Health inspection·August 27, 2025

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some could not have 2 cigarettes when they go out to smoke. During an interview on 08/26/25 at 9:55AM, Resident #33 said it made him upset that the facility did not allow him to have two cigarettes at a smoking time. He said he has asked in the past and the staff would not let him have a second cigarette. 3. Record review of Resident #40's face sheet, dated 08/26/25, indicated she was a [AGE] year-old female, admitted to the facility on [DATE]. Her diagnoses included chronic obstructive pulmonary disease (a chronic lung disease that causes inflammation and narrowing of the airways, leading to airflow obstruction). Record review of Resident #40's admission MDS assessment, dated 08/15/25, indicated she had a BIMS score of 15, which indicated intact cognition. She was able to make herself understood and she was able to understand others. During an interview on 08/26/25 at 10:04AM Resident #40 said the staff did not allow the residents to smoke 2 cigarettes at a smoke time. She said she has asked in the past and the staff told her No, we cannot do that. She said the staff only brought enough cigarettes for each resident to have one. She said it made her upset she could not have two cigarettes at a smoke time because she was not always able to make it to all of the smoking times. She said she took a diuretic medication that makes her use the bathroom often and she was not always able to make it outside at the smoking times. 4. Record review of Resident #64's face sheet, dated 08/26/25, indicated she was a [AGE] year-old female, admitted to the facility on [DATE]. Her diagnoses included heart failure (a condition where the heart muscle is weakened or stiffened, making it unable to pump blood effectively). Record review of Resident #64's quarterly MDS assessment, dated 05/23/25, indicated she had a BIMS score of 14, which indicated intact cognition. She was able to make herself understood and she was able to understand others. During an interview on 08/25/25 at 10:50AM Resident #64 said the staff that took the residents outside to smoke would not allow them to have 2 cigarettes at a smoke time. She said she has asked the staff before, and they told her it was against facility policy. She said it made her upset that she could not have a second cigarette. During an observation on 08/25/25 at 10:31AM, there were 5 residents outside smoking, including Resident #64, Resident #16, and Resident #33. Dietary Aide B was outside supervising the residents. During the observation Resident #16 asked if she could have a second cigarette and Dietary Aide B told her no. During an interview on 08/25/25 at 10:39AM, Dietary Aide B said that she would allow the residents to smoke a second cigarette if they asked. She said she did not deny Resident #16 a second cigarette. She said Resident #16 said she was going to have a second cigarette at the next smoke time. During an anonymous resident group interview on 08/26/2025 at 2:00 PM, the group said the staff had never let them smoke more than 1 cigarette during a session. They further indicated they were told by staff that the staff made a decision on 08/25/25 that the residents were allowed to have 2 cigarettes and they were only still getting one. They said they felt degraded, and one resident in the group said they came to this facility because they allowed the residents to smoke. They said they felt it was their right to smoke more than one cigarette if they wanted. Record review of a Resident Council Report, dated 08/04/25, reflected: .Smokers would like to know if they can have 2 cigarettes instead of 1. During an observation on 08/27/25 at 9:35AM, ADON A pulled out the smoking supplies safe at the nursing station to show to the surveyor. The box had a sign taped to it and the sign reflected: 08/25/25 [Attention] Staff:Residents will be allowed to smoke 2 cigarettes during smoke break. The sign had the Administrator's signature at the bottom. During an interview on 08/27/2025 at 12:17 PM, ADON A said she had been one of the ADONs for about 4 months. She said the procedure was that the residents were only able to have 1 cigarette at each smoke time. She said it had been that way since she started at the facility. She said she did not think it was her place to question the residents only being allowed to have one cigarette. She said on Monday 08/25/25 the Administrator let the staff know that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675379 If continuation sheet Page 2 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete they should allow the residents to have 2 cigarettes at the smoke times. She said the residents should be allowed to have the right to have 2 cigarettes. She said if she was unable to have more than one cigarette she would be upset. During an interview on 08/27/25 at 12:31PM the DON said she felt the residents had the right to smoke 2 cigarettes at each smoke time. She said the staff recently had a discussion with the Administrator to allow the residents to smoke 2 cigarettes. She said they were now allowed to have two cigarettes when they smoked. She said the procedure that the residents were only allowed 1 cigarette came from everyone thinking it was common practice. She said a resident could