Health inspection·July 31, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few resident's reach. CNA C stated she did not recall the date of the in-service. She stated if the nursing staff was not near the resident's room, it was a possibility the staff would not hear a resident yell for help. CNA C stated any staff entered a resident room was responsible to ensure the call light was within reach of the resident. Review of Resident #30's face sheet, dated on 07/29/2025, reflected a 88- year-old- female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included dementia ,unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety (memory and thinking problems that are mild and not specifically identified without behaviors), unsteadiness on feet (a lack of stability or coordination while walking or standing), and need assistance for personal care (a person needs assistance with daily living activities such as: bathing, dressing, toileting, and grooming). Review of Resident #30's Quarterly MDS Assessment, dated 06/06/2025, reflected Resident #30 had a BIMS score of 1, which indicated her cognition was severely impaired. Resident #30 did not reject care. She required partial/moderate assistance (helper does less than half the effort) with personal hygiene, showers, toileting and lower body dressing. She required supervision/or touching assistance (helper provides verbal cues and/ or touching assistance) with the following: upper body dressing, and oral hygiene. Review of Resident #30's Comprehensive Care Plan, with a completion date 06/28/2025, reflected Resident #30 had an ADL self-care performance deficit. Interventions: Encourage Resident #30 to use call light for assistance. She required assistance with personal hygiene, showers, dressing, and toileting. Resident #30 was a high risk for falls related to generalized weakness and poor safety awareness. Intervention: Resident #30 needs a safe environment including a working and reachable call light. Observation and interview on 07/29/2025 at 7:28 AM, revealed Resident #27 was lying in bed. Her call light was on the floor approximately 6 feet from her bed. Resident #27 was not interviewable. Interview on 07/31/2025 at 9:20 AM CNA D stated all residents call lights were expected to be placed within reach of the resident when a resident was in their room. She stated if a resident was sitting in a wheelchair the call light was expected to be attached to the wheelchair. CNA D stated i a resident was lying in bed the call light was expected to be attached to the pillowcase, the sheet or the bedspread where the resident was able to reach it when they needed assistance from nursing staff. She stated if a call light was on the floor or lying on bedside table and the resident was not able to reach the call light, there was a possibility a resident may fall trying to stand up from wheelchair or from the bed when they needed assistance. She stated it was everyone's responsibility to ensure the residents call light was within reach. CNA D stated if a CNA was in the shower and a nurse was in a resident's room, the nursing staff may not be able to hear a resident yell for help. Interview on 07/31/2025 at 10:20 AM ADON stated if a resident was in their room lying in bed or sitting in a wheelchair, the call light was expected to be within reach of the resident. She stated if a resident was unable to reach their call light there was a potential a resident may fall from the bed or wheelchair if the call light was not within reach and the resident needed assistance. The ADON stated any staff who entered a resident's room was expected to check the call lights of the residents and if the call light was not in reach, any staff could place the call light within reach of the resident's wheelchair or bed. She stated in-service had been given to staff on placing call lights within reach of residents when they are in their room. The ADON stated she did not recall the date of the in-service. Review of the facility's Policy on Call Lights: Accessibility and Timely Response, dated 10/13/2022 reflected, The purpose of this policy is to assure the facility is adequately equipped with a call light at each residents' bedside, toilet, and bathing facility to allow residents to call for assistance. Call lights will directly relay to a staff member or centralized location to ensure appropriate response. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675942 If continuation sheet Page 2 of 7 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 675942 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Towers Nursing Home 372 Hill Road Smithville, TX 78957 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Policy Explanation and Compliance Guidelines: 1. Staff will ensure the call light is within reach of resident and secured, as needed. 