Health inspection·December 1, 2023

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the body processes blood sugar, the body either doesn't produce enough insulin or it resists insulin) with unspecified complications. Observation on 11/30/2023 at 2:23 PM of a yellow lined paper tablet on top of the medication cart for 600 hall containing confidential medical information for three residents. Resident #70's confidential patient information stated Foley 20 Fr. (20 French indicating the external size of the indwelling urinary catheter). Resident #94 had her name and CXR/Congestion and a set of vital signs. and Resident #46 had information stating need Lantus insulin. In an interview on 11/30/2023 at 2:30 PM LVN G stated she had worked in the facility for a few days and was a new employee. She stated the yellow tablet she left unattended on top of her medication cart was her cheat sheet that she wrote resident information on prior to documenting it in their charts. She stated Resident #70 had an indwelling urinary catheter and Resident #94 had a CXR that morning and her vital signs were on the sheet, sShe stated Resident #46 needed his Lantus insulin reordered and she also wrote blood sugar results from that morning on the paper. She stated that medical information should not be exposed as it is confidential patient information. She further stated she had not been trained on patient confidentiality at the current facility but had been trained in the past. In an interview on 12/01/2023 at 10:32 AM ADON H stated she had worked at the facility for two years in that position and was the supervisor over the nurses for 600 hall. She stated anyone could have walked up and seen the confidential patient information left on the cart by LVN G. She stated her expectation was for nurses to keep everything with confidential information either closed or locked. She stated nurses could place a blank piece of a paper to cover the tablet or keep it with them. In an interview on 12/01/2023 10:36 AM with the Administrator who stated the nurse should not have allowed confidential information to be accessible to anyone walking by. He stated staff should safeguard resident information as it wasis a HIPAA violation. He stated the facility had given an in-service and training on confidentiality and LVN C had signed it. He stated his expectation was staff would ensure that resident information was always safeguarded and kept with them. Record review of a facility policy and procedure titled Confidentiality for Information dated December 2006, reflected Policy Statement: Our facility shall treat all resident information confidentially. Policy Interpretation and Implementation 1. The facility will safeguard all resident records, whether medical, financial, or social in nature, to protect the confidentiality of the information. 2. Access to resident medical records will be limited to staff and consultants providing services to the resident. (Note: Representatives of state and federal regulatory agencies have access to resident information without the resident's consent.) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 2 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 residents who were unable to carry out activities of daily living received the necessary services to maintain good grooming and personal hygiene for four of twenty-one (Resident # 41, Resident #45, Resident #50, and Resident #51) reviewed for ADL's. Residents Affected - Some The facility failed to ensure Resident # 41's, Resident # 45's, Resident # 50's, and Resident # 51's fingernails were trimmed and cleaned. These failures could place residents at risk for poor hygiene, dignity issues and decreased quality of life. Findings included: 1. Record review of Resident #45's face sheet, dated 11/30/2023, reflected an 67 -year-old female admitted to the facility on [DATE] with diagnoses which included type one diabetes mellitus with ketoacidosis without coma, (develops when your body does not have enough insulin to allow blood sugar into your cells for use as energy), muscle weakness (when full effort does not produce a normal muscle movement) and, unspecified lack of coordination (a muscle control problem that causes inability to coordinate movements). Record review of Resident #45's Quarterly MDS assessment, dated 09/30/2023, reflected Resident # 45 was rarely/ never understood. Resident #45 was assessed to have poor short- and long-term memory recall. She was not able to recall current season, location of own room, staff names/faces, and that she was in a nursing home. Resident #45's decision making abilities were poor. She had difficulty focusing and was easily distracted. She did not reject care. Resident #45 required extensive assistance with personal hygiene and was total dependent on staff for bathing. Record review of Resident #45's Comprehensive Care Plan, dated 11/01/2023, reflected Resident #45 had an ADL self-care performance deficit. Intervention: Resident #45 required extensive assistance with personal hygiene. Observation on 11/29/2023 at 9:03 AM, reflected Resident #45 was lying in bed. She had embedded blackish substance underneath all nails on her right hand. In an interview on 11/29/2023 at 9:05 AM, Resident #45 did not speak or respond verbally or with gestures to any of the questions. Observation on 11/30/2023 at 10:03 AM, Resident #45 was lying in bed. She had embedded blackish substance underneath all nails on her right hand. Her right hand near her fingernails had an odor of feces. In an interview on 11/30 2023 at 10:5 AM Resident #45 did not communicate verbally or with gestures. 