Health inspection·September 26, 2023

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, used an assistive device, was encouraged to use call light system if she needed to get out of bed, and frequently checked on during rounds. Review of Resident #1's fall risk evaluation, dated 09/13/2023 at 2:00 AM, reflected she had a fall on 09/13/2023, fell in the last 90 days one or two times, did not have a fall anytime in the last month prior to admission, took narcotics, never could recall memory, had adequate vision patterns, was totally incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, strayed off the straight path of walking, and was unable to independently come to a standing position. Review of Resident #1's fall risk evaluation, dated 09/13/2023 10:24 PM, reflected she had another fall on 09/13/2023, multiple falls in the last 90 days, did not have a fall anytime in the last month prior to admission, took narcotics, never could recall memory, had adequate vision patterns, was totally incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, and was unable to independently come to a standing position. Review of Resident #1's fall risk evaluation, dated 09/24/2023, reflected it was blank. Review of Resident #1's progress notes reflected the following: 09/09/2023 11:40 PM Nurse's Note: Summoned to res. room by CNA. Upon entering room, noted res. kneeling on the floor next to her bed on the window side. Res. asked by this writer why did she get out of bed. Res. stated, I don't know. Res. assess res. for injury. Noted redness to her knees. No other visible injury noted at time of initial examination after fall. Res. denied any pain or discomfort at that time. Res. was not able to say if she hit her head. Neuro. assessment initiated per facility protocol. Res. assisted to bed X 2 assist. Noted res. incont. of urine. Incont. care provided by staff. Safety mat on floor at time of fall but was on the other side of bed. Bed was in lowest position and call light was in reach at time of fall. Discussed and educated res. to call light system and the importance of using call light and waiting for staff to come and help her if she needed to get out of bed. Notified family and DON of fall. Notified on call NP of fall and received PRN pain medication order for Tylenol after family member came into facility and stated that Resident #1her mother had a headache and back pain. 09/11/2023 3:14 PM Nurse's Note: No injury noted from fall. Neuro checks within normal limits and no distress noted. 09/13/2023 2:15 AM Nurse's Note: Resident was observed on the fall mat by CNA while doing rounds on the hall. Range of motion X4 extremities with no pain or discomfort. Vitals within normal limits. No injuries noted upon skin assessment. Resident assisted back into bed with no complaints. After 15 minutes resident was placed in wheelchair at the nurse's station due to her continuing to try to get up. 09/23/2023 2:53 PM Nurse's Note: Resident came out of the dining room and another staff stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 2 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 she had a skin tear Level of Harm - Minimal harm or potential for actual harm approx. 3cm cleaned with normal saline applied steri strips. Family member, DON, and NP notified. 09/23/2023 10:42 PM Nurse's Note: Small skin tear to top of left hand. Clean, dry. Will continue to monitor. Residents Affected - Some Review of Resident #2's face sheet, dated 09/26/2023, reflected a [AGE] year-old woman who was admitted to the facility on [DATE] with diagnoses including Parkinson's disease, unspecified asthma, recurrent unspecified major depressive disorder, anxiety disorder, unspecified sleep apnea, essential (primary) hypertension (high blood pressure), unspecified atrial fibrillation (an irregular heart rhythm), generalized muscle weakness, and unspecified lack of coordination. Review of Resident #2's quarterly MDS assessment, dated 08/24/2023, reflected a BIMS score of 12, indicating moderate cognitive impairment. Resident #2 was occasionally incontinent with urinary continence and always continent with bowel continence. Resident #2 had no falls since admission. Resident #2 required limited assistance of one person with bed mobility and transfers, extensive assistance of one person with dressing and toilet use, supervision of one person with personal hygiene, and physical help with bathing. Review of Resident #2's care plans reflected her last comprehensive person-centered care plan was completed on 05/23/2023. Resident #2 also had a comprehensive person-centered care plan started on 08/22/2023 with no completion date. During an interview on 09/26/2023 at 11:05 AM, the DON stated residents' care plans were updated a day after the facility's morning meeting. The DON stated staff were still adjusting Resident #1's care plan. The DON stated residents' baseline care plan were to be completed within 48 hours of the residents' admission. The DON stated she was not sure when residents' comprehensive care plans were to be