Health inspection·February 8, 2024

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the skin surrounding the wound was not clean also so she should be careful to not touch the wound with the gauze that already touched the outside of the wound. In an interview with the ADON on 02/07/2024 at 10:59 AM, the ADON stated the proper technique in cleaning the wound was cleaning the center first and then the outside of the wound. The ADON also said the gauze should be discarded after each wipe. The ADON said improper wound care could cause cross contamination and infection. The ADON said the expectation was for the staff to know how to clean a wound to prevent unfavorable outcomes. The ADON said she would do an in-service about wound care and monitor their adherence to the right procedure of wound care. In an interview with the DON on 02/07/2024 at 11:17 AM, the DON stated the proper way of cleaning the wound was from the inside to outward. The DON said this method would promote healing, prevent cross contamination, and prevent infection. The DON said the expectation was for the staff to have a conscious effort in doing the right method of doing wound care. The DON further added she would re-educate the staff regarding wound care and closely monitor if they were following the policy and procedure for wound care. In an interview with the Administrator on 01/08/2024 at 8:32 AM, the Administrator stated the staff should do whatever was the right procedure in doing wound care to promote healing. The Administrator said the expectation was for the staff to make sure proper technique was used in doing wound care to prevent wound infection. The Administrator said he would collaborate with the clinicians to remind the staff to use the proper technique for wound care. Review of facility's policy Wound Care, 2001 MED-PASS, Inc. rev. June 2022 revealed Purpose: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing . Steps in the Procedure . 9. Wash wound in a circular motion from the inside out with ordered wound cleanse. Use additional gauze and repeat as needed with fresh gauze each time. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 2 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure each resident received adequate supervision and assistance devices to prevent accidents for 1 (Resident #10) of 3 residents reviewed for adequate supervision in that: CNA A and CNA B failed to ensure Resident #10 did not swing around in the Hoyer lift sling during a transfer from the bed to the wheelchair. This failure could place residents at risk for decline in health, and decreased quality of life. Findings included: Review of Resident #10's significant change MDS , dated 12/10/23, revealed the resident was a [AGE] year-old male admitted to the facility on [DATE]. The resident's diagnosis included multiple sclerosis. The MDS further reflected the resident's cognition was severely impaired. The resident was dependent on staff for transfers. Review of Resident #10's care plan, revised on 12/10/23, reflected: Increased risk of injury related to transfer. Facility interventions included use a mechanical lift, if warranted, use 2-4 persons to transfer resident, and maintain proper safe techniques during all transfers. An observation on 02/06/24 at 11:23 AM revealed Resident #10 was in bed. CNA A and CNA B were preparing the resident for a Hoyer lift transfer. The sling was placed under the resident. The resident was lifted in the sling and suspended in the air above the bed. CNA B pushed the bed towards the window. The resident remained suspended in the air. CNA B grabbed the wheelchair and faced it opposite of the resident's head. CNA A turned the lift to place the resident in the wheelchair. Neither CNA was guiding the sling during the transfer. As CNA A turned the lift, the resident in the sling started swinging around in the air. CNA B was behind the wheelchair and CNA A was behind the Hoyer lift. The lift was moved, and the resident was suspended in the air above the wheelchair. CNA A lowered the Hoyer lift, and the resident was placed in his wheelchair without incident. An interview on 02/06/24 at 11:50 AM with CNA A revealed she had worked at the facility for 2 weeks. She said for the transfer of Resident #10, they needed another person to help with the transfer to stabilize the resident while he was suspended in the air in the sling. She said it was not safe for the resident to swing around in the sling. CNA A said she had never operated the Hoyer lift prior to the transfer of Resident #10 and was not trained by the facility to complete a Hoyer lift transfer. An interview on 02/06/24 at 11:55 AM with CNA B revealed she had worked for the facility for 7 months. She said she usually worked as a MA, not a CNA. CNA B said the transfer of Resident #10 was the first time she had used the Hoyer lift. She said she was not trained by the facility to do a Hoyer lift transfer. CNA B said it was not safe for Resident #10 to swing around in the sling. CNA B said CNA A positioned the lift incorrectly and the room had very little space to maneuver the lift. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 3 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few An interview on 02/06/24 at 12:05 PM with the DON revealed she was not aware that CNA A and CNA B had not been in-serviced to do a Hoyer lift transfer and said they should have been. The DON said she would pull CNA A and CNA B and train them immediately. Review of the facility's Competency Assessment, Using a Mechanical Lifting Machine, revised 03/31/23, reflected: .15. Slowly lift the resident. Only lift as high as necessary to complete the transfer. 16. Gently support the resident as he or she is moved but do not support any weight. 17. When the transfer destination is reached, slowly lower the resident to the receiving surface . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 4 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 0727 Level of Harm - Minimal harm or potential for actual harm Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to maintain the services of a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week for 1 of 1 facility reviewed for RN coverage. Residents Affected - Many The facility failed to ensure the facility maintained the required RN coverage for 9 days between August 2023 - January 2024. This failure placed residents at risk of not receiving higher levels of patient care. Findings included: Review of the facility provided time sheets for Registered Nurses for the review period from August 2023 January 2024, revealed the facility failed to have RN coverage on the following dates: 8/13/23 8/26/23 9/23/23 10/7/23 10/21/23 11/5/23 12/16/23 12/17/23 12/31/23 An interview on 02/07/24 at 2:42 PM with the DON revealed she had been at the facility or one week. She said she was not aware that there were days with no RN coverage for August 2023 - January 2024. She said she thought a corporate nurse might have worked some of the days but was not able to show any days that were worked. The DON said RN coverage was important because the RN weekend supervisor acted as the DON on the weekends. An interview on 02/08/24 at 1:21 PM with the Administrator revealed he had been at the facility for a few weeks. He said he thought that previously the RN coverage schedule was scheduled by the corporate nurse. He said that going forward the DON and staffing coordinator would be working together to schedule RN coverage. Review of the facility policy, Staffing, revised 09/28/23, reflected: .4. The facility utilizes the services of a registered nurse for at least 8 consecutive hours a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 5 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 0727 day, 7 days a week. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 6 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 that assured accurate and timely acquiring and receiving of all medications to meet the needs of the two residents (Residents # 3 and Resident #56) of five residents reviewed according to facility policy and federal regulations to ensure accurate and timely dispensing of medications according to physician orders. The facility failed to ensure MA B re-ordered medications on a timely manner for Resident #3 (Donepezil 5 mg) and Resident #56 (Januvia 50 mg). This failure could place the residents at risk of not receiving medications as ordered by the physician. Findings included: Resident # 3 Review of Resident #3's Face Sheet dated 02/07/2024 reflected resident was a [AGE] year-old female admitted on [DATE]. Relevant diagnoses included depression and dementia (loss of cognitive functioning). Review of Resident #3's Quarterly MDS assessment dated [DATE] reflected resident was cognitively intact with a BIMS score of 13. The Quarterly MDS Assessment also indicated non-Alzheimer's Dementia as one of Resident #3's active diagnoses. Review of Resident #3's Comprehensive Care Plan dated 01/08/2024 reflected resident had dementia and one of the interventions was to assess for mood/behavior problem. Review of Resident #3's Physician Order for donepezil dated 04/24/2023 reflected Donepezil HCl (hydrochloride) 5 MG Tablet: GIVE 1 TABLET BY MOUTH ONCE DAILY. Resident #56 Review of Resident #56's Face Sheet dated 02/07/2024 reflected resident was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included hyperlipidemia (high levels of fat particles in the blood) and type 2 diabetes mellitus (high level blood sugar in the blood stream). Review of Resident #56's Quarterly MDS assessment dated [DATE] reflected resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment also indicated diabetes mellitus as one of Resident #56's active diagnoses. Review of Resident #56's Comprehensive Care Plan dated 12/26/2023 reflected resident had was at risk for high blood glucose level and one of the interventions was administer medication as per order. Review of Resident #56's Physician's Order for Januvia dated 08/10/2023 reflected, Januvia 50 MG Tablet: GIVE 1 TABLET BY MOUTH ONCE DAILY. