Health inspection·July 8, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few or fear ), and essential hypertension(high blood pressure ).Record review of Resident #2's Quarterly MDS dated [DATE] , reflected a BIMS score of 13, which indicated she was cognitively intact.Record review of Resident #2's June 27, 2025 care plan reflected interventions addressing safety, mood, and behavior. The care plan noted Resident #2 preferred to eat in her room and had minimal peer interaction. No history of aggressive behaviors was documented. Record review of progress notes dated 06/26/25 relevant to the incident were reviewed. The progress notes reflected that Resident #2 was involved in an altercation with another resident. Resident #2 was assessed both physically and emotionally afterward. The progress notes reflect that first aid was administered, a skin assessment and pain assessment were completed, and that Resident #2 received support following the incident. The progress notes reflected appropriate post-incident procedures were followed, but did not include an in-depth description of the resident's behavior or emotional state beyond confirming that interventions were provided.Record review of Resident #2's progress notes 06/26/25 reflected law enforcement was dispatched to the facility following the altercation. Resident #2 initially requested to be sent to the hospital when officers arrived but later refused treatment upon ambulance arrival, and stated she felt fine. A small laceration approximately 2 cm in length was noted on her forehead. The wound did not require stitches or advanced intervention. Record review treatment orders for Resident #2's forehead laceration were discontinued on , 07/08/25 which indicated the wound had resolve. Record review of documentation by social services dated 06/27/25 reflected Resident #2 was alert, oriented, and stated she was feeling better. She accepted supportive counseling and was encouraged to avoid contact with Resident #1 and to report any further concerns. Resident #2 consented to a referral for psychological services. Documentation reflected plans for continued monitoring and supportive interventions due to the incident . Interview on 7/8/25 at 12:38 p.m. with Resident #2 During the interview with Resident #2 the resident appeared visibly irritated and used profanity multiple times. However, her irritation did not appear to be related to the altercation that occurred with Resident #1. Resident #2 expressed frustration that her handwritten Do Not Disturb sign, which was posted on her door, was not being respected by staff or others entering her room. She specifically stated that staff continued to knock on her door to deliver meals and medications, which she felt disregarded her request to not be disturbed.Before initiating the interview, surveyor made an attempt was made to contact the resident using the phone number listed in the system; however, the number was not in service. As the resident remained in the building and the sign on the door had not been removed during the time the surveyor was on site, surveyor knocked on her door to attempt the interview before leaving the facility. Resident #2 acknowledged during the interview that she was not mad at the surveyor directly, but also emphasized, You saw the sign on the door and still knocked and bothered me anyway. Based on her comments and demeanor, it appeared that she remained frustrated with the interruption despite stating it was not personal. Resident # 2's irritation during the interaction appeared to be tied to the presence of the Do Not Disturb sign being ignored, rather than to the prior incident with Resident #1. Interview on 7/8/25 at 12:45 p.m. with the Assistant Director of Nursing revealed she was working on the backside of the unit at the time of the incident and reported hearing raised voices, though she was unable to make out what was being said or which residents were involved. She stated that shortly afterward, staff came to notify her that assistance was needed. She secured her medication cart and responded to the location of the incident. Upon arrival, she observed that the two residents. Resident #1 and Resident #2 had already been separated. The ADON stated she observed blood coming from a laceration on Resident #2's forehead and immediately began assessing the resident, initiated the abuse protocol, and contacted law enforcement. She confirmed that 911 was called and that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675417 If continuation sheet Page 2 of 4 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 675417 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fair Park Health & Rehabilitation Center 2815 Martin Luther King Jr Blvd Dallas, TX 75215 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 Resident #2 initially agreed to be transported to the hospital for further evaluation, but later refused treatment upon arrival. The ADON described the injury as minor. She added that Resident #1 had just returned to the facility prior to the incident and was later transported to the hospital for psychiatric evaluation in accordance with facility protocol.Interview on 7/8/25 at 1:32 p.m. with the Director of Nursing revealed that