Inspection·August 9, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few intubated CR#1. At 10:56am, CR#1 was pronounced dead by the emergency technicians.Record review of CR#1's assessments for August 2025, there were no changes in condition assessments for abnormal vitals or IV dislodging. There was a change in condition assessment dated [DATE] for elevated temperature of 100.4F, it stated CR#1 had altered level of consciousness. CR#1 had interventions which included changes in medication, IV fluids for hydration, and NP A ordered blood and urinalysis tests.Record review of CR#1's MAR for August 2025, she had the following vitals: on 8/4/2025 she had blood pressure of 129/71 and pulse of 85. and on 8/5/2025 she had a blood pressure of 118/90 and pulse of 96.Interview with CR#1's RP on 8/5/2025 at 1:52 p.m., they were concerned when on 8/4/2025 they did not see CR#1 talking or drinking water and was not awake or aware of what was going on. The RP told CR #1's nurse, who then told NP A on 8/4/2025 and NP A ordered labs and IV hydration for CR#1 on 8/4/2025. On 8/5/2025 in the morning the facility told CR#1's RP that EMT was called to the facility because CR#1 was unresponsive. In a later interview on 8/6/2025 at 4:26 p.m., the RP said she was not aware of CR#1's IV being dislodged or of her abnormal vitals, she was only told on 8/5/2025 that CR#1 was in a critical condition.Interview with RN A on 8/5/2025 at 2:44 p.m., she started a month ago and was CR#1's nurse on 8/5/2025. CR#1 had normal blood pressure earlier that morning during RN A's shift but at 9:15 a.m., CR#1's IV dislodged and after cleaning CR#1's IV site, RN A checked CR#1's vitals which came back as 98/60 for blood pressure from what she could remember, 57 for pulse, and 17 for respiratory rate, and temperature was 97.5F. RN A found that these vital signs were low compared to the morning values. RN A said she told the UM that CR#1 was not feeling good, but did not convey the low blood pressure to either the UM or CR#1's NP. RN A said she told the UM she was planning to call the physician but did not. RN A said CR#1 had a change in condition on 8/5/2025 at 9:15 a.m. when RN A noticed CR#1's blood pressure was low, and her pulse dropped from 111 to 57. RN A said she messed up and she only told the UM about the IV being out and the change in condition related to CR#1's lethargy and not being alert in the morning. RN A took report from the previous shift's nurse and found out that CR#1 had an IV. The CNA from the previous shift (she could not remember their name) told RN A that CR#1 was sleeping a lot on 8/4/2025 but was more active on 8/3/2025. RN A said if the blood pressure was low nurses should be checking it again every 15 minutes, and if she told the UM that person could have checked the blood pressure too. If a physician was not notified in a timely manner, interventions for resident-centered care including assessments would not take place promptly. RN A said that she had in-services on notifying the physician immediate after a change in condition through verbal in-services and skilled checkoffs during orientation. Attempted phone interview with RN A on 8/6/2025 at 8:47 a.m., left a voicemail and no response. Further attempt to reach RN A was unsuccessful. Interview with the UM on 8/5/2025 at 3:02 p.m., RN A told her that CR#1's IV was dislodged so she helped RN A clean up the site and told RN A to call the physician to discontinue the IV since the bag was empty and CR#1 had completed the bag. RN A told the UM that RN A got the order to discontinue the peripheral IV, but the UM did not check the system because it was RN A's responsibility to do so. The UM said at 9:45am CR#1 was on oxygen and still breathing un-laboriously and that the UM could see CR#1's rise and fall of her chest as she appeared to be sleeping. The UM said RN A reported normal vitals for CR#1, and the blood pressure was 110 over something. If RN A had reported abnormal vitals to the UM, the UM would have told RN A to do a respiratory or changes in condition assessment. RN A never told her about the low blood pressure or the low pulse. A blood pressure of 98/60 and a pulse of 57 was considered abnormal and RN A should have notified the doctor and let them know about the changes. RN A should have also informed the nursing management team. If the ADON had known, she would have gone to assess CR#1 and worked to stabilize her vitals or call 911. Interview (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 2 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with the DON on 8/5/2025 at 3:30 p.m., she said CR#1 admitted on [DATE] for a right humerus (upper arm) fracture. CR#1 was alert but not communicative. The DON said nurses would let her know about changes in condition. The DON was told about the IV dislodging 8/5/2025 in the morning and the UM went in CR#1's room and took care of it. No one told the DON about abnormal vitals. If the DON was told about the low blood pressure, she would ask about interventions like elevating the feet to increase circulation and check the blood pressure again. The DON was not told about the pulse going from 111 to 57. 111 would be an abnormal vital but 57 would not be dangerous. 98/60 was not a bad blood pressure and the DON said she would have to review CR#1's baseline to determine she would have proceeded. A later interview on 8/5/2025 at 4:18pm, she said RN A told her that the low pulse of 57 might've belonged the Resident #27, who was sent out to the hospital on 8/5/2025 in the morning but RN A was not sure.Interview with the Administrator on 8/5/2025 at 3:55pm, she said nurses should do a change in condition (SBAR: Situation, Background, Assessment, Recommendation) assessment immediately. The Administrator expected nurse to assess and check everything for a resident. In a later interview on 8/6/2025 at 12:05pm, the Administrator said she did not hear about CR#1 not getting an order but remembered hearing about the IV being dislodged. The Administrator supposed that nurses should have gotten an order before taking out the IV. A harm of not getting an order from the physician would be adverse effects to the resident. Interview with CR#1's physician on 8/5/2025 at 4:47pm, she said the facility left a voicemail that CR#1 was going through CPR. The physician called back, and the DON told her she was helping the nurse and EMS with CPR. The physician was aware CR#1 had decreased appetite and a diagnosis of COPD and that NP A gave her IV fluids. Later interview on 8/6/2025 at 10:07am, the physician said NP A would know about the labs, as most communications went through him. The physician said that CR#1 had dementia and cognitive decline, a history of stroke and an enlarged heart, and CR#1 could have aspirated. The physician said she believed CR#1 passed away naturally and to refer to NP A for more information on CR#1. Interview with NP A on 8/6/2025 at 10:17am, he first saw CR#1 on 8/4/2025 and she