Health inspection·September 9, 2025

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete and line staff should improve. She provided photos of the heel injury. Treatment in place and hospice is aware.What Action Was Taken:Daily document of [Resident #1] dx and what is going on with her on 24-hour report. Set up a care plan meeting with and hospice to ensure we are all on the same page Administrator will attend care plan meeting. Resolved by the Administrator on [DATE] Review of Resident #1's physician's order dated [DATE] reflected: WOUND CARE NURSE TO CHANGE DRSG TO LEFT HEEL ON MON & WED & FRIDAY/ BLISTER/DTI -ON MEDIAL LEFT HEEL/ CLEAN WITH VASHE/ APPLY BETADINE TO HEEL-ALLOW TO DRY/ APPLY ADAPTIC TO AREA/THEN COVER WITH TETRA NET ELASTIC DRSG / PLEASE DATE & INITIAL DRSG. USE HEEL BOOT AT ALL TIMES TO OFFLOAD PRESSURE/ USE LIDOCAINE SPRAY PRIOR TO WOUND CARE TO HELP CONTROL PAIN. Review of Resident #1's progress notes dated [DATE] reflected Resident #1 expired on [DATE]. During an interview on [DATE] at 3:00 pm Resident #1's family stated a fluid filled blister was identified on Resident #1's left heel sometimes in April of 2025. Resident #1's family stated Resident #1 was noted with tennis shoes on after it was communicated with the ADON that Resident #1 didn't need the tennis shoes due to the pressure area on Resident #1's heel. Resident #1's family stated she spoke with LVN A who stated Resident #1 was not supposed to be wearing tennis shoes. Resident #1's family stated she spoke with the CNA on duty that day and the CNA stated she did not know Resident #1 was not supposed to wear the tennis shoes. Resident #1's family stated she took the tennis shoes home. During an interview on [DATE] at 12:09 pm, the Wound Care Nurse stated Resident #1 had a pressure area to her left heel which started as a fluid filled blister and DTI. The Wound Care Nurse stated she heard in conversation that Resident #1's tennis shoes were put on her. The Wound Care Nurse stated there should have been an order for Resident #1 to wear only socks or opened back house shoes. The Wound Care Nurse stated she or the ADON were responsible to put in the order. The Wound Care Nurse stated putting tennis shoes on Resident #1's foot with a pressure area would cause discomfort. The Wound Care Nurse stated the facility had boots ordered, they were offloading Resident #1's heels and providing positioning pillows and wedges and repositioning her every 2 hours and as needed. During an interview on [DATE] at 1:12 pm, the ADON stated, when the blister had started on Resident #1's left heel, she and Resident #1's family had discussed that maybe the shoes were tight. The ADON stated she asked Resident #1's family if it was ok to a house shoe on the Resident #1 and the family agreed. The ADON stated she communicated with staff. The ADON stated 3-4 days after the discussion, an agency staff working with Resident #1 put the shoes on Resident #1 and the family was visiting and saw the shoes on the Resident #1. The ADON stated that was the only time the shoes were put on Resident #1, after that incident the shoes were not in the Resident #1's room. During an interview on [DATE] at 12:57 pm the DON stated it was discussed in a care plan meeting concerning Resident #1 not wearing her tennis shoes. The DON stated, I believe they had asked the family to take the shoes home, but the family didn't. I believe there was a missed communication with the CNAs, the charge nurse was supposed to notify the CNA. I will have to check with the ADON to find out if there was an in-service with the staff not to put the tennis shoes on Resident #1. I don't remember what the wound looked like back in June ([DATE]) but once it was agreed upon not to put the shoes on Resident #1, the staff shouldn't have put the shoe on the resident. Review of facility's in-services for the months of May, June, and [DATE] reflected no in-service regarding Resident #1 not to wear tennis shoe due to pressure areaRequested Skin and wound Care policy from the Administrator on [DATE] at 09:30 am and it was not provided. Event ID: Facility ID: 675886 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 675886 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coryell Health Rehabliving at the Meadows 110 Chicktown Rd Gatesville, TX 76528 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure that pain management is provided to residents who require such services, consistent with professional standards of practice, the comprehensive person-centered care plan, and the residents' goals and preferences for one (Resident #1) of three residents reviewed for pain. The facility failed to assess Resident #1 pain level on [DATE] when family reported Resident #1 was hurting and needed pain medication. These failures could place residents at risk of increased pain, hospitalization, and a decreased quality of life.Findings included: Review of Resident #1's undated face sheet reflected