Inspection·September 1, 2023

F 0600 -Maintain a calm environment and approach to the resident Level of Harm - Immediate jeopardy to resident health or safety Further review of Resident #1's comprehensive care plan listed the problem Behavioral Symptoms, edit date 7/3/23, included the following approaches: Residents Affected - Some -If elopement occurs, maintain supervision at a distance as tolerated by resident for safety concerns. Redirect resident when calm -Initiate one on one staff to resident observation. Maintain appropriate safety measures at all times -Consider placement on secure unit if wandering, elopement attempts continue Record review of the progress note written by LVN A, titled Elopement, dated 5/18/23 and time stamped 10:57 a.m. revealed in part, Resident #1 was very agitated and wanted to go off the property for a walk .resident on the walking trail for a few minutes and we were able to get him back into the facility without incident . Record review of the progress note written by LVN A, titled Elopement, dated 5/18/23 and time stamped 11:00 a.m. revealed in part, .Psychiatric NP B .was notified and saw the patient via telehealth. New order received for one time dose of Clonazepam 1mg (a benzodiazepine prescribed to treat generalized anxiety), administered by this nurse . Record review of the Psych Encounter note written by Psychiatric NP B, dated 5/18/23 revealed in part, .Resident #1 with a history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .Today he is being seen for increased agitation. Staff reports he is eloped out of the building and when staff tried to bring him back, he became combative. He did not want to come back in, was very resistant and agitated .Denies paranoia. Denies past trauma. Denies suicidal ideation, homicidal ideation, audio hallucinations and visual hallucinations .No GDR recommended at this time. Resident #1 continues to display agitation and anxiety. Will continue current dose . Further review of the Psych Encounter Note revealed Give Clonazepam (a sedative) 1 mg x 1 dose for agitation .Start Trazadone (an anti-depressant and sedative) 25 mg at 4 PM for agitation .return appointment 1 month with Psychiatric NP B . Record review of the Psych Encounter note written by Psychiatric NP B, late entry 6/13/23 for visit date 6/7/23 revealed in part, .Resident #1 with history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .Staff report he is always aggressive, exit seeking and would fight before coming back to the building .Resident continues to display agitation and anxiety .Start Haldol (an antipsychotic used to treat mental disorders) 5mg/ml. Give 2.5mg IM every 6 hours PRN for 'restlessness and agitation.' Order to expire in 14 days . Record review of the Psych Encounter note written by Psychiatric NP B, late entry 6/23/23 for visit date 6/21/23 revealed in part, .Resident with a history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .constantly tries to elope the building .was getting angry and agitated talking to me .No GDR recommended at this time. Resident continues to display agitation and anxiety .Start Haldol 1mg gel. Apply 2 mg every 6 hours as needed, to wrist area, for 'restlessness and agitation' for dementia with behavioral disturbance. Order valid for 14 days. Start Haldol 5mg/ml. Give 2.5 mg IM every 6 hours PRN for 'restlessness and agitation.' Order to expire in 14 days . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 2 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Record review of the progress note written by LVN C, dated 6/23/23 and time stamped 5:37 p.m. revealed in part, .Shift nurse heard the alarms going off on the hall when the nurse went all [sic] the hall found the door open and the resident (Resident #1) in the yard hiding in the bushes .MD gave new PRN orders nurse will carry those orders out . Record review of the facility Event Report dated 7/5/23 and completed by LVN D revealed Resident #1 had a psychotic episode that caused injuries to others. The Event Report revealed, multiple staff members were pushed, punched and grabbed very aggressively. Under the section, Indicate Pharmacological measures taken, Other was checked and indicated, Haldol IM given by ADON per MD orders. Record review of the Neuropsychological Assessment by the Licensed Psychologist, dated 8/16/23 revealed in part, .Referred by medical for neurocognitive evaluation to clarify diagnosis and assist with treatment plan in the context of aggressive behaviors, and to assess for depression, anxiety, or any other psychiatric conditions that might be focus of attention at this time .Patient is NOT currently a danger to self/others .Treatment Plan/Recommendations .Psychiatric and psychological treatment .Follow up with neuropsychological testing as soon as feasible . Record review of the progress note written by the DON, dated 8/27/23 and time stamped 1:15 p.m. revealed in part, .obtaining verbal consent for new medication ABH (made from a combination of Ativan, a sedative to relieve anxiety, Benadryl an anti-histamine and, Haldol an anti-psychotic used to treat mental disorders) gel for 'aggressive behaviors' .resident (Resident #1) behaviors had increased in frequency with increased agitation and aggressiveness towards other residents and staff . Record review of the progress note written by LVN A, dated 8/27/23 and time stamped 9:15 p.m. revealed in part, .Resident #1 coming out of the locked hall and acting aggressive toward staff . I am the nurse that administered ABH gel to the resident . During a telephone interview on 8/28/23 at 10:30 a.m., the Medical Director stated, We don't think the resident [Resident #1] is appropriate for this facility. He has proved he is not appropriate for this facility. The Medical Director further stated, [Psychiatric NP B] is perfectly capable of making medication adjustments and they are supervised by a licensed psychiatrist. No reason why this should not have been handled. The Medical Director further stated, I have recommended the facility to either contact [Psychiatric NP B] or give Haldol IM as needed. During an interview on 8/28/23 at 12:14 p.m., the ADON revealed, Resident #1 had been seen by Psychiatric NP B and stated, but I don't believe she made any real medication changes other than PRN Haldol. During an interview on 8/28/23 at 5:52 p.m., LVN A revealed, Resident #1 had a behavior on 8/27/23 and was surrounded by 3 male aides and Resident #1 was getting really mad at one of the male aides, Nurse Aide F. LVN A revealed, the next thing she knew, Resident #1 was by the front door sitting on the ground, and Nurse Aide G holding Resident #1 by one arm facing forward and Nurse Aide H holding the resident by the other arm and the third aide, Nurse Aide F holding down the resident's legs. LVN A stated she told the Aides to let Resident #1 go and then LVN A applied the ABH gel to Resident #1. LVN A stated, we are a restraint free facility, no we should not have been restraining [Resident #1]. LVN A revealed she told Nurse Aide F he could not do that, restrain Resident #1 to which Nurse Aide F replied, am I in trouble now? LVN A stated, what I did see is [Nurse Aide F] and the other two male aides restrain [Resident #]1. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 3 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 8/28/23 at 7:22 p.m., LVN D revealed Resident #1 resided in the male secure unit and had gotten out multiple times. LVN D revealed approximately one month ago, June 2023, Resident #1 barged outside of the secure unit. LVN D revealed Resident #1 was held back by multiple staff members after the resident pushed the MDS Coordinator. LVN D stated, staff tried to hold [Resident #1] under the arms as he was swinging. LVN D revealed, Resident #1 was eventually held down in a chair and the ADON gave the resident a Haldol injection. LVN D stated, I feel bad they had to tranquilize [Resident #1] to get him to calm down. LVN D stated, the [ADON], the [DON] and the [Administrator] were all here in the facility when this incident (with the MDS Coordinator) occurred, and they were aware [Resident #1] was held down. LVN D stated, I do not feel like anyone here is trained to deal with [Resident #1's] behaviors. LVN D stated, Agency LVN E, who no longer worked for the facility, used to work in a psychiatric facility and told other staff how to hold Resident #1 in a seated position. During an interview on 8/28/23 at 7:23 p.m., Nurse Aide F revealed he was assigned one to one to Resident #1 on 8/27/23. Nurse Aide F revealed, Resident #1 became agitated on 8/27/23 after Nurse Aide G asked the resident if he was okay and the resident started kicking the air and moving his hands rapidly. Nurse Aide F stated, Resident #1 moved towards the door leading to the front with Nurse Aide G and himself following and Resident #1 pushed open the door from the locked unit and moved toward the inner facility. Nurse Aide F stated, Nurse Aide H came to assist as Resident #1 grabbed Nurse Aide F's shirt from the front. Nurse Aide F stated, they both [Nurse Aide G and Nurse Aide H] took [Resident #1] by an arm and held him back and we got him to the ground so the nurses could apply the ABH cream on him. Nurse Aide F stated, [Resident #1] wasn't able to get up. Nurse Aide F stated, I don't think [Resident #1] is appropriate for this facility, he needs to be somewhere where staff are trained for that. I am not trained to deal with that on a regular basis. Nurse Aide F stated, We have been instructed to keep [Resident #1] in the unit but didn't really get any instruction on how to keep him in the unit. During an interview on 8/29/23 at 8:59 a.m., the Assistant BOM revealed, an incident occurred on 8/27/23 at approximately 7:00 p.m. or 7:30 p.m., before preparing to leave her office. The Assistant BOM stated, Resident #1 was observed heading in the direction past the nurse's station toward the front door. The Assistant BOM stated, her office was close to the facility front door and observed Resident #1 followed by Nurse Aide F, Nurse Aide G and Nurse Aide H. The Assistant BOM stated, LVN A had her gloves on ready to apply the ABH gel when Resident #1 hit Nurse Aide F on the upper chest, then grabbed Nurse Aide F's shirt and started to shake him. The Assistant BOM stated, at that point [Nurse Aide G[ and [Nurse Aide H] come in and they are right by my office door wall and in the meantime, I am trying to call the [Administrator]. At this point, the guys are trying to hold [Resident #1] and they are holding his arms, like under his elbows and [Nurse Aide F] is still trying to get loose. Everybody goes down, they fall down, and [Resident #1] starts to kick. The Assistant BOM revealed, LVN A then applied the ABH gel to Resident #1's hands. The Assistant BOM stated, it had been discussed during in-services that staff were not to touch Resident #1 because it would escalate his anxiety and aggression. During a telephone interview on 8/29/23 at 3:02 p.m., Agency LVN E revealed she had worked at the facility through a contracted agency but discontinued her contract after 30 days. Agency LVN E revealed, Resident #1 had behaviors that were sometimes avoidable but sometimes not. Agency LVN E revealed an incident occurred in June 2023 in which Resident #1 pushed the MDS Coordinator and had also made contact with the Activity Director. Agency LVN E stated, everyone swarms, [Resident #1] seems like he is going towards everybody and there is a lot of yelling, I step back because less is more. Agency LVN E further stated, [Resident #1] had a hold of the [Activity Director] and is not letting go. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 4 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some [Resident #1] was restrained, because that is what it was called. But [Resident #1] could still move. Agency LVN E revealed, the physical restraint used on Resident #1 was called bear paws so as not to cause bruising while being restrained. Agency LVN E stated, she and CNA I restrained Resident #1 and once we got him to the ground, he [Resident #1] starts to relax. Agency LVN E stated, the restraint to Resident #1 lasted a total time of 15 to 20 minutes until the police arrived. Agency LVN E revealed, the facility had not provided training on anything related to the incident, nothing on dementia, nothing on aggression, nothing on behaviors. Agency LVN E stated she did not know who the Abuse Coordinator was and approximately a month ago was given a paper to sign on an in-service on abuse and neglect. Agency LVN E stated, I do not think we are supposed to touch them (residents) but there was no way of getting around it. During an interview on 8/29/23 at 5:47 p.m., the DON stated, Resident #1 could not be stopped from having behaviors and just to keep him safe. The DON revealed staff could not lay hands on Resident #1 and to make sure all the residents were safe. The DON stated, our policy is to follow [Resident #1], keep him safe and call police to help us get him back into the building safely. During an interview on 8/30/23 at 2:38 p.m., Nurse Aide G revealed an incident occurred on 8/27/23 at approximately 7:00 p.m., after the residents had eaten. Nurse Aide G stated Nurse Aide F had been assigned Resident #1's one to one staff when Resident #1 got out of the secure unit with Nurse Aide F following. Nurse Aide G stated, Resident #1 grabbed Nurse Aide F's shirt and Nurse Aide G came behind [Resident #1] and put my arms around his upper shoulder as if to grab him and [Resident #1] took his arm and swung it back and that's how we fell on the floor. Nurse Aide G stated, he, Resident #1, Nurse Aide F and Nurse Aide H fell together on the floor with the force of Resident #1 trying to swing at them and Resident #1 still holding onto Nurse Aide F's shirt. Nurse Aide G stated, I have never seen any staff hold him [Resident #1], we try to talk to him and calm him down. Nurse Aide G revealed he did not consider the incident on 8/27/23 resulted in Resident #1 being restrained. During an interview on 8/30/23 at 3:29 p.m., the Administrator revealed, the Assistant BOM contacted him by phone on 8/27/23 at approximately 7:20 p.m. regarding the incident in which Resident #1 came out of the secure unit and was followed by Nurse Aide F, Nurse Aide G and Nurse Aide H. The Administrator stated, the Assistant BOM was giving the Administrator a narrative while it was going on. The Administrator stated, basically, [Resident #1] rushed [Nurse Aide F] and grabbed him, and two other aides pulled the resident off of [Nurse Aide F]. The Administrator stated, [Nurse Aide F] was standing in front of [Resident #1] because another resident was in [Resident #1's] path. The Administrator further stated, the other two aides grabbed [Resident #1] by the arms and pulled him back while [Resident #1] was holding onto [Nurse Aide F's] shirt, and they all fell down. The Administrator stated, [Nurse Aide F] held one of[ Resident #1's] legs because he was kicking him, just didn't want him to hurt anybody and then the nurse put the cream on him and then [Resident #1] got up by himself and went for a walk with them. [Resident #1] was not restrained. The Administrator stated, I have never been informed [Resident #1] had ever been restrained. The Administrator revealed he recalled the incident in which Resident #1 pushed the MDS Coordinator. The Administrator stated, [Resident #1] pushed the [MDS Coordinator] and the staff, don't recall who it was, held [Resident #1] down. I think it was one (staff) on each side of him, to calm him down. The Administrator stated, again [Resident #1] was not hurt. The Administrator stated, the incident with the [MDS Coordinator], we didn't know what to do and [Resident #1] was held down to keep him from hurting other people, I'm sure. The Administrator revealed, the staff at the facility were not trained to deal with that kind of behavior. During an interview on 8/30/23 at 4:11 p.m., the MDS Coordinator revealed he recalled the incident in which Resident #1 pushed him. The MDS Coordinator revealed, staff were guiding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 5 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #1 to sit in a wheelchair, holding the resident's arms and the resident was resistive and combative. The MDSCoordinator stated, Resident #1 got up from the wheelchair and two staff, could not recall who, had their arms under the resident's upper arms and they backed up until they backed up against the wall and slid down the wall still holding the resident by the arms and talking to him and then the police showed up. The MDS Coordinator revealed, there was one nurse, Agency LVN E who stated she was trained for this (restraints). The MDS Coordinator stated, they were restraining him, I would think, but it was reasonable intervention because it was a very erratic behavior, he [Resident #1] was kind of out of control. During a follow up interview on 8/31/23 at 8:22 a.m., the DON revealed, the facility did not do behavioral health training of staff and staff were only instructed to remove them (residents) and calm the situation. The DON stated, most of our residents don't have violent behaviors. [Resident #1] seemed to be the one factor in these situations. During an interview on 8/31/23 at 1:18 p.m., CNA I stated, he had not heard or seen residents being restrained. CNA I revealed, residents, including Resident #1, could not be restrained, and staff should not provoke or argue with the residents, leave them be and keep residents safe. CNA I denied ever having restrained Resident #1. Record review of the facility's policy and procedure titled Abuse Prevention Program, revision date April 2013, revealed in part, .Our residents have the right to be free from abuse, neglect, misappropriation of resident property, corporal punishment, and involuntary seclusion .1. Our facility is committed to protecting our residents from abuse by anyone including, but not necessarily limited to: facility staff, other residents, consultants, volunteers, staff from other agencies providing services to our residents, family members, legal guardians, surrogates, sponsors, friends, visitors or any other individual .a. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish .5. Along with other staff and management, the Medical Director will help identify situations that might constitute or could be constituted as neglect; for example .inappropriate management of problematic behavior .repeated failure to check for correct application of restraints . The Administrator was given the IJ template and was notified of the Immediate Jeopardy {IJ} on 8/31/23 at 6:01 p.m. and a plan of removal was requested. On 9/1/23 at 8:38 a.m., the facility provided a plan of removal that was accepted. It was documented as follows: SURVEY TYPE: Complaint Survey SURVEY DATE: 8/31/23 Plan for REMOVAL Plan to remove immediate jeopardy.

