Health inspection·October 5, 2023

F 0550 start therapy. Level of Harm - Minimal harm or potential for actual harm During an interview with Resident #2's family on 10/03/2023 at 10:30 a.m., Resident #2's family stated they were informed sometime in June of 2023 that Resident #2 would be picked back up on therapy. Resident #2's family stated it was hard for Resident #2 to change her routine and took time for her to acclimate and she remembered the conversation for that reason. Resident #2's family stated it would be good for Resident #2 to have routine exercise because it kept her out of the bed more and the SW told her it would be for 6 months. Resident #2's family stated she had not been informed there was an issue with the process of obtaining approval for Resident #2 to have therapy. Residents Affected - Few During an interview on 10/04/2023 at 11:10 a.m., with the PASRR Habilitation Coordinator it was revealed that the meeting on 06/11/2023 was the quarterly PASRR meeting mandated by the state. The PASRR Habilitation Coordinator stated it was the decided in the meeting that Resident #2 would benefit from occupational therapy services and the process was initiated for Resident #2 to be evaluated and the paperwork to be submitted by the facility for approval for funding by the PASRR service group for the therapy. She stated the team present in the meeting decided it would be beneficial for her to have a reason to get out of bed every day and have therapy to look forward to. The PASRR Habilitation Coordinator stated after the meeting took place and she put her notes into the system it was up to the facility to complete the process. During an interview on 10/04/2023 at 12:20 p.m., CNA C stated Resident #2 would benefit from getting therapy services because she liked to be the center of attention. CNA C stated Resident #2 needed people to encourage her and tell her she was doing a good job. CNA C stated therapy would have given Resident #2 a boost to her mood would have added to her quality of life. During an interview on 10/05/2023 at 12:25 p.m., the DON stated she agreed that Resident #2 receiving therapy services would have boosted her mood and quality of life. The DON stated everyone that does therapy loves it and has a good time doing it. The DON had no comment on the process of obtaining approval for PASRR approved therapy services. During an interview on 10/05/2023 at 12:45 p.m., the Administrator stated there had been no harm done to Resident #2 by not participating in therapy services. The Administrator stated Resident #2 came to her office daily and there had been no change in her demeanor, mood, or behavior. The Administrator stated any resident that needed therapy services should be afforded the right to participate in the service and being PASRR positive was no exception. Record review of the facility Resident Rights policy dated 12/01/2018 revealed .residents of Texas nursing facilities have all the rights, benefits, responsibilities, and privileges granted by the Constitution and laws of this state and the United States . they have the right to be free of interference, coercion, discrimination, and reprisal in exercising these rights as citizens of the United States . dignity and respect . have the right to be treated with dignity, courtesy, consideration, and respect . participate in activities inside and outside the facility . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 2 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to promote resident self-determination through support of family choice for 1 of 6 residents reviewed for resident rights. (Resident #1) The facility did not place Resident #1's tennis shoes on his feet daily per family requested. This failure could place dependent residents at risk for feelings of depression, lack self-determination and decreased quality of life. Findings included: Record review of a face sheet dated 10/03/23 revealed Resident #1 was [AGE] years old and was admitted on [DATE] with diagnoses including quadriplegia (paralysis of all four limbs), muscle spasms, and recurrent depressive disorders. Record review of the most recent MDS dated [DATE] indicated Resident #1 was rarely to never understood. The MDS indicated a BIMS was not conducted due to Resident #1 being rarely to never understood. The MDS indicated Resident #1 was totally dependent on staff for all ADLs including dressing. Record review of a care plan last revised on 05/31/23 indicated Resident #1 had a self-care deficit. There was an intervention that indicated Resident #1 was a total assist with dressing, grooming, hygiene, and bathing. The care plan indicated Resident #1 wished to have a representative involved in care decisions. Record review of nurse's notes from 9/22/23 to 10/03/23 did not indicate Resident #1 had refused to wear his tennis shoes daily. During an observation on 10/3/23 at 8:13 a.m. Resident #1 was resting in bed. There was a sign hanging on the window beside the resident's bed that indicated, 8-5-2023, Please turn (Resident #1's) feeding off from 2:00 pm til 4:00 p.m. daily. It's down time per the doctor. Please put his tennis shoes on during his down time for the 2 hours. We are trying to help prevent foot drop. Thank You. During an observation on 10/3/23 at 3:24 