Inspection·March 27, 2024

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Administrator is the Abuse Coordinator. The Administrator considers the Director of Nursing a designee for reporting and investigation of alleged abuse. In their absence, Admin and DON can appoint appropriate supervisory personnel to initiate investigation. 5. The Administrator and Director of Nursing are responsible for investigation and reporting. They are also ultimately responsible for the following as they relate to abuse, neglect, and/or misappropriation of property standards and procedures: Ongoing monitoring Reporting Investigation Tracking and trending 6. Implementation and ongoing monitoring consist of the following: Screening Training Prevention Identification Protection Investigation Reporting DEFINITIONS: Abuse Willful infliction of injury Unreasonable confinement Intimidation with resulting physical harm or mental anguish Punishment with resulting physical harm or pain or mental health Deprivation by the individual, including a caretaker, of good or service that is necessary to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 2 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 attain or maintain physical, mental, and psychosocial well being . Level of Harm - Immediate jeopardy to resident health or safety Physical Abuse Includes hitting, slapping, pinching, scratching, spitting, holding, roughly, etc. It also includes controlling behavior through corporal punishment . Residents Affected - Few Training 1. Provide training for new employees through orientation and with ongoing training programs. Training will include, but not limited to: Definitions of abuse, neglect, mistreatment, and misappropriation of property. Identification of abuse . Utilization of appropriate interventions to deal with aggressive and/or catastrophic (detrimental) reactions of residents/patients. How to provide protection for residents/patients How to investigate and report incidents of abuse, neglect, mistreatment, and misappropriation of property. Prevention of abuse, neglect, mistreatment, and misappropriation of property including, but not limited to, recognizing signs of burnout, frustration and stress . Prevention Ensure that prevention techniques are implemented in the facility including, but not limited to, ongoing supervision of employees through visual observation of care delivery and recognition of signs of burnout, frustration, and stress. 1. Identify, correct, and intervene in situations where abuse, neglect, and/or mistreatment are more likely to occur. This includes, but is not limited to, identification/analysis of: Secluded areas of the facility Sufficient staffing on each shift to meet the needs of the residents/patients Assigned staff demonstrating knowledge of individual resident/patient needs Sufficient and appropriate supervisory staff to identify inappropriate behaviors Residents with needs and behaviors which might lead to conflict or neglect (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 3 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 2. Level of Harm - Immediate jeopardy to resident health or safety Encourage residents/patients and families to report concerns, incident, and grievances without fear of retribution. Provide feedback regarding the concerns that have been expressed. 3. Residents Affected - Few Instruct staff that they are required to report resident concerns, incidents, and grievances. Identification 1. Identify events, such as suspicious bruising of residents/ patients, occurrences, patterns, and trends that mat constitute abuse, neglect, and/or mistreatment and investigate . 3. instruct staff, resident/patient, family call my visitor, etc. to report immediately, without fear of reprisal, any knowledge or suspicion of suspected abuse, neglect, mistreatment, and/or misappropriation of property. Protection 1. provide for the immediate safety of the resident patient upon identification of suspected abuse, neglect, mistreatment, and/or this appropriation of property. Means of providing protection include, but are not limited to: Moving resident/patient to another room or unit Provide 1:1 monitoring as appropriate Immediate suspension of suspected employee(s) pending outcome of the investigation . 2. Initiate behavior crisis management interventions, as applicable . 2. Administrator and/or designee will initiate the Investigation. The investigation should be thorough with witness statements from staff, resident, family members who are interview-able and have information regarding the allegation . Employee Suspension from Duty 1. Any time an allegation is made involving abuse, neglect, or mistreatment of a resident/patient which names a specific employee, laws and regulations are specific about protecting all residents/patients from harm / potential harm farmer which means suspending the employee until the completion of the investigation. 2. The employee is not to remain on duty, and is not to be assigned to any other area of the facility. 3. The administrator, or in his/her absence the Director of Nursing, Assistant Director of Nursing, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 4 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 or Charge nurse, in that order, must relieve the employee of his/her duty without pay until the investigation is complete. If the allegation is substantiated, the employee will be terminated immediately. Level of Harm - Immediate jeopardy to resident health or safety 4. if the result of the investigation is in favor of the employee or is inconclusive, the employee will be paid regular wages during the time he/she was relieved from duty. Residents Affected - Few Reporting 1. Notify the Administrator, DON, or Shift Supervisor/Charge Nurse immediately if suspected abuse, neglect, mistreatment, or misappropriation of property occurs. 2. Notify the appropriate State agency(s) after identification of alleged incident. initiate process according to State-specific regulations. 3. Person(s) initially identifying potential abuse, neglect, mistreatment, and/or misappropriation of property are accountable to report to proper chain of command. 4. Notify the legal guardian, spouse, or responsible family members/ significant other of the alleged or suspected abuse, neglect, mistreatment, and/or misappropriation of property. 5. Notify the physician of allegation and investigation. 6. Initiate contact with local law enforcement, immediately, when warranted, as required by state law. 7. Report results of investigation to the proper authorities as required by State law. 8. Follow up with resident/patient results and outcome of investigation and ensure their feelings of safety and security. Review of facility policy, titled Reporting Abuse, Neglect, and Mistreatment, with no date, revealed the following: Alleged, suspected or observed abuse, neglect or mistreatment of a resident or patient or his/her belongings are thoroughly investigated by the Administrator and/or the Director of Nursing. Alleged, suspected or observed violations are reported immediately to the Administrator, Regional [NAME] President, Medical Director, VP Quality & Compliance, Ombudsman, State Health and Environmental Departments, and all other officials required by state law. In all cases, the Administrator or Director of Nursing will immediately notify the resident or patient's legal guardian, family member, responsible party or significant other of the alleged, suspected or observed abuse, neglect or mistreatment. If a direct caregiver is observed, suspected or alleged to have engaed in abuse, neglect or mistreatment of resident/patient belongings, the caregiver will be relieved of duty and placed under investigative suspension by the Administrator, Director of Nursing or Nursing Supervisor, until the investigation is completed . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 5 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 - Immediate jeopardy to resident health or safety Residents Affected - Few Review of a facesheet for Resident #1, dated 03/27/2024, revealed he was a [AGE] year-old male admitted to the facility on [DATE] and had diagnoses including: altered mental status, chronic pain, speech disturbances, muscle weakness, contracture of muscle (multiple sites), and dysphagia (difficulty swallowing). Review of Resident #1's Quarterly MDS, dated [DATE], revealed he had a Brief Interview for Mental Status (BIMS) score of 12, indicating moderate impairment. Resident #1's behavior and functional status revealed he had no physical or verbal behavioral symptoms directed towards others exhibited, he had impairment to both sides of upper and lower extremities and required substantial/maximal assistance with toileting hygiene. Review of Resident #1's care plan, revised 03/05/2024, revealed he had interventions in place for history of aggression with staff and dementia with behaviors to include: stopping and returning if resident becomes agitated, approach resident in a calm manner, talk while providing care, when resident becomes agitated intervene before agitation escalates by guiding away from source of distress, engaging calmly in conversation, approach at a later time if response is aggressive, and encourage resident to express feelings appropriately. Review of incident statement, dated 02/28/2024, signed by Administrator, revealed the following: Informed by [CNA C] that another [HA] had informed her that she had witnessed abuse by another staff member [CNA A]. Called [HA] to confirm statement. [HA] stated she was in the resident's room [Resident #1], with [CNA A] during incontinent care the resident punched her [HA] in the stomach, and she stepped back away from him. Then [CNA A] rolled resident over to his back and hollered motherfucker, do not do that again while slapping him in the forehead several times. The resident then swung at [CNA A]. When asked why [HA] did not report to supervisor immediately, she stated because she was scared of [CNA A] and that she had a look when she turned to look at her and she was upset about everything. Did not tell anyone until the next day when she told the other CNA, who reported to me. Review of witness statement, dated 02/28/2024 at 3:00 p.m., signed by CNA C, revealed the following: On 2-27-24 at approx. 6:30 pm, staff member [HA] told me that on Monday night while doing incontinent care, [Resident #1] had punched her in the stomach. HA said she stepped back and [CNA A] rolled [Resident #1] over and slapped him in the face and grabbed his hand. She said this scared her and she didn't know what to do. I told her she needed to go and report this to DON or Admin. She said she felt that she could come to me and that she didn't want to get anyone in trouble. [HA] said she had called her family member to talk about the situation. Review of witness statement, dated 02/28/2028, signed by HA, revealed the following: [HA] interviewed about incident that occurred with (Resident #1). She stated that on Tuesday morn (morning) at 3am (3:00 a.m.) during incontinent rounds, she and co-worker [CNA A] went into [Resident #1's] room. When they first went in the room he drew is fist back. [HA] stated she tried to talk him down because usually this will work. They began performing care and rolled him over toward her (she was between the bed and the wall) but he started hitting her in the stomach. [CNA A] then rolled him back over and slapped him more than once on the forehead. [HA] stated [CNA A] said I'll beat the f--- out of you. You know you laying in the bed and can't move. They finished the care and put a brief on him and left the room. After this [HA] said she went outside because she was upset. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 6 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 - Immediate jeopardy to resident health or safety she thought about leaving but didn't, she came back inside to complete shift. She didn't go to charge nurse at that time. Stated she was afraid she would be in trouble as well. This was the last round of the evening so nothing else occurred with other residents and [CNA A]. [HA] stated she went back into [Resident #1's] room and gave him a hug. He was fine and didn't seem upset. Stated she knows she should have said something but that she had never seen anything like this and it just scared her. Tuesday 2-27-24 at 6:30pm [HA] told [CNA C] what had occurred with [Resident #1] that morning during her shift. Residents Affected - Few Review of witness statement, dated 02/28/2024, signed by LVN D, revealed the following: DON interviewed [LVN D] regarding alleged abuse incident that occurred with Resident #1. [LVN D] stated aides did not tell her that [Resident #1] hit [HA] or anything else that occurred after that point. She stated they told her that [Resident #1] was being difficult during incontinent care. The time reported to her was between 3am (3:00 a.m.) and 4am (4:00 a.m.) so it would have been their last round with him that night. Review of Associate Disciplinary Memorandums, dated 02/28/2024, revealed CNA A, HA, and CNA C were suspended pending investigation. CNA C and HA were reinstated and received training on abuse. CNA C received formal written disciplinary action for failing to report abuse. Supervisors Comments revealed CNA C was aware of reporting guidelines, understands not to wait if she believed anything has occurred, and stated she told employee to report to DON or Admin. CNA A was discharged effective 03/05/2024 due to employee confirming allegation of incident that warrants termination. Review of witness statement, dated 02/29/2024, signed by CNA A, revealed the following: [CNA A] interviewed in person by DON and Administrator on 2-29-24 at 10:15am. She was off on 2-28-24 when the investigation initiated and we were unable to reach her until late that evening. The meeting was set up for Thursday 2-29-24 to obtain statement and her version of events that occurred on 2-27-24 at 3am with [Resident #1]. STATEMENT: We went in to do incontinent care on [Resident #1]. He punched [HA] in the stomach. I tried to hold him down with his hands on his chest so he couldn't hit her anymore. When she was cleaning between his legs he tried to punch me. I told him: stop this, this is not how things go. We don't hit women, it does not work that way. [HA] said my doesn't even hit me. He continued to try to hit us. I did not hit him, it wouldn't do any good anyway. So I just held him down. I did not tell the nurse at that time, she wouldn't do anything anyway. I thought [HA] was going to tell her. No one should have to go into a room and wonder if they are going to get hit. It was self defense. Follow up: Admin asked about the curse words that were alleged. Asked her if she used the f-word. stated that she did not curse . maybe the worst she said was damn don't do this. Admin asked about the allegation that she slapped on the forehead several times and she said well yes she did do that just to get him to stop hitting. I asked her to demonstrate and she slapped her forehead several times with her fingers, palm down in front of nose. Admin asked about why she didn't just back away when he was combative as this could be one approach - she stated they just had to get the job done. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 7 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 - Immediate jeopardy to resident health or safety Review of personnel record for CNA A revealed she was hired on 12/06/2018 and signed and dated policy for reporting abuse, responsibility for reporting abuse, and Senate [NAME] 9 employee acknowledgement that mistreatment or abuse will not be tolerated and will be subject to immediate discharge. Review of personnel record for HA revealed she was hired on 12/28/2023 and signed and dated policy for reporting abuse and responsibility for reporting abuse. Residents Affected - Few Review of audit, titled Staff Awareness on What Constitutes Abuse, dated 01/25/2024, revealed CNA A and HA met criteria for knowing when and who to report allegations of abuse. Audit revealed met criteria for knowledge of reporting physical abuse immediately to the Administrator. Review of training records, dated 3/5/2024, completed by CNA A, revealed the following education was provided: Preventing, Recognizing, and Reporting Abuse, and Managing Anger completed on 08/13/2023 and Communication and People with Dementia completed on 02/05/2024. Review of training records, dated 3/1/2024, completed by CNA C, reveled the following education was provided: Communication and People with Dementia completed on 1/31/2024, Managing Anger on 08/09/2023, and Preventing, Recognizing, and Reporting Abuse on 03/03/2024. Review of Provider Investigation Report, dated 03/06/2024, revealed the following: .Description of the Allegation: Employee (HA) alleged that resident (Resident #1) had hit her in the stomach while they were performing incontinent care. (CNA A) had cursed at the resident telling him not to do that and slapped him on the forehead several times . Description of assessment . Resident had no physical injuries. His forehead had no discoloration or bruising noted. No redness or complaints of pain. Resident was interviewed as to the allegation and denied anything had occurred. His behavior was normal for his baseline. He has been doing his normal routine with no concerns from staff. DON checked daily for three days and assessed his mood and behaviors with no changes noted . Provider Response: . Upon receipt of allegations, employees involved were suspended immediately, including the individual making the allegation, pending outcome of investigation. Resident was assessed for injuries and evaluated for his feeling of safety, and any need for intervention as a result of the alleged incident. Resident had no physical injuries and denied the occurrence of the incident, stating he had no complaints about the staff. Residents responsible party, position and investment were notified. Police were called to report the allegation . Investigation Summary: . Resident #1 was the first with no injuries noted. He also denied that anything had occurred regarding an employee slapping him and cursing at him. His roommate, who was alert and oriented, was interviewed about if he witnessed or heard anything at the time this was alleged to occur, he stated that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 8 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 - Immediate jeopardy to resident health or safety Residents Affected - Few he didn't know of anything out of the ordinary but that (Resident #1) was all the time fighting the girls. Resident's roommate, (Resident #2), was asked about his feeling of safety and if anything had ever happened to him, as far as staff mistreating him, during his stay here and he stated no everything was fine. Responsible party of (Resident #1) was notified of allegation and to determine if he had shared anything related to allegation or any other time regarding his feeling of safety and well-being. She was not aware of anything abnormal or anything with him. Staff working the night of the alleged abuse were interviewed and were not aware of anything out of the ordinary occurring (with exception of the witness who reported the incident). (CNA A), alleged perpetrator, was interviewed. (CNA A) Stated that after (Resident #1) punched (HA) in this stomach, she (CNA A) had held him down so he could not hit her anymore. (CNA A) Stated that he had also tried to hit her. She denied cursing at him but said she told him this was unacceptable-that you cannot hit women. initially she denied slapping him but when asked by administrator if she had hit him on the forehead she stated she only did it to get him to stop hitting them. She demonstrated the same motion that was displayed by (HA) during her interview. Fingertips slapping forehead, palm down in front of face. Residents cared for by (CNA A) were interviewed to determine if they felt safe and if there were any other issues to report regarding staff treatment of residence. (Resident #1) continues to display no negative effects related to the incident. (CNA A) confirmed the allegation and was terminated from employment .Physician, family, police, and Ombudsman were notified of the incident. Investigation Findings: Confirmed. Provider Action Taken Post Investigation: Employee (CNA A) was terminated post investigation. (CNA C) and (HA) were suspended but reinstated after receiving additional training on abuse/neglect, reporting guidelines, and how to handle dementia and combative residence. Facility staff received in service training on abuse neglect, handling them into residence, and how they handle combative residents. Post test given and follow up on any staff lacking proper knowledge during testing related to abuse/neglect. training upon hire, at minimum annually and as needed. Review of Resident #1's progress notes by ADON, dated 02/29/2024, revealed Resident #1 head to toe skin assessment was performed with no skin alterations noted. Review of Provider Investigation Report, dated 3/6/2024, revealed monitoring statements signed by the Administrator for Resident #1, dated between 02/28/2024 and 03/01/2024 The monitoring statements signed by the Administrator revealed Resident #1 had exhibited no physical or psychosocial harm, had no indication of stress, no behaviors, he was socializing normally, and had no concerns. Review of statement, dated 03/06/2024, signed by Administrator, revealed Ombudsman spoke with Resident #1 that told her They fired her and slapped his head a few times when asked what happened and he denied that it hurt and had no further concerns. Review of inservices and employee roster provided by Administrator and DON, dated between 02/28/2024 and 03/01/2024 revealed all nursing staff received education on abuse and reporting. During an interview with the Administrator and DON on 03/26/2024 at 1:42 p.m., the Administrator said she was the abuse coordinator and was aware of a self-reported incident of abuse concerning Resident #1. The Administrator said the aide admitted that she did pat his head lightly to try to keep him from hitting her and they terminated her. She said the resident showed no signs of psychosocial or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 9 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 - Immediate jeopardy to resident health or safety Residents Affected - Few physical harm when the Administrator monitored him for three days following report of incident documented in her monitoring statements in provider investigation report. During an interview on 03/26/2024 at 3:05 p.m., the Ombudsman said Resident #1 was physically abused with two staff in the room and the Ombudsman had spoken with his RP and she was okay with how the facility was handling it. The Ombudsman said he has a speech impediment and was not aware of any skin changes or bruising. During an interview on 03/26/2024 at 3:26 p.m., PTA said he did not suspect abuse at this facility and had received training on abuse and handling dementia residents via in-services. PTA said if he suspected abuse he would