Inspection·December 9, 2025

F 0695 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some were not completed on 10/11/25, 10/12/25, 10/13/25, 10/18/25, 10/19/25, 10/25/25, and 10/26/25. 3. the trach aerosol tubing, mask, jet nebulizer bottle, and water trap had no documentation of being changed. Record review of Resident #1's TAR for November 2025 revealed 1. Trach was suctioned every shift as ordered. No additional prn suctions were completed, 2. The trach ties were ordered to be changed daily. Review of the TAR revealed that these orders were not completed on 11/2/25, 11/3/25, 11/4/25, 11/5/25, 11/6/25, 11/7/25, 11/8/25, , 11/9/25, , 11/16/25, , 11/23/25, , 11/24/25, , and 11/27/25. 3. the trach aerosol tubing, mask, jet nebulizer bottle, and water trap had no documentation of being completed. Record review of Resident #1's Respiratory Progress Notes by RT, dated 10/10/25, 10/17/25, 10/22/25, 10/23/25, 11/3/25, 11/7/25, 11/11/25, 11/21/25, and 11/26/25 indicated no distress. Record review of Resident #1's progress note documented by LVN D, dated 11/26/25 at 6:38 a.m., revealed that Resident #1 was sent to the hospital via EMS due to brown/black emesis (vomit) from mouth and trach. Resident #1 transferred via stretcher to hospital without any complications. In an interview on 12/3/25 at 12:02 p.m., LVN A stated she worked at the facility for two years on the 6:00 a.m. to 2:00 p.m. shift. She stated she suctioned Resident #1's trach prn, every shift, and the ties were changed daily and prn. LVN A stated the last time she performed trach care for Resident #1 was on 11/25/25 and she stated there was a slight odor a few weeks in 11/25 before they did a culture and started him on antibiotics. LVN A stated sometimes Resident #1 refused suctioning and he communicated with staff by pointing and shaking his head at commands or questions. LVN A stated , she could not explain why the trach collar was discontinued from his treatment orders because Resident #1 had a very strong cough and mucus would often wet the collar and ties. She stated Resident #1 had very thick mucus and his cough was so forceful that she could see particles of mucus on the mirror across the room. When LVN A was asked if she had ever completed the order to change the trach aerosol (change out the tubing of the trach), she said she did not document it because she washed it but did not change it. LVN A stated she changed the tubing but she could not remember documenting it and should have put it in the notes. She explained the purpose of changing out the aerosol equipment was for cleanliness and the harm in not changing out the equipment could be infections. In an interview on 12/3/25 at 12:35 p.m., CNA A stated she worked at the facility for almost 2 years and worked the 6:00 a.m. to 2:00 p.m. shift. She stated she never performed trach care for Resident #1 and only cleaned around his chest and under his neck. He produced a lot of mucus and he communicated with her by mouthing words and moving his hands. In an interview on 12/3/25 at 1:15 p.m. with the RT, she stated she saw Resident #1 a minimum of once weekly. Her role included trach care, training nursing staff, and documenting her visits and findings. She described him to have a very productive cough and produced a lot of secretions/mucus that required frequent monitoring due to the amount of secretions. She statedshe seldomly worked with patients that produced as much mucus as him and stated that he would need to be suctioned more than once a shift and there was a prn order in place. She stated she noticed an odor from his trach and that was why she requested a lab order. When asked if she noticed any issues with the trach care preformed at the facility, she stated she did not know if she should answer questions regarding the quality of the trach care prior to her session with him, but stated that every time she arrived at the facility, she performed complete trach care, and she would create a report to give to the DON and provide pictures and names to inform her of who needed more training. She advised to follow up with the DON regarding specifics of nursing care because she did not want to disclose that information. RT explained that the harm of not changing out equipment as ordered could be a possible infection and a soiled trach collar could lead to skin breakdowns around the neck. In an interview on 12/3/25 at 2:07 p.m., the DON stated she oversaw all trach care and there were no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 2 of 6 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 12/09/2025 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 0695 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some concerns that she could think of regarding trach care at the facility. She explained that Resident #1 produced a lot of secretions and he was suctioned frequently, which she described as every shift and noted that there was a prn order in place. She time lined that staff collected a sputum sample on 11/10/25, he was identified to have pseudomonas (a [NAME] of common bacteria found in soil, water, and plants, known for causing opportunistic infections in humans, especially those with weakened immune system) and was prescribed antibiotics to treat it. When asked what prompted staff to collect the sputum sample, she stated that she did not know because no SBAR, CIC, or progress note was documented in the resident's chart. The DON stated that she communicated with the RT after her visits, and RT did have concerns regarding his secretions and that was why he