Health inspection·July 30, 2025

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Resident #1's Comprehensive Care Plan, dated 04/28/2025, reflected the focus resident at risk for falls was initiated on 05/25/2025. Interventions included staff x 1 to assist resident with transfers, ensure the resident's call light was within reach and encourage the resident to use it for assistance as needed, and ensure the resident was wearing appropriate footwear when ambulating or mobilizing in his wheelchair. The care plan did not reflect each fall or a new intervention after each fall. Record review of Resident #1's Fall Risk Assessments, dated 06/12/2025, 06/20/2025, and 06/22/2025, reflected Resident #1 was in the high-risk category for falls. Record review of the facility's incident reports reflected Resident #1 fell on [DATE], 04/11/2025, 04/15/2025, 04/20/2025, 05/25/2025, 06/10/2025, 6/20/2025 which did not result in a serious injury. Resident #1 was sent to the hospital after he fell on [DATE]. Record review of Resident #1's progress notes, dated 06/13/2025, reflected RN C documented This client is somewhat confused. He does not abide by the nurses' instructions about his safety and constantly gets out of the recliner and makes movements that could severely hurt him. He slid out of the recliner at 2145. Once we put him in bed, 30 minutes later, we found him by the door in his chair, naked.We need a baby monitor so that the nurse can see him from the nurse's station. Record review of Resident #1's progress notes, dated 06/20/2025, reflected RN X documented This nurse was called by an Aide that resident was on the floor. Resident was lying next to his recliner and bed. Resident said he was trying to use the bathroom. Resident was lifted off the floor with a Hoyer lift. Resident sustained a skin tear on his right elbow. Site was cleaned and covered with border dressing. Resident assessed and his vital signs were normal. DON, family, and NP were notified. Record review of Resident #1's progress notes, dated 06/22/2025, reflected RN C documented nurse was called to resident room and observed resident on the floor next to the bed, resident is alert and able to response to verbal commands, disorientation also noted, head to toe assessment done at this time, laceration of about 1 cm x 0.5 cm noted right side of the head, extensive bruising from his right shoulder to right lower back, vital signs recorded at this time within normal range, scant amount of blood noted to laceration site, emergency services called, emergency personnels arrive and assessed patient, resident was transported to hospital for further evaluation. Record review of Resident #1's progress notes, dated 06/22/2025, reflected RN C also documented patient fell at 00:51 am, unwitnessed, sustained penetrating injury to his head in the right temporal area. Had an extensive bruise from left shoulder blade diagonally to right waist area. The patient needs close monitoring because he isn't aware of usage of call light. The client is confused, needs one on one or baby monitoring to prevent further falls. Record review of the incident report completed by RN C, dated 06/22/2025, reflected Resident #1 had an unwitnessed fall and was discovered on the floor next to his bed. The incident report reflected Resident #1 stated he tried to get up and fell out of bed. Record review of Resident #1's hospital records, dated 06/23/2025, reflected Resident #1 was admitted to the emergency department on 06/22/2025 at 1:38 AM with a large left subdural hematoma (brain bleed) with a mid-line shift to the right (displacement of the brain away from center line). Resident #1 was not a candidate for surgical repair of the bleed and was placed on palliative care until he passed away in the hospital on [DATE] at 3:30 AM. During a telephone interview on 06/26/2025 at 10:42 AM, CNA D stated Resident #1 tried get up by himself all the time. CNA D stated Resident #1 used a walker and would take himself to the restroom without using the call light and waiting for assistance. She stated when she rounded on her residents, just a few minutes before Resident #1 fell, he was asleep. CNA D stated she was at the nurse's station when she heard someone say help me and found Resident #1 on the floor. CNA D stated she called for RN C to assess the resident and told the resident not to move. She stated Resident #1 told her that he hurt and when CNA D asked where, he said he wasn't sure. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 2 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some She stated RN C assessed Resident#1 and the resident had a laceration on the right side of his head and 2 reddish color marks on his back. She stated Resident #1 was taken to the hospital. During an interview with RN C on 06/26/25 12:54 PM, he stated he was the resident's nurse at the time of the fall on 06/22/2025. He stated CNA D notified him Resident #1 fell and he went to the resident's room and assessed him. RN C stated the resident had a laceration on the right side of his head. He stated he notified the physician and received an order to send Resident #1 to the hospital for evaluation. RN C stated Resident #1 was supposed to use his call light before getting up but did not always do that. During an interview on 06/26/25 at 1:35 PM, the Administrator stated staff notified him Resident #1 was sent to the hospital after a fall. The Administrator stated he called CNA D and RN C to get their statements. He stated he talked to all staff who cared for Resident #1 starting 24 hours before the fall to see if anyone had seen anything out of the normal for Resident #1. He stated staff had not noticed anything different about him. During an interview on 06/26/2025 at 4:18 PM, ADON B stated RN C reported at about midnight he went to Resident #1's room. He stated RN C told him the resident was on the floor next to his bed and had a cut on his head. ADON B stated when RN C asked what happened, Resident #1 stated he thought it was morning and was getting up to get dressed. ADON B stated RN C called 911 because Resident #1 hit his head when he fell, and he was sent to the hospital. ADON B stated Resident #1 had previous falls and therapy had worked with him for balance/gait. He stated the resident used a walker. During an interview on 06/27/25 at 8:55 AM, the Rehab Director stated therapy services were discontinued for Resident #1 on 06/09/2025 and the resident was walker level. She stated the resident fell on the Friday before the incident. She stated Resident #1 needed lots of verbal reminders to walk with someone and not by himself. She stated the resident would use his walker to go to the restroom in his room without calling for assistance. She stated Resident #1 had a walker and wheelchair in his room. She stated the resident had cognition/safety impairment. She stated if Resident #1's knees were bothering him, he would use his wheelchair for longer distances. She stated she had not observed a change in Resident #1's condition prior to his fall. During an interview on 07/02/2025 at 10:26 AM, CNA H stated she worked on different halls and was not working on Resident #1's hall the day he transferred to the hospital. She stated Resident #1 used a walker to go to the bathroom by himself and changed his clothes without assistance. She stated he was not considered a high fall risk. She stated she rounded and checked on Resident #1 and his roommate every two hours. She stated Resident #1 liked to sit in his recliner and watch television. She stated after his wife brought the recliner to the facility; Resident #1 also slept in it. She stated the resident walked to the dining room for breakfast and ate lunch in his room because his wife was visiting with him. She stated the day of the fall she saw Resident #1 in the hall using his walker and another time he was pushing his wheelchair. She stated Resident #1 sat in his wheelchair when he got tired. She stated she did not see any change in mobility or cognition prior to the fall. 2. Record review of Resident #2's Face Sheet, dated 07/02/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #2 had diagnoses which included aftercare following joint replacement surgery, bipolar disorder (extreme mood swings that include emotional highs and lows), COPD (lung condition that makes it difficult to breathe), limitation of activities due to disability, and the need for assistance with personal care. Resident #2 had discharged from the facility. Record review of Resident #2's admission MDS Assessment, dated 05/22/2025, reflected moderately impaired cognition with a BIMS score