Health inspection·August 15, 2025

F 0550 Level of Harm - Actual harm Residents Affected - Few Record review of Resident #3's quarterly MDS dated [DATE] indicated he was cognitively stable with a BIMS of 14. During an interview on 8/13/25 at 10:40 a.m., the DON said they were running low on briefs and wipes, but the staff had enough supplies to make do. She said they could put briefs together if needed. The DON stated the family of Resident #3 called the police and said he was laying in urine all day. The police came and she was told they found no issues. She also said they had the police incident written down; a copy was requested. There was no police report provided. During an interview on 8/13/25 at 1:40 p.m., Resident #3 said he was very upset this weekend at the way he was treated. He said the facility did not have briefs to fit him and he had to lay in urine most of the day. He said they did not have briefs from 7:30 p.m. Saturday night until about 2:30 p.m. Sunday 8/10/25. He said he was mad because he was told he could not get out of bed. He said he had called his family member and told them about the situation. He said the police came and the RN Weekend Supervisor came in and lied to the police in front of his face about having briefs. He said they brought a pack of brief in at that time with two briefs in it. He said he felt it was a stupid situation to have to lay in urine all that time because the facility did not have what they needed. He said he was told they had smaller briefs, but none that would fit him. He said it make him feel very low, like what he needed did not matter. He said they had some good aids, and they tried but had nothing to work with. During an interview on 8/13/25 at 1:54 p.m., the RN Weekend Supervisor said she was made aware the facility was out of bariatric briefs on Sunday morning, 8/10/25. She said she called the sister facility, and they loaned them one package of bariatric briefs about 10 in the pack. She said on Sunday afternoon, the police came after Resident #3's family member called them to report, Resident #3 was laying in urine all night and day. The RN Weekend Supervisor said she had seen Resident #3 out of the bed on Friday and Saturday. She said she had told her staff to put some medium briefs together to get residents up. She said the staff would not be unable to fasten the briefs on the sides, but they had to make do with what they had. She said earlier that day she asked Resident #3 if he wanted to get up and he said no. She said when the police came, they checked Resident # 3 and their supply of briefs at that time and they had no concerns and left. During an interview on 8/13/25 at 2:30 p.m., LVN E said she worked on Sunday 8/10/25. She said she heard they did not have briefs. She had several residents complained. She said Resident #3 was up Saturday and Sunday, but he heard him complain about not having briefs. She said the aides were having a hard time trying to find the supplies they needed to provide care to the residents. During an interview on 8/14/25 at 11:08 a.m. the family member of Resident #3 said he called on Sunday 8/10/25 and said Resident #3 was laying in urine because the facility did not have any briefs. The family member said they called the RN Weekend Supervisor and was told the facility did not have any briefs to fit Resident #3. The family member said she was told by the RN Weekend Supervisor the resident had to stay in the bed, and lay in urine and poo until they had to change the sheets. The family member said she was told the order did not come in, and they did not know where the truck was. The family member said the RN Weekend Supervisor was short and abrupt in her conversation and appeared to not want to be bothered. The family member said that was why they called the police. The family member said they felt it was a crime for the facility to treat the residents worse than animals; having them lay in their own waste and did nothing about it. The family member said the police did not let them know what they found. Record review of Resident #5's quarterly MDS dated [DATE] indicated she was cognitively stable with a BIMS of 14. During an interview on 8/13/25 at 1:05 p.m., Resident #5 said there were no briefs over the weekend, and it started on Friday, 8/8/25. She said on Friday, the aide found one brief that fit her. She said they had hidden the brief so that she could have it for her doctor's appointment on Monday. She said it (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 2 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0550 Level of Harm - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete caused her anxiety to think she would have to go to her doctor's appointment and embarrass herself due to not having any briefs that fit her. She said they had no wipes and no washcloths, so they didn't have anything to wipe her with either. Resident #5 said she felt, due to the shortage of wipes, the laundry could not keep up with the demand. She said an aide had taken two smaller briefs and put them together, but they did not fit. Resident #5 said, on Sunday night, they were able to find a washcloth and she was cleaned up for her appointment on 8/11/25. She said the whole episode caused her a lot of anxiety and discomfort. She said she was afraid to go to activities because she was afraid that she would embarrass herself. Resident #5 said she was more concerned about going to her physician's appointment. She said that it was a very upsetting weekend. She said on Saturday and Sunday they used the smaller briefs as best they could. She said one aide brought some wipes from home and left them in her room so she could have some. She said the briefs they had available would cut off her circulation if they were able to close them at all.Record review of Resident #6's BIMs score dated 7/23/25 indicated she was cognitively stable with a BIMS of 14. During an interview on 8/13/25 at 1:10 p.m., Resident #6 said she witnessed the lack of briefs over the weekend and witnessed her roommate's anxiety and frustration at the situation. During an interview on 8/13/25 at 5:54 p.m., CNA F said she worked this weekend, and they did not have any large briefs. She said she had one resident on the hall that required bariatric briefs, and that was Resident #5. She said she worked on 8/9/25 and 8/10/25, and they could only find one bariatric brief on her hall. She stated she used two medium briefs, layered them, and had to pull the resident's pants up to hold them in place. She said Resident #5 wanted to get up every day about 11:00 a.m., and she explained that there were no briefs. CNA F said Resident #5 said she could not lay in bed all day. CNA F said Resident #5 said it was uncomfortable, but better than lying in bed all day Record review of Resident #4's quarterly MDS dated [DATE] indicated he was cognitively stable with a BIMS of 15. During an interview on 8/13/25 at 3:35 p.m. Resident #4 said she had on a brief at the current time, but it was not the right size, and it was cutting into her skin. She said over the weekend they had found a couple of briefs that kind of fit her, but she did not have any problems getting up. Resident #4 said hopefully they would have some more briefs today because the ones they had were too tight for her. She said