Health inspection·December 19, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some integrity related to itching (date initiated 10/17/24). He had potential for pressure ulcer development related to limited mobility and had seizures related to stroke and bowel/bladder incontinence related to neurological impairment. He had ADL self-care performance deficit related to weakness and took anti-anxiety and depressive medications. Record review of Resident #1's Change of condition dated 12/16/25 at 1:57 pm by LVN C revealed, No new medications changes, status of evaluation was for a rash: New skin issues #001) front axilla (under shoulder joint) wound acquired in-house, #002) below right elbow wound acquired in-house, #003) front left thigh wound acquired inhouse, #004) Right Achilles (heel). (all areas were unmeasurable). Skin issues note: Resident has rash like areas over various areas of skin. Resident statesareas [sic] itch. The primary care provider feedback: was blank for recommendations, new testing orders and new intervention orders . (There were no orders to monitor). Record review of Resident #1's Nurse Progress note dated 12/16/25 at 2:22 pm by LVN C revealed, Resident's skin assessment performed. Resident noted with itchy rash like areas over extremities. Resident states this has occurred before but unsure of past treatment. [NP G ]notified via telephone message. No orders received at this time. [FM ] notified. (There were no orders to monitor). Record review of Resident #1's Nurse Progress note dated 12/17/25 at 2:25 am by LVN B revealed, Rash all over extremities Day 2. (The Doctor/NP was not called). Record review of Resident #1's Nurse Progress note dated 12/18/25 at 1:01 am, by LVN E revealed, Change of condition day 3/3 for rash on extremities. NARN . Continuing current treatment orders. (The Doctor/NP was not called and there were no treatment orders given yet). Record review of Resident #1's Skin Wound note dated 12/18/25 at 12:47 pm by Treatment Nurse F revealed, Skin/Wound Note: Skin assessment complete. Skin warm and dry, color appropriate to ethnicity: no pallor (pale skin), cyanosis (bluish skin, lips or nails), or jaundice (yellowish skin) observed. Resident noted with calm rash to BUE and BLE and low back. Resident states it is very itchy. Rash noted to L armpit with an odor. Body wiped with cleanser with effective results. NP G notified by phone of findings. Pending review. Record review of Resident #1's Skin Wound note dated 12/18/25 at 1:23 pm by Treatment Nurse F revealed, No bruising, abrasions, irritations to perineal area. NP G ordered nystatin/ triamcinolone 100000units BID for moisture related dermatitis x 10 days and Benadryl 25 mg daily at bedtime x 3 days. EMR updated. FM contacted by phone. FM informed this nurse that resident has a hx of psoriasis. FM notified of findings, orders and plan of care with no concerns voiced. Interview and observation on 12/18/25 at 10:47 am, Resident #1 was lying in bed at a 45 degree angle and did not appear to be in any distress or pain. He stated he was not able to use left arm because of a stroke he had but his right arm worked well. Resident #1's right upper arm close to his shoulder had three small reddish spots on it that appeared dry and he used his right hand to scratch that same area and said he had occasional itchiness that did not interfere with his daily tasks during the day or at night. He stated he told the nurses about the arm rash about a week ago and the Doctor/NP was supposed to be getting him something for it. He stated in the past he had psoriasis and was not sure if it was that or something else. He stated the rash was on his back and right arm. He stated he hoped he would get some cream on the areas because he was tired of itching. Interview on 12/19/25 at 2:50 pm, LVN A stated he was a PRN nurse and was currently working the 400 hall. He stated he assessed Resident #1 today 12/19/25 and he had rashes under his right armpit and upper right arm. Interview on 12/19/25 at 1:09 pm, LVN B stated Resident #1 had a rash all over his body and he notified the [FM]. He stated Resident #1 started having a rash a week ago, that was on his right leg and thigh and pinkish in color. He stated he did not call the Doctor/NP because the previous nurse on shift said she had already called about it. He stated the last time he worked last Tuesday 12/16/25 and Resident #1 had a rash on his thigh that was pinkish in color. Interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 2 of 5 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 12/19/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some on 12/19/25 at 1:26 pm, LVN C stated she worked the 400 hall last Tuesday 12/16/25, and noticed Resident #1 had a rash on different areas of his skin. She stated Resident #1's left and right arms and left foot were reddish in color. She stated