Health inspection·April 25, 2023

F 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some be free from Abuse .4. The Executive Director, and in his/her absence, the Director of Nursing, will perform the duties of the Abuse Prevention Coordinator. 5. The Abuse Prevention Coordinator will assure that all facility staff is in-serviced on recognizing abuse, abuse prevention and abuse reporting upon employment, and as necessary to maintain an abuse free environment .6. Our facility will not retaliate against any person who in good faith reports an allegation. Accidents and Incidents must be reported internally and externally in accordance with Reportable Incident Protocol .a. Staff will be made aware of the name and contact phone number for the Abuse Prevention Coordinator. b. All persons who report an allegation of Abuse or Neglect will be kept confidential by the Abuse Prevention Coordinator. c. A person who believes he or she has been subjected to retaliation as a result of reporting an allegation or who believes an allegation has been ignored, may contact the Abuse Prevention Coordinator, the DADS office or the Office of the Attorney General .7. The following definitions are provided to assist our facility's staff members in recognizing incidents of patient/resident abuse; a. Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Instance of abuse of all patient/resident, irrespective of any physical or mental condition cause physical harm, pain or mental anguish. Willful as used in this definition of abuse, means the individual must have acted deliberately, not that the individual must have intended to inflict injury or harm .d. Verbal abuse is defined as any use of oral, written or gestured language that includes disparaging and derogatory terms to patient/residents or their families, or within their hearing distance to describe Patient/Residents, regardless of their age, ability to comprehend, or disability .f. Physical abuse is defined as hitting, slapping, pinching, kicking etc. It also includes controlling behavior through corporal punishment .h. Mental abuse is defined as, but not limited to, humiliation, harassment, threats of punishment, or withholding of treatment or services .8. Any person observing an incident of Patient/Resident Abuse or suspecting Patient/Resident Abuse must immediately report such incidents to the Charge Nurse. The following information should be reported to the Charge Nurse: a. The name of the Patient/Resident involved; b. The date and time that the incident occurred; c. Where the incident took place; d. The name(s) of the person(s) committing the incident, if known; e. The name(s) of any witnesses to the incident; f. The type of abuse that was committed (i.e. verbal, physical, sexual, etc); and g. Other information that may be requested by the Charge Nurse. 9. The Charge Nurse will immediately examine the Patient/Resident and notify the Abuse Prevention Coordinator upon receiving report of mental, physical or sexual abuse. Findings of the examination will be recorded in the Patient/Resident's medical record. 10. The Abuse Prevention Coordinator will: a. Immediately (within 2 hours) report to The Department of Aging and Disability Services (DADS) and other appropriate authorities of Patient/Resident Abuse as required under applicable regulations and regulatory guidance .b. Immediately (within 24 hours) suspend the employee for an abuse allegation until an investigation is completed. c. Conduct and document on a Patient/Resident Abuse Investigation a thorough investigation of each incident of Patient/Resident abuse .to include: observations, interviews and reviews of all patient/residents involved -interviews of all witnesses, including patient/residents, staff and family members -notifying physician -notifying families and responsible parties of the involved Patients/Residents -recording all relevant physical findings. d. Complete an appropriate assessment of all patient/residents involved e. Take all steps necessary to protect the Facility's patient/residents form further incidents of patient/resident abuse .while the investigation is in process .g. Be responsible for carrying out any interventions or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 2 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some follow-up steps subsequent to the investigation of any abuse or alleged abuse .(Investigation) 11. The Patient/Resident abuse questionnaire must be completed on a sampling of Patient/Residents and/or family members during an investigation of an abuse allegation to determine their awareness of abuse that may have occurred inside the facility. 12. An employee abuse investigation questionnaire must be completed on a sampling of employees during an investigation of an abuse allegation to determine their awareness of abuse that may have occurred inside the facility. 13. When an incident of Patient/Resident Abuse is suspected or determined, the incident must be reported to the Charge Nurse regardless of the time lapse since the incident occurred .20. The Abuse Prevention Coordinator will (a) report all alleged incidents of Patient/resident abuse to DADS .In addition, the results of all investigations will reported to the State Agency within 5 working days of the incident if the alleged violations are verified are appropriate, corrective action will be taken. 1. Observation on 04/19/23 at 10:35 AM, revealed PT B was in therapy room. Observation on 04/19/23 revealed PT B was in therapy room while Resident #4 was in therapy room on the exercise bike. Observation on 04/19/23 at 1:05 PM revealed PT B was pushing Resident #4 in her wheelchair from therapy to common area near nurse's station. Observation on 04/19/23 at 2:46 PM, revealed PT B was pushing a resident in wheelchair down the hall. Observations on 04/20/23 at 9:15 AM and 12:35 PM PT B was in therapy room. Review of Resident #1's face sheet dated 04/19/23 reflected he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of cellulitis (bacterial skin infection) of left lower limb, Chronic Kidney Disease, Heart Failure, Respiratory Failure and Diabetes. Resident #1 was his own responsible party. Resident #1 was discharged on 03/03/23. Review of Resident #1's admission MDS assessment dated [DATE] reflected Resident #1 had a BIMS of 15 indicating he was cognitively intact. Resident #1 required extensive assistance with ADLs except eating supervision assistance only. Resident #1 was occasionally urinary incontinent and frequently bowel incontinent. Resident #1 was on OT and PT services. Review of Resident #1's undated comprehensive care plan reflected Resident #1's ADL functions. Interventions included to assist with ADL's as needed. Review of OT A's email to Regional Director of Rehab dated 02/22/23 at 2:51 PM, reflected the following about Resident #1: On Monday, February 20th, 2023, around approximately 11:45 A.M., another incident occurred that I personally witnessed. I had a patient to see, [Resident #1]. [PT B] also had this patient on her schedule and asked me if she could come with me so that we could see him together. We went into the patient's room. The patient was still in bed and reported that he needed to be cleaned up. [Resident #1] had a BM (bowel movement) in his brief. [PT B] immediately became upset and stated, A grown man, laying there, pooping in his diaper, that's just great. [Resident #1] immediately got upset and told [PT B] that she did not need to be so mean. [PT B] started arguing with the patient. This went on for a few minutes. [PT B] and resident were arguing back and forth. The patient was telling [PT B] that he didn't appreciate her being rude, and [PT B] was telling the patient that he needed to stop being lazy, and that he needed to use the toilet instead of his diaper. Finally, after a few minutes of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 3 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some this, [PT B] told the patient we would clean him up. The patient had a sore/wound on his bottom. [PT B] took some wet wipes and began cleaning the patient; however, she was being very aggressive and ruff. The patient asked her multiple times to be more gentle, and he also told her multiple times that she was hurting him. She continued on anyways, with the same aggression and the same roughness. We helped the patient get transferred into his wheelchair and get ready for lunch. I asked the patient if he would come down, after lunch, to do a little more therapy. He agreed to do so. After lunch, [Resident #1] came down to the therapy room where he did some more therapy. At the end of the session, patient wanted to walk. I walked with the patient, with a gait-belt, while [PT B] walked behind us, following us with the wheelchair. The patient walked approximately 100 feet when he asked to sit down to take a rest break. Patient started to sit down in his wheelchair. [PT B] started telling the patient in an aggressive raised tone, Reach back for your chair before you sit. The patient was holding onto the hallway railing that he was standing next to, so he did not listen to [PT B] and continued to sit on down in the wheelchair. [PT B] stuck her hand underneath the patient's bottom, pushing on him, in an upward motion, trying to keep him from sitting. She started yelling at him, stating, No! No! I told you to reach back for your chair and that's what you're going to do. [PT B] was being so loud that the social worker heard her from across the way, in her office, approximately 150 feet away. She came out of her office and down the hallway toward us, to see what was happening. I stayed with the patient to help him get back to his room. [PT B] was speaking to the social worker, telling a different version of the story, blaming everything on the patient, stating that he was just not listening today, and that he was being difficult. I attempted to locate the building administrator and the building DON/ADON multiple times throughout the day, so that I could report this incident, however, I was never able to locate any of them. The administrator's office was also locked. I also attempted to locate them the next day as well, with no luck. That is why I am reaching out to you about this. [Director of Rehab] stated that she spoke to [PT B], however, [PT B] continues to act inappropriately and unprofessional. I'm afraid if this continues on, she will not only continue to act inappropriately and unprofessionally with the residents, but I am afraid this will also affect outsiders view of the facility as a whole. Review of PT B's statement dated 02/23/23 signed by PT B reflected I know an allegation has been made against me concerning the treatment of my patients, and my professionalism as a therapist. I would like to take this time to rebut some of these accusations. Monday 02/20/2023 with [Resident #1]: when I went to ask [Resident #1] that morning what time he would prefer to participate in his therapy services, he stated he would like to after lunch. I then asked if he would like to practice his transfers by getting up in his chair right before lunch so he could eat in the dining room. He agreed and said yes that would be good. I responded OK I will see you a little before lunch, and maybe after lunch we can practice our gait training? He was also agreeable to this plan. When it was time to practice transferring to his w/c I noticed his call light was on and [OT A] was here so I asked her if she would like to be part of his treatment list too. [Resident #1 was on her treatment list too. [Resident #1] had been a patient at OT A and OT I facility several times. OT A and OT I had made several comments about how difficult and self-limiting [Resident #1] could be. When we entered [Resident #1's] room I asked if he was ready to get up, if that was the reason he had turned on his call light. He proceeded to tell us he was waiting to be cleaned up he had a bowel movement in his brief. I had already had a conversation with [Resident #1] the week before about being independent with his toileting because his plan was to return to an assisted living facility. When he told us had had soiled himself I felt it was my responsibility to re-iterate the conversation from earlier regarding toileting, and reminded him it may take a few minutes for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 4 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some staff to respond to his call light and he should turn it on as early as possible to get to the bathroom in time to avoid an accident. I said well, let's get clean up and go to lunch. As I was cleaning his bottom he said Oh one time, I thought it was because the wipes were cold (I saw no sores, or skin break-down I checked with the wound nurse who stated he had none. I then told [Resident #1] I'm sorry I've got to get you clean. Nothing else was said by [Resident #1] during the cleaning process. [Resident #1] got out of bed SBA for safety purposes and took himself to lunch. After lunch [Resident #1] came to the gym as promised to practice his gait training. We walked about 100 feet with a [two wheeled walker] and [side bend/contact guard assist] for safety, I was wheeling the w/c behind [Resident #1] as OT A walked beside him so when he required a rest break all he had to do was reach back for the w/c, but [Resident #1] just started sitting he did not reach to make sure the w/c was in the proper position to prevent a fall. Again I was concerned for my patients safety, and it frightened me that he would not reach back to not only make sure the chair was there but to prevent him from causing trauma to his spine by sitting down too hard in the chair. [Resident #1] was not following proper safety protocol that was given and stated I'm holding onto the rail I told him that was not safe, he need to reach back for the chair for safety. He raised his voice to me so loud the Social Worker came to investigate the disturbance. I took her aside and explained what was going on, she was very concerned about [Resident #1's] safety. OT A and I continued walking with [Resident #1] after his rest break back to his room, When he arrived in his room he made the comment Let me reach back before I sit down I praised him for his safe practice and we laughed. [Resident #1] wanted to know how far he had walked, I left his room to measure the footage. I came back a few minutes later to let him know the results, OT A had already left his room. I told [Resident #1] how far he had walked and what a great job he had done, he then apologized for yelling at me and not following the safety precautions/instructions while involved in gait training. If I was being at all abusive to my patient at any time would it not be the responsibility of anyone hearing the conversation to intervene, especially if this was an ongoing occurrence? I feel that my assertiveness has been misconstrued because abuse is totally different from assertiveness. I feel that my personality has been attacked and my character has been defamed. I feel like I am being unfairly scrutinized for my treatment practices and the way I educate my patients to keep them safe. Each of my patients is different, what may work for one does not necessarily work with another. I have to be more assertive with some patients, it is my job to keep them as safe as possible when they are in my care. Review of facility's investigation completed by Administrator, provided on 04/19/23 at 5:56 PM reflected the following: Email dated 02/22/23 at 5:53 PM from [NAME] President of Operations to the Administrator reflected I'm forwarding you an exchange regarding potential allegation. Email dated 02/22/23 at 7:22 PM from Administrator to [NAME] President of Operations reflected I am reading this now and I will get right on it. I was not contacted by the community nor was the DON as I spoke to her this evening and I am sure she would have told me. I will get right on this as there is a window of time to get information. I will contact [Director of Rehab] now and go from there. Thank you and I will have a full report as I found out more information. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 5 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 - Level of Harm - Immediate jeopardy to resident health or safety Administrator wrote down Resident #1's statement dated 02/23/23 about PT B 1. We are like oil and water, she never compliments me, she always says I do not do the things that she said for you to do. 2. How many times, did I tell you, and then you can stabilize the chair and make sure that it won't slide behind you. 3. It comes off as her being concerned that I am going to hurt myself in a motherly way. I have a bad temper and I asked the other girls later if I used profanity when I yelled back to her. They stated no. 4. I do truly believe that [PT B] has best interest at heart and she is trying to ensure that I understand how to make myself the most independent. 5. Did she get on my nerves telling me, yes, but I never felt unsafe or uncomfortable with any care or treatment that she gave me. Residents Affected - Some There was no provider investigation report. There were no staff witness statements or resident safe surveys to alleged incident. There was no summary of facility's investigation findings for alleged abuse. Review of Resident #1's progress notes including nurse notes for February to March 2023 reflected no documentation of resident abuse/neglect allegations. Review of February 2023 Incident/Accident Reports reflected no incident/accident reports for Resident #1. Review of PT Treatment Notes reflected Resident #1 received PT services by PT B on 02/14/23, 02/16/23, 02/17/23, 02/20/23 and 02/22/23. Review of OT Treatment Notes reflected Resident #1 received OT services by OT A on 02/20/23 and 02/21/23. Review of Resident #1's Discharge summary dated [DATE] reflected he was discharged on 03/03/23 at 10:30 AM to an assisted living facility with home health services. Interview on 04/19/23 at 11:27 AM with OT A revealed she was cotreating with PT B when she witnessed the morning of 02/20/23 PT B being verbally abusive with Resident #1 when he had soiled on himself and needed to be changed. She stated PT B told Resident #1 he was a lazy and a grown man should not poop on himself. She stated PT B was physically abusive by being rough when wiping Resident #1's butt during incontinent care and Resident #1 told her she did have to mean and hateful to him. She stated Resident #1 told PT B she was hurting him but continued providing incontinent care. She stated she did not report to the Charge Nurse about Resident #1 complaining of pain and allegation of abuse by PT B. She stated she tried to find the Administrator, who is the abuse coordinator, and was unable to find her so she did not report the allegation of abuse to the Abuse Coordinator. She stated she witnessed another incident the same day after lunch when she was walking with Resident #1 using gait belt and PT B was behind Resident #1 pushing the wheelchair. She stated she was to the side of Resident #1 and Resident #1 wanted to sit down but PT B yelled at Resident #1 telling him No, No and placed her hand under his bottom smacking him on bottom not allowing him to sit down. She stated PT B continued yelling at Resident #1 and other staff overheard her yelling including LVN D and CNA E. She stated social worker came out of her office and started She stated she did not report it to the Administrator about incident and did not speak to the social worker about what happened either. OT A (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 6 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some stated she did not know she needed to report abuse allegation to the charge nurse for Resident #1 as per the facility policy. She stated she did not report the allegation of verbal/physical abuse to the Director of Rehab due to a past allegation of abuse by PT B was reported to the Director of Rehab and nothing happened. She stated she could not find the Administrator or DON so she did not report the abuse allegations by PT B. She stated on 02/22/23 she reported it to Regional Director of Rehab Services the allegations of witnessed verbal and physical abuse by PT B. She stated the next morning (02/23/23) the Administrator talked to her about what she witnessed and said she had gotten a report from Resident #1 who denied any abuse. She stated PT B was not suspended during investigation but was taken off Resident #1's services after the abuse allegation. Interview 04/19/23 at 1:20 PM with CNA E revealed she witnessed PT B being verbally abusive to Resident # 1. CNA E stated PT B threatened and yelled at Resident #1 saying I told you to lock the wheelchair when Resident #1 tried to sit down and told Resident #1 what would you do if I had taken the wheelchair away. She stated LVN D witnessed it along with another therapist. CNA E stated she did not immediately report it to the Administrator. She stated Administrator knew about alleged abuse incident she thought by Resident #1 or by other staff. CNA E stated she did not witness any physical abuse by PT B. She stated she was not asked by Administrator about what she witnessed on Resident #1's incident and did not complete a witness statement. Surveyor attempted to contact Resident #1 on 04/19/23 at 2:43 PM via telephone leaving a voicemail but Resident #1 did not call surveyor back. Interview on 04/20/23 at 10:15 AM with LVN D revealed she witnessed PT B being verbally abusive towards Resident #1. LVN D stated PT B was behind Resident #1 pushing the wheelchair. She stated PT G was hateful and yelling at Resident #1 saying You have to lock brakes when Resident #1 wanted to sit down. She stated PT B and Resident #1 continued arguing back and forth. She stated another therapist and CNA E also witnessed the incident. She stated LVN H was aware of the incident she thought. She stated she did not remember the exact date it happened but was about a week to a few days or so before Resident #1 was discharged . LVN D did not report it to the Administrator immediately. She stated she thought she talked with the Administrator about the incident the next day but did not fill out witness statement or an incident report. Interview on 04/20/23 at 10:27 AM with LVN H revealed she was unaware of any allegations of abuse in regards to Resident #1. She was not aware of any incident involving a therapist yelling at a resident. She stated the facility had in-serviced on abuse/neglect but was not sure how recent it was. She stated the Administrator was the abuse coordinator who she would need to report any abuse allegations to immediately. Interviews on 04/19/23 at 5:50 PM and 04/20/23 at 1:15 PM, the Social Worker revealed she did not witness any verbal abuse by PT B towards Resident #1. She stated PT B was talking loudly to Resident #1 in the 600 hallway but she did not hear exactly what was said. She stated PT B and Resident #1 were arguing but did not know the specifics about what happened. She stated no one came to her after incident to allege any allegations of abuse by PT B towards Resident #1. She stated any resident abuse allegations should be reported to the Administrator who is the abuse coordinator immediately and Administrator was responsible for reporting allegations to the state. She stated she completed the resident safe surveys when an allegation of abuse/neglect was suspected for the investigation but she did not complete any resident safe surveys about allegations of abuse in regards to therapist. Interview on 04/20/23 at 10:58 AM with Regional Director of Rehab revealed he received a phone call (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 7 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some from OT I and OT A about concerns of PT B allegedly being rude and having a tone with Resident #1 during a therapy session and said she had not told the Director of Rehab due to a past incident