Health inspection·April 30, 2025

F 0565 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview with Director of Operations on 4/30/25 at 3:43 PM revealed whenever there was a complaint, a grievance should have been filled out by the staff who received the complaint. That staff should have provided the complaint to the Department Heads who the complaint pertained to. Any complaints at a Resident Council meeting, a grievance should have been filed. Once the grievance was investigated, the staff member who facilitated the next Resident Council Meeting should provide the update on the grievances filed from the previous meeting and what was being done about them. He stated he did not believe there was any risk to the resident of their complaints at the Resident Council Meeting not being filed as a grievance, as residents had multiple opportunities to file a grievance and complaint outside of the Resident Council meetings. Record review of the facility's Grievances, updated on November 2017, reflected Policy .Grievances include those with respect to care and treatment which has been furnished as well as that which has not been furnished, the behavior of staff and of other patients .Guidelines: 1. The facility must make prompt efforts to resolve grievances and must make information on how to file a grievance or complaint available to the patient. 2. The facility must make information on how to file a grievance policy if requested. 3. When the facility is made aware of a problem or concern voiced by a patient or on behalf of the patient, the facility must make every effort for prompt resolution of all grievance regarding the residents' rights .c. the right to obtain a written decision regarding his or her grievance .4. The following steps should be taken for concern resolution: a. Attempt to solve the problem yourself and check back with the patient to see if they are satisfied with the outcome. B. involve your Executive Director or Director of Nursing Services .&. The executive Director is the designated grievance official for the facility with the Director of Nursing as the designee who is responsible for overseeing: A. The grievance process to include initiation of resolutions within 72 hours of received the grievance. B. the receiving and tracking grievances to their conclusion. C. leading any necessary investigations by the facility .e. issuing written grievance decisions to the Patient/Resident if requested. F. Coordinating with state and federal agencies as necessary in light of specific allegations .8. Any grievance which arises to the level of abuse, mistreatment, or neglect, or injuries of unknown source, and/or misappropriation of resident property shall be reported to the state agency immediately FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 2 of 33 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 04/30/2025 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 - Few 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 interview and record review the facility failed to ensure all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, were reported immediately, but not later than 2 hours after the allegation was made, if the events that caused the allegation involved abuse or resulted in serious bodily injury to the administrator of the facility and to the other officials, including to the State Survey Agency, in accordance with State law through the established procedures for one of 7 residents (Resident #66) reviewed for abuse and neglect . The facility failed to report allegations of neglect and abuse which involved Resident #66 to the Administrator and appropriate State Agency immediately on 04/26/25. This failure could place residents at risk of abuse and neglect. Findings Include: Record review of Resident #66's admission MDS assessment, dated 4/26/25, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. She had little to no cognitive impairment and had a BIMs of 15 . Her active diagnoses included coronary artery disease (a heart condition where plaque builds up inside the coronary arteries), Hypertension (elevated blood pressure), Ulcer (the break or erosion in the lining of an organ or tissue), Diabetes (a disease that results in too much sugar in the blood), Thyroid Disorder(a condition that prevents your thyroid from making the right amount of hormones , and wedge compression fracture of first lumbar vertebra, she required some help with self-care to include moderate assistance with toileting and substantial help with bathing. Record review of Resident #66's admission Assessment, dated 4/25/25, reflected the resident had a catheter, was continent, a high fall risk, and required a retraining program for bowel and bladder. Record review of Resident #66's Daily Care Guide, dated 4/30/25, reflected Resident #66 needed assistance with bathroom, was a fall risk, voiding method was toilet and was continent for urine and bowel. Her transfer needs were 1 person Gait Belt assist and partial lift 1 person assist for sit to stand. Record review of facility's incident logs for April 2025 did not reflect an incident had been documented for Resident #66. Record review of progress notes for Resident #66 on 4/26/25 did not reflect the allegation of abuse and neglect were reported or documented. In an interview with Resident #66's family member on 4/29/25 at 9:43 AM revealed Resident #66 was admitted to the facility on [DATE] for therapy. She reported the night of admission, Resident #66 called for help to go to the restroom and LVN B responded but did not help her. It was reported LVN B laughed at her because Resident #66 had a bowel movement in her pull-up . The family member stated she talked to the weekend supervisor the morning of 4/26/25, and weekend supervisor apologized for the nurse's behavior. The family member reported she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 3 of 33 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 04/30/2025 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 decided to discharge Resident #66 from the facility that day due to the incident. Level of Harm - Minimal harm or potential for actual harm In an interview with RN M on 4/29/25 at 3:19 PM revealed she was the weekend supervisor. She spoke to Resident #66 and her relative on 4/26/25 and was told during the night shift, Resident #66 had requested help getting up to go to the restroom. She stated no one helped her and when staff went in they didn't help her and laughed. The resident identified LVN B as the nurse who laughed instead of helping Resident #66. The relative stated Resident #66 had been lying in her poop for over any hour when she arrived. RN M stated when they brought the incident to her attention LVN B had already left. She had not interviewed LVN B or questioned her about the incident. Resident #66 had requested to go home, and she assisted them with Home Health to discharge with the appropriate supports. RN M stated she told the Manager on Duty of the incident and assumed she would take care of reporting it to the Administrator. RN M stated the incident should have been reported to the Administrator. Residents Affected - Few In an interview with the Lifestyle Director on 4/29/25 at 3:46 PM revealed she was the MOD on 4/26/25. She reported RN M provided the complaint from Resident #66 and her relative and she talked to the family and assisted with the discharge. She stated she provided the update on this resident at the stand-up meeting Monday morning. The Lifestyle Director stated she did not know she needed to report it to their abuse coordinator and assumed RN M would have reported it since she was the one who had told her about the complaint. She stated it could have been abuse and therefore should have been investigated . She was not aware that she needed to ensure it was reported as the MOD for the weekend. She stated she believed an email by another staff member was sent to the Administrator about the incident because Resident #66's relative wanted to speak to Administrator. In an interview with Director of Operations on 4/29/25 at 4:03 PM revealed he was covering for the Administrator while he was on vacation. He stated if there was an allegation of abuse or neglect, they would have needed to report it to the abuse coordinator immediately, which would be him while the Administrator is on leave. He stated staff should have been aware of reporting it to him. He stated he did not know about the incident and was barely being made aware of it during this interview. Now that it had been brought up, he would call the family and see if they felt it was abuse and would report it to the state survey agency immediately or within 2 hours and would have taken the following steps: conducted an assessment of the resident, investigated the incident, suspend the alleged perpetrator until the investigation was complete, in-service with staff and completed safe surveys. In an interview with the Regional Nurse Consultant on 4/30/25 at 11:55 AM revealed whoever received a complaint or witnessed the alleged abuse or neglect should have reported it to the abuse coordinator, the Administrator. RN M should have reported the complaint to the Administrator when is happened on 4/26/25. In an interview with the Director of Operations on 4/30/25 at 12:47 PM revealed he contacted Resident #66's relative and received the complaint earlier on 4/30/25. He initiated the abuse/neglect protocol immediately, called in the report to the state survey agency and suspended LVN B until he completed his investigation . He started to in-service staff and conducted safe surveys with residents. Record review of the facility's Abuse and Neglect Policy, updated August 2024, reflected .8. Any person observing an incident of Patient Abuse or suspecting Patient Abuse must immediately report such incidents to the Charge Nurse .9. The Charge Nurse will immediately examine the Patient and notify the Abuse Prevention Coordinator upon receiving reports of mental, physical, or sexual abuse . 