Inspection·September 1, 2023

F 0677 person assist for bath. It also revealed the resident was incontinent of bowel and bladder. Level of Harm - Minimal harm or potential for actual harm Record review of Resident # 91's progress note dated 05/15/23 b y the DON read Resident requesting shower every Sunday 2 -10 shift. Nurse to document why not given. Residents Affected - Some Record review of Resident #91 for August 2023 POC (point of care) for showers revealed it was not signed or had any comments the resident refused showers or if showers were given. Record review of Resident # 91's care plan date initiated 09/28/21 revealed resident has ADL self-care performance deficit relater to muscle weakness, interventions: shower every day 2 - 10 shifts, nurse to document why it was not given. During an interview on 09/29/23 at 11:04 a.m., Resident #91 said she had not had any shower or bed bath for the past 16 days. She said the aide had not washed her hair, and her scarp was dry, flaking off and falling on her face. She said her whole body was dry and itching, making her feel dirty . Resident #91 said she asked CNA Q why she did not give her shower on08/27/23(Sunday) she said she forgot was the respond she gave for not showering her. She said she had body odor because she could smell herself; it was awful. During an observation and interview on 08/29/23 at 12:01 p.m., the treatment nurse and LVN T did a head to toe assessment on Resident #91. It revealed the resident's scalp was dry and covered with flaking, dry skin, and when the treatment nurse ran her hand on her hair, the dry skin fell off the resident's face. The treatment nurse said the aides had not been showering the resident. Then LVN T said yes, maybe the aides did not shower her because most of her skin was dry and flaking off, and that is why she had a dry scalp because her hair had not been washed for a while by the aides. During an interview on 08/29/23 at 2:21 p.m., CNA P said she needed help to shower Resident #91 because other aides were busy attending to their residents, and the shower bed was always in use. CNA P told Resident # 91 she could take showers only on Sunday because she needed help to shower, and since other residents are not showered on Sunday, she could get another aide to help her. She said the resident agreed and told the DON that Resident #91 agreed to shower on Sundays. She said she gave the resident a bed bath most of the time by herself on weekdays. She said if she refused to shower on Sundays, it was because she was sick, and she would give her a bed bath. She said she had not worked in 400 hall for ten days and wondered if the aides showered Resident # 91. She said Resident #91 did not initiate the Sunday, showers she initiated it, and she agreed to it. During an interview on 08/31/23 at 11:00 a.m., the DON said she spoke to the resident and she wanted to shower on Sundays only. She said she documented in the resident progress note and put it on the nurse's MAR to remind the aide that would work with Resident #91 on Sunday to shower her, but at the end of July, corporate told her to take it off the nurse's MAR. She said the resident refused to shower, and they talked about it during morning meetings. She did not respond to what intervention was put in place after they discussed it during the morning meeting. The DON stated Resident #91 was doing all this because the aide she liked was removed from her hall, and she thought the state was in the building because of her. She said residents are offered a shower or bed bath three times a week, and if the resident refuses, the nurse should talk to the resident, and if the resident refused, the nurse should document it. She said there was no documentation of refusal by Resident #91's progress notes until 08/28/23, and she care planed on 09/29/23 that Resident #91 refused shower on 08/29/23 . She said if a resident was not showered, the resident skin would become dry flaky, rashes, redness, body odor, and even infection. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 2 of 8 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 675744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Friendship Haven Healthcare and Rehabilitation Cen 1500 Sunset Dr Friendswood, TX 77546 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 - Some During an interview on 08/31/23 at 2:30 p.m., CNA Q said she worked with Resident # 91 on 08/27/23, and she did not shower because it was a Sunday, and they do not shower residents on Sunday. She said Resident #91 had refused to shower about two months before, and she told her change nurse, who no longer works in the facility, and she was not sure if she documented it. She said she did not document because the shower days are not popping up POC(point of care)for the aides to enter if the resident was showered or refused to shower. CNA Q stated she had told the DON about it and said it would corrected, but it is still not fixed . She said residents are offered shower or bed baths three times a week, and if the aides did not shower Resident 91, she could have a skin breakdown, body odor, or infection. She said she could not tell