p.m., Resident #1 was resting in bed. The resident did not have on tennis shoes. He only had socks on his feet. The sign was still hanging beside the bed. During an interview on 10/03/23 at 5:05 p.m., a family member of Resident #1 said they wanted the resident to wear his tennis shoes between 2 p.m. and 4 p.m. The family member said they had placed the sign on the window requesting for his tennis shoes to be placed on him each day. She said he never had on his tennis shoes. During an observation on 10/4/23 at 2:20 p.m., Resident #1 resting bed. Feet propped up on a pillow. There were socks on his feet. He did not have on tennis shoes. The resident's feeding was disconnected and was on down time. During an observation on 10/4/23 at 3:15 p.m., Resident #1 resting in bed. Feet propped up on a pillow. There were socks on his feet. He did not have on tennis shoes. The resident's feeding was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 3 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 0561 disconnected and was on down time. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/04/23 at 3:44 p.m., CNA A said she had never noticed the sign hanging on the window requesting for Resident #1 to have his tennis shoes on from 2 p.m. to 4 p.m. She said she had never seen Resident #1 with tennis shoes on his feet. Residents Affected - Few During an interview on 10/05/23 at 8:40 a.m., CNA B said a family member did request for Resident #1 to have his tennis shoes on daily. She said there had been times when Resident #1 had shaken his head and did not want them on. She said Resident #1's refusals were not charted that she was aware of. During an interview on 10/5/2023 at 8:52 a.m., CNA C said she had never seen Resident #1 with his tennis shoes on and she was not aware his family wanted him to wear his tennis shoes. She said she normally did not take care of Resident #1. She said she just helped the aide that took care of him. During an interview on 10/5/2023 at 9:32 a.m., LVN D said she had not witnessed Resident #1 ever having on his tennis shoes and she had just noticed the sign on 10/5/23. During an interview 10/5/2023 at 10:33 a.m., the DON said she wished that nursing staff would put tennis shoes on Resident #1. She said Resident #1 did not like wearing the tennis shoes and refused to wear them. She said she would have expected any refusals to have been documented in the nurse's notes. During an interview on 10/05/23 at 11:50 a.m., the Administrator said she would want the family to better communicate that they wanted tennis shoes on Resident #1. She said she would want the family's preferences to be honored as long as they were safe for the resident. She said any refusals should have been documented in the nurse's progress notes. Review of a Resident Right's policy last revised on August 14, 2022 indicated, .The staff will abide by and protect resident rights in accordance with state and federal guidelines . Staff will abide by resident rights as outlined within CMS State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities (Rev. 11-22-17) . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 4 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed incorporate the recommendations from the PASRR level II determination and the PASRR evaluation report into a resident's assessment, care planning, and transitions of care for one out of one resident (Resident #2) reviewed for PASRR. The facility failed to submit NFSS forms timely for Resident #2. These failures could place residents identified at a Level II for PASRR Evaluation at risk for their specialized services not being provided in a timely manner. Findings include: 1. Record review of a face sheet dated10/03/2023 revealed Resident #2 was a [AGE] year-old female that admitted to the facility on [DATE] with the diagnoses of cerebral palsy (caused by abnormal brain development or damage to the developing brain that affects a person's ability to control his or her muscles), paranoid schizophrenia (stems from delusions-firmly held beliefs that persist despite evidence to the contrary-and hallucinations-seeing or hearing things that others do not), and muscle weakness. Record review of Resident #2's quarterly MDS dated [DATE] revealed Resident #2 had a BIMS of 99, which indicated Resident #2 was cognitively impaired. Resident # 2 required extensive assistance for locomotion, bed mobility, bathing, and dressing. The MDS indicated Resident #2 was usually understood and usually understood others. Record review of Resident #2's care plan dated 07/15/2023 stated Resident #2 was PASRR positive for the diagnosis of cerebral palsy and paranoid schizophrenia. Resident #2's ADL care plan indicated Resident #2 would have PT/OT evaluate and treat as needed to maintain or improve physical function. Record review of the habilitation service plan (HSP) dated 06/12/2023, revealed Resident #2 was recommended to receive occupational therapy 5 times per week for 6 months to increase Resident #2's independence and safety with dressing and bathing. The sign in sheet for the HSP, also dated 06/12/2023 indicated Resident #2, the PASRR Habilitation Coordinator, the social worker, the MDS Coordinator, and the Physical Therapy Assistant were present during the meeting and agreed on the