Inspection·September 10, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with diagnoses which included including Alcohol induced Dementia (loss of cognitive functioning), psychosis disorder (a severe mental condition in which thoughts and emotions are so affected that contact is lost with external reality), chronic obstructive pulmonary disease (a lung disease that blocks airflow making it difficult to breathe), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think and how you act). He was discharged on 06/11/2025 to an acute care behavioral hospital. Record review of Resident #3's quarterly MDS assessment, dated 05/08/2025, indicated he had a BIMS score of 03 which indicated he had severely impaired cognition and was sometimes able to make self-understood and sometimes understood others. He had behaviors of inattention and disorganized thinking which fluctuates (comes and goes, changes in severity). The functional abilities self-care indicated he required set-up or clean up assistance (helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) with eating, oral care, upper body dressing, shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated he required set-up or clean up assistance with all tasks and used a manual wheelchair for mobility. Record review of Resident #3's care plan, dated 02/04/2025, indicated he had episodes of inappropriate behaviors and is at risk for further increased episodes and injury related to dementia with behaviors and psychosis. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. 1. Record review of provider investigation report dated 01/27/2025 for Resident-to-Resident incident between Resident # 2 and Resident #3 indicated Resident #3 hit Resident #2 on the right side of her neck and pulled her hair on 01/21/2025. An assessment was conducted on Resident #2 and indicated she had a small pink/red area noted to the right side of neck and no pain and there were no bruising or other injuries to her neck. On 01/22/2025 a skin assessment on Resident #2 was clear, no redness noted at right side of neck. Resident #3 was placed on 1:1 monitoring until transferred to behavioral hospital for evaluation and treatment. Record review of Resident #2's incident report and nurses progress note dated 01/21/2025 indicated on 01/21/2025 at 9:50 a.m., LVN C was down the hallway and noticed Resident #2 screaming: while looking down the hall LVN C witness Resident #2 being hit by Resident #3. Resident #3 was seen hitting Resident #2 in the face on the right side of her neck and pulling her hair. LVN C immediately intervened and separated the residents. Resident #2 was assessed and had redness noted to neck, no other injuries or bruising, and reported no pain when asked if she was hurting. RP, DON, ADON and the administrator were notified of the incident. During an observation and interview on 09/08/2025 at 11:30 a.m., Resident #2 wheeled to the dining room in manual wheelchair. She appeared well groomed with no foul odors and no signs of abuse or neglect were identified. Resident #2 interacted with facility staff with no indication of fear or discomfort. Resident #2 does not recall the incidents and denied any current abuse or neglect from facility staff or other residents. Unable to interview Resident #3, he no longer resides at the facility. During an interview on 09/08/2025 at 6:00 p.m., LVN C said she was the nurse that witnessed the incident between Resident #2 and Resident #3 on 01/21/2025. She said she was walking down hall and heard Resident #2 scream, looked down hallway and saw Resident #3 hit Resident #2 one time around face on right side of her neck and pulled her hair. Both residents were in wheelchairs in the hallway. She said she immediately intervened and separated the residents. She said Resident #3 was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 2 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Minimal harm or potential for actual harm Residents Affected - Some returned to his room, placed in bed, assessed with no injuries and initiated 1:1 monitoring until he was transported to behavioral hospital for evaluation. She said Resident #2 was assessed with redness to her neck with no additional injuries or bruising noted. She said she reported the physical abuse incident to RP, DON, ADON and the administrator/AC. She said that Resident #2 has Huntington's disease, and she has involuntary movements (flinging her arms and legs) and could startle other residents and visitors. She said that Residents #2 and #3 had a history of Resident-to-Resident incidents and staff were aware to monitor them closely for incidents or behaviors. 2. Record review of an incident report and nurses progress note dated 05/18/2025 indicated on 05/18/2025 around 1:00 p.m., LVN F observed Resident #2 and Resident #3 both in wheelchairs in the hallway. Resident #2 raised arms, not in an aggressive way, and Resident #3 punched Resident #2 in the arm. Residents were separated and Resident #3 was taken back to his room and staff assisted him to bed. Resident #2 was assessed and had no notable redness, injuries or bruising, and reported no pain when asked if she was hurting. DON, ADON and the administrator were notified of the incident. During an interview on 09/09/2025 at 11:39 a.m., LVN F said she was the nurse that witnessed the incident between Resident #2 and Resident #3 on 05/18/2025. She said she was walking up the hall and saw Resident #2 and Resident #3 in their wheelchairs in the hallway. Resident #2 was raising her arm, involuntary movement from her Huntington's disease, and Resident #3 intentionally punched Resident #2 in the arm. She said she immediately separated the residents and Resident #3 was returned to his room, placed in bed, assessed with no injuries and initiated monitoring. She said Resident #3 punched Resident #2, so she reported the physical abuse incident to DON, ADON and the administrator/AC. She said she worked until 6:00 p.m. the day of the incident and continued to monitor both Resident #2 and Resident #3 with no further incidents or negative effects identified and reported the incident to the oncoming staff. Resident #4 Record review of Resident #4's admission Record dated 09/08/2025 indicated he was a [AGE] year-old male who was initially admitted to the facility on [DATE] with diagnoses which included including vascular dementia (loss of cognitive functioning caused by brain damage from impaired blood flow), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think and how you act). Record review of Resident #4's quarterly MDS assessment, dated 04/25/2025, indicated resident had a BIMS score of 06 which indicated he had severely impaired cognition and was able to make self-understood and understood others. He had no behaviors indicated. The functional abilities self-care indicated he required supervision or touching assistance with eating, oral care, upper body dressing, shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated he required supervision or touching assistance with all tasks and ambulated independently.Record review of Resident #4's care plan, dated 03/19/2025, indicated he had episodes of behaviors and is at risk for further increased episodes and had an altercation with another resident on 07/02/2025. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. Resident #5 Record review of Resident #5's admission Record dated 09/08/2025 indicated he was a [AGE] year-old male who was readmitted on [DATE] and initially admitted to the facility on [DATE] with diagnoses which included including post-traumatic stress disorder (a mental health condition that's triggered by a terrifying event - either experiencing it or witnessing it), Alzheimer's disease (progressive disease that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 3 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Minimal harm or potential for actual harm Residents Affected - Some destroys memory and other important mental functions), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think and how you act). Record review of Resident #5's quarterly MDS assessment, dated 05/25/2025, indicated he had a BIMS score of 11 which indicated he had moderately impaired cognition and was able to make self-understood and understood others. He had no behaviors indicated. The functional abilities self-care indicated he was independent with eating, oral care, upper body dressing, lower body dressing, putting on/taking off footwear and setup or clean-up assistance with shower/bathing and personal hygiene. The functional abilities mobility indicated he is independent with all tasks and used a walker for mobility. Record review of Resident #5's care plan, dated 02/04/2025, indicated he had episodes of inappropriate behaviors and is at risk for further increased episodes and injury related to post traumatic stress disorder, bipolar disorder and Alzheimer's Disease. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. 