an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including Dementia with behavioral disturbance, DM w/o complication type II, Anxiety, Chronic diastolic CHF (congestive heart failure- is a long-term condition that happens when your heart can't pump blood well enough to give your body a normal supply.), Chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease (COPD) is an ongoing lung condition caused by damage to the lungs), Dependence on supplemental oxygen, Age related osteoporosis, Dementia without behavioral disturbance, Generalized muscle weakness, Abnormality of gait due to impairment of balance, Benign hypertensive heart disease with congestive heart failure, Sprain of unspecified ligament of left ankle, Unspecified fall, subsequent encounter. Review of Resident #1's quarterly MDS assessment, dated [DATE], reflected a BIMS score of 06, indicating severe cognitive impairment. Section I (Active diagnosis) reflected she had Chronic Pain. Section J (Health Conditions) reflected she had been hurting within the past five days and her pain intensity of 06 on the pain scale 00-10. (0 meaning no pain and 10 meaning worst pain) Section M (Skin Condition) indicated the resident was at risk of developing pressure ulcer/ injuries. Review of Resident #1's quarterly care plan, initiated [DATE] and modified on [DATE], reflected she had a blister on her left heel with interventions to Off load heels with cushion or pillow to prevent skin breakdown on heels, change dressings as ordered. Care plan also reflected Resident #1 had LTC Pain IPOC, with outcome of Pain Level Maintained at Less Than Moderate. Review of Resident #1's physician's orders reflected the following:Hydromorphone 1.5 mg, Oral, Liquid, every 1 hr, PRN pain, First Dose: [DATE] 12:42:00 CDT, Routine Give 1.5 ml = 1.5 mg every one (1) hours as neededFentanyl 12 mcg, Transdermal, every 72 hr, First Dose: [DATE] 6:00 pm RoutineHydromorphone-- 2 mg, Oral, Tab, QID, First Dose: [DATE] 4:00 pm Routine Per HospiceAcetaminophen 650 mg, Oral, Tab, every 4 hr, PRN fever, First Dose: [DATE] 1:26 pm Routine Give TWO (2) tablets of 325 to equal 650 mg total dose for fever Review of Resident #1's narcotic count sheet dated [DATE] reflected Resident #1 was given Hydromorphone 2 mg 2 tabs at 7:31 pm by LVN A. Review of Resident # 1's narcotic count sheet dated [DATE] reflected Resident #1 was given Hydromorphone 5mg/5ml solution at about 8:00 pm by LVN A for break through pain. During an interview on [DATE] at 3:00 pm, Resident #1's family stated Resident #1 was crying of pain at about 6:30 pm on [DATE] and the nurse stated the resident had just gotten her 6:00 pm medication and could not get pain medication until 7:00 pm. Review of Resident #1's pain assessment on [DATE] reflected the following:No actual or suspected pain (Charted at [DATE] 10:46pm)No actual or suspected pain (Charted at [DATE] 11 :42 am)There was no pain assessment noted on [DATE] at about 6:30 to 7:30 pm when Resident #1's family requested pain medication. Review of Resident #1's progress notes dated [DATE] reflected Resident #1 expired on [DATE]. During an interview on [DATE] at 09:04 am LVN A stated, she was not sure of the date but there was a day Resident #1's family requested pain medication, and she told Resident #1's family that Resident #1 had just gotten pain medication at 6:00 pm. LVN A stated Resident #1's family stated Resident #1 did not get pain medication at 6:00 pm. LVN A stated she called the medication aide to confirm, and the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675886 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 675886 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coryell Health Rehabliving at the Meadows 110 Chicktown Rd Gatesville, TX 76528 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 0697 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete medication aide stated she did not give Resident #1 pain medication at 6:00 pm. LVN A stated she gave Resident #1 her pain medication within the time frame, which was an hour before or an hour after. LVN A stated she would have given Resident #1 PRN pain medication as ordered but she was out of the time frame for medication administration. LVN A stated it depends on the day, some days Resident #1's was in so much pain and on other days she was not in pain. LVN A could say how much pain Resident #1 was in on [DATE]. During an interview on [DATE] at 1:55 pm the DON stated if a resident was complaining of pain, it was the expectation of the nurse to assess the resident's pain level. The DON stated not assessing the resident's pain level, they wouldn't be able to know what medication to give the resident or how to treat them. The DON reviewed Resident #1's MAR and TAR for [DATE] and stated Resident #1 was supposed to be assessed for pain every time the nurses administered pain medication. The DON stated Resident #1's schedule Hydromorphone was schedule for 08:00 am, 12:00 noon, 4:00 pm and 8:00 pm so Resident #1 was not scheduled for