Health inspection·November 25, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few taken off 1:1 as long as there is no physical aggression, threats, SI, HI for at least 24 hours. Re-fer for psychological counseling for anger management. Continue current appropriate treatment. All psychoactive medications were reviewed for continued need or dosage adjustment. Gradual dose reduction or medication reduction not recommended at this time due to ongoing signs/ symptoms. Continue to monitor mood, behaviors and potential SEs of medications. Follow up next visit or PRN.Record review of Resident #2's progress notes reflected she had not hit any other resident since she hit Resident #1 on 09/20/2025. During an interview on 09/26/2025 at 10:41 AM, RN D stated she was not working when Resident #2 hit Resident #1. She stated she worked the day shift Monday to Friday in the female memory care unit. She stated Resident #2 cursed and yelled at other residents at times. She stated Resident #2 was ok most of the time and she had not seen her hit another resident. She stated if Resident #2 seemed agitated, they directed her to her room or took her to therapy. RN D stated the other residents were not afraid of Resident #2. She stated Resident #1 was calm and had displayed no behaviors of yelling or hitting. During an observation and interview on 09/26/2025 at 11:10 AM, Resident #2 was sitting at a table with another resident in the main living area of the memory care unit. When asked if she had an issue with any of the residents, she pointed at a resident at another table and stated the resident called her a bitch and she (Resident #2) hit her on the shoulder. She stated they put her on restriction after that. When asked what that meant, she replied she could not go out with her parents. When the surveyor pointed at Resident #1 and asked how they got along, Resident #2 stated she don't bother me and denied hitting Resident #1.During an observation and interview on 09/26/2025 at 11:17 AM, Resident #1 was sitting in the main living area of the memory care unit. She was not near Resident #2. When asked if she felt safe, Resident #1 replied yes. When asked if another lady had hit her, she said no. When asked if she had grandchildren, she replied she had people with her, but she did not know their ages. Resident #1 did not remember the incident and was unable to provide information due to her cognitive status. During a telephone interview on 09/26/2025 at 12:39 PM, CNA C stated she was cleaning the floor when she heard a slap noise. She stated she had her back to Resident #2 and did not observe the incident. She stated a resident was pointing and said she slapped her, indicating Resident #2 hit Resident #1. CNA C stated Resident #2 said yes, I slapped her because she told me to shut up. CNA C stated Resident #1 touched her face and said she was ok. She stated Resident #1 did not reply when asked if Resident #2 hit her. CNA C stated she had not seen Resident #2 hit anyone else. She stated she got the charge nurse and Resident #2 was placed on 1:1 monitoring. The interview revealed CNA C was knowledgeable about the types of abuse and to report any signs of abuse to the administrator who was the facility's abuse coordinator. During an interview on 09/26/2025 at 2:11 PM, DON A stated CNA C reported while she was cleaning in the day area another resident said Resident #2 hit Resident #1. The DON stated during follow-up interviews Resident #2 denied hitting Resident #1 and Resident #1 did not remember the incident. DON A stated the facility began in-service training for staff members. She stated Resident #2 was placed on 1:1 monitoring and had a psych televised visit. She stated the resident also saw psych services in the facility. She stated Resident #2 was care planned for behaviors of yelling at staff and residents. She stated measures were taken to help ensure Resident #2 did not hit another resident. Staff were educated to be proactive. She stated the CNAs and nurses assigned to the memory care unit were positioned in the main area where they could see all residents at all times. She stated prevention was the best policy. She stated staff were educated to notify management if they witnessed any behaviors by residents. She stated Resident #2 had not hit anyone else. During an interview on 09/26/2025 at 2:30 PM, the Social Worker stated she was told another resident said Resident #2 hit Resident #1. She stated Resident #2 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 2 of 6 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 11/25/2025 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete was placed on 1:1 monitoring until she was seen and cleared by psych services. She stated the incident occurred on Saturday and she spoke with both residents the following Monday. She stated when she spoke with the residents, Resident #1 denied being hit and Resident #2 denied hitting her. She stated Resident #2 was autistic and processed feelings