Inspection·November 25, 2025

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some week, stating that the food was not good and residents did not like it. In an interview on 10/10/25 at 12:01 p.m. with Resident #1, she stated that since she has been at the facility over the past couple of years, the food has gone from bad to worse. She stated that she had really bad acid reflux and she started experiencing increased episodes of diarrhea that led to her doctor increasing her medication dosage to provide some relief. Resident #1 stated that she constantly had to tell the kitchen staff and DM B that she did not like sausage, but they constantly placed it on her plate every morning during breakfast. She expressed that she hated sausage and seeing it on her tray made her want to throw up. Everyday her breakfast ticket said no sausage but staff would still place it on her plate because they were not reading the tickets. She also received meals covered in gravy after she listed that she did not like gravy. She stated that she had informed the ADM about her kitchen concerns and felt she did not care because the staff were contracted with a different company. In an interview on 10/10/25 at 12:42 p.m. with DM B, she stated she was the dietary manager at the facility from 06/30/25 until she was termed on 10/06/25. She stated that prior to employment, her predecessor was well liked by everyone in the facility, and it was a hard task coming behind her and she probably was not a good fit. DM B explained that she received several grievances regarding the menu and food being cold. She felt that some of the complaints she received were valid and some of the grievances came from chronic complainers who were hard to please. She explained that during her employment, there were several dietary staff members who worked in the kitchen without their food handler's certification. She explained that in her 20 years of working in dietary, she had never received so many grievances. Some of the grievances she felt were valid like the ones who came from Resident #1. She knew that Resident #1 did not like gravy on her food and staff continued to do it because they were not slowing down and reading the tickets. She explained that when she arrived to work on 9/26/25, she received about 9 or 10 grievances regarding the meal service from the night before and in-services were given to herself and the dietary staff regarding storage of proper food items, chain of command, and food temperatures. She did remember some complaints regarding diarrhea that stemmed from the cold grilled cheese sandwiches and tomato soup that was served during dinner on 09/25/25, but she was off that day. [NAME] E prepared the meal that night and she explained that she had made the grilled cheese sandwiches ahead of the service. DM B stated that she had to do a corrective action for [NAME] E and concluded that the facility was a really tough building to work in. She stated [NAME] E was terminated from this role shortly after. In an interview with the ADM on 10/10/25 at 2:16 p.m., she stated that she sat in on the Resident Council Meeting in August and she was concerned about all the complaints she received regarding the dietary department. This prompted her to begin a QAPI and start in-services to her staff. The facility tried to coach with DM B but her attitude made her difficult to work with and receive feedback, ultimately leading to her termination. Record review of the facility's grievance and complaint log for August showed that on 8/20/25, there were 13 grievances directed towards the dietary department. Record review of the grievances for September 2025 documented 15 complaints directed towards the dietary department. Record review of the Resident Council Meeting minutes conducted on 9/16/25 at 2:00 p.m. revealed that complaints were made regarding food being served cold, overcooked, and failure by kitchen staff to follow meal preferences. Resident #1 stated that her breakfast was served cold that morning and her waffles were still frozen. Resident #1 stated that she did not want any sausage on her breakfast tray but she still received sausage on her tray every time it was served. She also stated that she received two bowls of oatmeal that morning for breakfast instead of the bowl of dry cereal with milk and cranberry juice she requested. Record review of an in-service dated on 09/15/25 revealed that the ADM educated all nursing staff on mealtimes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675894 If continuation sheet Page 2 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0804 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete and stated the goal was to deliver warm food with a great presentation. Record review of an in-service titled Food temperatures dated on 09/26/25 with the dietary staff highlighted the purpose of the in-service was to ensure all dietary staff understood proper food temperature control and how it directly impacted resident satisfaction, safety, and compliance. This