F600 On 8/31/23, Resident #1 no longer resided at the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 6 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some On 8/31/2023 the Regional Nurse Consultant completed in-service with the DON, ADON and the Administrator on abuse and neglect, abuse and neglect reporting guidelines/policy, abuse, and neglect CE pathways, and on reporting then investigating to follow the current regulatory provider letter. On 8/31/2023 DON and ADON assessed residents residing on Hall A (secure unit) for signs and symptoms of abuse, no negative findings. The Medical Director was notified of no changes in condition by DON on 8/31/2023. On 8/31/2023 the Director of Nursing and ADON initiated in-service with facility staff on abuse and neglect, abuse, and neglect reporting guidelines/policy, reporting abuse to management staff/abuse coordinator. Education to be completed on 8/31/23. Any staff that is not available will be educated prior to their next scheduled workday. The in-service was completed on 9/1/23. On 8/31/23 the Administrator and the Regional Reimbursement Consultant will complete safe surveys with residents, to ensure the health and safety of all residents. The IDT, NHA (Nursing Home Administrator), DON, ADON, Regional Nurse Consultant, and MDS Coordinator will review the findings and will immediately notify the Administrator for further action, if necessary. The safety survey was completed on 9/1/23. On 8/31/23 an Ad-Hoc QAPI meeting was held with the Medical Director, NHA (Nursing Home Administrator), DON, Regional Nurse Consultant, Assistance Director of Nursing, Regional MDS, Regional Director of Operations and MDS Coordinator to review the deficiency and the plan for removal of immediacy. Sign-in sheet was reviewed on 9/1/23. Starting on 8/31/2023, IDT (Interdisciplinary team), including Administrator, DON, ADON and MDS Coordinator will review abuse and neglect monitoring Monday to Friday, and Manager on Duty Saturday and Sunday for 1 month to ensure the health and safety of the residents. The findings will be immediately brought up to the Administrator for further action, if necessary. A sign-in sheet was provided of the IDT meeting with the aforementioned staff on 9/1/23. The Administrator/designee will monitor compliance by completing an audit of residents that have behaviors/aggression every week for four (4) weeks, MD being notified, Family being notified, and behavioral services to be notified. If Behavioral Services is not available, then the Medical Director will be notified for any psychosocial concerns. This will be initiated on 8/31/2023. Any identified concerns will be addressed immediately and if trends and patterns are identified, the facility will conduct an Ad-Hoc QAPI meeting to discuss if additional interventions are needed to ensure compliance for the next 2 months. The facility provided an audit dated 8/31/23, initiated by the administrator on 9/1/23. The Administrator will be responsible for ensuring this plan is completed on 8/31/2023. The RDO will provide oversight of Administrator and DON to ensure that the items on the plan of removal are reviewed and completed. Monitoring of the implementation of the POR: Plan to remove immediate jeopardy. During an observation and interview on 9/1/23 at 8:03 p.m., Resident #2 was in his room lying in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 7 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some bed watching television. Resident #2 revealed he felt safe and had been asked by facility staff about abuse/neglect. Resident #2 stated, you're the third person who has asked me. Resident #2 did not appear to be in any obvious distress or discomfort. During an observation and interview on 9/1/23 at 8:08 p.m., Resident #3 was in her room sitting up in a wheelchair. Resident #3 did not appear to be in any obvious distress or discomfort. Resident #3 stated the ADON had talked to her on 8/31/23 about abuse/neglect. Resident #3 stated she felt safe in the facility. During an observation and interview on 9/1/23 at 8:11 p.m., Resident #4 appeared well-groomed and appropriately dressed and did not appear to be in any obvious distress or discomfort. Resident #4 stated she had been asked by the ADON about abuse and revealed she wanted to be with her boyfriend. Record review of the facility interviews with 70 residents on 8/30/23 revealed the safety survey was completed. Most of the residents in the facility were not interview able, and those that were did not make any new allegations of abuse or neglect. Record review of the facility Ad-Hoc QAPI meeting held on 8/31/23 revealed signatures for the Medical Director, NHA (Nursing Home Administrator), DON, Regional Nurse Consultant, Regional MDS, Regional Director of Operations and the MDS Coordinator. A log was created for the IDT to review and monitor for abuse and neglect Monday to Friday and the Manager on Duty for Saturday and Sunday to be monitored for 1 month to ensure the health and safety of the residents. Any adverse findings would be reported to the Administrator for further action if necessary. Record review of the facility IDT meeting held on 8/31/23 included the Administrator, DON, ADON and MDS coordinator revealed the Administrator would monitor for compliance by completing an audit of 5 residents per week for the next 4 weeks of residents with behaviors/aggression with MD notification for request of behavioral services, initiated on 8/31/23. The log dated 9/1/23 revealed 5 random residents were chosen for the audit and signed by the Administrator. During a joint interview on 9/1/23 at 5:36 p.m., the DON, ADON, Regional Nurse Consultant, the COO and RN Director of Quality revealed review of the POR for abuse/neglect highlighted training on identifying and reporting suspected abuse. Record review of the facility in-service dated 8/31/23, titled Abuse Neglect Policy/Reporting Guidelines/Abused and Neglect Pathways revealed 67 facility employed staff signed the sign-in sheet. The facility had 55 total facility employees and utilized agency staff. During a joint interview on 9/1/23 at 5:22 p.m., the DON and the Administrator revealed the abuse/neglect in-service highlighted identifying forms of abuse, reporting suspected abuse for investigation and adhering to reporting guidelines. 1. During an interview on 9/1/23 at 3:50 p.m., Housekeeping Staff J revealed she had worked for the facility for just 4 months and worked Monday through Saturday from 2:00 p.m. to 10:00 p.m. Housekeeping Staff J revealed she had been in-serviced on abuse/neglect that morning and revealed she was to report abuse/neglect to the Administrator and to keep the residents safe. 2. During an interview on 9/1/23 at 3:55 p.m., CNA L revealed she had worked for the facility off and on since January 2023 and worked 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 8 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some she had been in-serviced on abuse/neglect on 9/1/23 and the in-serviced covered identifying abuse/neglect and to report to the Administrator while keeping the residents safe. 3. During an interview on 9/1/23 at 4:00 p.m., the Assistant BOM revealed she worked every day with varying hours and had been in-serviced on abuse/neglect in the morning on 9/1/23. The Assistant BOM stated, abuse/neglect was to be reported to the DON and the Administrator. The Assistant BOM stated, remove the resident from an unsafe environment and keep them safe. 4. During an interview on 9/1/23 at 4:05 p.m., the BOM stated she had worked for the facility for 5 years and worked Monday to Friday. The BOM stated she had been in-serviced on abuse/neglect last week and was to report suspicion of wrongdoing to the residents to the Administrator. The BOM stated, if the Administrator was not available, abuse and neglect should be reported to the DON and the charge nurse. 5. During an interview on 9/1/23 at 4:12 p.m., CNA L revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L stated she had been in-serviced by the ADON on 9/1/23 on abuse/neglect. CNA L revealed the highlight of the in-service covered identifying abuse/neglect and the process for reporting. CNA L revealed abuse/neglect was reported to the Administrator while keeping the resident safe. 6. During an interview on 9/1/23 at 4:16 p.m., CNA M revealed she had worked for the facility for about a month but had been employed over a year ago and had been working the 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA M stated she had been in-serviced on 9/1/23 on abuse/neglect. CNA M stated, abuse was physical, verbal, and emotional. CNA M stated if abuse/neglect was suspected, report to the Administrator and if not available, report to the DON and the charge nurse. 7. During an interview on 9/1/23 at 4:23 p.m., Nurse Aide N revealed she had worked for the facility for 6 months and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. Nurse Aide N stated she had received an in-service by the ADON on abuse/neglect on 8/31/23. Nurse Aide N stated abuse could be verbal, physical, or making a resident do something they did not want. Nurse Aide N stated she was supposed to report abuse/neglect to the Administrator and to the nurse. 8. During an interview on 9/1/23 at 4:28 p.m., CNA O revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating shift. CNA O revealed she had been in-serviced on abuse/neglect in the morning on 9/1/23. CNA O revealed the in-service highlighted types of abuse such as verbal, physical, restraints, and yelling at residents. CNA O revealed abuse/neglect was to be reported to the Administrator while keeping the residents safe. 9. During an interview on 9/1/23 at 4:35 p.m., Nurse Aide P revealed she had worked for the facility for 2 weeks and worked the 6:00 a.m. to 6:00 p.m. shift on a rotating schedule. Nurse Aide P stated she had been in-serviced on abuse/neglect this week and the in-service highlighted on identifying abuse/neglect and reporting to the Administrator. 10. During an interview on 9/1/23 at 4:40 p.m., Kitchen Staff Q revealed she had worked for the facility for the past 6 weeks and had been in-serviced on abuse/neglect this week. Kitchen Staff Q stated abuse/neglect was physical or verbal and was not allowed. Kitchen Staff Q revealed if she suspected abuse/neglect she was supposed to report it to the Administrator and keep the residents safe. 11. During an interview on 9/1/23 at 4:46 p.m., LVN C revealed she had worked for the facility for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 9 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0600 8 years and worked varying shifts and had been in-serviced this week. LVN C stated, abuse/neglect was Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 10 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents were free from physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms for 1 of 4 residents (Resident #1) reviewed for freedom from physical and chemical restraints, in that: Residents Affected - Some The facility failed to ensure Resident #1 was free from any physical or chemical restraints when exhibiting aggressive behaviors These failures resulted in an IJ on 8/31/23 at 6:01 p.m. While the IJ was removed on 9/1/23 at 8:19 p.m., the facility remained out of compliance at noactual harm with a potential for more than minimal harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of their plan of removal. This deficient practice could place residents at risk of unnecessary restriction of their freedom of movement (any change in place or position for the body or any part of the body that the person is physically able to control). The findings included: Record review of Resident #1's face sheet, dated 8/26/23 revealed a [AGE] year old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included schizophrenia (a disorder that affects a person's ability to think, feel and behave clearly), delusional disorders (a mental health condition in which a person can't tell what's real from what's imagined), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dementia without behavioral disturbance and impulse disorder (characterized by urges and behaviors that are excessive and/or harmful to oneself or others). Record review of Resident #1's most recent quarterly MDS assessment, dated 8/2/23 revealed the resident was severely cognitively impaired for daily decision-making skills. Record review of Resident #1's comprehensive care plan, edit date 8/23/23 listed the problem Mood State which included the following approaches: -Allow resident to have control over situations, if possible -Assign consistent staff member -Do not confront, argue against, or deny resident's thoughts -Maintain a calm environment and approach to the resident Further review of Resident #1's comprehensive care plan listed the problem Behavioral Symptoms, edit date 7/3/23, included the following approaches: -If elopement occurs, maintain supervision at a distance as tolerated by resident for safety (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 11 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 concerns. Redirect resident when calm Level of Harm - Immediate jeopardy to resident health or safety -Initiate one on one staff to resident observation. Maintain appropriate safety measures at all times Residents Affected - Some Further review of Resident #1's comprehensive care plan did not address an assessment for the use of restraints or the need for the use of restraints. -Consider placement on secure unit if wandering, elopement attempts continue Record review of the progress note written by LVN A, titled Elopement, dated 5/18/23 and time stamped 10:57 a.m. revealed in part, Resident #1 was very agitated and wanted to go off the property for a walk .resident on the walking trail for a few minutes and we were able to get him back into the facility without incident . Record review of the progress note written by LVN A, titled Elopement, dated 5/18/23 and time stamped 11:00 a.m. revealed in part, .Psychiatric NP B .was notified and saw the patient via telehealth. New order received for one time dose of Clonazepam 1mg (a benzodiazepine prescribed to treat generalized anxiety), administered by this nurse . Record review of the Psych Encounter note written by Psychiatric NP B, late entry 6/13/23 for visit date 6/7/23 revealed in part, .Resident #1 with history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .Staff report he is always aggressive, exit seeking and would fight before coming back to the building .Resident continues to display agitation and anxiety .Start Haldol (an antipsychotic used to treat mental disorders) 5mg/ml. Give 2.5mg IM every 6 hours PRN for 'restlessness and agitation.' Order to expire in 14 days . Record review of the Psych Encounter note written by Psychiatric NP B, late entry 6/23/23 for visit date 6/21/23 revealed in part, .Resident with a history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .constantly tries to elope the building .was getting angry and agitated talking to me .No GDR recommended at this time. Resident continues to display agitation and anxiety .Start Haldol 1mg gel. Apply 2 mg every 6 hours as needed, to wrist area, for 'restlessness and agitation' for dementia with behavioral disturbance. Order valid for 14 days. Start Haldol 5mg/ml. Give 2.5 mg IM every 6 hours PRN for 'restlessness and agitation.' Order to expire in 14 days . Record review of the progress note written by LVN C, dated 6/23/23 and time stamped 5:37 p.m. revealed in part, .Shift nurse heard the alarms going off on the hall when the nurse went all [sic] the hall found the door open and the resident (Resident #1) in the yard hiding in the bushes .MD gave new PRN orders nurse will carry those orders out . Record review of the facility Event Report dated 7/5/23 and completed by LVN D revealed Resident #1 had a psychotic episode that caused injuries to others. The Event Report revealed, multiple