Health inspection·August 4, 2022

F 0640 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #20's face sheet dated 08/03/22 revealed he was a [AGE] year-old male admitted to the facility on [DATE]. His diagnoses included Cerebral Palsy (a condition that affect movement and muscle tone or posture) essential hypertension, Paraplegia, bipolar disorder, muscle weakness and lack of coordination. Record review of Resident #20's annual MDS with ARD date of 03/16/22 was signed as completed on 04/12/22 which was 28 days after the ARD Day, 14 days past due. 3-Resident # 32 Record review of Resident #32's face sheet dated 08/03/22 revealed he was a [AGE] year-old male who admitted to the facility on [DATE]. His diagnoses included congestive heart failure, chest pain, Chronic obstructive pulmonary disease (lungs disease) and Parkinson's disease. Record review of Resident #32's annual MDS with ARD date of 11/12/21 was signed as completed on 12/20/21 which was 26 days after the ARD Day 12 days past due. Interview with the DON on 08/03/22 at 10:00 AM, She said the MDS staff can answer any question regarding MDS. During an interview with MDS staff on 08/04/22 at 9:00AM, he said he would look but came back and said the MDS for CR #1 was not completed. He said would complete the MDS and transmit it. He said he was not at the facility during the time of Resident death at the facility. He said he was not at the facility when both MDS were done and there was a time when someone else was doing the MDS. He said it was his responsibility to ensure that all MDS were done timely and notify the RN for review and signatures. Record review of the Facility provided policy dated November 2017 titled Patient care Management system 12 Assessment did not address timely data transmission of the MDS FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 2 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure the assessment accurately reflected the resident's status for 4 of 18 residents (Resident's #20, #28 , #32, and #88) whose assessments were reviewed for accuracy in that:. Residents Affected - Some -1.Resident's #20, #28, and #32, and Resident #88 were not assessed for their dentures on their annual assessment. -2 Resident #88 was not assessed for his Unhealed pressure ulcers/injuries. This failur could place residents at risk of inaccurate assessment and not having their needs met. Findings included: Resident #20 1 Record review of Resident #20's face sheet dated 08/03/22 revealed he was a 64 -year-old male admitted to the facility on [DATE]. His diagnoses included Cerebral Palsy (a condition that affect movement and muscle tone or posture) essential hypertension, Paraplegia, bipolar disorder, muscle weakness and lack of coordination. Record review of Resident #20's Annual MDS, with ARD date of 03/16/22 and completed 04/12/22, revealed his BIMSs score was coded as 15 out of 15 indicating he was cognitively intact. He was assessed as total assist on his ADL assessment. Review of section L oral\denture status check all that apply was checked as none of the above were present indicating that the resident had his natural teeth. Observation and interview on 08/03/22 at 2:40 PM, revealed Resident #20 was in bed, alert and oriented. Observation during conversation revealed he had no teeth in his mouth. When asked if he had dentures, he said yes and pointed to his dentures on his nightstand. He said he did not wear them because he was about to sleep. 2 Resident # 28 Record review of Resident #28's face sheet dated 08/03/22 revealed she was a 103 -year -old female admitted to the facility on [DATE]. Her diagnoses included Osteoarthritis (degenerative joint disease), hypertension, Pain in right hip, left shoulder and gait abnormality. Record review of Resident # 28's Annual MDS, dated [DATE] and completed 01/6/22, revealed her BIMS score was coded as 6 out of 10 indicating she was moderately impaired. cognitively. Review of section L oral\denture status was checked as none of the above were present indicating the resident had her natural teeth. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 3 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0641 Level of Harm - Minimal harm or potential for actual harm Observation and interview on 08/03/22 at 12:40 PM, revealed Resident #28 was in bed. She was alert and oriented. Observation revealed she had no teeth in her mouth. Interview at this time, she said she had no teeth and lost all her teeth over the years. 