Health inspection·November 24, 2025

F 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some facility's bank. Money orders associated with the deposit identified three money orders, one in the amount of $1,000.00, one in the amount of $900.00, and one in the amount of $284.00, all paid to the nursing facility for Resident #1.During an interview with Resident #1's family member, on [DATE] at 12:47 p.m., he said he was Resident #1's responsible party and was responsible for making Resident #1's monthly payments to the facility. He said he made cash payments to the former BOA for Resident #1's monthly payment. He said he made the following cash payments in 2025: June for $360.00, July for $354.00, August made two payments for $364.00 each, and September for $354.00. He said he also made a cash payment of $1,644.00 on [DATE] for the facility to pay back the SSA for the overpayment received in [DATE] through [DATE] because resident was living in a medical care facility. He said the former BOA took the cash payments and provided him with a payment receipt with each payment and told him she would pay the balance due to SSA for the overpayment. He said he received a second request from SSA about the overpayment balance after he had made the payment to the former BOA for payment submission and he contacted the facility with his concerns. He said he provided the facility with a copy of the payment receipts and bank statements showing the cash withdrawals. He said he went to the bank to make a cash withdrawal and went to the facility and made the monthly payment. He said the facility administrator and regional business office informed him the misappropriation of the resident's funds would be reported to the state, local police, and investigated. He said the facility investigated the incident and reported to him his cash payment was not deposited into the facility bank account and was unable to be located or reconciled. He said the facility credited Resident #1's account for his monthly payments involved in this incident and reimbursed Resident #1 the $1,644.00 for the payment to SSA for the overpayment due. He said he took the reimbursement check and paid the SSA for the amount due. He said the facility handled the incident professionally and admirably, but he was upset with the former BOA and contacted local law enforcement regarding pressing charges as well. During an interview on [DATE] at 2:44 p.m., the Administrator said she did not know the former BOA was misappropriating resident's funds. She said Resident #1's family member notified her on [DATE] that he had received a collection call from corporate billing regarding payments that he claimed were paid to the former BOA. She said Resident #1's family member stated the payments in question were paid in cash to former BOA along with a payment for a SSA overpayment. She said Resident #1's family member said he had handwritten receipts and bank transactions showing his payment records. She said she requested Resident #1's family member bring his payment receipts, banking transactions and SSA overpayment letter to the facility for review. She said she immediately notified the regional business office associate, regional support team, state agency, and local police department. She said the regional business office associate, support team, and herself immediately began to investigate the alleged misappropriation. She said the former BOA turned in a letter of resignation on [DATE]. She said she accepted the letter and advised the former BOA it was effective immediately on [DATE]. She said the evidence collected during the investigation indicated the former BOA misappropriated Resident #1's funds. She said the facility reimbursed or credited Resident #1 for the cash payments. 2. Record review of Resident #2's admission Record, dated [DATE], indicated a [AGE] year-old female, admitted on [DATE] and readmitted [DATE]. Resident #2 had diagnoses including Alzheimer's Disease (progressive disease that destroys memory and other important mental functions), diabetes mellitus (chronic condition that affects the way the body processes blood sugar), major depressive disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life) and dementia (loss of cognitive functioning). Record review of Resident #2's quarterly MDS Assessment, dated [DATE], indicated a BIMS score of 05 indicating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675540 If continuation sheet Page 2 of 8 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 675540 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center 1206 N Travis St Liberty, TX 77575 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she was severely impaired cognitively. She usually made herself understood and sometimes understood others. She was dependent on staff for self-care and mobility. Record review of Resident #2's care plan, dated [DATE], indicated Resident #2 had an impaired cognitive function/impaired thought process and communication problems related to dementia and stroke. Interventions included clear communication, asking yes or no questions, staff identification and making eye contact, keeping routine consistent, allowing adequate time to respond, repeat as necessary, do not rush, and request clarification from the residents to ensure understanding.Record review of furniture store invoice, dated [DATE], indicated a solid wood bed side nightstand was ordered/purchased for Resident #2 and delivered [DATE] between 9:00 a.m. - 4:00 p.m. with a total due of $497.94. Record review of Resident #2's RFMS withdrawal record dated [DATE] created by former BOA, indicated $500.00 was withdrawn from the account for personal needs items on [DATE]. Resident #2's name was signed on an authorized signature line.During an interview on [DATE] at 1:25 p.m., Resident #2 was