Inspection·September 19, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some first time this had happened, but this time there was a witness to confirm it. Resident #2 stated the situation made her feel bad about herself because she knew she was fat and did not need to be reminded of it. Interview on 09/17/23 at 11:40 AM, Resident #67 stated the Social Worker had come around asking if any staff had been abusive towards her, and she reported that in April of 2023 Hospitality Aide A had caught her foot under the bed while using the Hoyer lift to transfer her. When Resident #67 told Hospitality Aide A her foot was stuck under the bed, Hospitality Aide A just pulled the Hoyer lift back, scraping the top of Resident #67's foot on the underside of the bed. When Resident #67 mentioned that it hurt, Hospitality Aide A just continued about her business as if nothing had happened and never apologized for it. Resident #67 stated she felt frustrated and upset afterwards that the aide just acted like nothing had happened. Interview on 09/19/23 at 10:28 AM, the DON stated he had been made aware of the accusation of Hospitality Aide A being verbally abusive towards Resident #2 on 04/18/23 and began his investigation. Based on his interviews with Hospitality Aide B, Resident #2, and the results of the Safety Surveys, Hospitality Aide A was terminated in April 2023. Interview on 09/19/23 at 11:20 AM, Hospitality Aide B stated she had been working with Hospitality Aide A in April of 2023 when they entered Resident #2's room to put her back to bed. Hospitality Aide A had lifted Resident #2 out of her wheelchair and in the process of moving her to the bed she accidentally hit the resident's foot on the furniture. When Resident #2 said something about it hurting Hospitality Aide A stated, If you don't quit fucking bitching so much, I'm going to just leave your fat ass in the bed all day. Hospitality Aide B stated she knew this was wrong and reported it to the nurse as soon as she could. Phone interview on 09/19/23 at 3:26 PM, Hospitality Aide A stated she had no recall of the event in April 2023, and she terminated the interview. Review of the facility's Prohibiting and Preventing Abuse, Neglect, Exploitation, and Misappropriation of Property policy and procedure, dated 2022, described verbal abuse as: .including but not limited to the use of oral, written, or gestured language that willfully includes disparaging or derogatory terms to residents .Examples include cursing, yelling, name calling, threatening or saying things to frighten a resident . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 2 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents were free from abuse for 2 of 3 residents (Residents #2 and Resident #67) reviewed for abuse. The facility failed to ensure Hospitality Aide A did not abuse Residents #2 and #67 in April 2023. This failure left the residents feeling unsafe around Hospitality Aide A. Findings included: Review of Resident #2's admission Record revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included dementia falls, anxiety, and depression. Review of Resident #2's quarterly MDS, dated [DATE], revealed a BIMS score of 5 indicating severe cognitive impairment. Her Functions Status revealed she required extensive assistance with most of her ADLs. Review of Resident #2's care plan, dated 09/07/23, revealed she required the assistance of staff for her ADLs, with interventions of providing a mechanical lift for transfers. Review of Resident #67's admission Record revealed she was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included mild cognitive impairment, diabetes, non-pressure related chronic ulcer, and muscle weakness Review of Resident #67's quarterly MDS, dated [DATE], revealed a BIMS score of 14, indicating intact cognition. Her Functional Status indicated she required extensive assistance with most of her ADLs. Review of Resident #67's care plan, dated 08/03/23, revealed she required the use of a mechanical lift to transfer, and an electric wheelchair to move about, with intervention of physical help for the resident. Interview on 09/17/23 at 11:29 AM, Resident #2 stated she had an incident in April 2023 that she reported to the nurse and the Administrator. Hospitality Aide A was putting her back to bed, using the Hoyer Lift, when she struck Resident #2's leg against the TV stand. Resident #2 stated when she told the aide that it hurt, the aide was very rude and cursed at her. Resident #2 stated it was not the first time this had happened, but this time there was a witness to confirm it. Resident #2 stated the situation made her feel unsafe around Hospitality Aide A as she was known to be verbally abusive towards the residents. Interview on 09/17/23 at 11:40 AM, Resident #67 stated the Social Worker had come around asking if any staff had been abusive towards her and she reported that in April of 2023 the Hospitality Aide A had caught her foot under the bed while using the Hoyer lift to transfer her. When Resident #67 told Hospitality Aide A her foot was stuck under the bed, Hospitality Aide A just pulled the Hoyer lift back, scraping the top of Resident #67's foot on the underside of the bed. When Resident #67 mentioned that it hurt, Hospitality Aide A just continued about her business as if nothing had happened (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 3 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and never apologized for it. Resident #67 stated she felt frustrated because she would tell staff about things Hospitality Aide A would say and do but no one would do anything about it. Interview on 09/19/23 at 10:28 AM, the DON stated he had been made aware of the accusation of Hospitality Aide A being verbally abusive towards Resident #2 on 04/18/23 and began his investigation. Based on his interviews with Hospitality Aide B, Resident #2, and the results of the Safety Surveys, Hospitality Aide A was terminated. The DON stated any form of abuse was not tolerated at the facility and reports of abuse were taken seriously. Interview on 09/19/23 at 11:20 AM, Hospitality Aide B stated she had been working with Hospitality Aide A in April of 2023 when they entered Resident #2's room to put her back to bed. Hospitality Aide A had lifted Resident #2 out of her wheelchair and in the process of moving her to the bed she accidentally hit the resident's foot on the furniture. When Resident #2 said something about it hurting Hospitality Aide-A stated, If you don't quit fucking bitching so much, I'm going to just leave your fat ass in the bed all day. Hospitality Aide B stated she knew this was wrong and reported it to the nurse as soon as she could. Phone interview on 09/19/23 at 3:26 PM, Hospitality Aide A stated she had no recall of the event in April, and she terminated the interview. Review of the facility's Prohibiting and Preventing Abuse, Neglect, Exploitation, and Misappropriation of Property policy and procedure, dated 2022, described verbal abuse as: .including but not limited to the use of oral, written, or gestured language that wilfully includes disparaging or derogatory terms to residents .Examples include cursing, yelling, name calling, threatening or saying things to frighten a resident . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 4 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0635 Provide doctor's orders for the resident's immediate care at the time the resident was admitted. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure residents had complete admission orders for the resident's immediate care for 1 of 3 residents (Resident #97) reviewed for physician orders. Residents Affected - Few The facility failed to ensure Resident #97 had dialysis orders in place when she was admitted . This failure placed residents at risk of not receiving the care they required. Findings included: Review of Resident #97's admission Record revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included end stage kidney disease requiring dialysis, diabetes, and heart failure. Review of Resident #97's admission MDS, dated [DATE], revealed a BIMS score of 9, indicating moderate cognitive impairment. Her Functional Status indicated she required limited assistance with her ADLs. Review of Resident #97's admission care plan revealed she required hemodialysis for her kidney failure, with interventions of dialysis on Monday, Wednesday, and Friday every week. Review of Resident #97's physician orders revealed no order for the resident to go to dialysis. Interview on 09/17/23 at 11:32 AM, Resident #97 stated she was just admitted on [DATE] and the facility had done a good job of getting her to her dialysis appointments on time. They provided her with a snack to eat while at dialysis, as well as an extra blanket to keep her warm. She stated her dialysis days are Monday, Wednesday, and Friday. Interview on 09/19/24 at 10:28 AM, the DON stated Resident #97 should have had her dialysis orders in place when the physician wrote her admission orders. The DON stated he was glad staff did not miss any of her dialysis days, but they should have noticed there was no order in place. Review of the facility's Hemodialysis Access Care policy and procedure did not cover physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 5 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0679 Provide activities to meet all resident's needs. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to provide an ongoing program of activities designed to meet the interests and the physical, mental, and psychosocial well-being of 11 of 13 residents reviewed for activities. Residents Affected - Some The facility failed to ensure there were organized activities during the weekends according to 11 residents who attended the confidential group interview. The failure placed residents at risk for a diminished quality of life, isolation, lack of stimulation, and a decline in mental status. Findings included: Observation on 09/17/23 from 9:05 AM-3:00 PM residents were observed in their rooms either sleeping or watching television or in the lobby sitting. No activities were observed being provided. Review of facility's current September 2023 Activities Calendar, revealed weekends activities scheduled were repetitive for every weekend 6am coffee bar & daily chronicles, 8am Sunday Morning Show, All day Activity Packets, 10am Shuffleboard, 2pm Resident Choice Movie, 4pm Yahtzee. During the confidential resident group interview, on 09/18/23 at 9:48 AM, 11 of the 13 residents in attendance revealed during the weekends they had nothing to do. Residents revealed disliking the weekends because all they did was either stay in their rooms, sleep, watch television or find a place in the facility and sit all day. Residents stated they were aware of the activities that were schedule for them during the weekends; however, they did not like them. Residents stated they would like other options for activities. Residents stated they wanted to do activities other than coloring. Residents stated, Staff have more fun during the weekends than us (residents). Residents stated they had asked staff about other activities; however, nothing was being done. Residents stated the staff always wanted to provide them with drawings for them to color like if they were 2 years old. Residents stated the lack of activities had made them feel bored because they had nothing to do during the weekends. Interview on 09/19/23 at 1:20 PM, the Activity Director revealed she had been employed since December 2022. She stated she worked Monday-Friday, but if a resident had a birthday during the weekend, she would come in to celebrate. She stated she completed the monthly activity schedules and during the weekends residents had activities like different coloring pages, crossword puzzles, movies and card games. The Activities Director stated the weekend staff were responsible for providing those activities to the residents. She stated residents could come in the activities rooms and do whatever they liked. She stated she had not had any residents complain about weekend activities. Interview on 09/19/23 at 2:51 PM, RN G revealed he was the Weekend Supervisor and had been employed for about two weeks. He stated the Activities Director completed the monthly activities schedule. He stated during the weekends residents liked playing bingo. He stated they tried to encourage the residents to come to the activities room to watch a movie or find other things to do. He stated they did not have an assigned staff who did activities, it was whomever was available to do activities with the residents. He stated he had not had any residents complain about weekend activities. Interview on 09/19/23 at 3:18 PM, Housekeeper J revealed she had been scheduled to work during the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 6 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0679 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some weekends. She stated when she worked during the weekends, she had not seen any activities being provided to the residents. She stated at times she would see residents coloring in the activity room, but no other activities were being provided. Interview on 09/19/23 at 3:22 PM, LVN I stated she had been scheduled to work during the weekends. She stated since football season started residents watched football in their individual rooms. She stated they had an activities schedule planned for residents like puzzles, coloring pages, and movies. She stated some residents did attend but not all the time. She stated this past weekend she did not observe any activities being provided; she was not sure why. She stated she had offered residents to play dominos, but she was declined. She stated all the residents appeared content and were acquainted to their environment. Interview via phone call on 09/19/23 at 3:27 PM, CNA H revealed he had been employed for three months and worked only the weekends. He stated residents did not have a lot of activities going on during the weekends. He stated they had an activities calendar with things to do with residents; however, they did not follow the schedule due to residents not wanting to participate. He stated residents mostly were sitting at the front area of the facility or would go outside and sit. He stated they tried to encourage residents to do activities like puzzles or bingo, but at times they do not want to. He stated this past Sunday 09/17/23 they had no activities provided to residents, and he was unsure why. He stated the weekend scheduled activities were repetitive. He stated the risk of not having weekend activities was that resident would be bored or depressed. Interview on 09/19/23 at 3:52 PM, the DON revealed the Weekend Supervisor was responsible for ensuring weekend activities were being provided to the residents. He stated he has had conducted walk-ins during the weekends and had not had any residents mention any concerns regarding activities. He stated he had spoken to residents regarding weekend activities and no resident had mentioned any concerns. Review of facility's current Quality of Life - Self Determination and Participation policy, dated December 2023, reflected the following: .1. Each resident shall be allowed to choose activities, schedules and health care that are consistent with his or her interests, assessments and plans of care, including: a. Daily routine, such as sleeping, eating, exercise and bathing schedules; b. Personal care needs, such as bathing methods, grooming styles and dress; c. Health care scheduling, such as times of day for therapies and certain treatments; d. Activities, hobbies and interests; and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 7 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0679 e. Level of Harm - Minimal harm or potential for actual harm Religious affiliation and worship preference Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 8 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 observation, interview, and record review the facility failed to