3 Residents Affected - Some Resident # 32 Record review of Resident #32's face sheet dated 08/03/22 revealed he was a 64-year- old male who admitted to the facility on [DATE]. His diagnoses included congestive heart failure, chest pain, Chronic obstructive pulmonary disease (lungs disease) and Parkinson's disease. Record review of Resident #32's annual MDS with ARD dates of 11/12/21 was signed as completed on 12/20/21 revealed his BIMS score was coded 13 out of 15 indicating he was cognitively intact. Review of section L oral\denture status check all that apply was checked as none of the above were present indicating the resident had his natural teeth. Observation and interview on 08/03/22 at 1:50PM, revealed Resident #32 was in bed. He was alert and oriented. Observation revealed he had no teeth in his mouth. In an interview. He said he had no teeth but had dentures. He pointed to his dentures on his bed side table. He did not indicate why he did not have them on. 4 Resident # 88 Record review of Resident #88's face sheet revealed she was a [AGE] year-old female that was admitted to the facility on [DATE] with a diagnosis of cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it), end stage renal disease (final, permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own), Pressure ulcer of sacral region, stage 3 (skin injuries that occur in the sacral region of the body, near the lower back and spine) and type 2 diabetes mellitus with diabetic chronic kidney disease. Record review of Resident #88's Quarterly MDS dated [DATE] revealed he had a BIMS of 06 out of 15 indicating severely impaired cognitively. Resident required extensive assistance from staff with personal hygiene, toilet use, dressing, transfer, and bed mobility. Further review of Section M0150: is this resident at risk of developing pressure ulcers/injures? Coded-blank. M0210: Unhealed pressure ulcers/injuries: coded-blank. Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Coded-blank Record review of Resident #88's Wound Evaluation & Management Summary dated 7/26/22 read in part: .Wound Size (L x WxD): 8 x 9.7 x 0.2 cm. Primary Dressing(s) Drain sponge apply once daily for 23 days; ABD pad apply once daily for 23 days; Santyl apply once daily for 23 days. SITE 1: SURGICAL EXCISIONAL DEBRIDEMENT PROCEDURE: Remove Necrotic Tissue and Establish the Margins of Viable Tissue. PLAN OF CARE REVIEWED AND ADDRESSED Recommendations: Zinc sulphate 220mg once daily PO for 14 days; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 4 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0641 Vitamin C 500mg twice daily PO . Level of Harm - Minimal harm or potential for actual harm Record review of Resident#88's Wound Evaluation & Management Summary dated 8/2/22 read in part: .Wound Size (L x WxD): 8 x 9.7 x 0.2 cm. Primary Dressing(s) Drain sponge apply once daily for 23 days; ABD pad apply once daily for 23 days; Santyl apply once daily for 23 days. SITE 1: SURGICAL EXCISIONAL DEBRIDEMENT PROCEDURE: Remove Necrotic Tissue and Establish the Margins of Viable Tissue. PLAN OF CARE REVIEWED AND ADDRESSED Recommendations: Zinc sulphate 220mg once daily PO for 14 days; Vitamin C 500mg twice daily PO . Residents Affected - Some Record review of Resident #88's nurses notes dated 8/02/22 written by the Treatment nurse read in part: .Pt readmitted from the hospital. Pt lying in bed denies pain and discomfort. Pt has stg 3 to sacrum. Wound bed red with serous drainage . In an interview on 8/4/22 at 11:02 a.m., with the Treatment nurse, she said Resident#88 was re-admitted on [DATE] from the hospital with stage 3 pressure ulcer on sacrum. She said the Wound care doctor came to the facility on 8/2/22 and did the initial wound evaluation. She said Resident#88 did not have any other wounds/deep tissue injuries. In an interview with the MDS coordinator on 08/03/22 at 4:00PM, he said he was responsible for ensuring that the MDS accurately reflect resident's condition. He looked at all 3 MDS and said they MDS should have been coded as no natural teeth on section L of the MDS and not none of the above. He said he completed the MDS by gathering information from all disciplines. to complete the MDS. He said he was not at the facility when these MDS were completed. In an interview and record review on 8/4/22 at 12:05p.m., with the MDS coordinator , he said the MDS was completed and accepted on 7/28/22. He said Resident #88's wound assessments were not captured under wound tab in Matrix by nursing until 7/28/22. He said when the residents re-admit he usually looked at hospital records to capture resident's condition/needs, but the medical records had not uploaded hospital records in matrix yet. He said he read nurses notes that resident was re-admitted with wounds, so he made correction on 8/3/22. He said it was important have accurate MDS so the paperwork would match the resident's condition and receive the proper care resident needed. Record review of Facility's provided policy dated November 2017 titled Patient care Management system 12 Assessment did not address Accuracy of MDS assessment. The MDS Coordinator said the facility uses the RAI manual set by CMS. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 5 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that residents received the necessary treatment and services, to promote healing and prevent infection for 1 of 3 residents (Resident #88) reviewed for pressure ulcer in that: Residents Affected - Few -Resident #88's Stage Ill Pressure wound dressing was not changed as per physician's orders. -Treatment nurse failed to transcribe wound care doctor order for Resident #88 dated 7/26/22 until 8/2/22. -Treatment nurse failed to follow up with wound care doctor's recommendation for supplements for Resident #88. These failures could place residents with wounds or who are at risk of developing wounds placing them at risk of infection, a decline in health, pain, and hospitalization. Findings included: Record review of Resident #88's face sheet revealed she was a [AGE] year-old female that was admitted to the facility on [DATE] with a diagnosis of cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it), end stage renal disease (final, permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own), Pressure ulcer of sacral region, stage 3 (skin injuries that occur in the sacral region of the body, near the lower back and spine) and type 2 diabetes mellitus with diabetic chronic kidney disease. Record review of Resident #88's Quarterly MDS dated [DATE] revealed she had a BIMS of 06 out of 15 indicating severely impaired cognitively. Resident required extensive assistance from staff with personal hygiene, toilet use, dressing, transfer, and bed mobility. Further review of Section M0150: is this resident at risk of developing pressure ulcers/injures? Coded-blank. M0210: Unhealed pressure ulcers/injuries: coded-blank. Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Coded-blank. Record review of MDS correction to prior assessment dated [DATE] revealed Section M0150: is this resident at risk of developing pressure ulcers/injures? Coded-Yes. M0210: Unhealed pressure ulcers/injuries: coded-Yes. Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Coded -1. G. Unstageable-Deep tissue injury: 1. Number of unstageable pressure injuries presenting as deep tissue injury. Coded- 2. 2. Number of these unstageable pressure injuries that were present upon admission/entry or reentry. Coded- 2. Record review of Resident #88's care plan initiated 6/20/22 revealed the following: Problem: Stage 3 pressure ulcer to sacrum (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 6 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0686 Goal: The size of ulcer will decrease with evidence of healing over the next 30 days. Level of Harm - Minimal harm or potential for actual harm Interventions: Perform treatments per order, if no improvement x2 weeks report to MD. Perform nutritional screening. Adjust diet/supplements as indicated to reduce the risk of skin breakdown. Residents Affected - Few Record review of Resident #88's Wound Evaluation & Management Summary dated 7/26/22 read in part: .Wound Size (L x WxD): 8 x 9.7 x 0.2 cm. Primary Dressing(s) Drain sponge apply once daily for 23 days; ABD pad apply once daily for 23 days; Santyl apply once daily for 23 days. SITE 1: SURGICAL EXCISIONAL DEBRIDEMENT PROCEDURE: Remove Necrotic Tissue and Establish the Margins of Viable Tissue. PLAN OF CARE REVIEWED AND ADDRESSED Recommendations: Zinc sulphate 220mg once daily PO for 14 days; Vitamin C 500mg twice daily PO . Record review of Resident#88's Wound Evaluation & Management Summary dated 8/2/22 read in part: .Wound Size (L x WxD): 8 x 9.7 x 0.2 cm. Primary Dressing(s) Drain sponge apply once daily for 23 days; ABD pad apply once daily for 23 days; Santyl apply once daily for 23 days. SITE 1: SURGICAL EXCISIONAL DEBRIDEMENT PROCEDURE: Remove Necrotic Tissue and Establish the Margins of Viable Tissue. PLAN OF CARE REVIEWED AND ADDRESSED Recommendations: Zinc sulphate 220mg once daily PO for 14 days; Vitamin C 500mg twice daily PO . Record review of Resident#88's physician order dated 7/22/22 revealed an order for wound TreatmentCollagen four times weekly. Note: Clean wound to sacrum with ns pat day apply collagen and cover with dry dressing rp aware. This order was discontinued on 08/02/22. Record review of Resident#88's physician order dated 8/2/22 revealed an order for wound TreatmentSantyl one time daily. Note: Clean wound to sacrum with ns pat day apply Santyl and cover with dry dressing rp aware. Record review of Resident#88's physician order dated 8/2/22 revealed an order for multivitamin with minerals tablet (1 tab) one time a day via g-tube. Record review of Resident#88's physician order dated 8/2/22 revealed an order for Vitamin C 500 mg tablet (1 tab) two times a day oral. Record review of Resident#88's physician order dated 8/2/22 revealed an order for wound supplement (30 ml) one time daily via g-tube. Record review of Resident#88's physician order dated 8/3/22 at 3:50pm entered by the Treatment Nurse revealed an order for Wound Treatment - Dry Dressing PRN. May use ABD pad for wound treatment as needed for excessive drainage rp aware Record review of Resident #88's nurses notes dated 8/02/22 written by the Treatment nurse read in part: .Pt readmitted from the hospital. Pt lying in bed denies pain and discomfort. Pt has stg 3 to sacrum. Wound bed red with serous drainage . Observation and attempted interview on 8/3/22 at 9:23 a.m., revealed Resident #88 was resting in his bed. Resident was not on an air mattress. He was alert and well groomed. Resident did not respond to the questions asked about his pressure ulcer. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 7 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 8/3/22 at 9:45a.m., revealed Treatment Nurse providing wound care for Resident #88. The Treatment Nurse was assisted by LVN AA. The Treatment Nurse gathered the supplies at the treatment cart in the hallway before bringing them into Resident #88's room. Prior to initiation of the treatment, Resident #88 was assisted on to his right side. Continued observation revealed an open area of approximately 8.0 centimeters in diameter. The Treatment nurse cleansed the wound with normal saline, pat dried, applied a nickel-thick layer of Santyl to wound bed and covered it with one dry 4x4 gauze and dry border dressing. The Treatment nurse did not use ABD pad as ordered by the physician. In an interview on 8/3/22 at 12:27p.m., with the Treatment Nurse, she said she printed the wound evaluation this morning. She said I don't use ABD pad. Only use 4x4 or 6x6 protected dry dressing. She said she used 6x6 dry dressing this morning during wound care on Resident #88. She said ABD pad were used on surgical site and heavy drainage. Treatment nurse reviewed wound evaluation dated 8/2/22 with the Surveyor. Treatment nurse said, wound care doctor specifically said ABD pad. I didn't see that when I reviewed it this morning. She said, wound care doctor can recommend nutrition supplements, but we feel it's better to use our own protocol. She said, our protocol for stage lll and lV nutrition intervention included multivitamin with mineral, vitamin C and liquid 30cc wound healing supplement. In an interview on 8/4/22 at 10:01a.m., with the DON, she said Resident #88 did not have excessing drainage. She said her, and the treatment nurse called the wound care doctor yesterday evening (8/3/22) and got the prn order to use ABD for excessing drainage. The DON reviewed wound evaluation dated 7/26/22 and 8/2/22 with the Surveyor. The DON said wound care doctor recommended certain meds: zinc, protein, and multivitamin. She said the facility had their own nutrition protocol, but the Treatment nurse should have called the Resident's doctor and see if he wanted to add wound care doctor's recommended supplements for 14 days for wound healing. This Surveyor explained that the resident was re-admitted on [DATE] with stage 3 pressure ulcer and that the treatment nurse did not follow facility's nutrition protocol and wound care doctor's orders for Santyl on 7/26/22 Zinc Sulphate/Vitamin C. The DON said she would have to ask Treatment nurse why she failed to follow up with wound care doctor's orders/recommendations. She said she started 7 weeks ago at this facility. She said she was responsible to oversee the Treatment Nurse. When asked how she monitor staff to ensure they are implementing care planned interventions. How did she monitor the resident's wound progress and how did she determine the appropriate interventions. The DON said she had not been spot checking or reviewing the wound evaluations with the treatment nurse to make sure the orders were being following. The DON said, I thought Treatment nurse knew what she was doing. I will have to watch her now. In an interview on 8/4/22 at 2:48p.m., with the Treatment Nurse, she said she was the certified wound care nurse. Surveyor reviewed wound evaluation dated 7/26/22 with the Treatment Nurse. She said she did not know wound care doctor saw Resident #88 on 7/26/22. This is the first time I am seeing this wound evaluation. She said the wound care doctor came to the facility every Tuesday and sent the wound evaluation by every Wednesday. She said she failed to enter vitamins orders and change order from collagen to Santyl until 8/2/22. She said I overlooked orders and didn't put it in. It's error on my part. She said the DON did not spot check/review wound evaluations with her. She said she had done a competency check off with previous DON. She said it was important to match wound care doctor order and need for vitamins for wound healing. In an interview on 8/4/22 at 3: 19p.m., with the DON, she said she did not have a chance to do competency check off with the Treatment nurse because the Treatment nurse came to the facility at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 8 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few different times as she worked at this facility and their sister facility. She said she would do in service with the Treatment nurse to follow physician order to prevent wounds from deteriorating. At this time policy on following physician orders was requested. Record review of facility's Skin policy dated July 2022 read in part: .19. The Director of Nursing or designee will audit and verify system compliance weekly including prevention-focused rounding and education as appropriate . Record review of facility's pressure ulcer protocol dated June 2022 read in part: .This protocol contains suggested interventions. You should work with the patient's attending physician to implement this nutrition protocol by obtaining any necessary physician's orders. Guidelines: Stage lll and lV: Suggested interventions: a. multivitamin