she was fine just a little uncomfortable. She said she did not know what size it was, but it was a size to small.During an interview and observation on 8/13/25 at 1:20 p.m. of CNA B and two other staff were placing briefs in a room as an overflow. They said that they had got 3 1/2 pallets of supplies and they had plenty of large, extra-large, and bariatric briefs that had arrived today. During an interview on 8/13/25 at 3:40 p.m., LVN G said she worked at over the weekend on 8/9/25 and 8/10/25 and they did not have large briefs. She said some of those residents could not get up because they did not have briefs to fit them. Review of a purchase order dated 8/7/25 indicated the facility had order 22 boxes of briefs in different sizes and 21 boxes of wipes. The order indicated it was approved for purchase on 8/8/25. Event ID: Facility ID: 675424 If continuation sheet Page 3 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to immediately consult with the physician when a need to alter treatment significantly due to adverse consequences for 2 of 5 residents reviewed for resident rights. (Resident #1 and Resident #2) The facility failed to notify or consult with Residents #1 and #2's physician for the following: Resident #1 was readmitted to the facility on [DATE] with surgical incisionto the left groin, right groin, and left knee. He did not have treatment orders for these wounds.On 8/10/25 Resident #1's groin area was noted to have signs of infection. Resident #1 went to the hospital on 8/11/25 with a diagnosis of groin infection. Resident #2 was readmitted to the facility on [DATE] at 10:00 p.m. with a stage 4 to her sacrum. She did not have orders to treat the wound as of 6:00 p.m. on 8/13/25. An Immediate Jeopardy (IJ) situation was identified on 8/14/25 at 1:00 p.m. While the IJ was removed on 8/15/25 at 3:22 p.m., the facility remained out of compliance at a potential for not actual harm with a potential for more than minimal harm with a scope of pattern, due to the facility's need to evaluate the effectiveness of the corrective systems. These deficient practices could place residents at risk for pain and suffering. Findings included: Record review of Resident #1's face sheet indicated he was a [AGE] year-old male admitted to the facility on [DATE]. He had a readmission date of 8/5/25. He had diagnoses of peripheral vascular disease (PVD) (a condition where the arteries and veins in the arms, legs, and feet become narrowed or blocked reducing blood flow.) and a history of stroke. Record review of Resident #1's admission MDS assessment dated [DATE] indicated his cognition was intact with a BIMS score of 13. The MDS indicated he used a walker and a wheelchair, but required supervision or touching assistance with most ADLs. Record review of Resident #1's care plan dated 6/2/25 indicated he was incontinent of bowel and bladder. Some of the interventions were to assist to toilet as needed, provide weekly skin checks to monitor for redness, circulatory problems, breakdown or skin concerns, and report any new skin conditions to the physician. Record review of Resident #1's computerized physician orders dated 8/11/25 indicated no orders for treatment to his groin incisions were listed. Record review of Resident #1's After Visit Summary dated 8/4/25 provided instructions to call the provider if redness, tenderness or signs of infection (pain, swelling, redness, odor or green/yellow discharge around incision site, and for severe uncontrolled pain. Record review of Resident #1's Admit/Readmit Evaluation dated 8/5/25 at 1:32 a.m. indicated he had surgical incision wounds on the left groin, right groin, and left front knee. There were no other descriptions. Record review of Resident #1's Admit/Readmit note dated 8/5/25 at 1:32 a.m. indicated he was admitted from the hospital with a diagnosis of deep vein thrombosis, and PVD. He needed limited assistance with transfers, self-performance. He was continent of urine and bowels and needed limited assistance with toileting, self-performance. He had pitting edema to both lower extremities. He complained of pain and was given pain medications. (no mention of surgical wounds) Record review of Resident #1's nursing notes dated 8/5/25 indicated he had a telehealth visit. The resident was readmitted last night with bilateral groin stent placement for PVD. He reported difficult urinating and severe incisional pain. He was requesting to be sent back to the ER and was transferred at 6:12 a.m. to the hospital. At 8:00 a.m. the resident returned from the hospital and was given pain medications. Record review of Resident #1's nursing notes dated 8/7/25 at 1:14 p.m. indicated Resident has open wounds; vascular and surgical. The resident received wound care with no changes in skin condition noted, and there were no signs and symptoms of infection. Record review of Resident #1's Skilled Observation note dated 8/10/25 at 9:37 p.m. indicated no infection was present the wound had redness and inflammation. The skin was warm and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 4 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some dry. The surgical incision was open with wound care and notable changes in skin condition. The observation described the incision with staples on the left side of the groin to have a foul-smelling drainage. The area was red and inflamed, it was cleansed with wound cleanser and was tender to touch. The groin on the right side had no visible signs and symptoms of infection. The note indicated would report to the oncoming charge nurse. Written by LVN E (there was no indication the physician was notified. Record review of Resident #1's nursing notes dated 8/11/25 at 5:50 p.m. the resident was sent to the hospital due to altered mental status. No other information was documented. Record review of Resident #1's hospital records dated 8/11/25 revealed the resident was admitted due to generalized weakness. He had bilateral groin incisions with staples that were irritated, with redness to the left and right groin and a foul smell. It appeared yeasty in nature. He stated his groin infections hurt and itched. His diagnosis was surgical incision infection. He was prescribed Cephalexin 500 mg two times a day for 7 days and Nystatin cream apply to groin area two times a day for 7 days. He returned to the facility on 8/11/25 at 11:14 p.m. and new orders were noted. Record review of Resident #1's nursing note dated 8/11/25 at 11:14 p.m. indicated he was readmitted to the facility with diagnoses of generalized weakness, yeast infection, and incisional infection. He had new orders for cephalexin 500 mg three times a day for 7 days and Nystatin Cream 100,000 units to bilateral groin two times a day for 7 days. Record review of Resident #1's computerized physician orders indicated an order with a start date of 8/12/25 at 8:00 a.m. for Nystatin External cream 100,000 units to bilateral groin area two times daily. An order with a start date of 8/12/25 at 8:00 a.m. for Cephalexin Oral Capsule 500 mg by mouth three times daily for 7 days.After Investigator intervention a treatment administration record was generated on 8/13/25, and indicated his treatment was to start on 8/13/25 at 6 p.m. During a telephone interview on 8/11/25 at 12:06 p.m., an Anonymous staff said Resident #1 