Health inspection·September 13, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few back and forth. Record review of Resident #15's PIR dated 8/27/25 indicated, .8/22/25 at 5:00 a.m.resident room.interviewable. alleged perpetrator.LVN M. denied. Resident #15 stated she did not receive 4:00 pm medications, and LVN M would not administer the 4:00 pm in addition to the 6:00 am medication. Resident #15's behavior was upset about missing the medications. Record review of an undated facility's investigation summary by the ADM indicated, .on the morning of August 22, 2025, this writer [ADM] was informed that Resident #15 informed the AIT that she was verbally abused by LVN M because she refused to administer her 4:00 a.m. pain medications in addition to the 6:00 a.m. pain medication at the same time. Resident #15 reported that LVN M was screaming and clapping her hands at her as she was speaking and still refused to administer the pain medication. the writer interviewed LVN M. LVN M stated that she was not screaming at the Resident [Resident #15]. She [LVN M] stated that she was trying to explain to the Resident [Resident #15] that her 4:00 medications should have been on the previous shift. She [LVN M] explained that she cannot legally administer pain medications that were due on the previous shift. She [LVN M] stated that she offered to administer the 6:00 medication, but the Resident [Resident #15] refused. During an interview on 9/8/25 at 5:04 p.m., Resident #15 said she did not get her Gabapentin and Oxycodone at 4 p.m. on 8/21/25. She said she woke up around 5:30 p.m. in pain. She said she had called the front desk at 6:15 p.m. and 6:40 p.m., asking for her 4 p.m. medications. She said LVN M did not show up until almost 10:00 p.m. She said she was so upset. She said she and LVN M both raised their voices at each other. She said LVN M was clapping her hands at her. She said she did not like how LVN M was condescending and superior acting. She said LVN M could be stern and superior acting sometimes even before this incident. During an interview on 9/9/25 at 10:42 a.m., LVN M said she had been employed at the facility for about 30 days. She said she worked 6pm-6am shift. LVN M said Resident #15 was upset about not receiving her 4 p.m. oxycodone. She said she arrived around 10 p.m. to give Resident #15 the evening medications. She said Resident #15 started yelling at her. She said she never yelled back at Resident #15. She said she did not clap her hands at Resident #15. During an interview on 9/11/25 at 5:03 p.m., CNA TT said she witnessed the incident between Resident #15 and LVN M. She said LVN M was talking forcefully and had an attitude with Resident #15. She said LVN M tone was not helping the tense situation with Resident #15. She said she did not agree with the way LVN M spoke to Resident #15. She said it was disrespectful. She said LVN M spoke to Resident #15 like they were on the streets. She said she had never seen Resident #15 so upset. She said that was the first time she had heard LVN M speak to a resident like that. She said LVN M spoke to other staff members with an attitude but not the residents. During an interview on 9/12/25 at 9:15 a.m., Resident #15 said the incident with LVN M made her angry and upset. She said it made her feel like none of her issues or concerns would be resolved. She said LVN M thought she was accusing her of being late with the evening medications. She said which was not the case at all. She said it was like I was a child, and she just wanted me to be quiet. During an interview on 9/12/25 at 10:45 a.m., the DON said she expected the staff to be polite and speak to the residents with dignity. She said if an issue could not be resolved civilly, then the staff should leave and come back later. She said the staff could also send someone else to speak to the resident. She said she did not expect the staff to speak to the resident in a disrespectful manner. She said if a resident was spoken to in a disrespectful manner, then their resident rights were not being honored. She said it could make the resident feel upset, unheard, and disrespected. She said the staff were educated on the residents' rights upon hire and through training and in-services. She said LVN M spoke with her hands and had a loud personality. She said LVN M mannerism could be perceived in the wrong way. She said LVN M had received customer service training after the incident. During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 2 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 9/12/25 at 12:51 p.m., the ADM said either LVN M or the DON reported the incident with Resident #15 to her. She said LVN M said she was stern with Resident #15. She said Resident #15 reported, LVN M used her hands when they were talking. She said if a staff member spoke to the resident in a disrespectful manner, then it was a dignity and resident rights issue. She said the resident could feel disrespected. She said everyone was responsible for ensuring the residents were treated with dignity and respect. Record review of an undated facility's Resident Rights policy indicated, .the resident has a right to a dignified existence.a facility must treat each resident with respect and dignity. Event ID: Facility ID: 675386 If continuation sheet Page 3 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to consult with the resident's physician when there was a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental, or psychosocial status in either life-threatening conditions or clinical complications) for 1 of 25 residents (Resident #6) reviewed for quality of care.The facility failed to notify the physician when Resident #6 experienced low blood pressure, low heart rate and/or low blood pressure with an increased heart rate on 7/16/25, 7/18/25, 7/20/25, 7/21/25, 7/23/25, 7/25/25, 7/26/25, 7/27/25, 7/28/25,7/29/25, 7/30/25, and 8/1/25. On 8/1/25, Resident #6 had low hemoglobin 5.8 and low hematocrit 21.6. Resident #6 was sent to the ER due to critical lab values. Resident #6 was admitted and diagnosed with gastrointestinal hemorrhage. Resident #6 received a blood transfusion at the hospital. An Immediate Jeopardy (IJ) was identified on 9/11/25. The IJ Template was provided to the facility on 9/11/25 at 2:01 p.m. While the IJ was removed on 9/12/25 at 4:40 p.m., the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with potential for more than minimal harm that was not immediate jeopardy due to the facility's need to complete training in-services with all staff and evaluate the effectiveness of the corrective systems. This failure could place residents at risk of a decline in condition, delay in life-saving treatments, hospitalization, serious harm, and death. Findings included: Record review of Resident #6's face sheet dated 9/8/25 indicated Resident #6 was an [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE]. Resident #6 had diagnoses including Dementia (is a general term describing a group of conditions that cause a progressive decline in cognitive abilities, including memory, thinking, reasoning, and judgment, which interfere with daily life), gastrointestinal hemorrhage (is when there is blood loss from any of the several organs included in your digestive system), iron deficiency anemia (is a common blood disorder that affects your red blood cells) secondary to blood loss (chronic), hypertension (is when the pressure in your blood vessels is too high (140/90 mmHg or higher)), and acute embolism and thrombosis of deep veins of right lower extremity (is a condition where a blood clot forms in a deep vein, often in the leg). Resident #6's most recent hospital stay was 8/1/25-8/5/25. Record review of Resident #6's quarterly MDS assessment dated [DATE] indicated Resident #6 was sometimes understood and sometimes had the ability to understand others. Resident #6 had a BIMS score of 2 which indicated severe cognitive impairment. Resident #6 required supervision for eating, substantial assistance for oral and personal hygiene, and dependent for toileting hygiene, shower/bathe self and dressing. Resident #6 was on an anticoagulant (is a medical treatment that prevents blood clots from forming). Record review of Resident #6's care plan dated 3/5/25 indicated: *Resident #6 was on an anticoagulant therapy. Intervention included monitor/document/report to MD signs/symptoms of anticoagulant complications such as lethargy, loss of appetite, sudden change in mental status, and significant or sudden changes in vital signs. *Resident #6 had a diagnosis of hypertension. Intervention included give anti-hypertensive medications as ordered. Monitor for side effects such as orthostatic hypotension (is a condition where blood pressure drops significantly upon standing up from a sitting or lying position) and increased heart rate and effectiveness. Record review of Resident #6's order summary dated 8/1/25 indicated: *Eliquis (anticoagulant) Oral Tablet 5 MG, give 1 tablet by mouth two times a day related to acute embolism and thrombosis of deep veins of right lower extremity. Start date 3/4/25. *Lisinopril (antihypertensive; treats high blood pressure) Oral Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure (is the pressure when your heart beats to pump blood (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 4 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few around your body) below 100, diastolic blood pressure (measures the pressure on blood vessel walls when your heart is relaxed between contractions) below 55 or heart rate less than 50. Start date 3/5/25. *Metoprolol Tartrate (antihypertensive; treats high blood pressure) Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Start date 3/5/25. Record review of Resident #6's medication administration record dated 7/1/25-7/31/25 indicated: *Eliquis (anticoagulant) Oral Tablet 5 MG, give 1 tablet by mouth two times a day related to acute embolism and thrombosis of deep veins of right lower extremity. Resident #6 received 61 out of 62 doses. *Lisinopril (antihypertensive; treats high blood pressure) Oral Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6's MAR indicated (AM) 7/16/25 (BP: 118/63, HR: 98) MA B, 7/18/25 (BP: 90/65, HR: 88) MA X; Vitals Outside of Parameters, 7/20/25 (BP: 96/56, HR: 56) MA Y, 7/21/25 (BP: 110/66, HR: 105) MA B, 7/23/25 (Hold see nurse notes) MA B, 7/25/25 (BP: 108/74, HR: 108) MA B, 7/26/25-7/28/25 (Hold see nurse notes) MA B, 7/29/25 (BP: 119/60, HR: 98) MA Z, and 7/30/25 (BP: 110/67, HR: 88) MA Z. *Metoprolol Tartrate (antihypertensive; treats high blood pressure) Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6's MAR indicated (AM) 7/16/25 (BP: 118/63, HR: 98) MA B, 7/18/25 (BP: 90/65, HR: 88) MA X; Vitals Outside of Parameters, 7/20/25 (BP: 96/56, HR: 56) MA Y, 7/21/25 (BP: 110/66, HR: 105) MA B, 7/23/25 (Hold see nurse notes) MA B, 7/25/25 (BP: 108/74, HR: 108) MA B, 7/26/25-7/28/25 (Hold see nurse notes) MA B, 7/29/25 (BP: 119/60, HR: 98) MA Z, and 7/30/25 (BP: 110/67, HR: 88) MA Z. Resident #6's MAR indicated PM 7/18/25 (BP: 110/62, HR: 84) MA AA, 7/20/25 (BP: 115/76, HR: 60) MA AA, 7/21/25 (BP: 98/63, HR 79) MA X, 7/25/25 (BP: 90/70, HR: 100) MA X, 7/27/25 (BP: 90/41, HR: 116); Vitals Outside of Parameters, 7/29/25 (BP: 100/55, HR: 95) MA BB, 7/30/25 (Vitals Outside of Parameters) *Amlodipine Besylate Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 110, diastolic blood pressure below 60 or heart rate less than 55. Discontinued on 7/30/25. Resident #6's MAR indicated 7/16/25 (BP: 118/63, HR: 98) MA B, 7/18/25 (BP: 90/65, HR: 88) MA X; Vitals Outside of Parameters, 7/20/25 (BP: 96/56, HR: 56) MA Y, 7/21/25 (BP: 110/66, HR: 105) MA B, 7/23/25 (Hold see nurse notes) MA B, 7/25/25 (BP: 108/74, HR: 108) MA B, 7/26/25-7/28/25 (Hold see nurse notes) MA B, 7/29/25 (BP: 119/60, HR: 98) MA Z, and 7/30/25 (BP: 110/67, HR: 88) MA Z. Record review of Resident #6's MAR dated 8/1/25-8/31/25 indicated: *Lisinopril Oral Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6's MAR indicated (AM) 8/1/25 (BP: 115/85, HR: 123) MA AA. *Metoprolol Tartrate Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6's MAR indicated (AM) 8/1/25 (BP: 115/85, HR: 123) MA AA. Record review of Resident #6's progress notes dated 7/1/25-9/8/25 indicated: *7/23/25 at 12:44 p.m. by MA B: Amlodipine Besylate Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 110, diastolic blood pressure below 60 or heart rate less than 55. Resident #6 BP low 127/51. *7/23/25 at 12:45 p.m. by MA B: Metoprolol Tartrate Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6 BP low. *7/26/25 at 1:15 p.m. by MA B: Lisinopril Oral Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 5 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few pressure below 55 or heart rate less than 50. Resident #6 BP low. *7/26/25 at 1:15 p.m. by MA B: Amlodipine Besylate Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 110, diastolic blood pressure below 60 or heart rate less than 55. Resident #6 BP low 96/53 HR 101. *7/26/25 at 1:16 p.m. by MA B: Metoprolol Tartrate Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6 BP low. *7/27/25 at 12:55 p.m. by MA B: Amlodipine Besylate Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 110, diastolic blood pressure below 60 or heart rate less than 55. Resident #6 BP low 95/72 HR 58. *7/27/25 at 12:55 p.m. by MA B: Lisinopril Oral Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6 BP low. *7/27/25 at 12:56 p.m. by MA B: Metoprolol Tartrate Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6 BP low. *7/28/25 at 12:48 p.m. by MA B: Amlodipine Besylate Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 110, diastolic blood pressure below 60 or heart rate less than 55. Resident #6 diastolic BP low 115/52 HR 101. *7/28/25 at 12:49 p.m. by MA B: Lisinopril Oral Tablet 5 MG, give 1 tablet by mouth one time a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6 diastolic BP low 115/52 HR 101. *7/28/25 at 12:50 p.m. by MA B: Metoprolol Tartrate Oral Tablet 50 MG, give 1 tablet by mouth two times a day related to hypertension. Hold for systolic blood pressure below 100, diastolic blood pressure below 55 or heart rate less than 50. Resident #6 diastolic BP low. *7/30/25 at 6:00 a.m. by LVN O: Neuro assessment BP 98/48, Pulse 93. Resident #6 had an unwitnessed fall in his room. *7/30/25 at 6:30 a.m. by LVN O: [NAME] assessment BP 87/45, Pulse 80. *7/30/25 at 6:45 a.m. by LVN O: [NAME] assessment BP 110/67, Pulse 88. *7/30/25 at 7:15 a.m. by LVN O: [NAME] assessment BP 100/56, Pulse 60. *7/30/25 at 7:45 a.m. by LVN O: [NAME] assessment BP 98/52, Pulse 87. *7/30/25 at 8:45 a.m. by LVN O: [NAME] assessment BP 92/59, Pulse 95. *7/30/25 at 9:45 a.m. by LVN O: [NAME] assessment BP 114/62, Pulse 82. *7/30/25 at 10:24 a.m. by LVN O: Notified MD K of family's concerns about the resident [Resident #6] being drowsy so much of the time. *7/30/25 at 11:45 a.m. by LVN O: [NAME] assessment BP 98/58, Pulse 82. *7/30/25 at 1:11 p.m. by LVN O: New order received from MD K to stop Amlodipine, Mirtazapine and Marinol. To get CBC (is a blood test that measures the number and types of various cells in the blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets), CMP (is a blood test that measures multiple substances in the body to assess overall health and identify potential medical conditions), and ammonia (measures the amount of ammonia in the blood) in AM. *7/30/25 at 1:45 p.m. by LVN O: Neuro assessment BP 94/54, Pulse 79. *7/30/25 at 9:45 p.m. by RN T: Neuro assessment BP 88/65, Pulse 71. *7/31/25 at 5:44 a.m. by RN T: Neuro assessment BP 108/64, Pulse 69. *7/31/25 at 1:08 p.m. by LVN L: When resident [Resident #6] was gotten up this morning his BP dropped to 75/62 and HR was 100. Resident #6 was laid back down and his BP and HR returned to normal. MD K notified and said to monitor. *7/31/25 at 7:20 p.m. by RN T: Neuro assessment BP 96/64, Pulse 76. *8/1/25 at 3:31 a.m. by RN T: Neuro assessment BP 93/56, Pulse 76. *8/1/25 at 11:18 a.m. by LVN L: Dr. lab called with critical labs. WBC 15.33 (The normal white blood cell count ranges between 4,000 and 11,000 cells per microliter), Hemoglobin (is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues; The normal Hb level for males is 14 to 18 g/dl (grams per deciliter)) 5.8, Hematocrit (is a blood test that measures the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 6 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few amount (percent) of your blood that is made up of red blood cells; The normal hematocrit for men is 40 to 54%) 21.6. *8/1/25 at 11:21 a.m. by LVN L: MD K notified about labs, no new orders. *8/1/25 at 5:08 p.m. by LVN L: Notified MD K of critical labs and he [MD K] recommended that we send him out to the hospital.Resident #6's progress note did not reflect any documented SBARs. Record review of Resident #6's hospital records dated 8/1/25 indicated, .brought in from nursing home after found to have some abnormal labs. he [Resident #6] does appear to be severely anemic with hemoglobin of 5.8.due to his anemia, a stool occult blood was checked in the ER which was positive though he [Resident #6] has not had an actual visible GI bleeding.impression.gastrointestinal hemorrhage. plan. transfuse PRBCs (packed red blood cells). Record review of Resident #6's hospital Discharge summary dated [DATE] indicated, .chief complaint.severe anemia. final diagnoses. iron deficiency anemia due to blood loss. gastrointestinal hemorrhage.hospital course.he [Resident #6] has been noted to be more fatigued recently, and blood work revealed severe anemia.he was found to be profoundly anemic initially with a hemoglobin of 5.8, and elevated creatinine 2.5.he received IV fluids and blood transfusion.he [Resident #6] was guaiac positive (a test result indicating the presence of occult (hidden) blood in the stool), and Gastroenterology (is the medical specialty that studies and treats diseases of the digestive system) was consulted.the plan was for the patient to undergo EGD (is a medical procedure used to examine the lining of the esophagus, stomach, and upper part of the small intestine (duodenum)) and colonoscopy (is an examination of the inside of your large intestine (colon)) yesterday, but he had episode of severe epistaxis (nosebleed), and it was felt the patient will not be able to tolerate an NG (nasogastric) tube.for the pre-op medication. On 9/9/25 at 9:40 a.m., attempted to contact MA Y by phone. Contact was unsuccessful. Unable to leave a message because the subscriber was not accepting calls. During an interview on 9/9/25 at 9:46 a.m., MA B said that she got the residents' vital signs for blood pressure medication. She said if the residents' vital signs were out of the parameters, she documented in the facility's charting system and held the medication. She said when she documented the medication was held due to the vital signs being out of range, it notified the charge nurse. She said the charge nurse received a notification in the facility's charting system. She said the held documentation, on the residents' MAR, flowed over to the progress notes. She said she also verbally notified the charge nurse when she held a blood pressure medication due to the vital signs being out of range. She said if she held a blood pressure medication on Resident #6, she probably reported to the charge nurse. She said if a resident had a low blood pressure (It is typically defined as a systolic pressure (the top number) below 90 mmHg and/or a diastolic pressure (the bottom number) below 60 mmHg) and high heart rate, it could mean the resident was in atrial fibrillation (is an irregular and often very rapid heart rhythm) or distress. She said it was important to notify the MDs if a blood pressure medication was held due to vital signs being out of range so they could make medication adjustments. On 9/9/25 at 10:27 a.m., attempted to contact LVN O by phone. Contact was unsuccessful and a message was left with callback phone number. During an interview on 9/9/25 at 11:37 a.m., the DON said the MAs were responsible for notifying the charge nurses when a blood pressure medication was held due to vital signs being outside of the parameters. She said the charges nurses were responsible for notifying the MD. She said the MD should be notified every time the blood pressure medication was held. She said the charges nurses documented in the residents' progress notes when they contacted the MD. She said if a resident had a low blood pressure and increased heart rate, it could indicate sepsis, dehydration, infection, and volume loss. She said the signs and symptoms of a GI bleed were low blood pressure, nosebleed, vomiting of blood, and tarry stools. She said when a resident's hemoglobin was low, they could experience low blood pressure, drowsiness, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 7 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few fatigue. She said the ADON and DON should monitor this process by following up on vital sign alerts from the facility's charting system. She said she was not aware Resident #6 had several days of missed blood pressure medication and vital signs out of the parameters. During an interview on 9/9/25 at 2:52 p.m., RN P said the MAs were supposed to report to the charge nurses when a residents' vital signs were out of the parameters. She said the charge nurse should recheck the residents' vital signs. She said if the residents' vital signs were still out of range, then the charge nurse should notify the MD and family and do a SBAR. She said the facility's charting system did not notify the charge nurses when a medication was held due to vital signs being out of the parameters. She said if a resident had lower blood pressures it could indicate cardiac arrest and shock. She said the resident could need the emergency room. She said the charge nurses documented in a progress note when the physician was notified. She said it was important for the physician to be notified to receive orders. During an interview on 9/9/25 at 3:16 p.m., MD K said he could not recall what was reported to him on 7/31/25 in relation to Resident #6. He said he did not know if he would have changed his orders to only monitor Resident #6 if he knew about the other blood pressure and heart rate issues. He said he would have needed more information. He said he would have wanted to be notified of Resident #6's low blood pressures with lower (is a condition where the heart beats at a rate below 60 beats per minute (bpm) while resting) and higher heart rates (is a condition where the heart beats faster than normal, typically at a rate of over 100 beats per minute (bpm) at rest). He said he would have wanted to be notified when Resident #6's blood pressure medications were held due to vital signs being out of the parameters. He said a sign or symptom of a GI bleed was low blood pressure. During an interview on 9/9/25 at 3:38 p.m., LVN O said she did not remember being notified about Resident #6's low blood pressure readings and blood pressure medications being held. She said the MAs verbally notified the charge nurses about out-of-range vital signs and documented on the MAR. She said the charge nurses were responsible for notifying the physician. She said she did not recall doing a neuro assessment on Resident #6 after a fall in July 2025. She said if Resident #6's had a trend of low blood pressure readings then the MD should have been notified. She said signs or symptoms of a GI bleed were low blood pressure, tarry stool, and passing of blood. She said it was important to notify the physician because the resident could not need the prescribed blood pressure medication and so they could address the issue. During an interview on 9/10/25 at 9:45 a.m., LVN L said she was not aware Resident #6 had several days of low blood pressure readings with low and high heart rates prior to the incident on 7/31/25. She said when she called MD K about Resident #6 incident on 7/31/25, she did not report his previous low blood pressure readings with low and high heart rates. She said the MAs usually verbally told the charge nurses when the residents' vital signs were out of range and the medication was held. She said then the charge nurse could notify the MD. She said if the residents' blood pressure continued to be low, then the MD needed to be contacted for a medication adjustment. She said if the residents' blood pressure was low but the heart rate was high, then it could indicate anemia. She said if MD K had been given more information on 7/31/25, related to Resident #6's vital signs being out of normal range prior to the incident on 7/31/25, he may have done a different intervention. She said she wished she had known about Resident #6's previous vital signs so she could have reported it. She said the charge nurses documented on a progress note when the MD was notified and responded back. She said she did not know why there were two different notification entries on 8/1/25 to MD K about Resident #6 critical labs. During an interview on 9/11/25 at 1:03 p.m., the ADM said the charge nurses were responsible for notifying the physician when a resident had a change in condition. She said the charge nurses should also notify the ADON and DON. She said it was important to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 8 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few notify the physician in case the resident needed to be sent out to the ER or medication changed. She said the charge nurses documented the physician notification in a progress note. She said if the physician was not contacted, it could be detrimental to the resident. She said the nursing management should ensure the charge nurses responded to the residents' change of condition. She said the nursing management should ensure this process by doing in-services. Record review of an undated facility's Abuse/Neglect policy indicated, . Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Record review of a facility's Notifying the Physician of Change in Status policy revised 3/11/2013 indicated, .The nurse should not hesitate to contact the physician at any time when an assessment and their professional judgment deem it necessary for immediate medical attention. This facility utilizes the INTERACT tool, Change in Condition - When to Notify the MD/NP/PA to review resident conditions and guide the nurse when to notify the physician. This tool informs the nurse if the resident condition requires immediate notification of the physician or non-immediate/Report on Next Work day notification of the physician. The nurse will notify the physician immediately with significant change in status. The nurse will document signs and symptoms of significant change, time/date of call to physician, and interventions that were implemented in the resident's clinical record. Before the physician is contacted, the nurse will gather and organize resident information. Applicable information will include current medications, vital signs, signs and symptoms initiating call, current laboratory information, and interventions that have currently been implemented. The nurse is responsible, however, for responding to a change of condition in a timely and effective manner. The nurse will document the time of the call to the physician in the clinical record. Record review of a facility's Medication Administration and General Guidelines policy revised 3/2025 indicated, . Medications are administered as prescribed, in accordance with State Regulations using good nursing principles and practices. If a dose of regularly scheduled medication is withheld, refused, or given at other than the scheduled time. The physician must be notified when a dose of medication has not been given. If an electronic medical record is being utilized then the caregiver administering the medication will enter the correct documentation that will then be electronically date/time stamped with their initials. The ADM and the Regional Compliance Nurse were notified of an IJ on 9/11/25 at 1:59 p.m. and a Plan of Removal (POR) was requested. The IJ template was emailed to the ADM on 9/11/25 at 2:01 p.m. The following plan of removal was submitted by the facility and accepted on 09/12/25 at 4:40 p.m. and included the following: Interventions: 1. Resident #6 no longer resides in the facility as of 9/11/25. 2. All residents in the facility had their blood pressures and heart rates reviewed for any abnormal readings. No additional changes in condition were noted that required notification to the MD. Completed 9/11/25. 3. The DON/ADON/Designee will review the 24hr report and PCC dashboard (is a customized, centralized view within the PointClickCare healthcare management platform that provides real-time, at-a-glance information relevant to a user's role, displaying clinical, financial, or administrative data to improve efficiency, decision-making, and patient care) daily for abnormal vital signs or changes in condition that need to be communicated to the MD. Completed 9/11/25 and will continue indefinitely. 4. The Administrator and DON were in-serviced 1:1 by the Regional Compliance Nurse and Area Director. Completed 9/11/25. a. Abuse and Neglect: Examples include failure to provide assistance with showers, changing clothes, meal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 9 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few trays, eating, positioning with enteral feeding, providing treatments, following MD orders, treating pain, administer medication, notifying MD of change in condition, provide adequate supervision to prevent falls or resident to resident altercations. b. Notification of Change in Condition: notify a MD and RP of all changes in conditions such as abnormal vital signs, new onset or worsening pain or injuries from incidents. Med aides will report all abnormal vital signs during medication administration to charge nurse immediately. c. PCC Dashboard/24hr Report: Charge nurses will monitor the PCC Dashboard/24hr report throughout their shift and at change of shift for any abnormal vital signs that need to be reported to the physician. 5. The medical director was notified of the immediate jeopardy citation by the administrator on 9/11/25. 