Inspection·November 21, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some with the ADM, she stated the SW would receive the DNR and put in the Order and update it in the electronic medical records. The ADM stated she was not sure when the SW would put it in the care plan but assumed it was when she completed the review. The ADM stated care plans are multi-disciplinary on who was responsible, but the SW was who did it. When an interview was attempted, the ADM stated the SW was on PTO and not available to be interviewed but the ADM stated the SW did not know about the DNR status not being updated in this record, or it would have been done. 2.Record review of Resident #2's electronic health record revealed a [AGE] year-old male, admission date [DATE], Diagnoses: atrial fibrillation (rhythm disorder where the upper chambers beat irregularly and rapidly), cerebral infarction (blood flow to the brain is interrupted causing brain cells to die), hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side (paralysis & weakness), generalized anxiety disorder (severe ongoing anxiety that interferes with daily activities), vascular dementia, moderate, with other behavioral disturbance (cognitive decline caused by damage to blood vessels in the brain), major depressive disorder, recurrent, severe with psychotic symptoms (persistent and overwhelming sadness with delusions or false beliefs). BIMS of 03, severely impaired cognition.Record review of Resident #2's Care Plan dated [DATE] revealed no mention of discharge planning. 3.Record review of Resident #3's electronic health record revealed a [AGE] year-old female, admission date [DATE], Diagnoses: senile degeneration of brain (progressive decline in memory, behavior, and cognitive skills), atherosclerotic heart disease of native coronary artery without angina pectoris (plaque buildup that restricts blood flow but not yet severe enough to cause chest pain), radiculopathy, lumbar region(nerve root is compressed or irritated), chronic pain syndrome(lasting longer than 3 months impacting quality of life), muscle wasting and atrophy (wasting & thinning of muscles). BIMS of 00, severely impaired cognition.Record review of Resident #3's Care Plan dated [DATE] revealed no mention of discharge planning. 4.Record review of Resident #4's electronic health record revealed a [AGE] year-old female, admission date [DATE], Diagnoses: dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (cognitive decline in cognitive ability such as memory, thinking, reasoning and judgement), type 2 diabetes mellitus without complications(persistently high blood sugar without nerve damage or kidney disease), senile degeneration of brain (progressive decline in memory, behavior, and cognitive skills). BIMS of 00, severely impaired cognition.Record review of Resident #4's Care Plan dated [DATE] revealed no mention of discharge planning. 5.Record review of Resident #5's electronic health record revealed a [AGE] year-old male, admission date of [DATE], Diagnoses: acute on chronic systolic (congestive) heart failure(weakened heart muscle cannot pump blood effectively and sudden worsening symptoms), morbid (severe) obesity due to excess calories(excessive body weight due to consuming more calories than the body burns), combined systolic (congestive) and diastolic (congestive) heart failure(heart muscle is impaired in both its ability to contract and its ability to relax and fill with blood), acute and chronic respiratory failure with hypoxia(blood's oxygen level are extremely low both suddenly and long-term), acute and chronic respiratory failure with hypercapnia(lungs cannot remove carbon dioxide), chronic respiratory failure with hypoxia(lungs fail to provide oxygen), primary osteoarthritis (cartilage wear down and cause pain), longstanding persistent atrial fibrillation(rhythm disorder where the upper champers beat irregularly and rapidly), chronic peptic ulcer, site unspecified, without hemorrhage or perforation(recurrent sores in lining of stomach or small intestine), gout (inflammatory arthritis), chronic kidney disease, stage 3 (moderate level of kidney damage), cerebral infarction (blood flow to the brain is interrupted causing brain cells to die). BIMS of 15, little to no impairment of cognition (Normal thinking and memory).Record review of Resident #5's Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675572 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 675572 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glen Rose Nursing and Rehab Center 1019 Holden St Glen Rose, TX 76043 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Plan dated [DATE] revealed no mention of discharge planning. In an interview on [DATE] at 10:03am with the DON, she stated she knew discharge planning was to be in the care plan because it was asked at every care plan meeting. She stated she did not know the discharge plan was not in the care plan for Resident #1, Resident #2, Resident #3, Resident #4, or Resident #5. The DON stated she believed it to be the MDS Coordinator or the SW that would put that information in the care plan but probably the SW because she worked discharge planning. In an interview on [DATE] at 11:33am with the MDS Coordinator, she stated she did not know that resident discharge planning preference had to go in the care plan unless there was a discharge plan and the SW was the one to work that so the SW would update that in the care plan. In an interview on [DATE] at 11:45am with the ADM, she stated the SW would put in the update to care plans for discharge planning but that she did not know that resident preference on the discharge plan was a requirement in the care plan if there was no plan for them to discharge. When an interview was attempted with the SW, the ADM stated the SW was on PTO, so she was not available to interview. The ADM stated she would have the SW update the care plans upon her return. The ADM stated she was sure the SW did not know, or it would have been done. The ADM stated she did not know of any effects to the residents if this information was not in the care plan if there was no discharge plan in place. Event ID: Facility ID: 675572 If continuation sheet Page 3 of 3