recommendation. Record review on an email correspondence dated 08/15/2023 between the PASRR Unit Program Specialist and the Administrator revealed the facility was informed and instructed in writing to submit a NFSS Request by a specific deadline but failed to do so. Also, the NFSS Request submittal by the NF was denied and there was not a follow up submittal to ensure the request was approved to provide specialized services for PASRR for the resident. The instructions included the following : Be sure your facility checks the status of the requests daily to ensure they are approved. Prompt attention should be given to the request if it has a pending denial status once it is submitted. This is a time sensitive status and can result in system generated denial if not followed up on by date noted by the reviewer in the request. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 5 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of Simple LTC portal (portal used to submit PASRR service requests) for Resident #2's OT Assessment reflected a note, dated 08/11/2023, NFSS form for OT was not submitted within 30 calendar days of the IDT meeting and it was form was not accepted. During an interview on 10/04/2023 at 11:10 a.m., with the PASRR Habilitation Coordinator revealed the meeting on 06/11/2023 was the quarterly PASRR meeting mandated by the state. The PASRR Habilitation Coordinator stated it was decided in the meeting that Resident #2 would benefit from occupational therapy (OT) services and the process was initiated for Resident #2 to be evaluated and the paperwork to be submitted by the facility for approval for funding by the PASRR service group for the therapy. She stated the team present in the meeting decided it would be beneficial for her to have a reason to get out of bed every day and have therapy to look forward to. The PASRR Habilitation Coordinator stated after the meeting took place and she put her notes into the system it was up to the facility to complete the process. During an interview on 10/04/2023 at 11:55 a.m., the PASRR Unit Program Specialist, stated her emails to the facility were self-explanatory and the facility failed to comply with the emails she sent. She stated it was important to file the NFSS form within 30 days after the IDT meeting and failure to do so may result in a resident not receiving needed rehabilitative services and could contribute to a decline in functional status. During an interview with the MDS nurse 10/04/2023 at 2:00 pm, stated that she started she was unsure why the Simple LTC portal had not been checked daily to ensure Resident #2's OT request was followed up on. The MDS nurse stated it was important for the NFSS form to be completed 30 days after the IDT meeting. The MDS nurse stated that failure to submit the NFSS form within the timeframe may lead to residents not receiving services at the facility. During an interview with the DON on 10/05/2023 at 12:20 p.m., stated she was unfamiliar with the process of PASRR and left it to the corporate MDS nurse to assist in those matters. During an interview with the Administrator on 10/05/2023 at 1:40 p.m., stated she had received the emails from the PASRR specialist and a phone call. The Administrator stated the PASRR specialist called and said follow the instructions on the email and added no assistance with the process. The Administrator stated it was the right of Resident #2 to receive OT, but the Administrator did not feel Resident #2 had suffered any ill affect from having not received the services. Policy related to PASRR services was requested 10/05/2023 at 10:00 a.m. and 1:00 p.m. by the Administrator and no policy was provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 6 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 provide the necessary services to maintain personal hygiene for 1 of 6 residents reviewed for ADLs. (Resident #1) Residents Affected - Few The facility failed to provide incontinent care to keep Resident #1 clean and dry. The facility failed to provide scheduled baths/showers for Resident #1. These failures could place residents who required assistance from staff for ADLs at risk of not receiving care and services to meet their needs which could result in poor care, risk for skin breakdown, feelings of poor self-esteem, lack of dignity and health. Findings included: Record review of a face sheet dated 10/03/23 revealed Resident #1 was [AGE] years old and was admitted on [DATE] with diagnoses including quadriplegia (paralysis of all four limbs), muscle spasms, and recurrent depressive disorders. Record review of the most recent MDS dated [DATE] indicated Resident #1 was rarely to never understood. The MDS indicated a BIMS was not conducted due to Resident #1 being rarely to never understood. The MDS indicated Resident #1 was totally dependent on staff for all ADLs including toilet use and bathing. Record review of a care plan last revised on 05/31/23 indicated Resident #1 had a self-care deficit. There was an intervention that indicated Resident #1 was a total assist with dressing, grooming, hygiene, and bathing. There was an intervention to provide assistance with self-care as needed. The care plan indicated Resident #1 was at risk for problems with elimination. There was an intervention to