where nothing was done about PT B. Regional Director of Rehab stated OT A told him she had not informed the Administrator. Regional Director of Rehab asked OT A to email him her statement. He stated he received the email the same day OT A called him. He stated he tried to call the facility to get hold of Administrator but Administrator was not at facility nor was the DON so he reached out to his boss. He forwarded the email to the [NAME] President of Operations and Administrator about the allegations of abuse for Resident #1. He stated the email from OT A revealed suspected allegations of abuse and required the Administrator who is the abuse coordinator to investigate these alleged abuse allegations. He stated PT B was not suspended and did not know if Resident #1 was taken off her caseload. Interviews on 04/19/23 at 3:16 PM and 04/20/23 at 12:20 PM the Director of Rehab revealed she was not made aware of OT A reporting abuse by PT B for Resident #1 until after Administrator contacted her. She stated the Administrator was the abuse coordinator who was responsible for investigating the allegation of abuse. She stated she was not aware if this allegation of abuse was reported to the state. She stated Administrator investigated the alleged incident and Resident #1 reported he felt safe. She stated PT B was not suspended but was taken off Resident #1's treatment caseload. She stated Administrator inserviced the staff on abuse/neglect and reporting guidelines. Interview with OT F on 04/20/23 at 11:14 AM revealed she became aware of allegation of abuse for Resident #1 by PT B when OT A reported it to her either face to face or via telephone. She could not recall when she specifically became aware of the alleged incident. She stated OT A reported she and PT B had gone into Resident #1's room who told them he was waiting to be changed and had a bowel movement. She stated it was reported to her that PT B told Resident #1 Grown man should not be shitting upon himself and this upset Resident #1. She stated OT A stated when PT B was doing incontinent care on Resident #1 he reported she was hurting him. OT F stated OT A stated later same day when walking Resident #1 when he wanted to sit down PT B yelled at him saying If you try to sit down we will pull this chair from underneath you. She stated when she became aware it was after the Administrator was already made aware of the allegations of abuse. She did not report the allegation of abuse to the Administrator. Interview on 04/19/23 at 3:35 PM with PT B revealed Administrator reported there was a complaint about my treatment and allegation of abuse for Resident #1 on 02/20/23. She was told by Administrator Resident #1 did not have any issues with it. She stated she talked with Administrator the same day as her statement (02/23/23) about two incidents with Resident #1. She stated first incident OT A and her went into Resident #1's room. PT B stated Resident #1 had a bowel movement and was waiting to be changed. She stated she provided incontinent care to him and when he rolled over said Oh. She stated he was not complaining of pain during incontinent care. She denied any verbal abuse or physical abuse to Resident #1. She stated after she provided incontinent care she assisted in in transfer to go to dining room for lunch. She stated after lunch the same day she was doing gait belt training with Resident #1 with OT A. PT B stated she was holding the wheelchair while OT A was beside Resident #1 when walking down the hall. She stated Resident #1 was holding until rail and not reaching back for wheelchair when wanting to rest. She stated she did raise her voice because she was concerned about his safety and him falling. PT B stated she told him to reach for wheelchair before trying to sit down because he was not reaching back. PT B stated she sometimes had to raise her voice to get resident's attention or if concerned about their safety but she denied any verbal abuse. She stated social worker overheard it and checked on incident. She stated LVN D was standing at her cart when the incident happened on 02/20/23. She stated she was not sent home nor was suspended pending (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 8 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete investigation by Administrator due to allegation of abuse for Resident #1. She stated she was in-serviced on abuse/neglect. She stated Resident #1 was taken off of her caseload after she talked with Administrator as a precaution but no disciplinary action was taken. Interview with Administrator on 04/19/23 at 4:07 PM revealed she did not report the allegation of verbal and physical abuse by PT B for Resident #1 to the state agency within 2 hours. She stated she was at a corporate meeting on 02/22/23. She stated OT A should have reported the allegation of abuse to her immediately on 02/20/23 when alleged incidents occurred. She stated OT A reported the alleged allegation of abuse by PT B to Regional Director of Rehab on 02/22/23 and she was informed by an email of OT A's statement on the evening of 02/22/23. She stated she contacted Director of Rehab on 02/22/23 to get her a statement from PT B. Administrator stated she would immediately notify the state if a resident or family member reported an alleged allegation of abuse/neglect, suspend alleged perpetrator pending investigation and investigate the incident. She stated at first stated this alleged allegation of abuse was hearsay by staff member. She stated she would report the allegation if the resident when interviewed stated an allegation of abuse/neglect occurred to the state. She stated she interviewed Resident #1 the next day on 02/23/23 who denied any abuse and felt safe at facility. She stated PT B provided a witness statement on 02/23/23. She stated since Resident #1 denied any abuse occurred so she did not report it and PT B denied any abuse occurred. She stated PT B was not suspended but Resident #1 was taken off her caseload just to be safe. She stated staff were in-serviced on abuse/neglect and reporting after incident. She stated OT A alleged the first incident that PT B was rude to Resident [TRUNCATED] Event ID: Facility ID: 675441 If continuation sheet Page 9 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review the facility to ensure that all alleged violations involving abuse were reported to the administrator and State Survey Agency immediately, but no later than 2 hours after the allegation was made for allegations that involved abuse and neglect for three of four residents (Residents #1, #2 and #3) reviewed for reportable incidents of resident abuse and neglect. 1. OT A, LVN D, CNA E and OT F failed to ensure the allegations of abuse were reported to the abuse coordinator within 2 hours for Resident #1. 2. OT A, OT F and Director of Rehab failed to ensure an allegation of verbal abuse were reported to the abuse coordinator within 2 hours for Resident #2. 3. The Administrator/Abuse Coordinator failed to report allegations of abuse within 2 hours after the allegation for Residents #1 and #2. The Abuse Coordinator failed to submit the results of the investigations for Resident #1 and #2 to the State Agency. 4. ST C and OT F failed to ensure an allegation of verbal and physical abuse within 2 hours for Resident #3 were reported to the Abuse Coordinator. These failures could place residents at risk for further abuse due to unreported and uninvestigated allegations of abuse. Findings included: 1. Observation on 04/19/23 at 10:35 AM, revealed PT B was in therapy room. Observation on 04/19/23 revealed PT B was in therapy room while Resident #4 was in therapy room on the exercise bike. Observation on 04/19/23 at 1:05 PM revealed PT B was pushing Resident #4 in her wheelchair from therapy to common area near nurse's station. Observation on 04/19/23 at 2:46 PM, revealed PT B was pushing a resident in wheelchair down the hall. Observations on 04/20/23 at 9:15 AM and 12:35 PM PT B was in therapy room. Review of Resident #1's face sheet dated 04/19/23 reflected he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of cellulitis (bacterial skin infection) of left lower limb, Chronic Kidney Disease, Heart Failure, Respiratory Failure and Diabetes. Resident #1 was his own responsible party. Resident #1 was discharged on 03/03/23. Review of Resident #1's admission MDS assessment dated [DATE] reflected Resident #1 had a BIMS of 15 indicating he was cognitively intact. Resident #1 required extensive assistance with ADLs except eating supervision assistance only. Resident #1 was occasionally urinary incontinent and frequently bowel incontinent. Resident #1 was on OT and PT services. Review of Resident #1's undated comprehensive care plan reflected Resident #1's ADL functions. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 10 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Interventions included to assist with ADL's as needed. Level of Harm - Minimal harm or potential for actual harm Review of OT A's email to Regional Director of Rehab dated 02/22/23 at 2:51 PM, reflected the following about Resident #1: Residents Affected - Some On Monday, February 20th, 2023, around approximately 11:45 A.M., another incident occurred that I personally witnessed. I had a patient to see, [Resident #1]. [PT B] also had this patient on her schedule and asked me if she could come with me so that we could see him together. We went into the patient's room. The patient was still in bed and reported that he needed to be cleaned up. [Resident #1] had a BM (bowel movement) in his brief. [PT B] immediately became upset and stated, A grown man, laying there, pooping in his diaper, that's just great. [Resident #1] immediately got upset and told [PT B] that she did not need to be so mean. [PT B] started arguing with the patient. This went on for a few minutes. [PT B] and resident were arguing back and forth. The patient was telling [PT B] that he didn't appreciate her being rude, and [PT B] was telling the patient that he needed to stop being lazy, and that he needed to use the toilet instead of his diaper. Finally, after a few minutes of this, [PT B] told the patient we would clean him up. The patient had a sore/wound on his bottom. [PT B] took some wet wipes and began cleaning the patient; however, she was being very aggressive and ruff. The patient asked her multiple times to be more gentle, and he also told her multiple times that she was hurting him. She continued on anyways, with the same aggression and the same roughness. We helped the patient get transferred into his wheelchair and get ready for lunch. I asked the patient if he would come down, after lunch, to do a little more therapy. He agreed to do so. After lunch, [Resident #1] came down to the therapy room where he did some more therapy. At the end of the session, patient wanted to walk. I walked with the patient, with a gait-belt, while [PT B] walked behind us, following us with the wheelchair. The patient walked approximately 100 feet when he asked to sit down to take a rest break. Patient started to sit down in his wheelchair. [PT B] started telling the patient in an aggressive raised tone, Reach back for your chair before you sit. The patient was holding onto the hallway railing that he was standing next to, so he did not listen to [PT B] and continued to sit on down in the wheelchair. [PT B] stuck her hand underneath the patient's bottom, pushing on him, in an upward motion, trying to keep him from sitting. She started yelling at him, stating, No! No! I told you to reach back for your chair and that's what you're going to do. [PT B] was being so loud that the social worker heard her from across the way, in her office, approximately 150 feet away. She came out of her office and down the hallway toward us, to see what was happening. I stayed with the patient to help him get back to his room. [PT B] was speaking to the social worker, telling a different version of the story, blaming everything on the patient, stating