completed. The DON stated the MDS Coordinator was responsible for preparing residents' comprehensive care plans. During an interview on 09/26/2023 at 11:16 AM, the MDS Coordinator stated she was responsible for completing residents' care plans. The MDS Coordinator stated she was behind on completing some residents' care plans because she recently got access to the system and completed training. The MDS Coordinator stated care plans were to be completed every quarter or whenever a resident had a significant change of condition. The MDS Coordinator stated the former MDS Coordinator was assisting her with completing residents' care plans. The MDS Coordinator stated residents whose care plans she was behind on completing included Resident #1 and #2. Review of the facility's incident log from 06/01/2023 through 09/26/2023 reflected Resident #1 had a fall on 09/09/2023 at 11:40 PM, 09/13/2023 at 2:00 AM and 10:02 PM, and 09/24/2023 at 6:00 PM. Review of the facility's comprehensive person-centered care plans policy and procedure, dated March 2022, reflected the following: Policy Statement: A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 3 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 Policy Interpretation and Implementation: Level of Harm - Minimal harm or potential for actual harm 2. The comprehensive, person-centered care plan is developed within seven days of the completion of the required MDS assessment (Admission, Annual or Significant Change in Status), and no more than 21 days after admission. Residents Affected - Some 7. The comprehensive, person-centered care plan: a. includes measurable objectives and timeframes; b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being, including: Review of the facility's care planning interdisciplinary team policy and procedure, dated March 2022, reflected the following: Policy Statement: The interdisciplinary team is responsible for the development of resident care plans. Policy Interpretation and Implementation: 11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change. 12. The interdisciplinary team reviews and updates the care plan. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 4 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that each resident received treatment and care in accordance with professional standards of practice for 1 of 7 residents (Resident #1) reviewed for quality of care in that: Residents Affected - Some Staff did not monitor, assess, and document neurological checks on Resident #1 after her falls on 09/09/2023, 09/13/2023, and 09/24/2023. This failure could place residents at risk of pain, mental anguish, emotional distress, physical harm, diminished quality of life, and death. Findings included: Review of Resident #1's face sheet, dated 09/26/2023, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including unspecified cerebral infarction (stroke), dysarthria (difficulty speaking because the muscles for speech are weak), essential (primary) hypertension (high blood pressure), obstructive sleep apnea, and age-related physical debility. Review of Resident #1's five-day MDS assessment, dated 09/13/2023, reflected a BIMS score of 7, indicating severe cognitive impairment. Resident #1 was also always incontinent with urinary continence and frequently incontinent with bowel continence. Resident #1 had falls since admission, two falls in which she sustained no injury and one fall in which she sustained a minor injury. Resident #1 required extensive assistance of one person with bed mobility, transfers, dressing, toilet use, and personal hygiene and physical help with bathing. Review of Resident #1's baseline care plan, undated, reflected no information addressing Resident #1's falls. Resident #1 also did not have a comprehensive person-centered care plan. Review of Resident #1's fall risk evaluation, dated 09/09/2023, reflected she had a fall on 09/09/2023, fell in the last 90 days one or two times, did not have a fall anytime in the last month prior to admission, took diuretics, nonsteroidal anti-inflammatory drugs, narcotics and sedatives/hypnotics more than three times a week, sometimes could recall memory, had adequate vision patterns, was frequently incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, used an assistive device, was encouraged to use call light system if she needed to get out of bed, and frequently checked on during rounds. Review of Resident #1's neurological assessments, dated 09/09/2023 at 11:40 PM, reflected staff completed assessments on 09/09/2023 at 11:40 PM and 11:55 PM, 09/10/2023 at 12:10 AM, 12:25 AM, 12:55 AM, 1:25 AM, 1:55 AM, 2:25 AM, 3:25 AM, 4:25 AM, 5:25 AM, 6:25 AM, 8:25 AM, 10:25 AM, 12:25 PM and 2:25 PM, 09/11/2023 4:00 AM, 12:00 PM and 7:00 PM, and 09/12/2023 at 12:00 AM. Staff completed an assessment and did not check Resident #1's vitals on 09/11/2023 at 12:00 AM. There were also three blank assessments for the 8-hour 4th, 5th, and 6th check. Review of Resident #1's fall risk evaluation, dated 09/13/2023 at 2:00 AM, reflected she had a fall on 