of 10. Section I (Active Diagnoses) reflected the need for assistance with personal care, limitation of activities due to disability, and unsteadiness on feet. Resident #2 discharged from the facility on 07/02/2025. Record review of Resident #2's Comprehensive Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 3 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Plan, dated 04/28/2025, reflected the focus resident at risk for falls was initiated on 05/16/2025. Interventions included staff x 1 to assist resident with transfers, ensure the resident's call light was within reach and encourage the resident to use it for assistance as needed, and ensure the resident was wearing appropriate footwear when ambulating or mobilizing in wheelchair. The care plan did not reflect each fall or a new intervention after each fall. Record review of Resident #2's Comprehensive Care Plan, dated 04/28/2025, reflected The resident has an ADL Self Care Performance. Interventions included Bed Mobility: requires staff x1 for assistance. The resident uses a wheelchair. Toilet use: requires staff x1 for assistance. Record review of Resident #2's Fall Risk Assessments, dated 05/24/2025, 06/03/2025, and 06/12/2025, and 06/17/2025 reflected the resident was in the high risk category for falls. Record review of the facility's incident reports reflected Resident #2 had a fall on 05/24/2025, 05/25/2025, 05/27/2025, 6/17/2025, and 06/29/2025. The falls did not result in serious injury. 3. Record review of Resident #3's Face Sheet, dated 07/02/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #3 had diagnoses which included unspecified dementia (decline in mental ability that interferes with daily life) with behavioral disturbances, bipolar disorder, and unsteadiness on feet. Record review of Resident #3's Quarterly MDS Assessment, dated 05/23/2025, reflected severely impaired cognition with a BIMS score of 0. Section C (Cognitive Patterns) reflected the resident demonstrated inattention and disorganized thinking. Section GG (Functional Abilities) reflected Resident #3 required partial/moderate assistance with mobility. Record review of Resident #3's Comprehensive Care Plan, dated 04/28/2025, reflected the focus resident at risk for falls was initiated on 05/05/2025. Interventions included anticipate and meet the resident's needs and ensure the resident was wearing appropriate footwear when ambulating or mobilizing in wheelchair. The care plan did not reflect each fall or a new intervention after each fall. Record review of Resident #3's Fall Risk Assessments, dated 05/11/25, 06/24/25, 06/28/25, 06/29/25, and 07/01/25, reflected Resident #3 was in the high-risk category for falls. Record review of the facility's incident reports reflected Resident #3 had a fall on 5/11/2025, 06/08/2025, 06/24/2025, 6/28/2025, 06/29/2025, and 07/01/2025. The falls did not result in serious injury. A follow-up record review of Resident #3's Comprehensive Care Plan reflected additional fall prevention interventions were initiated on 07/01/2025 which included Resident is to wear a soft helmet when out of bed to help prevent fall with major head injury and FREQUENT RESIDENT MONITORING: staff is to ensure that they can visualized residents where about as frequent as possible to help with redirection. An observation on 07/02/2025 at 11:35 AM revealed Resident #3 sitting in the tv room with other residents in the memory care unit. An attempt to interview Resident #3 was unsuccessful because of her cognitive status. Resident #3 was wearing a helmet. During an interview on 07/03/2025 at 11:44 AM, LVN F stated worked in different areas, but was working in the memory care unit today. She stated staff used a lot of redirections with residents in the memory unit. She stated residents wandered and it was important to ensure the space was free of clutter. She stated someone always has to have their eye on the residents. During the interview, LVN F went to assist Resident #3 when she stood up. She stated staff walked with Resident #3 to ensure her safety. During an interview on 07/03/2025 at 11:52 AM, CNA N stated it was important to monitor residents closely especially those who were a high fall risk. She stated Resident #3 liked to get up and walk, but someone had to be with her to be sure she did not fall. She stated Resident #3 was wearing the hat to prevent injury because she had previous falls. Review of the facility's policy Preventive Strategies to Reduce Fall Risk, dated 10/05/2016, reflected The goal of fall prevention strategies is to design interventions that minimize fall risk by eliminating or managing contributing factors while maintaining or improving the resident's (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 4 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some mobility. Review of the facility's policy Falls/Ambulation Difficulty, dated 2003, reflected Risk factors should be assessed upon admission and thereafter as necessary. Risk factors will be identified for all residents. This was determined to be an Immediate Jeopardy (IJ) on 07/02/2025 at 5:21 PM. The Administrator, Director of Nurse, Area Director of Operations and Regional Compliance Nurse were notified. The Director of Nurses, Area Director of Operations, and Regional Compliance Nurse were provided with the IJ template on 07/02/2025 at 5:21 PM and a POR was requested. The following Plan of Removal submitted by the facility was accepted on 07/03/2024 at 1:04 PM. Facility: [Facility Name]Date: 07/02/2025Problem: F689 Accidents and Hazards Plan of Removal Interventions: 1. Resident #1 no longer resides in facility as of 6/22/25. Resident #2 has discharged from the facility and no longer resides in the facility as of 7/2/25. Resident #3 assessed 7/2/25 for fall risk and individual care plan updated to reflect that she is now part of the Falling Stars Program. In addition, new order for a soft-shell helmet to help prevent injury. 2. All residents in the facility were assessed on 7/2/25 for risk of falls or repeat fall residents. Active care plans updated to include interventions and monitoring by the DON/ADON/Regional Compliance Nurse. 3. We have initiated the NEW Falling Star Program. All residents that have had 5 falls in the last 6 months have Falling Stars Program initiated. This includes notation on the care plan and daily shift acknowledgement that the resident is high risk for falls. Resident #3 is a part of the Falling Star Program Total number of falls in 6 months: 115. 9 residents were identified as high risk for falls due to 5 falls or greater within the last 6 months. 4. The Compliance Nurse in-serviced the Administrator, DON, and ADON 1:1 on the following topics below: This was completed on 7/2/25. All residents whom are identified at high risk of falls will have an active care plan with resident specific interventions with the addition of the falling stars high risk fall program. Upon admission, and as needed, all residents will be assessed for risk of falls. The care plan will reflect findings, interventions based off of each resident's assessment post fall with individualized intervention to prevent serious injury, and monitoring weekly to ensure fall interventions are effective and in place. Upon admission the nurse/designee will be responsible for developing and implementing interventions within the care plan of risk of falls based upon their assessment. Inservice on care plan location and how to access the care plan in PCC (online electronic health record), including how to identify a resident high risk of falls in the Kardex (documentation system used to access and modify resident information). The following in-services were initiated by the DON, ADON, Regional Compliance Nurse : Any staff member not present or in-serviced on 7/2/25, will not be allowed to assume their duties until in-serviced.Licensed Nurses and Therapy Staff:All residents whom are identified at high risk of falls will have an active care plan with resident specific interventions with the addition of the falling stars high risk fall program. Upon admission, and as needed, all residents will be assessed for risk of falls. The care plan will reflect findings, interventions based off of each resident's assessment post fall with individualized intervention to prevent serious injury, and monitoring weekly to ensure fall interventions are effective and in place. Upon admission the nurse/designee will be responsible for developing and implementing interventions within the care plan of risk of falls based upon their assessment. Inservice on care plan location and how to access the care plan