with minerals once per day. B. Vitamin C 500 mg BID. C. Wound Healing supplement (30cc) once per day . No policy on following physician orders were provided on exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 9 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services, including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals, to meet the needs for 1 (Residents #193) of 18 residents reviewed for pharmacy services. The facility failed to ensure Resident #193's hospital discharge medication order was followed, give two times a day (BID) instead of three times a day (TID) Pantoprazole (Protonix, reduces gastric acid secretion) 40 mg tablet enteric coated (delayed release). This failure could place all residents at risk of not receiving medications as per hospital discharge order and had the potential to cause adverse reactions, medication overdosing, and worsening of medical condition. Findings Included: Record review of Resident #193's clinical record revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of gastroesophageal reflux disease with esophagitis (inflammation of the esophagus) without bleeding, cerebral infarction, hemiplegia (complete loss of strength one side) and hemiparesis (weakness on one side) following stroke and type 2 diabetes mellitus. Record review of Resident #193's Baseline Care Plan dated 7/23/22 revealed he was alert and cognitively intact with initial goals established bed in lowest position and meeting date discussed. He required limited assistance with 1 staff most ADLs and gait belt transfer assist. Record review of Resident #193's Hospital discharge order dated 7/23/22 revealed, give two times a day (BID) Pantoprazole (Protonix) 40 mg tab by mouth, enteric coated (delayed release=DR), for gastroesophageal reflux disease with esophagitis, without bleeding. Record review of Resident #193's Physician Order dated August 2022 revealed, give three times a day (TID) Pantoprazole (Protonix) DR 40 mg tab by mouth, for gastroesophageal reflux disease with esophagitis, without bleeding, start date 7/23/22. Record review of MAR dated August 2022, revealed Resident #193 received three times a day (TID) Pantoprazole (Protonix) DR 40 mg tab by mouth, for gastroesophageal reflux disease with esophagitis, without bleeding, start date 7/23/22. Interview on 8/04/22 at 11:30 am, the weekend Supervisor stated she asked the Nurse Practitioner regarding the administered order of TID Protonix DR 40 mg tab of Resident #193, instead of BID Protonix DR 40 mg tab according to hospital discharge order. She said the NP stated the problem, Resident #193's hospital discharge order was not followed to give two times a day (BID), and not three times a day (TID) Protonix delayed release (DR) 40 mg tab. She added admitting charge nurse calls MD regarding if either to continue with hospital discharge orders or not, and then former DON and former unit manager would go through to verify if the MD orders correspond with hospital discharge orders and accurate. Interview on 8/04/22 at 11:40 am, The DON stated the NP responded to discontinue TID Protonix DR 40 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 10 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mg and decreased to BID Protonix DR 40 mg tab according to Resident #193's Hospital discharge order. The DON stated Resident #193's Hospital discharge order was not followed, and moving forward she will verify the physician orders next day if accurate and correspond with Hospital discharge orders together with weekend supervisor. The DON stated she was also assigned to reconcile monthly physician orders with the weekend supervisor. She stated she will follow-up on the issues on pharmacy services and she will be monitoring them. She stated she just started last month, and she cannot answer for previous DON. Record review of the facility policy titled Medications dated November 2017 revealed, upon admission including re-admission of each Resident, the physician orders for the Resident must be reviewed and reconciled by the charge nurse and the DON or designee for accuracy in the Electronic Medical Record. Record review of the facility policy titled, Safe Medication Assistance and Administration, revised date 07/2015, revealed initiations, dosage changes . will be coordinated with the prescriber and discussed as needed to ensure staff and/or the person served has a clear understanding of the order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 11 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure all drug regimen irregularities identified by the licensed pharmacist were reported to the attending physician and acted upon in order, to minimize or prevent adverse consequences to the extent possible for 2 (Residents #47, #88) of 18 Residents reviewed for drug regimen review. -The facility failed to report Pharmacist consultant recommendation to update appropriate indication of use for Lamictal (neuroleptic) for anxiety. Neuroleptics (Antipsychotic) are not considered an appropriate use for anxiety due to the risk of side-effects vs benefits