2. Record review of Resident #51's face sheet, dated 11/30/2023, reflected a 67 -year-old female admitted to the facility on [DATE] with diagnoses which included osteoarthritis, unspecified site (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 3 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (joint disease-occurs most frequently in the hands, hips, and knees), generalized muscle weakness (when full effort does not produce a normal muscle movement), and Alzheimer's disease (affects memory, thinking and behavior). Record review of Resident #51's Quarterly MDS assessment, dated 08/14/2023, reflected Resident # 51 had a BIMS score of 0 which indicated residents' cognition was severely impaired. She did not reject care. Resident #51 required extensive assistance with ADLs. She was dependent on staff for all her bathing needs. Record review of Resident #51's Comprehensive Care Plan, dated 11/02/2023, reflected Resident #51 had an ADL self-care performance deficit. Intervention: Resident #51 required extensive assistance with personal hygiene. Observation on 11/29/2023 at 9:23 AM, reflected Resident # 51 was lying in bed. Her fingernails on her right hand were jagged and long. Resident #51 had blackish hard substance underneath all nails on her right and left hands. In an interview on 11/29/2023 at 9:25 AM, Resident #51 did not communicate verbally or with gestures. Observation on 11/30/2023 at 10:10 AM, Resident #51 was lying in bed. Her fingernails on her right hand were long and jagged. She had blackish hard substance underneath all nails on her left and right hands. In an interview on 11/30/2023 at 10:12 AM, Resident #51 did not communicate verbally or with gestures. 3. Record review of Resident #50's face sheet, dated 11/30/2023, reflected a 76 -year-old female admitted to the facility on [DATE] and was readmitted on [DATE] with diagnoses which included type 2 diabetes mellitus with unspecified complications ( a disease that occurs when a person's body does not use insulin effectively), need for assistance with personal care (person cannot fully care for themselves), age- related osteoarthritis (person cannot fully care for themselves), muscle weakness (when full effort does not produce a normal muscle movement), and arthropathy (medical condition that causes inflammation in the joint region). Record review of Resident #50's Quarterly MDS assessment, dated 10/28/2023, reflected Resident # 50 was rarely/never understood. She had poor short- and long-term memory recall. Resident #50 unable to recall the current season, the location of her room, staff names and faces, and that she was living in a nursing home. She did not reject care. Resident #50 required assistance with personal hygiene. Record review of Resident #50's Comprehensive Care Plan, dated 09/22/2023, reflected Resident #50 had an ADL Self-Care performance deficit. Intervention: Resident #50 required extensive assistance of two staff participation with personal hygiene. Observation on 11/29/2023 at 9:44 AM, reflected Resident #50 was sitting in her wheelchair waiting to be transferred to dialysis. Resident # 50 had a black substance underneath her forefinger and ring finger on her right hand. Her middle finger, forefinger, and ring fingernails on her right hand were long and jagged. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 4 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 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 0677 In an interview on 11/29/2023 at 9:45 AM, Resident #50 did not communicate verbally or using gestures. Level of Harm - Minimal harm or potential for actual harm Observation on 11/30/2023 at 10:16 AM Resident #50 was lying in bed. Her middle finger, forefinger and ring finger on her right hand had a black substance underneath the nails and these nails were long and jagged. Residents Affected - Some In an interview on 11/30/2023 at 10:18 AM Resident #50 did not communicate verbally or with gestures. 4. Record review of Resident #41's face sheet, dated 11/30/2023, reflected an 77 -year-old female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included type 1 diabetes mellitus with diabetic neuropathy unspecified, (destruction of insulin- producing pancreatic beta cells and neuropathy is a type of nerve damage that can occur if you have diabetes), need assistance with personal care ( person cannot fully care for themselves), muscle weakness (when full effort does not produce a normal muscle movement), unspecified lack of coordination (a muscle control problem that causes inability to coordinate movements) and, dementia ( impaired ability to remember, think, or make decisions that interferes with doing everyday activities). Record review of Resident #41's Quarterly MDS assessment, dated 09/15/2023, reflected Resident # 41 had a BIMS score of 5 which indicated residents' cognition was severely impaired. Resident #41 did not reject care. Resident #41 required extensive assistance with personal hygiene and was total dependent on staff for bathing. Record review of Resident #41's