Health inspection·November 24, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat each resident with respect and dignity and care in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life, recognizing each resident's individuality for 1 (Resident #1) of 3 residents reviewed for resident rights. This failure could affect the resident who required assistance with her Activities of Daily Living (ADL) from facility staff by placing them at risk for social isolation, loss of dignity, and self-worth. The facility failed to ensure Resident #1 was provided with personal grooming (changed brief and clean clothing) before her discharge to the hospital on [DATE]. This failure placed residents at risk for embarrassment, at risk of loss of dignity and a decrease in quality of life.The findings include: Record review of Resident #1's Face Sheet dated 10/17/2025 revealed a [AGE] year-old female who was admitted to the facility on [DATE] and discharged on 10/17/2025. Resident #1 had diagnoses included: End stage renal disease (inadequate kidneys function), acute kidney failure (condition where the kidneys suddenly lose their ability to filter waste products from the blood), protein-calorie malnutrition (inadequate food intake), hypertensive heart and chronic kidney disease without heart failure (damages the heart and kidneys, but the heart does not experience heart failure), cognitive communication deficit (difficulty with memory, problem solving, and speech), and aphasia (inability to speak). Record review of Resident #1's 10/09/2025 psychosocial evaluation reflected the residents had a Brief Interview for Mental Status (BIMS) score of 11 indicating the resident had moderate cognitive impairment. Record review of Resident #1's undated Care Plan reflected: FOCUS: ADL self-care performance deficit related to immobility. GOAL: Maintain current level of function through the review date. INTERVENTION/TASKS: Bathing/Showering: the resident had total dependency on 2 staff to provide bath/shower as necessary. Dressing: The resident required Partial/moderate assistance by 1 staff to dress. Record review of Resident #1's Progress Note dated 10/16/2025 at 01:10 a.m. reflected Resident #1 had a Change of Condition (critical labs) and was sent to the hospital, created by Registered Nurse (RN) A. During an interview on 10/17/2025 at 06:45 pm. Hospital RN A stated that Resident #1 had been admitted to the hospital with dirty clothes, dirty brief, unclean skin, and an odor. Hospital RN A stated it appeared that Resident #1's less than well appearance had contributed to the inadequate ADLs the resident received at the facility she had admitted from. She stated that the hospital staff had to changed Resident #1's out of her dirty clothes and soiled brief when the resident arrived at the hospital. During an observation on 10/20/2025 at 08:05 am. Resident #1 was observed in bed. The resident appeared clean and groomed with no odors. The resident had not aroused to voice or sound. During an observation on 10/20/2025 at 08:12 a.m. Hospital RN B stated that Resident #1 had been compliant with ADLs, but staff were performing 100% of care ADL care. Resident #1 had not been communitive or able to answer or respond to questions or commands and had been disoriented times 4 (refers to a state where an individual is not aware of Page 1 of 6 675612 675612 11/24/2025 Paradigm at Westbury 5201 S Willow Dr Houston, TX 77035

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few four key aspects: person, place, time, and event). During an interview on 10/20/2025 at 11:41 a.m. Family A stated Resident #1's hair had to be cut off because the facility had not groomed the resident's hair and it had continuously become tangled and unmanageable. Family A stated that no formal complaint had been made with the facility. She stated that the issues were addressed with the on shift staff at the times of the occurrences (no specific days or times were provided). Family A stated that staff had to be asked for clean gowns to change Resident #1 out of dirty gowns at least 3x a week after observing the resident in soiled briefs, unbrushed and tangled hair, unbrushed teeth, and dirty gowns. During an interview on 10/21/2025 at 02:07 p.m. RN A stated that on 10/16/2025 at about 01:00 a.m. Resident #1 had been prepared to discharge to the hospital. She stated that a certified nurse aid (CNA) had been responsible for changing the resident's brief and clothing to ensure that the resident discharged in an appropriate manner to the hospital. RN A stated that she had not recalled who the CNA had been who changed the resident for discharge because she had been preparing the resident's face sheet and ensuring that the resident's heart vest had a charged battery. During an interview on 10/21/2025 at 03:08 p.m. CNA A stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. She stated she had not assisted in preparing Resident #1 for discharge on the early morning hours of 10/16/2025. During an