Health inspection·March 22, 2024

F 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Therapeutic Diet: Yes. Description of Therapeutic Diet: Real Diet for ESRD. Diet Type: Regular, Renal Diet. Resident's Dietary Risk: Risk for weight loss. Resident's dietary goals: Maintain current weight. Dietary Interventions: Resident eats in room, Dentures or partial. Eating: Set up help only. Record review of Resident #1's undated Care Plan revealed: Care Plan Goals - Will minimize risk for hypo/ hypertensive episodes daily and ongoing over the next 90 days. Interventions - Diet as ordered. Status Active. Role(s) - Dietary/Nursing. Start Date - 02/06/24. Record review of Resident #1's undated Care Plan revealed: Care Plan Description - At risk for SOB, chest pains, edema, elevated blood pressure (B/P), infected access area, itchy skin, NN, and risk for bleeding secondary to heparin use during dialysis. DX: end-stage renal disease (ESRD). Category - Dialysis TypeOn-going. Status - Active on Discharge. Resident/Representative was involved/informed of this Care Plan 02/06/2024 03:18 p.m. Communication Method - Face-to-face. Care Plan Goals - Will minimize risk for SOB, chest pains, edema, elevated B/P, infections, itchy skin or bleeding daily and ongoing over the next 90 days. Active - 05/6/24. Start Date - 02/06/2024. Interventions - Arrange for dialysis as ordered. Status Active. Role(s) - Nursing. Start Date 02/06/2024. Record review of Resident #1's Progress Notes dated 02/08/2024 at 08:12 p.m. written by RN C revealed; Received call from dialysis. Dialysis transportation door malfunctioning. Had to send another van. Resident's estimated time of arrival (ETA), another hour. Record review of Resident #1's Progress Notes dated 02/08/2024 at 10:23 p.m. written by RN C revealed; Peanut butter and jelly (pb & j) sandwich provided for snack. Record review of Resident #1's Progress Notes dated 02/09/2024 at 01:23 p.m. written by ADON revealed; Family #1 stated Resident #1 had not had the greatest experience, resident had not eaten much. ADON noted barbeque chips on bedside table and a snack was offered of which Resident #1 declined. In an interview on 02/10/2024 at 11:28 a.m., Family #1 stated on 02/08/2024 she spoke with Resident #1 sometime after 9 p.m. learning that when she returned to the facility from dialysis there was a cold dinner tray sitting waiting. She stated it was unknown how long the tray had been sitting and the resident refused to eat it after it was reheated by CNA B. She stated resident requested something fresh, but by the time it was received the resident was too tired to eat and went to bed without eating anything the entire day. She stated the resident does not often eat breakfast. In an interview on 02/10/2024 at 01:41 p.m., Resident #1 stated on 02/08/2024 CNA staff had gotten her ready for dialysis and the transportation was supposed arrive by 2:00 p.m., but the transportation was late picking her up and then she arrived at dialysis late. She stated she left the facility with no snacks and no bagged lunch on that day. She stated she was at dialysis several hours and was feeling extremely weak and fatigue from the dialysis treatment, low oxygen level, and lack of food. She stated she was not offered a snack at dialysis that she recalls. She stated the transportation vehicle designated to return her to the facility broke down and a second vehicle was sent in its place making the wait to return to the facility extended. She stated she was hungry, tired and fatigue and felt extremely bad and uncomfortable. She stated by the time she returned to the facility it was after 9:00 p.m. and she was in distress from lack of oxygen and the anxiety of getting back to the facility late. She stated when she arrived in her room there was a dinner tray that had been sitting there since dinner was served to the other residents like it was every time, she when out for dialysis. She stated she would not have eaten that meal because it had sat out all evening. She stated she was hungry and asked for a fresh meal from a staff name and title unknown and was brought a pb & j (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 2 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few sandwich. She stated she was physically and emotional incapable of requesting another meal and fell asleep without eating the sandwich she felt was an inadequate substitute for a meal for a patient who had not eaten all day. She stated at present, she was at the hospital due to oxygen complications and did not