had staples to his right and left groin area. The staff said on 8/10/25, a nurse had gone to look at the surgical incisions and they looked infected. The staff said that an unidentified nurse had not called the physician. She stated she had cleansed the area with wound cleanser and wound care was supposed to be done today, 8/11/15 by the treatment nurse. During an observation and interview on 8/11/25 at 3:20 p.m., Resident #1 was noted with EMS in his room. LVN A said Resident #1 was going to the hospital due to a change in his level of consciousness. She said he had staples in his right and left groin area and the left groin area was inflamed. She said it had yellow slimy drainage. She stated she told EMS his blood pressure was 88/56. Resident #1 was noted to be able to ambulate from the bed to the stretcher and was taken by EMS. LVN A said Resident #1's surgical incision appeared infected. During an interview on 8/11/25 at 5:59 p.m., LVN C/Treatment nurse said Resident #1 had surgical incisions on both sides of his groin. She said she was informed the right side of Resident #1's groin was red and inflamed. She was going to reach out to see if they wanted to remove the staples, but had not done so yet. She said they had orders to monitor the areas and put on a dry dressing. (There was no order noted) During an interview on 8/13/25 at 10:46 a.m., the DON said Resident#1 did not have any orders to treat his surgical incisions. The DON said LVN D was on duty when Resident #1 was readmitted to the facility on [DATE], and she should have passed his information on to the oncoming nurse. The DON said LVN D sent Resident #1 back out the same night and did not get an order for his surgical incisions. She said her staff were trained to go by the hospital After Visit Summary for orders. However, if a resident came in as a new admit or a readmit and did not have an order, they were to call the doctor to get an order. The DON said since Resident #1 did not have an order to treat the surgical incisions, someone should have followed up with the physician. After review of the Resident #1's observation note dated 8/10/25, the DON said LVN E should have contacted the physician (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 5 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some when she noted Resident #1's wound looked infected. During an interview on 8/13/25 at 1:54 p.m., the RN Weekend Supervisor said she filled in for the treatment nurse on the weekends, and when the treatment nurse was out. She said Resident#1 did not have an order to treat his surgical incisions on the groin area. She said if a resident did not have an order or treatment in place, she was not aware they had any areas. The RN Weekend Supervisor stated when Resident #1 came from the hospital with surgical wounds and did not have anything down to treatment the areas . She said the nursing staff should have called the doctor to see what he wanted done. She said good nursing judgment indicated they should have called the hospital for orders or called the doctor to at least see what the physician wanted done with the wounds. During an interview on 8/13/25 at 2:30 p.m., LVN E said she worked on Friday 8/10/25 and had seen Resident #1's wounds, but did not provide any treatment. She said she was under the impression the treatment nurse was providing treatments to his groin area. She said she asked LVN C/Treatment nurse earlier in the week, and she said Resident #1's wound was getting cleaned and left to open air. LVN E said on the afternoon of Sunday 8/10/25, Resident #1's family brought to her attention that they thought Resident #1's groin area was infected. She said they sent pictures, and she had gone to look at the wound. LVN E said she cleaned the wounds on Resident #1's groin and noted in an observation note the left side was inflamed and red. She said the area could have been infected; it had an odor, and yellow drainage, it was red and inflamed . She said she had not contacted the physician; she passed the information on to the oncoming shift. During an interview on 8/14/25 at 9:45 a.m., the MD said he was not told Resident #1's surgical wound was infected prior to his discharge. He said he expected staff to call him and let him know of changes that occurred with residents. He said when a resident came back from the hospital they needed orders in place. He said if the facility does not have any orders, they should reach out to him for orders. He said the facility usually did a skin assessment and would call him for an order. He said especially if a resident was a readmitted and did not have a previous order for wound care. He said he expected to be notified of Resident conditions. Resident #2 Record review of Resident #2's face sheet dated 8/13/25 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with a readmission date of 8/12/25. She had diagnoses of stroke, end stage renal disease, chronic respiratory failure, heart disease, diabetes, and bipolar disorder. Record review of Resident# 2's admission MDS dated [DATE] indicated she was cognitively intact with a BIMS score of 14. Resident #2 required partial to substantial assist with ADLs. She required supervision with bed mobility, partial to moderate assist with sit to laying, and did not attempt to stand or transfer due to medical condition. The MDS indicated she was at risk for a pressure ulcer. Review of Resident #2's care plan dated 5/19/15 indicated she was at risk for pressures ulcers. One of the interventions was to monitor for redness, circulation problems, pressure sores, open areas, and changes in skin integrity. Review of Resident #2's computerized physician orders dated 8/13/25 at 4:00 p.m. did not reveal an order for treatment to her sacrum wound. Review of Resident #2's nursing notes dated 7/31/25 at 6:00 a.m. revealed the resident was sent to the hospital due to her calling EMS and stating she was having difficulty breathing. Record review of Resident #2's hospital records dated 7/31/25 indicated the resident was admitted to the hospital on [DATE] after a ground level fall. She was discharged to the facility on 7/30/25 and readmitted to the hospital on [DATE] with complaints of shortness of breath and pain associated with groin buttock wounds. Review of Resident #2's hospital After Visit Summary dated 8/12/25 indicated the primary diagnoses for hospitalization was pressure injury of sacral region stage 4, end stage renal disease, uncontrolled diabetes, and fluid overload. There was no order for the care of the pressure injury of the sacrum. Record review of Resident #2's Admit Readmit Evaluation 8/12/25 at 10:00 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 6 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some indicated skin integrity with wounds present on admission, with bruising, discoloration, and an open wound. The comments indicated a pressure injury of the sacral region, stage 4, and bruising to the hands and front of the elbow. Record review of the facility's 24-hour report for 8/12/25 indicated Resident #2 returned from the hospital at 9:35 p.m., and she had a stage 4 pressure wound on her sacrum. During an interview on 8/13/25 at 6:01 p.m., the Administrator said they did not have any treatment orders for Resident #2's treatments, and she did not have a