Health inspection·November 19, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 10/15/2025 did not reveal care plan revision documentation of an update of communication strategies for hearing loss. During an observation and interview on 10/14/2025 at 10:30 AM, [JM1] [SM2] Resident #1 was observed in her manual wheelchair sitting near a nursing staff member assigned to hallway 100. The nursing staff member was observed getting at eye level with Resident #1 and speaking loudly and clearly in English and in Spanish to ask her a question about going to her room or going outside. Resident responded to the nursing staff that she wanted to stay put in her chair. Resident #1 appeared groomed well, appropriately dressed ambulating with her manual wheelchair unassisted and without injury. Resident #1 agreed to move the interview to her room for privacy. She revealed in Spanish that her left side hurt, and she pointed to her left elbow. She stated she required total care. She stated she injured herself about two weeks back but doesn't recall where she was in the facility during this injury. She stated she recalls hitting herself on her left elbow, she is given medication for pain, she had x-rays done, and she was taken to the hospital. She stated she doesn't recall what happened, only that she remembers she was standing. She stated the doctor prescribed her medication for pain, she was given an injection for pain, she was offered physical therapy, but she declined. She stated she is administered Tylenol for pain when she asks for it, and it does help to relieve pain. She stated she uses a wheelchair to help her get around. She doesn't go outside often as she has sinus issues and doesn't want to become ill. She stated she cannot recall details of what occurred to hurt herself but knows she didn't fall, and she has no concerns with staff and feels safe.[JM3] [SM4] The resident did have minor issues during the interview, such as not being able to answer questions, she couldn't recall timeframes, surveyor had to repeat questions and speak loudly for Resident #1 to understand and respond. Resident's cognitive functions such as memory, attention, and problem-solving skills were delayed during the interview, but when she understood and could hear the question, she was able to respond appropriately. During an observation and interview on 10/15/2025 at 2:01 PM, Resident #1 revealed that she can speak to staff when she needs care. She stated sometimes it is hard to hear, and she pointed at her ears. She stated nursing staff need to speak loudly so she can understand them. She stated she did not know where her hearing aids were. She stated that LVN A was very helpful, and she was able to write down questions for her. When asked if writing down questions was helpful, she would smile and nod. She stated she couldn't recall when she misplaced her hearing aids, but it doesn't bother her to not have them. She stated the nursing staff cares for her well and she gets her needs met. Record review of Resident #1's progress notes, dated 10/15/2025 for progress notes created from 09/09/2025 to 09/24/2025 reflected:- Nurses Note dated 09/24/2025 at 12:57 PM by nursing department, Resident's alert, oriented to self. She has episodes of confusion and she is hard of hearing. Needs are anticipated and meet by nursing staff. Resident denies pain or discomfort. No grimaces of pain/discomfort noted.- Nurses Note dated 09/24/2025 at 12:57 PM by nursing department, Resident #1 was unable to hear her RP talking to her on the phone. I spoke to RP and let her know that I would try to put her at ease with info RP gave about coming to see her tomorrow. Resident #1 was able to read note I wrote her letting her know of tomorrow's visit and she calmed down and thanked me for the note.- Nurses Note dated 09/11/2025 at 1:44 PM by nursing department, Resident's alert, oriented to name only. Responsive to verbal and physical stimuli. She is hard of hearing.- Nurses Note dated 09/09/2025 at 21:44 PM by nursing department, I wrote a note for her to read saying that both of her RP were on their way home and safe. Record review of Resident #1's Social Service Progress Review Form, dated 09/04/2025, reflected:Sensory/Communication Status: Resident #1 noted as having hearing limitations that are affecting the resident's ability to function and uses adaptive equipment, Sometimes understands.Usually makes self understood.wheelchair, hearing aids (often (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 2 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few lost by she takes them out). Resident #1 was noted to have independent daily decision-making ability, Res is able to make daily decisions sometimes with prompting/redirection. Her RP is her major decision maker for medical and financial res shown to have a significant decline in BIMS as she was unable to answer any of the questions. Although hearing aids being worn, res still has difficulty hearing and this may be a contributing factor. res is involved at her leisure. She is pleasant and will socialize but due to hearing loss this can be difficult for her. Record review of Resident #1's Multidisciplinary Care Conference Form, dated 09/03/2025, reflected: F. Activities Summary, a. Problems/needs: Resident #1 requires assistance with hearing and some direction to participate in activities. G. Social Work Summary, a.1 Comments on results: BIMS 0 res independently make daily decisions sometimes w prompting to assist w major decisions. Sometimes difficult for resident to complete assessments independently as res (resident) is hard of hearing and rambles off topic.Record review of Resident #1's Social Service Progress Review Form, dated 08/22/2025, reflected: Sensory/Communication Status: Resident #1 noted as having hearing limitations that are affecting the resident's ability to function and uses adaptive equipment, Sometimes understands.Usually makes self understood.wheelchair, hearing aids (often lost bc she takes them out). Resident #1 was noted to have independent daily decision-making ability, Res is able to make daily decisions sometimes with prompting/redirection. Her RP is her major decision maker for medical and financial .res is involved at her leisure. She is pleasant and will socialize but due to hearing loss this can be difficult for her.Record review of Resident #1's progress notes, dated 10/15/2025 for progress notes created from 08/18/2025 to 08/24/2025 reflected: Resident #1 had a history of having hearing aids go missing and found by staff with final note of hearing aids remained missing on 08/24/2025. No further notes regarding the loss or recovery of hearing aids were documented for Resident #1. - Orders - Administration Note dated 08/24/2025 at 9:32 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS[JM9] [SM10] . Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule h/a missing at this time family aware.- Orders - Administration Note dated 08/23/2025 at 6:47 PM, 08/23/2025 at 7:15 PM, 08/24/2025 at 9:31 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule unable to locate- Orders - Administration Note dated 08/21/2025 at 7:25 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Found right hearing aid.- Orders - Administration Note dated 08/20/2025 at 8:25 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Unavailable. Family knows.- Orders - Administration Note dated 08/19/2025 at 6:33 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Not available. Family was notified.