in-service documented that it was used as a learning opportunity to reinforce the standards and prevent recurrence of the recent incident in which grilled cheese sandwiches and tomato soups were served cold. Best practices indicated to take and document food temps before service begins, after transport, and on the line. Always use a calibrated food thermometer. Label and cover trays to retain heat and coordinate closely with nursing or dining teams to time delivery properly. Lastly, never guess temperatures based on feel or appearance. Record review of an in-service dated 09/29/25 revealed that the ADM educated all nursing staff on resident rights, abuse and neglect, and the policy on meal pass times and temperatures. Record review of DM B's employee file reflected that on 10/6/25, DM B received a 90-day performance review that stated that while coaching and feedback were consistently provided, the outcomes have not met the expectations for a food service manager at [name] company. Her areas of concern included the resident dissatisfaction regarding meal services, defensiveness or blame shifting when receiving feedback, raised tones and dismissive behavior towards staff that resulted in low morale and workplace tensions, and low progress to coaching sessions. She was effectively demoted on 10/6/25 to the position as a cook. DM B refused to sign this document and her employment with the facility and the contracted dietary company was terminated. Record review of a letter written by the ADM to whom it may concern from the contracted dietary company on 10/6/25 read that: Despite repeated attempts to address these issues through one-on-one discussions, progress has been limited. A primary barrier to resolution appears to be [DM B's] overall attitude and approach. She frequently became defensive or agitated when concerns were raised, often providing excuses or shifting blame rather than working towards solutions. Additionally, she had been observed raising her voice at her staff and had demonstrated dismissive or uncooperative behavior when approached by her nursing or administrative team members in collaboration. Given the continued complaints, the influence of grievances, and the lack of meaningful improvement, it appears to be the best interest of the facility to move forward and parting ways with [DM B] at this time. Event ID: Facility ID: 675894 If continuation sheet Page 3 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure each resident received and was provided food that accommodated resident allergies, intolerances, and preferences for 1 (Resident #1) of 5 residents reviewed for meal preferences. Resident #1 received sausage for breakfast and gravy on her food during mealtimes after she consistently requested the removal of these items from her plate. This failure could lead to a diminished quality of life. Findings included: Record review of Resident #1's facesheet revealed an eighty-one-year-old female who was admitted to the facility on [DATE]. Her admitting diagnoses were Type 2 Diabetes, GERD, hypertension (high blood pressure), gout (a form of arthritis), and anxiety disorder. Record review of Resident #1's care plan revealed that she was on a therapeutic CCD regular diet with regular consistency. Interventions listed were to alert the NP/MD and document residents' inability to consume diet, offer supplements and alternatives if less than 50% of the meal is consumed or resident does not like the meal, and provide diet as MD order. In relation to her Type 2 Diabetes, the intervention listed was to observe compliance with diet and document any problems. Record review of Resident #1's nutrition progress note dated 9/09/25 at 11:06 am documented that Resident #1 stopped the dietician and requested supplements and no gravy on food. Record review of the facility's dietary staffing list revealed that there were 9 employees who worked in the kitchen. During an interview on 10/09/25 at 10:18 a.m., DM A informed the surveyor that it was her third day in that role, and she was trying to revamp the kitchen. The health department visited the facility's kitchen on 10/08/25 for an impromptu inspection due to a call for a foodborne outbreak at the facility and she could provide the documentation of their passing score. She stated she could tell the previous manager did not focus on checking temperatures In an interview on 10/10/25 at 10:20 a.m. with the AD, she stated that she had worked at the facility for over 20 years. She oversaw the resident council that met every 3rd Tuesday of the month. During the last resident council meeting, she had several complaints regarding the food not being good. In an interview on 10/10/25 at 12:01 p.m. with Resident #1, she stated that since she has been at the facility over the past couple of years, the food has gone from bad to worse. Resident #1 stated that she constantly had to tell the kitchen staff and DM B that she did not like sausage, but they constantly placed it on her plate every morning during