3. Record review of provider investigation report dated 07/09/2025 for Resident-to-Resident incident between Resident #4 and Resident #5. Resident #4 pushed Resident #5 causing him to fall on 07/02/2025. An assessment was conducted on Resident #5 indicated he had no injuries noted. Resident #4 was placed on 1:1 monitoring until transferred to behavioral hospital for evaluation and treatment. Record review of Resident #4's incident report and nursing progress note dated 07/02/2025 indicated on 7/02/2025 at 9:30 a.m., LVN C heard a resident falling in the dining room, LVN C went to check on Resident #4 and Resident #5 and found Resident #5 on the floor upset because Resident #4 had pushed him down. Residents were separated and Resident #4 was taken back to his room and placed on 1:1 monitoring. Residents #4 & #5 were assessed and had no redness, injuries or bruising. RN, DON, ADON and administrator were notified of the incident. During an observation on 09/08/2025 at 11:45 a.m., Resident #5 was ambulating with walker independently throughout the facility. He appeared well groomed with no foul odors and no signs of abuse or neglect were identified. During an observation and interview on 09/08/2025 at 11:50 a.m., Resident #4 was in his room resting. He appeared well groomed with no foul odors and no signs of abuse or neglect were identified. He said he was going to lunch and got up independently, walked to the dining room and sat at a dining table alone. He interacted with facility staff members passing lunch trays. During an interview on 09/08/2025 at 1:00 p.m., Resident # 5 said he recalled the incident with Resident #4, he was in the dining room, spoke to Resident #4 does not recall conversation and Resident #4 pushed him causing him to fall on the floor. He said he was not injured in the fall, but the nurses checked him over. He said he was upset at the time and may have cussed at Resident #4 after he pushed him down for no reason but now, he just avoids him and does not interact with him. He denied wanting to fight Resident #4 or making any negative comments toward Resident #4 the day of the incident. He said he has not had any other interactions with Resident #4 since the incident and feels safe at the facility. He said that he has arthritis and has frequent pain, but the medications administered by staff help the pain. He denies injuries during the incident and demonstrates he can move all extremities without increased pain or discomfort. During an interview on 09/08/2025 at 1:15 p.m., Resident #4 said he did not recall the incident with Resident #5 and denied pushing or hitting other residents. During an interview on 09/09/2025 at 10:30 a.m., contracted lab technician said he was at the facility on 07/02/2025 to collect blood specimens for ordered labs and around 9:30 a.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 4 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Minimal harm or potential for actual harm Residents Affected - Some he witnessed Resident #4 and Resident #5 standing in dining room having what appeared to be a normal conversation, then Resident #4 pushed Resident #5 and Resident #5 lost his balance and fell to the floor landing on his bottom/back. He said LVN C saw Resident #5 had fallen and immediately responded and separated the two residents. He said LVN C talked with him regarding what he saw that day. He said he did not hear here the conversation between the residents, just saw from a distance Resident #4 push Resident #5 and Resident #5 lost his balance and fell backwards. He said Resident #5 did not hit his head; he caught himself as he was falling backward. During an interview on 09/08/2025 at 6:30 p.m., LVN C said she was sitting at the nurses' station on 07/02/2025 at 9:30 a.m. and heard a patient fall and commotion, she looked up and immediately intervened. She said Resident #5 was sitting on the floor in front of Resident #4 in the dining room. She said Resident #5 was cussing that Resident #4 just pushed him down for no reason. She said she immediately separated the residents and Resident #4 was returned to his room and placed on 1:1 monitoring until transferred to behavioral hospital later that evening. LVN C said Resident #4 said he thought Resident #5 wanted to fight so he was defending himself, but Resident #5 denied making any negative comments or attempting to fight. During an interview on 09/09/2025 at 1:30 p.m., UM M said Resident #4 would ambulate around the facility sometimes but usually stayed in room, came to dining room for meals and activities. She said she had not had any issues or incidents with Resident #4 since he returned from the behavioral hospital and had medication adjustments. During an interview on 09/09/2025 at 2:10 p.m., the DON said she expected staff to prevent residents from being abused. She said they could not control a resident's unexpected behaviors or reactions to other residents' actions. She said the aggressive resident in an incident would be placed on 1:1 monitoring until released by psych services or transferred to behavioral hospital for evaluation. She said staff should be alerted to identify behaviors and to attempt to deescalate or redirect to prevent incidents if possible. She said resident abuse could place residents at risk for emotional distress, fear, and further abuse. During an interview on 09/10/2025 at 2:00 p.m., the Administrator said she expected facility residents to remain free from abuse and neglect and for staff to follow policies and procedures to prevent abuse and neglect. She said staff should be alerted to identify behaviors and to attempt to deescalate or redirect to prevent incidents if possible. She said resident abuse could place residents at risk for emotional distress, fear, and further abuse. Record review of the facility's policy Abuse, Neglect, Exploitation Prevention Policy and Procedure, date revised 09/10/2020, indicated Policy statement Our facility prohibits the abuse, mistreatment, neglect, and/or exploitation of residents. We believe that all residents have the right to be free from such actions by anyone, including but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving our community, family members or legal guardians, friends, or any other individuals. Therefore, our facility abuse, neglect, and exploitation prevention policy and procedure include the following seven components: Pre-Employment screening, ANE Training, ANE Prevention, ANE Identification, Investigation of ANE, Protection from ANE and Reporting/Response of ANE. The facility administrator, or his/her designee, will be designated as the facilities ANE coordinator and will be responsible for overseeing the ANE Prevention Program and directing any such investigation. Definitions: .Abuse is defined as the willful infliction of injury. Physical Abuse includes hitting, slapping, pinching and/or kicking.Reporting 1. It is the responsibility of all individuals who witness, or have knowledge of, an event regarding the abuse, neglect, and/or exploitation of any resident, regardless of the length of time between the actual event and his/her coming to knowledge of it, to immediately report it to the Administrator and/or Director of Nursing. If the Administrator or Director of Nursing is not present in the facility at the time, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 5 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete he/she should be contacted regardless of the time of day and made known of the event. The Administrator, Director of Nursing, or his/her will notify corporate director of clinical services and chief operating officer of any allegation or event concerning abuse, neglect, and/or exploitation. The Administrator, Director of Nursing, or his/her designee shall report all alleged violations and all substantiated incidents to the state agency and to all other agencies as required and take all necessary corrective actions depending on the results of the investigation. Event ID: Facility ID: 675391 If continuation sheet Page 6 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that all alleged violations involving abuse were reported, immediately but not later than 2 hours after the allegation was made, if the events that cause the allegation involves abuse or results in serious bodily injury, to the State Survey Agency for 1 of 5 residents (Residents #2) reviewed for reporting allegations of abuse. The facility failed to report an allegation of abuse to the state agency within 2 hours after Resident #3 punched Resident #2 in the arm on 05/18/2025. The failures could place residents at risk of not having allegations reported within the required timeframes. Findings included: Record review of Resident #2's admission Record dated 09/08/2025 indicated she was a [AGE] year-old female who was initially admitted to the facility on [DATE] with diagnoses which included Huntington's disease (causes nerve cells in the brain to decay over time and the disease affects a person's movements, thinking ability and mental health), bipolar disorder (mental disorder associated with episodes of mood swings ranging from depressive lows to manic highs), major depressive disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), schizoaffective disorder (mental health condition with a combination of symptoms of schizophrenia and mood disorder), anxiety disorder (persistent and excessive worry that interferes with daily activities), and muscle spasms. Record review of Resident #2's quarterly MDS assessment, dated 04/09/2025, indicated she had a BIMS score of 07 which indicated she had severely impaired cognition and was sometimes able to make self-understood and usually understood others. She had no behaviors indicated. The functional abilities self-care indicated she required partial assistance with eating, oral care, upper body dressing and required maximal assistance with shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated she required maximum assistance with all tasks except walking greater than 50 feet which required totally dependent and used a manual wheelchair for mobility. Record review of Resident #2's care plan, dated 02/04/2025, indicated she had diagnosis of schizophrenia of a bipolar type with psychotic features, Huntington's disease and is at risk for