09/13/2023, fell in the last 90 days one or two times, did not have a fall anytime in the last (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 5 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 0684 Level of Harm - Minimal harm or potential for actual harm month prior to admission, took narcotics, never could recall memory, had adequate vision patterns, was totally incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, strayed off the straight path of walking, and was unable to independently come to a standing position. Residents Affected - Some Review of Resident #1's neurological assessments, dated 09/13/2023 at 2:00 AM, reflected staff completed assessments on 09/13/23 at 2:15 AM, 2:30 AM, 3:00 AM, 3:30 AM, 4:00 AM, 4:30 AM, 5:00 AM, 7:00 AM, 8:00 AM, 11:00 AM, 2:00 PM, 3:00 PM and 6:00 PM. Staff completed assessments and did not check Resident #1's vitals on 09/13/2023 at 2:45 AM, 6:00 AM, 9:00 AM and 10:00 PM. There were also blank assessments for the 4 hour 2nd check, 8 hour 1st, 2nd, 3rd, 4th, 5th, and 6th check. Review of Resident #1's fall risk evaluation, dated 09/13/2023 10:24 PM, reflected she had another fall on 09/13/2023, multiple falls in the last 90 days, did not have a fall anytime in the last month prior to admission, took narcotics, never could recall memory, had adequate vision patterns, was totally incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, and was unable to independently come to a standing position . Review of Resident #1's neurological assessments, dated 09/13/2023 at 10:15 PM, reflected staff completed assessments on 09/13/2023 at 10:15 PM, 10:30 PM, 10:45 PM, 11:00 PM and 11:30 PM, 09/14/2023 at 12:30 AM, 1:00 AM, 2:00 AM, 4:00 AM, 5:00 AM, 5:00 PM, 9:00 PM and 11:00 PM, and 09/15/2023 at 11:00 AM. Staff completed assessments and did not check Resident #1's vitals on 09/14/2023 at 12:00 AM and 3:00 AM and 09/15/2023 at 1:00 AM and 6:00 AM. There were also blank assessments for the 8 hour 1st, 2nd, 3rd, 4th, 5th, and 6th check. Review of Resident #1's fall risk evaluation, dated 09/24/2023, reflected it was blank. Review of Resident #1's neurological assessments, dated 09/24/2023 at 6:26 PM, reflected staff completed assessments on 09/24/2023 at 6:00 PM. Staff completed assessments and did not check Resident #1's vitals on 09/24/2023 at 6:45 PM, 7:00 PM and 9:00 PM, 09/25/2023 at 6:30 AM and 12:00 AM, and 09/26/2023 at 12:00 AM. There were also blank assessments for the 15 minute 4th check, 30 minute 3rd check, 60 minute 3rd and 4th check, 2 hour 1st, 2nd and 3rd check, and 8 hour 2nd, 3rd, 4th, 5th and 6th check. There were also incomplete assessments for the 30 minute 1st, 2nd and 4th check, 60 minute 1st check, and 4 hour 2nd check. Review of Resident #1's progress notes reflected the following: 09/09/2023 11:40 PM Nurse's Note: Summoned to res. room by CNA. Upon entering room, noted res. kneeling on the floor next to her bed on the window side. Res. asked by this writer why did she get out of bed. Res. stated I don't know. Res. assess res. for injury. Noted redness to her knees. No other visible injury noted at time of initial examination after fall. Res. denied any pain or discomfort at that time. Res. was not able to say if she hit her head. Neuro. assessment initiated per facility protocol. Res. assisted to bed X 2 assist. Noted res. incont. of urine. Incont. care provided by staff. Safety mat on floor at time of fall but was on the other side of bed. Bed was in lowest position and call light was in reach at time of fall. Discussed and educated res. to call light system and the importance of using call light and waiting for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 6 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some staff to come and help her if she needed to get out of bed. Notified family and DON of fall. Notified on call NP of fall and received PRN pain medication order for Tylenol after family member came into facility and stated that Resident #1had a headache and back pain. 09/11/2023 3:14 PM Nurse's Note: No injury noted from fall. Neuro checks within normal limits and no distress noted. 09/13/2023 2:15 AM Nurse's Note: Resident was observed on the fall mat by CNA while doing rounds on the hall. Range of motion X4 extremities with no pain or discomfort. Vitals within normal limits. No injuries noted upon skin assessment. Resident assisted back into bed with no complaints. After 15 minutes resident was placed in wheelchair at the nurse's station due to her continuing to try to get up. 09/23/2023 2:53 PM Nurse's Note: Resident came out of the dining room and another staff stated that she had a skin tear approx. 3cm cleaned with normal saline applied steri strips. Family member, DON, and NP notified. 