Inspection·June 18, 2025

F 0627 hearing and clear speech. Resident #1 required substantial/maximal assistance with most ADLs. Level of Harm - Minimal harm or potential for actual harm Review of Resident #1's care plan dated 02/17/25 reflected Resident #1 has an ADLs self-care performance deficit and is at risk for not having her needs met in a timely manner. Residents Affected - Few Record review of the appeal decision dated 03/26/25 reflected the following: APPEAL ID: 5329037 Before the Texas Health and Human Services Commission Appeals Division In the Matter § Fair Hearing Of § Decision § Appellant § § I. LEGAL AUTHORITY The fair hearing was conducted under the authority provided by Title 1, Sections 357.1 through 357.25 of the Texas Administrative Code (TAC) and related law. II. HISTORY 1. On January 16, 2025, the Agency notified the Appellant of the discharge. 2. The Appellant disagreed with the discharge and filed an appeal on February 12, 2025. 3. The Appellant did not remain in the facility because the facility refused to accept her back from the hospital she was admitted to. 4. A Notice of Hearing was mailed to Appellant on February 19, 2025, by first class mail, for a hearing scheduled for March 12, 2025. 5. The fair hearing was conducted on March 12, 2025, and the record was closed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675852 If continuation sheet Page 2 of 6 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 675852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Wichita 4810 Kemp Blvd Wichita Falls, TX 76308 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 0627 III. FINDINGS OF FACT Level of Harm - Minimal harm or potential for actual harm Finding of Fact 1: On August 6, 2024, the Appellant was admitted into the nursing facility. Finding of Fact 2: On January 16, 2025, the nursing facility issued the Appellant a Residents Affected - Few notice of discharge due to nonpayment. Finding of Fact 3: The Agency did not provide the Texas Administrative Code to support the discharge; therefore, did not meet their burden of proof. IV. CONCLUSIONS OF LAW 1 TAG §357.9 states the burden of proof in a fair hearing regarding a specific issue is proof by a preponderance of evidence. The party that bears the burden of proof meets the burden if the stronger evidence, on the whole, favors that party, as determined by the Hearings Officer. The Agency or its designee bears the burden of proof in this case. Based on the findings of fact and applicable authority, the Hearings Officer concludes that: Conclusion of Law 1: Because the Agency Representative did not provide the necessary policy to support the discharge, and based on 1 TAG §357.9, Agency failed. to meet its burden of proof. Therefore, the Agency action is REVERSED. Signed this 26th day of March 2025 Lead Hearings Officer Health and Human Services Commission. Record review of the resident medical records from the month of February 2025 revealed no physician documentation on discharge of Resident #1. Record review of Resident #1 medical records from the month of February 2025 revealed Resident #1was transferred to the hospital on [DATE] for evaluation and treatment for pneumonia. She was ready to be discharge from the hospital on [DATE] but the facility refiused to take her back During interview with the RP for Resident #1 on 06/18/25 at 9:07p.m, she said she was the responsible party for Resident #1. She explained the resident had a change in condition after fall from her (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675852 If continuation sheet Page 3 of 6 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 675852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Wichita 4810 Kemp Blvd Wichita Falls, TX 76308 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few wheelchair. According to the resident, she was on the floor for more than an hour before the facility responded to the fall. Resident #1 was transported to the hospital for evaluation and treatment due to severe pain from the fall. The RP stated after resident was stabilized in the hospital, the facility refused to take the resident back from the hospital due to non-payment. She explained the facility failed to fill papers with Medicaid to receive the necessary services. The family was advised to file appeal with HHSC. They filed the appeal which concluded that the facility must readmit Resident #1 to the facility. The facility refused after several attempts to come back to the facility, they decided to go to another facility. The RP explained the facility filed a lawsuit against the resident for non-payment. The RP stated that the Facility Administrator stated, the facility will never take the resident back and he don't care what the State said. In an interview with the BOM on 06/18/25 at 10:31a.m, she said she was the Business Office Manager for the facility. She Stated she was familiar with Resident #1. The BOM explained the resident was given 30-day notice but was transferred to the hospital for evaluation and treatment. She noted the resident was sent to the hospital few days before the 30-day notice ended. She stated the resident was not allowed to return to the facility for non-payment. The resident was owing more than $44,000. The BOM explained the resident and family refused to submit necessary documentation to apply for Medicaid as required. She was made aware that the family sold the resident's house and did not deposit the money on her account. The BOM stated she was not aware resident had an appeal with HHSC until the surveyor brought it to her notice. She noted she was not aware of any attempt to get the resident back to the facility. During interview with the DON on 06/18/25 at 1:41p.m, she stated she was familiar with Resident #1. The DON explained resident fell and was transferred to the hospital for further evaluation and treatment. She stated the facility notified the hospital of their intention not to readmit the resident for non-payment. She noted Resident #1 and family was non-complaint in providing required documentation Medicaid payor source approval. They kept holding information and stated they were switching to private pay. The Family did not make payment and was owing more than $44,000 in non-payment. The DON stated she was not aware of an appeal to stay in the facility by Resident #1. She said the Administrator may know but he was no longer employed by the facility. She noted the resident was given 30-day notice but was transferred before the end of the notice. Record review of notice letter dated 01/16/25 revealed Resident #1 was given a 30-day notice leave the facility. Record review of the facility policy on Admission, Transfer and discharge date d 10/10/17 reflected: Policy Statement This facility complies with federal regulations to permit each resident to remain in the facility, and not transfer or discharge unless the following criteria is met: Fundamental Information 1. The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675852 If continuation sheet Page 4 of 6 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 675852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Wichita 4810 Kemp Blvd Wichita Falls, TX 76308 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 0627 Level of Harm - Minimal harm or potential for actual harm 2. The transfer or discharge is appropriate because the president's health has improved sufficiently so the resident no longer needs the service provided by the facility. 3. The safety of the individuals in the facility is endangered due to the clinical or behavioral status of the resident. Residents Affected - Few 4. The health of individuals in the facility would otherwise be endangered. 5. Respite residents are discharged based upon the agreed length of stay and plan of care 6. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility; or 7. The facility ceases to operate. Policy Explanation and Compliance Guidelines: The facility will evaluate and determine the level of care needed for the resident prior to admission to ensure the facility's ability to meet the resident's needs. 2. The facility permits each resident to remain in the facility, and not transfer or discharge the resident from the facility except in limited situations when the health and safety of the individual or other residents are endangered. 3. The facility may initiate transfers or discharges in the following limited circumstances: a. The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility. b. The residents' health has improved sufficiently so that the resident no longer needs the care. and/or services of the facility. c. The safety of the individuals in the facility is endangered due to the clinical or behavioral status of the resident. d. The health of the individuals in the facility would otherwise be endangered. e. The resident has failed, after reasonable and appropriate notice, to pay or have paid under Medicare or Medicaid for his or her stay at the facility. f. The facility ceases to operate. 4. Nonpayment applies if the resident does not submit the necessary paperwork for third party payment or (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675852 If continuation sheet Page 5 of 6 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 675852 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Wichita 4810 Kemp Blvd Wichita Falls, TX 76308 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. 5. When a resident exercises his or her right to appeal a transfer or discharge, the facility will not transfer or discharge the resident while the appeal is pending, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. Event ID: Facility ID: 675852 If continuation sheet Page 6 of 6