check resident every 2 hours and assist with toileting as needed. Record review on nurse's notes from 9/01/23 to 10/03/23 did not indicate Resident #1 had refused care. Record review of ADL bathing documentation dated 9/2/223 - 10/03/23 indicated Resident #1 received a bath/shower on Wednesday 09/06/23, Monday 09/18/23, Wednesday 09/20/23, Friday 09/22/23, and Monday 09/25/23. There were no other baths/showers documented. During an interview on 10/3/23 at 4:20 p.m., Resident #1's family member said staff did not get Resident #1 up for his scheduled showers. The family member said they had to bathe him. She said the odor got bad at times. The family member said Resident #1 was often soaked with urine. She said staff do not keep him clean and dry. During an observation on 10/03/23 at 5:05 p.m., Resident #1 was in bed. Resident #1's brief was wet and yellow on the inside. There was a large damp area to the front of the Resident's gown. There was a pad under the resident. On the pad there was a large brown ring around the resident. The ring extended approximately 5 - 6 inches from the left side of the resident. During an interview on 10/04/23 at 3:44 p.m., CNA A said she worked the 2:00 p.m. to 10:00 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 7 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 - Few shift. She said there have been a couple of times she had come in on her shift and Resident #1 has been excessively wet and was soaked. She said Resident #1 was bathed by staff on the 6:00 a.m. to 2:00 p.m. shift. During an interview on 10/05/23 at 8:40 a.m., CNA B said Resident #1 was bathed on Mondays, Wednesdays, and Fridays. She said he did not miss his baths on the day she took care of him. She said she had come in on her shift and his whole bed was soaked. She said the pads were wringing wet. She said she has come in for her shift many, many times and Resident #1 would be soaking wet. She said she reported this to the Staffing Coordinator. During an interview on 10/05/23 at 9:19 a.m., the Staffing Coordinator said it had been reported to him one time that Resident #1 had been left wet. He said he talked to the CNA that was responsible and coached her. He said he told the CNA to check on Resident #1 more frequently. He said that was the only issue that has been reported to him. He said this was approximately two months ago. During an interview on 10/05/23 at 9:32 a.m., LVN D said she had not known Resident #1 to miss his baths/showers lately. She said she knew him to have missed baths a year ago or so. She said she had never witnessed him being saturated. She said the aides have told her that he had been saturated when they come in on their shift. During an interview on 10/05/23 at 10:50 a.m., the DON said the family liked for Resident #1 to not want him to actually have a brief on, only pulled up between his legs. She said he appeared to be fine and dry when you look at the front of his brief and the pad did not look wet. She said she feels he urinates out of the back of the brief. She said she felt like he was being changed appropriately but the way he is urinating soaks him. She said resident's not being changed timely and being left wet could cause skin issues and infection. She said the documentation did show Resident #1 only received 5 baths since September 1, 2023. She said she would expect him to be bathed on his scheduled days and for the bath to be documented on the ADL record. She said a resident not getting a bath could cause skin issues and infection. During an interview on 10/05/23 at 11:50 a.m., the Administrator said she would expect Resident #1 to have received all of his scheduled baths and the baths should be documented in the ADL documentation. She said good hygiene leads to better outcomes. She said she would expect Resident #1 to be kept clean and dry as much as possible. She said he needed to be changed and be kept clean and dry. She said urine did go everywhere because of how the family wants the brief placed on him. Review of Bathing facility policy dated January 12, 2018 and last revised on January 20, 2023 indicated, .Staff will provide bathing services for residents within standard practice guidelines .Record the procedure in the record .If the resident refuses to independently or allow staff to assist with bathing, document the refusal in the record . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 8 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to provide residents with limited range of motion appropriate treatment and services to increase range of motion and to prevent further decrease in range of motion for 1 of 5 residents reviewed for range of motion. (Resident #1) The facility did not provide restorative therapy for Resident #1's contractures. This failure could place residents who had contractures at risk of not attaining/or maintaining their highest level of physical, mental, and psychosocial well-being. Findings included: Record review of a face sheet dated 10/03/23 revealed Resident #1 was [AGE] years old and was admitted on [DATE] with diagnoses including quadriplegia (paralysis of all four limbs), muscle spasms, and recurrent depressive disorders. Record review of physician's orders dated 10/04/23 did not indicate an order for restorative therapy for