Health inspection·October 21, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete around to the rooms to check. In an interview on 10/21/25 at 9:00 AM, the Administrator was advised of Residents #1 and #2 not having their call lights within reach. He stated the staff made their rounds at least every two hours and they checked to ensure the call lights were within reach of the residents. He stated they also conducted Champion rounds daily and the leadership checked for call lights being within reach as well. In an interview on 10/21/25 at 12:00 PM, RN M was told by the Surveyor about Resident #2's call light not being within her reach. She stated she was told by CNA G about the resident's call light not being within her reach. She stated the call light needed to be within the resident's reach for their safety and if they needed anything from the nursing staff. In an interview on 10/21/25 at 12:07 PM, ADON G stated leadership told her about Resident #1 and #2 not having their call light within their reach. She stated she expected the call lights to be within reach of the resident so they could contact staff if they needed anything. She stated a risk of the call light not being in reach was the resident could have an emergency In an interview on 10/21/25 at 12:16 ADON E stated her nursing staff advised her of call lights not being in reach of the residents and she stated her expectation was for the call light to be within reach of every resident. She stated if the call lights were not within reach of the residents, they would not be able to contact staff. In an interview on 10/21/25 at 1:27 PM, the DON was told and shown photos by the Surveyor of the call lights for Residents #1 and #2 not being within reach of the residents. She stated the call light needed to be within the residents reach for their safety. She stated the nursing staff should be checking for this when they made their rounds. The nursing staff provided copy of an in-service with the nursing staff on 6/15/25 for Answering Call lights and Call lights Within Reach. The in-service revealed it is the responsibility of staff to round each room every shift and confirm that call lights are accessible to all residents. Event ID: Facility ID: 675402 If continuation sheet Page 2 of 7 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 675402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rockwall Nursing Care Center 206 Storrs Rockwall, TX 75087 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 interviews, and record reviews, the facility failed to provide adequate supervision and assistance to prevent accident hazards for one of ten residents (Resident #3) reviewed for accidents and hazards. CNA A failed to follow Resident #3's care plan and mechanical lift instructions of using two people to perform the transfer on 09/27/25, which resulted in the resident falling and fracturing 5 ribs. The non-compliance was identified as PNC on 10/21/25 and the IJ template was provided to the facility on [DATE] at 4:30 PM. The noncompliance began on 09/27/25 and ended 09/29/25. The facility corrected the non-compliance before the investigation began. This failure placed the resident at risk of serious harm, injury and death. Findings included: Record review of Resident #3's Face Sheet, dated 10/21/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnosis included obesity and lack of coordination. Record review of Resident #3's Quarterly MDS assessment, dated 10/09/25, reflected a BIMS score of 11, a moderate cognitive impairment. For ADL care, it reflected the resident required maximal assistance and a two-person assist. Active diagnosis included obesity and muscle weakness. Record review of Resident #3's Comprehensive Care plan, dated 9/11/25, reflected the resident required ADL care and an intervention included the requirement of 2 people for mechanical lift participation with transfers. Record review of LVN K's witness statement, dated 9/30/25, reflected Upon entering the room, this nurse observed the resident on the floor flat with sling attached to all four hooks on the Hoyer lift, with hook piece on resident's chest. The Hoyer was laying sideways on the floor near resident. The sling was under resident and shower bed was in corner of the room. Record review of the hospital records, dated 9/29/25, reflected Resident #3 was seen in the emergency room and was treated for Mildly displaced fractures of the seventh, eighth, ninth, tenth, and eleventh ribs. In an interview on 10/21/25 at 9:00 AM, the Administrator stated he received a report from the DON on 09/29/27 that on 09/27/25, CNA A had used a Hoyer lift by herself to provide Resident #3 a shower. He stated when the CNA was attempting to transfer the resident back into her bed the Hoyer lift had fallen while the resident was in the Hoyer lift and the Hoyer collapsed, sending the resident to the floor and the mechanical lift landed on top of the resident. He stated the facility conducted an x-ray on 9/27/25 and there were no concerns observed, which was verified by the surveyor. He stated the resident was complaining of pain the next day and wanted to send the resident to the ER but the resident refused. He stated the resident was complaining of pain while at the dialysis clinic, and they persuaded her to go to the ER on [DATE]. He stated he received a report that their x-rays revealed the resident had suffered five fractured ribs. He stated they kept the resident for five days for pain management. The Administrator stated he interviewed CNA A and she initially stated she attempted to get someone to assist her with the Hoyer lift but could not find anyone. He stated CNA A admitted to using the Hoyer lift by herself. He stated he interviewed all of the CNAs on shift at the time, and all of them denied CNA A asking