report it to the ADM immediately. PTA said Resident #1 was doing good and has known him for 6 or 7 years and has had no change in condition. PTA said he can have behaviors but that he has known him for a long time but that they had a good relationship and he knew how to talk and approach him to maintain his trust. PTA said Resident #1 liked coming to therapy and doing his legs and had never had any concerns with staff being abusive or rough with him. During an interview and observation on 03/26/2024 at 4:20 p.m., Resident #1 said he was doing good and that everyone was nice to him at the facility. Resident #1 said he had no concerns. The Resident appeared well groomed, free from apparent injury, pleasant, and in no distress sitting up in wheelchair in his room watching television. During an interview on 03/27/2024 at 11:41 a.m., HA L said she did not suspect abuse, had been trained on abuse, reporting, and dementia residents via in-services, and had been employed at the facility for 2 years. HA L said it was important for resident's care plan to be followed to prevent harm and make sure all residents receive proper care. During an interview on 03/27/2024 at 11:56 a.m., CNA T said she had been employed at the facility for 5 years and did not suspect abuse. CNA T said she had received training on abuse, reporting, and caring for dementia residents. CNA T said if there is a resident that is showing signs or aggression she would try again later after the resident had calmed down and that if she ever witnessed any abuse she would report to the ADM or DON immediately. During an interview via phone on 03/27/2024 at 12:45 p.m., CNA C said The hospitality aide that worked at night came in and said I need to talk to you. She said I don't know what to do [CNA A] slapped the resident in the face twice. I said you should have reported it to the charge nurse. CNA C said HA told her she was scared, and afraid CNA A would retaliate on her if she reported the incident. CNA C said she knew should have reported it then, but she did not report it until the next day to her DON because she had told HA to report it. CNA C said Resident #1 had no injuries or behavior changes and the facility had provided training on abuse and when to report. CNA C said she would report to the DON or ADM any suspected abuse immediately and the abuse coordinator was the Administrator. CNA C felt the facility took care of that situation. CNA C said she had no previous concerns with the care provided by CNA A and believed it was an isolated incident. CNA C said it was important to report abuse immediately to ensure resident safety. During an interview on 03/27/2024 at 1:45 p.m., the Administrator said staff expectation was to report alleged abuse immediately. The Administrator said it was important to report immediately so that residents could be prevented from further harm and to allow the facility to respond to the situation. The Administrator said all staff received education on abuse and reporting. The Administrator said she has conducted a verbal audit check monthly to ensure staff knowledge on abuse, neglect, and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 10 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 reporting. The Administrator said she was the abuse coordinator and was responsible for training on abuse. Level of Harm - Immediate jeopardy to resident health or safety During an interview via phone on 03/27/2024 at 2:11 p.m., HA said she had been at the facility for 5 months and works on the night shift. HA said she did witness the incident with Resident #1 and said she saw CNA A hit the resident on the face with her fingers on his forehead multiple times, roll him around and heard her tell the resident she could have someone come in to whoop his ass whenever she wanted to with him being in this bed. HA said after that happened CNA A left the room and HA stepped out of the room due to being upset and scared. HA said she returned to the room to finish his care and gave him a hug. HA said he had no injuries and never had any social isolation following the incident. HA said she has taken care of him since then and that he seems to be doing better with no combative behavior and appears happy. HA said the incident happened early in the morning between midnight and 4:00 a.m. HA said she did not know if CNA A worked the next day and that she does not remember working with her. HA said that she knew she should have reported the incident immediately to the abuse coordinator but that it was late and did not have her phone number. HA said she notified another CNA, CNA C, around 6:30 p.m. on 2/27/2024 and that CNA C notified the Administrator immediately. HA said that she had received training on abuse briefly in orientation and that she did receive training following the incident. HA said the abuse coordinator was the Administrator and that it was important for alleged abuse to be reported immediately to her to prevent abuse from occurring and further protect residents from harm. HA said she believed the incident was isolated and had no concerns with CNA A prior to this incident. HA said that CNA A was fired and that she felt the facility handled the situation appropriately. Residents Affected - Few During an interview and record review on 03/27/2024 at 5:28 p.m., the Administrator said her expectations of staff was to report abuse immediately and that if she was notified of the abuse allegation promptly she would have responded the same way by suspending the perpetrator once notified, ensure residents were safe, and assess the resident/victim involved in the incident. The Administrator confirmed via timesheet the perpetrator continued to work the remainder of her shift following the abuse incident as well as the following shift the next day. The Administrator said the perpetrator was showing signs of different behavior and believe she had personal things going on at home that may have contributed to this isolated incident and that the employee had no concerns with her background check and had been working at the facility for 5 years. The Administrator and DON said they were responsible for training staff on abuse, reporting, and their expectations of staff when caring for aggressive residents included to approach in a calm manner, to stop what they are doing and come back later once the resident has calmed down. The Administrator said she had conducted an audit check of nursing staff to ensure knowledge of abuse, reporting, and handling residents with dementia and she would continue to conduct verbal audit checks monthly to verify knowledge of training. During an interview via phone on 03/28/2024 at 11:23 a.m., Detective K said there have been no warrants issued at this time for CNA A and that she had no criminal history or background indicating history of abusive behavior. Detective K said she was aware Resident #1's family was looking to FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 11 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Immediate jeopardy to resident health or safety **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to implement policies and procedures that prohibit and prevent abuse, neglect, and exploitation of resident to ensure residents were free from physical abuse for one of four residents (Resident #1) reviewed for abuse. Residents Affected - Few 1. The facility failed to prevent physical abuse of Resident #1 who was hit on the head by CNA A on 02/27/2024. 2. The facility failed to ensure CNA A was not allowed to work after the allegation of abuse had been reported The noncompliance was identified as PNC. The IJ began on 02/27/2024 and ended on 03/05/2024. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk for physical harm, psychosocial harm, unsafe environment, and further abuse. Findings included: Review of facility policy, titled Abuse/Neglect Policy & Procedure, with no date, revealed the following: PREVENTION AND REPORTING: 1. The facility prohibits the mistreatment, neglect, and abuse of residents/patients and misappropriation of resident/patient property by anyone including staff, family, friends, etc. 2. The facility has designed and implemented processes, which strives to ensure the prevention and reporting of suspected or alleged resident/patient abuse, neglect, mistreatment, and/or misappropriation of property. 3. The facility has implemented the following processes in an effort to provide residents/patients and staff a safe and comfortable environment. 4. Administrator is the Abuse Coordinator. The Administrator considers the Director of Nursing a designee for reporting and investigation of alleged abuse. In their absence, Admin and DON can appoint appropriate supervisory personnel to initiate investigation. 5. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 12 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few The Administrator and Director of Nursing are responsible for investigation and reporting. They are also ultimately responsible for the following as they relate to abuse, neglect, and/or misappropriation of property standards and procedures: Ongoing monitoring Reporting Investigation Tracking and trending 6. Implementation and ongoing monitoring consist of the following: Screening Training Prevention Identification Protection Investigation Reporting DEFINITIONS: Abuse Willful infliction of injury Unreasonable confinement Intimidation with resulting physical harm or mental anguish Punishment with resulting physical harm or pain or mental health Deprivation by the individual, including a caretaker, of good or service that is necessary to attain or maintain physical, mental, and psychosocial well being . Physical Abuse Includes hitting, slapping, pinching, scratching, spitting, holding, roughly, etc. It also includes controlling behavior through corporal punishment . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 13 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Training Level of Harm - Immediate jeopardy to resident health or safety 1. Provide training for new employees through orientation and with ongoing training programs. Training will include, but not limited to: Residents Affected - Few Definitions of abuse, neglect, mistreatment, and misappropriation of property. Identification of abuse . Utilization of appropriate interventions to deal with aggressive and/or catastrophic (detrimental) reactions of residents/patients. How to provide protection for residents/patients How to investigate and report incidents of abuse, neglect, mistreatment, and misappropriation of property. Prevention of abuse, neglect, mistreatment, and misappropriation of property including, but not limited to, recognizing signs of burnout, frustration and stress . Prevention Ensure that prevention techniques are implemented in the facility including, but not limited to, ongoing supervision of employees through visual observation of care delivery and recognition of signs of burnout, frustration, and stress. 1. Identify, correct, and intervene in situations where abuse, neglect, and/or mistreatment are more likely to occur. This includes, but is not limited to, identification/analysis of: Secluded areas of the facility Sufficient staffing on each shift to meet the needs of the residents/patients Assigned staff demonstrating knowledge of individual resident/patient needs Sufficient and appropriate supervisory staff to identify inappropriate behaviors Residents with needs and behaviors which might lead to conflict or neglect 2. Encourage residents/patients and families to report concerns, incident, and grievances without fear of retribution. Provide feedback regarding the concerns that have been expressed. 