Comprehensive Care Plan, dated 09/20/2023, reflected Resident #41 had an ADL self-care performance deficit related to dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities). Interventions: personal hygiene Resident #41 required assistance of one staff. Observation on 11/29/2023 at 10:17AM, reflected Resident #41 was lying in bed. She had blackish hard substance underneath each nail on her right and left hand. In an interview on 11/29/2023 at 10:19 AM, Resident #41 stated my nails are dirty and needed someone to clean them. I do not know who to ask to clean my nails. She changed the subject when asked if she reported her dirty nails to anyone. Observation on 11/30/2023 at 10:03 AM, reflected Resident #41 was lying in bed. Her nails had blackish hard substance underneath each nail on her right and left hand. The blackish substance was above the tip of her middle fingernail on her right hand. In an interview on 11/30/2023 at 10:05 AM, Resident #41 stated I told the girl last night to clean my nails and she did not. She stated she did not know the girl's name. She stated I am tired and do not want to talk anymore. In an interview on 12/01/23 at 8:35 AM, LVN A stated the nurses was responsible to trim and clean all residents with diagnosis of diabetes nails. She stated it was the CNA's responsibility to clean and trim all other residents' nails. LVN A stated the CNAs report to nurses of any diabetic residents' nails needed trimmed or cleaned. She stated the nurses makes rounds and check residents with diabetes nails. She also stated the CNAs usually did nail care when residents received a shower or as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 5 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some needed. LVN A stated if anyone observed a brownish and/or blackish substance underneath residents nails the nursing staff were expected to clean the residents' nails or ask the appropriate nurse to complete the nail care. She stated the blackish/ brownish substance possibility could be feces or any type of bacteria underneath the residents' nails. LVN A stated if a resident swallowed the bacteria there was a possibility a resident may become extremely ill with stomach issues such as diarrhea or vomiting. She also stated a resident may become dehydrated and may require to be transfer to hospital for further medical assessment. LVN A stated if a residents' nails were long or rough a resident may scratch themselves and cause a skin tear and there was a possibility the skin tear become infected. LVNA stated she was not aware of any of these residents refusing nail care. She also stated she had been assigned to 300 hall where Resident #45, Resident #51, Resident #50 and Resident #41 resided. In an interview on 12/01/23 at 8:48 AM, LVN B stated it was the nurses and CNAs responsibility to trim, cut and clean residents' fingernails. She stated only the nurses can trim and clean residents with diagnosis of diabetes. LVN B stated if a resident's nails were jagged there was a possibility a resident my infect their skin if the resident scratched themselves and develop a skin tear. LVN B stated if there was a blackish substance underneath a resident's nails there was a possibility the substance was feces. She stated if a resident placed their finger in their mouth the feces could transfer from their fingers to their mouth. LVN B also stated if the resident swallowed the feces or other bacteria a resident may develop a stomach infection such as E. Coli (a bacteria that is commonly found in the lower intestine and can cause serious food poisoning) and the resident may need to be treated at the emergency room. She stated the symptoms of a stomach infection may include the following: diarrhea, vomiting and/or loss of appetite. Resident # 45, Resident #51, Resident # 50, Resident #41 would require assistance from staff with all their fingernail care. She stated she knew two or three of these residents were diabetics and the nurse would need to do their nail care. LVN B also stated the CNAs completed nail care during showers and the CNAs would notify the nurses at that time if a resident with diagnosis of diabetes needed any nail care completed. In an interview on 12/01/23 at 9:03 AM, CNA C stated the CNAs were responsible for nail care unless a resident was a diabetic. She stated the CNAs usually trimmed, and cleaned nails during showers, however, the nails can be cleaned or trimmed by nurses or CNAs as needed. CNA C stated the nursing staff was expected to clean and trim residents' nails immediately if there were blackish substance underneath the residents' nails and/ or if their nails needed to be trimmed. She stated if the nursing staff waited until shower the resident had a potential of scratching themselves and develop a skin tear. She also stated it was a possibility the resident may get an infection from the skin tear. CNA C stated the blackish substance may be fecal matter underneath the residents' nails. She stated if a resident swallowed the blackish substance there was a possibility a resident may become ill with stomach issues or any type of intestinal issues. She stated a resident may need to be assessed at the emergency room if they became severely ill. She stated she had been in serviced on cleaning and cutting residents nails. CNA C stated she did not recall