10. The Abuse Prevention Coordinator will: a. Immediately (within 2 hours) report to the State agency and other appropriate authorities' incidents of Patient Abuse as required under applicable regulations (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 4 of 33 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 04/30/2025 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 and regulatory guidance Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 5 of 33 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 04/30/2025 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 - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to have evidence that all alleged violations were thoroughly investigated for one of 7 residents (Resident #66) reviewed for abuse and neglect. Residents Affected - Few The facility failed to ensure allegations of abuse and neglect were investigated when Resident #66 reported an allegation of abuse and neglect to the facility. This failure could place residents at risk for abuse and neglect . Findings Include: Record review of Resident #66's admission MDS assessment, dated 4/26/25, reflected an [AGE] year-old female who was admitted to the facility on [DATE]. She had little to no cognitive impairment and had a BIMs of 15 . Her active diagnoses included coronary artery disease (a heart condition where plaque builds up inside the coronary arteries), Hypertension (elevated blood pressure), Ulcer (the break or erosion in the lining of an organ or tissue), Diabetes (a disease that results in too much sugar in the blood), Thyroid Disorder(a condition that prevents your thyroid from making the right amount of hormones , and wedge compression fracture of first lumbar vertebra, she required some help with self-care to include moderate assistance with toileting and substantial help with bathing. Record review of Resident #66's admission Assessment, dated 4/25/25, reflected the resident had a catheter, was continent, a high fall risk, and required a retraining program for bowel and bladder. Record review of Resident #66's Daily Care Guide, dated 4/30/25, reflected Resident #66 needed assistance with bathroom, was a fall risk, voiding method was toilet and was continent for urine and bowel. Her transfer needs were 1 person Gait Belt assist and partial lift 1 person assist for sit to stand. In an interview with RN M on 4/29/25 at 3:19 PM revealed she was the weekend supervisor. She spoke to Resident #66 and her relative on 4/26/25 and was told during the night shift, Resident #66 had requested help getting up to go to the restroom. She stated no one helped her and when staff went in they didn't help her and laughed. The resident identified LVN B as the nurse who laughed instead of helping Resident #66. The relative stated Resident #66 had been lying in her poop for over any hour when she arrived. RN M stated when they brought the incident to her attention LVN B had already left. She had not interviewed LVN B or questioned her about the incident. Resident #66 had requested to go home, and she assisted them with Home Health to discharge with the appropriate supports. RN M stated she told the Manager on Duty of the incident and assumed she would take care of reporting it to the Administrator. RN M stated the incident should have been reported to the Administrator. In an interview with the Lifestyle Director on 4/29/25 at 3:46 PM revealed she was the MOD on 4/26/25. She reported RN M provided the complaint from Resident #66 and her relative and she talked to the family and assisted with the discharge. She stated she provided the update on this resident at the stand-up meeting Monday morning. The Lifestyle Director stated she did not know she needed to report it to their abuse coordinator and assumed RN M would have reported it since she was the one who had told her about the complaint. She stated it could have been abuse and therefore should have been investigated . She was not aware that she needed to ensure it was reported as the MOD for the weekend. She stated she believed an email by another staff member was sent to the Administrator about the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 6 of 33 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 04/30/2025 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 incident because Resident #66's relative wanted to speak to Administrator. Level of Harm - Minimal harm or potential for actual harm In an interview with the Director of Operations on 4/29/25 at 4:03 PM revealed that he was covering for the Administrator while he was on vacation. He stated if there was an allegation of abuse or neglect, they would have needed to report it to the abuse coordinator, which would be him, while the Administrator was on leave. He stated he did not know about the incident and was barely being made aware of it during this interview. Now that it was brought up, he would call the family and see if they felt it was abuse and would report it to the state and take the appropriate steps. He stated it would be investigated if the family felt it was abuse . Residents Affected - Few In an interview with the Regional Nurse Consultant on 4/30/25 at 11:55 AM revealed RN M should have reported the complaint to the Administrator when it happened so that it could be investigated and the abuse protocol could be followed. Record review of the facility's Abuse and Neglect Policy, updated August 2024, reflected . immediately (within 24 hours) suspend the employee for an abuse allegation until an investigation is completed. C. conduct and document on a Patient Abuse Investigation (see form 3-5) a thorough investigation of each incident or patient abuse, neglect, exploitation or mistreatment to include: observation, interviews and reviews of all patients involved, interviews of all witnesses, including Patients, staff and family members, notify physicians, notify families and responsible parties of the involved patients, recording all relevant physical findings FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 7 of 33 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 04/30/2025 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for 2 of 8 residents (Resident #61 and Resident #23) reviewed for ADLs. Residents Affected - Some 1. The facility failed to ensure staff provided consistent showers/baths for Resident #61. 2. The facility failed to ensure staff provided consistent bed baths on 6 p.m. to 6 a.m. shift on Tuesdays, Thursdays and Saturdays for Resident #23. These failures could place residents at risk of not receiving needed hygiene care which could cause skin breakdown, a loss of dignity and self-worth. Findings include: 1. Record review of Resident #61's quarterly MDS assessment, dated 03/21/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. She had a BIMS score of 13, which indicated she was cognitively intact. She had not rejected care and required supervision and touch assistance with showers and baths. Her active diagnoses included diabetes and dementia. Record review of Resident #61's care plan, dated 04/30/25, reflected [Resident #61] ADL Function (current) .Goals .Will maintain a sense of dignity by being clean, dry, odor free, and well-groomed over the next 90 days .Interventions . set-up, assist, give shower, shave, oral, hair, nail care scheduled and prn Record review of the facility's, undated, shower schedule reflected Resident #61 was scheduled for showers on Monday, Wednesday, Friday on the 6:00 p.m. to 06:00 a.m. shift. Record review of Resident #61s ADL documentation survey report for March 2025 reflected no showers were provided. No days marked as offered and refused. Record review of Resident #61's ADL documentation survey report for April 2025 reflected she received a shower on 04/16/25. No other days were marked as offered and refused. Record review of Resident #61's shower sheets for April 2025 reflected Resident #61 received a shower on 04/11/25 (Friday), 04/14/25 (Monday), 04/16/25 (Wednesday), 04/23/25 (Wednesday). Notation on 04/16/25, reflected Needs to be moved to AM shower,. There were no shower sheets for March 2025. In an interview and observation with Resident #61 on 04/29/25 at 08:25 a.m., she stated she was not getting her showers. She stated they didn't come get her for showers. She stated she could not remember the last time she had her shower and was not sure what her shower days were. The resident was observed to have very oily hair. In an interview on 04/29/25 at 10:35 a.m. with CNA H, she stated she just finished giving Resident #61 a shower. She stated she really needed a shower. She stated the resident was a 06:00 p.m. to 06:00 a.m. shower. She stated she thought the resident had been refusing her showers on the PM shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 8 of 33 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 04/30/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm In an interview with LVN A on 04/29/25 at 04:00 p.m., she stated the CNAs were supposed to complete a shower sheet on every resident who was scheduled for a shower and turn it into them and then they turned the shower sheets into the staffing coordinator. She stated if a resident refused a shower, then the aide and the Nurse had to co-sign off that the shower was reattempted and note the ongoing refusal. She stated she could not recall any refusal of showers for Resident #61. Residents Affected - Some In an interview with CNA F on 04/29/25 at 05:04 p.m., she stated she worked the 06:00 p.m. to 06:00 a.m. shift. She stated they had not been able to get to their assigned showers since they had been so short-handed in the last several weeks. She stated by the time they got their first rounds made and people back to bed it was almost 10:00 p.m. and the residents were not wanting their showers that late. She stated in the past 3 weeks they had been working with only 2 aides on the 6:00 p.m. to 06:00 a.m. shift. She stated when they had 3 aides, they were able to get most of their assigned showers done, but they were not able with just 2 aides. She stated CNA G was usually assigned to Resident #61. She stated the resident frequently asked to get her shower. In an interview with LVN B on 04/30/25 at 08:45 a.m., she stated she was one of the 10 p.m. to 6 a.m. Charge nurses. She stated she had very few residents who were willing to take their showers after 10:00 p.m. She stated if the aides did provide the resident a shower they were supposed to turn in a shower sheet to the Nurse, who signed off and then put the shower sheet under the door of the Staffing Coordinator. In an interview with CNA G on 04/30/25 at 09:12 a.m., she stated she worked the 06:00 p.m. to 06:00 a.m. shift. She stated she had offered Resident #61 a shower, but it was usually after 10:00 p.m. when she had offered, and the resident would refuse because it was too late. She stated this was the time they usually got around to getting to showers since they had been so shorthanded. She stated she had not been turning in a shower sheet or logging it into the computer system when she offered, and the resident refused. In an interview with the Staffing Coordinator on 04/30/25 at 10:05 a.m., she stated when a resident was admitted to the facility, they were assigned a shower day and assigned AM or PM showers. She stated the aides worked 12 hour shift. She stated they were getting ready to go to 8 hours shifts, but then had several aides quit. She stated when they had 3-4 aides on the 06:00 p.m. to 06:00 a.m. shift they did not have any issues getting showers done. She stated the aides were supposed to sign off when the shower was completed and turn the shower sheets into the nurse. She stated if a resident refused a shower they were supposed to have the nurse co-sign with them. She stated the nurse was supposed to attempt to see if the resident wanted their shower at another time or was simply refusing the shower and document the refusal. She stated she had only been keeping the shower sheets for a month at a time and was not aware until today she was supposed to keep them for a year. She stated Resident #61 told her yesterday (04/29/25) she was not getting her showers and wanted a shower. She stated she told the aides she needed a shower. She stated she had not been notified Resident #61 was refusing her showers after 10:00 p.m. She stated she had since moved the resident to the day shift shower schedule. In an interview with CNA E on 04/30/25 at 10:10 a.m., she stated she worked the 06:00 p.m. to 06:00 a.m. shift. She stated she had not been giving any showers on her shift, and she was not aware they were supposed to provide showers on the evening shift. 