interview on 10/21/2025 at 03:16 p.m. CNA B stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. and had not been aware of Resident #1's discharge to the hospital nor prepared the resident for discharge. During an interview on 10/21/2025 at 05:27 p.m. CNA C stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. and had not worked with Resident #1 on 10/15/2025 or 10/16/2025 and had not assisted with the resident's discharge to the hospital during her shift. During an interview on 10/22/2025 at 10:31 a.m. CNA D stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. but had not assisted or worked with Resident #1 to prepare the resident for discharge to the hospital. During an interview on 10/22/2025 at 11:20 a.m. Director of Nursing (DON) stated that the staffing schedule dated 10/15/2025 shift 10 p.m. into 10/16/2025 to 6 a.m. reflecting that CNA A, CNA B, CNA C, CNA D, CNA E, and CNA F had worked and confirmed that all CNA's on the schedule had been the actual CNAs who had worked on those dates. During an interview on 10/22/2025 at 01:04 p.m. CNA E stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. She stated she had been familiar with Resident #1 but had not assisted in the preparation of resident's discharge to the hospital on the morning of 10/16/2025. During an interview on 10/22/2025 at 02:50 p.m. CNA F stated she worked 10/15/2025 at 10 p.m. to 6 a.m. on 10/16/2025, had been familiar with Resident #1, but had not assisted in sending the resident out to the hospital on [DATE]. During an interview on 10/23/2025 at 02:01 p.m. the Administrator (ADM) stated that she had not been made aware of any issues with Resident #1's discharge to the hospital on [DATE]. ADM stated that it had been her expectations that residents discharged out of the facility were to be clean and comfortable, requiring staff to ensure that the residents' briefs and clothing were clean and appropriate for outside of the facility. She stated that nurses and the CNA assigned to Resident #1 were responsible for ensuring the resident discharged appropriately on 10/16/2025. She stated that all residents deserve the right to quality of care. During an interview on 10/23/2025 at 02:14 p.m. DON stated that the nurse who had sent Resident #1 out uncleaned, should have admitted they had not had the time or had an issue that hindered them in ensuring Resident #1 had a proper appearance before discharging out of the facility. She stated she had not been made aware that Resident #1 had been sent out to the hospital in a less than appropriate condition. She stated it had been her expectation that staff would have changed Resident 1's brief and ensured the resident had on clean clothing before sending the resident out of the facility. She stated at 675612 Page 2 of 6 675612 11/24/2025 Paradigm at Westbury 5201 S Willow Dr Houston, TX 77035

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 01:00 a.m. the staff would have been completing rounds and stated maybe the staff were assisting other residents during that time frame and were unavailable to ensure Resident #1 had been properly prepared to discharge to the hospital. Record review of the facility's staffing schedule dated 10/15/2025 10 p.m. into 10/16/2025 at 6 a.m. reflected that CNA A, CNA B, CNA C, CNA D, CNA E, and CNA F worked and were on shift. Record review of undated facility policy titled EXHIBIT 4 State Resident Rights. Texas Human Resources Code Title 6, Section102.003 Rights of the Elderly. (a) An elderly individual has all the rights, benefits, responsibilities, and privileges granted by the constitution and laws of this state and the United States, except where lawfully restricted. The elderly individual has the right to be free of interference, coercion, discrimination, and reprisal in exercising these civil rights. (b) An elderly individual has the right to be treated with dignity and respect for the personal integrity of the individual, without regard to race, religion, national origin, sex, age, disability, marital status, or source of payment. This means that the elderly individual: (1) has the right to make the individual's own choices regarding the individual's personal affairs, care, benefits, and services;(2) has the right to be free from abuse, neglect, and exploitation; and (3) if protective measure are required, has the right to designate a guardian or representative to ensure the right to quality stewardship of the individual's affairs. (f) An elderly individual may complain about the individual's care or treatment. 675612 Page 3 of 6 675612 11/24/2025 Paradigm at Westbury 5201 S Willow Dr Houston, TX 77035