Resident #1. Record review of the most recent MDS dated [DATE] indicated Resident #1 was rarely to never understood. The MDS indicated a BIMS was not conducted due to Resident #1 being rarely to never understood. The MDS indicated Resident #1 was totally dependent on staff for all ADLs. The MDS indicated Resident #1 had Range of Motion impairment to both side of the upper and lower extremities. Record review of a care plan last revised on 05/31/23 indicated Resident #1 had a self-care deficit. There was an intervention that indicated Resident #1 was a total assist with dressing, grooming, hygiene, and bathing. There was an intervention to provide assistance with self-care as needed. The care plan indicated Resident #1 had impaired mobility related to limited joint mobility. There were interventions for OT/PT (occupation therapy/physical therapy) screen and/or evaluation as needed. There was an intervention for RNA (restorative nurse aide) referral as needed. Record review of a Therapy Screen of Resident #1 and was dated 09/08/23 indicated, Recommendations-Restorative Nursing Services are indicated . This was signed by the Rehabilitation Therapy Manager. Record review of the electronic medical record access on 10/3/23, 10/04/23, and 10/05/23 did not indicated any restorative nursing documentation. During an interview on 10/04/23 at 10:50 a.m., the DON said there were no recent restorative notes for Resident #1. She said he had not been receiving restorative therapy because the therapy was not ordered. During an interview on 10/04/23 at 1:15 p.m., the Rehabilitation Therapy Manager said she has completed contracture screenings on Resident #1. She said she did not know if Restorative Therapy even required an order. She said she verbally tell the MDS Coordinator if she recommended someone for restorative therapy. She said the MDS Coordinator was over the Restorative Program. The Rehabilitation Therapy Manager said she had nothing to do with the Restorative Program and did not know how it worked. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 9 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 10/04/23 at 1:25 p.m., the MDS Coordinator said one of her responsibilities was the restorative program. She said she met once a week with the Rehabilitation Therapy Manager. She said this was when she was made aware of each recommendation. She said she then initiated the restorative services for the residents. She said she did not know the Rehabilitation Therapy Manager had made a recommendation for Resident #1. I guess we need to get a better system. She said a negative outcome would depend on each resident's current level of care. During an interview on 10/05/23 at 10:33 a.m., the DON said there was no documentation of Resident #1 receiving restorative therapy and he had not been receiving restorative therapy. She said someone not receiving recommended therapy could lead to a decrease in function. During an interview on 10/05/23 at 11:50 a.m., the Administrator said the therapist was supposed to notify herself and the MDS Coordinator of any recommendation made during Therapy Screens. She said herself and the MDS Coordinator were not made aware of his restorative therapy recommendation. She said it was not communicated in a meeting. She said a resident not receiving therapy could cause continued physical decline and could prevent them from maintain current function. Review of a Screening, Rehabilitation facility policy dated April, 2012 indicated, .the outcome of the screen may be to proceed with a physician's order to evaluate or that no additional rehabilitation services are required at that time . An article titled Contractures and Splinting, https://www.advanced-healthcare.com/wp-content/uploads/2011/07/August-2014-Inservice.pdf, dated August 2014 indicated, . Contractures - Joint movement is similar to the hinge on a door. Regularly moving the door keeps it working properly, so the door opens and closes easily. When the door isn't moved regularly, the hinge may rust from lack of use, making the door harder to open and close. Similarly, the structures in and around the joints stretch, flex, and move all day long keeping them functional. If the joint is not moved, it shrinks, becomes stiff, and loses the ability to stretch and move. This causes changes in fluids that lubricate the inside of the joint. Movement squeezes and pushes the fluid around, lubricating the joint. When a joint stops moving, so does the fluid. Now both the outside and inside of the joint are immobile. Contractures are joint deformities caused by immobility. Keeping residents active and moving is the best way to prevent contractures . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 10 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 respiratory care was provided consistent with professional standards of practice for 1 of 7 residents reviewed for respiratory care. (Resident #1) Residents Affected - Few The facility failed to ensure Resident #1's suction tip catheter (suction equipment used for oral suctioning) was properly stored. These failures could place residents at risk of respiratory complications or respiratory infection. Findings included: Record review of a face sheet dated 10/03/23 revealed Resident #1 was [AGE] years old and was admitted on [DATE] with diagnoses including quadriplegia (paralysis of all four limbs), muscle spasms, and recurrent depressive disorders. Record review of physician's orders dated 10/04/23 did not indicate an order for restorative therapy for Resident #1. Record review of the most recent MDS dated [DATE] indicated Resident #1 was rarely to never understood. The MDS indicated a BIMS was not conducted due to Resident #1 being rarely to never understood. The MDS indicated Resident #1 was totally dependent on staff for all ADLs. Record review of a care plan last revised on 05/31/23 indicated Resident #1 had a self-care deficit. There was an intervention to provide assistance with self-care as needed. The care plan indicated Resident #1 had a breathing pattern problem related to increase secretions and risk of aspiration. There was an intervention to suction as needed for increased secretions. During an observation on 10/3/23 at 8:13 a.m., Resident #1 was resting in bed. The suction tip catheter was attached to the suction canister at bedside and was laying in floor. The suction tip catheter was under the bed touching the bed frame. During an observation on 10/3/23 at 9:21 a.m., Resident #1 was resting in bed. The suction tip catheter was attached to the suction canister at bedside and was laying in floor under the bed. During an observation on 10/3/23 at 11:15 a.m. Resident #1 was resting in bed. The suction tip catheter was attached to the suction canister at bedside and was laying in floor under the bedside table. The suction tip catheter was touching the frame of the bedside table. During an observation and interview on 10/3/23 beginning at 5:05 p.m., the suction tip catheter was on the floor beside the bed. The tubing was hanging over the bottom of the feeding pump pole and the tip was touching the floor. The other end of the tubing was attached to the suction canister at bedside. Resident #1's family member said the suction tip was always in the floor and they would have to pick it up and wash it before suctioning Resident #1. During an interview on 10/05/23 at 8:40 a.m., CNA B said she had to pick up Resident #1's suction (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 11 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 Residents Affected - Few equipment up off of the floor. She said it was in the floor all of the time. She said when she found it on the floor she just picked it up and washed it. During an interview on 10/05/23 at 10:50 a.m., the DON said suction equipment should be stored in a bag and kept off of the floor when not in use. She said staff should not be washing the suction tip and not reusing the tip. She said the tip should have been replaced after being found in the floor. She said a suction tip on the floor was contaminated. She said it could lead to infection and it was disgusting. A respiratory equipment storage policy was requested and was not received prior to exit. Review of a Resident General Equipment Cleaning facility policy last reviewed on February 20, 2023, indicated, .Resident's general equipment will be cleaned on a routine basis in accordance with manufacturer's specifications and guidelines .proper infection control methods will be utilized .General equipment may include .Respiratory equipment . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 12 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide pharmaceutical services including procedures that assure the accurate administering of all drugs and biologicals, to meet the needs of 1 of 7 residents reviewed for pharmacy services. (Resident #1) The facility failed administer all scheduled medications to Resident #1. This failure could place residents at risk for inaccurate drug administration and side effects from missed doses of medication. Findings included: Record review of a face sheet dated 10/03/23 revealed Resident #1 was [AGE] years old and was admitted on [DATE] with diagnoses including quadriplegia (paralysis of all four limbs), muscle spasms, and recurrent depressive disorders. Record review of physician's orders dated 10/04/23 indicated an order for Amlodipine (blood pressure medication) 5 milligram tablet, 1 tablet 1 time per day with a start date on 06/27/21. There was an order for Claritin (medication for allergy symptoms) 10 milligram tablet, 1 tablet 1 time per day with a start date of 05/08/23. There was an order Clonidine HCL (blood pressure medication) 0.1 milligram tablet, 1 time per day with a start date of 06/27/21. There was an order for Citalopram (used for depression) 10 milligram tablet, 1 time per day with a start date of 06/27/21. There was an order for Colace (stool softener) 100 milligram tablet 2 times per day with a start date of 11/01/22. There was an order for Cyclobenzaprine (treats pain and muscle stiffness) 5 milligram tablet every 8 hours with a start date of 11/01/22. There was an order for a multi vitamin, 1 tablet 1 time per day with a start date of 11/01/22. There was an order for Esomeprazole Magnesium (used to treat stomach and esophagus problems such as acid reflex, ulcer) 20 milligram, delayed release, 1 time per day with a start date of 06/27/21. There was an order for Fluticasone Propionate 50 micrograms/actuation nasal spray, 1 spray nasally 2 times per day with