Health inspection·July 19, 2023

F 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Resident #1's Face Sheet dated 07/18/23 reflected he had an RP who was also his emergency contact and his attending physician was MD A. Review of the Resident #1's clinical chart revealed the RP was his Medical Power of Attorney. An interview with Resident #1's RP on 07/18/23 at 12:55 PM revealed he/she was upset because she felt there was retaliation against Resident #1 due to the facility being investigated by HHSC. The RP stated Resident #1's g-tube was clogged on 04/02/23 and he had to be sent out to the ER and the hospital doctor told the RP the tubing had just been changed out so it should not have gotten clogged. The hospital doctor told her Resident #1 was dehydrated and was concerned the g-tube was not being flushed after each medication was given. On 03/25/23, the RP said she sent an email to the ADM about her concerns with the g-tube but did not receive a response, which she said was common practice when there was a concern voiced about Resident #1. The RP stated on 04/09/23, Resident #1 was observed by the RP to be moaning, grunting and grimacing and had dried vomit on his clothing and g-tube site was leaking around his stoma. The nurse (RN B) told the RP the g-tube was clogged and he was having a challenging time to get Resident #1's g-tube to flow with the machine and could only get it to work with gravity. The RP requested to see the clogged tubing and confirmed the nurse was unable to get any enteral feed to flow. The RP stated Resident #1 appeared to be in distress and told RN B the resident would need to be sent out because of how he was presenting and knew something was wrong. The RP was concerned that since it was in the afternoon, Resident #1 was not able to have his medications administered that day due to the clogged g-tube. The RP was frustrated that it was the second time Resident #1 had a clogged g-tube. The RP stated the nurse left the room to notify the physician and arrange transport and a different nurse came in, RN C. At that time, the RP noticed Resident #1's catheter was almost off, so she lifted it up and said it stunk and said it ended up having to be changed later in the hospital because there was blood in his urine and he had a bad infection. The RP said prior to these two incidents, the RP's Urologist suggested that he/she could clean the stoma site by changing the dressings. The RP told him an order would be needed and he wrote one, even though the RP knew the facility had already talked to he/her about not doing it. So on 04/09/23, when Resident #1 was observed to have a clogged and dirty g-tube insertion site, the RP asked RN B who was present in the room prior to Resident #1 being sent out, for permission to clean the resident's stoma site. The RP stated RN B brought in the supplies and the RP helped her; the RP said RN B was passing the gauze and the RP asked her if she minded if the RP helped and the nurse replied she did not mind. The RP said RN B was a weekend charge nurse but was not aware of how to secure and hang Resident #1's specific type of catheter securing device because she had not learned how to use that type when she worked in the hospital. The RP stated he/she purchased and used a specific type of catheter securing device that the facility did not have in stock, so the RP brought them to the facility to use. The RP said he/she and the DON even had a conversation about it in the past, where the RP had to inform the DON not all of the nurses knew how to secure the catheter properly and showed the DON how to use it because the DON told her she did not know how. When Resident #1 was at the hospital from the second clogged gtube on 04/09/23, the RP sent the DON an email on 04/10/23 which discussed Resident #1's condition, how the RP continuously found the catheter securing device waded up and how it had caused trauma to his bladder. The RP also told the DON in the email that Resident #1 was filthy, unchanged and foul smelling at times and that the RP had a physician's order which indicated the RP could change his dressing and I said I will contact State to see if I am in violation of changing his bandages or if it is his right to have whoever assist with dressing changes because I am his POA. The RP was able to talk to the HHSC investigator who was at the facility conducting a complaint investigation related to Resident #1 and the investigator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 2 of 8 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 675305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Valley Healthcare and Rehabilitation Cent 1525 Pleasant Valley Rd Garland, TX 75040 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few told her that dressing changes needed to be done by licensed staff and that the facility was following their policy in requesting that the RP not do it. On 04/12/23 at 4:56 PM, the RP emailed the DON and ADM and wrote, I will not be changing dressings or cleaning sites, but I do expect it to get done. There is no reason for him to have a foul smelling stoma site. The RP also asked the DON and ADM to please have the nurses clean the area better and more frequently. The