was placed on antibiotics. DON was informed that on the TAR, there was no documentation to sign off the completion of changing the aerosol tubing for October and November and she stated that she was not aware of this and would have to find out why. She explained that in the TAR or MAR, if an order was left blank it meant that it was not completed. DON was informed that there were several inconsistencies in the completion of changing out the trach ties as documented in the TAR, and most of these inconsistencies could be seen through weekend documentation. She had no idea why this was not completed. When asked why the order to change the trach collar every Sunday was discontinued on 11/13/25, she was not aware it was discontinued. DON explained the risk of these orders not being followed were infections and skin breakdown. She was notified that Resident #1 had a CIC that resulted in brown emesis coming from his mouth and trach on 11/28/25, but she did not follow up for additional details after he was admitted to the hospital. DON stated that Resident #1 would be welcomed back into the facility, but was unsure if he would return. In a phone interview on 12/3/25 at 2:52 p.m., the HSW, stated she reviewed the hospital progress notes and Resident #1 had MRSA bacterium in his sputum. The HSW read from the progress notes that there was blood on the trach upon his arrival to the hospital, and the trach had not been changed in a long time. In an observation and interview on 12/3/25 at 3:51 p.m., Resident #1 was sitting in his bed with trach and g-tube in place. He was alert and oriented but not easily understood when he tried to vocalize his responses to questions. His cough was productive and could be heard through his lungs. He was able to shake his head and shook yes when asked if he could understand me. When asked if the facility provided good trach care while he was there, he shook his head no. When asked if nurses were suctioning as needed and changing out the tubing equipment (pointed at the tube coming from his mask) he shook his head no. He was asked why they were not changing out the equipment as ordered, he mouthed because they didn't want to He was asked why not, was it too much work, and he shook his head yes. He was asked if he was going to return to the facility after hospital discharge and he shook his head no. In an interview on 12/3/25 at 4:10 p.m., the HDR stated he was not Resident #1's usual doctor and he was substituting in for the day so he was not very familiar with the case. He stated Resident #1 had MRSA bacterium, was admitted for pneumonia, and arrived with rust colored bloody sputum. He explained not having Resident #1's trach equipment changed regularly would put him at greater risk for infection His health outcome was multifactorial, which included improper care and him being immunocompromised (having a weakened immune system). In an interview on 12/4/25 at 11:13 a.m., LVN B stated she worked at the facility for one year usually the 10:00 p.m.- 6:00 a.m. shift. She stated the last time she performed trach care for Resident #1 was on 11/23/25 and she remembered changing all his equipment. She stated she did not put a progress note in, but the TAR would flag red if you did not document it. She stated because he had a lot of secretions, staff suctioned more often and there were prn orders in place. She explained that you had to suction Resident #1 every hour/hour and a half. She stated that she did not document this and could not recall (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 3 of 6 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 12/09/2025 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 0695 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some documenting any completed prn orders. She explained that Resident #1 was alert and oriented and knew what was going on. He was able to answer questions by mouthing out words and shaking his head. In an interview on 12/4/25 at 1:25 p.m. with Resident #1's PCP, he stated he thought Resident #1 aspirated (breathing down the wrong pipe) the way it was conveyed by the nurse. He explained that in regard to the orders, Resident #1 was an immunocompromised patient with terminal cancer and everything had to be sterile (free from bacteria or other living microorganisms). Record review of the facility's policy titled Tracheostomy Care Policy reviewed 9/24/25 reflected the following: The facility will provide and perform tracheostomy care in accordance with physician orders and current standard of care.Procedure:1. Tracheostomy care will be performed daily and PRN unless otherwise noted by the physician. This procedure should be performed using sterile technique and includes the cleaning of the stoma and neck, cleaning or replacing inner cannula, (depending on type of trach- disposable or reusable), and replacing the tracheostomy tube holder and drainage sponge2. Tracheostomy patient should be assessed and documented on in the patient medical record at least every four hours. This was determined to be an Immediate Jeopardy (IJ) on 12/4/25 at 3:30 p.m. The ADM and DON were notified. The ADM was provided with the IJ template on 12/4/25 at 3:30 p.m. The following Plan of Removal submitted by the facility was accepted on 12/5/25 at 8:08 a.m. Plan of Removal: Re: IJ 12/4/2025 F695 Facility Failed to ensure that a resident who needs respiratory care, including tracheostomy and tracheal suctioning is provided. Corrective Action for Those Found to Have Been Affected by the Deficient Practice: Identified resident was transferred