Inspection·March 22, 2023

F 0561 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the next shift know Resident #12 wanted a bed bath because he was scheduled to get one the next day. CNA E stated it was important for the residents to receive a bed bath if they requested one, so they did not stink and for health reasons. CNA E stated not giving the residents a bed bath when they requested it could make them feel horrible. During an interview on 03/22/2023 at 1:35 PM, LVN A stated if Resident #12 requested a bed bath it should have been given. LVN A stated he was responsible for ensuring the CNAs gave the residents baths/showers. LVN A stated CNA E should have reported to him that she did not have time to give Resident #12 a bed bath so he could ensure the next shift did it. LVN A stated it was important to give residents a bath when they requested it to make them feel better and for their skin. During an interview on 03/22/2023 at 6:01 PM, ADON Q stated the CNAs should give a resident a bed bath if the resident requested it. Even if it was not their shower day. ADON Q stated it was important because the facility was their home, and it was important to do what the residents requested. ADON Q stated it was also important because the residents needed a bath for their skin and skin care, and because the staff was there to take care of them and meet the residents' needs. ADON Q stated the nurse was responsible for making sure the CNAs respected the resident's choices. ADON Q stated nurse management monitored the CNAs respecting resident's choices by providing trainings and in-services on this subject. During an interview on 03/22/2023 at 6:23 PM, the Administrator stated if Resident #12 requested a bed bath the CNAs should have given it to him. The Administrator stated the residents should be bathed when they wanted to be bathed. The Administrator stated the IDT and nurse management should be making sure the residents' choices were respected. The Administrator stated it was for the resident's dignity to respect their choices. The Administrator stated he expected all staff to respect the residents' choices. The Administrator stated ensuring the residents' choices were respected was monitored by the grievances, angel rounds, daily IDT meetings, and in-services/trainings were provided quarterly if not more often. During an interview on 03/22/2023 at 6:56 PM, the DON stated if a resident requested a bed bath, they should receive it. The DON stated he was not aware Resident #12 had requested a bed bath and it was not provided. The DON stated the nurse was responsible for ensuring the CNAs did this. The DON stated he did in-services monthly and as needed to ensure the residents' rights were respected. The DON stated not respecting a resident's choices could make them feel bad. Record review of the facility's policy titled, Resident Rights and Responsibilities, Notice of, last revised 01/2022 revealed, Self-Determination. You have a right to self-determination through support of your choice, including the right to: choose activities, schedules (including sleeping and waking times), health care and providers of health care services consistent with your interests, assessments, plan of care, make choices about aspects of your life in the facility that are significant to you . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 2 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe, clean, and comfortable environment for 1 of 24 resident room (room [ROOM NUMBER]A) reviewed for a homelike environment. The facility failed to repair deep scratches that exposed the sheetrock and dents with cracks on the wall behind the head of the bed in room [ROOM NUMBER]A. This failure could place residents at risk for a diminished quality of life and a diminished clean well-kept environment. Findings included: During an observation on 03/20/23 at 2:39 PM, room [ROOM NUMBER]A behind the head of the bed had deep scratches to the wall that exposed the sheetrock and dents with cracks. During an interview on 03/22/2023 at 3:55 PM, MA N stated she was aware of the deep scratches and dents with cracks behind the head of the bed in room [ROOM NUMBER]A. MA N stated if there was damage in the rooms it was supposed to be put in the maintenance book for the maintenance director to fix it. MA N stated she did not put room [ROOM NUMBER]A's damages in the maintenance book. MA N stated she verbally reported it to the previous maintenance director. MA N stated it was important for the residents' rooms to be fixed because the facility was their home and it was supposed to be safe, secure, and clean. During an observation and interview on 03/22/2023 at 3:59 PM, the Maintenance Director stated nobody had told him room [ROOM NUMBER]A needed to be fixed. The Maintenance Director stated the staff was supposed to be logging rooms that needed to be fixed in the maintenance book. The Maintenance Director stated he had not done any training with the staff to ensure they knew to use the maintenance book because he had just started. The Maintenance Director stated it was important to fix the residents' rooms because the damaged surfaces were not smooth and it could cause more dust, and it could make the residents unhappy to have their home this way. During an interview on 03/22/2023 at 6:04 PM, ADON Q stated all the staff should know about using the maintenance book. ADON Q stated the maintenance supervisor was responsible for fixing damages to the residents' rooms. ADON Q stated she was not aware of the deep scratches and dents with cracks on the wall in room [ROOM NUMBER]A. ADON Q stated it was important for the rooms not to have deep scratches and dents on the wall because their room was supposed to be a homelike environment. During an interview on 03/22/2023 at 6:27 PM, the administrator stated that any staff member that was going into the residents' rooms was responsible for reporting damages to the room. The administrator stated he monitored the maintenance director and the tasks he completed by checking the maintenance log. The administrator stated he performed random room checks daily to ensure the residents' rooms were free of damages. The administrator stated he had not noticed room [ROOM NUMBER]A had deep scratches and dents with cracks on the wall. The administrator stated it was the resident's right to have a room that was not damaged. During an interview on 03/22/2023 at 7:03 PM, the DON stated all the staff were responsible for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 3 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0584 Level of Harm - Minimal harm or potential for actual harm making sure the residents' rooms were homelike and not damaged. The DON stated he was not aware of the damage to the wall in room [ROOM NUMBER]A. The DON stated any of the staff members that went into room [ROOM NUMBER]A should have reported the damages to the wall. The DON stated the residents' rooms were monitored for damages by the maintenance director randomly daily. The DON stated it was important for the residents' rooms to be repaired for them to have a homely atmosphere. Residents Affected - Few Record review of the facility's maintenance log with dates ranging between 01/11/2023-03/14/2023, revealed no entries for room [ROOM NUMBER]A. Record review of the facility's policy titled, Resident Rights and Responsibilities, Notice of, last revised on 01/2022 revealed, . Safe environment you have the right to a safe, clean, comfortable, and homelike environment, including but not limited to receiving treatment and supports for daily living safely . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 4 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure prompt efforts were made to resolve grievances for 1 of 3 residents (Resident #12) reviewed for grievances. The facility did not ensure a grievance was filed for Resident #12's black blanket when it was not returned from the laundry. These failures could place residents at risk for grievances not being addressed or resolved promptly. Findings included: Record review of a face sheet dated 03/22/2023 revealed Resident #12 was a [AGE] year old male initially admitted [DATE] and re-admitted [DATE], with diagnoses which included unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life), chronic obstructive pulmonary disease (acute) exacerbation (chronic inflammatory lung disease that causes obstructed airflow from the lungs), and chronic (systolic) congestive heart failure (chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body's needs for blood and oxygen). Record review of the quarterly MDS assessment dated [DATE] revealed Resident #12 was understood and understood others. The MDS assessment revealed Resident #12 had a BIMS score of 15, indicating he was cognitively intact. The MDS assessment indicated Resident #12 required extensive assistance with bed mobility, transfer, dressing, toilet use and personal hygiene, and limited assistance for eating. Record review of the facility's grievances did not reveal a grievance for Resident #12's missing black blanket. During an interview on 03/21/2023 at 9:36 AM, Resident #12 stated last Friday his black blanket was taken to the laundry and it was never brought back. Resident #12 stated he had told the nurses and the CNAs (he did not know their names) that the black blanket was lost, but they did not resolve anything for him. During an interview on 03/22/2023 at 7:49 AM, LVN A stated if a resident notified him of a missing item, he would notify the administrator. If the administrator was not available, he would notify the social worker or the DON. LVN A stated the social worker handled all the grievances. LVN A stated he only filled out a grievance form if the social worker or DON told him to. LVN A stated Resident #12 had not reported he was missing a black blanket to him. LVN A stated it was important for the residents to have their personal belongings because it was their right to have their belongings. During an interview on 03/22/2023 at 8:13 AM, Laundry Aide T stated if the residents reported a clothing item or blanket missing, she would go to the laundry and look for it. Laundry Aide T stated if she did not find it, she would return to the resident and let them know she did not find the item and she would notify the nurse. Laundry Aide T stated nobody had ever told her to let the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 5 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0585 Level of Harm - Minimal harm or potential for actual harm administrator or social worker know if a missing item was not found. Laundry Aide T stated she did not know who oversaw the grievances because there had been a lot of turn over at the facility. Laundry Aide T stated Resident #12 had reported to her he was missing a black blanket 4 days ago. Laundry Aide T stated Resident #12 reported to her it was sent to the laundry and it was never returned. Laundry Aide T stated she had looked for it and had not found it. Laundry Aide T stated she did not report this to anybody. Residents Affected - Few During an interview on 03/22/2023 08:26 AM, the maintenance director stated if a missing clothing or blanket was reported to the laundry the staff should go to the social worker for her to do a grievance report. The maintenance director stated he was not aware Resident #12 was missing a black blanket. The maintenance director stated he assumed Laundry Aide T knew to report missing clothing or blankets that were not found to the social worker. The maintenance director stated he was new and had not done any training on what to do if missing laundry items were not found. The maintenance director stated it was important for the residents' personal belongings to be returned to them because it was theirs. During an interview on 03/22/2023 at 11:34 AM, the social worker stated the staff should notify her if the resident was missing clothing items or a blanket and a grievance should be filed if the item was not immediately found. The social worker stated she was responsible for the grievances. The social worker stated any staff member could file a grievance. The social worker stated she was not notified