be offended if they were denied 2 cigarettes. She said the facility was their home and they should be allowed to smoke two if they desire. During an interview on 08/27/25 at 12:39PM the Administrator said she was unaware of the residents only being allowed 1 cigarette. She said it was not a rule. She said she was okay with the residents having more than one cigarette if they wanted. She said she put a note on the smoking supplies box that the residents could have more than 1 cigarette if they wanted. She said there was not a policy or document that reflected the residents could only have one resident. She said she figured that the staff only gave each resident 1 cigarette because it was how they thought things were done. She said she thought the residents would be frustrated. She said she feels like it is a resident right to have more than one cigarette. Record review of the facility's policy, Resident Rights, last revised August of 2020, reflected: .residents have a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility including those specified in this policy. Record review of the facility's policy, Smoking by Residents, last revised June of 2020, reflected: .X. Smoking session will be limited to 15-minute segments.The policy did not address the number of cigarettes a resident would be allowed to smoke at a time. Event ID: Facility ID: 675379 If continuation sheet Page 3 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0565 Honor the resident's right to organize and participate in resident/family groups in the facility. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to promptly resolve grievances for 6 of 6 Anonymous residents reviewed for grievances during a confidential meeting. The facility failed to ensure 6 of 6 Anonymous residents' grievances related to wet napkins on room trays were promptly resolved. This deficient practice could place the residents at risk for decreased quality of life and feelings of neglect or hopelessness. The findings included: During a confidential interview on 8/26/25 at 2:00 P.M. 6 of 6 Anonymous residents indicated grievances were not addressed or resolved promptly. Anonymous residents indicated they had made complaints about the napkins being wet on the hall trays in several resident council meetings. Anonymous residents indicated the Activity Director was present during the resident council meetings and was aware of complaints about the wet napkins. Anonymous residents stated it was still happening during meal pass and made them feel like no cared how they felt. Record review of the resident council minutes for 6/2/25, 6/23/25, 6/30/25, 7/14/25, 7/21/25, 7/28/25, 8/4/25 and 8/12/25 indicated Napkins on trays are being wet when served to residents. During an interview on 8/27/25 at 12:25 P.M., the Activity Director stated she believed that complaints during resident council were considered grievances. The Activity Director stated she wrote down the minutes for the resident council meetings. She stated she wrote that the residents had been complaining about their napkins being wet on their trays. She stated the residents were saying the drinks on the tray was getting on the napkins. She stated she did not know exactly how many months the residents had complained about the wet napkins. She stated she wrote it down when the residents complained, she reported it in a stand down meeting and she reported it to the Dietary Manager. She stated she felt the wet napkins were an issue and if the residents were complaining about it the facility needed to fix it. She stated a negative effect of the wet napkins on the trays was the residents could not use the napkins. During an interview on 8/27/25 at 12:55 P.M., the Dietary Manager stated she thought she was notified about the wet napkins on the resident hall trays during the last resident council meeting and she thought the issue was resolved. She stated she was not aware that the residents had complained about the wet napkins for 3 months. She stated if she would have known the residents had complained that many times, she would have monitored the trays for wet napkins herself. She stated she did an in-service on the wet napkins before, and she thought it was all clear. She stated if the residents complained about something it should be taken care of. She stated a negative effect of residents having wet napkins would be they could not clean their hands and face. During an interview on 8/27/2025 at 1:07 P.M., the ADON D stated he was unaware of the numerous complaints of residents getting wet napkins with their meals. He stated a negative effect of wet napkins on trays was it would not allow residents to clean themselves appropriately and that no one wanted a wet napkin. He stated not resolving the complaints gave residents a sense that the facility did not care about them. During an interview on 8/27/25 at 1:11 P.M., the DON stated she was unaware of the resident council complaints. She stated she was not aware of the numerous complaints of wet napkins on trays. She stated she had never passed a tray with a wet napkin. She stated a negative effect of being served a wet napkin was the residents could not properly clean their hands with a wet napkin. She stated the residents' concerns needed to be addressed. She stated the residents needed to feel like