breakfast. She expressed that she hated sausage and seeing it on her tray made her want to throw up. Everyday her breakfast ticket said no sausage but staff would still place it on her plate because they were not reading the tickets. She also received meals covered in gravy after she listed that she did not like gravy. She stated that she had informed the ADM about her kitchen concerns and felt she did not care because the staff were contracted with a different company. In an interview on 10/10/25 at 12:42 p.m. with DM B, she stated she was the dietary manager at the facility from 06/30/25 until she was termed on 10/06/25. She stated that prior to employment, her predecessor was well liked by everyone in the facility, and it was a hard task coming behind her and she probably was not a good fit. DM B explained that she received several grievances regarding the menu and food being cold. She felt that some of the complaints she received were valid and some of the grievances came from chronic complainers who were hard to please. She explained that during her employment, there were several dietary staff members who worked in the kitchen without their food handler's certification. She explained that in her 20 years of working in dietary, she had never received so many grievances. Some of the grievances she felt were valid like the ones who came from Resident #1. She knew that Resident #1 did not like gravy on her food and staff continued to do it because they were not slowing down and reading the tickets. In an (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675894 If continuation sheet Page 4 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 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 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete interview with the ADM on 10/10/25 at 2:16 p.m., she stated that she sat in on the Resident Council Meeting in August and she was concerned about all of the complaints she received regarding the dietary department. This prompted her to begin a QAPI and start in-services to her staff. The facility tried to coach with DM B but her attitude made her difficult to work with and receive feedback, ultimately leading to her termination. Record review of the facility's grievance and complaint log for August showed that on 8/20/25, there were 13 grievances directed towards the dietary department. Record review of the grievances for September 2025 documented 15 complaints directed towards the dietary department. Record review of the Resident Council Meeting minutes conducted on 9/16/25 at 2:00 p.m. revealed that complaints were made regarding food being served cold, overcooked, and failure by kitchen staff to follow meal preferences. Resident #1 stated that her breakfast was served cold that morning and her waffles were still frozen. Resident #1 stated that she did not want any sausage on her breakfast tray but she still received sausage on her tray every time it was served. She also stated that she received two bowls of oatmeal that morning for breakfast instead of the bowl of dry cereal with milk and cranberry juice she requested. Record review of an in-service dated on 09/15/25 revealed that the ADM educated all nursing staff on mealtimes and stated the goal was to deliver warm food with a great presentation. Record review of an in-service dated 09/29/25 revealed that the ADM educated all nursing staff on resident rights, abuse and neglect, and the policy on meal pass times and temperatures. Record review of DM B's employee file reflected that on 10/06/25, DM B received a 90-day performance review that stated that while coaching and feedback were consistently provided, the outcomes have not met the expectations for a food service manager at [name] company. Her areas of concern included the resident dissatisfaction regarding meal services, defensiveness or blame shifting when receiving feedback, raised tones and dismissive behavior towards staff that resulted in low morale and workplace tensions, and low progress to coaching sessions. She was effectively demoted on 10/06/25 to the position as a cook. DM B refused to sign this document and her employment with the facility and the contracted dietary company was terminated. Record review of a letter written by the ADM to whom it may concern from the contracted dietary company on 10/06/25 read that: Despite repeated attempts to address these issues through one-on-one discussions, progress has been limited. A primary barrier to resolution appears to be [DM B's] overall attitude and approach. She frequently became defensive or agitated when concerns were raised, often providing excuses or shifting blame rather than working towards solutions. Additionally, she had been observed raising her voice at her staff and had demonstrated dismissive or uncooperative behavior when approached by her nursing or administrative team members in collaboration. Given the continued complaints, the influence of grievances, and the lack of meaningful improvement, it appears to be the best interest of the facility to move forward and parting ways with [DM B] at this time. Event ID: Facility ID: 675894 If continuation sheet Page 5 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for 1 of 1 kitchen reviewed for kitchen compliance. 