staff members were pushed, punched and grabbed very aggressively. Under the section, Indicate Pharmacological measures taken, Other was checked and indicated, Haldol IM given by ADON per MD orders. Record review of the progress note written by the DON, dated 8/27/23 and time stamped 1:15 p.m. revealed in part, .obtaining verbal consent for new medication ABH (made from a combination of Ativan, a sedative to relieve anxiety, Benadryl an anti-histamine and, Haldol an anti-psychotic used to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 12 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Level of Harm - Immediate jeopardy to resident health or safety treat mental disorders) gel for 'aggressive behaviors' .resident (Resident #1) behaviors had increased in frequency with increased agitation and aggressiveness towards other residents and staff . Record review of the progress note written by LVN A, dated 8/27/23 and time stamped 9:15 p.m. revealed in part, .Resident #1 coming out of the locked hall and acting aggressive toward staff . I am the nurse that administered ABH gel to the resident . Residents Affected - Some During a telephone interview on 8/28/23 at 10:30 a.m., the Medical Director stated, We don't think the resident [Resident #1] is appropriate for this facility. He has proved he is not appropriate for this facility. The Medical Director further stated, [Psychiatric NP B] is perfectly capable of making medication adjustments and they are supervised by a licensed psychiatrist. No reason why this should not have been handled. The Medical Director further stated, I have recommended the facility to either contact [Psychiatric NP B] or give Haldol IM as needed. During an interview on 8/28/23 at 12:14 p.m., the ADON revealed, Resident #1 had been seen by Psychiatric NP B and stated, but I don't believe she made any real medication changes other than PRN Haldol. During an interview on 8/28/23 at 5:52 p.m., LVN A revealed, Resident #1 had a behavior on 8/27/23 and was surrounded by 3 male aides and Resident #1 was getting really mad at one of the male aides, Nurse Aide F. LVN A revealed, the next thing she knew, Resident #1 was by the front door sitting on the ground, one male aide holding him by one arm facing forward and the other aide holding the resident by the other arm and the third aide, Nurse Aide F holding down the resident's legs. LVN A stated she told the Aides to let Resident #1 go and then LVN A applied the ABH gel to Resident #1. LVN A stated, we are a restraint free facility, no we should not have been restraining [Resident #1]. LVN A revealed she told Nurse Aide F he could not do that, restrain Resident #1 to which Nurse Aide F replied, am I in trouble now? LVN A stated, what I did see is [Nurse Aide F] and the other two male aides restrain [Resident #1]. During an interview on 8/28/23 at 7:22 p.m., LVN D revealed Resident #1 resided in the male secure unit and had gotten out multiple times. LVN D revealed approximately one month ago, June 2023, Resident #1 barged outside of the secure unit. LVN D revealed Resident #1 was held back by multiple staff members after the resident pushed the MDS Coordinator. LVN D stated, staff tried to hold [Resident #1] under the arms as he was swinging. LVN D revealed, Resident #1 was eventually held down in a chair and the ADON gave the resident a Haldol injection. LVN D stated, I feel bad they had to tranquilize him to get him to calm down. LVN D stated, the [ADON], the [DON] and the [Administrator] were all here in the facility when this incident with [MDS Coordinator] occurred, and they were aware [Resident #1] was held down. LVN D stated, I do not feel like anyone here is trained to deal with [Resident #1's] behaviors. LVN D stated, Agency LVN E, who no longer worked for the facility, used to work in a psychiatric facility and had told other staff how to hold Resident #1 in a seated position. During an interview on 8/28/23 at 7:23 p.m., Nurse Aide F revealed he was assigned one to one to Resident #1 on 8/27/23. Nurse Aide F revealed, Resident #1 became agitated on 8/27/23 after Nurse Aide G asked the resident if he was okay and the resident started kicking the air and moving his hands rapidly. Nurse Aide F stated, Resident #1 moved towards the door leading to the front with Nurse Aide G and himself following and Resident #1 pushed open the door from the locked unit and moved toward the inner facility. Nurse Aide F stated, Nurse Aide H came to assist as Resident #1 grabbed Nurse Aide F's shirt from the front. Nurse Aide F stated, they both [Nurse Aide G] and [Nurse Aide H] took [Resident #1] by an arm and held him back and we got him to the ground so the nurses could apply the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 13 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some ABH cream on him. Nurse Aide F stated, [Resident #1] wasn't able to get up. Nurse Aide F stated, I don't think [Resident #1] is appropriate for this facility, he needs to be somewhere where staff are trained for that. I am not trained to deal with that on a regular basis. Nurse Aide F stated, We have been instructed to keep [Resident #1] in the unit but didn't really get any instruction on how to keep him in the unit. During an interview on 8/29/23 at 8:59 a.m., the Assistant BOM revealed, an incident occurred on 8/27/23 at approximately 7:00 p.m. or 7:30 p.m., before preparing to leave her office. The Assistant BOM stated, Resident #1 was observed heading in the direction past the nurse's station toward the front door. The Assistant BOM stated, her office was close to the facility front door and observed Resident #1 followed by Nurse Aide F, Nurse Aide G and Nurse Aide H. The Assistant BOM stated, LVN A had her gloves on ready to apply the ABH gel when Resident #1 hit Nurse Aide F on the upper chest, then grabbed Nurse Aide F's shirt and started to shake him. The Assistant BOM stated, at that point [Nurse Aide G] and [Nurse Aide H] come in and they are right by my office door wall and in the meantime, I am trying to call the [Administrator]. At this point, the guys are trying to hold [Resident #1] and they are holding his arms, like under his elbows and [Nurse Aide F] is still trying to get loose. Everybody goes down, they fall down, and [Resident #1] starts to kick. The Assistant BOM revealed, LVN A then applied the ABH gel to Resident #1's hands. The Assistant BOM stated, it had been discussed during in-services that staff were not to touch Resident #1 because it would escalate his anxiety and aggression. During a telephone interview on 8/29/23 at 3:02 p.m., Agency LVN E revealed she had worked at the facility through a contracted agency but discontinued her contract after 30 days. Agency LVN E revealed, Resident #1 had behaviors that were sometimes avoidable but sometimes not. Agency LVN E revealed an incident occurred in June 2023 in which Resident #1 pushed the MDS Coordinator and had also made contact with the Activity Director. Agency LVN E stated, everyone swarms, [Resident #1] seems like he is going towards everybody and there is a lot of yelling, I step back because less is more. Agency LVN E further stated, [Resident #1] had a hold of the [Activity Director] and is not letting go. [Resident #1] was restrained, because that is what it was called. But [Resident #1] could still move. Agency LVN E revealed, the physical restraint used on Resident #1 was called bear paws so as not to cause bruising while being restrained. Agency LVN E stated, she and CNA I restrained Resident #1 and once we got him to the ground, [Resident #1] starts to relax. Agency LVN E stated, the restraint to Resident #1 lasted a total time of 15 to 20 minutes until the police arrived. Agency LVN E revealed, the facility had not provided training on anything related to the incident, nothing on dementia, nothing on aggression, nothing on behaviors. Agency LVN E stated she did not know who the Abuse Coordinator was and approximately a month ago was given a paper to sign on an in-service on abuse and neglect. Agency LVN E stated, I do not think we are supposed to touch them (residents) but there was no way of getting around it. During an interview on 8/29/23 at 5:47 p.m., the DON stated, Resident #1 could not be stopped from having behaviors and just to keep him safe. The DON revealed staff could not lay hands on Resident #1 and to make sure all the residents were safe. The DON stated, our policy is to follow [Resident #1], keep him safe and call police to help us get him back into the building safely. During an interview on 8/30/23 at 2:38 p.m., Nurse Aide G revealed an incident occurred on 8/27/23 at approximately 7:00 p.m., after the residents had eaten, in which Resident #1 got out of the secure unit with Nurse Aide F following, who was assigned the resident's 1 to 1. Nurse Aide G stated, Resident #1 grabbed Nurse Aide F's shirt and Nurse Aide G came behind [Resident #1] and put my arms around his upper shoulder as if to grab him and [Resident #1] took his arm and swung it back and that's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 14 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some how we fell on the floor. Nurse Aide G stated, he, Resident #1, Nurse Aide F and Nurse Aide H fell together on the floor with the force of Resident #1 trying to swing at them and Resident #1 still holding onto Nurse Aide F's shirt. Nurse Aide G stated, I have never seen any staff hold [Resident #1], we try to talk to him and calm him down. Nurse Aide G revealed he did not consider the incident on 8/27/23 resulted in Resident #1 being restrained. During an interview on 8/30/23 at 3:29 p.m., the Administrator revealed, the Assistant BOM contacted him by phone on 8/27/23 at approximately 7:20 p.m. regarding the incident in which Resident #1 came out of the secure unit and was followed by Nurse Aide F, Nurse Aide G and Nurse Aide H. The Administrator stated, the Assistant BOM was giving the Administrator a narrative while it was going on. The Administrator stated, basically, [Resident #1] rushed [Nurse Aide F] and grabbed him, and two other aides pulled the resident off of [Nurse Aide F.] The Administrator stated, [Nurse Aide F] was standing in front of [Resident #1] because another resident was in [Resident #1's] path. The Administrator further stated, the other two aides grabbed [Resident #1] by the arms and pulled him back while [Resident #1] was holding onto [Nurse Aide F's] shirt, and they all fell down. The Administrator stated, [Nurse Aide F] held one of [Resident #1's] legs because he was kicking him, just didn't want him to hurt anybody and then the nurse put the cream on him and then [Resident #1] got up by himself and went for a walk with them. [Resident #1] was not restrained. The Administrator stated, I have never been informed [Resident #1] had ever been restrained. The Administrator revealed he recalled the incident in which Resident #1 pushed the MDS Coordinator. The Administrator stated, [Resident #1] pushed the [MDS Coordinator] and the staff, don't recall who it was, held [Resident #1] down. I think it was one (staff) on each side of him, to calm him down. The Administrator stated, again [Resident #1] was not hurt. The Administrator stated, the incident with the [MDS Coordinator], we didn't know what to do and [Resident #1] was held down to keep him from hurting other people, I'm sure. The Administrator revealed, the staff at the facility were not trained to deal with that kind of behavior. During an interview on 8/30/23 at 4:11 p.m., the MDS Coordinator revealed he recalled the incident in which Resident #1 pushed him. The MDS Coordinator revealed, staff were guiding Resident #1 to sit in a wheelchair, holding the resident's arms and the resident was resistive and combative. The MDS Coordinator stated, Resident #1 got up from the wheelchair and two staff, could not recall who, had their arms under the resident's upper arms and they backed up until they backed up against the wall and slid down the wall still holding [Resident #1] by the arms and talking to him and then the police showed up. The MDS Coordinator revealed, there was one nurse, Agency LVN E who stated she was trained for this (restraints). The MDS LVN stated, they were restraining [Resident #1], I would think, but it was a reasonable intervention because it was a very erratic behavior. [Resident #1] was kind of out of control. During a follow up interview on 8/31/23 at 8:22 a.m., the DON revealed, the facility did not do behavioral health training of staff and staff were only instructed to remove them (residents) and calm the situation. The DON stated, most of our residents don't have violent behaviors. [Resident #1] seemed to be the one factor in these situations. During an interview on 8/31/23 at 1:18 p.m., CNA I stated, he had not heard or seen residents being restrained. CNA I revealed, residents, including Resident #1, could not be restrained, and staff should not provoke or argue with the residents, leave them be and keep residents safe. CNA I denied ever having restrained Resident #1. Record review of the facility policy and procedure titled Abuse Prevention Program, revision date April 2013, revealed in part, .Our residents have the right to be free from abuse, neglect, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 15 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some misappropriation of resident property, corporal punishment, and involuntary seclusion .1. Our facility is committed to protecting our residents from abuse by anyone including, but not necessarily limited to: facility staff, other residents, consultants, volunteers, staff from other agencies providing services to our residents, family members, legal guardians, surrogates, sponsors, friends, visitors or any other individual .a. Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish .5. Along with other staff and management, the Medical Director will help identify situations that might constitute or could be constituted as neglect; for example .inappropriate management of problematic behavior .repeated failure to check for correct application of restraints . Record review of the facility's policy and procedure titled Use of Restraints, revision date December 2007 revealed in part, .Restraints shall only be used for the safety and well-being of the resident(s) and only after other alternatives have been tried unsuccessfully. Restraints shall only be used to treat the resident's medical symptom(s) and never for discipline or staff convenience .6. Prior to placing a resident in restraints, there shall be a pre-restraining assessment and review to determine the need for restraints. The assessment shall be used to determine possible underlying causes of the problematic medical symptoms and to determine if there are less restrictive interventions (programs, devices, referrals, etc.) that may improve the symptoms .19. Documentation regarding the use of restraints shall include: a. Full documentation of the episode leading to the use of the physical restraint. This includes not only the resident symptoms but also the conditions, circumstances, and environment associated with the episode; b. A description of the resident's medical symptoms (i.e., an indication or a characteristic of a physical or psychological condition) that warranted the use of restraints; c. How the restraint use benefits the resident by addressing the medical symptom; d. The type of the physical restraint used; e. The length of effectiveness of the restraint time; and f. Observation, range of motion and repositioning flow sheets . The Administrator was given the IJ template and was notified of the Immediate Jeopardy {IJ} on 8/31/23 at 6:01 p.m. and a plan of removal was requested. On 9/1/23 at 8:38 a.m., the facility provided a plan of removal that was accepted. It was documented as follows: SURVEY TYPE: Complaint Survey SURVEY DATE: 8/31/23 Plan for REMOVAL Plan to remove immediate jeopardy.