in PCC, including how to identify a resident high risk of falls in the Kardex. The following in-services were initiated by the DON, ADON, Regional Compliance Nurse : Any staff member not present or in-serviced on 7/2/25, will not be allowed to assume their duties until in-serviced.Non-Licensed Nursing Staff Inservice on care plan location and how to access the care plan in PCC, including how to identify a resident high risk of falls in the Kardex. All residents whom are at risk of falls will have an active care plan with interventions and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 5 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some monitoring.Monitoring: The DON/ADON/Designee will monitor all incidents and fall risk assessment post fall in daily stand-up meeting for 6 weeks and then PRN to ensure all resident specific interventions are in place with active care plan. The DON/ADON/Designee will monitor admission assessments, daily stand-up meeting for 6 weeks to ensure all resident care plans reflect their risk of falls and resident specific interventions based off current care needs and status. The DON/ADON/Designee will monitor falling star program weekly for 6 weeks and then PRN to ensure resident specific interventions are in place.An ADHOC QAPI was completed on 7/2/25 with medical director and interdisciplinary team to discuss the immediate jeopardy and plan of removal.The medical director was notified of this plan and monitoring on 7/2/25 when IJ was called at 5:21PM.The QAPI committee will review findings and makes changes as needed.*Active care planning addresses all acute needs of the resident**All monitoring will be located in the IJ Binder**All residents are at risk for falls, 9 residents identified at high risk for falls**No active restraints within the facility* Observations on 07/03/2025 at 09:20 AM revealed facility staff had placed a yellow star on the name plates of the doors of Resident #3, Resident #5, Resident #6, Resident #7, Resident #8, Resident #9, Resident #10, Resident #11, and Resident #12 to indicate they were a high fall risk. In a follow-up interview with the DON on 07/03/2025 at 12:32 PM, she stated the facility implemented the falling stars program on 07/02/2025 so everyone would know which residents were a high fall risk. The DON stated staff placed yellow stars on the name plates on high fall risk residents' doors the evening before. She stated the staff received in-service training on 07/02/2025 related to fall risk and prevention. She stated CNAs were in-serviced to ensure they knew how to access resident care information in Kardex. She stated if a resident fell, the resident's nurse should immediately put an intervention in place and include it in the resident's care plan. She stated staff were to increase monitoring and ensure all care planned interventions, such as a fall mat, bed in the lowest position, non-slip pad for wheelchair seat, or helmet were in place for the falling stars or residents at high risk for falls. The DON stated the facility had at risk meetings every week and evaluated residents' care plans and put appropriate interventions in place. She stated staff also discussed any concerns or changes during the interdisciplinary team meetings. The DON stated it was important to ensure residents were assessed as needed and interventions put in place to provide resident centered care and keep the residents safe. In interviews with direct care facility staff on 07/03/2025, between 10:30 AM and 4:10 PM, the DON, ADON A, ADON B, the Rehab Director, the MDS Coordinator, the Physical Therapist, COTA, Hospitality Aide RN C, CNA D, CNA E, LVN F, CNA G, CNA H, Medication Aide I, LVN J , CNA K, Medication Aide L, RN M, CNA N, CNA O, CNA P, RN Q, CNA R, CNA S, CNA T, CNA U, CNA V stated in-service training was provided 07/03/2025 focused on the importance of keeping residents safe in the facility. Staff were reminded to ensure every transfer was safe for the resident. In-service training included to ensure residents wore socks that prevented slipping or had on appropriate fitting shoes. Staff stated high fall risk residents had a yellow star on their name plate on the door and the information was also included in the Kardex. CNAs stated they were responsible for communicating with the nurse if they were going on break or needed to leave the hall briefly. Nursing staff were in-serviced about assessing residents with each fall, putting a new resident specific intervention in place, and ensuring the care plan was updated. Nurses stated they were responsible for communicating with CNAs and ensuring call lights were answered which included the nurse answering call lights when the CNAs were busy with another resident. Timely completion of Elopement Assessments (all assessments;) When a Significant Change in Status documentation and/or re-assessment is required, and Examples of Decline. In interviews with other staff members on 07/03/2025 between 10:30 AM and 4:10 PM, the Maintenance Director, Social Service, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 6 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some Dietary Staff, Dietary Cook, and Housekeeping stated it was important to observe residents around them to ensure residents were safe in their environment and to report any concerns to nursing staff. Staff stated the facility placed yellow stars on the name plates of doors to identify residents who were at high risk for falls. Record review of residents identified as high risk for falls on 07/03/2025 at 10:45 AM revealed compliance with resident specific care plans and inclusion in the facility's falling star program. Record review on 07/03/2025 of In-service, High Fall Risk: Yellow Star, conducted by RCN, reflected all high-risk residents would have a yellow star next to their name on the door and a yellow star on the Kardex. The In-Service included a list of falling star residents. The In-service roster included signatures of direct care staff. Record review on 07/03/2025 of In-service, Fall Risk, Intervention, Prevention, Monitoring, Care Plan Update, conducted by RCN, reflected on admission, and as needed, all residents would be assessed for risk of falls and the care plan would reflect findings, interventions, and monitoring. The In-service included identifying risk factors, reducing environmental hazards, and prevention of unsafe transfers and ambulation. The In-service included evaluating the residents' footwear, daily routine, medications, and social and psychological needs. It also included assessment of resident's gait by physical therapy and/or a nurse. This In-service was provided to all facility staff. The Director of Nurses, Area Director of Operations, and Regional Compliance Nurse were informed the Immediate Jeopardy was removed on 07/03/2025 at 1:04 PM. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. 2.Record review of Resident #5's Face Sheet on 07/15/2025 at 11:31 AM revealed he was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included Chronic Viral Hepatitis C (viral infection that causes inflammation and damages the liver,) Alcohol Abuse, Dementia (general decline in mental ability,) and bipolar disorder (mental illness that causes a shift in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.) Record Review of Resident #5's Quarterly Minimum Data Set (MDS) dated [DATE], revealed his cognition was severely impaired with a Brief Interview Mental Status (BIMS) score of 03. He was wheelchair bound. Section E- Behavior E. 0900 Wandering - Presence & Frequency (1) Behavior of this type occurred 1 to 3 days. Record review of Resident #5's Comprehensive Care Plan dated 07/08/2025, revealed no interventions related to wandering and/or elopement prior to the elopement incident on 07/12/2025. Record Review of Resident #5's ELOPEMENT RISK ASSESSMENT V5 dated 07/08/2025. Resident #5 Scored out as a 9, shows him to be low risk for elopement. B. Physical Capability - Self propels wheelchair C. Adjustment to Facility - Understand ad verbalizes acceptance of need for nursing home careD. Cognitive Skills for Daily Decision Making - Modified independence - some difficulty in new situations only E. History No attempts to leave own residence/facility Record Review of Resident #5's ELOPEMENT RISK ASSESSMENT V5 dated 07/13/2025. Resident #5 Scored out as a 19 shows him to be a high risk for elopement. C. Adjustment to facility - Verbalized anger and frustration re: placement D. Cognitive Skills Moderately impaired - decisions poor; cues/supervision required. E. History - Previous attempts to leave facility - No attempts to