TAR generated at the current time due to no orders being in place. During an interview 8/14/25 at 11:00 a.m., the RN Weekend Supervisor said whoever admitted Resident #2 should have gotten orders from the hospital. She said if not, they should've gotten orders from the doctor regarding resident service. She said she completed the wound care on Resident #2 yesterday evening.During an interview on 8/13/25 at 4:50 p.m., the DON said Resident #2 had been in the hospital for 45 days. She said every time Resident #2 came to the facility, she was only there for a day or a few hours and then back to the hospital. The DON said normally when a resident was admitted or readmitted , the admitting nurse contacted the hospital for additional orders or contacts the physician for orders. She stated if it was during the night, the treatment nurse would be notified and the next day to do a skin assessment, notify the physician . She said at that time if a resident had wounds or if they needed any kind of treatment, they would get orders. She said she did not know why there were no orders for Resident #2. Record review of the facility's Notification of Changes policy last revised 2/10/21 indicated their policy to provide guidance on when to communicate acute changes in status to the MD, NP and responsible party. The will would immediately inform the resident: consult with the resident's physician, and responsible party for any significant change in physical, mental, or psychosocial status of the resident. The facility documents resident assessments, interventions, physician and family notification on the SBAR, Nursing Progress Note, or Telephone order form as appropriate. This was determined to be an Immediate Jeopardy (IJ) on 8/14/25 at 1:00 p.m. The Administrator, DON, and RNC were informed of the IJ situation on 8/14/25 at 1:00 p.m. a copy of the IJ template was emailed to them at 1:00 p.m. A POR was requested and accepted on 8/15/25 at 10:45 a.m. [The facility failed to implement policies and procedures regarding physician notification to prevent the hospitalization of Resident #1 due to a surgical wound infection.Immediate Action Taken:On 08/14/2025 at 2:30 PM, the attending physician for Resident #1 and #2 was notified of the status of the surgical incision, wounds and the lack of prior communication regarding wound condition. Resident #1and #2 were immediately assessed by the facility's wound care nurse and physician. Orders were received and implemented, including wound care protocols and infectious disease consult. 2. Identification of Residents Affected or Likely to be Affected:A head-to-toe skin and wound assessment was completed on all residents by the Director of Nursing (DON) and Wound Nurse on 08/14/2025. A facility-wide audit was initiated on 08/14/2025 by the DON/Designee to ensure all residents have current wound descriptions, physician orders, and proper documentation of physician notification using skin observation sheets and any discrepancies will be documented in the nurse's notes. Any discrepancies were immediately corrected, and responsible nurses were given additional education by DON/Designee. Telehealth and/or physician will be notified after hours and on weekends. Notification to physician will be documented in the nurse's notes by the licensed nurses. DON/designee educated all licensed nurses on policy/procedure on Change of condition notification. Licensed nurses will use the 24-hour report, the care plan, and Treatment administration record to communicate from shift to shift for all resident's change of conditions and care needs. 3. Actions to Prevent Occurrence/Recurrence:Staff Education On 08/14/2025, all licensed nurses received personized education on: Physician notification requirements will be upon admission/readmission and any change of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 7 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some condition License nurses will contact physicians to clarify admission or readmission orders when there are discrepancies with hospital records, change of conditions of wounds and signs of infection and ensure orders transferred to computer, MAR and TAR,Documentation of wound assessments. Use of SBAR (Situation-Background-Assessment-Recommendation) communication tool upon change of condition prior to physician notification. DON/Designee educated staff on notification of physician and staff were required to demonstrate understanding via return demonstration or post-education quiz. Education will be completed on 8/14/25. Staff unavailable to attend in service on 08/14/2025 will receive personalized in service prior to assuming their duties. Wound Communication Process A daily Wound Rounds Checklist was implemented to ensure: Each wound has documented assessment, treatment orders, and notification status. Any change is reported immediately to DON/Designee and documented in progress notes DON/Designee will complete a weekly interdisciplinary wound rounds initiated as of 08/14/2025 with physician participation (in person or telehealth). Monitoring and Oversight PlanDaily audits of physician notification for any changes in condition by DON or designee for 14 days (08/14-08/28/2025), then weekly x4 weeks. DON/Designee will review all new admissions and readmissions within 24 hours to ensure physician orders and wound care protocols are in place by DON/ Weekend Supervisor/ Designee. Review will be documented on the admission Audit tool.DON or designee will: Review progress notes, nurse notes, and MARs for compliance. Validate timely physician notifications. Audit results will be reported weekly to the Quality Assurance & Performance Improvement (QAPI) committee for 3 months. Continued noncompliance will trigger retraining or disciplinary action. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: 8/14/25] On 8/15/25 the investigator confirmed the facility implemented their plan of removal sufficiently to remove the IJ by: Review of facility skin assessments, facility audit of records to include wound descriptions, physician orders, and documentation in the nursing notes. The skin assessments were reviewed for all residents in the facility and noted two residents were found with redness to the buttocks, one resident with an open area to the buttocks, and one resident with redness to an ostomy site. There were orders noted to be placed, a description of the areas, and the physician was notified. Review of documentation showed Resident #1 and Resident #2 had descriptions of their wounds and treatment orders in place. Review of the facility Wound Daily Audit dated 8/14/25 through 8/24/25 indicated 3 newly admitted residents with skin assessments completed, the physician notified, a wound order in place, the wound care physician notified, and family notified. Record review of in-service dated 8/14/25 indicated nurses were educated on Change in Condition, completing the SBAR when a resident has a change in condition. When a nurse was notified or identified a change in condition they were to immediately, assess the resident gather vital signs, ask specific questions, if possible, notify MD, responsible part, DON and then document in the computer and add to the 24-hour report. Record review of in-service dated 8/14/25 indicated 19 nurses were educated on pressure