2. Record Review of Resident #23's face sheet undated reflected Resident #23 was a [AGE] year-old female admitted to the facility on [DATE]. Resident #23 had diagnoses which included chronic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 9 of 33 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 04/30/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some obstructive pulmonary disease (Lung disease causing restricted airflow and breathing problems), type 2 diabetes (elevated blood sugar), paraplegia (paralysis of the legs and lower body), parkinsonism (neurological disorders characterized by slowed movements, stiffness and tremors) and peripheral vascular disease (circulation disorder caused by narrowing, blockage or spasms in a blood vessel), and heart failure (chronic condition where the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen). Record review of Resident #23's Quarterly MDS, dated [DATE], reflected Resident #23 had a BIMS of 14, which indicated she was cognitively intact. Resident #23 required substantial/maximal assistance with showering/bathing. Record review of Resident #23's, undated, comprehensive care plan reflected the following: Resident #23 required extensive to total assistance required with bathing . Frequency of bath/shower was 3 times weekly. [Resident #23] will allow bed bath given at times. Record review of Resident #23's Daily Care Guide, printed 04/30/25, reflected Resident #23 required assist x 1 for bath/shower evening shift Tuesday, Thursday, and Saturday. Record review of facility's shower schedule reflected Resident #23 was a Tuesday, Thursday and Saturday shower from 6 pm to 6 am shift. Record review of Resident #23's electronic ADL documentation for CNAs from 04/01/25 to 04/25/25 reflected no documentation of bathing for Resident #23. Record review of 100 hall shower sheets for March to April 2025 reflected the following: -dated 03/04/25 by CNA G reflected Resident #23 received a shower. -dated 04/02/25 by CNA G reflected Resident #23 refused because it was too late and did not want a shower at night. -dated 04/10/25 by CNA H reflected Resident #23 refused shower. No reason given. -dated 04/17/25 (day shift) reflected Resident #23 received a shower. -dated 04/22/25 (day shift) reflected Resident #23 received a shower. There was no other shower documentation found for Resident #23 for March to April 2025. Observation and interview on 04/29/25 at 9:13 a.m. revealed Resident #23 was lying in bed with oily hair. Resident #23 stated she was dependent on staff for bathing. She stated she preferred bed baths on her shower days which were Tuesdays, Thursdays and Saturdays in the evenings. Resident #23 stated she did not like getting bed baths at 10 pm because she liked to go to bed early. She stated she recently talked to the facility staff about changing her showers times so they were not so late and she was told it could not be changed. She stated she did not refuse bed baths. She could not recall the last time she was given a bed bath and thought it had been a week or two. She stated she was not offered a bed bath at times due to short of staff in the evenings . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 10 of 33 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 04/30/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In an interview on 04/29/25 at 2:18 p.m., CNA N revealed Resident #23 preferred bed baths. She was scheduled for bed baths on Tuesdays, Thursdays and Saturdays on the 6 p.m. to 6 a.m. shift. She stated Resident #23 received a bed bath twice last week due to staffing issues on the evening shifts. She could not recall what date last week she bathed Resident #23. She stated the staffing coordinator, LVN A and LVN I knew about Resident #23 complaints of not getting bed baths on the evening shifts on her scheduled bath days. In an interview on 04/29/25 at 2:29 p.m. with CNA H revealed Resident #23 preferred bed baths and was on the evening and night shift for bed baths on Tuesdays, Thursdays and Saturdays. She stated Resident #23 complained on Sunday (April 27) of not getting a bed bath on Saturday. She stated she reported this to LVN I of Resident #23 not getting a bed bath. She stated the ADON was aware of the residents not getting showers on the evening and night shifts. In an interview on 04/29/25 at 2:55 p.m. with the ADON revealed Resident #23 preferred bed baths. He stated it had not been reported to him that Resident #23 was not getting showers on the evening shift. He was not aware Resident #23 was not getting showers. The ADON stated he had been the ADON for last 5 days only. In an interview on 04/29/25 at 3:32 p.m. with CNA C revealed Resident #23 allowed staff to give her bed baths. She was not aware of Resident #23 refusing bed baths recently, but she worked the day shift. She stated last week on Thursday (04/24/25) she gave Resident #23 a bed bath on the day shift since they were short staff on evening shifts. She stated for the last month there was difficulty on evening shifts for residents to get baths and showers due to short staff. In an interview on 04/29/25 at 3:52 p.m. with LVN A revealed the last time Resident #23 was given a bed bath was last week but could not recall which day. She stated Resident #23 preferred bed baths and was not aware of the resident refusing bed baths. She stated the 6 p.m. to 6 a.m. shift had been short staff recently. In an interview on 04/29/25 at 05:03 p.m. with CNA F revealed when they had 3 CNAs in the evening and nights, they were able to get all the showers/bed baths. She stated CNA G worked with Resident #23. She stated she was not able to get all showers completed on her shift and did not know she should document why showers were not given to residents if they were unable to get to them due to staffing. In an interview on 04/30/25 at 08:48 a.m. with LVN B revealed she was aware Resident #23 preferred bed baths and was not aware of Resident #23 refusing bed baths. She stated she was an evening shower and if evening shift was not short of staff, then residents were able to get shower/baths. She stated she knew day shift would provide Resident #23 her bed baths doing the day sometimes if Resident #23 complained of not getting her bed baths. In an interview on 04/30/25 at 09:15 a.m. with CNA G revealed Resident #23 preferred bed baths on her shift, but she could not recall the last time she was given bed bath. She stated the last 3 weeks they were short on CNAs and had one less CNA on evening shifts. She stated the charge nurse was aware of residents not getting showered or bathed due to short staff. In an interview on 04/30/25 at 10:04 a.m. with the Staffing Coordinator revealed on Monday (04/28/25) Resident #23 reported she did not get her bed baths on Saturday. She stated she talked to LVN I of Resident #23's complaint of not getting showers, but she had not followed up with the evening (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 11 of 33 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 04/30/2025 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some night shift nurse, LVN A, about Resident #23's complaint of not getting her bed bath. She stated she had difficulty getting the shower sheets from the night shift and was not aware she should be keeping them. She stated residents not getting showers or baths could lead to skin issues. She stated inadequate staffing could lead to increase in residents' falls and not getting their ADL care. She stated the 6 p.m. to 6 a.m. shift stated there were times only 1 CNA was working the night shift. She stated she did not have consistent CNAs on the evening shifts and tried to have at least 2 CNAs on evening shifts. She stated based on the resident census and resident needs, she could have 3 full-time CNAs on the 6 p.m. to 6 a.m She stated when she had at least 3 CNAs on the 6 p.m. to 6 a.m. shift showers were getting done and shower sheets were turned in to her. In an interview on 04/30/25 at 12:01 p.m. with LVN I revealed Resident #23 preferred bed baths and had voiced to her about not getting her bed baths on the evening shift. She stated the facility tried to accommodate and provide bed baths on day shift if they could. LVN I stated she reported her concerns to the Staffing Coordinator about Resident #23 not getting bed baths on her shower/bath days. In an interview on 04/30/25 at 12:05 PM with the Regional Nurse Consultant reflected she took over the facility about 3 weeks ago and had only been able to come to the facility about once a week. She stated the risk to residents not getting showers could place residents at risk of body odor and it was a dignity issue. She stated the previous DON gave her notice on 04/17/25 and did not come back after this date. She stated the facility was in process of hiring a new DON to start in May 2025. She stated she was unaware of any residents not getting their showers or bed baths on their shower days. Record review of the facility's policy Activities of Daily Living, dated May 2016, reflected 2. A Daily Care Guide must be prepared from the electronic medical record (EMR) to assist direct care staff in providing assistance to Patients in their activities of daily living .5. CNA ADL Tracking Record must be maintained in accordance with the MDS coding guidelines and specific to the Patient's needs. CNA ADL Tracking Records must be regularly monitored by the DON or the designee to ensure that tasks are being performed as scheduled. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 12 of 33 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 04/30/2025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that a resident who is fed by enteral means receives the appropriate treatment and services to prevent complications of enteral feeding for two of seven residents (Resident #171 and Resident #21) reviewed for quality of care. 1. The facility failed to ensure LVN A followed physician ordered water flushes between each medication administration given via the G-Tube for Resident #171 on 04/28/25. 2. The facility failed to ensure LVN J followed physician ordered water flushes between each medication administration given via the G-Tube for Resident #21 on 04/28/25. These failures could place residents at risk of nausea, shortness of breath and a decrease potential fluid overload. Findings include: 1. Record review of Resident #171's face sheet dated 04/30/25 reflected a [AGE] year-old male with and admission date 04/23/25. Diagnoses included dysphagia (difficulty swallowing), cerebral vascular accident (stroke), atrial fibrillation (irregular, rapid heartbeat) and gastroesophageal reflux (condition where stomach contents back up into the esophagus. Record review of Resident #171's Nurse admission assessment dated [DATE] did not address Resident #171' g-tube (a tube inserted through the abdomen that delivers nutrition directly to the stomach). Record review of Resident #171's base line care plan with an effective date of 04/23/25 did not address Resident 171's g-tube status. Record review of Resident #171's April 2025 Physician order sheet report reflected, .Flush G-tube with 50 cc water before and after medication administration .Medication water Mix-May mis and flush each med with 5-10 ml of water . with a start date of 04/23/25. Record review of Resident #171's Medication administration record for April 2025 reflected, Flush G-tube with 50 cc water before and after medication administration .Medication water Mix-May mis and flush each med with 5-10 ml of water . with a start date of 04/23/25. An observation on 04/28/25 at 01:30 p.m. of G-Tube medication administration revealed LVN A prepared medication for Resident #171. LVN A placed 1/2 tablet Baclofen 10 mg (muscle relaxant), 1 tablet of Hydrocodone-acetaminophen 10-325 mg (opioid for pain), and Sucralfate 1 gram tablet (used to treat/prevent ulcers) and placed them in and individual cup and crushed each tablet. LVN A placed the 3 medication cups and a cup filled with approximately 8 ounces of water on a tray and entered the resident's room. LVN A poured approximately 10 cc of water into each medication cup and the then retrieved a 60-cc piston syringe and placed the piston syringe into the G-tube connector and checked for residual. LVN A then flushed the G-tube with 50 ccs of water and then administered the first medication by gravity and flushed with 50 cc of water after the first medication. LVN A then capped the G-Tube and went to the sink to retrieve another full glass of water. LVN A reconnected the piston syringe to the G-Tube and flushed the tube again with another 50 cc of water and then administered the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 13 of 33 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 04/30/2025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some second medication followed by another 50 cc of water. LVN A then administered the last medication and flushed again with 50 cc of water. LVN A then reconnected the feeding tube and turned the pump back on. In an interview with LVN A on 04/28/25 at 01:45 p.m. she stated she was required to flush the G-tube with 50 cc of water before and after each med pass. When LVN A looked at the medication administration record, she stated oh it was supposed to be 10 ml of water after each medication. She stated she misread the orders when she saw the order for flush with 50 cc of water before and after mediation administration, she assumed it meant after each individual medication, not the beginning and end of the medication administration. She stated she should not have assumed and was required to review with physicians' orders prior to giving any medication and clarify if it was not clear. She stated not flushing with the prescribed amount of water could result in possible fluid overload. 