Resident #1's rashes were different sizes and he complained of itchiness and she tried to get him something for it but it was 1:45 pm and her shift was almost over. She stated she called the NP and left a message and left after her shift ended. She stated she notified the [FM] last Tuesday 12/16/25. She stated the NP did not call back during her shift and she was not able to get treatment orders for his rashes that day. She stated the Doctor and NP phone number was the same and neither had called back before her shift ended. She stated she told the oncoming nurse LVN D to follow-up with the NP because of his rash. She stated she was not sure if Resident #1 still had the rash. Interview on 12/19/25 at 1:46 pm, LVN D stated she usually worked the 2:00 pm - 10:00 pm shift on the 400 hall. She stated she worked last Tuesday 12/16/25 and had not received any reports that Resident #1 had a rash or treatment order for a rash. She stated for rashes, the nurse would have to call the Doctor or NP for a treatment plan. She stated if Resident #1's medications for his rash were delivered she would have documented it and started doing the treatments to get rid of his rash. Interview on 12/19/25 at 2:14 pm, LVN E stated she usually worked 10:00 pm to 6:00 am on the 400 hall. She stated Resident #1 had a rash on his right arm and he had an order for nystatin cream to put on it as of yesterday 12/18/25. She stated she worked last Wednesday 12/17/25 and was aware of Resident #1's rash that was reported on a different shift Tuesday 12/16/25. She stated last night 12/18/25 she put the nystatin cream on Resident #1's right upper arm. She stated Resident #1's nystatin cream and Benadryl were ordered 12/18/25 by another nurse. Interview on 12/19/25 at 2:40 pm, LVN A stated Treatment Nurse F told him yesterday (12/18/25) after she assessed Resident #1 she noticed a rash underneath the back of his right arm. He stated when he went to check Resident #1 had a rash that was a small reddish colored area. He stated this was his first time seeing Resident #1 yesterday 12/18/25. He stated the last time he saw Resident #1 was last year. He stated today 12/19/25 he put the nystatin ointment on Resident #1's rash and stated his Benadryl was ordered to be given at bedtime. Interview on 12/19/25 at 3:08 pm, Treatment Nurse F stated when the residents had any skin issues the nurses were supposed to let her know about it. She stated she needed to assess the resident's skin issues as soon as the nurses noticed an issue for a treatment plan. She stated there were no reports of Resident #1 having any rashes earlier this week. She stated she went to Resident #1's room yesterday 12/18/25 just to check him out. She stated she was not asked by a nurse to check him out but noticed as she talked to him he was scratching and complained of itchiness. She stated she asked Resident #1 if he was having some itchiness and he said yes. She stated she assessed him and noticed some areas of redness then notified NP G about her findings and NP G ordered nystatin and Benadryl. She stated she called the [FM] and the [FM] said he had a history of having psoriasis. She stated she was not sure what was causing his rashes but the NP was called yesterday 12/18/25 at 12:47 pm. She stated the nurses needed to notify her if they saw something on the residents' skin, to let her know immediately so she could assess them and notify the Doctor/NP. She stated if she knew about Resident #1's rash last Tuesday 12/16/25 or Wednesday 12/17/25 she would have assessed him sooner and notified the Doctor/NP. She stated after she double checked her calendar she worked last Tuesday 12/16/25 and Wednesday 12/17/25 and none of the nurses notified her about Resident #1's rash issues. She stated for untreated rashes the rash could get way worse or infected. She stated a resident could pick or scratch the rash which could turn into an open wound that could get painful. Interview on 12/19/25 at 5:18 pm, the DON stated Resident #1 had a rash over various areas of his body that appeared on his skin and went away. She stated he had a treatment in place now with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 3 of 5 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 12/19/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some some cream and oral medication. She stated they found out about Resident #1's rash and complaints of itchiness yesterday 12/18/25. She stated yesterday Treatment Nurse F assessed Resident #1 and she called to get him a Doctor/NP's order for Nystatin-Triamcinolone cream and Benadryl. She stated Resident #1's rash flared up the evening of Tuesday 12/16/25 but he did not have a rash on 12/17/25. She stated she was not sure why LVN B documented on 12/17/25 saying Resident #1 had a rash all over his extremities. She stated LVN D said the Doctor/NP called her last Tuesday 