09/23/2023 10:42 PM Nurse's Note: Small skin tear to top of left hand. Clean, dry. Will continue to monitor. During an interview on 09/26/2023 at 11:05 AM, the DON stated she usually checked the neurological assessments during the facility's morning meetings. The DON stated if a resident's neurological status was fine and there was no evidence of head injury, then staff could stop conducting neurological checks at the 8-hour check increments. The DON stated residents could be negatively affected if staff did not complete neurological assessments on them after a fall. The DON stated her and the ADON were responsible for checking the neurological assessments. The DON stated charge nurses and LVNs were responsible for conducting and completing the neurological assessments on residents. During an interview on 09/26/2023 at 11:16 AM, the MDS Coordinator stated Resident #1 had falls since admission. The MDS Coordinator stated Resident #1 did not retain the education given by staff, was impulsive, and her family refused to allow staff to install a fall mat at bedside. During an interview on 09/26/2023 at 11:45 AM, CNA A stated she was trained and in-serviced on resident rights, neglect, and call lights. CNA A stated she was not trained on falls. CNA A stated in-services were given on an as needed basis. CNA A stated if she observed a resident on the ground, she was trained to stay with the resident and notify a nurse. CNA A stated nurses neurologically assessed residents and documented the assessments on a log. During an interview on 09/26/2023 at 11:51 AM, LVN A stated she was trained and in-serviced on resident rights, neglect, call lights and falls. LVN A stated in-services were given on an as needed basis. LVN A stated if she observed a resident on the ground, she was trained to assess the resident, check the resident's vitals, and make sure the resident was safe. LVN A stated she documented assessments in a fall risk management program. LVN A stated neurological assessments were completed for 72 hours following a resident's fall. LVN A stated nurses completed neurological assessments. LVN A stated the ADON checked neurological assessments to make sure they were completed. LVN A stated she observed a nurse miss completing a neurological assessment in the past. LVN A stated residents could be negatively affected if staff did not complete neurological assessments. LVN A stated residents who were at risk for falls were placed within staff's eyesight so staff can monitor them. LVN stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 7 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 0684 residents were educated on falls. Level of Harm - Minimal harm or potential for actual harm During an interview on 09/26/2023 at 12:23 PM, CNA B stated she was trained and in-serviced on falls, neglect, resident rights, and call lights. CNA B stated in-services were given on an as needed basis. CNA B stated if she observed a resident on the ground, she was trained to get assistance and not to touch or pick up the resident until a nurse assessed the resident. CNA B stated nurses completed neurological assessments. Residents Affected - Some During an interview on 09/26/2023 at 12:34 PM, LVN B stated he was trained and in-serviced periodically on resident rights, neglect, call lights, and falls. LVN B stated in-services were given monthly and on an as needed basis. LVN B stated if he observed a resident on the ground, he was trained to call for assistance, assess the resident for external injuries, check the resident's range of motion, check the resident's vitals, and move the resident to a safer location. LVN B stated he would also notify all appropriate parties. LVN B stated neurological assessments were started on a resident if the resident's fall was unknown or they hit their head. LVN B stated neurological assessments were completed for the next 72 hours after a resident fell. LVN B stated neurological assessments were documented in a resident's electronic health records. LVN B stated CNAs checked residents' vital signs. LVN B stated he never seen neurological assessments not completed by staff. LVN B stated a resident's electronic health record did not alert staff when to conduct and document the next neurological assessment. LVN B stated residents could possibly be negatively affected if staff did not complete neurological assessments because residents' signs and symptoms could go missed. LVN B stated DON and ADON checked neurological assessments. LVN B stated he was not sure if there were interventions implemented after Resident #1's fall. LVN B stated Resident #1 would try to self-ambulate. LVN B stated whenever Resident #1 attempted to self-ambulate, he would redirect her to her wheelchair. LVN B stated he was not sure if Resident #1 was educated on falls and reminded to use her call light. LVN B stated he reminded Resident #1 to use her call light. During an interview on 09/26/2023 at 1:22 PM, the DON stated Resident #1's falls took place mostly in the evening and night. The DON stated Resident #1 was checked on every hour. The DON stated she was not informed about staff watching over Resident #1 at the nursing station. Review of the facility's risk management log reflected staff logged Resident #1's falls on 09/09/2023 at 11:40 PM, 09/13/2023 at 2:00 AM, and 09/13/2023 at 11:02 PM. Review of the