resting in bed. She was well groomed with no foul odor. She did not respond appropriately to interview questions. Resident #2's room observation indicated no personal needs items of solid wood bedside nightstand noted in her room. During an interview on [DATE] at 1:35 p.m., housekeeping staff identified the nightstand in Resident #2's room as a standard issued nightstand table issued by the facility. During an interview on [DATE] at 1:08 p.m., Resident #2's responsible party said he did not authorize funds to be removed from Resident #2 account to purchase furniture on [DATE] and that Resident #2 had Alzheimer's disease and she was not cognitively able to make financial decisions and was not able to sign her name. He said Resident #2 never received any new furniture in June or July of 2025 from the alleged purchase. He said the facility contacted him regarding the incident and reimbursed Resident #2 the $500.00.Record review of Resident #3's admission Record, dated [DATE], indicated a [AGE] year-old female, who was originally admitted to the facility on [DATE] and readmitted on [DATE]. Resident #3 had diagnoses including chronic systolic heart failure (condition in which the heart's main pumping chamber (left ventricle) is weak), right sided hemiplegia (severe or complete loss of strength leading to paralysis on one side of the body and is usually the result of brain damage) following a stroke, speech and swallowing difficulties following a stroke, diabetes mellitus (chronic condition that affects the way the body processes blood sugar) with diabetic neuropathy (weakness, numbness, and pain from nerve damage, usually in the hands and feet), and major depressive disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life). Record review of Resident #3's quarterly MDS Assessment, dated [DATE], indicated a BIMS score of 15 indicating she was intact cognitively. She usually made herself understood and usually understood others. She required assistance for self-care of dressing, and bathing and was independent with mobility once up in wheelchair. Record review of Resident #3's care plan, dated [DATE], indicated Resident #3 had an impaired cognitive function related to stroke. Interventions included clear communication, asking yes or no questions, staff identification and making eye contact, keeping routine consistent, allowing adequate time to respond, repeat as necessary, do not rush, and request clarification from the residents to ensure understanding.Record review of furniture store invoice dated [DATE], indicated a solid wood five drawer chest, solid wood bed side end table, wall decoration, and tall decorative lamp was ordered/purchased for Resident #3 and estimated delivery in two weeks, deliver Monday-Friday between 8:00 a.m. - 5:00 p.m. with total due of $2,276.30. Record review of Resident #3's RFMS withdrawal record dated [DATE], created by former BOA, indicated that $2,300.00 was withdrawn from Resident #3's account for personal needs items on [DATE]. Resident #3's name was signed on an authorized signature line.During an observation and interview on [DATE] at 2:15 p.m., (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675540 If continuation sheet Page 3 of 8 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 675540 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center 1206 N Travis St Liberty, TX 77575 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #3 was observed sitting in her bed in her room. She was well groomed with no foul odor. She was alert and oriented and answered interview questions appropriately. She denied requesting or authorizing a purchase for furniture in the amount of $2,276.30 in May of 2025, she furthermore denied that the signature she observed on the withdrawal record was hers. She said she did not sign the withdrawal record or give anyone permission to sign the withdrawal record. She said she did not receive any new furniture in May, June or [DATE]. She said the furniture in her room was from the facility and if she wanted or needed it replaced, she would speak with housekeeping or the maintenance department. She said if she wanted to purchase large items, she asked her family to make the purchases not the facility. Observations indicated no solid wood five drawer chest, solid wood bedside end table, wall decoration, and tall decorative lamp noted in her room. She said the facility notified her regarding the incident, ongoing investigation, police notification and her rights to press charges. She said the facility reimbursed the $2,300.00.Record review of Resident #4's admission Record, dated [DATE], indicated a [AGE] year-old male, who was originally admitted to the facility on [DATE] and readmitted on [DATE]. Resident #4 had diagnoses including cerebral palsy (congenital disorder of movement, muscle tone, or posture due to abnormal brain development), multiple contractures (chronic loss of joint mobility) of the hands, fingers, wrist, shoulder, elbows, and knees, and intellectual disabilities (condition that affects a person's ability to learn and function at an expected level). Resident #4 expired at the facility under hospice care on [DATE].Record review of Resident #4's quarterly MDS Assessment, dated [DATE], indicated he was unable to complete the brief interview for mental status, and severely impaired cognitively for daily decision making. He sometimes made himself understood and rarely/never understood others. He was dependent on staff for self-care and mobility. Record review of Resident #4's care plan, dated [DATE] indicated Resident #1 had an impaired cognitive function related to cerebral palsy. Interventions included clear communication, asking yes or no questions, staff identification and making eye contact, keeping routine consistent, allowing adequate time to respond, repeat as