Health inspection·August 1, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few CR #1, she was screaming, she guesses CNA A was frustrated with CR #1which was why she was forcing on CR #1. The administrator did not tell me about, CR#1's RP stated she asked the administrator, and she was told an investigation was started, but she did not want to tell me until she had finished her investigation, so she would have something to tell. CR #1 stated there was no bruise on CR #1 but was told the incident happened on [DATE] but was notified about it on [DATE]. Interview with Administrator on [DATE] at 1:25 pm. Said CR#1, is no longer in this facility. She had a change in condition and was transferred to the hospital on [DATE] hospital, where she finally died of natural death. On the incident that happened while she was in this facility, I came to work on Monday around noon, a resident by the name resident #26 came to me and told me that a resident was physically abused on Sunday late afternoon by a CNA A. She said that CR#1, was trying to stand up from her wheelchair, and CNA A forcefully pushed her back in the wheelchair. I asked her if she had told any staff, and she said no. I started an investigation immediately and removed the employee from the schedule pending investigation. After investigation, it was undetermined if staff abused the resident. Training on abuse/neglect was done on [DATE], and every month/PRN, last done on [DATE]. Examples of abuse are physical, mental, verbal, financial, and sexual. An example of neglect is not changing the residents or not providing care. She stated that she had not witnessed any abuse before. If there is any suspected abuse, all staff report to her, and she starts an investigation immediately.In another interview with Administrator on [DATE] at 4:57 pm. She said the incident happened on [DATE], knew about it on [DATE] through resident #26, and it was reported to HHSC on [DATE] at 5:45 p.m. She stated that, there was nothing to corroborate any signs of abuse. No signs of injury, no change in behaviors. The facility's process of reporting abuse is that investigation is started, to make sure the facility had done something about it, to make sure it was taken care of. The facility's investigation did not reveal that any abuse had happened. She even interviewed residents. She saw CR #1's RP that Tuesday or Wednesday and told her about the allegation. The administrator did not answer the question for reporting abuse timely. She said what was more important is that we started our investigation right away. Additional harm can happen. There was no intent to not report. Risk to the resident when RP was not notified of abuse. Potentially harm could come to the resident. Telephone Interview with ADON on [DATE] at 9:50 am., she stated she worked PRN at this facility and has not been there in the past 45 days. She stated the incident involving CR#1, she cannot remember everything; however, a regular head-to-toe assessment of CR#1 was conducted during that period of alleged abuse. The facility has a process in place that, whenever suspected abuse is reported, an assessment is performed. The facility completed a completed a head-to-toe assessment on CR#1, no physical injury found. Whenever there is a suspected or an allegation of abuse, an investigation is started. If it is resident-to-resident, the resident is removed, or staff-to-resident, the staff is removed from the care; the administrator, NP, and RP are notified. The allegation is also reported to HHSC within 2hours to 24 hours. The risk of not reporting to HHSC will be that the residents will continue to get harmed from the abuse. The risk of not notifying the resident RP is that the RP will not be aware and will not help the resident to make an informed decision at that time. ADON stated she had received in-service for abuse and neglect; the last in-service was last month, June. Examples of abuse are physical, verbal, emotional, and sexual. An example of neglect is the failure to provide care. If there is any suspected abuse, it is always reported to the administrator. A record review of the facility's policy on abuse, neglect, and exploitation revealed the following: Abuse is the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Instances of abuse of all residents, irrespective of any mental, or physical condition, cause (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675420 If continuation sheet Page 2 of 5 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 675420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Brazos 2127 Preston St Richmond, TX 77469 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete physical harm, pain or mental anguish. It includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled using 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. Component IV: Identification1. Staff members will identify and assess suspected or alleged reports of abuse or neglect, focusing on objective and observable evidence, such as suspicious bruising, witness reports