they were being heard, because the facility was their home. During an interview on 8/27/25 at 1:25 P.M., the ADM stated that complaints during resident council were considered grievances. She stated she was unaware of the numerous complaints of wet napkins on the residents' trays. She stated the wet napkins was never brought up in a meeting. She stated she did not have an answer as to why the wet napkins were not corrected, because no one had mentioned it to her until today. She stated the Activity Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675379 If continuation sheet Page 4 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Director had never said a word to her about the residents complaining about wet napkins. She sated she truly did not know there was an issue with the napkins on the trays being wet. She stated the ADON had started an in-service to try to figure out why the napkins were getting wet on the trays. She stated a negative effect of wet napkins on the resident's food tray was they could not use them and the appearance of the wet napkins on the tray would not look nice. She stated it was important to address grievances and resident council complaints promptly, but she could not address what she did not know. Record review of Grievances and Complaints policy revised on February 2025 revealed Grievances Investigation: . A. Upon receiving a resident grievance/complaint form, the Grievance Official or designee begins an investigation into the allegations. The Grievance Official will take immediate action to prevent further potential violations of any resident right while the alleged violation is being investigated. The department director of an involved employee is notified of the nature of the complaint and that an investigation is underway. Record review of Resident Council policy revised on 06/2020 revealed Responsibilities of the Resident Council: . C. If the Council raises an issue of concern, the Department responsible for the issue or service is responsible for addressing the item(s) of concern promptly. D. The Facility will respond in writing to written request or concerns of the family council in a prompt and timely manner. Event ID: Facility ID: 675379 If continuation sheet Page 5 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe, clean, comfortable, homelike environment maintaining a comfortable noise level for 1 of 18 residents (Resident #39) reviewed for dining services. The facility failed to ensure the noise level in the dining room was kept at a comfortable level for Resident #39 on 08/25/25 during the lunch meal. This failure could place residents at risk for a decreased quality of life.The findings included: Record review of the face sheet, dated 09/02/25, reflected Resident #39 was a [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses of dementia (memory loss), history of a stroke, and a history of traumatic brain injury. Record review of the annual MDS assessment, dated 07/19/25, reflected Resident #39 had unclear speech, was usually understood by others, and was usually able to understand others. Resident #39's BIMS score was 3, which indicated severe cognitive impairment. The MDS reflected Resident #39 had no behaviors or refusal of care during the look-back period. Record review of the comprehensive care plan, revised 05/12/25, reflected Resident #39 had impaired cognitive function or thought processes. The interventions included: .reduce any distractions - turn off TV, radio, close door, etc. The care plan further reflected Resident #39 had potential for communication problems related to unclear speech. The interventions included: anticipate and meet needs. During an observation on 08/25/25 beginning at 11:44 AM, there were 18 residents sitting in the dining room. Gospel music was playing loudly, over a speaker. Resident #39 was sitting across the room in front of the television, which was on and playing. During an observation and interview on 08/25/25 beginning at 11:50 AM, Resident #39 placed her hands over her ears and stated, too loud. Resident #39 pointed at the television and shook her head side-to-side. Resident #39 shook her head yes, when asked if the music was often played too loudly. The surveyor alerted staff to Resident #39's request, and the music was turned down. During an interview on 08/27/25 beginning at 10:16 AM, LVN C stated the music was not normally played loudly with the television going at the same time in the dining room. LVN C stated Resident #39 had not complained about the music prior to 08/25/25. LVN C stated she was not in charge of the music in the dining room and was unsure who set it up. LVN C stated if the resident's complained about the noise level she would request the music be turned down. LVN C stated it was important to ensure the noise levels were kept at a comfortable level to make sure the environment remained comfortable. LVN C stated the facility was their home and it was hard to understand things happening elsewhere if the noise was too loud. During an interview on 08/27/25 beginning at 10:29 AM, the DON stated the AD was responsible for the entertainment in the dining room. The DON stated there had not been any complaints about the noise level in the dining room. The DON stated Resident #39 had not complained about the music being too