- Orders Administration Note dated 08/18/2025 at 6:08 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Resident lost them. Family and Dr. were notified. During an interview on 10/14/2025 at 1:15 PM, CNA C stated she was in-serviced on resident rights and knows she can review the electronic care plan when needing to know of a resident's specific care. She stated the electronic care plan provides information on residents' ADLs, and how to care for them. She stated Resident #1 cannot hear very well. She stated that she must speak very loudly to the resident for her to hear, but she can speak in English and Spanish. She can answer questions and tell you if she needs help with care. During an interview on 10/14/2025 at 1:30 PM, LVN A stated Resident #1 requires care with ADLs, transfers, redirection, she gets confused at times and has no (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 3 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few behaviors. She stated Resident #1 complains of pain in her left elbow, and she can communicate with her when she needs her PRN Tylenol. She stated it can be a challenge to communicate with the resident at times because she must ask question numerous times before the resident understood. During an interview on 10/15/2025 at 10:39 AM, LVN A stated Resident #1 can communicate in English and Spanish. She stated she has some good days and some bad days. She stated Resident #1 usually has more bad days than good ones. She stated on her bad days it takes longer to communicate with the resident, and she will ask more questions to understand her. She stated the DON has a communication tablet and will write a question down for Resident #1, let her read it, and she will respond quickly. She stated this is the first day she was provided with the writing tablet to use with Resident #1. She stated this is good for Resident #1. She stated she is now easily able to communicate with Resident #1. She stated she can write down a question on the whiteboard and the resident excitedly answers with clear understanding. She stated that during Resident #1's admission into the facility she had hearing aids, and her family stated she constantly misplaces her hearing aids. She stated throughout the months she has lost both hearing aids and found them numerous times. She stated the family has made the decision not to order a new pair of hearing aids as they have become costly and she has lost more than 6 pairs over the years. She stated the communication with the resident consists of repeating questions and speaking loudly and directly in front of the resident at eye level. During an interview on 10/15/2025 at 10:50 AM, CNA E stated he has been provided training on Resident Rights and understands if residents are not allowed to exercise their rights it can be frustrating and cause behavior problems. During an interview on 10/15/2025 at 11:00 AM, LVN B stated residents have all the rights at the facility, they have the right to refuse care as well. She stated that if residents are not allowed to exercise their rights it can cause them to become angry. During an interview on 10/15/2025 at 11:23 AM the DON stated Resident #1 has difficulties hearing, she lost her hearing aids about a month back and family no longer wants to replace as this is the 6th pair lost. She stated she constantly removes her hearing aids, stores them in her purse, napkin, dressers and forgets where they are. She stated she can communicate if she needs assistance. She stated she can read well and will answer questions. The DON stated she began using a whiteboard to write and communicate with Resident #1 about 7-10 days back. She stated she has conveyed the use of the whiteboard to communicate with Resident #1 during an IDT meeting or morning meeting. She wasn't sure when this information was communicated to the nursing management team. She stated she is unsure if the SW or MDS Nurse were aware or received this information. She stated information wasn't communicated to the full nursing staff and Resident #1's care plan had not been revised to include this intervention. The DON stated she was unsure why this information had not been communicated to all nursing staff, and she could not provide a response. She stated Resident #1 can and does communicate to the nursing staff when she has pain and she is administered PRN pain medication. She stated Resident #1 could benefit from having communication methods care planned. She stated the nursing management team during the morning meetings are responsible for informing the MDS nurse about updates/changes for residents that should be included in the care plan. During an interview on 10/15/2025 at 11:53 AM, OTD stated he had picked up Resident #1 for physical therapy when she had the elbow fracture and she was not to use it at the time. He stated he was trying to work with her on safety and general ADLs. He stated because of her hearing loss she did have hearing aids but was not wearing them. He stated the best way to communicate would be writing. He stated he would write it out and she would verbally respond. He stated he was having somewhat of a hard time engaging with her and the business office manager said the resident does pretty good when you write things down and believes this information was discussed in an IDT meeting but (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 4 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few could not recall. He stated that at one time he was able to communicate with her, and she would follow directions. During an interview on 10/15/2025 at 11:52 AM, LVN A stated she has been in-serviced on Resident Rights, but could not recall how long it had been, but it did cover that resident has the right to care, right to tell staff what they like and don't like, refuse their medications/care. She stated that she and the aids review the electronic care plan to confirm the direct care that residents require. The electronic care plan provides information on the residents' ADLs and how staff can approach residents. She stated all nursing staff are to review the electronic care plan as this is a guide for all direct care provided to the residents of the facility. During an interview on 10/15/2025 at 11:57 AM, SW stated that Resident #1 had extreme hearing concerns, when she conducted the Brief Interview for Mental Status with her, she noticed the lack of hearing and stated that the resident will not use her hearing aids. She stated she would regularly take them out of her ears and put them in multiple places. She stated the hearing aids have been replaced many times, and the family can no longer replace them. She stated Resident #1 was unable to answer questions during the Brief Interview for Mental Status she last conducted on 08/22/2025, which resulted in a score of 0, indicating cognition is severely impaired. She stated the low BIMS score is due to the resident not being able to repeat the words required and given her diagnosis it is difficult for the resident. The surveyor pointed out that there was a significant decline from last quarter, 05/28/2025 Brief Interview for Mental Status rendered a score of 9 and her initial Brief Interview for Mental Status from admission was an 8. SW stated the significantly lower BIMS score could be that Resident #1 couldn't adequately hear the questions and stated she is not sure if the resident was wearing her hearing aids when she scored higher. She stated she has never used the whiteboard to communicate with Resident #1 and didn't know this communication method was being utilized for this resident. She stated she did not receive information from the DON regarding this communication method previously. She stated that moving forward she would be utilizing the whiteboard to communicate with Resident #1 and would work with the MDS Nurse to put this intervention into her care plan. SW stated that she has no doubt if she were to use the whiteboard to communicate with Resident #1, she could answer the first 3 questions of the BIMS. She stated the resident can communicate pain, she will ask her if she needs anything and she can communicate discomfort. She stated Resident #1 may need some prompting but is able to communicate most of the time. During an interview on 10/15/2025 at 11:57 AM, MDS Nurse stated she trained with the corporate nurse July 2022, and she was trained that the MDS sections she is responsible for only require a 7-day look back period, sections B, C, D, E, and Q. She stated she received training verbally, no guides were provided; however, she does have the option to look over the MDS manual. She stated she reviews progress notes, physician notes, therapy and occupational therapy notes and interviews residents to assist her in completing MDS assessments. MDS Nurse stated residents can have a delay in care due to inaccurate assessments. She stated the SW was responsible for the Brief Interview of Mental Status (BIMS). She reviewed Resident #1's progress notes with the surveyor and stated that the resident lost her hearing aids on 08/18/2025. She stated that she believes the significant change in BIMS scores is concerning and would be investigated. She stated that she is aware of Resident #1's hearing loss and hearing aids and stated she has never used the whiteboard to communicate with Resident #1. She stated she didn't know this communication method was being utilized for this resident. She stated she did not receive information from the DON regarding this communication method previously. She stated that moving forward she would be utilizing the whiteboard to communicate with Resident #1 and would work with SW to put this intervention into her care plan. The MDS Nurse stated that the nursing management team during morning meetings determines the interventions