RP stated that during the hospital visit, a family member was at the facility and the ADM and DON approached him and wanted to give him a letter to restrict visitation to weekdays only because there was a concern he was being violent, was a threat, and used foul language with RN B on the date Resident #1 had to be sent to the ER on [DATE], and he refused to sign it. The RP stated the family member was present in the room on that date, but he only said, unbelievable when there were continued issues with Resident #1's clogged g-tube. The RP said RN B did not appear fearful and continued to provide care and the RP had all of this on her AEM footage. RP stated she felt the facility was mad because they had a complaint investigation from HHSC related to Resident #1 occur at the same time he was in the hospital. The RP stated he/she also ended up getting an email around that same time stating the RP could not visit on the weekends either and could only come Monday through Fridays from 8:00 AM to 5:00 PM because he/she was doing direct care to Resident #1, even though the RP had already told them he/she would no longer do it, after talking to the HHSC Investigator. Then on 04/13/23, the RP stated she received an email from the ADM who thanked the RP for the response and wanted to meet about a plan to move Resident #1 to another facility. The RP said that was how he/she found out Resident #1 was being discharged and was given a 30-day notice, but the RP did not want to move him and felt the facility ADM and SW began to aggressively start calling and texting the RP within 24 hours to find an alternate placement. The RP read where she could appeal the discharge, but also stated it was written on the discharge notice that the appeal could be superseded if there was a risk of danger or harm, which the facility documented there was with the family member being allegedly violent. As a result, the RP did not think an appeal applied to Resident #1's situation. The RP stated he/she asked the ADM and SW for more time because the RP did not have anyone to help the family navigate finding a new place and it had only been one day. The RP stated, They had just told us the day before he had to go and then started pushing to get rid of us. The RP stated the facility documented on the 30-day discharge notice they could not meet the family's needs, But there were no needs, we just wanted to give him good quality of care. We didn't understand what needs were you not able to meet? The RP stated the discharge notice also included the other family member using violent language and was a threat as a reason, as well as the RP had given direct care to the resident, even when RN C had given her permission. The RP stated the facility hounded the family from 04/14/23 through 04/17/23 and pressed them to find another facility and the RP felt pressured and wanted to be left alone. The RP stated, I have PTSD because of this, he was forced out, it was horrible. The RP stated it felt like there was not a choice in discharging Resident #1 and finally on 04/17/23, the RP chose another facility because he/she felt the facility was trying to get rid of us. On 04/18/23, Resident #1 was moved to a new facility. The RP stated there was no option to have a care plan meeting to discuss the facility's concerns prior to, or during the discharge notification. Review of an initial letter signed by the ADM on 01/04/23 to the RP reflected in part, It has come to my attention that you have been providing direct care to [Resident #1]; specifically on 10/10/22 in care plan meeting with [MDS, DON, ADON and ADM], we asked for all direct care to stop. 12/30/22 an email was sent in response to [RP's] email stating what direct patient care [he/she] is providing and facility asked you to stop. We have already discussed this with you on 10/10/22 and 12/30/22, but we remain concerned that your actions have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 3 of 8 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 675305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Valley Healthcare and Rehabilitation Cent 1525 Pleasant Valley Rd Garland, TX 75040 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few continued and are interfering with the care of your [Resident #1]; .Please execute and return the enclosed Visitation Agreement to acknowledge and confirm that you understand [facility's name] visitation policy, including the fact that family and visitors are expected to abide by conduct supportive of the Facility and, if they interfere with the general comfort and care of the residents, visitors or staff, future visitations can be denied .When visitors interfere with patient care, based on their actions or otherwise, it is the obligation of Facility Administration to take appropriate action .The Facility reserves the right to take further action as necessary and appropriate if your conduct presents an immediate danger to the safety and welfare of [Resident #1]. Record Review of the following notifications related to visitation/discharge for Resident #1 included: -Review of a Visitation Agreement dated 01/04/23 and signed by the DON, DOR and ADM reflected, Family or visitors may be asked to leave the