facility's incident log from 06/01/2023 through 09/26/2023 reflected Resident #1 had a fall on 09/09/2023 at 11:40 PM, 09/13/2023 at 2:00 AM and 10:02 PM, and 09/24/2023 at 6:00 PM. Review of the facility's in-services from June 2023 through September 2023 reflected staff were not trained on falls and neurological checks. Review of the facility's neurological assessment policy and procedure, dated October 2010, reflected the following: Purpose: The purpose of this procedure is to provide guidelines for a neurological assessment: 1) upon physician order; 2) when following an unwitnessed fall; 3) subsequent to a fall with a suspected head injury; or 4) when indicated by resident condition. General Guidelines: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 8 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 0684 1. Neurological assessments are indicated: Level of Harm - Minimal harm or potential for actual harm a. Upon physician order; b. Following an unwitnessed fall; Residents Affected - Some c. Following a fall or other accident/injury involving head trauma; or d. When indicated by resident's condition. 2. When assessing neurological status, always include frequent vital signs. Particular attention should be paid to widening pulse pressure (difference between systolic and diastolic pressures). This may be indicative of increasing intracranial pressure. Steps in the Procedure: 3. Perform neurological checks with the frequency as ordered or per falls protocol. 4. Determine resident's orientation to time, place and person. 5. Observe resident's patterns of speech and speech clarity. 6. Take temperature, pulse, respirations, blood pressure. 7. Check pupil reaction. 8. Determine motor ability. 9. Determine sensation in extremities. 12. Check eye opening, verbal, and motor responses. 13. Reposition the bed covers. Make the resident comfortable. 14. Place the call light within easy reach of the resident. Documentation: The following information should be recorded in the resident's medical record: 1. The date and time the procedure was performed. 2. The name and title of the individuals who performed the procedure. 3. All assessment data obtained during the procedure. 6. The signature and title of the person recording the data. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 9 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record reviews, the facility failed to ensure the resident environment remained free of accidents and hazards and each resident received adequate supervision and assistance devices to prevent accidents for 1 of 7 residents (Resident #1) reviewed for accidents and hazards in that: The facility failed to supervise Resident #1, who fell once on 09/09/2023, twice on 09/13/2023, and once on 09/24/2023. This failure could place residents at risk for further falls, pain, and/or injury. Findings included: Review of Resident #1's face sheet, dated 09/26/2023, reflected a [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including unspecified cerebral infarction (stroke), dysarthria (difficulty speaking because the muscles for speech are weak), essential (primary) hypertension (high blood pressure), obstructive sleep apnea, and age-related physical debility. Review of Resident #1's five-day MDS assessment, dated 09/13/2023, reflected a BIMS score of 7, indicating severe cognitive impairment. Resident #1 was also always incontinent with urinary continence and frequently incontinent with bowel continence. Resident #1 had falls since admission, two falls in which she sustained no injury and one fall in which she sustained a minor injury. Resident #1 required extensive assistance of one person with bed mobility, transfers, dressing, toilet use, and personal hygiene and physical help with bathing. Review of Resident #1's baseline care plan, undated, reflected no information addressing Resident #1's falls. Resident #1 also did not have a comprehensive person-centered care plan. Review of Resident #1's fall risk evaluation, dated 09/09/2023, reflected she had a fall on 09/09/2023, fell in the last 90 days one or two times, did not have a fall anytime in the last month prior to admission, took diuretics, nonsteroidal anti-inflammatory drugs, narcotics and sedatives/hypnotics more than three times a week, sometimes could recall memory, had adequate vision patterns, was frequently incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, used an assistive device, was encouraged to use call light system if she needed to get out of bed, and frequently checked on during rounds. Review of Resident #1's fall risk evaluation, dated 09/13/2023 at 2:00 AM, reflected she had a fall on 09/13/2023, fell in the last 90 days one or two times, did not have a fall anytime in the last month prior to admission, took narcotics, never could recall memory, had adequate vision patterns, was totally incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, strayed off the straight path of walking, and was unable to independently come to a standing position. Review of Resident #1's fall risk