Inspection·December 12, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated it was just a hostile situation, and he believed if someone had gotten in front of him Resident #2) he would not have been hit by Resident #5. Resident #2 stated he did not want to be near Resident #5 until he became calmer about the situation. He stated he would not harm Resident #5, but he was still upset over the situation. Resident #2 stated he had diarrhea because of the foods he ate, and he had history of diarrhea most of his life. He stated he did not eat the proper food, and his family brought food for him that hurt his stomach and caused diarrhea, but he did not report this to his family. Resident #2 stated his roommate stayed mad at him due to his diarrhea and the odor in the room. He stated this was the entire argument last week when he was hit by Resident #5 about the odor in his room and him not immediately taking a shower. Resident #2 stated he did see the psychiatrist after the incident with Resident #5, but she did not ask him any questions about the incident and him being mad toward Resident #5. Resident #2 stated he did feel safe at this facility and did not want to move to another facility or go anywhere else to live. 2. Review of Resident #5's face sheet, dated 12/12/2025, reflected a [AGE] year-old male resident admitted on [DATE] and readmitted on [DATE] with the following diagnoses bipolar disorder, current episode mixed, severe, with psychotic features ( Manic symptoms: high energy, racing thoughts , irritability, less need for sleep, rapid speech, and agitation. Depressive symptoms: sadness, loss of interest, low energy, and feelings of worthlessness. Psychotic features which involved losing touch with reality, Hallucinations seeing hearing or feeling things that are not there. Delusions: firmly held false beliefs believing you have superpowers or are being ruined), and generalized anxiety disorder (a mental health condition causing persistent, excessive, and uncontrollable worry about everyday things (work, health or family). Review of Resident #5's Quarterly MDS Assessment, dated 09/05/2025, reflected Resident # 5 had a BIMS score of 15 indicating his cognition was intact. Resident #5 had a diagnosis of anxiety and bipolar disorder. Review of Resident #5's Comprehensive Care Plan, revised on 12/04/2025 and 12/07/2025, reflected Resident #5 exhibited physical aggression. Resident #5 punched his roommate (Resident #2) in the nose. Interventions: Analyze key times, places, circumstances, triggers, and what de-escalates behavior and document. Assess and address for contributing sensory deficits. Assess and anticipate resident's needs: food, thirst, toileting needs, comfort level, pain, etc. (and similar things). Communication: provide physical and verbal cues to alleviate anxiety; give positive feedback, assist verbalization of source of agitation, assist in setting goals for more pleasant behaviors, encourage seeing out of staff member when agitated. Evaluate side effects of medications. Give the resident as man choices as possible about care and activities. If Resident #5 had physical behaviors toward another resident, immediately intervene to protect the residents involved and call for assistance. If intervening is unsafe, call out for staff assistance immediately. Monitor, document, and report to MDS of danger to self and others. Notify the charge nurse of any physically abusive behaviors. Psych consult as indicated. Move Resident #5 to another room. Resident #5 had potential to exhibit verbal threats. Interventions: Assist resident in avoiding other residents that may cause outbursts. Be non-judgmental but firm that inappropriate behavior was not acceptable. Coordinate care to help maintain control of his behavior for example: in a group have Resident #5 to sit from other residents according to his preferences. Educate Resident #5 in alternative ways of dealing with anger. If Resident #5 becomes angryleave him alone- give him time to calm. If Resident #5 has altercation with another resident separate immediately to separate locations, notify MD, notify Administrator, Responsible Party and if needed call sheriff department or 911. Monitor residents' location every 15 minutes until resolved. Provide 1:1 with Resident #5 as ordered. Record review of Resident #5's one on one interventions reflected staff was with the resident one on one for 72 hours after the incident on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 2 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 - Few 12/04/2025. Interview on 12/12/2025 at 9:15 AM Resident #5 stated he was mad at his roommate at the time (Resident #2). He stated Resident #2 always had diarrhea and the room would smell like poop. He stated on 12/04/2025 Resident #2 came out of the bathroom and had poop odor on him, in the bathroom, and in the room. Resident #5 stated he became angry due to Resident #2 would not changing his clothes taking a shower. He stated he told Resident #2 to get a shower before he went to therapy, and Resident #2 would not listen to him. Resident #5 stated Resident #2 entered the hallway and spoke to CNA A about getting a shower. Resident #5 stated Resident #2 refused the shower and went to the therapy room. Resident #5 stated he became very angry about the situation of how Resident #2 had poop odor and was going to therapy. Resident #5 stated he had been arguing with his roommate. Resident #2, about his diarrhea and how he smelled and how the room smelled. Resident #2 stated housekeeping cleaned but Resident #2 still had an odor of poop. Resident #5 stated this argument was occurring more frequently and he was getting more agitated and angrier toward Resident #2. He stated he followed Resident #2 to the therapy room, and he began to yell and cuss at Resident # 2. He stated he called Resident #2 a son of a bitch and intended oof knocking some sense into him. Resident #5 stated two female therapists tried to stop him by telling him to calm down and go for a walk. Resident #5 stated that was the wrong thing to say to him because no one told him to calm down and that made him angrier. He stated Resident #2 was sitting in a chair with his walker in front of him and made a statement if you think you are big enough and can do something why don't you come over here and try to hit me. Resident #5 stated no one was trying to stop him at that point and he walked directly to Resident #2 and hit him in the nose. Resident #5 stated no staff attempted to prevent him from hitting Resident#2. He stated he left the therapy room, and the nurse checked him from head to toe. Resident #5 stated they moved him to another room and had someone with him all day and night for several days. He stated he did not want to see Resident #2 right now, but he would eventually like to talk to him in a calm manner but not now. Resident #5 stated he would not hit Resident #2 or cause any problems with him as long as he wasn't his roommate and stayed on the other side of the building. Resident #5 stated he had not seen Resident #2 since the incident, and he had no intention of hurting anyone or himself. Resident #5 stated he did not report to any staff of him having issues with his roommate. He stated he did not