necessary, do not rush, and reality orientation during care.Record review of a furniture store invoice, dated [DATE], indicated a solid wood tall chest of drawer, solid wood bedside end table was ordered/ purchased for Resident #4 and estimated delivery in about two weeks, deliver Monday-Friday between 8:00 am - 5:00 pm with a total due of $2,143.33. Record review of Resident #4's RFMS withdrawal record dated [DATE] created by former BOA, indicated $2,150.00 was withdrawn from account for personal needs items on [DATE]. Resident #2's name was initialed on an authorized signature line with -two2 staff members (CMA B and LVN A) signatures noted.During an interview on [DATE] at 1:15 p.m., MA B said Resident #4 had contractures in his hands, wrist and fingers and was unable to hold a pen for a signature, so he could not have signed a document. MA B reviewed Resident #4's withdrawal record from [DATE] and said that Resident #4 did not sign the document because he was unable to hold a pen and MA B's signature on the form was forged because that was not her signature and her name was spelled wrong. During an interview on [DATE] at 1:25 p.m., LVN A said Resident #4 had contractures in his hands, wrist and fingers and was unable to hold a pen for a signature, so he could not have signed a document. LVN A reviewed Resident #4's withdrawal record from [DATE] and said Resident #4 did not sign the document because he was unable to hold a pen and LVN A's signature on the form was forged because that was not her signature.An attempted telephone interview on [DATE] at 1:30 p.m. with Resident #4's responsible party was unsuccessful left message and no return call back received.During an interview on [DATE] at 2:50 p.m., the Administrator said during the facility audit of all resident's funds they identified three additional questionable invoices and sales receipts from what appeared to be a local furniture store. She said Residents #2, #3, and #4 had (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675540 If continuation sheet Page 4 of 8 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 675540 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center 1206 N Travis St Liberty, TX 77575 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some invoices from this furniture store and withdrawals from each respective resident's trust fund account related to personal need items on the invoice dates. She said she contacted the telephone number identified on the invoices and the individual who answered stated they had no affiliation with a furniture store or the BOA. She said she visited the local furniture location in person and provided a copy of the invoices and the store manager confirmed the invoices and sales receipt she presented were not from that furniture store, salesperson's listed on the documents were not a current or former employee, the invoice numbers were not be found in the database and the equipment description was not correct. She said after collecting this information, she and the IT department searched former BOA's computer and found false invoices, logos and sales receipt templates, created and stored on the former BOA's work computer matching the invoices utilized as Resident #2, #3, and #4's furniture store invoices/receipts. She said after collecting this evidence she felt the former BOA fabricated fraudulent invoices and withdrew the money from the residents' personal funds. She said the administrator had to approve or sign the check for the withdrawal and she was not the active administrator during the time in question. During an interview on [DATE] at 5:46 p.m., the former interim Administrator said she recalled the former BOA presenting her invoices and a check requiring a signature for purchasing residents' furniture or personal need items to lower their account balance. She said she signed the checks under the assumption the funds withdrawn would be used for residents' personal need items. She said she did not recall the names of the residents or what personal need items were identified on the invoices/receipts. 3. Record review of Resident #5's admission Record, dated [DATE], indicated a [AGE] year-old male, who was originally admitted to the facility on [DATE] and readmitted on [DATE]. Resident #5 had diagnoses including Alzheimer's Disease (progressive disease that destroys memory and other important mental functions), diabetes mellitus (chronic condition that affects the way the body processes blood sugar), major depressive disorder (mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life) and dementia (loss of cognitive functioning).Record review of Resident #5's quarterly MDS Assessment, dated [DATE], indicated a BIMS score of 05 indicating he was severely impaired cognitively. He made himself understood and usually understood others. His vision was severely impaired and was dependent on staff for self-care and mobility. Record review of Resident #5's care plan, dated [DATE] indicated Resident #1 had an impaired cognitive function related to dementia. Interventions included clear communication, asking yes or no questions, staff identification and making eye contact, keeping routine consistent, allowing adequate time to respond, repeat as necessary, do not rush, and reality orientation during care.Record review of money orders signed by Resident #5's responsible party indicated she purchased two money orders dated [DATE] for $925.00 each. One money order indicated it was made out to the facility and the second money order indicated it was made out to the former BOA, and the former BOA endorsed the back of the money order and indicated deposit only into the same account number that the employee paycheck was direct deposited. Record review of BOA's personnel file indicated the account number on the facility direct deposit