ensure that residents received treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices for 1 of 10 Residents (Resident #61) reviewed for quality of care. Residents Affected - Few The facility failed to ensure Resident #61 was wearing compression wraps (a specialized hosiery designed to help prevent the occurrence of and guard against further progression of venous disorders such as swelling/inflammation and blood clots) as ordered by the physician. This failure placed residents at risk of not receiving appropriate care and worsening of their conditions. Findings included: Record review of Resident #61's face sheet revealed the resident was a [AGE] year-old male, admitted [DATE] and readmitted [DATE] with diagnosis of Type 2 Diabetes (high blood sugar), peripheral vascular disease (slow and progressive circulation disorder), cellulitis (bacterial infection), dermatitis (skin inflammation), edema (buildup of fluid), unsteadiness on feet, and high blood pressure. Record review of Resident #61's quarterly MDS dated [DATE], revealed a BIMS score of 15 indicating the resident's cognition was intact. The assessment reflected Resident #61 required supervision with dressing, one-person physical assist. Record review of Resident #61's undated care plan revealed the care plan did not address Resident #61's order for bilateral knee high 15 compression hose. Record review of Resident #61's physician order dated 08/08/23 revealed Bilateral knee high 15 compression hose one time a day, apply in the morning Remove at bedtime remove per schedule. Record review of Resident #61's clinical records did not reveal the resident had refused physician order for compression hose. Observation and interview with Resident #61 on 09/17/23 beginning at 11:16 AM revealed the resident sitting on the side of the bed. The resident was observed with both feet swollen and with dry flaky skin. Resident #61 stated he has been having problems with both feet being swollen and hurting at times. When asked about his feet, Resident #61 stated he needed cream or lotion on them to prevent the dry skin. The resident stated he should be wearing compression hose everyday; however, he had not worn them in about a month. Resident #61 stated he required assistance to get them on because they are so tight, they were used to help prevent the swelling. Resident #61 stated staff had not asked or attempted to put them on in a long while. Observation of Resident #61 on 09/18/23 at 9:15 AM revealed Resident #61 sitting on the side of the bed, Resident #61 was observed without compression hose, both feet swollen and dry with flaky skin. Observation and interview with Resident #61 on 09/18/23 beginning at 3:00 PM without compression hose, Resident #61 stated staff did not assist or offer to place compressions hose today, the hose are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 9 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 in my armoire (pointing behind the door). Level of Harm - Minimal harm or potential for actual harm Observation of Resident #61 on 09/19/23 at 9:30 AM without his compression hose, feet were swollen with dry skin. Residents Affected - Few Interview on 09/18/23 at 10:36 AM with LVN E revealed Resident #61 will have compression hose put on and he will take them off or refuse to have them on. According to LVN E, the last time he attempted to put them on was yesterday morning, they could be in his top drawer, or he will put them in the laundry. LVN E stated he was not aware of the risk involved with not having on the socks. LVN E stated Resident #61 does frequently have swollen feet and takes 80 milligrams of Lasix. LVN E stated there was an active order in place to have the compression hose on daily and removed at bedtime. LVN E stated it was facility policy to follow doctor orders. LVN E stated nursing staff were responsible for ensuring to attempt to put the socks on daily. LVN E stated nursing staff were responsible to document and notify the doctor if residents refuse the order. Interview on 09/19/23 at 3:35 PM with the DON revealed Resident #61's feet were usually swollen. The DON stated Resident #61 did have an active order to wear compression hose. According to the DON, Resident #61 did not always leave the compression hose on due to them feeling tight on his legs. The DON stated he was not sure of the last time nursing staff had put the compression hose on Resident #61. The DON stated he assisted Resident #61 at least two weeks ago to place on the hose. The DON stated he expected staff to assist Resident #61 with the compression hose daily and as stated in the order. The DON stated the charge nurse was responsible for initiating and administering the compression hose on a daily basis. The DON stated not using the compression hose could place Resident #61 at risk of complications of edema (swelling caused by excess fluid trapped in tissue). According to the DON, he expected staff to properly document in resident charts anytime a resident was administered treatment, resident refused treatment or a change in resident condition. The DON stated not accurately documenting resident treatment would affect resident treatment goals and outcomes. A policy regarding Treatment orders was requested; however, it was not provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 10 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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, interview, and record review the facility failed to ensure residents received adequate supervision to prevent accidents for 2 of 6 residents (Residents #37 and #72) reviewed for accidents and supervision. The facility failed to ensure Residents #37 and #72 were properly covered with a smoking apron while being supervised during smoking breaks. These deficient practices could place residents at risk for burns causing injury or harm. Findings included: Record review of a Face Sheet for Resident #37 revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] and readmitted on [DATE]. His diagnoses included repeated falls, weakness, high blood pressure, acute upper respiratory infection, chronic obstructive pulmonary disease, lack of coordination, abnormal posture. Record review of Resident #37's Quarterly MDS dated [DATE] revealed a BIMS score of 11 which indicated a cognition level that was moderately impaired. Record review of Resident #37 ' s's Smoking Evaluation dated 01/24/23 revealed resident was able to smoke independently but could not safely have smoking paraphernalia. Record review of Resident #37's undated care plan revealed a focus that Resident #37 was a smoker and required staff supervision/adaptations when using smoking tobacco. Goals: I will follow tobacco policy of community without injuring myself or others. Interventions: I require facility to keep all tobacco and fire-starting materials for safety. Observe my clothing, skin, and environment for signs of cigarette burns. Staff will complete a smoking assessment to ensure my safety quarterly and as needed. Record review of a Face Sheet for Resident #72 revealed an [AGE] year-old female admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses included chronic obstructive pulmonary disease (diseases that cause airflow blockage), lack of coordination, repeated falls, weakness, other fatigue, pneumonia, acute respiratory failure with hypoxia, high blood pressure, tobacco use. Record review of Resident #72's Quarterly MDS dated [DATE] revealed a BIMS score of 14 which indicated a cognition level that was intact. Record review of Resident #72's Smoking Evaluation dated 01/24/23 revealed resident was able to smoke independently but could not safely have smoking paraphernalia. Record review of Resident #72's undated care plan revealed a focus that Resident #72 was a smoker and required staff supervision/adaptations when using smoking tobacco. Goals: I will follow tobacco policy of community without injuring myself or others. Interventions: I require facility to keep all tobacco and fire-starting materials for