premises if they become disruptive or interfere with the general comfort and care of the residents, visitors, or staff (specifically here, when the visitor provides direct care to the resident). It was noted on the agreement that the family refused to sign in and would like an attorney to review it first. -Review of a letter dated 04/12/23 to the DON and ADM from Resident #1's physician (MD A) reflected, This letter serves as my explanation for why I conclude that we are unable to provide care for [Resident #1]. The physician documented Resident #1 had been under his care continuously since March 2021 and that during that time it had become progressively more difficult and now proves impossible. MD A documented, The problem here is that the family member in question continues to interfere with my practice's ability to provide care for this patient. The MD listed out four examples, 1) The RP would not agree to the addition of hypertension medications to treat his significantly elevated systemic blood pressure readings, in the setting of known previous stroke and underlying hypertension; 2) The family member was interfering with the operation of Resident #1's indwelling suprapubic urinary bladder catheter and had gone so far as to recruit the outside Urologist to write a prescription for the RP to do so; 3)When taken out to see an infectious disease specialist for repeated urinary tract infections, the ID physician indicated a specific course of treatment, and documented the family member agreed but then when MD A tried to write the order, the family member then refused; and 4) [Resident #1] has returned from multiple hospitalizations with changes to medications that we have judged as appropriate including the reduction of frequent doses of Acetaminophen. However, the patient's family member then demands that the staff continue to treat the patient as per [the RP's] wishes. MD A concluded by documenting, I understand that families have the ability to be informed of the care of their loved ones, and to participate in their health journey. However, I do not accept that a family member can or should compel me as a Physician or my Nurse Practitioner's as my Physician Extenders either to pursue a treatment that is not appropriate or to be prevented from pursuing a treatment that is appropriate. Given the above, I conclude we are unable to provide for this patient's care. -Review of a discharge planning note dated 04/12/2023 at 11:44AM reflected, Type: Discharge Planning Text : Social Worker contacted [facility] for male bed availability, under direction of Admin. Social Worker sent resident's clinicals to [facility] for review. -Review of a letter to Resident #1's family member by the ADM dated 04/13/23 reflected, It has come to my attention that you have exhibited physically threatening behavior towards one or more of our staff members. Specifically on April 9th, 2023, you used aggressive language and became physically threatening by aggressively approaching one nurse who was caring for [Resident #1]. The Facility does (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 4 of 8 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 675305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Valley Healthcare and Rehabilitation Cent 1525 Pleasant Valley Rd Garland, TX 75040 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few not tolerate this behavior and it must stop now. Please execute the enclosed Visitation Agreement to acknowledge and confirm that you understand [facility's name] visitation policy, including the fact that family and visitors are expected to abide by conduct supportive of the Facility and, if they interfere with the general comfort and care of the residents, visitors or staff, future visitations can be denied. It is the obligation of Facility Administration to take appropriate action, including restricting or denying future visitation. Effective immediately, your visitations will be restricted to Mondays through Fridays from 8:00 a.m. to 5:00 p.m.the Facility also reserves the right to take further action as necessary and appropriate if your conduct presents an immediate danger to the safety and welfare of the Facility's staff, residents or visitors. Hand written on the letter was a note that stated the family member refused hand delivery. -Review of a Notice of Proposed Transfer/Discharge dated 04/13/23 and signed by the ADM reflected the transfer/discharge for Resident #1 was necessary for the resident's welfare and his needs could not be met in the facility due to (a) Please see attached letter, (b) The Facility attempts to meet the resident's needs, and the resident's response, included: POA continues to interfere with care and Dr. orders against medical advice. Please see attached letter. The notice also reflected, The Facility will not discharge/transfer you while your discharge/transfer is pending if you exercise your right of appeal unless the failure to discharge/transfer you would endanger your health or safety or that of other residents/other individuals in the facility .The danger presented is summarized as follows: Family/POA has become threatening to our staff and residents by tempting to provide direct resident care