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 7 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 observation and interview with MA B on 02/07/2024 starting at 3:23 PM revealed Resident #3's blister pack for donepezil had only 2 tablets left and Resident#56's blister pack for Januvia also had only 2 tablets left. MA B said the medications were usually delivered 2 to 3 days after the request depending on the insurance. MA B explained they could re-order medications through the system, through faxing, and by calling pharmacy. MA B said she would check their medication overflow located inside the medication room. MA B went inside the medication room and checked if Resident #3's donepezil and Resident #56's Januvia were in the medication cart where they put the medication overflow. MA B said the medications were not on the overflow. MA B said she would check the system if the medications were re-ordered through the system and what were the dates the medications were re-ordered. MA B logged in and search for Resident #3's medication in eMAR. The eMAR indicated Resident #3's donepezil was last re-ordered 01/10/2024. MA B said she had not re-ordered Resident #3's medication yet. MA B said she would re-order Resident #3's donepezil. MA B clicked the re-supply button corresponding to Resident #3's donepezil. MA B then searched for Resident #56's profile and search for his medication in eMAR. The eMAR indicated Resident #56's Januvia was last re-ordered December 2023. MA B said she would check the faxed forms to see if the medication was re-ordered through fax. MA B said they usually filed the faxed forms inside the medication room. MA B said she was responsible for re-ordering medication that were running low. MA B stated the medication should be re-ordered when the medication reached the blue portion of the blister pack. MA B stated she did not notice the said blister packs were running low. MA B said if medications were not re-ordered on a timely manner, the residents might run out of medications and their present medical situations might worsen. MA B stated she would check the carts and re-order the medications that were running low. In an observation and interview with the ADON on 02/07/2024 at 3:39 PM, the ADON said they should re-order the medications once the medications hit the dark blue portion of the blister pack. The ADON said the dark blue portion of the blister pack would be the signal the medications should be re-ordered. The ADON said she would look for the form that was faxed and see if Resident #56's medication was re-ordered through fax. The ADON went inside the medication room and tried to look if Resident #56's Januvia was included on any form that was faxed to the pharmacy. The ADON was not able to find the form. The ADON said she would look for it. In an interview with the ADON on 02/07/2024 at 4:12 PM, the ADON stated she was not able to find out if Resident #56's Januvia was faxed to the pharmacy. The ADON said she went ahead and re-ordered the medication to ensure Resident #56 would have his Januvia delivered. The ADON said the nurses and the MAs were responsible in re-ordering medications once they were running low. The ADON said if the medications were not re-ordered on a timely manner, there could be a possibility the residents would not have their medications if there were issues with the delivery of the medications. The ADON added without the medications the medical issues of the residents could worsen. The ADON said the expectation was for the staff to be diligent in re-ordering the medications to prevent missed medications. The ADON said the facility had an e-kit but said the e-kit should not be used because the medications were not re-ordered on a timely manner. The ADON said she would do an in-service for ordering and re-ordering the medications. In an interview with the Administrator on 02/08/2024 at 8:32 AM, the Administrator said the medications should be re-ordered on time to prevent missed medications. The Administrator said the residents would be the most affected when the medications were not available. The