Inspection·January 4, 2024

F 0558 Level of Harm - Minimal harm or potential for actual harm have their call lights, the residents might fall trying to reach for the call light or even try to get the remote by themselves. Without the call lights, the needs of the residents would not be addressed. CNA M went inside Resident #1's room, went to the left side of the bed, pulled the call light from behind the headboard, and placed on top of the bed. CNA M acknowledged he missed putting the call light near the resident after attending to his needs. Residents Affected - Some Interview with LVN S on 01/03/2024 at 9:18 AM, LVN S stated all the residents must have their call lights within reach. LVN S said the residents used their call lights to let the staff know they needed an assistance. LVN S said without the call lights, the staff would not know if the residents needed something, wanted to go to the bathroom, or was having any pain. LVN S added the residents might fall trying to get the call light or trying to get somebody to help them. LVN S added she had been educating the CNAs to make sure the call lights were with the resident before they leave the room. Resident #2 Review of Resident #2's Face Sheet dated 01/04/2024 reflected resident was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included contracture (tightening of the muscles) of right hand, contracture of left hand, and muscle wasting (Loss of muscle leading to its shrinking and weakening). Review of Resident #2's Quarterly MDS assessment dated [DATE] reflected resident had a severe cognitive impairment with a BIMS score of 03. Resident #2 required extensive assistance for bed mobility and limited assistance for transfer and eating. Review of Resident #2's Comprehensive Care Plan dated 10/14/2023 reflected resident was at risk for falls related to gait/balance problems and one of the interventions was to have a safe environment by having a working and reachable call light. Observation on 01/04/2023 at 8:17 AM revealed Resident #2's was laying on his bed sleeping. Resident #2's call light was noted hanging behind the side table located on the right side of the bed. Resident #3 Review of Resident #3's Face Sheet dated 01/04/2023 reflected resident was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included muscle wasting, lack of coordination, and generalized muscle weakness. Review of Resident #3's Quarterly MDS assessment dated [DATE] reflected resident was not able to complete the interview to determine the BIMS score. Resident #3 required extensive assistance for bed mobility, eating, and toilet use. Review of Resident #3's Comprehensive Care Plan dated 11/18/2023 reflected resident was at risk for falls related to gait/balance problems and one of the interventions was to ensure the call light was within reach and encourage the resident to use it for assistance. Observation and interview with Resident #3 on 01/04/2024 starting at 8:17 AM revealed Resident #3 was sitting on his wheelchair on the left side of his bed. Resident #3's call light was noted hanging behind the side table located on the left side of the bed. When asked where his call light was, the resident looked towards his bed and then shrugged his shoulders and shook his head. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675453 If continuation sheet Page 2 of 6 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 675453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Collinwood Nursing and Rehabilitation 3100 S Rigsbee Rd Plano, TX 75074 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 0558 Resident #4 Level of Harm - Minimal harm or potential for actual harm Review of Resident #4's Face Sheet dated 01/04/2024 reflected resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included unsteadiness on feet, lack of coordination, and repeated falls. Residents Affected - Some Review of Resident #4's Quarterly MDS assessment dated [DATE] reflected resident had a severe cognitive impairment with a BIMS score of 00. Resident #4 required extensive assistance for bed mobility, transfer, eating, and toilet use. Review of Resident #4's Comprehensive Care Plan dated 10/22/2023 reflected resident was at risk for falls related to muscle weakness and one of the interventions was to be sure the call light was within reach and encourage the resident to use it for assistance. The Comprehensive Care Plan also indicated had actual falls on 01/15/2023, 05/11/2023, 05/31/2023, and 07/29/2023. Observation and interview with Resident #4 on 01/04/2024 starting at 8:16 AM revealed Resident #4 was laying on her bed. She said she was waiting for her breakfast. Resident #4's call light was noted hanging behind the side table located on the right side of the bed. When asked where her call light was, Resident #4 stated her call light was hanging by the wall since last night. Resident #5 Review of Resident #5's Face Sheet dated 01/04/2024 reflected resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included monoplegia (paralysis restricted to one limb or region of the body) of upper limb following unspecified cerebrovascular disease (a group of conditions affecting the blood flow in the brain) affecting right dominant side and speech and language deficits following cerebral infarction (stroke). Review of Resident #5's Quarterly MDS assessment dated [DATE] reflected resident had a severe cognitive impairment with a BIMS score of 03. Resident #3 was dependent for transfer and toilet use and required extensive assistance for bed mobility. Review of Resident #5's Comprehensive Care Plan dated 12/14/2023 reflected resident was at risk for falls related to