3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 14 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Instruct staff that they are required to report resident concerns, incidents, and grievances. Level of Harm - Immediate jeopardy to resident health or safety Identification Residents Affected - Few Identify events, such as suspicious bruising of residents/ patients, occurrences, patterns, and trends that mat constitute abuse, neglect, and/or mistreatment and investigate . 1. 3. instruct staff, resident/patient, family call my visitor, etc. to report immediately, without fear of reprisal, any knowledge or suspicion of suspected abuse, neglect, mistreatment, and/or misappropriation of property. Protection 1. provide for the immediate safety of the resident patient upon identification of suspected abuse, neglect, mistreatment, and/or this appropriation of property. Means of providing protection include, but are not limited to: Moving resident/patient to another room or unit Provide 1:1 monitoring as appropriate Immediate suspension of suspected employee(s) pending outcome of the investigation . 2. Initiate behavior crisis management interventions, as applicable . 2. Administrator and/or designee will initiate the Investigation. The investigation should be thorough with witness statements from staff, resident, family members who are interview-able and have information regarding the allegation . Employee Suspension from Duty 1. Any time an allegation is made involving abuse, neglect, or mistreatment of a resident/patient which names a specific employee, laws and regulations are specific about protecting all residents/patients from harm / potential harm farmer which means suspending the employee until the completion of the investigation. 2. The employee is not to remain on duty, and is not to be assigned to any other area of the facility. 3. The administrator, or in his/her absence the Director of Nursing, Assistant Director of Nursing, or Charge nurse, in that order, must relieve the employee of his/her duty without pay until the investigation is complete. If the allegation is substantiated, the employee will be terminated immediately. 4. if the result of the investigation is in favor of the employee or is inconclusive, the employee will be paid regular wages during the time he/she was relieved from duty. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 15 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Reporting Level of Harm - Immediate jeopardy to resident health or safety 1. Notify the Administrator, DON, or Shift Supervisor/Charge Nurse immediately if suspected abuse, neglect, mistreatment, or misappropriation of property occurs. Residents Affected - Few 2. Notify the appropriate State agency(s) after identification of alleged incident. initiate process according to State-specific regulations. 3. Person(s) initially identifying potential abuse, neglect, mistreatment, and/or misappropriation of property are accountable to report to proper chain of command. 4. Notify the legal guardian, spouse, or responsible family members/ significant other of the alleged or suspected abuse, neglect, mistreatment, and/or misappropriation of property. 5. Notify the physician of allegation and investigation. 6. Initiate contact with local law enforcement, immediately, when warranted, as required by state law. 7. Report results of investigation to the proper authorities as required by State law. 8. Follow up with resident/patient results and outcome of investigation and ensure their feelings of safety and security. Review of facility policy, titled Reporting Abuse, Neglect, and Mistreatment, with no date, revealed the following: Alleged, suspected or observed abuse, neglect or mistreatment of a resident or patient or his/her belongings are thoroughly investigated by the Administrator and/or the Director of Nursing. Alleged, suspected or observed violations are reported immediately to the Administrator, Regional [NAME] President, Medical Director, VP Quality & Compliance, Ombudsman, State Health and Environmental Departments, and all other officials required by state law. In all cases, the Administrator or Director of Nursing will immediately notify the resident or patient's legal guardian, family member, responsible party or significant other of the alleged, suspected or observed abuse, neglect or mistreatment. If a direct caregiver is observed, suspected or alleged to have engaed in abuse, neglect or mistreatment of resident/patient belongings, the caregiver will be relieved of duty and placed under investigative suspension by the Administrator, Director of Nursing or Nursing Supervisor, until the investigation is completed . Review of a facesheet for Resident #1, dated 03/27/2024, revealed he was a [AGE] year-old male admitted to the facility on [DATE] and had diagnoses including: altered mental status, chronic pain, speech disturbances, muscle weakness, contracture of muscle (multiple sites), and dysphagia (difficulty swallowing). Review of Resident #1's Quarterly MDS, dated [DATE], revealed he had a Brief Interview for Mental (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 16 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Status (BIMS) score of 12, indicating moderate impairment. Resident #1's behavior and functional status revealed he had no physical or verbal behavioral symptoms directed towards others exhibited, he had impairment to both sides of upper and lower extremities and required substantial/maximal assistance with toileting hygiene. Review of Resident #1's care plan, revised 03/05/2024, revealed he had interventions in place for history of aggression with staff and dementia with behaviors to include: stopping and returning if resident becomes agitated, approach resident in a calm manner, talk while providing care, when resident becomes agitated intervene before agitation escalates by guiding away from source of distress, engaging calmly in conversation, approach at a later time if response is aggressive, and encourage resident to express feelings appropriately. Review of incident statement, dated 02/28/2024, signed by Administrator, revealed the following: Informed by [CNA C] that another [HA] had informed her that she had witnessed abuse by another staff member [CNA A]. Called [HA] to confirm statement. [HA] stated she was in the resident's room [Resident #1], with [CNA A] during incontinent care the resident punched her [HA] in the stomach, and she stepped back away from him. Then [CNA A] rolled resident over to his back and hollered motherfucker, do not do that again while slapping him in the forehead several times. The resident then swung at [CNA A]. When asked why [HA] did not report to supervisor immediately, she stated because she was scared of [CNA A] and that she had a look when she turned to look at her and she was upset about everything. Did not tell anyone until the next day when she told the other CNA, who reported to me. Review of witness statement, dated 02/28/2024 at 3:00 p.m., signed by CNA C, revealed the following: On 2-27-24 at approx. 6:30 pm, staff member [HA] told me that on Monday night while doing incontinent care, [Resident #1] had punched her in the stomach. HA said she stepped back and [CNA A] rolled [Resident #1] over and slapped him in the face and grabbed his hand. She said this scared her and she didn't know what to do. I told her she needed to go and report this to DON or Admin. She said she felt that she could come to me and that she didn't want to get anyone in trouble. [HA] said she had called her family member to talk about the situation. Review of witness statement, dated 02/28/2028, signed by HA, revealed the following: [HA] interviewed about incident that occurred with (Resident #1). She stated that on Tuesday morn (morning) at 3am (3:00 a.m.) during incontinent rounds, she and co-worker [CNA A] went into [Resident #1's] room. When they first went in the room he drew is fist back. [HA] stated she tried to talk him down because usually this will work. They began performing care and rolled him over toward her (she was between the bed and the wall) but he started hitting her in the stomach. [CNA A] then rolled him back over and slapped him more than once on the forehead. [HA] stated [CNA A] said I'll beat the f--- out of you. You know you laying in the bed and can't move. They finished the care and put a brief on him and left the room. After this [HA] said she went outside because she was upset. She stated she thought about leaving but didn't, she came back inside to complete shift. She didn't go to charge nurse at that time. Stated she was afraid she would be in trouble as well. This was the last round of the evening so nothing else occurred with other residents and [CNA A]. [HA] stated she went back into [Resident #1's] room and gave him a hug. He was fine and didn't seem upset. Stated she knows she should have said something but that she had never seen anything like this and it just scared her. Tuesday 2-27-24 at 6:30pm [HA] told [CNA C] what had occurred with [Resident #1] that morning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 17 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 during her shift. Level of Harm - Immediate jeopardy to resident health or safety Review of witness statement, dated 02/28/2024, signed by LVN D, revealed the following: Residents Affected - Few DON interviewed [LVN D] regarding alleged abuse incident that occurred with Resident #1. [LVN D] stated aides did not tell her that [Resident #1] hit [HA] or anything else that occurred after that point. She stated they told her that [Resident #1] was being difficult during incontinent care. The time reported to her was between 3am (3:00 a.m.) and 4am (4:00 a.m.) so it would have been their last round with him that night. Review of Associate Disciplinary Memorandums, dated 02/28/2024, revealed CNA A, HA, and CNA C were suspended pending investigation. CNA C and HA were reinstated and received training on abuse. CNA C received formal written disciplinary action for failing to report abuse. Supervisors Comments revealed CNA C was aware of reporting guidelines, understands not to wait if she believed anything has occurred, and stated she told employee to report to DON or Admin. CNA A was discharged effective 03/05/2024 due to employee confirming allegation of incident that warrants termination. Review of witness statement, dated 02/29/2024, signed by CNA A, revealed the following: [CNA A] interviewed in person by DON and Administrator on 2-29-24 at 10:15am. She was off on 2-28-24 when the investigation initiated and we were unable to reach her until late that evening. The meeting was set up for Thursday 2-29-24 to obtain statement and her version of events that occurred on 2-27-24 at 3am with [Resident #1]. STATEMENT: We went in to do incontinent care on [Resident #1]. He punched [HA] in the stomach. I tried to hold him down with his hands on his chest so he couldn't hit her anymore. When she was cleaning between his legs he tried to punch me. I told him: stop this, this is not how things go. We don't hit women, it does not work that way. [HA] said my doesn't even hit me. He continued to try to hit us. I did not hit him, it wouldn't do any good anyway. So I just held him down. I did not tell the nurse at that time, she wouldn't do anything anyway. I thought [HA] was going to tell her. No one should have to go into a room and wonder if they are going to get hit. It was self defense. Follow up: Admin asked about the curse words that were alleged. Asked her if she used the f-word. stated that she did not curse . maybe the worst she said was damn don't do this. Admin asked about the allegation that she slapped on the forehead several times and she said well yes she did do that just to get him to stop hitting. I asked her to demonstrate and she slapped her forehead several times with her fingers, palm down in front of nose. Admin asked about why she didn't just back away when he was combative as this could be one approach - she stated they just had to get the job done. Review of personnel record for CNA A revealed she was hired on 12/06/2018 and signed and dated policy for reporting abuse, responsibility for reporting abuse, and Senate [NAME] 9 employee acknowledgement that mistreatment or abuse will not be tolerated and will be subject to immediate discharge. Review of personnel record for HA revealed she was hired on 12/28/2023 and signed and dated policy for reporting abuse and responsibility for reporting abuse. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 18 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of audit, titled Staff Awareness on What Constitutes Abuse, dated 01/25/2024, revealed CNA A and HA met criteria for knowing when and who to report allegations of abuse. Audit revealed met criteria for knowledge of reporting physical abuse immediately to the Administrator. Review of training records, dated 3/5/2024, completed by CNA A, revealed the following education was provided: Preventing, Recognizing, and Reporting Abuse, and Managing Anger completed on 08/13/2023 and Communication and People with Dementia completed on 02/05/2024. Review of training records, dated 3/1/2024, completed by CNA C, reveled the following education was provided: Communication and People with Dementia completed on 1/31/2024, Managing Anger on 08/09/2023, and Preventing, Recognizing, and Reporting Abuse on 03/03/2024. Review of Provider Investigation Report, dated 03/06/2024, revealed the following: .Description of the Allegation: Employee (HA) alleged that resident (Resident #1) had hit her in the stomach while they were performing incontinent care. (CNA A) had cursed at the resident telling him not to do that and slapped him on the forehead several times . Description of assessment . Resident had no physical injuries. His forehead had no discoloration or bruising noted. No redness or complaints of pain. Resident was interviewed as to the allegation and denied anything had occurred. His behavior was normal for his baseline. He has been doing his normal routine with no concerns from staff. DON checked daily for three days and assessed his mood and behaviors with no changes noted . Provider Response: . Upon receipt of allegations, employees involved were suspended immediately, including the individual making the allegation, pending outcome of investigation. Resident was assessed for injuries and evaluated for his feeling of safety, and any need for intervention as a result of the alleged incident. Resident had no physical injuries and denied the occurrence of the incident, stating he had no complaints about the staff. Residents responsible party, position and investment were notified. Police were called to report the allegation . Investigation Summary: . Resident #1 was the first with no injuries noted. He also denied that anything had occurred regarding an employee slapping him and cursing at him. His roommate, who was alert and oriented, was interviewed about if he witnessed or heard anything at the time this was alleged to occur, he stated that he didn't know of anything out of the ordinary but that (Resident #1) was all the time fighting the girls. Resident's roommate, (Resident #2), was asked about his feeling of safety and if anything had ever happened to him, as far as staff mistreating him, during his stay here and he stated no everything was fine. Responsible party of (Resident #1) was notified of allegation and to determine if he had shared anything related to allegation or any other time regarding his feeling of safety and well-being. She was not aware of anything abnormal or anything with him. Staff working the night of the alleged abuse were interviewed and were not aware of anything out of the ordinary occurring (with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 19 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few exception of the witness who reported the incident). (CNA A), alleged perpetrator, was interviewed. (CNA A) Stated that after (Resident #1) punched (HA) in this stomach, she (CNA A) had held him down so he could not hit her anymore. (CNA A) Stated that he had also tried to hit her. She denied cursing at him but said she told him this was unacceptable-that you cannot hit women. initially she denied slapping him but when asked by administrator if she had hit him on the forehead she stated she only did it to get him to stop hitting them. She demonstrated the same motion that was displayed by (HA) during her interview. Fingertips slapping forehead, palm down in front of face. Residents cared for by (CNA A) were interviewed to determine if they felt safe and if there were any other issues to report regarding staff treatment of residence. (Resident #1) continues to display no negative effects related to the incident. (CNA A) confirmed the allegation and was terminated from employment .Physician, family, police, and Ombudsman were notified of the incident. Investigation Findings: Confirmed. Provider Action Taken Post Investigation: Employee (CNA A) was terminated post investigation. (CNA C) and (HA) were suspended but reinstated after receiving additional training on abuse/neglect, reporting guidelines, and how to handle dementia and combative residence. Facility staff received in service training on abuse neglect, handling them into residence, and how they handle combative residents. Post test given and follow up on any staff lacking proper knowledge during testing related to abuse/neglect. training upon hire, at minimum annually and as needed. Review of Resident #1's progress notes by ADON, dated 02/29/2024, revealed Resident #1 head to toe skin assessment was performed with no skin alterations noted. Review of Provider Investigation Report, dated 3/6/2024, revealed monitoring statements signed by the Administrator for Resident #1, dated between 02/28/2024 and 03/01/2024 The monitoring statements signed by the Administrator revealed Resident #1 had exhibited no physical or psychosocial harm, had no indication of stress, no behaviors, he was socializing normally, and had no concerns. Review of statement, dated 03/06/2024, signed by Administrator, revealed Ombudsman spoke with Resident #1 that told her They fired her and slapped his head a few times when asked what happened and he denied that it hurt and had no further concerns. Review of inservices and employee roster provided by Administrator and DON, dated between 02/28/2024 and 03/01/2024 revealed all nursing staff received education on abuse and reporting. During an interview with the Administrator and DON on 03/26/2024 at 1:42 p.m., the Administrator said she was the abuse coordinator and was aware of a self-reported incident of abuse concerning Resident #1. The Administrator said the aide admitted that she did pat his head lightly to try to keep him from hitting her and they terminated her. She said the resident showed no signs of psychosocial or physical harm when the Administrator monitored him for three days following report of incident documented in her monitoring statements in provider investigation report. During an interview on 03/26/2024 at 3:05 p.m., the Ombudsman said Resident #1 was physically abused with two staff in the room and the Ombudsman had spoken with his RP and she was okay with how the facility was handling it. The Ombudsman said he has a speech impediment and was not aware of any skin changes or bruising. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 20 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few During an interview on 03/26/2024 at 3:26 p.m., PTA said he did not suspect abuse at this facility and had received training on abuse and handling dementia residents via in-services. PTA said if he suspected abuse he would report it to the ADM immediately. PTA said Resident #1 was doing good and has known him for 6 or 7 years and has had no change in condition. PTA said he can have behaviors but that he has known him for a long time but that they had a good relationship and he knew how to talk and approach him to maintain his trust. PTA said Resident #1 liked coming to therapy and doing his legs and had never had any concerns with staff being abusive or rough with him. During an interview and observation on 03/26/2024 at 4:20 p.m., Resident #1 said he was doing good and that everyone was nice to him at the facility. Resident #1 said he had no concerns. The Resident appeared well groomed, free from apparent injury, pleasant, and in no distress sitting up in wheelchair in his room watching television. During an interview on 03/27/2024 at 11:41 a.m., HA L said she did not suspect abuse, had been trained on abuse, reporting, and dementia residents via in-services, and had been employed at the facility for 2 years. HA L said it was important for resident's care plan to be followed to prevent harm and make sure all residents receive proper care. During an interview on 03/27/2024 at 11:56 a.m., CNA T said she had been employed at the facility for 5 years and did not suspect abuse. CNA T said she had received training on abuse, reporting, and caring for dementia residents. CNA T said if there is a resident that is showing signs or aggression she would try again later after the resident had calmed down and that if she ever witnessed any abuse she would report to the ADM or DON immediately. During an interview via phone on 03/27/2024 at 12:45 p.m., CNA C said The hospitality aide that worked at night came in and said I need to talk to you. She said I don't know what to do [CNA A] slapped the resident in the face twice. I said you should have reported it to the charge nurse. CNA C said HA told her she was scared, and afraid CNA A would retaliate on her if she reported the incident. CNA C said she knew should have reported it then, but she did not report it until the next day to her DON because she had told HA to report it. CNA C said Resident #1 had no injuries or behavior changes and the facility had provided training on abuse and when to report. CNA C said she would report to the DON or ADM any suspected abuse immediately and the abuse coordinator was the Administrator. CNA C felt the facility took care of that situation. CNA C said she had no previous concerns with the care provided by CNA A and believed it was an isolated incident. CNA C said it was important to report abuse immediately to ensure resident safety. During an interview on 03/27/2024 at 1:45 p.m., the Administrator said staff expectation was to report alleged abuse immediately. The Administrator said it was important to report immediately so that residents could be prevented from further harm and to allow the facility to respond to the situation. The Administrator said all staff received education on abuse and reporting. The Administrator said she has conducted a verbal audit check monthly to ensure staff knowledge on abuse, neglect, and reporting. The Administrator said she was the abuse coordinator and was responsible for training on abuse. During an interview via phone on 03/27/2024 at 2:11 p.m., HA said she had been at the facility for 5 months and