that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 5 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few should be placed into a resident's care plan to address a resident's needs and if care plans are not updated with appropriate interventions, it could place residents at risk of not receiving the care they need. During an interview on 10/15/2025 at 1:10 PM, SW stated she received training in care plans and MDS assessments from her corporate officer. She stated she is in constant contact with the corporate officer if she has any specific questions. She stated the care plans include resident ADLS, activities, social services, and therapy. She stated any areas or care specific to the resident is listed on their care plan. She stated if something specific occurs it would be updated on the resident's care plan by the next day. She stated if care plans and MDS assessments are not correct or updated it could be a potential risk to the residents. During an interview on 10/15/2025 at 1:40 PM, MDS Nurse stated Resident #1 does have hearing loss, communicating with long conversations can be challenging for her, and short conversations she is all in and can converse. She stated Resident #1 has no significant behaviors, other than keeping her hearing aid in her ears, she engages well with staff and wheels herself around in her wheelchair. During an interview on 10/15/2025 at 2:03 PM, CNA D stated he was provided with resident rights training last month and stated the training covered the resident's right to be cleaned, changed, repositioned, and to be treated with respect. He stated that if there are new residents or if he is not at the facility for a few days he will review the electronic care plan to know the specific ADLS the resident requires assistance with. He stated the electronic care plan gives detail as to what nursing staff should be doing when working with a specific resident. During an interview on 10/15/2025 at 3:03 PM, DON stated she receives training online and all new employees receive resident rights training upon hire. She stated the residents' rights in-services are provided quarterly or if needed she will create conduct an in-service at that time. She was knowledgeable of resident rights and provided examples. She stated yes, communication would be considered a resident right. She stated if unable to communicate for whatever reason, dementia or memory problems can make the residents very frustrated. She stated she has been provided with care plan training. She stated she and regional staff at corporate level will come in and talk about general responsibilities including care plans. She stated some of her care plan training also derives from HHSC sites. She stated the care plan trainings she's participated in focus on interventions and emphasize that care plans are updated timely depending on what changes the resident is going through, significant changes, follow-up from outside visits. DON stated the MDS Nurse is responsible for completing and updating the care plans. She stated she has a lot of support. She stated during morning meetings the team will discuss any specific concerns or interventions, and this will then be added to the resident's care plan. She stated information is gathered from daily meetings and IDT meetings and will be updated on the same day. She stated if care plans are not completed or revised it delays communication with the rest of the staff and how to provide care to the residents. She stated about a week back she began using the whiteboard to communicate with Resident #1 and the therapist has been using the whiteboard for the last two months. She stated not having her hearing aids would be a barrier but believes Resident #1 does get enough attention from the staff and is able to hear some people very well. She stated nursing staff are expected to review the electronic care plan for resident ADLs. She stated all important information regarding a resident will be in the electronic are plan. During an interview on 10/15/2025 at 4:00 PM, ADM stated that the leadership team will provide the nursing staff with resident rights in-services. He stated the nursing staff are expected to adhere to the residents' rights and stated they are in this position to serve. He stated if the nursing staff are not following resident rights, it could impact the residents negatively and become abuse and neglect, which is not tolerated by the company, and they can lose their jobs and can face jail time. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 6 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview on 10/15/2025 at 4:25 PM, CNA F, stated he has been in-serviced on abuse, neglect, and resident rights. He stated not providing care, going against resident's wishes are examples of abuse and neglect and should be reported immediately. Record review of policy titled, Resident Rights, dated February 2021, revealed: 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the residents' right to: f. communication with and access to people and services, both inside and outside the facility. jj. equal access to quality care, regardless of source of payment. Event ID: Facility ID: 675678 If continuation sheet Page 7 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that each resident's MDS assessment accurately reflects the resident's status for one of seven residents (Resident #1) reviewed for accuracy of assessments. The facility failed to ensure the 09/04/2025 MDS assessment accurately reflected Resident #1's cognitive status and the resident's use of hearing aids, which had been lost as of 08/24/2025 This failure could place residents at risk for inaccurate care planning and care delivery. The findings included: Record review of Resident #1's admission Record, dated 10/14/2025, revealed a [AGE] year-old female admitted on [DATE]. Record review of Resident #1's Medical Diagnoses, dated 10/14/2025, revealed diagnoses including unspecified dementia (range of symptoms affecting memory, thinking, and social abilities), Alzheimer's disease (most common type of dementia), nondisplaced fracture of head of left radius, initial encounter for closed fracture (means that the fracture has not caused the bone fragments to shift out of alignment and has not punctured the skin), depression (mental state of low mood and aversion to activity), and muscle weakness. Record review of Resident #1's Significant Change MDS Assessment, dated 09/04/2025, reflected Resident #1 had a BIMS of 00 indicating severe cognitive impairment, which was a significant change upon admission of 08 indicating moderate cognitive impairment. She was noted as having moderate difficulty with hearing when using hearing aids and the speaker had to increase volume and speak distinctly. She was noted for using hearing aids for completing the assessment. She usually made herself understood and had some difficulty communicating some words or finishing thoughts but is able if prompted or given time to respond. She was noted to sometimes understand others and responds adequately to simple, direct communication only. She had no evidence of an acute change in mental status from her baseline. She had no inattention behaviors present; however, she had disorganized thinking behaviors present.Her Significant Change MDS Assessment didn't accurately reflect that Resident #1 did not wear hearing aids as they were lost as of 08/24/2025. Record review of Resident #1's care plan, dated 04/02/2025, revealed Resident #1- Had impaired cognitive function related to diagnosis of Dementia/Alzheimer's with the intervention to include ask yes/no questions to determine needs with intervention to include communicating basic needs daily through the review date, initiated, date initiated 09/16/2025.- Had moderate decreased hearing loss in both ears and used hearing aids, date initiated 07/28/2025.- Had a history of choosing not to wear her hearing aids, taking them out, and losing them with the intervention to include assisting resident with putting the hearing aids in each day, facing resident when speaking and speaking in clear simple sentences, and ensuring hearing aids are kept in a safe place, date initiated 07/28/2025.