Inspection·December 8, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some mattress and to turn and reposition during rounds and more often as needed. Further interventions included handling fragile skin with caution and report to nurse if any concerns arise. Review of Resident #1's care plan dated 05/12/2025 reflected she had end stage renal disease and required dialysis treatments. Review of Resident #1's care plan with revision date of 05/19/2025 reflected Resident #1 had incontinence related to previous cerebral infarction, ESRD with dialysis and diabetes with goal to remain free from any skin breakdown due to incontinence and brief use. Interventions included to check and change on rounds as needed and provided incontinent care assistance every shift and as needed. Review of Resident #1 physician orders reflected Ascorbic acid tablet with start date of 05/19/2025 to promote wound healing. Review of Resident #1 physician orders reflected an order for Zinc Sulfate for wound healing with a start date of 05/19/2025.Review of Resident #1 physician orders reflected an order to cleanse buttock with soap and water, pat dry and apply zinc paste to buttock daily and as needed with incontinent episodes to prevent skin breakdown with start day of 06/18/2025. Review of Resident #1 physician orders reflected an order for medihoney wound and burn dressed external paste and to apply to coccyx topically once a day every three days for found healing with a start date of 07/11/2025.Review of Resident #1 physician orders reflected cleanse buttock with normal saline, pat dry and apply triad paste daily with each incontinent episode one time a day for MASD with a start date of 08/29/2025. Review of Resident #1 undated Kardex (quick reference for resident information) reflected to turn and reposition resident regularly during rounds and more often as needed. Review reflected to handle fragile skin with caution and report to nurse of any skin concerns. Review also reflected Resident #1 as a skin injury risk and report to MD/NP as indicated to ensure appropriate treatment is in place. Review of Resident #1 skin assessment dated [DATE] reflected Resident #1 had MASD on left gluteus upon admission area to residents buttock is revolved with no opening noted all bright new pink tissue no drainage or bleeding noted. Resident continues to complain of discomfort from sitting for long periods of time at dialysis resident encouraged to offload while in bed as to prevent issue from reoccurring. Review reflected selection was made that practitioner was notified and it was the wound care nurse practitioner. Review of skin assessment dated [DATE] reflected Resident #1 had MASD on her coccyx and had new open area to coccyx related to excessive moisture. Review reflected wound care NP was notified, name of wound care NP was not documented. Review of picture of coccyx reflected a small area that was red around the edge and lighter pink / white in center. Area above reflected a lighter pink area. Review of skin assessment dated [DATE] reflected Resident #1 had MASD on her coccyx related to excessive moisture. Review reflected wound care NP was notified. Review of picture of coccyx reflected there were additional areas with red around the edge with lighter pink / white. Review of skin assessment dated [DATE] reflected Resident #1 had MASD on her coccyx related to excessive moisture. Review reflected wound care NP was notified. Review of picture of coccyx reflected additional white lighter pink areas on gluteus. Review of skin assessment dated [DATE] reflected Resident #1 had MASD on her coccyx with note that area to resident's buttock showed improvement with measurements smaller in size. Review reflected wound care NP was notified. Review of picture reflected 2 areas light [NAME] pink. Review of skin assessment dated [DATE] reflected Resident #1 had MASD and condition to this resident area appears stalled resident often noted lying flat in bed. Review reflected that resident was reeducated on importance of off loading and turning side to side to alleviate pressure to this area. Resident voiced understanding but does refuse care. Review reflected wound care NP was notified. Review of picture reflected several areas with a slight larger area that appeared red with light yellow in the middle with another small area that appeared scabbed. Review of progress reflected it was stalled. Review of skin assessment dated [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some reflected Resident #1 had MASD on her coccyx and progress appeared stalled with note that Resident would be seen by wound care NP this week before leaving to dialysis if possible. Review reflected wound care NP was notified. Review of picture reflected increased area with darker red areas on gluteus. Review reflected Resident #1 was reeducated on turning and repositioning while in bed and offered pillows and a wedges as well, but often refused wedge. Review reflected Resident sits for long periods during dialysis 3 times a week and a foam cushion was provided for her wheelchair. Review of skin assessment dated [DATE] reflected Resident #1 had MASD to her coccyx and was seen by wound care NP and educated on turning and repositioning. Review of the picture reflected larger area to resident's coccyx with varying shades of yellow, red and light pink. Review of skin assessment dated [DATE] reflected Resident #1 MASD to resident's coccyx and that resident's area to sacrum was assessed and treatment was revised to area to promote more effective healing. Healing progress reflected it was stalled. Resident #1 had new cushion added to her chair when at dialysis to aide in this healing. Review of picture reflected larger area of redden skin that appeared with some yellow in the center. Review of skin assessment dated [DATE] reflected Resident #1 had MASD to her coccyx. Progress appeared as deteriorating and review reflected wound care NP revised treatment schedule to promote healing. Review of skin assessment dated [DATE] reflected Resident #1 had a pressure wound that was unstageable to her coccyx. Review reflected progress