was difficult to arouse. CR#1's RP said CR#1 had not eaten in a few days and NP A started CR#1 on an IV for normal saline and ordered labs and urinalysis. NP A said the labs came back at night and they were not terribly bad, but she appeared to be dehydrated. NP A said there was no need to send CR#1 out right away and ordered monitoring of CR#1's vitals. NP A said the urinalysis results had not come in. The facility notified NP A that CR#1 was found unresponsive and passed away on 8/5/2025. No one texted NP A regarding the drop in blood pressure. If he had found that the abnormal vitals were unusual for the resident, he would have given orders for monitoring the resident or doing something different. NP A also said no one told him about CR#1's IV dislodging, or he would have sent her out to intensive care. NP A did not give any orders for the IV to be discontinued. Interview with the DON and UM on 8/6/2025 at 10:49am, the DON said nurses should document once an intervention was provided and when an intervention is delayed it could cause harm to residents. The UM reviewed CR#1's medical records and saw CR#1's IV order but no discontinued date and said the order to discontinue the IV should have been entered before RN A stopped the IV. The UM was not sure if RN A called the doctor. Negative outcomes from not telling the physician about the IV would be an adverse drug reaction, not following proper protocol and nurse have to get an order to start or discontinue any medication. The UM said on 8/5/2025 at 9:45am, CR#1 looked stable with her oxygen on. The UM said there was no infiltration (meaning when the IV solution enters the surrounding tissue rather than the bloodstream).Interview with CNA L on 8/8/2025 at 9:00am, she was the night shift CNA on 8/4/2025. CNA L said when she made rounds that night, she changed CR#1 and felt CR#1 was kind of warm and notified the charge nurse who told CNA L that CR#1 had a fever that day and were treating it. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 3 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Record review of the facility's policy on change in resident's condition or status , it read in part, The nurse will notify the resident's attending physician or physician on call when there has been an . accident or incident involving the resident .adverse reaction to medication .significant change in the resident's physical/emotional /mental condition need to alter the resident's medical treatment significantly .significant instruction to notify the physician of changes in the resident's condition . A 'significant change' of condition is a major decline or improvement in the resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions .Record review of the facility's policy on acute condition changes last revised December 2015, it read it part, 3. Direct care staff, including Nursing Assistants will be trained in recognizing subtle but significant changes in the resident (for example, a decrease in food intake, increased agitation, changes in skin color or condition) and how to communicate these changes to the Nurse .6.Before contacting a physician about someone with an acute change of condition, the nursing staff will make detailed observations and collect pertinent information to report to the Physician; for example, history of present illness and previous and recent test results for comparison .Phone calls to attending or on-call physicians should be made by an adequately prepared nurse who has collected and organized pertinent information, including the resident's current symptoms and status. b.Nurses are encouraged to use the SBAR Communication Form and Progress Note .as a tool to help gather and organize information before notifying the Physician. 7.The nursing staff will contact the Physician based on the urgency of the situation. For emergencies, they will call or page the Physician and request a prompt response (within approximately one-half hour or less).Record review of the facility's policy on resident rights dated November 2016, it read in part, The resident has a right to access to persons and services inside and outside the facility . Event ID: Facility ID: 675663 If continuation sheet Page 4 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 - Minimal harm or potential for actual harm 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 observation, interview and record review, the facility failed to ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to other officials (including to the State Survey Agency and adult protective services) for 1 (Residents #58) of 5 residents reviewed for reporting allegations. -The facility failed to report Resident #58's unwitnessed fall. Resident #58 had limited mobility. This deficient practice could place residents at risk for abuse, neglect, exploitation, and or mistreatment. Record review of Resident #58's face sheet captured on [DATE] revealed a [AGE] year-old female originally admitted to the facility on [DATE] and recently expired on [DATE]. Her medical diagnoses included: cognitive communication deficit (difficulty with communication muscle weakness (generalized), and displaced fracture of olecranon (break in the bony tip of the elbow at the ulna bone) process without intraarticular extension of right ulna, initial encounter for closed fracture. Record review of Resident #58's Quarterly MDS (a resident assessment tool) dated [DATE] revealed she had a BIMS score of 8, indicating moderately cognitive impairment. She was coded as unable to make herself understood and was unable to understand others with clear comprehension. She had an impairment on one side of her lower extremity and used a wheelchair. She was totally dependent on toileting, showering or bathing self, upper and lower body dressing, putting on and taking off footwear. She was also totally dependent on mobility, including transferring to and from bed, sitting to standing and lying to sitting on the side of the bed. Record review of Resident #58's care plan completed [DATE] for fall risk revealed the following dates for unwitnessed falls were: *[DATE], *[DATE], *[DATE] (fell at 7:37 AM), *[DATE] (fell on 8:41 PM) and *[DATE]. Review Resident #58's of fall risk assessment dated [DATE] reflected history of falls past 3 months. The level of consciousness/mental status indicate the resident had intermittent confusion, resident was chairbound, incontinent and required use of assistive devices (i.e. cane, wheelchair, walker). Fall risk score was 15.0, indicating risk of falls. Record review of the facility incident note date [DATE] at 10:51PM, written by LVN B reflected immediately charge nurse stepped out of Resident #58's room, she heard a sound, went straight back to resident's room observed resident by her bedside laying on her right side, with noted bleeding from her forehead, upon assessment, noted a large amount of blood flowing from resident right forehead, charge nurse immediately called for help, 911 