regarding unusual occurrences or patterns or trends of potential abuse or neglect.Types of abuse include BUT ARE NOT LIMITED TO:B. Mental abuse: 1) Humiliation 2) Harassment3) Threats4) Punishment or deprivation5) Intentional disrespect or disregard for an individual's right to privacy and dignity as it relates to their person and property. Component V: Reporting/ResponseAll alleged violations concerning abuse, neglect, or misappropriation of property are reported immediately but no later than 2 hours after the incident occurs or is suspected. Event ID: Facility ID: 675420 If continuation sheet Page 3 of 5 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 675420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Brazos 2127 Preston St Richmond, TX 77469 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchen reviewed for storage, preparation and sanitation. -The facility failed to seal, label the contents of the packages and date when food items were opened in the refrigerator and dry storage. -The facility failed to discard expired cooked food from the walk-in refrigerator.-The facility failed remove a scoop in the flour container. These failures could place residents who received meals and/or snacks from the kitchen at risk for food-borne illness and food contamination if consumed. Findings included: Kitchen Observation on 07/29/25 at 8:15 AM revealed the following: -1 Plastic bag of cooked Spanish rice that was not labeled or dated in the walk-in refrigerator.-1 Plastic bag cooked ham chunks that was not labeled or dated in the walk-in refrigerator.-1 plastic bag of diced tomatoes that was not labeled or dated in the walk-in refrigerator.-15 8oz glasses of orange juice that was not labeled or dated in the walk-in refrigerator.-1 -25 lb box of instant food thickener that was opened, unsealed, and undated in the dry storage area. - 1 plastic bag of opened and [NAME] Crispy cereal that was not labeled or dated in the dry storage area.- 1 opened 5 lb bag of Rotini that was not labeled or dated in the dry storage area.- 1 opened 3-gallon container of vanilla ice cream that was not dated in the walk-in freezer.- 1 container of tomato soup with an expired date of 07/22/25 in the dry storage area.- 20 Liter flour container noted with scoop left in container in the dry storage area. During an interview on 07/29/25 at 8:30 AM, Dietary Aide B said all open items should be labeled and dated. Dietary Aide B said these items should be discarded because the staff does not know when the items were opened. During an interview on 07/31/25 at 4:50 PM, [NAME] E said the kitchen staff was responsible for labeling and dating food items. She said cooked food should be labeled and dated, and it should be discarded after 2-3 days. [NAME] E said the risk of not labeling and dating food was that the residents could get sick, which could lead to food poisoning. During an interview on 07/31/25 at 5:01 PM, the Dietary Manager said the expectation was for all kitchen staff to label and date open items in the refrigerator and in the dry storage areas. She also said the scoop should not be left in the flour container because it could be an infection control concern. The Dietary manager said the risk of unlabeled, unsealed, or outdated food would not be good for residents to consume because serving outdated food could cause harm and lead to food borne illness. During an interview on 07/31/25 at 5:15 PM, the Administrator said she expected the kitchen staff to label and date all foods per policy. She said food without labels or dates should be discarded. She said outdated food can cause harm and the resident can get sick. Record review of the Nutrition Services policy and procedure, dated 08/12/19, reflected, . Food Safety in Receiving and Storage It is the policy of this facility that food will be received and stored by methods to minimize contamination and bacterial growth. Procedures: Receiving Guidelines: 7. Check expiration dates and use-by dates to assure the dates are within acceptable parameters. General food: Place food that is repackaged in a leak-proof, pest-proof, non-absorbent, sanitary container with a tight-fitting lid. Label both the container and its lid with the common name of the contents and the date it was transferred to the new container. It is recommended that food stored in bins (e.g. flour or sugar) be removed from its original packaging . Record review of the Food and Drug Administration Food Code, dated 2022, reflected, 3-305.11 Food Storage.(B) .refrigerated, ready-to eat time/temperature control for safety food prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675420 If continuation sheet Page 4 of 5 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 675420 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm at the Brazos 2127 Preston St Richmond, TX 77469 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 0812 Level of Harm - Minimal harm or potential for actual harm premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675420 If continuation sheet Page 5 of 5