- Her care plan did not include a noted intervention for communication strategies for hearing loss after hearing aids were lost by the resident on 08/24/2025.Record review of Resident #1's EMR on 10/14/2025 and 10/15/2025 did not reveal care plan revision documentation of an update to the loss of hearing aids on 08/24/2025. Record review of Resident #1's EMR on 10/14/2025 and 10/15/2025 did not reveal care plan revision documentation of an update of communication strategies for hearing loss. Record review of Resident #1's progress notes, dated 10/15/2025 for progress notes created from 08/14/2025 to 08/24/2025 reflected: Resident #1 had a history of having hearing aids go missing and found by staff with final note of hearing aids remained missing on 08/24/2025. No further notes regarding the loss or recovery of hearing aids were documented for Resident #1. - Orders - Administration Note dated 08/24/2025 at 9:32 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule h/a missing at this time family aware.- Orders - Administration Note dated 08/14/2025 at 9:27 AM BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 8 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with Nurse. one time a day for Hearing deficit and remove per schedule Unable to find right hearing aid this morning.Record review of Resident #1's Quarterly MDS Assessment, dated 08/24/2025 reflected sizable differences from the Significant Change MDS Assessment, dated 09/04/2025. Differences included cognitive patterns; she was noted to have evidence of an acute change in mental status from her baseline and behaviors of inattention were present and fluctuated.Her Quarterly MDS Assessment did not include section on preferences for customary routine and activities. Her Quarterly MDS Assessment did not accurately reflect cognitive pattern changes nor was evidence present in Resident #1's EMR of an acute change in mental status from her baseline and behaviors. Record review of Resident #1's Brief Interview for Mental Status (3.0 BIMS) Forms, dated 03/18/2025 to 09/03/2025 reflected:- 09/03/2025, reflected N /A for overall score indicating severe impairment, signed by the MDS- 08/22/2025, reflected N /A for overall score indicating severe impairment, signed by the SW- 05/28/2025, reflected 9 for overall score indicating moderate cognitive impairment, signed by the SW- 03/18/20025, reflected 8 for overall score indicating moderate cognitive impairment, signed by the SWHer Brief Interview for Mental Status (3.0 BIMS) on 08/22/2025 and 09/03/2025 were not accurately performed as Resident #1 was missing one or both hearing aids during these interviews. Record review of Resident #1's progress notes, dated 10/15/2025 for progress notes created from 09/09/2025 to 09/24/2025 reflected:- Nurses Note dated 09/24/2025 at 12:57 PM by nursing department, Resident's alert, oriented to self. She has episodes of confusion and she is hard of hearing. Needs are anticipated and meet by nursing staff. Resident denies pain or discomfort. No grimaces of pain/discomfort noted.- Nurses Note dated 09/24/2025 at 12:57 PM by nursing department, Resident #1 was unable to hear her RP talking to her on the phone. I spoke to RP and let her know that I would try to put her at ease with info RP gave about coming to see her tomorrow. Resident #1 was able to read note I wrote her letting her know of tomorrow's visit and she calmed down and thanked me for the note.- Nurses Note dated 09/11/2025 at 1:44 PM by nursing department, Resident's alert, oriented to name only. Responsive to verbal and physical stimuli. She is hard of hearing.- Nurses Note dated 09/11/2025 at 1:44 PM by nursing department, Resident's alert, oriented to name only. Responsive to verbal and physical stimuli. Hard of hearing. Administered PRN medication prophylactic for pain/discomfort. She removed split to left arm. Stated that it's uncomfortable and heavy. Able to move left arm without grimaces of pain/discomfort.- Nurses Note dated 09/09/2025 at 21:44 PM by nursing department, I wrote a note for her to read saying that both of her family members were on their way home and safe.Record review of Resident #1's Social Service Progress Review Form, dated 09/04/2025, reflected:Sensory/Communication Status: Resident #1 noted as having hearing limitations that are affecting the resident's ability to function and uses adaptive equipment, Sometimes understands.Usually makes self understood.wheelchair, hearing aids (often lost bc she takes them out). Resident #1 was noted to have independent daily decision-making ability, Res is able to make daily decisions sometimes with prompting/redirection. Her RP is her major decision maker for medical and financial res shown to have a significant decline in BIMS as she was unable to answers any of the questions. Although hearing aids being worn, res still has difficulty hearing and this may be a contributing factor. res is involved at her leisure. She is pleasant and will socialize but due to hearing loss this can be difficult for her.Record review of Resident #1's Multidisciplinary Care Conference Form, dated 09/03/2025, reflected: F. Activities Summary, a. Problems/needs: Resident #1 requires assistance with hearing and some direction to participate in activities. G. Social Work Summary, a.1 Comments on results: BIMS 0 res independently make daily decisions sometimes w prompting. to assist w major decisions. Sometimes difficult for resident to complete assessments independently as res (resident) is hard of hearing and rambles off topic. Record (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 9 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few review of Resident #1's Social Service Progress Review Form, dated 08/22/2025, reflected:Sensory/Communication Status: Resident #1 noted as having hearing limitations that are affecting the resident's ability to function and uses adaptive equipment, Sometimes understands.Usually makes self understood.wheelchair, hearing aids (often lost bc she takes them out). Resident #1 was noted to have independent daily decision making ability, Res is able to make daily decisions sometimes with prompting/redirection. Her RP her major decision maker for medical and financial .res is involved at her leisure. She is pleasant and will socialize but due to hearing loss this can be difficult for her.During an observation on 10/14/2025 at 12:30 PM and 4:10 PM, Resident #1 was observed ambulating in her manual wheelchair up and down the hallways from her room to the dining room. She was observed communicating with nursing staff who offered her assistance.During an interview on 10/15/2025 at 11:57 AM, SW stated that Resident #1 had extreme hearing concerns, when she conducted the Brief Interview for Mental Status with her, she noticed the lack of hearing and stated that the resident will not use her hearing aids. She stated she would regularly take them out of her ears and put them in multiple places. She stated the hearing aids have been replaced many times, and the family can no longer replace them. She stated Resident #1 was unable to answer questions during the Brief Interview for Mental Status she last conducted on 08/22/2025, which resulted in a score of 0, indicating cognition is severely impaired. She stated the low BIMS score is due to the resident not being able to repeat the words required and given her diagnosis it is difficult for the resident. The surveyor pointed out that there was a significant decline from last quarter, 05/28/2025 Brief Interview for Mental Status rendered a score of 9 and her initial Brief Interview for Mental Status from admission was an 8. SW stated the significantly lower BIMS score could be that Resident #1 couldn't adequately hear the questions and stated she is not sure if the resident was wearing her hearing aids when she scored higher. She stated she has never used the whiteboard to communicate with Resident #1 and didn't know this communication method was being utilized for this resident. She stated she did not receive information from the DON regarding this communication method previously. She stated that moving forward she would be utilizing the whiteboard to communicate with Resident #1 and would work with the MDS Nurse to put this intervention into her care plan. SW stated that she has no doubt if she were to use the whiteboard to communicate with Resident #1, she could answer the first 3 questions of the BIMS. She stated the resident can communicate pain, she will ask her if she needs anything and she can communicate discomfort. She stated Resident #1 may need some prompting but is able to communicate most of the time. During an interview on 10/15/2025 at 11:57 AM, MDS Nurse stated she trained with the corporate nurse July 2022, and she was trained that the MDS sections she is responsible for only require a 7-day look back period, sections B, C, D, E, and Q. She stated she received training verbally, no guides were provided; however, she does have the option to look over the MDS manual. She stated she reviews progress notes, physician notes, therapy and occupational therapy notes and interviews