pain medication at 6:00 pm. Review of facility's policy titled Pain - Clinical Protocol undated reflected: Assessment and Recognition1. The physician and staff will identify individuals who have pain or who are at risk for having pain.a. This includes reviewing known diagnoses and conditions that commonly cause pain; for example, degenerative joint disease, rheumatoid arthritis, osteoporosis (with or without vertebral compression fractures), diabetic neuropathy, oral or dental pathology, and post-stroke syndromes.b. It also includes a review for any treatments that the resident currently is receiving for pain, including complementary and non-pharmacologic treatments.2. The nursing staff will assess each individual for pain upon admission to the facility, at the quarterly review, whenever there is a significant change in condition, and when there is onset of new pain or worsening of existing pain.3. The staff and physician will identify the characteristics of pain such as location, intensity, frequency,pattern, and severity.a. Staff will use a consistent approach and a standardized pain assessment instrument appropriate to the resident's cognitive level.4. The nursing staff will identify any situations or interventions where an increase in the resident's pain may be anticipated; for example, wound care, ambulation, or repositioning.5. The staff and physician will evaluate how pain is affecting mood, activities of daily living, sleep, and the resident's quality of life, as well as how pain may be contributing to complications such as gait disturbances, social isolation, and falls.Monitoring1. The staff will reassess the individual's pain and related consequences at regular intervals, at least each shift for acute pain or significant changes in levels of chronic pain and at least weekly in stable chronic pain.a. Review should include frequency, duration and intensity of pain, ability to perform activities of daily living (ADLs), sleep pattern, mood, behavior, and participation in activities. Event ID: Facility ID: 675886 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 675886 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coryell Health Rehabliving at the Meadows 110 Chicktown Rd Gatesville, TX 76528 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 interviews and records review the facility failed to provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident for one (Resident #1)of three residents review for medication administration.The facility failed to administer Resident 1's antibiotic on [DATE] as was ordered on [DATE].This failure could place residents at risk of ineffective therapeutic effect.Findings included:Review of Resident #1's undated face sheet reflected an [AGE] year-old female who was admitted to the facility on [DATE] with diagnoses including Dementia with behavioral disturbance, DM w/o complication type II, Anxiety, Chronic diastolic CHF (congestive heart failure- is a long-term condition that happens when your heart can't pump blood well enough to give your body a normal supply.), Chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease (COPD) is an ongoing lung condition caused by damage to the lungs), Dependence on supplemental oxygen, Age related osteoporosis, Dementia without behavioral disturbance, Generalized muscle weakness, Abnormality of gait due to impairment of balance, Benign hypertensive heart disease with congestive heart failure, Sprain of unspecified ligament of left ankle, Unspecified fall, subsequent encounter. Review of Resident #1's quarterly MDS assessment, dated [DATE], reflected a BIMS score of 06, indicating severe cognitive impairment. Section I (Active diagnosis) reflected she had Chronic Pain. Section J (Health Conditions) reflected she had been hurting within the past five days and her pain intensity of 06 on the pain scale 00-10. Section M (Skin Condition) indicated the resident was at risk of developing pressure ulcer/ injuries. Review of Resident #1's physician's order dated [DATE] reflected: Cephalexin 500 mg. Oral, cap, every 12 hr (sch), Antibiotic Indication Urinary Tract Infection, first Dose: [DATE] 8:00 pm, Stop Date: [DATE] 7:59 PM, Physician Stop, Routine -do NOT crush or chew Review of Resident #1's Medication Administration Records (MAR) for the month of [DATE] reflected Resident #1's Cephalexin 500 mg. Oral, cap, every 12 hr (sch), was not given on [DATE]. Review of Resident #1's MAR for the month of [DATE] reflected Resident #1's Cephalexin 500 mg. Oral, cap, every 12 hr (sch), was given as followed:On [DATE] at 8:00 pmOn [DATE] at 1:32 pm and at 7:48 pm. On [DATE] at 7:59 am and at 7:24 pm. On [DATE] at 7:51 am and at 7:06 pmOn [DATE] at 8:26 am and at 7:10 pmOn [DATE] at 8:36 am and at 7:01 pm Review of Resident #1's progress notes for [DATE] and [DATE] reflected no documentation of Resident #1 starting an antibiotic on [DATE] or why the ABT was not given on [DATE]. Review of Resident #1's progress notes dated [DATE] written by LVN A