6. An ADHOC QAPI meeting was held with interdisciplinary team including the medical director to discuss the immediate jeopardy and plan of removal. Completed on 9/11/25. In-services: 1. The following in-services were initiated by Administrator, Regional Compliance Nurse, DON, ADON for all staff.? Any staff member not present or in-serviced as of 9/11/25 will not be allowed to assume their duties until in-serviced. All new hires will be in-serviced during orientation. All PRN, agency staff, or staff on leave will in serviced prior to assuming their next assignment. Completion date 9/11/25.? a. Abuse and Neglect: Examples include failure to provide assistance with showers, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following MD orders, treating pain, administer medication, notifying MD of change in condition, provide adequate supervision to prevent falls or resident to resident altercations. b. Notification of Change in Condition: notify a MD and RP of all changes in conditions such as abnormal vital signs, new onset or worsening pain or injuries from incidents. c. PCC Dashboard/24hr Report: Charge nurses will monitor the PCC Dashboard/24hr report throughout their shift and at change of shift for any abnormal vital signs that need to be reported to the physician The surveyor verification of the Plan of Removal from 9/12/25 was as follows: *Record review of a resident roster provided on 9/8/25 indicated Resident #6 was not in the facility. *Record review of Resident #6's progress note dated 8/27/25 at 1:45 a.m., reflected Resident #6 was pronounced at 12:25 a.m. *Record review of the facility's Weights and Vitals Summary dated 9/8/25-9/30/25 indicated all residents, unit, and floors had been reviewed. The vital signs of blood pressure and pulse were targeted. Twenty-six residents had blood pressure and/or pulse that triggered a warning. RCN DD reviewed and signed the report on 9/12/25. *Record review of an email sent by RCN EE to MD K dated 9/11/25 at 7:09 p.m., indicated an attached list of residents with low pulse (5 residents), high pulse (3 residents), low blood pressure readings (7 residents), and high blood pressure readings (20 residents). *Record review of an email sent back from MD K to RCN EE dated 9/12/25 at 1:39 a.m., indicated MD K made medication adjustments for 2 residents. MD K acknowledged other vital signs and no new orders. *Record review of the facility's Daily Quality Assurance Meeting dated 9/11/25 at 9:00 a.m., indicated the 24-hour report, medication administration, and the facility's charting system dashboard had been reviewed by the DON. The clinical alerts had been reviewed. *Record review of the facility's 24-hour Summary report dated 9/11/25-9/12/25 indicated residents' vital signs and progress notes. Five residents had reported changes of conditions or new findings. The report indicated notifications to the MD, family, and hospice. *Record review of a provided document from the ADO on 9/12/25 indicated the Medical Director, MD K, was notified by the ADM on 9/11/25 at 3:55 p.m. of the immediate jeopardy citations. *Record review of a facility's AD Hoc QAPI Meeting dated 9/11/25 indicated the following members were in attendance: ADM, DON, ADON, Medical Director (via phone), Social Service, Dietary, RNC EE, Administrator in Training, MDS Coordinator RR and MDS Coordinator QQ. *Record review of the in-service training report, dated 09/11/25, reflected the DON and Administrator signed and received in-service (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 10 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete training on abuse and neglect which included the following: examples such as failure to provide assistance with shower, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following physician orders, treating pain, administering medications, notify the physician of changes in condition, and providing adequate supervision to prevent falls or resident to resident altercations. It also included the abuse/neglect policy and procedure. *Record review of the in-service training report, dated 09/11/25, reflected the DON and Administrator signed and received in-service education on notifying physician of change in status which included the following: notifying the physician and responsible party of all changes in conditions such as abnormal vital signs, pain or injuries from accidents. It also included the Notifying the Physician of Change in Status policy. *Record review of the in-service training report dated 9/12/25, reflected the DON and Administrator signed and received in-service training on PCC Dashboard/ 24 Hour Report which included the following: the Charge nurses will monitor the PCC Dashboard/24hr report throughout their shift and at change of shift for any abnormal vital signs that need to be reported to the physician. *During an interview on 09/12/25 at 3:08 PM, the Medical Director stated he was notified of the immediate jeopardy situations at the facility. He said he was notified by the Regional Compliance Nurse on 09/11/25 and it was discussed with plans being implemented. *During an interview on 09/12/25 at 4:05 PM, the DON stated she was provided 1:1 in-service education as follows: Abuse and neglect to include the types of abuse and examples of each. The DON stated that failure to provide care and services such as notifying the physician of change of condition, following physician orders, Event ID: Facility ID: 675386 If continuation sheet Page 11 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure residents had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 20 of 25 (Resident's #2, #4, #5, #6, #8, #9, #10, #12, #13, #14, #16, #17, #18, #19, #20, #21, #22, #23, #24) reviewed for abuse and neglect. 1. The facility failed to ensure LVN D did not physically abuse Resident #4 when she picked her up from her wheelchair and threw her on to the mattress on the floor on 07/17/25. Resident #4 sustained a bruise to her right elbow and redness to the mid abdomen. 2. The facility failed to ensure LVN E did not verbally abuse Resident #9 when LVN E yelled and cursed at Resident #9 when she asked for pain medication on 08/17/25. 3. The facility failed to ensure Resident #12 did not physically abuse Resident #13 when he shoved her on 08/07/25 and on 08/23/25. On 08/23/25, Resident #13 sustained scratches to her face. 4. The facility failed to ensure Resident #5 was properly positioned during a tube feeding on 08/20/25. Resident #5's head and torso were leaning over the left armrest of his Geri-chair for approximately 1 hour and 30 minutes, which resulted in aspiration pneumonia. 5. The facility failed to ensure sufficient staff were available to provide wound care treatment and documentation for Resident's #2, #16, #17, #18, #19, #20, #23 and #24 during August 2025 and September 2025. 6. The facility failed to ensure Resident's #4, #6, and #19 were provided feeding assistance during mealtimes. 7. The facility failed to ensure the secured unit was adequately staffed to prevent accidents for Resident's #8, #10, #12, #13, #14, #19, and #21. 8. The facility failed to ensure Resident #7, Resident #8, Resident #14 Resident #21, and Resident #22 were provided supervision during the lunch meal on 09/08/25. An immediate jeopardy (IJ) was identified on 09/11/25 at 12:59 PM. The IJ template was provided to the facility on [DATE] at 2:01 PM. While the IJ was removed on 09/13/25 at 12:49 PM, the facility remained out of compliance at a scope of a pattern and a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy because all staff had not been provided education on abuse and neglect, notification of changes in condition, documentation policy, pain management policy, fall prevention policy, pressure prevention policy, medication administration policy, enteral feeding policy, and the bathing and showers policy. These failures could place residents at risk of abuse, humiliation, intimidation, fear, shame, agitation, decreased quality of life, serious harm, injury, impairment, and death.Findings included:1. Record review of a face sheet dated 09/17/25 indicated Resident #4 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including Huntington's disease (an inherited condition in which nerve cells in the brain break down over time), schizoaffective disorder (a mental health condition including schizophrenia and mood disorder), anxiety disorder, abnormal weight loss, dysphagia (difficulty swallowing foods or liquids). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #4 understood others and was never/rarely understood by others. The MDS indicated Resident #4 had a BIMS score of 0 which indicated Resident #4 was severely impaired and unable to complete the interview. The MDS indicated Resident #4 required supervision and touching assistance with eating, and dependent for showering, toileting, hygiene and transfers. Record review of Resident #4's care plan with a revised date of 09/08/25 indicated Resident #4 had a history of falls due to Huntington's disease and required staff times two for transfers. Record review of Resident #4's Order Summary Report dated 09/17/25 indicated an order for mattresses on floor with walls and floor surrounding mattresses padded every shift dated 07/12/25. Record review of a Provider Investigation Report dated 07/17/25 at 07:09 PM, indicated Resident #4's family member come to the facility and reported that she saw on the camera that a staff member had brought Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 12 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some #4 to her room in her wheelchair and threw her down on the mattress. The facility completed skin and pain assessment and order x-rays. Documented facility follow-up action was to in-service staff members with 1:1 education and physical therapy in-service regarding transfer of residents, police department notified, safe surveys conducted, trauma assessments for all residents. Record review of skin assessment completed on 07/17/25 by LVN CC indicated Resident #4 had bruising on right elbow and redness to lower abdomen. Record review of written statement by LVN D dated 07/17/25, indicated after Resident #4 had finished eating, she was slipping out of her chair. LVN D returned Resident #4 to her room in the wheelchair. LVN D stated when she stood up Resident #4 and she pulled against her, and she let her go before she knew it and had tried to grab her. LVN D stated she did not want to fall on her. LVN D wrote she saw Resident #4 was ok and left to clean up the wheelchair. During an observation on 09/09/25 at 09:32 AM, Resident # 4 was laying on the mattress in room. Resident #4 was non- interviewable. During an interview on 09/09/25 at 10:05 AM, Resident #4's family member stated she was very upset upon viewing the camera video of how LVN D threw Resident #4 on to the mattress during the transfer. Resident's 4's family member stated she immediately contacted the Administrator regarding the unnecessary roughness and lack of care used when providing care to Resident #4 on 07/17/2025. Resident #4's family member said she provided the Administrator with the video of the transfer. Resident #4's family member stated to her knowledge LVN D had not been back into Resident #4's room and was terminated. Resident #4's family member was tearful. Resident #4 ‘s family member stated Resident #4 had a bruise to her right elbow and redness on her abdomen. During an observation on 09/09/25 at 1:27 PM of a video, date stamped 07/17/25 at 01:08 PM, LVN D wheeled Resident #4 into her room. Resident #4's bed mattress was located directly on the floor. LVN D lifted Resident #4 from the wheelchair and threw her onto the mattress. Resident #4 could be heard moaning and was rolling from side to side. LVN D turned and walked out of the room. Attempted telephone call to LVN D on 09/09/25 at 02:15 PM; left a voice message and requested a call back. During an interview on 09/09/25 at 04:30 PM, the Administrator stated she was the abuse coordinator for the facility and responsible to investigate and report any and all abuse allegations. The Administrator stated the importance of reporting and investigation timely was to prevent any further harm or harm to residents. The Administrator stated she had seen the video provided by Resident #4's family member on 07/17/25. The Administrator said the police were notified immediately. The Administrator said she did not report LVN D to the board of nursing because the police stated they could not get a good view to decide if LVN D had pushed or just lost her balance when Resident #4 was transferred. The Administrator stated LVN D was terminated on 07/18/25 and had not provided care to any residence after 07/17/25. The Administrator become tearful during the interview and said the care provided by LVN D during the video was abuse. Attempted telephone call to LVN D on 09/09/25 at 09:01 PM; left a voice message and requested a call back. Record review of the personnel chart of LVN D reflected she was terminated on 07/18/25. Record review of the personnel chart of LVN D reflected completion of Abuse and Neglect training upon hire date of 10/03/18 and yearly thereafter. The following Employee Disciplinary Memorandums for LVN D: 10/18/24 regarding failure to properly perform skin assessments. 2. Record review of a face sheet dated 09/11/25 indicated Resident #9 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including acute kidney failure, metabolic encephalopathy (imbalance in body's chemical processes leading to abnormal brain function), chronic obstructive pulmonary disease (progressive lung disease causing shortness of breath, cough, and airflow limitations), type 2 diabetes mellitus (excessive sugar in the blood). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #9 understood others and was understood by others. The MDS indicated Resident #9 had a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 13 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some BIMS score of 11 and was moderately cognitively impaired. The MDS indicated Resident #9 was independent with eating, required moderate assistance with showering and dressing, and dependent with toileting hygiene. Record review of Resident #9's care plan dated 08/06/25 indicated Resident #9 had a history of trauma related to being choked that may have a negative impact. The interventions included monitor for escalating anxiety, depression and sleep disturbances, perform de-escalation techniques as needed. Record review of Resident #9's Order Summary Report dated 09/11/25 indicated Acetaminophen-Codeine Tablet 300-30mg, give one tablet by mouth every 6 hours as needed for pain related to kidney failure dated 007/29/25 Record review of a Provider Investigation Report dated 08/18/25 at 08:17 AM, indicated Resident #9 alleged, [LVN E] refused to give her pain medications and hit the side of her mattress with her fist and told her she didn't need the pain medication. [Resident #9] alleged LVN E stormed out of the room cussing and yelling up and down the hall. LVN E was suspended pending investigation and safe surveys conducted, staff in services and trauma assessment completed on Resident #9. Record review of trauma assessment completed on 08/18/25 by the SW indicated Resident #9 had no trauma. Record review of written statement by LVN E dated 08/20/25 stated, whenever, Resident #9, asks for her medicine (pain meds) I always check the time, assess her pain and let her know whether it's time or not. Sometimes she agrees and sometimes she doesn't. She often states that she doesn't know why she turns her light on (forgets) or she just shrugs her shoulders. Most times she is easily redirected. Sunday, August 17th, 2025, I had the opportunity to meet and greet Resident #9's . I kneeled down in front of Resident #9 because she was in her wheelchair, took her left hand held it and greeted her and introduced myself to her family and thanked them for allowing me to be a part of her care. I stated it was my pride and privilege to take care of their loved one. The smiled, nodded and said, that is enough. It startled me just a bit, I stood up and apologized for interrupting their visit. He smiled and that was it. I empathically deny any allegations of cussing up and down the hall. First, profanity is verbal abuse. Second, there were CNA's present most of the night. I was the only one there at 02:30 AM. Third, I respect these elders home period. Attempted telephone call to LVN E on 09/09/25 at 11:40 AM left a voice message and requested a call back. During an interview on 09/09/25 at 12:25 PM, Resident #9's family member stated, he had received a call at approximately 03:00 AM on 08/17/25 from Resident #9. Resident #9's family member stated that Resident #9 complained that LVN E would not give her pain medications and was cussing and yelling at her. Resident #9 stated LVN E snatched up the blanket and slammed it back down on to her feet. Resident #9 family member stated he contacted the facility by phone and spoke with a nurse but could not recall the name and requested Resident #9's was checked on and pain medication administered appropriately. Resident #9's family member stated he did not hear anything more from Resident #9 or the facility the remainder of the night. Resident #9's family member stated that on 08/17/25 while visiting Resident #9, he had encountered LVN E. Resident #9's family member stated LVN E was talking to Resident #9 like she was a child and in a condescending manner. Resident #9's family member stated he told LVN E that was enough. Resident #9's family member stated, LVN E acted very peculiar as if she was on drugs. Resident #9's family member stated he received a call from the Administrator on 08/18/25 regarding Resident #9's previous allegations regarding LVN E. Resident #9's family member confirmed he had received the call from Resident #9. Resident #9's family member stated he also reported the incident wherein he had told LVN E to stop talking to Resident #9 in the childlike, condescending manner on 07/17/25 during a visit. Resident #9's family member stated he had requested LVN E not take care of Resident #9 due to her behaviors. Resident #9's family member stated that later perhaps the next day or so, he had received a call from the Administrator wherein she stated the allegations had been confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 14 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some and LVN E was terminated from the facility. During an interview on 09/09/25 at 12:45 PM, Resident #9 stated she had used the call light button and waited on LVN E for a long time the night the incident occurred. Resident #9 stated upon LVN E entering her room she asked for her pain medication. Resident #9 stated LVN E began cussing and hitting the side of her bed and said she was not getting her pain medication, and she could not have it. Resident #9 said LVN E picked up her covers and slammed it back down over her feet. Resident #9 said LVN E then left her room yelling and cussing that she was not going to get the pain medication for her. Resident #9 stated she called her family member. Resident #9 stated she did not see LVN E for the remainder of the shift. Resident #9 said it was not very long before the day shift arrived, and she received her medication. Resident #9 said LVN E was always talking and moving around fast and rushed. Resident #9 stated she reported the incident to the one of the night shifts nurses the following evening. Resident #9 stated that later that evening after she told the nurse about the incident with LVN E, the Administrator spoke with her regarding the incident. During an interview on 09/09/25 at 12:55 PM, the Administrator stated Resident #9 had reported to RN T on 08/18/25 at approximately 07:00 PM that LVN E had grabbed her and thrown her into a chair and cursed her. The Administrator stated upon interviewing Resident #9, she stated she had used her call light and requested pain medication after waiting a long time. Resident #9 stated when LVN E walked into the room, she told Resident #9 she was not getting pain medication and begin hitting the side of the bed and slung the covers off her. The Administrator stated Resident #9 said she was not physically touched by LVN E. The Administrator stated Resident #9 left the room and was cussing and yelling in the halls. The Administrator stated when she contacted Resident #9's family member, she was told that LVN E had talked to Resident E in a condescending manner. The Administrator stated Resident #9's family member expressed concern and requested LVN E be kept away from Resident #9. The Administrator stated she had interviewed staff and confirmed LVN E had erratic behaviors such has yelling and cussing in front of the residents. The Administrator stated LVN E had only worked at the facility for about 2 weeks. The Administrator stated LVN E was terminated on 08/20/25. Attempted telephone call to LVN E on 09/09/25 at 01:15 PM; left a voice message and requested a call back. Attempted telephone call to RN T on 09/09/25 at 04:17 PM; sent a text message requesting call back per the voice mail message instructions. Attempted telephone call to RN T on 09/09/25 at 07:30 PM; sent a text message requesting call back per the voice mail message instructions Attempted telephone call to LVN E on 09/09/25 at 07:49 PM; left a voice message and requested a call back. During an interview on 09/09/25 at 07:50 PM, CNA F stated she had worked at the facility for 14 years. CNA F stated she currently worked the B hall. CNA F stated she had heard LVN E hollering before in the hallways. CNA F stated she did not know the situation of why LVN E was cussing and hollering but she had heard it. CNA F stated she had been reassigned to work B hall over the last month and had been working in the locked unit before. Attempted telephone call to LVN E on 09/10/25 at 02:30 PM; left a voice message and requested a call back. During an interview on 09/12/25 at 10:57 AM, the DON stated she had witnessed, on the night shift, LVN E holler and using profanity in the hallway while residents were present. The DON stated it was around the time of the incident with Resident #9. The DON stated she immediately addressed the issue with LVN E and had written up LVN E for those actions. The DON stated she expected the staff to treat the residents with respect and dignity. The DON stated all staff were responsible to report any suspicion or allegations of abuse to the abuse coordinator immediately. The DON stated the facility was the resident's home and no one appreciated being talked to or listening to that type of language in their own homes. The DON said using profanity to the residents was considered verbal abuse and could result in the residents feeling frightened, scared, degraded, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 15 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some or even humiliated. During an interview on 09/12/25 at 12:30 PM, the Administrator said she was the abuse coordinator. The Administrator said she expected all staff to report any type of abuse to her immediately. The Administrator said it was her responsibility to report and investigate allegations of abuse. The Administrator said the purpose of reporting timely and investigating properly was to prevent further abuse from occurring. The Administrator said LVN E was terminated following the investigation that involved Resident #9. Record review of the personnel chart of LVN E reflected she was terminated on 08/21/25. Record review of the personnel chart of LVN E reflected completion of Abuse and Neglect training upon hire date of 08/06/25 and yearly thereafter. The following Employee Disciplinary Memorandums for LVN E: 08/15/25 regarding hollering and using profanity in the hallways with residents present. 3. Record review of the face sheet, dated 09/11/25, reflected Resident #12 was a [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses of dementia (memory loss) psychosis (state of impaired reality), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest). Record review of the admission MDS assessment, dated 08/11/25, reflected Resident #12 had clear speech, was usually understood, and was usually able to understand others. Resident #12 had a BIMS score of 9, which indicated moderately impaired cognition. The MDS reflected Resident #12 had physical behaviors directed toward others 1-3 days and wandering behaviors 4 to 6 days during the look-back period. Record review of Resident #12's comprehensive care plan, initiated on 08/06/25, reflected no care plan had been developed for behaviors. Record review of the order summary report, dated 09/11/25, reflected Resident #12 had an order, which started on 07/31/25, that indicated he may reside on the secured unit related to exit seeking behaviors. Record review of the behavior incident report, dated 08/07/25 at 7:25 AM, reflected CNA N reported that Resident #13 was in Resident #12's room looking at pictures on his nightstand when Resident #12 pushed Resident #13. There were no injuries. The report reflected Residents #12 and #13 were separated and the Administrator was notified. Record review of the behavior incident report, dated 08/23/25 at 6:20 AM, reflected Resident #12 pushed Resident #13 to the floor. Resident #12 reported Resident #13 tried to come into his room, so he stopped her. The incident was unwitnessed by staff. Record review of Resident #12's progress notes, reflected the following: On 09/06/25 at 12:41 PM, Resident #12 was transferred to another facility. Record review of the face sheet, dated 09/11/25, reflected Resident #13 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of dementia (memory loss) and anxiety disorder. Record review of the quarterly MDS assessment, dated 05/29/25, reflected Resident #13 had clear speech, was usually understood, and was sometimes able to understand others. Resident #13 had a BIMS score of 3, which indicated severe cognitive impairment. The MDS reflected Resident #13 had no behaviors or refusal of care. Record review of the comprehensive care plan, last reviewed 06/05/25, reflected Resident #13 had the potential to demonstrate verbally and physically abusive behaviors. The care plan further revealed Resident #13 was at risk for elopement and resided on the secured unit. The interventions included: supervise closely and make regular compliance rounds whenever resident is in room. Record review of the order summary report, dated 08/23/25, reflected Resident #13 had an order, which started on 02/26/25, that she may reside on the secured unit related to exit seeking behaviors. Record review of Resident #13's progress notes, reflected the following: On 08/07/25 at 4:25 PM a trauma assessment was completed and was negative. On 08/08/25 at 9:02 PM, it was documented Resident #13 had no injury or adverse reaction from being pushed. On 08/23/25 at 6:20 AM, an event note was completed that reflected Resident #13 had 2 scratches on the right side of face and redness to side of left arm below the elbow. She reported that Resident #12 pushed her. X-rays were ordered of hips and elbows. On 08/23/25 at 9:11 AM, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 16 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Social Worker documented that she was notified Resident #13 was pushed by another male resident, which resulted in a fall to the floor. Resident #13 did not appear to be in distress, she was smiling and in a pleasant mood. On 08/26/25 at 12:04, Resident #13 was discharged to another facility. 