ulcers/wounds upon admission or readmission. They were instructed to complete a head-to-toe assessment, measure wounds or open areas, complete the skin assessment, document in the computer system on admission or readmission, call the physician or use the [NAME]- health after hours to receive wound care orders, notify family about the wounds and the wound care company, wounds will be care planned, and to call the DON regarding any wounds found on admission or readmission. A copy of the skin management policy was attached. Record review indicated the facility had conducted skilled nursing facility nursing competency testing on nursing staff dated 8/14/25. Some of the questions indicated the physician should be notified as soon as a change was identified, when a resident is admitted with a pressure sore, the responsibility was to notify the MD, after receiving Wound care orders, put them in the computer and initiate care protocol. When observations showed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 8 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0580 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete increased redness or drainage from a wound, notify the MD and request updated wound care orders. There were also true and false questions. During an interview on 8/15/25 at 11:45 a.m., the RNC said the facility's census was 103 today and they did 101 skin assessments. She said one resident was up and 1 resident refused, and they are going to try and get them later. She said they did the in services and had a return demonstration test for the nurses. They were not able to have all nurses do the testing because they had called some on the phone. She said they would do their testing later. The RNC said they had done chart audits and had the monitoring tool in place. She stated they were currently doing everything on paper due to the current computer system being down and they were transitioning to another system. During an interview on 8/15/25 at 12:10 p.m., the DON said she in-serviced nurses on change in condition, when to notify the doctor, and the steps to take upon admission. The staff were given a test to determine if they knew what to do for a new admission and when to follow up. She said one resident had surgery and did not have any orders when he was admitted on how to treat the wound, the physician was contacted, and new orders were obtained. The DON said another resident had a tiny area on her bottom and they got an order for the treatment of the wound. She had in-serviced 20 nurses. She had 12 full time nurses and 8 PRN nurses. The DON said, on today, they had the ADON, who was acting as treatment nurse, and 3 charge nurses, in the building. She said Resident #2 had gone back to the hospital. They were doing paper charting on today. During an interview on 8/15/25 at 3:00 p.m., the Administrator said he would admit some mistakes were made with Resident #1. He said he did not agree with the IJ level of severity. He said however the interventions they had put into place with staff training, ensuring the physician was notified, and making sure documentation was in place, had fixed many issues. He said the morning oversight meetings should bring issues to the attention of administration, and they would be able to put systems in place to prevent future problems. He said they would form a habit of doing things the right way. Interviews conducted with nurses the following shift nurses on 8/15/25 between 12:15 p.m. and 2:15 p.m. determined staff were knowledge about the in-services and education provided. At 12:15 p.m. LVN I worked 6p to 6aAt 12:20 p.m. LVN J /ADON worked all shiftsAt 1:15 p.m. LVN L worked 6p to 6aAt 1:30 p.m. LVN M worked 6a to 6pAt 1:34 LVN G worked 6a to 6pAt 1:45 p.m. LVN N worked 6a to 6pAt 1:50 p.m. LVN C/treatment nurse worked all shiftsAt 1:57 LVN K- PRN worked all shiftsAt 2:10 p.m. LVN O worked PRN weekends At 2:15 p.m. LVN A worked 6a to 2p The Administrator, DON, and RNS were informed the IJ was removed on 8/15/25 at 3:35 p.m. The facility remained out of compliance at a severity level of potential harm with a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 675424 If continuation sheet Page 9 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents received treatment and care in accordance with professional standards of practice for 2 of 5 residents reviewed for resident rights. (Resident #1 and Resident #2) The facility failed to notify or consult with Residents #1 and #2's physician for the following: Resident #1 was readmitted to the facility on [DATE] with surgical incisionto the left groin, right groin, and left knee. He did not have treatment orders for these wounds. On 8/10/25 Resident #1's groin area was noted to have signs of infection. Resident #2 was readmitted to the facility on [DATE] at 10:00 p.m. with a stage 4 to her sacrum. She did not have orders to treat the wound as of 6:00 p.m. on 8/13/25. An Immediate Jeopardy (IJ) situation was identified on 8/14/25 at 1:00 p.m. While the IJ was removed on 8/15/25 at 3:22 p.m., the facility remained out of compliance at a potential for not actual harm with a potential for more than minimal harm with a scope of pattern, due to the facility's need to evaluate the effectiveness of the corrective systems. These deficient practices could place residents at risk for pain and suffering.Findings included: Record review of Resident #1's face sheet indicated he was a [AGE] year-old male admitted to the facility on [DATE]. He had a readmission date of 8/5/25. He had diagnoses of peripheral vascular disease (PVD) (a condition where the arteries and veins in the arms, legs, and feet become narrowed or blocked reducing blood flow.) and a history of stroke. Record review of Resident #1's admission MDS assessment dated [DATE] indicated his cognition was intact with a BIMS score of 13. The MDS indicated he used a walker and a wheelchair, but required supervision or touching assistance with most ADLs. Record review of Resident #1's care plan dated 6/2/25 indicated he was incontinent of bowel and bladder. Some of the interventions were to assist to toilet as needed, provide weekly skin checks to monitor for redness, circulatory problems, breakdown or skin concerns, and report any new skin conditions to the physician. Record review of Resident #1's computerized physician orders dated 8/11/25 indicated no orders for treatment to his groin incisions were listed. Record review of Resident #1's After Visit Summary dated 8/4/25 provided instructions to call the provider if redness, tenderness or signs of infection (pain, swelling, redness, odor or green/yellow discharge around incision site, and for severe uncontrolled pain. Record review of Resident #1's Admit/Readmit Evaluation dated 8/5/25 at 1:32 a.m. indicated he had surgical incision wounds on the left groin, right groin, and left front knee. There were no other descriptions. Record review of Resident #1's Admit/Readmit note dated 8/5/25 at 1:32 a.m. indicated he was admitted from the hospital with a diagnosis of deep vein thrombosis, and PVD. He needed limited assistance with transfers, self-performance. He was continent of urine and bowels and needed limited assistance with toileting, self-performance. He had pitting edema to both lower extremities. He complained of pain