residents to assist her in completing MDS assessments. MDS Nurse stated residents can have a delay in care due to inaccurate assessments. She stated the SW was responsible for the Brief Interview of Mental Status (BIMS). She reviewed Resident #1's progress notes with the surveyor and stated that the resident lost her hearing aids on 08/18/2025. She stated that she believes the significant change in BIMS scores is concerning and would be investigated. She stated that she is aware of Resident #1's hearing loss and hearing aids and stated she has never used the whiteboard to communicate with Resident #1. She stated she didn't know this communication method was being utilized for this resident. She stated she did not receive information from the DON regarding this communication method previously. She stated that moving forward she would be utilizing the whiteboard to communicate with Resident #1 and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 10 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few would work with SW to put this intervention into her care plan. The MDS Nurse stated that the nursing management team during morning meetings determines the interventions that should be placed into a resident's care plan to address a resident's needs and if care plans are not updated with appropriate interventions, it could place residents at risk of not receiving the care they need. During an interview on 10/15/2025 at 1:10 PM, SW stated she received training in care plans and MDS assessments from her corporate officer. She stated she is in constant contact with the corporate officer if she has any specific questions. She stated the care plans include resident ADLS, activities, social services and therapy. She stated any areas or care specific to the resident is listed on their care plan. She stated if something specific occurs it would be updated on the resident's care plan by the next day. She stated if care plans and MDS assessments are not correct or updated it could be a potential risk to the residents. During an interview on 10/15/2025 at 3:03 PM, DON stated she receives training online and all new employees receive resident rights training upon hire. She stated the residents' rights in-services are provided quarterly or if needed she will create conduct an in-service at that time. She was knowledgeable of resident rights and provided examples. She stated yes, communication would be considered a resident right. She stated if unable to communicate for whatever reason, dementia or memory problems can make the residents very frustrated. She stated she has been provided with care plan training. She stated she and regional staff at corporate level will come in and talk about general responsibilities including care plans. She stated some of her care plan training also derives from HHSC sites. She stated the care plan trainings she's participated in focus on interventions and emphasize that care plans are updated timely depending on what changes the resident is going through, significant changes, follow-up from outside visits. DON stated the MDS Nurse is responsible for completing and updating the care plans. She stated she has a lot of support. She stated during morning meetings the team will discuss any specific concerns or interventions, and this will then be added to the resident's care plan. She stated information is gathered from daily meetings and IDT meetings and will be updated on the same day. She stated if care plans are not completed or revised it delays communication with the rest of the staff and how to provide care to the residents. She stated about a week back she began using the whiteboard to communicate with Resident #1 and the therapist has been using the whiteboard for the last two months. She stated not having her hearing aids would be a barrier but believes Resident #1 does get enough attention from the staff and is able to hear some people very well. She stated nursing staff are expected to review the electronic care plan for resident ADLs. She stated all important information regarding a resident will be in the electronic are plan. During an interview on 10/15/2025 at 4:00 PM, ADM stated accuracy of assessments is necessary as funding and direct care services rely on it. The impact of not accurately completing assessments can cause a delay in resident care Record review of CMS's LTC Resident Assessment Instrument 3.0 User's Manual, dated October 2025, revealed:Section Z0400: Signatures of Persons Completing the Assessment or Entry/Death Reporting: To obtain the signature of all persons who completed any part of the MDS. Legally, it is an attestation of accuracy with the primary responsibility for its accuracy with the person selecting the MDS item response. Each person completing a section or portion of a section of the MDS is required to sign the Attestation Statement. 1.3 Completion of the RAI: In addition, an accurate assessment requires collecting information from multiple sources, some of which are mandated by regulations. Those sources must include the resident and direct care staff on all shifts, and should also include the resident's medical record, physician, and family, guardian and/or other legally authorized representative, or significant other as appropriate or acceptable. It is important to note here that information obtained should cover the same observation period as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 11 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete specified by the MDS items on the assessment and should be validated for accuracy (what the resident's actual status was during that observation period) by the IDT completing the assessment. As such, nursing homes are responsible for ensuring that all participants in the assessment process have the requisite knowledge to complete an accurate assessment. Record review of policy titled, Care Plans, Comprehensive Person-Centered, dated March 2022, revealed: 3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment.7. The comprehensive, person-centered care plan: a. includes measurable objectives and timeframes; b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being.e. reflects currently recognized standards of practice for problem areas and conditions.8. Services provided for or arranged by the facility and outlined in the comprehensive care plan are: a. provided by qualified persons; b. culturally competent; and c. trauma-informed.9. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making.10. When possible, interventions address the underlying source(s) of the problem area(s), not just symptoms or triggers.11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change.12. The interdisciplinary team reviews and updates the care plan:a. when there has been a significant change in the resident's condition. Record review of policy titled, Change in a Resident's Condition or Status, dated February 2021, revealed: If a significant change in the resident's physical or mental condition occurs, a comprehensive assessment of the resident's condition will be conducted. Record review of policy titled, Behavioral Assessment, Intervention and Monitoring, dated March 2019, revealed:2. As part of the comprehensive assessment, staff will evaluate, based on input from the resident, family and caregivers, review of medical record and general observations: a. The resident's usual patterns of cognition, mood and behavior; b. The resident's usual method of communicating things like pain, hunger, thirst, and other physical discomforts.3. The nursing staff will identify, document, and inform the physician about specific details regarding changes in an individual's mental status, behavior, and cognition, including: b. Any recent precipitating or relevant factors or environmental triggers.7. Interventions will be individualized and part of an overall care environment that supports physical, functional and psychosocial needs, and strives to understand, prevent or relieve the resident's distress or loss of abilities. Record review of policy titled, Resident Rights, dated February 2021, revealed: Resident rights to communication with and access to people and services, both inside and outside the facility. Event ID: Facility ID: 675678 If continuation sheet Page 12 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to ensure that the comprehensive care plan was reviewed and revised by the interdisciplinary team after each assessment for one of seven residents (Resident #1) reviewed for care plans. The facility failed to update or add interventions to Resident #1's care plan regarding the loss of her hearing aids that impacted her communication