4. Record review of the face sheet, dated 09/11/25, reflected Resident #5 was a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills), severe protein-calorie malnutrition (not getting enough protein or calories to meet the bodies demands), gastrostomy status (an opening into the stomach from the abdominal wall, made surgically for the introduction of food), anorexia (loss of appetite), and dysphagia (difficulty swallowing). Record review of the quarterly MDS assessment, dated 07/30/25, reflected Resident #5 had unclear speech, was rarely/never understood, and was rarely/never able to understand others. Resident #5 had short-term and long-term memory problems. Resident #5 had no memory or recall ability and had severely impaired decision- making skills. The MDS reflected Resident #5 had upper and lower extremity impairments to both sides which interfered with daily functions. The MDS reflected Resident #5 was dependent on staff for all his ADLs. Resident #5 used a feeding tube while a resident and also received a mechanically altered diet. The MDS reflected Resident #5 received 51% of more of his total calories through tube feeding. Record review of the comprehensive care plan, last reviewed 06/17/25, reflected Resident #5 required tube feeing related to anorexia and Alzheimer's disease. The interventions included: .the resident needs the head of bed elevated 30 degrees during and thirty minutes after tube feeding. The care plan further reflected Resident #5 had an ADL self-care deficit and required staff assistance x 1 with eating. Record review of the order summary report, dated 09/11/25, reflected Resident #5 had an order for regular diet and pureed texture with pudding consistency fluids, [Family member] or nurse to assist with feeding. The order started on 08/26/25. Record review of the progress notes reflected the following: On 08/21/25 at 4:03 AM, the note reflected [Resident #5]'s family member requested a chest x-ray due to possible aspiration . due to positioning of resident in chair on previous shift.No signs or symptoms of aspiration noted . head of bed elevated to 30 degrees. On 08/21/25 at 7:47 AM, the note reflected a response was received from the physician for a chest x-ray. On 08/22/25 at 3:29 AM, the note reflected Resident #5 was transferred to the hospital related to chest x-ray results findings indicated aspiration. Record review of Resident #5's diagnostic chest x-ray report, dated 08/21/25, reflected .reported gastrostomy tube is not definitely visualized.air distended stomach.left basilar airspace disease (condition in which the lower lungs of the left lung collapse, preventing air exchange), likely atelectasis (collapse of lung or part of lung from lack of air in the air sacs) given elevation of the hemidiaphragm. Record review of the inpatient hospital record, dated 08/22/25, reflected Resident #5 arrived at the hospital at 4:04 AM via ambulance and was discharged back to the facility at 5:46 AM. The problems addressed was aspiration into airway, initial encounter. During an observation on 09/08/25 beginning at 1:25 PM of a video date and time stamped, 08/20/25 3:13 PM, revealed Resident #5 leaning over the left armrest of his Geri-chair. He was moaning and grunting, unable to lift his torso or head. At 3:16 PM, CNA G walked into the room, pulls his arm and ask him to sit up, and then walked out of the room. The interaction lasted approximately 45 seconds. Resident #5 returned to the same position within approximately 30 seconds after CNA G left the room. Resident #5 remained in the same position, where his head and torso were leaning over the left armrest for approximately 1 hour and 30 minutes. Resident #5 constantly moaned and grunted during the video until LVN L sets up him with pillows and positioned him comfortably at 4:26 PM. During an interview on 09/09/25 beginning at 2:38 PM, Resident #5's family member stated on 08/20/25 she had gone out to eat and did not watch the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 17 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some camera as she normally did. Resident #5's family member stated when she got home, she noticed a neck pillow was blocking the view of the camera, so she called the facility. Resident #5's family member stated she went back to review the video prior to the pillow blocking camera and noticed he had been leaning over his chair for about 2 hours. Resident #5's family member was concerned he may have aspirated so she requested a chest x-ray be performed. Resident #5's family member stated the chest x-ray showed aspiration pneumonia, and he was sent to the hospital. Resident #5's family member stated he was returned to the facility on antibiotics. Resident #5's family member stated the facility staff did not have enough help. Resident #5's family member stated she believed the incident would not have occurred if the facility had sufficient staffing because they would have been able to check on him more frequently. During an interview on 09/09/25 beginning at 10:55 AM, LVN M stated Resident #5's family member had requested that he go to the hospital because she was concerned about something that had occurred on the camera, and she believed he could have possibly aspirated. LVN M stated she notified the physician, and he was agreeable, so she sent Resident #5 to the hospital per the family member's request. LVN M stated Resident #5 had no signs or symptoms of aspiration, such as nasal drainage, shortness of breath, or wheezing. LVN M stated the facility had obtained the order for a chest x-ray, but it had not been completed before he was sent to the hospital, if she remembered correctly. LVN M stated Resident #5 did not return back from the hospital on her shift, so she was unaware of what he was treated for at the hospital. During an interview on 09/09/25 beginning at 11:50 AM, CNA G stated on 08/20/25 she was on the way to answer another resident's call light when she walked by Resident #5's room and noticed he was leaning over. CNA G stated she grabbed Resident #5 under the arm and elbow to sit him up. CNA G stated she sat Resident #5 up the best she could then proceeded to answer the call light. CNA G stated she was the only staff member assigned to her hallway and stated she never thought to check on him again because she had so much going through her mind. CNA G stated she was called later on to provide a statement of the incident. CNA G said she had just graduated CNA school about 4 months ago and was still learning things. CNA G stated grabbing someone by the arm was not the proper way to position them. CNA G stated the facility did provide her one-on-one education on proper positioning. CNA G stated looking back she should have checked on Resident #5 sooner, but it was hard to recognize in the moment because of the staffing concerns. CNA G stated Resident #5 should have been positioned in a Fowler's position (upright) during a tube feeding. CNA G stated improperly positioning a resident during a tube feeding could result in aspiration. CNA G stated she did help the nurse with wound care for Resident #2 because there was no one else to help. CNA G stated there were staffing concerns at the facility because no one wanted to work. CNA G stated the facility staff did not like the management staff. CNA G stated she had only worked at the facility since June 2025. CNA G stated at times she was the only CNA who was assigned to two halls, which was approximately 25 residents. CNA G stated she was unable to provide the care and services each resident required when she was scheduled alone. CNA G stated she felt rushed with the residents. CNA G stated management staff were aware of the staffing concerns, but felt like nothing was addressed. CNA G stated management did not consistently help out on the floor. CNA G stated the DON would provide assistance to one resident because of the camera in the room, but most of the time when she asked for help the DON would say Let me find someone to help you. CNA G stated she normally worked the C-Hall (the secured unit) and was the only staff member scheduled. Record review of Resident #2's face sheet dated 9/11/25 indicated Resident #2 was an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #2 had diagnosis including acute posthemorrhagic anemia (is a condition that develops when you lose a large amount of blood quickly), heart failure (is a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 18 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete condition where the heart muscle cannot pump blood effectively enough to meet the body's needs), type 2 diabetes (is a chronic condition that happens when you have persistently high blood sugar levels), dementia (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life), and pressure ulcer of left heel, stage 3 (injuries extend through the skin into deeper tissue and fat but do not reach muscle, tendon, or bone). Record review of Resident #2's quarterly MDS assessment dated [DATE] indicated Resident #2 was understood and usually had the ability to understand others. Resident #2's had a BIMS score of 7 which indicated moderate cognitive impairment. Resident #2 required setup assistance for eating, supervision for oral hygiene, partial assistance for upper body dressing and personal hygiene, and dependent for toileting hygiene, shower/bathe self, and lower body dressing. Resident #2 was always incontinent for urine and occasionally incontinent for bowel. Resident #2 had one, stage 3 unhealed pressure ulcers/injuries. Resident #2 had pressure reducing device for bed and pressure ulcer/injury care. Record review of Resident #2's care plan, revised on 9/11/25, indicated Resident #2 had a pressure ulcer due to decreased mobility. Resident #2 had stage 3 pressure injury to left heel. Interventions included follow facility policies/protocols for the prevention/treatment of skin breakdown and administer medications as ordered. Record review of Resident #2's order summary report dated 9/11/25 indicated: Stage 3 pressure injury, cleanse left heel with normal saline, apply collagen powder, and cover with gauze island with border every day and as needed, one time a day for wound healing. Start date 8/25/25. Record review of Resident #2's wound administration record dated 8/1/25-8/31/25 indicated: Cleanse left heel with normal saline, apply collagen powder, and cover with gauze island with border ev Event ID: Facility ID: 675386 If continuation sheet Page 19 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0602 Protect each resident from the wrongful use of the resident's belongings or money. 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 the resident had the right to be free from misappropriation of property for 1 of 2 residents reviewed for misappropriation of property. (Resident #15) The facility failed to prevent a drug diversion (misappropriation) of Resident #15's Oxycodone 10 MG on 8/15/25. This failure could place residents at risk for decreased quality of life, unrelieved pain, misappropriation of property, and dignity.Findings included:Record review of Resident #15's face sheet dated 9/8/25 indicated Resident #15 was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #15 had diagnoses including fibromyalgia (is a long-term condition that involves widespread body pain), and low back pain.Record review of Resident #15's quarterly MDS assessment dated [DATE] indicated Resident #15 had clear speech, adequate hearing and vision. Resident #15 was understood and had the ability to understand others. Resident #15 had a BIMS score of 15 which indicated intact cognition. Resident #15 was independent for eating, oral hygiene, and toilet hygiene, partial assistance for shower/bathe self and personal hygiene. Resident #15 received scheduled pain medication regimen. Resident #15 received opioids. Record review of Resident #15's care plan dated 3/23/22 indicated Resident #15 was on pain medication therapy related to fibromyalgia and wound. Intervention included administer medications as ordered. Record review of Resident #15's order summary report dated 8/1/25 indicated: Oxycodone Oral Tablet 10 MG (is used to relieve pain severe enough to require opioid treatment and when other pain medicines did not work well enough or cannot be tolerated), give 1 tablet by mouth five times a day for pain. Start date 8/8/25. Record review of Resident #15's MAR dated 8/1/25-8/31/25 indicated Oxycodone Oral Tablet 10 MG, give 1 tablet by mouth five times a day for pain. Times: 6am, 11am, 4pm, 9pm, and 1am. The MAR indicated on 8/15/25, Resident #15 received doses at 1am, 6am, 11am, 4pm, and 9pm. Record review of Resident #15's Individual Control Drug Record for Oxycodone 10 MG dated 8/8/25 indicated:*8/15/25 at 1am or 9am (notation of time is unclear), 1 pill given, 55 pills left, LVN E.*8/15/25 at (notation of time is unclear), 1 pill given, 54 pills left, LVN E.*8/15/25 at 6am, 1 pill given, 53 pills left, LVN E.*8/15/25 at 11am, 1 pill given, 52 pills left, MA B.*8/15/25 at 4pm, 1 pill given, 51 pills left, LVN Q*Unknown date at 8:26 pm, 1 pill given, 50 pills left, LVN LResident #15's Individual Control Drug Record reflected 6 administrations of oxycodone on 8/15/25. Resident #15 is scheduled for 5 oxycodone doses each shift (1am, 6am, 11am, 4pm, and 9pm). Record review of Resident #15's e-MAR report dated 9/9/25 provided by RCN EE indicated:*8/15/25: Scheduled for 1am, 1 tablet, given at 12:25 am by LVN E.*8/15/25: Scheduled for 6am, 1 tablet, given at 5:58 am by LVN E.*8/15/25: Scheduled for 11am, 1 tablet, given at 11:04 am by MA B.*8/15/25: Scheduled for 4pm, 1 tablet, given at 4:25 pm by LVN Q.*8/15/25: Scheduled for 9pm, 1 tablet, given at 8:25 pm by DON.Resident #15's e-MAR report did not reflect 6 administration times on 8/15/25 to correlate with the Individual Control Drug Record. Record review of a witness statement by the DON dated 8/15/25 indicated, .issue related to: medication administration error. on Friday, August 15th this nurse was notified around 2 pm by the CMA [MA B] and Treatment Nurse [LVN L] that LVN E had signed out too many Oxycodone for Resident #15 on the morning of August 15th. This nurse [DON] assessed the resident and asked her about this. Resident #15 state that [LVN E] administers her medications but not always at the right time. No adverse side effects or harm was done to the resident. Signature of witness: DON. Signature of Management Employee Obtaining Statement: ADM. During an interview on 9/9/25 at 9:46 a.m., MA B said she had been working at the facility for 2 years. She said she worked Hall C and D. She said on 8/15/25, she started the shift and counted Resident #15's oxycodone pills. She said she noticed an extra entry on the narcotic count sheet for Resident Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 20 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few #15. She said when she asked LVN E about the extra entry, LVN E said she must have given Resident #15 too many pills. MA B said that did not seem right because Resident #15 counted her pills before she took them. She said she asked Resident #15 if LVN E gave her an extra oxycodone pill. She said Resident #15 said, no. She said she reported the issue to the ADM and DON. She said 8/15/25 was the first time she had noticed a medication administration issue from LVN E. She said LVN E had strange behaviors. She said LVN E moved around really fast all time. She said LVN E continued to work Hall D with Resident #15. She said she eventually was fired for another incident. Attempted telephone call to LVN E on 9/9/25 at 01:15 PM left a voice message and requested a call back. Attempted telephone call to LVN E on 9/9/25 at 07:49 PM left a voice message and requested a call back. During an interview on 9/10/25 at 9:45 a.m., LVN L said on 8/15/25, MA B reported to her that she did a shift-to-shift narcotic count with LVN E. She said MA E said the count with LVN E was not right. She said MA B reported there were too many entries for LVN E's shift. She said she could not quite remember LVN E exact words on what caused the discrepancy. She said LVN E reported to the effect, that she thought she gave Resident #15 her oxycodone but could not remember. She said one of Resident #15's oxycodone pills was missing and could not be accounted for. She said LVN E did not say she wasted or discarded one of Resident #15's oxycodone pills. She said she reported the incident to the ADM and DON. She said the DON went to Resident #15 to see if she had received pain medication. She said she did not know what Resident #15 had reported to the DON. She said Resident #15 counted and inspected her pills during medication pass. She said the incident with LVN E could have been a drug diversion. She said that was why she reported the incident to the ADM and DON. She said LVN E was an abnormally strange person. She said LVN E was eventually let go, but not for the incident on 8/15/25. During an interview on 9/10/25 at 12:42 p.m., Resident #15 said she did not recall the incident on 8/15/25. She said sadly, she got asked about her pain medication all the time. She said she inspected and counted her pills before she took them. She said she would not have taken an extra oxycodone on 8/15/25. Attempted telephone call to LVN E on 09/10/2025 at 02:30 PM left a voice message and requested a call back. During an interview on 9/12/25 at 10:45 a.m., the DON said the incident on 8/15/25 with LVN E was reported by MA B. She said when she questioned LVN E about the documented extra oxycodone dose on Resident #15; LVN E said she administered it at the right time but wrote down the wrong time. She said the MA B did not report what LVN E said when asked about the extra entries on the narcotic count sheet. She said she did not get a written statement from LVN E about the incident on 8/15/25. She said the incident on 8/15/25 could have possibly been a drug diversion. She said she did not ask Resident #15 if LVN E gave her an extra oxycodone dose on 8/15/25. She said when a resident medication was misappropriated, they could miss a dose or get too many. She said when a resident medication was misappropriated, it was considered abuse and neglect. She said the MAs and CNs should initially ensure a resident did not experience misappropriation. She said then it was the responsibility of the ADON and DON. During an interview on 9/12/25 at 12:51 p.m., the ADM said she was aware of the incident on 8/15/25 regarding LVN E. She said if Resident #15's oxycodone was missing then it would be considered a drug diversion. She said the staff did not report LVN E had any suspicious behavior on 8/15/25. She said when a residents' medication was misappropriated, it could cause harm. She said the DON was responsible for ensuring the residents' medications were not appropriated. During an interview on 9/12/25 at 4:37 p.m., RCN EE said the DON asked her for help with a medication error. She said the DON texted her and reported that LVN E had administered Resident #15's oxycodone too close together. She said the DON reported when she looked at Resident #15's narcotic count sheet, it looked like LVN E signed the oxycodone out too close together. She said the DON may have not known how to run an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 21 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete eMAR report on Resident #15's oxycodone to see the actual times of administration. She said the DON was new to the facility and role as a DON. She said she asked the DON if Resident #15 had experienced any adverse effects from the medication error. She said the DON reported Resident #15 had not experienced adverse effects. She said the DON reported LVN E said she gave Resident #15's oxycodone too close together also. She said she instructed the DON to notify the MD of the incident and do a medication error report. She said if a drug diversion was suspected, then the facility suspended the MA or CN involved in the incident. She said the facility also drug tested the staff members if suspicious behavior was noted. She said it was important to prevent misappropriation because the resident needed their medications, and it affected their quality of life. She said the MAs and CNs were responsible for ensuring the residents' medications were not misappropriated. She said the shift-to-shift count should ensure misappropriation did not occur. Record review of LVN E's Employee Disciplinary Report dated 8/15/25 indicated, .LVN E. date of Infraction: 8/15/25. written counseling. LVN E failed to adhere to the Corporate Code of Conduct by failing to meet their job duty/responsibility expectations. On 8/15/25, LVN E failed to administer medication correctly, resulting in a medication error. Record review of an undated facility's Abuse/Neglect policy indicated, . The resident has the right to be free from abuse, neglect, misappropriation of resident property. Residents should not be subjected to abuse by anyone, including, but not limited to, facility staff. misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent. Event ID: Facility ID: 675386 If continuation sheet Page 22 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0610 Respond appropriately to all alleged violations. 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 all allegations of abuse and neglect had evidence that all alleged violations were thoroughly investigated and prevent further potential for 2 of 20 residents (Resident #15 and Residents #9) reviewed abuse, neglect and misappropriation. 1. The ADM and DON, failed to thoroughly investigate allegation of misappropriation of property, when LVN E documented an extra administration of Resident #15's oxycodone on 8/15/25. Resident #15 denied receiving an extra dose on 8/15/25. The ADM and DON, failed to provide evidence that Resident #15's incident on 8/15/25, with allegation of misappropriation of property, Oxycodone 10 MG, was thoroughly investigated. The facility failed to protect Resident #15 from potential further misappropriation of property after the allegation. LVN E continued to work from the date of the incident until suspension on 8/18/25. 2. The facility failed to protect Resident #9, after not thoroughly investigating Resident #15 incident on 8/15/25, from experiencing allegation of neglect from LVN E. LVN E failed to administer Resident #9 her pain medication as requested on 08/17/2025. The facility failed to investigate Resident #9's allegation of neglect when LVN E failed to administer Resident #9 her pain medication as requested on 08/17/2025. These failures could place residents at risk increased pain, decreased quality of life, and further abuse and neglect.Findings include: Residents Affected - Few 1. Record review of a witness statement by the DON dated 8/15/25 indicated, “…issue related to: medication administration error… on Friday, August 15th this nurse was notified around 2 pm by the CMA [MA B] and Treatment Nurse [LVN L] that LVN E had signed out too many Oxycodone for Resident #15 on the morning of August 15th… This nurse [DON] assessed the resident and asked her about this… Resident #15 state that [LVN E] administers her medications but not always at the right time… No adverse side effects or harm was done to the resident… Signature of witness: DON… Signature of Management Employee Obtaining Statement: ADM…” Record review of LVN E's “Employee Disciplinary Report” dated 8/15/25 indicated, “…LVN E… date of Infraction: 8/15/25… written counseling… LVN E failed to adhere to the Corporate Code of Conduct by failing to meet their job duty/responsibility expectations… On 8/15/25, LVN E failed to administer medication correctly, resulting in a medication error…” Record review of Resident #15's face sheet dated 9/8/25 indicated Resident #15 was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #15 had diagnoses including fibromyalgia (is a long-term condition that involves widespread body pain), low back pain, major depressive disorder (a persistently low or depressed mood and a loss of interest in activities that you used to enjoy), and anxiety (intense, excessive, and persistent worry and fear about everyday situations). Record review of Resident #15's quarterly MDS assessment dated [DATE] indicated Resident #15 had clear speech, adequate hearing and vision. Resident #15 was understood and had the ability to understand others. Resident #15 had a BIMS score of 15 which indicated intact cognition. Resident #15 was independent for eating, oral hygiene, and toilet hygiene, partial assistance for shower/bathe self and personal hygiene. Resident #15 received scheduled pain medication regimen. Resident #15 received opioids. Record review of Resident #15's care plan dated 3/23/22 indicated Resident #15 was on pain medication therapy related to fibromyalgia and wound. Intervention included administer medications as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 23 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0610 ordered. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #15's “Individual Control Drug Record” Oxycodone 10 MG dated 8/8/25 indicated LVN E signed out administrations on 8/15/25, 8/16/25, 8/17/25, and 8/18/25. Residents Affected - Few During an interview on 9/9/25 at 9:46 a.m., MA E said she had been working at the facility for 2 years. She said she worked Hall C and D. She said on 8/15/25, she started the shift and counted Resident #15's oxycodone pills. She said she noticed an extra entry on the narcotic count sheet for Resident #15. She said when she asked LVN E about the extra entry, LVN E said she must have given Resident #15 too many pills. MA E said that did not seem right because Resident #15 counted her pills before she took them. She said she asked Resident #15 if LVN E gave her an extra oxycodone pill. She said Resident #15 said, “no”. She said she reported the issue to the ADM and DON. She said 8/15/25 was the first time she had noticed a medication administration issue from LVN E. She said LVN E had strange behaviors. She said LVN E moved around really fast all time. She said LVN E continued to work Hall D with Resident #15. She said she eventually was fired for another incident. She said she did not recall receiving an in-service related to the incident on 8/15/25. Attempted telephone call to LVN E on 9/9/25 at 01:15 PM left a voice message and requested a call back. Attempted telephone call to LVN E on 9/9/25 at 07:49 PM left a voice message and requested a call back. During an interview on 9/10/25 at 9:45 a.m., LVN L said on 8/15/25, MA B reported to her that she did a shift-to-shift narcotic count with LVN E. She said MA B said the count with LVN E was not right. She said MA B reported there were too many entries for LVN E's shift. She said she could not quite remember LVN E exact words on what caused the discrepancy. She said LVN E reported to the effect, that she thought she gave Resident #15 her oxycodone but could not remember. She said one of Resident #15's oxycodone pills was missing and could not be accounted for. She said LVN E did not say she wasted or discarded one of Resident #15's oxycodone pills. She said she reported the incident to the ADM and DON. She said the DON went to Resident #15 to see if she had received pain medication. She said she did not know what Resident #15 had reported to the DON. She said Resident #15 counted and inspected her pills during medication pass. She said the incident with LVN E could have been a drug diversion. She said that was why she reported the incident to the ADM and DON. She said LVN E was an “abnormally strange” person. She said LVN E was eventually let go, but not for the incident on 8/15/25. She said she may have received abuse and neglect training after the incident. She said she did not recall training about medication administration and narcotic counts sheets. During an interview on 9/10/25 at 12:42 p.m., Resident #15 said she did not recall the incident on 8/15/25. She said sadly, she got asked about her pain medication all the time. She said she inspected and counted her pills before she took them. She said she would not have taken an extra oxycodone on 8/15/25. Attempted telephone call to LVN E on 09/10/2025 at 02:30 PM left a voice message and requested a call back. On 9/11/25 at 8:57 a.m., requested a copy of Resident #15's investigation by email. The email was sent to the ADM and RCN EE. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 24 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0610 On 9/11/25 at 1:00 p.m., requested a copy of Resident #15's investigation from ADM. Level of Harm - Minimal harm or potential for actual harm During an interview on 9/12/25 at 10:45 a.m., the DON said the incident on 8/15/25 with LVN E was reported by MA B. She said she told the ADM about the incident. She said the ADM was the Abuse Coordinator. She said the ADM told her to investigate the incident. She said she got a statement from MA B, spoke to Resident #15 and called LVN E. She said she did not get a written statement from LVN E about the incident on 8/15/25. She said when she questioned LVN E about the documented extra oxycodone dose on Resident #15; LVN E said she administered it at the right time but wrote down the wrong time. She said the incident on 8/15/25 could have possibly been a drug diversion. She said the staff did not report LVN E having any suspicious behaviors. She said she did not ask Resident #15 if LVN E gave her an extra oxycodone dose on 8/15/25. She said LVN E continued to pass medication to Resident #15. She said it was important to do a thorough investigation to make sure the abuse did not go any further and stop it from happening. She said when it was not done the resident could experience continued abuse. She said after the incident on 8/15/25, LVN E yelled at the staff and a resident. She said similar allegation were reported on LVN E related to pain medication. Requested a copy of Resident #15's investigation. Did not receive a copy prior or after exit. Residents Affected - Few During an interview on 9/12/25 at 12:51 p.m., the ADM said she was aware of the incident on 8/15/25 regarding LVN E. She said if Resident #15's oxycodone pill was missing then it would be considered a drug diversion. She said the staff did not report LVN E had any suspicious behavior on 8/15/25. She said the DON investigated the incident because it was nursing related. She said the DON told her it was a medication error. She said she also thought RCN EE was a part of investigation and agreed it was a medication error. She said it important to do a thorough investigation because it affected the residents' quality of life. She said if the incident was thorough investigated, the drug diversion process would have been followed. She said whoever the investigation was assigned to, was responsible its thoroughness. She said she was the abuse coordinator for the facility. During an interview on 9/12/25 at 4:37 p.m., RCN EE said the DON asked her for help with a medication error. She said the DON texted her and reported that LVN E had administered Resident #15's oxycodone too close together. She said the DON reported when she looked at Resident #15's narcotic count sheet, it looked like LVN E signed the oxycodone out too close together. She said the DON may have not known how to run an eMAR report on Resident #15's oxycodone to see the actual times of administration. She said the DON was new to the facility and role as a DON. She said the DON reported LVN E said she gave Resident #15's oxycodone too close together also. She said if the DON did not ask Resident #15 if she received two pills at an administration time, then it was not thorough investigated. She said when an investigation was not thoroughly investigated, it put the resident at risk for continued misappropriation of property. She said the ADM and DON were responsible for investigating allegation of abuse and neglect. She said if a drug diversion was suspected, then the facility suspended the MA or CN involved in the incident. She said the facility also drug tested the staff members if suspicious behavior was noted. 2. Record review of a face sheet dated 09/11/2025 indicated Resident #9 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including acute kidney failure (condition in which the kidneys cannot filter waste from blood), metabolic encephalopathy (imbalance in body's chemical processes leading to abnormal brain function), chronic obstructive pulmonary disease (progressive lung disease causing shortness of breath, cough, and airflow limitations), and type 2 diabetes mellitus (excessive sugar in the blood). Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #9 understood others (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 25 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and was understood by others. The MDS indicated Resident #9 had a BIMS of 11 and was moderately cognitively impaired. The MDS indicated Resident #9 was independent with eating, required moderate assistance with showering and dressing, and was dependent with toileting hygiene. Record review of Resident #9's care plan dated 08/06/2025 indicated Resident #9 had a history of trauma related to being choked that may have a negative impact. The interventions included to monitor for escalating anxiety, depression and sleep disturbances, perform de-escalation techniques as needed. Record review of Resident #9's Order Summary Report dated 09/11/2025 indicated Resident #9 had an order for Hydrocodone/Acetaminophen (a narcotic pain reliever) 5-325 tablet, give one tablet by mouth every four hours as needed for pain with a start date of 08/10/2025. Record review of a Provider Investigation Report dated 08/18/2025 at 08:17 AM, indicated Resident #9 alleged, “LVN E refused to give her pain medications and hit the side of her mattress with her fist and told her she didn't need the pain medication. Resident #9 alleged LVN D stormed out of the room cussing and yelling up and down the hall. LVN E was suspended pending investigation and safe surveys conducted, staff in services and trauma assessment completed on Resident #9”. Record review of A The Provider Investigation indicated there was no documentation to reflect a pain assessment was completed for Resident #9. Additionally, there was no documentation that reflected Resident #9's medication administration record had been reviewed to verify whether the medication was charted as given or omitted, and there were no documented attempts to determine the reason for the alleged omission. Record review of trauma assessment completed on 08/18/2025 by the SW indicated Resident #9 had no trauma. Record review of a written statement by LVN E dated 08/20/2025 stated, “whenever, Resident #9, asks for her medicine (pain meds) I always check the time, assess her pain and let her know whether it's time or not. Sometimes she agrees and sometimes she doesn't. She often states that she doesn't know why she turns her light on (forgets) or she just shrugs her shoulders. Most times she is easily redirected. Sunday, August 17th, 2025, I had the opportunity to meet and greet Resident #9's son and his wife. I kneeled down in front of Resident #9 because she was in her wheelchair, took her left hand held it and greeted her and introduced myself to her family and thanked them for allowing me to be a part of her care. I stated it was my pride and privilege to take care of their loved one. The son smiled, nodded and said, “that is enough”. It startled me just a bit, I stood up and apologized for interrupting their visit. His wife smiled and that was it. I empathically deny any allegations of cussing up and down the hall. First, profanity is verbal abuse. Second, there were CNA's present most of the night. I was the only one there at 02:30 AM. Third, I respect these elders home period.” Record review of Resident #9's Individual Control Drug Record for Hydrocodone/Acetaminophen (a narcotic pain reliever) 5-325 tablet, give one tablet by mouth every four hours as needed for pain was not signed on for 08/17/2025. During an interview on 09/09/2025 at 12:25 PM, Resident #9's family member stated, he had received a call at approximately 03:00 AM on 08/17/2025 from Resident #9. Resident #9's family member stated that Resident #9 complained she was in pain and that LVN E would not give her pain medications and was cussing and yelling at her. Resident #9 stated LVN E snatched up the blanket and slammed it back (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 26 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few down on to her feet. Resident #9's family member stated he contacted the facility by phone and spoke with a nurse (unsure of name) and requested Resident #9 to be checked on and pain medication to be administered appropriately. Resident #9's family member stated he did not hear anything more from Resident #9 or the facility the remainder of the night. Resident #9's family member stated that on 08/17/2025 while visiting Resident #9, he had encountered LVN E. Resident #9's family member stated LVN E was talking to Resident #9 like she was a child and in a condescending manner. Resident #9's family member stated he told LVN E that was enough. Resident #9's family member stated, “LVN E acted very peculiar as if she was on drugs.” Resident #9's family member stated he received a call from the Administrator on 08/18/2025 regarding Resident #9's previous allegations regarding LVN E. Resident #9's family member confirmed he had received the call from Resident #9. Resident #9's family member stated he also reported the incident where he had told LVN E to stop talking to Resident #9 in the childlike, condescending manner on 08/17/2025 during a visit. Resident #9's family member stated he had requested LVN E not take care of Resident #9 due to her behaviors. Resident #9's family member stated that later perhaps the next day or so, he had received a call from the Administrator where she stated the allegations had been confirmed and LVN E was terminated from the facility. During an interview on 09/09/2025 at 12:45 PM, Resident #9 stated on the day of the incident (08/17/25) she had used the call light button because she was in pain and needed pain medication. She said she waited on LVN E for a long time that night. Resident #9 stated upon LVN E entering her room she asked for her pain medication. Resident #9 stated LVN E “began cussing and hitting the side of her bed and said she was not getting my pain medication, and I could not have it”. Resident #9 said LVN E picked up her covers and slammed it back down over her feet. Resident #9 said LVN E “then left her room yelling and cussing that she was not going to get the pain medication for me”. Resident #9 stated she called her family member and reported the incident to them. Resident #9 stated she did not see LVN E for the remainder of the shift. Resident #9 stated she drifted off to sleep. Resident #9 said it was not very long before the day shift arrived, and she received her pain medication at that time. Resident #9 said LVN E was always talking and moving around fast and rushed. Resident #9 stated she reported the incident to one of the night shift nurses the following evening. Resident #9 stated that later that evening after she told the nurse about the incident with LVN E, the Administrator spoke with her regarding the incident. Resident #9 stated the Administrator did not ask her anything more about her pain medication. Resident #9 stated the day nurse assessed her pain around 7 the next AM. Resident #9 stated that was approximately 3 to 4 hours later after she had requested the pain medication from LVN E. During an interview on 09/09/2025 at 12:55 PM, the Administrator stated upon interviewing Resident #9, she stated she had used her call light and requested pain medication after waiting a long time. Resident #9 stated when LVN E walked into the room, she told Resident #9 she was not getting pain medication and begin hitting the side of the bed and slung the covers off her. The Administrator stated Resident #9 said she was not physically touched by LVN E. The Administrator stated LVN E left the room and was cussing and yelling in the halls. The Administrator stated when she contacted Resident #9's family member, she was told that LVN E had talked to Resident #9 in a condescending manner. The Administrator stated Resident #9's family member expressed concern and requested LVN E be kept away from Resident #9. The Administrator stated she had interviewed staff and confirmed LVN E had erratic behaviors such has yelling and cussing in front of the residents. The Administrator stated LVN E had only worked at the facility for about 2 weeks. The Administrator stated LVN E was terminated on 08/21/2025. The administrator stated she had not inquired any further regarding the pain medication because she was not clinical and had told the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 27 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0610 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few DON. The Administrator stated she was not responsible to follow -up on clinical side. The Administrator said neglect and misappropriation was considered abuse. The Administrator said she was the abuse coordinator for the facility. The Administrator said the lack of appropriate investigations of alleged allegations could result in a resident experiencing an increase in pain as well as a decreased quality of life. Attempted telephone call to LVN E on 09/09/2025 at 01:15 PM left a voice message and requested a call back. Attempted telephone call to LVN E on 09/09/2025 at 07:49 PM left a voice message and requested a call back. Attempted telephone call to LVN E on 09/10/2025 at 02:30 PM left a voice message and requested a call back. During an interview on 09/12/2025 at 10:57 AM, the DON stated she had not investigated the allegations of Resident # 9 not receiving pain medications. The DON stated that was the responsibility of the Administrator because she was the Abuse Coordinator. The DON stated when she had heard of the allegations it was days later and the resident was no longer complaining of pain. The DON said misappropriation was considered abuse. The DON said when allegations not investigated could leave the resident at risk of decreased quality of life if they had experience untreated pain. Record review of the facility's undated “Abuse/Neglect Policy”, indicated, “The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart … Comprehensive investigations will be the responsibility of the administrator and/or Abuse Preventionist… All allegations of abuse, neglect, exploitation, mistreatment of residents, misappropriation of resident property and injuries of unknown source will be investigated… The administrator in consultation with the Risk Management Department will be responsible for investigating and reporting cases to the HHSC… The Abuse Preventionist and/or administrator will conduct a thorough investigation of the incident(s)…” FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 28 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 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 interview and record review, the facility failed to ensure adequate supervision and assistance devices to prevent accidents for 11 out of 25 (Resident's #4, #7, #8, #10, #11, #12, #13, #14, #19, #21, and #22) residents reviewed for accidents. 1. The facility failed to ensure adequate supervision on the secured unit to prevent two resident-to-resident physical altercations between Resident #12 and Resident #13 on 08/07/25, and 08/23/25, which resulted in scratches to Resident #13's face. 2. The facility failed to ensure the secured unit was adequately supervised to prevent unwitnessed fall accidents for Resident's #8, #10, #12, #13, #14, #19, and #21. Resident #14 sustained a radius fracture and required 6 sutures to her left eye on 07/01/25. Resident #21 was sent to the ER after she hit her head and complained of pain on 07/03/25. Resident #10 sustained an abrasion to his left knee on 08/08/25. 3. The facility failed to ensure CNA H provided Resident #11 the correct level of assistance during toileting hygiene. On 07/14/25, CNA H provided incontinence care without assistance to Resident #11 which resulted in Resident #11 falling to the floor and hitting her head. Resident #11's fall mat had been moved for care, and she sustained a skin tear and facial bruising. An immediate jeopardy (IJ) was identified on 09/11/25 at 12:59 PM. The IJ template was provided to the facility on [DATE] at 2:01 PM. While the IJ was removed on 09/13/25 at 12:49 PM, the facility remained out of compliance at a scope of a patterned and a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy because all staff had not been provided education on abuse and neglect, notification of change in condition, fall prevention policy, and the Kardex. This failure could place residents at risk of serious injuries, harm, impairment, and death.The findings included: 1. Record review of the face sheet, dated 09/11/25, reflected Resident #12 was a [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses of dementia (memory loss) psychosis (state of impaired reality), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest). Record review of the admission MDS assessment, dated 08/11/25, reflected Resident #12 had clear speech, was usually understood, and was usually able to understand others. Resident #12 had a BIMS score of 9, which indicated moderately impaired cognition. The MDS reflected Resident #12 had physical behaviors directed toward others 1-3 days and wandering behaviors 4 to 6 days during the look-back period. Record review of Resident #12's comprehensive care plan, initiated on 08/06/25, reflected no care plan had been developed for behaviors. Record review of the order summary report, dated 09/11/25, reflected Resident #12 had an order, which started on 07/31/25, that indicated he may reside on the secured unit related to exit seeking behaviors. Record review of the behavior incident report, dated 08/07/25 at 7:25 AM, reflected CNA N reported that Resident #13 was in Resident #12's room looking at pictures on his nightstand when Resident #12 pushed Resident #13. There were no injuries. The report reflected Resident #12 and #13 were separated and the Administrator was notified. Record review of the behavior incident report, dated 08/23/25 at 6:20 AM, reflected Resident #12 pushed Resident #13 to the floor. Resident #12 reported Resident #13 tried to come into his room, so he stopped her. The incident was unwitnessed by staff. Record review of Resident #12's progress notes, reflected the following: On 09/06/25 at 12:41 PM, Resident #12 was transferred to another facility. 2. Record review of the face sheet, dated 09/11/25, reflected Resident #13 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of dementia (memory loss) and anxiety disorder. Record review of the quarterly MDS assessment, dated 05/29/25, reflected Resident #13 had clear speech, was usually understood, and was sometimes able to understand others. Resident #13 had a BIMS score of 3, which indicated severe cognitive (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 29 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some impairment. The MDS reflected Resident #13 had no behaviors or refusal of care. Record review of the comprehensive care plan, last reviewed 06/05/25, reflected Resident #13 had the potential to demonstrate verbally and physically abusive behaviors. The care plan further revealed Resident #13 was at risk for elopement and resided on the secured unit. The interventions included: supervise closely and make regular compliance rounds whenever resident is in room. Record review of the order summary report, dated 08/23/25, reflected Resident #13 had an order, which started on 02/26/25, that she may reside on the secured unit related to exit seeking behaviors. Record review of Resident #13's progress notes, reflected the following: On 08/07/25 at 4:25 PM a trauma assessment was completed and was negative. On 08/08/25 at 9:02 PM, it was documented Resident #13 had no injury or adverse reaction from being pushed. On 08/23/25 at 6:20 AM, an event note was completed that reflected Resident #13 had 2 scratches on the right side of face and redness to side of left arm below the elbow. She reported that Resident #12 pushed her. X-rays were ordered of hips and elbows. On 08/23/25 at 9:11 AM, the Social Worker documented that she was notified Resident #13 was pushed by another male resident, which resulted in a fall to the floor. Resident #13 did not appear to be in distress, she was smiling and in a pleasant mood. On 08/26/25 at 12:04, Resident #13 was discharged to another facility. 3. Record review of Resident #8's face sheet dated 9/11/25 indicated Resident #8 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #8 had diagnoses including dementia with anxiety (a group of thinking disorders that interferes with activities of daily living with intense, excessive, and persistent worry and fear about everyday situations), chronic obstructive pulmonary disease (decrease airflow of the lungs), protein calorie malnutrition (when not enough protein calories are consumed to meet the body's needs), hypertension (high blood pressure). Record review of Resident #8's admission MDS assessment, dated 08/16/25, reflected Resident #8 was able to understand others and was understood by others. Resident #8 had a BIMS score of 4, which indicated her cognition was severely impaired. Resident #8 required setup and cleanup assistance with eating, and partial to moderate assistance with shower, toileting, and lower body dressing and personal hygiene. Record review of Resident #8's care plan, dated 09/11/2025, reflected Resident #8 had a significant unplanned weight loss. The care plan interventions were labs as ordered, monitor and record food intake, monitor and report any changes in residents eating habits, notify dietician, physician and family of any weight loss, Red Glass on meal tray to identify the resident and staff as possibly needing assistance, encouragement, and substitutes, weight the resident weekly for at least 4 weeks or until weight is stabilized. The care plan did not address risk of falls. Record review of Resident #8's Order Summary Report indicated Resident #8 had an order for regular diet dated 08/16/2025. Resident #8 had an order dated 09/10/2025 for Mirtazapine Tablet 7.5. mg give one tablet at bedtime for weight loss. Record review of the fall incident report, dated 09/06/25 at 3:05 PM, Resident #8 was found sitting on the floor in another resident's room without any bottoms on by the CNA. Resident #8 stated she was going to the bathroom and fell down when the other resident yelled at her for being in her room. The incident was unwitnessed and there were no injuries. 4. Record review of a face sheet dated 09/11/25 indicated Resident #10 was a [AGE] year-old male re-admitted to the facility on [DATE] with diagnoses including dementia (a group of thinking and social symptoms that interferes with daily functioning), chronic obstructive pulmonary disease (progressive lung disease causing shortness of breath, cough, and airflow limitations), wandering, adult failure to thrive, and anxiety. Record review of the Quarterly MDS assessment dated [DATE] indicated Resident #10 usually understood others and was sometimes understood by others. The MDS indicated Resident #10 had a BIMS of 3 and was severely cognitively impaired. The MDS indicated Resident #10 had a history of falls. Record review of Resident #10's care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 30 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some plan dated 04/15/24 indicated a risk for falls related to dementia with generalized weakness. The interventions included anticipate and meet the resident's needs, be sure the resident's call light is within reach and encourage the resident to use it for assistance as needed, fall mat at bedside, educate the resident/family/caregivers about safety reminders and what to do if a fall occurs. Record review of Resident #10's Order Summary Report dated 09/11/25 indicated the following: An order dated 04/12/24 to admit to the secure unit for exit seeking behaviors. An order dated 02/25/25 for bevel fall mat at bedside. Record review of the fall incident report, dated 08/08/25 at 7:05 AM, reflected Resident #10 had an unwitnessed fall. The report indicated Resident #10 was found in his room, beside the bed, sitting on the fall mat. Resident #10 reported he just sat down. There were no injuries. Record review of the fall incident report, dated 08/28/25at 5 PM, reflected Resident #10 was discovered in his room, sitting on the floor mat with legs stretched out and back leaning against the bed, smiling. The reported indicated the incident was unwitnessed and there were no identified injuries. Record review of the fall incident report, dated 09/04/25 at 8 AM, reflected Resident #10 was found on his knees, in a praying position, on the side of his bed. Resident #10 reported he got on his knees himself and did not fall. The incident was unwitnessed and there were no injuries identified. 5. Record review of the face sheet, dated 09/11/25, reflected Resident #14 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills) and Parkinson's disease (a progressive movement disorder of the nervous system). Record review of the quarterly MDS assessment, dated 09/01/25, reflected Resident #14 had clear speech, was usually understood, and was usually able to understand others. Resident #14 had a BIMS score of 4, which indicated severely impaired cognition. Resident #14 had no behaviors or refusal of care. The MDS reflected Resident #14 was usually independent with eating, required partial/moderate assistance with shower/bathing, and independent with transfers and bed mobility. The MDS reflected Resident #14 had no recent falls. Resident #14 received a therapeutic diet while a resident. Record review of the comprehensive care plan, last reviewed on 05/21/25, reflected Resident #14 had an ADL self-care performance deficit and required supervision with bed mobility and walking. The care plan did not address assistance with meals. The care plan reflected Resident #14 was at risk for falls related to parkinsonism. Record review of the order summary report, dated 09/11/25, reflected Resident #14 had an order for no salt on tray diet with regular texture and regular consistency fluids. Lids on cups with hot liquids. The order started on 05/24/22. Record review of the fall incident report, dated 07/01/25 at 7:51 AM, reflected Resident #14 was found in the hallway sitting on the floor. Resident #14 was bleeding from a laceration over her left eye and glasses were lying beside her. Resident #14 stated she did not know what happened, she just fell. The fall was unwitnessed. Resident #14 was sent to the hospital with 8 out of 10 pain on the 0 - 10 pain scale and the deep laceration on her face. Record review of Resident #14's progress notes, reflected the following: On 07/01/25 at 12:56 PM, it was documented Resident #14 returned to the facility with a radius fracture, colitis, and the laceration she received from the fall. On 07/01/25 at 1:03 PM, it was documented Resident #14 returned with 6 sutures above her left eye and a splint to left arm. Record review of the fall incident report, dated 07/30/25 at 4:20 PM, reflected Resident #14 was found in the dining room on the ground. The incident was unwitnessed. Resident #14 stated she fell trying to pick up a pencil. There were no injuries. 6. Record review of the face sheet, dated 09/12/25, reflected Resident #19 was a [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses of senile degeneration of brain (encompasses a range of neurological disorders characterized by a progressive decline in cognitive function, impacting memory, reasoning, and the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 31 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some ability to perform everyday activities). Record review of the significant change MDS assessment, dated 08/06/25, reflected Resident #19 had unclear speech, was sometimes understood, and was sometimes able to understand others. Resident #19 had a BIMS score of 4, which indicated severe cognitive impairment. The MDS reflected Resident #19 had a lower extremity impairment to both sides which interfered with daily function. Resident #19 was totally dependent on staff for ADLs, which included eating. The MDS reflected Resident #19 had a fall within the last month prior to admission. Resident #19 was checked for signs and symptoms of a swallowing disorder: holding food in mouth/cheeks or residual food in mouth after meals. Resident #19 required a mechanically altered diet while a resident of the facility. Record review of Resident #19's comprehensive care plan, last reviewed 09/09/25, reflected the following: Resident #19 had an ADL self-care performance deficit and required staff assistance x 1 with eating and was resistive to eating at times. Resident #19 had a history of falls and the interventions included: fall mat beside bed, appropriate footwear, call light in reach, anticipate needs, and staff assistance x 2 with transfers. Record review of Resident #19's order summary report, dated 09/12/25, reflected an order, which started on 09/01/25 for a regular diet with pureed texture, and regular consistency liquids. Record review of Resident #19's fall incident report, dated 07/03/25, reflected LVN O was called to Resident #18's room by a CNA and found Resident #19 laying on the floor on her right side with wheelchair about 2 feet away. Resident #19 stated she was trying to walk around. The CNA reported to LVN O that Resident #19 had just returned from therapy where she was up walking with assistance. The incident was unwitnessed. No injuries were obtained. 7. Record review of Resident #21's face sheet dated 9/21/25 indicated Resident #21 was an [AGE] year-old female admitted to the facility on [DATE]. Resident #21 had diagnoses including dementia (a group of thinking disorders that interferes with activities of daily living), chronic obstructive pulmonary disease (decrease airflow of the lungs), protein calorie malnutrition (when not enough protein calories are consumed to meet the body's needs), hypertension (high blood pressure). Record review of Resident #21's Quarterly MDS assessment, dated 06/20/25, reflected Resident #21 was able to usually understand others and was sometimes understood by others. Resident #21 had a BIMS score of 3, which indicated her cognition was severely impaired. Resident #21 required setup and cleanup with eating, supervision and touching with shower, toileting, upper and lower body dressing and personal hygiene. Record review of Resident 21's care plan, with a revised date 09/05/25, reflected Resident #21 had a diet order for fortified/enhanced mechanical soft texture with risk for unplanned weight loss. The care plan interventions for Resident #21 were determine food preferences and provide within dietary limitations, divided plate, broth with all meals, finger foods offered when available, add sandwich with meals, may have whole bacon with breakfast. Resident #21's care plan also addressed potential for malnutrition dated 05/24/23 with interventions that included monitor and document meal intake, monitor weights, labs, notify physician. The care plan indicated Resident #21 was also at risk for significant unplanned/unexpected weight loss dated 02/15/24 with 2 calorie/cc supplement with medication pass. The care plan indicated Resident #21 was at risk for falls. The interventions included: anticipate and meet the resident's needs, resident needs a safe environment with even floors free from spills, clutter, and proper footwear while ambulating or in wheelchair. Record review of Resident #21's Order Summary Report indicated Resident #21 had an order for Fortified/Enhanced Diet Mechanical Soft texture, regular consistency, Fortified/Enhanced Diet Mechanical Soft texture, preferences and provide within dietary limitations, divided plate, broth with all meals, finger foods offered when available, add sandwich with meals, may have whole bacon with breakfast dated 08/07/24, Health Shake two times a day, offer house shake two times a day with lunch and dinner dated and Readycare 2.0 four times (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 32 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some a day to promote weight gain (60 ML four times daily) dated 05/20/24. Record review of the fall incident report, dated 07/03/25 at 9:45 AM, Resident #21 had an unwitnessed fall in the dining room. LVN O found Resident #21 in the dining room lying flat on her ack next to the table. Resident #21 reported she tried to sit in the chair and missed it. No injuries were indicated. Record review of the fall incident report, dated 08/20/25 at 2:20 PM, LVN L found Resident #21 on the floor in another resident's room. The fall was unwitnessed and there were no injuries noted. During an observation on 09/08/25 at 11:23 AM, Resident #21 walked out of the dining room to the secured unit doors. There was wet floor signs posted, and the floor was wet. There was no staff supervision. 8. Record review of the face sheet, dated 09/11/25, reflected Resident #7 was an [AGE] year-old female who admitted to the facility on [DATE] with a diagnosis of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills). Record review of the admission MDS assessment, dated 08/19/25, reflected Resident #7 had clear speech, was usually understood, and was usually able to understand other. Resident #7 had a BIMS score of 2, which indicated severe cognitive impairment. The MDS reflected Resident #7 wandered daily but had no refusal of care. The MDS reflected Resident #7 was independent with eating. Resident #7 required a mechanically altered diet while a resident and had no natural teeth or tooth fragments. Record review of the comprehensive care plan, revised on 09/09/25, reflected Resident #7 had an ADL self-care deficit the goal was to maintain her current level of functioning. There were no interventions. The care plan further reflected Resident #7 was at risk for malnutrition and the interventions included: monitor and document meal intake. Record review of the order summary report, dated 09/11/25, reflected Resident #7 had an order for regular diet with mechanical soft texture, regular consistency liquids, milk on all trays, which started on 08/24/25. During an observation on 09/08/25 at 10:48 AM, Resident #7 was wheeling herself around the facility. She was repeatedly asking for the time and when lunch would be served. 