a start date of 05/08/23. There was an order for Levetiracetam (used to treat seizures) 100 milligrams/milliliters oral solution, 10 milliliters 2 times per day with a start date of 06/27/21. There was an order for Robitussin Cough-Chest Congestion DM 5 milligram/50 milligrams/5 milliliters every 6 hours with a start date of 11/01/22. Record review of the most recent MDS dated [DATE] indicated Resident #1 was rarely to never understood. The MDS indicated a BIMS was not conducted due to Resident #1 being rarely to never understood. The MDS indicated Resident #1 received an antidepressant. The MDS indicated Resident #1 had an active diagnosis of hypertension (high blood pressure), a seizure disorder or epilepsy, and depression. Record review of a care plan last revised on 05/31/23 indicated Resident #1 was prescribed an anti-convulsant - Levetiracetam (used to treat seizures) 100 milligrams/milliliters oral solution, 10 milliliters 2 times per day. There was an intervention to administer the medication as ordered. The care plan indicated the resident was prescribed an anti-depressant, Citalopram (used for depression) 10 milligram tablet, 1 time per day. There was an intervention to administer the medication as ordered. The care plan indicated the resident was prescribed anti-hypertensive medications, Amlodipine (blood pressure medication) 5 milligram tablet, 1 tablet 1 time per day and Clonidine HCL (blood pressure medication) 0.1 milligram tablet, 1 time per day. There was an intervention to administer the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 13 of 14 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 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reunion Plaza Senior Care and Rehabilitation Cente 1401 Hampton Rd Texarkana, TX 75503 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 medications as ordered. Level of Harm - Minimal harm or potential for actual harm Record review of an eMAR (electronic medication administration record) dated 07/01/23 - 07/31/23 indicated on 07/04/23, Amlodipine and Clonidine were not administered as ordered. On 07/05/23, Amlodipine, Citalopram, Claritin, Clonidine, Colace, Cyclobenzaprine, a multi-vitamin, Esomeprazole Magnesium, Fluticasone Propionate, Levetiracetam, and Robitussin Cough-Chest were not administered as ordered. On 07/08/23, 07/10/23, 07/13/23, 07/14/23, 07/18/23, 07/19/23, 07/20/23, 07/23/23, 07/24/23, 07/25/23 Resident #1 did not receive Amlodipine and Clonidine as ordered. On 07/28/23, Resident #1 did not receive Amlodipine and Clonidine as order. The eMAR indicated on 07/29/23, Resident #1 did not receive Clonidine, Colace, Robitussin Cough-Chest Congestion and Levetiracetam were not administered as ordered. Residents Affected - Few Record review of an eMAR dated 09/01/23 - 09/30/23 indicated on 9/10/23, Resident #1 did not receive Citalopram as ordered. The eMAR indicated on 09/18/23 and 09/26/23, Resident #1 did not receive Amlodipine and Clonidine as ordered. Record Review of Nurse's notes dated 07/01/23 - 09/30/2023 indicated on 07/28/23 a nurse's note read, Medication was administered outside of scheduled parameters, provider informed that resident medication was delayed . The note was signed by the DON. There were no further notes concerning delayed medication or medications that were not administered. During an interview on 10/3/23 at 4:20 p.m., a family member of Resident #1 said on 07/28/23 Resident #1 did not receive his medication as prescribed. During an interview on 10/03/23 at 5:05 p.m., a family member said Resident #1 had not always received his scheduled medications. The family member said they had found medications at the bedside. During an interview on 10/04/23 at 2:48 p.m., the DON said she did not know why Residents #1's medications were not given on time on 7/28/2023. She said she did not know what happened. She said for some reason the medications were delayed and the nurse practitioner was notified. During an interview on 10/5/2023 at 9:32 a.m., LVN D said document did indicate Resident #1 did miss several medications in July and September. She said if they were held for any reason there should be a nurse's note. She said the blood pressure medications may have been held due the resident's blood pressure or heart rate. She said, if it's not documented it's not done. During an interview on 10/5/23 at 10:33 a.m., the DON said according to the documentation for July and September it did appear Resident #1 did not receive all of his medications. She said that the blood pressure medicines were probably held because his vital signs. She said she would have expected if the medicine was being held because of the vital signs, this should be documented. She said residents' not receiving their medications could cause them to have high or low blood pressure. During an interview on 10/05/23 at 11:50 a.m., the Administrator said she would expect Resident #1 to get his scheduled medications as ordered. She said any negative outcome would depend on the medication such affecting blood pressure. Review of a Medications - Guidelines on Clinical Practice policy dated January 12, 2020 indicated, .Staff will provide medications in accordance with standard practice guidelines . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 14 of 14