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 a resident who was unable to carry out activities of daily living (ADLs) received the necessary services to maintain nutrition, grooming and personal and oral hygiene for 1 of 3 residents (Resident #1) reviewed for ADLs. The facility failed to ensure Resident #1 was provided with personal grooming before her discharged to the hospital on [DATE]. This failure could place residents at risk for discomfort and dignity issues.Findings included: Record review of Resident #1's Face Sheet dated 10/17/2025 revealed a [AGE] year-old female who was admitted to the facility on [DATE] and discharged on 10/17/2025. Resident #1 had diagnoses included: Acute kidney failure (condition where the kidneys suddenly lose their ability to filter waste products from the blood), contusion (bruising) of right lower leg, End stage renal disease (inadequate kidneys function), hypertensive heart and chronic kidney disease without heart failure (damages the heart and kidneys, but the heart does not experience heart failure), protein-calorie malnutrition (inadequate food intake), dysphagia (difficulty swallowing), cognitive communication deficit (difficulty with memory, problem solving, and speech), and aphasia (inability to speak). Record review of Resident #1's psychosocial evaluation dated 10/09/2025 reflected the residents had a Brief Interview for Mental Status (BIMS) score of 11 indicating the resident had moderate cognitive impairment. Record review of Resident #1's undated Care Plan reflected: FOCUS: The resident had an ADL self-care performance deficit related to immobility. GOAL: Resident will maintain current level of function in through the review date. INTERVENTION/TASKS: Bathing/Showering: the resident is totally dependent on 2 staff to provide bath/shower as necessary. Dressing: The resident requires Partial/moderate assistance by 1 staff to dress. FOCUS: The resident had oral/dental health problems. GOAL: Resident will remain free of infection, pain or bleeding in oral cavity by review date. INTERVENTION/TASKS: Administer medications as ordered. Monitor/document for side effects and effectiveness. Coordinate arrangements for dental care, transportation as needed/as ordered. Monitor/document/report as needed (PRN) any signs and symptoms (s/sx) of oral/dental problems needing attention: Pain (gums, toothache, palate), Abscess, debris in mouth, lips cracked or bleeding, teeth missing, loose, broken eroded, decayed, tongue (black, coated, inflamed white, smooth), ulcers in mouth, lesions. Record review of Resident #1's Progress Note dated 10/16/2025 at 01:10 a.m. and created by RN A reflected Resident #1 had a Change of Condition (critical labs) and was sent to the hospital. During an observation on 10/20/2025 at 08:05 am. Resident #1 was observed in bed. The resident had not aroused to voice or sound. The resident appeared clean and groomed with no odors. During an interview on 10/17/2025 at 06:45 pm. Hospital Registered Nurse (RN) A stated that Resident #1 had been admitted to the hospital with a less than well appearance: dirty clothes, soiled brief, with unclean skin, and an odor. She stated the hospital staff had to change the resident's soiled brief and clothing immediately upon arriving at the hospital. She stated that it appeared that Resident #1 had not been receiving inadequate ADLs at the facility she had arrived from. During an observation on 10/20/2025 at 08:12 a.m. Hospital RN B stated that Resident #1 had not been communitive or able to answer or respond to questions or commands and had been disoriented times 4 refers to a state where an individual is not aware of four key aspects: person, place, time, and event). Hospital RN B stated Resident #1 had been compliant with ADLs, but staff were performing 100% of care. During an interview on 10/20/2025 at 11:41 a.m. Family A stated since Resident #1 had been admitted , observations had been made at least 3 times a week (no specific days or times were provided) where resident had been uncleaned in soiled briefs, unbrushed and tangle hair, unbrushed teeth, and stained/dirty gowns. Family A stated that staff had to be asked Residents Affected - Few 675612 Page 4 of 6 675612 11/24/2025 Paradigm at Westbury 5201 S Willow Dr Houston, TX 77035

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few for clean gowns to change Resident #1 and change soiled briefs. Family A stated Resident #1's hair had to be cut off because the facility had not groomed the resident's hair. Family A stated that she had not made a formal complaint, only addressed the issue with the staff on shift at the times. During an interview on 10/21/2025 at 2:07 p.m. RN A stated that on 10/16/2025 at or about 01:00 a.m. she prepared Resident #1 to discharge to the hospital. She stated a certified nurse aid (CNA) changed the resident's brief and put on appropriate clothes for the hospital. RN A stated that she had not recalled who the CNA had been who changed the resident's brief and clothing because she had been preparing printing the resident's face sheet and ensuring that the resident's heart vest had a charged battery. During an interview on 10/21/2025 at 3:08 p.m. CNA A stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. She stated she had been aware that Resident #1 had a change of condition and had been sent out to the hospital, but