works on the night shift. HA said she did witness the incident with Resident #1 and said she saw CNA A hit the resident on the face with her fingers on his forehead multiple times, roll him around and heard her tell the resident she could have someone come in to whoop his ass whenever she wanted to with him being in this bed. HA said after that happened CNA A left the room and HA (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 21 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few stepped out of the room due to being upset and scared. HA said she returned to the room to finish his care and gave him a hug. HA said he had no injuries and never had any social isolation following the incident. HA said she has taken care of him since then and that he seems to be doing better with no combative behavior and appears happy. HA said the incident happened early in the morning between midnight and 4:00 a.m. HA said she did not know if CNA A worked the next day and that she does not remember working with her. HA said that she knew she should have reported the incident immediately to the abuse coordinator but that it was late and did not have her phone number. HA said she notified another CNA, CNA C, around 6:30 p.m. on 2/27/2024 and that CNA C notified the Administrator immediately. HA said that she had received training on abuse briefly in orientation and that she did receive training following the incident. HA said the abuse coordinator was the Administrator and that it was important for alleged abuse to be reported immediately to her to prevent abuse from occurring and further protect residents from harm. HA said she believed the incident was isolated and had no concerns with CNA A prior to this incident. HA said that CNA A was fired and that she felt the facility handled the situation appropriately. During an interview and record review on 03/27/2024 at 5:28 p.m., the Administrator said her expectations of staff was to report abuse immediately and that if she was notified of the abuse allegation promptly she would have responded the same way by suspending the perpetrator once notified, ensure residents were safe, and assess the resident/victim involved in the incident. The Administrator confirmed via timesheet the perpetrator continued to work the remainder of her shift following the abuse incident as well as the following shift the next day. The Administrator said the perpetrator was showing signs of different behavior and believe she had personal things going on at home that may have contributed to this isolated incident and that the employee had no concerns with her background check and had been working at the facility for 5 years. The Administrator and DON said they were responsible for training staff on abuse, reporting, and their expectations of staff when caring for aggressive residents included to approach in a calm manner, to stop what they are doing and come back later once the resident has calmed down. The Administrator said she had conducted an audit check of nursing staff to ensure knowledge of abuse, reporting, and handling residents with dementia and she would continue to conduct verbal audit checks monthly to verify knowledge of training. During an interview via phone on 03/28/2024 at 11:23 a.m., Detective K said there have been no warrants issued at this time for CNA A and[TRUNC FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 22 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that all alleged violations involving abuse or mistreatment were reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse, to the administrator of the facility and to other officials (including to the State Survey Agency where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures for one of four residents (Resident #1) reviewed for abuse. 1. The facility failed to report physical abuse of Resident #1 to the Administrator immediately following HA witnessing CNA A hit Resident #1 on the head on 02/27/2024 at approximately 3:00 a.m. during incontinent care. 2. HA notified CNA C of a witnessed abuse incident on 02/27/2024 at 6:30 p.m. and CNA C did not report the allegation of abuse to the administrator/abuse prohibition coordinator until 02/28/2024 at approximately 3:00 p.m. The noncompliance was identified as PNC. The IJ began on 02/27/2024 and ended on 03/05/2024. The facility had corrected the noncompliance before the survey began. This failure could place residents at risk for physical harm, psychosocial harm, unsafe environment, and further abuse. Findings included: Review of facility policy, titled Abuse/Neglect Policy & Procedure, with no date, revealed the following: PREVENTION AND REPORTING: 1. The facility prohibits the mistreatment, neglect, and abuse of residents/patients and misappropriation of resident/patient property by anyone including staff, family, friends, etc. 2. The facility has designed and implemented processes, which strives to ensure the prevention and reporting of suspected or alleged resident/patient abuse, neglect, mistreatment, and/or misappropriation of property. 3. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 23 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 The facility has implemented the following processes in an effort to provide residents/patients and staff a safe and comfortable environment. Level of Harm - Immediate jeopardy to resident health or safety 4. Residents Affected - Few Administrator is the Abuse Coordinator. The Administrator considers the Director of Nursing a designee for reporting and investigation of alleged abuse. In their absence, Admin and DON can appoint appropriate supervisory personnel to initiate investigation. 5. The Administrator and Director of Nursing are responsible for investigation and reporting. They are also ultimately responsible for the following as they relate to abuse, neglect, and/or misappropriation of property standards and procedures: Ongoing monitoring Reporting Investigation Tracking and trending 6. Implementation and ongoing monitoring consist of the following: Screening Training Prevention Identification Protection Investigation Reporting DEFINITIONS: Abuse Willful infliction of injury Unreasonable confinement (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 24 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 Intimidation with resulting physical harm or mental anguish Level of Harm - Immediate jeopardy to resident health or safety Punishment with resulting physical harm or pain or mental health Deprivation by the individual, including a caretaker, of good or service that is necessary to attain or maintain physical, mental, and psychosocial well being . Residents Affected - Few Physical Abuse Includes hitting, slapping, pinching, scratching, spitting, holding, roughly, etc. It also includes controlling behavior through corporal punishment . Training 1. Provide training for new employees through orientation and with ongoing training programs. Training will include, but not limited to: Definitions of abuse, neglect, mistreatment, and misappropriation of property. Identification of abuse . Utilization of appropriate interventions to deal with aggressive and/or catastrophic (detrimental) reactions of residents/patients. How to provide protection for residents/patients How to investigate and report incidents of abuse, neglect, mistreatment, and misappropriation of property. Prevention of abuse, neglect, mistreatment, and misappropriation of property including, but not limited to, recognizing signs of burnout, frustration and stress . Prevention Ensure that prevention techniques are implemented in the facility including, but not limited to, ongoing supervision of employees through visual observation of care delivery and recognition of signs of burnout, frustration, and stress. 1. Identify, correct, and intervene in situations where abuse, neglect, and/or mistreatment are more likely to occur. This includes, but is not limited to, identification/analysis of: Secluded areas of the facility Sufficient staffing on each shift to meet the needs of the residents/patients (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 25 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 Assigned staff demonstrating knowledge of individual resident/patient needs Level of Harm - Immediate jeopardy to resident health or safety Sufficient and appropriate supervisory staff to identify inappropriate behaviors Residents Affected - Few 2. Residents with needs and behaviors which might lead to conflict or neglect Encourage residents/patients and families to report concerns, incident, and grievances without fear of retribution. Provide feedback regarding the concerns that have been expressed. 3. Instruct staff that they are required to report resident concerns, incidents, and grievances. Identification 1. Identify events, such as suspicious bruising of residents/ patients, occurrences, patterns, and trends that mat constitute abuse, neglect, and/or mistreatment and investigate . 3. instruct staff, resident/patient, family call my visitor, etc. to report immediately, without fear of reprisal, any knowledge or suspicion of suspected abuse, neglect, mistreatment, and/or misappropriation of property. Protection 1. provide for the immediate safety of the resident patient upon identification of suspected abuse, neglect, mistreatment, and/or this appropriation of property. Means of providing protection include, but are not limited to: Moving resident/patient to another room or unit Provide 1:1 monitoring as appropriate Immediate suspension of suspected employee(s) pending outcome of the investigation . 2. Initiate behavior crisis management interventions, as applicable . 2. Administrator and/or designee will initiate the Investigation. The investigation should be thorough with witness statements from staff, resident, family members who are interview-able and have information regarding the allegation . Employee Suspension from Duty 1. Any time an allegation is made involving abuse, neglect, or mistreatment of a resident/patient which names a specific employee, laws and regulations are specific about protecting all residents/patients from harm / potential harm farmer which means suspending the employee until the completion of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 26 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 the investigation. Level of Harm - Immediate jeopardy to resident health or safety 2. The employee is not to remain on duty, and is not to be assigned to any other area of the facility. Residents Affected - Few 3. The administrator, or in his/her absence the Director of Nursing, Assistant Director of Nursing, or Charge nurse, in that order, must relieve the employee of his/her duty without pay until the investigation is complete. If the allegation is substantiated, the employee will be terminated immediately. 4. if the result of the investigation is in favor of the employee or is inconclusive, the employee will be paid regular wages during the time he/she was relieved from duty. Reporting 1. Notify the Administrator, DON, or Shift Supervisor/Charge Nurse immediately if suspected abuse, neglect, mistreatment, or misappropriation of property occurs. 2. Notify the appropriate State agency(s) after identification of alleged incident. initiate process according to State-specific regulations. 3. Person(s) initially identifying potential abuse, neglect, mistreatment, and/or misappropriation of property are accountable to report to proper chain of command. 