Health inspection·September 24, 2025

F 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Administrator said the callers reported Van Driver A was speeding, and changing lanes frequently. The Administrator said Van Driver A denied there was any previous incident of a resident falling on the van. During a telephone interview on 9/23/25 at 1:48 p.m. Van Driver A said he did not remember Resident #1 falling while on the van during transport. During an interview on 9/24/25 at 10:05 a.m. Resident #1 said she remembered falling out of the wheelchair when Van Driver A did not put the seatbelt on her during transportation to her dialysis appointment. She said he was coming around a corner or something, but he hit the brakes, and she slid out of the wheelchair. She said she hit the floor and the nurses at the dialysis clinic came on the van and got her off the van floor. She remembered the incident but could not provide a time frame. She said it may have been 4 or 5 months ago. Resident #1 said she hurt her foot. She said she did not tell anyone because the nurses at the dialysis clinic knew, so when she came back to the facility, she did not tell the facility nurses. She said her wheelchair did not fall or tilt over, she just slid out of the chair. Resident #1 said the wheelchair was still strapped down. During an interview on 9/24/25 at 10:50 a.m. the Clinical Coordinator/RN[ at the dialysis clinic said she remembered the incident when Resident#1 had fallen on the van. She said she looked, and they did not have any notes. She said she was not there and could not find any staff that were working today that were present when the incident happened. She said she remembered it was on a Saturday and between her and the staff that were at the clinic today, they thought it was about two months ago. The Clinical Coordinator said she was not there but remembered the staff talking about Resident #1 falling on the van and they had to go and pick her up off the van floor. Resident #2 Record review of Resident #2's face sheet indicated he was a [AGE] year-old male admitted to the facility on [DATE]. Record review of Resident #2's BIMS indicated he had moderate cognitive impairment with a BIMS score of 12. Record review of a grievance form dated 8/11/25 indicted Resident #2 said the Van Driver A needed to pay better attention to the road. The Resident complained the Driver was not paying attention to the road during transport. The resolution was the Administrator spoke to Van Driver A about his erratic, inattentive driving. Van Driver A was informed his undivided attention was required during driving for safety. Van Driver A was informed, we would not have another conversation about safe driving. Signed by the Administrator. Record review of Resident #2's Discharge Summary indicated he was discharged home on 8/27/25. During interview on 9/23/25 at 12:45 p.m. the Administrator said he received a complaint from Resident #2 about the way Van Driver A was driving. The Administrator said Resident #2 said Van Driver A appeared more interested in his drink than what he was doing while driving. The Administrator said he had counseled with Van Drive A about driving safely and having food in the van. He said Van Driver A had worked at the facility since 2019 and within the last few weeks he had gotten complaints about his driving. The Administrator said he had talked to Van Driver A and gave him a stern warning after Resident #2's complaints. Resident #3 Record review of Resident #3's face sheet indicated she was a [AGE] year-old female admitted to the facility on [DATE]. Record review of Resident #3's MDS dated [DATE] she was cognitively intact with a BIMS score of 15. She was ambulatory with a wheelchair. She was dependent on staff to come to a standing position from sitting in a chair. She was dependent on staff for transfer from bed to chair or chair to bed. Record review of Resident #3's care plan dated 9/24/25 indicated she was at risk for pain and discomfort related to being admitted with a hip fracture with hemorrhage and underlying arthritis. One of the interventions was to position for comfort. Record review of Resident #3's Weekly Skin Date report dated 9/10/25 at 4:00 p.m. indicated she had a skin tear to the left lateral hand and bruise to the left anterior forearm during fall on facility transport. Record review of Resident #3's nursing notes dated 9/10/25 at 5:07 p.m. indicated Resident #3 sustained an unwitnessed fall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 2 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some while in the facility van for an appointment. Neuro checks were initiated. The Resident initially complained of a headache at 7 out of 10 for pain but increased to 8 out of 10. The patent request to be evaluated at the local emergency room. Record review of Resident #3's hospital CT (medical imaging test) of the spine and CT of the head revealed no findings. Record review of Van Driver A's employee file indicted he began work as a van driver on 6/4/2019. He had in service sign in sheets for the mobility company (the company responsible for training on transportation) indicated he received training on 10/11/22, 7/16/23, 4/4/24, 10/11/24 and 7/8/25. A Personnel Action Form dated 9/10/25 indicated Van Driver A was terminated due to violation of company's transportation policy and procedures. Review of the facility Provider Investigation Report dated 9/12/25 indicated on 9/10/25 Resident # 3 was transported at 10:30 a.m. to an appointment. Van Driver A failed to secure Resident #3 during transport. The report indicated the facility put measures in place to fix the noncompliance. The facility obtained a statement from Van Driver A and he was suspended. The van equipment was checked for proper operation with no issues noted. Transport training was conducted for the backup driver (Van Driver B), the Administrator did ride along for skills verification with the backup driver. An onsite training was scheduled with the mobility company for 9/29/25 for a new driver and backup drivers. The van driver was terminated. An Ad-Hoc QAPI meeting was conducted on 9/10/25. A written statement by Van Driver A dated 9/10/25 stated: I was transporting Resident # 3 and I forgot to hook the right hook to her chair. I was in a hurry and just forgot. I pulled out on the access road and the chair tipped backwards. During a telephone interview on 9/23/35 at 1:48 p.m. Van Driver A said Resident # 3 fell out of the wheelchair to the floor while he was transporting her to an appointment on 9/10/25. He said he pulled over and parked. He said picked Resident # 3 off the floor. He said he then asked her if she wanted to go back to the facility or go to her appointment. He said Resident # 3 said she wanted to go to her appointment. He said he did not notify anyone at that time, he took her to her appointment. Van Driver A said he had never had an incident like that happen before, so he did what he thought best at the time. Van Driver A said when he arrived back to the facility with Resident # 3, he told the Administrator what had occurred. During an interview on 9/24/25 at 9:20 a.m. Administrator said Van Driver A was in- serviced by an outside company that did the training for the van safety and resident security. He said someone from the corporate office came and provided the training on the van and transportation once or twice a year. The Administrator said at the current time the Maintenance Director/ Van Driver B was the only person conducting transport. He said they did use two other outside transport services when needed to transport residents. He said they only used ride along staff if the doctor requested, the resident was confused, and/ or the family was unable to attend the appointment. He said Van Driver A was in- serviced on the facility policy to not move a resident if they fall and to notify staff if a fall occurred. He said Van Driver A had been educated at least yearly since he had been driving the van over the facility policies several times. During an interview on 9/24/24 at 10:15 a.m. Resident #3 said on 9/10/25 Van Driver A put her in the van and buckled her down as far as she knew. She said Van Driver A stopped and when he pulled off, the wheelchair went backward, and she fell to the floor. She said she was still in the wheelchair ; he had buckled the waist and shoulder belts. She said her head hit the wheelchair belt holder and she hurt her hand. Resident # 3 said Van Driver A picked her up off the floor, and he apologized. She said he asked if she wanted to go back to the facility or her appointment. She said she told him she wanted to go to her appointment. She said she was not sent to the ER until she got back to the facility that afternoon. Resident # 3 said her head was still hurting so they sent her out, but everything was fine. During an interview on 9/24/25 at 11:00 a.m. the DON said on 9/10/25 Resident # 3's skin (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 3 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some assessment showed she had a skin tear on left hand and bruise on her left forearm. She said the resident complained of head pain and was sent to the hospital. The DON said Van Driver A said he had never had anyone to fall on the van in the past and did not seem too concerned about the incident. She said he did not say much and did not provide much information. Corrective actions taken to correct the noncompliance on 9/10/25 through 9/12/25 included: Record review indicated an Ad-Hoc QAPI meeting was conducted on 9/10/25 with signatures of the Administrator, DON, ADON. Record review of the facility Transportation and Procedure policy indicated areas of how to secure the wheelchair for transport. If an emergency occurs and a resident fell during transport, call 911, for ambulance to transport the resident to the ER for evaluation. Do not move the resident or transport the resident yourself. Call the DON, ADON[ or Administrator. If they are not at the facility call cell phone numbers until you reach one of these individuals. If the resident sustains any injury other than a small skin tear or abrasion without a fall, still call 911 for transport to ER. Do not transport the resident yourself. If the resident sustains minor injuries while being transported to the appointment notify the physician office personnel of the injury on arrival. Transport drivers and passengers must always wear safety seat belts during transport. The training to be completed with all designated drivers, including PRN, by Administrator on policy and procedures on 9/11/25. Each driver would be provided with a copy of the policy and procedures related to safely securing residents, use of seatbelts, and emergency procedures. The training included a competency evaluation, transportation in-service. This training would be conducted with any newly hired drivers as part of the orientation process going forward. These training results will be kept in their files for future reference and verification of compliance. Record review of Van Driver B's mobility training record indicated