Resident #12 was missing a black blanket. The social worker stated the DON was responsible for educating the staff on grievances. The social worker stated it was important to file grievances so that the residents' belongings could be returned and to ensure a proper investigation. During an interview on 03/22/2023 at 1:30 PM, CNA E stated Resident #12 had not reported to her that he was missing a black blanket. CNA E stated if a resident reported a missing item to her, she would go ask the laundry and if not found then she would report it to the nurse, DON, and administrator. CNA E stated it was important for the residents' belongings to be returned to them because it was theirs and it could make them feel bad. During an interview on 03/22/2023 at 6:08 PM, ADON Q stated if a resident reported a missing clothing item or blanket the staff should go and check the laundry to locate the missing item. If they were unable to find the item, they should let the social worker know and she would write a grievance. ADON Q state the social worker monitored the grievances. ADON Q stated she was not aware Resident #12 had a missing blanket. ADON Q stated it was important for a grievance to be filed if an item was not found because it was the residents' personal belongings and things they valued. During an interview on 03/22/2023 at 6:31 PM, the administrator stated if a resident reported a missing clothing item or blanket to a CNA, the CNA should go look for it in the laundry, and if it was not found they should report it to the social worker or any manager. The administrator stated he was not aware Resident #12 was missing a black blanket. The administrator stated a grievance should have been filed for the blanket. The administrator stated management was responsible for ensuring the staff reported missing items that were not found. The administrator stated the social worker was responsible for the grievances. The administrator stated filing a grievance was important because it showed that the facility did an investigation and it helped with continuity to ensure things are followed up on. The administrator stated missing items could cost the family money. During an interview on 03/22/2023 at 7:05 PM, the DON stated he was not aware Resident #12 had a missing black blanket. The DON stated if a clothing item or blanket was missing the staff should (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 6 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete notify him and the social worker. The DON stated a grievance should be filed, the family contacted, and the facility should get back to the family within 3 days on what would be done. The DON stated missing items could affect the residents emotionally because sometimes they are attached to their personal items. Record review of the facility's policy titled, Resident Rights Grievances, last revised 11/23/2016 revealed, . It is the policy of this facility to establish a grievance process to: 1. Address resident concerns without fear of discrimination or reprisal. Such grievances include those with respect to care and treatment which has been furnished as well as that which has not been furnished, the behavior of staff and of other residents; and other concerns regarding their facility stay; and make prompt efforts to resolve grievances the resident may have. Procedures: 1. The facility's grievance official is responsible for overseeing the grievance process, receiving and tracking grievances; leading any necessary investigations by the facility; maintaining confidentiality of all information associated with grievances; issuing written grievance decisions to the residents . Event ID: Facility ID: 675774 If continuation sheet Page 7 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review, the facility failed to complete a comprehensive resident-centered assessment of each resident's cognitive, medical, and functional capacity in a timely manner for 4 of 20 residents (Resident's #7, #23, #27, and #129) reviewed for comprehensive assessments and timing. 1. The facility failed to ensure Resident #129's cognitive status was assessed. 2. The facility failed to ensure Resident #7, #23, and #27's cognitive and mood statuses were assessed. This failure could place residents at risk of not having their needs identified and met. The findings included: 1. Record review of Resident #129's face sheet dated 3/20/23 revealed he was a [AGE] year-old, male, and admitted to the facility on [DATE] with diagnoses of cerebral infarction (disruption of blood flow to the brain which can parts of the brain to die off, also known as a stroke), hemiplegia and hemiparesis of right dominant side (weakness or inability to move the right side of the body), aphasia (loss of ability to understand or express speech caused from brain damage), dysphagia (difficulty swallowing), diabetes (disease of too much sugar in the blood), hypertension (high blood pressure), and anxiety (feeling of worry, unease, or nervousness). Record review of Resident #129's admission MDS dated [DATE] revealed Resident #129's BIMS interview was dashed, which indicated the BIMS interview was not completed. During an interview on 3/22/23 at 3:00 PM with MDS Coordinator G revealed Resident #129 should have had a BIMS, but the BIMS was not completed during the seven-day look back period. She said the Social Worker was responsible for completing the BIMS, but there was a time frame when they did not have a steady social worker. MDS Coordinator G said she identified there was a problem with the BIMS not being completed timely and had corrected the problem by having the social worker or the speech therapist responsible for completing the BIMS. 2. Record review of Resident #7's face sheet, dated 03/22/2023, revealed Resident #7 was an [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of Alzheimer's disease (brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks) and pulmonary fibrosis (disease in which the lungs become scarred (fibrosed) and damaged causing difficulty in breathing). Record review of the MDS assessment, dated 03/07/2023, revealed Resident #7 had clear speech and was understood by staff. The MDS revealed Resident #7 was able to understand others. The MDS revealed Resident #7's BIMS interview, which assessed cognitive function, should have been completed. The MDS revealed Resident #7's BIMS interview was dashed, which indicated the BIMS interview was not completed. The MDS revealed Resident #7's PHQ-9 interview, which assessed mood, should have been completed. The MDS revealed Resident #7's PHQ-9 interview was dashed, which indicated the PHQ-9 interview was not completed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 8 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 3. Record review of Resident #23's face sheet, dated 03/22/2023, revealed Resident #23 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of moderate intellectual disabilities (level of cognitive development and adaptive behavior that is moderately below age expectations), schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania), and borderline personality disorder (mental disorder characterized by the instability in mood, behavior, and functioning). Record review of the MDS assessment, dated 03/08/2023, revealed Resident #23 had clear speech and was understood by staff. The MDS revealed Resident #23 was able to understand others. The MDS revealed Resident #23's BIMS interview, which assessed cognitive function, should have been completed. The MDS revealed Resident #23's BIMS interview was dashed, which indicated the BIMS interview was not completed. The MDS revealed Resident #23's PHQ-9 interview, which assessed mood, should have been completed. The MDS revealed Resident #23's PHQ-9 interview was dashed, which indicated the PHQ-9 interview was not completed. 4. Record review of Resident #27's face sheet, dated 03/22/2023, revealed Resident #27 was an [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of dementia without behavioral disturbance (group of symptoms affecting memory, thinking and social abilities severely enough to interfere with your daily life) and major depressive disorder (mood disorder that causes a persistent feeling of sadness and loss of interest). Record review of the MDS assessment, dated 03/06/2023, revealed Resident #27 had clear speech and was understood by staff. The MDS revealed Resident #27 was able to understand others. The MDS revealed Resident #27's BIMS interview, which assessed cognitive function, should have been completed. The MDS revealed Resident #27's BIMS interview was dashed, which indicated the BIMS interview was not completed. The MDS revealed Resident #27's PHQ-9 interview, which assessed mood, should have been completed. The MDS revealed Resident #27's PHQ-9 interview was dashed, which indicated the PHQ-9 interview was not completed. During an interview on 03/22/2023 at 5:44 PM, MDS Coordinator G stated the social worker was responsible for completing the BIMS and the PHQ-9. MDS Coordinator G stated she was ultimately responsible for ensuring the BIMS and PHQ-9 interviews were completed prior to the ARD date. MDS Coordinator G stated the social worker started at the end of January 2023 and started completing the BIMS and PHQ-9 interviews timely. MDS Coordinator G stated the BIMS and PHQ-9 interviews were not completed for Residents #7, #23, and #27 because the ARD date was set late, and the interviews were not completed during the look-back period. MDS Coordinator G stated during the weekly Medicaid meeting it was determined by the IDT that an MDS assessment needed to be completed to capture current residents' statuses. MDS Coordinator G stated it was important to accurately assess Resident #7, #23, and #27's cognitive and mood statuses to ensure the MDS assessment accurately reflected the residents' status. MDS Coordinator G stated completing the BIMS and PHQ-9 was important for monitoring the resident's status, care planning, and to ensure the resident had no decline. During an interview on 03/22/2023 at 7:32 PM, the Administrator stated the IDT was responsible for ensuring the BIMS and PHQ-9 interviews were completed by the ARD date. The Administrator stated the IDT member's responsible could have been the social worker, therapist, or therapy assistant. The Administrator stated the IDT met multiple times a week to review the ARD dates and to ensure all parts were completed. The Administrator stated he expected the BIMS and PHQ-9 interview to be completed during the look-back period. The Administrator stated the MDS assessment should have accurately (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 9 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0636 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete reflected the resident's status. The Administrator stated ensuring the MDS assessment had a completed BIMS and PHQ-9 interview was important because the facility used an MDS assessment to update the plan of care and services being provided. The MDS policy was requested. The Administrator stated the facility did not have a MDS policy, they referred to the RAI manual. Review of the CMS RAI Version 3.0 Manual, dated October 2019, revealed, in Chapter 3, Section C, page C-2 Coding Tips: Attempt to conduct the interview with ALL residents. This interview is conducted during the look-back period of the Assessment Reference Date (ARD) . The RAI Manual further revealed, in Chapter 3, Section D, page D-2 Coding Tips and Special Populations: Attempt to conduct the interview with ALL residents. This interview is conducted during the look-back period of the Assessment Reference Date (ARD) . Event ID: Facility ID: 675774 If continuation sheet Page 10 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 observations, interviews, and record review the facility failed to ensure an accurate MDS was completed for 2 of 20 residents (Resident's #38 and #76) reviewed for MDS assessment accuracy. Residents Affected - Few 1. The facility failed to accurately document oral status for Resident #38 on the MDS assessment. 