loud. The DON stated it was important to ensure the noise level was kept at a comfortable level to maintain the residents best interest, cater to the residents, and ensure activities were conducted. During an interview on 08/27/25 beginning at 12:22 PM, the AD stated she was responsible for playing the music in the dining room. The AD stated the music and television were not usually playing at the same time. The AD stated if any resident's complained about the noise level of the music, it would have been turned down. The AD stated Resident #39 had not complained about the noise level of the music. The AD stated Resident #39 used to watch television in her room but had been watching television in the dining room more frequently. The AD stated it was important to ensure the noise level was kept at a comfortable level in the dining room because it was the residents right. During an interview on 08/27/25 beginning at 12:33 PM, the Administrator stated Resident #39 had not been herself (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675379 If continuation sheet Page 6 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete recently because her long-time roommate was leaving the facility. The Administrator stated Resident #39 usually loved to listen to gospel music. The Administrator stated if any residents complained of the noise level of the music it should have been turned down. The Administrator stated all staff were responsible for monitoring the noise levels at the facility. The Administrator stated she expected the noise level to be kept at a comfortable level. The Administrator stated it was important to ensure the noise level was kept at comfortable levels so residents could hear what was going on during activities. Record review of the Resident Rooms and Environment policy, revised 08/2020, reflected .Facility staff aim to create a personalized, homelike atmosphere, playing close attention to the following.comfortable noise levels. Event ID: Facility ID: 675379 If continuation sheet Page 7 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0641 Ensure each resident receives an accurate assessment. 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 ensure assessments accurately reflected the resident status for 2 of 19 residents (Resident #3 and Resident #12) reviewed for MDS assessment accuracy. The facility did not ensure Resident #3's and Resident #12's MDS assessments accurately identified a medication as an anti-platelet instead of an anticoagulant. These failures could place residents at risk for not receiving care and services to meet their needs.Findings included: 1. Record review of Resident #3's face sheet, dated 08/26/25, indicated she was an [AGE] year-old female, admitted to the facility on [DATE]. Her diagnoses included dementia (a group of conditions that cause a progressive decline in cognitive abilities), and type 2 diabetes mellitus (chronic disease where your body either doesn't produce enough insulin or doesn't use insulin properly, leading to high blood sugar levels). Record review of Resident #3's quarterly MDS assessment, dated 08/04/25, indicated she did not have a BIMS score due to her rarely/never being understood. She rarely/never understood others. The assessment further indicated she took an anticoagulant medication. Record review of Resident #3's physician's orders, dated 08/25/25, indicated the following orders:*Aspirin Low Dose oral tablet chewable 81mg (an antiplatelet medication used to prevent cardiovascular events like heart attacks and strokes) Give 1 tablet by mouth one time a day. The start date was 07/11/24.* Clopidogrel Bisulfate oral tablet 75mg (an antiplatelet medication used to prevent heart attack, stroke, and other cardiovascular problems) Give 1 tablet by mouth one time a day for cerebrovascular disease. The start date was 07/11/24.There was not an order for an anticoagulant medication. Record review of Resident #3's care plan, indicated a focus dated 05/10/25 of Resident #3 was on anti-platelet medication related to cerebrovascular accident (stroke). Interventions included monitor/document/report to MD PRN signs and symptoms of anti-platelet complications. 2. Record review of Resident #12's face sheet, dated 08/26/25, indicated he was a [AGE] year-old male, admitted to the facility on [DATE]. His diagnoses included heart failure (a condition where the heart muscle is weakened or stiffened, making it unable to pump blood effectively) and chronic kidney disease (a condition where the kidneys gradually lose their ability to filter waste products from the blood). Record review of Resident #12's quarterly MDS assessment, dated 07/17/25, indicated he had a BIMS score of 11, which indicated moderate cognitive impairment. He was able to make himself understood and he was able to understand others. The assessment further indicated he took an anticoagulant medication. Record review of Resident #12's physician's orders, dated 08/25/25, indicated the following orders:*Aspirin Low Dose oral tablet chewable 81mg Give 1 tablet by mouth one time a day. The start date was 09/15/24.