voice a grievance or concern about his roommate to anyone. He stated he thought it would get better, and he did not want to snitch on anyone. Resident #5 stated he felt safe living at this facility. During an interview on 12/12/2025 at 10:40 a.m., CNA A stated Resident #2 exited his room and he asked Resident #2 if he wanted a shower. CNA A stated Resident #2 he wanted to get a shower after therapy. CNA A stated he was not aware of any arguments between Resident #2 and Resident #5. He stated he thought both residents, Resident #2 and Resident #5, were friends and did not argue with one another. CNA A stated, after the incident, Resident #2 refused a shower that particular day. CNA A stated Resident #2 never refused showers when he was assigned to him. During an interview on 12/12/2025 at 12:20 p.m., the Director of Therapy stated she was present when Resident #5 entered the therapy room cursing and yelling. She stated Resident #5 called Resident #2 a son of a bitch and continued to curse and yell. She started to walk to Resident #2 and attempted to talk to him and asked him to calm down and go for a walk with her. The Director of Therapy stated Resident #5 became angrier and more agitated. She stated OT was standing near Resident #2 providing therapy. The Director of Therapy stated Resident # 5 continued to walk toward Resident #2 very agitated and angry. She stated Resident #2 made the statement, Why don't you try and hit me. The Director of Therapy stated they did not know what to do because she attempted to take Resident #5 for a walk and asked him to calm down, but it did not work. She stated Resident #5 walked to Resident #2, who was seated, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 3 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete hit him in the nose. The Director of Therapy stated the OT helped her with Resident #5 to get him to go for a walk. She stated if one of them had stepped in front of Resident #2 then Resident #5 would not have hit Resident #2. She stated she was in-serviced on interventions on behaviors with residents. She stated after talking about it she realized they did not implement the proper interventions. The Director of Therapy stated the intervention they did escalated the situation, and what they should have removed Resident #2 from the situation when they realized Resident #5 was not going to leave the therapy room. Interview on 12/12/2025 at 1:05 p.m., the Administrator stated they did a complete investigation following their abuse and neglect protocol. She stated when the incident with Resident #2 and Resident #5 was brought to her attention, the facility staff immediately moved Resident #5 into another room on the opposite side of the facility. She stated Resident #2 and Resident #5 did not have roommates. She stated she was not aware of any issues between Resident #2 and Resident #5 until 12/04/2025. She stated a staff was with Resident #5 1:1 for 72 hours or more. She stated incident and accident reports, and skin assessments were completed on both residents. She stated Resident #2 had a nosebleed. The Administrator stated the care plans were updated and the MD, Ombudsman and families were contacted as well as HHSC. She stated all staff were in-serviced on abuse and neglect. The administrator stated all interviewable residents were asked if they felt safe in the facility and if they were abused by anyone. She stated no residents reported any abuse and all felt safe in the facility including Resident #2 and Resident #5. She stated they finished their investigation of the incident on 12/11/2025. During an attempted interview on 12/12/2025 at 3:00 p.m., a voice message was left for the OT including return contact information. Record review of the Facility's Policy on Abuse and Neglect, not dated, reflected, The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. Residents should not be subjected to abuse by anyone, including, but not limited to, facility staff, other residents, consultants or volunteers, staff of other agencies serving the resident, family members or legal guardians, friends, or other individuals.The facility will provide and ensure the promotion and protection of resident rights. It is each individual's responsibility to recognize, report, and promptly investigate actual or alleged abuse, neglect, exploitation, mistreatment of residents or misappropriation of resident property abuse and situations that may constitute abuse or neglect to any resident in the facility.DefinitionsAbuse: Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instances of abuse of all residents, irrespective of any mental or physical condition, cause physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. Willful, as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm. Event ID: Facility ID: 675399 If continuation sheet Page 4 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0679 Provide activities to meet all resident's needs. 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 provide an ongoing activity program to support residents in their choice of activities, both facility sponsored group and individual activities, and independent activities, designed to meet the interests of and support the physical, mental, and psychosocial well-being of each resident, encouraging both independence and interaction in the community for 3 of 59 residents reviewed for activities. The facility failed to provide activities for all residents in the facility for the entire months of August 2025 and September 2025. This failure could place residents at risks of boredom, depression, behavior, diminished quality of life and decreased cognitive function. Findings included:Record review of the activity participation record binder for the year of 2025 reflected there were not any participation records for the months of August 2025 and September of 2025. Record review of the QAPI, dated 12/08/2025, reflected the Activity Director and Activity Department were discussed and a plan developed. Review of Resident #2's face sheet, dated 12/12/2025, reflected a [AGE] year-old male admitted on [DATE] with a diagnosis of major depressive disorder ( a mental condition characterized by a persistently depressed mood and long-term loss of pleasure or interest in life, often with other symptoms such as disturbed sleep or feelings of guilt), diarrhea, unspecified ( a condition in which feces are discharged from the bowels frequently and in a liquid form), other depressive disorder, recurrent without psychotic features (someone having repeated , severe depression episodes but without delusions, meaning they stay grounded in reality).Review of Resident #2's Annual MDS, dated [DATE], reflected Resident #2 had a BIMS score of 15 indicating his cognition was intact. His activity preferences were the following: being around pets, going outside for fresh air when the weather was good, keeping up with the news, listening to music, and doing favorite activities. Review of Resident #2's Quarterly MDS, dated [DATE], reflected Resident #2 had a BIMS score of 15 indicating his cognition was intact. Resident #2 felt down, depressed, or hopeless 7-11 days out of the 14-day assessment period. He had trouble falling asleep or sleeping too much. He