4. Notify the legal guardian, spouse, or responsible family members/ significant other of the alleged or suspected abuse, neglect, mistreatment, and/or misappropriation of property. 5. Notify the physician of allegation and investigation. 6. Initiate contact with local law enforcement, immediately, when warranted, as required by state law. 7. Report results of investigation to the proper authorities as required by State law. 8. Follow up with resident/patient results and outcome of investigation and ensure their feelings of safety and security. Review of facility policy, titled Reporting Abuse, Neglect, and Mistreatment, with no date, revealed the following: Alleged, suspected or observed abuse, neglect or mistreatment of a resident or patient or his/her belongings are thoroughly investigated by the Administrator and/or the Director of Nursing. Alleged, suspected or observed violations are reported immediately to the Administrator, Regional [NAME] President, Medical Director, VP Quality & Compliance, Ombudsman, State Health and Environmental Departments, and all other officials required by state law. In all cases, the Administrator or Director of Nursing will immediately notify the resident or patient's legal guardian, family member, responsible party or significant other of the alleged, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 27 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 suspected or observed abuse, neglect or mistreatment. Level of Harm - Immediate jeopardy to resident health or safety If a direct caregiver is observed, suspected or alleged to have engaed in abuse, neglect or mistreatment of resident/patient belongings, the caregiver will be relieved of duty and placed under investigative suspension by the Administrator, Director of Nursing or Nursing Supervisor, until the investigation is completed . Residents Affected - Few Review of a facesheet for Resident #1, dated 03/27/2024, revealed he was a [AGE] year-old male admitted to the facility on [DATE] and had diagnoses including: altered mental status, chronic pain, speech disturbances, muscle weakness, contracture of muscle (multiple sites), and dysphagia (difficulty swallowing). Review of Resident #1's Quarterly MDS, dated [DATE], revealed he had a Brief Interview for Mental Status (BIMS) score of 12, indicating moderate impairment. Resident #1's behavior and functional status revealed he had no physical or verbal behavioral symptoms directed towards others exhibited, he had impairment to both sides of upper and lower extremities and required substantial/maximal assistance with toileting hygiene. Review of Resident #1's care plan, revised 03/05/2024, revealed he had interventions in place for history of aggression with staff and dementia with behaviors to include: stopping and returning if resident becomes agitated, approach resident in a calm manner, talk while providing care, when resident becomes agitated intervene before agitation escalates by guiding away from source of distress, engaging calmly in conversation, approach at a later time if response is aggressive, and encourage resident to express feelings appropriately. Review of incident statement, dated 02/28/2024, signed by Administrator, revealed the following: Informed by [CNA C] that another [HA] had informed her that she had witnessed abuse by another staff member [CNA A]. Called [HA] to confirm statement. [HA] stated she was in the resident's room [Resident #1], with [CNA A] during incontinent care the resident punched her [HA] in the stomach, and she stepped back away from him. Then [CNA A] rolled resident over to his back and hollered motherfucker, do not do that again while slapping him in the forehead several times. The resident then swung at [CNA A]. When asked why [HA] did not report to supervisor immediately, she stated because she was scared of [CNA A] and that she had a look when she turned to look at her and she was upset about everything. Did not tell anyone until the next day when she told the other CNA, who reported to me. Review of witness statement, dated 02/28/2024 at 3:00 p.m., signed by CNA C, revealed the following: On 2-27-24 at approx. 6:30 pm, staff member [HA] told me that on Monday night while doing incontinent care, [Resident #1] had punched her in the stomach. HA said she stepped back and [CNA A] rolled [Resident #1] over and slapped him in the face and grabbed his hand. She said this scared her and she didn't know what to do. I told her she needed to go and report this to DON or Admin. She said she felt that she could come to me and that she didn't want to get anyone in trouble. [HA] said she had called her family member to talk about the situation. Review of witness statement, dated 02/28/2028, signed by HA, revealed the following: [HA] interviewed about incident that occurred with (Resident #1). She stated that on Tuesday morn (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 28 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few (morning) at 3am (3:00 a.m.) during incontinent rounds, she and co-worker [CNA A] went into [Resident #1's] room. When they first went in the room he drew is fist back. [HA] stated she tried to talk him down because usually this will work. They began performing care and rolled him over toward her (she was between the bed and the wall) but he started hitting her in the stomach. [CNA A] then rolled him back over and slapped him more than once on the forehead. [HA] stated [CNA A] said I'll beat the f--- out of you. You know you laying in the bed and can't move. They finished the care and put a brief on him and left the room. After this [HA] said she went outside because she was upset. She stated she thought about leaving but didn't, she came back inside to complete shift. She didn't go to charge nurse at that time. Stated she was afraid she would be in trouble as well. This was the last round of the evening so nothing else occurred with other residents and [CNA A]. [HA] stated she went back into [Resident #1's] room and gave him a hug. He was fine and didn't seem upset. Stated she knows she should have said something but that she had never seen anything like this and it just scared her. Tuesday 2-27-24 at 6:30pm [HA] told [CNA C] what had occurred with [Resident #1] that morning during her shift. Review of witness statement, dated 02/28/2024, signed by LVN D, revealed the following: DON interviewed [LVN D] regarding alleged abuse incident that occurred with Resident #1. [LVN D] stated aides did not tell her that [Resident #1] hit [HA] or anything else that occurred after that point. She stated they told her that [Resident #1] was being difficult during incontinent care. The time reported to her was between 3am (3:00 a.m.) and 4am (4:00 a.m.) so it would have been their last round with him that night. Review of Associate Disciplinary Memorandums, dated 02/28/2024, revealed CNA A, HA, and CNA C were suspended pending investigation. CNA C and HA were reinstated and received training on abuse. CNA C received formal written disciplinary action for failing to report abuse. Supervisors Comments revealed CNA C was aware of reporting guidelines, understands not to wait if she believed anything has occurred, and stated she told employee to report to DON or Admin. CNA A was discharged effective 03/05/2024 due to employee confirming allegation of incident that warrants termination. Review of witness statement, dated 02/29/2024, signed by CNA A, revealed the following: [CNA A] interviewed in person by DON and Administrator on 2-29-24 at 10:15am. She was off on 2-28-24 when the investigation initiated and we were unable to reach her until late that evening. The meeting was set up for Thursday 2-29-24 to obtain statement and her version of events that occurred on 2-27-24 at 3am with [Resident #1]. STATEMENT: We went in to do incontinent care on [Resident #1]. He punched [HA] in the stomach. I tried to hold him down with his hands on his chest so he couldn't hit her anymore. When she was cleaning between his legs he tried to punch me. I told him: stop this, this is not how things go. We don't hit women, it does not work that way. [HA] said my doesn't even hit me. He continued to try to hit us. I did not hit him, it wouldn't do any good anyway. So I just held him down. I did not tell the nurse at that time, she wouldn't do anything anyway. I thought [HA] was going to tell her. No one should have to go into a room and wonder if they are going to get hit. It was self defense. Follow up: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 29 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Admin asked about the curse words that were alleged. Asked her if she used the f-word. stated that she did not curse . maybe the worst she said was damn don't do this. Admin asked about the allegation that she slapped on the forehead several times and she said well yes she did do that just to get him to stop hitting. I asked her to demonstrate and she slapped her forehead several times with her fingers, palm down in front of nose. Admin asked about why she didn't just back away when he was combative as this could be one approach - she stated they just had to get the job done. Residents Affected - Few Review of personnel record for CNA A revealed she was hired on 12/06/2018 and signed and dated policy for reporting abuse, responsibility for reporting abuse, and Senate [NAME] 9 employee acknowledgement that mistreatment or abuse will not be tolerated and will be subject to immediate discharge. Review of personnel record for HA revealed she was hired on 12/28/2023 and signed and dated policy for reporting abuse and responsibility for reporting abuse. Review of audit, titled Staff Awareness on What Constitutes Abuse, dated 01/25/2024, revealed CNA A and HA met criteria for knowing when and who to report allegations of abuse. Audit revealed met criteria for knowledge of reporting physical abuse immediately to the Administrator. Review of training records, dated 3/5/2024, completed by CNA A, revealed the following education was provided: Preventing, Recognizing, and Reporting Abuse, and Managing Anger completed on 08/13/2023 and Communication and People with Dementia completed on 02/05/2024. Review of training records, dated 3/1/2024, completed by CNA C, reveled the following education was provided: Communication and People with Dementia completed on 1/31/2024, Managing Anger on 08/09/2023, and Preventing, Recognizing, and Reporting Abuse on 03/03/2024. Review of Provider Investigation Report, dated 03/06/2024, revealed the following: .Description of the Allegation: Employee (HA) alleged that resident (Resident #1) had hit her in the stomach while they were performing incontinent care. (CNA A) had cursed at the resident telling him not to do that and slapped him on the forehead several times . Description of assessment . Resident had no physical injuries. His forehead had no discoloration or bruising noted. No redness or complaints of pain. Resident was interviewed as to the allegation and denied anything had occurred. His behavior was normal for his baseline. He has been doing his normal routine with no concerns from staff. DON checked daily for three days and assessed his mood and behaviors with no changes noted . Provider Response: . Upon receipt of allegations, employees involved were suspended immediately, including the individual making the allegation, pending outcome of investigation. Resident was assessed for injuries and evaluated for his feeling of safety, and any need for intervention as a result of the alleged incident. Resident had no physical injuries and denied the occurrence of the incident, stating he had no complaints about the