called assessed bleeding and site wrapped. Resident #58 was transferred to a local hospital via 911 ambulance. Review of Resident #58's nurses progress notes dated [DATE] revealed resident had four stitches to her forehead. In an interview with DON on [DATE] at 2:39 PM she said Resident #58 was very confused had repeated falls, resident had history of Alzheimer's disease, had 2 falls sometimes in a day while trying to go to the restroom, on [DATE] Resident #58 had a fall with injury to her forehead with bleeding and was sent to the hospital and she had 4 stitches on her forehead. DON said Resident #58 was not able to relate to how she fell due to cognitive impairment, and she did not suspect any abuse hence she did not report it to the state. In an interview with the Administrator on [DATE] at 9:45 AM she said when resident had an unwitnessed fall especially if they hit the head, or had an injury, we send them out to a local hospital, and she would report it to the state. She stated they recently got the provider letter and look at it verbatim. She referred to provider letter. In an interview with the DON on [DATE] at 10:02am the DON said if resident could not tell you (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 5 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete what happened and there were injuries, she would send them out. Once they get to the hospital, she follows up with the hospital to see the injury. She would report it to the Administrator, IDT and the family. If the injury is a reportable, she would report to the state. If it was a suspicious injury due to neglect or abuse, then she would report it. DON said the last training on abuse was [DATE]. Record review the facility in-services dated [DATE] revealed Abuse/neglect and Residents Right in-services were provided to staff. The facility had all staff in-serviced on abuse and neglect on [DATE], including CNA L. Event ID: Facility ID: 675663 If continuation sheet Page 6 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that residents receive treatment and care in accordance with professional standards of practice the comprehensive person-centered care plan that will mean each resident's physical, mental and psychosocial needs for 1 (CR#1) of 5 residents reviewed for quality of care.-RN A failed to properly complete assessments for CR#1 when RN A found CR#1 had low blood pressure and low pulse and had her IV dislodged on 8/5/2025 around 9:15am. CR#1 was pronounced dead on 8/5/2025 at 10:56am.This failure to accurately assess resident health status for potential interventions in a timely manner could lead to harm, injury and death.Record review of CR#1's face sheet dated 8/5/2025, she was a [AGE] year-old female originally admitted on [DATE] with medical diagnoses including fracture of the right humerus (upper arm), chronic obstructive pulmonary disease (a group of lung and airway diseases that restrict breathing, urinary tract infection, type 2 diabetes mellitus (high blood sugar), hyperlipidemia (high cholesterol), hypertension (high blood pressure), dementia (decline in cognitive function affecting memory, thinking and changes in personality and emotional control issues), and cognitive communication deficit. Record review of CR#1's Physician Orders dated 08/05/2025, she had orders for peripheral iv inserted in the left arm with a start date of 08/04/2025, vital signs every shift with a start date of 08/04/2025. Record review of CR#1's care plan dated 8/4/2025, she had altered cardiovascular status related to Hypertension diagnosis, with interventions including administering medications as ordered and assessing and monitoring cardiovascular status and identify complications. CR#1 had an intravenous access IV for fluid therapy related to dehydration, with interventions including administering intravenous fluids as prescribed and maintaining rate of infusion as ordered and check infusion rate every one hour. CR#1 had a focus area of antidepressant medication related to depression, with interventions including administering antidepressant medications as ordered by physician and monitoring and documenting side effects and effectiveness every shift and monitoring, documenting and reporting PRN adverse reactions to antidepressant therapy like changes in cognition, decline in ADL ability, falls, appetite loss and insomnia. CR#1 was also care-planned for having a stroke and taking antiplatelet medication with interventions including giving medications as ordered by the physician and monitoring and documenting side effects and effectiveness. Record review of CR#1's progress notes for August 2025, there were no notes related to CR#1 having abnormal vitals or IV dislodgement. CR#1 had documentation on 8/1/2025 at 10:14pm, her Amitriptyline for depression was awaiting delivery. On 8/2/2024 at 8:23am-8:24am, CR#1 was documented as awaiting supply from the pharmacy for Cymbalta for depression, Clopidogrel for blood thinner and Ezetimibe for cholesterol. Record review of CR#1's progress notes for August 2025, there were no notes related to CR#1 having abnormal vitals or IV dislodgement. On 08/04/2025 at 1:05pm, CR #1 was documented as having a temperature of 100.4 F with Tylenol 325 mg given for fever and fluids encouraged and upon reassessment CR#1's temperature was 98.6F. On 08/04/2025 at 4:48pm, it was documented that CR#1 was at risk of weight loss from diagnoses of dementia, medications and fair intake and was prescribed supplements and nutritional shakes. CR#1's intake was documented as over 50% at mealtimes. On 08/04/2025 at 10:01pm, it was documented that NP A suspected CR#1 had an infection and ordered antibiotics and IV hydration (Sodium Chloride Solution 0.9 % Use 70 ml every hour intravenously for 48 hours for dehydration). NP A ordered monitoring for CR#1 and said to not send CR#1 out. On 08/05/2025 at 11:00am, it was documented that the UM called a code at 10:25am, and the DON got the crash cart, someone else got a staff on the AED and all three initiated CPR at 10:22am with the DON and UM taking turns. Staff called 911 at 10:23am and CPR continued. 