disturbed thought processes, and alteration in mood or exhibitions of behavioral symptoms. She has potential for impaired skin related to risk of falls; involuntary movements related to Huntington's Disease and alteration in musculoskeletal status related to Huntington's Disease. Interventions included communication techniques, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for therapy and psych services and report to MD if changes were identified. Record review of Resident #3's admission Record dated 09/09/2025 indicated he was a [AGE] year-old male who was initially admitted to the facility on [DATE] with diagnoses which included including Alcohol induced Dementia (loss of cognitive functioning), psychosis disorder (a severe mental condition in which thoughts and emotions are so affected that contact is lost with external reality), chronic obstructive pulmonary disease (a lung disease that blocks airflow making it difficult to breathe), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think and how you act). He was discharged on 06/11/2025 to an acute care behavioral hospital. Record review of Resident #3's quarterly MDS assessment, dated 05/08/2025, indicated he had a BIMS score of 03 which indicated he had severely impaired cognition and was sometimes able to make self-understood and sometimes understood others. He had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 7 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few behaviors of inattention and disorganized thinking which fluctuates (comes and goes, changes in severity). The functional abilities self-care indicated he required set-up or clean up assistance (helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) with eating, oral care, upper body dressing, shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated he required set-up or clean up assistance with all tasks and used a manual wheelchair for mobility. Record review of Resident #3's care plan, dated 02/04/2025, indicated he had episodes of inappropriate behaviors and is at risk for further increased episodes and injury related to dementia with behaviors and psychosis. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. During an observation and interview on 09/08/2025 at 11:30 a.m., Resident #2 wheeled to the dining room in manual wheelchair. She appeared well groomed with no foul odors and no signs of abuse or neglect were identified. Resident #2 interacted with facility staff with no indication of fear or discomfort. Resident #2 does not recall the incident. Record review of an incident report and nurses progress note dated 05/18/2025 indicated on 05/18/2025 around 1:00 p.m., LVN F observed Resident #2 and Resident #3 both in wheelchairs in the hallway. Resident #2 raised arms, not in an aggressive way, and Resident #3 punched Resident #2 in the arm. Residents were separated and Resident #3 was taken back to his room and staff assisted him to bed. Resident #2 was assessed and had no notable redness, injuries or bruising, and reported no pain when asked if she was hurting. DON, ADON and the administrator were notified of the incident. Record review of Texas Unified Licensure Information Portal (TULIP) on 08/09/2025 at 1:50 P.M. indicated no self-reported incidents regarding allegations of abuse were reported for Resident # 2. During an interview on 09/09/2025 at 11:39 a.m., LVN F said she was the nurse that witnessed the incident between Resident #2 and Resident #3 on 05/18/2025. She said she was walking up the hall and saw Resident #2 and Resident #3 in their wheelchairs in the hallway. Resident #2 was raising her arm, involuntary movement from her Huntington's disease, and Resident #3 intentionally punched Resident #2 in the arm. She said she immediately separated the residents and Resident #3 was returned to his room, placed in bed, assessed with no injuries and initiated monitoring. She said Resident #3 punched Resident #2, so she reported the physical abuse incident to DON, ADON and the administrator/AC. During an interview on 09/09/2025 at 2:00 p.m., the DON said she was aware of the incident on 05/18/2025 between Resident #2 and Resident #3 and during her investigation she identified that Resident #2 denied being hit/punched by Resident #3. Resident #2 said [Resident #3] just moved her arm out of his face and did not hit her. The DON said she reported the incident to the administrator and corporate nurse and was advised that the incident was not a reportable event. The DON acknowledges that the facility policy identifies physical abuse includes hitting, slapping, pinching and/or kicking and the alleged physical abuse should have been reported and then investigated for confirmation. During an interview on 09/10/2025 at 2:00 p.m., the Administrator said she was notified by the DON regarding the incident on 05/18/2025 between Resident #2 and Resident #3 and the ADON and DON investigated and identified that Resident #2 denied being punched/hit by Resident #3. She said after a review of the incident by corporate, the corporate nurse advised that the incident was not a reportable event. The administrator acknowledges that the facility policy identifies physical abuse includes hitting, slapping, pinching and/or kicking and the alleged physical abuse should have been reported to the state agencies within 2 hours of the allegation of abuse and then investigated for confirmation. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 8 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility's policy Abuse, Neglect, Exploitation Prevention Policy and Procedure, date revised 09/10/2020, indicated Definitions: .Abuse is defined as the willful infliction of injury. Physical Abuse includes hitting, slapping, pinching and/or kicking.Reporting 1. It is the responsibility of all individuals who witness, or have knowledge of, an event regarding the abuse, neglect, and/or exploitation of any resident, regardless of the length of time between the actual event and his/her coming to knowledge of it, to immediately report it to the Administrator and/or Director of Nursing. If the Administrator or Director of Nursing is not present in the facility at the time, he/she should be contacted regardless of the time of day and made known of the event. The Administrator, Director of Nursing, or his/her will notify corporate director of clinical services and chief operating officer of any allegation or event concerning abuse, neglect, and/or exploitation. The Administrator, Director of Nursing, or his/her designee shall report all alleged violations and all substantiated incidents to the state agency and to all other agencies as required and take all necessary corrective actions depending on the results of the investigation. Event ID: Facility ID: 675391 If continuation sheet Page 9 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 have evidence that all allegations of abuse, neglect, exploitation, or mistreatment, were thoroughly investigated for 4 of 6 residents (Resident #2, Resident #3, Resident #4 and Resident #5) reviewed for abuse and neglect. 1. The facility did not thoroughly investigate an incident in which Resident #2 was slapped on the neck by Resident #3 on 01/21/2025. 2. The facility did not investigate an incident in which Resident #2 was punched on the arm by Resident #3 on 05/18/2025. 3. The facility did not thoroughly investigate an incident in which Resident #4 pushed Resident #5 causing him to fall on 07/02/2025. This failure could place residents at risk for abuse/neglect and could lead to a diminished quality of life and psychosocial harm. The findings included: Resident #2Record review of Resident #2's admission Record dated 09/08/2025 indicated she was a [AGE] year-old female who was initially admitted to the facility on [DATE] with diagnoses which included Huntington's disease (causes nerve cells in the brain to decay over time and the disease affects a person's movements, thinking ability and mental health), bipolar disorder (mental disorder associated with episodes of mood swings ranging from depressive lows to manic highs), major depressive disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), schizoaffective disorder (mental health condition with a combination of symptoms of schizophrenia and mood disorder), anxiety disorder (persistent and excessive worry that interferes with daily activities), and muscle spasms. Record review of Resident #2's quarterly MDS assessment, dated 04/09/2025, indicated resident had a BIMS score of 07 which indicated she had severely impaired cognition and was sometimes able to make self-understood and usually understood others. She had no behaviors indicated. The functional abilities self-care indicated she required partial assistance with eating, oral care, upper body dressing and required maximal assistance with shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated she required maximum assistance with all tasks except walking greater than 50 feet which required totally dependent and used a manual wheelchair for mobility. Record review of Resident #2's care plan, dated 02/04/2025, indicated she had diagnosis of schizophrenia of a bipolar type with psychotic features, Huntington's disease and is at risk for disturbed thought processes, and alteration in mood or exhibitions of behavioral symptoms. She has potential for impaired skin related to risk of falls; involuntary movements related to Huntington's Disease and alteration in musculoskeletal status related to Huntington's Disease. Interventions included communication techniques, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for therapy and psych