abilities.This failure could place residents at risk of not receiving the necessary services or having the appropriate interventions to meet their current needs.The findings included: Record review of Resident #1's admission Record, dated 10/14/2025, revealed a [AGE] year-old female admitted on [DATE]. Record review of Resident #1's Medical Diagnoses, dated 10/14/2025, revealed diagnoses including unspecified dementia (range of symptoms affecting memory, thinking, and social abilities), Alzheimer's disease (most common type of dementia), nondisplaced fracture of head of left radius, initial encounter for closed fracture (means that the fracture has not caused the bone fragments to shift out of alignment and has not punctured the skin), depression (mental state of low mood and aversion to activity), and muscle weakness. Record review of Resident #1's Significant Change MDS Assessment, dated 09/04/2025, reflected Resident #1 had a BIMS of 00, indicating severe cognitive impairment, which was a significant change upon admission of 08 indicating moderate cognitive impairment. She was noted as having moderate difficulty with hearing when using hearing aids and the speaker had to increase volume and speak distinctly. She was noted for using hearing aids for completing the assessment. She usually made herself understood and had some difficulty communicating some words or finishing thoughts but is able if prompted or given time to respond. She was noted to sometimes understand others and responds adequately to simple, direct communication only. She had no evidence of an acute change in mental status from her baseline. She had no inattention behaviors present; however, she had disorganized thinking behaviors present.Her Significant Change MDS Assessment didn't accurately reflect that Resident #1 did not wear hearing aids as they were lost as of 08/24/2025. Record review of Resident #1's Quarterly MDS Assessment, dated 08/24/2025 reflected sizable differences from the Significant Change MDS Assessment, dated 09/04/2025. Differences included cognitive patterns; she was noted to have evidence of an acute change in mental status from her baseline and behaviors of inattention were present and fluctuated. Her Quarterly MDS Assessment did not include section on preferences for customary routine and activities. Her Quarterly MDS Assessment did not accurately reflect cognitive pattern changes nor was evidence present in Resident #1's EMR of an acute change in mental status from her baseline and behaviors.Record review of Resident #1's Brief Interview for Mental Status (3.0 BIMS) Forms, dated 03/18/2025 to 09/03/2025 reflected:- 09/03/2025, reflected N /A for overall score indicating severe impairment, signed by the MDS- 08/22/2025, reflected N /A for overall score indicating severe impairment, signed by the SW- 05/28/2025, reflected 9 for overall score indicating moderate cognitive impairment, signed by the SW- 03/18/20025, reflected 8 for overall score indicating moderate cognitive impairment, signed by the SWHer Brief Interview for Mental Status (3.0 BIMS) on 08/22/2025 and 09/03/2025 were not accurately performed as Resident #1 was missing one or both hearing aids during these interviews. Record review of Resident #1's care plan, dated 04/02/2025, revealed Resident #1- Had impaired cognitive function related to diagnosis of Dementia/Alzheimer's with the intervention to include ask yes/no questions to determine needs with intervention to include communicating basic needs daily through the review date, initiated, date initiated 09/16/2025.- Had moderate decreased hearing loss in both ears and used hearing aids, date initiated 07/28/2025. - Had a history of choosing not to wear her hearing aids, taking them out, and losing (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 13 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few them with the intervention to include assisting resident with putting the hearing aids in each day, facing resident when speaking and speaking in clear simple sentences, and ensuring hearing aids are kept in a safe place, date initiated 07/28/2025.- Her care plan did not include a noted intervention for communication strategies for hearing loss after hearing aids were lost by the resident on 08/24/2025. Record review of Resident #1's EMR on 10/14/2025 and 10/15/2025 did not reveal care plan revision documentation of an update to the loss of hearing aids on 08/24/2025. Record review of Resident #1's EMR on 10/14/2025 and 10/15/2025 did not reveal care plan revision documentation of an update of communication strategies for hearing loss. During an observation and interview on 10/14/2025 at 10:30 AM, Resident #1 was observed in her manual wheelchair sitting near a nursing staff member assigned to hallway 100. The nursing staff member was observed getting at eye level with Resident #1 and speaking loudly and clearly in English and in Spanish to ask her a question about going to her room or going outside. Resident responded to the nursing staff that she wanted to stay put in her chair. Resident #1 appeared groomed well, appropriately dressed ambulating with her manual wheelchair unassisted and without injury. Resident #1 agreed to move the interview to her room for privacy. She revealed in Spanish that her left side hurt, and she pointed to her left elbow. She stated she required total care. She stated she injured herself about two weeks back but doesn't recall where she was in the facility during this injury. She stated she recalls hitting herself on her left elbow, she is given medication for pain, she had x-rays done, and she was taken to the hospital. She stated she doesn't recall what happened, only that she remembers she was standing. She stated the doctor prescribed her medication for pain, she was given an injection for pain, she was offered physical therapy, but she declined. She stated she is administered Tylenol for pain when she asks for it, and it does help to relieve pain. She stated she uses a wheelchair to help her get around. She doesn't go outside often as she has sinus issues and doesn't want to become ill. She stated she cannot recall details of what occurred to hurt herself but knows she didn't fall, and she has no concerns with staff and feels safe.The resident did have minor issues during the interview, such as not being able to answer questions, she couldn't recall timeframes, surveyor had to repeat questions and speak loudly for Resident #1 to understand and respond. Resident's cognitive functions such as memory, attention, and problem-solving skills were delayed during the interview, but when she understood and could hear the question, she was able to respond appropriately. Record review of Resident #1's progress notes, dated 10/15/2025 for progress notes created from 08/18/2025 to 08/24/2025 reflected: Resident #1 had a history of having hearing aids go missing and found by staff with final note of hearing aids remained missing on 08/24/2025. No further notes regarding the loss or recovery of hearing aids were documented for Resident #1.- Orders - Administration Note dated 08/24/2025 at 9:32 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule h/a missing at this time family aware.- Orders - Administration Note dated 08/23/2025 at 6:47 PM, 08/23/2025 at 7:15 PM, 08/24/2025 at 9:31AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule unable to locateOrders - Administration Note dated 08/21/2025 at 7:25 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Found right hearing aid.- Orders - Administration Note dated 08/20/2025 at 8:25 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Unavailable. Family knows.