F604 On 8/31/23, Resident #1 no longer resided at the facility, confirmed on 8/31/23. On 8/31/2023 the Regional Nurse Consultant completed in-service with the DON, ADON and the Administrator on abuse and neglect, abuse and neglect reporting guidelines/policy, abuse, and neglect, physical and chemical restraint prevention and how to care for patients with aggressive behavior. On 8/31/2023 DON and ADON assessed residents for any signs or symptoms of physical or chemical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 16 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Level of Harm - Immediate jeopardy to resident health or safety restraints with no other residents identified. The Medical Director was notified there were no changes in condition by the DON on 8/31/23. On 8/31/2023 the Director of Nursing and ADON initiated in-service with facility staff on abuse and neglect, physical and chemical restraint prevention and dealing with residents with aggressive behaviors. Education to be completed on 8/31/23. The in-service was completed on 9/1/23. Residents Affected - Some On 8/31/23 the Administrator and the Regional Reimbursement Consultant will complete safe surveys with residents, to ensure the health and safety of all residents. The IDT, NHA (Nursing Home Administrator), DON, ADON, Regional Nurse Consultant, and MDS Coordinator will review the findings and will immediately notify the Administrator for further action, if necessary. The safety survey was completed on 9/1/23. On 8/31/23 an Ad-Hoc QAPI meeting was held with the Medical Director, NHA (Nursing Home Administrator), DON, Regional Nurse Consultant, Assistance Director of Nursing, Regional MDS, Regional Director of Operations and MDS Coordinator to review the deficiency and the plan for removal of immediacy. Sign-in sheet was reviewed on 9/1/23. Starting on 8/31/2023, IDT (Interdisciplinary team), including Administrator, DON, ADON and MDS Coordinator will review abuse and neglect monitoring Monday to Friday, and Manager on Duty Saturday and Sunday for 1 month to ensure the health and safety of the residents. The findings will be immediately brought up to the Administrator for further action, if necessary. A sign-in sheet was provided of the IDT meeting with the aforementioned staff on 9/1/23. The Administrator/designee will monitor compliance by completing an audit of residents that have behaviors/aggression every week for four (4) weeks, MD being notified, Family being notified, and behavioral services to be notified. If Behavioral Services is not available, then the Medical Director will be notified for any psychosocial concerns. This will be initiated on 8/31/2023. Any identified concerns will be addressed immediately and if trends and patterns are identified, the facility will conduct an Ad-Hoc QAPI meeting to discuss if additional interventions are needed to ensure compliance for the next 2 months. The facility provided an audit dated 8/31/23, initiated by the administrator on 9/1/23. The Administrator will be responsible for ensuring this plan is completed on 8/31/2023. The RDO will provide oversight of Administrator and DON to ensure that the items on the plan of removal are reviewed and completed. Monitoring of the implementation of the POR: Plan to remove immediate jeopardy. During an observation and interview on 9/1/23 at 8:03 p.m., Resident #2 was in his room lying in bed watching television. Resident #2 revealed he felt safe and had been asked by facility staff about abuse/neglect. Resident #2 stated, you're the third person who has asked me. Resident #2 did not appear to be in any obvious distress or discomfort. During an observation and interview on 9/1/23 at 8:08 p.m., Resident #3 was in her room sitting up in a wheelchair. Resident #3 did not appear to be in any obvious distress or discomfort. Resident #3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 17 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Level of Harm - Immediate jeopardy to resident health or safety stated the ADON had talked to her on 8/31/23 about abuse/neglect. Resident #3 stated she felt safe in the facility. During an observation and interview on 9/1/23 at 8:11 p.m., Resident #4 appeared well-groomed and appropriately dressed and did not appear to be in any obvious distress or discomfort. Resident #4 stated she had been asked by the ADON about abuse and revealed she wanted to be with her boyfriend. Residents Affected - Some Record review of the facility interviews with 70 residents on 8/30/23 revealed a safety survey was completed. Most of the residents in the facility were not interview able, and those that were did not make any new allegations of abuse or neglect. Record review of the facility Ad-Hoc QAPI meeting held on 8/31/23 revealed signatures for the Medical Director, NHA (Nursing Home Administrator), DON, Regional Nurse Consultant, Regional MDS, Regional Director of Operations and the MDS Coordinator. A log was created for the IDT to review and monitor for abuse and neglect Monday to Friday and the Manager on Duty for Saturday and Sunday to be monitored for 1 month to ensure the health and safety of the residents. Any adverse findings would be reported to the Administrator for further action if necessary. Record review of the facility IDT meeting held on 8/31/23 included the Administrator, DON, ADON and MDS coordinator revealed the Administrator would monitor for compliance by completing an audit of 5 residents per week for the next 4 weeks of residents with behaviors/aggression with MD notification for request of behavioral services, initiated on 8/31/23. The log dated 9/1/23 revealed 5 random residents were chosen for the audit and signed by the Administrator. During a joint interview on 9/1/23 at 5:36 p.m., the DON, ADON, Regional Nurse Consultant, the COO and RN Director of Quality revealed review of the POR for abuse/neglect highlighted training on identifying and reporting suspected abuse, restraints and dealing with residents with aggressive behaviors. Record review of the facility in-service dated 8/31/23, titled Abuse Neglect Policy/Reporting Guidelines/Abused and Neglect Pathways revealed 67 facility employed staff signed the sign-in sheet. The facility had 55 total facility employees and utilized agency staff. Record review of the facility in-service dated 8/31/23, titled Restraints Prevention/How to Care for Patients with Aggressive Behaviors revealed 67 facility employed staff signed the sign-in sheet. The facility had 55 total facility employees and utilized agency staff. Record review of the facility in-service dated 8/31/23, titled Managing Difficult Behavior in Residents with Dementia revealed 67 facility employed staff signed the sign-in sheet. The facility had 55 total employees and utilized agency staff. During a joint interview on 9/1/23 at 5:22 p.m., the DON and the Administrator revealed the abuse/neglect in-service highlighted identifying forms of abuse, reporting suspected abuse for investigation and adhering to reporting guidelines. 1. During an interview on 9/1/23 at 3:50 p.m., Housekeeping Staff J revealed she had worked for the facility for just 4 months and worked Monday through Saturday from 2:00 p.m. to 10:00 p.m. Housekeeping Staff J revealed she had been in-serviced on abuse/neglect and the use of restraints that morning and revealed she was to report abuse/neglect to the Administrator and to keep the residents safe. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 18 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0604 Housekeeping Staff J stated, we do not restrain, try not to touch the resident and be patient. Level of Harm - Immediate jeopardy to resident health or safety 2. During an interview on 9/1/23 at 3:55 p.m., CNA L revealed she had worked for the facility off and on since January 2023 and worked 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L revealed she had been in-serviced on abuse/neglect and the use of physical/chemical restraint prevention on 9/1/23 and the in-serviced covered identifying abuse/neglect and to report to the Administrator while keeping the residents safe. CNA L further revealed, Residents who have dementia can become aggressive and forms of distraction had to be used but residents could not be restrained. CNA L revealed, if the resident became aggressive, keep other residents safe and report to the nurse. Residents Affected - Some 3. During an interview on 9/1/23 at 4:00 p.m., the Assistant BOM revealed she worked every day with varying hours and had been in-serviced on abuse/neglect and physical/chemical restraint prevention in the morning on 9/1/23. The Assistant BOM stated, abuse/neglect was to be reported to the DON and the Administrator. The Assistant BOM stated, remove the resident from an unsafe environment and keep them safe. The Assistant BOM stated, we do not do restraints, we can't force a resident to stay in a chair and no one can hold down or pull down a resident. The Assistant BOM stated, it was facility policy to try to de-escalate a behavior by talking in a nice tone, acknowledging the resident by name and keep the environment calm. The Assistant BOM stated, aggression in residents would be reported to the nurse. 4. During an interview on 9/1/23 at 4:05 p.m., the BOM stated she had worked for the facility for 5 years and worked Monday to Friday. The BOM stated she had been in-serviced on abuse/neglect last week and was to report suspicion of wrongdoing to the residents to the Administrator. The BOM stated, if the Administrator was not available, abuse and neglect should be reported to the DON and the charge nurse. The BOM stated, an in-service on restraints was given and highlighted how restraints were a form of abuse and were not practiced in the facility. The BOM revealed if a resident exhibited aggressive behavior, the staff were supposed to keep other residents safe and divert the resident exhibiting aggression by offering snacks, take them for a walk or watch a movie. The BOM revealed, residents exhibiting aggressive behaviors should be reported to the Administrator and the nursing staff. 5. During an interview on 9/1/23 at 4:12 p.m., CNA L revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L stated she had been in-serviced by the ADON on 9/1/23 on abuse/neglect, restraints and how to handle residents with aggressive behavior. CNA L revealed the highlight of the in-service covered identifying abuse/neglect and the process for reporting, not restraining residents because it was a form of abuse and using diversion tactics for residents who exhibited aggressive behavior. CNA L revealed abuse/neglect was reported to the Administrator while keeping the resident safe. CNA L revealed the use of restraints was against facility policy and aggressive behavior was to be reported to the Administrator and nursing staff. 6. During an interview on 9/1/23 at 4[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 19 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement written policies and procedures that prohibit and prevent abuse, neglect, exploitation or mistreatment of residents and establish policies and procedures to investigate such allegations for 1 of 4 residents (Resident #5) reviewed for abuse and neglect in that: Residents Affected - Few The facility failed to report an altercation and failed to have evidence a thorough investigation was conducted following a resident-to-resident altercation between Resident #1 and Resident #5. This failure could place residents at risk for continued abuse and neglect due to inappropriate interventions after an incomplete investigation was conducted. The findings included: Record review of the facility's policy and procedure, titled Reporting Abuse to Facility Management, revision date April 2012 revealed in part, .It is the responsibility of our employees, facility consultants, Attending Physicians, family members, visitors, etc., to promptly report any incident or suspected incident of neglect or resident abuse, including injuries of unknown source, and theft or misappropriation of resident property to facility management .Our facility does not condone resident abuse by anyone, including staff members .other residents . Record review of the facility's policy and procedure, titled Resident-to-Resident Altercations, revision date December 2007 revealed in part, .All altercations, including those that may represent resident-to-resident abuse, shall be investigated and reported to the Nursing Supervisor, the Director of Nursing Services and to the Administrator .If two residents are involved in an altercation, staff will .Report incidents, findings, and corrective measures to appropriate agencies . 1. Record review of Resident #1's face sheet, dated 8/26/23 revealed a [AGE] year old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included schizophrenia (a disorder that affects a person's ability to think, feel and behave clearly), delusional disorders (a mental health condition in which a person can't tell what's real from what's imagined), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dementia without behavioral disturbance and impulse disorder (characterized by urges and behaviors that are excessive and/or harmful to oneself or others). Record review of Resident #1's most recent quarterly MDS assessment, dated 8/2/23 revealed the resident was severely cognitively impaired for daily decision-making skills. Record review of Resident #1's comprehensive care plan, edit date 8/23/23 listed the problem Mood State which included the following approaches: -Allow resident to have control over situations, if possible -Assign consistent staff member -Do not confront, argue against, or deny resident's thoughts (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 20 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0607 -Maintain a calm environment and approach to the resident Level of Harm - Minimal harm or potential for actual harm Further review of Resident #1's comprehensive care plan listed the problem Behavioral Symptoms, edit date 7/3/23, included the following approaches: Residents Affected - Few -If elopement occurs, maintain supervision at a distance as tolerated by resident for safety concerns. Redirect resident when calm -Initiate one on one staff to resident observation. Maintain appropriate safety measures at all times 2. Record review of Resident #5's face sheet, dated 8/28/23 revealed a [AGE] year-old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included cognitive communication deficit, obsessive-compulsive disorder (disorder characterized by unreasonable thoughts and fears that lead to compulsive behaviors), dementia, anxiety, lack of coordination, abnormalities of gait and mobility and muscle weakness. Record review of Resident #5's most recent quarterly MDS assessment, dated 6/13/23 revealed the resident was severely cognitive impaired for daily decision-making skills. Record review of Resident #5's comprehensive care plan, revision date 8/22/23 revealed the following: -created on 8/3/23 by MDS Coordinator: Potential for infection/complication related to scratches on neck, right upper extremity with the goal for injuries to resolve and will be free from infection/complications thru next review date. -Resident #5 resides in secure unit and is at risk for injury from wandering in an unsafe environment as evidenced by impaired safety awareness. Resident #5 is at risk for injury from others while residing in secure unit due to altered cognition. Resident #5 wanders into other resident rooms and lays in the wrong bed. The goal was for Resident #5's dignity will be maintained, and resident will wander about unit without the occurrence of any injury over the next quarter. Record review of the facility Event Report dated 8/2/3 and completed by RN Z revealed Resident #5 received aggression. The Event Report, under the section, Was resident or others injured during the behavioral episode? was marked yes. The Event Report revealed Resident #5 had scratches to the neck, right arm, and left elbow. The Event Report, under the section, Describe impact on resident and others, as necessary was marked, Resident fought back with patient once pushed by him. Record review of the progress note written by RN Z dated 8/2/23 and time stamped 11:00 a.m. revealed, [Resident #5] had altercation with another resident [Resident #1], shift nurse attempted to de-escalate the situation but was ineffective. Another resident [Resident #1] pushed [Resident #5] and he pushed him back. Shift nurse and CNA were able to separate both residents. Administrator, DON, ADON notified and went to unit. Management was able to calm the aggressor down and shift nurse stayed with other resident [Resident #5] and cleansed his wounds, RP notified. Record review of the progress note written by LVN S dated 8/26/23 and time stamped 6:30 p.m. revealed, [Resident #1] aggressively grabbed [Resident #5] by the neck and became hostile towards staff. Administrator and nurses were able to calm [Resident #1] down. [Resident #1] was discharged to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 21 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0607 Level of Harm - Minimal harm or potential for actual harm hospital. Further review of the progress note written by LVN S revealed, Edited by: LVN S on 8/27/23 9:16 a.m. Reason: Incorrect data. Record review of the revised progress note written by LVN S on 8/27/23 and time stamped 9:16 a.m. revealed, [Resident #1] aggressively grabbed at other residents and became hostile towards staff. Administrator and nurses were able to calm [Resident #1] down. [Resident #1] was discharged to the hospital. Residents Affected - Few During an interview on 8/28/23 at 12:42 p.m., the Administrator revealed he had reported an incident to HHSC related to resident-to-resident altercation between Resident #1 attacking both Resident #6 and Resident #7. The Administrator revealed the incident occurred on 6/5/23. The Administrator stated Resident #1 had not had altercations with any other residents since 6/5/23. During an interview on 8/28/23 at 12:51 p.m., RN Z revealed, there was a resident-to-resident altercation between Resident #1 and Resident #5 on 8/2/23. RN Z revealed, Resident #1 was angry because he believed Resident #5 wanted to fight him and once Resident #1 went toward Resident #5, Resident #5 tried to defend himself. RN Z stated, [Resident #1] had [Resident #5] by the shirt, and I think that is how [Resident #5] got the scratches. RN Z revealed she completed the incident report for both Resident #1 and Resident #5 and notified the family. During an interview on 8/28/23 at 1:22 p.m., LVN S revealed, on 8/26/23 at approximately 5:45 p.m. or 6:15 p.m., while residents were eating, I saw [Resident #1] grab [Resident #5] and was pinning him against the wall. LVN S stated, I saw redness on [Resident #5's] neck and assumed [Resident #1] grabbed him by the neck but didn't actually see it. LVN S revealed, [CNA X] also witnessed the event. [Resident #5] pointed to his elbow and pointed at [Resident #1] several times. LVN S stated, I did see [Resident #1] pin [Resident #5] against the wall. LVN S stated, I reported it to the [ADON], I don't remember what the [ADON] told me, I think just to document it. During a follow up interview on 8/28/23 at 2:53 p.m., the Administrator stated, my understanding on self-reports was if the resident-to-resident altercation was resolved because the resident could not remember what happened, then it would not be reportable. Even if the staff witnessed it. The Administrator further reiterated, again, [Resident #5] after 24 hours was not psychologically harmed because he could not remember the incident and since there was no injury it would not be reportable. The Administrator revealed he had not witnessed the resident-to-resident altercation between Resident #1 and Resident #5, only that he had been told about it and went into the unit after it occurred. During an interview on 8/30/23 at 1:06 p.m., CNA X revealed he recalled the resident-to-resident incident between Resident #1 and Resident #5. CNA X stated, [Resident #1] got upset and grabbed [Resident #5] from the shirt and pulled him down to the ground. CNA X stated, a female nurse, could not recall who, came into the unit and calmed Resident #1 down. CNA X stated, Resident #5 got a little scratch. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 22 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that included measurable objectives and time frames to meet a resident's mental, nursing, and psychosocial needs that were identified in the comprehensive assessment, for 1 of 4 Residents (Resident #1) reviewed for care plans, in that: The facility failed to fully develop a comprehensive person-centered care plan that was specific for Resident #1 to address the resident's aggression and elopements. This failure could place residents at risk for not getting their medical, physical, and psychosocial needs met and not being provided with the necessary care or services and having personalized plans developed to address their specific needs. The findings included: Record review of Resident #1's face sheet, dated 8/26/23 revealed a [AGE] year old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included schizophrenia (a disorder that affects a person's ability to think, feel and behave clearly), delusional disorders (a mental health condition in which a person can't tell what's real from what's imagined), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dementia without behavioral disturbance and impulse disorder (characterized by urges and behaviors that are excessive and/or harmful to oneself or others). Record review of Resident #1's most recent quarterly MDS assessment, dated 8/2/23 revealed the resident was severely cognitively impaired for daily decision-making skills and required set up only for bed mobility and transfers. Further review of Resident #1's quarterly MDS assessment, under Section E Behavior revealed the resident had exhibited physical behavioral symptoms directed toward others. Record review of Resident #1's comprehensive care plan, edit date 8/23/23 listed the problem Mood State which included the following approaches: -Allow resident to have control over situations, if possible -Assign consistent staff member -Assist resident in identifying the effects of his/her behaviors on others -Begin short, concise interaction with resident; increase as suspicion decreases -Clarify meanings with resident -Do not confront, argue against, or deny resident's thoughts -Encourage resident to implement new coping mechanisms. Give honest feedback to resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 23 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 -Explore with resident ineffective coping mechanisms Level of Harm - Minimal harm or potential for actual harm -Maintain a calm environment and approach to the resident -Refocus resident when he/she changes the subject in middle of conversation Residents Affected - Few -Reinforce and focus on reality. Use clear, concise terms. -Set limits and expectations for resident's behavior -Tell resident you are unable to follow his/her train of thinking Further review of Resident #1's comprehensive care plan listed the problem Behavioral Symptoms, edit date 7/3/23, included the following: Potential/high risk for injury related to identified elopement risk factors and or exit seeking behavior related to: Cognitive Impairment/loss, poor safety awareness, history of elopement. Unsuccessful elopement attempt 5/18/23-No injury. Unsuccessful Elopement attempt 5/27/23-no injury. New event 6/3/23 (7:37 a.m.)-Unsuccessful Elopement attempt/no injury. New event 6/3/23 (8:50 a.m.)-Unsuccessful Elopements attempt/no injury. And included the following approaches: -If elopement occurs, maintain supervision at a distance as tolerated by resident for safety concerns Redirect resident when calm -Initiate one on one staff to resident observation. Maintain appropriate safety measures at all times -Psych referral as ordered. Initiate any new orders. -Consider placement on secure unit if wandering, elopement attempts continue -Develop and [sic] activities program to divert attention and meet needs for social, cognitive stimulation Further review of Resident #1's comprehensive care plan listed the problem, Activities, edit date 7/3/23, included the following: -Resident needs encouragement to attend activities And included the following approaches: -Allow resident to express feelings and desires -Encourage resident to become involved with activities (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 24 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 -Expand activity program to include resident choices if possible Level of Harm - Minimal harm or potential for actual harm -Inform resident of upcoming events by: (provide activity calendar, verbal reminders, escort encouragement, etc.) Residents Affected - Few -Involve resident with those who have shared interests -Praise involvement -Provide setting in which activities are preferred (e.g. -own room, day room, etc.) -Vary the physical environment when possible (e.g., outdoors) Further review of Resident #1's comprehensive care plan listed the problem Cognitive Loss/Dementia, edit date 8/23/23, included the following approaches: -Promote dignity. Converse with resident and ensure privacy while providing care -Provide a program of activities that accommodates resident's problem. Engage in structures activities, sensory stimulation activities -Provide cues, promoting demonstration if resident is unable to complete a task independently -Provide reality orientation and validation prn -Use communication techniques which facilitate optimal interaction: use preferred name, identify yourself with each contact as needed, face when speaking and make eye contact, use brief simple consistent words, cues, and statements. If resident is restless or agitated, shorten conversation. Resume later prn. Record review of Resident #1's current order summary, undated revealed the following: -Admit to facility male secure unit for wandering, with start date 4/6/23 and no end date Record review of Resident #1's Elopement Risk Assessment, dated 8/26/23 revealed the resident was at risk of elopement with interventions that included for routine monitoring, re-direction, and involvement of psychosocial and/or activity program. During an interview on 8/27/23 at 2:25 p.m., the Activities Director revealed Resident #1 enjoyed karaoke, snacks, bowling, connect 4 board game and meditation. The Activities Director revealed she would do her part to keep the resident busy but stated, I'm not here at night. The Activities Director revealed, Resident #1 tried to sneak out of the secure unit and would use the opportunity to leave when staff were assisting other residents. The Activities Director stated she did not know if Resident #1 had ever left the unit without staff knowing. During an interview on 8/28/23 at 3:40 p.m., the MDS Coordinator revealed he was solely responsible for developing the comprehensive care plan and obtained information from the diagnoses list, the MD's history and physical and was revised when there was a new incident or new diagnosis. The MDS Coordinator revealed, if a new event occurred the comprehensive care plan was generally revised the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 25 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few following day, unless the event occurred on the weekend then it would be revised the following Monday. The MDS Coordinator stated, interventions associated with the care plan was a team effort. The MDS Coordinator stated, the floor staff have access to the care plans. The MDS Coordinator revealed, Resident #1 was anxious all the time and needed a lot of interaction and enjoyed going out to the courtyard, getting snacks, dancing, and liked to listen to music from certain artists. The MDS Coordinator stated, [Resident #1] liked to dance and listen to a particular singer/musician, and it should have been included in the care plan, but sometimes I see that doesn't even work. The staff should at least try. The MDS Coordinator stated, It's hard to get things done when you are always being interrupted. I believe the information in the care plan is enough to help care for [Resident #1], but I do agree those things about [Resident #1] liking to dance and listen to a particular singer/musician should have been included in the care plan. During an interview on 8/28/23 at 7:23 p.m., Nurse Aide F revealed he was capable of viewing Resident #1's care plan on the computer tablet but had not actually read Resident #1's care plan. Nurse Aide F stated, the only one who told me [Resident #1] preferred music and a particular singer/musician was [LVN C]. Nurse Aide F stated any new events were communicated to him by the floor nurses such as if a resident displayed erratic behavior. Nurse Aide F revealed he had been instructed to keep Resident #1 in the unit but was not given any instruction on how to keep the resident in the unit, only to follow the resident if he wanted to leave. During an interview on 8/29/23 at 8:59 a.m., the Assistant BOM revealed she was familiar with Resident #1 for having behaviors and aggression. The Assistant BOM stated, when [Resident #1] had a behavior or a moment, he likes to sing, and when he wants to go outside, he wants to hear a particular singer/musician and he likes football. It's a deterrent from him acting out. The Assistant BOM revealed she had attended in-services but had not looked at the comprehensive care plan. The Assistant BOM stated, it had been discussed during in-services that we were not to touch [Resident #1] because it would escalate his anxiety and aggression. [Resident #1] will calm easier with females rather than males. During an interview on 8/29/23 at 12:30 p.m., the ADON revealed, Resident #1 did not have behaviors the first month and a half the resident was in the facility, only slightly agitated but music played from a particular singer/musician calmed the resident. The ADON stated, but then [Resident #1's] behavior slowly started to be more frequent and more escalated and there's no rhyme or reason. [Resident #1's] behavior was so erratic. The ADON revealed, the MDS Coordinator took care of the care plans and floor staff were able to pull up care plans on their computer tablets, including the Nurse Aides. The ADON stated she would talk to the MDS Coordinator about adding interventions and if something needed to be added to the care plan and stated, the [DON] doesn't do it, that I'm aware of. The ADON revealed, the care plan was important, and diversions (for managing behaviors) should have been added to Resident #1's care plan. The ADON stated, the care plan gives you a picture of the resident and probably adding those likes and dislikes should have been care planned. During an interview on 8/30/23 at 9:42 a.m., CNA O revealed she had been employed by the facility for 2 years. CNA O stated, I don't know what a care plan is. Is it like what is the care of each resident? I don't know where to find it. I have heard from other staff [Resident #1] likes doughnuts, likes listening to a particular singer/musician because the resident is always saying how much he likes it. During an interview on 8/30/23 at 1:06 p.m., CNA X revealed the comprehensive care plan could be found on the computer tablet but relied on the other CNA's and nurse aides for report during shift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 26 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few change. CNA X stated, I haven't seen a care plan, I guess it's in the computer tablet. CNA X revealed an incident occurred the first week of August 2023, when Resident #1 grabbed Resident #5 by the shirt and pulled him down to the ground. CNA X revealed, a female nurse came into the unit and calmed Resident #1. During an interview on 8/30/23 at 1:24 p.m., Nurse Aide AA revealed she had been employed by the facility for 2 years. Nurse Aide AA stated, [Resident #1] gets randomly angry, and you can tell by his facial expressions, starts stomping his feet, runs towards the wall and bumps it against his shoulder. A way to calm him down is playing music, old-school songs, a particular singer/musician, take him for a walk. Nurse Aide AA revealed, Resident #1 had different types of triggers and by now everybody should know how to calm him down. Nurse Aide AA stated, the computer tablet tell you about residents, like chart for bowel movements if they've had one or not. Nothing in there if somebody had a behavior or what to do. I've heard of a care plan. It's been a while, kinda don't really know. During an interview on 8/30/23 at 2:38 p.m., Nurse Aide G stated, [Resident #1] had days when he was out of control. Don't know what goes on in his mind. When it looks like he will have a behavior, we are there but keep our distance and try to move the residents out of the way. Nurse Aide G revealed he had not seen a feature on the computer tablet specific to care plans and did not know what a care plan was. Nurse Aide G revealed, Resident #1 enjoyed eating ice cream, listening to music, in particular a certain singer/musician, classic music, and dancing. Nurse Aide G revealed when Resident #1 had a behavior to call the nurses. During an interview on 8/30/23 at 3:29 p.m., the Administrator revealed, Resident #1 had a history of elopement and had recently displayed aggression. The Administrator revealed, Resident #1 enjoyed listening to music to calm him and it worked when the resident was held down in a chair and the resident was able to get up on his own. The Administrator stated, it may not be in care plan, but as we found out more things about [Resident #1], staff talk to each other, and we share information among each other, talk about it at morning meetings. The Administrator revealed, the purpose of the care plan was to show what the individual might benefit from and gave a true picture of the resident. During an interview on 9/1/23 at 9:56 a.m., the DON revealed, the care plan was important because it provided an idea on how to take care of the residents. The DON revealed she knew the nursing staff and floor staff were aware how to get access to the care plan. The DON revealed, she believed the MDS Coordinator, and she was responsible for individualizing the care plan. The DON stated, I don't think there was a negative outcome because everybody knew what [Resident #1] liked to do, listen to a particular singer/musician, go on walks. A request for the facility policy and procedure for comprehensive care plans, requested on 9/1/23 at 9:56 a.m. was not provided at the time of the exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 27 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure the Resident(s) environment remained as free of accident hazards as possible and each resident received supervision and assistance devices to prevent accidents for 1 of 4 residents (Resident #1) reviewed for elopements in that: The facility failed to provide adequate safety interventions to prevent Resident #1 from elopement. Resident #1 had elopement events recorded on 5/18/23, 5/27/23, 8/22/23, 8/25/23. On 8/26/23, Resident #1 was found in the middle of the street a half mile down the road from the secure unit. These failures resulted in an IJ on 8/26/23 at 6:00 p.m. While the IJ was removed on 9/1/23 at 8:19 p.m., the facility remained out of compliance at a level of no actual harm with a potential for more than minimal harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of their plan of removal. This failure placed residents at risk for harm, injury, or death due to elopement. The findings included: Record review of Resident #1's face sheet, dated 8/26/23 revealed a [AGE] year old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included schizophrenia (a disorder that affects a person's ability to think, feel and behave clearly), delusional disorders (a mental health condition in which a person can't tell what's real from what's imagined), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dementia without behavioral disturbance and impulse disorder (characterized by urges and behaviors that are excessive and/or harmful to oneself or others). Record review of Resident #1's most recent quarterly MDS assessment, dated 8/2/23 revealed the resident was severely cognitively impaired for daily decision-making skills and required set up only for bed mobility and transfers. Record review of Resident #1's comprehensive care plan, edit date 8/23/23 listed the problem Mood State which included the following approaches: -Allow resident to have control over situations, if possible -Assign consistent staff member -Do not confront, argue against, or deny resident's thoughts -Maintain a calm environment and approach to the resident Further review of Resident #1's comprehensive care plan listed the problem Behavioral Symptoms, edit date 7/3/23, included the following: Potential/high risk for injury related to identified elopement risk factors and or exit seeking behavior related to: Cognitive Impairment/loss, poor safety awareness, history of elopement. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 28 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Unsuccessful elopement attempt 5/18/23-No injury. Unsuccessful Elopement attempt 5/27/23-no injury. New event 6/3/23 (7:37 a.m.)-Unsuccessful Elopement attempt/no injury. New event 6/3/23 (8:50 a.m.)-Unsuccessful Elopements attempt/no injury. And included the following approaches: -If elopement occurs, maintain supervision at a distance as tolerated by resident for safety concerns Redirect resident when calm -Initiate one on one staff to resident observation. Maintain appropriate safety measures at all times -Consider placement on secure unit if wandering, elopement attempts continue Record review of Resident #1's current order summary, undated revealed the following: -Admit to facility male secure unit for wandering, with start date 4/6/23 and no end date Record review of Resident #1's Elopement Risk Assessment, dated 4/6/23 revealed the resident was at risk of elopement with interventions that included for routine monitoring and re-direction. Record review of Resident #1's Secure Unit Consent, dated 4/6/23 revealed the following: -Based on the Elopement Assessment, the resident has the following indicators for an appropriate admission unto the Secure Unit: Diagnosis of dementia or Alzheimer's or confusion, ambulates independently, pace, wander, try to get out of the door and exhibit signs of sundowners. Benefits of a Secure Unit: allows the resident to ambulate independently in a controlled, safe environment; protection for external stressors and expectations that may increase anxiety. Potential Risks of Secure Unit: anxiety due to inability to come and go at will, Residents may wander into others personal space and pick up/take personal items. Record review of Resident #1's Elopement Risk Assessment, dated 8/26/23 revealed the resident was at risk of elopement with interventions that included for routine monitoring, re-direction, and involvement of psychosocial and/or activity program. Record review of Resident #1's history and physical dated 4/7/23 revealed the resident was previously at another facility and was moved due to elopement with police report filed as a missing person. Further review of Resident #1's history and physical revealed the resident was found 2.5 miles away from the facility by CNA staff. [Resident #1] is now admitted to the facility in memory care locked unit. Record review of the Event Report created by LVN A, dated 5/18/23 and time stamped 10:23 a.m., revealed Resident #1 was off of A hall with staff members walking on the trail right behind the building. [Resident #1] left A hall without the nurse but was intercepted prior to leaving the property. This nurse and 2 other staff members walked on the walking trail with [Resident #1] and got him back inside without incident. Record review of the Event Report created by LVN A, dated 5/27/23 and time stamped 10:30 a.m., revealed Resident #1 went out the back door of A hall due to the alarm being disabled. Staff and other (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 29 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 residents saw the patient and was able to get him before he was able to get off property. Level of Harm - Immediate jeopardy to resident health or safety Record review of the progress note by LVN C, dated 6/3/23 and time stamped 7:37 a.m. revealed, roughly around 7:15 a.m., nursing staff heard the alarms going off at the back door in A hall (secure unit) when the aides followed the resident, she found the fence magnetic unlocked and the fence door open. Shift nurse went to look for the resident along with nursing staff, [Resident #1] was found behind the laundry room on a walking path and was brought back to the facility. Residents Affected - Some Record review of the progress note by LVN C, dated 6/3/23 and time stamped 8:50 a.m. revealed around 8:30 a.m. the shift nurse heard the alarms go off again and nursing staff ran out the door to look for [Resident #1], and once again the fence was opened, and the magnetic lock was opened again. Nursing staff and aides went looking for [Resident #1] and found him walking on the pathway again, [Resident #1] was found by nursing staff and brought the resident back to the facility. Record review of the progress note by the Regional Nurse Consultant dated 8/22/23 and time stamped 9:38 a.m. revealed Resident #1 became upset and busted through the doorway on the secure unit then exited outside front door, accompanied by facility staff. The Regional Nurse consultant wrote, when I got outside [Resident #1] was across the parking lot heading towards the highway in front of the facility. The [Administrator] and [ADON] were walking behind [Resident #1]. Record review of the progress note by LVN C, dated 8/25/23 and time stamped 9:00 a.m., revealed Resident #1 started to yell and hitting the air and stated, 'I am going through those door [sic]. The progress notes further revealed, Resident #1 did bust through the door of the secured unit and then resident began to go towards the font door and Resident #1 was within eyesight the whole time. [Resident #1] began to walk down the street, 911 and ambulance was called for assist, [Resident #1] ended up being in police custody. Record review of the Observation Detail List Report created by LVN S, dated 8/26/23 and time stamped 2:40 p.m., revealed Resident #1 forced door open and walked half mile down the road. During interview with Police on 8/26/23 at 10:28 a.m. , they state a call was received from facility staff stating that Resident #1 walked out of the front door and was headed toward the duck pond that was located across the street. During an interview on 8/26/23 at 12:17 p.m., CNA X revealed Resident #1 had tried to leave several times and if that happens, we follow the resident. CNA X stated, [Resident #1] tried to leave today (8/26/23, from the secure unit), has left at least two times this month and had been caught in the front yard. CNA X stated, Resident #1 had gotten as far as the street up to the little park with the ducks across the street. CNA X stated he was assisting a resident with a shower in the secure unit and heard the door alarm go off. CNA X stated, I saw the back door open, and I went to see, and I didn't see anybody. I called the nurse and [Laundry Staff Y] followed [Resident #1] out. During an interview on 8/26/23 at 12:17 p.m., Laundry Staff Y stated, Resident #1 left on 8/26/23 before 10:00 a.m., from the back door (of secure unit) and Laundry Staff Y followed him. Laundry Staff Y revealed Resident #1 kept telling her he just wanted to walk and pushed the back gate open. Laundry Staff Y stated, [Resident #1] kept saying he wanted to go to the main street where the cars were driving. Laundry Staff Y revealed she used her cell phone to call for help and LVN S took over and walked with Resident #1. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 30 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During an interview on 8/26/23 at 1:13 p.m., LVN S stated he was working on B Hall on 8/26/23 and heard the alarm going off at approximately 8:00 a.m. LVN S stated, CNA X told him he believed Resident #1 went out of the unit but did not see Resident #1 push the door. LVN S stated he saw Resident #1 with Laundry Staff Y and Resident #1 repeatedly said I'm walking. LVN S stated he was on the phone with the ADON and was instructed by the ADON to call the police and to stay with Resident #1. LVN S stated when the police came, he and Resident #1 were driven back to the facility. LVN S stated, the DON instructed staff that Resident #1 was not to be physically stopped when he left and only to follow Resident #1 anytime he left the unit or the building. During an interview on 8/26/23 at 1:40 p.m., LVN C stated she was working in C hall on 8/26/23 at approximately 7:30 a.m. or 7:45 a.m. when she saw Resident #1 walking by outside of a resident's window. LVN C revealed she made her way to A hall secure unit and asked CNA X where Resident #1 was to which CNA X replied, he got out. LVN C stated she then went out the front door while calling the ADON and was told to go back to the facility as LVN S was already on the phone with police trying to get Resident #1 back to the facility. LVN C stated Resident #1 had walked on a specific route and stated, it's a very busy road. LVN S stated, the road has a sidewalk part of it, so I consider that off the property. LVN S stated, yesterday (8/25/23) at approximately 8:07 a.m., [Resident #1] hit the front door, gets down like a linebacker with his arm and punches the door and gets it open. LVN S stated, [Resident #1} did the same thing to the front door and went out. So, then me and [Resident #]1 went across the parking lot into the green grass and then he turned right, and we were going down the main road. LVN C stated, so then I called 911 and told them I am in the middle of the road, the Emergency Medical Technicians blocked one side of the street and then police blocked the other and I blocked the other, making a triangle. LVN C stated, if Resident #1] is off the property he's off the property but I don't know if I would consider that an elopement, I was with him the whole time. During an interview on 8/26/23 at 2:55 p.m., the ADON stated, the incident on 8/25/23 occurred around 8:00 a.m. when Resident #1 busted from the secure unit, hit the egress door from the front entry door with staff following. The ADON revealed, Resident #1 was followed by herself and LVN C when LVN C called 911 to get police and EMS to help. The ADON stated Resident #1 kept saying he was going for a stroll. The ADON revealed, Resident #1 was gone from the facility from approximately 8:14 a.m. to 8:37 a.m. after Resident #1 was placed in the EMS vehicle. The ADON stated, this was not the first time [Resident #1] had left (the facility). I don't consider it was elopement because we had sight of [Resident #1] the entire time. The ADON revealed, the last time Resident #1 tried to leave was on 8/22/23 at 9:19 a.m. During an interview on 8/26/23 at 3:48 p.m., the MDS Coordinator revealed, on 8/25/23 he was informed by LVN C Resident #1 had gone out the door and left and the ADON had called the police. The MDS Coordinator stated, I saw[ Resident #1] come into the facility with a police officer and [Resident #1] appeared calm and chuckled a little bit saying, 'everything was ok' and did not seem in distress. The MDS Coordinator revealed, that was not the first time Resident #1 had left the facility and revealed a similar incident occurred earlier in the week. The MDS Coordinator stated, according to the definition, I would say yes, that would be considered an elopement or at least an attempt. The MDS Coordinator revealed he relied on his superiors to determine if that type of incident would be reportable. The MDS Coordinator stated, if [Resident #1] was in that situation, because of aggressiveness and behavior to only follow [Resident #1] if he leaves but not to physically prevent him from leaving and follow and stay to keep safe and talk to the resident. During an interview on 8/26/23 at 5:54 p.m., the DON stated, according to our policy, we don't consider it an elopement, we stay with [Resident #1] when he has left the unit. [Resident #1] is never (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 31 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some out of our site. I don't believe that is a true elopement. The DON further stated, Resident #1 leaving was not an elopement and out policy is no because he was never missing, but I know that it's not safe when [Resident #1] leaves. We can't take him down; we are not trained. During an interview on 8/26/23 at 6:14 p.m., the Administrator revealed he believed Resident #1 leaving the facility was not considered an elopement because staff followed the resident, kept the resident within their sight and the resident did not have any injuries. The Administrator further stated, we call the police when [Resident #1] leaves but during that time we verbally prompt him to come back. During a follow up interview on 8/27/23 at 9:16 a.m., the Administrator stated, when [Resident #1] first admitted , he was automatically placed in the secure unit, we knew [Resident #1] had a history of elopement from the other facility. The Administrator re-iterated, every time [Resident #1] had left the building he had never been hurt. We have never had injuries. During an interview on 8/27/23 at 10:18 a.m., Resident #1 stated he had been in the facility a little while, recalled being in the hospital the day before but did not know why. Resident #1 stated the police had taken him to the hospital but he was not sick. Resident #1 stated, the police hold me down, they have guns. During a telephone interview on 8/28/23 at10:30 a.m., the Medical Director revealed he believed Resident #1 was not appropriate for the facility due to aggressive behaviors. The Medical Director stated, I am informed every time [Resident #1] attempts an elopement. [Resident #1] will intermittently kick out a window. The Medical Director revealed, Resident #1 could initially be re-directed, did not believe Resident #1 leaving the facility was a true elopement because when the resident leaves, staff follow. The Medical Director stated he had been given information that Resident #1 had made it to the street, staff are with him, but only that [Resident #1] had made it out. During an interview on 8/28/23 at 12:51 p.m., RN Z revealed she had been in the facility when Resident #1 had tried to leave the facility. RN Z stated, we stay with [Resident #1], we walk with him. We call other staff, re-set the alarm, and do a head count. RN Z stated, I know [Resident #1] wanted to cross the street but have not witnessed him going into the street. RN Z revealed she was not sure if Resident #1's attempts to leave were considered an elopement. Record review of the facility policy and procedure titled, Wandering, Unsafe Resident, revision date August 2014 revealed in part, .The facility will strive to prevent unsafe wandering while maintaining the least restrictive environment for residents who are at risk of elopement .A missing resident is considered a facility-wide emergency .If a resident is missing, the elopement/missing resident emergency procedure will be initiated .If the resident was not authorized to leave, initiate a search of the building(s) and premises .If the resident is not located, notify the Administrator and the Director of Nursing Services .Initiate an extensive search of the surrounding area .When the resident returns to the facility, the Director of Nursing Services or Charge Nurse shall .Examine the resident for injuries .Complete and file an incident report . The Administrator was given the IJ template and was notified of the Immediate Jeopardy {IJ} on 8/26/23 at 6:00 p.m. and a plan of removal was requested. On 8/29/23 at 11:03 a.m. the facility provided a plan of removal that was accepted. It was documented as follows: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 32 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 SURVEY TYPE: Complaint Level of Harm - Immediate jeopardy to resident health or safety SURVEY DATE: 8/26/2023 Residents Affected - Some

F689 Plan for REMOVAL Residents #1 was assessed by DON on 8/26/2023 and support was provided as accepted, physician was notified of the alleged deficiency on 8/26/23. Order was provided by Physician to send patient to the hospital for evaluation, RP was notified by Administrator of alleged deficiencies and plan of correction. Upon return to the facility from the hospital Resident #1 will be observed 1:1 on 8/26/23 and will continue until another placement is obtained. Medication management was reviewed by Physician and new orders in place as of 8/26/2023 with monitoring by nurses' effectiveness, facility will redirect resident by taking him for walks/outing as needed; including decrease active attempts of eloping, plan of care updated. On 8/26/23 all residents on Secure units were assessed by DON/Designee - no other residents have active attempt to elope. The Medical Director was notified - no new orders were provided. On 8/26/2023 the Administrator and Director of Nurses notified the Medical Director of immediate jeopardy. Starting on 8/26/2023 the Director of Nursing/Designee will initiate in-service with staff on adequate supervision to prevent a resident from leaving the facility, including policies on elopement/missing resident, how to handle residents who become agitated/aggressive and or attempt to elope was included in the 8/26/23 education. The in-services will be completed on 8/26/2023. No staff member will be allowed to work without being in-serviced by DON/Designee. 9/1/23: DON and ADON initiated in-service on adequate supervision to prevent elopement and handling residents with agitation/aggression was reviewed and completed on 8/26/23. Ad-Hoc QAPI meeting was held on 8/26/2023, with the Medical Director, NHA (Nursing Home Administrator), RDO (Regional Director of Operations), Director of Nursing, Assistant Director of Nursing, and RNC (Regional Nurse Consultant) to review the alleged deficiency, policy and procedure, and the plan for removal of immediacy. 9/1/23: Sign in sheet provided for QAPI meeting held on 8/26/23 that included the Medical Director, DON, Regional Nurse Consultant, ADON, Regional MDS, MDS Coordinator and Regional Director of Operations. Starting on 8/26/2023, IDT (Interdisciplinary team), including Administrator, Director of Nursing, Assistant Director of Nursing, and MDS Coordinator will review headcount of all residents residing on secure units in the facility daily Monday to Friday, and Manager on Duty Saturday and Sunday to determine if any residents have active attempts to elope and was appropriate supervision provided, MD notified, and plan of care updated. IDT team will utilize daily census roster to visually verify residents in the facility at least once a day starting 8/26/2023. The findings will be immediately (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 33 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 brought up to the Administrator for further action, if necessary. Level of Harm - Immediate jeopardy to resident health or safety 9/1/23: The sign in sheet provided of IDT meeting review for elopement and supervision and facility monitoring Monday to Friday and Manager on Duty Saturday and Sunday with the findings reported to administrator initiated 8/26/23 was reviewed. Residents Affected - Some The Administrator/designee will monitor compliance by completing an audit of five (5) residents on secure unit per week for four (4) weeks who are actively attempting to elope and were adequate supervision provided to prevent from patient eloping. This was initiated on 8/26/2023. Any identified concerns will be addressed immediately and if trends and patterns are identified, the facility will conduct an Ad-Hoc QAPI meeting to discuss if additional interventions are needed to ensure compliance for next 2 months. 9/1/23: The administrator to monitor for compliance of at least 5 residents each week for the next 4 weeks of residents that have behaviors/aggression, with MD notification for request of behavioral services, initiated on 8/26/23 was reviewed. The Administrator will be responsible for ensuring this plan is completed on 8/26/2023. The RDO will provide oversight of Administrator to ensure that the items on the plan of removal are reviewed and completed. Monitoring of the implementation of the POR: Plan to remove immediate jeopardy. During a joint interview on 9/1/23 at 5:36 p.m., the DON, ADON, Regional Nurse Consultant, the COO and RN Director of Quality revealed review of the POR for elopements highlighted training providing adequate supervision for preventing elopement and strategies for coping with residents who exhibited agitation and/or aggression. Record review of the facility in-service dated 8/29/23, titled De-Escalation tactics for behavioral residents and residents who attempt to elope from the facility and Wandering, Unsafe Resident, revealed 67 facility employed staff signed the sign-in sheet. The facility had 55 total facility employees and utilized agency staff. During a joint interview on 9/1/23 at 5:22 p.m., the DON and the Administrator revealed the elopement in-service highlighted strategies for addressing residents with aggression and strategies for prevention of elopements. 1. During an interview on 9/1/23 at 3:50 p.m., Housekeeping Staff J revealed she had worked for the facility for just 4 months and worked Monday through Saturday from 2:00 p.m. to 10:00 p.m. Housekeeping Staff J revealed she had been in-serviced on elopements and learned only to follow the resident who tried to elope and keep safe. Housekeeping Staff J revealed she was report to the nurse if a resident attempted to elope. Housekeeping J stated it was important to try to talk to the resident and distract to prevent elopement. 2. During an interview on 9/1/23 at 3:55 p.m., CNA L revealed she had worked for the facility off and on since January 2023 and worked 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L revealed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 34 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some she had been in-serviced on elopement and dealing with residents who had aggression on 9/1/23. CNA L revealed if a resident attempted to leave to report to the nurse and try to talk to the resident, follow the resident and keep safe. CNA L acknowledged most residents in the facility had dementia and you have to talk to them and distract them, so they don't get aggressive. 3. During an interview on 9/1/23 at 4:00 p.m., the Assistant BOM revealed she worked every day with varying hours and had been in-serviced on elopement and how to care for residents with aggressive behaviors on the morning of 9/1/23. The Assistant BOM revealed, if a resident tried to elope, report it, talk to the resident, follow them and be aware of their surroundings. The Assistant BOM stated, if a resident goes missing, call the Administrator and if we can't find them call the police. The Assistant BOM revealed staff had to try to de-escalate the behavior by talking in a nice tone, acknowledge by name and if confuse or incoherent, try to converse with them. 4. During an interview on 9/1/23 at 4:05 p.m., the BOM stated she had worked for the facility for 5 years and worked Monday to Friday. The BOM stated she had been recently in-serviced on elopements and how to care for residents with aggressive behaviors. The BOM revealed the in-services highlighted how to keep other residents safe and diversion tactics for a resident who displayed aggression. The BOM revealed the resident could be diverted by offering snacks, take for a walk or watch a movie, talk to the resident, and offer an activity. The BOM revealed, if a resident tried to leave, verbally re-direct and report to the nurse. 5. During an interview on 9/1/23 at 4:12 p.m., CNA L revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L stated she had been in-serviced by the ADON on 9/1/23 on elopement and residents with aggression. CNA L revealed staff had to report to the Administrator and nursing staff if a resident had displayed aggressive behavior. CNA L revealed, if a resident tried to leave, try to talk to them, calm them down, offer snacks. 6. During an interview on 9/1/23 at 4:16 p.m., CNA M revealed she had worked for the facility for about a month but had been employed over a year ago and had been working the 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA M stated she had been in-serviced on 9/1/23 on elopement and caring for residents who had aggression. CNA M revealed the in-services highlighted using verbal re-direction, diversions such as playing games, activities and offering snacks. CNA M revealed if a resident tried to leave, notify the nurse, and follow the resident to keep safe. 7. During an interview on 9/1/23 at 4:23 p.m., Nurse Aide N revealed she had worked for the facility for 6 months and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. Nurse Aide N stated she had received an in-service by the ADON on 8/31/23 on elopements and dealing with residents who displayed aggression. Nurse Aide N revealed the in-services highlighted de-escalating aggression by offering snacks, put on a movie, play music and trying to keep the resident calm. Nurse Aide N revealed if a resident tried to leave the facility, report to the nurse, follow the resident and keep them safe. 8. During an interview on 9/1/23 at 4:28 p.m., CNA O revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating shift. CNA O revealed she had been in-serviced on elopements and caring for residents who had aggression. CNA O revealed the in-services highlighted on keeping the residents safe, using diversion to keep the resident from elopement and keeping a calm environment. CNA O revealed if a resident attempted to elope, report to the nurse. 9. During an interview on 9/1/23 at 4:35 p.m., Nurse Aide P revealed she had worked for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 35 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some facility for 2 weeks and worked the 6:00 a.m. to 6:00 p.m. shift on a rotating schedule. Nurse Aide P stated she had been in-serviced on elopements and working with residents who aggression this week. Nurse Aide P revealed the in-services highlighted tactics on diverting the behavior such as offering snacks, talking to the resident in a calm voice and finding a quiet place. Nurse Aide P revealed, for a resident who tried to elope, keep calm, keep them safe, follow the resident, report to the nurse, and get help. 10. During an interview on 9/1/23 at 4:40 p.m., Kitchen Staff Q revealed she had worked for the facility for the past 6 weeks and had been in-serviced on elopements and dealing with residents who had aggression this week. Kitchen Staff Q revealed the in-services given taught about keeping the residents safe from residents who exhibited aggression and reporting to the nurse. Kitchen Staff Q revealed, if a resident tried to elope, try to follow them, talk nicely to the resident, and get help. 11. During an interview on 9/1/23 at 4:46 p.m., LVN C revealed she had worked for the facility for 8 years and worked varying shifts and had been in-serviced this week. LVN C stated, residents with aggression had to be verbally re-directed to de-escalate the aggression. LVN C stated, staff should try diverting the behavior by offering going for a walk or playing music. LVN C stated if the resident's aggression continued to escalate, continue to verbally re-direct and report to administrative staff. LVN C revealed, if a resident tried to elope, make sure you are always with the resident, keep them safe, get help, try to re-direct and report to the Administrator. 12. During an interview on 9/1/23 at 4:59 p.m., Dietary Aide R revealed he had worked for the facility for approximately 2 weeks and was in-serviced on 9/1/23 on elopement and aggressive behaviors. Dietary Aide R revealed, if residents got aggressive, give them their space, do not touch them and report to the nurse. Dietary Aide R revealed if a resident tried to elope, follow the resident, and call for help. 13. During an interview on 9/1/23 at 5:02 p.m., LVN S revealed he had worked for the facility for less than a month and worked the weekend shifts. LVN S revealed he had been in-serviced on 9/1/23 on elopements and residents with aggressive behaviors. LVN S revealed the in-services highlighted on diversion tactics for de-escalating aggressive behaviors such as talking to the resident, keeping calm and offering an activity. LVN S revealed, if a resident tried to elope, try to verbally re-direct, follow the resident and report to the Administrator. 14. During an interview on 9/1/23 at 5:26 p.m., the Maintenance Director revealed he had worked for the facility for 2 months and worked varying hours and days and was on call 24/7. The Maintenance Director stated he had been in-serviced on 8/31/23 and 9/1/23 on various subjects including elopements and residents with aggression. The Maintenance Director revealed, if a resident got upset, give them room, and keep other residents safe, then report to the nursing staff. The Maintenance Director revealed, if a resident tried to elope, follow the resident and don't leave them out of your site and report to nursing. 