services and report to MD if changes were identified. Resident #3Record review of Resident #3's admission Record dated 09/09/2025 indicated he was a [AGE] year-old male who was initially admitted to the facility on [DATE] with diagnoses which included including Alcohol induced Dementia (loss of cognitive functioning), psychosis disorder (a severe mental condition in which thoughts and emotions are so affected that contact is lost with external reality), chronic obstructive pulmonary disease (a lung disease that blocks airflow making it difficult to breathe), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think and how you act). He was discharged on 06/11/2025 to an acute care behavioral hospital. Record review of Resident #3's quarterly MDS assessment, dated 05/08/2025, indicated resident had a BIMS score of 03 which indicated he had severely Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 10 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Some impaired cognition and was sometimes able to make self-understood and sometimes understood others. He had behaviors of inattention and disorganized thinking which fluctuates (comes and goes, changes in severity). The functional abilities self-care indicated he required set-up or clean up assistance (helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) with eating, oral care, upper body dressing, shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated he required set-up or clean up assistance with all tasks and used a manual wheelchair for mobility. Record review of Resident #3's care plan, dated 02/04/2025, indicated he had episodes of inappropriate behaviors and is at risk for further increased episodes and injury related to dementia with behaviors and psychosis. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. 1. Record review of provider investigation report dated 01/27/2025 for Resident-to-Resident incident between Resident # 2 and Resident #3 indicated Resident #3 hit Resident #2 on the right side of her neck and pulled her hair on 01/21/2025. The investigation summary and provider actions taken post-investigation indicated staff interviews, skin assessments of involved residents, aggressor transferred to behavioral hospital but does not indicate evidence (safe surveys) that other residents were interviewed following an allegation of abuse to ensure their safety and wellbeing. 2. Record review of an incident report and nurses progress note dated 05/18/2025 indicated on 05/18/2025 around 1:00 p.m., LVN F observed Resident #2 and Resident #3 both in wheelchairs in the hallway. Resident #2 raised arms, not in an aggressive way, and Resident #3 punched Resident #2 in the arm. Residents were separated and Resident #3 was taken back to his room and staff assisted him to bed. Resident #2 was assessed and had no notable redness, injuries or bruising, and reported no pain when asked if she was hurting. DON, ADON and the administrator were notified of the incident. Record review of Texas Unified Licensure Information Portal (TULIP) on 08/09/2025 at 1:50 P.M. indicated no self-reported incidents or provider investigation report regarding allegations of abuse were reported for Resident # 2. During an interview on 09/09/2025 at 11:39 a.m., LVN F said she was the nurse that witnessed the incident between Resident #2 and Resident #3 on 05/18/2025. She said she was walking up the hall and saw Resident #2 and Resident #3 in their wheelchairs in the hallway. Resident #2 was raising her arm, involuntary movement from her Huntington's disease, and Resident #3 intentionally punched Resident #2 in the arm. She said she immediately separated the residents and Resident #3 was returned to his room, placed in bed, assessed with no injuries and initiated monitoring. She said Resident #3 punched Resident #2, so she reported the physical abuse incident to DON, ADON and the administrator/AC. She said she worked until 6:00 p.m. the day of the incident and continued to monitor both Resident #2 and Resident #3 with no further incidents or negative effects identified and reported the incident to the oncoming staff. She said the DON interviewed her during the investigation process and asked her to change her documentation from punched to tapped since they had missed the 2-hour window to report the incident to the state agency. Resident #4 Record review of Resident #4's admission Record dated 09/08/2025 indicated he was a [AGE] year-old male who was initially admitted to the facility on [DATE] with diagnoses which included including vascular dementia (loss of cognitive functioning caused by brain damage from impaired blood flow), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 11 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Some and how you act). Record review of Resident #4's quarterly MDS assessment, dated 04/25/2025, indicated resident had a BIMS score of 06 which indicated he had severely impaired cognition and was able to make self-understood and understood others. He had no behaviors indicated. The functional abilities self-care indicated he required supervision or touching assistance with eating, oral care, upper body dressing, shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated he required supervision or touching assistance with all tasks and ambulated independently. Record review of Resident #4's care plan, dated 03/19/2025, indicated he had episodes of behaviors and is at risk for further increased episodes and had an altercation with another resident on 07/02/2025. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. Resident #5 Record review of Resident #5's admission Record dated 09/08/2025 indicated he was a [AGE] year-old male who was readmitted on [DATE] and initially admitted to the facility on [DATE] with diagnoses which included including post-traumatic stress disorder (a mental health condition that's triggered by a terrifying event - either experiencing it or witnessing it), Alzheimer's disease (progressive disease that destroys memory and other important mental functions), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (mental illness that negatively affects how you feel, the way you think and how you act). Record review of Resident #5's quarterly MDS assessment, dated 05/25/2025, indicated he had a BIMS score of 11 which indicated he had moderately impaired cognition and was able to make self-understood and understood others. He had no behaviors indicated. The functional abilities self-care indicated he was independent with eating, oral care, upper body dressing, lower body dressing, putting on/taking off footwear and setup or clean-up assistance with shower/bathing and personal hygiene. The functional abilities mobility indicated he is independent with all tasks and used a walker for mobility. Record review of Resident #5's care plan, dated 02/04/2025, indicated he had episodes of inappropriate behaviors and is at risk for further increased episodes and injury related to post traumatic stress disorder, bipolar disorder and Alzheimer's Disease. Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. 3. Record review of provider investigation report dated 07/09/2025 for Resident-to-Resident incident between Resident #4 and Resident #5 indicated Resident #4 pushed Resident #5 causing him to fall on 07/02/2025. The investigation summary and provider actions taken post-investigation indicated staff interviews, skin assessments of involved residents, aggressor transferred to behavioral hospital but does not indicate evidence (safe surveys) that other residents were interviewed following an allegation of abuse to ensure their safety and wellbeing. During an interview on 09/09/2025 at 11:10 a.m., the Social Worker said she was the part time social worker for the facility for the last few months. She said she was not involved with the indicated allegation of abuse investigation with Resident #2 being hit by #3, and Resident #4 pushing Resident #5 causing him to fall. She said she was not the active social worker at the time of these incidents. She said she visits the facility and sister facility 2-3 times a week to provide services. She said if she is aware of abuse or neglect allegation and is at the facility or called to the facility, that she provides safe surveys after the incidents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 12 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Some or allegations. She said she interviewed other residents to make sure the residents feel safe and there were no adverse effects from the incident. She said each incident is different so her safe surveys may be done by halls, interactions with accused residents, or staff. She said safe surveys need to be provided after allegations to identify other residents involved and to make sure residents feel safe at the facility. During an interview on 09/09/2025 at 2:00 p.m., the DON said she was aware of the incident on 05/18/2025 between Resident #2 and Resident #3 and during her investigation she identified that Resident #2 denied being hit/punched by Resident #3. Resident #2 said [Resident #3] just moved her arm out of his face and did not hit her. The DON said she reported the incident to the administrator and corporate nurse and was advised that the incident was not a reportable event. The DON acknowledges that the facility policy identifies physical abuse includes hitting, slapping, pinching and/or kicking and the alleged physical abuse should have been reported to the administrator/abuse coordinator for submission to the state agency within 2 hours of the allegation and then investigated for confirmation. The DON