evaluation, dated 09/13/2023 10:24 PM, reflected she had another (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 10 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 - Minimal harm or potential for actual harm Residents Affected - Some fall on 09/13/2023, multiple falls in the last 90 days, did not have a fall anytime in the last month prior to admission, took narcotics, never could recall memory, had adequate vision patterns, was totally incontinent in the last 14 days, did not exhibit agitated behaviors in the last seven days, exhibited loss of balance while standing, was confined to a chair and disoriented, had no drop in systolic blood pressure, required hands-on assistance to move from place to place, and was unable to independently come to a standing position . Review of Resident #1's fall risk evaluation, dated 09/24/2023, reflected it was blank. Review of Resident #1's progress notes reflected the following: 09/09/2023 11:40 PM Nurse's Note: Summoned to res. room by CNA. Upon entering room, noted res. kneeling on the floor next to her bed on the window side. Res. asked by this writer why did she get out of bed. Res. stated, I don't know. Res. assess res. for injury. Noted redness to her knees. No other visible injury noted at time of initial examination after fall. Res. denied any pain or discomfort at that time. Res. was not able to say if she hit her head. Neuro. assessment initiated per facility protocol. Res. assisted to bed X 2 assist. Noted res. incont. of urine. Incont. care provided by staff. Safety mat on floor at time of fall but was on the other side of bed. Bed was in lowest position and call light was in reach at time of fall. Discussed and educated res. to call light system and the importance of using call light and waiting for staff to come and help her if she needed to get out of bed. Notified family (daughter) and DON of fall. Notified on call NP of fall and received PRN pain medication order for Tylenol after daughter came into facility and stated that her mother had a headache and back pain. 09/11/2023 3:14 PM Nurse's Note: No injury noted from fall. Neuro checks within normal limits and no distress noted. 09/13/2023 2:15 AM Nurse's Note: Resident was observed on the fall mat by CNA while doing rounds on the hall. Range of motion X4 extremities with no pain or discomfort. Vitals within normal limits. No injuries noted upon skin assessment. Resident assisted back into bed with no complaints. After 15 minutes resident was placed in wheelchair at the nurse's station due to her continuing to try to get up. 09/23/2023 2:53 PM Nurse's Note: Resident came out of the dining room and another staff stated that she had a skin tear approx. 3cm cleaned with normal saline applied steri strips. daughter, DON, and NP notified. 09/23/2023 10:42 PM Nurse's Note: Small skin tear to top of left hand. Clean, dry. Will continue to monitor. During an interview on 09/26/2023 at 11:05 AM, the DON stated after Resident #1's fall on 09/24/2023, staff started to toilet her before and after meals. During an observation and interview on 09/26/2023 at 11:31 AM, Resident #1 was sitting in her wheelchair in her room. Resident #1 had a call light sitting on top of her lowered bed. R esident #1 had a bandage on her left hand. Resident #1 stated she hurt her hand when she was lifting her hand and banged it on the bottom of a table. Resident #1 could not recall any of her falls at the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 11 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 - Minimal harm or potential for actual harm Residents Affected - Some Resident #1 stated her family was concerned about staff not knowing if she fell in the bathroom because she fell off the toilet in the past without staff present. Resident #1 stated she was independent getting in and out of bed and was not supposed to get help from staff with transfers. Resident #1 also stated staff never educated her on safe transfers. During an interview on 09/26/2023 at 11:45 AM, CNA A stated she was trained and in-serviced on resident rights, neglect, and call lights. CNA A stated she was not trained on falls. CNA A stated in-services were given on an as needed basis. CNA A stated if she observed a resident on the ground, she was trained to stay with the resident and notify a nurse. CNA A stated nurses neurologically assessed residents and documented the assessments on a log. During an interview on 09/26/2023 at 11:51 AM, LVN A stated she was trained and in-serviced on resident rights, neglect, call lights and falls. LVN A stated in-services were given on an as needed basis. LVN A stated if she observed a resident on the ground, she was trained to assess the resident, check the resident's vitals, and make sure the resident was safe. LVN A stated she documented assessments in a fall risk management program. LVN A stated neurological assessments were completed for 72 hours following a resident's fall. LVN A stated nurses completed neurological assessments. LVN A stated the ADON checked neurological assessments