of wound was deteriorating and wound care NP provided treatment and revised treatment orders. Review of picture reflected larger pink area with raised edges and spots of red, light pink and white in center. Review also reflected a hole on coccyx area. Review of wound care note dated 08-28-2025 reflected Resident #1 was seen as a consultation for evaluation of wounds. Resident #1 was seen for initial wound care visit and evaluation of MASD to her sacrum. No signs of symptoms of infection noted. Review of former NP note dated 08/23/2025 reflected skin was warm and dry, area on buttocks being treated with cream, no rashes, lesions, or unusual pigmentation, skin turgor normal'. Review of former NP note dated 08/19/2025 reflected skin was warm and dry, area on buttocks being treated with cream, no rashes, no itching, no skin discoloration, no bruising, no lesions and area on buttocks being treated with cream. Review of former NP note dated 08/12/2025 reflected skin was warm and dry, area on buttocks being treated with cream, no rashes, no itching, no skin discoloration, no bruising, no lesions. Review of former NP note dated 08/04/2025 reflected skin was warm and dry, area on buttocks being treated with cream, no rashes, no itching, no skin discoloration, no bruising, no lesions. Review of former NP note dated 07/22/2025 reflected area on buttocks being treated with cream, no rashes, no itching, no skin discoloration, no bruising, no lesions. Review of former NP note date 07/14/2025 reflected area on buttocks being treated with cream, no rashes, no itching, no skin discoloration, no bruising, no lesions. Review of former NP note dated 07/04/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions or unusual pigmentation, skin turgor normal. Review of former NP note dated 06/30/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions or unusual pigmentation, skin turgor normal. Review of NP note dated 06/27/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal and to monitor area on buttocks for progression. Review of former NP note dated 06/23/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal. Review of former NP note date 06/20/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal and to monitor area on buttocks for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some progression. Review of former NP note dated 06/17/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal and to monitor area on buttocks for progression. Review of former NP note dated 06/14/2025 reflected skin was warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal and to monitor area on buttocks for progression. Review of form NP note dated 06/09/2025 reflected skin warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal. Review of former NP note dated 06/02/2025 reflected skin warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal. Review of former NP note dated 05/30/2025 reflected skin warm and dry, area on buttocks being treated with cream, not yet an open decubitus, no rashes, lesions, or unusual pigmentation, skin turgor normal. Review of former NP note dated 05/27/2025 reflected skin was warm and dry, no rashes, lesions, or unusual pigmentation, skin turgor normal. Review of former NP note dated 05/26/2025 reflected skin was warm and dry no rashes lesions, or unusual pigmentation, skin turgor normal. Review of above for NP notes reflected no notification to former NP was made that MASD to Resident #1's buttocks was reported to former NP that new areas were developing or not healing and no changes in treatment from 05/26/2025 to 08/28/2025. During an interview on 09/30/2025 at 10:08 AM, FM stated that Resident #1 had not been seen by a wound care doctor at the facility and had a nurse that provided wound care. FM stated Resident #1 had a small wound to her bottom when she admitted and felt it got worse. During an interview on 09/30/2025 at 9:17 AM LVN A stated that changes in skin are reported to her by CNAs or the charge nurse who conducts the weekly skin assessment. LVN A stated if changes are noted staff notified her and she will gather measurements and assess and then will send to the wound care NP for orders. LVN A stated after those changes are found, the wound care NP would start weekly visits, but she was able to send pictures to the wound care NP for treatment sooner than the next weekly wound visit. LVN A stated that any break in the skin is considered a wound and if there is an open area to a resident's coccyx the wound care NP started following that resident immediately. LVN A stated that Resident #1 had an open area when she admitted and LVN A stated she took pictures and started a treatment plan with the wound care NP. LVN A stated a few months later the area started to break down again and the wound care NP came back on board and resumed previous treatment. LVN A stated that the area started to gradually get worse and wound care NP would revise treatment and then one area would get better and another area would start to breakdown. LVN A stated she was unsure why the initial wound visit note from the wound care NP was dated for 08/28/2025. During an interview on 09/30/2025 at 12:59 PM, wound care NP stated that he visited the facility at least once a week. He stated that anything pressure related or full thickness (extending beyond first two layers of skin) he should be involved from the beginning. Wound care NP stated when he first saw Resident #1's coccyx it had already advanced to full thickness. Wound care NP stated with MASD there was not full thickness, but for Resident #1 there were some elements of pressure involved and it was just past full thickness and had already progressed to a point past what he wanted it to. Wound care NP stated that he attempted to see Resident #1 the week before 08/28/2025 (on 08/22/2025), but Resident #1 had left to dialysis already. NP stated that prior to 08/22/2025 he did not communicate with the facility regarding Resident #1. Wound care NP stated when the wound goes from one open or broken down areas to more open or broken down areas he expected to be involved. Wound care NP stated he was not