reflected: Resident is Day 1 of 7 for start of medication: Keflex for cystitis (is a medical condition that refers to inflammation of the bladder. It is a common infection of the urinary tract, typically caused by bacteria.) Adverse reaction / Side effects: no. If yes, document adverse reaction / side effects below: Medication appears to be_, If ineffective, has PCP been notified To early to see effects resident has only had 2 doses Electronically Signed on [DATE] 01:34 pm. Review of Resident #1's progress notes dated [DATE] reflected Resident #1 expired on [DATE]. During an interview on [DATE] at 2:28 pm, the Hospice Nurse stated she was not aware of Resident #1's ABT not being in the facility or not arriving on time. The Hospice Nurse stated the facility staff were good at communicating with hospice that the medication was not in the E-kit. The Hospice Nurse stated if it was communicated with hospice that Resident #1's ABT was not available, she would have ordered the medication from the nearby pharmacy or ordered the medication to start the following day. During an interview on [DATE] at 3:00 pm Resident #1's family stated on [DATE] Resident #1 was smelling of a foul urine odor. Resident #1's family stated hospice was contacted and an ABT was ordered. Resident #1's family stated hospice confirmed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675886 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 675886 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coryell Health Rehabliving at the Meadows 110 Chicktown Rd Gatesville, TX 76528 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 FORM CMS-2567 (02/99) Previous Versions Obsolete the ABT was ordered, and Resident #1 was starting the ABT on [DATE]. Resident #1 family stated she called on [DATE] and spoke with LVN A and asked about Resident #1's ABT administration. Resident #1's family stated she was told by LVN A that Resident #1 did not get her morning and evening dose of ABT due to the medication not being put in the system. Resident #1's family stated LVN A stated she would put the orders in the computer system. Resident #1's family stated she did not complain to hospice, the DON, ADON or the Administrator because she couldn't process what to say. During an interview on [DATE] at 09:04 am, LVN A stated she couldn't remember the exact incident regarding Resident #1's ABT orders because it has been a while. LVN A stated they may have started Resident #1's ABT the next day or so. LVN A stated it might have been pharmacy issues. LVN A stated they could take the ABT from the e-kit, but there were lot of residents in the facility who also got medication from the e-kit and staff had to wait for the medication to be refilled in the e-kit. During an interview on [DATE] at 10:52 am the DON stated if there is an order for ABT, the nurses were expected to get it from the Cubex (e-kit). The DON stated hospice usually provided the medication once it was ordered. The DON stated, if hospice was unable to provide a medication, the facility provided it. The DON stated she did not recall an instance where Resident #1 was ordered an ABT, and she did not get the medication as ordered or the medication was not provided by hospice. Later the DON stated, she did not know why Resident #1's ABT was not given on [DATE]. The DON stated she would check and see why. The DON stated the expectation was for the nurses to give the initial dose of the ABT from the e-kit /cubex and continue as ordered. The DON stated she couldn't remember from 3 months ago, but the process was to call the pharmacy to find out why the medication was not delivered; if they can't get the medication, they order it from the local pharmacy. The DON stated is Resident #'s ABT was not given as ordered, it should have been documented in Resident #1's progress why the medication was not given, and hospice and the MD should should have been notified. The DON again stated she couldn't find where the ABT was ordered, but the initial dose was given on [DATE]. The DON stated maybe there was an error with when the medication being put in the computer system. The DON stated she couldn't tell who put the medication in the computer system, but the next dose was given on [DATE]. The DON stated not administering an ABT as ordered could have impact on the effectiveness of the medication. Review of the facility's medication errors for the months of May, June and [DATE] reflected no medication error for Resident #1. Review of the facility's policy titled Medication and Treatment Orders revised [DATE] reflected: Policy Statement Orders for medications and treatments will be consistent with principles of safe and effective order writing.Policy Interpretation and Implementation7. Verbal orders must be recorded immediately in the resident's chart by the person receiving the order and must include prescriber's last name, credentials, the date and the time of the order. Event ID: Facility ID: 675886 If continuation sheet Page 6 of 6