4 emergency technicians arrived at 10:29am and Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 7 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few took over care, administered .09% normal saline and intubated CR#1. At 10:56am, CR#1 was pronounced dead by the emergency technicians. Record review of CR#1's MAR for August 2025, CR#1 did not get Amitriptyline Hcl 50 mg 1 tablet by mouth at bedtime for depression on 8/1/2025 at 9pm, Clopidogrel Bisulfate 75 mg 1 tablet by mouth one time a day for blood thinner on 8/2/2025 at 9:00am, Cymbalta Capsule 60 mg 1 capsule by mouth one time a day for depression on 8/2/2025 at 9am and Ezetimibe 10-10 MG 1 tablet by mouth one time a day for depression on 8/2/2025 at 9am. CR#1 had the following vitals: on 8/4/2025 she had blood pressure of 129/71 and pulse of 85. and on 8/5/2025 she had a blood pressure of 118/90 and pulse of 96. Record review of CR#1's assessments for August 2025, there were no changes in condition assessments for abnormal vitals or IV dislodging. There was a change in condition assessment dated [DATE] for elevated temperature, and it stated CR#1 had altered level of consciousness. Interview with CR#1's RP on 8/5/2025 at 1:52pm, they were concerned when on 8/4/2025 they did not see CR#1 talking or drinking water and was not awake or aware of what was going on. On 8/5/2025 in the morning the facility told CR#1's RP that EMT was called to the facility because CR#1 was unresponsive. [add interview that she was not told about the IV or abnormal vitals. In a later interview on 8/6/2025 at 4:26pm, the RP said she was not aware of CR#1's IV being dislodged or of her abnormal vitals, she was only told on 8/5/2025 that CR#1 was in a critical condition. Interview with RN A on 8/5/2025 at 2:44pm, she started an month ago and was CR#1's nurse on 8/5/2025. CR#1 had normal blood pressure earlier that morning during RN A's shift but at 9:15am CR#1's IV dislodged and after cleaning CR#1's IV site, RN A checked CR#1's vitals which came back as 98/60 for blood pressure from what she could remember, 57 for pulse, and 17 for respiratory rate, and temperature was 97.5F. RN A found that these vital signs were low compared to the morning values. RN A said she told the UM that CR#1 was not feeling good, but did not convey the low blood pressure to either the UM or CR#1's NP. RN A said she told the UM she was planning to call the physician but did not. RN A said CR#1 had a change in condition on 8/5/2025 at 9:15am when RN A noticed CR#1's blood pressure was low, and her pulse dropped from 111 to 57. RN A said she messed up and she only told the UM about the IV being out and the change in condition related to CR#1's lethargy and not being alert in the morning. RN A took report from the previous shift's nurse and found out that CR#1 had an IV. The CNA from the previous shift (she could not remember their name) told RN A that CR#1 was sleeping a lot on 8/4/2025 but was more active on 8/3/2025. RN A said if the blood pressure was low nurses should be checking it again every 15 minutes, and if she told the UM that person could have checked the blood pressure too. If a physician was not notified in a timely manner, interventions for resident-centered care including assessments would not take place promptly. RN A said that she had in-services on notifying the physician immediate after a change in condition through verbal in-services and skilled checkoffs during orientation. Attempted phone interview with RN A on 8/6/2025 at 8:47am, left a voicemail and no response. Further attempt to reach RN A was unsuccessful. Interview with the UM on 8/5/2025 at 3:02pm, RN A told her that CR#1's IV was dislodged so she helped RN A clean up the site and told RN A to call the physician to discontinue the IV since the bag was empty and CR#1 had completed the bag. RN A told the UM that RN A got the order to discontinue the peripheral IV, but the UM did not check the system because it was RN A's responsibility to do so. The UM said at 9:45am CR#1 was on oxygen and still breathing un-laboriously and that the UM could see CR#1's rise and fall of her chest as she appeared to be sleeping. The UM said RN A reported normal vitals for CR#1, and the blood pressure was 110 over something. If RN A had reported abnormal vitals to the UM, the UM would have told RN A to do a respiratory or changes in condition assessment. RN A never told her about the low blood pressure or the low pulse. A blood pressure of 98/60 and a pulse of 57 were considered abnormal and RN A (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 8 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few should have notified the doctor and let them know about the changes. RN A should have also informed the nursing management team. If the ADON had known, she would have gone to assess CR#1 and worked to stabilize her vitals or call 911. Interview with the DON on 8/5/2025 at 3:30pm, she said CR#1 admitted on [DATE] for a right humerus (upper arm) fracture. CR#1 was alert but not communicative. The DON said nurses would let her know about changes in condition. The DON was told about the IV dislodging 8/5/2025 in the morning and the UM went in CR#1's room and took care of it. No one told the DON about abnormal vitals. If the DON was told about the low blood pressure, she would ask about interventions like elevating the feet to increase circulation and check the blood pressure again. The DON was not told about the pulse going from 111 to 57. 111 would be an abnormal vital but 57 would not be dangerous. 98/60 was not a bad blood pressure and the DON said she would have to review CR#1's baseline to determine she would have proceeded. A later interview on 8/5/2025 at 4:18pm, she said RN A told her that the low pulse of 57 might've belonged the Resident #27, who was sent out to the hospital on 8/5/2025 in the morning but RN A was not sure. Interview with the Administrator on 8/5/2025 at 3:55pm, she said nurses should do a change in condition (SBAR: Situation, Background, Assessment, Recommendation) assessment immediately. The Administrator expected nurse to assess and check everything for a resident. In a later interview on 8/6/2025 at 12:05pm, the Administrator said she did not hear about CR#1 not getting an order but remembered hearing about the IV being dislodged. The Administrator supposed that nurses should have gotten an order before taking out the IV. A harm of not getting an order from the physician would be adverse effects to the resident. Interview with CR#1's physician on 8/5/2025 at 4:47pm, she said the facility left a voicemail that CR#1 was going through CPR. The physician called back, and the DON told her she was helping the nurse and EMS with CPR. The physician was aware CR#1 had decreased appetite and a diagnosis of COPD and that NP A gave her IV fluids. Later interview on 8/6/2025 at 10:07am, the physician said NP A would know about the labs, as most communications went through him. The physician said that CR#1 had dementia and cognitive decline, a history of stroke and an enlarged heart, and CR#1 could have aspirated. The physician said she believed CR#1 passed away naturally and to refer to NP A for more information on CR#1. Interview with NP A on 8/6/2025 at 10:17am, he first saw CR#1 on 8/4/2025 and she was difficult to arouse. CR#1's RP said CR#1 had not eaten in a few days and NP A started CR#1 on an IV for normal saline and ordered labs and urinalysis. NP A said the labs came back at night and they were not terribly bad, but she appeared to be dehydrated.NP A said there was no need to send CR#1 out right away and ordered monitoring of CR#1's vitals. NP A said the urinalysis results had not come in. The facility notified NP A that CR#1 was found unresponsive and passed away on 8/5/2025. Interview with the DON and UM on 8/6/2025 at 