Health inspection·January 8, 2026

F 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and slapped her on the left side of face. [CNA B] immediately separated the residents. Nurse notified. [Resident #1] was nonverbal and unable to provide a statement. Monitoring initiated. Head to toe assessment completed. No skin issues noted. Pain assessment completed. No pain or discomfort indicated at the time of the incident. Vitals taken. Will continue to monitor. Administrator, DON, Ombudsman, local police department, NP with Psych, NP with MD, and RP notified of incident.Record review of the provider investigation report dated 07/22/2025 for the Resident-to-Resident incident revealed Resident #1 hit another resident on the left side of face/neck on 07/18/2025. An assessment of both residents revealed no injuries. Resident #1 was placed on behavioral monitoring for 72 hours with no adverse events.Record review of Resident #1's progress notes/incident report, authored by LVN C, indicated on 08/16/2025 at 9:45 am, [CNA B] reported to [LVN C], [Resident #1] hit her roommate twice in the chest. Roommates immediately separated for safety. Assessed for injuries and pain. No injuries noted to hands. Shakes head no to pain. Administrator, DON, Ombudsman, local police department, NP with Psych, NP with MD, and RP notified of incident. Orders for labs and urine to be collected on Monday 8-18-25. Behavior monitoring started. Local police department interviewed involved residents.Record review of the provider investigation report dated 08/16/2025 for the Resident-to-Resident incident revealed Resident #1 hit another resident on the chest on 08/16/2025. An assessment of both residents with no injuries. Resident #1 was placed on behavioral monitoring for 72 hours with no adverse events.Unsuccessful attempts to interview CNA B on 01/06/2026 at 11:40 a.m., 01/07/2026 at 11:35 a.m., and 01/08/2026 at 11:41 a.m. were made, with no returned call to voice mail or text message.During an interview on 01/08/2026 at 1:03 p.m., LVN A said she was the nurse on duty 7/18/2025 when CNA B reported she witnessed Resident #1 hit another resident. She said that Resident #1 was non-verbal and tended to hit other residents to get their attention because she did not speak. She said that facility staff had been trained to report all physical contact to charge nurses and administrator for alleged physical abuse. She said that she assessed both residents after the incident, and no injuries were identified. She said she followed the facility's protocol separated involved residents for residents' safety, initiated monitoring for 72 hours, assessments, notified administrator/AC, DON, MD/NP, RP, local police, ombudsman, and followed any new orders received. She said Resident #1 did make physical contact to get staff or other residents' attention, but not to cause harm or injury. She said during the assessment, following the incident, Resident #1 did not show any aggressive behavior. She said Resident #1 may have patted face or hit arm or chest to get attention or direct eye contact. She said that Resident #1 had been provided with a communication board to attempt to communicate and staff monitor her and redirect if anticipated incidents. She said she worked until 6:00 p.m. the day of the incident and continued to monitor both residents with no further incidents or negative effects identified and reported the incident to the oncoming staff. She said when residents had incidents or changes in condition, the care plans were revised or updated by the MDS Coordinator or DON.During an interview on 01/08/2025 at 11:58 a.m., LVN C said she was the nurse on duty on 08/16/2025 when CNA B reported she witnessed Resident #1 hit another resident. LVN C said that Resident #1 was non-verbal and patted/hit to get others attention because she did not speak. LVN C said that facility staff have been trained to report all physical contact to the nurse and administrator for alleged physical abuse. LVN C said CNA B reported while she was changing linens and making the roommate's bed, Resident #1 was touching and putting her feet on the bed. LVN C said the roommate and CNA instructed Resident #1 to stop and she did. LVN C said the roommate exited the room and Resident #1 remained in the room, then the roommate returned to the room and Resident #1 went up to her roommate and hit/patted her on the chest. LVN C said she assessed both residents after the incident and no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675541 If continuation sheet Page 2 of 3 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 675541 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cascades at Senior Rehab 8825 Lamplighter LN Port Arthur, TX 77642 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete injuries were identified. LVN C said she followed the facility' protocol after the incident was reported, separate or verified separation for residents' safety, initiated monitoring for 72 hours, head-to-toe assessments, notified proper authorities, followed any new orders received. LVN C said Resident #1 was found to have a UTI and received treatment. LVN C said since the residents involved were roommates, Resident #1 was moved to another room to prevent further interactions. LVN C said Resident #1 is non-verbal and did pat/hit to get staff or other residents' attention, but not to cause harm or injury. LVN C said that she did not feel that Resident #1 hit her roommate in the chest to causes harm or injury. LVN C said that she worked until 6:00 pm the day of the incident and monitored Resident #1 with no further incidents. LVN C said when residents have incidents or changes in condition that the care plans or revised or updated by the MDS Coordinator.During an interview on 01/08/2025 at 3:00 p.m., MDS Coordinator said she participated in morning meetings and incident reports, and allegations were discussed during the morning meeting, if residents' care plans require updating and/or the IDT care plan meeting scheduling required it to be completed, if applicable. She said she recalls discussing the incidents with Resident #1 on 07/18/2025 and 8/16/2025 and thought the care plan was updated to reflect the incidents and the interventions updated. She said the care plan should have been updated to reflect the current residents' needs and interventions. She said that monitoring interventions for 72 hours was completed, authority notification and communication techniques were discussed, and the care plan should have reflected those interventions. She said she had forgotten to update the care plans with the revised interventions. She said she was responsible for updating or revising care plans and the DON reviews the care plans for completion. She said that the facility did not have a policy for care plan updating or revision, they followed the Resident Assessment Instrument (RAI) Manual. During an interview on 01/08/2026 at 3:30 p.m., the DON said that all incidents and allegations were discussed during morning meetings (including herself, Assistant DONs, administrator, department heads, MDS Coordinator, and Regional Nurse per phone if needed) and the MDS Coordinator is notified of any incidents requiring care plan revisions, and she was responsible for updating the care plans. She stated new interventions should be added to the care plan regarding recurrent resident-to-resident altercations. She stated she did not know why the care plans and interventions for Residents #1 had not been updated and/or revised after the alleged incidents. She said the MDS Coordinator is responsible for updating and revising the care plan as indicated. She said she was responsible for monitoring and ensuring that the care plans were completed and updated by the MDS Coordinator. She said if care plans were not updated or revised, the care plan would not reflect the current residents' needs. She said that the facility did not have a policy for care plan updating or revision, they followed the Resident Assessment Instrument (RAI) Manual. During an interview on 01/08/2026 at 4:00 p.m., the Administrator said the MDS Coordinator, and the DON were responsible for ensuring all care plans were updated/revised as needed. He said the possible negative outcome of care plans not being revised or updated could be residents not receiving the care they needed.Requested a policy for care plan updating and revision, the DON and MDS Coordinator said they did not have a care plan policy for updating or revising care plans. They followed the Resident Assessment Instrument (RAI) Manual. Record review of the mds-3.0-rai-manual-v1.20.1_October_2025 indicated A significant change is a major decline or improvement in a resident's status that: 1. Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions, the decline is not considered self-limiting; 2. Impacts more than one area of the resident's health status; and 3. Requires interdisciplinary review and/or revision of the care plan. Event ID: Facility ID: 675541 If continuation sheet Page 3 of 3