leave facility Record Review of facility's Incident Report for July 2025, dated 07/16/2025, revealed no documentation of Resident #5's wandering, exit seeking, and/or elopement behavior/incident from 07/08/2025.Review of Resident #5's Pre-admission Clinical Documents revealed Treatment Notes from a neurology provider on 04/29/2025 revealed Patient is alert to self only. [Resident #5's RP] reports at that time [Provider] recommended him to be in a care facility. [Resident #5's RP] reports the facility. did not accept him because he was a flight risk. During an interview on 07/16/2025 at 2:15 PM ADON stated she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 7 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0656 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete believed Resident #5 was care planned for the Elopement. ADON said she knew Resident #5 had an Elopement Risk Assessment completed previously and thought it had already been care planned. ADON stated that the MDS nurse was responsible for preparing and updating care plans. The ADON indicated the purpose of care plans was to inform direct care staff about resident care needs and preferences. The ADON stated the Care Plan can be reviewed at any time. She added the care plan should be updated and reviewed at least quarterly thereafter, then annually and with significant changes in conditions as defined in the RAI (Resident Assessment Instrument) manual. Additional updates to the care plan may be done as indicated. ADON stated it was the responsibility of the DON, MDS Coordinator to make sure care plans were updated. The ADON confirmed participation in an in-service training that covered topics including abuse, elopement protocols, and internal emergency codes.During a follow up interview on 07/16/2025 at 2:40 PM with SW she stated she has only been there about 3 months. Stated not entirely yet involved in the Care Planning of things still learning all the procedures. SW stated if resident was assessed it should have been in their care plan as an Elopement Risk. SW stated she was not working on the date the Elopement occurred. The SW stated the main focus and purpose of care plans was to inform direct care staff, about resident care needs and preferences. SW stated the care plan can be reviewed at any time. The SW stated the care plan can and should be updated as soon as a change in condition is noted. If not, the care plan should be updated and reviewed at least quarterly thereafter, then annually unless any significant changes occur. The SW stated she did receive an in-service training that covered topics including abuse, elopement protocols, and internal emergency codes.During an interview on 07/16/2025 at 3:35 PM DM stated has been DM for 5 years. DM stated is not involved specifically in care planning, unless there are dietary concerns, then both she and the dietician, become involved with the care plan. The care plan should serve as a guide, which should direct care needs, care choices and care preferences of the resident. DM stated it would have a negative affect if a resident had needs not properly cared planned, in terms of dietary issues from the types of food, how it is prepared and what they can and cannot eat. DM stated she did receive in-service training that covered topics including abuse, elopement protocols, and internal emergency codes.During an interview on 07/16/2025 at 3:53 PM AD stated have been an AD for 3 months. Stated not familiar with too much of the care planning of residents, she has her own type of care plan, Event ID: Facility ID: 675939 If continuation sheet Page 8 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some 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 observations, interviews, and record review the facility failed to ensure the resident environment remained as free of accident hazards as is possible and each resident received adequate supervision to prevent accidents for 4 (Residents #1, #2, #3 and #5) of 9 residents reviewed for accidents and hazards. Based on observations, interviews, and record review the facility failed to ensure the resident environment remained as free of accident hazards as is possible and each resident received adequate supervision to prevent accidents for 4 (Residents #1, #2, #3 and #5) of 9 residents reviewed for accidents and hazards. 1. A. The facility failed to implement and modify interventions to ensure Resident #1 did not experience 7 falls after admitting to the facility on [DATE], and as a result of the last fall on 06/22/2025, sustain a head injury which resulted in the resident's death in the hospital on [DATE]. B. The facility failed to implement and modify interventions to ensure Resident #2 did not experience 5 falls after admitting to the facility on [DATE] with a right hip fracture resulting from a fall at home. C. The facility failed to implement and modify interventions to ensure Resident #3 did not experience 5 falls after admitting to the facility on [DATE]. 2. A. The facility failed to adequately assess, devise, and implement appropriate interventions to prevent Resident #5's elopement from the facility for approximately 5 minutes on 07/12/2025. The first non-compliance was identified, and an Immediate Jeopardy (IJ) situation was identified on 07/02/2025. The IJ was removed on 07/16/2025. The facility remained out of compliance at a scope of a pattern with a potential for more than minimal harm, due to the facility's need to evaluate the effectiveness of the corrective systems. The second non-compliance was identified, and an Immediate Jeopardy (IJ) Template was presented to facility Administrator and DON on 07/15/2025 at 5:37 PM. The IJ was removed on 07/16/2025. The facility remained out of compliance at a scope of a pattern with a potential for more than minimal harm, due to the facility's need to evaluate the effectiveness of the corrective systems. The failures could place residents at risk of harm and injuries, hospitalization, and death. Findings include: 1. 1. Record review of Resident #1's Face Sheet, dated 06/26/2025, reflected the resident was a [AGE] year-old male who admitted to the facility on [DATE]. Resident #1 had diagnoses which included Parkinson's disease (movement disorder of the nervous system that worsens over time), unspecified abnormalities of gait (walking pattern) and mobility, and a history of falls. Record review of Resident #1's admission MDS (tool used to assess health status) Assessment, dated 04/19/2025, reflected moderately impaired cognition with a BIMS (screening tool to assess cognitive status) score of 10. Section J (Health Conditions) reflected Resident #1 had 2 or more falls since admission with no injury. Record review of Resident #1's Comprehensive Care Plan, dated 04/28/2025, reflected the focus resident at risk for falls was initiated on 05/25/2025. Interventions included staff x 1 to assist resident with transfers, ensure the resident's call light was within reach and encourage the resident to use it for assistance as needed, and ensure the resident was wearing appropriate footwear when ambulating or mobilizing in his wheelchair. The care plan did not reflect each fall or a new intervention after each fall. Record review of Resident #1's Fall Risk Assessments, dated 06/12/2025, 06/20/2025, and 06/22/2025, reflected Resident #1 was in the high-risk category for falls. Record review of the facility's incident reports reflected Resident #1 fell on [DATE], 04/11/2025, 04/15/2025, 04/20/2025, 05/25/2025, 06/10/2025, 6/20/2025 which did not result in a serious injury. Resident #1 was sent to the hospital after he fell on [DATE]. Record review of Resident #1's progress notes, dated 06/13/2025, reflected RN C documented This client is somewhat confused. He does not abide by the nurses' instructions about his safety and constantly gets out of the recliner and makes movements that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 9 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some could severely hurt him. He slid out of the recliner at 2145. Once we put him in bed, 30 minutes later, we found him by the door in his chair, naked.We need a baby monitor so that the nurse can see him from the nurse's station. Record review of Resident #1's progress notes, dated 06/20/2025, reflected RN X documented This nurse was called by an Aide that resident was on the floor. Resident was lying next to his recliner and bed. Resident said he was trying to use the bathroom. Resident was lifted off the floor with a Hoyer lift. Resident sustained a skin tear on his right elbow. Site was cleaned and covered with