10:49am, the DON said nurses should document once an intervention was provided and when an intervention is delayed it could cause harm to residents. The UM reviewed CR#1's medical records and saw CR#1's IV order but no discontinued date and said the order to discontinue the IV should have been entered before RN A stopped the IV. The UM was not sure if RN A called the doctor. Negative outcomes from not telling the physician about the IV would be an adverse drug reaction, not following proper protocol and nurse have to get an order to start or discontinue any medication. The UM said on 8/5/2025 at 9:45am, CR#1 looked stable with her oxygen on. The UM said there was no infiltration (meaning when the IV solution enters the surrounding tissue rather than the bloodstream). Interview with CNA L on 8/8/2025 at 9:00am, she was the night shift CNA on 8/4/2025. CNA L said when she made rounds that night, she changed CR#1 and felt CR#1 was kind of warm and notified the charge nurse who told CNA L that CR#1 had a fever that day and were treating it. Record review of the facility's policy on acute condition changes last revised December 2015, it read it part, 3. Direct care staff, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 9 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete including Nursing Assistants will be trained in recognizing subtle but significant changes in the resident (for example, a decrease in food intake, increased agitation, changes in skin color or condition) and how to communicate these changes to the Nurse .6. Before contacting a physician about someone with an acute change of condition, the nursing staff will make detailed observations and collect pertinent information to report to the Physician; for example, history of present illness and previous and recent test results for comparison .Phone calls to attending or on-call physicians should be made by an adequately prepared nurse who has collected and organized pertinent information, including the resident's current symptoms and status. b. Nurses are encouraged to use the SBAR Communication Form and Progress Note .as a tool to help gather and organize information before notifying the Physician. 7.The nursing staff will contact the Physician based on the urgency of the situation. For emergencies, they will call or page the Physician and request a prompt response (within approximately one-half hour or less). Record review of the facility's policy on change in resident's condition or status , it read in part, The nurse will notify the resident's attending physician or physician on call when there has been an . accident or incident involving the resident .adverse reaction to medication .significant change in the resident's physical/emotional /mental condition need to alter the resident's medical treatment significantly .significant instruction to notify the physician of changes in the resident's condition . A 'significant change' of condition is a major decline or improvement in the resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions . Record review of the facility's policy on charting and documentation last revised July 2017, it read in part, 1.Documentation in the medical record may be electronic, manual or a combination.2. The following information is to be documented in the resident medical record:a. Objective observations;b. Medications administered;c. Treatments or services performed;d. Changes in the resident's condition;e. Events, incidents or accidents involving the resident; andf. Progress toward or changes in the care plan goals and objectives.7. Documentation of procedures and treatments will include care-specific details, including:a. the date and time the procedure/treatment was provided;b. the name and title of the individual(s) who provided the care;c. the assessment data and/or any unusual findings obtained during the procedure/treatment;d. how the resident tolerated the procedure/treatment;e. whether the resident refused the procedure/treatment;f. notification of family, physician or other staff, if indicated; andg. the signature and title of the individual documenting. Record review of the facility's policy and procedures on vital signs dated 08/04/2025, it read in part, the purpose to obtain accurate pulse rate, rhythm and volume included documentation of the date, time, rhythm (regular or irregular), whether or not the physician was notified and the signature and title of the licensed nurse. It also reviewed obtaining blood pressure and covered nurses documenting the time, date, blood pressure reading with systolic/diastolic pressure, any deviations in pressure and the licensed nurse's signature and title. Record review of the facility's policy on physician orders dated February 2010, it read in part that nurses were to obtain orders from physician authorized or their designee. record review of the facility's policy on physician orders record maintenance last revised January 2020 read in part, 6. Medications, diets, therapy, or any treatment may not be administered to the Patient without a written order from the attending physician. Record review of the facility's policy on assessments dated February 2012, it read in part, An SBAR must be completed upon a patient's change in condition and prior to contacting the attending physician. Event ID: Facility ID: 675663 If continuation sheet Page 10 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident received appropriate treatment and services to prevent urinary tract infections for 1 (Resident #65) of 2 residents observed for indwelling urinary catheters. -The facility failed to ensure CNA A provided appropriate care for Resident #65 during Foley catheter care. Resident #65's indwelling catheter was not secured to his thigh, his catheter bag was placed on the bed when it should have been emptied before incontinent care. CNA A did not open Resident #65's labia to clean and did not clean the catheter from the insertion site. This failure could place residents at risk for urinary tract infection, discomfort, skin breakdown and decreased quality of life. Record review of Resident #65's face sheet revealed 78 years- old female was admitted to the facility on [DATE]. Her diagnose were encephalopathy (any group of conditions that cause brain dysfunction characterized by confusion, pressure ulcer stage 2, urinary tract infection dementia (a decline in mental ability severe enough to interfere with daily life), and obstructive reflux uropathy (a condition in which the flow of urine is blocked) Record review of Resident #65's admission MDS dated [DATE] indication BIMS (Brief Interview for Mental Status) of 14 revealed mild cognitive impaired. Section H (Bladder and Bowel) reflected the resident was always incontinent (continent voiding). It further revealed the resident was extensive to totally dependent on staff with all ADL care, with one to two staff assist. It also revealed the resident was incontinent of bowel and continent of