Administrator said they would address this during meetings and remind the staff to do what should be done to prevent missed medications. Interview with the DON on 02/08/2024 at 8:46 AM, the DON stated medications should be re-ordered in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 8 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 a timely manner. The DON said anything could happen that could affect the delivery of the medications from the pharmacy. The DON continued there could be a delay caused by accidents, traffic, and inclement weather. The DON said the staff must make sure they re-order the medications on a timely manner so the residents would have their needed medications all the time. The DON said the staff should not wait for the last minute to re-order. The DON said if the residents will not have their medications, their medical issues may aggravate. The DON said they would in-service the staff about ordering and re-ordering medications. The DON said whoever staff saw the medication was running low should re-ordered it. The DON continued the staff only needed to click the re-supply button on the residents' profile or peel the sticker from the blister pack and fax it to the pharmacy. The DON further said the staff could also call pharmacy to re-order medications. The DON concluded the expectation was for the staff to be diligent in re-ordering medications and said they would audit the carts to check which medications needed re-ordering. Record review of facility policy, Ordering and Receiving Non-Controlled Medications Nursing Care Center Pharmacy Policy & Procedure Manual copyright 2010 revealed Policy: Medications and related products are received from the provider pharmacy on a timely basis. The nursing care center maintains accurate records of medications order . Procedures . 1. Ordering medications . b. reorder routine medications . to assure an adequate supply is on hand. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 9 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 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 4 (Resident #24, Resident #53, Resident #43, and Resident #38) of 10 residents observed for infection control. Residents Affected - Some 1. The facility failed to ensure MA A sanitized the blood pressure cuff between Resident #24, Resident # 53, and Resident #43. 2. The facility failed to ensure LVN A wiped Resident #38's bottom away from the wound in the sacrum. These failures could place the residents at risk of cross-contamination and development of infections. Findings included: Resident #24 Review of Resident #24's Face Sheet dated 02/07/2024 reflected resident was a [AGE] year-old male admitted on [DATE]. One of Resident #24's diagnoses was hypertension. Review of Resident #24's Quarterly MDS assessment dated [DATE] reflected resident was cognitively intact with a BIMS score of 15. The Quarterly MDS Assessment indicated hypertension as one of the active diagnoses of Resident #24. Review of Resident #24's Comprehensive Care Plan dated 01/13/2024 reflected resident was hypertensive and was taking lisinopril and metoprolol. The Comprehensive Care Plan disclosed one of the approaches was to assess blood pressure every shift. Review of Resident #24's Physician's Order for lisinopril dated 03/16/2023 reflected Lisinopril 2.5 MG Tablet: GIVE 1 TABLET BY MOUTH ONCE DAILY. Review of Resident #24's Physician's Order for metoprolol dated 03/16/2023 reflected Metoprolol Tartrate 25 MG Tablet: GIVE 1/2 TABLET BY MOUTH TWICE DAILY. HOLD IF SYSTOLIC BLOO DPRESSURE < 110, DIASTOLIC BLOOD PRESSURE < 60 OR PULSE < 60 AND NOTIFY MD. Resident # 53 Review of Resident #53's Face Sheet dated 02/07/2024 reflected resident was a [AGE] year-old female admitted on [DATE]. One of Resident #53's diagnoses was hypertension. Review of Resident #53's Quarterly MDS assessment dated [DATE] reflected resident had a moderate impairment in cognition with a BIMS score of 10. The Quarterly MDS Assessment indicated hypertension (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 10 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 as one of the active diagnoses of Resident #53. Level of Harm - Minimal harm or potential for actual harm Review of Resident #53's Comprehensive Care Plan dated 01/21/2024 reflected resident had a diagnosis of hypertension and was taking hypertensive medicine. The Comprehensive Care Plan disclosed one of the approaches was to monitor blood pressure. Residents Affected - Some Review of Resident #53's Physician's Order for amlodipine dated 10/01/2023 reflected amlodipine Besylate 5 MG Tablet: GIVE 1 TABLET BY MOUTH ONCE DAILY. HOLD IF SYSTOLIC BLOOD PRESSUREIS BELOW 130. Review of Resident #53's Physician's Order for