want to return to the facility. She felt like they would kill her if she returned. She stated the Administrator and Director of Nursing (DON) were unkind to her and did not do all they could to make her stay feel safe and comfortable. She stated the nursing staff were incompetent and she feared for her safety when they moved her from her bed. She stated the sack lunches the facility provided to dialysis residents were not an adequate meal: sandwich and a milk to give to a patient undergoing dialysis treatment who missed meals. In an interview on 02/10/2024 at 02:28 p.m. [NAME] A stated he was on shift from 5 a.m. to 1 p.m. on 02/08/2024. He stated he was responsible for ensuring that snack lunches were made for the resident (Resident #1) who went out for dialysis on 02/08/2024. He stated a nursing staff comes to the dietary department for the lunches and they dietary staff pass that nursing staff the lunch and the lunch was then sent with the resident to dialysis. He stated on 02/08/2024, no nursing staff came for a sack lunch, and he had no knowledge as to why not. In an interview on 02/10/2024 at 04:01 p.m., RN A stated on 02/08/24 (exact time unknown) CNA A reheated the dinner tray for the resident. In an interview on 02/13/2024 at 03:14 p.m., CNA A stated on 02/08/2024 Resident #1 ate from her breakfast tray before leaving for dialysis. In an interview on 02/13/2024 at 03:39 p.m., CNA B stated she when Resident #1 returned from dialysis on 02/08/2024 (exact time unknown) resident did not request a meal alternative, but resident did not request. In an interview on 02/13/2024 at 03:55 p.m., RN B stated he had worked for the facility for 2 years and worked the 6 a.m. to 6 p.m. shift on 02/08/2024. He stated he was responsible for getting Resident #1 prepared to transport to dialysis on 02/08/2024. He stated it was procedure for nursing staff to get a sack lunch from the dietary department to send with dialysis residents on their dialysis days. He stated on 02/08/2024, he had gotten busy, and he forgot to send a sack lunch with the Resident #1 before she departed to dialysis. He stated he was aware of the policy that dialysis residents are to go out with a sack lunch because they miss meals. In an interview on 03/22/2024 at 11:29 a.m., Administrator stated it was her expectations that dialysis residents were sent out with sack lunches on their dialysis days. She stated on 02/09/2024 (exact time unknown) she learned from Family #1 that Resident #1 had gone to dialysis on 02/08/2024 without a sack lunch. She stated on 02/09/2024, (exact time unknown), the DON contacted the dialysis center and was informed that on 02/08/2024, the dialysis center provided Resident #1 with a snack. She stated she was unsure what snack was provided or who the DON spoke to at the dialysis center. She stated when she learned that the resident had left for dialysis without a bagged lunch, she completed a grievance based on the families' complaints. She stated she also in-serviced the staffing on sending lunches out with dialysis residents on their dialysis days. She stated RN B was a new RN who had never received any negative performance marks on his record. She stated because the facility had only 2-long term dialysis residents nursing and dietary staff were familiar with their dialysis days. Since the incident, she stated she spot checked occasionally to ensure that dialysis residents were being sent to dialysis with lunches. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 3 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0800 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 03/22/2024 at 11:45 a.m., DON stated RN B had forgotten to give Resident #1 a lunch when she transported to dialysis on 02/08/2024. She stated she contacted the dialysis center and was ensured by the staff there that the resident had been given a snack. She stated she does not have the name of the dialysis staff she spoke to or the specific snack the resident received. She stated on 02/08/2024, the resident returned to the facility from dialysis and was given a dinner. She stated the resident was not happy with what she was given, and it was exchanged out. She stated she was unsure what those meals consisted of. She stated it was her expectation that dialysis residents were sent to dialysis with a bagged meal. She stated it was the dialysis centers practice, if patients come without snacks that snacks will be provided to them by the dialysis center. She stated Family #2 also accompanied the resident to her dialysis