bladder with the use of indwelling catheter. Record review of Resident #65's care plan dated 8/2/25 revealed the resident has an indwelling foley catheter related to the obstructive reflux uropathy. Interventions: provide catheter cleaning and perineal hygiene every shift and PRN (as needed) if soiled. Record review of Resident #65's Physician Order Summary Report for the month of July 2025 reflected the following order: -Dated 07/31/25, Urethral indwelling urinary catheter 16Fr with 10cc normal saline balloon using a closed drainage system (a catheter inserted into the urinary bladder and connected to tubing that is connected to a drainage bag. The drainage of urine is total dependent on gravity. The tubing and drainage bag to collect urine must be kept below the level of the bladder). Observation on 08/07/25 at 1:53 PM, of Foley catheter care for Resident #65 by CNA A and CNA B assisting, revealed the staff washed their hands and donned PPE that consisted of a disposable gown and gloves. The staff removed the resident's Foley drainage bag which hung to gravity on the right side of bed below the resident bladder, placed the Foley drainage bag in the bed with resident, and proceeded with Foley catheter care which was not secured. CNA A did not open the labia to clean and did not cleaned the indwelling catheter from the insertion site, she left the catheter bag on the bed, with cloudy urine sediments and had 700cc yellow urine. When staff was done providing care, they placed the resident to her left side and placed the resident's Foley drainage bag below the resident's bladder on the bedrail. Interview on 08/7/25 at 2:28 PM, CNA A said she was not aware the urine bag had 700 cc of urine she would have emptied it before performing Foley care. CNA A said she had been working with the facility for 2 years n the 6a-2p shift, she did no in-service on foley incontinent care, but she had it on incontinent care. Incontinent care was 2 years ago with the previous DON and had it this morning 8/7/25. UM watched her do it and had checkoffs today. She said she should have emptied her foley first, she said this was not her hall. She said the last aide should have emptied it, but because it was not. CNA A should have emptied the bag at the start of incontinent care, and she said when someone started providing incontinent care, they do not want to disturb the bag. She placed the 700cc bag on the bed, and there was sediment. The bag should not be pulling during (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 11 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete incontinent care, and so it should have been taped to hold it in place, and it was not there either. She should have opened the labia to clean. Interview with CNA B on 8/7/25 at 2:45 PM, she said CNA A did not open the labia. The nurse should have put a clip to secure the foley bag so that it would not pull out and Resident #65 should have received barrier cream. Interview on 08/07/25 at 4:57 PM, the DON said when providing Foley catheter care for a resident, the Foley drainage bag should not be placed on the bed because this placed the resident at risk for urinary tract infections. The DON said the facility did not have a policy on Foley catheter care and no in-services for catheter was presented.Interview on 08/07/25 at 5:04 PM, the UM said when a staff provided care for a resident with a Foley catheter, the drainage bag should not be placed on a resident's bed for infection control and because urine could backflow placing the resident at risk for urinary tract infection. The UM said the foley drainage bag should be placed on the side of the bed below the bladder when they repositioned the resident in bed and the nurses secures the foley to prevent pulling. Record review of the facility dated (Revised September 2014) policy on Catheter care read in part . the purpose of this procedure is to prevent catheter associated urinary tract infection . Maintaining Unobstructed urine flow.3. The urinary drainage must be held or positioned lower than the bladder at all times to prevent the urine in the tubing and drainage bag from flowing back into the urinary. Changing Catheters.2. Ensure that the catheter remains secured with a leg strap to reduce friction and movement at the insertion site (Note: Catheter tubing should be strapped to the resident's inner thigh): Steps in the procedure . # 15 . use wash clothes with warm water and soap to clean the labia . then with clean washcloths rinse with warm water . # 19. check drainage tubing and bag to ensure that the catheter is draining properly. Event ID: Facility ID: 675663 If continuation sheet Page 12 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide pharmaceutical services (including procedures that assure the accurate administration of all drugs and biologicals) to meet the needs of each resident for 2 (Resident #26 and CR#1) of 6 residents reviewed for pharmacy services. -Resident #26's physician's order for Calcium-Vitamin D Tablet 600-200 MG-UNIT was not administered as ordered on 08/06/2025. Residents #26's physician order for supplement 30 ml order date was not given as ordered on 7/6/25. Resident #26 was given 120 mls instead of 30 mls.--The facility failed to provide CR#1 with her medications following physician orders including Amitriptyline HCl Oral Tablet 50 MG one tablet by mouth at bedtime for depression with a start date of 8/1/2025, Clopidogrel Bisulfate Oral Tablet 75 MG one tablet by mouth one time a day for blood thinner with a start date of 8/2/2025, Cymbalta Oral Capsule Delayed Release Particles 60 MG one capsule by mouth one time a day for depression with a start date of 8/2/2025, Ezetimibe oral tablet 10-10mg one tablet by mouth in the evening for lower cholesterol with a start date of 8/2/2025. The deficient practice could place residents at risk of not receiving the therapeutic effects from their medications as intended by the prescribing physician order. Resident #26 Record review of Resident #26's face sheet, dated 08/06/2025 reflected Resident #26 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of edema (swelling), obesity (excess fat), and chronic respiratory failure (syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination). Record review of Resident #26's quarterly MDS, dated [DATE], reflected Resident #26 had a BIMS score of 13, indicating no cognitive impairment. Record review of Resident #26's physician order dated 07/06/2025 reflected Calcium-Vitamin D Tablet 600-200 MG-UNIT Give 1 tablet by mouth one time a day and Supplement Pass two times a day for supplement 30 ml start order date was 01/24/2025. Record review of Resident #26's MAR order dated 08/01/2025 revealed no order for Calcium-Vitamin D Tablet 600-200 MG-UNIT Give 1 tablet by mouth one time and Supplement Pass two times a day for supplement 30 ml. During medication administration observation on 08/06/2026 at 8:01 am LVN O did not give Resident #26's Calcium-Vitamin D