if the resident had body odor. During an interview on 09/01/23 at 10:42 a.m., the unit manager said she was the manager for 400 hall and none of the nurses or aides had told her Resident #91 had refused to shower. She said she could not remember if they had talked about Resident #91 refusing to shower. She said maybe somebody spoke about it, and maybe she missed it. She said it was the facility protocol to document if a resident refused care, and she did not see any documentation in the progress note that indicated she refused to shower. Resident #11 Record review of Resident #11 face sheet revealed a [AGE] year-old female was admitted to the facility on [DATE]. Her diagnoses were Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills), major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), and hypertension (blood vessels have persistently raised pressure). Record review of Resident # 11's admission MDS dated [DATE] revealed BIMS of 10 indicating moderate impaired cognition. It also revealed the resident required limited to extensive assistance with one staff assist with ADL. It also revealed the resident was occasionally incontinent of bowel and bladder. Record review of Resident # 11's care plan dated 06/21/23 revealed resident is at risk for ADL self-care performance deficit related to decline in health. Interventions: personal hygiene: the resident required limited to extensive assist with one to two staff assist. During an observation on 08/29/23 at 10:28 a.m. revealed Resident #11 had long nails on all fingers, and it was about 1.5 cm long, and she had facial hair on her chin. During an interview on 08/29/23 at 10:31 a.m., Resident #11 said she wanted her fingernails cut and the facial hair shaved or plucked. Resident #11 said she could break her skin when she scratched herself with the long fingernail, and she does not feel well-groomed with the long nails. During an interview on 08/29/23 at 10:45 a.m., CNA S said Resident #11 fingernails and facial hair are cut by the aides on shower days and as needed. CNA S said she was Resident #11's aide for today, and she came to work today at 6:00 a.m. She said she saw the resident when she gave the resident water but did not notice that her fingernails were long or her facial hair. She said Resident #11 could give herself a skin tear if she scratched herself. She said if the resident did not want the facial hair, it would be a dignity issue, and the resident would feel uncared for by the staff. She said she had skills - check off and in service on personal hygiene, which included nail care and shaving. She stated the nurse monitors the aides when the nurses make rounds. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 3 of 8 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 675744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Friendship Haven Healthcare and Rehabilitation Cen 1500 Sunset Dr Friendswood, TX 77546 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 - Some During an observation and interview on 08/29/23 at 10:49 a.m., CNA S said Resident # 11 fingernails on both hands were very long, and the resident said she had been asking for her nails to be cut, but the aides had not done so. She also said the resident had facial hair on her chin. During an observation and interview on 08/29/23 at 10:54 a.m., LVN T said Resident #11's fingernails on both hands were long, and she had facial hair on his chain. LVN T said she was Resident #91's nurse and had made rounds but did not see the long nails and facial hair on the resident's face. She said the resident could feel unkempt and could cut her skin (skin tear) by herself unintentionally. LVN T stated the podiatrist cut the resident's fingernails and toenails. She said she was unsure when the podiatrist would cut her nails because she was alert, and she guessed the aides would be responsible for cutting the resident's fingernails and shaving the resident on shower days. LVN T said the nurses monitored the aide when the nurse signed off on the shower sheet. During an interview on 09/31/23 at 12:45 p.m., the ADON said fingernails are done any day of the week, and the aides do not cut diabetic resident fingernails. She said only the nurses cut diabetic resident fingernails. She said Resident #11 would infect her skin if she broke her skin with her long nails. She stated the nurse managers monitored the nurses when they made random rounds on the residents, while the charge nurse monitored the aide during rounding. Resident # 50 Record review of Resident #50 face sheet revealed a [AGE] year-old female was admitted to the facility on [DATE] and readmitted to the facility on [DATE]. Her diagnoses were spondylosis (degeneration of the intervertebral disk), scoliosis (abnormal lateral curvature of the spin), hypertension (blood vessels have persistently raised pressure), and asthma (a chronic condition that affects the airways in the lung). Record review of Resident # 50's quarterly MDS dated [DATE] revealed BIMS of BIMS of 09 indicating moderate impaired cognition. It also revealed the resident required limited to extensive assistance with one staff assist with ADL. It