appointments. She stated on 02/08/2024, Family #2 told her he had stopped and had gotten the resident a meal before she returned to the facility from dialysis. Record review of Resident #1's Progress Notes dated 01/31/2024 at 08:14 p.m. written by LVN A. Resident #1 arrived by ambulance on stretcher from hospital. Dialysis patient. Right internal jugular catheter. Dialysis catheter intact. Dialysis days: Tuesday, Thursday, Saturday 03:30 p.m. Record review on 03/22/2024 at 10:59 a.m., RN B's employee file revealed; no disciplinary action noted. Record review of undated mealtimes revealed : Cold breakfast/cereal 7 a.m. - 8 a.m., Dining Room Breakfast 8 a.m., lunch 12:00 p.m./Noon and Dinner 5:00 p.m. Record review of In-service dated 02/09/2024 conducted by Dietary Manager (DM) revealed; Subject covered: Preparing packed lunch for renal patients. Kitchen staff need to prepare packed lunches according to dialysis schedule and take them to the nurse station. Record review of In-service dated 02/09/2024, conducted by ADON revealed; Subject covered: All dialysis patients must take snacks and drinks with them. Kitchen will prepare a bag of snacks, drinks. Ensure ambulance takes it. Record review of undated facility policy titled Record Review End-Stage Renal Disease Care of a Resident with Policy Statement revealed; Residents with ESRD)will be cared for according to currently recognized standards of care. Policy Interpretation and Implementation: 5. The facility will ensure that all residents receiving dialysis care outside the facility receive a meal during dialysis that is nutritionally comparable to the nursing home meal. Record review of the facility policy titled Resident's [NAME] of Rights revised dated November 2014 revealed; Objectives: We realize that everyone who is admitted to the facility has certain rights. These rights must be guaranteed and respected not only by our personnel, but also by physicians, family visitors and other residents of the facility. Statement of The Resident's [NAME] of Rights. 15. Is treated with consideration, respect and full recognition of his or her dignity and individuality, including privacy in treatment and in care for personal needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 4 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure meals and snacks are served at times in accordance with resident’s needs, preferences, and requests. Suitable and nourishing alternative meals and snacks must be provided for residents who want to eat at non-traditional times or outside of scheduled meal times. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that each resident received, and the facility provided at least three meals daily, at regular times comparable to normal mealtimes in the community for 1 of 3 residents (Resident #1) reviewed for timely meals, in that: 1. Resident #1 was sent to dialysis without a lunch during lunch time and returned hungry. 2. Resident #1 sometimes did not get breakfast before she left for dialysis. 3. Resident #1 felt hungry when she did not get an adequate meal when returning from dialysis. The failures placed residents at risk of unplanned weight loss, altered nutritional status, decreased feelings of self-worth. Resident #1 had a diminished quality of life; not getting a lunch on her dialysis day, feeling hungry and not feeling cared for. Findings included: Record review of Resident #1's Face Sheet dated 02/10/2024 revealed, a [AGE] year-old female who admitted to the facility on [DATE] and discharged on 02/09/2024 with some diagnoses of: heart failure, hypertension (high blood pressure), end stage renal disease (ESRD) (kidney failure), pneumonia (infection in one or both lungs), pure hypercholesterolemia (high cholesterol levels), asthma (lung disease that complicates airflow), chronic obstructive pulmonary disease, (COPD) (airflow blockage) or chronic lung disease, respiratory failure (blood lacks oxygen), acute respiratory failure with hypoxia (body tissues lack oxygen), emphysema (breathlessness), and muscle weakness (generalized). Record review of Resident #1's Minimum Data Set (MDS) dated [DATE] revealed, the resident had a BIMS score of 14 indicating resident was cognitively intact. Record review of Resident #1's Baseline Care Plan dated 02/04/2024 at 08:08;17 a.m., revealed: Therapeutic Diet: Yes. Description of Therapeutic Diet: Real Diet for ESRD. Diet Type: Regular, Renal Diet. Resident's Dietary Risk: Risk for weight loss. Resident's dietary goals: Maintain current weight. Dietary Interventions: Resident eats in room, Dentures or partial. Eating: Set up help only. Record review of Resident #1's undated Care Plan revealed: Interventions - diet as ordered. Status - Active. Role(s) - Dietary/Nursing. Start Date 02/06/2024. Interventions - Arrange for dialysis as ordered. Status Active. Role(s) - Nursing. Start Date 02/06/2024. Record review of Resident #1's Progress Notes dated 02/08/2024 at 08:12 p.m. written by RN C revealed; Received call from dialysis. Dialysis transportation door malfunctioning. Had to send another (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 5 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0809 van. Resident's estimated time of arrival (ETA), another hour. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #1's Progress Notes dated 02/08/2024 at 10:23 p.m. written by RN C revealed; pb & j sandwich provided for snack. Residents Affected - Few Record review of Resident #1's Progress Notes dated 02/09/2024 at 01:23 p.m. written by ADON revealed; Family #1 stated Resident #1 had not had the greatest experience, resident had not eaten much. ADON noted barbeque chips on bedside table and a snack was offered of which Resident #1 declined. In an interview on 02/10/2024 at 11:28 a.m., Family #1 stated on 02/08/2024 she spoke with Resident #1 after 9 p.m. learning that when the resident returned to the facility to a cold dinner tray. She stated it was unknown the length of time the tray had been there before the resident arrived from dialysis. She stated that the resident refused to eat the cold meal after CNA B reheated the food. She stated resident refused the food because it had been sitting out. She stated the resident received an alternative meal, but resident was too tired to eat it by the time the food arrived. In an interview on 02/10/2024 at 01:41 p.m., Resident #1 stated on 02/08/2024 CNA staff had gotten her ready for dialysis, but dialysis was late and had not arrived at the 2:00 p.m. pickup time. She stated she left the facility with no snacks and no bagged lunch on that day. She stated she could not recall if dialysis offered her a snack, but she had not gotten one. She stated by the time she returned to the facility it was after 9:00 p.m. She stated a dinner tray had been sitting in her room since dinner was served at that facility. She stated she refused to eat the meal because it had sat out all evening. She stated she was hungry and asked for a fresh meal and was brought a pb & j sandwich. She stated she did not feel that a sandwich was not an inadequate meal substitute. In an interview on 02/10/2024 at 02:28 p.m. [NAME] A stated he prepared a sack lunches for Resident #1 to take with her to dialysis on 02/08/2024, but no nursing staff came for the lunch. In an interview on 02/10/2024 at 04:01 p.m., RN A stated on 02/08/24 (exact time unknown) CNA A reheated the dinner tray for the resident. In an interview on 02/13/2024 at 03:14 p.m., CNA A stated on 02/08/2024 Resident #1 ate from her breakfast tray before leaving for dialysis. In an interview on 02/13/2024 at 03:39 p.m., CNA B stated she when Resident #1 returned from dialysis on 02/08/2024 (exact time unknown) resident did not request a meal alternative, but resident did not request. In an interview on 02/13/2024 at 03:55 p.m., RN B stated he was responsible for getting a sack lunch from dietary and sending it with Resident #1 to dialysis on 02/08/2024 but forgot to send the lunch with the resident. Record review of Grievance dated 02/08/2024 revealed, Resident #1 delay in dialysis transportation and staff hung up on Family #1. Signed 02/09/2024 by Administrator. In an interview on 03/22/2024 at 11:29 a.m., Administrator stated it was her expectations that nursing and/or dietary staff send dialysis residents with a sack lunch on their dialysis days. She stated when she learned that the resident had left for dialysis without a bagged lunch, she completed a grievance based on the families' complaints. She stated staff were in-serviced on sending lunches (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 6 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0809 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few with dialysis residents on their dialysis days. She stated the facility was well aware of the facility's 2-long term care residents (Resident #2 and Resident #3) and with their dialysis days. Since the incident, the dialysis residents were sent with lunches on their dialysis days. In an interview on 03/22/2024 at 11:45 a.m., DON stated on 2/08/2024 RN B had