Tablet 600-200 MG. LVN O gave Resident #26's Supplement Pass 120 mls. During an interview with LVN O on 08/07/2026 at 1:44p.m., LVN O stated the Nurses were responsible for transcribing physician's orders to MAR and she did not see an order for Calcium-Vitamin D Tablet 600-200 MG and for giving Resident #26 supplement pass of 120 ml instead of 30ml, she said she was very sorry and would check the physician's order well. During an interview with the DON, 08/08/2025 at 11:50a.m., the DON stated she was informed on the missed Calcium-Vitamin D Tablet 600-200 MG and she research the order and found out the NP wrote the order in the TAR instead of the MAR and would notified the physician of the missed dose The DON stated it was important to not miss a dose of the Calcium-Vitamin because it needs to be a consistent treatment and we are to follow the physician orders. CR #1 Record review of CR#1's face sheet dated 8/5/2025, she was a [AGE] year-old female originally admitted on [DATE] with medical diagnoses including fracture of the right humerus (upper arm), chronic obstructive pulmonary disease (a group of lung and airway diseases that restrict breathing, urinary tract infection, type 2 diabetes mellitus (high blood sugar), hyperlipidemia (high cholesterol), hypertension (high blood pressure), dementia (decline in cognitive function affecting memory, thinking and changes in personality and emotional control issues), and cognitive communication deficit. Record review of CR#1's Physician Orders dated 08/05/2025, she had the following orders: *peripheral iv inserted in the left arm with a start date of 08/04/2025, *vital signs every shift with a start date of 08/04/2025, *Amitriptyline HCl Oral Tablet 50 MG one tablet by mouth at (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 13 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some bedtime for depression with a start date of 8/1/2025, *Clopidogrel Bisulfate Oral Tablet 75 MG one tablet by mouth one time a day for blood thinner with a start date of 8/2/2025, *Cymbalta Oral Capsule Delayed Release Particles 60 MG one capsule by mouth one time a day for depression with a start date of 8/2/2025, and *Ezetimibe oral tablet 10-10mg one tablet by mouth in the evening for lower cholesterol with a start date of 8/2/2025. Record review of CR#1's care plan dated 8/4/2025, she had altered cardiovascular status related to Hypertension diagnosis, with interventions including administering medications as ordered and assessing and monitoring cardiovascular status and identify complications. CR#1 had an intravenous access IV for fluid therapy related to dehydration, with interventions including administering intravenous fluids as prescribed and maintaining rate of infusion as ordered and check infusion rate every one hour. CR#1 had a focus area of antidepressant medication related to depression, with interventions including administering antidepressant medications as ordered by physician and monitoring and documenting side effects and effectiveness every shift and monitoring, documenting and reporting PRN adverse reactions to antidepressant therapy like changes in cognition, decline in ADL ability, falls, appetite loss and insomnia. CR#1 was also care-planned for having a stroke and taking antiplatelet medication with interventions including giving medications as ordered by the physician and monitoring and documenting side effects and effectiveness. Record review of CR#1's progress notes for August 2025, revealed the following: * 8/1/2025 at 10:14pm written by LVN T indicated her Amitriptyline for depression was awaiting delivery. * 8/2/2024 at 8:23am-8:24am, CR#1 written by LVN T indicated as awaiting supply from the pharmacy for Cymbalta for depression, Clopidogrel for blood thinner and Ezetimibe for cholesterol. Further review revealed there were no notes related to CR#1 having abnormal vitals or IV dislodgement. Record review of CR#1's MAR for August 2025 revealed the resident did not receive following medications as ordered: * Amitriptyline Hcl 50 mg 1 tablet by mouth at bedtime for depression on 8/1/2025 at 9pm, * Clopidogrel Bisulfate 75 mg 1 tablet by mouth one time a day for blood thinner on 8/2/2025 at 9:00am, *Cymbalta Capsule 60 mg 1 capsule by mouth one time a day for depression on 8/2/2025 at 9am, and *Ezetimibe 10-10 MG 1 tablet by mouth one time a day for depression on 8/2/2025 at 9am. Record review of CR#1's assessments for August 2025, there were no changes in condition assessments for abnormal vitals or IV dislodging. There was a change in condition assessment dated [DATE] for elevated temperature, and it stated CR#1 had altered level of consciousness. Interview on 8/2/2025 at 1:52pm with CR#1's RP, she said she found out that CR#1 had not been given medication for 8/2/25 yet, and a male nurse told her that afternoon that CR#1's medications had not come in yet. The RP brought CR#1's nighttime medications in case the medications did not come but they eventually arrived either later in the afternoon or evening. Interview with NP A on 8/6/2025 at 10:17am, he said he reviewed medications with the nurses on duty when CR#1 was admitted to the facility. NP A said NPs reviewed medications list, and he was not aware CR#1 did not receive medications on 8/1/2025 and 8/2/2025. There was a procedure the facility followed when there was a medication delay, and he knew the pharmacy had a delivery schedule but did not know more than that. Interview with the Administrator on 8/6/2025 at 12:05pm, she said that upon admission if the facility knew CR#1 had an order then the resident should have gotten her medications as soon as possible. If CR#1's medications had an alternate brand, then the nurse could pull that medication and provide it to the resident. Interview with LVN T on 8/7/2025 at 3:23pm, he worked 8/2/2025 and 8/3/2025 with CR#1. LVN T said the family brought a small case of home medications. The facility sent the same script to the pharmacy and CR#1 received her medications around 3-5pm. LVN T said he did not remember if CR#1 missed any medications during his shifts, but most were given. LVN T said that the pharmacy would deliver medications the next day unless it required immediate delivery. LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 14 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some T could not answer when asked if missing any medications could put CR#1 at any harm. LVN T had training on pharmacy services since working at the facility. Record review of CR#1's MAR for August 2025, she was not administered the following medications at the following dates and times as ordered by the physician due to medication unavailability: *Simvastatin oral tablet (high cholesterol) 10-10 mg one tablet by mouth on 8/2/2025 at 9:00am (she took Atorvastatin on 8/2/25 at 8:00pm), *Amitriptyline HCl Oral Tablet 50 MG one tablet at bedtime for depression on 8/1/2025 at 9:00pm, *Clopidogrel Bisulfate Oral Tablet 75 MG one