losartan dated 05/26/2023 reflected Losartan Potassium 50 MG Tablet: GIVE 1 TABLET BY MOUTH TWICE DAILY. HOLD FOR SYSTOLIC BLOODPRESSURE LESS THAN 115. Resident #43 Review of Resident #43's Face Sheet dated 02/07/2024 reflected resident was a [AGE] year-old male admitted on [DATE]. One of Resident #43's diagnoses was hypertension. Review of Resident #43's Quarterly MDS assessment dated [DATE] reflected resident had a moderate impairment in cognition with a BIMS score of 11. The Quarterly MDS Assessment indicated hypertension as one of the active diagnoses of Resident #43. Review of Resident #43's Comprehensive Care Plan dated 01/21/2024 reflected resident had a history of hypertension and was taking hypertensive medicine. The Comprehensive Care Plan disclosed one of the approaches was to monitor blood pressure. Review of Resident #43's Physician's Order for carvedilol dated 11/07/2023 reflected Carvedilol 6.25 MG Tablet: GIVE 1 TABLET BY MOUTH TWICE DAILY. HOLD IF SYSTOLIC BLOOD PRESSURE< 110, DIASTOLIC BLOOD PRESSURE < 65, HR < 65. In an observation and interview with MA A on 02/07/2024 at 7:27 AM revealed MA A was about to prepare Resident #24's medication. MA A said she would check Resident #24 blood pressure first. MA A picked up the blood pressure cuff from the medication cart. MA A placed the blood pressure cuff on Resident #24's arm. MA A went back to her medications cart and said the blood pressure cuff was not working. She said she had a spare blood pressure cuff on the last drawer. MA A opened the last drawer and took a blood pressure cuff from a bag. MA A went to Resident #24 and took his blood pressure. The blood pressure cuff was not sanitized before taking Resident #24's blood pressure. After the blood pressure reading was completed, MA A placed the blood pressure cuff on top of the medication cart, prepared the medications, and gave the medications to Resident #24. The blood pressure cuff was not sanitized after usage. Observation on 02/07/2024 at 7:50 AM revealed MA A picked up the blood pressure cuff from the medication cart. MA A placed the blood pressure cuff on Resident #53's arm. After the blood pressure reading was completed, MA A placed the blood pressure cuff on the medication cart. MA A prepared the medications and gave the medications to Resident #53. The blood pressure cuff was not sanitized after using it to take Resident #53's blood pressure. Observation on 02/07/2024 at 8:48 AM revealed MA A picked up the blood pressure cuff from the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 11 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 Residents Affected - Some medication cart. MA A placed the blood pressure cuff on Resident #43's arm. After the blood pressure reading was completed, MA A placed the blood pressure cuff on the medication cart. MA A prepared and gave the medications to Resident #43. The blood pressure cuff was not sanitized after usage. In an interview and observation with MA A on 01/07/2023 at 9:34 AM, MA A stated she obtained the blood pressure of the residents before giving the medication for hypertension to know if the medication needed to be given or not. MA A said the right thing to do was to wash or sanitize hands before and after giving medications. MA A also stated the blood pressure cuff should be sanitized after using it and before using it on another resident. MA A then acknowledged she forgot to sanitize the blood pressure cuff in between residents when she passed the medications. MA A pulled the third drawer of the medication cart and took a sanitizing container. MA A stated the blood pressure cuff should be sanitized in between residents because infection could transfer from one resident to another. 2. Review of Resident #38's Face Sheet dated 02/07/2024 reflected resident was a [AGE] year-old male admitted on [DATE]. One of Resident #38's diagnoses was pressure ulcer of sacral region. Review of Resident #38's Quarterly MDS assessment dated [DATE] reflected resident had a severe impairment in cognition with a BIMS score of 00. The Quarterly MDS Assessment indicated pressure ulcer of sacral region as one of the active diagnoses of Resident #38. Review of Resident #38's Comprehensive Care Plan dated 01/21/2024 reflected resident had pressure ulcer to sacrum and one of the approaches was assess the pressure ulcer. Review of Resident #38's Physician's Order for wound care to sacrum dated 01/08/2024 reflected Clean with Normal Saline / Wound Cleanser, apply collagen powder then calcium alginate to wound bed, cover with SUPERABSORBANT SILICONE BORDER DRESSING, APPLY BARRIER CREAM TO PERI WOUND (around the wound). In an observation on 02/07/2024 at 9:42 AM revealed LVN A was preparing Resident #38 for wound