that he was just not listening today, and that he was being difficult. I attempted to locate the building administrator and the building DON/ADON multiple times throughout the day, so that I could report this incident, however, I was never able to locate any of them. The administrator's office was also locked. I also attempted to locate them the next day as well, with no luck. That is why I am reaching out to you about this. [Director of Rehab] stated that she spoke to [PT B], however, [PT B] continues to act inappropriately and unprofessional. I'm afraid if this continues on, she will not only continue to act inappropriately and unprofessionally with the residents, but I am afraid this will also affect outsiders view of the facility as a whole. Review of PT B's statement dated 02/23/23 signed by PT B reflected I know an allegation has been made against me concerning the treatment of my patients, and my professionalism as a therapist. I would like to take this time to rebut some of these accusations. Monday 02/20/2023 with [Resident #1]: when I went to ask [Resident #1] that morning what time he would prefer to participate in his therapy services, he stated he would like to after lunch. I then asked if he would like to practice his transfers by getting up in his chair right before lunch so he could eat in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 11 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the dining room. He agreed and said yes that would be good. I responded OK I will see you a little before lunch, and maybe after lunch we can practice our gait training? He was also agreeable to this plan. When it was time to practice transferring to his w/c I noticed his call light was on and [OT A] was here so I asked her if she would like to be part of his treatment list too. [Resident #1 was on her treatment list too. [Resident #1] had been a patient at OT A and OT I facility several times. OT A and OT I had made several comments about how difficult and self-limiting [Resident #1] could be. When we entered [Resident #1's] room I asked if he was ready to get up, if that was the reason he had turned on his call light. He proceeded to tell us he was waiting to be cleaned up he had a bowel movement in his brief. I had already had a conversation with [Resident #1] the week before about being independent with his toileting because his plan was to return to an assisted living facility. When he told us had had soiled himself I felt it was my responsibility to re-iterate the conversation from earlier regarding toileting, and reminded him it may take a few minutes for staff to respond to his call light and he should turn it on as early as possible to get to the bathroom in time to avoid an accident. I said well, let's get clean up and go to lunch. As I was cleaning his bottom he said Oh one time, I thought it was because the wipes were cold (I saw no sores, or skin break-down I checked with the wound nurse who stated he had none. I then told [Resident #1] I'm sorry I've got to get you clean. Nothing else was said by [Resident #1] during the cleaning process. [Resident #1] got out of bed SBA for safety purposes and took himself to lunch. After lunch [Resident #1] came to the gym as promised to practice his gait training. We walked about 100 feet with a [two wheeled walker] and [side bend/contact guard assist] for safety, I was wheeling the w/c behind [Resident #1] as OT A walked beside him so when he required a rest break all he had to do was reach back for the w/c, but [Resident #1] just started sitting he did not reach to make sure the w/c was in the proper position to prevent a fall. Again I was concerned for my patients safety, and it frightened me that he would not reach back to not only make sure the chair was there but to prevent him from causing trauma to his spine by sitting down too hard in the chair. [Resident #1] was not following proper safety protocol that was given and stated I'm holding onto the rail I told him that was not safe, he need to reach back for the chair for safety. He raised his voice to me so loud the Social Worker came to investigate the disturbance. I took her aside and explained what was going on, she was very concerned about [Resident #1's] safety. OT A and I continued walking with [Resident #1] after his rest break back to his room, When he arrived in his room he made the comment Let me reach back before I sit down I praised him for his safe practice and we laughed. [Resident #1] wanted to know how far he had walked, I left his room to measure the footage. I came back a few minutes later to let him know the results, OT A had already left his room. I told [Resident #1] how far he had walked and what a great job he had done, he then apologized for yelling at me and not following the safety precautions/instructions while involved in gait training. If I was being at all abusive to my patient at any time would it not be the responsibility of anyone hearing the conversation to intervene, especially if this was an ongoing occurrence? I feel that my assertiveness has been misconstrued because abuse is totally different from assertiveness. I feel that my personality has been attacked and my character has been defamed. I feel like I am being unfairly scrutinized for my treatment practices and the way I educate my patients to keep them safe. Each of my patients is different, what may work for one does not necessarily work with another. I have to be more assertive with some patients, it is my job to keep them as safe as possible when they are in my care. Review of facility's investigation completed by Administrator, provided on 04/19/23 at 5:56 PM reflected the following: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 12 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 - Level of Harm - Minimal harm or potential for actual harm Email dated 02/22/23 at 5:53 PM from [NAME] President of Operations to the Administrator reflected I'm forwarding you an exchange regarding potential allegation. Residents Affected - Some Email dated 02/22/23 at 7:22 PM from Administrator to [NAME] President of Operations reflected I am reading this now and I will get right on it. I was not contacted by the community nor was the DON as I spoke to her this evening and I am sure she would have told me. I will get right on this as there is a window of time to get information. I will contact [Director of Rehab] now and go from there. Thank you and I will have a full report as I found out more information. Administrator wrote down Resident #1's statement dated 02/23/23 about PT B 1. We are like oil and water, she never compliments me, she always says I do not do the things that she said for you to do. 2. How many times, did I tell you, and then you can stabilize the chair and make sure that it won't slide behind you. 3. It comes off as her being concerned that I am going to hurt myself in a motherly way. I have a bad temper and I asked the other girls later if I used profanity when I yelled back to her. They stated no. 4. I do truly believe that [PT B] has best interest at heart and she is trying to ensure that I understand how to make myself the most independent. 5. Did she get on my nerves telling me, yes, but I never felt unsafe or uncomfortable with any care or treatment that she gave me. There was no provider investigation report. There were no staff witness statements or resident safe surveys to alleged incident. There was no summary of facility's investigation findings for alleged abuse. Review of Resident #1's progress notes including nurse notes for February to March 2023 reflected no documentation of resident abuse/neglect allegations. Review of February 2023 Incident/Accident Reports reflected no incident/accident reports for Resident #1. Review of PT Treatment Notes reflected Resident #1 received PT services by PT B on 02/14/23, 02/16/23, 02/17/23, 02/20/23 and 02/22/23. Review of OT Treatment Notes reflected Resident #1 received OT services by OT A on 02/20/23 and 02/21/23. Review of Resident #1's Discharge summary dated [DATE] reflected he was discharged on 03/03/23 at 10:30 AM to an assisted living facility with home health services. Interview on 04/19/23 at 11:27 AM with OT A revealed she was cotreating with PT B when she witnessed the morning of 02/20/23 PT B being verbally abusive with Resident #1 when he had soiled on himself and needed to be changed. She stated PT B told Resident #1 he was a lazy and a grown man should not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 13 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some poop on himself. She stated PT B was physically abusive by being rough when wiping Resident #1's butt during incontinent care and Resident #1 told her she did have to mean and hateful to him. She stated Resident #1 told PT B she was hurting him but continued providing incontinent care. She stated she did not report to the Charge Nurse about Resident #1 complaining of pain and allegation of abuse by PT B. She stated she tried to find the Administrator, who is the abuse coordinator, and was unable to find her so she did not report the allegation of abuse to the Abuse Coordinator. She stated she witnessed another incident the same day after lunch when she was walking with Resident #1 using gait belt and PT B was behind Resident #1 pushing the wheelchair. She stated she was to the side of Resident #1 and Resident #1 wanted to sit down but PT B yelled at Resident #1 telling him No, No and placed her hand under his bottom smacking him on bottom not allowing him to sit down. She stated PT B continued yelling at Resident #1 and other staff overheard her yelling including LVN D and CNA E. She stated social worker came out of her office and started She stated she did not report it to the Administrator about incident and did not speak to the social worker about what happened either. OT A stated she did not know she needed to report abuse allegation to the charge nurse for Resident #1 as per the facility policy. She stated she did not report the allegation of verbal/physical abuse to the Director of Rehab due to a past allegation of abuse by PT B was reported to the Director of Rehab and nothing happened. She stated she could not find the Administrator or DON so she did not report the abuse allegations by PT B. She stated on 02/22/23 she reported it to Regional Director of Rehab Services the allegations of witnessed verbal and physical abuse by PT B. She stated the next morning (02/23/23) the Administrator talked to her about what she witnessed and said she had gotten a report from Resident #1 who denied any abuse. She stated PT B was not suspended during investigation but was taken off Resident #1's services after the abuse allegation. Interview 04/19/23 at 1:20 PM with CNA E revealed she witnessed PT B being verbally abusive to Resident # 1. CNA E stated PT B threatened and yelled at Resident #1 saying I told you to lock the wheelchair when Resident #1 tried to sit down and told Resident #1 what would you do if I had taken the wheelchair away. She stated LVN D witnessed it along with another therapist. CNA E stated she did not immediately report it to the Administrator. She stated Administrator knew about alleged abuse incident she thought by Resident #1 or by other staff. CNA E stated she did not witness any physical abuse by PT B. She stated she was not asked by Administrator about what she witnessed on Resident #1's incident and did not complete a witness statement. Surveyor attempted to contact Resident #1 on 04/19/23 at 2:43 PM via telephone leaving a voicemail but Resident #1 did not call surveyor back. Interview on 04/20/23 at 10:15 AM with LVN D revealed she witnessed PT B being verbally abusive towards Resident #1. LVN D stated PT B was behind Resident #1 pushing the wheelchair. She stated PT G was hateful and yelling at Resident #1 saying You have to lock brakes when Resident #1 wanted to sit down. She stated PT B and Resident #1 continued arguing back and