Health inspection·December 5, 2025

F 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident #5 Record review of Resident #5's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old male admitted to the facility on [DATE]. The resident was diagnosed with shortness of breath. Record review of Resident #5's Physician Order, dated 08/15/2025, reflected Oxygen LPM: 2 - 4 Via: Nasal Cannula every shift. Resident #6 Record review of Resident #6's Face Sheet, dated 11/04/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with respiratory failure with hypoxia (insufficient amount of oxygen in the body). Record review of Resident #6's Physician Order, dated 11/21/2024, reflected O2 @ 2L via NC CONTINUOUS at night at bedtime. 2. Record review of Resident #7's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with obstructive and reflux uropathy (a blockage in the urinary tract). Record review of Resident #7's Physician Order, dated 09/24/2025, reflected Urinary Catheter 16F (French: unit used to indicate the size of the catheter)/10cc to gravity drainage every shift related to OBSTRUCTIVE AND REFLUX UROPATHY. 3. Resident 8 Record review of Resident #8's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with end stage renal disease (a condition where the kidneys can no longer function adequately). Record review of Resident #8's Physician Order, dated 06/16/2025, reflected . Hemodialysis on Monday, Wednesday, Friday @ 1430. Resident 9 Record review of Resident #9's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with chronic kidney disease (kidneys stop working). Record review of Resident #9's Physician Order, dated 06/16/2025, reflected Dialysis - Resident receives dialysis at . on Tuesday-Thursday-Saturdayroutinely. Resident 10 Record review of Resident #10's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with chronic kidney disease. Record review of Resident #10's Physician Order, dated 10/02/2025, reflected Dialysis Every Mon-Wed-Fri @ 10:30 AM one time a day every Mon, Wed, Fri. 4. Resident 11 Record review of Resident #11's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with gastrostomy status (having done a surgical procedure that creates artificial opening into the stomach to provide nutritional support). Record review of Resident #11's Physician Order, dated 10/06/2025, reflected every 12 hours Isosource 1.5 Cal continuous with 2h downtime. 5. Resident 12 Record review of Resident #12's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with presence of cardiac pacemaker. Record review of Resident #12's Comprehensive MDS Assessment, dated 08/17/2025, reflected the resident had severe impairment in cognition with a BIMS score of 04. The Comprehensive MDS Assessment indicated the resident had a cardiac pacemaker. Record review of Resident #12's Comprehensive Care Plan, dated 08/21/2025, reflected the resident had a pacemaker and one of the interventions was to monitor vital signs as ordered. Record review of Resident #12's Physician Order, dated 07/12/2024, reflected Vital signs to include O2 sat q shift. Resident 13 Record review of Resident #13's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with presence of cardiac pacemaker. Record review of Resident #13's Comprehensive MDS Assessment, dated 09/24/2025, reflected the resident was unable to complete the interview to determine the BIMS score. The Staff Assessment for Mental Status of the resident showed that the resident had a memory problem. The Comprehensive MDS Assessment indicated the resident had a presence of cardiac pacemaker. Record review of Resident #13's Comprehensive Care Plan, dated 10/07/2025, reflected the resident had a pacemaker and one of the interventions was to monitor vital signs as ordered. Record review of Resident #13's Physician Order, dated 08/31/2025, reflected Assess resident's vital signs one time a day . and report abnormal to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 2 of 4 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 12/05/2025 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some MD/NP. Resident 14 Record review of Resident #14's Face Sheet, dated 11/04/2025, reflected a [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with atrial fibrillation (an irregular, rapid heartbeat). Record review of Resident #14's Comprehensive MDS Assessment, dated 10/12/2025, reflected the resident had moderate impairment in cognition with a BIMS score of 12. The Comprehensive MDS Assessment indicated the resident had atrial fibrillation. Record review of Resident #14's Comprehensive Care Plan, dated 08/29/2025, reflected the resident had a pacemaker and one of the interventions was to monitor vital signs as ordered. Observation on 11/04/2025 at 8:49 AM revealed a piece of paper on top a nurse's cart that was parked in the hallway. On the piece of paper were the last names of residents who were using oxygen (Resident #1, #2, #3, #4, #5, and #6), with a Foley (Resident #7), was undergoing dialysis (Residents #8, #9, and #10), with a g-tube (Resident #11), and with pacemakers (Residents #12, #13, and #14). The cart was facing the hallway and the piece of paper, that was not flipped, was visible to individuals passing by the cart. In an interview on 11/04/2025 at 8:53 AM, LVN A said he did not put the paper on top of his cart. He said he was not the one who placed the paper on his cart and did not know who left it on his cart. During an observation and interview on 11/04/2025 at 8:54 AM, the ADON saw the paper that was on top of the nurse's cart. She took the paper and said the paper only have the last names of the residents and did