for assistance to operate the Hoyer lift for Resident #3. The Administrator stated CNA A was initially suspended, and after the internal investigation was completed, they decided to terminate her. He stated the facility always required two people to operate the Hoyer lift. He stated the resident had been able to attend her dialysis appointments since she had returned and continued to be monitored for pain management. The Administrator stated on 9/29/25 he completed in-services with the nursing staff on mechanical lift transfers, pain management, bed to chair transfers, trauma informed care, abuse and neglect reporting procedures, incident reporting, and change in conditions. The Administrator provided copies of staff competencies conducted on gate belt transfers and Hoyer lift transfers. He stated he implemented a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 3 of 7 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 675402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rockwall Nursing Care Center 206 Storrs Rockwall, TX 75087 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 monitoring process which required the nursing leadership to observe ten ADL care to residents to ensure transfers, feeding, and bed repositioning were done accurately. In an interview on 10/21/25 at 12:28 PM, CNA A stated she had no intention in harming Resident #3, and it was an unfortunate accident. She stated they were always short-staffed, and it was difficult to get a second person to assist her with the Hoyer lift. She stated the resident was insistent on getting a shower, she could not wait any longer, and her intention was to give the resident a successful shower. She stated she thought she would get in trouble if she did not give the resident a shower. She stated two people were required to use the mechanical lift and she had seen other CNAs using the Hoyer lift by themselves all the time. She stated two people were required for the Hoyer lift for the transfer, but she did not know the risk if two people were not used. In an interview and observation on 10/21/25 at 11:40 AM, Resident #3 stated CNA A was providing her a shower on 09/27/25. She stated the CNA used the Hoyer lift by herself to lift her out of the bed and onto the shower chair and took her to the shower room for a shower. She stated when the CNA had returned her to the room, she used the Hoyer lift by herself to place her back in bed and when the CNA was turning her around, the Hoyer lift fell on top of her and she fell on the floor. She stated she was screaming for the Hoyer lift to be taken off her. She stated the CNA ran to get help and returned with two other staff members and got her hooked back on the Hoyer lift and placed back in bed. She stated the nurse on duty ordered x-rays and she stated she told the nurse she was okay. She stated when she went to Dialysis on 9/29/25, she was in pain and when she returned to the facility, they encouraged her to go to the ER. She stated staff had been using two people to conduct transfers since the incident. The resident was observed lying in bed and she did not appear to be in any distress. In an interview on 10/21/25 at 1:27 PM, the DON stated she expected two people to operate the Hoyer lift at all times. She stated that was required to avoid the resident having an accident. She stated she had never received any reports from staff of any CNAs operating the mechanical lifts by themselves until this incident and she had not observed it. She stated she was not at the facility at the time of the incident. An attempt to interview LVN K on 10/21/2025 at 2:00 PM and 10/23/2025 at 1:30 PM was unsuccessful. Prior to the investigation on 10/21/25, the surveyor reviewed in-services completed with the nursing staff on 9/29/25 on mechanical lift transfers, pain management, bed to chair transfers, trauma informed care, abuse and neglect reporting procedures, incident reporting, and change in conditions. The Administrator provided copies of staff competencies conducted on gate belt transfers and Hoyer lift transfers. He stated he implemented a monitoring process which required the nursing leadership to observe ten ADL care to residents to ensure transfers, feeding, and bed repositioning were done accurately. Record review on 10/21/25 of CNA A's personal file indicated she was suspended and terminated on 09/29/25. The Administrator stated beginning on 9/29/25, monitoring tools were in place, which required the nursing leadership to monitor ten ADL care to residents per week by the nursing leadership to ensure transfers, feeding, and bed repositioning were done accurately beginning 09/29/25 Incident logs were reviewed and there were no reported incidents since 09/27/25. Documented Gait belt transfer and Mechanical lift transfer skills checklist completed with nursing staff on 09/29/25 and 09/30/25. Interviews on 10/21/25 between 12:00 PM and 5:06 PM were conducted with multiple staff members which included the Administrator, DON, ADON G, ADON E, RN R, RN M, CNA G, CNA O, CNA L, CNA E, CNA M, and CNA J. Interviews revealed staff members received in-services on mechanical lift transfers, and bed and chair transfers. Staff were reminded to ensure they inspect the mechanical lift prior to using it, check the weight allowance on the mechanical lift to ensure it could hold the resident's weight, and ensure two people are always operating the mechanical lift. Record review of the facility's policy on Mechanical lift (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 4 of 7 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 675402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rockwall Nursing Care Center 206 Storrs Rockwall, TX 75087 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 usage, undated, revealed A Hoyer lift must always be operated by two staff members. Never attempt to use a Hoyer lift alone. It is unsafe for both the resident and the staff member. One staff member should focus on operating the lift controls, while the second staff member ensures the resident's safety, positioning, and comfort. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 5 of 7 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 675402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rockwall Nursing Care Center 206 Storrs Rockwall, TX 75087 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to ensure that residents, who needed respiratory care, were provided care consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for four of seven residents (Residents #1, #3, and #4) reviewed for respiratory care. The facility failed to ensure Residents #1, #3, and #4 nasal cannulas and breathing devices were properly stored in a bag when not in use on 10/21/25. This failure could place residents at risk for respiratory infection and not having respiratory needs met.Findings include: 1. Record review of Resident #1's Face Sheet, dated 10/21/25, reflected she was an [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnoses included Supraventricular Tachycardia (irregular heartbeat). Record review of Resident #1's Quarterly MDS assessment, dated 10/01/25, reflected a BIMS score of 11, a moderate cognitive impairment. For ADL care, it reflected the resident required substantial assistance. She had an active diagnosis of atrial fabulation fracture (irregular heartbeat). Record review of Resident #1's physician's orders, dated 10/21/25, reflected Ipratropium Bromide Inhalation Solution 0.02%, 1 vial orally every 8 hours as needed for wheezing In an observation and interview on 10/21/25 at 8:52 AM revealed Resident #1's breathing mask for her nebulizer was observed sitting on top of the nebulizer, which was located on a chair. She stated she used the nebulizer twice a day and had already used it in the morning and would not use it again until later in the day. 2. Record review of Resident #3's Face Sheet, dated 10/21/25, reflected she was a [AGE] year-old female admitted to the facility on [DATE]. Relevant diagnosis included Hyperkalemia (excessive potassium). Record review of Resident #3's Quarterly MDS assessment, dated 10/09/25, reflected a BIMS score of 11, moderate cognitive impairment. For ADL care, it reflected the resident required maximal assistance. Active diagnosis included obesity. Record review of Resident #3's physician's orders, dated 10/21/25, reflected May use oxygen @ 2 l/m via nasal canula during night for Oxygen therapy. In an observation on 10/21/25 at 8:54 PM, revealed Resident #3's nasal canula was observed on the floor, near the oxygen device, unbagged. 3. Record review of Resident #4's Face Sheet, dated 10/21/25, reflected he was an [AGE] year-old male admitted to the facility on [DATE]. Relevant diagnosis included COPD. Record review of Resident #4's Quarterly MDS assessment, dated 8/08/25, reflected his BIMS score of 9, moderate cognitive impairment. The resident had an active diagnosis of heart failure. Record Review of Resident #4's physician's orders, dated 10/21/25, reflected Comb/vent Aerosol 18-103 MCG/ACT, 2 puff inhale orally every 4 hours as needed for SOB. In an observation on 10/21/25 at 8:57 PM, revealed Resident #4's breathing treatment inhaler was observed sitting inside a nightstand, unbagged. In an interview on 10/21/25 at 9:00 AM, RN R was shown pictures of Resident #1, #3, and #4's breathing devices unbagged while not in use. She stated the nasal cannulas and breathing devices should be bagged when not in use to avoid infection control. She stated all nurses should check for this when making their rounds. In an interview on 10/21/25 at 12:00 PM, RN M was told by the Surveyor about Resident #1, #3, and #4's breathing devices unbagged while not in use. She stated nasal cannulas and breathing devices should be bagged when not in use to avoid infection control. She stated it was the nurses responsibility to ensure the devices were bagged when not in use. In an interview on 10/21/25 at 12:07 PM, ADON G was shown photos of Resident #1, #3, and #4's breathing devices not being bagged when not in use. She stated all breathing devices should be bagged to avoid the residents getting an infection. She stated the nurses check to ensure the breathing devices were bagged when making their rounds. In an interview on 10/21/25 at 12:16, ADON E was told by the Surveyor of Resident #1, #3, and #4's breathing devices not being bagged when not in use. She stated the nurses were Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 6 of 7 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 675402 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rockwall Nursing Care Center 206 Storrs Rockwall, TX 75087 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 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete required to ensure breathing devices were bagged for infection control. In an interview on 10/21/25 at 1:27 PM, the DON was told by the Surveyor of Resident #1, #3, and #4's breathing devices not being bagged when not in use. She stated she expected all breathing devices to be bagged when not in use for infection control purposes. She stated all nurses, including the ADONs and DON was expected to check for this when making rounds. Review of the facility's policy Respiratory Care Policy, undated, reflected Purpose - To ensure that all residents requiring respiratory care in the long-term care facility receive safe, evidence-based, and individualized respiratory services that optimize respiratory function, prevent complications, and improve quality of life. Event ID: Facility ID: 675402 If continuation sheet Page 7 of 7