staff. Residents responsible party, position and investment were notified. Police (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 30 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 were called to report the allegation . Level of Harm - Immediate jeopardy to resident health or safety Investigation Summary: . Residents Affected - Few Resident #1 was the first with no injuries noted. He also denied that anything had occurred regarding an employee slapping him and cursing at him. His roommate, who was alert and oriented, was interviewed about if he witnessed or heard anything at the time this was alleged to occur, he stated that he didn't know of anything out of the ordinary but that (Resident #1) was all the time fighting the girls. Resident's roommate, (Resident #2), was asked about his feeling of safety and if anything had ever happened to him, as far as staff mistreating him, during his stay here and he stated no everything was fine. Responsible party of (Resident #1) was notified of allegation and to determine if he had shared anything related to allegation or any other time regarding his feeling of safety and well-being. She was not aware of anything abnormal or anything with him. Staff working the night of the alleged abuse were interviewed and were not aware of anything out of the ordinary occurring (with exception of the witness who reported the incident). (CNA A), alleged perpetrator, was interviewed. (CNA A) Stated that after (Resident #1) punched (HA) in this stomach, she (CNA A) had held him down so he could not hit her anymore. (CNA A) Stated that he had also tried to hit her. She denied cursing at him but said she told him this was unacceptable-that you cannot hit women. initially she denied slapping him but when asked by administrator if she had hit him on the forehead she stated she only did it to get him to stop hitting them. She demonstrated the same motion that was displayed by (HA) during her interview. Fingertips slapping forehead, palm down in front of face. Residents cared for by (CNA A) were interviewed to determine if they felt safe and if there were any other issues to report regarding staff treatment of residence. (Resident #1) continues to display no negative effects related to the incident. (CNA A) confirmed the allegation and was terminated from employment .Physician, family, police, and Ombudsman were notified of the incident. Investigation Findings: Confirmed. Provider Action Taken Post Investigation: Employee (CNA A) was terminated post investigation. (CNA C) and (HA) were suspended but reinstated after receiving additional training on abuse/neglect, reporting guidelines, and how to handle dementia and combative residence. Facility staff received in service training on abuse neglect, handling them into residence, and how they handle combative residents. Post test given and follow up on any staff lacking proper knowledge during testing related to abuse/neglect. training upon hire, at minimum annually and as needed. Review of Resident #1's progress notes by ADON, dated 02/29/2024, revealed Resident #1 head to toe skin assessment was performed with no skin alterations noted. Review of Provider Investigation Report, dated 3/6/2024, revealed monitoring statements signed by the Administrator for Resident #1, dated between 02/28/2024 and 03/01/2024 The monitoring statements signed by the Administrator revealed Resident #1 had exhibited no physical or psychosocial harm, had no indication of stress, no behaviors, he was socializing normally, and had no concerns. Review of statement, dated 03/06/2024, signed by Administrator, revealed Ombudsman spoke with Resident #1 that told her They fired her and slapped his head a few times when asked what happened and he denied that it hurt and had no further concerns. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 31 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Review of inservices and employee roster provided by Administrator and DON, dated between 02/28/2024 and 03/01/2024 revealed all nursing staff received education on abuse and reporting. During an interview with the Administrator and DON on 03/26/2024 at 1:42 p.m., the Administrator said she was the abuse coordinator and was aware of a self-reported incident of abuse concerning Resident #1. The Administrator said the aide admitted that she did pat his head lightly to try to keep him from hitting her and they terminated her. She said the resident showed no signs of psychosocial or physical harm when the Administrator monitored him for three days following report of incident documented in her monitoring statements in provider investigation report. During an interview on 03/26/2024 at 3:05 p.m., the Ombudsman said Resident #1 was physically abused with two staff in the room and the Ombudsman had spoken with his RP and she was okay with how the facility was handling it. The Ombudsman said he has a speech impediment and was not aware of any skin changes or bruising. During an interview on 03/26/2024 at 3:26 p.m., PTA said he did not suspect abuse at this facility and had received training on abuse and handling dementia residents via in-services. PTA said if he suspected abuse he would report it to the ADM immediately. PTA said Resident #1 was doing good and has known him for 6 or 7 years and has had no change in condition. PTA said he can have behaviors but that he has known him for a long time but that they had a good relationship and he knew how to talk and approach him to maintain his trust. PTA said Resident #1 liked coming to therapy and doing his legs and had never had any concerns with staff being abusive or rough with him. During an interview and observation on 03/26/2024 at 4:20 p.m., Resident #1 said he was doing good and that everyone was nice to him at the facility. Resident #1 said he had no concerns. The Resident appeared well groomed, free from apparent injury, pleasant, and in no distress sitting up in wheelchair in his room watching television. During an interview on 03/27/2024 at 11:41 a.m., HA L said she did not suspect abuse, had been trained on abuse, reporting, and dementia residents via in-services, and had been employed at the facility for 2 years. HA L said it was important for resident's care plan to be followed to prevent harm and make sure all residents receive proper care. During an interview on 03/27/2024 at 11:56 a.m., CNA T said she had been employed at the facility for 5 years and did not suspect abuse. CNA T said she had received training on abuse, reporting, and caring for dementia residents. CNA T said if there is a resident that is showing signs or aggression she would try again later after the resident had calmed down and that if she ever witnessed any abuse she would report to the ADM or DON immediately. During an interview via phone on 03/27/2024 at 12:45 p.m., CNA C said The hospitality aide that worked at night came in and said I need to talk to you. She said I don't know what to do [CNA A] slapped the resident in the face twice. I said you should have reported it to the charge nurse. CNA C said HA told her she was scared, and afraid CNA A would retaliate on her if she reported the incident. CNA C said she knew should have reported it then, but she did not report it until the next day to her DON because she had told HA to report it. CNA C said Resident #1 had no injuries or behavior changes and the facility had provided training on abuse and when to report. CNA C said she would report to the DON or ADM any suspected abuse immediately and the abuse coordinator was the Administrator. CNA C felt the facility took care of that situation. CNA C said she had no previous concerns with the care provided by CNA A and believed it was an isolated incident. CNA C said it was important to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 32 of 33 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 675624 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Whitehall Rehab & Nursing 1116 E Loop 304 Crockett, TX 75835 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 0609 report abuse immediately to ensure resident safety. Level of Harm - Immediate jeopardy to resident health or safety During an interview on 03/27/2024 at 1:45 p.m., the Administrator said staff expectation was to report alleged abuse immediately. The Administrator said it was important to report immediately so that residents could be prevented from further harm and to allow the facility to respond to the situation. The Administrator said all staff received education on abuse and reporting. The Administrator said she has conducted a verbal audit check monthly to ensure staff knowledge on abuse, neglect, and reporting. The Administrator said she was the abuse coordinator and was responsible for training on abuse. Residents Affected - Few During an interview via phone on 03/27/2024 at 2:11 p.m., HA said she had been at the facility for 5 months and works on the night shift. HA said she did witness the incident with Resident #1 and said she saw CNA A hit the resident on the face with her fingers on his forehead multiple times, roll him around and heard her tell the resident she could have someone come in to whoop his ass whenever she wanted to with him being in this bed. HA said after that happened CNA A left the room and HA stepped out of the room due to being upset and scared. HA said she returned to the room to finish his care and gave him a hug. HA said he had no injuries and never had any social isolation following the incident. HA said she has taken care of him since then and that he seems to be doing better with no combative behavior and appears happy. HA said the incident happened early in the morning between midnight and 4:00 a.m. HA said she did not know if CNA A worked the next day and that she does not remember working with her. HA said that she knew she should have reported the incident immediately to the abuse coordinator but that it was late and did not have her phone number. HA said she notified another CNA, CNA C, around 6:30 p.m. on 2/27/2024 and that CNA C notified the Administrator immediately. HA said that she had received training on abuse briefly in orientation and that she did receive training following the incident. HA said the abuse coordinator was the Administrator and that it was important for alleged abuse to be reported immediately to her to prevent abuse from occurring and further protect residents from harm. HA said she believed the incident was isolated and had no concerns with CNA A prior to this incident. HA said that CNA A was fired and that she felt the facility handled the situation appropriately. During an interview and record review on 03/27/2024 at 5:28 p.m., the Administrator said her expectations of staff was to report abuse immediately and that if she was notified of the abuse allegation promptly she would have responded the same way by suspending the perpetrator once notified, ensure residents were safe, and assess the resident/victim involved in the incident. The Administrator confirmed via timesheet the perpetrator continued to work the remainder of her shift following the abuse incident as well as the following shift the next day. The Administrator said the perpetrator was showing signs of different behavior and believe she had personal things going on at home that may have contributed to this isolated incident and that the employee had no concerns with her background check and had been working at the facility for 5 years. The Administrator and DON said they were r[ FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675624 If continuation sheet Page 33 of 33