9. Record review of Resident #22's face sheet dated 09/12/25 indicated Resident #22 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #22 had diagnoses including dementia with anxiety a (a group of thinking disorders that interferes with activities of daily living), protein calorie malnutrition (when not enough protein calories are consumed to meet the body's needs), hypertension (high blood pressure), tremors, and weakness. Record review of Resident #22's Quarterly MDS assessment, dated 06/20/25, reflected Resident #22 was able to sometimes understand others and was sometimes understood by others. Resident #22 had a BIMS score of 7, which indicated her cognition was severely impaired. Resident #22 required supervision and touching with eating, moderate assistance with shower, and maximal assistance with toileting, upper and lower body dressing and personal hygiene. Record review of Resident 22's care plan, dated 09/19/25, reflected Resident #22 had a significant unplanned weight loss. The care plan interventions for Resident #22 were labs as ordered, monitor and record food intake, monitor and report any changes in residents eating habits, notify dietician, physician and family of any weight loss, Red Glass on meal tray to identify the resident and staff as possibly needing assistance, encouragement, and substitutes, weight the resident weekly for at least 4 weeks or until weight is stabilized, and praise resident for eating well. Record review of Resident #22's Order Summary Report indicated Resident #22 had an order for regular diet dated 04/24/25. During an interview on 09/08/25 at 10:25 AM, LVN A was on the secured unit. She stated she was the only one scheduled for the secured unit today. LVN A stated there were 11 residents on the secured unit and one person was not enough. LVN A stated she had to all the residents up and dressed, showered, and ready for breakfast. LVN A stated she was expected to pass all the trays and provide feeding assistance to the residents in their rooms. LVN A stated she was overwhelmed with the care needed for the residents most days and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 33 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some did not even get a bathroom break. LVN A stated she was unable to complete all her assigned duties regularly because of the insufficient staffing. LVN A stated she was unable to provide the residents with adequate supervision because she was unable to supervise the residents when she was providing care in other resident's room. During an observation on 09/08/25 at 10:45 AM, LVN A entered a resident room down the hallway on the secured unit. There were 3 resident's left in the dining room unsupervised. During an observation on 09/08/25 at 11:38 AM, Multiple residents were sitting in the dining room, unsupervised. LVN A was sitting outside the dining room in the hallway, unable to visualize the residents. A resident sitting in the dining room told another resident loudly to LEAVE IT ALONE. LVN A immediate stood up and walked to the dining room entrance to investigate and redirected the residents. During an observation on 09/08/25 at 12:12 PM, The Dietician left the dining room and secured unit. Resident #7, Resident #8, Resident #14 Resident #21, and Resident #22 were left in the dining room, unsupervised, for approximately 15 minutes. During an interview on 09/08/25 at 3:54 PM, the Regional Nurse Consultant stated the facility staff tried to schedule 2 staff members on the secured unit, but they were okay with only staff member on the secured unit. The Regional Nurse consultant stated the staffing needs were based on the census. During an interview on 09/08/25 at 4:22 PM, the ADON stated she had only worked at the facility for about 3 weeks. She stated it had been crazy with staffing. The ADON stated she had to work the floor this weekend and most days since she started at the facility. The ADON stated the facility just got approval to offer sign-on bonus for new applicants and shift-bonus for staff who pick up extra shifts. During an observation on 09/08/25 at 8:50 AM, Resident #21 was sitting in a chair in the hallway. Resident #21 was unsteadily bending over while sitting in the chair trying to put her drink on the ground. LVN A and Medical Records were down the hallway in a resident room. During an interview on 09/09/25 at 3:31 PM, LVN O stated she normally worked Hall C (secured unit) and Hall B. LVN O stated only one person, usually the CNA, was assigned to work the secured unit all shift. LVN O stated the nurse did not remain on the secured unit at all times. LVN O stated one person on the secured unit was not enough to provide adequate supervision. LVN O stated there should have been at least 2 staff members on the secured unit at all times. LVN O stated the residents on the secured unit required a lot of care and redirection. LVN O stated she was aware that CNAs assigned to the secured unit were unable to complete all their assigned tasks, such as showers. LVN O stated did not remember the exact details of every incident that happened on the secured unit. LVN O stated she was the nurse on duty for 6 of the 9 unwitnessed fall incidents. LVN O stated she believed the lack of supervision and insufficient staffing heavily contributed to the unwitnessed fall incidents and resident to resident altercations. LVN O stated lack of supervision and insufficient staffing could lead to injury from unwitnessed incidents and abuse or neglect. During an interview on 09/10/25 at 9:05 AM, CNA N stated she remembered the incident between Resident #12 and Resident #13. CNA N stated she was working on C-Hall and Resident #13 was doing her normal wandering and walking around. Resident #12 had a picture on the table in the dining room and Resident #13 stopped, picked up the photo, and started walking away. CNA N said No, put it back to Resident #13. Resident #13 started to put the photo back on the table, when Resident #12 got up and pushed her. CNA N stated she immediately separated the residents. CNA N stated Resident #13 was not hurt physically but she started crying. CNA N stated she explained to Resident #12 that he could not push other residents. CNA N stated Resident #12 then got up from his seat, started pacing the room, and talked about getting shot in the head. CNA N stated she tried to keep an eye of both of them the best she was able, and she reported the incident to the charge nurse. CNA G stated she was asked to write a statement. CNA N stated that was Resident #12's first or second day at the facility and he was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 34 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some scary. CNA N stated he was more aggressive than any other resident on the secured unit. CNA N said Resident #12 was particular about his space and did not want anyone touching his things. CNA N stated Resident #12 would become angry and upset when he would try to get off the hallway and it was locked. CNA N stated Resident #13 wandered up and down the hallways and would stare out the back windows. CNA N stated Resident #13 did not like to be told to put things back but would just stare at you and eventually say Okay, fine. CNA N stated she would be sassy at times, but she was not aggressive. CNA N stated she was the only staff member on the hallway during the incident. CNA N stated it was normal for her to be the only staff member assigned to the secured unit. CNA N stated it was impossible to complete all her assigned tasks, provide adequate supervision, and complete her documentation. CNA N stated she was unable to be at two places at one time and was unable to see what happening in the dining room or hallway when she was in a resident room. CNA N stated she had to prioritize eating and feeding, so she was unable to complete showers and provide adequate supervision most of the time. CNA N stated she had rush through rounds and was unable to provide the adequate care and services. During an interview on 09/10/25 beginning at 9:22 AM, LVN L stated she was the treatment nurse while employed at the facility, but she also worked as the charge nurse. LVN L stated she was the nurse assigned to C hall (secured unit) during several incidents on the secured unit. LVN L stated the resident to resident altercation on 08/07/25 between Resident #12 and Resident #13 was reported to her by CNA N. LVN L stated she completed the incident report on both residents and there were no injuries. LVN L stated Resident #12's medications were adjusted after the incident as he was new to the facility. LVN L stated she was unaware of any history of aggressive behaviors. LVN L stated Resident #13 was known to wander around the facility and pick up items. LVN L stated there were no further issues after that incident to her knowledge. LVN L stated she was unable to remember the details of the incidents that occurred on the secured unit, but she believed the inadequate supervision and insufficient staffing contributed to the unwitnessed incidents on the secure unit and could have possibly been prevented. LVN L stated usually one staff member was assigned the secured unit and then the nurse floated between the halls. LVN L stated the secured unit was not her only assignment, so she did not stay on the secured unit full time. LVN L stated management staff was aware of the staffing issues and would help occasionally but not most of the time. LVN L stated she felt like she was left without the resources needed to complete her job duties and that was why she was no longer working at the facility. During an interview on 09/10/25 at 10:27 AM, The Social Worker stated she was aware of two resident-to-resident altercations between Resident #12 and Resident #13. The Social Worker stated from her understanding Resident #13 was in Resident #12's personal space. The Social Worker stated if her memories were correct, the first incident had to do with photos. The Social Worker looking back on his stay at the facility, his brother was a trigger for him. The Social Worker stated Resident #12 kept brining up being shot in the head and Resident #13 kept going into his personal space. The Social Worker stated Resident #12 did not have any issues with any other resident on the secured unit. The Social Worker stated on the second incident Resident #12 shoved Resident #13 a little harder and she had some injuries. The Social Worker stated after the second incident he was placed on monitoring and sent to the behavioral hospital. The Social Worker stated once Resident #12 returned from the behavioral hospital, he was sent to a sister facility to be closer with his family. The Social Worker stated Resident #12 had no history of aggression. She said Resident #12 had been living with his father in another facility and when his father passed, he attempted to elope, which was why he needed the secured unit. The Social Worker stated after the first incident his medications were adjusted, he was provided a working television, and snacks. The Social Worker stated that kept (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 35 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Resident #12 happy. The Social Worker stated Resident #13 just liked to wander and ended up in Resident #12's room. During an interview on 09/11/25 at 11:15 AM, The DON stated she had been completing the staffing schedule the last few weeks. The DON stated she tried to schedule 2 nurses, 2 MAs, and 5 CNAs on the day shift. The DON stated she tried to schedule 2 MAs, 2 nurses, and 4 - 5 CNAs. The DON stated MAs worked 8 hour shifts, but the nurses and CNAs worked 12 hour shifts. The DON stated the facility has been unable to schedule what she needs since April 2025, when she started. The DON stated any time someone calls off and she was unable to get it covered, she has to work the floor. The DON stated she has tried to ask sister facilities for help, but she does not always get the help she requested. The DON stated she has received numerous complaints from residents, staff, and families about the care the residents receive and the inability to complete their assigned duties. The DON stated she has spoken with the Administrator, ADO, and Regional Compliance Nurse to let them know she needed help with staffing with no success. The DON stated the corporation has approved sign-on bonuses and extra shift bonuses for existing staff picking up extra shifts. The DON stated it was important to ensure the facility was sufficiently staffed so residents received good quality of care. The DON stated not receiving good quality of care could cause a decline the residents health and well-being. During an interview on 09/11/25 at 1:02 PM, The Administrator stated it was important to ensure the building was sufficiently staffed to ensure the residents were receiving the care they need. The Administrator stated if the residents were not receiving the care they needed it could have been harmful to them. The Administrator stated she had not received any complaints about one staff member being scheduled to the secured unit. The Administrator stated she was having complaints about the night shift on the secured unit and started havi Event ID: Facility ID: 675386 If continuation sheet Page 36 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0693 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents who were fed by enteral means received the appropriate treatment and services to prevent complications of enteral feeding for 1 of 3 residents (Resident #5) reviewed for enteral nutrition. During a tube feeding on 08/20/25, Resident #5's head and torso were leaning over the left armrest of his Geri-chair for approximately 1 hour and 30 minutes, which resulted in aspiration pneumonia. An immediate jeopardy (IJ) was identified on 09/11/25 at 12:59 PM. The IJ template was provided to the facility on [DATE] at 2:01 PM. While the IJ was removed on 09/12/25 at 4:40 PM, the facility remained out of compliance at a scope of isolated and a severity level of no actual harm that is not immediate jeopardy with the potential for more than minimal harm because all staff had not been provided education on abuse and neglect, notification of changes in condition, and enteral feeding tube management. This failure could place residents with gastrostomy tube at risk for complications from feeding tube administration such as aspiration and pneumonia, serious injury, harm, impairment, and death. The findings included: Record review of the face sheet, dated 09/11/25, reflected Resident #5 was a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills), severe protein-calorie malnutrition (not getting enough protein or calories to meet the body's demands), gastrostomy status (an opening into the stomach from the abdominal wall, made surgically for the introduction of food), anorexia (loss of appetite), and dysphagia (difficulty swallowing). Record review of the quarterly MDS assessment, dated 07/30/25, reflected Resident #5 had unclear speech, was rarely/never understood, and was rarely/never able to understand others. Resident #5 had short-term and long-term memory problems. Resident #5 had no memory or recall ability and had severely impaired decision making skills. The MDS reflected Resident #5 had upper and lower extremity impairments to both sides which interfered with daily functions. The MDS reflected Resident #5 was dependent on staff for all his ADLs. Resident #5 used a feeding tube while a resident and also received a mechanically altered diet. The MDS reflected Resident #5 received 51% of more of his total calories through tube feeding. Record review of the comprehensive care plan, last reviewed 06/17/25, reflected Resident #5 required tube feeding related to anorexia and Alzheimer's disease. The interventions included: .the resident needs the head of bed elevated 30 degrees during and thirty minutes after tube feeding. The care plan further reflected Resident #5 had an ADL self-care deficit and required staff assistance x 1 with eating. Record review of the order summary report, dated 09/11/25, reflected Resident #5 had an order for regular diet and pureed texture with pudding consistency fluids, family member or nurse to assist with feeding. The order started on 08/26/25. During an observation of a video date and time stamped, 08/20/25 3:13 PM, revealed Resident #5 leaning over the left armrest of his Geri-chair. He was moaning and grunting, unable to lift his torso or head. At 3:16 PM, CNA G walks into the room, pulls his arm and ask him to sit up, and then walked out of the room. The interaction last approximately 45 seconds. Resident #5 returned to the same position within approximately 30 seconds after CNA G left the room. Resident #5 remained in the same position, where his head and torso were leaning over the left armrest for approximately 1 hour and 30 minutes. Resident #5 constantly moans and grunts during the video until LVN L sets up him with pillows and positioned him comfortably at 4:26 PM Record review of the progress notes reflected the following: On 08/21/25 at 4:03 AM, the note reflected Resident #5's family member requested a chest x-ray due to possible aspiration . due to positioning of resident in chair on previous shift.No signs or symptoms of aspiration [entry of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 37 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0693 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few solid or liquid material such as secretions, food, drink, or stomach contents from the mouth or stomach into the lungs] noted . head of bed elevated to 30 degrees. On 08/21/25 at 7:47 AM, the note reflected a response was received from the physician for a chest x-ray. On 08/22/25 at 3:29 AM, the note reflected Resident #5 was transferred to the hospital related to chest x-ray results findings indicated aspiration. Record review of Resident #5's diagnostic chest x-ray report, dated 08/21/25, reflected .reported gastrostomy tube [opening from the abdomen directly into the stomach] is not definitely visualized.air distended stomach.left basilar airspace disease [condition in which the lower lungs of the left lung collapse, preventing air exchange], likely atelectasis [collapse of lung or part of lung from lack of air in the air sacs] given elevation of the hemidiaphragm. Record review of the inpatient hospital record, dated 08/22/25, reflected Resident #5 arrived at the hospital at 4:04 AM via ambulance and was discharged back to the facility at 5:46 AM. The problems addressed was aspiration into airway, initial encounter. During an interview on 09/09/25 beginning at 2:38 PM, Resident #5's family member stated on 08/20/25 she had gone out to eat and did not watch the camera as she normally did. Resident #5's family member stated when she got home, she noticed a neck pillow was blocking the view of the camera, so she called the facility. Resident #5's family member stated she went back to review the video prior to the pillow blocking camera and noticed he had been leaning over his chair for about 2 hours. Resident #5's family member was concerned he may have aspirated so she requested a chest x-ray be performed. Resident #5's family member stated the chest x-ray showed aspiration pneumonia, and he was sent to the hospital. Resident #5's family member stated he was returned to the facility on antibiotics. Resident #5's family member stated the facility staff did not have enough help. Resident #5's family member stated she believed the incident would not have occurred if the facility had sufficient staffing because they would have been able to check on him more frequently. During an interview on 09/09/25 beginning at 10:55 AM, LVN M stated Resident #5's family member had requested that he go to the hospital because she was concerned about something that had occurred on the camera, and she believed he could have possibly aspirated. LVN M stated she notified the physician, and he was agreeable, so she sent Resident #5 to the hospital per the family member's request. LVN M stated Resident #5 had no signs or symptoms of aspiration, such as nasal drainage, shortness of breath, or wheezing. LVN M stated the facility had obtained the order for a chest x-ray, but it had not been completed before he was sent to the hospital, if she remembered correctly. LVN M stated Resident #5 did not return back from the hospital on her shift, so she was unaware of what he was treated for at the hospital. During an interview on 09/09/25 beginning at 11:50 AM, CNA G stated on 08/20/25 she was on the way to answer another resident's call light when she walked by Resident #5's room and noticed he was leaning over. CNA G stated she grabbed Resident #5 under the arm and elbow to sit him up. CNA G stated she sat Resident #5 up the best she could then proceeded to answer the call light. CNA G stated she was the only staff member assigned to her hallway and stated she never thought to check on him again because she had so much going through her mind. CNA G stated she was called later on to provide a statement of the incident. CNA G said she had just graduated CNA school about 4 months ago and was still learning things. CNA G stated grabbing someone by the arm was not the proper way to position them. CNA G stated the facility did provide her one-on-one education on proper positioning. CNA G stated looking back now she should have checked on Resident #5 sooner, but it was hard to recognize in the moment because of the staffing concerns. CNA G stated Resident #5 should have been positioned in a Fowler's position (upright) during a tube feeding. CNA G stated improperly positioning a resident during a tube feeding could result in aspiration. CNA G stated there were staffing concerns at the facility because no one wanted to work. CNA G stated the facility (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 38 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0693 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few staff did not like the management staff. CNA G stated she had only worked at the facility since June 2025. CNA G stated at times she was the only CNA who was assigned to two halls, which was approximately 25 residents. CNA G stated she was unable to provide the care and services each resident required when she was scheduled alone. CNA G stated she felt rushed with the residents. CNA G stated management staff were aware of the staffing concerns but felt like nothing was addressed. CNA G stated management did not consistently help out on the floor. CNA G stated the DON would provide assistance to one resident because of the camera in the room, but most of the time when she asked for help the DON would say Let me find someone to help you. CNA G stated she normally works C-Hall (the secured unit) and is the only staff member scheduled. During an interview on 09/10/25 beginning at 9:22 AM, LVN L stated on 08/20/25 she was acting as charge nurse. LVN L stated she was on the secured unit completing the medication pass and providing care as there was no CNA assigned to the secured unit. LVN L stated a little while later, she had someone relieve her on the secured unit and she was walking down B Hall when she noticed Resident #5 was slumped over. LVN L stated Resident #5 was repositioned and placed in the bed. LVN L stated CNA G had not reported he had been improperly positioned or slumped over. LVN L stated Resident #5 had a runny nose and snot was coming out of his nose. LVN L stated Resident #5's shirt was changed because the snot had made his shirt wet. LVN L stated Resident #5 had a slight runny nose after the incident but was not acting abnormal. LVN L stated Resident #5 had no signs or symptoms of respiratory distress. LVN L stated being improperly positioned during a tube feeding could have caused aspiration pneumonia. LVN L stated she expected the CNAs to notify her if they needed help. LVN L stated she believed if the facility was adequately staffed, this incident would not have occurred. During an interview on 09/11/25 beginning at 1:02 PM, The Administrator stated the charge nurse was responsible for monitoring to ensure residents who required a tube feeding were positioned properly. The Administrator stated the ADON was responsible for educating and overseeing the nurses and CNAs. The Administrator stated she was at a training on 08/20/25 when Resident #5 was left improperly positioned during a tube feeding. The Administrator stated the DON called her and explained what happened. The Administrator stated she was able to review the incident and the video that was obtained the next day. The Administrator stated in the video Resident #5 laid slumped over in his chair for approximately an hour and half. The Administrator stated she completed the self-report to HHSC and started 30 minute monitoring for Resident #5. The Administrator stated if any issues with positioning were observed, he was repositioned. The Administrator stated the DON provided 1:1 education with CNA G regarding proper positioning. The Administrator stated it was important to ensure residents were properly positioned during tube feedings to prevent aspiration. Record review of the Enteral Nutrition policy, undated, reflected .problems with the administration of the tube feeding are monitored and corrected by nursing. The policy did not address positioning. The Administrator was notified on 09/11/25 at 1:59 PM that an Immediate Jeopardy situation was identified due to the above failure. The Administrator was provided the Immediate Jeopardy template on 09/11/25 at 2:01 PM. The following plan of removal was submitted by the facility and accepted on 09/12/25 at 12:05 PM and included the following: Interventions:1. Resident #5 was assessed for proper positioning and signs of aspiration. No signs of a change in condition noted to any residents. Completed 9/11/25. 2. All residents on enteral feeds in the facility were assessed for proper positioning and signs of aspiration. All enteral feedings are in place according to orders. No additional changes in condition were noted that required notification to the MD. Charge Nurses, CNAs, and Med Aides will be responsible for monitoring the positioning of residents on enteral feedings throughout the shift at a minimum of every two hours. Clinical leadership will verify proper positioning of residents on enteral (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 39 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0693 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few feedings during clinical rounds daily throughout the day. Clinical rounds will be documented on a monitoring tool. Completed 9/11/25. 3. The Administrator and DON were in-serviced 1:1 by the Regional Compliance Nurse and Area Director. Completed 9/11/25. a. Abuse and Neglect: Examples include failure to provide assistance with showers, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following MD orders, treating pain, administer medication, notifying MD of change in condition, provide adequate supervision to prevent falls or resident to resident altercations.b. Notification of Change in Condition: notify a MD and RP of all changes in conditions such as abnormal vital signs, new onset or worsening pain or injuries from incidents.c. Enteral Feeding Policy to include adequate positioning- HOB elevated to prevent the risk of aspiration. If a resident is not positioned with the HOB elevated during enteral feedings, the charge nurse will be notified immediately. This in-service includes the signs and symptoms of aspiration such as coughing, drooling, choking, fever, noisy breathing, shortness of breath or wheezing. 4. The medical director was notified of the immediate jeopardy citation by the administrator on 9/11/25. 5. An ADHOC QAPI meeting was held with interdisciplinary team including the medical director to discuss the immediate jeopardy and plan of removal. Completed on 9/11/25. In-services:1. The following in-services were initiated by Administrator, Regional Compliance Nurse, DON, ADON for all staff. Any staff member not present or in-serviced as of 9/11/25 will not be allowed to assume their duties until in-serviced. All new hires will be in-serviced during orientation. All PRN, agency staff, or staff on leave will in serviced prior to assuming their next assignment. Completion date 9/11/25.a. Abuse and Neglect: Examples include failure to provide assistance with showers, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following MD orders, treating pain, administer medication, notifying MD of change in condition, provide adequate supervision to prevent falls or resident to resident altercations.b. Notification of Change in Condition: notify a MD and RP of all changes in conditions such as abnormal vital signs, new onset or worsening pain or injuries from incidents.c. Enteral Feeding Policy to include adequate positioningHOB elevated to prevent the risk of aspiration. If a resident is not positioned with the HOB elevated during enteral feedings, the charge nurse will be notified immediately. This in-service includes the signs and symptoms of aspiration such as coughing, drooling, choking, fever, noisy breathing, shortness of breath or wheezing. On 09/12/25 the surveyor confirmed the facility implemented their plan of removal sufficiently to remove the immediate jeopardy (IJ) by: 1. Record review of the inpatient hospital record, dated 08/22/25, reflected Resident #5 arrived at the hospital at 4:04 AM via ambulance and was discharged back to the facility at 5:46 AM. The problems addressed was aspiration into airway, initial encounter. 2. Record review of Resident #5 Resident #16, Resident #20's progress notes, reflected an assessment was completed on 09/11/25 of the feeding tubes and no issues or concerns were identified. 3. During an observation on 09/12/25 at 12:33 PM, Resident #5 was positioned in semi-Fowlers (30 - 45-degree angle) position. No issues or concerns with feeding. No signs or symptoms of aspiration were observed. 4. During an observation on 09/12/25 at 12:34 PM, Resident #16 was positioned in semi-Fowlers position with sitter at bedside. No issues or concerns with feeding. No signs or symptoms of aspiration were observed. 5. During an observation on 09/12/25 at 12:35 PM, Resident #20 was positioned in semi-Fowlers position. No issues or concerns with feeding. No signs or symptoms of aspiration was observed. 6. Record review of the in-service training report, dated 09/11/25, reflected the DON and Administrator signed and received in-service training on abuse and neglect which included the following: examples such as failure to provide assistance with shower, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following physician orders, treating pain, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 40 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0693 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few administering medications, notify the physician of changes in condition, and providing adequate supervision to prevent falls or resident to resident altercations. It also included the abuse policy and procedure. 7. Record review of the in-service training report, dated 09/11/25, reflected the DON and Administrator signed and received in-service education on notifying physician of change in status which included the following: notifying the physician and responsible party of all changes in conditions such as pain or injuries from accidents. It also included the Notifying the Physician of Change in Status policy. 8. Record review of the in-service training report, dated 09/11/25, reflected the DON and Administrator signed and received in-service education on the enteral nutrition policy and procedure, which included: adequate positioning with the head of the bed elevated to prevent the risk of aspiration, notification of the charge nurse if a resident was improperly positioned, and signs or symptoms of aspiration such as coughing, drooling, choking, fever, noisy breathing, shortness of breath or wheezing. 9. During an interview on 09/12/25 at 3:08 PM, the Medical Director stated he was notified of the immediate jeopardy situations at the facility. He said he was notified by the Regional Compliance Nurse on 09/11/25 and it was discussed with plans being implemented. 10. During an interview on 09/12/25 at 4:05 PM, the DON stated she was provided 1:1 in-service education as follows: Abuse and neglect to include the types of abuse and examples of each. The DON stated that failure to provide care and services such as showers, wound treatments, adequate supervision, changing clothing, providing assistance with eating, and improper positioning with enteral feeding was considered neglect. Notification of changes in condition to include examples of resident change in condition such as new skin issues or increased or new pain. The DON stated a change in condition should be reported immediately. The DON stated the physician should be notified and an assessment completed. Enteral feeding policy to include adequate positioning. The DON stated residents would be checked for positioning at least every 2 hours by the CNAs, MAs, and nurses. The DON stated residents who received enteral nutrition should have the head of the bed elevated at least 30 degrees. The DON stated signs or symptoms of aspiration included: coughing, drooling, or wheezing. 11. During an interview on 09/12/25 at 4:14 PM, the Administrator stated she was provided 1:1 in-service education as follows: Abuse and neglect to include the types of abuse and examples of each. The Administrator stated that failure to provide care and services such as showers, wound treatments, adequate supervision, changing clothing, providing assistance with eating, and improper positioning with enteral feeding was considered neglect. Notification of changes in condition to include examples of resident change in condition such as new skin issues or increased or new pain. The Administrator stated a change in condition should be reported immediately. The Administrator stated the physician should be notified and an assessment completed. Enteral feeding policy to include adequate positioning. The Administrator stated residents would be checked for positioning at least every 2 hours by the CNAs, MAs, and nurses. The Administrator stated residents who received enteral nutrition should have the head of the bed elevated at least 30 degrees. The Administrator stated signs or symptoms of aspiration included: coughing, drooling, or wheezing. 12. During an interview on 09/12/25 at 4:26 PM, the Regional Compliance Nurse stated she provided all the 1:1 in-service education for the DON and Administrator. 13. Record review of the AD HOC QAPI meeting dated 09/11/25, reflected 12 members were in attendance. 