the facility was aware that both residents displayed behaviors such as verbal agitation, including the use of profane language and raised voices. One resident was described as feisty, a term often used informally to indicate someone who is spirited, outspoken, or easily upset. In this context, it reflects the resident's tendency to become verbally agitated or assertive, including using strong language or raising their voice. This description did not imply physical aggression or violence but highlighted that the resident may express frustration or disagreement loudly or passionately.Interview on 7/8/25 at approximately 2:00 p.m. with the facility Administrator revealed he considered the incident an isolated event which involved two residents with a known history of behavioral concerns at previous facilities. He stated neither resident had exhibited physically aggressive behavior while at the current facility. The Administrator reported both residents declined to provide written statements. He responded to the facility 30-45 minutes after being notified and expressed confidence that the facility responded appropriately by separating the residents and contacting emergency service. According to facility records and staff interviews, neither of the two residents had any history of physical or verbal altercations with each other while residing at the current facility. Both residents were known to display verbal agitation and use profane language individually, but there were no documented incidents of conflict or behavioral issues between them prior to the reported incident.Interview conducted on 7/8/25 at approximately 2:30 p.m. with the LVN A revealed that she assessed Resident #2's wound the day after the incident occurred. The LVN A explained that the incident took place late at night, near midnight, and by the time of documentation and follow-up, it was already considered the next calendar day. She further clarified that although she personally evaluated the wound the following day during her scheduled shift, other nursing staff had already responded to and assessed the resident at the time of the incident. The LVN A stated that Resident #2 was selective about who she allowed to examine her, and she did not permit paramedics or certain staff to view or treat the area. The LVN A described the wound as minor, resembling a scratch, and noted that it was already beginning to heal by the time she observed it. She also mentioned that the resident had removed the initial bandage herself prior to the LVN A's assessment.Interview on 7/8/25 at 1:46 p.m. with CNA A revealed she was present the day of the incident and had prior familiarity with both residents. CNA A stated Resident #1 typically left the facility during the day and returned in the evening, while Resident #2 usually stayed in her room and did not participate in group dining. CNA A reported the residents had never bumped heads before meaning they had never had a disagreement, argument, or conflict and typically stayed to themselves. She stated, They would speak to each other and go about their day. I've never known either of them to be physical with anyone. CNA A stated since the incident occurred, the residents were separated and there had been no further incidents between the two residents. Additional interviews conducted with staff on 7/8/25 from 12:45 PM to 2:45 PM revealed consistent knowledge of the facility's abuse and neglect policies, including guidelines related to resident-to-resident aggression. Interviews were conducted with the Assistant Director of Nursing, Director of Nursing, Licensed Vocational Nurse, Certified Nursing Assistant, and the Administrator. Staff members stated they received in-service training covering abuse prevention, behavioral interventions, resident rights, and reporting requirements. Staff were able to describe the process for managing residents with behavioral concerns. Attempted interview on 7/8/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675417 If continuation sheet Page 3 of 4 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 675417 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fair Park Health & Rehabilitation Center 2815 Martin Luther King Jr Blvd Dallas, TX 75215 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 at 2:10 p.m. with Family Member #1 (associated with Resident #1): A voicemail was left; no return call was received.Attempted interview on 7/8/25 at 2:11 p.m. with Family Member #2 (associated with Resident #2): A voicemail was left; no return call was received.Attempted interview on 7/8/25 at 2:05 p.m. with the facility Social Worker: The Social Worker was not on site at the time of the visit. A phone interview was attempted using the number provided by facility staff. A voicemail was left; no return call was received.Record review of the facility's, undated, Abuse/Neglect policy reflected all residents had the right to be free from all forms of abuse, including abuse by other residents. The policy directed that the facility must investigate all allegations of abuse, report findings, and implement measures to ensure resident safety when abuse is suspected or confirmed. Event ID: Facility ID: 675417 If continuation sheet Page 4 of 4