the date of the in-service. In an interview on 12/01/23 at 9:15 AM, The Director of Nurses stated if a resident had dirty nails such as a blackish substance there was a possibility of bacteria on their fingers and/or underneath the resident's nails. He stated there was a potential a resident could ingest bacteria from their fingernails into their mouth. He stated it depended on the type of bacteria of what type an illness a resident could receive from the bacteria. The Director of Nurses stated a resident potentially could become ill with stomach issues or any type of infection. He stated there was a possibility a resident may need to be assessed at the emergency room. He also stated a resident had a potential to scratch themselves and may develop a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 6 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some skin concern such as a skin tear and may develop an infection if the residents' nails were not trimmed properly. The Director of Nurses stated it was the nurse supervisor responsibility to monitor nursing staff to ensure residents were receiving proper nail care. He also stated the CNA's or Nurses was responsible cut, trim, and clean residents' nails. He also stated the nurses was responsible for the residents with diagnosis of diabetes. He stated the staff was required to trim, cut, and clean nails during their showers and as needed. In an interview on 12/01/23 at 10:15 AM, The Administrator stated the residents' nail care was the CNAs responsibility. He stated if a resident was a diabetic it was the nurse's responsibility. The Administrator stated nail care was expected to be taken care of when nails were visibly dirty or needed to be trimmed. He stated if the blackish substance was a certain type of bacterial a resident may become physically ill. He stated there was a possibility a resident may require medical care from the hospital and that depended on what type of bacteria a resident may ingest. He said it was the nurse supervisor's responsibility to monitor residents nail care. He also stated if a resident's nails were long and not smooth a resident may scratch themselves and cause a skin tear or a small scratch area on the skin. In an interview on 12/01/23 at 10:55 AM, CNA D stated she would report to a nurse if a resident with diabetes nails needed to be cut or cleaned. She stated the CNAs were responsible for all other resident's nail care such as cleaning, trimming, and filing the nails. She stated nail care was usually completed during showers or as needed. CNA D stated nail care was to be completed daily if a resident's nails were dirty. She also stated if a resident had a blackish/brownish substance underneath their nails it could be any type of germs. CNA D stated there was a possibility a resident may eat with their hands and the blackish substance may transfer from residents' hands to the food. She stated the resident may develop stomach problems such as nausea and vomiting. She stated it was a possibility a resident may need to be assessed at a hospital if it was severe. CNA D stated if a residents' nails were rough there was a possibility a resident may scratch themselves and develop a skin tear or could scratch their eyes and may develop an infection. She stated she had been in serviced to clean and trim residents' nails in the shower and/or as needed except for diabetic nails. She stated she did not recall when the last in-service on nail care was given by nurse supervisors. Review of the Facility Policy on Care of Fingernails, dated, 2010 reflected the purpose of this procedure are to clean the nail bed, to keep nails trimmed, and to prevent infections. Nail care includes daily cleaning and regular trimming. Proper nail care can aid in the prevention of skin problems around the nail bed. Trimmed and smooth nails prevent the resident from accidentally scratching and injuring his or her skin. Gently remove the dirt around and under each nail with an orange stick. Do not trim nails below the skin line or cut the skin. Trim fingernails in an oval shape. Smooth the nails with a nail file or emery board. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 7 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare, distribute food in accordance with professional standards for food service safety for one of one kitchen reviewed for kitchen sanitation. 1. The facility failed to ensure Dietary [NAME] E and Dietary Aide F wore a hair restraint while in the kitchen. 2. The facility failed to properly label and date leftover food in one of one walk-in refrigerator. 3. The facility failed to ensure Dietary [NAME] E properly sanitized her hands between tasks. These failures could place residents who were served from the kitchen at risk for health complications, foodborne illnesses, and decreased quality of life. Findings included: 1. Observation on 11/29/2023 between 8:30 AM - 9:00 AM revealed Dietary [NAME] E was standing over clean dishes, and food in a pan on the food prep table. She turned and began walking to the kitchen door leading to the dining room when surveyor entered the kitchen. Dietary [NAME] E had her hair pinned to the top of her head; however, she was not wearing a hair net. Observation on 11/29/2023 between 8:30 AM - 9:00 AM revealed Dietary Aide F was in the kitchen standing over clean dishes. Dietary Aide F had a head band around a portion of her hair. The top section of her hair was not covered by hair net or by the head band. 2. Observation on 11/29/2023 at 8:45 AM revealed the following: Leftover rice not in the original package was not labeled or dated. Nine left over sausage patties not completely wrapped in aluminum foil was not labeled or dated. Five pound left over mild cheddar cheese not completely covered with plastic wrapped was not labeled or dated and was stored in parmesan box. Left over parmesan cheese not in the original package and partially opened was not labeled or dated. Partially opened leftover approximately three inches ham slices were not in the original package was not labeled or dated. 