to the hospital for further evaluation and treatment. The identified resident will be re-admitted if orders for such. Education will be completed regarding following physician orders for trach care to include changing trach aerosol tubing, mask, nebulizer bottle, water trap, trach ties and trach color as ordered. This education will be provided to current licensed nursing staff by the Director of Nursing/Respiratory Therapist and/or Regional Nurse Consultant. This training will be provided prior to staff working and will be completed by 12-5-25. Licensed staff will not provide direct care to residents until training is completed. Divisional Clinical Nurse reviewed facility's policy and procedures for tracheostomy care. No changes made. No new patients/residents requiring tracheostomy care/tracheal suctioning will be admitted until 100% of licensed staff have been trained and deemed competent.Identification of Other Residents Having the Potential to be Affected: Two additional residents requiring respiratory/tracheostomy care and tracheal suctioning reside in the facility. Documentation of physician orders is current for these two residents. The two additional residents requiring respiratory/tracheostomy care and tracheal suctioning will be seen 12-4-25 by the attending physician, or medical director to ensure no negative assessment findings. No issues identified. DON/Designee conducted an audit of current residents and tracheostomy supplies to validate trach supplies were available at bedside. No issues identified. Measures/Systemic Changes to Ensure the Deficient Practice does Not Recur: The Director of Nursing will begin immediate in-servicing of LVN A, RN B, and LVN C, on the following and will be completed on 12-5-25. o Completion and documentation of physician ordered tracheostomy care.o Return demonstration of trach care w/competency documented. Licensed staff will ensure that the orders for trach care will include changing trach aerosol tubing, mask, nebulizer bottle, water trap, trach ties and trach collar as ordered. DON/designee will review MARs/TARs daily (to include weekends) to validate trach care orders are carried out. LVN A, RN B, and LVN C, (same comment as above) staff will not be allowed to begin their shift until they have received the education/competency as noted above. Licensed weekend staff will be provided with 1:1 re-education on care for patients with tracheotomies. The education will include competency for tracheal care, suctioning, tubing changes, and documentation. Ongoing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 4 of 6 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 12/09/2025 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 0695 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Monitoring: The Director of Nursing, Assistant Director of Nursing or Regional Nurse Consultant will complete the following until substantial compliance has been met and achieved:o Daily audits of residents requiring respiratory/tracheostomy care and tracheal suctioning will be reviewed to ensure that physician orders for such are documented. The facility will continue to provide the in-servicing as noted above to newly hired licensed staff, annually and as needed. The Director of Nursing or Assistant Director of Nursing will audit licensed nurses training and competency records to ensure tracheostomy care/tracheal suctioning training compliance. Nurse Managers will round on trach patients on weekends to validate trach care performed and there are no signs/symptoms of infection. Any issues identified will be addressed immediately. All components of this plan of correction will be submitted to the facility QAPI meeting and additional recommendations will be made until substantial compliance has been achieved.The Director of Nursing, Assistant Director of Nursing and Regional Nurse Consultant is responsible for the corrections and continued monitoring. The Medical Director was notified and agrees with the plan of removal. Completion Date: 12-4-25 Monitoring Day 1: 12/5/25Trach care observations:Resident #1 was in the hospital on [DATE]. He did not plan to return to the facility. In an observation and interview on 12/5/25 at 10:47 a.m., LVN A and RN D prepared to preform trach care for Resident #2. RT provided hands on education and a skills test earlier that morning, and Resident #2 declined to have staff preform full trach care but she allowed the staff to do a hands on walk through to show their knowledge of proper trach care. LVN A, verbalized the steps for tracheostomy suctioning and site care, including use of sterile supplies, identification of clean versus dirty hands, suctioning until resistance or cough, limiting suction passes to 10-15 seconds, and proper disposal of equipment. Each step was simulated with the supplies and was performed according to resident orders. RN D, was present and assisted with supply management to maintain a sterile environment. LVN A further verbalized cleaning the stoma using a single-wipe technique, drying the site, reapplying dated trach collar and gauze, preventing moisture at the site, and increasing oxygen as indicated during care. Monitoring observations reflected staff's ability to complete appropriate tracheostomy care procedures. Resident #2 was able to communicate by mouthing words and writing commands. She was admitted on [DATE] and voiced no concerns with trach care from staff. During an interview and observation on 12/5/25 at 11:30 a.m., RN E was observed simulated tracheostomy care or Resident #3. RN E had