time a day for blood thinner on 8/2/2025 at 9:00am and *Cymbalta Oral Capsule Delayed Release 60 MG one time a day for depression on 8/2/2025 at 9:00am (she took Quetiapine 8/2/2025 at 9:00am) Interview with the UM on 8/5/2025 at 3:02pm, she said the facility was responsible for ensuring the medication was in-house and that the medications matched a resident's discharge orders from the hospital. The UM said floor nurses assigned to newly admitted residents were in charge of calling and verifying medications. The UM verified that medications matched hospital discharge orders. medications should be available as soon as possible and it could also be called in stat which meant it would be prioritized for delivery. If residents did not have their medications delivered from the local pharmacy in two hours, nurses could find medications in the emergency kit. If a resident's medication was not in the facility, nurses should notify the doctor and the DON. The UM was not notified of any medications not given to CR#1. Interview with the DON on 8/5/2025 at 3:30pm, she said that when residents admit, nurses would call the pharmacy to get it and if they were admitted later in the evening nurses could get their medications through the emergency kit. If it was not in the emergency kit, nurses would be responsible for getting to the pharmacy and if there was pushback on delivery from the pharmacy, the pharmacy and nurses could call her. No one called her. Every morning, the online portal would notify the facility of medications not given. Interview with the Administrator on 8/5/2025 at 3:55pm, she said when the facility received paperwork from the hospital, she expected nurses to check the resident's medication list and ensure they had everything was in-house and be aware of all the medications residents should have. Nurses could request from the emergency kit or request it stat. If the resident did not get their blood pressure medication it could cause a change in the body and not feeling well like feeling dizzy, loopy or have a stroke. Interview with the DON and UM on 8/6/2025 at 11:14am, the DON said CR#1 missing one dose of her Simvastatin for high cholesterol would not have affected her. CR#1 did not get her depression medications Amitriptyline or Cymbalta but she received Sertraline so there was no risk. When asked if the facility followed physician orders, she said it was tricky to answer because the nurse had followed physician orders and transcribed it correctly, but that the pharmacy has occasional delays. If there was a delay the next day, the DON would call the Pharmacy director and order it stat. Nurses should follow up with the pharmacy and let the doctor know. The DON said she was not notified of CR#1's medication unavailability the night she was admitted . The nurse on duty should have let the DON know the medications started the next day so she could have done something. Residents should have their medications at the facility before they arrive. Record review of facility in-service, dated 06/6/2025, stated administering medications: the licensed nurse will follow medication administration guidelines, the licenses nurse/medication aide will ensure that all medications are given as scheduled. At the end of the shift the licensed nurse/medication aide will check using the missing medication tab to ensure all medications and treatments were given as scheduled. If there is medication missing a call to the physician will be made by the licensed nurse and seek physician guidance to see if medication can still be given. In addition, the in-service stated, The licensed nurse will notify the director of nurses of any missing doses, as soon as the nurse is aware. The in-service has 8 nurse signatures, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 15 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0755 including LVN O. Record review of the facility's Medication Administration policy, undated, it did not cover the procedures for medication unavailability in the facility. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675663 If continuation sheet Page 16 of 17 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 675663 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fort Bend Healthcare Center 3010 Bamore Rd Rosenberg, TX 77471 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to ensure drugs and biologicals used in the facility were secured and stored properly for one of three medication carts (100 Hall Nurse Medication Cart) reviewed for drug storage. - UM failed to ensure 100 hall Nurse medication cart was locked when left unattended on 08/07/2025. -There were 4 over-the-counter medications observed opened with no date in the medication cart on 08/07/2025, including 24-hour Allergy Nasal spray, Latanoprost Sol 0.005%, Geri-Tussin -Guaifenesin (expectorant), and Milk of Magnesia. These failures could place residents at risk for possible drug diversions or accidental ingestion. During observation on 8/7/25 at 1:35PM, medication cart on 100 hall was left unlocked and there was no nurse around the medication cart. At 1:45 PM UM came to the hallway stated she mistakenly left the cart open, and she thought she locked it. Further observation of the 100 Med cart revealed the following medications were not dated: 1. 24 -hour Allergy Nasal spray open with no dated 2. Latanoprost Sol 0.005% open not dated 3. Geri-Tussin -Guaifenesin -expectorant 16 FL oz (473) 4. Milk of Magnesia -16Fl oz (473ml) open not dated Interview with UM on 8/7/25 at 1:48 PM she said it supposed to have open date and it only good for 30 days after it was open. The UM said she did not realize she left the medication cart unlocked. UM said medication cart should not be left opened or unlocked to prevent confused residents taking wrong medications or any staffs assessing medication cart. Interview on 08/7/25 at 4:26 p.m., the DON said all medication carts should be locked at all times before the cart is left unattended. She said if the resident took the drug, the resident might have an adverse reaction. Medication opened should be dated to help nurses know it effectiveness, DON said most drugs are good for 30 days when opened. Record review of the facility's policy on Security of Medication Cart: Policy reviewed April 2007, had the following heading: The medication cart shall be secured during medication passes. 3. When it is not possible to park the medication cart in the doorway, the cart should be parked in the hallway against the wall with doors and drawers facing the wall. The cart must be locked before the nurse enters the resident's room. 4. Medication carts must be securely locked at all times when out of the nurse's view. 5. When the medication cart is not being used, it must be locked and parked at the nurses' station or inside the medication room. Storage of medications revised April 2007 did not address dating medication. Event ID: Facility ID: 675663 If continuation sheet Page 17 of 17