* Clopidogrel Bisulfate oral tablet 75mg Give 1 tablet by mouth one time a day. The start date was 09/15/24.There was not an order for an anticoagulant medication. Record review of Resident #12's care plan, indicated a focus dated 09/21/24 of Resident #12 was on anti-platelet therapy related to disease process. Interventions included monitor/document/report to MD PRN signs and symptoms of anti-platelet complications. During an interview on 08/27/25 at 12:08PM, the MDS Coordinator said she would have to modify the MDS assessments for Resident #3 and Resident #12. She said she was not sure how the residents' assessments were marked for anticoagulants. She said anticoagulant should have been marked no on both residents' assessments. She said the residents were taking antiplatelet medications. She said there was no risk to the residents because of the inaccurate MDS. During an interview on 08/27/2025 at 12:17 PM, ADON A said she had been one of the ADONs for about 4 months. She said the current MDS Coordinator was new. She said her expectation was that the MDS assessments were completed accurately. She said she was going to in-service and make sure the MDS assessments for Resident #3 and Resident #12 were corrected. During an interview on 08/27/25 at 12:31PM, the DON Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675379 If continuation sheet Page 8 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete said she expected the MDS for Resident #3 and Resident #12 to be accurate. She said there was no risk to the resident due to the MDS being marked wrong for anticoagulant. During an interview on 08/27/25 at 12:39PM, the Administrator said she expected the MDS to be accurate. She said she did not think there was a risk to the resident due to the MDS being marked for anticoagulant. Record review of the facility's policy, Minimum Data Set Policy, last revised 03/14/24, reflected: .Procedure1. IDT to utilize RAI for all processes pertaining to MDS. Event ID: Facility ID: 675379 If continuation sheet Page 9 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring, receiving, and dispensing of routine drugs and biologicals to meet the needs of each resident for 2 of 2 (Resident #1 and Resident #2) residents reviewed for gastrostomy tube. 1. The facility failed to ensure Resident #1 received potassium chloride (supplement), acidophilus (probiotic), Bactrim DS (antibiotic), and valproic acid (anticonvulsant) within the scheduled time frame on 08/26/25. 2. The facility failed to ensure Resident #2 received apixaban (anticoagulant), ferrous sulfate (iron supplement), furosemide (diuretic), and valproic acid (anticonvulsant) within the scheduled time from on 08/26/25. These failures could place residents at risk for medication errors and adverse effects from medication.The findings included: Record review of face sheet, dated 08/27/25, reflected Resident #1 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnosis of mild cognitive impairment and dysphagia (difficulty swallowing). Record review of the admission MDS assessment, dated 08/11/25, reflected Resident #1 had unclear speech, was sometimes understood by others, and was sometimes able to understand others. Resident #1 had a BIMS score of 4, which indicated severe cognitive impairment. The MDS reflected Resident #1 had no behaviors or refusal of care during the look-back period. The MDS reflected Resident #1 used a feeding tube while a resident. Record review of the comprehensive care plan, revised 08/08/25, reflected Resident #1 required a feeding tube related to dysphagia. Record review of the order summary report, dated 08/27/25, reflected Resident #1 had the following orders:1. acidophilus probiotic - give 1 capsule via gastrostomy tube two times a day for probiotic support x 7 days with antibiotics.2. Bactrim DS 800-160 mg - give 1 tablet via gastrostomy tube two times a day for UTI x 7 days.3. potassium chloride solution - give 40 mEq via gastrostomy tube one time a day for supplement.4. valproic acid oral solution 250 mg/5 mL - give 5 mL via gastrostomy tube one time a day for mood disorder. Record review of Resident #1's MAR, dated August 2025, reflected the following:1. potassium chloride solution - give 40 mEq via gastrostomy tube one time a day for supplement was scheduled for 8 AM.2. acidophilus probiotic - give 1 capsule via gastrostomy tube two times a day for probiotic support x 7 days with antibiotics was scheduled for 8 AM.3. Bactrim DS 800-160 mg - give 1 tablet via gastrostomy tube two times a day for UTI x 7 days was scheduled for 8 AM.4. valproic acid oral solution 250 mg/5 mL - give 5 mL via gastrostomy tube one time a day for mood disorder was scheduled for 8 AM. 2. Record review of the face sheet, dated 08/27/25, reflected Resident #2 was a [AGE] year-old female who initially admitted on [DATE] with diagnoses of history of stroke, dysphagia (difficulty swallowing), and gastrostomy status (opening into the stomach from the abdominal wall, made surgically for the introduction of food). Record review of the quarterly MDS assessment, dated 08/06/25, reflected Resident #2 had no speech, was sometimes understood by others, and was sometimes able to understand others. Resident #2's staff assessment for mental status reflected a short-term memory problem, long-term memory problem, and severely impaired decision making skills. Resident #2 was unable to recall current season, location of own room, staff names and faces, and that they are in a nursing home. The MDS reflected no behaviors