and was given pain medications. (no mention of surgical wounds) Record review of Resident #1's nursing notes dated 8/5/25 indicated he had a telehealth visit. The resident was readmitted last night with bilateral groin stent placement for PVD. He reported difficult urinating and severe incisional pain. He was requesting to be sent back to the ER and was transferred at 6:12 a.m. to the hospital. At 8:00 a.m. the resident returned from the hospital and was given pain medications. Record review of Resident #1's nursing notes dated 8/7/25 at 1:14 p.m. indicated Resident has open wounds; vascular and surgical. The resident received wound care with no changes in skin condition noted, and there were no signs and symptoms of infection. Record review of Resident #1's Skilled Observation note dated 8/10/25 at 9:37 p.m. indicated no infection was present the wound had redness and inflammation. The skin was warm and dry. The surgical incision was open with wound care and notable changes in skin condition. The observation described the incision with staples Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 10 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some on the left side of the groin to have a foul-smelling drainage. The area was red and inflamed, it was cleansed with wound cleanser and was tender to touch. The groin on the right side had no visible signs and symptoms of infection. The note indicated would report to the oncoming charge nurse. Written by LVN E (there was no indication the physician was notified. Record review of Resident #1's nursing notes dated 8/11/25 at 5:50 p.m. the resident was sent to the hospital due to altered mental status. No other information was documented. Record review of Resident #1's hospital records dated 8/11/25 revealed the resident was admitted due to generalized weakness. He had bilateral groin incisions with staples that were irritated, with redness to the left and right groin and a foul smell. It appeared yeasty in nature. He stated his groin infections hurt and itched. His diagnosis was surgical incision infection. He was prescribed Cephalexin 500 mg two times a day for 7 days and Nystatin cream apply to groin area two times a day for 7 days. He returned to the facility on 8/11/25 at 11:14 p.m. and new orders were noted. Record review of Resident #1's nursing note dated 8/11/25 at 11:14 p.m. indicated he was readmitted to the facility with diagnoses of generalized weakness, yeast infection, and incisional infection. He had new orders for cephalexin 500 mg three times a day for 7 days and Nystatin Cream 100,000 units to bilateral groin two times a day for 7 days. Record review of Resident #1's computerized physician orders indicated an order with a start date of 8/12/25 at 8:00 a.m. for Nystatin External cream 100,000 units to bilateral groin area two times daily. An order with a start date of 8/12/25 at 8:00 a.m. for Cephalexin Oral Capsule 500 mg by mouth three times daily for 7 days.After Investigator intervention a treatment administration record was generated on 8/13/25, and indicated his treatment was to start on 8/13/25 at 6 p.m. During a telephone interview on 8/11/25 at 12:06 p.m., an Anonymous staff said Resident #1 had staples to his right and left groin area. The staff said on 8/10/25, a nurse had gone to look at the surgical incisions and they looked infected. The staff said that an unidentified nurse had not called the physician. She stated she had cleansed the area with wound cleanser and wound care was supposed to be done today, 8/11/15 by the treatment nurse. During an observation and interview on 8/11/25 at 3:20 p.m., Resident #1 was noted with EMS in his room. LVN A said Resident #1 was going to the hospital due to a change in his level of consciousness. She said he had staples in his right and left groin area and the left groin area was inflamed. She said it had yellow slimy drainage. She stated she told EMS his blood pressure was 88/56. Resident #1 was noted to be able to ambulate from the bed to the stretcher and was taken by EMS. LVN A said Resident #1's surgical incision appeared infected. During an interview on 8/11/25 at 5:59 p.m., LVN C/Treatment nurse said Resident #1 had surgical incisions on both sides of his groin. She said she was informed the right side of Resident #1's groin was red and inflamed. She was going to reach out to see if they wanted to remove the staples, but had not done so yet. She said they had orders to monitor the areas and put on a dry dressing. (There was no order noted) During an interview on 8/13/25 at 10:46 a.m., the DON said Resident#1 did not have any orders to treat his surgical incisions. The DON said LVN D was on duty when Resident #1 was readmitted to the facility on [DATE], and she should have passed his information on to the oncoming nurse. The DON said LVN D sent Resident #1 back out the same night and did not get an order for his surgical incisions. She said her staff were trained to go by the hospital After Visit Summary for orders. However, if a resident came in as a new admit or a readmit and did not have an order, they were to call the doctor to get an order. The DON said since Resident #1 did not have an order to treat the surgical incisions, someone should have followed up with the physician. After review of the Resident #1's observation note dated 8/10/25, the DON said LVN E should have contacted the physician when she noted Resident #1's wound looked infected. During an interview on 8/13/25 at 1:54 p.m., the RN Weekend Supervisor said she filled in for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 11 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some the treatment nurse on the weekends, and when the treatment nurse was out. She said Resident#1 did not have an order to treat his surgical incisions on the groin area. She said if a resident did not have an order or treatment in place, she was not aware they had any areas. The RN Weekend Supervisor stated when Resident #1 came from the hospital with surgical wounds and did not have anything down to treatment the areas . She said the nursing staff should have called the doctor to see what he wanted done. She said good nursing judgment indicated they should have called the hospital for orders or called the doctor to at least see what the physician wanted done with the wounds. During an interview on 8/13/25 at 2:30 p.m., LVN E said she worked on Friday 8/10/25 and had seen Resident #1's wounds, but did not provide any treatment. She said she was under the impression the treatment nurse was providing treatments to his groin area. She said she asked LVN C/Treatment nurse earlier in the week, and she said Resident #1's wound was getting cleaned and left to open air. LVN E said on the afternoon of Sunday 8/10/25, Resident #1's family brought to her attention that they thought Resident #1's groin area was infected. She said they sent pictures, and she had gone to look at the wound. LVN E said she cleaned the wounds on Resident #1's groin and noted in an observation note the left side was inflamed and red. She said the area could have been infected; it had an odor, and yellow drainage, it was red and inflamed . She said she had not contacted the physician; she passed the information on to the oncoming shift. During an interview on 8/14/25 at 9:45 