forth. She stated another therapist and CNA E also witnessed the incident. She stated LVN H was aware of the incident she thought. She stated she did not remember the exact date it happened but was about a week to a few days or so before Resident #1 was discharged . LVN D did not report it to the Administrator immediately. She stated she thought she talked with the Administrator about the incident the next day but did not fill out witness statement or an incident report. Interview on 04/20/23 at 10:27 AM with LVN H revealed she was unaware of any allegations of abuse in regards to Resident #1. She was not aware of any incident involving a therapist yelling at a resident. She stated the facility had in-serviced on abuse/neglect but was not sure how recent it was. She stated the Administrator was the abuse coordinator who she would need to report any abuse (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 14 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 allegations to immediately. Level of Harm - Minimal harm or potential for actual harm Interviews on 04/19/23 at 5:50 PM and 04/20/23 at 1:15 PM, the Social Worker revealed she did not witness any verbal abuse by PT B towards Resident #1. She stated PT B was talking loudly to Resident #1 in the 600 hallway but she did not hear exactly what was said. She stated PT B and Resident #1 were arguing but did not know the specifics about what happened. She stated no one came to her after incident to allege any allegations of abuse by PT B towards Resident #1. She stated any resident abuse allegations should be reported to the Administrator who is the abuse coordinator immediately and Administrator was responsible for reporting allegations to the state. She stated she completed the resident safe surveys when an allegation of abuse/neglect was suspected for the investigation but she did not complete any resident safe surveys about allegations of abuse in regards to therapist. Residents Affected - Some Interview on 04/20/23 at 10:58 AM with Regional Director of Rehab revealed he received a phone call from OT I and OT A about concerns of PT B allegedly being rude and having a tone with Resident #1 during a therapy session and said she had not told the Director of Rehab due to a past incident where nothing was done about PT B. Regional Director of Rehab stated OT A told him she had not informed the Administrator. Regional Director of Rehab asked OT A to email him her statement. He stated he received the email the same day OT A called him. He stated he tried to call the facility to get hold of Administrator but Administrator was not at facility nor was the DON so he reached out to his boss. He forwarded the email to the [NAME] President of Operations and Administrator about the allegations of abuse for Resident #1. He stated the email from OT A revealed suspected allegations of abuse and required the Administrator who is the abuse coordinator to investigate these alleged abuse allegations. He stated PT B was not suspended and did not know if Resident #1 was taken off her caseload. Interviews on 04/19/23 at 3:16 PM and 04/20/23 at 12:20 PM the Director of Rehab revealed she was not made aware of OT A reporting abuse by PT B for Resident #1 until after Administrator contacted her. She stated the Administrator was the abuse coordinator who was responsible for investigating the allegation of abuse. She stated she was not aware if this allegation of abuse was reported to the state. She stated Administrator investigated the alleged incident and Resident #1 reported he felt safe. She stated PT B was not suspended but was taken off Resident #1's treatment caseload. She stated Administrator inserviced the staff on abuse/neglect and reporting guidelines. Interview with OT F on 04/20/23 at 11:14 AM revealed she became aware of allegation of abuse for Resident #1 by PT B when OT A reported it to her either face to face or via telephone. She could not recall when she specifically became aware of the alleged incident. She stated OT A reported she and PT B had gone into Resident #1's room who told them he was waiting to be changed and had a bowel movement. She stated it was reported to her that PT B told Resident #1 Grown man should not be shitting upon himself and this upset Resident #1. She stated OT A stated when PT B was doing incontinent care on Resident #1 he reported she was hurting him. OT F stated OT A stated later same day when walking Resident #1 when he wanted to sit down PT B yelled at him saying If you try to sit down we will pull this chair from underneath you. She stated when she became aware it was after the Administrator was already made aware of the allegations of abuse. She did not report the allegation of abuse to the Administrator. Interview on 04/19/23 at 3:35 PM with PT B revealed Administrator reported there was a complaint about my treatment and allegation of abuse for Resident #1 on 02/20/23. She was told by Administrator Resident #1 did not have any issues with it. She stated she talked with Administrator the same day as her statement (02/23/23) about two incidents with Resident #1. She stated first incident OT A and her went into Resident #1's room. PT B stated Resident #1 had a bowel movement and was waiting to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 15 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some changed. She stated she provided incontinent care to him and when he rolled over said Oh. She stated he was not complaining of pain during incontinent care. She denied any verbal abuse or physical abuse to Resident #1. She stated after she provided incontinent care she assisted in in transfer to go to dining room for lunch. She stated after lunch the same day she was doing gait belt training with Resident #1 with OT A. PT B stated she was holding the wheelchair while OT A was beside Resident #1 when walking down the hall. She stated Resident #1 was holding until rail and not reaching back for wheelchair when wanting to rest. She stated she did raise her voice because she was concerned about his safety and him falling. PT B stated she told him to reach for wheelchair before trying to sit down because he was not reaching back. PT B stated she sometimes had to raise her voice to get resident's attention or if concerned about their safety but she denied any verbal abuse. She stated social worker overheard it and checked on incident. She stated LVN D was standing at her cart when the incident happened on 02/20/23. She stated she was not sent home nor was suspended pending investigation by Administrator due to allegation of abuse for Resident #1. She stated she was in-serviced on abuse/neglect. She stated Resident #1 was taken off of her caseload after she talked with Administrator as a precaution but no disciplinary action was taken. Interview with Administrator on 04/19/23 at 4:07 PM revealed she did not report the allegation of verbal and physical abuse by PT B for Resident #1 to the state agency within 2 hours. She stated she was at a corporate meeting on 02/22/23. She stated OT A should have reported the allegation of abuse to her immediately on 02/20/23 when alleged incidents occurred. She stated OT A reported the alleged allegation of abuse by PT B to Regional Director of Rehab on 02/22/23 and she was informed by an email of OT A's statement on the evening of 02/22/23. She stated she contacted Director of Rehab on 02/22/23 to get her a statement from PT B. Administrator stated she would immediately notify the state if a resident or family member reported an alleged allegation of abuse/neglect, suspend alleged perpetrator pending investigation and investigate the incident. She stated at first stated this alleged allegation of abuse was hearsay by staff member. She stated she would report the allegation if the resident when interviewed stated an allegation of abuse/neglect occurred to the state. She stated she interviewed Resident #1 the next day on 02/23/23 who denied any abuse and felt safe at facility. She stated PT B provided a witness statement on 02/23/23. She stated since Resident #1 denied any abuse occurred so she did not report it and PT B denied any abuse occurred. She stated PT B was not suspended but Resident #1 was taken off her caseload just to be safe. She stated staff were in-serviced on abuse/neglect and reporting after incident. She stated OT A alleged the first incident that PT B was rude to Resident #1 by stating grown man laying there pooping in his diaper and wiping aggressive and rough during incontinent care provided by PT B. Interview on 04/20/23 at 1:44 PM with Administrator revealed she did contact LVN G on 02/22/23 in the evening to have him talk to Resident #1 about allegation of abuse. She stated she talked with Resident #1 in the morning on 02/23/23 about the alleged incident and he denied any abuse by PT B. She stated she was not aware of any other staff being witnesses to the second alleged allegation of abuse. She stated she did not interview facility staff to determine if there were any witnesses to the alleged allegations of abuse for Resident #1. She stated not reporting allegations of resident abuse immediately to abuse coordinator can place residents at risk of further abuse if they do not report it. She stated PT B was currently in the facility providing therapy services. She was not aware the facility policy stated to report suspected abuse to Charge Nurse. Interview on 04/21/23 at 11:47 AM with LVN G revealed he was not the charge nurse for Resident #1. He stated the Administrator did not contact him about allegation of abuse for Resident #1. LVN G stated he did not speak with Resident #1 about allegation of abuse or therapy issues. He was unaware of any (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 16 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 alleged abuse concerns for Resident #1. Level of Harm - Minimal harm or potential for actual harm 2. Review of Resident #2's face sheet dated 04/19/23 reflected Resident #2 was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses of gout, myocardial infarction, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease and osteoarthritis. She was discharged on 01/12/23. Residents Affected - Some Review of Resident #2's admission MDS assessment dated [DATE] reflected Resident #2 had a BIMS of 12 indicating she was moderately cognitively impaired. Resident #2 required limited assistance with ADLs except extensive for bathing and supervision with eating. Resident #2 was on OT and PT services. Review of Resident #2's Grievance Report dated 01/02/23 reflected Resident #2's responsible party reported family was upset with therapist as the patient currently has an order to wear back brace at all times while up. This order is in the patients medical record and the family stated the patient should only have to wear it when she is comfortable. The nurses will be getting an intervention to clarify the order with the MD and either keep the brace when up or make it prn for comfort. The grievance was resolved on 01/05/23. It did not mention about an issues with therapist yelling at Resident #2. Review of OT A's email to the Regional Director of Rehab dated 02/22/23 at 2:51 PM reflected the following about Resident #2: A few months ago, approximately sometime toward the end of December, I was in a resident's room working with her. Her name was [Resident #2]. We were in the middle of some seated exercises and it was me, [Resident #2], and [Resident #2's family member] in the room. [PT B] opened the door and came into the room. She saw a walker, in the room, that had been left by the OT. [PT B] immediately became upset and started raising her voice, with a hateful tone, and stated, Well, I see you got your way, and you got the walker that you were wanting. [PT B] did not want the resident to have the walker, in her room, and was angry that the OT had left one for her. [PT B] then noticed that the patient was not wearing her back brace while she was seated upright in a chair. [PT B] started becoming more and more agitated and aggressive with her tone and speaking. She began getting onto the resident for not having her back brace on. The patient stated that she did not have to have the brace on. The patient stated that the brace was for comfort only, to help reduce back pain with support and compression. The son also stated that the brace was only for comfort purposes and was not a requirement. [PT B] continued to raise her voice and argue with the patient, stating that this information wasn't true, and that the patient was supposed to wear the brace at all times when out of bed. [PT B] finally left the room because things were getting too heated. Shortly after [PT B] left the room, the son's wife arrived, [Resident #2's] daughter-in-law. The son shared with her what had just happened. He was upset with the way that [PT B] had handled the whole situation, and with how she had spoken to his mother. The daughter-in-law was also very angry and upset. The daughter-in-law immediately went and found [PT B] and confronted her about what had happened, telling her that she had not right to speak to her mother with that tone and in that manner. This was the first incident that occurred that I had personally witnessed myself. I contacted [OT F] and told her about what had happened. I also notified the [Director of Rehab]. [Director of Rehab] stated that she would talk to [PT B] about it. Review of Resident #2's PT Treatment Notes dated 12/22/22, 12/23/23 and 01/05/23 reflected PT B worked with Resident #2. Review of Resident #2's December 2022 and January 2023 Progress notes including nurse notes reflected no concerns with therapy or abuse/neglect. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 17 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0609 Level of Harm - Minimal harm or potential for actual harm Review of facility's incident reports for December 2022 and January 2023 reflected no incident reports for Resident #2. Review of Resident #2's Discharge Plan of Care date 01/12/23 reflected Resident #2 was discharged home with family with home health services. Residents Affected - Some Interview on 04/19/23 at 11:27 AM with OT A revealed this was the first time she had worked with PT B before with Resident #2. She stated end of December 2022 she witnessed PT B being verbally abusive towards Resident # 2 when she walked into her room noticed a walker in room left by another therapist. OT A stated PT B was upset about walker being in Resident #2's room and was hateful and raised her voice telling he Well I see you got your way, and you got walker you were wanting. She then stated PT B noticed she was not wearing her back brace like she should while sitting in a chair. PT B was yelling at Resident #2 for not wearing a back brace that she had to wear per doctor's orders. OT A stated Resident #2 and the family member were telling PT B it was just for comfort measures. OT A stated she failed to report the allegation of abuse to the Administrator but did report it[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 18 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Respond appropriately to all alleged violations. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review revealed the facility failed to, in response to allegations of abuse, thoroughly investigate the alleged violation for two (Residents #1 and #2) of nine residents reviewed for resident abuse. Residents Affected - Some 1. The facility failed to immediately investigate two incidents which occurred on 02/20/23 after allegations of verbal and physical abuse for Resident #1 were reported to the Abuse Coordinator. Abuse Coordinator/Administrator was made aware on 02/22/23 and failed to thoroughly investigate the allegations of abuse. PT B was not suspended pending investigation. 2. The facility failed to investigate after allegation of verbal abuse for Resident #2 by PT B. OT A and Director of Rehab failed to report an allegation of verbal abuse by PT B for Resident #2 which occurred in December 2022. On 02/22/23 Administrator was made aware of an allegation of verbal abuse for Resident #2 but failed to investigate alleged abuse for Resident #2. PT B continued to work at the facility since Administrator did not look into or investigate the allegation of abuse for Resident #2. PT B was not suspended pending investigation into abuse allegations for Residents #1, #2, and #3 and was allowed to continue working despite allegations of abuse. On 04/19/23 and 04/20/23, PT B was in facility and providing PT services to residents. These failures resulted in an identification of an Immediate Jeopardy (IJ) on 04/21/23 at 11:15 AM, . While the IJ was removed on 04/24/23 at 4:15 PM, the facility remained out of compliance at a scope of pattern and a no actual harm with potential for more than minimal harm that is not immediate jeopardy due to the facility continuing to monitor the implementation and effectiveness of their corrective systems. These failures could place the residents at risk for further potential abuse due to uninvestigated allegations of abuse. Findings included: 1. Observation on 04/19/23 at 10:35 AM, revealed PT B was in therapy room. Observation on 04/19/23 revealed PT B was in therapy room while Resident #4 was in therapy room on the exercise bike. Observation on 04/19/23 at 1:05 PM revealed PT B was pushing Resident #4 in her wheelchair from therapy to common area near nurse's station. Observation on 04/19/23 at 2:46 PM, revealed PT B was pushing a resident in wheelchair down the hall. Observations on 04/20/23 at 9:15 AM and 12:35 PM PT B was in therapy room. Review of Resident #1's face sheet dated 04/19/23 reflected he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of cellulitis (bacterial skin infection) of left lower limb, Chronic Kidney Disease, Heart Failure, Respiratory Failure and Diabetes. Resident #1 was his own responsible party. Resident #1 was discharged on 03/03/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 19 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Review of Resident #1's admission MDS assessment dated [DATE] reflected Resident #1 had a BIMS of 15 indicating he was cognitively intact. Resident #1 required extensive assistance with ADLs except eating supervision assistance only. Resident #1 was occasionally urinary incontinent and frequently bowel incontinent. Resident #1 was on OT and PT services. Review of Resident #1's undated comprehensive care plan reflected Resident #1's ADL functions. Interventions included to assist with ADL's as needed. Review of OT A's email to Regional Director of Rehab dated 02/22/23 at 2:51 PM, reflected the following about Resident #1: On Monday, February 20th, 2023, around approximately 11:45 A.M., another incident occurred that I personally witnessed. I had a patient to see, [Resident #1]. [PT B] also had this patient on her schedule and asked me if she could come with me so that we could see him together. We went into the patient's room. The patient was still in bed and reported that he needed to be cleaned up. [Resident #1] had a BM (bowel movement) in his brief. [PT B] immediately became upset and stated, A grown man, laying there, pooping in his diaper, that's just great. [Resident #1] immediately got upset and told [PT B] that she did not need to be so mean. [PT B] started arguing with the patient. This went on for a few minutes. [PT B] and resident were arguing back and forth. The patient was telling [PT B] that he didn't appreciate her being rude, and [PT B] was telling the patient that he needed to stop being lazy, and that he needed to use the toilet instead of his diaper. Finally, after a few minutes of this, [PT B] told the patient we would clean him up. The patient had a sore/wound on his bottom. [PT B] took some wet wipes and began cleaning the patient; however, she was being very aggressive and ruff. The patient asked her multiple times to be more gentle, and he also told her multiple times that she was hurting him. She continued on anyways, with the same aggression and the same roughness. We helped the patient get transferred into his wheelchair and get ready for lunch. I asked the patient if he would come down, after lunch, to do a little more therapy. He agreed to do so. After lunch, [Resident #1] came down to the therapy room where he did some more therapy. At the end of the session, patient wanted to walk. I walked with the patient, with a gait-belt, while [PT B] walked behind us, following us with the wheelchair. The patient walked approximately 100 feet when he asked to sit down to take a rest break. Patient started to sit down in his wheelchair. [PT B] started telling the patient in an aggressive raised tone, Reach back for your chair before you sit. The patient was holding onto the hallway railing that he was standing next to, so he did not listen to [PT B] and continued to sit on down in the wheelchair. [PT B] stuck her hand underneath the patient's bottom, pushing on him, in an upward motion, trying to keep him from sitting. She started yelling at him, stating, No! No! I told you to reach back for your chair and that's what you're going to do. [PT B] was being so loud that the social worker heard her from across the way, in her office, approximately 150 feet away. She came out of her office and down the hallway toward us, to see what was happening. I stayed with the patient to help him get back to his room. [PT B] was speaking to the social worker, telling a different version of the story, blaming everything on the patient, stating that he was just not listening today, and that he was being difficult. I attempted to locate the building administrator and the building DON/ADON multiple times throughout the day, so that I could report this incident, however, I was never able to locate any of them. The administrator's office was also locked. I also attempted to locate them the next day as well, with no luck. That is why I am reaching out to you about this. [Director of Rehab] stated that she spoke to [PT B], however, [PT B] continues to act inappropriately and unprofessional. I'm afraid if this continues on, she will not only continue to act inappropriately and unprofessionally with the residents, but I am afraid this will also affect outsiders view of the facility as a whole. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 20 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Review of PT B's statement dated 02/23/23 signed by PT B reflected I know an allegation has been made against me concerning the treatment of my patients, and my professionalism as a therapist. I would like to take this time to rebut some of these accusations. Monday 02/20/2023 with [Resident #1]: when I went to ask [Resident #1] that morning what time he would prefer to participate in his therapy services, he stated he would like to after lunch. I then asked if he would like to practice his transfers by getting up in his chair right before lunch so he could eat in the dining room. He agreed and said yes that would be good. I responded OK I will see you a little before lunch, and maybe after lunch we can practice our gait training? He was also agreeable to this plan. When it was time to practice transferring to his w/c I noticed his call light was on and [OT A] was here so I asked her if she would like to be part of his treatment list too. [Resident #1 was on her treatment list too. [Resident #1] had been a patient at OT A and OT I facility several times. OT A and OT I had made several comments about how difficult and self-limiting [Resident #1] could be. When we entered [Resident #1's] room I asked if he was ready to get up, if that was the reason he had turned on his call light. He proceeded to tell us he was waiting to be cleaned up he had a bowel movement in his brief. I had already had a conversation with [Resident #1] the week before about being independent with his toileting because his plan was to return to an assisted living facility. When he told us had had soiled himself I felt it was my responsibility to re-iterate the conversation from earlier regarding toileting, and reminded him it may take a few minutes for staff to respond to his call light and he should turn it on as early as possible to get to the bathroom in time to avoid an accident. I said well, let's get clean up and go to lunch. As I was cleaning his bottom he said Oh one time, I thought it was because the wipes were cold (I saw no sores, or skin break-down I checked with the wound nurse who stated he had none. I then told [Resident #1] I'm sorry I've got to get you clean. Nothing else was said by [Resident #1] during the cleaning process. [Resident #1] got out of bed SBA for safety purposes and took himself to lunch. After lunch [Resident #1] came to the gym as promised to practice his gait training. We walked about 100 feet with a [two wheeled walker] and [side bend/contact guard assist] for safety, I was wheeling the w/c behind [Resident #1] as OT A walked beside him so when he required a rest break all he had to do was reach back for the w/c, but [Resident #1] just started sitting he did not reach to make sure the w/c was in the proper position to prevent a fall. Again I was concerned for my patients safety, and it frightened me that he would not reach back to not only make sure the chair was there but to prevent him from causing trauma to his spine by sitting down too hard in the chair. [Resident #1] was not following proper safety protocol that was given and stated I'm holding onto the rail I told him that was not safe, he need to reach back for the chair for safety. He raised his voice to me so loud the Social Worker came to investigate the disturbance. I took her aside and explained what was going on, she was very concerned about [Resident #1's] safety. OT A and I continued walking with [Resident #1] after his rest break back to his room, When he arrived in his room he made the comment Let me reach back before I sit down I praised him for his safe practice and we laughed. [Resident #1] wanted to know how far he had walked, I left his room to measure the footage. I came back a few minutes later to let him know the results, OT A had already left his room. I told [Resident #1] how far he had walked and what a great job he had done, he then apologized for yelling at me and not following the safety precautions/instructions while involved in gait training. If I was being at all abusive to my patient at any time would it not be the responsibility of anyone hearing the conversation to intervene, especially if this was an ongoing occurrence? I feel that my assertiveness has been misconstrued because abuse is totally different from assertiveness. I feel that my personality has been attacked and my character has been defamed. I feel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 21 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some like I am being unfairly scrutinized for my treatment practices and the way I educate my patients to keep them safe. Each of my patients is different, what may work for one does not necessarily work with another. I have to be more assertive with some patients, it is my job to keep them as safe as possible when they are in my care. Review of facility's investigation completed by Administrator, provided on 04/19/23 at 5:56 PM reflected the following: Email dated 02/22/23 at 5:53 PM from [NAME] President of Operations to the Administrator reflected I'm forwarding you an exchange regarding potential allegation. Email dated 02/22/23 at 7:22 PM from Administrator to [NAME] President of Operations reflected I am reading this now and I will get right on it. I was not contacted by the community nor was the DON as I spoke to her this evening and I am sure she would have told me. I will get right on this as there is a window of time to get information. I will contact [Director of Rehab] now and go from there. Thank you and I will have a full report as I found out more information. Administrator wrote down Resident #1's statement dated 02/23/23 about PT B 1. We are like oil and water, she never compliments me, she always says I do not do the things that she said for you to do. 2. How many times, did I tell you, and then you can stabilize the chair and make sure that it won't slide behind you. 3. It comes off as her being concerned that I am going to hurt myself in a motherly way. I have a bad temper and I asked the other girls later if I used profanity when I yelled back to her. They stated no. 4. I do truly believe that [PT B] has best interest at heart and she is trying to ensure that I understand how to make myself the most independent. 5. Did she get on my nerves telling me, yes, but I never felt unsafe or uncomfortable with any care or treatment that she gave me. There was no provider investigation report. There were no staff witness statements or resident safe surveys to alleged incident. There was no summary of facility's investigation findings for alleged abuse. Review of Resident #1's progress notes including nurse notes for February to March 2023 reflected no documentation of resident abuse/neglect allegations. Review of February 2023 Incident/Accident Reports reflected no incident/accident reports for Resident #1. Review of PT Treatment Notes reflected Resident #1 received PT services by PT B on 02/14/23, 02/16/23, 02/17/23, 02/20/23 and 02/22/23. Review of OT Treatment Notes reflected Resident #1 received OT services by OT A on 02/20/23 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 22 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 02/21/23. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #1's Discharge summary dated [DATE] reflected he was discharged on 03/03/23 at 10:30 AM to an assisted living facility with home health services. Residents Affected - Some Interview on 04/19/23 at 11:27 AM with OT A revealed she was cotreating with PT B when she witnessed the morning of 02/20/23 PT B being verbally abusive with Resident #1 when he had soiled on himself and needed to be changed. She stated PT B told Resident #1 he was a lazy and a grown man should not poop on himself. She stated PT B was physically abusive by being rough when wiping Resident #1's butt during incontinent care and Resident #1 told her she did have to mean and hateful to him. She stated Resident #1 told PT B she was hurting him but continued providing incontinent care. She stated she did not report to the Charge Nurse about Resident #1 complaining of pain and allegation of abuse by PT B. She stated she tried to find the Administrator, who is the abuse coordinator, and was unable to find her so she did not report the allegation of abuse to the Abuse Coordinator. She stated she witnessed another incident the same day after lunch when she was walking with Resident #1 using gait belt and PT B was behind Resident #1 pushing the wheelchair. She stated she was to the side of Resident #1 and Resident #1 wanted to sit down but PT B yelled at Resident #1 telling him No, No and placed her hand under his bottom smacking him on bottom not allowing him to sit down. She stated PT B continued yelling at Resident #1 and other staff overheard her yelling including LVN D and CNA E. She stated social worker came out of her office and started She stated she did not report it to the Administrator about incident and did not speak to the social worker about what happened either. OT A stated she did not know she needed to report abuse allegation to the charge nurse for Resident #1 as per the facility policy. She stated she did not report the allegation of verbal/physical abuse to the Director of Rehab due to a past allegation of abuse by PT B was reported to the Director of Rehab and nothing happened. She stated she could not find the Administrator or DON so she did not report the abuse allegations by PT B. She stated on 02/22/23 she reported it to Regional Director of Rehab Services the allegations of witnessed verbal and physical abuse by PT B. She stated the next morning (02/23/23) the Administrator talked to her about what she witnessed and said she had gotten a report from Resident #1 who denied any abuse. She stated PT B was not suspended during investigation but was taken off Resident #1's services after the abuse allegation. Interview 04/19/23 at 1:20 PM with CNA E revealed she witnessed PT B being verbally abusive to Resident # 1. CNA E stated PT B threatened and yelled at Resident #1 saying I told you to lock the wheelchair when Resident #1 tried to sit down and told Resident #1 what would you do if I had taken the wheelchair away. She stated LVN D witnessed it along with another therapist. CNA E stated she did not immediately report it to the Administrator. She stated Administrator knew about alleged abuse incident she thought by Resident #1 or by other staff. CNA E stated she did not witness any physical abuse by PT B. She stated she was not asked by Administrator about what she witnessed on Resident #1's incident and did not complete a witness statement. Surveyor attempted to contact Resident #1 on 04/19/23 at 2:43 PM via telephone leaving a voicemail but Resident #1 did not call surveyor back. Interview on 04/20/23 at 10:15 AM with LVN D revealed she witnessed PT B being verbally abusive towards Resident #1. LVN D stated PT B was behind Resident #1 pushing the wheelchair. She stated PT G was hateful and yelling at Resident #1 saying You have to lock brakes when Resident #1 wanted to sit down. She stated PT B and Resident #1 continued arguing back and forth. She stated another therapist and CNA E also witnessed the incident. She stated LVN H was aware of the incident she thought. She stated she did not remember the exact date it happened but was about a week to a few days or so (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 23 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some before Resident #1 was discharged . LVN D did not report it to the Administrator immediately. She stated she thought she talked with the Administrator about the incident the next day but did not fill out witness statement or an incident report. Interview on 04/20/23 at 10:27 AM with LVN H revealed she was unaware of any allegations of abuse in regards to Resident #1. She was not aware of any incident involving a therapist yelling at a resident. She stated the facility had in-serviced on abuse/neglect but was not sure how recent it was. She stated the Administrator was the abuse coordinator who she would need to report any abuse allegations to immediately. Interviews on 04/19/23 at 5:50 PM and 04/20/23 at 1:15 PM, the Social Worker revealed she did not witness any verbal abuse by PT B towards Resident #1. She stated PT B was talking loudly to Resident #1 in the 600 hallway but she did not hear exactly what was said. She stated PT B and Resident #1 were arguing but did not know the specifics about what happened. She stated no one came to her after incident to allege any allegations of abuse by PT B towards Resident #1. She stated any resident abuse allegations should be reported to the Administrator who is the abuse coordinator immediately and Administrator was responsible for reporting allegations to the state. She stated she completed the resident safe surveys when an allegation of abuse/neglect was suspected for the investigation but she did not complete any resident safe surveys about allegations of abuse in regards to therapist. Interview on 04/20/23 at 10:58 AM with Regional Director of Rehab revealed he received a phone call from OT I and OT A about concerns of PT B allegedly being rude and having a tone with Resident #1 during a therapy session and said she had not told the Director of Rehab due to a past incident where nothing was done about PT B. Regional Director of Rehab stated OT A told him she had not informed the Administrator. Regional Director of Rehab asked OT A to email him her statement. He stated he received the email the same day OT A called him. He stated he tried to call