border dressing. Resident assessed and his vital signs were normal. DON, family, and NP were notified. Record review of Resident #1's progress notes, dated 06/22/2025, reflected RN C documented nurse was called to resident room and observed resident on the floor next to the bed, resident is alert and able to response to verbal commands, disorientation also noted, head to toe assessment done at this time, laceration of about 1 cm x 0.5 cm noted right side of the head, extensive bruising from his right shoulder to right lower back, vital signs recorded at this time within normal range, scant amount of blood noted to laceration site, emergency services called, emergency personnels arrive and assessed patient, resident was transported to hospital for further evaluation. Record review of Resident #1's progress notes, dated 06/22/2025, reflected RN C also documented patient fell at 00:51 am, unwitnessed, sustained penetrating injury to his head in the right temporal area. Had an extensive bruise from left shoulder blade diagonally to right waist area. The patient needs close monitoring because he isn't aware of usage of call light. The client is confused, needs one on one or baby monitoring to prevent further falls. Record review of the incident report completed by RN C, dated 06/22/2025, reflected Resident #1 had an unwitnessed fall and was discovered on the floor next to his bed. The incident report reflected Resident #1 stated he tried to get up and fell out of bed. Record review of Resident #1's hospital records, dated 06/23/2025, reflected Resident #1 was admitted to the emergency department on 06/22/2025 at 1:38 AM with a large left subdural hematoma (brain bleed) with a mid-line shift to the right (displacement of the brain away from center line). Resident #1 was not a candidate for surgical repair of the bleed and was placed on palliative care until he passed away in the hospital on [DATE] at 3:30 AM. During a telephone interview on 06/26/2025 at 10:42 AM, CNA D stated Resident #1 tried get up by himself all the time. CNA D stated Resident #1 used a walker and would take himself to the restroom without using the call light and waiting for assistance. She stated when she rounded on her residents, just a few minutes before Resident #1 fell, he was asleep. CNA D stated she was at the nurse's station when she heard someone say help me and found Resident #1 on the floor. CNA D stated she called for RN C to assess the resident and told the resident not to move. She stated Resident #1 told her that he hurt and when CNA D asked where, he said he wasn't sure. She stated RN C assessed Resident#1 and the resident had a laceration on the right side of his head and 2 reddish color marks on his back. She stated Resident #1 was taken to the hospital. During an interview with RN C on 06/26/25 12:54 PM, he stated he was the resident's nurse at the time of the fall on 06/22/2025. He stated CNA D notified him Resident #1 fell and he went to the resident's room and assessed him. RN C stated the resident had a laceration on the right side of his head. He stated he notified the physician and received an order to send Resident #1 to the hospital for evaluation. RN C stated Resident #1 was supposed to use his call light before getting up but did not always do that. During an interview on 06/26/25 at 1:35 PM, the Administrator stated staff notified him Resident #1 was sent to the hospital after a fall. The Administrator stated he called CNA D and RN C to get their statements. He stated he talked to all staff who cared for Resident #1 starting 24 hours before the fall to see if anyone had seen anything out of the normal for Resident #1. He stated staff had not noticed anything different about him. During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 10 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some 06/26/2025 at 4:18 PM, ADON B stated RN C reported at about midnight he went to Resident #1's room. He stated RN C told him the resident was on the floor next to his bed and had a cut on his head. ADON B stated when RN C asked what happened, Resident #1 stated he thought it was morning and was getting up to get dressed. ADON B stated RN C called 911 because Resident #1 hit his head when he fell, and he was sent to the hospital. ADON B stated Resident #1 had previous falls and therapy had worked with him for balance/gait. He stated the resident used a walker. During an interview on 06/27/25 at 8:55 AM, the Rehab Director stated therapy services were discontinued for Resident #1 on 06/09/2025 and the resident was walker level. She stated the resident fell on the Friday before the incident. She stated Resident #1 needed lots of verbal reminders to walk with someone and not by himself. She stated the resident would use his walker to go to the restroom in his room without calling for assistance. She stated Resident #1 had a walker and wheelchair in his room. She stated the resident had cognition/safety impairment. She stated if Resident #1's knees were bothering him, he would use his wheelchair for longer distances. She stated she had not observed a change in Resident #1's condition prior to his fall. During an interview on 07/02/2025 at 10:26 AM, CNA H stated she worked on different halls and was not working on Resident #1's hall the day he transferred to the hospital. She stated Resident #1 used a walker to go to the bathroom by himself and changed his clothes without assistance. She stated he was not considered a high fall risk. She stated she rounded and checked on Resident #1 and his roommate every two hours. She stated Resident #1 liked to sit in his recliner and watch television. She stated after his wife brought the recliner to the facility; Resident #1 also slept in it. She stated the resident walked to the dining room for breakfast and ate lunch in his room because his wife was visiting with him. She stated the day of the fall she saw Resident #1 in the hall using his walker and another time he was pushing his wheelchair. She stated Resident #1 sat in his wheelchair when he got tired. She stated she did not see any change in mobility or cognition prior to the fall. 2. Record review of Resident #2's Face Sheet, dated 07/02/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #2 had diagnoses which included aftercare following joint replacement surgery, bipolar disorder (extreme mood swings that include emotional highs and lows), COPD (lung condition that makes it difficult to breathe), limitation of activities due to disability, and the need for assistance with personal care. Resident #2 had discharged from the facility. Record review of Resident #2's admission MDS Assessment, dated 05/22/2025, reflected moderately impaired cognition with a BIMS score of 10. Section I (Active Diagnoses) reflected the need for assistance with personal care, limitation of activities due to disability, and unsteadiness on feet. Resident #2 discharged from the facility on 07/02/2025. Record review of Resident #2's Comprehensive Care Plan, dated 04/28/2025, reflected the focus resident at risk for falls was initiated on 05/16/2025. Interventions included staff x 1 to assist resident with transfers, ensure the resident's call light was within reach and encourage the resident to use it for assistance as needed, and ensure the resident was wearing appropriate footwear when ambulating or mobilizing in wheelchair. The care plan did not reflect each fall or a new intervention after each fall. Record review of Resident #2's Comprehensive Care Plan, dated 04/28/2025, reflected The resident has an ADL Self Care Performance. Interventions included Bed Mobility: requires staff x1 for assistance. The resident uses a wheelchair. Toilet use: requires staff x1 for assistance. Record review of Resident #2's Fall Risk Assessments, dated 05/24/2025, 06/03/2025, and 06/12/2025, and 06/17/2025 reflected the resident was in the high risk category for falls. Record review of the facility's incident reports reflected Resident #2 had a fall on 05/24/2025, 05/25/2025, 05/27/2025, 6/17/2025, and 06/29/2025. The falls did not result in serious injury. 