preformed trach care 10 minutes prior to observation and a simulated trach care and interview was requested to support Resident #3's comfortability. RN E simulated tracheostomy care and showed proper tracheostomy practices, including ensuring trach ties were dated and changed daily to prevent skin breakdown, verifying inner cannula changes, and documenting care and PRN use in the clinical record. RN E stated on 12/5/25, staff demonstrated their grasp of the training by preforming it back to the RT, testing, and competency validation following training taught by the RT. During demonstration, RN E was observed wiping down the bedside table, preparing supplies, donning (put on) sterile gloves for suctioning, connecting saline to the catheter, advancing the catheter to resistance, applying suction while withdrawing for a limited duration, and repeating suctioning as indicated by secretions. RN E verbalized changing gloves between tasks, removing and replacing gauze, cleaning and drying the stoma, applying new gauze, and discarding supplies after completion of care. RN E further verbalized assessment of sputum characteristics, appropriate response if secretions were abnormal, and oxygen management during careInterviews: In an interview on 12/5/25 at 11:16 a.m., the stated that in the recent training, she taught staff how to do resident assessments upon entering the room, use of Airvo (a respiratory device delivering warm, humidified high-flow oxygen to spontaneously breathing patients) for residents with long-term tracheostomies or increased secretions, suctioning (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675671 If continuation sheet Page 5 of 6 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 12/09/2025 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 0695 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete techniques, emergency equipment availability at the bedside, and the importance of hyperoxygenation prior to suctioning. RT reported that training included teach-back methods, identification and correction of improper technique during practice, and reinforcement of sterile versus dirty hand use. RT stated that suctioning should be limited to 10-15 seconds per pass, with advancement to resistance and withdrawal while applying suction. RT further stated that staff were required to complete return demonstrations, testing, and competency validation, and that documentation and follow-up were completed to ensure staff understanding and compliance following training. Nursing staff were interviewed on 12/5/25 between 11:10 am - 2:43 p.m. These staff members included ADON, LVN D, RN D, WCN, LVN E, LVN F, LVN G, LVN H, LVN I, RN B, and RN C. All nursing staff interviewed reported that they recently received tracheostomy-care training with respiratory therapy and nursing leadership. Staff stated the training reviewed tracheostomy care, suctioning technique, use of Airvo and oxygen equipment, tubing and trach-tie changes, infection control practices, and proper documentation of routine and PRN orders. Staff reported that training included hands-on instruction, teach-back, return demonstrations, and opportunities to ask questions. Staff verbalized understanding of suctioning limits (10-15 seconds per pass), using sterile supplies, recognizing resistance, preventing tissue injury, managing secretions, maintaining skin integrity, and ensuring orders are in place for all care provided. Staff stated they felt the training was thorough, helpful, and served as a refresher. All staff interviewed reported feeling confident in their ability to safely perform tracheostomy care and suctioning going forward and stated they understood expectations and available support if they had any questions. In an interview on 12/5/25 at 3:07 p.m. with FMD, he stated the facility conducted monthly QAPI meetings to review quality indicators, including falls, patient care, pharmacy services, weight monitoring, and physician services, with participation from the DON, ADON, WCN, pharmacy, and other disciplines as needed. He stated tracheostomy care practices and treatment plans were reviewed and updated, with involvement from respiratory therapy and nursing to ensure appropriate treatment and follow-through. FMD reported that residents with tracheostomies, catheters, and g-tubes were routinely reviewed. He stated a prevention, detection, and correction process was in place, beginning with nursing leadership and extending through nursing staff, respiratory therapy, and physicians to ensure responsibilities were clearly defined. FMD further stated weekend orders were reviewed by the DON and FMD. He stated efforts were made to maintain consistent follow-through and appropriate assessments to support resident safety and quality of care. Record Review:Record review revealed that Resident #2 and Resident #3 were assessed to identify any care issues and orders were reviewed to ensure they reflected residents' needs and prn orders were placed. No issues found. Record review showed all nursing staff completed in person training on 12/4/25 and 12/5/25 with the ADON, DON, or RT. Skilled demonstrations were completed for Tracheostomy tube change and documented on a checklist. The ADM was notified on 12/5/25 at 3:40 p.m. that the IJ had been removed. While the IJ was removed, the facility remained at a level of no actual harm at a scope of pattern that is not immediate jeopardy due to the facility's need to evaluate the effectiveness of the corrective systems. Event ID: Facility ID: 675671 If continuation sheet Page 6 of 6