2. Record review of Resident #21's quarterly MDS assessment, dated 04/15/25, reflected a [AGE] year-old female with an admission date of 09/20/21. Resident #21 had BIMs score of 15 which indicated she was cognitively intact. She was totally depended on all ADL and always incontinent of bowel and bladder and she received 25% or more of total calories through a feeding tube. Diagnoses included dysphagia (difficulty swallowing), cerebral vascular accident (stroke), and diabetes. Record review of Resident #21's Care Plan, with an effective date of 09/20/21 to present, reflected, . [Resident #21] has g-tube due to past problems with dysphagia. She refused to swallow her pills and request all medications to be given via G-tube but does not take feeding. Eats orally .Goals .will be free from complications with G-tube and will remain free from signs and symptoms of infection or breakdown . Record review of Resident #21's April 2025 Physician order sheet report reflected, .Flush G-tube with 50 cc water before and after medication administration .Medication water Mix-May mis and flush each med with 5-10 ml of water . with a start date of 10/25/21. Record review of Resident #21's Medication administration record for April 2025 reflected, Flush G-tube with 50 cc water before and after medication administration .Medication water Mix-May mis and flush each med with 5-10 ml of water . with a start date of 10/25/21. An observation on 04/28/25 at 04:40 p.m. of G-Tube medication administration revealed LVN J prepared medication for Resident #21. LVN J placed Atorvastatin 40 mg 1 tab (used to treat high cholesterol), Metformin 850 mg 1 tab (treats diabetes), and placed them in and individual cup and crushed each tablet. She then poured 6 ml of Gabapentin 250 mg/ 5 ml in a medication cup. LVN J then diluted each medication with 10 ml of water and placed the 3 medication cups and a cup filled with approximately 8 ounces of water on a tray and entered the resident's room. LVN J then retrieved a 60-cc piston syringe and placed the piston syringe into the G-tube connector and checked for residual. LVN J then flushed the G-tube with 50 ccs of water and then administered the first medication by gravity and flushed with 20 cc of water. LVN J repeated the process with the next 2 medications, flushing each time with 20 cc after each medication. In an interview with LVN J on 04/28/25 at 04:40 p.m. she stated she was required to flush the G-tube with 50 cc of water before and after each med pass and then 20 cc of water between each medication. When LVN J looked at the medication administration record, she stated oh it was supposed to be 10 ml of water after each medication. She stated she misread the orders and swore it was 20 ccs. She stated she was required to review with physicians' orders prior to giving any medication. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 14 of 33 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 04/30/2025 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not flushing with the prescribed amount of water could result in possible fluid overload if someone was on fluid restrictions. In an interview with the Regional Nurse Consultant/DON on 04/28/25 at 4:55 p.m., she stated staff were to always to follow the docts' orders on the amount of fluid to flush before and after medications. She stated failing to follow the orders could result in complication with the G-tube and discomfort to the resident. She stated flushing with the too much water could cause fluid overload. She stated all nurses were skills checked prior to G-tube medications administration and were expected to follow the physician ordered flushes. She stated any time a nurse questioned an order it was their responsibility to clarify the order. She stated they would be doing follow up monitoring to ensure staff were following proper procedures. Record review of the facility's policy, Medication Administration through a Feeding Tube, dated May 2012, reflected, .Dilute liquid medications with 10 -30 cc of water (or as ordered by the physician) and dissolve or suspend crushed medications in 5-10 cc (or as ordered by the physician) .Flush feeding tube with at least 30 cc of water. Pour medication into 60 cc syringe. Allow mediation to flow from syringe into tube. Flush the tube with 5-10 cc of water (or as ordered by physician) between each medication. After all medications have been administered, flush syringe with at least 30 cc of water to assure complete dose of medication will be administered. Clamp tubing and detach syringe . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 15 of 33 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 04/30/2025 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure that a resident who needed respiratory care, including tracheostomy care, was provided such care, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents goals and preferences for two of three (Resident #170, and Resident #52) reviewed for respiratory care. Residents Affected - Some 1. The facility failed to have Physician orders for the use of Oxygen and the amount to be administered to Resident #170 upon her admission to the facility on [DATE]. 2. The facility failed to have Physician orders for the use of Oxygen and the amount to be administered to Resident #52 upon his re-admission to the facility on [DATE]. These failures could place residents at risk of receiving an incorrect amount of oxygen and the risk of oxygen toxicity (occurs when the body inhales too much supplemental oxygen which can damage the lungs and affect the central nervous system). Findings include: 1. Record review of Resident #170's face sheet, dated 04/30/25, reflected a [AGE] year-old female with an admission date of 04/21/25. Resident #170 had diagnoses which included acute cystitis with hematuria (bladder infection accompanied by blood in the urine, pneumonia (infection that inflames the air sacs of the lungs) and chronic respiratory failure with hypoxia (condition where the body's respiratory system is unable to effectively provide enough oxygen to the blood, leading to low blood oxygen levels). Record review of Resident #170's Nursing admission Assessment, dated 04/21/25 completed by RN L and LVN K, reflected, Primary admission diagnosis- Acute cystitis .Orientation .Alert and oriented x 4 .had non-labored shortness of breath with exertion .diminished breath sounds bilateral lungs and was on continuous oxygen Record review of Resident #170's hospital discharge orders dated 04/21/25, reflected, .Portable oxygen .Nasal Cannula with Activity at 2 L/Min . Record review of Resident #170 Nurse progress note, dated 04/21/25 by LVN K, reflected Resident arrived with family to facility after being discharged from the hospital in [city name]. Resident is A&O x 4. Able to make needs and want known .Respirations even and unlabored. O2 @ 92 % on 3L. Resident does use a CPAP (continuous positive airway pressure used to deliver a steady stream of pressurized air through a mask worn over the nose or mouth during sleep). Machine set up for resident to use this evening Record review of nurse progress note, dated 04/22/25 by LVN A, reflected Skilled nursing Respiration even non-labored O2 at 3 lpm via NC . Record review of Resident #170's base line care plan completed by LVN A on 04/24/25 did not reflect the resident needed for continuous oxygen. Record review of Resident #170's Physician Order Summary for April 2025 on 04/28/25 reflected no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 16 of 33 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 04/30/2025 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 0695 orders for Oxygen. Level of Harm - Minimal harm or potential for actual harm An observation and interview with Resident #170 on 04/28/25 at 09:55 a.m. revealed the resident lying in bed. Resident #170 was receiving oxygen at 3 liters per minute via a nasal cannula. The resident stated she had recently discharged from the hospital and was on antibiotics for about 2 weeks. She stated she was on oxygen since admission to the facility and used oxygen prior to her hospital stay. She stated she was using 3 lpm at home. Residents Affected - Some Observation and interview of Resident #170 on 04/29/25 at 10:15 a.m. revealed the resident was up in her wheelchair with O2 via nasal cannula. A portable oxygen tank was attached to the back of the wheelchair and was set to deliver 3 liters per minute. In an interview on 04/29/25 at 10:20. a.m., LVN I stated any resident who received oxygen had to have a physician's order for oxygen and the amount to administer. She stated she had not noticed there were no orders for the Oxygen for Resident #170. She stated she had been on oxygen since her admission. She stated the admitting nurse (LVN A) was responsible for obtaining the admission orders when a new resident came into the facility. She stated Oxygen was considered a medication and a nurse could not provide it without an order. She stated giving to much oxygen or providing oxygen that was not needed could make the residents breathing worse. She stated 2 nurses reviewed admission orders to make sure they did not miss any orders at the time of admission, and then the DON or ADON reviewed the admission orders the next day. She stated she would add the oxygen orders today. In an interview with LVN A on 04/29/25 at 11:00 a.m., she stated she started the admission on Resident #170 and put the medications in the system but had not seen the order for the oxygen. She stated the resident came in right around the end of her shift and the oncoming nurse (LVN K) was from a sister facility. She stated she assumed they completed the admission. She stated she had not noticed the resident did not have an order for oxygen. She stated all residents who had oxygen had to have an order for the amount to be delivered. Interview with the ADON on 04/29/25 at 11:30 a.m., he stated they were reviewing new admits in the morning stand up meetings but had not gone line by line on reviewing hospital discharge orders to ensure all the orders were captured. He stated if the hospital discharge orders did not address how much Oxygen a resident required, they had to clarify it with the physician to determine the amount and frequency the Oxygen was to be delivered. He stated giving to much Oxygen could be toxic to a resident. Record review of Resident #170's updated Physician Order Summary for April 2025 reflected, Oxygen (O2) at 2 L/min per nasal canula. With a start date of 04/29/25. 