Inspection·December 14, 2023

F 0580 assistance for bed mobility and for transfers. Level of Harm - Actual harm -resided in the Memory Care Unit related to impaired cognition needed for reduced stimuli. Interventions included provide activities that accommodate the resident's abilities. Residents Affected - Few -dependent on staff for meeting emotional, intellectual, physical, and social needs related to cognitive deficits. Interventions included all staff to converse with resident while providing care. -had trouble with memory/cognition related to dementia. Interventions included refer to psych as needed and remind of family members' names. In an interview on 12/14/2023 at 7:48 p.m., Resident #1 said he did not fall yesterday, 12/13/2023, or go to the hospital. In an interview on 12/14/2023 at 12:35 p.m., CNA A said she had been working at the facility since March 2023. She said she worked with Resident #1 in the secured unit yesterday, 12/13/2023. She said she went to Resident #1's room at approximately 6:15 a.m., and when she opened his bedroom door, he was lying on the floor in front of his bed on his side and stomach. She said he was conscious and talking to her. She said she asked him what happened, and he told her he slipped. She said she got Nurse A who assessed him. She said Nurse A, Nurse B, and she lifted Resident #1 back onto his bed, and Nurse A and B continued their assessment. She said and she was leaving Resident #1's room, Nurse A and B were taking his blood pressure and she heard them talking about a red spot on his head and not knowing if it was new or just happened. She said between 7:00 a.m. and 7:30 a.m. she took Resident #1 his breakfast tray and tried to get him to eat. She said it appeared to her that he was asleep. She said she left to finish passing and picking up trays. She said around lunch time, 11:00 a.m., Nurse A told her they were sending Resident #1 to the hospital because he would not respond. In an interview on 12/14/2023 at 11:26 a.m., Nurse A, said she had been working at the facility since 2010. She said Resident #1 had an unwitnessed fall in his room by his bed yesterday, 12/13/2023. She said he had a low pulse rate in the 40's and guessed that when he stood up his pulse rate went down further, and he fell and/or passed out. She said when she entered his room, he was on the floor and was awake and alert. She said he was able to move all of his extremities, and she took his vitals. She said after he was assessed she and 2 other aides, (she could not recall their names), helped get the resident back into bed. She said she took his vitals again, talked to the resident, checked his skin, and made sure he could move his extremities. She said afterwards, the other staff members and she left the resident's room. She said she notified his family member, his doctor, and continued taking his vitals and neuros per facility protocol. She said the resident got up at approximately 7:30 a.m. and ate breakfast and then went back to his bed and went to sleep. She said she went back to his room around 9:00 a.m. to take his vitals and to do neuro checks but could not awake him up. She said she called his name multiple times, opened his eyes with her hands, touched his hand, and checked his vitals. She said the Unit Manager came to Resident #1 's room and assessed him and did a sternal rub . She said after the sternal rub, the resident flailed his arms, grimaced, but did not open his eyes or talk to either of them. She said the Unit Manager and she decided to send Resident #1 out to the hospital. She said when EMS arrived, Resident #1 sat up on the side of his bed and literally transferred himself onto the stretcher in front of EMS while they were there. She said EMS took him to the hospital for a couple of hours and the Unit Manager picked him up. She said the physician was not notified when the resident fell because the resident was awake, alert, moved all his extremities, got up, walked, and she knew the Physician was coming to the facility around 11:00 a.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675344 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675344 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Sweeny 109 N McKinney Sweeny, TX 77480 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 0580 Level of Harm - Actual harm Residents Affected - Few In an interview on 12/14/2023 at 2:24 p.m., the DON said she had been working at the facility since 2019. She said Resident #1 had a fall yesterday but was unable to recall what time the fall occurred. She said no injuries were sustained from the fall. She said the physician was notified via telephone when the fall occurred. She said Nurse A told her she was monitoring Resident #1's neuros per protocol. She said when Nurse A went back to his room during one of the neuro checks, she said she started to tap him, and saw he was slow to respond. She said to her knowledge Resident #1 was never unresponsive and only slow to respond. She said Nurse A told her she took his vitals, and his heart rate was low and that was what warranted Nurse A to contact the physician to have Resident #1 sent out to the hospital to be evaluated. She said if a resident was not on any blood thinners, neuro checks were completed to ensure no changes were occurring and/or whatever the doctor prescribed . In a telephone interview on 12/14/2023 at 10:20 a.m., the Physician said Resident #1 had Bradycardia and a DVT . He said the resident was on a blood thinner to decrease the size of the blood clot. He said the facility called him once to tell him the resident fell down and he said he told them to send him to the hospital because he was on a blood thinner. He said Resident #1 falls because he had a low heart rate. In a follow-up telephone interview on 12/14/2023 at 3:56 p.m., the Physician said he did not think he needed to be notified of every fall. He said it depended on the severity of the fall and it was subjective. He said the staff were very good at using their judgement. In a follow-up interview on 12/14/2023 at 4:23 p.m., Nurse A said she was not aware Resident #1 was on an anticoagulant at the time of his fall. She said she was not aware until she was filling out his transfer form to go to the hospital. She said if she knew he was on an anticoagulant, she would have contacted the physician when he had fallen, would have sent him out to the hospital with a doctor's order, and/or if the physician thought it was necessary . She said initially, Resident #1 had a red spot on the right side of his temporal area, but it was in the process of fading when he was sent out to the hospital. She said it was the facility's policy to notify the family and doctor for all falls. She said the potential risk for not notifying the doctor when a resident had an unwitnessed fall was the resident could have an intercranial bleed, fracture, and/or concussion. In a follow-up telephone interview on 12/14/2023 at 4:40 p.m., the Physician said if a resident was on an anticoagulant, it was pretty much an automatic send out to the hospital and facility would call the doctor first. He said they erred on the side of caution when there was any question about a resident's health. In a follow-up interview on 12/14/2023 at 4:46 p.m., the DON said if a resident were to have an unwitnessed fall it would depend on the doctor and what he wanted to do. She said in the event of a fall, the physician and/or their afterhours network company of physicians, the DON, administrator, and family/RP would be notified. She said if a resident was on an anticoagulant, it was an automatic send out to the hospital. Record review of Resident #1's SBAR Summary progress note, dated 12/13/2023 at 06:22 , revealed Resident #1 had a change in condition identified as a fall. Further review revealed resident attempted to get out of bed and had a syncopal episode due to pulse in the 40's. The summary indicated the physician was notified at 11:30 a.m. Record review of Resident's #1 SBAR Summary progress note, dated 12/13/2023 at 10:42 , revealed Resident #1 had a change in condition identified as unresponsiveness. Further review revealed resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675344 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675344 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at Sweeny 109 N McKinney Sweeny, TX 77480 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 0580 fell earlier with no injury and was now unresponsive. Level of Harm - Actual harm Record review of the facility's policy titled Subject: Fall Management, revised 01/2019, revealed in part .In The Event of a Fall: .8. Notify the physician for further orders and follow instructions. (All falls must be reported to the physician) .Note: .3. A fall without injury is still a fall. 1. Unless there is evidence suggesting otherwise, when a resident is found on the floor, a fall is considered to have occurred. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675344 If continuation sheet Page 4 of 4