for this dx., to physician. -The facility failed to report Pharmacist consultant recommendation of duplicate therapy for Resident #47 Nystop (Nystatin, treats antifungal infection) for candidiasis of skin and nails, to physician. - The facility failed to report Pharmacist consultant recommendation on 7/22/22 for Protonix and Prevacid active-duplicate therapy for Resident #88, to the physician. These failures could place residents receiving medication, who required monthly Medication Regimen Reviews and place them at risk for medication errors, unnecessary medications and incorrect administration. Findings included: Resident #47 Record review of Resident #47's clinical record revealed a [AGE] year old female admitted to the facility on [DATE] with diagnoses of anxiety disorder, candidiasis of skin and nails, congestive heart failure, non-Alzheimer's dementia and HTN. Record review of Pharmacist consultant recommendation/ MRR, dated 7/22/22, revealed Resident #47 Nystop (Nystatin, treats antifungal infection) BID order was a duplicate order. Further review read, Please update diagnosis to appropriate indication of use for Lamictal (neuroleptic) for dx. anxiety. Neuroleptics (Antipsychotic) are not considered an appropriate use for anxiety in our setting, due to the risk of side-effects vs benefits for this dx. Please review for discontinue via taper off. Record review of Resident #47's Physician Order dated August 2022 revealed, give Lamictal 25 mg 2 tabs BID for dx. anxiety disorder, start date 6/10/22. Nystatin 100,000 unit /gm topical cream 1 application BID, for candidiasis skin and nail, start date 6/10/22. Nystop 100,000 unit/gm topical powder apply small amount BID, for candidiasis skin and nail, start date 7/14/22. Record review of MAR dated August 2022 revealed Resident #47 received Lamictal 25 mg 2 tabs BID for dx. anxiety disorder, start date 6/10/22. Nystatin 100,000 unit /gm topical cream 1 application BID, for candidiasis skin and nail, start date 6/10/22. Nystop 100,000 unit/gm topical powder apply small amount BID, for candidiasis skin and nail, start date 7/14/22. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 12 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 8/04/22 at 11:30 am, the weekend supervisor stated the former DON or designee former unit manager reviewed the Consultant Pharmacist recommendations to follow-up with the Physician. She said that moving forward they will have the MD folders at the front receptionist desk for MD/NP to sign the physician letter/MRR, since it takes time if sent out, and to receive it back. Interview on 8/04/22 at 11:40 am, the DON stated she was currently designated to follow-up on the monthly Pharmacist MRR with weekend supervisor. She stated Resident #47's MRR on 7/22/22 was not done and moving forward she will ensure Pharmacist recommendations followed through within 72 hrs and reported to MD, and order carried out. She stated she will be working on the process and ensure the physician letter was given personally to MD/ NP if present in the facility. She said she will be monitoring them and have the physician letter at the front desk and signed by MD/NP. The DON stated she was also assigned to reconcile monthly physician orders with the weekend supervisor. She stated she will follow-up on the issues on pharmacy services and she will be monitoring them. She stated she just started last month, and she cannot answer for previous DON. Resident #88 Record review of Resident #88's face sheet revealed she was a [AGE] year-old female that was admitted to the facility on [DATE] with a diagnosis of cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it), end stage renal disease (final, permanent stage of chronic kidney disease, where kidney function has declined to the point that the kidneys can no longer function on their own), Pressure ulcer of sacral region, stage 3 (skin injuries that occur in the sacral region of the body, near the lower back and spine) and type 2 diabetes mellitus with diabetic chronic kidney disease. Record review of Resident #88's Quarterly MDS dated [DATE] revealed she had a BIMS of 06 out of 15 indicating severely impaired cognitively. Resident required extensive assistance from staff with personal hygiene, toilet use, dressing, transfer, and bed mobility. Record review of Resident #88's care plan initiated 6/20/22 revealed the following: Potential for Gastro-Intestinal disturbance r/t: _X__Gastric Ulcers PEPTIC ULCERS Goal: Resident's s/s will be relieved/resolved during the next 90 days. Interventions: Administer meds as ordered by MD. Observe and report to MD any adverse s/e of medications. Monitor and record non-compliance with specified diet. Monitor and record increase in s/s and report to MD. Record review of Resident #88's physician order dated 6/27/22 revealed an order for pantoprazole 40 mg tablet, delayed release 1 Time Daily for gastrostomy status, - type 2 diabetes mellitus with diabetic chronic kidney disease, - mild protein-calorie malnutrition. Record review of Resident #88's physician order dated 6/14/22 revealed an order for Prevacid 30 mg capsule, delayed release (1 Tab. Daily) Capsule, delayed release (enteric coated) oral continuous. Record review of Consultant Pharmacist's Medication Regimen Review for Resident #88 dated 7/22/22 read in part: .Protonix and prevacid both active-duplicate therapy please ask MD to DC one . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 13 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Record review of Resident #88's MAR dated August 2022 revealed Resident received pantoprazole 40 mg tablet, delayed release 1 Time Daily for gastrostomy status, - type 2 diabetes mellitus with diabetic chronic kidney disease, - mild protein-calorie malnutrition and Prevacid 30 mg capsule, delayed release (1 Tab. Daily) Capsule, delayed release (enteric coated) oral continuous. In an interview and record view on 8/4/22 at 10:01a.m., with the DON, the DON reviewed Medication regimen review dated 7/22/22 with the Surveyor. The DON said it's not been done. Will call the doctor now. We were in process of doing and y'all showed up. She said she and the ADON were responsible for completing the drug regimen review. She said she received the report from the pharmacist on 7/23/22 and started working on it right away and sent the letters to the doctor for them to sign. She said now the process will be that she will hold the letters and wait for doctor to come to the facility to sign the letters. She said the doctor comes every Friday to the facility. She said it was important to follow pharmacist recommendation to make sure residents were receiving the right medication and if there were duplicate order to take them off the resident's medical record. She said she reviewed resident's orders at the time of admission and then monthly. Record review of the facility policy titled Medications dated November 2017 revealed, recommendations made in a Consultant Pharmacist Report must be reviewed and corrections initiated within 2 business days of the visit. Any change in orders must be entered in the EMR for each recommendation approved by the physician. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 14 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. 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 ensure each resident's drug regimen was free from unnecessary medications for 2 of 18 residents reviewed for medications. (Resident # 193 and # 47) Residents Affected - Some The facility failed to ensure Resident #193's hospital discharge medication order was followed, give two times a day (BID) instead of three times a day (TID) Pantoprazole (reduces gastric acid secretion) 40 mg tab delayed release. The facility's Pharmacist consultant recommended on 7/22/22 to please update dx to appropriate indication of use for Lamictal (neuroleptic). Neuroleptics (Antipsychotic) are not considered an appropriate use for anxiety due to the risk of side-effects vs benefits for this dx. Resident #47 received a duplicate therapy for candidiasis of skin and nail, Nystatin 100,000 unit /gm topical cream, and Nystop 100,000 unit/ gm topical powder applied BID. These failures could place residents at risk of serious harm due to side effects, adverse reactions from the medication and receiving unnecessary medications. Findings included: Resident #193 Record review of Resident #193's clinical record revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of GERD with esophagitis (inflammation of the esophagus) without bleeding, cerebral infarction, hemiplegia (complete loss of strength one side) and hemiparesis (weakness on one side) following stroke and type 2 diabetes mellitus. Record review of Resident #193's Baseline Care Plan dated 7/23/22 revealed he was alert and cognitively intact with initial goals established bed in lowest position and meeting date discussed. He required limited assistance with 1 staff most ADLs and gait belt transfer assist. Record review of Resident #193's Hospital discharge order dated 7/23/22 revealed, give two times a day (BID) Pantoprazole (Protonix) 40 mg tab by mouth, enteric coated (delayed release=DR), for gastroesophageal reflux disease with esophagitis, without bleeding. Record review of Resident #193's Physician Order dated August 2022 revealed, give three times a day (TID) Pantoprazole (Protonix) DR 40 mg tab by mouth, for gastroesophageal reflux disease with esophagitis, without bleeding, start date 7/23/22. Record review of MAR dated August 2022 revealed Resident #193 received three times a day (TID) Pantoprazole (Protonix) DR 40 mg tab by mouth, for gastroesophageal reflux disease with esophagitis, without bleeding, start date 7/23/22. Interview on 8/04/22 at 11:30 am, the weekend Supervisor stated she asked the Nurse Practitioner regarding the administered order of TID Protonix DR 40 mg tab of Resident #193, instead of BID Protonix DR 40 mg tab according to hospital discharge order. She said the NP stated the problem, Resident #193's hospital discharge order was not followed to give two times a day (BID), and not three times a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 15 