to make sure they were completed. LVN A stated she observed a nurse miss completing a neurological assessment in the past. LVN A stated residents could be negatively affected if staff did not complete neurological assessments. LVN A stated residents who were at risk for falls were placed within staff's eyesight so staff can monitor them. LVN stated residents were educated on falls. During an interview on 09/26/2023 at 12:23 PM, CNA B stated she was trained and in-serviced on falls, neglect, resident rights, and call lights. CNA B stated in-services were given on an as needed basis. CNA B stated if she observed a resident on the ground, she was trained to get assistance and not to touch or pick up the resident until a nurse assessed the resident. CNA B stated nurses completed neurological assessments. During an interview on 09/26/2023 at 12:34 PM, LVN B stated he was trained and in-serviced periodically on resident rights, neglect, call lights, and falls. LVN B stated in-services were given monthly and on an as needed basis. LVN B stated if he observed a resident on the ground, he was trained to call for assistance, assess the resident for external injuries, check the resident's range of motion, check the resident's vitals, and move the resident to a safer location. LVN B stated he would also notify all appropriate parties. LVN B stated neurological assessments were started on a resident if the resident's fall was unknown or they hit their head. LVN B stated neurological assessments were completed for the next 72 hours after a resident fell. LVN B stated neurological assessments were documented in a resident's electronic health records. LVN B stated CNAs checked residents' vital signs. LVN B stated he never seen neurological assessments not completed by staff. LVN B stated a resident's electronic health record did not alert staff when to conduct and document the next neurological assessment. LVN B stated residents could possibly be negatively affected if staff did not complete neurological assessments because residents' signs and symptoms could go missed. LVN B stated DON and ADON checked neurological assessments. LVN B stated he was not sure if there were interventions implemented after Resident #1's fall. LVN B stated Resident #1 would try to self-ambulate. LVN B stated whenever Resident #1 attempted to self-ambulate, he would redirect her to her wheelchair. LVN B stated he was not sure if Resident #1 was educated on falls and reminded to use her call light. LVN B stated he reminded Resident #1 to use her call light. During an interview on 09/26/2023 at 1:22 PM, the DON stated Resident #1's falls took place mostly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 12 of 13 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hill Country Heights 810 Industrial Ave Copperas Cove, TX 76522 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 - Minimal harm or potential for actual harm in the evening and night. The DON stated Resident #1 was checked on every hour . The DON stated she was not informed about staff watching over Resident #1 at the nursing station. Review of the facility's risk management log reflected staff logged Resident #1's falls on 09/09/2023 at 11:40 PM, 09/13/2023 at 2:00 AM, and 09/13/2023 at 11:02 PM. Residents Affected - Some Review of the facility's incident log from 06/01/2023 through 09/26/2023 reflected Resident #1 had a fall on 09/09/2023 at 11:40 PM, 09/13/2023 at 2:00 AM and 10:02 PM, and 09/24/2023 at 6:00 PM. Review of the facility's in-services from June 2023 through September 2023 reflected staff were not trained on falls. Review of the facility's accidents and incidents investigating and reporting policy and procedure, dated July 2017, reflected the following: Policy Statement: All accidents or incidents involving residents, employees, visitors, vendors, etc., occurring on our premises shall be investigated and reported to the administrator. Policy Interpretation and Implementation: 1. The nurse supervisor/charge nurse and/or the department director or supervisor shall promptly initiate and document investigation of accident or incident. 2. The following data, as applicable, shall be included on the Report of Incident/Accident form: a. The date and time the accident or incident took place; b. The nature of the injury/illness (e.g., bruise, fall, nausea, etc.); c. The circumstances surrounding the accident or incident; d. Where the accident or incident took place; e. The name(s) of witnesses and their accounts of the accident or incident; 5. The nurse supervisor/charge nurse and/or the department director or supervisor shall complete a Report of Incident/Accident form and submit the original to the director of nursing services within 24 hours of the incident or accident. 7. Incident/accident reports will be reviewed by the safety committee for trends related to accident or safety hazards in the facility and to analyze any individual resident vulnerabilities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 If continuation sheet Page 13 of 13