he was in serviced on 7/6/23. Record review of Van Driver B's training record indicated he was trained on the facility Transportation Policy and Procedures for safety during transport and securing the chair on 9/10/25. He received the transportation monitoring on 9/11/25 and 9/12/25. The form indicated the driver was reviewed on his understating of the transportation policies, securing passengers, articulated the procedures for safely securing a passenger, how to handle a resident during an emergencies, injuries and emergency contacts. Record review of Van Driver B's Transportation monitoring form dated 9/12/25 indicated an understanding of transportation policy and procedures regarding safely securing passengers and emergency situations, property secure the passenger, drive articulate the procedures for safely, articulate the procedure on how to handle a resident during an emergency. The driver knew what he can and cannot do as it pertains to handling residents' injuries during transport. The driver knows who to notify in case of an emergency or resident injury. Record review of the facility Transportation Policy and Procedure Manual updated 4/1/20 and signed by the Administrator and Van Driver B on 9/10/25 contained information on: Driver requirements, vehicle lift safety, safety during transport, securing the chair, emergency procedures, use of seat belts, who can ride on transport, use of vehicle, safety maintenance checks, transport logbook, scheduling transports, standard items kept in vehicle, storage of resident property, transport vehicle paperwork, noise levels, food and beverages in vehicle, cleaning vehicle, safety responsibilities of the driver, transport safety program-defensive driving, policy and procedure acknowledgement form, transport driver job specific orientation, transport in-service, transport driver job description, and acknowledgment form and vehicle maintenance issues.‘ During an interview on 9/24/25 at 9:46 a.m. Van Driver B said he worked at the facility for 5 years. He said the corporate person completed the training on driving the van. He said he had the training to be an alternate driver on a few occasions over the past years. He said he was in- serviced on 9/10/25 again over the procedures on how to drive the van. He said he did not have to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675444 If continuation sheet Page 4 of 5 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/24/2025 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 0689 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete told not to move a resident if they fall. He said if he was walking down the hall and saw a resident on the floor, he knew not to move them. He said if a resident were to fall on the van, he was to make sure he was in a safe location and call 911. He would call EMS to pick them up and report to the facility immediately. Van Driver B said it was the general rule of the whole facility if you are not licensed you are not allowed to pick a resident up. He said if a resident fell a nurse had to assess them, before they were moved. He said part of the job as the van driver, was to take time and make sure the resident was secure prior to transport. During an interview on 9/24/25 at 12:20 p.m. Resident # 4 said she rode the van to dialysis three times weekly. She said she did not have any issues with Van Driver A or Van Driver B. During an interview on 9/24/25 at 12:21 p.m. Resident # 5 said he rode the van to dialysis three times weekly. He said he did not have any issues with Van Driver A or Van Driver B. During an observation on 9/24/25 at 12:25 p.m. of Van Driver B securing a resident in a wheelchair in the van. The facility van showed it was just wide enough for one wheelchair. Observation revealed the back tie downs could be connected on the back of the van. However, to connect the front wheelchair tiedowns you had to stand on the ground with the door opened and buckle them from the outside of the van. Observation of Van Driver B showed he connected the resident wheelchair tiedowns on all four wheels of the wheelchair. He strapped the seat belts over the shoulder and around the waist of the resident. Once the resident was secured, he released the brakes of the wheelchair and tried to move the wheelchair from side to side and back and forth. He said that was an extra precaution to check and make sure the resident was secured. He then relocked the breaks. Observation of the right wheel of the wheelchair not tied down showed the wheelchair would only move to the right about 2 to 4 inches when tilted backward. Observations indicated for the wheelchair to fall backward both the right and the left wheelchair tiedowns would need to be unsecured. During an interview on 9/24/25 at 12:50 p.m. the Administrator said he felt they did the right thing by terminating Van Driver A. They had the company coming on 9/29/25 to train the new staff member on driving the van. He said the company was supposed to come on 9/22/25 but they got their times crossed up somehow. He said the new driver, Van Driver B, and himself as a backup driver would be given the training for safe and secure transportation of residents. He said they were already trained on the facility policy for transportation of residents and would be trained again as part of the company training procedures. On 9/24/25 at 3:50 p.m. the Administrator, DON, ADON, and MDS coordinator were informed of the PNC IJ verbally and emailed the IJ template. Event ID: Facility ID: 675444 If continuation sheet Page 5 of 5