- Orders Administration Note dated 08/19/2025 at 6:33 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 14 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Nurse. one time a day for Hearing deficit and remove per schedule Not available. Family was notified.Orders - Administration Note dated 08/18/2025 at 6:08 AM by nursing department, BILATERAL HEARING AIDES. On in AM and Off at HS. Keep HA secured with Nurse. one time a day for Hearing deficit and remove per schedule Resident lost them. Family and Dr. were notified. During an interview on 10/15/2025 at 2:01 PM, Resident #1 revealed that she can speak to staff when she needs care. She stated sometimes it is hard to hear, and she pointed at her ears. She stated nursing staff need to speak loudly so she can understand them. She stated she did not know where her hearing aids were. She stated that LVN A was very helpful, and she was able to write down questions for her. When asked if writing down questions was helpful, she would smile and nod. She stated she couldn't recall when she misplaced her hearing aids, but it doesn't bother her to not have them. She stated the nursing staff cares for her well and she gets her needs met. During an interview on 10/14/2025 at 1:15 PM, CNA C stated she has been in-serviced on residents rights and knows she can review the electronic care plan when needing to know of a resident's specific care. She stated the electronic care plan provides information on residents' ADLs, and how to care for them. She stated Resident #1 cannot hear very well. She stated that she must speak very loudly to the resident for her to hear, but she can speak in English and Spanish. She can answer questions and tell you if she needs help with care. During an interview on 10/14/2025 at 1:30 PM, LVN A stated Resident #1 requires care with ADLs, transfers, redirection, she gets confused at times and has no behaviors. She stated Resident #1 complains of pain in her left elbow, and she can communicate with her when she needs her PRN Tylenol. She stated it can be a challenge to communicate with the resident at times. During an interview on 10/15/2025 at 10:39 AM, LVN A stated Resident #1 can communicate in English and Spanish. She stated she has some good days and some bad days. She stated Resident #1 usually has more bad days than good ones. She stated on her bad days it takes longer to communicate with the resident, and she will ask more questions to understand her. She stated the DON has a communication tablet and will write a question down for Resident #1, let her read it, and she will respond quickly. She stated this is the first day she was provided with the writing tablet to use with Resident #1. She stated this is good for Resident #1. She stated she is now easily able to communicate with Resident #1. She stated she can write down a question on the whiteboard and the resident excitedly answers with clear understanding. She stated that during Resident #1's admission into the facility she had hearing aids, and her family stated she constantly misplaces her hearing aids. She stated throughout the months she has lost both hearing aids and found them numerous times. She stated the family has made the decision not to order a new pair of hearing aids as they have become costly and she has lost more than 6 pairs over the years. During an interview on 10/15/2025 at 10:50 AM, CNA E stated he has been provided training on Resident Rights and understands if residents are not allowed to exercise their rights it can be frustrating and cause behavior problems. He stated he reviews the electronic care plan, so he is informed of the specific care and ADL assistance each resident requires. During an interview on 10/15/2025 at 11:00 AM, LVN B stated residents have all the rights at the facility, they have the right to refuse care as well. She stated that if residents are not allowed to exercise their rights it can cause anger. She stated the expectation for nursing staff on her shift is to review the electronic care plan to provide the care they need. During an interview on 10/15/2025 at 11:23 AM the DON stated Resident #1 has difficulties hearing, she lost her hearing aids about a month back and family no longer wants to replace as this is the 6th pair lost. She stated she constantly removes her hearing aids, stores them in her purse, napkin, dressers and forgets where they are. She stated she can communicate if she needs assistance. She stated she can read well and will answer questions. The DON stated she began using a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 15 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few whiteboard to write and communicate with Resident #1 about 7-10 days back. She stated she has conveyed the use of the whiteboard to communicate with Resident #1 during an IDT meeting or morning meeting. She wasn't sure when this information was communicated to the nursing management team. She stated she is unsure if the SW or MDS Nurse were aware or received this information. She stated information wasn't communicated to the full nursing staff and Resident #1's care plan had not been revised to include this intervention. [JM17] [SM18] The DON stated she was unsure why this information had not been communicated to all nursing staff, and she could not provide a response. She stated Resident #1 can and does communicate to the nursing staff when she has pain and she is administered PRN pain medication. She stated Resident #1 could benefit from having communication methods care planned. She stated the nursing management team during the morning meetings are responsible for informing the MDS nurse about updates/changes for residents that should be included in the care plan. During an interview on 10/15/2025 at 11:53 AM, OTD stated he had picked up Resident #1 for physical therapy when she had the elbow fracture and she was not to use it at the time. He stated he was trying to work with her on safety and general ADLs. He stated because of her hearing loss she did have hearing aids but was not wearing them. He stated the best way to communicate would be writing, He stated he would write it out and she would verbally respond. He stated he was having somewhat of a hard time engaging with her and the business office manager said the resident does pretty good when you write things down and believes this information was discussed in an IDT meeting but could not recall. He stated that at one time he was able to communicate with her, and she would follow directions. During an interview on 10/15/2025 at 11:52 AM, LVN A stated she has been in-serviced on Resident Rights, but could not recall how long it had been, but it did cover that resident has the right to care, right to tell staff what they like and don't like, refuse their medications/care. She stated that she and the aides review the electronic care plan to confirm the direct care that residents require. The electronic care plan provides information on the residents' ADLs and how staff can approach residents. She stated all nursing staff are to review the electronic care plan as this is a guide for all direct care provided to the residents of the facility. During an interview on 10/15/2025 at 11:57 AM, the SW stated that Resident #1 had extreme hearing concerns, when she conducted the Brief Interview for Mental Status with her, she noticed the lack of hearing and stated that the resident will not use her hearing aids. She stated she would regularly take them out of her ears and put them in multiple places. She stated the hearing aids have been replaced many times, and the family can no longer replace them. She stated Resident #1 was unable to answer questions during the Brief Interview for Mental Status she last conducted on 08/22/2025, which resulted in a score of 0, indicating cognition is severely impaired. She stated the low BIMS score is due to the resident not being able to repeat the words required and given her diagnosis it is difficult for the resident. The surveyor pointed out that there was a significant decline from last quarter, 05/28/2025 Brief Interview for Mental Status rendered a score of 9 and her initial Brief Interview for Mental Status from admission was an 8. SW stated the significantly lower BIMS score could be that Resident #1 couldn't adequately hear the questions and stated she is not sure if the resident was wearing her hearing aids when she scored higher. She stated she has never used the whiteboard to communicate with Resident #1 and didn't know this communication method was being utilized for this resident. She stated she did not receive information from the DON regarding this communication method previously. She stated that moving forward she would be utilizing the whiteboard to communicate with Resident #1 and would work with the MDS Nurse to put this intervention into her care plan. SW stated that she has no doubt if she were to use the whiteboard to communicate with Resident #1, she could answer the first 3 questions of the BIMS. She stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 16 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the resident can communicate pain, she will ask her if she needs anything and she can communicate discomfort. She stated Resident #1 may need some prompting but is able to communicate most of the time. During an interview on 10/15/2025 at 11:57 AM, MDS Nurse stated she trained with the corporate nurse July 2022, and she was trained that the MDS sections she is responsible for only require a 7-day look back period, sections B, C, D, E, and Q. She stated she received training verbally, no guides were provided; however, she does have