safety. Observe my clothing, skin, and environment for signs of cigarette burns. Staff will complete a smoking assessment to ensure my safety quarterly and as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 11 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 Observation on 09/18/23 1:30 PM revealed Residents #37 and #72 was observed outside smoking with Hospitality Aide M, Resident #37 was observed being handed a cigarette by Hospitality Aide M. Hospitality Aide M then reached over to light Resident #37's cigarette. Hospitality Aide M then passed Resident #72 a cigarette box which housed cigarettes, lighter, and smoking apron, then she sat down. Resident #72 lit her own cigarette. Hospitality Aide M was then told by residents that were outside smoking, in unison, they told Hospitality Aide M that Resident #37 also required an apron. Hospitality Aide M passed Resident #72 a smoking apron. During the smoking break, Resident #37 and Resident #72, were not properly wearing their smoking aprons to cover their entire body. Hospitality Aide M was observed sitting with residents, Hospitality Aide M was heard calling Resident #72 to wake up and finish cigarette. Hospitality Aide M was then observed to sit closer and engage with Resident #72 until she completed her smoke break. During Interview on 09/18/23 at 1:47 PM with Hospitality Aide M revealed staff will pass out cigarettes to the smokers. Hospitality Aide M stated she would light cigarettes for residents that need a little more assistance, however most residents are able to light their own cigarettes on their own. Hospitality Aide M stated she was fairly new and was never told anything about the use of the aprons but there are two in the bag, residents told her who would use them. Hospitality Aide M stated she was responsible to make sure resident's aprons were fully covering their body for protection. Hospitality Aide M stated aprons are to be laid over the resident's lap and used to protect residents against fallen ashes. Hospitality Aide M stated, Resident #37 ad #72 did not have their smoking aprons on correctly because it did not cover their entire bodies, the aprons were only placed across their lap. Observation on 09/18/23 03:33 PM Resident #37 and #72 were outside smoking with CNA L supervising. Resident #37 or Resident #72 were observed to have their smoking apron properly covering their body. Weekend Supervisor was observed to walk outside past Resident #37 and returned, instructing the CNA L to ensure smoking aprons are worn properly. Weekend Supervisor was observed in placing the strap around Resident #37's neck. During interview with CNA L revealed certain hall assignments are responsible for taking residents outside for smoke break, staff are present to bring smoking products out and supervise residents to ensure they do not burn themselves. CNA L stated Resident #37 had the apron on his lap because he got upset when she attempted to strap it around his neck, he rather have it on his lap. CNA L stated Resident #72 does require one due to her ability to fall asleep. CNA L stated she was responsible for ensuring residents were properly wearing smoking aprons. CNA L stated hopefully there would not be any risk to residents because she was there to supervise otherwise residents could burn themselves. CNA L stated it was a state requirement to have the smoking apron worn properly to prevent injuries. During interview on 09/19/23 at 2:51 PM with Weekend Supervisor revealed smoking products are kept by facility staff and are passed out during smoking breaks. Weekend Supervisor stated there are 2 residents that tend not to pay attention to the ashes falling on them, putting themselves at risk for burns or injury. Weekend Supervisor stated prior to Resident #37 and Resident #72 being handed a cigarette, staff are responsible to properly place a smoking apron to cover resident's entire body. Weekend Supervisor stated smoking risk assessments are completed and based on the score it would determine who would require the smoking aprons, reassessments are completed quarterly or as needed. Weekend Supervisor stated according to Resident #37's last assessment he did not require the use of a smoking apron. Resident #72's last assessment revealed she required supervision, and the assessment prior to that revealed Resident #72 required an apron. Weekend Supervisor stated he did not feel the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 12 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 assessments were completely accurate due to both requiring close supervision. Level of Harm - Minimal harm or potential for actual harm Record review of the facility Smoking Policy - Residents policy, revised December 2011, reflected: Residents Affected - Some This facility shall establish and maintain safe resident smoking practices prior to or upon admission residents shall be informed about any limitation on smoking, including designated smoking areas .any smoking-related privileges, restrictions, and concerns (for example, need for close monitoring) shall be noted on the care plan, and all personnel caring for the resident shall be alerted to these issues. .any resident with restricted smoking privileges requiring monitoring shall have the direct supervision of a staff member at all times while smoking. .the staff will review the status of a resident's smoking privileges periodically FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 13 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure residents fed by enteral means received the appropriate treatment and services to prevent complications of enteral feedings for 1 of 1 resident (Resident #51) reviewed for enteral nutrition. The facility failed to follow Resident #51's physician orders for enteral feeding. These failures could affect residents receiving enteral nutrition/hydration and place them at risk of health complications and decline in health. Findings included: Record review of Resident #51's face sheet dated 09/19/23 revealed the resident was [AGE] year-old female admitted on [DATE] with a diagnosis that included cerebral infarction (stroke), and dysphagia (swallowing difficulties), Record review of Resident #51's admission MDS dated [DATE] revealed the resident had moderate cognitive impairment with a BIMS score of 10. The assessment reflected Resident #51 required limited assistance with eating, one-person physical assist, and the resident received nutrition via a feeding tube. Record review of Resident #51's care plan revised dated 09/07/23 revealed: Resident requires tube feeding r/t Swallowing problem. Goal: The resident will be free of aspiration through the review date. The resident will maintain adequate nutritional and hydration status aeb weight stable, no s/sx of malnutrition or dehydration through review date. The resident will remain free of side effects or complications related to tube feeding through review date. Record review of Resident #51's physician order dated 08/27/23 revealed enteral Feed Order every 24 hours Isosource 1.5 at 55ml/hr continue x20hr. w/ water flushes 150mL q4h (off at 9am/on at 1pm). The order start date was 08/27/23. Record review of Resident #51's physician order dated 08/27/23 revealed Tube Feeding off for 4hrs every 24 hours. The order start date was 08/27/23 9:00 AM. Record review on 09/17/23 at 2:10 PM of Resident #51's September 2023 MAR revealed resident had been disconnected at 9:53 AM and was connected at 12:36 PM by LVN F. Observation on 09/17/23 at 2:14 PM of Resident #51 lying in bed sleeping. Observed a feeding pump next to Resident #51 bed not infusing. A bag of enteral feeding was hanging from the pole of the feeding pump with a date of 09/17/23, time 5:30 AM, rate of 55 ml/hr x 20 hours. Observation on 09/17/23 at 2:48 PM of Resident #51 lying in bed sleeping. Observed a feeding pump next to Resident #51 bed infusing. A bag of enteral feeding was hanging from the pole of the feeding pump with a date of 09/17/23, time 5:30 AM, rate of 55 ml/hr x 20 hours. Interview