CNA stated she had not assisted changing the resident's brief or dressing for the discharge on the early morning hours of 10/16/2025. During an interview on 10/21/2025 at 3:16 p.m. CNA B stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. but had not worked with Resident #1 nor prepared her for discharge to the hospital. During an interview on 10/21/2025 at 5:27 p.m. CNA C stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. but had not worked with Resident #1 nor prepared the resident for discharge to the hospital on the early morning hours of 10/16/2025. During an interview on 10/22/2025 at 10:31 a.m. CNA D stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. but had not worked with Resident #1 nor prepared her for discharge to the hospital. During an interview on 10/22/2025 at 11:20 a.m. Director of Nursing (DON) stated that the staffing schedule dated 10/15/2025 shift 10 p.m. into 10/16/2025 at 6 a.m. reflecting that CNA A, CNA B, CNA C, CNA D, CNA E, and CNA F were working and on shift and no other's CNAs worked that shift's date/times. During an interview on 10/22/2025 at 01:04 p.m. CNA E stated she had worked on 10/15/2025 from 10 p.m. through 10/16/2025 at 6 a.m. but had been familiar with Resident #1 nor prepared the resident for discharge to the hospital on the early morning hours of 10/16/2025. During an interview on 10/22/2025 at 2:50 p.m. CNA F stated she worked 10/15/2025 at 10 p.m. to 6 a.m. on 10/16/2025. She stated that she had been familiar with Resident #1 and had not assisted in sending Resident #1 out to the hospital on the early morning of 10/16/2025. During an interview on 10/23/2025 at 02:01 p.m. the Administrator (ADM) stated that she had not been made aware of any issues with Resident #1's discharge to the hospital and it had been her knowledge that the resident had discharged in stable condition. She stated it had been her expectations that residents discharged out of the facility for any reason, change of condition or not were to be clean and comfortable which meant changing a resident's brief and placing them in clean clothing, appropriate for outside. She stated that all residents deserve the right to quality of care. She stated that nurses and the CNA assigned to Resident #1 were responsible for ensuring the resident discharged appropriately. During an interview on 10/23/2025 at 02:14 p.m. DON stated she had not been made known that Resident #1 had been sent out to the hospital in less than appropriate conditions. She stated that the nurse or other staff who had sent Resident #1 out uncleaned should had admitted they had not had the time or there was an issue properly preparing the resident to discharge. She stated it had been her expectation that someone would have changed Resident 1's brief and ensured she had on clean clothes and had been in a clean and upkept situation before sending the resident out of the facility. She stated at 01:00 a.m. the staff should have been doing their rounds, and maybe the staff were busy and unable to assist in ensuring Resident #1 had been properly cleaned and dressed to discharge to the hospital. Record review of staffing schedule for 10/15/2025 10 p.m. to 6 a.m. on 10/16/2025 reflected that CNA A, CNA B, CNA C, CNA D, CNA E, and CNA F 675612 Page 5 of 6 675612 11/24/2025 Paradigm at Westbury 5201 S Willow Dr Houston, TX 77035

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few worked and were on shift. Record review of facility policy revised dated 3/2019 and titled Nursing Policies and Procedures reflected Subject: Activities of daily living - Highest Level of Functioning Policy: It is the policy of this facility to provide care and services to ensure that a resident is able to maintain their ability to self-perform their activities of daily living, at their level of functioning prior to facility admission, unless circumstances of the individual's clinical condition demonstrate that diminishment in ability was unavoidable. The facility is responsible to provide necessary care to all resident who are unable to carry out activities of daily living on their own to ensure they maintain proper . grooming and hygiene. Definitions: Activities of daily living (ADLs), refer to tasks related to personal care including, grooming, dressing, oral hygiene, transfer, bed mobility, eating and communication. Record review of facility policy revised dated 10/2023 and titled Policies and Procedures Standards of Care. Policy the purpose of this policy is to establish and maintain acceptable standards of care for all residents, ensuring their safety, well-being, and dignity are maintained. Procedure: 1. Health and Safety Standards a. All care provided will comply with current guidelines, best practices, and Federal/State regulations. Responsibility: All staff members are responsible for adhering to this policy and for providing care that meets these standards. The administrator will oversee the implementation and compliance with this policy. 675612 Page 6 of 6