1. Dietary staff failed to ensure all dishes and silverware were properly cleaned before utilizing during meal services. 2. Dietary staff failed to properly label/date dry storage items stored inside their pantry. 3. Dietary staff failed to properly seal dry storage items inside their pantry. 4. Dietary staff failed to utilize the chlorine sanitizer test strips and accurately document the results during each shift. 5. Dietary staff failed to document dishwashing temperatures daily. This failure could place residents at risk of contracting a foodborne illness and a diminished quality of life. Findings Included:During an interview on 10/09/25 at 10:18 a.m., DM A informed the surveyor that it was her third day in that role and she was trying to revamp the kitchen. The health department visited the facility's kitchen on 10/08/25 for an impromptu inspection due to a call for a foodborne outbreak at the facility and she could provide the documentation of their passing score. She stated she could tell the previous manager did not focus on checking temperatures of the food before meal service labeling items in the kitchen. In an observation on 10/09/25 at 10:20 a.m. inside of the dry storage inside the kitchen, the following items were found not dated or incorrectly sealed:4 bags of cornflakes (amount not specified) not dated6 bags of rice puffs (name not specified) were on the shelf and not dated. Packaged boxes of dry food in the middle of the floor were not dated. box of condiments not dated 2 boxes of 12lb sugar packets not dated2 62.9fl oz of caramel not dated1lb of celery salt not dated1lb vegetable seasoning not dated1lb hot cereal quick grits not dated5.75lb of mashed potatoes with vitamin c were not dated. 10lb bag of various classic durum wheat dried pasta shells. There was a hole in the bag and it was not sealed properly. The top was cut off and the bag was folded over once and sat on the shelf.10lb bag of noodles was left out on the shelf and folded over. Not secured or packaged in a way that maintained freshness. Dated 8-20.2 10lb bags of tri color pasta were not dated on the shelf.5 boxes of lasagna 1lb pasta boxes not dated. 2 packs 12 count hamburger buns not dated. pack of wheat bread that felt stale to the touch sat next to the buns, 13 slices of bread not dated. Crispy feel when touched. In an observation on 10/09/25 at 10:40 a.m., stacked on a rack by the sink were green and black acrylic drink mugs. Two of the mugs were dirty and sat upright with brown splatters, brown dripping liquid, and a leftover ring from a drink. The investigator smelled inside the mugs and confirmed that the brown splatters were from coffee. Another black cup had a cream-colored residue of a leftover food substance inside. On the same row of mugs, two green mugs also had leftover splatters of black coffee inside. In an observation and interview on 10/09/25 at 10:47 a.m. with TA F, he stated that he had been working there since the middle of September, but he was previously employed at the facility. He explained that his job responsibilities were to keep the dishwashing room clean, get the trays out, and wash the dishes. When the dishes came back after meal service, he would load them and run them through the dishwasher. He explained that each load of dishes got washed for about 5 minutes and all the clean dishes would be stacked and placed on trays by another kitchen staff. When asked what type of dishwasher he used, he stated that he did not know and he could not locate the type on the machine. The temperature log was hung on the wall and TA F stated that he checked the temperature every day. When asked how, he stuttered and began to look around the dishwasher. DM A walked by and he asked her how to check the dishwasher's temperature, and she asked him where the temperature gauge was, and he could not answer. DM A asked TA F where his test strips were and he stated he did not have any and she gave (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675894 If continuation sheet Page 6 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some him a pack of chlorine sanitizer test strips and a quaternary test kit (strips used to test sanitizer solution strength) that expired on 02/01/23. TA F took one of the strips out of the quaternary test kit and attempted to test the water by dipping the strip into the water inside the dishwasher. The strip did not change colors. He grabbed another strip out of the chlorine sanitizer test strip and dipped it in the water again. He stated it's purple and walked quickly to the trashcan without sharing the results. The surveyor asked him to let her see and he replied oh. TA F grabbed another chlorine test strip out of the bottle and dipped it inside the water of the dishwasher again. It did