12/16/25 and said the Doctor/NP gave no new orders and for the nurses to monitor the areas. She stated she was not sure why LVN D did not document what NP G said to just monitor the rashes. She stated she was not sure why LVN D told the HHSC investigator she was not aware of Resident #1 having a rash. She stated the process for reporting skin changes was for the nurse to get the initial report and pass it to the next shift nurse and document in the 24 hour report book. She stated the nurse managers were responsible for ensuring the change of condition processes were completed. She stated she was going to follow through on making sure she talked to the nurses about completing their nurse's documentation. She stated untreated rashes would not result in an infection but could cause symptoms of itching and the resident could scratch themselves. Interview on 12/19/25 at 5:57 pm, the Administrator stated the nurses were good about assessing and treating residents with rashes. He stated he was not aware of the delay in getting Resident #1 treatment of the rash. He stated the DON and ADON were responsible for ensuring the change of condition procedures were followed. He stated untreated rashes could spread and get worse. He stated the facility did not have a skin assessment policy. Interview on 12/19/25 at 5:59 pm, the DON interrupted the interview with the Administrator and said she spoke to LVN D. She stated LVN D said she was confused as to what was being asked by the HHSC Investigator. She stated LVN D said she received the report from NP G Tuesday night 12/16/25 to monitor Resident #1 with no new orders. She stated she was not sure why LVN D did not document NP G's report to monitor. She stated she was not sure why LVN D told the HHSC investigator she was not aware of Resident #1's rash condition last Tuesday 12/16/25 or Wednesday 12/17/25. Interview on 12/19/25 at 6:35 pm , NP G stated she was notified by LVN D last Tuesday 12/16/25 of Resident #1's arm rash, and the nurse said he had a rash. She stated Resident #1 did not complain of any itching and she told LVN D to notify her if Resident #1 continued to have a rash. She stated yesterday 12/18/25 she received a call from Treatment Nurse F about Resident #1 complaining of itching and a rash. She stated it was reported Resident #1 had had a rash around his arm pit and she gave Treatment Nurse F orders for nystatin cream and Benadryl and to keep Resident #1 dry (increase incontinent care). She stated Resident #1 had a previous history of having a rash and with him being bed bound the rash condition could have developed into contact dermatitis (skin inflammation from direct contact with soap, cleaners or allergen) . She stated she had no calls from Treatment Nurse F until yesterday 12/18/25. She stated she had not spoken to LVN B on 12/17/25 or LVN C on 12/16/25 about Resident #1's rash condition. She stated she only received a call from LVN D last Tuesday 12/16/25 and Treatment Nurse F yesterday 12/18/25 about Resident #1's rash. Record review of the Facility's Change of condition policy revised 07/2015 revealed, Policy: It is the policy of this facility that all changes in resident condition will be communicated to the physician. Purpose: To clearly define guidelines for timely notification of a change in resident condition. Procedures: .Routine Medical Changes - 1. Unusual signs and symptoms will be communicated to the physician promptly. Routine changes are minor changes in physical and mental behavior, abnormal laboratory and x-ray results that are not life threatening. 2. The nurse in charge is responsible for notification of physician prior to end of assigned shift when a significant changes in resident's condition is noted. 3. If unable to reach physician all calls to physicians or exchanges (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675305 If continuation sheet Page 4 of 5 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 12/19/2025 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete requesting callbacks will be documented on the nursing progress notes. 4. If the physician has not returned the call by the end of the shift, the on-coming nurse will be notified for follow-up. 5. If unable to contact attending physician or alternate timely, notify Medical Director for response and follow-up to change in residents status. 6. Document resident change of condition and response in nursing progress notes and update resident Care Plan, as indicated. 7. All attempts to reach the physician and responsible party will be documented in the nursing progress notes. Documentation will include time and response. Follow-up: 1. The licensed nurse responsible for the Resident will continue assessment and documentation every shift for at least seventy-two (72) hours or until condition has stabilize. Event ID: Facility ID: 675305 If continuation sheet Page 5 of 5