Health inspection·March 10, 2023

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on [DATE] at 2:23 pm RN G said if Resident #138 coded (an emergency requiring resuscitation), she would start CPR because there was no advance directive in her electronic chart. She said whoever did not have an advance directive in their electronic chart would be treated as full code. She said a resident with DNR status would have DNR marked by their name on the electronic chart. In an interview on [DATE] at 2:32 p.m. the Director of Operations said Medical Records and the Director of Social Services positions were new. He said in the next hour the facility would have the advance directives uploaded to the residents' electronic health record. He said the facility saw an opportunity with advance directives and they conducted a performance improvement plan to correct it. In a telephone interview on [DATE] at 12:35 p.m. the PRN Social Worker said she trained the Director of Social Services on advance directives and said her responsibility was to ensure the OOH-DNR forms were completed correctly. She said after verifying the accuracy of the form she would give it to the DON or BOM to scan into the resident's electronic health record and mark the code status. She said the residents' code status would be visible in the left upper corner on the resident's electronic health record. In an interview on [DATE] at 1:57 p.m. the DON said the Director of Social Services was responsible for validating the OOH-DNR, scanning it into the resident's electronic chart, and confirming the code status was listed on the ribbon (located on the upper left corner by the resident's name). She said if a resident coded, she would expect the nurse to look at the patients face sheet to confirm the code status. She said it was important for a resident's code status to be in the electronic chart so the nurse could treat the patient according to their preferred status, either full code with CPR or DNR with no CPR. She said if the advance directive was not in the chart there was a risk that the resident would not get the treatment they needed, and the facility could go against the resident's will. In an interview on [DATE] at 2:50 p.m. the Administrator said she expected the Director of Social Services to scan the advance directives in the resident's electronic chart and indicate the code status. She said the Director of Social Services was new and they needed to monitor better. She said the facility did not follow up as well as they should have on the advance directives. She said it was important for facility staff to know the wishes of the residents because that is what drove them. Record review of the facility's Advance Directives/Self-Determination policy dated [DATE] read in part, . Service standard: advanced directives provide guidance for medical treatment . 1 . communities recognize that the best health care is based upon a partnership of trust and communication between the resident, the resident's physician, and the community. 3 . will make every reasonable attempt to honor advance directives and resident wishes as expressed by the resident or health care decision-makers when the resident is no longer able to make decisions . 5. The social worker will work along with nursing and administration to assure that the appropriate procedures for advance directives and self-determination are followed and documented accordingly. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 2 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 interview and record review the facility failed to develop and implement person-centered care plans for each resident which included measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that were identified in the comprehensive assessment for 1 (Resident #22) of 8 residents reviewed for care plans. The facility failed to update Resident #22's care plan to reflect a fall and interventions that occurred on 3/5/23. This failure could place residents at risk of not receiving care based on identified needs. Findings included: Record review of Resident #22's face sheet revealed an [AGE] year-old female admitted to the facility on [DATE]. Her diagnosis included surgical aftercare, syncope (fainting resulting from certain stressful triggers which lead to sudden drop in blood pressure and heart rate) and collapse, difficulty in walking, muscle weakness, need for assistance with personal care, and cognitive communication deficit. Record review of Resident #22's admission MDS assessment dated [DATE] revealed a BIMS score of 14 out of 15 which indicated intact cognition. She required extensive assistance of one person for toilet use. She had one fall with no injury since admission. Record review of Resident #22's care plan dated 3/10/23 indicated the resident was at risk for falls related to weakness. Interventions included call light, bedside table, and telephone