2. The facility failed to accurately complete a nursing home discharge MDS assessment for Resident #76. These failures could place residents at risk for not receiving care and services to meet their needs. The findings included: 1. Record review of Resident #38's face sheet, dated 03/20/2023, revealed Resident #38 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of unspecified dementia without behavioral disturbances (group of symptoms that affects memory, thinking and interferes with daily life), PTSD (mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback and avoidance of similar situations), and schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania). Record review of Initial admission Record assessment, dated 12/30/2022, revealed Resident #38 had carious (cavities), loose, missing, and broken teeth. Record review of the MDS assessment, dated 01/04/2023, revealed Resident #38 had clear speech and was usually understood by staff. The MDS revealed Resident #38 was able to understand others. The MDS revealed Resident #38 had a BIMS score of 0, which indicated severe cognitive impairment. The MDS revealed Resident #38 required extensive assistance with personal hygiene that included brushing her teeth. The MDS revealed Resident #38 required a mechanically altered diet. The MDS revealed Resident #38 had no broken, carious, loose, or missing teeth. Record review of Resident #38's comprehensive care plan, dated 01/13/2023, did not address dental status. During an observation and interview on 03/20/2023 at 10:15 AM, Resident #38 was sitting up in her bed with the head of the bed elevated slightly. Resident #38 had her breakfast tray sitting on the bedside table in front of her. Resident #38 had eaten about 50% of her ground sausage with gravy and about 50% of her scrambled eggs. Resident #38 showed and pointed to her teeth when the surveyor asked about eating. Resident #38 had missing bottom and top middle teeth. She was able to wiggle her bottom, right lateral incisor (tooth to the right of her middle teeth). Resident #38 also had red, inflamed gums and brown discoloration between her teeth and near the gums. Resident #38 stated her teeth did not hurt, but her teeth made it difficult to eat. During an interview on 03/22/2023 at 5:44 PM, MDS Coordinator G stated when completing the MDS assessment she looked at the initial assessment record to accurately code section L (oral or dental (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 11 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 status) of the MDS. MDS Coordinator G stated she probably did not see the initial admission record when she was completing the MDS assessment but was unsure because it was completed a few months ago. MDS Coordinator G stated it was important to ensure oral or dental status was accurately coded to ensure Resident #38's dental status was care planned and appropriate interventions were put in place. During an interview on 03/22/2023 at 6:08 PM, the DON stated MDS was responsible for ensuring dental status was accurately coded. The DON stated he was responsible for overseeing the MDS department. The DON stated he was not aware Resident #38 had missing, loose, carious, and broken teeth. The DON stated it was important to ensure the MDS assessment accurately reflected the dental status so the residents' received the appropriate care and services. During an interview on 03/22/2023 at 7:32 PM, the Administrator stated he expected the MDS Coordinator to accurately reflect the residents oral or dental status on the MDS. The Administrator stated it was important to accurately reflect the dental status on the MDS so a care plan could have been developed to ensure the resident received the correct diet, dental referral, and the IDT could have monitored the dental status. 2. Record review of Resident #76's face sheet (no date) indicated he was a [AGE] year-old male that was admitted to the facility on [DATE]. Resident #76 had diagnoses of type 2 diabetes (chronic condition that affects the way the body processes blood sugar), hypertension (force of blood against the artery walls is too high) and hyperlipidemia (high concentration of fats or lipids in the blood). Record review of the comprehensive MDS assessment dated [DATE] indicated Resident #76 did not have a BIMS score. Record review of the nursing home discharge MDS assessment dated [DATE] indicated Resident #76 was discharged to an acute hospital. Record review of Resident #76's Discharge summary dated [DATE] indicated he was discharged home with his family member. During an interview on 03/22/23 at 4:29 PM, MDS Coordinator G stated the discharge MDS should have indicated Resident #76 was sent home. MDS Resource H stated she had completed the discharge MDS assessment on Resident #76 and had filled in the wrong thing. MDS Coordinator G stated she was primarily responsible for filling out the MDS and MDS Resource H helped her at times when she needed it. MDS Coordinator G stated the MDS discharge assessment was for accurately tracking residents and would not negatively impact the resident. During an interview on 03/22/23 at 1:48 PM, the DON stated the MDS nurse was responsible for filling out the MDS discharge assessment and he expected it to be accurate. The DON stated he, did not know how it would impact the resident if the form was not filled out accurately because the facility had never had that problem in the past. During an interview on 03/22/23 at 1:47 PM, the Administrator stated he expected the MDS discharge assessment to be filled out correctly and the MDS coordinator was responsible. During an interview on 03/22/23 at 1:47 PM, the facility's policy on MDS was requested from the Administrator and not provided. The Administrator stated the facility followed the RAI manual. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 12 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 Review of the CMS RAI Version 3.0 Manual, dated October 2019, revealed in Chapter 3, Section A, page A-32 Steps for Assessment: 1. Review the medical record including the discharge plan and discharge orders for documentation of discharge location. The RAI Manual further revealed in Chapter 3, Section L, page L-2 Steps for Assessment: 1. Ask the resident about the presence of chewing problems or mouth or facial pain/discomfort. 4. Conduct exam of the resident's lips and oral cavity with dentures or partials removed, if applicable. Use a light source that is adequate to visualize the back of the mouth. Visually observe and feel all oral surfaces including lips, gums, tongue, palate, mouth floor, and cheek lining. Check for abnormal mouth tissue, abnormal teeth, or inflamed or bleeding gums. The assessor should use his or her gloved fingers to adequately feel for masses or loose teeth. 5. If the resident is unable to self-report, then observe him or her while eating with dentures or partials, if indicated, to determine if chewing problems or mouth pain are present. Event ID: Facility ID: 675774 If continuation sheet Page 13 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to coordinate assessments with the pre-admission screening and resident review program (PASRR) to the maximum extent practicable to avoid duplicative testing and effort for 2 of 21 residents (Resident #52 and Resident #2) reviewed for PASRR. The facility failed to indicate on the PASRR level 1 screening completed by the facility that Resident #52 had a mental illness. The facility failed to coordinate Resident #2's annual IDT PASSR meeting. This failure could affect residents with mental illnesses and place them at risk of not being assessed to receive needed services. Findings include: 1.Record review of Resident #52's consolidated physician orders dated 03/22/23 indicated she was a [AGE] year-old woman admitted to the facility on [DATE]. Resident #52 had a diagnosis of type 2 diabetes (chronic condition that affects the way the body processes blood sugar), bipolar (episodes of mood swings ranging from depressive lows to manic highs) and hypertension (force of blood against the artery walls is too high). Record review of Resident #52's MDS assessment dated [DATE] indicated Resident #52 had a BIMS score of 4 for severe impairment and an active diagnosis of bipolar disorder. Record review of Resident #52's physician order's (no date) indicated risperidone tablet 0.25mg was taken daily for bipolar starting on 12/22/22. Record review of the care plan (no date) indicated Resident #52's focus was on antidepressant medication used related to bipolar depression. The goal indicated Resident #52 would be free from discomfort or adverse reactions. The interventions included to give antidepressant medications ordered by the physician and to monitor the side effects and effectiveness. Record review of Resident #52's PASRR Level 1 Screening completed on 07/12/22 by the facility indicated in section C0100 no evidence this individual had a mental illness. Record review of the electronic health record revealed the facility had not completed a Form 1012 (form that assists nursing facilities in determining whether a resident needs further evaluation for mental illness) for Resident #52. During an interview on 03/22/23 at 10:33 AM, the MDS coordinator stated Resident #52 should have had a 1012 form completed due to her bipolar diagnosis. The MDS coordinator stated she was responsible for completing the PASRR's and the MDS resource assisted with quarterly audits. The MDS coordinator stated the MDS resource assisted her quarterly with running a diagnosis report on all of the facility residents to audit and made sure the residents that needed a 1012 form were completed. The MDS coordinator stated the importance of making sure PASRR's were filled out correctly was to make sure the facility was complying with state regulations. The MDS coordinator stated if the PASRR was not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 14 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few filled out correctly, the resident could have missed out on months of PASSR services that she could have benefited from. The MDS coordinator stated she missed getting the 1012 form signed on Resident #53 because she thought if they had a diagnosis of bipolar for a long time, then the form was not needed. During an interview on 03/22/23 at 1:48 PM, the DON stated he expected the MDS coordinator to complete the PASRR's accurately and the MDS coordinator was responsible. The DON stated not filling out the PASRR correctly could have impacted patient care negatively if it was not done correctly. During an interview on 03/22/23 at 1:47 PM, the Administrator stated he expected the PASRR's to be completed accurately. The Administrator stated if they were not completed accurately, then the resident could have missed out on needed PASRR services, or their services could have been delayed. The Administrator stated the MDS coordinator was responsible for making sure the PASRR was correct and the other nurse managers were responsible for looking at it as well. 2. Record review of Resident #2's face sheet, dated 03/22/2023, revealed Resident #2 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of bipolar disorder (serious mental illness characterized by extreme mood swings), schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania), and anxiety disorder (group of mental conditions characterized by excessive fear of or apprehension about real or perceived threats). Record review of the PASRR Comprehensive Service Plan was dated 11/12/2021, which indicated the date of the last annual PASRR IDT meeting for Resident #2. The annual PASSR IDT meeting for Resident #2 should have been completed in November of 2022. Record review of the MDS assessment, dated 01/11/2023, revealed Resident #2 had a serious mental illness that qualified her for PASSR services. The MDS revealed Resident #2 had clear speech and was understood by staff. The MDS revealed Resident #2 was able to understand others. The MDS revealed Resident #2 had no BIMS interview, which assessed cognitive status. Record review of the comprehensive care plan, last revised on 02/09/2023, revealed Resident #2 was PASSR positive for diagnosis of schizoaffective disorder and bipolar disorder. The interventions included: IDT meeting to be completed as required. During an interview on 03/22/2023 at 5:44 PM, MDS Coordinator G stated Resident #2 was still on PASSR services. MDS Coordinator G stated an annual IDT meeting was scheduled today for next week. MDS Coordinator G stated the facility had not had a social worker and she was trying to keep up with everything herself and she just missed Resident #2's annual IDT PASSR meeting. MDS Coordinator G stated it was important to coordinate Resident #2's annual PASSR IDT meetings to ensure Resident #2 continued with PASSR services and to stay in compliance. During an interview on 03/22/2023 at 6:08 PM, the DON stated the MDS coordinator was responsible for ensuring annual IDT PASSR meetings were completed. The DON stated the MDS Coordinator was usually good at keeping up with annual IDT PASSR meetings and she just probably overlooked Resident #2's. The DON stated annual IDT PASSR meetings were important to ensure Resident #2 continued services she was entitled to. During an interview on 03/22/2023 at 7:32 PM, the Administrator stated the MDS Coordinator or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 15 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Social Worker was responsible for ensuring annual IDT PASSR meetings were conducted. The Administrator stated he expected annual IDT PASSR meetings to be conducted. The Administrator stated ensuring annual IDT PASSR meetings were conducted was important to ensure residents receive the extra care and services for their diagnoses and because state wanted to make sure they were being completed. Record review of the guidelines followed by the facility What is PASSR?, undated, did not address timelines for annual IDT PASSR meetings. During an interview on 03/22/23 at 1:47 PM, the facility's policy was requested from the Administrator and was not provided. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 16 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to implement a comprehensive person-centered care plan to meet resident's medical, nursing, mental and psychosocial needs identified in the comprehensive assessment for 1 of 20 residents reviewed for care plans. (Resident #38) The facility failed to ensure Resident #38's oral or dental status was care planned. These failures could place the residents at increased risk of not having their individual needs met and a decreased quality of life. The findings included: Record review of Resident #38's face sheet, dated 03/20/2023, revealed Resident #38 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of unspecified dementia without behavioral disturbances (group of symptoms that affects memory, thinking and interferes with daily life), PTSD (mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback and avoidance of similar situations), and schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania). Record review of Initial admission Record assessment, dated 12/30/2022, revealed Resident #38 had carious (cavities), loose, missing, and broken teeth. Record review of the MDS assessment, dated 01/04/2023, revealed Resident #38 had clear speech and was usually understood by staff. The MDS revealed Resident #38 was able to understand others. The MDS revealed Resident #38 had a BIMS score of 0, which indicated severe cognitive impairment. The MDS revealed Resident #38 required extensive assistance with personal hygiene that included brushing her teeth. The MDS revealed Resident #38 required a mechanically altered diet. The MDS revealed Resident #38 had no broken, carious, loose, or missing teeth. Record review of Resident #38's comprehensive care plan, dated 01/13/2023, did not address dental status. During an observation and interview on 03/20/2023 at 10:15 AM, Resident #38 was sitting up in her bed with the head of the bed elevated slightly. Resident #38 had her breakfast tray sitting on the bedside table in front of her. Resident #38 had eaten about 50% of her ground sausage with gravy and about 50% of her scrambled eggs. Resident #38 showed and pointed to her teeth when the surveyor asked about eating. Resident #38 had missing bottom and top middle teeth. She was able to wiggle her bottom, right lateral incisor (tooth to the right of her middle teeth). Resident #38 also had red, inflamed gums and brown discoloration between her teeth and near the gums. Resident #38 stated her teeth did not hurt, but her teeth made it difficult to eat. During an interview on 03/22/2023 at 4:24 PM, CNA E stated Resident #38 did not require assistance with eating. CNA E stated Resident #38 usually would eat her breakfast tray until lunch time. CNA E stated she had not noticed Resident #38's loose or missing teeth. CNA E stated Resident #38 had not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 17 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few complained of dental pain to her knowledge. CNA E stated oral hygiene and care was important to keep Resident #38 healthy and able to eat. During an interview on 03/22/2023 at 4:41 PM, RN F stated she normally worked with Resident #38. RN F stated she was unaware of Resident #38's missing, loose, carious, and broken teeth. RN F stated she would not have had any reason to look at Resident #38's mouth. RN F stated she was unsure if Resident #38 had a referral to the dentist. RN F stated it took Resident #38 a while to eat. RN F stated Resident #38 ate independently with supervision. RN F stated oral health was important to prevent decline in oral intake and to prevent weight loss. During an interview on 03/22/2023 at 5:44 PM, MDS Coordinator G stated when completing the MDS assessment she looked at the initial assessment record to accurately code section L (oral or dental status) of the MDS. MDS Coordinator G stated she probably did not see the initial admission record when she was completing the MDS assessment but was unsure because it was completed a few months ago. MDS Coordinator G stated the oral status should have been accurately coded, so an appropriate plan of care was developed and implemented. MDS Coordinator G stated it was important to ensure oral or dental status was accurately coded to ensure Resident #38's dental status was care planned and appropriate interventions were put in place. During an interview on 03/22/2023 at 6:08 PM, the DON stated MDS was responsible for ensuring dental status was care planned. The DON stated he was responsible for overseeing the MDS department. The DON stated he was not aware Resident #38 had missing, loose, carious, and broken teeth. The DON stated it was important to ensure the care plan accurately reflected the dental status so the residents' received the appropriate care and services. During an interview on 03/22/2023 at 7:32 PM, the Administrator stated he expected the MDS Coordinator to accurately reflect the residents oral or dental status on the MDS. The Administrator stated it was important to accurately reflect the dental status on the MDS so a care plan could have been developed to ensure the resident received the correct diet, dental referral, and the IDT could have monitored the dental status. Record review of the Comprehensive Person-Centered Care Planning policy, last revised 01/2022, revealed 4. The facility IDT will develop and implement a comprehensive person-centered care plan for each resident within 7 days of completion of the Resident Minimum Data Set (MDS) and will include resident's needs identified in the comprehensive assessment . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 18 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 review, the facility failed to ensure that the comprehensive care plan was reviewed by the interdisciplinary team and that the resident representative was invited to participate in developing the care plan and making decisions about his or her care for 1 of 24 resident reviewed for care plan timing and revision. The facility failed to ensure Resident #26's resident representative was invited to participate in the development, review, and revision of her care plan. This failure could place residents at risk of not being able to attain or maintain their highest practicable level of physical, mental, and psychosocial well-being. Findings included: Record review of a face sheet dated 03/22/2023, revealed Resident #26 was a [AGE] year-old female initially admitted on [DATE] and re-admitted on [DATE] with diagnoses which included, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety(loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life), major depressive disorder, recurrent, severe with psychotic symptoms (a serious mood disorder involving one or more episodes of intense psychological depression or loss of interest or pleasure that lasts two or more weeks), and chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of the quarterly MDS assessment dated [DATE] revealed Resident #26 was understood and understood others. The MDS assessment revealed Resident #26's cognition was not assessed. The MDS assessment revealed Resident #26 required extensive assistance with bed mobility, transfers, dressing, toilet use and personal hygiene and supervision for eating. Record review of Resident #26's care plan with a target date of 04/01/2023 revealed, Resident #26 wished to remain long term in the facility and had an intervention of inviting the resident and requested family to care plan quarterly and as needed. During an interview on 03/20/2023 at 4:00 PM, Resident #26's resident representative stated she had not been invited to participate in a care plan meeting in over 3 months. Resident #26's resident representative stated it had been so long that she could not remember when the last one was. During an interview on 03/21/2023 at 1:55 PM, the DON stated the social worker was responsible for the care plan meetings, and the care plan meetings were documented in the electronic health record under the assessments as an IDT care plan review. Record review of the electronic health record on 03/22/2023 revealed Resident #26 last IDT care plan review was on 08/25/2021 and the care plan review was incomplete. During an interview on 03/22/2023 at 5:50 PM, ADON Q stated the social worker was responsible for setting up the care plan meetings. ADON Q stated the care plan meetings should be done on admission, quarterly and with any changes in condition and the family and IDT should be present. ADON Q stated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 19 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 she was not sure what happened that Resident #26 had not had a care plan meeting since 08/25/2021. ADON Q stated the care plan meetings were monitored by the system. The system in the electronic health record notified the facility staff when a resident required a care plan meeting. ADON Q stated it was important to have care plan meetings to review the plan of care and to update the family on how the resident was doing, and if the family had any concerns, they could verbalize them. Residents Affected - Few During an interview on 03/22/2023 at 6:20 PM, the administrator stated the social worker was responsible for scheduling the care plan meetings. The administrator stated he expected the social worker to schedule the care plan meetings and for them to be done as required. The administrator stated it was important for the care plan meetings to be done to ensure the staff was providing the residents the care they needed, to find out from the family the residents likes/dislikes, and to improve the resident's quality of life. During an interview on 03/22/2023 at 6:48 PM, the DON stated the social worker was responsible for the care plan meetings and was responsible for monitoring to ensure they were occurring. The DON stated the resident's family, and the IDT should be present to review the care plan. The DON stated he did not know why Resident #26 had not had a care plan meeting since 08/25/2021. The DON stated care plan meetings should be done on admission, quarterly, and with any changes in condition. The DON stated it was important to have care plan meetings to discuss the residents plan of care, and not having the care plan meetings they could miss the opportunity for the family or resident to discuss their care. During an interview on 03/22/2023 at 7:25 PM, the social worker stated she was responsible for the care plan meetings. The social worker stated she monitored the care plan meetings by using the system in the electronic health record to know when a resident required a care plan meeting. The social worker stated care plan meetings should be done on admission, quarterly, and with any changes in condition. The social worker stated the care plan meetings should be done with the family and the IDT. The social worker stated it was important to have care plan meetings because it gave the family and the resident time to voice their concerns and the family could be updated on the resident's care. The social worker stated she was new at the facility (started 01/30/2023), and she did not know why Resident #26's care plan meetings had not been done. Record review of the facility's policy titles Comprehensive Person-Centered Care Planning, last revised 01/2022 revealed, . The resident's comprehensive plan of care will be reviewed and/or revised by the IDT after each assessment, including both the comprehensive and quarterly review assessments. 