Health inspection·July 23, 2025

F 0558 the resident's room. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675680 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brentwood Place One 3505 S Buckner Blvd Bldg 2 Dallas, TX 75227 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review the facility failed to provide the necessary services for residents who were unable to carry out activities of daily living to maintain good grooming and personal hygiene for 2 residents (Resident #1 and #Resident #2) of 6 residents reviewed for ADLs. The facility failed to ensure: 1. Resident #1 had her fingernails cleaned and trimmed on 07/22/25.2. Resident #2 had her fingernails cleaned and trimmed on 07/22/25.These failures could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections, and a de Findings included: 1. Record review of Resident #1's Quarterly MDS assessment dated [DATE] reflected Resident #1 was a [AGE] year-old female initially admitted to the facility on [DATE]and readmitted on [DATE] her diagnoses included hypertension (elevated blood pressure), diabetes mellitus (elevated blood sugar), muscle weakness, need for assistance with personal care, and dementia (diseases that affect memory, thinking, and the ability to perform daily activities). Resident #1's had a BIMS score of 6, which indicated severe cognitive impairment. The MDS assessment indicated Resident #1 required maximum assistance with personal hygiene. Record review of Resident #1's Care Plan dated 05/15/25, reflected the following: Focus: [Resident#1] has an ADL selfcare performance deficit related to Dementia and muscle weakness. Goal: [Resident#1] will maintain current level of function . Personal hygiene. Interventions: Personal hygiene.the Resident requires substantial/maximal assistance (X1) staff participation with personal hygiene . In an observation and interview on 07/22/25 at 10:22 AM revealed Resident #1 was laying in her bed. Resident#1 nails on both hands were approximately 0.4cm in length extending from the tip of her fingers, and jagged. The nails were discolored tan with black matter underneath. Resident #1 stated she would like her fingernails trimmed and cleaned. In an interview on 07/22/25 at 10:25 AM CNA A looked at Resident#1 fingernails and stated she would clean and trim them today after Resident#1 shower. CNA A stated that both CNAs and Nurses were responsible for nailcare. She said that if Resident has diabetes, then nurses trim their fingernails. She stated that if nails were long and dirty, residents may be at risk of infection. 2. Record review of Resident #2's Quarterly MDS assessment dated [DATE] reflected Resident #2 was [AGE] year-old female with initial admission date to facility on 11/16/2017. Resident #2 had diagnoses of Hypertension (elevated blood pressure), and dementia (diseases that affect memory, thinking, and the ability to perform daily activities). Resident #2 had BIMS score of 7 which indicated severe cognitive impairment. Resident #1 needed maximum assistance for personal hygiene. Record review of Resident #2's Comprehensive Care Plan revised on 07/16/25 reflected, Focus: [ Resident #2] has an ADL Self Care, Performance Deficit related to Confusion, fatigue, Impaired balance, limited mobility. Goal: [Resident #2] will maintain current level of function in Bed Mobility, Transfers, Eating, Dressing, Toilet Use and Personal Hygiene through the review date. Intervention: PERSONAL HYGIENE/ORAL CARE: the resident requires extensive assistance (times one) staff participation with personal hygiene . In an observation and attempted interview on 07/22/25 at 11:02 AM revealed Resident #2 was up in her wheelchair in the dining room. The Resident's nails on both hands were approximately 0.4cm in length extending from the tip of her fingers. The nails were discolored tan and had brown colored residue underneath. Resident #2 was not able to participate in interview and just kept looking at her fingernails. In an interview and observation on 07/22/25 at 11:06 AM RN C stated that both nurses and CNAs were responsible for doing nail care for the residents. She stated that fingernails should be trimmed and cleaned on shower days and as needed. She stated that Resident #2 had dirty, untrimmed nails and they will provide nail care to the Resident after lunch. She stated that dirty nails could lead to risk in infections. In an Interview on Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675680 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675680 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brentwood Place One 3505 S Buckner Blvd Bldg 2 Dallas, TX 75227 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 07/22/25 at 2:45 PM, the DON stated nail care should be completed as needed and every time aides wash the residents' hands. The DON stated nails should be observed daily. The DON stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. The DON stated she expected CNAs to offer to cut and clean nails if they were long and dirty. The DON stated the ADON, and the DON would do the routine rounds to monitor. The DON stated residents having long and dirty could be an infection control issue. Record review of the facility policy titled, Grooming Care of the Fingernails and Toenails undated reflected, Nail care is given to clean and keep the nails trimmed . Fingernail are trimmed by Certified Nursing Assistants except for residents with the following condition A. Diabetes or circulatory impairment of the hands, B. Ingrown, infected, or painful nails . Event ID: Facility ID: 675680 If continuation sheet Page 4 of 4