against medical advice along with threatening behavior towards staff. Please see attached letter. An interview with the ADM and DON on 07/18/23 at 9:55 AM revealed the facility issued a 30-day discharge notice to the resident and family and had the family sign a behavior contract related to visitation. The ADM stated the family chose to move Resident #1 to another facility. A follow up interview with the ADM on 07/18/23 at 11:06 AM revealed the nurse who was threatened by Resident #1's family member no longer worked at the facility but she thought she had an incident report/witness statement from him. An interview with the SW on 07/18/23 at 3:00 PM revealed she started employment in April 2023 and she was notified of a 30-day discharge by the ADM and began discharge planning at that time. The SW stated the facility initiated discharge occurred due to us no longer being compatible of a good fit for him. The SW stated there was no care plan meeting with the RP prior to discharge. The SW stated that there were no issues with Resident #1 and when she started working at the facility, she was coming in at the end of his stay and was not a part of the family's behavior contract or discharge discussions prior to decisions being made. The SW stated, As social worker, if a facility has issues with a family member wanting to be too involved in resident care, driving care, overstepping physician decisions, etc., overstepping plan of care would usually be communicated with me during stand up if that was the situation and I may bring up maybe have a care plan meeting and bring in attending physician. An interview with the DON on 07/18/23 at 3:38 PM revealed the facility had a medical director (MD A) and three attending physicians available to chose from for the residents. The DON stated if an RP does not work well with a certain physician, other physicians could be offered if they want to choose another one, or the facility could listen to the RP's concerns and mitigate and be the communicator between the RP and the physician. If the physician does not want to work with a resident due to family behavior dynamics, the DON stated the same thing would apply, communicate with all parties, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 5 of 8 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 675305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Valley Healthcare and Rehabilitation Cent 1525 Pleasant Valley Rd Garland, TX 75040 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few offer a change in physician and see if they have a preference. The DON stated the types of care an RP/family can provide to a resident included feeding, dressing, bathing, grooming, repositioning as long as it is safe for the resident and the resident is in agreement. The DON said family cannot provide care that requires a licensed nurse to perform. The DON stated Resident #1's RP did some dressing changes over his stay but could not recall specific dates. The DON stated she witnessed the RP once doing peg tube and suprapubic care, cleaning and reapplying dressings. The DON said she told the RP to hold on and allow the nurse to do it. She said the facility met with the RP to make sure the RP had education on what he/she could do versus what licensed staff can do. The DON said the RP told the facility he/she had cared for Resident #1 at home previously to going into a nursing home and he/she wanted things done very specific to his/her preference, things that would not necessarily require a doctor's order. The DON thought the RP wanted the resident's dressings changes more frequently than daily and PRN. She could not confirm if the RP's periodic care of his stoma site dressings and catheter placed him at risk for infection due to the resident have a suprapubic catheter, obstructions and a history of infections. The DON stated Resident #1 was discharged because the facility could no longer meet his needs and the RP wanted to manage care related to medication management which would have placed him at risk for negative side effects. The DON stated, The discharge was because we could no longer meet the resident's needs, not because of the [family member who was allegedly aggressive]. The DON said there was no direct witnesses other than facility and RN B regarding the aggression incident. She stated RN B called her immediately after the incident and said the family member stepped towards him and aggressively yelled at him and RN B felt at risk. The DON said the family member had been aggressive once before when he got up and stomped out of a care plan meeting in the past. The DON said the facility had tried to have care plan meetings with the RP and family about facility concerns, but the RP said the meetings were too traumatizing. The DON said when RN C went to help Resident #1 on 04/09/23, the DON was not present but from her memory, RN C entered the room to do a dressing change and the RP was not satisfied and took over. The DON stated she did not see the AEM footage for Resident #1 for the time/date that the family had available to show there was no aggression incident. The DON said the RP had a preference and supplied the facility with a specific securing device for Resident #1's catheter that was called a STATLOCK (Foley Stabilization Device is a strap free device, which locks the foley catheter in place, stabilizes the catheter and eliminates any chance of a sudden pull). The DON said it was allowable for the RP to show the nursing staff how to use it because she was part of the plan of care. The DON then stated, If [RP] is directing care and putting residents at risk, then we cannot meet the resident's needs medically. The DON stated the final incident that caused the 30-day discharge notice to be given was when Resident #1's RP would not allow any additional medications to be ordered/administered for his hypertension, changing med times and not wanting the nurses to give him insulin per his sliding scale. The DON said the RP would want Resident #1's pain management medication time frames increased in frequency and would not agree sometimes with some of the hospital discharge orders. The DON said the RP also did not want to add Amlodipine (Amlodipine is a calcium channel blocker. It works by affecting the movement of calcium into the cells of the heart and blood vessels. This relaxes the blood vessels and lowers blood pressure and increases the supply of blood and oxygen to the heart while reducing its workload) to treat his hypertension because the RP was worried it would slow Resident #1's pulse to low. The DON then stated, But he was also on pain meds which would have slowed his heart rate down. The DON was asked to provide copies of all grievances lodged by the RP, care plan meeting invite forms and care plan meeting minutes to reflect the facility discussed their concerns with the RP. An interview with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 6 of 8 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 675305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Valley Healthcare and Rehabilitation Cent 1525 Pleasant Valley Rd Garland, TX 75040 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the ADM on 07/19/23 at 11:56 AM revealed when an RP/MPOA does not work well with the resident's physician, the facility would need to do a root cause analysis and see if it was something we absolutely cannot get over or is there a bridge related to communication. She said if a physician no longer wants to work with a resident due to perceived family behavior and issued a 30-day Physician discharge notice, then it would be up to the facility to find a new physician and the facility is liable. The ADM said residents' RPs and family members were allowed to provide bed baths, shave, apply lotion, feed, dress and reposition a resident, but they cannot do anything related to a doctor's order. The ADM said families were aware of these rules because every so often, We have a text messaging platform through the company and I was sending out messages letting families know about our protocols with meds and orders. The ADM said she had not personally witnessed the RP completing a dressing change for Resident #1 but the DON had once in 2022 and they educated the RP at that time to stop. The ADM said the RP was concerned the nursing staff were not completing Resident #1's care correctly. The ADM could not say if the RP completing a dressing change caused any infections. The ADM stated, The concern was every time [the RP] would come and visit and even through emails sent, [the RP] would say he/she was lifting up [Resident #1's] bandage which was directly related to his stoma and then he would be sent out a few days later related to his stoma and we can't tell if that was caused by improper infection control procedures. [RP] is not a nurse and not hired to perform care by us. The ADM stated Resident #1 was discharged by the facility because the MPOA/RP was going directly against doctor's orders and medical advice regarding dressing changes. The ADM felt that she could discharge Resident #1 if the RP broke the behavior contract. The ADM stated, Even if we changed physicians, it would not have stopped her behavior; .I felt it was in the best interest of the facility and the resident to go somewhere else. The ADM stated there was no care plan meeting to discuss the recent concerns in April 2023, prior to her issuing a discharge notice because the RP refused any kind of communication. The ADM was asked why the facility discharge notice documented there were multiple witnesses to the aggression incident between the family member and RN B. She replied that there were no witnesses in the room, only staff who saw RN B after he came out of the room and his demeanor. The ADM acknowledged that RN C did not appear to intervene at the time on 04/09/23 when the RP was doing a dressing change and stated, This was something we kind of questioned as well. The ADM stated that RN C was taken off guard as soon as the RP began providing care and thought that she may have been fearful of the RP threatening her license if she did not let the RP to the care. The ADM stated she did not view or request to view any AEM footage by the RP from that incident to validate what actually occurred. The ADM stated she had a witness statement for RN A and RN B related to the two separate incidents and was asked to provide them. When the RP violated the behavior