3. Observation on 11/30/2023 at 10:35 AM revealed Dietary [NAME] E washed her hands and placed new pair of gloves on both hands. She began to prepare the puree chicken salad. She touched her pants, her arm and surveyor's shirt with her ring finger, middle finger, fore finger, and small finger on her right hand. Dietary [NAME] E did not change her gloves as she placed the chicken salad in the puree processor. Her fore finger and middle finger on her right hand touched the chicken salad as she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 8 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many placed it in the processor. Dietary [NAME] E continued the process of puree chicken salad and poured the puree chicken salad in sliver container to place in the refrigerator. In an interview on 11/29/2023 at 8:35 AM Dietary [NAME] E stated she was not wearing a hair net. She stated she was required to wear hair net when in the kitchen. She stated she did cook breakfast on 11/29/2023. Dietary [NAME] E stated hair may fall into food, cups, plates, or anything in the kitchen. She stated germs may be on the hair and if a resident had hair in their food the resident may have stomach problems such as vomiting or diarrhea. Dietary [NAME] E stated she had been in-serviced on wearing hair nets when in the kitchen. In an interview on 11/29/2023 at 8:40 AM Dietary Aide F stated she thought the hair band was covering all her hair and did not realize the top of her head was not covered. She stated she was expected for all her hair to be covered when in the kitchen. She also stated there was a possibility hair may fall on the clean plates to be used for the lunch meal. Dietary Aide F stated if a resident did swallow hair the resident may become ill with stomach problems such as vomiting from the germs may be on the hair. Dietary Aide F stated she had been in serviced to cover all her hair when in the kitchen. In an interview on 11/29/2023 at 1:17 PM the Registered Dietician stated all staff in the kitchen was required to wear hair nets. She stated if the staff was wearing hair wraps the hair was expected to be covered with the hair wraps. She stated if the hair wraps did not completely cover the staff's hair a hair net was required to be worn on the portion of the hair being exposed. Registered Dietician stated there was a potential of hair falling in food or on plates. She stated if a resident ingested the hair there was a possibility a resident may become physically ill with stomach issues such as vomiting and diarrhea. She also stated hair was contaminated. Registered Dietician stated all leftover foods in the refrigerator was required to be completely covered, labeled, and dated. She stated if leftover food was not labeled or dated and stayed in the refrigerator two or three weeks and was served to a resident the resident had a potential to become ill with a type of food borne illness such as food poisoning. She stated there was a possibility a resident may need to be assessed at the hospital. In an interview on 11/30/2023 at 10:50 AM Dietary [NAME] E stated the gloves on her right hand did touch her clothes, surveyor clothes and her arm. She stated she was expected to remove the gloves, wash her hands, and place new gloves on her hands. She stated it was a possibility germs and bacteria could have cross contaminated from her gloves onto the chicken salad when she accidentally touched the chicken salad. She stated a resident had a potential of becoming seriously ill such as vomiting and diarrhea from food poisoning. Dietary [NAME] E stated she had been in serviced on hand hygiene. In an interview on 12/01/2023 at 8:40 AM Dietary Manager stated all staff entering the kitchen was expected to wear a hair net. He stated a hair wrap was acceptable only if the hair wrap covered all the staff's hair. He stated if it did not cover all the staff hair, he expected the staff to also wear a hair net. He stated there was a possibility hair could fall in the food. He also stated hair was considered contaminated. Dietary Manager also stated hair may have bacteria on it and chemicals from hair products. He stated if a resident swallowed hair a resident may become ill with stomach issues such as diarrhea and vomiting. He stated if a resident was severely ill and became dehydrated the resident may need to be admitted to the hospital. Dietary Manager stated the staff was expected to change gloves and wash hands prior to placing new gloves on their hands whenever the gloves on their hands had contacted anything contaminated. He stated clothes would be considered