not change color to reflect the strength of the sanitizer in the water and he asked it's supposed to change colors isn't it?. Referring to the temperature log, TA F was asked how he documented the temperature daily if he could not locate the thermometer. He responded that the lady who worked there before (DM B) would usually fill in the temperatures on the log. He said he knew that he told the surveyor that he checked and documented the water temperatures everyday but instead he would rewrite whatever was written down the previous day. In an interview on 10/09/25 at 11:02 a.m. with [NAME] D, he stated that he had been working at the facility for 1 month and his responsibilities were to cook, wash dishes, and store delivered items in the freezer. He stated that he did not stack the dishes that sat behind him on the rack and that the tray aides usually stacked their dishes after they washed them. He called out to TA F and they agreed that the night shift must have stacked the dirty dishes on the rack. When he was told that the dishes were still wet, [NAME] D stated that some of them must have been stacked that morning. [NAME] D explained that when a new shipment of food came in, the kitchen staff on shift at the time were to check that they received everything that was ordered, write the date it was delivered on the product, push the older stuff to the front, and the first shift would put up the frozen items and second shift would unpack the dry storage products. After the items were unboxed, the DM would go back and check to make sure everything was labeled. When asked how he checked the temperature of the kitchen sink, he replied that he used the little stick thing (referencing the chlorine sanitizer test strips) and stick it in the water but he had run out. In an interview on 10/09/25 at 11:17 a.m., DA G stated that he had been working at the facility for 2 months and some of his responsibilities were to wash dishes and help the cook read out tickets during serving times. He stated that the second aide was someone who was supposed to help the TA by checking the dishes to make sure they were clean and if they were dirty, they were supposed to put them to the side to be rewashed in the dishwasher. In an interview on 10/09/25 at 11:25 a.m. with DM A, she was informed about the dirty dishes found during the kitchen observation and she stated that she had dirty dishes on her list of things to talk to staff about. She explained that earlier that morning, she received a complaint that a resident had dried spinach on her drinking cup and she knew it was from the day before based off the fact that they did not have any breakfast items containing spinach. DM A was asked to provide the food handler certifications for her 9 staff members. She explained that the kitchen staff were contracted through a third-party company and she was only able to provide the certifications for 3 of the 5 kitchen staff currently on shift, but she would make copies once the others were found. She was also informed that [NAME] D and TA F did not know how to check the temperature of the kitchen sink or use the chlorine test strips. She stated that they would have to be retrained. In an interview on 10/10/25 at 10:20 a.m. with the AD, she stated that she had worked at the facility for over 20 years. She oversaw the resident council that met every 3rd Tuesday of the month. During the last resident council meeting, she had several complaints regarding the food was served on dirty plates accompanied by dirty silverware. In an interview on 10/09/25 at 12:01 p.m. with Resident #1 she stated in the last 4 months she had received 31 pieces of filthy silverware from the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675894 If continuation sheet Page 7 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some kitchen. She stated that she had informed the ADM about her kitchen concerns and felt she did not care because the staff were contracted with a different company. In an interview on 10/10/25 at 12:42 p.m. with DM B, she stated she was the Dietary Manager at the facility from 06/30/25 until she was termed on 10/06/25. She stated that prior to employment, her predecessor was well liked by everyone in the facility, and it was a hard task coming behind her and she probably was not a good fit. DM B explained that she received several grievances regarding dirty silverware. She felt that some of the complaints she received were valid and some of the grievances came from chronic complainers who were hard to please. She explained that during her employment, there were several dietary staff members who worked in the kitchen without their food handler's certification. She explained that in her 20 years of working in dietary, she had never received so many grievances. Some of the grievances she felt were valid like the ones who came from Resident #1. She explained that when she arrived to work on 9/26/25, she received about 9 or 10 grievances regarding the meal service from the night before and