said that during the investigation process of incidents (including the indicated allegations between Resident #2 & #3 and Resident #4 & #5) she does speak to other residents and interviews for involvement and safety, but usually the social worker conducts safe surveys after allegations. She said that she does not document her interviews with other residents during the investigation process because she thought the social worker would document with safe survey interviews. She said the facility must not have had an available social worker during the indicated incidents to perform safe surveys. She said when no social worker was available, she or the administrator should have conducted safe surveys and completed the documents and submitted with the provider investigation report. She said she does facility rounds multiple times a day and feels if residents did not feel safe or had concerns with an incident, they would notify her. She said not completing safe surveys could possibly miss a resident involved with an incident or have a negative outcome (fear, unreported abuse) on a resident. During an interview on 09/10/2025 at 2:00 p.m., the Administrator said was notified by the DON regarding the incident on 05/18/2025 between Resident #2 and Resident #3 and the ADON and DON investigated and identified that Resident #2 denied being punched/hit by Resident #3. She said after a review of the incident by corporate, the corporate nurse advised that the incident was not a reportable event. The administrator acknowledges that the facility policy identifies physical abuse includes hitting, slapping, pinching and/or kicking and the alleged physical abuse should have been reported to the state agencies within 2 hours of the allegation, investigated, and provided an investigation report to the state agency within 5 working days. She said the facility must not have had an available social worker during the indicated incidents (including the indicated allegations between Resident #2 & #3 and Resident #4 & #5) to perform safe surveys. She said it was the responsibility of the social worker to perform safe surveys after abuse allegations and if the social worker is not available to provide safe surveys, she, the DON or designee should have performed safe surveys and completed documents and submitted with the provider investigation report. She said not completing safe surveys could possibly miss a resident involved with an incident or have a negative outcome (fear, unreported abuse) on a resident. Record review of the facility's policy Abuse, Neglect, Exploitation Prevention Policy and Procedure, date revised 09/10/2020, indicated Investigation Process: 16. The individual conducting the investigation will, as a minimum: j. review the completed documentation forms; k. review the resident's medical records to determine events leading up to the incident; j. interview the person(s) reporting the incident; m. interview any witnesses. n. interview the resident.o. interview the resident's, attending physician. p. interview staff members . q. interview resident roommates, family, r. interview other residents. s. review all events (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 13 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 leading up the alleged incident. 20. The facility investigation will be documented on the required state investigation form. 21. The administrator will provide the facility's completed investigation including witness statements and other supporting documentation to the state survey and certification agency with five (5) working days of the reported incident. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 14 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, and record review, the facility failed to review and revise resident's comprehensive care plans by the interdisciplinary team after each assessment to reflect the current condition for 2 of 12 (Resident #2 and Resident #3) residents reviewed for comprehensive care plans. The facility failed to ensure Resident #2's care plan was updated to indicate Resident #2 had received aggression during a resident-to-resident incident on 01/21/2025 and 05/18/2025. The facility failed to ensure Resident #3's care plan was updated to indicate Resident #3 had an incident of resident-to-resident aggression on 01/21/2025 and 05/18/2025. This deficient practice could place residents at risk of not receiving appropriate interventions to meet their current needs. The findings included: Resident #2Record review of Resident #2's admission Record dated 09/08/2025 indicated she was a [AGE] year-old female who was initially admitted to the facility on [DATE] with diagnoses which included Huntington's disease (causes nerve cells in the brain to decay over time and the disease affects a person's movements, thinking ability and mental health), bipolar disorder (mental disorder associated with episodes of mood swings ranging from depressive lows to manic highs), major depressive disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life), schizoaffective disorder (mental health condition with a combination of symptoms of schizophrenia and mood disorder), anxiety disorder (persistent and excessive worry that interferes with daily activities), and muscle spasms. Record review of Resident #2's quarterly MDS assessment, dated 04/09/2025, indicated she had a BIMS score of 07 which indicated she had severely impaired cognition and was sometimes able to make self-understood and usually understood others. She had no behaviors indicated during the 7 day look back period prior to completing the MDS assessment. The functional abilities self-care indicated she required partial assistance with eating, oral care, upper body dressing and required maximal assistance with shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated she required maximum assistance with all tasks except walking greater than 50 feet which required totally dependent and used a manual wheelchair for mobility. Record review of Resident #2's care plan, dated 02/04/2025, indicated she had history of alteration in mood or exhibition of behavioral symptoms related to bipolar disorder, major depressive disorder, anxiety, schizoaffective disorder and behavioral problems regarding smoking and smoking times. Interventions included communication techniques, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for therapy and psych services and report to MD if changes were identified. The care plan did not indicate Resident #2 had an updated or revised care plan for receiving aggressive behavior from another resident during a resident-to-resident aggression on 01/21/2025, 05/18/2025 and/or updated or revised care plan for behavior problems of voicing suicidal ideation related to smoking break omitted due to weather conditions Resident #3Record review of Resident #3's admission Record dated 09/09/2025 indicated he was a [AGE] year-old male who was initially admitted to the facility on [DATE] with diagnoses which included including Alcohol induced Dementia (loss of cognitive functioning), psychosis disorder (a severe mental condition in which thoughts and emotions are so affected that contact is lost with external reality), chronic obstructive pulmonary disease (a lung disease that blocks airflow making it difficult to breathe), diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 15 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (mental illness that negatively affects how you feel, the way you think and how you act). He was discharged on 06/11/2025 to an acute care behavioral hospital. Record review of Resident #3's quarterly MDS assessment, dated 05/08/2025, indicated he had a BIMS score of 03 which indicated he had severely impaired cognition and was sometimes able to make self-understood and sometimes understood others. He had behaviors of inattention and disorganized thinking which fluctuates (comes and goes, changes in severity). The functional abilities self-care indicated he required set-up or clean up assistance (helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) with eating, oral care, upper body dressing, shower/bathing, lower body dressing, putting on/taking of footwear and personal hygiene. The Functional abilities mobility indicated he required set-up or clean up assistance with all tasks and used a manual wheelchair for mobility. Record review of Resident #3's care plan, dated 02/04/2025, indicated he had episodes of behavioral problems at times and see another resident [Resident #2] with voluntary movements as aggressive behavior.Interventions included communication techniques, redirection, effective strategies, monitor for confounding problems, frustration levels, physical/nonverbal indications, monitor and document behaviors, 1:1 interaction as needed, administer medications as needed, referrals for behavioral hospitals and psych services and report to MD if changes were identified. The care plan did not indicate Resident #3 had an updated or revised care plan for aggressive behavior incident of resident-to-resident aggression on 01/21/2025 and 05/18/2025. Record review of provider investigation report dated 01/27/2025 for Resident-to-Resident incident between Resident #2 and Resident #3. Resident #3 hit Resident #2 on the right side of her neck and pulled her hair on 01/21/2025. An assessment was conducted on Resident #2 indicated she had a small pink/red area noted to the right side of neck and no pain and there were no bruising or other injuries to her neck and on 01/22/2025 skin assessment on Resident #2 was clear, no redness noted at right side of neck. Resident #3 