on 09/17/23 at 2:54 PM LVN F revealed she was the nurse assigned for Resident #51. LVN F (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 14 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated she disconnected Resident #51 at 11:00 AM. LVN F reviewed Resident #51 orders and stated resident had an order to be disconnected at 9:00 AM, be off for 4 hours and be reconnected at 1:00 PM. LVN F stated when she came in today (09/17/23) between the times of 8:00 AM-9:00 AM Resident #51 g-tube machine was beeping due feeding tube was clamped by Resident #51's upper extremities. LVN F stated Resident #51 did not received her full feeding amount and she decided to keep her on the g-tube longer. When LVN F was asked if she had documented in the Resident #51's MAR prior to stopping Resident #51 formula feeding, LVN F stated she made a mistake by clicking on Resident #51's MAR at 9:53 AM. LVN F stated she did not disconnect Resident #51 at 9:53 AM. She stated she disconnected her at 11:00 AM, and she did not reconnect her at 12:36 PM but at around 2:45 PM. LVN F was asked if she notified the physician, she stated she did and the Weekend Supervisor RN G was in the room with her when she disconnected Resident #51 at 11:00 AM. LVN F stated the risk of not following physician orders was that it could cause weight loss and residents not receiving the correct amount of formula. Interview on 09/17/23 at 3:00 PM RN G revealed he was the Weekend Supervisor. He stated he had observed LVN F flush Resident #51 g-tube earlier this morning, unknown of the time. He stated he did not observe LVN F disconnect Resident #51, he stated he left the room. RN G stated he was unsure of Resident #51 physician orders; observed RN G review Resident #51's physician orders and stated Resident #51 had an order to be disconnected for 4 hours from 9:00 AM-1:00 PM. During the interview with RN G, LVN F intervened and stated to RN G remember you were in the room when I flushed her g-tube and I told you about [Resident #51] feeding machine beeping, that is why I disconnected her at 11AM. RN G stated he recalled LVN F had inform him about Resident #51's feeding machine beeping but did not observe when LVN F disconnected the resident. RN G stated his expectation was for the nurses to follow physician orders. If there was a problem, nurses should contact the physician for further instruction. RN G stated the risk of not following physician orders was that it could cause weight loss. Record review of Resident #51's Progress Notes dated 09/17//23 at 15:39 [3:59 PM] by LVN F revealed: Effective Date: 09/17/23 at 9:30 AM Upon entering residents' room at beginning of shift residents gtube machine was clamped by residents' upper extremities which caused machine to alarm. Supervisor notified. Discussed Let feeding run overtime because the feeding was unknown to be adequately flowing through tubing r/t delayed feeding r/t equipment. Tubing residual checked and in normal range. Record review of Resident #51's Progress Notes dated 09/17//23 at 15:56 [3:56 PM] by LVN F revealed: Effective Date: 09/17/23 at 14:54 [2:54 PM] Resumed feeding after 4 hrs of being stopped, residual within normal limits, Pain medications given for comfort. Will notify MD and hospice of Situation Interview on 09/19/23 at 3:47 PM with the DON revealed his expectation were for his staff to follow physician orders. He stated he was made aware by RN G who is also the weekend supervisor about a problem that had occurred with Resident #51's g-tube. He stated he was informed LVN G had disconnected Resident #51 after 9AM. The DON was notified Resident #51's MAR indicated Resident #51 was disconnected at 9:53 AM and was provided with her feeding at 12:36 PM; however, the resident was not connected until around 3:00 PM. The DON stated the best practice was for staff to follow physician orders and then document after the procedure was completed. The DON stated the risk of not following physician order would be weight loss. Interview via phone call on 09/19/23 at 4:24 PM with Resident #51's Physician revealed he had received a call from the facility on Sunday 09/17/23; however, he could not recall the conversation. Record review of the facility's Enteral Nutrition policy, revised January 2014, reflected: Adequate nutritional support through enteral feeding will be provided to residents as ordered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 15 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. 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 residents who require dialysis receive such services, consistent with professional standards of practice for 1 of 2 residents (Resident #97) reviewed for dialysis. Residents Affected - Some The facility failed to ensure staff provided ongoing assessment of Resident #97's condition and monitoring for complications after dialysis treatments received at a certified dialysis facility. This failure placed the residents at risk of undetected complications post-dialysis. Findings included: Review of Resident #97's admission Record revealed the resident was a [AGE] year-old female admitted to the facility on [DATE] with diagnoses that included end stage kidney disease requiring dialysis, diabetes, and heart failure. Review of Resident #97's admission MDS, dated [DATE], revealed a BIMS score of 9, indicating moderate cognitive impairment. Her Functional Status indicated she required limited assistance with her ADLs. Review of Resident #97's admission care plan revealed she required hemodialysis for her kidney failure, with interventions of dialysis on Monday, Wednesday, and Friday every week. Review of Resident #97's Dialysis Communication Sheets revealed she had been to dialysis three times since admission [DATE]) and had three communication sheets in her binder. The post dialysis assessments were not completed by the staff or 09/13/23 and 09/15/23. Review of nursing progress notes and daily assessments revealed no post dialysis assessments for either day as well. Interview on 09/19/23 at 10:28 AM, the DON stated all post dialysis assessments were documented on the dialysis communication sheets located in each resident's dialysis binder. The DON stated if the assessments were not completed it placed the residents at risk of post dialysis problems going undetected. Review on 09/19/23 of the facility policies reflected the facility did not have a policy addressing post dialysis assessments. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 16 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to ensure food, subject to spoilage and removed from its original container, was kept sealed, labeled, and dated in the facility's only kitchen. Residents Affected - Some The facility failed to ensure various foods stored in the freezer were sealed, dated and labeled. This failure could place all residents at risk for food contamination and food borne illness. Findings included: Observation of the freezer on 09/17/23 at beginning at 9:00 AM revealed a grey tub in the top of the freezer, 4 clear plastic bags one each of breaded rectangles measuring about 3 inches long and 1inch thick, white rectangles 3 inches long and 1 inch thick, potato wedges, diced potatoes, and a blue bag with circular noodles. The blue bag was not properly sealed, labeled or dated. The four clear bags were not properly labeled or dated. At the bottom of the freezer, it appeared to be spilled orange ice cream that was frozen at the bottom of the freezer. Interview on 09/17/23 at 9:05 AM with [NAME] D revealed the grey tub in the freezer was used to hose leftover items that were cooked from a previous day or food items that were taken from their original box. [NAME] D revealed bagged items in the tub were breaded fish, baked fish, potato wedges and diced potatoes. [NAME] D stated the blue bag were cheese Cannoli and it was tied in a knot when placed in the freezer. [NAME] D stated she would usually go back to the tub first before opening a new box food item to see what was available or to add to