in-services were given to herself and the dietary staff regarding the proper storage of food items, chain of command, and food temperatures. DM B stated that the facility was a really tough building to work in. In an interview with the ADM on 10/10/25 at 2:16 p.m., she stated that she sat in on the Resident Council Meeting in August and she was concerned about all the complaints she received regarding the dietary department. This prompted her to begin a QAPI and start in-services to her staff. The facility tried to coach DM B, but her attitude made her difficult to work with and receive feedback, ultimately leading to her termination. Record review of the facility's dietary staffing list revealed that there were 9 employees who worked in the kitchen. Record review of the dietary staff food handler's certification records revealed that 6 out of 9 staff members had active certifications. TA A's certification was not submitted during this investigation. Record review of the facility's grievance and complaint log for August showed that on 8/20/25, there were 13 grievances directed towards the dietary department. Record review of the grievances for September 2025 documented 15 complaints directed towards the dietary department. Record review of the Resident Council Meeting minutes conducted on 9/16/25 at 2:00 p.m. revealed several complaints about receiving dirty silverware and dishes during mealtimes. Record review of DM B's employee file reflected that on 10/06/25, DM B received a 90-day performance review that stated that while coaching and feedback were consistently provided, the outcomes have not met the expectations for a food service manager at [name] company. Her areas of concern included the resident dissatisfaction regarding meal services, defensiveness or blame shifting when receiving feedback, raised tones and dismissive behavior towards staff that resulted in low morale and workplace tensions, and low progress to coaching sessions. She was effectively demoted on 10/06/25 to the position as a cook. DM B refused to sign this document and her employment with the facility and the contracted dietary company was terminated. Record review of a letter written by the ADM to whom it may concern from the contracted dietary company on 10/06/25 read that: Despite repeated attempts to address these issues through one-on-one discussions, progress has been limited. A primary barrier to resolution appears to be [DM B's] overall attitude and approach. She frequently became defensive or agitated when concerns were raised, often providing excuses or shifting blame rather than working towards solutions. Additionally, she had been observed raising her voice at her staff and had demonstrated dismissive or uncooperative behavior when approached by her nursing or administrative team members in collaboration. Given the continued complaints, the influence of grievances, and the lack of meaningful improvement, it appears to be the best interest of the facility to move forward and parting ways with [DM B] at this time. Record review of the contracted dietary company's policy titled Ware washing Policy and Procedure (not dated, received 10/10/25) displayed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675894 If continuation sheet Page 8 of 9 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 675894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Manor of Conroe 1600 Grand Lake Dr Conroe, TX 77301 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete that: We prioritize the cleanliness and sanitation of all dishware, service ware, and utensils to uphold the highest health and safety standards.Procedures1. Training and Handling: Our Dietary Services staff undergo comprehensive training to proficiently operate dishwashing machinery and handle clean dishware, ensuring strict adherence to sanitary protocols.2. Machine Temperature Management: We regulate the temperature of dishwashing machine water according to the specifications provided by the manufacturer, whether utilizing high-temperature or low-temperature cleaning systems.3. Record Keeping: Meticulous logs are maintained to track either temperature or sanitizer concentration, depending on the type of machine, always guaranteeing compliance with sanitation standards.4. Drying and Storage: Cleaned dishware is air dried and stored appropriately to prevent any potential contamination prior to use, maintaining the integrity of our sanitary practices.Required Documentation: Dish Machine Log. Record review of the contracted dietary company's policy titled Dry Goods Storage Policy and Procedure (not dated, received 10/10/25) displayed that:5. Condition of Stored Items: All packaged and canned foods must be maintained in a clean, dry state and properly sealed to preserve their integrity.6. Organization: Storage areas shall be organized and maintained in a manner that allows for easy identification and access to items, with all goods appropriately dated. Event ID: Facility ID: 675894 If continuation sheet Page 9 of 9