was placed on was placed on 1:1 monitoring until transferred to behavioral hospital for evaluation and treatment. Record review of Resident #2's incident report and nurses progress note dated 01/21/2025 indicated on 01/21/2025 at 9:50 a.m., LVN C was down the hallway and noticed Resident #2 screaming: while looking down the hall LVN C witness Resident #2 being hit by Resident #3. Resident #3 was seen hitting Resident #2 around face on the right side of her neck and pulling her hair. LVN C immediately intervened and separated the residents. Resident #2 was assessed and had redness noted to neck, no other injuries or bruising, and reported no pain when ask if she was hurting. RP, DON, ADON and the administrator were notified of the incident. Record review of Resident #2's nursing process behavioral note dated 01/22/2025 at 5:31 a.m. indicated Resident #2 exhibited behaviors after being informed that the morning smoke break was omitted due to outside temperature below 20 degrees and stated, send me to the behavior center, I don't want to stay here. Resident was grabbing at medication cart looking for a trash bag, stated I will put a trash bag over my head before I stay here. Resident then requested a family member be contacted and staff obliged and left message. Monitoring initiated and all bags and harmful objects removed from the room. NP notified and order received to send referral to behavioral hospital. Record review of an incident report and nurses progress note dated 05/18/2025 indicated on 05/18/2025 around 1:00 p.m., LVN F observed Resident #2 and Resident #3 both in wheelchairs in the hallway. Resident #2 raised arms, not in an aggressive way, and Resident #3 punched Resident #2 in the arm. Residents were separated and Resident #3 was taken back to his room and staff assisted him to bed. Resident #2 was assessed and had no notable redness, injuries or bruising, and reported no pain when asked if she was hurting. DON, ADON and the administrator were notified of the incident. During an interview on 09/09/2025 at 11:39 a.m., LVN F said she was the nurse that witnessed the incident between (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 16 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #2 and Resident #3 on 05/18/2025. She said she was walking up the hall and saw Resident #2 and Resident #3 in their wheelchairs in the hallway. Resident #2 was raising her arm, involuntary movement from her Huntington's disease, and Resident #3 intentionally punched Resident #2 in the arm. She said she immediately separated the residents and Resident #3 was returned to his room, placed in bed, assessed with no injuries and initiated monitoring. She said Resident #3 punched Resident #2, so she reported the physical abuse incident to DON, ADON and the administrator/AC. She said she worked until 6:00 p.m. the day of the incident and continued to monitor both Resident #2 and Resident #3 with no further incidents or negative effects identified and reported the incident to the oncoming staff. She said when residents have incidents or changes in condition that the care plans or revised or updated by the MDS Coordinator or DON. During an interview on 09/10/2025 at 11:30 a.m., MDS Coordinator U stated she was the MDS Coordinator for the facility hired in March 2025 but did not start completing assessment until June 2025 after receiving training at sister facility and corporate MDS nurse. She said she participates in morning meetings and incident reports and allegations are discussed during the morning meeting, if residents care plans require updating and/or IDT care plan meeting scheduling required it is completed if applicable. She said she was not involved in the incidents with Resident #2 and Resident #3 but with the scenarios provided the care plans should have been updated to reflect the current resident needs and a Significant Change in Status Assessment completed if warranted. During an interview on 09/10/2025 at 2:20 p.m., the DON said that all incidents and allegations are discussed during morning meetings (including herself, administrator, department heads, MDS Coordinator, Unit Manager, corporate staff via phone at times) and the MDS Coordinator is notified of any incidents requiring care plan revisions and she was responsible for updating the care plans. She stated new interventions should be added to the care plan regarding recurrent resident-to-resident altercations. She stated she did not know why the care plans and interventions for Residents #2 and #3 had not been updated and/or revised after the alleged incidents. She said the MDS Coordinator is responsible for updating and revising the care plan as indicated. She said she was responsibility for monitoring and ensuring that the care plans were completed and updated by the MDS Coordinator. The DON said the current MDS Coordinator was not here during the time of those incidents, and she recalled directing the old MDS Coordinator to make those updates on the care plans during a morning meeting but did not go back into the care plans to ensure the changes were made. She said if care plans were not updated or revised, the care plan would not reflect the current resident's needs. Record review of the facility's policy Care Plan Revisions, date revised 05/2022, indicated Policy: The purpose of this procedure is to provide a consistent process for reviewing and revising the care plan for those residents within the facility. Guidelines: 1. The comprehensive care plan will be reviewed and revised every quarter, when a resident experiences a status change and as deemed necessary. 2. Procedure for reviewing and revising the care plan is as follows: a. Upon identification of a change in status, the nurse will notify the MDS Coordinator, the physician, and the resident representative, if applicable. b. The MDS Coordinator and the Interdisciplinary Team will discuss the resident condition and collaborate on intervention options. c. The care plan will be updated with the new or modified interventions. d. Staff involved in the care of the resident will report resident response to new or modified interventions. e. Care plans will be modified as needed by the MDS Coordinator or other designated staff member. f. The Unit Manager or other designated staff member will conduct an audit on all residents experiencing a change in status, at the time the change in status is identified, to ensure care plans have been updated to reflect current resident needs. 3. The MDS Coordinator will determine whether a Significant Change in Status Assessment is warranted. If so, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 17 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 0657 assessment will be completed according to established procedures. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 18 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Few 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 each resident received adequate supervision to prevent accidents for 1 of 3 residents reviewed for accidents and supervision. (Resident #1)The facility failed to provide adequate supervision for Resident #1 who was assessed as a high risk for elopement. On 03/23/25 CNA B who was assigned to cover the unit left the unit leaving the residents unattended. Resident #1 eloped from the unit and was found at his previous home address sitting on the porch steps approximately 1 mile from the facility. The non-compliance was identified as past non-compliance. The Immediate Jeopardy began on 03/23/25 and ended on 03/27/25. The facility had corrected the non-compliance before the survey began. This failure could prevent residents from receiving appropriate supervision which could lead to resident sustaining serious injury or harm. Findings included: Record review of a face sheet dated 09/09/25 indicated Resident #1 was a [AGE] year-old male admitted on [DATE]. His diagnosis included dementia (loss of cognitive functioning), hypertension (a condition in which the force of the blood against the artery walls is too high), type 2 diabetes (a chronic condition that affects the way the body processes blood sugar), anxiety (persistent and excessive worry that interferes with daily activities) , and depression (mental illness that negatively affects how you feel, the way you think and how you act). Record review of a Baseline Care Plan dated 03/17/25 indicated Resident #1 resided on the secured unit with an intervention to conduct frequent checks on the resident, especially during high-risk times and he was at risk for elopement with an intervention to monitor resident. Record review of a Clinical Risk assessment dated [DATE] the Elopement Risk section indicated Resident #1 was a high risk. Record review of an admission MDS form dated 03/27/25 indicated Resident #1 had a BIMS score of 07 indicating he had severely impaired cognition. He had clear speech and understood others. He had other behavioral symptoms not directed towards others that occurred 1 to 3 days during the lookback period. He had no impairment of the upper and lower extremities. He used no mobility devices. The Functional self-care assessment indicated supervision/touching assistance with most ADLs. The Functional mobility assessment indicated he required supervision/touching assistance with ambulation. Record review of Nurse Notes for Resident #1 indicated the following:* an entry on 3/21/25 at 05:56 a.m., Resident restless this shift. Residing on memory care unit, attempted to follow RCS off unit and began banging on the double doors. Resident had been observed pacing from double doors back to room stating that he needs to go home. Resident upset that he is locked behind double doors. Writer was able to talk to and calm resident at this time.