differently. She stated Resident #2 was fairly new at the facility and the resident's family member provided tips on what knowledge she had acquired over the years caring for the resident. She stated Resident #2 saw a counselor and psych services in the facility. The Social Worker stated after the incident, safe surveys were completed with other residents and trauma informed assessments completed for both parties involved. She stated she followed up with the residents daily for 3 days to monitor for any other concerns or behaviors. During a telephone interview on 09/26/2025 at 3:09 PM, RN B stated CNA C notified her Resident #2 hit Resident #1. She stated when she asked Resident #2 what happened, she just said she was sorry. RN B stated she separated the residents and Resident #2 was placed on 1:1 monitoring until psych cleared her. She stated Resident #2 had not hit another resident. The interview revealed RN B was knowledgeable about the types of abuse and to report any abuse to the administrator who was the abuse coordinator.During an interview on 09/26/2025 at 4:10 PM, the Administrator stated he was told CNA C was in the tv room when the incident occurred. He stated CNA C reported she was cleaning up fluids or a spill on the floor and heard a commotion. When CNA C stood up, a resident pointed and said she hit her, indicating Resident #2 had hit Resident #1. CNA C reported Resident #1 had a red face. The Administrator stated he arrived at the facility 45 minutes after the incident was reported to him. He stated Resident #1 and Resident #2 did not recall the incident happening. He stated Resident #2 did not recall hitting anyone. He stated Resident #2 curses and uses profane language. He stated he did not believe the residents knew what they were doing based on their cognitive ability. The Administrator stated in-service training was provided to staff on abuse, neglect, and de-escalation. He stated the staff had a heightened awareness of Resident #2 and monitored to ensure Resident #1 and Resident #2 were not in each other's personal space or sat at the same table for meals. He stated trauma assessments showed there were no adverse effects, and staff had not witnessed a change in the residents' daily routines. He stated both residents had a psych visit and the facility's consulting service would continue to provide guidelines and activities to redirect Resident #2. He stated Resident #2 had not hit another resident. Record review of the facility's policy Abuse/Neglect - Resident to Resident reflected The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.Residents should not be subjected to abuse by anyone including, but not limited to, facility staff, other residents.family members, or legal guardians, friends, or other individuals. The facility will provide and ensure the promotion and protection of resident rights. 1. Abuse. Abuse is the willful infliction of injury.with resulting physical harm, pain or mental anguish.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: 675402 If continuation sheet Page 3 of 6 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 11/25/2025 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. 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 implement written policies and procedures that prohibited and prevented abuse for 2 (Resident #1 and Resident #2) of 10 resident reviewed for abuse and neglect. The facility failed to implement their policies and procedures to ensure Resident #2 did not slap Resident #1 on the face on 09/20/2025. This failure could place residents at risk of continued abuse and neglect. Findings included: Record review of Resident #1's Face Sheet, dated 09/26/2025, reflected the resident was an [AGE] year-old female who admitted on [DATE]. Resident #1 had diagnoses which included dementia (decline in cognitive function that interferes with daily life), cognitive communication deficit (impacts how a person processes and conveys information), and the need for assistance with personal care. Resident #1 resided in the memory care unit. Record review of Resident #1's Quarterly MDS (tool used to assess health status) Assessment, dated 08/26/2025, reflected severely impaired cognition with a BIMS (screening tool to assess cognitive status) score of 04. Section E (Behavior) reflected verbal behavioral symptoms directed toward others occurred 1 to 3 days. Record review of Resident #1's Comprehensive Care Plan, dated 09/26/2025, reflected The resident has potential to demonstrate physical behaviors Dementia, Poor impulse control. Resident involved in a resident to resident event - this resident was hit by another resident. Date initiated 09/20/2025. Interventions included monitor right check, neuros initiated. Date initiated 09/20/2025.Psychiatric/Psychogeriatric consult as indicated. Date initiated 09/20/2025.Skin and trauma assessment. Date initiated 09/20/2025.Review of Resident #2's Face Sheet, dated 09/26/2025, reflected the resident was a [AGE] year-old