2. Each resident will be evaluated for unique needs and preferences to determine any special accommodations that may be needed in order for the resident to utilize the call system.3. Special accommodations will be identified on the resident's person-centered plan of care and provided accordingly. (Examples include touch pads, larger buttons, bright colors, etc.)4. The call system will be accessible to residents while in their bed or other sleeping accommodations within the resident's room. Event ID: Facility ID: 675942 If continuation sheet Page 3 of 7 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 675942 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Towers Nursing Home 372 Hill Road Smithville, TX 78957 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure a resident who was unable to carry out activities of daily living received the necessary services to maintain good nutrition, grooming, and personal and oral hygiene for two of eight residents (Resident# 30 and Resident # 65) reviewed for ADL care. The facility failed on 07/29/2025to ensure Resident #30, and Resident #65's fingernails were cleaned. This failure could place residents at risk of not receiving services or care, diminished quality of life, and decreased self-esteem. Findings included: Review of Resident #30's face sheet, dated on 07/29/2025, reflected a 88- year-old- female admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses which included dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, or anxiety (memory and thinking problems that are mild and not specifically identified without behaviors), lack of coordination (the inability to smoothly and precisely control movements), and need assistance for personal care (a person needs assistance with daily living activities such as: bathing, dressing, toileting, and grooming). Review of Resident #30's Quarterly MDS Assessment, dated 06/06/2025, reflected Resident #30 had a BIMS score of 1, which indicated her cognition was severely impaired. Resident #30 did not reject care. She required partial/moderate assistance (helper does less than half the effort) with personal hygiene, showers, toileting and lower body dressing. She required supervision/or touching assistance (helper provides verbal cues and/ or touching assistance) with the following: upper body dressing, and oral hygiene. Review of Resident #30's Comprehensive Care Plan, with a completion date 06/28/2025, reflected Resident #30 had an ADL self-care performance deficit. Interventions: required assistance with personal hygiene, showers, dressing, transfers and toileting. Observation and interview on 07/29/2025 at 7:28 AM, revealed Resident #30 was in her lying in bed. She had a blackish/ brownish substance underneath the middle and ring fingernails on her right hand. Resident #30 was not interview able. Record review of Resident # 65's face sheet dated 07/31/2025 reflected an [AGE] year-old female who was admitted to the facility on [DATE]. Resident #65 had diagnoses which included unspecified dementia with mood disturbance (memory and thinking problems that are mild and not specifically identified and includes behaviors), need for assistance with personal care (a person needs assistance with daily living activities such as: bathing, dressing, toileting, and grooming), and muscle weakness (a reduced ability to generate force in one or more muscles, impacting physical performance and daily activities). Record review of Resident #65's Quarterly MDS Assessment, dated 06/28/2025, reflected Resident #65 reflected the resident BIMS assessment was completed by staff. Resident #65 had poor short- and long-term memory recall (having difficulty remembering things that have just happened or been learned). Resident #65 required substantial/maximal assistance (helper does more than half the effort) with the following: personal hygiene, dressing, showers, toileting, oral hygiene, and transfers. Record review of Resident #65's Comprehensive Care Plan, with completion date of 07/02/2025, reflected Resident #65 had an ADL self-care performance deficit related to weakness. Intervention: Resident #65 required substantial/maximal assistance with personal hygiene, dressing, transfers showers, toileting and oral hygiene. Observation and interview on 07/29/2025 at 7:40 AM, revealed Resident #65 was in her room lying in bed. She had a blackish/ brownish substance underneath the middle ring and fore fingernails on her right hand. Resident #65 was not interview able. In an interview on 07/29/2025 at 7:18 AM, CNA C stated the CNAs (Certified Nurse Assistant) were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes (a disease occurs when blood sugar is too high). She stated the nurses were responsible for all the residents' nails with Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675942 If continuation sheet Page 4 of 7 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 675942 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Towers Nursing Home 372 Hill Road Smithville, TX 78957 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete a diagnosis of diabetes. CNA C stated the residents' nails were usually cleaned on Sundays, their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as vomiting and diarrhea. CNA C stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident # 30 and Resident #65, and they did not refuse nail care. In an interview on 07/31/2025 at 9:45 AM, LVN E stated the nurses were responsible for residents with diagnosis of diabetes with nail care such as trimming, cleaning, filing. She stated the CNAs were responsible for all other residents' nail care. CNA C stated if a resident had brownish/blackish substance underneath their nails and if a resident swallowed the substance there was a possibility a resident