7. The facility IDT includes, but is not limited to the following professionals: A. Attending physician or Non-Physician Practitioner (NPP) designee involved in resident's care; B. Registered Nurse with responsibility for the resident; C. Nurse Aide with responsibility for the resident D. Member of the Food and Nutrition services staff E. To the extent practicable, resident/or resident representative . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 20 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure that it was free of medication error rate of 5 percent or greater. The facility had a medication error rate of 27.78%, based on 10 errors out of 36 opportunities, which involved 1 of 6 residents (Resident #231) reviewed for medication administration. Residents Affected - Few The facility failed to ensure Resident #231 received Eliquis (prevent blood clots), escitalopram (treat depression), Namenda (treat dementia), Protonix (treat acid reflux), potassium chloride (mineral supplement), vitamin B12 (supplement), cholecalciferol (supplement), calcium (supplement), ocuvel (supplement), and magox (supplement). This failure could place residents at risk for not receiving the intended therapeutic benefit of their medications or receiving them as prescribed, per physician orders. Findings included: 1. Record review of Resident #231's order summary report, dated 03/22/2023, indicated Resident #231 was an [AGE] year-old female, admitted to the facility on [DATE] with a diagnosis included encephalitis (inflammation of the brain), essential hypertension (high blood pressure), and peripheral vascular disease (reduced circulation of blood to a body part). Further review of Resident #231's order summary report, dated 03/22/2023, indicated Resident #231 was prescribed Eliquis tablet, 2.5 mg by mouth two times a day for A-fib (irregular, often rapid heart rate) with a start date 03/10/2023; escitalopram oxalate tablet, 10 mg by mouth one time a day for depression with a start date 03/10/2023; Namenda tablet,10 mg by mouth two time a day for dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life); Protonix tablet, 40 mg by mouth one time a day for GI bleed (bleeding in the digestive tract) with a start date 03/10/2023; potassium chloride tablet, 10 meq by mouth two times a day for hypokalemia (low blood level in potassium) with a start date 03/10/2023; vitamin B12 tablet,1000 mcg by mouth one time a day for supplementary vitamin with a start date 03/10/2023; cholecalciferol capsule,125 mcg by mouth one time a day for supplementary vitamin with a start date 03/10/2023; calcium tablet, 600-400 mg-unit by mouth one time a day for supplementary vitamin with a start date 03/10/2023; ocuvel capsule (dose was not addressed) by mouth one time day for supplement with a start date 03/14/2023; and magox tablet, 400 mg by mouth a day for supplement with a start date 03/14/2023. Record review of the MAR dated 03/01/2023-03/31/2023 indicated Resident #231 had an order for vitamin B12 1000 mcg, calcium 600-400 mg-unit, cholecalciferol 125 mcg, escitalopram oxalate 10 mg, mag ox 400 mg, ocuvel, Eliquis 2.5 mg, potassium chloride 10 meq and Namenda 10 mg to be given at 9:00 a.m. Record review of the MAR dated 03/01/2023-03/31/2023 indicated Resident #231 had an order for Protonix 40 mg to be given at 7:30 a.m. During an observation on 03/22/2023 at 10:17 a.m., MA K administered Eliquis, vitamin B12, calcium, cholecalciferol, escitalopram oxalate, mag ox, ocuvel, potassium chloride, Namenda, and Protonix at 10:17 a.m. to Resident #231. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 21 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0759 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 03/22/2023 at 10:40 a.m., MA K stated the Protonix should have been given between 6:30 a.m. and 8:30 a.m. MA K stated the other medications should have been given between 8:00 a.m. and 10:00 p.m. MA stated she had an hour before the scheduled time and an hour after the scheduled time. MA K stated medications were given late due to her passing medications on other halls. MA K stated she had passed medications late before but not consistently. MA K stated this failure could potentially cause bleeding, and interactions with other medications. During an interview on 03/22/2023 at 4:32 p.m., the DON stated he expected medications to be given on time. The DON stated he spoke with MA K to see why the medications were delayed and she stated, the reason behind her not being able to administer the medications was due to stopping in between to help residents with toileting and other needs. The DON stated there had been complaints from residents stating their medications were not given in a timely manner. The DON stated the medication times were adjusted to the resident's preference. The DON stated prior to surveyor intervention there was not a system breakdown to ensure timely medication administration. The DON stated the failure of not administering medications on time were not following the physician's order and interactions with other medications. During an interview on 03/22/2023 at 6:51 p.m., the Administrator stated he expected medications to be given at the correct time. The Administrator stated this failure could cause interactions with other medications and a blood clot. Record review of the facility's policy titled, Physician Orders, revised on 05/2007 indicated, . it is the policy of this facility that drugs and treatments shall be administered/carried out upon the order of a person duly licensed and authorized to prescribe such drugs and treatments . Record review of the facility's policy titled, Medication Administration-Oral, revised on 05/2007 did not address administering medications in a timely manner. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 22 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0790 Provide routine and 24-hour emergency dental care for each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to assist residents in obtaining routine dental services to meet the needs of 1 of 1 (Resident #38) residents reviewed for dental services. Residents Affected - Few The facility failed to ensure Resident #38 received dental services when she had carious, missing, loose, and broken teeth. These failures could place residents at risk of not receiving needed dental care and a decreased quality of life. The findings included: Record review of Resident #38's face sheet, dated 03/20/2023, revealed Resident #38 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of unspecified dementia without behavioral disturbances (group of symptoms that affects memory, thinking and interferes with daily life), PTSD (mental health condition that develops following a traumatic event characterized by intrusive thoughts about the incident, recurrent distress/anxiety, flashback and avoidance of similar situations), and schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania). Record review of Initial admission Record assessment, dated 12/30/2022, revealed Resident #38 had carious (cavities), loose, missing, and broken teeth. Record review of the MDS assessment, dated 01/04/2023, revealed Resident #38 had clear speech and was usually understood by staff. The MDS revealed Resident #38 was able to understand others. The MDS revealed Resident #38 had a BIMS score of 0, which indicated severe cognitive impairment. The MDS revealed Resident #38 required extensive assistance with personal hygiene that included brushing her teeth. The MDS revealed Resident #38 required a mechanically altered diet. The MDS revealed Resident #38 had no broken, carious, loose, or missing teeth. Record review of Resident #38's comprehensive care plan, dated 01/13/2023, did not address dental status. Record review of the progress notes from 12/20/2023 to 01/15/2023, printed 03/21/2023, revealed no dental referral had been made for Resident #38. Record review of the DNT Patients for the mobile dentistry, printed on 02/08/2023, revealed Resident #38 was not on the do not treat list for the mobile dentistry services. Record review of the List of Everyone on Services, printed on 03/08/2023, revealed Resident #38 was not on the mobile dentistry services. During an observation and interview on 03/20/2023 at 10:15 AM, Resident #38 was sitting up in her bed with the head of the bed elevated slightly. Resident #38 had her breakfast tray sitting on the bedside table in front of her. Resident #38 had eaten about 50% of her ground sausage with gravy and about 50% of her scrambled eggs. Resident #38 showed and pointed to her teeth when the surveyor asked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 23 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0790 Level of Harm - Minimal harm or potential for actual harm about eating. Resident #38 had missing bottom and top middle teeth. She was able to wiggle her bottom, right lateral incisor (tooth to the right of her middle teeth). Resident #38 also had red, inflamed gums and brown discoloration between her teeth and near the gums. Resident #38 stated her teeth did not hurt, but her teeth made it difficult to eat. Resident #38 was unable to tell the surveyor if a dental referral had been made. Residents Affected - Few During an interview on 03/21/2023 at 2:33 PM, the DON stated the social worker was usually responsible for completing the referrals for dental. The DON stated while there was no social worker, himself, the DOR, or the admission Coordinator was responsible for completing the dental. The DON stated all long-term care residents should have been seen by the dental company every quarter and as needed. The DON stated approximately 3.5 months ago they were having an issue with the billing of the dental company and had to switch to a new dental company. The DON stated if a resident was admitted to the facility for long-term care back in December 2022, the resident should have already been seen by the dentist. The DON stated the mobile dentist came to the facility at least every quarter. During an interview on 03/21/2022 at 4:13 PM, Resident #38's family member stated Resident #38's teeth were in poor condition. The family member stated she was not asked about a dental referral, and she was unsure if one had been made. The family member stated it took Resident #38 a while to eat her food, but she tried to eat it all. During an interview on 03/22/2023 at 4:24 PM, CNA E stated Resident #38 did not require assistance with eating. CNA E stated Resident #38 usually would eat her breakfast tray until lunch time. CNA E stated she had not noticed Resident #38's loose or missing teeth. CNA E stated Resident #38 had not complained of dental pain to her knowledge. CNA E stated oral hygiene and care was important to keep Resident #38 healthy and able to eat. During an interview on 03/22/2023 at 4:41 PM, RN F stated she normally worked with Resident #38. RN F stated she was unaware of Resident #38's missing, loose, carious, and broken teeth. RN F stated she would not have had any reason to look at Resident #38's mouth. RN F