not have their first names so it was not considered HIPAA. The ADON did not reply when asked if a resident being on oxygen therapy was a medical information. In an interview on 11/04/2025 at 10:36 AM, the DON said the information on the paper were definitely medical information and she already started an inservice about not leaving the residents medical information around. She said there was an emergency and maybe that was reason why it was left in the cart facing up. She said but even though there was an emergency, the paper should have been flipped before assisting with the emergency. She said she did not know who left the paper on the cart. She said the medical information were private information and should be kept confidential. In an interview on 11/04/2025 at 12:24 PM, LVN A stated the paper left on his cart could be considered medical information because it did mention the names of the residents who were using oxygen. He said he had an emergency and did not notice who let the paper on his cart. He said, even though there was an emergency, whoever left the paper on cart should have flipped it. He said it would not take five seconds to flip the paper and he was not sure that whoever left the paper even participated in the emergency. He said the paper should have flipped to keep the information private. He said a visitor could take it and go around the facility verifying the names of the residents on the list. He said an in-service was already going around about securing the medical information of the residents. 6. Resident #15 Record review of Resident #15's Face Sheet, dated 11/04/2025, reflected an [AGE] year-old female admitted to the facility on [DATE]. The resident was diagnosed with hypertension (high blood pressure). Record review of Resident #15's Physician Order, dated 10/05/2025, reflected Amlodipine Besylate Oral Tablet 2.5 MG (Amlodipine Besylate) Give 3 tablet by mouth one time a day for Hypertension. Take 3 Tablets (7.5 mg Total)/ Hold for SBP less than 110 DBP less than 60 or HR less than 60. Observation on 11/04/2025 at 10:45 AM revealed Resident #15's blister pack was on top of the medication cart parked outside the nurses' station. The blister pack had the resident's name, name of medication, the prescription number, the name of the medical doctor, and the instruction on how to take the medication, and the name of the resident's pharmacy. Observation and interview on 11/04/2025 at 11:46 AM, the ADON stated the blister should have been left facing up on top of the medication aide's cart because it was considered a HIPAA violation. She took the blister pack from the cart. In an interview on 11/04/2025 at 12:28 PM, MA B stated she was about to give the blister pack to the nurse when she was distracted and left the blister cart on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675939 If continuation sheet Page 3 of 4 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 12/05/2025 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 0583 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete her cart. She said she should have flipped it before leaving her cart or put it inside the cart. She said the blister pack had the resident's names and the name of the medication she was taking. She said it was considered as HIPAA because somebody, who were not authorized, could see the confidential information. In an interview on 11/04/2025 at 12:43 PM, the ADON stated the first incident with the paper on top of the cart was not considered HIPAA but the blister pack on top of the medication cart was considered HIPAA. She said the blister pack should have been flipped because it had the resident's name, the name of the medication, and the instruction on how to take it. When asked why an in-service was going around about securing medical information after a paper on the nurse's cart was observed the ADON did not reply. In an interview on 11/04/2025 at 1:12 PM, the DON said, just like the piece of paper, the blister pack should have been secured before the staff left the cart. She said she would make sure the in-service would be done by all the staff. The DON stated medical information about a resident should be protected and not be visible for everybody to see because those were confidential information. She said the health information of a resident could not be shared without the permission of the resident or the resident's responsible party. She said the staff should have made sure the paper containing a list of residents with oxygen, gtube, pacemakers, Foley, and undergoing dialysis, and the blister pack were flipped, and not exposed. She said if the confidential information were exposed, non-nursing staff, other resident, and visitors would be able to see it. She said all staff, including her, were expected to provide full confidentiality of all the residents' personal and medical information. In an interview on 11/04/2025 at 1:45 PM, the Administrator stated the staff must make sure that the medical information of the residents were safeguarded to prevent unlawful use of their information. He said the expectation was for the staff to be mindful about privacy and confidentiality. He said an in-service about privacy and confidentiality was already initiated by the DON. Record review of the facility's policy entitled, RESIDENT RIGHTS undated, reflected Privacy and confidentiality: The resident has a right to personal privacy and confidentiality of his or her personal and medical records . 3. The resident has a right to secure and confidential personal and medical records. Event ID: Facility ID: 675939 If continuation sheet Page 4 of 4