within reach of resident. Assist resident to wear non-slick footwear that fits, assess risk for falls and implement fall prevention plan as indicated based on current level of functioning, assist resident to desired location. Make sure ambulatory assistive device remains close to resident, bed in lowest position, evaluate resident fall risk on admission, quarterly, and after a fall. Resident #22's fall that occurred on 3/5/23 along with the interventions were not listed on her care plan. Record review of Resident #22's Incident Report dated 3/5/23 written by LVN D revealed resident stated that she was trying to wheel herself from the bathroom, while doing that, her wheelchair bumped into the wall, and she fell. Neurological checks were initiated and there was no apparent injury. The final disposition completed by the DON on 3/10/23 revealed the investigation findings were the resident wheeled herself from the bathroom without assistance. Interventions included: resident was educated to use the call light for assistance, therapy to re-evaluate and treat as indicated, continue skilled therapy to regain strength and endurance. The interventions were not documented on the care plan following the fall. In an interview on 3/9/23 at 11:50 a.m. LVN D said she assessed Resident #22 after her fall on 3/5/23. She said the resident informed her she came out of her bathroom and hit the bump on the floor with her wheelchair and fell. The resident informed her there was no call light available, so she used her cell phone to call her family member. LVN D said after the fall she instructed the resident to use her call light and ask the nurse for assistance with the restroom. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 3 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 In an interview on 3/10/23 at 10:50 a.m. the MDS Nurse said she was responsible for updating care plans every time a MDS was due (i.e., admission, hospital, change in condition). She said she would also update the care plan if a resident had a fall. She said she did not update Resident #22's care plan after her fall because she was still working on her MDS assessment. She said her care plan should be updated right away with the fall interventions. She said the IDT discussed interventions for falls, but she was unsure what the intervention was for Resident #22. She said the care plan informed staff on how to take care of the resident. She said if the fall and interventions were not on the care plan staff would not know how to take care of the resident. In an interview on 3/10/23 at 11:08 a.m. the DON said the fall intervention for Resident #22 was to push the call button for help. She said she would update the care plan and had not updated it yet because she just returned to work. She said the MDS nurse was responsible for ensuring the care plan was updated with fall interventions. In an interview on 3/10/23 at 2:53 p.m. the Administrator said they discussed falls in the clinical meetings. She said interventions should be documented on the care plan within a day or as soon as the incident happened. She said care plans told clinical staff how to address the resident. Record review of the facility's Resident Plan of Care policy dated 1/25/23 read in part, .utilizing the resident assessment (MDS) an interdisciplinary team will develop a plan of care for each resident with input from the resident and/or family . 2. A comprehensive care plan will be developed within 7 days of completion of the resident's comprehensive assessment (MDS). The interdisciplinary team develops it . 4. The care plan will identify problem areas and interventions needed to meet the needs of the resident . 5. Assessments of residents are on-going and care plans are revised as information about the resident and his/her condition changes. 6. The interdisciplinary team is responsible for updating the care plan: a. when there has been a significant change in the resident's condition. b. when the desired outcome is not met . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 4 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents who were incontinent of bladder received appropriate treatment and services to prevent urinary tract infections and to restore continence to the extent possible for 1 of 2 residents (Resident #14) reviewed for incontinent care. CNA A failed to properly cleanse Resident #14 during incontinent care. CNA A failed to change gloves and perform hand sanitization during incontinent care for Resident #14. This failure could place residents at risk for urinary tract infections (UTI), urethral erosions (tearing of the urethra), discomfort, skin breakdown, and a decreased quality of life. Findings included: Record review of the admission sheet for Resident #14 revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included d diagnosis included dysphagia (difficulty swallowing) Idiopathic) normal