14. Record review of the in-service training report, dated 09/11/25, reflected in-service education was provided to all staff on the abuse and neglect policy and procedure to include the following: examples such as failure to provide assistance with shower, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following physician orders, treating pain, administering medications, notify the physician of changes in condition, and providing adequate supervision to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 41 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0693 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete prevent falls or resident to resident altercations. There were 36 staff signatures. 15. Record review of the in-service training report, dated 09/11/25, reflected in-service education was provided to all staff on notifying physician of change in status which included the following: notifying the physician and responsible party of all changes in conditions such as pain or injuries from accidents. It also included the Notifying the Physician of Change in Status policy. There were 36 staff signatures. 16. Record review of the in-service training report, dated 09/11/25, reflected in-service education was provided to direct care staff on the enteral nutrition policy and procedure, which included: adequate positioning with the head of the bed elevated to prevent the risk of aspiration, notification of the charge nurse if a resident was improperly positioned, and signs or symptoms of aspiration such as coughing, drooling, choking, fever, noisy breathing, shortness of breath or wheezing. There were 22 staff signatures. 17. During interviews between 09/12/25 and 09/13/25, staff from all departments and all shifts to include: the AD, Medical Records, MDS Coordinator QQ, MDS Coordinator RR, [NAME] HH, [NAME] KK, [NAME] MM, Dietary LL, Dietary NN, DM, Housekeeper OO, Housekeeping Supervisor PP, RN P, RN T, LVN A, LVN M, LVN Q, MA B, MA Z, MA UU, CNA C, CNA G, CNA V, CNA SS, CNA TT, Speech Therapist VV, Director of Rehabilitation WW, COTA XX, COTA ZZ, and PTA YY were provided in-service education and were able to verbalize the following: Abuse and Neglect to include the types of abuse and examples of each. The staff were able to give examples of neglect which included: failure to provide assistance with shower, changing clothes, meal trays, eating, positioning with enteral feeding, providing treatments, following physician orders, treating pain, administering medications, notify the physician of changes in condition, and providing adequate supervision to prevent falls or resident to resident altercations. The staff reported the Administrator was the abuse coordinator and any type of abuse should be reported immediately. Notification of changes in condition to include examples of resident change in condition such as new skin issues or increased or new pain. The staff were able to verbalize a change of condition should be reported to the charge nurse immediately. The charge nurses were able to verbalize the appropriate assessments and notifications of the physician and family during a change of condition. Enteral feeding policy to include adequate positioning. The facility staff reported residents would be checked for positioning at least every 2 hours by the CNAs, MAs, and nurses. The staff were able to verbalize residents who received enteral nutrition should have the head of the bed elevated at least 30 degrees. Staff reported if they noticed any residents were positioned improperly the charge nurse would be notified. The staff were able to verbalize the signs or symptoms of aspiration, which included: coughing, drooling, or wheezing. The Administrator was informed the IJ was removed on 09/12/25 at 4:40 PM. The facility remained out of compliance at a scope of isolated and a severity level of no actual harm that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 675386 If continuation sheet Page 42 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review the facility failed to ensure that pain management was provided to that require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices of 2 of 11 residents reviewed for pain management. (Resident #6 and Resident #15) 1. The facility failed to ensure Resident #15 received her scheduled Oxycodone as ordered on [DATE], [DATE], and [DATE]. The facility failed to ensure Resident #15 received her scheduled Gabapentin as ordered on [DATE]. The facility failed to notify Resident #15's physician when doses of the Oxycodone and Gabapentin, scheduled for 3pm and 4pm, were not administered on [DATE]. The facility failed to offer Resident #15 alternative prn pain medication options on [DATE] per the facility's policy. The facility failed to offer Resident #15 non-pharmacological interventions on [DATE] per the facility's policy. The facility failed to follow the Pain Management policy. 2. The facility failed to ensure Resident #6, who received scheduled opioid medications, had pain assessments at least every shift. The facility failed to ensure Resident #6, who displayed nonverbal signs of pain such as grimacing, hollering out and pushing staff away during ADL care, was administered prn medication. An Immediate Jeopardy (IJ) was identified on [DATE]. The IJ Template was provided to the facility on [DATE] at 2:01 p.m. While the IJ was removed on [DATE] at 12:49 p.m., the facility remained out of compliance at a scope of isolated and a severity level of no actual harm with potential for more than minimal harm that was not immediate jeopardy due to the facility's need to complete training in-services with all staff and evaluate the effectiveness of the corrective systems. These failures could place residents at risk for unrealized pain, serious harm, decrease quality of life and decline in condition.Findings included: 1. Record review of Resident #15's face sheet dated [DATE] indicated Resident #15 was a [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #15 had diagnoses including fibromyalgia (is a long-term condition that involves widespread body pain), low back pain, major depressive disorder (a persistently low or depressed mood and a loss of interest in activities that you used to enjoy), and anxiety (intense, excessive, and persistent worry and fear about everyday situations). Record review of Resident #15's quarterly MDS assessment dated [DATE] indicated Resident #15 had clear speech, adequate hearing and vision. Resident #15 was understood and had the ability to understand others. Resident #15 had a BIMS score of 15 which indicated intact cognition. Resident #15 was independent for eating, oral hygiene, and toilet hygiene, partial assistance for shower/bathe self and personal hygiene. Resident #15 received scheduled pain medication regimen. Resident #15 received opioids. Record review of Resident #15's care plan dated [DATE] indicated Resident #15 was on pain medication therapy related to fibromyalgia and wound. Intervention included administer medications as ordered. Record review of Resident #15's order summary report dated [DATE] indicated: *Tylenol Capsule 325 MG, give 2 capsules by mouth every 6 hours as needed for mild pain. Start date [DATE]. *Instant hot pack apply to affected area every hour as needed for pain, every 1 hour as needed for pain. Start date [DATE]. *Assess for pain each shift, every shift. Start date [DATE]. *Oxycodone Oral Tablet 10 MG (is used to relieve pain severe enough to require opioid treatment and when other pain medicines did not work well enough or cannot be tolerated), give 1 tablet by mouth five times a day for pain. Start date [DATE]. *Gabapentin Oral Capsule 300 MG (is an anticonvulsant medication used to treat nerve pain), give 1 capsule by mouth three times a day for pain for 5 days. Start dated [DATE]. Record review of Resident #15's Medication Administration Record dated [DATE]-[DATE] indicated: *Tylenol Capsule 325 MG, give 2 capsules by mouth every 6 hours as needed for mild pain. The MAR did not reflect an administration on [DATE]. This alternate prn pain Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 43 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few medication was not administered on [DATE]. *Instant hot pack apply to affected area every hour as needed for pain, every 1 hour as needed for pain. The MAR did not reflect an administration on [DATE]. This non-pharmacological option was not administered on [DATE]. *Assess for pain each shift, every shift. The MAR did not reflect assessments on [DATE] (Nights), [DATE] (Nights), and [DATE] (Nights). *Oxycodone Oral Tablet 10 MG, give 1 tablet by mouth five times a day for pain. Times: 1am, 6am, 11am, 4pm, and 9pm. The MAR indicated on [DATE] at 1am administration was not given due to sleeping. The MAR did not reflect administration on [DATE] at 4pm. The MAR indicated on [DATE] administration at 9pm. The MAR indicated on [DATE] administration at 6am. *Gabapentin Oral Capsule 300 MG, give 1 capsule by mouth three times a day for pain for 5 days. The MAR did not reflect administration on [DATE] at 3pm. Record review of Resident #15's Individual Control Drug Record for Oxycodone 10 MG dated [DATE] indicated: *[DATE] at 6am, 1 pill given by RN S. *[DATE] at 11am, 1 pill given by MA B. *[DATE] at 9pm, 1 pill given by LVN M. *[DATE] at 11:55 p.m., 1 pill given by RN T. *[DATE] at 8am, 1 pill given by the DON. The Individual Control Drug Record did not reflect entries for [DATE] at 1am and 4pm. The Individual Control Drug Record did not reflect entries for [DATE] at 9pm. The Individual Control Drug Record did not reflect entries for [DATE] at 6am. Resident #15 scheduled doses are 1am, 6am, 11am, 4pm, and 9pm. Record review of Resident #15's e-MAR report dated [DATE] provided by RCN EE indicated: *[DATE] at 1am, code: 7 (sleeping), RN S. *[DATE] at 6am, 1 tablet, RN S. *[DATE] at 11am, 1 tablet, MA B. *[DATE] at 9pm, 1 tablet, LVN M. *[DATE] at 11:55pm (9pm), 1 tablet, RN T. *[DATE] at 8am (6am), 1 tablet, DON. The e-MAR did not reflect an entry for [DATE] at 4pm. Record review of Resident #15's progress notes dated [DATE]-[DATE] indicated: *[DATE] at 9:37 a.m. by LVN M, . CNA to this nurse that resident [Resident #15] was upset because she didn't get her 3pm Oxycodone. I [LVN M] entered the resident room with PM medications in hand. Resident #15 stated, ‘I want to know why I didn't get my 3 o'clock pain medication'. I [LVN M] was not the nurse on duty at that time, apologized to her for her not receiving her 3 pm pain medication. I [LVN M] assured resident [Resident #15] am of what's going however at this time my hands are tied and the only thing I could do was give the medications that are due now. *[DATE] at 1:39 p.m., by the ADON, . Oxycodone Oral 10 MG.first oxycodone given late, so resident [Resident #15] refused this dose. *[DATE] at 8:00 a.m., by the DON, . Oxycodone Oral 10 MG.Resident #15 stated that she did not receive her medication at 6am. Resident state that she is in pain.This nurse [DON] administered medication and contacted NP. Record review of a PIR, Witness Statement by LVN M dated [DATE] indicated, . upon start of shift report is received off going nurse voiced she [RN P] can count with me [LVN M] but she didn't know what was going on either hall because she been all over the place and the ADON kept getting pulled off the floor so its gone be some stuff red cause I couldn't get to it. we [RN P & LVN M] then proceeded to count the nursing cart for A and D and the med aide cart for D. after counting the nurse [RN P] asked well do you want me to go ahead and catch up. I [LVN M] responded letting her know to do what she feels like she needed to do. Then she [RN P] asked for the keys to the cart back. Approx 15 min or so later she brought back the keys saying she has to go.This nurse [LVN M] to continue with only the scheduled medications for my shift. Record review of undated Customer Service Assessment submitted by a family member of Resident #15 indicated, .she [Resident #15] states that she received her 9:00 p.m. medications at 10:00 p.m., which technically not late. she [Resident #15] states that I called the desk at 5:00 about her 4:00 p.m. medications that did not come. she [Resident #15] saw no one until her nurse [LVN M] arrived at 10:00 p.m. Resident #15 states that she went 11 hours without pain medications. Resident #15 states that her medications have been more than two hours late many times, and no one addressed this.Resident #15 understands the window time frame of distributing medications (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 44 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few however this window time frame is very extensive from the prior dose. Record review of Resident #15's grievance dated [DATE] indicated Resident #15 reported to Social Service regarding a grievance related to medications. Resident #15 stated that she did not receive her 6am oxycodone. The DON and ADM were assigned to take action. Resident #15 was provided with her oxycodone at 8am. The grievance was confirmed. During an interview on [DATE] at 5:04 p.m., Resident #15 said she did not get her Gabapentin and Oxycodone at 4 p.m. on [DATE]. She said she woke up around 5:30 p.m. in pain. She said her pain level was a 6 on scale from 1-10. She said she had called the front desk at 6:15 p.m. and 6:40 p.m., asking for her 4 p.m. medications. She said LVN M did not show up until almost 10:00 p.m. She said when LVN M finally showed up, her pain level was 7-8. She said LVN M did not offer to give a prn medication or non-pharmacological option to help with the pain. She said she had not had pain medication since 11am. She said she was so upset. She said her pain medications were given late a lot and they also missed doses. During an interview on [DATE] at 10:42 a.m., LVN M said she had been employed at the facility for about 30 days. She said she worked 6pm-6am shift. LVN M said Resident #15 was upset about not receiving her 4 p.m. pain medications. She said she arrived around 10 p.m. to give Resident #15 the evening medications. She said Resident #15 said she was in pain but did not tell her a specific number. She said Resident #15 said she was always in pain. She said CNA TT reported to her around 9:30 p.m. that Resident #15 was looking for her pain medications. She said she thought Resident #15 was looking for her pm medications, not her missed afternoon pain meds. She said when a resident did not receive their scheduled pain medication, it could affect their mood, sleep, and participation in therapy. She said the MAs and CNs were responsible for administering the residents' pain medication on schedule. She said the MAs and CNs documented pain medication administration in the facility's charting system and narcotic count sheet. She said the residents' pain assessment should be documented in the facility's charting system. She said the residents' pain should be assessed before and after administering pain medication and with complaints of pain. She said she did not go back and check on Resident #15's pain level until 1am. She said Resident #15 did not want her in her room after their disagreement. She said she received report from RN P on [DATE]. She said RN P, said she did not know if she gotten to everything due for the shift. She said RN P, said there were residents' medications left in red. She said she did not remember, if RN P specified, that Resident #15 did not get her scheduled medications. During an interview on [DATE] at 2:52 p.m., RN P said she started back at the facility recently and started orientation around [DATE]. RN P said on [DATE], she and the ADON were working the same medication cart. She said she did not know which residents got their medications or not. She said Resident #15 may have been one of the residents who did not get their medications on [DATE]. She said Resident #15 was in her right mind. She said if Resident #15 said she did not get her pain medications, then she did not. She said the facility was short staffed that day ([DATE]). She said the residents' needed their pain medications because they could become agitated and be in pain. She said the residents should get their scheduled medications because it was ordered that way. She said the residents could not be able to sleep, eat, or be bothered when in pain. She said the MAs and CNs documented pain medication administration in the facility's charting system on the MAR. She said they also charted on the residents' narcotic count sheet. During an interview on [DATE] at 12:42 p.m., Resident #15 said she would have wanted to be woken up on [DATE] at 1am for her pain medication. She said after she called the front desk several time for her pain medication on [DATE] and no one came; she was mad. She said she got changed before she received her 9pm pain medication on [DATE]. She said she was in a lot of pain during the changing. She said her pain ramped up her agitation. She said which did not help the situation with LVN M. She said LVN M did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 45 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few offer to call the doctor, give her Tylenol, or a heating pad. She said LVN M, said it was not her responsibility to fix what another shift did not do. She said she was just screwed. She said when she got her pain medications late or missed doses, she was chasing her pain. She said her pain level was not going to get back level for a few days. On [DATE] at 5:31 p.m., attempted to contact LVN M by phone and sent text message. During an interview on [DATE] at 6:08 p.m., LVN M said she did not call the MD or NP when Resident #15 had a missed oxycodone dose on [DATE]. She said when she was counseled by the ADM and DON, they said she should have. She said she just did not think the MD or NP would let her have two doses of oxycodone. She said she did not offer Resident #15 any prn pain medication. She said when she previously offered Resident #15 the prn Tylenol for a headache, she said it did not work. She said she did not know Resident #15 had non-pharmacological options ordered. She said it was important to offer other option for pain to help with breakthrough pain. She said it helped keep the residents' pain under control. During an interview on [DATE] at 9:05 a.m., MA U said that scheduled medications were supposed to be given one hour before or after the scheduled time. She said that was the facility's policy. She said Resident #15's 6am oxycodone was administered late because of shift change. She said Resident #15 complained about her medications being late. She said when Resident #15's scheduled pain medications were given late or missed, it messed up the administration times for the next doses. She said Resident #15 could be in pain because of late or missed pain medications. During an interview on [DATE] at 5:03 p.m., CNA TT said Resident #15 called twice about her missed pain medications on [DATE]. She said she reported to LVN M, Resident #15 wanted her pain medications. She said Resident #15 was grimacing and red faced after the incident with LVN M. During an interview on [DATE] at 8:38 a.m., RN T said Resident #15 was not on her assigned hall. She said she had to administer Resident #15's medications because LVN M could not do it anymore. She said she may have given Resident #15's oxycodone late one night. She said she may have forgotten to pass medications to Resident #15 because she was not on her assigned hall. She said Resident #15 should get her scheduled medication on time so she did not hurt. She said it was also important because that was what Resident #15's body was used to. She said the residents' pain assessment were done each shift. She said it was important to do a pain assessment to make sure the pain medication was adequate for relief. During an interview on [DATE] at 10:45 a.m., the DON said she expected the nursing staff to wake the residents up to give medications. She said on [DATE], Resident #15's 6am oxycodone dose was not given. She said she notified the NP and administered the missed dose at 8am. She said she expected the nursing staff to assess the residents' pain every shift. She said it was important to do a pain assessment to address the residents' pain. She said if the residents' pain was not assessed and addressed, they could not be able to do ADLs and be uncomfortable. She said nursing staff should document medication administration when administered, not later. She said it was important to document the medications when administered so it would tell the actual time. She said the nursing staff should be following the 5 rights of medication administration. She said the ADON and DON oversaw the nursing staff to ensure pain assessments were done and timely medication administration. She said they should monitor this process by doing chart audits, reviewing the residents' MARs and TARs. She said she had not had a lot of time to do chart audits. She said morning meetings had not been happening to discuss the residents due to working the floor. 2. Record review of Resident #6's face sheet dated [DATE] indicated Resident #6 was an [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE]. Resident #6 had diagnoses including Dementia (is a general term describing a group of conditions that cause a progressive decline in cognitive abilities, including memory, thinking, reasoning, and judgment, which interfere with daily life), gastrointestinal hemorrhage (is when (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 46 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few there is blood loss from any of the several organs included in your digestive system), and chronic pain. Record review of Resident #6's quarterly MDS assessment dated [DATE] indicated Resident #6 was sometimes understood and sometimes had the ability to understand others. Resident #6 had a BIMS score of 2 which indicated severe cognitive impairment. Resident #6 required supervision for eating, substantial assistance for oral and personal hygiene, and dependent for toileting hygiene, shower/bathe self and dressing. Resident #6 was always incontinent of urine and bowel continence was not rated. Resident #6 received scheduled pain medication. Resident #6 had not received prn pain medications or was offered and declined. Resident #6 had not received non-medication intervention for pain. Resident #6's occasionally experienced pain in last 5 days, made it hard to sleep at night, limited participation in rehabilitation therapy sessions, and limited day-to-day activities. Resident #6 rated his worst pain as a 3 over the last 5 days. Resident #6 received opioid medications. Record review of Resident #6's care plan dated [DATE] indicated: *Resident #6 had impaired cognitive function/dementia or impaired thought process related to diagnosis of dementia. Intervention included monitor/document/report to MD any change in cognitive function. *Resident #6 had ADL self-care performance deficit. Intervention included monitor/document/report to MD PRN any changes and declined in function. Record review of Resident #6's care plan dated [DATE] indicated Resident #6 was on routine pain medication therapy. Intervention included administer medication as ordered Record review of Resident #6's care plan dated [DATE] indicated: *Resident #6 had terminal prognosis and/or was receiving hospice services. Intervention included observe closely for signs of pain, administer pain medication as ordered, and notify physician immediately if there was breakthrough pain. Work with nursing staff to provide maximum comfort for the resident. *Resident #6 required hospice as evidence by terminal illness. Intervention included monitor for signs and symptoms of increased pain and discomfort. Give meds and treatments and monitor for relief. Assists with ADLs and provide comfort measures as needed. Record review of Resident #6's order summary dated [DATE]-[DATE] indicated: *Tramadol Oral Tablet 50 MG, give 2 tablets by mouth two times a day related to chronic pain. Start dated [DATE]. *Tylenol Oral Capsule 325 MG, give 2 capsules by mouth every 4 hours as needed for mild pain or fever. Start date [DATE]. *Tylenol with codeine #3 Tablet 300-30 MG (is a prescription combination pain medication containing acetaminophen and the opioid codeine), give 1 tablet by mouth every 8 hours as needed for pain. Start date [DATE]. *Lorazepam Tablet 0.5 MG (is used to treat anxiety disorders), give 1 tablet by mouth every 4 hours as needed for agitation. Start dated [DATE]. *Morphine Sulfate 10MG/5ML (is a powerful opioid analgesic used to treat moderate to severe pain), give 10 milligrams by mouth every 3 hours as needed for pain. Start date [DATE]. The order summary did not reflect a pain assessment every shift. Record review of Resident #6's MAR dated [DATE]-[DATE] indicated: *Tramadol Oral Tablet 50 MG, give 2 tablets by mouth two times a day related to chronic pain. Start dated [DATE]. The MAR indicated Resident #6 received 35 of 44 doses. *Tylenol Oral Capsule 325 MG, give 2 capsules by mouth every 4 hours as needed for mild pain or fever. The MAR indicated administration on [DATE] for pain level of 4. *Tylenol with codeine #3 Tablet 300-30 MG (is a prescription combination pain medication containing acetaminophen and the opioid codeine), give 1 tablet by mouth every 8 hours as needed for pain. The MAR did not reflect any administrations. *Lorazepam Tablet 0.5 MG (is used to treat anxiety disorders), give 1 tablet by mouth every 4 hours as needed for agitation. The MAR did not reflect any administrations. *Morphine Sulfate 10MG/5ML (is a powerful opioid analgesic used to treat moderate to severe pain), give 10 milligrams by mouth every 3 hours as needed for pain. The MAR did not reflect any administrations. Record review of Resident #6's Individual Control Drug Record for Morphine indicated the starting balance of 30 ML and destroyed quantity of 30 ML. The record did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 47 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few reflect any administrations. Record review of Resident #6's progress notes dated [DATE]-[DATE] indicated: *[DATE] at 3:36 p.m. by LVN A, .Resident #6 has new order for Tylenol #3 for every 8 hours PRN for pain. Order to give before baths and wound care. *[DATE] at 9:08 p.m. by MD K, . Progress note.contractures, right knee.contracture, left knee. Stage 2 ulcers. administer Tylenol with codeine #3 as needed for pain.provide comfort care measures. he [Resident #6] exhibits signs of pain, particularly with movement. when attempting to place between his knees, even minimal movement of his left leg caused him to grimace and attempt to push the examiner's [MD K] hand away. *[DATE] at 11:48 a.m. by the DON, . family also informed that the resident [Resident #6] is being repositioned from side to side due to his knees being contracted upwards. Resident #6 moans and groans when turned and repositioned, and during incontinent care. Resident #6 continues to pull the pillow from between knees and pulls the wound care dressing off his knees and hip. Hospice Nurse spoke to the family about increasing routine pain medications. *[DATE] at 6:45 p.m. by the DON, . this nurse [DON] repositioned the resident [Resident #6] onto back, put pillow between his legs, and under his right side. Resident #6 moaning and groaning during repositioning. On [DATE] at 10:27 a.m., attempted to contact LVN O by phone. Contact was unsuccessful and a message was left with callback phone number. During an interview on [DATE] at 11:37 a.m., the DON said Resident #6 was in pain when he was admitted to hospice service. She said Resident #6 could not talk but vocalized pain by moaning. She said Resident #6 would moan when he was messed with. She said the residents' prn pain medications should be administered when the resident was in pain. She said if Resident #6 had prn pain medications ordered, she would have expected them to be used. She said it was important to administer prn pain medications to control pain, especially breakthrough pain. She said if a resident was in pain, it affected their ability to do ADLs or sleep more. She said a pain assessment should be documented in the facility's charting system. She said the nursing staff should document the pain assessment every shift and before prn pain medication was administered. During an interview on [DATE] at 1:20 p.m., the ADON said Resident #6 moaned when he was turned. She said Resident #6 screamed out in pain and grabbed at staff. She said Resident #6 was in pain and anxious when he pulled off his brief and clothes. She said she did not know if the CNs administered Resident #6 prn pain medication when he displayed signs of pain. She said she would have expected the CNs to administer Resident #6's ordered prn pain and anxiety medications when he was in pain. During an interview on [DATE] at 3:16 p.m., MD K said Resident #6 was severely contracted. He said Resident #6 was contracted into a fetal position. He said when he visited Resident #6, he moaned when moved. He said the staff would place a pillow between Resident #6's knees and he would start hollering out in pain. He said he would want the nursing staff to give prn pain medications if there were signs of distress. During an interview on [DATE] at 4:11 p.m., the hospice nurse said Resident #6 was admitted to the company on [DATE]. She said prn comfort medications were ordered for Resident #6. She said she saw Resident #6, two or three times before he expired on [DATE]. She said when the CNAs rolled Resident #6 for incontinence care or repositioning, he would say, stop or put his hand up. She said after Resident #6's care plan meeting on [DATE], she increased his scheduled pain medication. She said she increased Resident #6 scheduled pain medication because she knew he was guaranteed get it. She said Resident #6 was the most contracted man she had ever seen. She said she thought Resident #6 could not participant in therapy anymore because his contractures caused him so much pain. She said Resident #6 would have benefited from receiving prn pain medications. During an interview on [DATE] at 9:45 a.m., LVN L said she used to be the facility's treatment nurse. She said Resident #6 would wince when rolled over for wound care treatments. She said Resident #6 had 3 or 4 pressure ulcers. She said she wanted to say the nursing staff administered Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 48 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few #6 pain medication when he needed it. She said she could not remember though. She said if Resident #6 received prn pain medications, it would be documented on the MAR. She said the residents' pain level was assessed before and after administration. During an interview on [DATE] at 10:38 a.m., the Social Service said the facility had a care plan meeting with a family member of Resident #15. She said the family member of Resident #15 had reported, Resident #15 had been in pain on [DATE]. She said the family member of Resident #15 reported Resident #15 had waited an extended period for pain medication on [DATE]. She said the facility had a care plan meeting for Resident #6 on [DATE]. She said in the meeting, the DON and Hospice Nurse mentioned Resident #6 was in pain when touched or moved. She said they addressed the increased pain by scheduling Resident #6 pain medication. During an interview on [DATE] at 9:28 a.m., CNA AAA said Resident #6 pushed, grabbed, and held on to you when he was messed with. She said Resident #6 hollered out in pain when they would put a pillow between his knees, turned, and changed him. She said Resident #6 needed constant attention because he took off his gown and played in his feces. She said she reported it to the nurses and they gave Resident #6 pain medication. She said Resident #6 got pain medication before his bed baths, if it lined up with his scheduled dose times. She said when Resident #6 hollered out in pain, he was probably due for his scheduled pain medication. She said there may have been times she provided care to Resident #6 and he was in pain. She said the residents should receive pain medication to make them comfortable and easier to take care of. During an interview on [DATE] at 10:10 a.m., LVN O said Resident #6 moaned and groaned when he was turned and changed. She said Resident #6 stopped when they were done. She said she never gave prn pain medication before Resident #6's cares were done. She said she should have since it caused him so much pain. She said she did not premedicate him before wound care treatments. She said Resident #6 would holler out when his knees had to be separated for wound care. She said pain medications should be given to prevent or reduce pain. She said not providing pain medications when a resident displayed signs and symptoms could negatively affect them. During an interview on [DATE] at 1:03 p.m., the ADM said the CNs then the DON was responsible for the residents' pain management. She said the facility had a care plan meeting to address Resident #15's concerns. She said Resident #15 was given the ADON's phone number to contacted if she did not get her scheduled pain medications. She said LVN M should have notified Resident #15's physician when she found out she had missed doses of pain medications. She said LVN M was in-serviced on notifying the physician for missed doses of pain medications. She said LVN M should have offered Resident #15 prn pain medication and non-pharmacological options. She said she expected the nursing staff to follow the pain management policy. She said the staff were in-serviced on the pain management policy after the incident on [DATE] and probably before. She said it was important for the policy to be followed to take care of the residents and not to be in pain. She said Resident #6 was contracted. She said the few times she saw Resident #6; he was asleep. She said Resident #6 experienced pain when his contractures had to be pulled apart. She said she expected the nursing staff to give prn pain medication when needed. She said she expected the nursing staff to perform pain assessments. She said the CNs were responsible for administering prn pain medications. She said prn pain medication should be used when needed for comfort and pain management. She said when prn pain medication was not used, the residents could be uncomfortable, in pain, and decreased quality of life. She said the nursing management and hospice were responsible for Resident #6's pain management. She said they should review the residents' documentation to ensure prn medication were being used when needed. During an interview on [DATE] at 4:39 p.m., Resident #6's family member said Resident #6 moaned and groaned when he was touched. The family member of Resident #6 said they expressed this concern to the facility. During an interview on [DATE] at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 49 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0697 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 12:18 p.m., CNA R said when she was assigned the hall Resident #6 was on, she was a Hospitality Aide. She said she could not provide ADL care on him. She said she never touched Resident #6 but noticed when other staff did, he would be in pain. She said Resident #6 would scream out in pain, push staff away, or say leave me alone. She said when he was in pain, she saw the CNAs tell the nurses. She said she never saw a nurse give Resident #6 pain medication before turning or changing him. She said Resident #6 would have benefited from prn pain medications if he got cares done before the next scheduled dose. Record review of an undated facility's Abuse/Neglect policy indicated, . Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. Neglect is the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress. Record review of an undated facility's Pain Management, Assessment Scale policy indicated, . Pain is a subjective sensation of discomfort derived from multiple sensory nerve interactions generated by physical, chemical, biological. or psychological stimuli. Complaints of pain will be assessed accordingly by the nurse and effectively managed through prescribed medications, and comfort measures, and all available resources of the facility. PRN-if the resident comp Event ID: Facility ID: 675386 If continuation sheet Page 50 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review the facility failed to have sufficient nursing staff with the appropriate competencies and skills set to provide nursing and related services to assure resident safety and attain or maintain the highest practicable, physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity, and diagnoses of the facility's resident population in accordance with the facility assessment for 19 of 25 resident's (Resident's #2, #4, #5, #6, #7, #8, #10, #12, #13, #14, #16, #17, #18, #19, #20, #21, #22, #23, #24) reviewed for sufficient staffing. 1. The facility failed to ensure sufficient facility staff were available to assist Resident #5 with positioning during a tube feeding on 08/20/25. Resident #5's head and torso were leaning over the left armrest of his Geri-chair for approximately 1 hour and 30 minutes, which resulted in aspiration pneumonia. 2. The facility failed to ensure sufficient staff were available to provide wound care treatment and documentation for Resident's #2, #16, #17, #18, #19, #20, #23 and #24 during August 2025 and September 2025. 3. The facility failed to ensure the secured unit was adequately staffed to prevent accidents for Resident's #8, #10, #12, #13, #14, #19, and #21. 4. The facility failed to ensure the secured unit was adequately staffed to provide supervision during mealtime for Resident's #7, #8, #14, #21, and #22 on 09/08/25. 5. The facility failed to follow the facility assessment for sufficient nurse staffing. An immediate jeopardy (IJ) was identified on 09/11/25 at 12:59 PM. The IJ template was provided to the facility on [DATE] at 2:01 PM. While the IJ was removed on 09/13/25 at 12:49 PM, the facility remained out of compliance at a scope of patterned and a severity level of no actual harm with potential for more than minimal harm that is not immediate jeopardy because all staff had not been provided education on abuse and neglect, notification of changes in condition, documentation policy, pain management policy, fall prevention policy, pressure prevention policy, medication administration policy, enteral feeding policy, and the bathing and showers policy. These failures placed residents at risk of inadequate supervision, an unsafe environment, decreased quality of care, increased risk of pressure ulcers, unwitnessed falls, risk for impaired nutrition, serious harm, injury, abuse, and death.The finding included: 1. Record review of the face sheet, dated 09/11/25, reflected Resident #5 was a [AGE] year-old male who admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills), severe protein-calorie malnutrition (not getting enough protein or calories to meet the bodies demands), gastrostomy status (an opening into the stomach from the abdominal wall, made surgically for the introduction of food), anorexia (loss of appetite), and dysphagia (difficulty swallowing). Record review of the quarterly MDS assessment, dated 07/30/25, reflected Resident #5 had unclear speech, was rarely/never understood, and was rarely/never able to understand others. Resident #5 had short-term and long-term memory problems. Resident #5 had no memory or recall ability and had severely impaired decision making skills. The MDS reflected Resident #5 had upper and lower extremity impairments to both sides which interfered with daily functions. The MDS reflected Resident #5 was dependent on staff for all his ADLs. Resident #5 used a feeding tube while a resident and also received a mechanically altered diet. The MDS reflected Resident #5 received 51% of more of his total calories through tube feeding. Record review of the comprehensive care plan, last reviewed 06/17/25, reflected Resident #5 required tube feeing related to anorexia and Alzheimer's disease. The interventions included: .the resident needs the head of bed elevated 30 degrees during and thirty minutes after tube feeding. The care plan further reflected Resident #5 had an ADL self-care deficit and required staff (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 51 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some assistance x 1 with eating. Record review of the order summary report, dated 09/11/25, reflected Resident #5 had an order for regular diet and pureed texture with pudding consistency fluids, [family member] or nurse to assist with feeding. The order started on 08/26/25. Record review of the progress notes reflected the following: On 08/21/25 at 4:03 AM, the note reflected Resident #5's family member requested a chest x-ray due to possible aspiration . due to positioning of resident in chair on previous shift.No signs or symptoms of aspiration noted . head of bed elevated to 30 degrees. On 08/21/25 at 7:47 AM, the note reflected a response was received from the physician for a chest x-ray. On 08/22/25 at 3:29 AM, the note reflected Resident #5 was transferred to the hospital related to chest x-ray results findings indicated aspiration. Record review of Resident #5's diagnostic chest x-ray report, dated 08/21/25, reflected .reported gastrostomy tube [opening from the abdomen directly into the stomach] is not definitely visualized.air distended stomach.left basilar airspace disease [condition in which the lower lungs of the left lung collapse, preventing air exchange], likely atelectasis [collapse of lung or part of lung from lack of air in the air sacs] given elevation of the hemidiaphragm. Record review of the inpatient hospital record, dated 08/22/25, reflected Resident #5 arrived at the hospital at 4:04 AM via ambulance and was discharged back to the facility at 5:46 AM. The problems addressed was aspiration into airway, initial encounter. 2. Record review of Resident #2's face sheet dated 9/11/25 indicated Resident #2 was an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #2 had diagnosis including acute posthemorrhagic anemia (is a condition that develops when you lose a large amount of blood quickly), heart failure (is a condition where the heart muscle cannot pump blood effectively enough to meet the body's needs), type 2 diabetes (is a chronic condition that happens when you have persistently high blood sugar levels), dementia (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life), and pressure ulcer of left heel, stage 3 (injuries extend through the skin into deeper tissue and fat but do not reach muscle, tendon, or bone). Record review of Resident #2's quarterly MDS assessment dated [DATE] indicated Resident #2 was understood and usually had the ability to understand others. Resident #2's had a BIMS score of 7 which indicated moderate cognitive impairment. Resident #2 required setup assistance for eating, supervision for oral hygiene, partial assistance for upper body dressing and personal hygiene, and dependent for toileting hygiene, shower/bathe self, and lower body dressing. Resident #2 was always incontinent for urine and occasionally incontinent for bowel. Resident #2 had one, stage 3 unhealed pressure ulcers/injuries. Resident #2 had pressure reducing device for bed and pressure ulcer/injury care. Record review of Resident #2's care plan, revised on 9/11/25, indicated Resident #2 had a pressure ulcer due to decreased mobility. Resident #2 had stage 3 pressure injury to left heel. Interventions included follow facility policies/protocols for the prevention/treatment of skin breakdown and administer medications as ordered. Record review of Resident #2's order summary report dated 9/11/25 indicated: Stage 3 pressure injury, cleanse left heel with normal saline, apply collagen powder, and cover with gauze island with border every day and as needed, one time a day for wound healing. Start date 8/25/25. Record review of Resident #2's wound administration record dated 8/1/25-8/31/25 indicated: Cleanse left heel with normal saline, apply collagen powder, and cover with gauze island with border every day and as needed, one time a day for wound healing. Discontinued 8/24/25. Resident #2 did not have documentation for administration on 8/20/25, 8/21/25, 8/23/25, and 8/24/25. Resident #2 was in the hospital 8/3/25-8/13/25. Record review of Resident #2's wound administration record dated 9/1/25-9/30/25 indicated: Stage 3 pressure injury: Cleanse left heel with normal saline, apply collagen powder, and cover with gauze island with border every day and as needed, one time a day for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 52 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some wound healing. Resident #2 did not have documentation for administration on 9/2/25, 9/5/25, 9/6/25, and 9/8/25. 3. Record review of the face sheet, dated 09/11/25, reflected Resident #16 was a [AGE] year-old female who initially admitted to the facility on [DATE] had diagnoses of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills), pressure ulcer of sacral region, stage 4 (wound created from pressure that is characterized by full-thickness skin loss that extends to muscle, tendon, and/or bone), and chronic osteomyelitis (bone infection). Record review of the significant change MDS assessment, dated 08/04/25, reflected Resident #16 had unclear speech, was rarely/never understood, and was rarely/never able to understand others. Resident #16 had short-term and long-term memory problems, no memory recall ability, and severely impaired decision making skills. The MDS reflected Resident #16 had upper and lower extremity impairment to both sides that interfered with daily functions. Resident #16 was normally dependent on staff for all ADLs. Resident #16 had two stage 3 pressure ulcers and eight arterial wounds. The MDS reflected Resident #16 had a pressure reducing device for bed, nutrition or hydration interventions, pressure ulcer/injury care, application of non-surgical dressing, and application of dressings to feet. Record review of the comprehensive care plan, last reviewed 09/03/25, reflected the following: Resident #16 had an arterial wound to the right lateral ankle. The interventions included: position and treat the wound per facility protocol. Resident #16 had an arterial wound to the right heel. The interventions included: position and treat the wound per facility protocol. Resident #16 had an arterial wound of the left dorsal foot. The interventions included: position and treat the wound per facility protocol. Resident #16 had an arterial wound of the left heel. The interventions included: position and treat the wound per facility protocol. Resident #16 had an arterial wound of the right first toe. The interventions included: position and treat the wound per facility protocol. Resident #16 had a stage 3 pressure injury to her right upper back. The interventions included: follow facility protocol for treatment of injury, assist with turning and repositioning every 2 hours and as needed; low air loss mattress. Resident #16 had a stage 3 pressure ulcer to right upper back. The interventions included: Administer treatment and monitor for effectiveness, avoid positioning on injury, float heels, follow facility policies/protocols for prevention and treatment of skin issues, turn and reposition every 2 hours, cushion to wheelchair, bed as flat as possible, and use lifting devices, draw sheet, etc. to reduce friction. Resident #16 had a stage 3 pressure injury to sacrum. The interventions included: follow facility protocol for treatment of injury, assist with turning and repositioning every 2 hours and as needed; low air loss mattress. Resident #16 had an arterial wound to left shin. The interventions included: position and treat the wound per facility protocol. Resident #16 had an arterial wound to right shin. The interventions included: position and treat the wound per facility protocol. Resident #16 had a non-pressure wound to right chest. The interventions included: treat the wound per facility protocol. Record review of Resident #16's order summary report, dated 09/11/25, reflected the following: Arterial wound left heel. Apply skin prep three times a week and as needed until healed, every Monday, Wednesday, and Friday. Start date 08/11/25. Arterial wound of the left calf. Cleanse with normal saline, pat dry, apply xeroform to wound bed, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. Start date 09/05/25. Arterial wound of the left dorsal foot. Cleanse with normal saline, pat dry, apply xeroform to wound bed, wrap with kerlix, every day and as needed if saturated, soiled, or dislodged. Start date 09/05/25. Arterial wound of the left shin. Cleanse with normal saline, pat dry, apply xeroform to wound bed, wrap with kerlix, every day and as needed if saturated, soiled, or dislodged. Start date 09/05/25. Arterial wound of the right first toe. Apply skin prep 3 times a week on Monday, Wednesday, and Friday. Start date 09/08/25. Arterial wound (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 53 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some of the right foot. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. Start date 09/06/25. Arterial wound of the right heel. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix 3 times a week and as needed if saturated, soiled, or dislodged. Start date 08/06/25. Arterial wound of the right lateral ankle. Cleanse with normal saline, pat dry, apply Medi honey to wound bed, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. Start date 09/05/25. Arterial wound of the right shin. Cleanse with normal saline, pat dry, apply xeroform gauze, cover with dry border dressing three times per week and as needed if saturated, soiled, or dislodged every Monday, Wednesday, and Friday. Start date 08/06/25. Non-pressure injury of the right chest. Cleanse with normal saline, pat dry, apply alginate calcium, cover with dry dressing every day and as needed if saturated, soiled, or dislodged. Start date 08/05/25. Stage 3 pressure injury to upper back. Cleanse with normal saline, pat dry, apply calcium alginate, and cover with bordered dressing one time a day. Start date 08/25/25. Record review of Resident #16's wound administration record dated 8/1/25-8/31/25 indicated: Arterial wound left heel. Apply skin prep three times a week and as needed until healed, every Monday, Wednesday, and Friday. Resident #16 did not have documentation of administration on 08/11/25, 08/18/25, 08/20/25, and 08/29/25. Arterial wound of the left dorsal foot. Cleanse with normal saline, pat dry, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 08/04/25 and was missing documentation of administration for 08/02/25. Arterial wound of the left dorsal foot. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix every day and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 09/05/25. Resident #16 was missing documentation of administration on 08/05/25, 08/06/25, 08/09/25, 08/10/25, 08/11/25, 08/14/25, 08/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/21/25, and 08/29/25. Arterial wound of the left shin. Cleanse with normal saline, pat dry, apply Medi honey to wound bed, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 08/04/25 and was missing documentation of administration for 08/02/25. Arterial wound of the left shin. Cleanse with normal saline, pat dry, apply Medi honey to wound bed, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 09/05/25. Resident #16 was missing documentation of administration on 08/05/25, 08/06/25, 08/09/25, 08/10/25, 08/11/25, 08/14/25, 08/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/21/25, and 08/29/25. Arterial wound of the right foot. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix once daily and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 08/04/25 and was missing documentation of administration for 08/02/25. Arterial wound of the right foot. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix once daily and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 08/06/25 and was missing documentation of administration for 08/05/25 and 08/06/25. Arterial wound of the right lateral ankle. Cleanse wound with normal saline, pat dry, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on 09/05/25. Resident #16 was missing documentation of administration on 08/09/25, 08/10/25, 08/11/25, 08/14/25, 08/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/21/25, and 08/29/25. Arterial wound of the right lateral ankle. Cleanse wound with normal saline, pat dry, apply Medi honey to wound bed, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged one time a day for wound healing. The order was stopped on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 54 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some 08/04/25 and was missing documentation of administration for 08/02/25. Arterial wound of the right lateral ankle. Cleanse wound with normal saline, pat dry, apply Medi honey to wound bed, apply calcium alginate, wrap with kerlix every day and as needed if soiled or dislodged one time a day for wound healing. The order was stopped on 08/06/25 and was missing documentation of administration for 08/06/25. Arterial wound of the right shin. Cleanse with normal saline, pat dry, apply xeroform gauze, cover with dry border dressing tree times per week and as needed if saturated, soiled, or dislodged one time a day every Monday, Wednesday, and Friday for wound healing. Resident #16 was missing documentation for 08/06/25, 08/11/25, 08/18/25, 08/20/25, and 08/29/25. Non-pressure injury of the right chest. Cleanse with normal saline, pat dry, apply alginate calcium, cover with dry dressing every day and as needed if dressing is saturated, soiled, or dislodged one time a day for wound healing. Resident #16 was missing documentation of administration for 08/02/25, 08/05/25, 08/06/25, 08/09/25, 08/10/25, 08/11/25, 08/14/25, 08/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/21/25, and 08/29/25. Pressure wound to upper back. Apply calcium alginate to wound bed and dry dressing one time a day for promote wound healing. The order was stopped on 08/24/25 and was missing documentation of administration for 08/09/25, 08/10/25, 08/11/25, 08/14/15, 8/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, 08/21/25, 08/24/25, and 08/29/25. Stage 3 pressure injury to right upper back. Cleanse with normal saline, pat dry, apply Medi honey, cover with dry dressing every day and as needed if dressing is saturated, soiled, or dislodged, one time a day for wound healing. The order was stopped on 08/12/25 and was missing documentation of administration for 08/02/25, 08/05/25, 08/06/25, 08/09/25, 08/10/25, and 08/11/25. Stage 3 pressure injury to sacrum. Cleanse with normal saline, pat dry, apply xeroform gauze, cover with dry dressing every day and as needed if dressing is saturated, soiled or dislodged, one time a day for wound healing. The order was stopped on 08/28/25. Resident #16 was missing documentation of administration for 08/02/25, 08/05/25, 08/06/25, 08/09/25, 08/10/25, 08/11/25, 8/14/15, 8/16/25, 08/17/25, 08/18/25, 08/19/25, 08/20/25, and 08/21/25. Record review of Resident #16's wound administration record dated 9/1/25-9/30/25 indicated: Arterial wound of the left heel. Apply skin prep 3 times a week and as needed until healed one time a day every Monday, Wednesday, and Friday for promote wound healing. Resident #16 had missing documentation of administration for 09/03/25, 09/05/25, and 09/08/25. Arterial wound of the left calf. Cleanse with normal saline, pat dry, apply xeroform to wound bed, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. Resident #16 had missing documentation of administration for 09/08/25 and 09/09/25. Arterial wound of the left dorsal foot. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix every day and as needed if saturated, soiled, or dislodged for wound healing. The order was stopped on 09/05/25 and was missing documentation of administration for 09/02/25, 09/03/25, and 09/05/25. Arterial wound of the left dorsal foot. Cleanse with normal saline, pat dry, apply xeroform to wound bed, wrap with kerlix every day and as needed if saturated, soiled or dislodged for wound healing. Resident #16 was missing documentation of administration for 09/08/25 and 09/09/25. Arterial wound of the left shin. Cleanse with normal saline, pat dry, apply Medi honey to wound bed, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. The order was stopped on 09/05/25 and was missing documentation of administration for 09/02/25, 09/03/25, and 09/05/25. Arterial wound of the left shin. Cleanse with normal saline, pat dry, apply xeroform to wound bed, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. Resident #16 was missing documentation of administration for 09/08/25 and 09/09/25. Arterial wound of the right first toe. Apply skin prep three times a week on day shift on Monday, Wednesday, and Friday. Resident #16 was missing documentation of administration for 09/08/25. Arterial wound of the right foot. Cleanse with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 55 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some normal saline, pat dry, apply skin prep, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. There was missing documentation of administration on 09/08/25 and 09/09/25. Arterial wound of the right heel. Cleanse with normal saline, pat dry, apply skin prep, wrap with kerlix three times a week and as needed is saturated, soiled, or dislodged one time a day every Monday, Wednesday, and Friday for wound healing. There was missing documentation of administration for 09/03/25 and 09/08/25. Arterial wound of the right lateral ankle. Cleanse wound with normal saline, pat dry, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. The order was stopped on 09/05/25 and there was missing documentation of administration for 09/02/25, 09/03/25, and 09/05/25. Arterial wound of the right lateral ankle. Cleanse wound with normal saline, pat dry, apply Medi honey to wound bed, apply alginate calcium, wrap with kerlix every day and as needed if saturated, soiled, or dislodged. There was missing documentation for 09/08/25 and 09/09/25. Arterial wound of the right shin. Cleanse with normal saline, pat dry, apply xeroform gauze, cover with dry border dressing three times per week and as needed if saturated, soiled, or dislodged. There was missing documentation of administration for 09/03/25 and 09/08/25. Non-pressure injury of the right chest. Cleanse with normal saline, pat dry, apply alginate calcium, cover with dry dressing every day and as needed if dressing is saturated, soiled, or dislodged for wound healing. There was missing documentation of administration for 09/02/25, 09/03/25, 09/08/25, and 09/09/25. Stage 3 pressure injury to upper back. Cleanse with normal saline, pat dry, apply alginate calcium, cover with bordered dressing one time a day for promote wound healing. There was missing documentation of administration for 09/02/25, 09/03/25, 09/08/25, and 09/09/25. 4. Record review of the face sheet, dated 09/11/25, reflected Resident #17 was an [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills) and pressure ulcer of the sacral region, stage 4 (wound created from pressure that is characterized by full-thickness skin loss that extends to muscle, tendon, and/or bone). Record review of the significant change MDS assessment, dated 08/22/25, reflected Resident #17 had clear speech, was usually understood, and was usually able to understand others. Resident #17 had short-term and long-term memory problems, no recall ability, and severely impaired decision making skills. The MDS reflected Resident #17 had upper and lower extremity impairment to both sides that interfered with daily function. Resident #17 required total dependence with most ADLs. The MDS reflected Resident #17 had a stage 4 pressure ulcer. Resident #17 had a pressure reducing device for the bed and applications of nonsurgical dressings. Record review of the comprehensive care plan, last reviewed on 09/04/25, reflected Resident #17 had a stage 4 pressure injury to her sacrum. The interventions included: treatment as ordered and monitor effectiveness, turn and reposition every 2 hours, and air mattress. Record review of Resident #17's order summary report, dated 09/11/25, reflected the following: Stage 4 pressure injury to sacrum. Cleanse with normal saline, pat dry, apply collagen powder, apply calcium alginate, cover with dry border dressing daily and as needed if soiled or dislodged. Start date of 07/25/25. Record review of Resident #17's wound administration record dated 8/1/25-8/31/25 indicated: Stage 4 pressure injury to sacrum. Cleanse with normal saline, pat dry, apply collagen powder, apply calcium alginate, cover with dry border dressing daily and as needed if soiled or dislodged. There was missing documentation of administration for 08/06/25, 08/07/25, 08/12/25, 08/15/25, 08/16,25, 08/17/25, 08/20/25, 08/21/25, and 08/24/25. Record review of Resident #17's wound administration record dated 9/1/25-9/30/25 indicated: Stage 4 pressure injury to sacrum. Cleanse with normal saline, pat dry, apply collagen powder, apply calcium alginate, cover with dry border dressing daily and as needed if soiled or dislodged. There was missing documentation of administration (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 56 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some for 09/02/25, 09/05/25, 09/06/25, and 09/08/25. 