the menu as an alternate. [NAME] D stated the cooks and Dietary Manager are responsible for ensuring foods placed in the freezer are properly sealed, labeled and dated. [NAME] D state cooks and Dietary Manager were responsible for completing a walk through on a weekly basis to ensure anything past 7 days are discarded. [NAME] D stated she was unsure of who placed the items in the tub, however it should have been properly labeled and dated. [NAME] D stated she did not do a walk-through this morning to review the items in the tub. [NAME] D stated not having foods properly sealed, labeled, or dated could led staff to cook foods that are expired or out of date causing residents to have food poisoning. Interview on 09/17/23 at 12:30 PM with the Dietary Manager revealed the tub in the top of the freezer is where overflow foods are placed, when foods are low it is taken out the of the original box and in the tub. The Dietary Manager stated she was new back in the kitchen and recently had an in-service on how to properly seal, label, and date all food items by the dietician. The Dietary Manager stated it was the responsibility of all cooks and herself to ensure food items are sealed, labeled, and dated properly. The Dietary Manager stated she and the cooks complete a walkthrough at least weekly to discard old foods from each, the freezer, fridge, and the pantry. The Dietary Manager stated she was not aware of who placed the food items without labeling or dating them, but not doing so could cause food borne illnesses. The Dietary Manager stated she noticed the ice cream in the freezer, and it was cleaned. Interview on 09/18/23 at 11:45 AM with the Administrator revealed he was aware food was to be properly sealed, labeled and dated, that the kitchen was in-serviced recently by the Dietitian. The Administrator stated the Dietary Manager was responsible for ensuring food was kept in a safe manner to prevent food borne illnesses. The Administrator stated not properly sealing, labeling, and dating (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 17 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete food items could cause staff to use outdated food items. The Administrator stated he expects the kitchen to follow through with the in-service to properly store food items and to keep the storage equipment clean at all times. Review of the facility's Food Receiving and Storage policy, dated July 2014, reflected: Foods shall be received and stored in a manner that complies with safe food handling practices. Food Services, or other designated staff, will maintain clean food storage areas at all times. All foods stored in the refrigerator or freezer will be covered, labeled, and dated (use by date). Event ID: Facility ID: 675550 If continuation sheet Page 18 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the clinical record were maintained in accordance with accepted professional standards and practices and were complete and accurately documented for 2 of 18 residents (Resident #61 ad Resident #51) records reviewed for treatment documentation. 1. LVN E documented Resident #61 had been provided with his compression hose, but observation revealed resident was not provided with the care of compression hose. 2. LVN F documented Resident #51 had been connected to her g-tube feedings at 12:36 PM, but the resident was not connected to her g-tube feedings until 2:45 PM. These failures could affect the residents medical record not being an accurate representation of the residents medical condition or medical needs. Findings included: 1. Record review of Resident #61's face sheet revealed the resident was a [AGE] year-old male, admitted [DATE] and readmitted [DATE] with diagnosis of Type 2 Diabetes (high blood sugar), peripheral vascular disease (slow and progressive circulation disorder), cellulitis (bacterial infection), dermatitis (skin inflammation), edema (buildup of fluid), unsteadiness on feet, high blood pressure. Record review of Resident #61's quarterly MDS dated [DATE], revealed a BIMS score of 15 indicating the resident's cognition was intact. The assessment reflected Resident #61 required supervision with dressing, one-person physical assist. Record review of Resident #61's undated care plan revealed the care plan did not address Resident #61's order for Bilateral knee high 15-20mmHg compression hose. Record review of Resident #61s physician order dated 08/08/23 revealed Bilateral knee high 15-20mmHg compression hose one time a day, Apply in the AM Remove at bedtime remove per schedule. Record review of Resident #61's September 2023 MAR, revealed resident was provided with compression hose for the day of 09/17, 09/18 and 09/19/23 by LVN E. Applied at 0800 [8:00AM] and removed at 2000 [8:00PM]. Observation and interview with Resident #61 on 09/17/23 beginning at 11:16 AM revealed resident sitting on the side of the bed, resident was observed with both feet swollen and with dry flaky skin. Resident #61 stated he has been having problems with both feet being swollen and hurting at times. When asked about his feet, Resident #61 stated he needed cream or lotion on them to prevent the dry skin, Resident stated he should be wearing compression hose everyday however he had not worn them in about a month. Resident #61 stated he required assistance to get them on because they are so tight, they are used to help prevent the swelling. Resident #61 stated staff had not asked or attempted to put them on in a long while. Observation and interview with Resident #61 on 09/18/23 beginning at 9:15 AM revealed resident #61 sitting on the side of the bed, Resident #61 was observed without compression hose, both feet (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 19 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few swollen and dry with flaky skin. Resident was observed on 09/18/23 at 3:00 PM without compression hose, Resident #61 stated staff did not assist or offer to place compressions hose today, the hose are in my armoire (pointing behind the door). Observation of Resident #61 on 09/18/23 at 9:30 AM without his compression hose on, feet were swollen with dry skin. Interview on 09/18/23 at 10:36 AM with LVN E revealed Resident #61 will have compression hose put on and he will take them off or refuse to have them on. According to LVN E, the last time he attempted to put them on was yesterday morning, they could be in his top drawer, or he will put them in the laundry. LVN E stated he was not aware of the risk involved with not having on the socks. LVN E stated Resident #61 does frequently have swollen feet and takes 80 milligrams of Lasix. LVN E stated there was an active order in place to have the compression hose on daily and removed at bedtime. LVN E stated it was facility policy to follow doctor orders. LVN E stated nursing staff were responsible for ensuring to attempt to put the socks on daily. LVN E stated nursing staff were responsible to document and notify the doctor if residents refuse the order. Interview on 09/19/23 at 3:35 PM with the DON revealed Resident #61's feet are usually swollen; Resident #61 does have an active order to wear compression hose. According to the DON Resident #61 does not always leave the compressions hose on due to them feeling tight on his legs. The DON stated he was not sure of the last time nursing staff had put the compression hose on Resident #61. The DON stated he assisted Resident #61 at least 2 weeks ago to place the on the hose. The DON stated he expects staff to assist Resident #61 with the compression hose daily and as stated in the order. DON stated the charge nurse was responsible for initiating and administering the compression hose on a daily basis. The DON stated not using the compression hose could place Resident #61 at risk of complications of Edema (swelling caused by excess fluid trapped in tissue). According to the DON he expected staff to properly document in resident charts anytime a resident was administered treatment, resident refused treatment or a change in resident condition. The DON stated not accurately documenting resident treatment would affect resident treatment goals and outcomes. 