also revealed the resident was occasionally incontinent of bowel and bladder. Record review of Resident # 50's care plan dated initiated 09/28/21 revealed resident has ADL self-care performance deficit relater to muscle weakness, interventions: shower every day 2 - 10 shifts, nurse to document why it was not given. During an observation and interview on 08/29/23 at 11:27 a.m., revealed Resident 50's fingernails on the left hand were long; several of the nails were chipped and had a brown substance under the fingernails, and the right hand had two long fingernails. Resident #50 said she had asked some of the aides to cut her nails, but they did not. She said look at my nails. They are dirty. During an interview on 09/29/23 at 11:49 a.m., LVN T said Resident #50 had long fingernails on both hands, and some fingernails had dirt under the fingernails. She stated the aide was responsible for cutting the resident fingernails, and she did not see her fingernails when she made rounds. LVN T said Resident #50 could scratch herself and get an infection from the dirt if any open area on her skin or mouth. She said the unit manager monitored the nurses when she made rounds on the residents while the nurses monitored the aides. During an interview on 08/29/23 at 11:52 a.m., CNA R said she was Resident #50's aide for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 4 of 8 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 675744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Friendship Haven Healthcare and Rehabilitation Cen 1500 Sunset Dr Friendswood, TX 77546 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 morning shift . She said she had seen the resident when she made rounds but just noticed the fingernails now. She said most of Resident #50 fingernails were long and had dirt under the fingernail's tips. She said the resident's fingernails are cut on shower days and as needed. She said the resident could give herself skin tears because of her long fingernails. She stated the nurses monitored the aides when they made random rounds. She said she had in-service on ADL, and grooming was part of ADL. Residents Affected - Some During an interview on 09/01/23 at 8:21 a.m., the DON said the aide should cut Resident # 50 on shower days or at least offer to cut the resident's nails on shower days. She also said the activity director does nails, too. The DON said the aides and nurses should cut the resident's fingernails. At the same time, the unit managers and ADON monitored the nurses and CNA by making random rounds, and they brought up any issues they found during the morning meeting. The DON said Resident #50 could scratch herself or another resident. She also said if the resident had dirt under her fingernails, she could get an infection. Resident #4 Record review of Resident #4 face sheet revealed an [AGE] year-old female was admitted to the facility on [DATE] and readmitted on [DATE]. Her diagnoses were Alzheimer's disease (a brain disorder that slowly destroys memory and thinking skills), cerebral infraction (disrupted blood flow to the brain due to problems with blood vessels), and hypertension (blood vessels have persistently raised pressure). Record review of Resident # 4's annual MDS dated [DATE] revealed BIMS of 03 indicating severely impaired cognition. It also revealed the resident required extensive assistance with one staff assist with ADL. It also revealed the resident was incontinent of bowel and bladder. Record review of Resident # 4's care plan-initiated date 07/18/17 revealed resident is at risk for ADL self-care performance deficit related to decline in health. Interventions: personal hygiene: the resident required limited to extensive assist with one staff assist. During an observation on 08/29/23 at 1:05 p.m. revealed, Resident # 4 had facial hair on her chin and above her lips. The resident did not respond to the surveyor's greetings. During an observation and interview on 08/29/23 at 1:07 p.m., CNA Y said the aides should have shaved Resident #4 on shower days and needed to know the resident's shower days. She then looked at the shower schedule and said her shower days were Tuesday, Thursday, and Friday during the evening shift. She said Resident #4 would be shaved when the evening aides came. She said if Resident #4 wanted to be shaved and she was not, the aides were not taking care of the resident. She said she had skills check-off ADL care, which included grooming. During an interview on 9/01/23 at 7:31 a.m., the administrator said Resident # 4 should be saved when the resident wanted to be shaved and when there was visible facial hair. She said the direct care nursing staff are responsible for shaving Resident #4. She said the ambassadors and the charge nurses monitored the aides by rounding and looking at the residents. The administrator said she was not sure how Resident #4 would have felt if she had not been shaved. During an interview on 09/01/23 at 7:40 a.m., the regional clinical director said the aides, medication aides, and the nurses are responsible for shaving Resident #4. He said shaving is offered (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 