15. During an interview on 9/1/23 at 7:51 p.m., Nurse Aide T revealed he had worked for the facility for 7 months and worked the 6:00 p.m. to 6:00 a.m. shift on a rotating schedule. Nurse Aide T revealed he had been in-serviced this week on residents with aggression and elopement. Nurse Aide T revealed, if a resident tried to elope or was showing aggression, do not touch them, talk calmly to them, keep the resident safe and report to the nurse. 16. During an interview on 9/1/23 at 7:57 p.m., Nurse Aide U revealed he had worked for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 36 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete facility for 7 months and worked the 6:00 p.m. to 6:00 a.m. shift on a rotating schedule. Nurse Aide U revealed he had been in-serviced on elopements and residents who exhibited aggressive behaviors this week. Nurse Aide U revealed the in-services highlighted how to de-escalate the situation, so the resident does not get physical by verbally re-directing and keeping other residents safe. Nurse Aide U revealed, if a resident tried to elope, do not touch the resident, follow from a distance and report to the nurse. The Administrator was notified on 9/1/23 at 8:19 p.m., the Immediate Jeopardy was removed. While the immediacy was removed on 9/1/23, the facility remained out of compliance at[TRUNCATED] Event ID: Facility ID: 675371 If continuation sheet Page 37 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Ensure each resident must receive and the facility must provide necessary behavioral health care and services. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide the necessary behavioral health care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being for 1 of 4 residents, (Resident #1) reviewed for behavioral health services in that: The facility failed to ensure Resident #1 was provided appropriate or timely behavioral health services after showing increased signs of aggression. This failure resulted in an IJ on 8/31/23 at 6:01 p.m. While the IJ was removed on 9/1/23 at 8:19 p.m., the facility remained out of compliance at a level of no actual harm with a potential for more than minimal harm that is not immediate jeopardy with a scope of pattern due to the facility's need to evaluate the effectiveness of their plan of removal. This deficient practice could result in residents with depression and/or mood disorders failing to attain or maintain their highest practicable physical, mental, and psychosocial well-being. The findings included: Record review of Resident #1's face sheet, dated 8/26/23 revealed a [AGE] year old male admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that included schizophrenia (a disorder that affects a person's ability to think, feel and behave clearly), delusional disorders (a mental health condition in which a person can't tell what's real from what's imagined), anxiety disorder (mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dementia without behavioral disturbance and impulse disorder (characterized by urges and behaviors that are excessive and/or harmful to oneself or others). Record review of Resident #1's most recent quarterly MDS assessment, dated 8/2/23 revealed the resident was severely cognitively impaired for daily decision-making skills. Record review of Resident #1's comprehensive care plan, edit date 8/23/23 listed the problem Mood State which included the following approaches: -Administer medications as ordered. Monitor and record effectiveness. Monitor and report any adverse side effects -Allow resident to have control over situations, if possible -Assign consistent staff member -Do not confront, argue against, or deny resident's thoughts -Maintain a calm environment and approach to the resident Further review of Resident #1's comprehensive care plan listed the problem Behavioral Symptoms, edit date 7/3/23, included the following approaches: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 38 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety -If elopement occurs, maintain supervision at a distance as tolerated by resident for safety concerns. Redirect resident when calm -Initiate one on one staff to resident observation. Maintain appropriate safety measures at all times -Consider placement on secure unit if wandering, elopement attempts continue Residents Affected - Some -Psych referral as ordered. Initiate any new orders. Record review of Resident #1's physician orders revealed the following: -May see Respiratory, Podiatrist, Dentist, Optometrist/Ophthalmologist, Wound Specialist, and Mental Health professional as indicated/needed with start date 4/6/23 and no end date -Follow up with Psychology Services, with start date 6/9/23 and no end date Record review of the Psych Note Encounter by Psych (Psychiatric) NP B, dated 5/18/23 revealed in part, .[Resident #1] with a history of dementia, generalized anxiety disorder, impulse disorder and delusional disorder .Today he is being seen for increased agitation .staff reports he is eloped out of the building and when staff tried to bring him back, he became combative .He did not want to come back, was very resistant and agitated .[Resident #1] denies paranoia, denies past trauma, denies suicidal ideation, homicidal ideation, audio hallucinations and visual hallucinations .[Resident #1] continues to display agitation and anxiety .Will continue current dose .Give Clonazepam (a sedative) 1 mg x 1 dose for agitation .start Trazadone (an anti-depressant and sedative) 25 mg at 4 p.m. for agitation .return appointment 1 month with [Psychiatric NP B] . Record review of the Psych Encounter note written by Psych NP B, late entry 6/13/23 for visit date 6/7/23 revealed in part, .[Resident #1] with history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .Staff report he is always aggressive, exit seeking and would fight before coming back to the building .Resident continues to display agitation and anxiety .Start Haldol (an antipsychotic used to treat mental disorders) 5mg/ml. Give 2.5mg IM every 6 hours PRN for restlessness and agitation. Order to expire in 14 days .Return appointment 1 month with [Psych NP B] . Record review of the Psych Encounter note written by Psych NP B, late entry 6/23/23 for visit date 6/21/23 revealed in part, .Resident with a history of dementia, generalized anxiety disorder, impulse disorder, and delusional disorder .constantly tries to elope the building .was getting angry and agitated talking to me .No GDR recommended at this time. Resident continues to display agitation and anxiety .Start Haldol 1mg gel. Apply 2 mg every 6 hours as needed, to wrist area, for restlessness and agitation for dementia with behavioral disturbance. Order valid for 14 days. Start Haldol 5mg/ml. Give 2.5 mg IM every 6 hours PRN for restlessness and agitation. Order to expire in 14 days .Return Appointment: 1 month with [Psych NP B] . Record review of the Neuropsychological Assessment by the Licensed Psychologist, dated 8/16/23 revealed in part, .Referred by medical for neurocognitive evaluation to clarify diagnosis and assist with treatment plan in the context of aggressive behaviors, and to assess for depression, anxiety, or any other psychiatric conditions that might be focus of attention at this time .Treatment Plan/Recommendations .Psychiatric and psychological treatment .Follow up with neuropsychological testing as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 39 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 soon as feasible . Level of Harm - Immediate jeopardy to resident health or safety Record review of Resident #1's clinical record revealed the resident did not receive any routine psychiatric services after 6/21/23 until 8/16/23. Residents Affected - Some Record review of the facility Event Report dated 7/5/23 and completed by LVN D reflected Resident #1 had a psychotic episode that caused injuries to others. The Event Report reflected, multiple staff members were pushed, punched and grabbed very aggressively. Under the section, Indicate Pharmacological measures taken, Other was checked and indicated, Haldol IM given by ADON per MD orders. Record review of the progress note written by the DON, dated 8/27/23 and time stamped 1:15 p.m. reflected, .obtaining verbal consent for new medication ABH (made from a combination of Ativan, a sedative to relieve anxiety, Benadryl an antihistamine and, Haldol an anti-psychotic used to treat mental disorders) gel for 'aggressive behaviors' .resident (Resident #1) behaviors had increased in frequency with increased agitation and aggressiveness towards other residents and staff. Record review of the progress note written by LVN A, dated 8/27/23 and time stamped 9:15 p.m. revealed in part, .Resident #1 coming out of the locked hall and acting aggressive toward staff . I am the nurse that administered ABH gel to the resident. During an interview on 08/28/23 LVN D reported Resident #1 had gotten out of the secure until multiple times. LVN D reported Resident #1 was held back by multiple staff when pushed his way out of the secured unit and pushed the MDS coordinator in June of 2023. LVN D reported staff held Resident #1 under the arms as he was swinging, and Resident #1 was eventually held down in a chair and given a Haldol injection. LVN A reported the DON, ADON and Administrator were present when this occurred and she did not feel anyone had training to handle Resident #1's behaviors. During an interview on 08/28/23 Nurse Aide F reported he was assigned to Resident #1 on 08/27/23 and Resident #1 became agitated and began kicking the air as he made his way out of the locked unit into the inner part of the facility. Nurse Aide F reported Resident #1 grabbed his shirt from the front and Nurse Aide H was there to assist and they both took Resident #1 by the arm and held him back and got him to the ground. Nurse Aide F reported Resident #1 was not appropriate for the facility and should reside somewhere where staff are trained. Nurse Aide F reported he was not trained to deal with Resident #1. During an interview on 08/29/23 The Assistant BOM reported Resident #1 hit Nurse Aide F on the upper chest and grabbed his shirt and shook him. The Assistant BOM reported the nurse aides held Resident #1's arms under his elbows and staff and Resident #1 fell to the ground and Resident #1 began to kick. The Assistant BOM reported LVN A applied ABH gel to Resident #1's hands. During an interview on 08/29/23 LVN E reported Resident #1 had a behavior in June of 2023 when he pushed the MDS coordinator and Resident #1 had a hold on the Activity Director and Resident #1 was restrained by staff using a restraint called bear paws. LVN E reported she and CNA I restrained Resident #1 and got him to the ground, and he began to relax. LVN E reported she had not been provided training on behaviors, or aggression and she did not know who the abuse coordinator was. LVN E reported she did not think staff were supposed to touch residents, but she did not think there was a way of getting around it. During an interview on 08/30/23 Nurse Aide G reported Resident #1 grabbed Nurse Aide F's shirt and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 40 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Nurse Aide G went behind Resident #1 and put his arms around Resident #1's upper shoulder as if to grab him and Resident #1 swung his arm back and that's how they all fell to the floor. During an interview on 8/27/23 at 12:39 p.m., the Administrator stated, former Psych NP B left about a month ago and the new Psych NP V took over August 2023. The Administrator stated the Medical Director was doing psych evaluations after Psych NP B left. Residents Affected - Some During an interview on 8/27/23 at 1:11 p.m., the ADON revealed Psych NP B had been providing psych services until July 2023. The ADON stated, Psych NP B left on medical leave and Psych NP W was filling in doing tele-visits until Psych NP V took over. The ADON stated, she did not recall Psych NP B making any medication changes for Resident #1. The ADON stated she believed Psych NP W had probably seen Resident #1 one time in July 2023. During a telephone interview on 8/28/23 at 9:35 a.m., Psych NP B revealed she had left on medical leave 6/26/23 and the consulting firm she was contracted with had provided an on-call psychiatric consultant until Psych NP V could take over as the new consultant. Psych NP B stated, I am a nurse practitioner, I was doing psychiatric evaluations and I am able to adjust medications for psychiatric services. Psych NP B stated, Resident #1 was exhibiting constant aggression, was probably not appropriate for the facility and had been refusing his medications. Psych NP B stated, since [Resident #1] was not taking his medication, there is not much that I can do and that is beyond me. Psych NP B stated, I did not make contact with the [Medical Director.] I didn't know I need to make contact with them. Psych NP B revealed she would report to nursing about her observations and there was no discussion about getting another psychological evaluation for [Resident #1]. During a telephone interview on 8/28/23 at 10:01 a.m., Psych NP V revealed she had gone into the facility for psychiatric evaluation of residents for the first time on 8/25/23. Psych NP V revealed in addition to working for the consulting firm as a psychiatric consultant, Psych NP V stated she also had a full-time job. Psych NP V stated, I don't have a list of any of the patients (seen in the facility on 8/25/23), I don't remember [Resident #1]. Psych NP V revealed she was capable of making medication changes or adjustments and would notify the Medical Director and the nurses. Psych NP V revealed maybe Psych NP W could be more informative about Resident #1. During an interview on 8/28/23 at 10:10 a.m., the DON revealed, Resident #1 had been seen by Psych NP W during telehealth visits but could not recall any dates. The DON stated she believed the new Psych NP V had seen Resident #1 on 8/25/23 when she was in the building, but Psych NP V did not communicate with her before leaving the facility. The DON revealed, the ADON had given Psych NP V a list of residents for psychiatric evaluation and follow up and Resident #1 was priority on the list. The DON stated, it was her expectation the Psych NP should communicate any recommendations or any written orders. The DON revealed, it typically took a couple of days for the Psych NP to upload their recommendations into the electronic record and did not know if any of the information on the report was communicated to the medical director. The DON stated, I feel if [Psych NP V] had made any medication changes for [Resident #1], the nurses would have gotten that. No new orders were put into the system for [Resident #1]. During a follow up interview on 8/28/23 at 10:27 a.m., the ADON stated, I reached out to [Psych NP W] about getting reports of visits with [Resident #1]. The ADON stated, she was not sure if she had reached out to Psych NP W about doing a psychiatric evaluation on Resident #1, I can't find anything about [Psych NP W] seeing [Resident #1]. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 41 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some During a telephone interview on 8/28/23 at 10:30 a.m., the Medical Director stated he was also the attending physician to Resident #1 and revealed the corporate office wanted one psychiatric company to provide psychiatric services. The Medical Director stated, Unfortunately, they don't have any local folks, and no one was able to come down since like June. The Medical Director revealed the Psych NP could make medication adjustments and were supervised by a licensed psychiatrist. The Medical Director stated, I can contact them, the Psych NP but have never actually had the Psych NP contact me. The Medical Director stated, [Psych NP B] started [Resident #1] on Haldol gel on 7/21/23. At that time, we were probably not aware [Resident #1] had schizoaffective disorder. At that point that was what was recommended, I had recommended the facility to either contact [Psych NP B] or give Haldol IM as needed. During a follow up interview on 8/28/23 at 12:14 p.m., the ADON revealed she had provided Psych NP V a prioritized list of the residents that needed a psychiatric evaluation or follow up for Friday 8/25/23, and Saturday 8/26/23. The ADON stated, Resident #1 was first to be seen on the list. The ADON stated, Psych NP V did not communicate with her when she left, did not exit with anyone, and had only met Psych NP V when she entered the building on 8/25/23. The ADON stated, Psych NP V was supposed to be back on Saturday 8/26/23 and Sunday 8/27/23, but [Psych NP V[ did not come back on Sunday. The ADON stated, when Psych NP B had done psychiatric visits, [Psych NP B] would not give us any feedback either, she would tell us she was here, we would give her a list and then that was it. [Psych NP B] would either e-mail us orders and then add her notes into the electronic record. The ADON stated she did not believe Psych NP B had made any real medication changes other than prn Haldol for Resident #1. The ADON revealed it took probably a week for Psych NP B to upload her visit notes into the electronic record. During an interview on 8/28/23 at 1:09 p.m., LVN C revealed she had made a list of the residents that needed to be seen for psychiatric evaluation and for follow up provided to Psych NP V for the visit on 8/25/23 but was not sure if Psych NP V had seen Resident #1. LVN C stated, [Resident #1] was first on the list. LVN C revealed, Psych NP B was never in the building and did telehealth with Resident #1. LVN C stated, our complaint was that [Psych NP B] was not coming in the building and had been mentioned during morning meeting with Administrative staff and would be told they would take it up with corporate. LVN C stated, Psych NP B did not make any significant medication changes and Resident #1 continued to take the same medications since his admission. During an interview on 8/28/23 at 2:53 p.m., the Administrator revealed, Psych NP B physically made psychiatric evaluations and follow ups once a month and then did telehealth visits due to illness. The Administrator stated, this guy, [Psych NP W] took over in July 2023 for [Psych NP B]. The Administrator revealed he had not recalled seeing Psych NP W in the building and may have met Psych NP W once. The Administrator stated, the contracted psychiatric company could have done a better job. I don't think, personal opinion, they (the residents) would have been better served if the Psych NP was coming into the building to do an actual assessment. The Administrator stated, the NP and even the Medical Director would not be able to prescribe those medications or maybe the Medical Director was not comfortable with doing that, I don't know. The Administrator revealed he believed Resident #1's disease process had progressed and was referred to a neuro psychologist because the services provided by the psychiatric company were not adequate, that's the [Medical Director's] opinion and I agree with him. The Administrator revealed, Resident #1's medications should have been reviewed and modified by a psychiatric hospital. During a telephone interview on 8/29/23 at 10:30 a.m., Psych NP W revealed he could not recall doing a psychiatric evaluation or follow up with Resident #1. Psych NP W stated he had a lot of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 42 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety residents and did not have his computer in front of him to verify if he had seen Resident #1. Psych NP W stated, I'm just covering, I do visits virtually. Psych NP W stated he would call back with more information. During a voicemail message on 8/29/23 at 3:02 p.m., Psych NP W stated, I never saw [Resident #1], I was just covering for emergency issues. [Resident #1] was never bought to my attention. I never saw [Resident #1], I never evaluated [Resident #1]. Residents Affected - Some During a follow up interview on 8/29/23 at 5:08 p.m., the DON revealed, most residents in the facility had dementia and some required psychiatric services or evaluation. The DON stated, I know that psych services were available via telehealth and [Psych NP W] was our contact person for those residents that needed to be seen, after [Psych NP B] left. I called [Psych NP W] and left a message probably during the first incident when [Resident #1] burst through the doors in July. [Psych NP W] did not give me a response. I never got a return call. Record review of the facility policy and procedure titled, Dementia Residents and Managing Behaviors, undated, revealed in part, .Aggressive behaviors may be verbal or physical. They can occur suddenly, with no apparent reason, or result from a frustrating situation. While aggressive behaviors can be hard to cope with, understanding that the person with Alzheimer's or dementia is not acting this way on purpose can help .Treating Behavioral Symptoms .Anyone experiencing behavioral symptoms should receive a thorough medical checkup, especially when symptoms appear suddenly. Treatments depends on a careful diagnosis, determining possible causes and the types of behavior the person is experiencing . The Administrator was given the IJ template and was notified of the Immediate Jeopardy {IJ} on 8/29/23 at 4:15 p.m. and a plan of removal was requested. On 8/30/23 at 4:26 p.m., the facility provided a plan of removal that was accepted. It was documented as follows: SURVEY TYPE: Complaint Survey SURVEY DATE: 8/29/23 Plan for REMOVAL Plan to remove immediate jeopardy.