3. Record review of Resident #3's Face Sheet, dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 11 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some 07/02/2025, reflected the resident was a [AGE] year-old female who admitted to the facility on [DATE]. Resident #3 had diagnoses which included unspecified dementia (decline in mental ability that interferes with daily life) with behavioral disturbances, bipolar disorder, and unsteadiness on feet. Record review of Resident #3's Quarterly MDS Assessment, dated 05/23/2025, reflected severely impaired cognition with a BIMS score of 0. Section C (Cognitive Patterns) reflected the resident demonstrated inattention and disorganized thinking. Section GG (Functional Abilities) reflected Resident #3 required partial/moderate assistance with mobility. Record review of Resident #3's Comprehensive Care Plan, dated 04/28/2025, reflected the focus resident at risk for falls was initiated on 05/05/2025. Interventions included anticipate and meet the resident's needs and ensure the resident was wearing appropriate footwear when ambulating or mobilizing in wheelchair. The care plan did not reflect each fall or a new intervention after each fall. Record review of Resident #3's Fall Risk Assessments, dated 05/11/25, 06/24/25, 06/28/25, 06/29/25, and 07/01/25, reflected Resident #3 was in the high-risk category for falls. Record review of the facility's incident reports reflected Resident #3 had a fall on 5/11/2025, 06/08/2025, 06/24/2025, 6/28/2025, 06/29/2025, and 07/01/2025. The falls did not result in serious injury. A follow-up record review of Resident #3's Comprehensive Care Plan reflected additional fall prevention interventions were initiated on 07/01/2025 which included Resident is to wear a soft helmet when out of bed to help prevent fall with major head injury and FREQUENT RESIDENT MONITORING: staff is to ensure that they can visualized residents where about as frequent as possible to help with redirection. An observation on 07/02/2025 at 11:35 AM revealed Resident #3 sitting in the tv room with other residents in the memory care unit. An attempt to interview Resident #3 was unsuccessful because of her cognitive status. Resident #3 was wearing a helmet. During an interview on 07/03/2025 at 11:44 AM, LVN F stated worked in different areas, but was working in the memory care unit today. She stated staff used a lot of redirections with residents in the memory unit. She stated residents wandered and it was important to ensure the space was free of clutter. She stated someone always has to have their eye on the residents. During the interview, LVN F went to assist Resident #3 when she stood up. She stated staff walked with Resident #3 to ensure her safety. During an interview on 07/03/2025 at 11:52 AM, CNA N stated it was important to monitor residents closely especially those who were a high fall risk. She stated Resident #3 liked to get up and walk, but someone had to be with her to be sure she did not fall. She stated Resident #3 was wearing the hat to prevent injury because she had previous falls. Review of the facility's policy Preventive Strategies to Reduce Fall Risk, dated 10/05/2016, reflected The goal of fall prevention strategies is to design interventions that minimize fall risk by eliminating or managing contributing factors while maintaining or improving the resident's mobility. Review of the facility's policy Falls/Ambulation Difficulty, dated 2003, reflected Risk factors should be assessed upon admission and thereafter as necessary. Risk factors will be identified for all residents. This was determined to be an Immediate Jeopardy (IJ) on 07/02/2025 at 5:21 PM. The Administrator, Director of Nurse, Area Director of Operations and Regional Compliance Nurse were notified. The Director of Nurses, Area Director of Operations, and Regional Compliance Nurse were provided with the IJ template on 07/02/2025 at 5:21 PM and a POR was requested. The following Plan of Removal submitted by the facility was accepted on 07/03/2024 at 1:04 PM. Facility: [Facility Name]Date: 07/02/2025Problem: F689 Accidents and Hazards Plan of Removal Interventions: 1. Resident #1 no longer resides in facility as of 6/22/25. Resident #2 has discharged from the facility and no longer resides in the facility as of 7/2/25. Resident #3 assessed 7/2/25 for fall risk and individual care plan updated to reflect that she is now part of the Falling Stars Program. In addition, new order for a soft-shell helmet to help prevent injury. 2. All residents in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 12 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some the facility were assessed on 7/2/25 for risk of falls or repeat fall residents. Active care plans updated to include interventions and monitoring by the DON/ADON/Regional Compliance Nurse. 3. We have initiated the NEW Falling Star Program. All residents that have had 5 falls in the last 6 months have Falling Stars Program initiated. This includes notation on the care plan and daily shift acknowledgement that the resident is high risk for falls. Resident #3 is a part of the Falling Star Program Total number of falls in 6 months: 115. 9 residents were identified as high risk for falls due to 5 falls or greater within the last 6 months. 4. The Compliance Nurse in-serviced the Administrator, DON, and ADON 1:1 on the following topics below: This was completed on 7/2/25. All residents whom are identified at high risk of falls will have an active care plan with resident specific interventions with the addition of the falling stars high risk fall program. Upon admission, and as needed, all residents will be assessed for risk of falls. The care plan will reflect findings, interventions based off of each resident's assessment post fall with individualized intervention to prevent serious injury, and monitoring weekly to ensure fall interventions are effective and in place. Upon admission the nurse/designee will be responsible for developing and implementing interventions within the care plan of risk of falls based upon their assessment. Inservice on care plan location and how to access the care plan in PCC (online electronic health record), including how to identify a resident high risk of falls in the Kardex (documentation system used to access and modify resident information). The following in-services were initiated by the DON, ADON, Regional Compliance Nurse : Any staff member not present or in-serviced on 7/2/25, will not be allowed to assume their duties until in-serviced.Licensed Nurses and Therapy Staff:All residents whom are identified at high risk of falls will have an active care plan with resident specific interventions with the addition of the falling stars high risk fall program. Upon admission, and as needed, all residents will be assessed for risk of falls. The care plan will reflect findings, interventions based off of each resident's assessment post fall with individualized intervention to prevent serious injury, and monitoring weekly to ensure fall interventions are effective and in place. Upon admission the nurse/designee will be responsible for developing and implementing interventions within the care plan of risk of falls based upon their assessment. Inservice on care plan location and how to access the care plan in PCC, including how to identify a resident high risk of falls in the Kardex. The following in-services were initiated by the DON, ADON, Regional Compliance Nurse : Any staff member not present or in-serviced on 7/2/25, will not be allowed to assume their duties until in-serviced.Non-Licensed Nursing Staff Inservice on care plan location and how to access the care plan in PCC, including how to identify a resident high risk of falls in the Kardex. All residents whom are at risk of falls will have an active care plan with interventions and monitoring.Monitoring: The DON/ADON/Designee will monitor all incidents and fall risk assessment post fall in daily stand-up meeting for 6 weeks and then PRN to ensure all resident specific interventions are in place with active care plan. The DON/ADON/Designee will monitor admission assessments, daily stand-up meeting for 6 weeks to ensure all resident care plans reflect their risk of falls and resident specific interventions based off current care needs and status. The DON/ADON/Designee will monitor falling star program weekly for 6 weeks and then PRN to ensure resident specific interventions are in place.An ADHOC QAPI was completed on 7/2/25 with medical director and interdisciplinary team to discuss the immediate jeopardy and plan of removal.The medical director was notified of this plan and monitoring on 7/2/25 when IJ was called at 5:21PM.The QAPI committee will review findings and makes changes as needed.