may become ill, such as stomach problems nausea and vomiting. She stated she was in- serviced on nail care, however, she did not recall the date. She stated she would need to ask staff questions for the reason nail care was not completed on Resident #30 and Resident #65. In an interview on 07/31/2025 at 9:20 AM, CNA D stated the CNAs were responsible for cleaning, trimming, and filing all residents' nails except for the residents with a diagnosis of diabetes. She stated the nurses were responsible for all the residents' nails with a diagnosis of diabetes. CNA D stated the residents' nails were usually cleaned on Sundays, their shower days and as needed. She stated if there was a blackish substance on the residents' fingertips or underneath their nails and the resident swallowed the blackish substance there was a possibility a resident may become ill, such as nausea and diarrhea. CNA D stated she was in-serviced on cleaning, filing, and trimming residents' nails but she did not recall the date. She stated she had given care to Resident # 30 and Resident #65, and they did not refuse nail care. CNA D stated she did not know the last time these residents' nails were trimmed or cleaned she would need to check the medical records. In an interview on 07/31/25 at 10:20 AM, ADON stated if a resident ingested the blackish substance on their fingers or underneath their fingernails, there was a possibility the substance may be some type of bacteria, however it would be difficult to determine if the blackish/ brownish substance was bacteria. She stated it was a possibility a resident may become ill with stomach issues such as vomiting and nausea if they ingested the blackish/ brownish substance. She stated the CNAs were responsible for all residents' nails such as cleaning, trimming, and filing except for the residents with diabetes. She stated for any resident with a diagnosis of diabetes the nurse was responsible for these residents' fingernails. The ADON stated the nurse supervisor was responsible for monitoring CNAs giving ADL care which included nail care, and the ADON and DON was responsible for monitoring the nurse supervisors. Review of the facility's Policy on Activities of Daily Living (ADLs), dated 05/26/2023, reflected The facility will, based on the resident's comprehensive assessment and consistent with the resident's needs and choices, ensure a resident's abilities in ADLs do not deteriorate unless deterioration is unavoidable. A resident who is unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal, and oral hygiene. Event ID: Facility ID: 675942 If continuation sheet Page 5 of 7 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 675942 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Towers Nursing Home 372 Hill Road Smithville, TX 78957 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 on observation, interview, and record review the facility failed to establish and 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 and follow accepted national standards for two of six residents (Resident #10 and Resident #93) reviewed for infection control practices. The facility failed to ensure: MA B followed good nursing practices when preparing medications to prevent cross contamination of oral medications for Resident #93 on 07/30/2025 when MA B failed to perform hand hygiene and don gloves prior to touching Resident #93's medications with contaminated, ungloved hands. RN A used sanitary supplies during medication administration via g-tube (a tube inserted into the stomach) for Resident #10 when on 07/30/2025 RN A did not sanitize a tray table prior to use supplies and medications on while administering medications to Resident #10 via gastrostomy tube. This failure could place the resident at risk for cross contamination and infection. Findings included: 1. Review of Face sheet for Resident #93 reflected a [AGE] year-old female, admitted to the facility on [DATE]. Diagnoses included Alzheimer's disease (dementia that damages the brain), Congestive Heart Failure (heart disease that affects pumping action of the heart muscles), Legal Blindness (visual impairment limiting everyday tasks), and Gastro-esophageal reflux disease (acid from the stomach frequently backs up into the esophagus). Review of Annual Assessment MDS for Resident #93 dated 06/26/2025 reflected a BIMS score of 5 (severe cognitive impairment). Section B- Hearing, Speech, and Vision section indicated she was able to understand others and is able to make her ideas and wants known to others. Review of Care Plan for Resident #93 reflected a Problem section stating, [Resident #93] has impaired cognitive function or impaired thought processes r/t Alzheimer's. Date Initiated: 04/10/2018, with related Interventions stating, Administer medications as ordered. Monitor/document for side effects and effectiveness. Date Initiated: 04/10/2018 and [Resident #93] needs supervision with all decision making. Date Initiated: 09/07/2020. Review of Physician Orders for Resident #93 reflected an order for, Regular diet, Regular texture, Regular Liquids consistency started on 03/05/2019. Observation of Medication administration for Resident #93 on 07/30/2025 at 7:54AM revealed that MA B performed hand hygiene prior to dispensing medications. She then touched the medication