care. When the resident was turned to his left side, the resident passed some gas and LVN A said to wait for a while because the resident might be having a bowel movement. After a couple of minutes, LVN A said she would proceed with the wound care since Resident #38 did not have a bowel movement. LVN A said she would first wipe the resident's buttocks before proceeding. LVN A took some wipes and started wiping from the anal area towards the direction of the wound touching the dressing of the wound. LVN A repeated the procedure twice. In an interview with LVN A on 02/07/2024 at 10:41 AM, LVN A stated she cleaned the bottom of Resident #38 before she did the wound care. LVN A said she should had contained the wiping on the anal area instead of wiping towards the direction of the wound because it could cause infections. LVN A added wiping towards the wound could introduce new microorganisms to the existing wound. Said she would not wipe towards the wound on her next wound care. In an interview with the ADON on 02/07/2024 at 10:59 AM, the ADON stated the blood pressure cuff should had been sanitized after every use or after every resident. The ADON said that if the blood pressure cuff was not sanitized, it could cause cross contamination and infection could spread. The ADON said since the resident had a wound to the buttocks, the direction of the wiping should not be towards the wound. The ADON added there could be no specific procedure for this, but it was common (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 12 of 13 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 675790 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garland Nursing and Rehabilitation 321 N Shiloh Rd Garland, TX 75042 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 Residents Affected - Some sense that anyone should avoid touching the wound nor its dressing with dirty wipes. The ADON said prevention of infection should be part of the staff's uniform and should be a normal part of how they work. The ADON said the DON and the ADON were responsible in overseeing if the staff were following infection control. The ADON said the expectation was all the equipment, like the blood pressure cuff, oximeter, and glucometer, used for several residents must be sanitized in-between residents. She added another expectation was not to introduce additional microorganism to an existing wound. The ADON said she would do an in-service about infection control. In an interview with the DON on 02/08/2024 at 11:17 AM, the DON stated everything that were used by several residents should be sanitized after every use to prevent infection. The DON stated the blood pressure cuff should had been sanitized every after use. She said not sanitizing the blood pressure cuff could cause cross contamination or development of new infections. The DON said when cleaning the bottom of a resident with a wound, the direction of the wiping must not be towards the wound to avoid touching the wound or the dressing of the wound with soiled wipes. The DON said it might introduce another microorganism of any form to the existing wound. The DON said the expectation was for the staff to have a conscious effort in preventing infection. The DON further added she would re-educate the staff regarding infection control and closely monitor if they were following the policy and procedure of infection control. In an interview with the Administrator on 01/08/2024 at 8:32 AM, the Administrator stated he was made aware by the DON about the issues in infection control. The Administrator said they were already doing an in-service about infection control. The Administrator said the expectation was for the staff to make sure all items and equipment used by the residents were sanitized in between use to prevent infection. The Administrator also said dirty things should not touching any wound. The Administrator said all staff should observe and follow to the policy of infection control to ensure the safety of the residents. Record review of facility's policy Cleaning and Disinfection of Resident - Care Items and Equipment, 2001 MED_PASS, Inc., rev. October 2018 revealed Policy Statement: Resident-care equipment, including reusable items . will be cleaned and disinfected . 1. The following categories . levels of disinfection necessary . d. Reusable items are cleaned and disinfected or sterilized between residents. Record review of facility's policy Perineal Care revised 1/20/23 revealed Policy Statement: Perineal Care is providing cleanliness and comfort to the resident, to prevent infections, skin irritation, and to observe the resident's skin condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675790 If continuation sheet Page 13 of 13