2. Record review of Resident #51's face sheet dated 09/19/23 revealed the resident was [AGE] year-old female admitted on [DATE] with a diagnosis that included cerebral infarction (stroke), and dysphagia (swallowing difficulties). Record review of Resident #51's admission MDS dated [DATE] revealed the resident had moderate cognitive impairment with a BIMS score of 10. The assessment reflected Resident #51 required limited assistance with eating, one-person physical assist, and the resident received nutrition via a feeding tube. Record review of Resident #51's care plan revised dated 09/07/23 revealed: Resident requires tube feeding r/t Swallowing problem. Goal: The resident will be free of aspiration through the review date. The resident will maintain adequate nutritional and hydration status aeb weight stable, no s/sx of malnutrition or dehydration through review date. The resident will remain free of side effects or complications related to tube feeding through review date. Record review of Resident #51's physician order dated 08/27/23 revealed enteral Feed Order every 24 hours Isosource 1.5 at 55ml/hr continue x20hr. w/ water flushes 150mL q4h (off at 9am/on at 1pm). The order start date was 08/27/23. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 20 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0842 Level of Harm - Minimal harm or potential for actual harm Record review of Resident #51's physician order dated 08/27/23 revealed Tube Feeding off for 4hrs every 24 hours. The order start date was 08/27/23 0900AM. Record review on 09/17/23 at 2:10 PM of Resident #51's September 2023 MAR revealed resident had been disconnected at 9:53AM and was connected at 12:36 PM by LVN F. Residents Affected - Few Observation on 09/17/23 at 2:14 PM of Resident #51 lying in bed sleeping. Observed a feeding pump next to Resident #51 bed not infusing. A bag of enteral feeding was hanging from the pole of the feeding pump with a date of 09/17/23, time 5:30AM, rate of 55 ml/hr X 20 hours. Observation on 09/17/23 at 2:48 PM of Resident #51 lying in bed sleeping. Observed a feeding pump next to Resident #51 bed infusing. A bag of enteral feeding was hanging from the pole of the feeding pump with a date of 09/17/23, time 5:30AM, rate of 55 ml/hr X 20 hours. Interview on 09/17/23 at 2:54 PM LVN F revealed she was the nurse assigned for Resident #51. LVN F stated she disconnected Resident #51 at 11AM. LVN F reviewed Resident #51 orders and stated resident had an order to be disconnected at 9 AM, be off for 4 hours and be reconnected at 1PM. LVN F stated when she came in today (09/17/23) between the times of 8AM-9AM Resident #51 g-tube machine was beeping due feeding tube was clamped by Resident #51's upper extremities. LVN F stated Resident #51 did not received her full feeding amount and she decided to keep her on the g-tube longer. State Surveyor asked LVN F if she had documented in the Resident #51's MAR prior to stopping Resident #51 formula feeding, LVN F stated she made a mistake by clicking on Resident #51's MAR at 9:53AM. LVN F stated she did not disconnect Resident #51 at 9:53AM, she disconnected her at 11AM and she did not reconnect her at 12:36PM but at around 2:45PM. LVN F was asked if she notified the physician, she stated she did and the Weekend Supervisor RN G was in the room with her when she disconnected Resident #51 at 11AM. LVN F stated the risk of not documenting correctly could cause resident not receiving the correct amount of formula. Interview on 09/17/23 at 3:00 PM RN G revealed he was the weekend supervisor. He stated he had observed LVN F flush Resident #51 g-tube earlier this morning, unknown of the time. He stated he did not observe LVN F disconnect Resident #51, he stated he left the room. RN G stated he was unsure of Resident #51 physician orders; observed RN G review Resident #51's physician orders and stated Resident #51 had an order to be disconnected for 4 hours from 9AM-1PM. While in interview with RN G, LVN F intervene and stated to RN G remember you were in the room when I flushed her g-tube and I told you about Resident #51 feeding machine beeping, that is why I disconnected her at 11AM. RN G stated he recalls LVN F informed him about Resident #51's feeding machine beeping but did not observed when LVN F disconnected the resident. RN G stated his expectation are for the nurses to follow physician orders and if there was a problem nurses should contact the physician for further instruction. RN G stated nurses should document after they finished providing the care. Record review of Resident #51's Progress notes dated 09/17//23 at 15:39 [3:59 PM] by LVN F revealed: Effective Date: 09/17/23 at 9:30 AM Upon entering residents' room at beginning of shift residents gtube machine was clamped by residents upper extremities which caused machine to alarm. supervisor notified. discussed Let feeding run overtime because the feeding was unknown to be adequately flowing through tubing r/t delayed feeding r/t equipment. tubing residual checked and in normal range. Record review of Resident #51's Progress notes dated 09/17//23 at 15:56 [3:56 PM] by LVN F revealed: Effective Date: 09/17/23 at 14:54 [2:54 PM] Resumed feeding after 4 hrs of being stopped, residual within normal limits , Pain medications given for comfort. Will notify MD and hospice of Situation (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 21 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 09/19/23 at 3:47 PM with the DON revealed his expectation were for his staff to follow physician orders. He stated he was made aware by RN G who is also the weekend supervisor about a problem that had occurred with Resident #51's g-tube. He stated he was informed LVN G had disconnected Resident #51 after 9:00 AM. The DON was notified Resident #51's MAR indicated Resident #51 was disconnected at 9:53 AM and was provided with her feeding at 12:36 PM; however, the resident was not connected until around 3:00 PM. The DON stated the best practice was for staff to follow physician orders and then document after the procedure was completed. The DON stated not accurately documenting resident treatment would affect resident treatment goals and outcomes. Interview via phone call on 09/19/23 at 4:24 PM with Resident #51's Physician revealed he had received a call from the facility on Sunday 09/17/23; however, he could not recall the conversation. A policy regarding Charting/Documentation was requested; however, it was not provided prior to exit. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 22 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record reviews and interviews the facility failed to ensure staff did not prevent the development and transmission of communicable diseases and infections for 3 of 5 residents (Residents #24, #26, and #64) observed for infection control. Residents Affected - Some The facility failed to ensure LVN C sanitized her re-useable blood pressure cuff between resident uses. This failure placed residents at risk of contracting or spreading infectious agents. Findings included: Review of Resident #24's admission Record revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included stroke affecting his right side, diabetes, and candidiasis (fungal) infection. Review of Resident #24's quarterly MDS, dated [DATE], revealed a BIMS score of 13 indicating he was cognitively intact. His Functional Status indicated he required limited assistance with his ADLs. Review of Resident #24's care plan revealed he was at risk of impaired psychosocial well-being related to Covid. Review of Resident # 26's admission Record revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included skin infection of his leg, emphysema, and morbid obesity. Review of Resident #26's quarterly MDS, dated [DATE], revealed a BIMS score of 14 indicating he was cognitively intact. His Functional Status indicated he required limited assistance