2. Record review of Resident #52's face sheet, dated 4/30/25, reflected a [AGE] year-old male who was admitted to the facility on [DATE]. Resident #52 had diagnoses which included acute respiratory failure with hypoxia (a condition in which the body doesn't receive enough oxygen), Chronic Obstructive Pulmonary Disease (lung disease involving long-term poor air flow), and Pneumonia (infection that inflames air sacs in one or both lungs, which may fill with fluid). Record review of Resident #52's electronic medical record reflected he had no MDS completed as of 04/30/25. Record review of Resident #52's care plan, with an effective date of 02/07/25, did not indicate the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 17 of 33 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 04/30/2025 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 0695 resident had a need for oxygen. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #52's hospital discharge orders, dated of 4/24/25, reflected .Discharge Instructions .Diagnosis: Hypoxia - Chronic .Special Notes: Patient is to have 2 L nasal cannula oxygen as needed for low pulse ox Residents Affected - Some Record review of Resident #52's April 2025 Physician Order Sheet on 04/29/25, reflected no physician orders for continuous and/or as needed oxygen supplement. Record review of Resident #52's Nurse progress note, dated 04/23/25 by LVN A, reflected Resident #52 was sent to the hospital. Record review of Resident #52's electronic medical record reflected there was no Nurse admission Assessment for Resident #52 or Nurse's admission note for 4/24/25. Record review of Resident #52's progress note, dated 4/25/25 at 9:00 a.m., by LVN A, reflected Resident lying in bed took all medications this morning, pleasant, cooperative. No behaviors at this time. Resident O2 sat 76% RA (room air) SN applied O2 sat increased to 95% Observation and interview of Resident # 52, in his bedroom, on 4/28/25 at 9:44 a.m. revealed an oxygen concentrator running. The nasal cannula was laying on the bed. Resident #52 stated a nurse had turned on the oxygen for him. Resident #52 proceeded to grab the cannula and put it on his face. Observation of the oxygen tubing revealed a date of 4/26/25. In an interview with LVN A on 4/29/25 at 12:32 p.m. she revealed Resident #52 had not normally used oxygen but after his last hospitalization it was recommended due to him having been diagnosed with Hypoxia. Resident #52 had not kept his oxygen on when she administered it to him. When asked to provide an order for the oxygen, LVN A was unable to locate one. She stated the risk of the resident receiving oxygen without an order could be an increase in carbon monoxide, which could cause him more damage. Interview with the ADON on 4/29/25 at 1:04 p.m. revealed the resident had not required oxygen initially but had come back from this last hospitalization with oxygen. Interview with LVN B on 4/30/25 at 9:03 a.m. revealed if a resident was discharged from the hospital with an order for oxygen the order needed to be in the electronic system. The risk to the resident of not having had an order was the resident may not receive the required treatment they needed which in turn could result in O2 saturation dropping and they could become disoriented and possibly die. In an interview with the Regional Nurse Consultant/DON on 04/30/25 at 11:50 a.m., she stated any resident who required oxygen had to have an order from the physician which stated the number of liters to be delivered. She stated it was a requirement that the physician determined how much supplemental oxygen someone needed. She stated the nurses were supposed to assess the resident's respiratory status, which included ensuring the Oxygen was delivered at the prescribed rate. She stated giving to much oxygen could lead to Co2 build up and respiratory decline. Record review of the facility's policy titled, Oxygen Administration, dated October 2010, reflected Verify that there is a physician order for this procedure .Before administering oxygen, and while (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 18 of 33 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 04/30/2025 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 0695 Level of Harm - Minimal harm or potential for actual harm the resident is receiving oxygen therapy, asses for the following .Signs or symptoms of hypoxia .Signs or symptoms of oxygen toxicity .lung sounds .After completing the oxygen setup or adjustment, the following information should be recorded .The date and time that the procedure was performed. The name and title of the individual who performed the procedure. The rate of oxygen flow, route, and rationale, the frequency and duration of the treatment Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 19 of 33 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 04/30/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial wellbeing for 2 (Resident #61 and Resident #23) of 24 residents reviewed for staffing concerns. 1. The facility failed to ensure Residents #61 and #23 received consistent showers/bed baths on their shower days for the evenings of 6 pm to 6 am shift due to staffing issues. 2. The facility failed to ensure sufficient staff to meet resident needs in April 2025. These failures placed residents at risk of not getting needed care and services, a decrease in quality of care and quality of life and/or injury. Findings include: 1. Record review of Resident #61's quarterly MDS assessment, dated 03/21/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. She had a BIMS score of 13, which indicated she was cognitively intact. She had not rejected care and required supervision and touch assistance with showers and baths. Her active diagnoses included diabetes and dementia. Record review of Resident #61's care plan, dated 04/30/25, reflected, [Resident #61] ADL Function (current) .Goals .Will maintain a sense of dignity by being clean, dry, odor free, and well-groomed over the next 90 days .Interventions . set-up, assist, give shower, shave, oral, hair, nail care scheduled and prn . Record review of the facility's undated shower schedule reflected Resident #61 was scheduled for showers on Monday, Wednesday, Friday on the 6:00 PM to 06:00 AM shift. Record review of Resident #61's ADL documentation survey report for March 2025 reflected no showers were provided. No days marked as offered and refused. Record Review of Resident #61's ADL documentation survey report for April 2025 reflected she had received a shower on 04/16/25. No other days were marked as offered and refused. Record review of Resident #61's shower sheets for April 2025 reflected Resident #61 received a shower on 04/11/25 (Friday), 04/14/25 (Monday), 04/16/25 (Wednesday), 04/23/25 (Wednesday). Notation on 04/16/25, reflected, Needs to be moved to AM shower,. There were no shower sheets for March 2025. In an interview and observation with Resident #61 on 04/29/25 she stated she was not getting her showers. She stated they don't come get her for showers. She stated she cannot remember the last time she had her shower and was not sure what her shower days were. Resident was observed to have very oily hair. In an interview on 04/29/25 at 10:35 a.m. with CNA H she stated she just finished giving Resident #61 a shower. She stated she really needed a shower. She stated the resident was a 06:00 p.m. to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 20 of 33 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 04/30/2025 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 0725 06:00 a.m. shower. She stated she thought the resident had been refusing her showers on the PM shift. Level of Harm - Minimal harm or potential for actual harm In an interview with LVN A on 04/29/25 at 04:00 p.m. she stated the CNAs were supposed to complete a shower sheet on every resident who was scheduled for a shower and turn it into them and then they turned the shower sheets into the staffing coordinator. She stated if a resident refused a shower, then the aide and the Nurse had to co-sign off that the shower was reattempted and note the ongoing refusal. She stated she cannot recall any refusal of showers for Resident #61. Residents Affected - Many In an interview with CNA F on 04/29/25 at 05:04 p.m. she stated she worked the 06:00 p.m. to 06:00 a.m. shift. She stated to be honest, they have not been able to get to their assigned showers since they had been so short handed in the last several weeks. She stated by the time they get their first rounds made and people back to bed it is almost 10:00 p.m. and the residents were not wanting their showers that late. She stated in the past 3 weeks they had been working with only 2 aides on the 6:00 p.m. to 06:00 a.m. shift. She stated when they had 3 aides, they were able to get most of their assigned showers done, but they were not able with just 2 aides. She stated CNA G was usually assigned to Resident #61. She stated the resident frequently asked to get her shower. In an interview with CNA G on 04/30/25 at 09:12 a.m. she stated she works the 06:00 p.m. to 06:00 a.m. shift. She stated she had offered Resident #61 a shower, but it was usually after 10:00 p.m. when she had offered, and the resident would refuse because it was too late. She stated this was the time they usually got around to getting to showers since they had been so shorthanded. She stated she had not been turning in a shower sheet or logging it into the computer system when she offered, and the resident refused. Record Review of Resident #23's face sheet undated reflected Resident #23 was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses of chronic obstructive pulmonary disease (Lung disease causing restricted airflow and breathing problems), type 2 diabetes (elevated blood sugar), paraplegia (paralysis of the legs and lower body), parkinsonism (neurological disorders characterized by slowed movements, stiffness and tremors) and peripheral vascular disease (circulation disorder caused by narrowing, blockage or spasms in a blood vessel), and heart failure (chronic condition where the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen). Record Review of Resident #23's Quarterly MDS dated [DATE] reflected Resident #23 had a BIMS of 14 indicating she was cognitively intact. Resident #23 required substantial/maximal assistance with showering/bathing. Record Review of Resident #23's comprehensive care plan undated reflected the following: Resident #23 required extensive to total assistance required with bathing . Frequency of bath/shower was 3 times weekly. Resident #23 will allow bed bath given at times. Record Review of Resident #23's Daily Care Guide printed 04/30/25 reflected Resident #23 required assist x 1 for bath/shower evening shift Tuesday, Thursday, and Saturday. Record Review of facility's shower schedule reflected Resident #23 was a Tuesday, Thursday and Saturday shower from 6 pm to 6 am shift. Record Review of Resident #23's electronic ADL documentation for CNAs from 04/01/25 to 04/25/25 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 21 of 33 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 04/30/2025 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 0725 reflected no documentation of bathing for Resident #23. It was blank for bathing, but other ADLs for Resident #23 were captured. Level of Harm - Minimal harm or potential for actual harm Record Review of 100 hall shower sheets for March to April 2025 reflected the