stated she was unsure if Resident #38 had a referral to the dentist. RN F stated it took Resident #38 a while to eat. RN F stated Resident #38 ate independently with supervision. RN F stated oral health was important to prevent decline in oral intake and to prevent weight loss. During an interview on 03/22/2023 at 5:34 PM, the Social Worker stated she was responsible for making dental referrals. The Social Worker stated she started at the facility on 01/30/2023 and the mobile dentistry was already seeing residents. The Social Worker stated she created a binder to keep track of the referral process. The Social Worker stated when residents or resident's representative requested dental services the referral was made to the mobile dentistry. The Social Worker stated if Resident #38 was not on the lists for services she was either newly admitted to the facility or the family had not requested services. The Social Worker stated she was unaware Resident #38 had carious, loose, missing, and broken teeth. The Social Worker stated referring residents to mobile dentistry was important to prevent infection and increase health. During an interview on 03/22/2023 at 6:08 PM, the DON stated he was not aware Resident #38 had missing, loose, carious, and broken teeth. The DON stated Resident #38 should have already had a dental referral. The DON was unsure why Resident #38 had not received a referral. The DON stated dental referrals were important to ensure residents receive the appropriate care and services. The DON stated dental problems could have led to weight loss and decreased nutrition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 24 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0790 Level of Harm - Minimal harm or potential for actual harm During an interview on 03/22/2023 at 7:32 PM, the Administrator stated he expected the MDS Coordinator to accurately reflect the residents oral or dental status on the MDS. The Administrator stated it was important to accurately reflect the dental status on the MDS so a care plan could have been developed to ensure the resident received the correct diet, dental referral, and the IDT could have monitored the dental status. Residents Affected - Few Record review of the Dental Services policy, last revised in 01/2022, revealed In order to comply with the Facility's obligations as set forth in 42 CFR Section 483.55, the Facility will: Provide, or obtain from an outside resource, routine and emergency dental services for each resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 25 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide food that was palatable and served at an appetizing temperature for 8 of 20 residents reviewed for palatable food. (Resident #239, Resident #240, and 6 residents in a confidential group). Residents Affected - Some The facility failed to provide palatable food served at an appetizing temperature for Resident #239, Resident #240, and 6 residents in a confidential group. This failure could place residents who ate food from the kitchen at risk of weight loss, altered nutritional status, and diminished quality of life. Findings included: 1. Record review of Resident #239's face sheet dated 3/21/23 revealed she was an [AGE] year-old, female, and admitted to the facility on [DATE] with diagnoses of fracture of right ischium (broken right pelvis), history of falls, diabetes (disease of too much sugar in the blood), pain, and history of lung cancer. Record review of Resident #239's MDS revealed it had not been completed. Record review of Resident #239's BIMS assessment dated [DATE] revealed a BIMS of 15, which indicated she was cognitively intact. Record review of Resident #239's initial care plan dated 3/18/23 revealed she had a potential nutritional problem related to a disease process. Record review of the Resident #239's order summary report dated 3/21/23 revealed an order for a regular diet. During an interview on 3/20/23 at 4:34 PM, Resident #239 revealed the food was served cold and had no taste, especially the breakfast. She said breakfast was served with a top cover over a regular plate and did not have the bottom cover . During an observation and interview on 3/21/23 at 8:20 AM revealed a staff member delivered Resident #239's breakfast with just the top insulator covering a regular plate and sat the tray on the resident's bedside table and removed the top cover. Resident #239 said her food was cold again this morning and there was no salt or pepper for the egg. She said the whole plate was cold and asked the surveyor to touch the bottom of the plate, which reflected it was cool to touch. Resident #239 was served a hard fried egg, a biscuit, and 2 sausage patties and there were no condiments on the resident's tray to season the food. During an interview on 3/22/23 at 11:43 AM Resident #239 said her breakfast was cold again that morning, but there was an insulated cover on both the top and bottom of the plate. She said her pancakes were cold and would not melt her butter and her oatmeal was barely warm. She said lunch and dinner were usually warm, but nothing had any flavor, and they did not put salt or pepper on her trays. 2. Record review of Resident #240's face sheet dated 3/22/23 revealed she was a [AGE] year-old, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 26 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some female, and admitted to the facility on [DATE] with diagnoses of aortic valve stenosis (narrowing of the valve in the large blood vessel branching off the heart), aortic valve replacement (surgical replacement of the valve in the large blood vessel branching off the heart), diabetes (disease of too much sugar in the blood), hypertension (high blood pressure), paroxysmal atrial fibrillation (irregular, often rapid heart rate that causes poor blood flow), and chronic kidney disease (long term disease of the kidneys that effects the kidney's ability to filter waste and excess fluid from the blood). Record review of Resident #240's MDS revealed it had not been completed. Record review of Resident #240's BIMS assessment dated [DATE] revealed a BIMS of 14, which indicated she was cognitively intact. Record review of Resident #240's initial care plan dated 3/20/23 revealed the resident had a potential nutritional problem related to malnutrition. Record review of Resident #240's order summary report dated 3/22/23 revealed an order for a regular low concentrated sweets and no added sodium diet. During an interview on 3/22/23 at 11:52 AM Resident #240 revealed her breakfast was cold that morning, the eggs were overcooked, and there were no seasonings on the eggs or on her plate. She said the lunch pot roast yesterday was good, but the potatoes had no flavor, and the spinach was awful and tasted like it was just poured out of a can. She said she loved spinach and potatoes, but was unable to eat them, because they had no flavor. 3. During a confidential resident group meeting six out of six residents stated the food was not good at all. They stated most of the meals were cold and needed more seasoning. They stated the issue had been reported to staff but could not recall their names. They stated an alternative or substitution was usually requested. 4. During an observation and interview on 03/21/2023 at 12:36 p.m. a lunch tray was sampled by the Dietary Manager and five surveyors. The sample tray consisted of roast beef, potatoes & onions, spinach, a roll, and a brownie. The potatoes & onions were bland. The spinach was bland. The Dietary Manager stated the spinach and potatoes & onions were bland. There were no issues with the temperature of the food items tested. During an interview on 3/21/23 at 12:43 PM, the Dietary Manager revealed all meal trays for the residents on the hallways should have both top and bottom insulators to keep the plates warm during transport. She said if the resident's plate did not have the top and bottom insulators, the plate and food would cool down quicker. She said she was not in the facility during the breakfast service and was not aware the breakfast trays were served without the bottom insulator, but they should have had both a top and bottom insulator to keep the plates warm. Record review of the grievance resolution form dated 11/29/2022 indicated a resident complained about her meals being cold. The resolution stated the ADON informed the social worker a new scheduling system was set to be in place to reduce wait times for trays at mealtime. The Interim Administrator was working to correct issue. During an interview on 03/22/2023 at 1:47 p.m., CNA L stated residents complained to her about food (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 27 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some not being seasoned. CNA L stated she offered the residents an alternative. CNA L stated all food complaints were reported to the charge nurse. CNA L stated resident's not eating their food could potentially cause weight loss. During an interview on 03/22/2023 at 1:55 p.m., LVN A stated residents complained to him about the food being bland. LVN A stated they could tell by the intake amount that some residents did not like the meal that day. LVN A stated he had reported the complaints to the dietician. LVN A stated he offered the residents an alternative. LVN A stated resident's not eating their food could potentially cause weight loss. During an interview on 03/22/2023 at 3:00 p.m., the Dietary Manager stated she had not received any food complaints from staff or residents. The Dietary Manager stated she visited with residents randomly to see if there were any complaints about the food. The Dietary Manager stated she monitors by tasting each meal selection daily through a regular and pureed diet. The Dietary Manager stated previously a test tray was done with the dietician that raised concerns or palatability seasoning. The Dietary Manager stated a verbal in-service was done with the cook that prepared the meal. The Dietary Manager stated there was an ongoing issue with a certain cook. The Dietary Manager stated if she was not supervised by a manager or team lead, she did not follow the menu directions on how to properly season the food. The Dietary Manager stated the test tray that was given to the surveyors was prepared by the cook that was already being monitored for ensuring the food was aligned with the policy and procedures. The Dietary Manager stated this failure could potentially cause weight loss and decrease in residents' independence. During an interview on 03/22/2023 at 6:51 p.m., the Administrator stated he expected all food to be palatable. The Administrator stated he had not received any food complaints from residents or staff. The Administrator stated a test tray was done randomly and he did not notice any issues with flavor. The Administrator stated this failure would result in residents not eating their vegetables which then could result in decreased nutritional values. Record review of the Dietary Services policy, last revised on 10/2022, indicated .1. Director of food service responsibilities . J. Assure food that was served palatable . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 28 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0808 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure food was prepared in a form designed to meet individual needs and as prescribed by the physician for 2 of 3 residents (Resident #48 and Resident #26) reviewed for therapeutic diets. The facility failed to ensure Resident #48 received a pureed diet as ordered by the physician. The facility failed to ensure Resident #26 received a mechanical soft diet as ordered by the physician. This failure could place residents at risk for poor intake, weight loss, unmet nutritional needs, choking, and aspiration (when food or drinks enter the lungs). Findings Included: 1.Record review of a face sheet dated 03/22/2023, revealed Resident #26 was a [AGE] year-old female initially admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses which included, unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (loss of memory, language, problem solving and other thinking abilities that were severe enough to interfere with daily life), major depressive disorder, recurrent, severe with psychotic symptoms (a serious mood disorder involving one or more episodes of intense psychological depression or loss of interest or pleasure that lasts two or more weeks), and chronic obstructive pulmonary disease (chronic inflammatory lung disease that causes obstructed airflow from the lungs). Record review of the quarterly MDS assessment dated [DATE] revealed Resident #26 was understood and understood others. The MDS assessment revealed Resident #26's cognition was not assessed. The MDS assessment revealed Resident #26 required supervision for eating. The MDS assessment revealed Resident #26 required a mechanically altered diet (require change in texture of food or liquids examples: pureed food, thickened liquids). Record review of Resident #26's care plan with a target date of 04/01/2023 revealed Resident #26 had a nutritional problem or potential nutritional problem related to diet orders with mechanically altered diet with therapeutic diet with interventions that included diet as ordered by the physician, mechanical soft diet and thin liquids. Record review of the order summary report dated 03/20/2023 revealed Resident #26 had an order of NAS diet mechanical soft texture, thin liquids consistency, health shake with meals, divided plate start date of 11/22/2021. During an observation and interview of the lunch meal on 03/20/23 starting at 12:15 PM revealed Resident #26 had a meal ticket that indicated a mechanical soft diet. Resident #26 had a package of croutons on her lunch tray. Resident #26 was attempting to open the package to start eating them. The Surveyor intervened and LVN A stated Resident #26 should not have received the croutons and took them. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 29 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0808 Level of Harm - Minimal harm or potential for actual harm During an interview on 03/22/23 at 7:53 AM, LVN A stated at mealtime he should check the meal tray with the meal ticket and make sure the meal tray went to the right person. LVN A stated Resident #26 received the croutons due to him being nervous and not checking the trays correctly. LVN A stated CNA D should have also checked the meal tray before giving it to Resident #26. LVN A stated Resident #26 could have choked because of her swallowing deficiencies. Residents Affected - Few During an interview on 03/21/2023 at 3:50 PM the Dietician stated residents on a mechanical soft diet should not have received croutons with their meal. The Dietician stated the nurse in the dining area should have checked all the trays to ensure the diet matched the items on the tray. The Dietician stated Resident #26 received croutons on her tray due to the dietary aide had set up all the meal trays with croutons, but the nurse in the dining room should have checked the meal trays before they were passed out. The Dietician stated the Dietary Manager was responsible for ensuring the dietary aide set up the trays with the correct diet. The Dietician stated it was important for the residents to receive the correct diet for their safety. The Dietician stated Resident #26 receiving croutons on her tray could have caused her to choke or aspirate. During an interview on 03/21/2023 at 3:56 PM the Dietary Manager stated, I am responsible for making sure the trays are set up correctly. The Dietary Manager stated she ensured the trays were set up correctly by the dietary aides by watching them as they served the meals. The Dietary Manager stated she went between areas of the kitchen while the kitchen staff served. The Dietary Manager stated she had noticed the croutons were on all the trays, but by the time she noticed the trays had already been sent to the residents. The Dietary Manager stated the nurse was supposed to check the residents' meal trays before the staff passed out the trays. The Dietary Manager stated she did in-services with her staff to train them on setting up the meal trays. The Dietary Manager stated she did in-services when she noticed something was wrong, monthly, and as needed with all the dietary staff. The Dietary manager stated it was important for the residents to receive the correct diet, so they did not choke. During an interview on 03/21/2023 at 4:07 PM, Dietary Aide P stated she had set up all the trays with croutons before putting the meal tickets on the trays. Dietary Aide P stated was supposed to check the items on the tray with the meal ticket. Dietary Aide P stated a resident on mechanical soft diet should not have received croutons. Dietary Aide P stated the Dietary Manager taught her what each diet should receive on a meal tray. Dietary Aide P stated she guessed it was a mistake that the croutons were left on Resident #26's meal tray. Dietary Aide P stated Resident #26 could have choked on the croutons if she had eaten them. During an interview on 03/22/2023 at 5:57 PM, ADON Q stated a resident on mechanical soft diet should not have received croutons. ADON Q stated the nurse checking the meal trays was responsible for making sure the residents received the correct diet. ADON Q stated the nurse managers were responsible for making sure the nurses checked the trays at meals before they were passed out to the residents. ADON Q stated this was monitored by the nurse managers going to the dining area during meals to ensure the nurses were checking the trays. ADON Q stated she was not sure which nurse manager was supposed to be in the dining room when Resident #26 received the croutons. ADON Q stated it was important for the residents to receive the correct diet, so the residents did not choke or aspirate. During an interview on 03/22/2023 at 6:22 PM, the administrator stated the nurses were responsible for making sure the residents received the correct diet. The administrator stated it was not okay for a resident on a mechanical soft diet to receive croutons. The administrator stated he expected the nurses to ensure all residents received the correct diet. The administrator stated he did not know (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 30 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0808 what harm could be caused by giving a resident the wrong diet. Level of Harm - Minimal harm or potential for actual harm During an interview on 03/22/2023 at 6:52 PM, the DON stated the Dietary Manager, and the nurses were responsible for making sure the residents received the correct diet. The DON stated the ADONs and himself did trainings monthly with the staff to discuss the nurse checking the trays. The DON stated a resident on a mechanical soft diet should not have received croutons on their tray. The DON stated the dietary aide had put croutons on Resident #26's meal tray, but the nurse should have taken it off before it got to the resident. The DON stated Resident #26 could have aspirated if she ate the croutons. Residents Affected - Few During an attempted phone interview on 03/22/2023 at 7:41 PM, CNA D did not answer the phone 2.Record review of Resident #48's face sheet dated 03/33/23 indicated he was an [AGE] year-old male that was admitted to the facility on [DATE]. Resident #48 had a diagnoses of dementia (loss of intellectual functioning and memory impairment), dysphagia (difficulty swallowing), and type 2 Diabetes Mellitus (how the body processes blood sugar). Record review of Resident #48's comprehensive MDS assessment dated [DATE] revealed, Resident #48 usually made self-understood and usually understood others. Resident #48's BIMS score was 00 indicating severe cognitive impact. The MDS indicated Resident #48 was on a mechanically altered diet and a therapeutic diet. Record review of Resident #48's care plan (no date) indicated he had a potential for nutritional problems related to dementia. The goal indicated to maintain an adequate nutritional status as evidenced by maintaining weight with no signs or symptoms of malnutrition through the review date. The interventions included for occupational therapy to screen and provide adaptive equipment for feeding as needed. Resident #48 had a swallowing problem related to coughing and choking during meals or swallowing medications. The goals included to have no choking episodes when eating through the review date, to follow the prescribed diet, and for all staff to be informed of the resident's special dietary and safety needs. Record review of the order summary report dated 03/22/2023 revealed Resident #48 had a diet order for pureed texture with thin liquids started 07/05/2022. During an observation and interview on 03/20/23 at 12:17 PM, Resident #48 received croutons on his lunch meal tray. Resident #48's meal ticket revealed he was on a pureed diet. Resident #48's family member was feeding him and stated, He's on a pureed diet and I don't know why they gave him these. The family member stated, I know what he is supposed to have, so I just don't give it to him if he cannot have it. During an interview on 03/20/23 at 12:30 PM, LVN A stated he checked the meal tray for Resident #48 and saw the croutons on the tray. LVN A stated he did not know what was in the individual package or he would not have given it to Resident #48. LVN A stated if staff was feeding Resident #48 and not a family member, then they still would have made sure Resident #48 did not get the croutons. During an interview on 03/22/23 at 1:30 PM, Resident #48's family member stated she fed Resident #48 his lunch every day and the facility had given him the wrong meal on several occasions. The family member stated, I will fuss at them about giving him the wrong meal and they will do good for a little while. The family member stated she had reported her concerns to staff several times but could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 31 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0808 not remember which ones. Level of Harm - Minimal harm or potential for actual harm During an interview on 03/22/23 at 1:34 PM, LVN B stated the charge nurses were responsible for checking meal trays in the main dining room and when they come out on the carts for the halls. LVN B stated not checking the trays could result in residents choking if they were given the wrong diet. Residents Affected - Few During an interview on 03/22/23 at 1:38 PM, the dietary manager stated it was her responsibility to check the trays before they left the kitchen. The dietary manager stated the meal trays were double checked by her and the kitchen aid before they left the kitchen. The dietary manager stated once the trays left the kitchen the charge nurses were responsible for checking them a third time. The dietary manager stated Resident #48 should not have gotten croutons on a pureed diet because Resident #48 could have choked on them. The dietary manager stated it was the nurse's responsibility to make sure the tray was right. The dietary manager stated kitchen staff had set all the trays up prior to adding the meal tickets on them with the croutons. The dietary manager stated that was not a good way to set up trays and the facility will never do that again. During an interview on 03/22/23 at 1:48 PM, the DON stated Resident #48 should not have received the croutons because he was on a pureed diet. The DON stated the dietary manger was responsible for checking the meal tray prior to it leaving the kitchen along with the kitchen aid, and the charge nurse was responsible for checking the tray before giving it to the resident. The DON stated Resident #48 could have aspirated on the croutons or it could have caused harm to other residents if they received the wrong trays. During an interview on 03/22/23 at 1:47 PM, the Administrator stated he expected the residents to receive the correct diet on their meal trays. The Administrator stated Resident #48 should not have received croutons on a pureed diet and it could have been a choking hazard for the resident. The Administrator stated the charge nurses were responsible for making sure the trays were correct prior to giving them to residents. Record review of the, Diet and Nutrition Care Manual, dated 2021 indicated, food characteristics to avoid on a pureed diet were: crumbly bits, crispy or dry food. Record review of the facility's policy on, Meals and Food, dated 06/2017 indicated, the dietary manager was responsible for the total food service of the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 32 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 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 safety in the facility's only kitchen. Residents Affected - Some The facility failed to ensure: 1. The juice machine spigot was clean 2. The microwave was clean and free of food debris. 