pressure hydrocephalus, atrial fibrillation (fast heart rate), lack of coordination, Vitamin B12 deficiency anemia, Alzheimer's disease, Hypothyroidism, Urinary tract infection and repeated fall. Record review of Resident #14's admission MDS, dated [DATE], revealed a BIMS score of blank out of 15, which indicated severe cognitive impairment. She required extensive one-to-two-person assistance with bed mobility, toilet use and personal hygiene. She required extensive assistance of 2-person assistance with transfers. She was occasionally incontinent of bowel and bladder. Record review of Resident # 14's care plan, on 02/24/2023 read in part: .Problem-Resident #14 has frequent urinary incontinence putting her at risk for having a UTI, initiated on 03/23/2022. Goal: Resident #14 at risk for septicemia will be minimized/prevented via prompt recognition and treatment of symptoms of UTI through the review date .Interventions: Clean peri-area with each incontinence episode Check every two hours and as needed for incontinence. Wash, rinse, and dry perineum .Problem-Resident #14 has incontinence putting her at risk for having skin breakdown .Interventions: Keep skin clean and dry. Provide peri care with all incontinent episodes . Record review of physician's order dated 03/03/23 revealed Resident #14 Ertapenem 1 gram solution for injection 1 Time Daily for 7 for urinary tract infection completed on 03/09/23. Observation and interview on 02/23/2023 at 9:46 AM performed by CNA A revealed Resident #14 was lying in bed on her back. CNA A performed hand sanitization and donned (put on) clean gloves. CNA A unfastened the disposable brief. Using wet cleansing wipes, CNA A cleansed Resident #14's left groin from top to bottom, with a new cleansing wipe cleansed right groin from top to bottom and with a new cleansing wipe did not separate the labia to clean. CNA A and cleansed the labia area downward from top to bottom. CNA A rolled Resident #14 to her left side, resident had large loose bowel movement and she cleaned the resident, the right gloves got soiled with feces, CNA A doff (took off) soiled right hand gloves, using her left hand picked up cleaned gloves from her uniform pocket don ( put on) the right glove, while using cleansing wipes to rectal area. Resident #14 was still having bowel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 5 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few movement that soiled the draw sheet, CNA A rolled up the urine and feces soiled brief and placed in a plastic bag. With the same gloves, CNA A using the same gloves picked up cleaned brief and draw sheet from Resident #14's drawer and positioned the clean incontinent brief under the resident, rolled the resident back onto her back and secured the fasteners of the brief. CNA A touched the bed linens and adjusted the covers over the resident. CNA A removed the gloves, disposed into the plastic bag, tied up the bag, performed hand sanitization, walked out of the room, and deposited the garbage bag in the dirty utility room. When asked why she did not cleanse the labia as the first step, CNA A stated that it was too hard to open her legs. She stated she should have removed the used gloves, washed hands, donned clean gloves prior to touching the clean brief and bed linen to prevent cross contamination. Further interview with CNA A she had in-service with the lead CNA three weeks ago and she did not have her hand sanitizer on because the facility has sanitizer on the wall in the room. In an interview on 03/09/2023 at 1:50 PM, with Lead CNA AA stated that 's should have separated the labia in order to prevent urinary infections. He stated it was his expectation that CNA A would have ensured the rectum and vagina were fully cleaned before she completed the incontinence care. Interview on 03/09/23 at 02:14 PM. the DON stated the handwashing policy was soap and water for at least 20 seconds. The DON stated when changing gloves, hand sanitizer is to be used before putting on clean gloves. DON said the negative outcome is the potential for infection is greatly increased. DON stated the CNA AA does the checkoffs for new hires, yearly, or as needed. DON said she has not done any in-services and monitoring on incontinent. Interview on 03/09/2023 at 3:15 PM with the Administrator said the facility did not have a Policy and Procedure specifically for incontinent care and that best practices should be used. She said the facility was not required to have a P&P for incontinent care. Record review of the facility's check list Basics of Care for the resident who has urinary incontinence . 