*Active care planning addresses all acute needs of the resident**All monitoring will be located in the IJ Binder**All residents are at risk for falls, 9 residents identified at high risk for falls**No active restraints within the facility* Observations (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 13 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some on 07/03/2025 at 09:20 AM revealed facility staff had placed a yellow star on the name plates of the doors of Resident #3, Resident #5, Resident #6, Resident #7, Resident #8, Resident #9, Resident #10, Resident #11, and Resident #12 to indicate they were a high fall risk. In a follow-up interview with the DON on 07/03/2025 at 12:32 PM, she stated the facility implemented the falling stars program on 07/02/2025 so everyone would know which residents were a high fall risk. The DON stated staff placed yellow stars on the name plates on high fall risk residents' doors the evening before. She stated the staff received in-service training on 07/02/2025 related to fall risk and prevention. She stated CNAs were in-serviced to ensure they knew how to access resident care information in Kardex. She stated if a resident fell, the resident's nurse should immediately put an intervention in place and include it in the resident's care plan. She stated staff were to increase monitoring and ensure all care planned interventions, such as a fall mat, bed in the lowest position, non-slip pad for wheelchair seat, or helmet were in place for the falling stars or residents at high risk for falls. The DON stated the facility had at risk meetings every week and evaluated residents' care plans and put appropriate interventions in place. She stated staff also discussed any concerns or changes during the interdisciplinary team meetings. The DON stated it was important to ensure residents were assessed as needed and interventions put in place to provide resident centered care and keep the residents safe. In interviews with direct care facility staff on 07/03/2025, between 10:30 AM and 4:10 PM, the DON, ADON A, ADON B, the Rehab Director, the MDS Coordinator, the Physical Therapist, COTA, Hospitality Aide RN C, CNA D, CNA E, LVN F, CNA G, CNA H, Medication Aide I, LVN J , CNA K, Medication Aide L, RN M, CNA N, CNA O, CNA P, RN Q, CNA R, CNA S, CNA T, CNA U, CNA V stated in-service training was provided 07/03/2025 focused on the importance of keeping residents safe in the facility. Staff were reminded to ensure every transfer was safe for the resident. In-service training included to ensure residents wore socks that prevented slipping or had on appropriate fitting shoes. Staff stated high fall risk residents had a yellow star on their name plate on the door and the information was also included in the Kardex. CNAs stated they were responsible for communicating with the nurse if they were going on break or needed to leave the hall briefly. Nursing staff were in-serviced about assessing residents with each fall, putting a new resident specific intervention in place, and ensuring the care plan was updated. Nurses stated they were responsible for communicating with CNAs and ensuring call lights were answered which included the nurse answering call lights when the CNAs were busy with another resident. Timely completion of Elopement Assessments (all assessments;) When a Significant Change in Status documentation and/or re-assessment is required, and Examples of Decline. In interviews with other staff members on 07/03/2025 between 10:30 AM and 4:10 PM, the Maintenance Director, Social Service, Dietary Staff, Dietary Cook, and Housekeeping stated it was important to observe residents around them to ensure residents were safe in their environment and to report any concerns to nursing staff. Staff stated the facility placed yellow stars on the name plates of doors to identify residents who were at high risk for falls. Record review of residents identified as high risk for falls on 07/03/2025 at 10:45 AM revealed compliance with resident specific care plans and inclusion in the facility's falling star program. Record review on 07/03/2025 of In-service, High Fall Risk: Yellow Star, conducted by RCN, reflected all high-risk residents would have a yellow star next to their name on the door and a yellow star on the Kardex. The In-Service included a list of falling star residents. The In-service roster included signatures of direct care staff. Record review on 07/03/2025 of In-service, Fall Risk, Intervention, Prevention, Monitoring, Care Plan Update, conducted by RCN, reflected on admission, and as needed, all residents would be assessed for risk of falls and the care plan would reflect findings, interventions, and monitoring. The In-service included (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 14 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some identifying risk factors, reducing environmental hazards, and prevention of unsafe transfers and ambulation. The In-service included evaluating the residents' footwear, daily routine, medications, and social and psychological needs. It also included assessment of resident's gait by physical therapy and/or a nurse. This In-service was provided to all facility staff. The Director of Nurses, Area Director of Operations, and Regional Compliance Nurse were informed the Immediate Jeopardy was removed on 07/03/2025 at 1:04 PM. The facility remained out of compliance at a severity level of no actual harm with the potential for more than minimal harm that is not immediate and a scope of pattern due to the facility's need to evaluate the effectiveness of the corrective systems that were put into place. 2. Record review of Resident #5's Face Sheet, dated 07/15/2025 at 11:31 AM revealed he was a [AGE] year-old male admitted on [DATE]. Relevant diagnoses included Chronic Viral Hepatitis C (viral infection that causes inflammation and damages the liver,) Alcohol Abuse, Dementia (general decline in mental ability,) and bipolar disorder (mental illness that causes a shift in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.) Record Review of Resident #5's Quarterly Minimum Data Set (MDS) dated [DATE], revealed his cognition was severely impaired with a Brief Interview Mental Status (BIMS) score of 03. He was wheelchair bound. Section E- Behavior E. 0900 Wandering - Presence & Frequency (1) Behavior of this type occurred 1 to 3 days. Record review of Resident #5 Comprehensive Care Plan on 07/15/2025 at 1:24 PM revealed no interventions related to wandering and/or elopement prior to the elopement incident on 07/12/2025. Record review of Resident #5's Elopement Risk Assessment - V5 upon admission dated 07/08/2025 revealed he was at a low risk for elopement with a score of 09. The assessment stated Resident #5: -Self-propels himself in a wheelchair-Understands and verbalizes acceptance of need for nursing home care-Has modified independence related to cognitive skills for daily decision making-No previous attempts to leave his residence/facility-No restlessness or anxiety Record Review of Resident #5's ELOPEMENT RISK ASSESSMENT V5 dated 07/13/2025. Resident #5 was scored as a 19. Indicating at high risk. C. Adjustment to facility - Verbalized anger and frustration re: placement D. Cognitive Skills - Moderately impaired - decisions poor; cues/supervision required. E. History - Previous attempts to leave facility - No attempts to leave facility. Review of Resident #5's Pre-admission Clinical Documents revealed Treatment Notes from a neurology provider on 04/29/2025 revealed: Patient is alert to self only. [Resident #5's RP] reports at that time [Provider] recommended him to be in a care facility. [Resident #5's RP] reports the facility. did not accept him because he was a flight risk. Review of Resident #5's Event Nurses Note by RN C, titled Elopement, dated 07/12/2025 at 9:15 PM revealed Resident #5 was missing at 7:10 PM, and his wheelchair was located at the exit door. At 7:15 PM, Resident #5 was located walking in the parking lot. Attempts to interview RN C on 07/15/2025 at 2:00 PM and 3:07 PM were unsuccessful. In an interview with SW on 07/15/2025 at 1:57 PM, she stated that Resident #5 was very confused as to where he was and why. Resident #5 voiced to her that he wanted to leave on 07/09/2025. SW stated she observed Resident #5 wandering up and down the hallway of the facility and stated he wanted to go home. She stated she reported this to the DON at this time. She stated that Resident #5's wandering behavior was discussed multiple times in morning meeting which served as the facility's interdisciplinary meeting. She did receive an in-service training that covered topics including abuse, elopement protocols, and internal emergency codes. During an interview on 07/16/2025 at 2:45 PM CNA P stated was not present during the recent elopement but had been advised of the incident. CNA P stated does not develop or participate in the care planning of residents, that is a nursing thing. CNA P stated did