agreement related to dressing changes, the ADM confirmed suspension of visitation was documented as the consequence but, I went ahead and wrote the 30-day discharge to protect us. The ADM stated she had utilized the resources she had with the discharge determination and felt supported, but now thought that maybe she should have indicated in the behavior agreement initiated in January 2023 (to stop doing care or visitation could be revoked) and April 2023 (to stop doing care and that visitation is now suspended for weekends), that it should have included the consequence of a facility-initiated discharge option. The ADM stated, I did an umbrella to make it to where I could decided what I deemed appropriate. A follow up interview with the RP on 07/19/23 at 1:26 PM revealed he/she wanted to discuss MD A and how he alleged in his discharge letter that the RP was declining medications for Resident #1. The RP stated Resident #1 had uncontrollable blood pressure and there was an instance where a family member of the RP called the facility and felt Resident #1 did not need Hydralazine (Hydralazine is a direct (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 7 of 8 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 675305 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pleasant Valley Healthcare and Rehabilitation Cent 1525 Pleasant Valley Rd Garland, TX 75040 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 0622 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few vasodilator used orally to treat essential hypertension, among other diseases, and intravenously to rapidly reduce blood pressure in hypertensive urgency or emergency) and the family member wanted the facility to stop it. The NP contacted the RP, who then stated no, Resident #1 needed it. The RP stated the only time she asked the facility to not administer a medication was when she declined Diflucan because there was a concern Resident #1 had thrush, when it turned out it was due to poor oral care and was resolved with better dental care by the facility and not meds. The RP also said there was a time when Resident #1 was in the hospital for a UTI and the infectious disease doctor at the hospital wanted to start him on Hiprex (also known as Methenamine, which is used to prevent or control returning urinary tract infections caused by certain bacteria. It is not used to treat an active infection. Antibiotics must be used first to treat and cure the infection.) The RP stated she initially agreed to it but wanted a second opinion so she made an appointment with Resident #1's infectious disease doctor afterwards who advised the RP not to use Hiprex because it could cause dehydration and other side effects, So that is why I decided not to use that, and that is my right, I am his POA. The RP stated MD A hardly ever saw Resident #1 in the facility, it was always NP D, who knew the resident. The RP stated in February 2023, MD A came to the facility and wanted to prescribe Clonidine patches (An antihypertensive drug that lowers blood pressure and heart rate by relaxing the arteries and increasing the blood supply to the heart) but the RP felt because Resident #1 had second degree heart blockage and his pulse could drop from past indications into the 30's, there was a concern the resident's pulse would be at risk of dropping more with the additional hypertension medications. The RP stated she wrote to MD A on 02/26/23 and told him of her concerns and that she wanted a second opinion and to include the RP in his decision making process since he did not see the resident face to face often. After that, the RP said the NP D added Resident #1 on a low dose of Norvasc (A calcium channel blocker and may be used alone or in combination with other antihypertensive and antianginal agents for the treatment of hypertension to lower blood pressure). The RP also stated that on 02/22/23, she remembered helping the DON and charge nurse with care because he had gone to the urologist with his dressing stinking multiple times and it was oozing puss and leaking. The RP said the urologist (who had been Resident #1's doctor for over 10 years) told the RP that he highly recommended that the RP change the resident's dressings and help the facility staff if they are not doing it. The RP told the urologist an order would need for that, to which he wrote one. The RP was asked if he/she knew they were not supposed to be doing any dressing changes to Resident #1's g-tube site, to which the RP replied, You know when your family member is in pain, throwing up, clogged g-tube, I was panicked and worried and I know [resident] was breathing hard and his head was moving side to side, his SPC pulled over and he was in pain, I didn't know what was going on and he needed to be cared for .you do whatever to assist, jump to the aid. I wasn't thinking straight, so I responded as a family member, but as professionals, the nurses should have said no, let me do it. An attempted interview on 07/19/23 at 2:35 PM with RN C was unsuccessful. A voicemail was left with contact information with no return call. An interview with RN B on 07/19/23 at 3:10 PM revealed he remembered Res[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 8 of 8