5 of 8 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 675744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Friendship Haven Healthcare and Rehabilitation Cen 1500 Sunset Dr Friendswood, TX 77546 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 - Some during showers and as needed, and the resident would have to give permission to be shaved. He said the first line of monitoring the aides would be the nurse, then the unit manager, ADON, DON, and the IDT team by making random rounds. He said he would not know how Resident #4 felt if she did not want the facial hair. During an interview on 09/01/23 at 10:00 a.m., the ADON said all nursing staff are responsible for shaving Resident # 4. She also said if the resident were a female like Resident #4, the CNAs would ask her if she wanted to be shaved or plucked. The ADON said the aides are supposed to shave Resident #4 on shower days and PRN. She said the charge nurse monitors the aides by random rounds, and then the unit manager monitors the nurses. The ADON said she could not tell how Resident #4 felt but would feel bad because she did not want facial hair. During an interview on 09/01/23 at 10:39 a.m., the Unit manager said shaving should be done daily, but the aides did it on shower days. She said Resident #4 would feel pretty bad if she wanted to be shaved and she was not shaved. The unit manager said the nurse monitors the aide by making rounds and checking on the residents. Record review of the facility policy on fingernails and toenails 2001 MED - PASS, Inc. (Revised April 2007) read in part . the purpose of this procedure are to clean the nail bed, keep nails trimmed, and to prevent infections . Record review of the facility policy on shaving 2001 MED - PASS, Inc. (Revised December 2007) read in part .the purpose of this procedure is to promote cleanliness and to provide skin care . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 6 of 8 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 675744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Friendship Haven Healthcare and Rehabilitation Cen 1500 Sunset Dr Friendswood, TX 77546 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 - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. 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 in 1 of 1 kitchen reviewed for food procurement in that 4 Frozen rolls of 10 lb. ground beef in a pan being thawed in the sink. This failure could affect residents who ate food from the kitchen and place them at risk of food borne illness and disease. Findings Included: Observation of the facility kitchen on 08/29/23 at 8:30 AM revealed 4- 10 lb. frozen ground beef in a pan being thawed in the sink faucet water running with a temperature of 91 degrees Fahrenheit. Ground beef had an internal temperature of 73.8 degrees Fahrenheit indicating that the temperature is in the Danger Zone (41 degrees Fahrenheit to 135 degrees Fahrenheit). Interview with the Food Service Manager on 08/29/23 at 8:35 AM he stated that ground beef temperature of 73.8 degrees Fahrenheit indicates that the frozen beef was inappropriately being thawed. He also stated that he is responsible for training staff on thawing requirements ensuring dietary requirements are met. Record review of facility's Food and Nutrition Services Policy and Procedure dated 9/2017 read in part. Proper food thawing methods are as follows :1. Under refrigeration to maintain the temperature at below 41 degrees Fahrenheit. 2. Submerge under cold running water that is no greater than 70 degrees Fahrenheit and creates enough agitation to float off loose ice particles. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 7 of 8 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 675744 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/01/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Friendship Haven Healthcare and Rehabilitation Cen 1500 Sunset Dr Friendswood, TX 77546 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 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to dispose of garbage and refuse properly for 1 of 1 dumpster reviewed for garbage disposal. Residents Affected - Few -The facility failed to ensure the dumpster lids and doors were secured. This failure could place residents at risk of infection from improperly disposed garbage. Findings include: Observation on 08-29-23 at 8:50 am revealed the facility's dumpster area, which was in the lot behind the dietary department had a commercial -size dumpster ¾ full of garbage and the top lid was missing Interview on 08-29-23 at 8:50 am, the Food Service Director stated that the dumpster lids always must be closed to keep vermin, pests and insects out of the dumpster and from entering the facility. Record review of facility policy and procedure Dispose of Garbage and Refuse dated 8/2017 revealed all garbage and refuse will be collected and disposed of in a safe and efficient manner. Procedures read in part .that the Food Service Director will ensure that appropriate lids are closed and provided for the dumpster. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675744 If continuation sheet Page 8 of 8