receive in-service training today, which covered elopement prevention and response, identifying high-risk residents, and the correct reporting process. CNA P stated that now residents who are (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 15 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Immediate jeopardy to resident health or safety Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete at high risk for elopement will be identified by using the POC Kardex. In an interview with DON on 07/15/2025 at 12:55 PM, she stated on 07/09/2025, Resident #5 voiced to her that he was confused as to why he was at the facility. She stated he was confused but did not verbalize any desire to leave the facility. She did not recall if his wandering behaviors were discussed in the facility's morning meeting. She did not recall if SW reported to her his wandering behaviors on 07/09/2025. She stated that upon admission, Resident #5 was assessed as a low risk for elopement which did not warrant elopement precautions to be in place at that time. She stated she did not see any information in the Pre-admission Clinical Documents that he was an elopement risk. She stated it was her responsibility to review any pre-admission clinical documents and it was her responsibility to determine if a resident was appropriate for admission clinically. She stated she should have seen the treatment notes that stated he was a flight risk prior to admitting the resident. Additionally, DON stated her expectations were for Resident #5 to have been accurately assessed for elopement upon admission. She stated that accurate assessment and documentation was important. She stated when important information was not reviewed, someone that was high risk for elopement can be admitted inappropriately. Additionally, inaccurate assessment of a resident's elopement risk can result in elopements because relevant interventions will not be in place. She stated policy to discuss elopement response (what to do if a resident elopes) and prevention (monitoring and interventions in place for residents at risk for elopement) for all residents, including those that are at risk of elopement, monitoring, and interventions for those at risk. During an interview on 07/16/2025 at 3:15 PM CNA T stated has been there for about a year now. CNA T stated was not p Event ID: Facility ID: 675939 If continuation sheet Page 16 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 observations, interviews, 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 one (Resident #4) of eight residents observed for infection control. Based observations, interviews, 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 one (Resident #4) of eight residents observed for infection control. The facility failed to ensure that CNA E changed gloves and performed hand hygiene while providing incontinent care to Resident #4. These failures could place the residents at risk of cross-contamination and development of infections. Findings included: Review of Resident #4's Face Sheet, dated 06/27/2025, reflected the resident was a [AGE] year-old female who originally admitted to the facility on [DATE]. Resident #4 had diagnoses which included dependence on renal dialysis (medical treatment required when kidneys no longer function), unspecified dementia (decline in cognitive function that interferes with daily life), and type 2 diabetes (body does not use insulin effectively causing blood sugar levels to rise). Review of Resident #4's Quarterly MDS Assessment, dated 05/19/2025, reflected severely impaired cognition with a BIMS score of 03. The MDS Assessment indicated Resident #4 was incontinent of bowel and bladder and dependent on staff for self-care needs. Review of Resident #4's Comprehensive Care Plan, dated 08/28/2024, reflected Resident #4 was at risk for altered skin integrity related to end stage kidney disease and diabetes.One of the interventions was to ensure appropriate incontinent care was provided after each episode of incontinence. An observation and interview on 06/26/2025 at 2:45 PM, revealed CNA E and the Hospitality Aide were preparing to provide incontinent care for Resident #4. Incontinence care items were placed on a drape on Resident #4's bedside table. CNA E and the Hospitality Aide used hand sanitizer and put on gloves. CNA E pulled down the front of Resident #4's brief. The Hospitality Aide handed CNA E wipes and CNA E used a single wipe with each pass while cleaning Resident #4 and dropped the wipes into a trash bag. CNA E removed her gloves, used hand sanitizer, and put on clean gloves. The Hospitality Aide assisted CNA E to turn Resident #4 on her right side. The Hospitality Aide provided wipes to CNA E and she cleaned Resident #4's bottom. CNA E dropped the soiled brief in the trash bag. CNA E placed a clean brief under Resident #4. The Hospitality Aide squeezed barrier cream from a tube on CNA E's gloved right hand. CNA E placed her left hand on Resident #4's hip and used her right hand to apply cream to the resident's bottom. CNA E used her left hand to remove the glove from her right hand. The Hospitality Aide put hand sanitizer on CNA E's right hand from a bottle on the bedside table. CNA E rubbed her hands together to clean the ungloved right hand and gloved left hand and the Hospitality Aide put barrier cream on CNA E's right hand. She placed her left hand on Resident #4's hip and used her right hand to apply barrier cream to other side of the resident's bottom. The Hospitality Aide assisted the Resident #4 to roll on her back. CNA E removed both gloves and used hand sanitizer before putting on clean gloves. The Hospitality Aide put barrier cream on CNA E's right hand. CNA E pulled down the brief in the front and applied barrier cream on one side. She removed the right glove and the Hospitality Aide put hand sanitizer on CNA E's right hand. She rubbed her hands together to clean the ungloved right hand and gloved left hand. The Hospitality Aide put barrier cream on CNA E's right hand and she applied it to the other side. CNA E removed her gloves, used hand sanitizer, and applied clean gloves. She secured Resident #4's brief in the front and pulled up the sheet to cover the resident. The Hospitality Aide and CNA E washed their hands Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 17 of 18 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 675939 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vintage Health Care Center 205 N Bonnie Brae Denton, TX 76201 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete in the resident's restroom before exiting the room. CNA E stated she had been a CNA for 18 years. She stated maybe she could have put a second glove on her right hand and removed it before applying more barrier cream. CNA E then stated she should have removed both gloves and used hand sanitizer before putting on clean gloves. She stated the facility provided in-services on incontinence care and they had one the previous week. CNA E stated it was important to hand wash or use hand sanitizer after removing gloves to prevent the spread of germs. CNA E stated not doing that could cause the resident to get an infection. During an interview on 06/26/2025 at 3:15 PM, ADON A stated it was not appropriate for CNA E to use hand sanitizer to clean her gloved hand. She stated that broke the infection control chain. ADON A stated staff must remove the gloves and clean their hands. ADON A stated she would talk to CNA E about it. During an interview on 06/26/2025 at 4:01 PM, LVN F stated CNA E should not have used hand sanitizer to clean her gloved hand while providing incontinence care for Resident #4. LVN F stated it was cross-contamination and could cause the resident to get an infection. During an interview on 06/27/2025 at 11:55 AM, the Administrator stated CNA E should have removed both gloves prior to using hand sanitizer. He stated it was important to use proper hand hygiene to avoid cross contamination and prevent the spread of infection. During an interview on 06/27/2025 at 12:15 PM, the DON stated CNA E should have removed her glove before using hand sanitizer. She stated that presented a risk for infection. She stated it was also cross contamination to use the left gloved hand to remove the glove from the right hand and then continue using the left gloved hand. She stated staff would be in-serviced about incontinence care. Review of the facility's policy, Hand Hygiene, undated, reflected to use alcohol based hand cleaner or soap water for the following.after removing gloves. Event ID: Facility ID: 675939 If continuation sheet Page 18 of 18