involved with Resident #1 prior to 08/22/2025. Wound care NP stated he felt that Resident #1's dialysis (sitting for prolonged hours without being changed) contributed to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some the deterioration of the MASD. Wound care NP stated initially it was documented as MASD and had to advanced to full thickness tissue erosion. Wound care NP stated he saw no signs or symptoms of infection. During an interview on 10/01/2025 at 1:28 PM, CNA B stated changes in skin were documented and reported to the nurse. CNA B stated if it was a resident's shower day then it was documented on a shower sheet and reported verbally. CNA B stated any changes in skin were reported to the charge and wound nurse. CNA B stated she would report any scratches, tears, bruises or sores. During an interview on 10/01/2025 at 1:47 PM, RN C stated that charge nurses completed skin checks weekly and if there was something new the ADON or DON would be notified. RN C stated she was not sure who was responsible to get the wound care NP involved and believed it was LVN A. During an interview on 10/01/2025 at 2:48 PM, RN D stated that nurses completed weekly skin assessments and if the resident had any wounds the wound care nurse would do the weekly skin assessment. RN D stated any changes to the skin would be reported to the wound care nurse. RN D stated LVN A notifies the wound care NP. RN D stated that anytime there is a new breakdown area on the skin the wound care NP had to be involved. She stated anything more than a skin tear that could not be treated easily. During an interview on 10/01/2025 at 3:03 PM, the DON stated that weekly skin assessments were completed between the charge nurse and treatment nurse. The DON stated if there was a wound the skin assessment would fall on the treatment nurse. The DON stated that the wound care NP would be consulted depending on the extent of the wound and if the area was more serious or chronic or having a hard time healing then the wound care NP would definitely be consulted. The DON stated if areas were not healing then she expected the wound care NP to get involved. The DON stated Resident #1 sat on her bottom for 6 hours when she was at dialysis and was not repositioning when she was at dialysis. The DON stated that she expected the wound care nurse to involve the wound care NP if there are a few weeks of continued breakdown. The DON stated if anything worsened then LVN A would let the DON know. The DON stated that Resident #1 was discussed all the time and this included getting the wound care NP involved, but was unsure when that was. The DON stated that was probably when it started to get worse and breakdown continuously. The DON stated she thought that the wound care NP was involved with Resident #1 prior to 08/28/2025. During an interview on 10/01/2025 at 3:53 PM, with the previous NP for Resident #1, he stated that staff did not inform him of any MASD for Resident #1. NP stated that he expected to be informed of MASD and areas that were new. NP stated that Resident #1 was prone to skin breakdown because she was sitting in her chair for long periods in dialysis and that put her at a higher risk of breakdown. NP stated that he expected to be involved with any changes or any new areas and expected staff to have had the wound care NP involved. During a subsequent interview on 10/01/2025 at 4:29 PM, the DON stated that Resident #1 first saw wound care NP on 08/28/2025 and missed seeing her in 08/22/2025 because she was at dialysis. The DON stated that around 08/28/2025 the area started to get worse and that being on dialysis residents do not have great skin integrity. The DON stated that it was still superficial until the wound care NP was involved. The DON stated that residents with darker skin have healed skin that is the color pink which is why there are pink areas on Resident #1's coccyx. During an attempted interview on 10/17/2025 at 10:14 AM, Resident #1 was unable to recall when she got her wound and stated staff come in and check on her and reposition her every two hours. During an interview on 10/17/2025 at 10:40 AM, the ADM stated that the treatment nurse and charge nurses were responsible to conduct weekly skin assessments. The ADM stated if there was a change in skin such as breakdown or redness he expected the charge nurse to be notified and if necessary the charge nurse should notify LVN A. The ADM stated then LVN A should notify the IDT so interventions can be put in place whether that be barrier cream or getting the wound care NP involved. The ADM stated that the wound (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675536 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 675536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/08/2025 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete care nurse should be involved when there was significant breakdown or treatments are not effective. The ADM stated that if the area is initially MASD and it continues to progress and look like it was going to be stageable or unstageable wound (which could happen quickly) then the facility could get the wound care NP involved. The ADM stated if breakdown continued or got larger he expected the wound care NP to be involved, especially if what the facility was doing for treatment was ineffective. The ADM stated if the wound looks the same for a bit, but if progressing and looking to potentially form a wound then the wound care NP should be involved. The ADM stated that he was unsure when Resident #1 first saw the wound care NP. Review of facility policy titled Skin and Wound Prevention and Management with revision date of January 2023 reflected the licensed nurse should communicate all newly identified wounds or skin concerns as well as the status of current wound of skin concerns to the attending medical provider. Review of facility policy titled Changes In Resident Condition with revision date of January 2023 reflected assigned medical provider should be notified when there is a need to alter treatment significantly. Event ID: Facility ID: 675536 If continuation sheet Page 6 of 6