or refusal of care during the look-back period. Resident #2 had a feeding tube while a resident at the facility. Record review of the comprehensive care plan, revised 04/04/25, reflected Resident #2 required a feeding tube related to dysphagia secondary to stroke. Record review of the order summary report, dated 08/27/25, reflected the following:1. apixaban 2.5 mg - give 1 tablet via gastrostomy tube every morning and at bedtime for atrial fibrillation (irregular heart rhythm).2. ferrous sulfate oral solution 5 mg/20 mL - give 30 mL via gastrostomy tube two (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675379 If continuation sheet Page 10 of 11 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 675379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Oaks at Longview 111 Ruthlynn Dr Longview, TX 75601 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete times a day for supplement.3. furosemide 40 mg - give 1 tablet via gastrostomy tube two times a day for edema and atrial fibrillation.4. valproic acid oral solution 250 mg/5 mL - give 2.5 mL via gastrostomy tube two times a day for tremors. Record review of Resident #2's MAR, reflected the following:1. apixaban 2.5 mg - give 1 tablet via gastrostomy tube every morning and at bedtime for atrial fibrillation was scheduled for 8 AM.2. ferrous sulfate oral solution 5 mg /20 mL - give 30 mL via gastrostomy tube two times a day for supplement was scheduled for 8 AM.3. furosemide 40 mg - give 1 tablet via gastrostomy tube two times a day for edema and atrial fibrillation was scheduled for 8 AM.4. valproic acid oral solution 250 mg/ 5 mL give 2.5 mL via gastrostomy tube two times a day for tremors was scheduled for 8 AM. During an interview on 08/26/25 beginning at 6:45 AM, the Regional Nurse Consultant stated LVN C had already given Resident #1 and Resident #2 all the scheduled morning medications through the gastrostomy tube. The Regional Nurse Consultant stated the next medications due were at noon. During an interview on 08/27/25 beginning at 10:16 AM, LVN C stated she normally started her morning medication pass at around 6 AM. LVN C stated medications could have been given one hour before the scheduled time and one hour after the scheduled time. LVN C stated all medications should have been scheduled for the same time if possible. LVN C stated preferences should be considered within the timeframes for each resident. LVN C stated the charge nurses were responsible for putting orders into the computer and ADON D followed up to ensure the accuracy of the orders. LVN C stated Resident #1 and Resident #2's medications were usually given at the same time. LVN C stated it was important to ensure medications were given at the appropriate timeframes to prevent toxicity or drug interactions. LVN C stated some medications need to be given at certain times and could affect the absorption of the medication. During an interview on 08/27/25 beginning at 10:25 AM, ADON D stated ensuring medications were grouped together at the same time was a group effort. ADON D stated the nurse was responsible for putting the orders into the computer system. ADON D stated the nurse was responsible for administering the medication within the appropriate timeframes. ADON D stated medications should have been administered between one hour before the scheduled time or one hour after the scheduled time. ADON D stated Resident #1 and Resident #2's medications should have been scheduled at the time as possible. ADON D stated it was important to ensure medications were given within the appropriate timeframes to prevent drug interactions or overdose. During an interview on 08/27/25 beginning at 10:29 AM, the DON stated medications should have been given between one hour before or one hour after the scheduled time. The DON stated the nursing staff tried to group medications at the same time as possible. The DON stated she expected the nurse to explain or communicate any issues with medication administration to the management staff, such as inability to administer medications within the required timeframes. The DON stated nursing management could have consulted with the pharmacist and physician to ensure medications could have been given together during the same time. The DON stated it was important to ensure medications were given within the scheduled timeframes to ensure the best interest of the residents. During an interview on 08/27/25 beginning at 12:33 PM, the Administrator stated she expected the nurses to ensure medications were given according to the appropriate standards of practice and within the required timeframes. The Administrator stated nursing management was responsible for monitoring to ensure medications were given within the required timeframes. The Administrator stated it was important to ensure medications were given within the scheduled timeframes to prevent adverse drug side effects. Record review of the General Guidelines for Medication Administration policy, revised 08/2020, reflected .at a minimum, the 5 rights - .right time. - should be applied to all medication administration and reviewed at three steps in the process of preparation. medications are administered within 60 minutes of the scheduled administration time. Event ID: Facility ID: 675379 If continuation sheet Page 11 of 11