a.m., the MD said he was not told Resident #1's surgical wound was infected prior to his discharge. He said he expected staff to call him and let him know of changes that occurred with residents. He said when a resident came back from the hospital they needed orders in place. He said if the facility does not have any orders, they should reach out to him for orders. He said the facility usually did a skin assessment and would call him for an order. He said especially if a resident was a readmitted and did not have a previous order for wound care. He said he expected to be notified of Resident conditions. Resident #2 Record review of Resident #2's face sheet dated 8/13/25 indicated she was a [AGE] year-old female admitted to the facility on [DATE] with a readmission date of 8/12/25. She had diagnoses of stroke, end stage renal disease, chronic respiratory failure, heart disease, diabetes, and bipolar disorder. Record review of Resident# 2's admission MDS dated [DATE] indicated she was cognitively intact with a BIMS score of 14. Resident #2 required partial to substantial assist with ADLs. She required supervision with bed mobility, partial to moderate assist with sit to laying, and did not attempt to stand or transfer due to medical condition. The MDS indicated she was at risk for a pressure ulcer. Review of Resident #2's care plan dated 5/19/15 indicated she was at risk for pressures ulcers. One of the interventions was to monitor for redness, circulation problems, pressure sores, open areas, and changes in skin integrity. Review of Resident #2's computerized physician orders dated 8/13/25 at 4:00 p.m. did not reveal an order for treatment to her sacrum wound. Review of Resident #2's nursing notes dated 7/31/25 at 6:00 a.m. revealed the resident was sent to the hospital due to her calling EMS and stating she was having difficulty breathing. Record review of Resident #2's hospital records dated 7/31/25 indicated the resident was admitted to the hospital on [DATE] after a ground level fall. She was discharged to the facility on 7/30/25 and readmitted to the hospital on [DATE] with complaints of shortness of breath and pain associated with groin buttock wounds. Review of Resident #2's hospital After Visit Summary dated 8/12/25 indicated the primary diagnoses for hospitalization was pressure injury of sacral region stage 4, end stage renal disease, uncontrolled diabetes, and fluid overload. There was no order for the care of the pressure injury of the sacrum. Record review of Resident #2's Admit Readmit Evaluation 8/12/25 at 10:00 p.m. indicated skin integrity with wounds present on admission, with bruising, discoloration, and an open wound. The comments indicated a pressure injury of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 12 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some the sacral region, stage 4, and bruising to the hands and front of the elbow. Record review of the facility's 24-hour report for 8/12/25 indicated Resident #2 returned from the hospital at 9:35 p.m., and she had a stage 4 pressure wound on her sacrum. During an interview on 8/13/25 at 6:01 p.m., the Administrator said they did not have any treatment orders for Resident #2's treatments, and she did not have a TAR generated at the current time due to no orders being in place. During an interview 8/14/25 at 11:00 a.m., the RN Weekend Supervisor said whoever admitted Resident #2 should have gotten orders from the hospital. She said if not, they should've gotten orders from the doctor regarding resident service. She said she completed the wound care on Resident #2 yesterday evening.During an interview on 8/13/25 at 4:50 p.m., the DON said Resident #2 had been in the hospital for 45 days. She said every time Resident #2 came to the facility, she was only there for a day or a few hours and then back to the hospital. The DON said normally when a resident was admitted or readmitted , the admitting nurse contacted the hospital for additional orders or contacts the physician for orders. She stated if it was during the night, the treatment nurse would be notified and the next day to do a skin assessment, notify the physician . She said at that time if a resident had wounds or if they needed any kind of treatment, they would get orders. She said she did not know why there were no orders for Resident #2. Record review of the facility's Notification of Changes policy last revised 2/10/21 indicated their policy to provide guidance on when to communicate acute changes in status to the MD, NP and responsible party. The will would immediately inform the resident: consult with the resident's physician, and responsible party for any significant change in physical, mental, or psychosocial status of the resident. The facility documents resident assessments, interventions, physician and family notification on the SBAR, Nursing Progress Note, or Telephone order form as appropriate. This was determined to be an Immediate Jeopardy (IJ) on 8/14/25 at 1:00 p.m. The Administrator, DON, and RNC were informed of the IJ situation on 8/14/25 at 1:00 p.m. a copy of the IJ template was emailed to them at 1:00 p.m. A POR was requested and accepted on 8/15/25 at 10:45 a.m. [The facility failed to implement policies and procedures to prevent the hospitalization of Resident #1 due to a surgical wound infection.Immediate Action Taken:On 08/14/2025 at 2:30 PM, the attending physician for Resident #1 and #2 was notified of the status of the surgical incision, wounds and the lack of prior communication regarding wound condition. Resident #1and #2 were immediately assessed by the facility's wound care nurse and physician. Orders were received and implemented, including wound care protocols and infectious disease consult. 2. Identification of Residents Affected or Likely to be Affected:A head-to-toe skin and wound assessment was completed on all residents by the Director of Nursing (DON) and Wound Nurse on 08/14/2025. A facility-wide audit was initiated on 08/14/2025 by DON/Designee to ensure all residents have current wound descriptions, physician orders, and proper documentation of physician notification and will be completed by 8/15/25. Any discrepancies were immediately corrected, and responsible nurses were given additional education by DON/Designee.DON/Designee reviewed the last 5 admissions and completed an audit for any missing ordersDON/Designee provided education to licensed nurses on admission and readmission orders3. Actions to Prevent Occurrence/Recurrence:Staff Education On 08/14/2025, the DON/Designee educated all licensed nurses on: Documentation of wound assessments will be located in the progress notes and include descriptions of the wounds, skin tears, bruises, surgical incisions, sizes, measurements, drainage, and colors.Use of SBAR (Situation-Background-Assessment-Recommendation) communication tool will be completed upon identification of change in condition by the charge nurse immediately upon identification of change in conditionStaff were required to demonstrate understanding via return demonstration or post-education quiz. Staff unavailable to attend in service on 08/14/2025 will receive personalized in service prior to assuming their (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 13 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some