felt tired or had very little energy. Resident #2 had difficulty concentrating on things. Review of Resident #2's Comprehensive Care Plan with completion date of 09/25/2025, reflected Resident #2 had Problem initiated on 05/21/2025 Resident #2 had little or no activity involvement. Interventions: Establish and record the resident's level of activity involvement. Explain to Resident #2 the importance of social interaction, leisure activity time. Encourage Resident #2 to participate in activities. Interview on 12/12/2025 at 11:00 a.m. Resident #2 stated there were approximately two or three months where there were not many activities in the facility. He stated in the past 2 months there were activities daily. Resident #2 stated he was getting bored without anything to do except read and watch tv. He stated he enjoyed the socials and parties more than any other type of activities. Review of Resident #3's face sheet, dated 12/12/2025, reflected a [AGE] year-old male admitted on [DATE] and readmitted on [DATE] had a diagnosis of mild intellectual abilities ( involves challenges with thinking, learning, and daily skills (like communication, self-care, and social skills) but allows individuals to learn practical life skills), major depressive disorder, recurrent severe without psychotic features ( causing significant life impairment such as work, social and self-care but without hallucinations or delusions- seeing hearing tasting or feeling things that seems real but isn't, having no external source), featuring symptoms like sadness, loss of pleasure, energy loss, and guilt), and generalized anxiety disorder ( a mental health condition causing persistent , excessive, and uncontrollable worry about everyday things).Review of Resident #3's Annual MDS, dated [DATE], reflected Resident #3 had a BIMS score of 15 indicating his cognition was intact. Resident #3's activity preferences was the following: have books to read, listen Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 5 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to music, keep up with news, doing things in groups of people, doing favorite activities, going outside to get fresh air when the weather was good, and participating in religious activities. Review of Resident #3's Comprehensive Care Plan, dated 09/03/2025, reflected Resident #3 needed out-of-room social, spiritual, and stimulus activities and mental stimulation. Intervention: Activity Director will encourage and remind resident of current activities. Interview on 12/12/2025 at 11:30 a.m., Resident #3 stated he liked to do activities on his own most of the time but liked to go to music and parties. He stated there were a few months where there were no activities except sometimes church. He stated for the past two months there were activities every day. Resident #3 stated he did not get bored because he had lots to do. He stated his family brought him things to do and he would sit in the dining room and do his own activity. Review of Resident #5's face sheet, dated 12/12/2025, reflected a [AGE] year-old male resident admitted on [DATE] and readmitted on [DATE] with the following diagnoses bipolar disorder, current episode mixed, severe, with psychotic features ( Manic symptoms: high energy, racing thoughts , irritability, less need for sleep, rapid speech, and agitation. Depressive symptoms: sadness, loss of interest, low energy, and feelings of worthlessness. Psychotic features which involved losing touch with reality, Hallucinations seeing hearing or feeling things that are not there. Delusions: firmly held false beliefs believing you have superpowers or are being ruined), and generalized anxiety disorder (a mental health condition causing persistent, excessive, and uncontrollable worry about everyday things (work, health or family). Review of Resident #5's Quarterly MDS Assessment, dated 09/05/2025, reflected Resident # 5 had a BIMS score of 15 indicating his cognition was intact. Resident #5 had a diagnosis of anxiety and bipolar disorder.Review of Resident # 5's Significant Change MDS Assessment, dated 12/05/2025, reflected Resident #5 had a BIMS score of 15 indicating his cognition was intact. Resident #5 activity preference was the following: have books to read, listen to music, be around animals, do favorite activities, go outside to get fresh air when the weather was good, and participate in religious activities. Review of Resident #5's Comprehensive Care Plan, revised on 12/04/2025 and 12/07/2025, reflected Resident #5 needed out of room social, spiritual, and mental stimulation. Interventions: Will encourage Resident #5 to attend current activities. The Activity Director will provide resident reading material as needed. Interview on 12/12/2025 at 3:30 p.m. Resident #5 stated he did become bored sometimes. He stated there were a few months he did not see activities in the dining room and other areas. Resident #5 stated the past two months they had activities every day. Resident #5 stated he did not attend very many activities, but he would go listen to music. He said sometimes he liked to go to parties when they had food, but he didn't like to socialize with other residents so he would sit away from everyone. Interview on 12/12/2025 at 12:15 p.m. the Activity Director stated she did not have an excuse why activities were not always provided for the residents in the months of August 2025 and September of 2025. She stated she had no documentation of any activities provided during these two months (August 2025 and September of 2025). The Activity Director stated it was her fault, and she did not request help from anyone. She stated sometimes she provided activities during August 2025 and September 2025, however, she had no documentation proving activities were provided to any residents. She stated if a resident was not receiving activities there was a potential a resident may become depressed or more depressed, bored, isolate themselves, have a decline in their mental status, and a decline in their quality of life. She stated she was a certified activity director for over 10 years. She did not respond to any further questions about the activity programming not provided for the residents. Interview on 12/12/2025 at 1:05 p.m., the Administrator stated she expected all activity programming to be documented on the participation logs. She stated she was not aware of the activity director not documenting activity (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 6 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete programs. The Administrator stated she had been an Administrator at the facility for less than a year and she was monitoring one department at a time and was observing one department before she went to another department. She stated she was working with nursing department for the longest and she had not made any monitoring of the activity participation records until October 2025, and this is when she realized the Activity Director did not have any participation records for the months of August and September of 2025. She stated she had the Activity Director on action plan in QAPI meeting on 12/08/2025. The Administrator stated the Activity Director was responsible for all her documentation and she was responsible