with his ADLs. Review of Resident #26's care plan revealed he was at risk of impaired skin integrity related to poor nutrition and non-compliance with diet and hygiene. Review of Resident #64's admission Record revealed the resident was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses that included pneumonia, emphysema, and respiratory failure. Review of Resident #64's quarterly MDS, dated [DATE], revealed a BIMS score of 12 indicating moderate cognitive impairment. His Functional Status revealed he required limited assistance with his ADLs. Review of resident #64's care plan revealed he was at risk for impaired skin integrity related to fragile skin. Observation on 09/18/23 from 7:57 AM-8:59 AM LVN C exited Resident #24's room with a reusable blood pressure cuff and returned it to her cart without sanitizing it. LVN-C then next used the blood pressure cuff on Resident #24 and returned it to her cart without sanitizing it. Resident #24 notified LVN C that he was having symptoms of sore throat, cough, and congestion. LVN C stated he would have (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 23 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some to be tested for Covid. LVN C next used the blood pressure cuff on Resident #64 and again returned it to her cart without sanitizing it. Observation and interview on 09/18/23 at 10:35 AM LVN C's cart had sanitizing wipes located in the bottom drawer. LVN C stated the wipes were used to wipe down the cart, the glucose monitor, and the pill crusher. LVN C was asked if the wipes were for the blood pressure cuff and she affirmed they were. LVN C was asked why she had not sanitized the cuff between Residents #24, #26, and #64, and she admitted to being nervous with the surveyor monitoring her. She stated the risk of not sanitizing the blood pressure cuff between uses was spreading an infection from one resident to another. Interview on 09/19/23 at 10:28 AM, the DON stated all reusable medical equipment had to be sanitized between each resident in order to prevent spreading infectious agents from one resident to another. Review of the facility's Cleaning and Disinfection of Resident-Care Items and Equipment, policy, dated July 2014, reflected: .4. Reusable resident care equipment will be decontaminated and/or sterilized between residents FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 24 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to maintain an effective pest control program to ensure the facility was free of pests for 3 of 4 halls (Hall 100, Hall 200, Hall 300), 1 of 1 nurses' station. Residents Affected - Many The facility failed to ensure Hall 100, Hall 200, Hall 300, and nurses' station were free from gnats. This failure could place residents at risk for the potential spread of infection, cross-contamination, and decreased quality of life. Findings included: Observation of Hall 100 on 09/17/23 11:16 AM, Hall 100 revealed gnats circling in Resident #61's room and landing on his bedside table with personal items. Observation and interview of Hall 200 on 09/17/23 beginning at 11:58 AM, with Resident #3 and Resident #72 revealed gnats flying around room, Resident #3 had a fly swatter in her hand. Resident #3 stated her family member had purchased both her and Resident #72 fly swatters to kill gnats flying in their room. Resident #72 had gnats landed on her bedside table, landed on the privacy curtain, flying around her side of the bed, and over personal items. Observation of Hall 200 on 09/18/23 at 9:08 AM, Resident #75 had at least 5 gnats flying around resident room, fly swatter was observed at nightstand table. Observation of Hall 200 on 09/18/23 at 9:32 AM, Resident #78 had at least 8 gnats landed on her privacy curtain and flying over her bed. During the confidential resident group interview on 09/18/23 at 9:48 AM, 9 of the 13 residents in attendance revealed the facility had an issue with gnats. Residents stated they have observed pest control treat the facility but does not seem to work. Residents stated at this point they are just used to them. Observation on 09/19/23 11:35 AM, there were a few gnats flying around the nursing station while surveyor was interviewing staff. During interview on 09/19/23 at 10:27 AM, LVN C revealed the facility did have a big issue with flies, the facility had gotten rid of the flies and for a few weeks we were ok. LVN C stated a couple of days ago she began to see gnats starting to appear. LVN C stated she has seen pest control in the facility, and she has seen the Maintenance Director spraying to get rid of the gnats. According to LVN C when she saw gnats, she would inform the Maintenance Director. LVN C stated having gnats in the facility could cause infection and cross-contamination causing residents to possibly become ill. During interview on 09/19/23 at 3:17 PM, Housekeeper J revealed she had noticed gnats in the facility this past weekend while working on the 300 Hall. Housekeeper J stated she noticed most gnats in rooms beside the shower room. Housekeeper J stated she has observed the Maintenance Director going in and spraying for the gnats. Housekeeper J stated she also will use her disinfectant spray in an attempt to kill gnats. Housekeeper J stated she had not received complaints from residents about the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 25 of 26 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 675550 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pecan Tree Rehab and Healthcare Center 1900 E California St Gainesville, TX 76240 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 0925 Level of Harm - Minimal harm or potential for actual harm gnats, however received complaints from nursing staff that there was a lot of gnats in the building. Housekeeper J stated it was her responsibility to report the gnats to the Maintenance Director so that he could treat them or call pest control. Housekeeper J stated she would usually write down in the maintenance log when she needs the Maintenance Director to address pest and she notified her supervisor. Residents Affected - Many During interview on 09/19/23 at 3:32 PM, the DON revealed the facility had a company that came out a couple of months ago. The pest control company put something in different areas of the facility that got rid of pest like gnats. The DON stated they had placed fly bags out front, gnat lights, and an air curtain for the kitchen. The DON stated he noticed gnats last Friday. According to the DON having gnats flying around the facility could cause illness and cross contamination. The DON stated the Maintenance Director was responsible for contacting pest control to remove the gnats. During interview on 09/19/23 at 3:50 PM, the Maintenance Director revealed the facility has had an issue with gnats and flies. Maintenance Director stated pest control has come out to spray to get rid of the gnats. The Maintenance Director stated the facility installed gnat fly lights, in July, completed power washes at each entrance and hung fly bags. The Maintenance Director stated with the weather being so bad and the doors swinging open, gnats were able to enter the facility. The Maintenance Director stated he was responsible for contacting pest control to come out and spray if he saw gnats in the building or facility staff would alert him of a problem. The Maintenance Director stated having gnats in the building was unsanitary. Record review of facility pest control binder revealed the following: 8/28/23 resident room in restroom, 8/29/23 100 hall gnats, 9/06/23 resident room gnats kit, 9/18/23 resident room gnats kit, 9/19/23 300 hall gnats. Record review of facility's Pest Control policy, revised May 2008, reflected: Our facility shall maintain an effective pest control program. .This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents. .Maintenance services assist, when appropriate and necessary, in providing pest control services. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675550 If continuation sheet Page 26 of 26