the facility to get hold of Administrator but Administrator was not at facility nor was the DON so he reached out to his boss. He forwarded the email to the [NAME] President of Operations and Administrator about the allegations of abuse for Resident #1. He stated the email from OT A revealed suspected allegations of abuse and required the Administrator who is the abuse coordinator to investigate these alleged abuse allegations. He stated PT B was not suspended and did not know if Resident #1 was taken off her caseload. Interviews on 04/19/23 at 3:16 PM and 04/20/23 at 12:20 PM the Director of Rehab revealed she was not made aware of OT A reporting abuse by PT B for Resident #1 until after Administrator contacted her. She stated the Administrator was the abuse coordinator who was responsible for investigating the allegation of abuse. She stated she was not aware if this allegation of abuse was reported to the state. She stated Administrator investigated the alleged incident and Resident #1 reported he felt safe. She stated PT B was not suspended but was taken off Resident #1's treatment caseload. She stated Administrator inserviced the staff on abuse/neglect and reporting guidelines. Interview with OT F on 04/20/23 at 11:14 AM revealed she became aware of allegation of abuse for Resident #1 by PT B when OT A reported it to her either face to face or via telephone. She could not recall when she specifically became aware of the alleged incident. She stated OT A reported she and PT B had gone into Resident #1's room who told them he was waiting to be changed and had a bowel movement. She stated it was reported to her that PT B told Resident #1 Grown man should not be shitting upon himself and this upset Resident #1. She stated OT A stated when PT B was doing incontinent care on Resident #1 he reported she was hurting him. OT F stated OT A stated later same day when walking Resident #1 when he wanted to sit down PT B yelled at him saying If you try to sit down we will pull this chair from underneath you. She stated when she became aware it was after the Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 24 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some was already made aware of the allegations of abuse. She did not report the allegation of abuse to the Administrator. Interview on 04/19/23 at 3:35 PM with PT B revealed Administrator reported there was a complaint about my treatment and allegation of abuse for Resident #1 on 02/20/23. She was told by Administrator Resident #1 did not have any issues with it. She stated she talked with Administrator the same day as her statement (02/23/23) about two incidents with Resident #1. She stated first incident OT A and her went into Resident #1's room. PT B stated Resident #1 had a bowel movement and was waiting to be changed. She stated she provided incontinent care to him and when he rolled over said Oh. She stated he was not complaining of pain during incontinent care. She denied any verbal abuse or physical abuse to Resident #1. She stated after she provided incontinent care she assisted in in transfer to go to dining room for lunch. She stated after lunch the same day she was doing gait belt training with Resident #1 with OT A. PT B stated she was holding the wheelchair while OT A was beside Resident #1 when walking down the hall. She stated Resident #1 was holding until rail and not reaching back for wheelchair when wanting to rest. She stated she did raise her voice because she was concerned about his safety and him falling. PT B stated she told him to reach for wheelchair before trying to sit down because he was not reaching back. PT B stated she sometimes had to raise her voice to get resident's attention or if concerned about their safety but she denied any verbal abuse. She stated social worker overheard it and checked on incident. She stated LVN D was standing at her cart when the incident happened on 02/20/23. She stated she was not sent home nor was suspended pending investigation by Administrator due to allegation of abuse for Resident #1. She stated she was in-serviced on abuse/neglect. She stated Resident #1 was taken off of her caseload after she talked with Administrator as a precaution but no disciplinary action was taken. Interview with Administrator on 04/19/23 at 4:07 PM revealed she did not report the allegation of verbal and physical abuse by PT B for Resident #1 to the state agency within 2 hours. She stated she was at a corporate meeting on 02/22/23. She stated OT A should have reported the allegation of abuse to her immediately on 02/20/23 when alleged incidents occurred. She stated OT A reported the alleged allegation of abuse by PT B to Regional Director of Rehab on 02/22/23 and she was informed by an email of OT A's statement on the evening of 02/22/23. She stated she contacted Director of Rehab on 02/22/23 to get her a statement from PT B. Administrator stated she would immediately notify the state if a resident or family member reported an alleged allegation of abuse/neglect, suspend alleged perpetrator pending investigation and investigate the incident. She stated at first stated this alleged allegation of abuse was hearsay by staff member. She stated she would report the allegation if the resident when interviewed stated an allegation of abuse/neglect occurred to the state. She stated she interviewed Resident #1 the next day on 02/23/23 who denied any abuse and felt safe at facility. She stated PT B provided a witness statement on 02/23/23. She stated since Resident #1 denied any abuse occurred so she did not report it and PT B denied any abuse occurred. She stated PT B was not suspended but Resident #1 was taken off her caseload just to be safe. She stated staff were in-serviced on abuse/neglect and reporting after incident. She stated OT A alleged the first incident that PT B was rude to Resident #1 by stating grown man laying there pooping in his diaper and wiping aggressive and rough during incontinent care provided by PT B. Interview on 04/20/23 at 1:44 PM with Administrator revealed she did contact LVN G on 02/22/23 in the evening to have him talk to Resident #1 about allegation of abuse. She stated she talked with Resident #1 in the morning on 02/23/23 about the alleged incident and he denied any abuse by PT B. She stated she was not aware of any other staff being witnesses to the second alleged allegation of abuse. She stated she did not interview facility staff to determine if there were any witnesses to the alleged allegations of abuse for Resident #1. She stated not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 25 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some reporting allegations of resident abuse immediately to abuse coordinator can place residents at risk of further abuse if they do not report it. She stated PT B was currently in the facility providing therapy services. She was not aware the facility policy stated to report suspected abuse to Charge Nurse. Interview on 04/21/23 at 11:47 AM with LVN G revealed he was not the charge nurse for Resident #1. He stated the Administrator did not contact him about allegation of abuse for Resident #1. LVN G stated he did not speak with Resident #1 about allegation of abuse or therapy issues. He was unaware of any alleged abuse concerns for Resident #1. 2. Review of Resident #2's face sheet dated 04/19/23 reflected Resident #2 was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses of gout, myocardial infarction, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease and osteoarthritis. She was discharged on 01/12/23. Review of Resident #2's admission MDS assessment dated [DATE] reflected Resident #2 had a BIMS of 12 indicating she was moderately cognitively impaired. Resident #2 required limited assistance with ADLs except extensive for bathing and supervision with eating. Resident #2 was on OT and PT services. Review of Resident #2's Grievance Report dated 01/02/23 reflected Resident #2's responsible party reported family was upset with therapist as the patient currently has an order to wear back brace at all times while up. This order is in the patients medical record and the family stated the patient should only have to wear it when she is comfortable. The nurses will be getting an intervention to clarify the order with the MD and either keep the brace when up or make it prn for comfort. The grievance was resolved on 01/05/23. It did not mention about an issues with therapist yelling at Resident #2. Review of OT A's email to the Regional Director of Rehab dated 02/22/23 at 2:51 PM reflected the following about Resident #2: A few months ago, approximately sometime toward the end of December, I was in a resident's room working with her. Her name was [Resident #2]. We were in the middle of some seated exercises and it was me, [Resident #2], and [Resident #2's family member] in the room. [PT B] opened the door and came into the room. She saw a walker, in the room, that had been left by the OT. [PT B] immediately became upset and started raising her voice, with a hateful tone, and stated, Well, I see you got your way, and you got the walker that you were wanting. [PT B] did not want the resident to have the walker, in her room, and was angry that the OT had left one for her. [PT B] then noticed that the patient was not wearing her back brace while she was seated upright in a chair. [PT B] started becoming more and more agitated and aggressive with her tone and speaking. She began getting onto the resident for not having her back brace on. The patient stated that she did not have to have the brace on. The patient stated that the brace was for comfort only, to help reduce back pain with support and compression. The son also stated that the brace was only for comfort purposes and was not a requirement. [PT B] continued to raise her voice and argue with the patient, stating that this information wasn't true, and that the patient was supposed to wear the brace at all times when out of bed. [PT B] finally left the room because things were getting too heated. Shortly after [PT B] left the room, the son's wife arrived, [Resident #2's] daughter-in-law. The son shared with her what had just happened. He was upset with the way that [PT B] had handled the whole situation, and with how she had spoken to his mother. The daughter-in-law was also very angry and upset. The daughter-in-law immediately went and found [PT B] and confronted her about what had happened, telling her that she had not right to speak to her mother with that tone and in that manner. This was the first incident that occurred that I had personally witnessed myself. I contacted [OT F] and told her about what had happened. I also notified the [Director of Rehab]. [Director of Rehab] stated that she would (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 26 of 27 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 675441 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Renaissance Care Center 1400 Blackshill Dr Gainesville, TX 76240 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 0610 talk to [PT B] about it. Level of Harm - Immediate jeopardy to resident health or safety Review of Resident #2's PT Treatment Notes dated 12/22/22, 12/23/23 and 01/05/23 reflected PT B worked with Resident #2. Residents Affected - Some Review of Resident #2's December 2022 and January 2023 Progress notes including nurse notes reflected no concerns with therapy or abuse/neglect. Review of facility's incident reports for December 2022 and January 2023 reflected no incident reports for Resident #2. Review of Resident #2's Discharge Plan of Care date 01/12/23 reflected Resident #2 was discharged home with family with home health services. Interview on 04/19/23 at 11:27 AM with OT A revealed this was the first time she had worked with PT B before with Resident #2. She stated end of December 2022 she witnessed PT B being verbally abusive towards Resident # FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 27 of 27