for monitoring the Activity Director. She stated the Activity Director was to document each in room activity and each group activity on the participation record every time she provided an activity for a resident. Record review of the Activity Director's personnel record, dated 10/2024, reflected that she was a certified activity director. She was an Activity Director at this facility since 05/05/2025. Record review of the Facility Activity Director Job Description, not dated, signed by the Activity Director on 05/05/2025, reflected the following was non -exhaustive criteria related to the job of an Activity Director, and it was consistent with the business of the facility. These were legitimate measures of qualifications for an Activity Director and related to the functions essential to the job of an Activity Director. Knowledge base:Must be Certified Activity DirectorExcellent creative and communication skillsAbility to organize, document, and implement detailed programs.Genuine caring for and interest in elderly and handicapped people.Ability to comply with the Patient [NAME] of Rights and the Employee Responsibilities.Experience with creating and implementing effective care plans.Ability to develop, organize and implement a program of activities for the social, emotional, physical and other therapeutic needs of the residents. Maintain detailed records of activity programs and participation of individual residents, identifying progress toward established care plan goals. Event ID: Facility ID: 675399 If continuation sheet Page 7 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the residents' environment remained as free of accidents and hazards as possible for 1 of 3 shower rooms reviewed for accidents and supervision.The facility failed to ensure the shower door located on Mc [NAME] Hall was closed and locked.This failure could place residents at risk of injuries, illness, and hospitalization. Findings included:Observation on 12/12/2025 at 10:15 a.m. revealed the shower room door on [NAME] Hallway was left opened and propped open 1 time. Observation revealed no staff or residents in the hallway or near the shower room. In the shower room there was no-rinse scented spray cleanser, shampoo and body wash, and shaving cream located on top of the clothes barrel.Interview on 12/12/2025 at 10: 20 a.m. CNA A stated he unlocked the shower room door and closed it when he exited the shower room to assist a resident to the shower room. He stated the door was closed when he left it unlocked. He stated he knew not to leave the shower room unlocked and it was required to be locked at all times. CNA A stated he was in-serviced on ensuring the shower room door was closed and locked at all times but did not recall the last time he was in-serviced on securing the shower room. CNA A stated if a resident drank the cleanser there was a possibility of becoming severely ill and, if a resident was allergic to the ingredients, the resident may die. Interview on 12/12/2025 at 10: 50 a.m., the Director of Nurses stated all shower doors were expected to be closed and locked at all times. She stated a resident may enter the shower room and close the door and would not know how to open the door to leave the shower room. She stated a resident may fall and have difficulty finding the call light to get nursing assistance. The DON stated death was a possibility if a resident ingested the cleanser. She stated there were not any residents on the [NAME] Hall who wandered into other residents' rooms or any room in the facility. Interview on 12/12/2025 at 1:05 p.m., the Administrator stated her expectation was for the shower door to remain closed and locked at all times. She stated there was a possibility a resident may fall into the shower room and be unable to reach the call light or yell for help. The Administrator stated if a resident ingested the cleanser there was a possibility the resident may need to be hospitalized , and it was possible a resident may die from the chemical. She stated the staff were in-service on locking and closing shower doors and keeping all chemicals locked. The Administrator did not remember the date or time of the most recent in-service. She stated it was everyone's responsibility to ensure the shower doors were locked and secured. She stated if any staff walked down the hall and saw a shower door opened, they were too close and ensured it was locked and report it to the DON. Record review of the Safety Data Sheet for the scented cleanser, not dated, reflected may cause eye damage or irritation. Skin Contact: if irritation develops, wash area with water. Get medical attention if irritation persists. Inhalation: treat symptomatically. Not expected to be toxic. Toxicological information: Ingestion may be harmful if swallowed.During an interview on 12/12/2025 at 1:05 p.m., the Administrator was asked for the Safety Data Sheet for the shaving cream, body and hair wash, which was not provided prior to exit. During an interview on 12/12/2025 at 1:05 p.m., the Administrator stated the facility did not have a protocol for Accidents and Hazards. Event ID: Facility ID: 675399 If continuation sheet Page 8 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide the appropriate treatment and services to a resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review , the facility failed to ensure a resident who was diagnosed with a mental illness or psychosocial adjustment difficulty, or who had a history of trauma and/or post-traumatic stress disorder, received appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being for four (Resident #1, Resident #2, and Resident #3 ) of five resident reviewed for behavioral health.The facility failed to ensure Resident #1, Resident #2, and Resident #3 received appropriate psychiatric services. This failure could place residents at risk because their mental and psychosocial needs not being met and a decreased quality of life. Findings included: Record review of Resident #1's Face Sheet, dated 12/12/2025, reflected a [AGE] year-old female admitted on [DATE] with diagnoses of anxiety disorder ( involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes with panic attack - a sudden, intense wave of extreme fear or discomfort that triggers severe physical and mental symptoms, like racing heart, shortness of breath, trembling, dizziness, and a feeling of losing control or dying), unspecified dementia, severe, with other behavioral disturbance (advanced dementia where cognition decline (memory thinking) is profound, impacting daily life significantly, and accompanied by disruptive behaviors like agitations, aggression, wandering, shouting often stemming from unmet needs or environmental triggers), and alcohol use, unspecified with alcohol-induced persisting dementia ( a type of cognitive decline from long-term heavy drinking, causing permanent brain damage, severe memory loss, impaired judgement, personality changes, and difficulty with thinking, learning, and coordination).Record review of Resident #1's Significant Change MDS , dated 05/02/2025, reflected Resident #1 had a BIMS score of 7 indicating her cognition was severely impaired. Resident #1 had disorganized thinking. She had difficulty focusing and was easily