carts, medication cards, and computer keyboard prior to using ungloved hands to remove two pills from the medication cup for Resident #93. In an interview with MA B on 07/30/2025 at 8:00AM, she stated that she should have cleaned her hands and put on gloves before taking the pills out of the cup. She stated that the potential risk to the resident was that they, could get sick. 2. Review of Face sheet for Resident #10 reflected a [AGE] year-old male, admitted to the facility on [DATE]. Diagnoses included Aphasia (difficulty using or comprehending language), Dysphagia (difficulty swallowing), and Gastrostomy status (gastrostomy tube in place, a tube inserted into the stomach). Review of Quarterly Assessment MDS for Resident #10 dated 05/05/2025 reflected a BIMS score of 12 (moderate cognitive impairment). Section B-Hearing, Speech, and Vision indicated that Resident #10 is usually able to understand others and usually able to make his ideas and wants known to others. Review of Care Plan for Resident #10 reflected a Problem area stating [Resident #10] has the need for Enhanced Barrier Precautions due to a feeding tube Is at risk for infection, depression, feelings of isolation, and decline in physical activity Date Initiated: 05/10/2024 and a related Intervention stating, Administer medication as ordered. Date Initiated: 05/10/2024. Review of Physician Orders for Resident #10 reflected and order for, NPO (nil per os-nothing by mouth) diet, NPO texture, Nectar Thickened Liquids consistency with a start date of 07/04/2025 and medication orders are all noted to be administered via G-Tube or PEG-Tube Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675942 If continuation sheet Page 6 of 7 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 675942 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Towers Nursing Home 372 Hill Road Smithville, TX 78957 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 (percutaneous gastrostomy tube-a type of gastrostomy tube that is inserted into the stomach). Observation of medication administration for Resident #10 on 07/30/2025 at 10:49AM with RN A revealed that she asked another staff member to bring her a tray table from the resident room directly across the hall from Resident #10. She then used the tray table from the other room to set all of her supplies and medications on while administering medications to Resident #10 via gastrostomy tube. In an interview with RN A on 07/30/2025 at 12:11PM, who stated that she should have cleaned the tray table before she used it for Resident #10. She stated that the risk of sharing un-sanitized equipment between residents is the potential for infection. In an interview on 07/31/25 at 1:00PM, the ADMIN who stated that she expected staff to follow the infection control practices for the facility. She stated she would not expect staff to touch medications with their bare hands. She stated that she expected staff to disinfect items that are used between residents. She stated that the risk to the residents of not following the infection control guidelines is the possibility of infection. In an interview on 07/31/25 at 1:02PM, the DON stated that staff are not supposed to touch pills with their bare hands. She stated that she expected staff to wash their hands prior to preparing the medications also. She stated that they should also observe any special instructions with medications regarding need for PPE (Personal Protective Equipment). She stated that any equipment used between residents should be sanitized between use. She stated the risk to the residents of not following the facility infection control guidelines is the possibility of infection. Review of facility policy for Infection and Prevention and Control Program dated 5/13/23 reflected: This facility has established and maintains 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 as per accepted national standards and guidelines. Standard Precautions: a. All staff shall assume that all residents are potentially infected or colonized with an organism that could be transmitted during the course of providing resident care services.b. Hand hygiene shall be performed in accordance with our facility's established hand hygiene procedures. c. All staff shall use personal protective equipment (PPE) according to established facility policy governing the use of PPE. d. Licensed staff shall adhere to safe injection and medication administration practices, as described in relevant facility policies.e. Environmental cleaning and disinfection shall be performed according to facility policy. Review of facility policy for Medication Administration dated 10/01/19 reflected: Medications are administered as prescribed in accordance with good nursing principles and practices only by persons legally authorized to do so. B. Handwashing and Hand Sanitation: The person administering medications adheres to good hand hygiene, which includes washing hands thoroughly before beginning a medication pass, prior to handling any medication, after coming into direct contact with a resident, and before and after administration of ophthalmic, topical, vaginal, rectal, and parenteral preparations and medications given via enteral tubes. Examination gloves are worn when necessary. Event ID: Facility ID: 675942 If continuation sheet Page 7 of 7