F740 Resident #1 no longer resided at the facility On 8/29/23 all residents with behaviors and who refuse medications were assessed by DON (Director of Nursing)/Designee - no other residents have active attempt to elope or have signs of being a danger to themselves or others. The Medical Director was notified, and medications were reviewed - no new orders were provided. Behavioral services were notified by Administrator of immediate jeopardy on 8/29/2023 and behavioral services were provided by NP for identified residents with behaviors on 8/30/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 43 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 On 8/29/2023 the Administrator and DON notified Medical Director of immediate jeopardy. Level of Harm - Immediate jeopardy to resident health or safety Starting on 8/29/2023 the DON/Designee will initiate in-service with staff on de-escalation tactics for behavioral residents and residents who attempt to elope from the facility. The in-services will be completed on 8/29/2023. No staff member will be allowed to work without being in-serviced by DON/Designee. Residents Affected - Some 9/1/23: DON and ADON initiated in-service of staff on de-escalation tactics for behaviors and elopement attempts reviewed and completed on 9/1/23. Ad-Hoc QAPI meeting was held on 8/29/2023, with the Medical Director, NHA (Nursing Home Administrator), RDO (Regional Director of Operations), DON, ADON (Assistant Director of Nursing), and RNC (Regional Nurse Consultant) to review the alleged deficiency, policy and procedure, and the plan for removal of immediacy. 9/1/23: A Sign in sheet was provided for QAPI meeting held on 8/31/23 that included the Medical Director, DON, Regional Nurse Consultant, ADON, Regional MDS, MDS Coordinator and Regional Director of operations. Starting on 8/29/2023, IDT (Interdisciplinary team), including Administrator, Director of Nursing, Assistant Director of Nursing, and MDS Coordinator will review events and progress notes for all residents in the facility daily Monday to Friday, and Manager on Duty Saturday and Sunday to determine if any residents have active attempts to elope and has aggressive behaviors toward others, MD notification, and need for plan of care updates. Any identified resident with behaviors, including attempts to elope will be referred to Behavioral services for evaluation in person or via Telehealth, starting 8/29/2023. The behavioral services will provide schedule for on-site visits to DON and Administrator on 8/30/2023 and will be available via Telehealth as needed. If Behavioral services require changes to the schedule, they will notify DON/Administrator via email of the changes and new schedule starting 8/29/2023. If behavioral services are unable to provide services, the Medical Director will be notified by DON/Designee and will review and address behavioral needs as necessary, starting 8/29/2023. The findings will be immediately brought up to the Administrator for further action, if necessary. 9/1/23: An IDT sign in sheet was reviewed for meeting on 8/29/23 that included the Administrator, DON, ADON and MDS coordinator. The Administrator/designee will monitor compliance by completing an audit of five (5) residents per week for four (4) weeks who are actively attempting to elope and/or have aggressive behaviors toward others. This was initiated on 8/29/2023. Any identified concerns will be addressed immediately and if trends and patterns are identified, the facility will conduct an Ad-Hoc QAPI meeting to discuss if additional interventions are needed to ensure compliance for next 2 months. 9/1/23: The administrator to monitor for compliance of at least 5 residents each week for the next 4 weeks of residents that are actively eloping and/or displaying aggression. Concerns identifying trends and patterns to be addressed at QAPI for additional interventions initiated on 8/29/23 was reviewed. The Administrator will be responsible for ensuring this plan is completed on 8/29/2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 44 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety The RDO will provide oversight of Administrator to ensure that the items on the plan of removal are reviewed and completed. Monitoring of the implementation of the POR: Plan to remove immediate jeopardy. Residents Affected - Some Record review of the facility interviews with 70 residents on 8/30/23 revealed checklists were completed. Most of the residents in the facility, including residents in the secure units were not interview able, and those that were did not make any new allegations. Ad-Hoc QAPI meeting was held on 8/29/2023, with the Medical Director, NHA (Nursing Home Administrator), RDO (Regional Director of Operations), Director of Nursing, Assistant Director of Nursing, and RNC (Regional Nurse Consultant) to review the alleged deficiency, policy and procedure, and the plan for removal of immediacy. On 9/1/23, a sign-in sheet was reviewed for the QAPI meeting held on 8/31/23 that included the Medical Director, DON, Regional Nurse Consultant, ADON, Regional MDS, MDS Coordinator and Regional Director of operations. The IDT held on 8/29/23 included the Administrator, DON, ADON and MDS Coordinator for review of events and progress notes for all residents in the facility daily Monday to Friday and the Manager on Duty to review on Saturday and Sunday in order to determine if any residents had actively attempted to elope and if any residents displayed behaviors towards others. The report to include MD notification and care plan update. Any residents identified with behaviors, including elopement attempts would be referred to behavioral health services for evaluation via telehealth as needed. Any changes to the behavioral health services would require notification to the DON/Administrator via e-mail. If behavioral services could not be provided, the DON/Designee would notify the Medical Director to review and address behavioral needs as necessary. Any new findings would be immediately brought to the Administrator for further action if necessary. The IDT sign-in sheet was reviewed on 9/1/23. Record review of the facility in-service dated 8/31/23, titled Managing Difficult Behavior in Residents with Dementia revealed 67 facility employed staff signed the sign-in sheet. The facility had 55 total facility employees and utilized agency staff. During a joint interview on 9/1/23 at 5:22 p.m., the DON and the Administrator revealed the behavioral health in-service highlighted de-escalation tactics for residents who displayed aggressive behaviors and for residents who attempted elopement from the facility. The DON and Administrator revealed, events and progress notes would be reviewed daily to identify residents with behaviors or residents who attempted elopements from the facility, prompting scheduled behavioral health services for on-site visits or for tele-health visits as needed. The DON and Administrator revealed, if there were a scheduling conflict, the Medical Director would be notified to address behavioral needs. During a joint interview on 9/1/23 at 5:36 p.m., the DON, ADON, Regional Nurse Consultant, the COO and RN Director of Quality revealed review of the POR for behavioral health services for residents who displayed aggressive behaviors highlighted training on de-escalation tactics for residents, including those residents who attempted elopement from the facility and providing behavioral health services. 1. During an interview on 9/1/23 at 3:50 p.m., Housekeeping Staff J revealed she had worked for the facility for just 4 months and worked Monday through Saturday from 2:00 p.m. to 10:00 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 45 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Housekeeping Staff J revealed she had been in-serviced on how to manage residents with aggressive behaviors that morning and revealed she was not to intervene, to report the behavior to the nurse and to keep other residents safe. 2. During an interview on 9/1/23 at 3:55 p.m., CNA L revealed she had worked for the facility off and on since January 2023 and worked 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L revealed she had been in-serviced on managing residents with aggressive behaviors on 9/1/23 and the in-serviced included using de-escalation tactics such as distractions and talking to the residents. CNA L stated, if a resident became aggressive, report to the nurses and keep the residents safe. 3. During an interview on 9/1/23 at 4:00 p.m., the Assistant BOM revealed she worked every day with varying hours and had been in-serviced on de-escalating behaviors in the morning on 9/1/23. The Assistant BOM stated, de-escalation tactics included talking to the resident in a nice tone, acknowledge the resident by name, and conversing with the resident if confused or incoherent and try to create a calm environment. The Assistant BOM stated the nurses were to be notified if residents displayed aggressive behaviors. 4. During an interview on 9/1/23 at 4:05 p.m., the BOM stated she had worked for the facility for 5 years and worked Monday to Friday. The BOM stated she had been in-serviced on de-escalation strategies for residents with aggressive behaviors last week and the in-service highlighted keeping other residents safe during the aggression, divert the resident by offering snacks, taking them for a walk or to watch a movie. The BOM stated, report to the nurse when a resident displayed aggressive behaviors. 5. During an interview on 9/1/23 at 4:12 p.m., CNA L revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA L stated she had been in-serviced by the ADON on 9/1/23 on de-escalation strategies for residents with aggressive behavior. CNA L revealed the highlight of the in-service covered trying to calm the resident down, offer them snacks, talk to the resident, and keep other residents safe from harm. CNA L revealed, report to the nurse when a resident displayed aggressive behaviors. 6. During an interview on 9/1/23 at 4:16 p.m., CNA M revealed she had worked for the facility for about a month but had been employed over a year ago and had been working the 6:00 a.m. to 6:00 p.m. on a rotating schedule. CNA M stated she had been in-serviced on 9/1/23 on managing residents with aggressive behaviors. CNA M stated, the in-service highlighted keeping other residents safe, divert the resident displaying aggression by offering an activity or snack and to report to the nurse a resident who displayed aggressive behaviors. 7. During an interview on 9/1/23 at 4:23 p.m., Nurse Aide N revealed she had worked for the facility for 6 months and worked from 6:00 a.m. to 6:00 p.m. on a rotating schedule. Nurse Aide N stated she had received an in-service by the ADON on managing residents with aggressive behaviors on 8/31/23. Nurse Aide N revealed, staff should try to calm the aggressive resident by offering a snack, play music, put on a movie. Nurse Aide N revealed she was to report to the nurse if a resident displayed aggressive behaviors. 8. During an interview on 9/1/23 at 4:28 p.m., CNA O revealed she had worked for the facility for 2 years and worked from 6:00 a.m. to 6:00 p.m. on a rotating shift. CNA O revealed she had been in-serviced on abuse/neglect in the morning on 9/1/23. CNA O revealed the in-service highlighted types of abuse such as verbal, physical, restraints, and yelling at residents. CNA O revealed abuse/neglect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 46 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0740 was to be reported to the Administrator while keeping the residents safe. Level of Harm - Immediate jeopardy to resident health or safety 9. During an interview on 9/1/23 at 4:35 p.m., Nurse Aide P revealed she had worked for the facility for 2 weeks and worked the 6:00 a.m. to 6:00 p.m. shift on a rotating schedule. Nurse Aide P stated she had been in-serviced on residents who displayed aggression this week and the in-service highlighted trying to calm the resident, take them to a quiet place or offer an activity. Nurse Aide P revealed, report to the nurse when a resident displayed aggressive behaviors. Residents Affected - Some 10. During an interview on 9/1/23 at 4:40 p.m., Kitchen Staff Q revealed she had worked for the facility for the past 6 weeks and had been in-serviced on managing residents with aggressive behaviors this week. Kitchen Staff Q stated if a resident [TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 47 of 48 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 675371 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverview Nursing & Rehabilitation 1102 River Rd Boerne, TX 78006 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 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to employ or contract a qualified social worker for a facility of 120 beds or less for 1 of 1 facility in that: Residents Affected - Many The facility failed to ensure an employed or contracted social worker visited the facility as needed. This failure could place all residents at risk for not receiving necessary social services. The findings included: Record review of the employee roster, dated 8/26/23 revealed there was no social worker on staff at the facility. During an interview on 8/27/23 at 1:11 p.m., the ADON stated, we don't have a social worker. We do have an activities director. During an interview on 8/28/23 at 4:46 p.m., the Administrator stated, the facility had not had a social worker for several months. The Administrator stated the facility had hired a social worker in July 2023 but then the newly hired social worker decided not to take the job. The Administrator stated the facility had not had a social worker in the past 4 to 5 months. The Administrator stated, I don't think not having a social worker would have benefited the resident. The Administrator revealed, resident discharges were a team effort and handled by himself, the DON, ADON, MDS Coordinator and BOM. During an interview on 9/1/23 at 8:56 a.m., the DON stated, the facility had not had a social worker since the time she had been hired by the facility on 6/19/23. The DON stated, it was important to have a social worker to help meet the needs of the residents such as airing their issues or concerns and to help with several different things. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675371 If continuation sheet Page 48 of 48