weakness, unsteady gait, history of Parkinson's disease and CVA (stroke) and one of the interventions was to ensure the call light was within reach and encourage the resident to use it for assistance. Observation on 01/04/2024 at 8:19 AM revealed Resident #5 was laying on her bed, awake. Resident #5's call light was noted hanging by wall where the resident could not reach it. Resident #5 was not interviewable due to language and speech deficit following cerebral infarction. Observation and interview with LVN E on 01/04/2024 starting at 8:32 AM, LVN E stated she was not aware Resident #2, 3, 4, and 5's call lights were not within their reach. She said she must had missed it when she made her morning round. LVN E said the call lights should always be within the reach of the residents at all times. LVN E said the call lights were used by the residents to call the attention of the staff if they needed something or if they needed help. LVN E added the call lights should be placed somewhere secured so that the call lights will not fall. She added if the call lights fell, the staff should place it back within reach of the residents. LVN E said without the call lights, the staff would not know if the residents needed something, wanted to go to the bathroom, or was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675453 If continuation sheet Page 3 of 6 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 675453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Collinwood Nursing and Rehabilitation 3100 S Rigsbee Rd Plano, TX 75074 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some having any pain. LVN E added the residents might fall trying to get the call light or trying to get somebody to help them. LVN E went inside Resident #2 and Resident #3's room and placed the call lights where the residents could reach it. LVN E then went to Resident #4's room and pulled the call light from behind the side table and secured it by Resident #4's pillow. LVN E then went to Resident #5 room and pulled the call light from behind the side table. LVN E said she would do her round to check on the call lights of the other residents. She added she would educate the staff to make sure the call lights were clipped near the resident. Interview with CNA A on 01/04/2024 at 9:01 AM, CNA A stated the call lights were important for the residents. The residents used their call lights to call the staff if they needed some assistance or if they needed the nurse because they were not feeling well. CNA A added if the residents did not have their call lights, the residents might be frustrated or mad because their needs were not met. CNA A further said the residents could fall in the process of getting the call light or getting the things they needed. CNA A said he would do round to check the call lights. Interview with the DON on 01/04/2024 at 9:59 AM, the DON stated the call lights must be always within the reach of the residents. The DON said the residents used the call lights if they needed help or to alert the staff they were not feeling well. The DON added a lot of things could happen if the call lights were not with the residents. She continued the residents might try to get up on their own and fall on the process. She added the staff will not be able to deal with the resident's needs during emergencies. The DON said the expectation was for the staff to make sure the call lights were within the reach of the residents. The DON said all the staff were responsible in placing the call lights within reach. The DON said she would make an audit of the call lights to make sure they were working and within the reach of the residents. She added she would do a scheduled rounds for two weeks and then randomly check if the staff were following the policy for call lights. Interview with the Administrator on 01/04/2024 at 12:31 PM, the Administrator stated the call lights should always be always within the reach of the residents. The Administrator said the call lights were part of the residents' voice. They used the call lights to say what they need or there was a medical emergency. The Administrator said a lot of things could happen if the call lights were far from the resident. She continued if the call lights were not within reach, the resident could fall, be injured, be unhappy, be frustrated, and the needs will not be met. She said the expectation was call lights be with the residents at all times. She said the staff, from top down should be educated on the importance of the call light for the residents. The Administrator said she would collaborate with the DON to make sure the call lights were being monitored. Record review of facility's policy Call Lights: Accessibility and Timely Response, rev. 12/01/2023 revealed Policy: . to assure the facility is adequately equipped with a call light at each resident's bedside . 1 . ensuring resident access to the call light. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675453 If continuation sheet Page 4 of 6 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 675453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Collinwood Nursing and Rehabilitation 3100 S Rigsbee Rd Plano, TX 75074 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to develop and implement a comprehensive person-centered care plan for two (Resident #3 and Resident #6) of four residents reviewed for Care Plans. The facility failed to ensure Resident #3, and Resident #6 were care planned for Hospice Care. This failure could place residents at risk for not receiving care and services to meet their needs, diminished function of health, and regressions in their overall health. Findings included: Resident #3 Review of Resident #3's Face Sheet dated 01/04/2024 reflected resident was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included muscle wasting (Loss of muscle leading to its shrinking and weakening), lack of coordination, and generalized muscle weakness. Review of Resident #3's Quarterly MDS assessment dated [DATE] reflected resident was not able to complete the interview to determine the BIMS score. Resident #3 required extensive assistance for bed mobility, eating, and toilet use. Review of Resident #3's Comprehensive Care Plan dated 11/18/2023 reflected no care plan for Hospice Care. Review of Resident #3's Physician's Order dated 02/10/2022 reflected Admit to . Hospice for palliative care Dx: BRAIN MASS . Resident #6 Review of Resident #6's Face Sheet dated 01/04/2024 reflected resident was a 72 -year-old female admitted on [DATE]. Relevant diagnoses included Parkinson's disease (movement disorder that causes tremor, stiffness, or slowing of movement) without dyskinesia (uncontrolled, involuntary movements of the face, arms, or legs), wedge compression fracture (break in the vertebrae) of second lumbar vertebra (bones in the lower back), and psychotic disorder with hallucinations (sensory experiences that appeared to be real) due to unknown physiological condition. Review of Resident #6's Quarterly MDS assessment dated [DATE] reflected resident was cognitively intact with a BIMS score of 14. Review of Resident #6's Comprehensive Care Plan dated 09/19/2023 reflected no plan of care for Hospice Care. Review of Resident #6's Progress Note dated 09/01/2023 reflected, Note Text: Resident evaluated by Hospice RN and admitted to . Hospice . palliative care Dx: Senile Degeneration of the brain (Parkinson) . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675453 If continuation sheet Page 5 of 6 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 675453 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Collinwood Nursing and Rehabilitation 3100 S Rigsbee Rd Plano, TX 75074 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview with Resident #6 on 01/04/2024 at 9:12 AM, Resident #6 stated she was on Hospice since September because her condition was not getting better. She said Hospice was taking good care of her. Interview with LVN E on 01/04/2024 at 9:43 AM, LVN E stated care plans were done and implemented to make sure that each resident will have an individualized care that would define the meaning of patient-centered care. LVN E said without the care plan, the current health status of the resident will not be addressed. If the medical issues were not addressed, the resident will not attain the quality of care appropriate for them. Observation and interview with the DON on 01/04/2024 starting at 9:59 AM, the DON stated that care planning was a team approach. The DON said the purpose of the care was for the care team to be on one page with regards to the care of the residents. The care plan was also a part of the residents' medical profile so the staff would have a correct and accurate documentation about the care of the residents. The DON said without a care plan, the current health issues would not be addressed and managed accordingly. The DON added it would be confusing for the staff what care to be given. The DON was advised that Resident #3 and Resident #6 did not have a care plan for Hospice Care. The DON turned on her laptop and checked the residents' care plan. The DON acknowledged the said residents did not have a care plan for Hospice Care. The DON said she was responsible for care planning acute changes of the residents and must have missed doing the care plan for Resident #3 and Resident #6. The DON concluded she would start to audit the care plans of the residents not just those receiving Hospice Care. Observation and Interview with the MDS nurse on 01/04/2024 starting at 10:51 AM, the MDS nurse stated the care plan was particularly important because was a proof that the residents were being cared for. The MDS Nurse said the care plan would contain the care needed by the residents, the equipment needed and provided, or the services needed and rendered. She said without the care plan, the medical issue of the residents will not have goals and interventions. She added without the proper interventions, the needed care will not be delivered. The MDS Nurse was advised Resident #3 and Resident #6 did not have a care plan for Hospice Care. She said resident in hospice should have a care plan for Hospice care. The MDS Nurse turned on her laptop, checked the residents care plan, and acknowledged the residents did not have a care plan for Hospice Care. The MDS Nurse started inputting the care plan for Hospice care for Resident #3 and Resident #6. Interview with the Administrator on 01/04/2024 at 12:31 PM, the Administrator said each resident must have a care plan to ensure that the needs of the residents were met. The Administrator stated that without a care plan, the resident would not have care needed and the direct care staff would not know what specific care the residents needed. The Administrator concluded that the expectation was every resident had a care plan with appropriate goal and interventions. She said she would collaborate with the DON to ensure that every issue of the residents are care planned. Record review of facility's policy, Care Plan - Interdisciplinary Plan of Care from Interim to Meeting, rev. March 2023 revealed Policy: The facility shall support that each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable . well-being . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675453 If continuation sheet Page 6 of 6