiene/Hand washing is the most important component for preventing the spread of infection . 1. Hand hygiene/hand washing is done . C. After contact with a contaminated object or source where there is a concentration of microorganisms, such as, mucous membranes, non-intact skin, body fluids . H. After removal of medical/surgical or utility gloves . C. Before putting on gloves, when changing into a fresh pair of gloves, and immediately after removing gloves. Event ID: Facility ID: 675292 If continuation sheet Page 23 of 23