forgotten to send a lunch with Resident #1 before she transported to dialysis. She stated the dialysis center had given Resident #1 a snack on 02/08/2024. She stated on 02/08/2024, the resident received dinner, but not happy with it and it was exchanged out. She stated it was her expectation dialysis residents took bagged lunches with them to dialysis. She stated Family #2 told her he had stopped and had gotten the resident a meal before she returned to the facility. Record review of Resident #1's Progress Notes dated 01/31/2024 at 08:14 p.m. written by LVN A. Resident #1 arrived by ambulance on stretcher from hospital. Dialysis patient. Right internal jugular catheter. Dialysis catheter intact. Dialysis days: Tuesday, Thursday, Saturday 03:30 p.m. Record review of In-service dated 02/09/2024 conducted by Dietary Manager (DM) revealed; Subject covered: Preparing packed lunch for renal patients. Kitchen staff need to prepare packed lunches according to dialysis schedule and take them to the nurse station. Record review of In-service dated 02/09/2024, conducted by ADON revealed; Subject covered: All dialysis patients must take snacks and drinks with them. Kitchen will prepare a bag of snacks, drinks. Ensure ambulance takes it. Record review of undated mealtimes revealed : Cold breakfast/cereal 7 a.m. - 8 a.m., Dining Room Breakfast 8 a.m., lunch 12:00 p.m./Noon and Dinner 5:00 p.m. Record review of undated facility policy titled Record Review End-Stage Renal Disease Care of a Resident with Policy Statement revealed; Residents with end-stage renal disease (ESRD) will be cared for according to currently recognized standards of care. Policy Interpretation and Implementation: 5. The facility will ensure that all residents receiving dialysis care outside the facility receive a meal during dialysis that is nutritionally comparable to the nursing home meal. Record review of the facility policy titled Resident's [NAME] of Rights revised dated November 2014 revealed; 15. Is treated with consideration, respect and full recognition of his or her dignity and individuality, including privacy in treatment and in care for personal needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 7 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 1 of 3 (Resident #1) room reviewed for food service safety. 1. The facility failed to ensure Resident #1 and Resident #2's dinner trays were property stored until residents arrived from dialysis. 2. The facility failed to have a system in place when storing dialysis resident's meals. These failures could place residents at risk of food borne illness. Findings included: Record review of Resident #1's Face Sheet dated 02/10/2024 revealed, a [AGE] year-old female who admitted to the facility on [DATE] and discharged on 02/09/2024 with some diagnoses of: heart failure, hypertension (high blood pressure), end stage renal disease (ESRD) (kidney failure), pneumonia (infection in one or both lungs), pure hypercholesterolemia (high cholesterol levels), asthma (lung disease that complicates airflow), chronic obstructive pulmonary disease, (COPD) (airflow blockage) or chronic lung disease, respiratory failure (blood lacks oxygen), acute respiratory failure with hypoxia (body tissues lack oxygen), emphysema (breathlessness), and muscle weakness (generalized). Record review of Resident #1's Minimum Data Set (MDS) dated [DATE] revealed, the resident had a BIMS score of 14 indicating resident was cognitively intact. Record review of Resident #1's Baseline Care Plan dated 02/04/2024 at 08:08;17 a.m., revealed: Therapeutic Diet: Yes. Description of Therapeutic Diet: Real Diet for ESRD. Diet Type: Regular, Renal Diet. Resident's Dietary Risk: Risk for weight loss. Resident's dietary goals: Maintain current weight. Dietary Interventions: Resident eats in room, Dentures or partial. Eating: Set up help only. Record review of Resident #1's undated Care Plan revealed: Care Plan Goals - Will minimize risk for hypo/ hypertensive episodes daily and ongoing over the next 90 days. Interventions - Diet as ordered. Status Active. Role(s) - Dietary/Nursing. Start Date - 02/06/24. Record review of Resident #1's undated Care Plan revealed: Care Plan Description - At risk for SOB, chest pains, edema, elevated blood pressure (B/P), infected access area, itchy skin, NN, and risk for bleeding secondary to heparin use during dialysis. DX: end-stage renal disease (ESRD). Category - Dialysis TypeOn-going. Status - Active on Discharge. Resident/Representative was involved/informed of this Care Plan 02/06/2024 03:18 p.m. Communication Method - Face-to-face. Care Plan Goals - Will minimize risk for SOB, chest pains, edema, elevated B/P, infections, itchy skin or bleeding daily and ongoing over the next 90 days. Active - 05/6/24. Start Date - 02/06/2024. Interventions - Arrange for dialysis as ordered. Status Active. Role(s) - Nursing. Start Date 02/06/2024. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 8 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #1's Progress Notes dated 02/08/2024 at 08:12 p.m. written by RN C revealed; Received call from dialysis. Dialysis transportation door malfunctioning. Had to send another van. Resident's estimated time of arrival (ETA), another hour. Record review of Resident #1's Progress Notes dated 02/08/2024 at 10:23 p.m. written by RN C revealed; Peanut butter and jelly (pb & j) sandwich provided for snack. Record review of Resident #1's Progress Notes dated 02/09/2024 at 01:23 p.m. written by ADON revealed; Family #1 stated Resident #1 had not had the greatest experience, resident had not eaten much. ADON noted barbeque chips on bedside table and a snack was offered of which Resident #1 declined. Observation on 02/10/2024 at 01:34 PM, Resident #2 not in room. Uneaten lunch tray sitting on bedside table. In an interview on 02/10/2024 at 11:28 a.m., Family #1 stated on 02/08/2024 she spoke with Resident #1 after 9 p.m. learning the resident had a cold dinner tray in her room. She stated it was unknown the time frame the food had sat until it was reheated by CNA B. In an interview on 02/10/2024 at 01:41 p.m., Resident #1 stated on 02/08/2024 by the time she returned to the facility from dialysis it was after 9:00 p.m. She stated a cold dinner tray that was served at dinner was in her room, but she refused to eat since it had sat out all evening. She stated she was hungry and was given a pb & j sandwich. In an interview on 02/10/2024 at 04:01 p.m., RN A stated on 02/08/24 (exact time unknown) CNA A reheated the dinner tray for the resident. In an interview on 02/13/2024 at 03:39 p.m., CNA B stated she when Resident #1 returned from dialysis on 02/08/2024 (exact time unknown) resident did not request a meal alternative. In an interview on 03/22/2024 at 11:29 a.m., Administrator stated it was her expectations that dialysis residents were sent out with sack lunches on their dialysis days. She stated staff were serviced on sending lunches out with dialysis residents on their dialysis days. Since the incident, she stated she spot checked occasionally to ensure that dialysis residents were being sent to dialysis with lunches. In an interview on 03/22/2024 at 11:45 a.m., DON stated RN B had forgotten to give Resident #1 a lunch when she transported to dialysis on 02/08/2024 but was given a meal when she returned. She stated the resident was unhappy with the meal which was exchanged out. Record review of In-service dated 02/09/2024 conducted by Dietary Manager (DM) revealed; Subject covered: Preparing packed lunch for renal patients. Kitchen staff need to prepare packed lunches according to dialysis schedule and take them to the nurse station. Record review of In-service dated 02/09/2024, conducted by ADON revealed; Subject covered: All dialysis patients must take snacks and drinks with them. Kitchen will prepare a bag of snacks, drinks. Ensure ambulance takes it. Record review of undated mealtimes revealed : Cold breakfast/cereal 7 a.m. - 8 a.m., Dining Room Breakfast 8 a.m., lunch 12:00 p.m./Noon and Dinner 5:00 p.m. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 9 of 10 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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 0812 Level of Harm - Minimal harm or potential for actual harm Record review of undated facility policy titled Record Review End-Stage Renal Disease Care of a Resident with Policy Statement revealed; Residents with ESRD)will be cared for according to currently recognized standards of care. Policy Interpretation and Implementation: 5. The facility will ensure that all residents receiving dialysis care outside the facility receive a meal during dialysis that is nutritionally comparable to the nursing home meal. Residents Affected - Few Record review of the facility policy titled Resident's [NAME] of Rights revised dated November 2014 revealed; 15. Is treated with consideration, respect and full recognition of his or her dignity and individuality, including privacy in treatment and in care for personal needs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 10 of 10