Inspection·October 5, 2023

F 0624 -DME semi electric bed patient lift with supplies sling size medium, dated 08/24/2023 Level of Harm - Minimal harm or potential for actual harm Record review of CR# 1 TAR for the month of August 2023 revealed that the NF was following physician orders for wound care treatment as ordered. Residents Affected - Few Record review of CR #1's wound assessment to the sacrum dated 08/18/2023 revealed no signs of infection. Record review of CR #1's Discharge Summary Information dated 08/26/2023 documented by RN A revealed that CR #1 was being discharged home via EMS staff. Further review revealed that section C (physical assessment on discharge) was not filled out. These areas included the following: Physical and Mental Functional Status including ADL's and ambulation, special treatments and procedures, skin condition, etc. Further review revealed that RN A did not address if CR #1 required follow-up physician care (call physician to schedule an appointment, if an appointment had been schedule, or any additional appointments). Interview on 09/01/2023 at 1:41p.m. ADON said CR #1 was admitted to the NF for Skill Nursing and Rehab Services and that CR #1 was admitted to the facility with a sacral wound that the Wound Care Doctor was following. The ADON said she believed CR #1 was discharged from the NF to home on [DATE]. The ADON said she was not at the facility when CR #1 was discharged home and that RN A was the nurse on duty that discharged CR #1 home. The ADON said she did not attend any IDT discharge meeting for CR #1. Interview on 09/01/2023 at 1:45p.m. Wound Care doctor said CR #1 admitted to the facility with a stage 4 wound to the sacrum. The wound care doctor said he last saw CR #1 at the facility on 08/21/2023 and that his wound to the sacrum had not shown much improvement and had enlarged some. The wound care doctor said because CR #1 was non-compliant with the plan of care along with his comorbidities, it hindered the wound from improving. The wound care doctor said CR #1 had a lot of necrotic (dead) tissue and the plan of treatment was treating the sacral wound with santyl (ointment that removes dead tissue from the wound) to break down the dead tissue so wound could began to heal. The wound care doctor said CR #1's sacral wound did not show any signs or symptoms of infection when he last observed CR #1 sacral wound. Interview on 09/01/2023 at 1:55p.m. RN A said she worked at the NF PRN. RN A said she was the nurse on duty the day that CR #1 was discharged home via EMS services. RN A said she provided teaching to CR #1 on wound care along with medications, and to follow-up with his Medical Doctor. RN A said she just discussed with CR #1 what was on the discharge paperwork which she could not remember in full detail. Interview on 09/01/2023 at 2:00p.m., the Discharge Planner said the previous Social Worker's last day working at the facility was on 08/25/2023. The discharge planner said CR #1 was on his parent insurance who had lost their job. The discharge planner said because the NF did not accept Medicaid, the facility was in the process of trying to get CR #1 approved for Medicaid services for long term care at another facility. The discharge planner said CR #1 was discharged home with DME. The discharge planner said she called CR #1's insurance to see if she could get more days but the insurance denied more days for CR #1. The discharge planner said she had followed up with the family member of CR #1 regarding insurance coverage and that CR #1's family member did not want CR #1 to go to an LTC facility. The discharge planner said CR #1 was his own RP and did not want to go to an LTC facility as well, and therefore wanted to be discharged home. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 2 of 4 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 675671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden Terrace Healthcare Center of Houston 7887 Cambridge St Houston, TX 77054 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 0624 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Interview on 09/01/2023 at 2:32p.m., the Social Worker said she just set up DME and transportation for CR #1. Interview on 09/01/2023 at 2:42p.m. RP said when the NF discharged CR #1 home on [DATE], they did not send any supplies to change CR #1's dressing to his wound. The RP said they knew how to change CR #1's dressing to the sacrum but had to send CR #1 to the hospital due to his catheter being clogged and urine not flowing. The RP said CR #1 was diagnosed at the hospital having a urinary tract infection. The RP said the NF never did a teaching with her on how to change CR #1's dressing to his sacral wound and neither did the NF set up for CR #1 to have Home Health Services. The RP said it was the hospital that arranged Home Health Services for CR #1. The RP said CR #1 was back at home receiving Home Health Services. Interview on 09/01/2023 at 3:14p.m., the DON said he spoke with the family member of CR #1 face to face prior to discharge regarding hands on training expressing she needed to come to the NF to receive the training. The DON said the process when discharging a resident from the facility to home was the Social Worker was supposed to coordinate the discharge by arranging DME and Home Health referrals. The DON said it was the Social Worker that was supposed to get an order from the physician for Home Health Services. The DON said he and the previous Social Worker had done a phone call with CR #1's family member regarding discharge, Home Health Services, and insurance coverage. The DON then called the previous Social Worker via phone with the surveyor being present. The Social Worker said she could not remember the name of the Home Health Agency that she had arranged for CR #1. Further interview with the DON revealed he was unable to find any documentation that an IDT care plan meeting was done discussing CR #1's needs for discharge planning to home. Interview on 09/01/2023 at 4:05p.m., the Discharge Planner said the Social Worker told her that CR #1's insurance did not cover Home Health due to his coverage ending on 08/31/23 and that the Home Health Agency was aware of that. Interview on 10/05/2023 at 4:00p.m., the Administrator said regarding the discharge process when resident was being discharged to home, an IDT meeting is done with the Social Worker coordinating the discharge meeting. The Administrator said routinely, the Administrator followed up on discharge IDT meetings to make sure everything is in place for a safe discharge. The Administrator said she started working at the NF on 10/02/2023. The Administrator said she would normally impress on the Social Worker that discharge planning began upon admission. The Administrator said the Social Worker was supposed to be looking at what all the residents may be needing prior to being discharged home pending on the authorization of the resident's insurance. The Administrator said if the resident would require certain medication or supplies, it had been her experience working at other facilities to send with the resident some supplies and medications due to there being a possible delay in Home Health Services getting to the home. The Administrator said the resident should not be discharged home empty handed. The Administrator said this was done to avoid a gap in treatment as well as maintaining the continuity of care for the resident until Home Health Services arrived at the home to evaluate and treat the resident. The Administrator said she would look to see what policy the NF had on resident discharge. The Administrator only provided the surveyor with the below policy. Record review of the NF Policy on Discharge Policy Area of Focus: Discharge Process and Bed Holds reviewed 11/23/2022 revealed in part: .Before a facility transfers or discharge a resident, the facility must---Notify the resident and the resident's representative(s) of the transfer or discharge and the reason for the move in writing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 3 of 4 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 675671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/05/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden Terrace Healthcare Center of Houston 7887 Cambridge St Houston, TX 77054 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 0624 and in a language and manner they understand . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 4 of 4