female who admitted on [DATE]. Resident #2 had diagnoses which included dementia (decline in cognitive function that interferes with daily life), schizophrenia (mental health disorder that affects how a person thinks, feels, and behaves), bipolar disorder (extreme mood swings, including emotional highs and lows), on), and cognitive communication deficit. Resident #2 resided in the memory care unit. Review of Resident #2's Quarterly MDS Assessment, dated 08/27/2025, reflected severely impaired cognition with a BIMS score of 02. Section E (Behavior) reflected verbal behavioral symptoms directed toward others occurred 4 to 6 days, but less than daily. Review of Resident #2's Comprehensive Care Plan, dated 08/28/2025, reflected The resident has potential to demonstrate physical behaviors Dementia, Poor impulse control. Resident involved in a resident to resident event - this resident hit another resident. Date Initiated: 09/20/2025. Interventions included Psychiatric/Psychogeriatric consult as indicated. Residents separated and this resident placed on 1-1 monitoring.COMMUNICATION: provide physical and verbal cues to alleviate anxiety; give positive feedback, assist verbalization of source of agitation, assist to set goals for more pleasant behavior, encourage seeking out of staff member when agitated. Evaluate for side effects of medications.Review of Resident #2's Provider Progress Notes, dated 09/22/2025, reflected an in-crease to the risperdal for mood. It may also help with Pt's sleep issues. Pt may be taken off 1:1 as long as there is no physical aggression, threats, SI, HI for at least 24 hours. Re-fer for psychological counseling for anger management. Continue current appropriate treatment. All psychoactive medications were reviewed for continued need or dosage adjustment. Gradual dose reduction or medication reduction not recommended at this time due to ongoing signs/ symptoms. Continue to monitor mood, behaviors and potential SEs of medications. Follow up next visit or PRN.During an interview on 09/26/2025 at 10:41 AM, RN D stated she was not working when Resident #2 hit Resident #1. She stated she worked the day shift Monday to Friday in the female memory care unit. She stated Resident #2 cursed and yelled at other residents at times. She stated Resident #2 was ok most of the time and she had not seen her hit another resident. She stated if Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 4 of 6 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 11/25/2025 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident #2 seemed agitated, they directed her to her room or took her to therapy. RN D stated the other residents were not afraid of Resident #2. She stated Resident #1 was calm and had displayed no behaviors of yelling or hitting. During an observation and interview on 09/26/2025 at 11:10 AM, Resident #2 was sitting at a table with another resident in the main living area of the memory care unit. When asked if she had an issue with any of the residents, she pointed at a resident sitting at another table and stated the resident called her a bitch and she (Resident #2) hit her on the shoulder. She stated they put her on restriction after that. When asked what that meant, she replied she could not go out with her parents. When the surveyor pointed at Resident #1, Resident #2 stated she don't bother me and denied hitting her. During an observation and interview on 09/26/2025 at 11:17 AM, Resident #1 was sitting quietly in a chair near a window in the main living area of the memory care unit. When asked if she felt safe, Resident #1 replied yes. When asked if another lady had hit her, she said no. When asked if she had grandchildren, she replied she had people with her but she did not know their ages. Resident #1 was unable to provide information about the incident due to her cognitive status. During a telephone interview on 09/26/2025 at 12:39 PM, CNA C stated she was cleaning the floor when she heard a slap noise. She stated she had her back to Resident #2 and did not observe the incident. She stated a resident was pointing and said she slapped her, indicating Resident #2 hit Resident #1. CNA C stated Resident #2 said yes I slapped her because she told me to shut up. CNA C stated Resident #1 touched her face and said she was ok. She stated Resident #1 did not reply when asked if Resident #2 hit her. She stated she had not seen Resident #2 hit anyone else. She stated she got the nurse and Resident #2 was placed on 1:1 monitoring. The interview revealed CNA C was knowledgeable about the types of abuse and to report to the administrator who was also the abuse coordinator. During an interview on 09/26/2025 at 2:11 PM, DON A stated CNA C reported while she was cleaning in the day area another resident said Resident #2 hit Resident #1. The DON stated during follow-up interviews Resident #2 denied hitting Resident #1 and Resident #1 did not remember the incident. DON A stated the facility began in-service