following: Residents Affected - Many -dated 03/04/25 by CNA G reflected Resident #23 received a shower. dated 04/02/25 by CNA G reflected Resident #23 refused because it was too late and did not want a shower at night. -dated 04/10/25 by CNA H reflected Resident #23 refused shower. No reason given. -dated 04/17/25 (day shift) reflected Resident #23 received a shower. -dated 04/22/25 (day shift) reflected Resident #23 received a shower. There was no other shower documentation found for Resident #23 for March to April 2025. Observation and Interview on 04/29/25 at 9:13 a.m. revealed Resident #23 was lying in bed with oily hair. Resident #23 stated she was dependent on staff for bathing. She stated she preferred bed baths on her shower days which were Tuesdays, Thursdays and Saturdays in the evenings. Resident #23 stated she did not like getting bed baths at 10 pm because she liked to go to bed early. She stated she recently had talked to the facility staff about changing her showers times so they were not so late and she was told it cannot be changed. She stated she did not refuse bed baths unless it was too late in the evening. She could not recall the last time she was given a bed bath thought it had been a week or two. She stated she was not offered a bed bath at times due to short of staff in the evenings. She stated CNAs tell her they do not have time to give her a bed bath. In an interview on 04/29/25 at 2:18 p.m. CNA N revealed Resident #23 preferred bed baths. She was scheduled for bed baths on Tuesdays, Thursdays and Saturdays on the 6 pm to 6 am shift. She stated Resident #23 received a bed bath twice on day shift last week due to staffing issues on the evening shifts. She cannot recall what date last week she bathed Resident #23. She stated the staffing coordinator, LVN A and LVN I knew about Resident #23 complaints of not getting bed baths on the evening shifts on her scheduled bath days. In an interview on 04/29/25 at 2:29 p.m. with CNA H revealed Resident #23 preferred bed baths and was on the 6 pm to 6 am shift for bed baths on Tuesdays, Thursdays and Saturdays. She stated Resident #23 complained on Sunday (04/27/25) of not getting a bed bath on Saturday (04/26/25). She stated she reported this to LVN I of Resident #23 not getting a bed bath. She stated the ADON and Staffing Coordinator were aware of residents not getting showers on the 6 pm to 6 am shifts. In an interview on 04/29/25 at 2:55 p.m. with the ADON revealed Resident #23 did prefer bed baths. He stated it had not been reported to him that Resident #23 was not getting bed baths on evening shift. The ADON stated he had been the ADON for last 5 days only. He stated he was having to work the floor as a charge nurse to assist with staffing needs. In an interview on 04/29/25 at 3:32 p.m. with CNA C revealed Resident #23 allowed them to give her bed baths. She was not aware of Resident #23 refusing bed baths recently but she worked the day shift. She stated last week on Thursday she gave Resident #23 a bed bath on day shift since they were (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 22 of 33 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 04/30/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many short staff on evening shifts. She stated for the last month there had been difficulty on evening shifts for residents to get baths and showers due to short staffed. In an interview on 04/29/25 at 3:52 p.m. with LVN A revealed last time Resident #23 was given a bed bath last week but cannot recall which day. She stated Resident #23 preferred bed baths and was unaware of resident refusing bed baths. She stated the 6 pm to 6 am shift had been short staff recently. In an interview on 04/29/25 at 05:03 p.m. with CNA F revealed when they had 3 CNAs from 6 pm to 6 am shift they were able to get all the showers/bed baths completed unless a resident refused. She stated CNA G worked with Resident #23 so she was not sure when Resident #23 received a bed bath or shower. She stated she was not able to get all showers completed on her shift and did not know she should document why showers were not given to residents. In an interview on 04/30/25 at 08:48 a.m. with LVN B revealed she was aware Resident #23 preferred bed baths and was not aware of Resident #23 refusing bed baths. She stated she was an evening shower and if evening shift was not short of staff then residents were able to get shower/baths. She stated she knew day shift would provide Resident #23 her bed baths doing the day sometimes if Resident #23 complained of not getting her bed baths. In an interview on 04/30/25 at 09:15 a.m. with CNA G revealed Resident #23 preferred bed baths on her shift but she could not recall the last time she was given bed bath. She stated the last 3 weeks they have been short on CNAs and have had one less CNA. She stated the charge nurse was aware of residents not getting showered or bathed due to short staff. In an interview with the Staffing Coordinator on 04/30/25 at 10:05 a.m. she stated when a resident was admitted to the facility, they were assigned a shower day and assigned AM or PM showers. She stated the aides work 12 hours shift. She stated they were getting ready to go to 8 hours shifts, but then had several aides quit. She stated when they had 3-4 aides on the 06:00 p.m. to 06:00 a.m. shift they do not have any issues getting showers done. She stated the aides were supposed sign off when the shower had been completed and turn the shower sheets into the nurse. She stated if a resident refused a shower they were supposed to have the nurse co-sign with them. She stated the nurse was supposed to attempt to see if the resident wanted their shower at another time or was simply refusing the shower and document the refusal. She stated she had only been keeping the shower sheets for a month at a time and was not aware until today she was supposed to keep them for a year. She stated Resident #61 had told her yesterday (04/29/25) she was not getting her showers and wanted a shower. She stated she told the aides she needed a shower. She stated she had not been notified Resident #61 was refusing her showers after 10:00 p.m. She stated she had since moved Resident #61 to the day shift shower schedule. She stated on Monday (04/28/25) Resident #23 reported she did not get her bed baths on Saturday. She stated she talked to LVN I of Resident #23's complaint of not getting showers, but she had not followed up with evening night shift nurse LVN A about Resident #23's complaint of not getting her bed bath in the evening shift. She stated she had difficulty getting the shower sheets from night shift. She stated residents not getting showers or baths can lead to skin issues. She stated inadequate staffing could lead to increase in residents' falls and not getting their ADL care. She stated the 6 pm to 6 am shift she stated there were times only 1 CNA was working the night shift. She was not aware if the facility could use agency staffing but she had reached out to Administrator of issues with staffing and assisted in helping her find staff to work from other facilities in the corporation. She stated she did not have consistent CNAs on the evening shifts and tried to have at least 2 CNAs on evening shifts. She stated based on resident census and resident needs she could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 23 of 33 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 04/30/2025 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 0725 Level of Harm - Minimal harm or potential for actual harm have 3 full-time CNAs on the 6 pm to 6 am with 2 nurses on the 6 pm to 6 am shift. She stated she reaches out to prn staff and staff who work other shifts to assist with their staffing needs. She stated on 2 pm to 10 pm shift she has 3 nurses. She stated they had hired new staff for 6 pm to 6 am shift, but some have already quit. She stated she had not asked the Administrator about agency staff as an option to assist with staffing. Residents Affected - Many In an interview with CNA E on 04/30/25 at 10:10 a.m. she stated she worked the 06:00 p.m. to 06:00 a.m. shift. She stated she had not been giving any showers on her shift, and stated she was not aware they were supposed to provide showers on the evening shift. In an interview on 04/30/25 at 11:50 a.m. with the Director of Operations stated the Administrator was working on addressing staffing concerns by calling other staff members from other facilities within the corporation to assist with CNAs and nurses. He stated agency was a contingency plan if needed but they had not used agency staff at this facility. He stated he was not aware of resident showers/baths not getting done on the evening shifts due to staffing. He stated the Administrator had hired more staff and the staffing concerns had gotten better than the Administrator first took over. He stated he was covering the facility this week since the Administrator was on leave. In an interview on 04/30/25 at 12:01 p.m. with LVN I revealed Resident #23 preferred bed baths and had voiced to her about not getting her bed baths on evening shift. She stated the facility tried to accommodate and provide bed baths on day shift if they could but this is not always possible with the residents they need to get showered on their shifts. LVN I stated she had reported her concerns to Staffing Coordinator about Resident #23 not getting bed baths on her shower/bath days. In an Interview on 04/30/25 at 12:05 p.m. with the Regional Nurse Consultant reflected she took over the facility about 3 weeks ago and had only been able to come to facility about once a week. She stated the risk to residents not getting showers could place residents at risk of body odor and it was a dignity issue. She stated the previous DON gave her notice on 04/17/25 and did not come back after this date. She stated the facility was in process of hiring a new DON to start in May 2025. She stated she was unaware of any residents not getting their showers or bed baths on their shower days. She stated inadequate staffing concerns could affect the residents' quality of care and quality of life. In an interview on 04/30/25 at 3:55 p.m. with the ADON revealed he worked the 2 pm to 10 pm and 10 pm to 6 am shifts to assist with staffing as a floor nurse. He stated one of the 6 pm to 6 am shifts he worked they were down to only 1 CNA with 2 nurses on the evening shift 6 pm to 6 am shift but could not recall the date. He stated he was the CNA and nurse on his hall. He stated the day shift did not have any issues with staffing. He stated he had to work the floor as a nurse to assist with staffing needs since he was hired in February 2025. In an interview on 04/30/25 at 04:51 PM with the Director of Operations revealed the Administrator was ultimately responsible to ensure adequate staffing to meet resident needs. Record Review of timesheets for Nurses and CNAs for April 2025 reflected the following for 6 pm to 6 am shifts: 04/01/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 1 CNA until 7:35 PM and 1 CNA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 24 of 33 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 04/30/2025 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 0725 from 7:33 pm until 6 AM Level of Harm - Minimal harm or potential for actual harm 04/03/25 - 2 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM Residents Affected - Many 04/06/25 - 4 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 3 CNAs from 6 pm to 10 pm, 2 CNAs until 11 pm, 1 CNA from 11:00 PM to 6 AM 04/07/25 - 2 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 3 CNAs from 6 PM to 11:20 PM, 2 CNAs from 11:20 PM to 6 AM 