contaminated. He also stated if the Dietary [NAME] E touched her clothes and another person clothes, she was expected (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 9 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many to remove gloves, wash hands using soap and water prior to placing new gloves on her hands. He stated if the cook touched the chicken salad with the contaminated gloves there was a possibility germ from the gloves may transfer to the food. Dietary Manager stated there was a potential for a resident to become ill such as vomiting and diarrhea. He also stated any leftover food was required to be sealed, labeled, and dated. He stated any leftover food was required to be discarded within 48 hours. He stated if there was not a label or date on the leftover food the staff would not know when it was placed in the refrigerator. Dietary Manager also stated if the leftover food was not discarded and was in the refrigerator for approximately three weeks and staff served it to the residents there was a possibility a resident may become seriously ill with food poisoning. He stated if a resident had food poisoning the resident may need to be hospitalized . He stated all staff had been in serviced on hand hygiene, label and dating all foods, and wearing hair nets. In an interview on 12/01/2023 at 10:47 AM the Dietary District Manager of Healthcare Services stated he expected the staff to change gloves and wash hands with soap and water between each task or when the gloves touched anything considered contaminated such as clothes. He stated if the cook touched inside of the puree processor and touched the food being poured into the processor when wearing contaminated gloves there was a possibility the food may become contaminated. He stated if a resident at the contaminated food there was a potential the resident may become physically ill with a stomach virus. He stated a resident may need to be examined at the hospital if the resident had severe vomiting and diarrhea. He also stated all staff in the kitchen was expected to have all hair covered with hair net. He stated there was a possibility hair may fall into the food and if a resident ingested the hair there was a possibility a resident may become ill with a type of food borne illness. He also stated all left over food was expected to be completely sealed, labeled, and dated. He stated leftover food was expected to be discarded within 48 hours. He stated if the left-over food was not labeled or dated and left in the refrigerator approximately three or four weeks there was a possibility a resident may become ill with food poisoning. He also stated all staff had been in serviced on hand hygiene, properly storing food, and hair nets. Review of the facility's Policy on Staff Attire dated 10/2023 reflected all staff members will have their hair off the shoulders, confined in a hair net or cap and facial hair properly restrained. Review of the facility's Policy on Food Preparation dated 2/2023 reflected all staff will practice proper hand washing techniques and glove use. Dining Services staff will be responsible for food preparation procedures that avoid contamination by potentially harmful physical, biological, and chemical contamination. Review of the facility's Labeling and Dating not dated reflected Guidelines for Label and Dating: leftovers must be labeled and dated with the date they are prepared and the use by date. The day of preparation or opening is considered day one when establishing the use by date. Guidelines food is properly stored, covered, and handled. Review of the FDA Food Code 2022, Section 2-402 Hair Restraints, 2-402.11 Effectiveness reflected Food employees shall wear hair restraints such as hair coverings or nets, beard restraints . that are designed and worn to effectively keep their hair from contacting exposed food, clean equipment, utensils and linens and unwrapped single service and single-use articles. Review of the FDA Food Code 2022, 3-501.17 Ready to eat, Time/Temperature control for safety food, date marking reflected food shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675431 If continuation sheet Page 10 of 11 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 675431 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Red Oak Health and Rehabilitation Center 101 Reese Dr Red Oak, TX 75154 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete which the food shall be consumed on the premises, sold, or discarded . 1) The day the original container is opened in the food establishment shall be counted as day 1, and 2)The day or date marked by the food establishment may not exceed a manufacturers use by date if the manufacturer determined the use-by date based on safety. Review of the FDA Food Code 2022 Section 2-301.14 When to wash reflected Food employees shall clean their hands and exposed portions of their arms immediately before engaging in food preparation including working with exposed food, clean equipment and utensils and unwrapped single service and single use articles and: A) After touching bare human body parts other than clean hands and clean, exposed portions of arms; E) After handling soiled equipment or utensils F) During food preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks. Event ID: Facility ID: 675431 If continuation sheet Page 11 of 11