1. Perform hand hygiene and gloves .5. Cleanse inner legs and outer peri area along the outside of labia, using a clean area of washcloth or wipe for each swipe of peri area. Soiled gloves and washcloths or wipes exchanged for clean ones, FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 6 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide pharmaceutical services (including procedures that assure the accurate administering of all drugs and biologicals) to meet the needs of 1 (Resident #28) of 6 residents reviewed for pharmacy services. LVN D did not administer Lisinopril 10 mg (a high blood pressure medication) to Resident #28 as ordered by the physician. This failure could place residents at risk of not receiving desired therapeutic outcomes, increased side effects, or a decline in health. Findings included: Record review of Resident #28's face sheet revealed a [AGE] year-old female admitted on [DATE]. Her diagnoses included cerebral infarction (stroke), hypertension (high blood pressure), hemiplegia (paralysis of one side of the body) following cerebral infarction, and gastrostomy status (an opening into the stomach from the abdominal wall, made surgically for the introduction of food). Record review of Resident #28's admission MDS assessment dated [DATE] revealed a BIMS score of 9 out of 15 which indicated moderate cognitive impairment. She was totally dependent with 1-2 staff for ADL assistance. Record review of Resident #28's Physician Order Sheet for March 2023 revealed an order for Lisinopril 10 mg 1 tablet one time daily, order date 2/18/23. Record review of Resident #28's March 2023 Treatments record revealed Lisinopril 10 mg was scheduled for 9:00 a.m. The medication was signed off as administered by LVN D on 3/9/23 for the 9:00 a.m. scheduled time. In an observation and interview on 3/9/23 at 9:13 a.m., LVN D prepared the following medications for Resident #28: Amlodipine 5 mg (1 tablet), Sertraline 25 mg (1 tablet), Carvedilol 6.25 mg (1 tablet), Famotidine 20 mg (1 tablet), and Methylphenidate 10 mg (1 ½ tablets). LVN D looked in the medication cup and said she had 5 ½ tablets to two State Surveyors. She crushed the medications together, entered the resident's room and administered the medication via g-tube. After medication administration she returned to the computer and documented that she administered Resident #28's morning medications which included Lisinopril 10 mg. LVN D did not prepare or administer Lisinopril 10 mg to Resident #28. In an interview on 3/9/23 at 11:50 am with LVN D she said she did not provide any additional medications to Resident #28 since the morning pass at 9:00 a.m. She said during the morning medication pass she administered either 5 1/2 or 6 1/2 tablets to Resident #28. LVN D said she remembered popping the lisinopril but that would have made 6 1/2 tablets. She said she checked the medications against the electronic record to verify that all medications were in the cup. She said she would recheck the resident's blood pressure and notify her NP. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 7 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview on 3/10/23 at 2:09 p.m. the DON said when administering medications nurses should compare the medication blister pack to the physician order and pop the medication in the cup. She said it was important for Resident #28 to receive her blood pressure medication and not miss it because her blood pressure could rise. In an interview on 3/10/23 at 2:57 p.m. the Administrator said she expected any medication order to be carried out. In an interview on 3/10/23 at 4:08 pm the Director of Operations said there was no policy for medication administration. He said the expectation was to following nursing standards and physician orders. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 8 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 0880 Provide and implement an infection prevention and control program. 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 maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 1 of 2 resident (Resident #14) reviewed for infection control. Residents Affected - Few The facility failed to ensure CNA A performed hand hygiene between dirty and clean care while providing incontinent care to Resident #14. These failures could place residents who require wound care and incontinent care at an increased risk for infection, decline in health and hospitalization. Findings included: Record review of the admission sheet for Resident #14 revealed a [AGE] year-old female admitted to the facility on [DATE]. Her diagnoses included d diagnosis included dysphagia (difficulty swallowing) Idiopathic) normal pressure hydrocephalus, atrial fibrillation (fast heart rate), lack of coordination, Vitamin B12 deficiency anemia, Alzheimer's disease, Hypothyroidism, Urinary tract infection and repeated fall. Record review of Resident #14's admission MDS, dated [DATE], revealed a BIMS score of blank out of 15, which indicated severe cognitive impairment. She required extensive one-to-two-person assistance with bed mobility, toilet use and personal hygiene. She required extensive assistance of 2-person assistance