Health inspection·November 18, 2025

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few an observation and interview on 11/17/2025 at 09:45 AM, Resident #1 said one of his two family members lived close by and visited him about once week and brought him snacks. He said he could not call anybody because his family member took his phone away from him and he wasn't allowed to leave the facility. He said he had some money, but his family member would not tell him how much he had left. He said he had a woman that came in and helped him when he lived in his house, but he didn't know where she was. He said, I just have to sit here. Resident #1 did not look at this surveyor while talking. He kept his face downcast toward his hands and lap and spread his hands apart in front of him when he ended that part of the conversation by saying there was nothing he could do about his circumstances. Resident #1 said the BOM knew about it. During a phone interview on 11/17/2025 at 09:40 AM, Resident #1's family member who lived close by said Resident #1 was admitted to the facility after being hospitalized for a fall. He said that prior to Resident #1 admitting to the facility, Resident #1 had allowed Female A to move in with him after his mother passed away. The family member said Female A exploited Resident #1 by taking him to the bank multiple times where Resident #1 wrote checks and withdrew money. He said the bank called him one time and told him Resident #1 and Female A were at the bank, and Resident #1 had withdrawn $9,999.00 after they asked the bank how much money he could write a check for without it being reported. The family member said multiple items were missing from Resident #1's farm including trailers, lawn [NAME], and other equipment. The family member said Female A had used his Resident #1's information to obtain credit cards and had tried to purchase a car about 6 months ago using Resident #1's information. He said he tried to make Resident #1 understand that he was being exploited by Female A and her friends. He said Resident #1's health and mental ability was declining which brought about Resident #1 being admitted to the nursing home. The family member said he made it clear when Resident #1 admitted to the facility that Resident #1 would not be returning to his home. He said he did not know why the care plan had a discharge plan for Resident #1 to discharge back to the community because he said he made it clear on admission that Resident #1 admission was for permanent placement. He said Female A and her boyfriend were not allowed to visit Resident #1 at the facility because Female A had come to the facility once and tried to take Resident #1 out to go to the bank. Resident #1 said the facility did not allow Resident#1 to leave with the Female A because he had made it clear that Resident #1 was not to leave the facility with anyone except family member #1 and family member #2. The family member #1 said he had given Resident #1 a cell phone, but Resident #1 either found a way to contact Female A, or Female A had contacted Resident #1 which ended up with the Female A coming to the facility and attempting to take Resident #1 out to the bank. He said he had to take the cell phone for Resident #1's safety, but he said he told Resident #1 to let the staff know when he wanted to use the facility phone to call him. The family member #1 said there had been a big turnover at the facility since Resident #1 admitted and he did not know if the current administration and nursing staff knew about Resident #1's history of being exploited and the actions to prevent it from occurring again. The family member #1 said he knew of no exploitation attempts in the last 6 months and said he reported all his concerns to the police. During an interview on 11/17/2025 at 10:30 AM with the BOM, she said she had been at the facility a few months and had heard there was a woman and man that would take Resident #1 out and to the bank to get money when Resident #1 lived in his own home, but the family member #1 stopped that from happening when Resident #1 admitted to the facility. She said the woman and man were not allowed to visit Resident #1 at the facility nor take him out of the facility. She said she did not know their names or where that information was documented. During an interview on 11/17/2025 at 10:40 AM, LVN B said she had worked at the facility for about 4 months and was not aware of any resident having any visitor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete restrictions. She said she did not know of any resident who had any restrictions regarding who they could leave the facility with. She said she did not know where she could look to see if a resident had specific instructions regarding visitors or going out on pass. During an interview on 11/17/2025 at 10:45 AM, LVN C said she had worked at the facility for about 1 month and knew of no residents having any visitor restrictions. She said she did not know where that would be documented. During an interview on 11/17/2025 at 10:50 AM, the SW said she was new to the facility and was not familiar with Resident #1's history. She said specific instructions regarding visitors and residents leaving the facility with someone would be communicated on the face sheet. The SW said she did not know what Resident #1's discharge plans were. During an interview with the Administrator on 11/17/2025 at 11:02 AM, the Administrator said she was not aware of Resident #1's history of being exploited. She said the nursing staff should know where information regarding special instructions about visitors and other safety matters were in the chart. During an interview with the DON on 11/18/2025, she said the MDS staff were responsible for care plans being updated and/or revised with input from the IDT. During an interview with MDS Coordinator D on 11/18/2025 at 11:18 AM, she said the MDS Coordinators schedule care plan meetings to coordinate with MDS scheduled assessments. She said Resident #1's care plan had not been updated or revised to reflect his history of exploitation and the restrictions on visitors because she and MDS Coordinator E were not aware of Resident #1's exploitation history nor visitor restrictions. She said the care plan had not been revised to reflect Resident #1's plan to remain in the facility long term because it had not been confirmed. A review of the facility's policy dated 02/10/202/revised 09/04/2024 and titled Comprehensive Care Plans included the following: Policy:It is the policy of this facility to develop and implement a comprehensive perResident #1-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment.Policy Explanation and Compliance Guidelines:1. The care planning process will include an assessment of the resident's strengths and needs and will incorporate the resident's strength and cultural preferences in developing goals of care. Services provided or arranged by the facility, as outlined by the comprehensive care plan, shall be culturally-competent and trauma-informed .5. The comprehensive care plan will be reviewed and revised by the interdisciplinary team after each comprehensive and quarterly MDS assessment . Event ID: Facility ID: 675424 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 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 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 observation, interview and record review, the facility failed to ensure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident for 1 of 6 residents (Resident #2) reviewed for pharmacy services. The facility failed to ensure Medication Aides used available resources to administer 3 missed doses of eye drops to Resident #2 as ordered by the physician. This failure could place residents at risk of not receiving medications as ordered. Findings included: A record review of Resident #2's face sheet indicated she was a [AGE] year-old female who admitted to the facility on [DATE]. She had diagnoses which included dry eye syndrome, anxiety, dementia, and quadriplegia C5-C7 (paralysis of all four limbs). A record review of the quarterly MDS assessment dated [DATE] indicated Resident #2 had a BIMS score of 14 which indicated her cognition was intact. Further review of the MDS indicated she was dependent on staff for most activities of daily living and was able to voice needs and concerns. A record review of the physician orders dated 11/18/2025 indicated Resident #2 had an order to receive 0.5% Carboxymethylcellulose Ophthalmic Solution 1 applicator in both eyes at bedtime for dry eyes. Record review of Resident #2's MAR dated 11/18/2025 indicated Resident #2 was to receive 0.5% Carboxymethylcellulose Ophthalmic Solution (eye drops) at 09:00 PM every night. The doses scheduled for 09:00 PM on 11/12/2025, 11/13/2025, and 11/17/2025 were documented as not being administered. Record review of Risk Management reports indicated there were no Medication Error Reports for the 3 missed doses of Carboxymethylcellulose Ophthalmic Solution. Record review of the progress notes did not reflect any reason for the eye drops not being administered on 11/12/25, 11/13/25, and 11/17/25. During observation and interview on 11/18/2025 at 09:40 AM, Resident #2 said she had not received her eye drops for the last 6 days. She said the medication aides kept telling her they didn't have any eye drops available to give her. Resident #2 said her eyes would get irritated and burn a little if she went too long without the eye drops. She said her eyes were ok then but did not want them to become irritated. During an interview on 11/18/2025 at 09:50 AM, MA F said the eye drops were an over-the-counter medication and come in a box with multiple individual ampules. She pointed to an area in a drawer of the medication cart and said that was where they would be but there were none there. MA F continued to look throughout the cart and located 4 single plastic ampules of the Carboxymethylcellulose Ophthalmic Solution in a basket in the small, top drawer. MA F said if she did not have an over-the-counter medication, she would look in the medication room first and if none were there, she would talk to the other medication aides to see if they had any in their carts. If they had none, she would tell the nurse or ADON. She said the ADON would run to one of the stores and get over the over-the-counter medications. During an interview on 11/18/2025 at 11:55 AM, MA G said he worked the evening of 11/17/2025. He said he did not administer the ordered eye drops to Resident #2 because he did not have any in his cart. He said Resident #2 told him she had not received her eye drops in 3 or 4 days. He said he notified the nurse after he checked the medication room and did not find any there. MA G said he only worked as needed and did not know the name of the nurse he spoke to about the missing eye drops. MA G said he had been a medication aide about 6 months. He said he forgot to document the reason for not administering the eye drops. On 11/18/2025 at 12:30 PM, an attempt to interview the medication aide who worked on the evenings of 11/12/20225 and 11/13/2025 by phone was unsuccessful. A message was received that the telephone number was no longer a working number. During an interview on 11/18/2025 at 12:05 PM, LVN H said she worked the evening of 11/17/2025. She said she was not made aware that Resident #2 did not have any eye drops for administration. During an interview on 11/18/2025 at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675424 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675424 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/18/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 12:20 PM, the DON said the medication aides were supposed to tell the charge nurse, ADON, or her when they did not have prescribed medication available for administration. She said the Carboxymethylcellulose eye solution had been ordered last week, and the facility was awaiting delivery. She said there was an ample supply of the eye drops on the other medication carts and there was enough for all residents who had orders for the eye drops for several days. The DON said the 11/12/2025, 11/13/2025, and 11/17/2025 doses of Carboxymethylcellulose eye drops solution were documented as not being given. She said the reason for not administering a medication was supposed to be documented but she said she did not see where that was documented for the 3 missed doses of Resident #2's eye drops. She said someone would go out and purchase more if needed before the order was delivered. A review of the facility's policy dated 01/09/2024 and revised 04/06/2023 and titled Medication-Treatment Administration and Documentation included the following: Anticipated Outcome: To provide a process for accurate, timely administration and documentation of medication and treatmentsProcess: 4. Administer the medication according to the physician order.7. Medications or treatments that were not administered should be documented as not administered on the EMAR/TAR with the reason for the not administration. 8. Complete a Medication Error Report for medication administration discrepancies . Event ID: Facility ID: 675424 If continuation sheet Page 5 of 5