the option to look over the MDS manual. She stated she reviews progress notes, physician notes, therapy and occupational therapy notes and interviews residents to assist her in completing MDS assessments. MDS Nurse stated residents can have a delay in care due to inaccurate assessments. She stated the SW was responsible for the Brief Interview of Mental Status (BIMS). She reviewed Resident #1's progress notes with the surveyor and stated that the resident lost her hearing aids on 08/18/2025. She stated that she believes the significant change in BIMS scores is concerning and would be investigated. She stated that she is aware of Resident #1's hearing loss and hearing aids and stated she has never used the whiteboard to communicate with Resident #1. She stated she didn't know this communication method was being utilized for this resident. She stated she did not receive information from the DON regarding this communication method previously. She stated that moving forward she would be utilizing the whiteboard to communicate with Resident #1 and would work with SW to put this intervention into her care plan. The MDS Nurse stated that the nursing management team during morning meetings determines the interventions that should be placed into a resident's care plan to address a resident's needs and if care plans are not updated with appropriate interventions, it could place residents at risk of not receiving the care they need. During an interview on 10/15/2025 at 1:10 PM, SW stated she received training in care plans and MDS assessments from her corporate officer. She stated she is in constant contact with the corporate officer if she has any specific questions. She stated the care plans include resident ADLS, activities, social services and therapy. She stated any areas or care specific to the resident is listed on their care plan. She stated if something specific occurs it would be updated on the resident's care plan by the next day. She stated if care plans and MDS assessments are not correct or updated it could be a potential risk to the residents. During an interview on 10/15/2025 at 2:03 PM, CNA D stated he was provided with resident rights training last month and stated the training covered the resident's right to be cleaned, changed, repositioned, and to be treated with respect. He stated that if there are new residents or if he is not at the facility for a few days he will review the electronic care plan to know the specific ADLS the resident requires assistance with. He stated the electronic care plan gives detail as to what nursing staff should be doing when working with a specific resident. During an interview on 10/15/2025 at 3:03 PM, DON stated she receives training online and all new employees receive resident rights training upon hire. She stated the residents' rights in-services are provided quarterly or if needed she will create conduct an in-service at that time. She was knowledgeable of resident rights and provided examples. She stated yes, communication would be considered a resident right. She stated if unable to communicate for whatever reason, dementia or memory problems can make the residents very frustrated. She stated she has been provided with care plan training. She stated she and regional staff at corporate level will come in and talk about general responsibilities including care plans. She stated some of her care plan training also derives from HHSC sites. She stated the care plan trainings she's participated in focus on interventions and emphasize that care plans are updated timely depending on what changes the resident is going through, significant changes, follow-up from outside visits. DON stated the MDS Nurse is responsible for completing and updating the care plans. She stated she has a lot of support. She stated during morning meetings the team will (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 17 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few discuss any specific concerns or interventions, and this will then be added to the resident's care plan. She stated information is gathered from daily meetings and IDT meetings and will be updated on the same day. She stated if care plans are not completed or revised it delays communication with the rest of the staff and how to provide care to the residents. She stated about a week back she began using the whiteboard to communicate with Resident #1 and the therapist has been using the whiteboard for the last two months. She stated not having her hearing aids would be a barrier but believes Resident #1 does get enough attention from the staff and is able to hear some people very well. She stated nursing staff are expected to review the electronic care plan for resident ADLs. She stated all important information regarding a resident will be in the electronic are plan. During an interview on 10/15/2025 at 4:00 PM, ADM stated the expectation of care plan revisions depend on the scope of care plan change. He stated if the care plan intervention requires an assessment first then this will take place. He stated communication for any change/updates to the care plan takes place in the morning meetings and is updated quickly. He stated the impact of not updating the care plan in a timely manner would delay the care the patient needs. Record review of policy titled, Care Plans, Comprehensive Person-Centered, dated March 2022, revealed: 3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment.7. The comprehensive, person-centered care plan: a. includes measurable objectives and timeframes; b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being.e. reflects currently recognized standards of practice for problem areas and conditions.8. Services provided for or arranged by the facility and outlined in the comprehensive care plan are: a. provided by qualified persons; b. culturally competent; and c. trauma-informed.9. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making.10. When possible, interventions address the underlying source(s) of the problem area(s), not just symptoms or triggers.11. Assessments of residents are ongoing and care plans are revised as information about the residents and the residents' conditions change.12. The interdisciplinary team reviews and updates the care plan:a. when there has been a significant change in the resident's condition. Record review of policy titled, Resident Rights, dated February 2021, revealed: 1. Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: f. communication with and access to people and services, both inside and outside the facility. jj. equal access to quality care, regardless of source of payment. Record review of policy titled, Change in a Resident's Condition or Status, dated February 2021, revealed: 2. A significant change of condition is a major decline or improvement in the resident's status that: a. will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions (is not self-limiting); c. requires interdisciplinary review and/or revision to the care plan.9. If a significant change in the resident's physical or mental condition occurs, a comprehensive assessment of the resident's condition will be conducted as required by current OBRA regulations governing resident assessments and as outlined in the MDS RAI Instruction Manual. Record review of policy titled, Behavioral Assessment, Intervention and Monitoring, dated March 2019, revealed:2. As part of the comprehensive assessment, staff will evaluate, based on input from the resident, family and caregivers, review of medical record and general observations: a. The resident's usual patterns of cognition, mood and behavior; b. The resident's usual method of communicating things like pain, hunger, thirst, and other physical discomforts.3. The nursing staff will identify, document, and inform the physician about specific details (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 18 of 19 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 675678 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Care Choice of Boerne 200 E Ryan St Boerne, TX 78006 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 0657 Level of Harm - Minimal harm or potential for actual harm regarding changes in an individual's mental status, behavior, and cognition, including: b. Any recent precipitating or relevant factors or environmental triggers.7. Interventions will be individualized and part of an overall care environment that supports physical, functional and psychosocial needs, and strives to understand, prevent or relieve the resident's distress or loss of abilities. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675678 If continuation sheet Page 19 of 19