* an entry on 3/22/25 at 06:00 a.m., Resident resides on memory care unit. Resident does not understand why he is locked up and wants to go home and will stand at double doors in an attempt to walk out with someone.* an entry on 3/23/25 at 05:02 p.m., Patient was observed being aggressive today, patient banged on doors today. Nurse observed patient throwing belongings on the floor, when asked patient what was wrong, patient stated aggressively to leave him alone and to get out the room. Nurse was able to give patient his morning medications. Nurse continued to monitor and do routine rounds on patient. Patient continued to bang on unit doors, nurse redirected patient and explained to patient that he couldn't bang on doors, patient started hallucination sand told nurse that his mother was on the other side, and he needed to get to her. Nurse went to do routine round on patient, patient was not in room or any of the available beds on the unit, nurse notified administrator, DON, ADON to let them know that patient was not on the unit. Observed findings of a chair near fence that is said to believe what patient used to climb over fence, available Staff immediately took action, loaded cars to look for patient. Patient was found at last known address sitting on his porch, patient (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 19 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Few was not hurt, no bruising noted. Patient was accompanied by three staff members, patient refused to load the vehicle, after advising him that we need to get him home to safety, patient reconsidered and got in the vehicle. Patient was transported back to facility and was assessed by nurse, patient does not c/o any pain at this time, when asked patient what he was doing out he said that he needed to go to his mother house and cook for tomorrow, but he is back to facility now. Family Notified and is fully aware and was not upset about the situation. Family agreed to send patient out.Record review of a Provider Investigation Report dated 03/27/25 indicated the following:* LVN C reported that she saw Resident #1 at approximately 3:00pm and he was banging on the locked doors. She went to the door and calmed him down by talking to him.* At about 3:15pm, LVN C rounded on the unit and did not find Resident #1. LVN C and LVN F went directly to the unit to check on the two residents that were residing in the unit. They couldn't find Resident #1 in his room on the locked unit. They proceeded to search for Resident #1 in every room on the unit. They alerted all staff that she had a missing resident. Staff searched the facility. In the courtyard of the locked unit there was a chair in the corner fence area with a red garbage can on top of the chair. Resident #1's cane was found outside the fence in the area the chair was found at on the inside of the fence. LVN C noted maglock not locking when she went into the courtyard.* At 3:15 pm search initiated.* At 3:17 pm Sign-out book checked* At 3:16 pm Announcement made over intercom* 3:28 pm LVN F notified ADON* 3:29 pm ADON notified Administrator.* 3:30 pm Administrator notified DON* 3:31 pm Administrator notified DSS* 3:32 pm ADON notified the local Police Department. Report number 2251465* 3:40 pm Administrator notified the VPO and the Regional Nurse Consultant; and* 3:43 pm DSS found Resident #1 sitting on his porch steps of his house.* Resident #1 admitted to Behavioral hospital on [DATE].* 03/24/2025 No patients on the locked unit. Closed the locked unit.* 03/25/2025 Active Elopement Drill done with staff.* 03/26/2025 Active Elopement Drill done with staff* 03/27/2025 Staff Town Hall active elopement drill performed, and staff trained on elopement policy. During a phone interview on 09/09/25 at 12:10 p.m., HA A said he started his shift on 03/23/25 at 06:00 a.m. on the secured unit. He said there were only 2 residents on the unit at the time. He said they did everything for themselves so all he had to do was to monitor them so they would not elope. He said CNA B came on shift at 02:00 p.m. and LVN C told CNA B to relieve him so he could take a lunch. He said he did not think CNA B had went to the unit because he saw her sitting the nurse's station playing on her phone when he went into the break room. He said a short time later CNA B went into the break room and sat down. He said one of the nurses had come into the break room and ask if both HA A and CNA B were on break then who was on the unit. He said the nurse left the break room and went to the secured unit. He said Resident #1 was not found on the unit but a chair with a trash can on it was by the fence in the courtyard of the unit. During an interview on 09/09/25 at 06:30 p.m., LVN C said she told CNA B when she came on duty at 02:00 p.m. to relieve HA A on the secured unit so he could take a lunch break. She said she had issues with CNA B staying on the secured unit because she would leave to go to her car and then she left and went to the break room. She said Resident #1 had been at the double doors banging on them about 03:00 p.m. prior to him eloping that day, so she went to talk with him and calm him down. She said when she made rounds on the secured unit at 03:15 p.m. he was not located, and CNA B was not on the unit. An attempt was made to contact CNA B on 09/09/25 at 12:19 p.m., 12:25 p.m., and 01:05 p.m. but a recording indicated the phone number had been changed or no longer in service on all 3 attempts. During an interview on 09/09/25 at 01:08 p.m., the HKS said she was the DSS at the time of Resident #1's elopement. She said when she received the call about him missing, she was familiar with him, so she thought to go check at his house to see if he was there. She said he was sitting on the front porch steps (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 20 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Few at his house about a mile from the facility. She said she called the DON to let him know where he was and 3 staff came to get him. She said at first, Resident #1 did not want to get into the vehicle but eventually they were able to talk him into it and he was taken back to the facility. During an interview on 09/09/25 at 04:45 p.m., the DON said CNA B was told by LVN C to cover the secured unit so HA A could take a lunch break. She said it was found that CNA B did not go to the secured unit like she was told and Resident #1 eloped while not being attended. She said Resident #1 was sent to the behavioral hospital the next day. She said he was allowed to return with one-on-one monitoring until he was discharged to another facility out of town so he would not try to go home again. She said the secured unit was shut down the day after the incident. During an interview on 09/09/25 at 05:24 p.m., the Administrator said Resident #1's family placed him at the facility and had him placed on the secured unit because they said there had been an issue with him wandering off from his home. She said the secured unit was closed the day after Resident #1 had eloped. She said when the resident was found and returned to the facility, he was placed on one-on-one supervision until he was discharged to a sister facility out of town. She said they did the elopement drills with staff after the incident until 03/27/25 so they would ensure to have all most all the staff from different shifts in-serviced. Observations during the investigation from 09/08/25 through 09/10/25 indicated Hall A, previously designated as the Memory Care Secured Unit, was not utilized as a secured unit. Unable to interview Resident #1, he no longer resided at the facility. Record review of a Disciplinary Action Form dated 03/23/35 indicated CNA B was not on the unit as assigned by her charge nurse. CNA B was suspended while investigating the incident. CNA B was terminated after the investigation. The form was signed by the Administrator and DON on 03/27/25. Record review of an Education In-Service Attendance Record with subject of Elopement dated 03/23/25, indicated that 18 staff members (1 HA, 7 LVNs, 1 MA, 8 CNAs and 1 therapist) signed the in-service record regarding elopement policy. Record review of an Education In-Service Attendance Record with subject of Staff on Unit dated 03/23/25, indicated that 16 staff members (1 HA, 6 LVNs, 1 MA, and 8 CNAs) signed the in-service record regarding the unit must have a staff member on it at all times; assigned nurse is to make frequent rounds on the unit during their shift; and assigned nurse is to assign relief for assigned staff to take a break/lunch. Record review of a Wander/Elopement Drill Report dated 03/25/25 indicated a mock elopement/missing resident drill was conducted at 10:18 a.m. and 16 staff (admission Coord, AD, MDS Nurse, SW, Laundry staff, 2 CNAs, 3 LVNs, and 6 other staff) participated. Some were staff who were not listed on the other trainings on 03/23/25. Record review of a Wander/Elopement Drill Report dated 03/26/25 indicated a mock elopement/missing resident drill was conducted at 11:06 a.m. and 22 staff (ADON, admission Coord, MDS Nurse, Transportation, DSS, 1 hskp, 1 dietary, 1 laundry, 1 HA, 1 MA, 6 CNAs, and 3 LVNs) participated. Some were staff who were not listed on the other trainings on 03/23/25 and drill on 03/25/25. Record review of a Wander/Elopement Drill Report dated 03/27/25 indicated a mock elopement/missing resident drill was conducted at 02:13 p.m. and 15 staff (DSS, Director of Rehab, SLP, SW, 1 dietary, 1 laundry, 2 hskp, 1 HA, 1 MA, 1 CNA, and 3 LVNs) participated. Some were staff who were not listed on the other trainings on 03/23/25 and drills on 03/25/25 and 03/26/25. Record review of the Employee Staff List indicated all but 1 prn staff member had been trained on Elopement. Record review of facility incident reports from 03/24/25 through 09/08/25 indicated there were no elopements. During a phone interview on 09/09/25 at 12:10 p.m. HA A said he had received in-service on 03/23/25 and participated in elopement drills several times after the elopement. During an interview on 09/09/25 at 01:08 p.m. the HKS said she was the DSS at the time of Resident #1's elopement. She said she had received in-service and participated in elopement drills several times after the elopement. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 21 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview on 09/09/25 at 02:10 p.m. LVN E said he had received in-service and had participated in elopement drills they had conducted several times after the elopement. During an interview on 09/09/25 at 03:30 p.m. the UM said in-service and elopement drills had been received from 03/23/25 through 03/27/25. During an interview on 09/09/25 at 06:00 p.m.:* CNA D said she was the receptionist at the time of the elopement but had received in-service and participated in elopement drills several times after the elopement.* CNA G said she received elopement training while she was in the CNA class at the facility.* CNA H and CNA J said they received elopement training when they were hired by the facility. During interviews on 09/10/25:* at 10:20 a.m. CNA N said she had received in-service and participated in elopement drills several times after the elopement.* at 10:25 a.m. CNA O said she had received in-service and participated in elopement drills several times after the elopement.* at 10:28 a.m. CNA R said she had received in-service and participated in elopement drills several times after the elopement. Record review of the Elopement policy revised 05/2024 indicated: Policy:The Facility will engage in active elopement prevention measures to mitigate the occurrence of elopement incidents. The Facility will deploy a prompt investigation and search if a resident is considered missing.Elopement Mitigation StrategiesThe Facility will implement the following mitigation strategies: Appropriateness of resident placement within the facility upon a::Jmission and during their stay. Completion of routine elopement risk assessments. Providing the resident with appropriate supervision. Completing environmental modifications as needed. Ensuring the resident's care plan is up to date. Conducting routine elopement drills. Having a resident photo in the electronic health record. Providing education for families, visitors, and volunteers. Conducting routine alarm checks/inspections. Initiate a manual monitoring system during power failure. On 09/09/25 at 05:40 p.m., the Administrator was informed of the Immediate Jeopardy. The non-compliance was identified as past non-compliance. The Immediate Jeopardy began on 03/23/25 and ended on 03/27/25. The facility had corrected the noncompliance before survey began. Event ID: Facility ID: 675391 If continuation sheet Page 22 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to establish a system of receipt and disposition of all controlled drugs in sufficient detail to enable accurate reconciliation and determine that drug records were in order and that an account of all controlled drugs were maintained and periodically reconciled for 1 of 4 residents (Resident #6) reviewed for controlled medications. * LVN X and RN Y did not count the narcotic medications during the shift change to ensure the count was correct and all narcotics had an Inventory Sheet. * Resident #6's hydrocodone 5 mg /acetaminophen 325 mg (narcotic pain medication for moderate or severe pain) were not counted and did not have an Inventory Sheet on 10/04/24. This failure could place residents at risk for medication overdose, medication under-dose, ineffective therapeutic outcomes, and drug diversion. Findings included: Record review of the face sheet dated 09/10/25 indicated Resident #6 was a [AGE] year-old female admitted on [DATE]. Her diagnoses included fracture of the hip (broken bone in the hip). Record review of the MDS dated [DATE] indicated Resident #6 was able to hear without difficulty, able to be understood and could understand others, had clear speech, had severely impaired cognition, and received opioid medications. Record review of the September and October 2024 physician orders indicated Resident #6 had an order for hydrocodone 5 mg /acetaminophen 325 mg. Record review of the September and October 2024 MARs indicated Resident #6 had received hydrocodone 7.5mg /acetaminophen 325 mg. Record review of the Provider Investigation Report dated 10/09/24 indicated: .On 10/04/24 at 1:00 p.m., the Administrator was notified that we had an alleged drug diversion involving Resident #6's hydrocodone 5/325, per [RP]'s statement to Administrator and DON, he stated he brought the pills up to the building on 09/29/24, the pills were counted by charge nurses LVN W and UM and there were 84 total pills and narcotic sheet was created. We received the blister pack for the resident's pain medication and only one has been given from it and there is a [narcotic] sheet for them. And this pill is accounted for. Furthermore, the [RP] stated he had received a call yesterday to come pick up the bottle of pills and today at around 10:30 am, he asked the nurse for the pills. The resident's [RP] counted the pills at the nurses' station after the nurse LVN X stated she counted 62 pills, and he counted 42. So initially, we were missing 20 pills. Further investigation revealed, LVN W in her statement said there were 76 on 10/3/24 when she counted with RN Y. Again, according to LVN W she stated the count yesterday was 76; however, the MAR only shows 5 given out of the bottle. The [narcotic] sheet is missing for the bottle of pills, but it was in the building yesterday per LVN W and RN Y who counted together last night on 10/03/24. RN Y stated she did not count with the nurse, LVN X day charge nurse on 10/04/24. But she stated she did count with LVN W. Hence, there is a discrepancy of 76 minus 42 is 34 missing pills, yet 84 minus 5 which show on the MAR is 79, but the count was 76. Hence, the total number of pills missing from the pill bottle is 37. The bottle was signed back to the [RP] and taken home with him. During an interview on 09/09/25 at 02:05 p.m. the UM said she and LVN W had counted Resident #6's hydrocodone/acetaminophen when the resident's husband brought them the bottle to the facility. She said she made a count sheet since it was from an outside pharmacy and did not have a count sheet. She said she remember there was eighty something tablets in the bottle. During an interview on 09/09/25 at 02:35 p.m. the DON said during the investigation RN Y admitted she did not count with LVN X at shift change but accepted the keys for the narcotics. She said both nurses were drug tested and suspended. She said RN Y was negative, but LVN X tested positive for other substances than the opioid. She said LVN X quit. She said she expected nurses to always count the narcotics before accepting the keys to the cart. She said not counting them could lead to medication not being administered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675391 If continuation sheet Page 23 of 24 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 675391 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Pines 705 Hwy 418 W Silsbee, TX 77656 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete to the resident. She said not having the Inventory Sheet for a narcotic could lead to drug diversion. During an interview on 09/09/25 at 04:25 p.m. the Administrator said she expected staff to follow policy regarding narcotic medications to prevent drug diversions and ensure residents receive their medication. Attempts were made to contact LVN X but recording indicated the caller was not taking calls. Attempts were made to contact RN Y and a message was left with no return call. Record review of the Narcotic Count policy revised 11/22 indicated the following: Policy: It is the policy of this facility to mitigate the risk of drug diversion by developing, implementing, and maintaining a narcotic count process. Procedures: The Narcotic Count and Inventory: 1. Controlled drugs will be counted every eight (8) - or twelve (12) -hour shift by authorized staff reporting on duty with the authorized staff reporting off duty.2. The inventory of controlled substances/drugs will be recorded on the Narcotic Records and signed for correctness of count.Process:1. At the end of every eight (8) - or twelve (12) -hour shift the authorized staff member reporting on duty and the authorized staff member reporting off duty meet at the designated medication cart or storage area to count controlled substances/drugs.2. The off-going authorized staff member reads down the controlled substance/drug Inventory Sheet one drug at a time.3. The oncoming authorized staff member counts the number of remaining controlled substance/drug and announces that number out loud.4. The off going authorized staff member checks this number against the Inventory Sheet. The remaining number is carried over to the controlled substance/drug Inventory Sheet for the new shift.5. Steps two (2) through four (4) are repeated for each controlled substance/drug in the inventory. Event ID: Facility ID: 675391 If continuation sheet Page 24 of 24