duties. Wound Communication Process A daily Wound Rounds Checklist was implemented to ensure: The DON/Designee audited each resident to ensure wound has documented assessment, treatment orders, orders transferred to computer, MAR and TAR, and notification status. The DON/Designee educated all licensed nurses on wound assessment, documentation, treatment orders, documentation on 24 hour report for shift to shift communication and notification to physicians . Any change is reported immediately to the physician and documented in progress notes.Weekly interdisciplinary wound rounds initiated as of 08/14/2025 with physician participation (in person or telehealth). Monitoring and Oversight PlanDaily audits of physician notification for any changes in condition by DON or designee for 14 days (08/14-08/28/2025), then weekly x4 weeks. All new admissions and readmissions will be reviewed within 24 hours to ensure physician orders and wound care protocols are in place by DON/ Weekend Supervisor/ Designee. Review will be documented on the admission Audit tool.DON or designee will: Review progress notes, nurse notes, and MARs for compliance. Validate timely physician notifications. Audit results will be reported weekly to the Quality Assurance & Performance Improvement (QAPI) committee for 3 months. Continued noncompliance will trigger retraining or disciplinary action. Date Facility Asserts Likelihood for Serious Harm No Longer Exists: 8/14/25] On 8/15/25 the investigator confirmed the facility implemented their plan of removal sufficiently to remove the IJ by: Review of facility skin assessments, facility audit of records to include wound descriptions, physician orders, and documentation in the nursing notes. The skin assessments were reviewed for all residents in the facility and noted two residents were found with redness to the buttocks, one resident with an open area to the buttocks, and one resident with redness to an ostomy site. There were orders noted to be placed, a description of the areas, and the physician was notified. Review of documentation showed Resident #1 and Resident #2 had descriptions of their wounds and treatment orders in place. Review of the facility Wound Daily Audit dated 8/14/25 through 8/24/25 indicated 3 newly admitted residents with skin assessments completed, the physician notified, a wound order in place, the wound care physician notified, and family notified. Record review of in-service dated 8/14/25 indicated nurses were educated on Change in Condition, completing the SBAR when a resident has a change in condition. When a nurse was notified or identified a change in condition they were to immediately, assess the resident gather vital signs, ask specific questions, if possible, notify MD, responsible part, DON and then document in the computer and add to the 24-hour report. Record review of in-service dated 8/14/25 indicated 19 nurses were educated on pressure ulcers/wounds upon admission or readmission. They were instructed to complete a head-to-toe assessment, measure wounds or open areas, complete the skin assessment, document in the computer system on admission or readmission, call the physician or use the [NAME]- health after hours to receive wound care orders, notify family about the wounds and the wound care company, wounds will be care planned, and to call the DON regarding any wounds found on admission or readmission. A copy of the skin management policy was attached. Record review indicated the facility had conducted skilled nursing facility nursing competency testing on nursing staff dated 8/14/25. Some of the questions indicated the physician should be notified as soon as a change was identified, when a resident is admitted with a pressure sore, the responsibility was to notify the MD, after receiving Wound care orders, put them in the computer and initiate care protocol. When observations showed increased redness or drainage from a wound, notify the MD and request updated wound care orders. There were also true and false questions. During an interview on 8/15/25 at 11:45 a.m., the RNC said the facility's census was 103 today and they did 101 skin assessments. She said one resident was up and 1 resident refused, and they are going to try and get them later. She said they did the in services and had a return demonstration test for the nurses. They were not able to have all nurses (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 14 of 15 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 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Athens 121 Commons Drive Athens, TX 75751 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 0684 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete do the testing because they had called some on the phone. She said they would do their testing later. The RNC said they had done chart audits and had the monitoring tool in place. She stated they were currently doing everything on paper due to the current computer system being down and they were transitioning to another system. During an interview on 8/15/25 at 12:10 p.m., the DON said she in-serviced nurses on change in condition, when to notify the doctor, and the steps to take upon admission. The staff were given a test to determine if they knew what to do for a new admission and when to follow up. She said one resident had surgery and did not have any orders when he was admitted on how to treat the wound, the physician was contacted, and new orders were obtained. The DON said another resident had a tiny area on her bottom and they got an order for the treatment of the wound. She had in-serviced 20 nurses. She had 12 full time nurses and 8 PRN nurses. The DON said, on today, they had the ADON, who was acting as treatment nurse, and 3 charge nurses, in the building. She said Resident #2 had gone back to the hospital. They were doing paper charting on today. During an interview on 8/15/25 at 3:00 p.m., the Administrator said he would admit some mistakes were made with Resident #1. He said he did not agree with the IJ level of severity. He said however the interventions they had put into place with staff training, ensuring the physician was notified, and making sure documentation was in place, had fixed many issues. He said the morning oversight meetings should bring issues to the attention of administration, and they would be able to put systems in place to prevent future problems. He said they would form a habit of doing things the right way. Interviews conducted with nurses the following shift nurses on 8/15/25 between 12:15 p.m. and 2:15 p.m. determined staff were knowledge about the in-services and education provided. At 12:15 p.m. LVN I worked 6p to 6aAt 12:20 p.m. LVN J /ADON worked all shiftsAt 1:15 p.m. LVN L worked 6p to 6aAt 1:30 p.m. LVN M worked 6a to 6pAt 1:34 LVN G worked 6a to 6pAt 1:45 p.m. LVN N worked 6a to 6pAt 1:50 p.m. LVN C/treatment nurse worked all shiftsAt 1:57 LVN K- PRN worked all shiftsAt 2:10 p.m. LVN O worked PRN weekends At 2:15 p.m. LVN A worked 6a to 2p The Administrator, DON, and RNS were informed the IJ was removed on 8/15/25 at 3:35 p.m. The facility remained out of compliance at a severity level of potential harm with a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. Event ID: Facility ID: 675424 If continuation sheet Page 15 of 15