with transfers. She was occasionally incontinent of bowel and bladder. Record review of Resident # 14's care plan, on 02/24/2023 read in part: .Problem-Resident #14 has frequent urinary incontinence putting her at risk for having a UTI, initiated on 03/23/2022. Goal: Resident #14 at risk for septicemia will be minimized/prevented via prompt recognition and treatment of symptoms of UTI through the review date .Interventions: Clean peri-area with each incontinence episode Check every two hours and as needed for incontinence. Wash, rinse and dry perineum .Problem-Resident #14 has incontinence putting her at risk for having skin breakdown .Interventions: Keep skin clean and dry. Provide peri care with all incontinent episodes . Observation and interview on 02/23/2023 at 9:46 AM performed by CNA A revealed Resident #14 was lying in bed on her back. CNA A performed hand sanitization and donned (put on) clean gloves. CNA A unfastened the disposable brief. Using wet cleansing wipes, CNA A cleansed Resident #14's left groin from top to bottom, with a new cleansing wipe cleansed right groin from top to bottom and with a new cleansing wipe did not separate the labia to clean. CNA A and cleansed the labia area downward from top to bottom. CNA A rolled Resident #14 to her left side, resident had large loose bowel movement and she cleaned the resident, the right gloves got soiled with feces, CNA A doff (took off) soiled right hand gloves, using her left hand picked up cleaned gloves from her uniform pocket don the right glove, while using cleansing wipes to rectal area. Resident #14 was still having bowel movement that soiled the draw sheet, CNA A rolled up the urine soiled brief and placed in a plastic bag. With the same gloves, without washing hand, CNA A using the same gloves picked up cleaned brief and draw sheet from Resident #14's drawer and positioned the clean incontinent brief under the resident, rolled the resident back onto her back and secured the fasteners of the brief. CNA A touched the bed linens and adjusted the covers over the resident. CNA A removed the gloves, disposed into the plastic bag, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 9 of 10 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 675777 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/10/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Place 1321 Park Bayou Dr Houston, TX 77077 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 0880 Level of Harm - Minimal harm or potential for actual harm tied up the bag, performed hand sanitization, walked out of the room, and deposited the garbage bag in the dirty utility room. When asked why she did not cleanse the labia as the first step, CNA A stated that it was too hard to open her legs. She stated she should have removed the used gloves, washed hands, donned clean gloves prior to touching the clean brief and bed linen to prevent cross contamination. Further interview with CNA A she had in-service with the lead CNA three weeks ago Residents Affected - Few In an interview on 03/09/2023 at 1:50 PM, with Lead CNA AA stated that CNA should have separated the labia in order to prevent urinary infections. He stated it was his expectation that CNA A would have ensured the rectum and vagina were fully cleaned before she completed the incontinence care. Interview on 03/09/2023 at 2:15PM with the DON, she said she expected the nurse doing wound care to hand wash or hand sanitize before starting and when removing old dressing. Hand sanitizes or wash hands if really soiled. She said hand wash should be done before they change gloves. The DON said she will do in-service with the nurse regarding wound care. During incontinent care she said she expected the CNA A to have performed hand hygiene between glove changes, before touching clean items and before putting on barrier skin cream. She said she monitors staff for infection control compliance by doing staff skills checklists. Interview on 03/09/2023 at 3:15 PM with the Administrator said the facility did not have a P&P specifically for incontinent care and that best practices should be used. She said the facility was not required to have a P&P for incontinent care. Record review of the facility's policy on Infection Control - Hand Hygiene Revision January 25, 2023:: Procedure as outlined by the CDC: (Centers for Disease Control and Prevention and the World Health Organization.) . Washing your hands is easy, and it's one of the most effective ways to prevent the spread pf germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community- from your home and workplace to childcare facilities and hospitals Use hand Sanitizer when you can't use soap and water. You can use an alcohol -based hand sanitizer that contains at least 60% alcohol if soap and water are not available. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675777 If continuation sheet Page 10 of 10