04/08/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/11/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 11:28 PM, 1 Nurse until 6 AM, 2 CNAs from 6 PM to 8:53 PM, 3 CNAs from 8:53 PM to 9:48 PM, 2 CNAs from 9:48 PM to 6 AM. 04/12/25 - 3 Nurses from 6 PM to 10 PM, 1 nurse from 10 PM to 6 AM, 3 CNAs from 6 PM to 11 PM, 2 CNAs from 11 PM to 6 AM 04/15/25 - 2 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/16/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/17/25 - 2 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 10 PM, 1 CNA from 10 PM to 6 AM 04/18/25 - 1 Nurse from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 25 of 33 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 04/30/2025 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 0725 04/19/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM Level of Harm - Minimal harm or potential for actual harm 04/20/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM Residents Affected - Many 04/21/25 - 1 Nurse from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/22/25 - 3 Nurses from 6 PM to 10 PM, 1 Nurse from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/23/25 - 3 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/24/25 - 2 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/26/25 - 4 Nurses from 6 PM to 10 PM, 2 Nurses from 10 PM to 6 AM, 2 CNAs from 6 PM to 6 AM 04/27/25 - 4 Nurses from 6 PM to 10:00 PM, 2 Nurses from 10 PM to 10:28 PM, 1 Nurse from 10:28 PM to 6 AM, 2 CNAs from 6 PM to 3:08 AM, 1 CNAs from 3:08 AM to 6:00 AM Review of staff sign in sheets for April 2025 reflected the ADON worked on 04/07/25, 04/08/25 and 04/18/25 the 2 PM to 10 PM shift as a nurse. It reflected on 04/11/25, 04/14/25 and 04/17/25 ADON worked the 10 pm to 6 am shift as a nurse. Review of facility's policy Staffing last revised April 2007 reflected Our facility provides adequate staffing to meet needed care and services for our resident population. 1. Our facility maintains adequate staffing on each shift to ensure that our resident's needs and service are met. Licensed registered nursing and licensed nursing staff are available to provide and monitor the delivery of resident care services 2. Certified Nursing Assistants are available on each shift to provide the needed care and services of each resident as outlined on the resident's comprehensive care plan .Inquires or concerns relative to our facility's staffing should be directed to the Administrator or his/her designee. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 26 of 33 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 04/30/2025 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate acquiring and administering of all medications to meet the needs of each resident for one of seven residents (Resident #55) reviewed for pharmacy services. The facility failed to ensure Resident # 55's discontinued Lorazepam 2mg/ml was removed from the Refrigerator in the Medication room. These failures could place residents at risk of nausea, shortness of breath and a decrease potential fluid overload. Findings include: During an observation of the facility's one Medication room on 04/30/25 at 11:41 a.m. with the ADON, revealed one medication was observed in the locked compartment of the medication rooms refrigerator. The lock box contained a vial of Lorazepam 2mg/ml for Resident #55. The fill date of the prescription was 07/19/25 with an expiration date 07/19/25. Record review of the Narcotic count sheet for Resident #55's Lorazepam 2mg/ml revealed the last time the medication was administered was on 01/25/24 with remaining amount of 29ml which matched the amount in bottle. In a follow up interview on 04/30/25 at 11:50 a.m. with the ADON, he stated Resident #55's Lorazepam 2mg/ ml was discontinued on 09/09/24. He stated he had pulled the medication and would place it in the DON locked area for drug destruction. He stated all discontinued medication was to be pulled from the stock as soon as it was stopped to prevent staff from inadvertently giving a medication that was no longer needed. He stated the risk of not pulling medication was possibly giving duplicate medications. In an interview on 04/30/25 at 12:04 p.m. with LVN I she stated they were expected to pull any discontinued medication as soon as it was discontinued. She stated the risk of not pulling discontinued medication was someone could give something that had been discontinued or the risk of drug diversion. She stated they had been counting Resident #55's Lorazepam every shift change but never thought to question if it was discontinued. In an interview on 04/30/25 at 12:30 p.m. with the Regional Nurse Consultant/DON she stated discontinued medication should be removed from the cart or medication room immediately, or if it was a narcotic as soon as it could be handed off to the DON for it to be logged and locked up for destruction. She stated the risk of having discontinued medication would be administering medication without an order or the potential for drug diversion. Record review of the facility's policy titled Storage of Medications, dated April 2007, reflected, . The nursing staff shall be responsible for maintaining medication storage The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 27 of 33 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 04/30/2025 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review the facility failed to label drugs and biologicals used in the facility in accordance with currently accepted professional principles, and include the appropriate accessory and cautionary instructions, and the expiration date when applicable for the facility's one medication room reviewed for storage. The facility failed to ensure a vial of TB PPD, that was opened and used, was not dated in the medication room refrigerator. This failure could affect residents and staff resulting in diminished effectiveness, and not receiving the therapeutic benefits of the medications. The findings included: An observation on 04/30/25 at 11:35 a.m. of the medication room refrigerator with the ADON revealed an undated open vial of Tuberculin Purified protein derivative. The ADON stated it appeared one dose might have been used out of the multi dose vial. In an interview with the ADON on 04/30/25 at 11:41a.m. he stated the TB PPD had to be dated when opened. He stated once it was open it would only be good for 30 days. He stated the risk of not dating it once opened was the potential for false positive or an inaccurate test, which could lead to a missed infection. He stated all the nurses perform the TB skin test on any new admission and whoever opened the vial was responsible for dating it. He stated going forward he would most likely be responsible for checking the medication room for expired medications. In an interview with the Regional Nurse Consultant/DON on 04/30/25 at 11:50 a.m. she stated once a multi-use vial of medication was opened the staff were required to date it. She stated when they open of vial of TB PPD it had to be dated to prevent the risk of using an expired medication which would render it ineffective and could give a false positive reading of the PPD. The Regional Nurse Consultant/DON said all nurses were responsible to check the medication carts and the medication rooms for expiration and labeling of medication. Record review of the facility's policy titled Storage of Medications, dated April 2007, reflected, .The facility shall not use discontinued, outdated, or deteriorated drugs or biologicals. All such drugs shall be returned to the dispensing pharmacy or destroyed The nursing staff shall be responsible for maintaining medication storage FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 28 of 33 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 04/30/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for the facility's only kitchen. Residents Affected - Many 1. The facility failed to ensure stove grease trap was cleaned and emptied. 2. The facility failed to ensure cold food temperatures were at or below 40 degrees F for 3 menu items for lunch on 04/28/25. 3. The facility failed to ensure hot food temperatures were taken and were above 135 F for menu items for lunch on 04/28/25. 4. The facility failed to ensure Dietary Manager wore a facial restraint for his mustache during lunch meal preparation on 04/28/25. These failures could affect residents who received their meals from the facility's only kitchen, by placing them at risk for food-borne illness, and food contamination. Findings include: 1. Observation on 04/28/25 at 9:32 AM revealed the stove grease trap had black sticky substances covering the bottom about 1 inch thick and had with food debris. Interview on 04/28/25 at 9:33 AM with the Dietary Manager revealed he had last emptied and cleaned out stove grease trap 2 days ago. He stated he emptied it every 2 days or more often if it gets full before then. Review of facility's policy Cleaning Ranges dated 11/03/04 reflected The cook on each shift is responsible for keeping the range as clean as possible during the meal preparation. The range will be cleaned after each use. Spills and food particles will be wipes as they occur. 2. Observation on 04/28/25 at 12:06 PM revealed the Dietary Consultant used the thermometer to take the food temperature of pico de gallo which was 52 F while the pico de gallo was on the steam table in a container with ice under it. Observation and Interview with the Dietary Consultant revealed she put more ice under the pico de gallo and lettuce containers to cool them down. At 12:27 PM, Dietary Consultant re-temped the pico de gallo which was on the steam table in container with ice under it, the food temperature was at 49 F degrees. Observation on 04/28/25 at 12:14 PM revealed the Dietary Consultant used the thermometer to take food temperature of pureed pico de gallo which was on steam table in container with ice under it, the food temperature was 43 F degrees . The Dietary Consultant did not take the food temperature of the pureed pico de gallo prior to serving for lunch meals. Observation on 04/28/25 at 12:28 PM revealed the Dietary Consultant used the thermometer to take food temperature of lettuce which was on steam table in a container with ice under, it was 48 F degrees. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 29 of 33 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 04/30/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Interview on 04/28/25 at 12:29 PM with the Dietary Consultant revealed the lettuce and pico de gallo should be served at 40 F or below. She stated she had ice under the containers to keep them cool. Observation on 04/28/25 at 12:31 PM revealed the Dietary Consultant started plating food for lunch including pico de gallo. At 12:33 PM, lettuce was put on resident plate for lunch. The Dietary Consultant did not take any food temperatures of the lettuce and pico de gallo which were both on the steam table with ice under their containers to ensure temperatures were below 41 for serving. Record Review of the facility's production recipe Pico de Gallo from US Food/Blue Print Menu Management System undated reflected to hold or serve cold food at or above 40 degree F. Record Review of the facility's production recipe Lettuce Shredded and Diced Tomato from US Food/Blue Print Menu Management System undated reflected to hold or serve cold food at or above 40 degree F. 3. Observation on 04/28/25 at 12:57 PM revealed a 2nd batch of enchiladas came out of the stove. The Dietary staff failed to take food temperature of the enchiladas prior to serving. The Dietary Consultant started scooping the enchiladas and placing it on residents lunch plates. Observation on 04/28/25 at 1:10 PM revealed a 2nd batch of beans was cooked on oven stove. The Dietary staff failed to take food temp of beans. The Dietary Consultant used a scoop to place beans in bowl and then placed the bowl of beans on resident meal trays. Observation on 04/28/25 at 1:35 PM of lunch test tray revealed the lettuce was warm. The beans were lukewarm. Interview on 04/28/25 at 1:46 PM with the Dietary Consultant revealed she was aware the food temperature of the beans should be served at 135 degrees F or higher, enchiladas at 135 degrees F or higher. She stated the pico de gallo and lettuce should have had the food temperatures taken and be within proper temperatures prior to serving for cold foods. She stated she did not obtain the food temperatures of enchiladas and beans prior to serving and should have taken the food temperatures. Record Review of the facility's production recipe Enchilada Beef from US Food/Blue Print Menu Management System undated reflected to hold or serve hot food at or above 140 degree F. Record Review of the facility's production recipe Beans Seasoned from US Food/Blue Print Menu Management System undated reflected to hold or serve hot food at or above 140 degree F. Record Review of the facility's policy Food Temperatures dated September 2010 reflected The Dining Services Director/designee shall check food temperatures routinely. PROCEDURE: 1. All hot and cold food items must be served to the Resident at a palatable temperature. All hot food must be held at a minimum of 145 degrees Fahrenheit. 2. All cold food items must be held at 40 (degrees) F or below .Food temperatures must be taken prior to placing on the steamtable/trayline .8. Temperatures should be taken periodically to ensure hot foods stay above 145 (degrees) F and cold foods stay below 40 (degrees) F all during the trayline period. Record Review of Review of the Food and Drug Administration Food Code, dated 2022, reflected, .3-501.19 Time as a Public Health Control. (A) Except as specified under (D) of this section, if time without temperature control is used as the public health control for a working supply of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 30 of 33 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 04/30/2025 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many TIME/TEMPERATURE CONTROL FOR SAFETY FOOD before cooking, or for READY-TO-EAT TIME/TEMPERATURE CONTROL FOR SAFETY FOOD that is displayed or held for sale or service . (B) If time without temperature control is used as the public health control up to a maximum of 4 hours: (1) Except as specified in (B)(2), the FOOD shall have an initial temperature of 5°C (41ºF) or less when removed from cold holding temperature control, or 57°C (135°F) or greater when removed from hot holding temperature control. 4. Observation on 04/28/25 at 12:52 PM the Dietary Manager was cutting up onions with no facial restraint for mustache. At 1:03 PM, the Dietary Manager put fruit in a cup for resident lunch with no facial restraint to cover the mustache. Interview on 04/28/25 at 01:48 PM with the Dietary Manager revealed he was not aware he needed to wear a facial hair restraint for his mustache. He stated he was only aware he needed a beard restraint if he had a beard. He was not aware of facility's specific policy on facial restraints. Follow-up interview on 04/30/25 at 2:43 PM with the Dietary Manager revealed he had only been working at facility about 1.5 months. He stated the importance of effective hair and facial restraints were to keep hair out of food. Review of the facility's policy Nutrition Services Department Dress Code last revised April 2019 reflected All employees will be require to abide by [corporate] minimum dress code standards, as detailed in the Staff Guidelines-Dress Code/Uniform Policy. The following are department specific standards: .j. Facial hair must be covered by a beard restraint. Review of the Food and Drug Administration Food Code, dated 2022, reflected, 2-402.11 Effectiveness. (Hair Restraints) .1. Code of Federal Regulations, Title 21, Sections 110.10 Personnel (6) Wearing, where appropriate, in an effective manner, hair nets, head bands, caps, beard covers, or other effective hair restraints. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 31 of 33 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 04/30/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain an Infection Prevention and Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 18 residents (Resident #171 and Resident #55) observed for infection control. Residents Affected - Some 1. The facility failed to ensure LVN A used the required PPE for Resident #171, who was on enhanced barrier precautions due to his g-tube (a tube inserted through the abdomen that delivers nutrition directly to the stomach), while administering residents' medication through the g-tube on 04/28/25. The facility failed to ensure Resident #171's room had a sign reflecting she was on enhanced barrier precautions. 2. The facility failed to ensure CNA K performed hand hygiene while providing incontinence care to Resident #55 on 04/28/25 and failed to ensure CNA K and Hospitality Aide D performed hand hygiene before leaving the resident's room. These failures could place the residents at risk of cross-contamination and development of infection. Findings included: 1. Record review of Resident #171's face sheet dated 04/30/25 reflected a [AGE] year-old male with an admission date of 04/23/25. Diagnoses included dysphagia (difficulty swallowing), cerebral vascular accident (stroke), atrial fibrillation (irregular, rapid heartbeat) and gastroesophageal reflux (condition where stomach contents back up into the esophagus. Record review of Resident #171's April 2025 Physician order sheet report reflected, .G-tube site care-Check GT site daily for s/s of infection . with a start date of 04/23/25. An observation on 04/28/25 at 01:30 p.m. of G-Tube medication administration revealed LVN A prepared medication for Resident #171. LVN A placed the 3 medication cups and a cup filled with approximately 8 ounces of water on a tray and entered the resident's room. There was no sign posted outside of the door which indicated Resident was on EBP. LVN A performed hand hygiene and put on gloves but did not put on a gown. LVN A turned off the feeding pump, checked for residual and then administered the medication and reconnected the feeding tube and turned the pump back on. LVN A removed her gloves and performed hand hygiene and left the room. In an interview with LVN A on 04/28/25 at 01:45 p.m. she stated any resident with a G-tube was required to be in enhanced barrier precautions. She stated she should have worn a gown and just overlooked it when she entered the room. She stated the risk of not following Enhanced Barrier Precautions was the spread of MDRO's. In an interview with the Regional Nurse Consultant/DON on 04/28/25 at 02: 45 p.m. she stated any resident who had any type of indwelling medical device was placed on Enhanced Barrier precautions to help reduce the spread of MDRO's. She stated signage was supposed to be posted outside to the door, which explains what PPE was to be worn and for what task the PPE is to be worn for. She stated any contact with a resident with a g-tube required the use of gown and gloves. She stated the staff had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 32 of 33 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 04/30/2025 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 0880 received numerous trainings on the use of Enhanced Barrier Precautions. Level of Harm - Minimal harm or potential for actual harm Record review of the Facility's policy titled, Enhanced Barrier Precautions, dated August 2022, reflected, Enhanced Barrier Precautions (EHPs) are utilized to prevent the spread of multi-drug resistant organisms (MDROs) to residents .EBP employ targeted gown and glove use during high contact resident care activities when contact precautions no not otherwise apply .Examples of high-contact resident care activities requiring the use of gown and gloves for EBP's include .device care or use ( .feeding tube .)EBPs remain in place for the duration of the residents stay or until resolution .or discontinuation of the indwelling medical device that places them at increased risk .Staff are trained prior to caring for resident on EBPs .Signs are posted in the door or wall outside the resident room indicating the type of precautions and PPE required . Residents Affected - Some 2. In an observation on 04/28/25 at 10:29 a.m. CNA C and Hospitality Aide D entered Resident #55's room to provide peri-care and get her up for the day. Both staff washed their hands and put on gloves and gown. CNA C uncovered resident and unfastened the resident brief. CNA C provided catheter care, cleaning down the tube away from the body. CNA C then cleaned the resident's front pubic area with several wipes, changing the surface of the wipe with each stroke. Both staff rolled the resident on her side revealing resident had a small bowel movement. CNA C cleaned the resident's anal area from front to back, removed the soiled brief and her gloves. CNA C then put on new gloves without performing hand hygiene. CNA C placed the clean brief under the resident and both staff rolled the resident over and closed the resident's brief. Both staff rolled the resident onto the mechanical sling and transferred the resident to her wheelchair. Both staff removed their PPE, gathered the trash, and soiled linens and left the room without performing hand hygiene. In an interview on 04/28/25 at 11:10 a.m. CNA C stated she was supposed to change her gloves and perform hand hygiene when she went from dirty to clean. CNA C stated she should sanitize her hands between change of gloves. She stated failing to provide proper care exposed the resident to infections. CNA C and Hospitality aide D stated they were supposed to wash their hands after they finished providing care to the resident and before leaving the room and both stated they had forgot to do that. Both stated the risk for not washing their hands was the spread of germs. In an interview on 04/28/25 at 02:25 p.m. with the Regional Nurse Consultant /DON stated staff were to change their gloves and sanitize their hands when going from dirty to clean. She stated staff were always required to perform hand hygiene before care and after care. She stated they do train on infection control during their skills checks and anytime they had any issues with infections in the building. She stated the risk of not adhering to the protocol was increased risk of infections. Record Review of the Facility's policy titled, Perineal Care, dated October 2010, reflected, The purpose of this procedure are to provide cleanliness and comfort to the resident, to prevent infections and skin irritation, and to observe the resident's skin condition .Wash and dry your hands .put on gloves .For female resident .Wash perineal area, wiping from font to back .Continue to wash the perineum moving from inside outward to and including thighs, alternating from side to side, and using downward strokes .Wash the rectal area thoroughly, wiping from the base of the labia towards and extending over the buttocks .Remove gloves .Wash and dry your hands . Record review of the facility's policy titled, Hand Washing, dated August 2012, reflected, .Hand washing is the single most important means of preventing the spread of infection .After Patient contact .Wash hands with soap and running water .May use Hand sanitizing gel in place of soap and water . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675441 If continuation sheet Page 33 of 33