training for staff members. She stated Resident #2 was placed on 1:1 monitoring and had a psych tele visit. She stated the resident also saw psych services in the facility. She stated Resident was care planned for behaviors of yelling at staff and residents. She stated measures were taken to help ensure Resident #2 did not hit another resident. Staff were educated to be proactive. She stated the CNAs and nurses assigned to the unit were positioned in the main area where they could see all residents at all times. She stated prevention was the best policy. She stated staff was educated to notify management if they witnessed any behaviors by residents. She stated Resident #2 had not hit anyone else. During an interview on 09/26/2025 at 2:30 PM, the Social Worker stated she was told another residents said Resident #2 hit Resident #1. She stated Resident #2 was placed on 1:1 monitoring until she was seen and cleared by psych services. She stated the incident occurred on Saturday and she spoke with both residents the following Monday. She stated when she spoke with the residents, Resident #1 denied being hit and Resident #2 denied hitting her. She stated Resident #2 was autistic and processing feelings was different for her. She stated Resident #2 was fairly new at the facility and the resident's family member provided tips on what knowledge she had acquired over the years caring for the resident. She stated Resident #2 saw a counselor and psych services in the facility. The Social Worker stated after the incident, safe surveys were completed with other residents able to answer questions and trauma informed assessments completed for both parties involved. She stated she followed up with the residents daily for 3 days for any other concerns or behaviors. During a telephone interview on 09/26/2025 at 3:09 PM, RN B stated CNA C notified her Resident #2 hit another Resident #1. She stated when she asked Resident #2 what happened, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675402 If continuation sheet Page 5 of 6 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 11/25/2025 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete she just said she was sorry. RN B stated she separated the residents and Resident #2 was placed on 1:1 monitoring until psych cleared her. She stated Resident #2 had not hit another resident. The interview revealed RN B was knowledgeable about the types of abuse and to report abuse to the abuse coordinator, who was the administrator. During an interview on 09/26/2025 at 4:10 PM, the Administrator stated he was told CNA C was in the tv room where the incident occurred. He stated CNA C reported she was cleaning up fluids or a spill on the floor and heard a commotion. When CNA C stood up, a resident pointed and said she hit her, indicating Resident #2 had hit Resident #1. CNA C reported Resident #1 had a red face. The Administrator stated he arrived at the facility 45 minutes after the incident was reported to him. He stated Resident #1 and Resident #2 did not recall the incident happening. He stated Resident #2 did not recall hitting anyone. He stated Resident #2 curses and uses profane language. He stated he did not believe the residents knew what they were doing based on their cognitive ability. The Administrator stated in-service training was provided to staff on abuse, neglect, and de-escalation. He stated the staff had a heightened awareness of Resident #2 and now ensured Resident #1 and Resident #2 were not in each other's personal space or sat at the same table for meals. He stated based on the trauma assessments, there were no adverse effects and no change in the residents' daily routines. He stated both residents had a psych visit and the facility's consulting service would continue to provide guidelines and activities to redirect Resident #2. He stated Resident #2 had not hit another resident. Record review of the facility's policy Abuse/Neglect - Resident to Resident reflected The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart.Residents should not be subjected to abuse by anyone including, but not limited to, facility staff, other residents.family members, or legal guardians, friends, or other individuals. The facility will provide and ensure the promotion and protection of resident rights.New employee orientation will consist of educational resources to identify abuse, neglect, exploitation, and misappropriation of resident property. Ongoing in-services will be conducted to educated staff regarding.how to reported suspected abuse, neglect. Interventions for aggressive behavior of residents, and dementia management and resident abuse prevention.The facility will be responsible to identify, correct, and intervene in situations of possible abuse/neglect. This facility established an environment that is as homelike as possible and includes a culture and environment that treats each resident with respect and dignity. Event ID: Facility ID: 675402 If continuation sheet Page 6 of 6