distracted. Resident #1 was assessed to have a diagnosis of anxiety Ddisorder, Aalcohol use, and not-traumatic brain dysfunction ( damage or impairment to the brain caused by internal factors such as : stroke - where blood flow to part of the brain stops - causing brain cells to die due to lack of oxygen - the body or its tissues aren't getting enough oxygen , tumors - abnormal mass of tissue from excessive cell growth, infections- invasion and growth of germs in the body, rather than an external blow to the head). Record review of Resident #1's Quarterly MDS Assessment, dated 12/02/2025, reflected Resident #1 had a BIMS score of 4 indicating her cognition was severely impaired. Resident had behavior of wandering ( 1 to 3 days per week). Resident was assessed to have a diagnosis of anxiety disorder, alcohol use, and not-traumatic brain dysfunction ( damage or impairment to the brain caused by internal factors such as : stroke - where blood flow to part of the brain stops- causing brain cells to die due to lack of oxygen- the body or its tissues aren't getting enough oxygen , tumors - abnormal mass of tissue from excessive cell growth, infections - invasion and growth of germs in the body, rather than an external blow to the head). Review of Resident #1's Comprehensive Care Plan dated, 10/27/2025, reflected Resident #1 had a history of trauma related to domestic violence that may have a negative impact initiated on 04/29/2025. Interventions, initiated 04/29/2025, included arrange Licensed Mental Health Provide as ordered by physician. Identify situation/ even/ images that trigger recollections of the traumatic event and limit the resident's exposure to these as much as possible. If the resident escalated, if at all possible, do not touch the resident unless absolutely necessary for resident's or others safety. Monitoring for escalating anxiety, depression, or suicidal thought and report immediately to the nurse. Problem initiated on 01/23/2025 and revised on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 9 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 08/25/20225- Resident #1 had a behavior problem related to resident would eat soap from dispensers, history of removing water from toilet, and scooping into the trash can. She wanders into other rooms and rummages through other belongings. Attempt to assist and dictate the care of others. Resident #1 had history of lifting her shirt up and pants down to expose her breast and vagina to others. She had history of defecating on the floor. Resident #1 had history of returning from out of pass with family or friends with alcohol on breath and in her personal possession. She has urinated in the hallway and in other residents' rooms. She has hit glass doors when wanting attention. Interventions Resident had activity memory boxes made to help with distraction. If Resident #1exposes herself cover her and escort to her bedroom. Intervene as necessary. Approach Resident #1 and speak in a calm manner. Divert Resident #1's attention. Anticipate Resident #1's and meet her needs. Monitor Resident #1's behavior episodes and attempt to determine underlying causes. Consider Resident #1's location, time of day, people involved and situations. Document Resident #1's behavior and potential causes. Problem: initiated on 04/17/2025 and revised on 09/16/2025 Resident #1 had physical aggression towards others related to dementia ( a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory). Resident #1 had history of knocking over chairs. Intervention initiated on 08/02/2025, 1:1 monitoring until staff feels she is stable with behaviors. Analyze key times, circumstances, triggers, and what de-escalates behavior and document findings. Assess and address for contributing sensory deficits. Assess Resident #1's needs such as: hunger, thirst, toileting needs, comfort level, body positioning, pain, etc. Psychiatric/ Psychogeriatric consult as indicated. When Resident #1 becomes agitated: Intervene before agitation escalates; Guide away from source of distress; Engage calmly in conversation; If Resident #1 becomes aggressive, staff walk calmly away, and approach at later time. Resident #1 was resistive to care such as refusing vital signs , spitting out medications . Interventions: Allow Resident #1 to make decisions about treatment regimen , to provide sense of control. Encourage Resident #1 as much participation/ interaction as possible during care. If Resident #1 resists with ADLs, reassure Resident #1, ensure safety, leave and return five to 10 minutes later and reapproach Resident #1 with assistance with ADL care. Review of Resident #1's Social Worker notes, dated, 08/04/2025, reflected Resident #1 allegedly placed her hands on another resident's neck in the day room. Resident #1 was placed on 1:1 .Review of Resident #1's one on one records from August 2025 until December 2025, reflected Resident #1 continued 1:1 supervision with staff due to behaviors toward other residents, self, and staff. Review of Resident #1's Psychiatry Progress Note, dated 08/19/2025 and signed by PMHNP-BC, reflected Resident #11 did not have any hostility toward peers and care givers. Resident #1 was not depressed and had no sleep complaints. Resident #1's energy level was normal. She had no social isolation or crying. Resident #1 continued with current medications. Review of Resident #1's Psychiatry Progress Note, dated 09/16/2025 and signed by PMHNP-BC, reflected Resident #1 had no anxiety, irritability, and hostility toward peers. She did not have any depression and no sleep complaints. Resident #1's energy level was normal. She did not have any paranoid ideations and was not resisting assistance with ADLs Resident #1 did not have any social isolation or refuse treatment. She did not have any verbal aggression. Resident #1 needed to continue with her medications.Review of Resident #1's Psychiatry Progress Note, dated 09/30/2025 and signed by PMHNP-BC, reflected Resident #1 did not have hostility toward peers or caregivers. She was not depressed and did not have any sleep complaints. Resident #1 energy level was normal. She did not have any physical aggression. Resident #1 did not have paranoid ideations and did not resist assistance with activities of daily living. Resident #1 did not socially isolate or refuse treatment. Resident #1 had anxiety, irritability and verbally aggressive.Review of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 10 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #1's Psychiatry Progress Note, dated 10/14/2025 and signed by PMHNP-BC, reflected Resident #1 had normal appetite. No anxiety and no hostility toward peers. Resident #1 did not have hostility toward care givers. She did not have depression and did not have any sleep complaints. Resident #1 energy level was normal. She did not have any paranoid ideations and was not resisting assistance with activities of daily living. She did not have any social isolation or was crying. She was oriented towards person and place. She was disoriented to time. Her mood was euthymic. (a normal stable and balanced mood state). Resident #1's thought process: no thought insertion was noted, no thought broadcast was noted, and no thought control was noted. Resident #1's Plan: medication list reviewed and will continue with medication. Resident #1's attempt dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Continue management options: risks and benefits have been considered. Medication Effectiveness: Multiple non-pharmacologic approaches have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Unless otherwise noted, and therefore not clinically contraindicated, continue current medications as per current standards of practice; any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating an underlying psychiatric disorder. PMHNP-BC prescribed Resident #1 t medications necessary to treat a specific condition as diagnosed and documented in this clinical record. Certain disorders such as chronic functional and organic mood, anxiety, impulse control, and thought disorders will require psychoactive medications indefinitely. Resident #1 diagnosis, Assessment and Plan: Acute anxiety, Alcohol dependence with alcohol-induced persisting dementia, Unspecified dementia, severe, with other behavioral disturbance. Review of Resident #1's Psychiatry Progress Note, dated 10/28/2025 and signed by PMHNP-BC, reflected Resident #1 had a normal appetite, no irritability, no depression, and no sleep complaints. Resident #1 did not have any loss of interest in activities. Her energy level was normal. She did not have any physical aggression, paranoid ideations and did not refuse treatment. Resident #1 did not have any auditory hallucinations and no visual hallucinations. She did not have any persecutory delusions or any verbal aggression. Resident #1 needs to continue with current medication: unless otherwise noted in this encounter, continue current medication regimen; any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating an undermine psychiatric disorder. No diagnosis of adverse effect of psychotropic agents noted otherwise, a psychotropic gradual dose reduction is contraindicated. Monitor Resident #1's behavioral signs and symptoms on each subsequent encoder. Medication reconciliation performed . Mental Status Exam: Resident 1 was not in acute distress; she was smiling and interacting. She was oriented towards person and place. Resident #1 was disoriented by time and situation. Her mood was euthymic. Resident #1's effect was reactive. Her thought process was not impaired, and thought disorder was not noted. The thought content revealed no impairment. Plan: Resident #1 medication list reviewed and continue with current medication and attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatrics instability by exacerbating and underlining psychiatric disorder. Medication effectiveness: Resident #1 had multiple non-pharmacologic approaches have been ineffective in relieving significant patient distress and/ or behavioral symptoms dangerous to this patient or others. Diagnosis, Assessment, and Plan for Resident #1: Acute anxiety, alcohol dependence with alcohol-induced persisting dementia, and unspecified dementia, severe, with other behavioral disturbance. Review of Resident #1's Psychiatric Progress Note, dated 11/11/2025 and signed by PMHNP-BC, reflected Resident #1 had normal appetite. She stated she was alright. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 11 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some She did not have any of the following: irritability, depressions, sleep complaints and/ or loss of appetite. Her energy level was normal. Resident #1 did not have physical aggression. She was not refusing treatment. She did not have any verbal aggression. Mental Status Exam: Resident 1 was not in acute distress. She was smiling and interactive. She was oriented to person and place and disoriented to time and situation. Resident #1's mood was euthymic, and affect was reactive. Her thought process was not impaired, and thought disorder was not noted. Resident #1 thought content revealed no impairment. Resident #1's Plan: Resident's #1 medication list reviewed. Continuing with Resident #1's medication, any attempted dose reduction would impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating an underline psychiatric disorder. Resident #1 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Diagnosis , Assessment and Plan for Resident #1: Acute anxiety, alcohol dependence with alcohol-induced persisting dementia, and unspecified dementia, severe, with other behavioral disturbance. Review of Resident #1's Psychiatric Progress Note, dated 11/25/2025 and signed by PMHNP-BC , reflected Resident #1' had normal appetite, no irritability, no depression, and no sleep complaints. She did not have loss of interest in activities. Her energy level was normal. Resident #1 did not have the following: no physical aggression, no paranoid ideations, no refusing treatment, no auditory/visual hallucinations and no verbal aggression. Mental Status Exam: Resident 1 was not in acute distress. She was smiling and interactive. She was oriented to person and place and disoriented to time and situation. Resident #1's mood was euthymic, and affect was reactive. Her thought process was not impaired, and thought disorder was not noted. Resident #1 thought content revealed no impairment. Resident #1's Plan: Resident's #1 medication list reviewed. Continue with Resident #1's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #1 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Diagnosis , Assessment and Plan for Resident #1: Acute anxiety, alcohol dependence with alcohol-induced persisting dementia, and unspecified dementia, severe, with other behavioral disturbance. Review of Resident #1's Psychiatric Progress Note, dated 12/09/2025, reflected Resident #1 had normal appetite. She did not have any anxiety, irritability, and no hostility toward peers or caregivers. Resident #1 did not have any depression or any sleep complaints. Her energy level was normal. Resident #1 did not have any physical aggression, did not resist assistance with activities of daily living. She did not have verbal aggression. Mental Status Exam: Resident #1 was not in acute distress. She was smiling and interactive. She was oriented to person and place and disoriented to time and situation. Resident #1's mood was euthymic, and affect was reactive. Her thought process was not impaired, and thought disorder was not noted. Resident #1 thought content revealed no impairment. Resident #1's Plan: Resident's #1 medication list reviewed. Continue with Resident #1's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #1 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Diagnosis , Assessment and Plan for Resident #1: Acute anxiety, alcohol dependence with alcohol-induced persisting dementia, and unspecified dementia, severe, with other behavioral disturbance. Signed by PMHNP-BC. 2. Review of Resident #2's face sheet, dated 12/12/2025, reflected a [AGE] year-old male admitted on [DATE] with a diagnosis of major depressive disorder ( a mental condition (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 12 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some characterized by a persistently depressed mood and long-term loss of pleasure or interest in life, often with other symptoms such as disturbed sleep or feelings of guilt), diarrhea, unspecified ( a condition in which feces are discharged from the bowels frequently and in a liquid form), other depressive disorder, recurrent without psychotic features (someone having repeated , severe depression episodes but without delusions, meaning they stay grounded in reality).Review of Resident #2's Quarterly MDS, dated [DATE], reflected Resident #2 had a BIMS score oof 15indicating his cognition was intact. Resident #2 felt down, depressed , or hopeless 7-11 days out of the 14-day assessment period. He had trouble falling asleep or sleeping too much. He felt tired or had very little energy. Resident #2 had difficulty concentrating on things. Review of Resident #2's Comprehensive Care Plan with completion date of 09/25/2025, reflected Resident #2 had chronic diarrhea. Intervention: diet as tolerated. Give Anti-diarrheal medications. Monitor lab values and inform physicians of abnormal findings. Resident #2 had potential for alterations in mood related to depression. Interventions: Arrange for psych consult, follow up as indicated. Monitor/ document/ report to nurse/ MD of signs and symptoms of depression, including hopelessness, sadness, negative statements, tearfulness, etc.Review of Resident #2's Nurses notes on 12/04/2025 reflected Resident # 5 called him by a name. Resident #2 stated he asked the other resident to stop. The conflict escalated when the other resident allegedly continued to call him names after Resident #2 refused to take a bath. Resident #2 hit Resident #5 on the nose. Review of Resident #2's Psychiatric Notes, dated 12/09/2025, reflected Resident #2 had normal appetite. He did not have any anxiety, no irritability, and no hostility toward peers or caregivers. He did not have any depression or any sleep complaints. His energy level was normal. He did not have any physical aggression. Resident #2 did not have any paranoid ideations and did not resist assistance with activities of daily living. He was not socially isolated from others. He did not refuse treatment or had verbal aggression. Mental Status Exam: Resident 2 was not in acute distress. He was smiling and interactive. Resident #2 was oriented to person, place, time and situation. His mood was euthymic. His speech was normal. Resident #2 did not have any thought insertion, not thought broadcast was noted, and no thought control was noted. He did not have any short- or long-term memory impairment. Resident #2's Plan: Resident #2's medication list reviewed. Continue with Resident #2's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #2 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Diagnosis, Assessment and Plan: Major depressive disorder, recurrent severe without psychotic features. Interview on 12/12/ 2025 at 11:00 a.m., Resident #2 stated he had diarrhea and came out of his bathroom. He stated his roommate, Resident #5 , told him to take a shower. Resident #1 stated he walked in hallway and talked to CNA A about his shower. Resident #2 stated he asked if he could get a shower after his therapy. Resident #2 stated Resident #5 overheard the conversation between him and the CNA A. Resident #2 stated when he went to therapy room and sat in chair Resident #5 entered the therapy room cursing and yelling at him. He stated the therapy staff attempted to talk to Resident #5 and he continued to walk toward him. Resident #2 stated he informed Resident #5 if he thought he was big enough to fight him to come on and they would fight. Resident #2 stated Resident #5 approached him while he was sitting in the chair in therapy room and hit him in the nose. Resident #2 stated he did not want to be near Resident #5 until he became calmer about the situation. He stated he would not harm Resident #5, but he was still upset over the situation. Resident #2 stated he had diarrhea because of the foods he ate, and he had history of diarrhea most of his life. He stated he did not eat the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 13 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some proper food, and his family brought food for him that hurt his stomach and caused diarrhea, but he did not report this to his family. Resident #2 stated his roommate stayed mad at him due to his diarrhea and the odor in the room. He stated this was the entire argument last week when he was hit by Resident #5 about the odor in his room and he did not immediately take a shower. Resident #2 stated he did see psychiatrist after the incident with Resident #5, but she did not ask him any questions about the incident and him being mad toward Resident #5. He stated he thought that is why Psychiatrist came to see people to help them when they were upset about something. Resident #2 stated he had seen the same Psychiatrist for several months and she never asked about his feelings and how he was having a hard time dealing with his depression. He stated she talked to him in front of his roommate (Resident #5) and he did not feel comfortable telling the psychiatrist about his feelings in front of the person ( Resident #5) giving him problems and making him depressed and upset prior to him seeing her this week ( week of 12/08/2025) Resident # 2 stated he had never had a normal appetite. He stated he ate all the time, and his appetite has never been normal. He stated this is why he had diarrhea all the time because of overeating and eating things that upset his stomach. Resident #2 stated, I don't know who told you I had a normal appetite because that was a lie. Resident #2 stated he had problems sleeping since that incident because it upset him. Resident #2 stated sometimes he refused to take a bath. He stated Psychiatrist saw him two days ago and never asked him how he felt toward the incident or asked him about any of his feelings. He stated after she was in the room for a few minutes the psychiatrist told him she needed to visit other patients. Resident #2 stated she was not in his new room long enough to know what was going on with him. Resident #2 stated he saw the same psychiatrist for the past several months. 3. Review of Resident #3's face sheet, dated 12/12/2025, reflected a [AGE] year-old male admitted on [DATE] and readmitted on [DATE] had a diagnosis of mild intellectual abilities ( involves challenges with thinking, learning, and daily skills (like communication, self-care, and social skills) but allows individuals to learn practical life skills), major depressive disorder, recurrent severe without psychotic features ( causing significant life impairment such as work, social and self-care but without hallucinations or delusions- seeing hearing tasting or feeling things that seems real but isn't, having no external source), featuring symptoms like sadness, loss of pleasure, energy loss, and guilt), and generalized anxiety disorder ( a mental health condition causing persistent , excessive, and uncontrollable worry about everyday things).Review of Resident #3's Annual MDS, dated [DATE], reflected Resident #3 had a BIMS score of 15 indicating his cognition was intact. Resident #3 had verbal behavioral symptoms directed at others such as: threatening others, screaming at others or cursing at others. Notified the MD.Review of Resident #3's Comprehensive Care Plan, dated 09/03/2025, reflected Resident #3 demonstrated verbal abusive behaviors towards staff and other residents. Resident #3 had history of entering other residents' rooms and making racial slurs. Resident #3 threatened others with physical harm. He yells and screams profanities. Intervention: Psychiatric consult as indicated. Resident #3 to be redirected to his room where there is less stimulus and allow him to become calm. When Resident #3 becomes agitated: intervene before agitation escalates; guide Resident #3 away from source of distress; Engage calmly in conversation; if Resident # 3's response was aggressive, ensure all residents involved were safe and staff to walk calmly away and approach at a later time. Analyze the key times, places, circumstances, triggers, and what de-escalate behavior and document. Review of Resident #3's Nurses Notes, dated 11/17/2025, reflected Resident #3 had experienced verbal behaviors directed toward others 1 to 3 days. Resident #3 did not have any physical behaviors toward others in the last week. Review of Resident #3's Psychiatric Progress Note, dated 10/14/2025, reflected Resident #3 had normal appetite. He did not have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 14 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some any anxiety or hostility toward peers or care givers. He did not have any depression and no sleep complaints. His energy level was normal. He did not resist assistance with activity of daily living. He did not isolate himself from others or had any crying episodes. Mental Status Exam: Resident 3 was not in any acute distress. He was smiling and interactive. He was oriented to person, place, and situation. Resident #3 was disoriented to time. His mood was euthymic. Resident #3's thought process: no thought insertion was noted, no thought broadcast was noted, and no thought control was noted. Plan: Resident 3's medication list reviewed. Continue with Resident #3's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #3 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Resident #3's Diagnosis, Assessment and Plan: Major Depressive disorder, recurrent without psychotic features. Generalized anxiety disorder, and Mild intellectual disabilities. Review of Resident #3's Psychiatric Progress Note, dated 10/28/2025, reflected Resident #3 had normal appetite, no irritability, no depression, and no sleep complaints. He did not have any loss of activity interest. Resident #3 energy level was normal. He did not have any physical aggression or verbal aggression. Mental Status Exam: Resident 3 was not in any acute distress. He was smiling and interactive. He was oriented to person, place, and situation. Resident #3 was disoriented to time. His mood was euthymic. Resident #3's thought process: no thought insertion was noted, no thought broadcast was noted, and no thought control was noted. Plan: Resident 3's medication list reviewed. Continue with Resident #3's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #3 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Resident #3's Diagnosis, Assessment and Plan: Major Depressive disorder, recurrent without psychotic features. Generalized anxiety disorder, and Mild intellectual disabilities. Review of Resident #3's Psychiatric Progress Note, dated 11/25/2025, reflected Resident #3 had normal appetite, no irritability, no depression, and not have any sleep complaints. He did not have any loss of interest. Resident #3 energy level was normal. He did not have any physical aggression or verbal aggression. Mental Status Exam: Resident 3 was not in any acute distress. He was smiling and interactive. He was oriented to person, place, and situation. Resident #3 was disoriented to time. His mood was euthymic. Resident #3's thought process: no thought insertion was noted, no thought broadcast was noted, and no thought control was noted. Plan: Resident 3's medication list reviewed. Continue with Resident #3's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #3 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Resident #3's Diagnosis, Assessment and Plan: Major Depressive disorder, recurrent without psychotic features. Generalized anxiety disorder, and Mild intellectual disabilities. Review of Resident # 3's Psychiatric Progress Note, dated 12/09/2025, reflected Resident #3 had normal appetite, no irritability, no depression, and not have any sleep complaints. He did not have any loss of interest. Resident #3 energy level was normal. He did not have any physical aggression or verbal aggression. Mental Status Exam: Resident 3 was not in any acute distress. He was smiling and interactive. He was oriented to person, place, and situation. Resident #3 was disoriented to time. His mood was euthymic. Resident #3's thought process: no thought insertion was noted, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675399 If continuation sheet Page 15 of 16 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 675399 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Navasota Nursing & Rehabilitation 1405 E Washington Navasota, TX 77868 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 0742 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete no thought broadcast was noted, and no thought control was noted. Plan: Resident 3's medication list reviewed. Continue with Resident #3's medication, any attempted dose reduction would likely impair the patient's function, increase distressed behavior, or cause psychiatric instability by exacerbating and underlining psychiatric disorder. Resident #3 had multiple non-pharmacologic approaches that have been ineffective in relieving significant patient distress and /or behavioral symptoms dangerous to this patient or others. Resident #3's Diagnosis, Assessment and Plan: Major Depressive disorder, recurrent without psychotic features. Generalized anxiety disorder, and Mild intellectual disabilities. Interview on 12/12/2025 at 11:30 a.m., Resident #3 stated the psychiatrist did visit him but she never asked about his feelings or if he was depressed. He stated she would come in and would say you are smiling and ask about pets. He stated they mostly talked about dogs and cats. Resident #3 stated sometimes he did become mad at other people and would yell at them, and he said sometimes he would say ugly words at people. Resident #3 stated the Psychiatrist never asked him about him yelling and cursing at other people. He said one time she came to visit me , and I just got finished yelling at someone who lived close by, and I was mad at them for not speaking to me and she never asked me if I had problems with getting upset with other people.Interview on 12/11/2025 at 2:47 p.m., the Psychiatrist stated he trained PMHNP-BC for three months prior to her entering a nursing facility to counsel any resident. He stated his expectations were for any Psychiatrist to speak with the DON, ADON, MDS nurse and make rounds with the DON prior to counseling the residents. He stated he expected any Psychiatric staff, including PMHNP-BC, to review orders with the DON or designee and discuss any behaviors of the residents. He stated he expected PMHNP-BC to counsel the residents of any new behaviors [TRUNCATED] Event ID: Facility ID: 675399 If continuation sheet Page 16 of 16