5. Record review of the face sheet, dated 09/12/25, reflected Resident #18 was an [AGE] year-old male who initially admitted to the facility on [DATE] with diagnoses of brain bleed, peripheral vascular disease (refers to any disease or disorder of the circulatory system outside of the brain and heart), stroke, and a history of colon, lung, and testicular cancer. Record review of the significant change MDS assessment, dated 07/16/25, reflected Resident #18 had clear speech, was understood, and was able to understand others. Resident #18 had a BIMS score of 15, which indicated no cognitive impairment. The MDS reflected Resident #18 had an upper extremity impairment to one side and a lower extremity impairment to both sides that interfered with daily function. The MDS reflected Resident #18 required total dependence with showers, toileting, and personal hygiene. Resident #18 required set-up help with eating and oral hygiene. Resident #18 required substantial/maximum assistance with dressing, bed mobility, and transfers. The MDS assessment reflected Resident #18 had a stage 4 pressure ulcer. Resident #18 had a pressure reducing device for bed and received pressure ulcer/injury care. Record review of the comprehensive care plan, last reviewed 07/14/25, reflected Resident #18 had a stage 4 pressure injury to right heel. The interventions included: treatment per orders and monitor for effectiveness, turn and reposition every 2 hours, and encourage the use of podus boot. Record review of Resident #18's order summary report, dated 09/12/25, reflected the following: Stage 4 pressure ulcer to right heel. Cleanse with normal saline, pat dry, apply collagen to wound bed, apply calcium alginate, and cover with dry dressing and wrap with kerlix daily and as needed related to soiling/dislodgement to promote wound healing. Start date of 06/18/25. Record review of Resident #18's wound administration record dated 8/1/25-8/31/25 indicated: Apply collagen powder to wound bed, cover with calcium alginate and dry dressing one time a day for promote wound healing. The order was stopped on 09/07/25. There was missing documentation of administration for 08/12/25, 08/14/25, 08/16/25, 08/20/25, 08/21/25, 08/23/25, and 08/25/25. Dakin's (1/4 strength) external solution 0.125% (sodium hypochlorite) - apply to right heel topically once time a day for apply Dakin's soaked gauze to wound bed. The order was stopped on 09/07/25. There was missing documentation of administration for 08/06/25, 08/07/25, 08/12/25, 08/16/25, 08/20/25, 08/21/25, and 08/24/25. Lymphedemic wound to left heel. Apply skin prep daily one time a day for promote wound healing. There was missing documentation of administration for 08/06/25, 08/07/25, 08/12/25, 08/16/25, 08/20/25, 08/21/25, and 08/24/25. Stage 4 pressure ulcer to right heel. Cleanse with normal saline, pat dry, apply collagen to wound bed, apply calcium alginate, and cover with dry dressing and wrap with kerlix daily and as needed related to soiling/dislodgment. There was missing documentation of administration for 08/06/25, 08/07/25, 08/12/25, 08/16/25, 08/20/25, 08/21/25, and 08/24/25. Record review of Resident #18's wound administration record dated 9/1/25-9/30/25 indicated: Apply collagen powder to wound bed, cover with calcium alginate and dry dressing one time a day for promote wound healing. The order was stopped on 09/07/25. There was missing documentation of administration for 09/02/25, 09/05/25, and 09/06/25. Dakin's (1/4 strength) external solution 0.125% (sodium hypochlorite) - apply to right heel topically one time a day for apply Daikin's soaked gauze to wound bed. The order was stopped on 09/07/25. There was missing documentation of administration for 09/02/25, 09/05/25, and 09/06/25. Lymphedemic wound to left heel. Apply skin prep daily one time a day for promote wound healing. There was missing documentation of administration for 09/02/25, 09/05/25, and 09/06/25. Stage 4 pressure ulcer to right heel. Cleanse with normal saline, pat dry, apply collagen to wound bed, apply calcium alginate, and cover with dry dressing and wrap with kerlix daily and as needed related to soiling/dislodgement. There was missing documentation of administration for 09/02/25, 09/05/25, and 09/06/25. 6. Record review of the face sheet, dated 09/12/25, reflected Resident #19 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 57 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0725 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete was a [AGE] year-old female who initially admitted to the facility on [DATE] with diagnoses of senile degeneration of brain (encompasses a range of neurological disorders characterized by a progressive decline in cognitive function, impacting memory, reasoning, and the ability to perform everyday activities). Record review of the significant change MDS assessment, dated 08/06/25, reflected Resident #19 had unclear speech, was sometimes understood, and was sometimes able to understand others. Resident #19 had a BIMS score of 4, which indicated severe cognitive impairment. The MDS reflected Resident #19 had a lower extremity impairment to both sides which interfered with daily function. Resident #19 was totally dependent on staff for ADLs, which included eating. The MDS reflected Resident #19 had a fall within the last month prior to admission. Resident #19 was checked for signs and symptoms of a swallowing disorder: holding food in mouth/cheeks or residual food in mouth after meals. Resident #19 required a mechanically altered diet while a resident of the facility. The MDS reflected Resident #19 was at risk for developing pressure ulcers/injuries. Resident #19 had a pressure reducing device for the bed. Record review of Resident #19's comprehensive care plan, last reviewed 09/09/25, reflected the following: Resident #19 had an ADL self-care performance deficit and required staff assistance x 1 with eating and was resistive to eating at times. Resident #19 had a history of falls and the interventions included: fall mat beside bed, appropriate footwear, call light in reach, anticipate needs, and staff assistance x 2 with transfers. Resident #19 had a stage 2 pressure ulcer to her right buttocks. The interventions included: treatments as ordered and monitor for effectiveness and follow facility policies/protocols for the prevention/treatment of pressure injuries. Record review of Resident #19's order summary report, dated 09/12/25, reflected the following: Regular diet with pureed texture, and regular c Event ID: Facility ID: 675386 If continuation sheet Page 58 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview, and record review the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 5 of 25 residents (Resident's #1, #2, #3, #7, and #8) reviewed for infection control practices. 1. The facility failed to ensure facility staff followed infection control protocol during a COVID-19 outbreak at the facility. 2. The facility failed to ensure Residents #1, #2, and #3 had airborne isolation precaution signage outside their room door on 09/08/25. 3. The facility failed to ensure the staff had access to face shields or goggles on the PPE isolation carts on 09/08/25 and 09/09/25. 4. The facility failed to ensure LVN A, MA B, and CNA C wore the appropriate PPE (face shield or goggles and N-95 mask) into a COVID-19 positive room, when providing care and services on 09/08/25. LVN A and MA B continued to provide care to residents on the secured unit and outside the secured unit who were not COVID-19 positive, wearing the same masks worn in the COVID-19 positive rooms. 5. The facility failed to ensure LVN A and MA B had access to hand sanitizer and performed hand hygiene after exiting a COVID-19 positive room and removing their PPE. 6. The facility failed to ensure Resident #7, and Resident #8 were tested for COVID-19 when they developed signs and symptoms. These failures could place residents and staff at risk for cross contamination and the spread of COVID-19, an infectious disease. The findings included: Record review of the COVID response plan, revised 05/08/23, reflected .implement source control measures. source control refers to use of respirators or well-fitting facemasks or cloth masks to cover a person's mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing. source control measures are recommended for people with suspected infection, had close contact with someone with COVID or those working in an area that is experiencing an outbreak.anyone with even mild symptoms of COVID-19.should receive a test as soon as possible.suspected or confirmed COVID-19 infection health care personnel should adhere to standard precautions and use an N-95 or higher mask, gown, gloves, and eye protection (face shield or goggles) . Record review of the Fundamentals of Infection Control Precautions policy, undated, reflected .hand hygiene continues to be the primary means of preventing the transmission of infection. The following is a list of some situations that require hand hygiene.before and after enter isolation precaution settings.before and after assisting a resident with meals.the wearing of masks, eye protection, and face shields in specified circumstances is mandatory. 1. Record review of the face sheet, dated 09/11/25, reflected Resident #1 was a [AGE] year-old male who initially admitted to the facility on [DATE] with a diagnosis of cerebral ischemia (disrupted blood flow to the brain). Record review of the quarterly MDS assessment, dated 08/12/25, reflected Resident #1 had clear speech, was understood by others, and was able to understand others. Resident #1 had a BIMS score of 4, which indicated severe cognitive impairment. Resident #1 had no behaviors or refusal of care. Record review of the comprehensive care plan, revised 09/13/20, reflected Resident #1 was at risk for signs and symptoms of COVID-19. The interventions included follow facility protocol for COVID-19 screening and precautions. Record review of the order summary report, dated 09/11/25, reflected Resident #1 had an order, which started on 09/07/25, for contact droplet isolation precautions x 10 days. 2. Record review of Resident #2's face sheet dated 09/11/25 indicated Resident #2 was an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Resident #2 had diagnosis including acute posthemorrhagic anemia (is a condition that develops when you lose a large amount of blood quickly), heart failure (is a condition where the heart muscle cannot pump blood effectively enough to meet the body's needs), type 2 diabetes (is a Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 59 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some chronic condition that happens when you have persistently high blood sugar levels), dementia (is a general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life), and pressure ulcer of left heel, stage 3 (injuries extend through the skin into deeper tissue and fat but do not reach muscle, tendon, or bone). Record review of Resident #2's quarterly MDS assessment dated [DATE] indicated Resident #2 was understood and usually had the ability to understand others. Resident #2's had a BIMS score of 7 which indicated severe cognitive impairment. Resident #2 required setup assistance for eating, supervision for oral hygiene, partial assistance for upper body dressing and personal hygiene, and dependent for toileting hygiene, shower/bathe self, and lower body dressing. Resident #2 was always incontinent for urine and occasionally incontinent for bowel. Resident #2 had one, stage 3 unhealed pressure ulcers/injuries. Resident #2 had pressure reducing device for bed and pressure ulcer/injury care. Record review of Resident #2's care plan dated 09/06/25 indicated Resident #2 required care and isolation precautions specifically related to active COVID-19 infection. Intervention included ensure that good infection control measures and personal protective equipment is used when working with me. Record review of Resident #2's order summary report dated 09/11/25 indicated: Contact Droplet Isolation every shift for positive COVID-19 for 10 days. Start date 09/06/25. Record review of Resident #2's progress notes dated 8/12/25-9/12/25 indicated:*9/6/25 at 10:30 a.m., .Resident #2 was being tested for COVID. non-productive cough. currently on contact precautions. the resident should not leave their room, and all care and services must be performed in the room.MD notified 9/6/25 at 10:50 a.m. RP notified 9/6/25 at 10:50 a.m.LVN W*9/6/25 at 10:39 a.m., .Covid test positive.LVN W 3. Record review of Resident #3's face sheet dated 09/11/25 indicated Resident #3 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #3 had diagnoses including chronic kidney disease (is a condition in which the kidneys gradually lose their ability to filter waste products from the blood), stage 3, type 2 diabetes (is a chronic condition that happens when you have persistently high blood sugar levels), and age-related cognitive decline. Record review of Resident #3' quarterly MDS assessment dated [DATE] indicated Resident #3 was understood and had the ability to understand others. Resident #3 had a BIMS score of 13 which indicated intact cognition. Resident #3 was independent for eating and required setup for oral hygiene, substantial assistance for shower/bath self and personal hygiene, and dependent for toileting hygiene. Resident #3 was always incontinent for urine and bowel. Record review of Resident #3's care plan dated 09/07/25 indicated Resident #3 required care and isolation precautions specifically related to active COVID-19 infection. Intervention included ensure that good infection control measures and personal protective equipment is used when working with me. Record review of Resident #3's order summary dated 9/11/25 indicated Contact Droplet Isolation every shift for positive COVID-19 for 10 days. Start date 9/6/25. Record review of Resident #3's progress notes dated 8/12/25-9/12/25 indicated:*9/5/25 at 9:51 p.m., .wet cough and congestion noted.MD K notified. new order for Mucinex. LVN M.*9/6/25 at 10:30 a.m., . [Resident #3] is being treated for COVID. nasal congestion and non-productive cough.MD K notified.RP notified. currently on contact precautions. LVN W.*9/6/25 at 10:35 a.m., .Covid test positive.LVN W 4. Record review of the face sheet, dated 09/11/25, reflected Resident #7 was an [AGE] year-old female who admitted to the facility on [DATE] with a diagnosis of Alzheimer's disease (a brain disorder that slowly destroys a person's memory and thinking skills). Record review of the admission MDS assessment, dated 08/19/25, reflected Resident #7 had clear speech, was usually understood, and was usually able to understand other. Resident #7 had a BIMS score of 2, which indicated severe cognitive impairment. The MDS reflected Resident #7 wandered daily but had no refusal of care. The MDS reflected Resident #7 required partial/moderate assistance (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 60 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with showers/bathing and was independent with eating. Record review of the comprehensive care plan, revised on 09/10/25, reflected Resident #7 was at risk for signs or symptoms of COVID-19 due to wandering on the secured unit. The interventions included: follow facility protocol for COVID-19 screening/precautions, observe for signs or symptoms of COVID-19 document and promptly report. 5. Record review of Resident #8's face sheet dated 09/11/25 indicated Resident #8 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #8 had diagnoses including dementia with anxiety (a group of thinking disorders that interferes with activities of daily living with intense, excessive, and persistent worry and fear about everyday situations), chronic obstructive pulmonary disease (decrease airflow of the lungs), protein calorie malnutrition (when not enough protein calories are consumed to meet the body's needs), hypertension (high blood pressure). Record review of Resident #8's admission MDS assessment, dated 08/16/25, reflected Resident #8 was able to understand others and was understood by others. Resident #8 had a BIMS score of 4, which indicated her cognition was severely impaired. Resident #8 required setup and cleanup assistance with eating, and partial to moderate assistance with shower, toileting, and lower body dressing and personal hygiene. Record review of Resident #8's care plan, dated 09/09/2025, reflected Resident #8 had an acute COVID-19 infection. The interventions included: stay in room as much as possible, monitor labs, x-rays, vital signs, effectiveness of medication. Record review of Resident #8's Order Summary Report indicated an order, which started on 09/10/25, for Contact/Droplet isolation for COVID-19 x 10 days. During an observation on 09/08/25 at 8:45 AM, the front doors had no signage to indicate the presence of a COVID-19 outbreak. The facility staff were not wearing any masks upon entrance of the facility. During an interview on 09/08/25 at 9 AM, during entrance conference the Administrator reported there were 6 residents who were positive for COVID-19 and required airborne isolation precautions, upon entrance into their rooms. The Administrator stated the facility staff were required to wear source control while in the facility. During an observation and interview on 09/08/25 at 10:25 AM, LVN A stated Resident #7 had multiple episodes of diarrhea and Resident #8 had developed a congested cough. LVN A stated it was her first day back, so she was unsure when the symptoms developed. Resident #8 was sitting up in the dining room during the interview and a wet, congested cough was observed. Resident #7 was self-propelling her wheelchair down the hallway. LVN A stated she requested for testing supplies to the secured unit so she could test them for COVID-19. LVN A stated the nursing management told her they did not need to be retested as they were all tested on [DATE]. LVN A stated 3 residents had tested positive for COVID-19 and were on isolation precautions. LVN A stated Resident #1 had no isolation precautions signage outside his door. LVN A stated facility staff were required to wear an N-95 mask, isolation gown, gloves, and a face shield or goggles. LVN A stated she did not have access to face shield or goggles, so they had not been wearing it. During an observation on 09/08/25 at 10:47 AM, Resident #1 entered the hallway wearing a white t-shirt and brief. He immediately turned back into his room. During an observation on 09/08/25 at 11:44 AM, there were no face shields or goggles on the isolation carts on the secured unit. Resident #1 had no airborne isolation precautions signage outside his room door. There was no signage to indicate type of PPE required. During an observation on 09/08/25 at 12:08 PM, MA B arrived to secured unit, stated she would help pass out trays. MA B left the secured unit to get a surgical mask. MA B was not wearing a mask. During an observation on 09/08/25 at 12:14 PM, MA B prepared to go into Resident #24's room, who was COVID-19 positive. She applied an isolation gown and gloves. MA B did not apply an N-95 mask or a face shield or goggles. During an observation on 09/08/25 at 12:15 PM, LVN A prepared to go into Resident #10's room, who was COVID-19 positive. She applied an isolation gown and gloves. LVN A did not apply an N-95 mask or a face shield or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 61 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some goggles. During an observation and interview on 09/08/25 at 12:17 PM, MA B and LVN A came out of the resident's rooms. MA B did not change her surgical mask and LVN A did not change her KN-95 mask. They were unable to perform hand hygiene because there was no sanitizer available. LVN A stated the hand sanitizer dispensers were taken off the wall because the residents were pulling them off the wall. During an observation on 09/08/25 at 12:18 PM, MA B prepared to go into Resident #24's room to assist him with eating. MA B wore the same mask, applied a new isolation gown, and gloves. MA B did not apply a face shield or goggles, or an N-95 mask. LVN A prepared to go into Resident #1's room, who was COVID-19 positive. She applied a new isolation gown, and gloves. She did not change her KN-95 mask or apply an N-95 mask. She did not wear a face shield or goggles. During an observation on 09/08/25 at 12:20 PM, LVN A came out of Resident #1's room. She continued to wear the KN-95 mask. During an observation on 09/08/25 at 12:21 PM, LVN A popped her head through the doorway of the dining room. LVN A then walked into Resident #19's room to assist her with eating. She was wearing the same KN-95 mask she wore into the COVID-19 positive rooms. Resident #19 was not positive for COVID-19. During an observation on 09/08/25 at 12:28 PM, MA B exited Resident #24's room. She continued to wear the same surgical mask out of Resident #24's room, who was COVID-19 positive. MA B did not perform hand hygiene. During an observation on 09/08/25 at 12:38 PM, MA B exited the secured unit wearing the same surgical mask that was worn into COVID-19 positive rooms. MA B started passing ice down D Hall. During an observation on 09/08/25 at 12:43 PM, the DON and CNA C were passing lunch trays on Hall D. CNA C entered Resident #2 and Resident #3's room with a surgical mask, not a N95 mask, and gown. CNA C did not have on a face shield or goggles. CNA C had a meal tray in her arms, unable to visualize if gloves were worn. The DON knocked on Resident #2 and #3's door and handed CNA C another meal tray. On the residents' door was a sign with instruction on what order to put on PPE. There was no signage to indicate the resident was on airborne precaution. In a clear storage bin, at Resident #2 and Resident #3's door, were N95 masks and gowns. The clear storage bin did not have face shields and/or goggles, and gloves. During an interview on 09/08/25 at 3:54 PM, the Regional Nurse Consultant stated the ADON was responsible for the infection control, but she was new to the facility and had only started 3 weeks ago. During an interview on 09/08/25 at 4:22 PM, the ADON said she had only been the ADON for 3 weeks. The ADON stated she was supposed to be taking over the infection control program but was new to the facility and had not quite taken over yet. The ADON stated the facility protocol for a COVID-19 outbreak included: notifying the family and physician on the residents who tested positive, notifying the health department and state if 5 or more residents were positive, placing isolation precautions signs outside the doors, placing biohazard boxes for clothing and trash, and placing PPE supplies outside the doors. The ADON stated the facility staff should have used isolation gowns, N-95 disposable mask, goggles or face shield, and gloves when entering a COVID-19 positive room. The ADON stated if the facility staff did not have access to the appropriate PPE, the ADON or DON should have been notified. The ADON stated she was unaware the PPE isolations carts had no face shields or goggles. The ADON was unaware Resident #1, Resident #2, and Resident #3's room had no signage to indicate isolation precautions. The ADON stated the nurse assigned to the hall was responsible for monitoring to ensure the appropriate PPE was available and the type of isolation signage was on the door. The ADON stated facility staff should have been changing their PPE between each resident room, which included masks. The ADON stated hand hygiene should have been performed between each resident's room, before taking off PPE, and before putting on PPE. The ADON stated Resident #1 was the first resident to test positive for COVID-19 on 09/05/25. The ADON said all the residents and staff were tested with the following residents testing positive: Resident #2, #3, #10, #24, and #25. The (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 62 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some ADON stated no staff members had tested positive or were symptomatic. The ADON stated COVID-19 testing was completed on 09/05/25 and was not scheduled to be completed again until 09/12/25. The ADON stated signs and symptoms of COVID-19 included: runny nose, cough, fever, and nausea or vomiting. The ADON stated residents who developed signs and symptoms of COVID-19 should have been tested. The ADON stated she was unaware Resident #7 and Resident #8 had signs or symptoms of COVID-19. The ADON stated she should have been notified immediately and testing performed. The ADON stated it was important to follow the infection control procedures related to the COVID-19 outbreak protocol to prevent the spread of COVID-19. During an interview on 09/08/25 at 4:42 PM, the DON said she had worked at the facility since April 2025. The DON stated she was unsure what the COVID-19 full facility protocol was. The DON stated if residents were showing signs or symptoms of COVID-19 they would have been tested. The DON said if the residents tested positive, they would go into a room by themselves or with another COVID-19 positive resident. The DON stated COVID-19 test results should have been entered into the progress notes section of the electronic charting system. The DON stated she was unsure how many times residents were required to be tested. The DON stated the facility used a symptom based testing. The DON stated Resident #1 tested positive for COVID-19 on 09/05/25 and then all the residents on C-Hall were tested. The DON stated it was the same for D hall. The DON stated if a resident had signs or symptoms of COVID-19 they should have been tested. The DON was unaware Resident #7 or Resident #8 had developed signs or symptoms of COVID-19. The DON stated signage should have been placed outside the resident's door to indicate the type of isolation required. The DON was unaware Resident #1, Resident #2, and Resident #3 had no signage outside the door to indicate the type of isolation precautions required. The DON stated an PPE isolation kit was then placed outside each room. The DON stated the required PPE for a resident who was COVID-19 positive included: N-95 face mask, face shield, gown, and gloves. The DON stated she expected the nursing staff to use the appropriate PPE each time they entered the resident's room. The DON stated she was unaware the facility staff did not have access to face shield or goggles. The DON stated she observed CNA C go into a COVID-19 positive room. The DON stated she had a surgical mask on and should have been wearing an N-95 mask. The DON stated she was not wearing a face shield or goggles. The DON stated did not think to stop or correct her. The DON stated for COVID-19 positive residents, the nursing staff reached out to the physician for any new orders and notified the families, and Administrator. The DON stated all staff should have been tested as soon as possible for staff at work and then before their next shift. The DON stated the ADON was new to the facility and was normally responsible for monitoring to ensure infection control procedures were followed. The DON stated she had been helping to monitor since the ADON was not fully trained. The DON stated it was important to ensure infection control protocols were followed during an outbreak to prevent the spread of COVID-19 and protect the residents, staff, and community. The DON stated signs and symptoms of COVID-19 included: cough, fever, body aches, nausea, vomiting, and shortness of breath. During an interview on 09/08/25 at 5:00 PM, the Administrator stated she was unsure what the COVID-19 outbreak protocol was. She stated she was fairly new and started in March 2025. The Administrator said when Resident #1 developed signs and symptoms of COVID-19, he was tested. The Administrator stated all the residents on the secured unit were tested, along with the facility staff. The Administrator stated approximately 2 - 3 days later someone on D hall tested positive for COVID-19, so the facility staff tested the residents on D-Hall. The Administrator stated it was her understanding, that COVID-19 was only reported after 10% of the building was positive. The Administrator stated after residents tested positive for COVID-19, the nursing staff should have notified the physician and the family. The Administrator stated signage should have been placed outside (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675386 If continuation sheet Page 63 of 64 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 675386 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whispering Pines Lodge 2131 Alpine Rd 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete of each resident's door who was positive for COVID-19. The Administrator said signage should have been placed outside the front door of the building to alert the community of the outbreak status. The Administrator stated she was unaware isolation precautions signage was not on all the doors, or the nursing staff had no access to the PPE supplies. The Administrator said the ADON was responsible for ensuring nursing staff had access to the appropriate PPE supplies. The Administrator stated she expected nursing staff to communicate their needs with the DON and ADON. The Administrator stated it was important to ensure infection control protocols were followed to protect the residents, staff, and community from the spread of COVID-19. During an interview on 09/09/25 at 8 AM, the Administrator stated an N-95 mask was required for entrance onto the secured unit. The Administrator stated an N-95 mask should have been worn down D Hall as well. During an observation on 09/09/25 at 8:30 AM, signage was noted outside the secured unit doors that stated, Warm Zone. The surveyor entered the secured unit and observed MA U was wearing two surgical masks, she was passing medications. LVN A was wearing a KN-95 mask. During an observation on 09/09/25 at 8:37 AM, MA U left the secured unit. LVN A took over medication administration. Medical Records entered the secured unit with no mask on her face. Medical Records obtained a surgical mask and put it on her face below her chin. During an observation on 09/09/25 at 8:43 AM, Medical Records went into a resident's room with the surgical mask on her chin. During an observation on 09/09/25 at 8:48 AM, there were no face shield or goggles on the isolation carts in the secured unit. Resident #1 had signage for the required PPE but no signage to indicate type of isolation precautions required. During an observation and interview on 09/09/25 at 9:22 AM, Medical Records stated she was not aware an N-95 mask was required to enter the secured unit. Medical Records was wearing her surgical mask on her chin. When the surveyor asked her if that was the appropriate way to wear her mask, she stated Oh my god. Medical Records stated she was unable to breathe in the surgical mask and understood it was a risk for her. Medical Records stated the good Lord would protect her from any harm. On 09/09/25 at 2:30 PM, attempted to contact CNA C by phone. Unable to leave a message. During an interview on 09/12/25 at 1:28 PM, MA B stated she should have worn the appropriate mask, which was an N-95 with gown, gloves, and a face shield or goggles, when going into a COVID-19 positive room. She stated she should have performed hand hygiene before putting on and taking off her PPE. She stated she did not use a face shield or goggles or perform hand hygiene on 09/08/25 because she did not have access. MA B stated it was important to follow infection control protocols especially during an outbreak to prevent the spread of COVID-19. Event ID: Facility ID: 675386 If continuation sheet Page 64 of 64