3. The cooking grease in the deep fryer was kept clean. These failures could place residents at risk for foodborne illness. Findings include: 1. During an observation in the kitchen on 03/20/2023 at 10:15 a.m., revealed yellow build up inside the microwave, a red gooey substance was observed in the juice machine spigot and dark brown grease noted inside the deep fryer. Record review of the daily cleaning schedule indicated [NAME] R was responsible for changing the grease in the deep fryer on 3/19/2023. The cleaning schedule indicated Dietary Aide S was responsible for cleaning the microwave. The cleaning schedule did not address the juice spigot. Record review of a dining services and sanitation audit dated 02/27/2023 completed by the Dietician indicated buildup was noted on the microwave and juice spigot. An attempted telephone interview on 03/22/2023 at 2:23 p.m. with [NAME] R, the cook for 03/19/2023. During an interview on 03/22/2023 at 2:27 p.m., Dietary Aide S stated the aides were responsible for cleaning the microwave after every use and the juice spigot daily. Dietary Aide S stated the cooks were responsible for changing the grease in the deep fryer. Dietary Aide S stated the fryer grease should be changed twice a week. Dietary Aide S stated she did not clean the juice spigot on 03/19/2023. Dietary Aide S stated I was busy doing other stuff.'' Dietary Aide S stated she cleaned the microwave on 03/19/2023. Dietary Aide S stated not changing the grease could alter the taste of food. Dietary Aide S stated these failures could potentially cause a food-borne illness. During an interview on 03/22/2023 at 3:00 p.m., the Dietary Manager stated cleanliness was important in the kitchen, so her staff were not spreading germs or contaminating anything. The Dietary Manager stated she was responsible for making sure the kitchen was cleaned appropriately. The Dietary Manager stated she used an order guide that was already in place upon hiring. The Dietary Manager stated she did have a cleaning log schedule with all items on it. The Dietary Manager stated all staff must follow and complete it on a daily basis. The Dietary Manager stated the aides were responsible for cleaning the juice spigot and microwave. The Dietary Manager sated the juice spigot should be cleaned daily and the microwave twice a day. The Dietary Manager sated the grease should be changed every Sunday by the cooks. The Dietary Manager stated she spot checked appliances throughout each shift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 33 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 - Some The Dietary Manager stated she had not noticed any issues. The Dietary Manager stated these failures could alter the taste of food and cause a food-borne illness. During an interview on 03/22/2023 at 4:03 p.m., the Dietician stated the microwave should be cleaned every day and the juice spigot should be taken apart and soaked overnight. The Dietitian stated the grease should be changed weekly but it really was dependent on the use. The Dietitian stated a sanitation audit was done monthly to ensure the facility was following the policy and procedures of the TFER. The Dietician stated these failures could affect palatability and cause food borne illness. During an interview on 03/22/2023 at 6:51 p.m., the Administrator stated he expected the kitchen to be clean and staff preventing cross contamination. The Administrator stated he was not familiar with how often the fryer grease should be changed or the microwave and juice spigot. The Administrator stated he conducted rounds once a week in the kitchen to ensure compliance with regulations. The Administrator stated he has not noticed any consistent issues. The Administrator stated this failure could alter the taste/quality of food and cause a food-borne illness. Record review of the facility's policy titled, Dietary, Sanitation, revised on 10/2007 indicated, . it is the policy of this facility that the food service area shall be maintained in a clean and sanitary manner . 1. All kitchens, kitchen areas, and dining areas shall be kept clean . 2. All utensils, counters shelves, and equipment shall be kept clean, maintained in good repair . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 34 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. 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 ensure safe and sanitary storage of resident's food items for 2 of 7 residents reviewed for personal food safety. (Resident's #2 and Resident #23) Residents Affected - Few The facility did not implement the personal food policy related to personal refrigerators for Resident's #2 and #23. These failures could place the residents at risk for food borne illness. The findings included: 1. Record review of Resident #2's face sheet, dated 03/22/2023, revealed Resident #2 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of bipolar disorder (serious mental illness characterized by extreme mood swings), schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania), and anxiety disorder (group of mental conditions characterized by excessive fear of or apprehension about real or perceived threats). Record review of the MDS assessment, dated 01/11/2023, revealed Resident #2 had clear speech and was understood by staff. The MDS revealed Resident #2 was able to understand others. The MDS revealed Resident #2 had no BIMS interview, which assessed cognitive status. During an observation and interview on 03/20/2023 at 10:30 AM, Resident #2 had a temperature log on her personal refrigerator that was last filled out and dated for 03/04/2023. Resident had a blue, undated, and unlabeled container of a creamy-like substance. Resident #2 was unsure how long it had been in her refrigerator. During an observation on 03/21/2023 at 10:25 AM, Resident #2 had a temperature log on her personal refrigerator that was missing temperatures for dates 03/05/2023 - 03/20/2023. Resident had a blue, undated, and unlabeled container of a creamy-like substance. 2. Record review of Resident #23's face sheet, dated 03/22/2023, revealed Resident #23 was a [AGE] year-old female who admitted to the facility on [DATE] with diagnoses of moderate intellectual disabilities (level of cognitive development and adaptive behavior that is moderately below age expectations), schizoaffective disorder (mental health disorder that is marked by a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania), and borderline personality disorder (mental disorder characterized by the instability in mood, behavior, and functioning). Record review of the MDS assessment, dated 03/08/2023, revealed Resident #23 had clear speech and was understood by staff. The MDS revealed Resident #23 was able to understand others. The MDS revealed Resident #23's BIMS interview, which assessed cognitive function, was not completed. During an observation on 03/20/2023 at 10:24 AM, Resident #23 had a temperature log on her personal refrigerator that was last filled out and dated for 03/04/2023. During an observation on 03/21/2023 at 10:19 AM, Resident #23 had a temperature log on her personal (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 35 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0813 refrigerator that was last missing temperatures for 03/05/2023 - 03/20/2023. Level of Harm - Minimal harm or potential for actual harm During an interview on 03/22/2023 at 5:08 PM, the BOM stated she was responsible for ensuring the temperature logs were completed for Resident #2 and Resident #23. The BOM stated she had been overseeing the wrong resident's room during daily angel rounds. The BOM stated it was important to ensure refrigerated items were labeled and dated and temperature logs were completed to keep food from freezing or expiring and to ensure refrigerators were functioning properly. Residents Affected - Few During an interview on 03/22/2023 at 7:32 PM, the Administrator stated personal refrigerators were monitored by management staff during daily angel rounds. The Administrator stated he expected staff to ensure food was labeled and dated and temperature logs were filled out. The Administrator stated monitoring personal refrigerators was important to ensure food is stored at proper temperature to prevent food-borne illness. Record review of the Resident/Personal Food Storage policy, revised 11/2016, revealed Staff will monitor and document unit refrigerator temperatures. Record review of the Refrigerator in Nursing Facility policy, revised 03/2009, revealed A temperature log should be kept on all residents' refrigerators. The policy further revealed If foods are retained in the refrigerator, they shall be covered and clearly identified as to contents and date initially covered. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 36 of 37 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 675774 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Legend Healthcare and Rehabilitation - Greenville 2300 Jack Finney Blvd Greenville, TX 75402 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 0868 Have the Quality Assessment and Assurance group have the required members and meet at least quarterly Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to maintain a quality assessment and assurance committee consisting at a minimum the required committee members for 2 of 5 meetings (November 2022, and December 2022) reviewed for QAPI. Residents Affected - Few The facility did not ensure the Administrator attended their QAPI meetings in November 2022, and December 2022. This failure could place residents at risk for quality deficiencies being unidentified, no appropriate plans of action developed and implemented, and no appropriate guidance developed. Findings include: Record review of the facility's QAPI Committee sign-in-sheets indicated the Administrator did not sign in for their meetings from November 2022 and December 2022. The sign-in-sheets did not indicate the owner, or a board member attended the meetings in November 2022 and December 2022. During an interview on 03/22/2023 at 9:56 a.m., Administrator C stated he was the interim Administrator for November 2022 and December 2022. Administrator C stated the Administrator, DON, MDS nurse and the DOR were supposed to be present at the QAPI meetings. Administrator C stated he did attend the meetings in November and December. When asked why his name was not on the sign in sheets, he stated I could not tell you that. Administrator C stated personally he did not feel there was a failure with him not attending the QAPI meetings due to someone was following up on the notes that were taken in the meeting. During an interview on 03/22/2023 at 11:32 a.m., the Clinical Market Leader stated per documentation it appeared Administrator C did not attend the QAPI meetings in November and December. The Clinical Market Leader stated if he attended the meetings, he should have signed the sign in sheet. The Clinical Market Leader stated not attending the meetings could result in not being able to follow up on quality assurance issues that were discussed. Record review of the facility's policy titled Quality Assurance-Performance Improvement, revised on 01/2022 indicated, the facility will establish and implement a Quality Assessment and Assurance Committee, develop a written Quality Assurance and Performance Improvement Plan, which will be reviewed and updated annually, and implement Performance Improvement Projects through a data driven and proactive approach 1. Quality Assessment and Assurance Committee a. members of the committee will include . Administrator . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675774 If continuation sheet Page 37 of 37