authorization slip dated [DATE] for the employee's paycheck to be deposited was the same account number for Resident #5's money order to be deposited. During an interview with Resident #5's family member, on [DATE] at 12:56 p.m., she said she was contacted by the collections department in early [DATE] regarding the payment for [DATE] and she had already made the payment via money order to the former BOA. She said she gave the former BOA two money orders for $925.00 in [DATE] for Resident #5's [DATE] and [DATE] payments. She said the former BOA told her to leave the money orders blank and she would fill them out for her. She said she provided the facility copies of the money order receipts and bank information showing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675540 If continuation sheet Page 5 of 8 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 675540 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center 1206 N Travis St Liberty, TX 77575 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some where the money orders were deposited. She said the former BOA made one of the money orders out to herself and that was very upsetting because she thought the former BOA was so nice and helpful. She said she was still contemplating if she was filing charges on the former BOA but was aware the facility reported the incident to the authorities. She said the facility credited Resident #5's account for his October monthly payment of $925.00.In a telephone interview on [DATE] at 11:49 a.m. the local police department said the department was investigating the misappropriation of property/exploitation of elderly incidents reported by the facility and it was an oncoming investigation so they could only provide public information. The police department said the case was being reviewed by the local district attorney's office for possible charges to be filed. The police department said the facility was helpful in the investigation and reported any new concerns as they arose in the case.During an interview on [DATE] at 11:00 a.m., the corporate BOM said she was the interim BOM since the former BOA resigned. She said she trained the former BOA and was overseeing her performance weekly via in person or remotely. She said accounts receivable was monitored closely. She said the former BOA was instructed to discourage cash payment and, if accepted, to make deposits at least weekly and all money orders were to be filled out completely prior to accepting. She said cash payments and money orders could not be scanned for a remote deposit, so they had to be physically taken to the out-of-town bank for deposit. She said during the audit it was noted that no physical deposits were made to the out-of-town bank from [DATE] until [DATE], the former BOA's last day of employment. She said she was involved with the investigation and review of all residents' accounts and was continuing to run reports, verifying deposits and reconciling. She said looking back the former BOA always volunteered to contact residents or family members regarding debt collections during the AR meetings. She said she informed the former BOA that personal items needed could be purchased for residents to spend their accounts down but the resident or resident's responsible party had to consent to the personal need items. She said for resident personal need items that the former BOA should have written a check for the purchase, and she should not have been cashing a check for the purchase of items. She said if check was not an acceptable payment, then the resident or resident responsible party would have to consent, approve and witness the cash withdrawal and all purchase receipts kept, signed and copied for proof of purchase. She said she and the corporate management, and facility administrator were currently working on running reports, auditing outstanding debts and working with residents or responsible parties to identify any unreconciled accounts or misappropriation of funds. During an interview on [DATE] at 11:20 p.m., the former BOA said when she resigned on [DATE] the administrator took it effective immediately and she was escorted to her car. She said a few days later ([DATE]) she discovered a facility money bag in the glovebox of her car that she had forgotten to deposit. She said it had $2,184.00 cash in it, so she took it to the out-of-town bank and made the cash deposit. She said the cash was for Resident #1's payments. She said she had a copy of the deposit slip to provide to the investigator but denied notifying the facility of the cash found or the deposit. She said she did not recall the furniture purchases for Residents #2, #3, #4 but assisted residents with getting personal need items to spend down their accounts and would create checks to be cashed once approved by the administrator for those purchases. She denied making any falsified documents (invoices or purchase receipts) on her work computer and said the work computer was password protected for security purposes. She said she did take the second blank money order provided by Resident #5's family member, made it out to herself, and deposited it into her personal account because she was late on rent and had all intentions of paying back the money but resigned and terminated at the same time. She said the cash found in her car glovebox was cash, but she took the cash to the local post office for money (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675540 If continuation sheet Page 6 of 8 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 675540 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center 1206 N Travis St Liberty, TX 77575 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some orders to be purchased to identify who the payments were for on the money order. She denied knowing where the remaining $1,256.00 of Resident #1's cash payment was located. During an interview on [DATE] at 1:45 p.m., the Administrator said her expectations were all residents remain free from misappropriation of property or exploitation. She said she was not aware the former BOA made a bank deposit after her termination date and that the employee denied having any items belonging to the facility to return. She said the former BOA's desk was searched by herself, corporate staff and HR representative for a receipt book, and it was unable to be located. She said during the continued audits the facility had discovered an unreconciled bank deposit on [DATE] and was working with the bank to reconcile the deposits. She said the former BOA was terminated on [DATE] and should not have been making facility deposits after her termination date. She said when the misappropriation/exploitation was identified, she notified authorities, trained staff, and sent resident statements to all residents and responsible parties and requested that any discrepancies be reported to her immediately. She said if there were any identified discrepancies, the facility asked residents or responsible parties make an appointment, bring in receipts, money order receipts, bank statements or any evidence identifying the payment, payment method and date. She said this was an ongoing audit and she was currently working with another resident to identify if her funds were misappropriated. She said a new process was put in place and if cash was accepted (discouraging this type of payment) there were two witnesses during any handling of cash and residents, or resident representatives signed receipts if facility made purchases. She said money order payments were not accepted without the payor line filled out completely. She said all physical payments received were provided a receipt with two witness signatures. She said residents involved in the current misappropriation allegations were reimbursed for their loss or their accounts were credited. She said during the ongoing audits if the evidence collected identified that the resident's funds were misappropriated or exploited the facility would reimburse the resident. She said she or the corporate business office manager was responsible for all business office responsibilities currently and required witnesses for all financial transactions. She said she was keeping the local police department, ombudsman, medical director and state authorities aware of any new misappropriation or exploitation found during the ongoing audit. She said she felt the former BOA misappropriated the resident's funds/exploited the residents' and, for the safety of the residents, staff were informed she and the local police were to be notified if the former BOA attempted to enter the facility. Record review of the facility's policy titled Abuse, Neglect and Exploitation revised in 2023 indicated; Policy: It is the policy of this facility to provide protections for the health, welfare and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, exploitation and misappropriation of resident property. Definitions: . Exploitation means taking advantage of a resident for personal gain through the use of manipulation, intimidation, threats, or coercion. Misappropriation of Resident Property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent, use of a resident's belongings or money without the resident's consent. Policy Explanation and Compliance Guidelines: 1. The facility will develop and implement written policies and procedures that: a. Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property. The components of the facility abuse prohibition plan are discussed herein: I. Screening A. Potential employees will be screened for a history of abuse, neglect, exploitation, or misappropriation of resident property. 1. Background, reference, and credentials' checks shall be conducted on potential employees, contracted temporary staff, students affiliated with academic institutions, volunteers, and consultants. 2. Screenings may be conducted by the facility itself, third-party agency or academic (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675540 If continuation sheet Page 7 of 8 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 675540 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Liberty Health Care Center 1206 N Travis St Liberty, TX 77575 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 0602 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete institution. 3. The facility will maintain documentation of proof that the screening occurred. II. Employee Training A. New employees will be educated on abuse, neglect, exploitation and misappropriation of resident property during initial orientation. B. Existing staff will receive annual education through planned in-services and as needed. C. Training topics will include: 1. Prohibiting and preventing all forms of abuse, neglect, misappropriation of resident property, and exploitation; 2. Identifying what constitutes abuse, neglect, exploitation, and misappropriation of resident property; 3. Recognizing signs of abuse, neglect, exploitation and misappropriation of resident property, such as physical or psychosocial indicators; 4. Reporting process for abuse, neglect, exploitation, and misappropriation of resident property, including injuries of unknown sources. III. Prevention of Abuse, Neglect and Exploitation The facility will implement policies and procedures to prevent and prohibit all types of abuse, neglect, misappropriation of resident property, and exploitation that achieves . IV. Identification of Abuse, Neglect and Exploitation. V. Investigation of Alleged Abuse, Neglect and Exploitation A. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur. Event ID: Facility ID: 675540 If continuation sheet Page 8 of 8