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some day (TID) Protonix delayed release (DR) 40 mg tab. She added admitting charge nurse calls MD regarding if either to continue with hospital discharge orders or not, and then the former DON and former unit manager would go through to verify if the MD orders correspond with hospital discharge orders and accurate. Interview on 8/04/22 at 11:40 am, The DON stated the NP responded to discontinue TID Protonix DR 40 mg and decreased to BID Protonix DR 40 mg tab according to Resident #193's Hospital discharge order. The DON stated Resident #193's Hospital discharge order was not followed and moving forward she will verify the physician orders next day if accurate and correspond with Hospital discharge orders together with weekend supervisor. The DON stated she was also assigned to reconcile monthly physician orders with the weekend supervisor. She stated she will follow-up on the issues on pharmacy services and she will be monitoring them. She stated she just started last month, and she cannot answer for previous DON. Resident #47 Record review of Resident #47's clinical record revealed a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of anxiety disorder, candidiasis of skin and nails, congestive heart failure, non-Alzheimer's dementia and HTN. Record review of Pharmacist consultant recommendation/ MRR, dated 7/22/22, revealed Resident #47 Nystop (Nystatin, treats antifungal infection) BID order was a duplicate order. Further review read, Please update diagnosis to appropriate indication of use for Lamictal (neuroleptic) for dx. anxiety. Neuroleptics (Antipsychotic) are not considered an appropriate use for anxiety in our setting, due to the risk of side-effects vs benefits for this dx. Please review for discontinue via taper off. Record review of Resident #47's Physician Order dated August 2022 revealed, give Lamictal 25 mg 2 tabs BID for dx. anxiety disorder, start date 6/10/22. Nystatin 100,000 unit /gm topical cream 1 application BID, for candidiasis skin and nail, start date 6/10/22. Nystop 100,000 unit/gm topical powder apply small amount BID, for candidiasis skin and nail, start date 7/14/22. Record review of MAR dated August 2022 revealed Resident #47 received Lamictal 25 mg 2 tabs BID for dx anxiety disorder, start date 6/10/22. Nystatin 100,000 unit /gm topical cream 1 application BID, for candidiasis skin and nail, start date 6/10/22. Nystop 100,000 unit /gm topical powder apply small amount BID, for candidiasis skin and nail, start date 7/14/22. Interview on 8/04/22 at 11:30 am, the weekend supervisor stated the former DON or designee former unit manager reviewed the Consultant Pharmacist recommendations to follow-up with the Physician. She said that moving forward they will have the MD folders at the front receptionist desk for MD/NP to sign the physician letter/MRR, since it takes time if sent out, and to receive it back. Interview on 8/04/22 at 11:40 am, the DON stated she was currently designated to follow-up on the monthly Pharmacist MRR with weekend supervisor. She stated Resident #47's MRR on 7/22/22 was not done and moving forward she will ensure Pharmacist recommendations followed through within 72 hrs and reported to MD, and order carried out. She stated she will be working on the process and ensure the physician letter was given personally to MD/ NP in the facility. She said she will be monitoring them and have the physician letter at the front desk and signed by MD/NP. The DON stated she was also (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 16 of 17 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 675423 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/04/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ashford Gardens 7210 Northline Dr Houston, TX 77076 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 0757 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some assigned to reconcile monthly physician orders with the weekend supervisor. She stated she will follow-up on the issues on pharmacy services and she will be monitoring them. She stated she just started last month, and she cannot answer for previous DON. Record review of the facility policy titled Medications dated November 2017 revealed, recommendations made in a Consultant Pharmacist Report must be reviewed and corrections initiated within 2 business days of the visit. Any change in orders must be entered in the EMR for each recommendation approved by the physician. Upon admission including re-admission of each resident, the physician orders for the resident must be reviewed and reconciled by the charge nurse and the DON or designee for accuracy in the Electronic Medical Record. Record review of the facility policy titled, Safe Medication Assistance and Administration, revised date 07/2015, revealed initiations, dosage changes .will be coordinated with the prescriber and discussed as needed to ensure staff and/or the person served has a clear understanding of the order. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675423 If continuation sheet Page 17 of 17